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Albania

Albania US Consular Information Sheet November 04, 2008

 COUNTRY DESCRIPTION

Albania is a parliamentary democracy that is transforming its economy into a market-oriented system. Albania's per capita income is among the lowest in Eu

ope, but economic conditions in the country are steadily improving. Tourist facilities are not highly developed in much of the country, and though Albania's economic integration into European Union markets is slowly underway, many of the goods and services taken for granted in other European countries are not yet available. Hotel accommodations are limited outside of major cities. Read the Department of State Background Notes on Albania for additional information.

ENTRY/EXIT REQUIREMENTS

 A passport is required. All travelers entering or exiting Albania must have six months or more validity on their passport. Customs officers strictly enforce this law. U.S. citizens do not require a visa prior to entering Albania, but those traveling without a visa will be charged a fee for an entry stamp at the point of entry, which is valid for a stay of up to 90 days. This fee is currently 10 Euros, or the equivalent in any easily convertible currency, including U.S. dollars. Travelers without a visa who intend to stay in Albania for more than 90 days should be aware that Albanian law allows a traveler without a visa to remain in Albania for 90 days only within a specific 180-day period. That 180-day period is defined from the first day of entry. For example, a traveler entering without a visa on January 1 may remain in Albania for 90 days total during the period of time between January 1 and June 28. Departing Albania during this time period does not "restart the clock." Travelers attempting to reenter Albania without a visa and within 180 days of a previous entry and after an aggregate stay of 90 days may be denied entry. For stays exceeding 90 days within a 180-day period, those interested must apply for a Residency Permit at the police station with jurisdiction over the city of residence. Information on how to apply for a residency permit is available on the Embassy of Albania web site at http://www.embassyofalbania.org/. There is also a departure fee of ten Euros, or the equivalent in any easily convertible currency, including U.S. dollars. Visit the Embassy of Albania web site at http://www.embassyofalbania.org/consular.html#visa for the most current visa information. Dual Nationality: The Albanian government considers any person in Albania of Albanian parents to be an Albanian citizen. In addition to being subject to all Albanian laws affecting U.S. citizens, dual nationals may be subject to Albanian laws that impose special obligations. Male Albanian citizens are subject to compulsory military service regulations. If such persons are found guilty of draft evasion in Albania, they are subject to prosecution by the Albanian court. Those who might be affected should inquire at an Albanian Embassy or Consulate outside Albania regarding their status before traveling. In some instances, dual nationality may hamper U.S. Government efforts to provide protection abroad. Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY

Although the overall security situation in Albania has improved in recent years, organized criminal activity continues to operate in all regions, and corruption is pervasive. US Government employees need permission to travel to the northern administrative districts of Shkoder, Malesi E Madhe and Tropoje (with the exception of the route along the national road to Montenegro and the city of Shkoder) and to the southern town of Lazarat, with such travel restricted to secure vehicles with escort. Travel restrictions for U.S. Government employees have been lifted for overnight stays in the city of Shkoder. In most cases, police assistance and protection is limited. A high level of security awareness should be maintained at all times. Photographing anything that authorities regard as being of military or security interest may cause travelers problems. All gatherings of large crowds should be avoided, particularly those involving political causes or striking workers. For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found. Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.

CRIME

In the latest State Department assessment, Albania’s crime rating is “medium.” Crime against foreigners is rare in Albania, as targeting foreigners is often viewed as too risky. Visitors should maintain the same personal security awareness that they would in any metropolitan U.S. city. Caution should be exercised in bars in Tirana where violent incidents, some involving the use of firearms, have occurred in the past, particularly in the early morning hours. Within the last years there have been fewer cases of carjacking compared with previous years. Anyone who is carjacked should surrender the vehicle without resistance. Armed crime continues to be more common in northern and northwestern Albania than in the rest of the country. Street crime is fairly common in Albania, particularly at night. Criminals do not seem to deliberately target U.S. citizens or other foreigners, but do seek targets of opportunity, and select those who appear to have anything of value. Vehicle theft is still one of the biggest problems in Albania. Pick-pocketing is widespread; U.S. citizens have reported the theft of their passports by pick-pockets. INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. The local equivalent to the “911” emergency line is 129, though coverage is inconsistent at best. See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION

Medical facilities and capabilities in Albania are limited beyond rudimentary first aid treatment. Emergency and major medical care requiring surgery and hospital care is inadequate due to lack of specialists, diagnostic aids, medical supplies, and prescription drugs. Travelers with previously diagnosed medical conditions may wish to consult their physicians before travel. As prescription drugs may be unavailable locally, travelers may also wish to bring extra supplies of required medications. Recent electricity shortages have resulted in sporadic blackouts throughout the country, which can affect food storage capabilities of restaurants and shops. While some restaurants and food stores have generators to properly store food, travelers should take care that food is cooked thoroughly to reduce the risk of food-borne illness. Water in Albania is not potable. Visitors should plan to purchase bottled water or drinks while in country. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Albania. Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en

MEDICAL INSURANCE

The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS

While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Albania is provided for general reference only, and may not be totally accurate in a particular location or circumstance. Major roads in Albania are often in very poor condition. Traveling by road throughout Albania is the most dangerous activity for locals and tourists. Vehicle accidents are the major cause of death, according to police statistics. Electricity shortages have resulted in sporadic blackouts throughout the country that can happen any hour of the day or night. Such outages affect traffic signals and street lights, making driving increasingly treacherous at any time of day. Travel at night outside the main urban areas is dangerous and should be avoided due to deplorable road conditions. During the winter months, travelers may encounter dangerous snow and icy conditions on the roads throughout mountainous regions in northern Albania. Buses travel between most major cities almost exclusively during the day, but they are often unreliable and uncomfortable. Many travelers looking for public transport prefer to use privately owned vans, which function as an alternate system of bus routes and operate almost entirely without schedules or set fares. Please note that many of these privately owned vans may not have official permission to operate a bus service and may not adhere to accepted safety and maintenance standards. Persons wishing to use privately owned vans should exercise caution. There are no commercial domestic flights and few rail connections. Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office at www.albaniantourism.com.

AVIATION SAFETY OVERSIGHT

As there is no direct commercial air service to the United States by carriers registered in Albania, the U.S. Federal Aviation Administration (FAA) has not assessed Albania's Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For further information, travelers may visit the FAA's web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa SPECIAL CIRCUMSTANCES: Albania's customs authorities may enforce strict regulations concerning temporary importation into or export from Albania of some items. It is advisable to contact the Embassy of Albania in Washington, D.C. or one of Albania's Consulates in the United States for specific information regarding customs requirements. As noted previously, the Albanian government considers any person in Albania of Albanian parents to be an Albanian citizen. In addition to being subject to all Albanian laws affecting U.S. citizens, dual nationals may be subject to Albanian laws that impose special obligations. Male Albanian citizens are subject to compulsory military service regulations. See our information pertaining to dual nationality. Albania is a cash economy. Credit cards and travelers checks are not generally accepted, except at the major new hotels in Tirana and some international airline offices. Travelers' checks can be changed at banks in larger towns. Automated Teller Machines (ATMs) are available in most cities. Please see our Customs Information CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Albania’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Albania are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties. Under Albanian law, police can detain any individual for up to 10 hours without filing formal charges. U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times to show proof of identity and U.S. citizenship if questioned by local officials.

CHILDREN'S ISSUES

For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION

 Americans living or traveling in Albania are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and to obtain updated information on travel and security within Albania. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at Rruga Elbasanit 103, tel. (355)(4) 2247285; fax (355)(4) 2232222. The U.S. Embassy web site is http://tirana.usembassy.gov/ * * * This replaces the Consular Information Sheet dated June 10, 2008, to update sections on Entry and Exit Requirements, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Fri, 9 Mar 2018 16:28:50 +0100

Tirana, March 9, 2018 (AFP) - The military has been deployed in northern Albania to help hundreds of people trapped by floods following heavy rainfall, authorities said on Friday.   More than 9,230 hectares (22,800 acres) of agricultural land is underwater in the Shkodra region, including villages where the only means of transport is by boat, the defence ministry said.

Army personnel are evacuating residents and securing food supplies in the affected areas, 100 kilometres (60 miles) north of the capital, Tirana.   The torrential rain in recent days has caused landslides damaging dozens of homes and flooding roads, said the transport ministry.   The rain has also forced the Albanian authorities to release excess water from a hydroelectric plant, which has added to the flooding in northern areas of the country.   Weather forecasters say the rain is likely to ease from Saturday.
Date: Sun, 3 Dec 2017 12:29:40 +0100

Tirana, Dec 3, 2017 (AFP) - Thousands of police and soldiers have been deployed in Albania to rescue stranded residents after heavy rainfall triggered major flooding, and caused the death of a utility worker, officials and the power company said Sunday.   The victim, Sabri Vlinga, died while he was working on a electricity pole at Roskovec in the flooded south of the country, the power company said in statement.   Two other people were injured in similar accidents. it added.   Some 6,400 police and soldiers have been sent to help rescue people stranded by the floods, Prime MInister Edi Rama said Saturday, calling the situation "very critical".

Around 1,500 people in the affected areas have been rescued, while several thousand homes were without electricity as many utility poles have been swept away by mudslides, said Shemsi Prenci, head of civil protection.   More than 7,874 hectares (19,450 acres) of farm land as well as 3,193 homes are under water and several roads in the south remained impassable.

Army forces have built a temporary bridge at Darezeze, about 70 kilometres (44 miles) from the capital Tirana, to come to the aid of 2,000 residents stranded by the floods, the defence ministry said.    In neighbouring Macedonia, the heavy rains have also caused flooding as several rivers include the main Vardar river have burst their banks, the MIA news agency reported.
Date: Sat 5 Aug 2017
From: Edmond Puca <edmond_puca@yahoo.com> [edited]

Here in Albania, we have 2 imported cases of haemorrhagic fever with renal syndrome (HFRS), one imported from the north of Greece and another from Macedonia in a village near the border with Albania.

The patient from Macedonia is 25 years old. He presented in the emergency room on 31 Jul [2017]. Right now, he is in good condition and will survive. He presented with fever, nausea and vomiting, abdominal pain, and lower back pain.

The other patient from Greece had been in our service for the previous 2 weeks and now is at home in good condition.

The disease is caused by Dobrava-Belgrade virus infection.
---------------------------------
Dr Edmond Puca
Infectologue
Department of Infectious Disease
UHC "Mother Teresa"
Tirana, Albania
===================
[ProMED-mail thanks Dr Edmond Puca for sending in this report.  This and the previous report are the 1st reports of hantavirus infections in Macedonia that ProMED-mail has posted. There is also evidence of HFRS in Greece, although ProMED-mail has not posted reports previously. Sero-epidemiological investigations conducted in several Balkan countries revealed an overall seroprevalence of 4 per cent in Greece (<http://www.sciencedirect.com/science/article/pii/S0168170213004887#>). There doubtless have been Dobrava-Belgrade virus infections in Greece and the Balkans over the years, given that this virus is known to circulate widely in the Balkans.

The yellow-necked field mouse (_Apodemus flavicollis_) is the principle vertebrate host for Dobrava-Belgrade virus. - ProMED Mod.TY]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Mon, 6 Feb 2017 04:30:32 +0100
By Briseida MEMA

Tirana, Feb 6, 2017 (AFP) - Emira Sela covers her face with her hand to hide a disfiguring abscess, the traumatic result of unregulated cosmetic treatments now rampant across Albania.   The 31-year-old began to worry when wrinkles appeared on her face. Sela's hairdresser told her that a simple injection, costing around 60 euros ($65), would banish the signs of ageing.   "She assured me that I would not risk anything. She even listed well-known names" of women who had undergone such treatment, said Sela.   "I did not think twice, I trusted her without asking questions," said the blonde woman with green eyes, her voice trembling.

Albanian hair and beauty salons lacking expertise and medical supervision are offering such cosmetic treatments, unregulated in a legal vacuum, much to the alarm of qualified doctors.   A single injection of a product whose content and dosage Sela knew nothing about was enough to ruin her life in late August.    Despite antibiotics she has permanent pain, fever and nausea, while the abscess on her right cheek forces her eye to half-close and her face is nearly paralysed.   "I am so disfigured that I tried to commit suicide," said Sela, who lost her job in a bank. Her only hope now is corrective surgery at an Italian hospital, scheduled for this month.

- Desiring Kardashian look -
"There are more and more impostors with syringes," said Panajot Papa, a plastic surgeon at a private clinic in Tirana.   "The problem is also the products... Forbidden in Europe, they enter illegally from Turkey or China."    Eriona Shehu, a dermatologist at Tirana's university hospital, said these unregulated synthetic products, such as injected liquid silicone and acrylamide, were being offered at temptingly low prices.

"Cosmetic interventions have become a lucrative industry. The patient is only a customer, exposed to a number of risks."   Shehu said the desire to look like voluptuous US reality television star Kim Kardashian was "destroying the lives of young Albanian girls looking for beauty".   Albanian doctors say the typical age of clients for such procedures is between 16 and 28.    In the country of about three million people, the demand for cosmetic interventions rose more than 50 percent in 2015, according to a study published by Albania's economic magazine Monitor.

Promotional offers can be seen everywhere, such as a beauty salon advertising 20 percent reductions for three people coming together for treatment during the holiday season.   Papa says he has treated a dozen young women aged between 20 and 27 who suffered complications after having their lips and cheekbones swollen with injected liquid silicone for 40 to 50 euros.    The product has been banned for cosmetic use in countries such as Italy and France for more than 15 years.   Papa said such botched interventions left these women prone to particularly bad swellings during their menstrual period, requiring further treatment -- and he warned they may suffer such symptoms for life.

- Closing legal gap -
Albanian doctors are worried about foreign practitioners who come from Italy, Turkey and Greece to work just for a weekend.   "They may not have a diploma, qualification or licence for these kind of interventions or for assuming the responsibility of a patient's medical follow-up," said Besim Boci, head of the otolaryngology department at Tirana's university hospital.   Due to legal loopholes, the judiciary cannot step in.    A spokesman at Tirana's tribunal, Alba Nikolla, admits that it is currently impossible to "open investigations and prosecute based only on complaints" against practitioners.

But authorities are set to tackle this with a draft law to control cosmetic products and beauty salons, which is due to be introduced in parliament in the next few months.   The law complies with the requirements of the European Union, which Albania aspires to join, and will enable authorities to shut down rogue establishments using synthetic products.    When health is adversely affected, practitioners could be imprisoned for three to 10 years.    Such regulations could go some way to easing the trauma of women like Elisa Lura, a 22-year-old economics student.   She underwent a laser treatment to restore her natural look after paying 50 euros to a neighbourhood salon for permanent eyebrow tattoos, which went wrong. But the laser made things much worse.   "Everything is spoiled!" she said of her face now covered with painful scars.
Date: Wed, 13 Jan 2016 04:21:54 +0100
By Briseida MEMA

Tirana, Albania, Jan 13, 2016 (AFP) - With her sick daughter in the arms, Mira Lela pushes her way through the hallway of the doctor's clinic, crowded with patients ailing from heavy pollution in Albania's capital.   "This is an emergency, she has difficulty breathing," said the tearful woman, forcing open the door to the office of Bardhyl Vaqari, who has worked in the specialist Tirana clinic for more than 20 years.   "An acute asthma attack," said the doctor on seeing the child.   "The number of people with respiratory allergies and cardiovascular problems has greatly increased," he told AFP, adding that the number of patients on the clinic's books has more than doubled to 8,000 in the last four years.

On the noisy and congested streets outside, clapped-out bangers and Hummer trucks cross paths with Mercedes, BMWs and overloaded buses that leave a trail of black smoke and heavy odour.    Having been cut off from the world under a strict communist regime until 1991, the Western Balkan city had just a few hundred cars on its roads in the 1990s.

But today, through a mixture of pride, luxury-seeking and necessity, given the lack of public transport, there are more than 190,000 cars circulating in a city of about one million people.   "Albanians take the car even when going to buy bread in a nearby store. That's why the traffic is overloaded all day and this increases pollution levels," said Altin Duka, a despairing 65-year-old shopkeeper.

The average age of vehicles on Tirana's roads is around 16 years, twice the European average, according to Gani Cupi, deputy manager of Albania's Road Transport Services.    Many of the vehicles do not meet the standards of the European Union, which Albania hopes to join.   "The traffic load, the age of vehicles, their technical condition but also the poor quality of fuel are all factors contributing to the capital's pollution," said Cupi.

- Taxing dilemmas -
In a bid to clean up the air, Albanian authorities considered doubling taxes on ageing vehicles but then dropped such plans. Analysts suggested the cost would weigh too heavily on citizens in one of the poorest countries in Europe.   New cars are already exempt from paying annual tax for the first three years, but authorities in 2012 lifted a levy on the import of old vehicles as the EU considered it a "fiscal discrimination".

Tirana's Mayor Erion Veliaj has pledged to battle against the fumes by increasing the number of green spaces, introducing hybrid buses and improving infrastructure in the city, which is crammed with mostly illegal constructions.   "The number of vehicles does not stop growing," he told AFP, pointing out that about 500 people die in the city each year "because of respiratory or cardiovascular problems related to pollution".

A report this year from the European Environment Agency noted a 20 to 30 percent decrease in Tirana's concentration levels of PM10 and PM2.5 -- damaging particulate matter -- according to data assessment from 2011 to 2013.   But Laureta Dibra, head of the air and climate change department at Albania's Environment Ministry, told AFP that PM10 levels had actually been rising in areas of heavy traffic in recent years.   Tirana remains "among the most polluted cities in Europe", added the director of the National Environment Agency, Julian Beqiri.   "The level of the population's exposure to pollutants is still a problem," he said.

- On your bikes -
In an effort to improve air quality in the capital and educate residents, Tirana organised two car-free days in 2015, when the air was said to be at least four times less polluted than usual.   Worried activists are campaigning to promote the bicycle as a means of transport and a way of life.   Ecovolis, a bike sharing system, rents out at least 200 bicycles from different tations around Tirana, at 60 leke (44 euro cents, $0.47) per bike per hour -- but many people still prefer getting behind the wheel.

Although Albania's energy minister claims that 95 percent of fuel meets the required standards, even Prime Minister Edi Rama attacked its quality in May last year.   "It is so bad that even a strong car like a Mercedes ends up being bad for Albanians' lungs," he said, calling for urgent measures to improve fuel controls.   The government says restrictions have since been tightened, but those at the frontline of the fumes remain unhappy.   "I come home in the evening with a completely dry throat and a bitter taste my mouth," said Bequir Veseli, 37, a traffic policeman who spends eight hours a day at the centre of a chaotic roundabout.   "I have trouble breathing but what can I do? The next day I have to go back to my post".
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France

France and Monaco US Consular Information Sheet
December 22, 2008
COUNTRY DESCRIPTION:
France is a developed and stable democracy with a modern economy.
Monaco is a developed constitutional monarchy.
Tourist facilities are widely
available.
Read the Department of State Background Notes on France and Monaco for additional information.
ENTRY/EXIT REQUIREMENTS:
France is party to the Schengen agreement.
As such, U.S. citizens may enter France for up to 90 days for tourist or business purposes without a visa.
A passport is required and should be valid for at least three months beyond the period of stay.
Anyone intending to stay more than 90 days must obtain the appropriate visa issued by one of the French Consulates in the U.S., prior to departure for France.
This also applies to anyone considering marriage in France.
For further information about travel into and within Schengen countries, please see our fact sheet.
A passport is required to enter Monaco. A visa is not required for tourist/business stays up to 90 days in Monaco.
For further information concerning entry requirements for France, travelers may contact the Embassy of France at 4101 Reservoir Road NW, Washington, DC
20007, tel. (202) 944-6000, email: info@ambafrance-us.org, or the French Consulates General in Atlanta, Boston, Chicago, Houston, Los Angeles, Miami, New Orleans, New York, or San Francisco.

For further information on entry requirements to Monaco, travelers may contact the Embassy of the Principality of Monaco. 2314 Wyoming Avenue, NW Washington, DC
20008, Tel: 202-234-1530, email: embassy@monaco-usa.org, or the Consulate General of Monaco, 565 Fifth Avenue – 23rd floor, New York, NY 10017, tel.: 212-286-0500, email: info@monaco-consulate.com.
For more information, visit the Embassy of France web site at www.consulfrance-washington.org or the Embassy of the Principality of Monaco web site at http://www.monaco-usa.org for the most current visa information.

Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
The Government of France maintains a threat rating system, known locally as “Vigipirate,” similar to the U.S. Department of Homeland Security Advisory System.
Under this plan, in times of heightened security concerns, the government augments police with armed forces and increases visibility at airports, train and metro stations, and other high-profile locations such as schools, major tourist attractions, and government installations.
Over the last few years, there have been numerous arrests of suspected Islamic militants involved in various terrorist plots.
As with other countries in the Schengen area, France maintains open borders with its European neighbors, allowing the possibility of terrorist operatives entering/exiting the country with anonymity.

Political assassinations and bombings have occurred in France.
The National Front for the Liberation of Corsica (FLNC), as part of its decades-long bombing campaign on the island of Corsica, continues to conduct limited operations in the south of France and on Corsica.
In the 1990s there was a wave of bombings and attacks in Paris carried out by Algerian terrorists.
Today, numerous radical Islamic groups claim sympathizers within France’s large immigrant community, as evidenced by arrests over the last few years.

Although Americans have not been specifically targeted in terrorist attacks in France within the past few years, travelers should maintain vigilance.
Immediately report unattended packages observed in public places or any other suspicious activities. French law enforcement authorities are proactive and will respond immediately.
If there is a security incident or suspicious package, do not linger in the area to observe.

Although violent civil disorder is rare in France, in the past, student demonstrations, labor protests, and other types of demonstrations have developed into violent confrontations between demonstrators and police.
This was the case in March/April 2006, when a series of large demonstrations took place in central Paris. Several weeks of unrest occurred in the suburbs of Paris, as well as in other French cities and towns, in November 2005.
Neither of these periods of disorder exhibited any anti-U.S. sentiment, but it is important to remember that even a passer-by can be harmed should demonstrations devolve into violence.
Americans are advised to avoid street demonstrations, particularly if riot police are on the scene.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, including the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or, for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, please see A Safe Trip Abroad.

CRIME:
While both France and Monaco have relatively low rates of violent crime, a limited number of neighborhoods in the larger French cities merit extra caution.
Additionally, although the overall crime rate has fallen slightly in recent years, the violent crime rate has increased.
Thieves commonly target vehicles with non-local license plates, and work in or near tourist attractions such as museums, monuments, restaurants, hotels, beaches, trains, train stations, airports, and subways.
Americans in France and Monaco should be particularly alert to pickpockets in train stations and subways.
Travelers should keep photocopies of travel documents and credit cards separate from the originals, along with key telephone numbers to contact banks for credit card replacement.

Although thieves may operate anywhere, the U.S. Embassy in Paris receives frequent reports of theft from several areas in particular:
Paris: The Paris Police Prefecture published a pamphlet entitled “Paris in Complete Safety,” which provides practical advice and useful telephone numbers for visitors and can be accessed at http://www.prefecture-police-paris.interieur.gouv.fr/prevention/article/paris_securite_anglais.htm. Thieves operate on the rail link (RER) from Charles de Gaulle Airport to downtown Paris, where they prey on jet-lagged, luggage-burdened tourists.
In one common ruse, a thief distracts a tourist with a question about directions while an accomplice steals a momentarily unguarded backpack, briefcase, or purse.
Thieves also time their thefts to coincide with train stops so they may quickly exit the car just before the automatic doors close.
Travelers should consider taking an airport shuttle bus or taxi from the airport into the city.
Reports of stolen purses, briefcases, and carry-on bags at Charles de Gaulle Airport are not uncommon.
Travelers should monitor their bags at all times and never leave them unattended.
As thieves commonly target laptop bags, travelers should avoid carrying passports and other valuables in computer bags.
Another common method involves picking up a traveler’s shoulder bag that has been placed on the floor while the traveler is busy at the ticket counter. Also be aware that unattended bags are subject to destruction by airport security.

There are reports of robberies in which thieves on motorcycles reach into a moving car by opening the car door or accessing an open window or even breaking the window to steal purses and other bags visible inside.
The same technique is used against pedestrians walking with purses/bags/cameras slung over their street-side shoulder.
Those traveling by car should remember to keep the windows up and the doors locked and items that may be attractive to thieves out of sight.
Pedestrians are encouraged to remain aware of their surroundings at all times, and to keep bags slung across the body, with the bag hanging away from the street.

Many thefts occur on the Number One Subway Line, which runs through the center of Paris by many major tourist attractions (including the Grand Arch at La Défense, the Arc de Triomphe, the Champs Elysées, Place de la Concorde, the Louvre, and the Bastille).
Pickpockets are especially active on this metro line during the summer months and use a number of techniques.
The most common, and unfortunately the most successful, is the simple “bump and snatch,” where an individual bumps into the tourist while at the same time reaching into the pockets/purse/bag.
Visitors should be particularly careful when metro doors are closing, as this is a favored moment for the less-sophisticated pickpockets to simply grab valuables and jump through the closing doors, leaving the victim helplessly watching as the thief flees.
Visitors are encouraged NOT to confront thieves aggressively; they often operate in groups and may become violent if cornered.
Simply drawing attention to an attempted theft will most likely stop the operation, and result in a tactical withdrawal by the thief.

Gare du Nord train station, where the express trains from the airport arrive in Paris, is also a high-risk area for pocket-picking and theft.
Travelers should also beware of thefts that occur on both overnight and day trains, especially on trains originating in Spain, Italy, and Belgium.
These involve the theft of valuables while passengers are sleeping, or when the bags are left unattended.

In hotels, thieves target lobbies and breakfast rooms, and take advantage of a minute of inattention to snatch jackets, purses, and backpacks.
While many hotels do have safety latches that allow guests to secure their rooms from inside, this feature is not as universal as it is in the United States.
If no chain or latch is present, a chair placed up against the door and wedged under the handle is usually an effective obstacle to surreptitious entry during the night.
There are, however, reports of thieves breaking into hotel rooms on lower floors through open windows while the occupants are sleeping.
To guard against this, hotel room windows should be kept locked at all times. Whenever possible, valuables should be kept in the hotel safe.

Many Americans report thefts occurring in restaurants and nightclubs/bars, where purses are stolen from the back of a chair or from under the table.
Again, keep valuables on your person and do not leave them unattended or out of sight.
Thefts also occur at the major department stores such as Galeries Lafayette and Printemps where tourists often place wallets, passports, and credit cards on cashier counters during transactions.

Automated Teller Machines (ATMs) are very common in France and provide ready access to cash, allowing travelers to carry as much money as they need for each day.
The rates are competitive with local exchange bureaus, and an ATM transaction is easier than cashing a traveler’s check.
However, crime involving ATMs is increasing.
Travelers should not use ATMs in isolated, unlit areas or where loiterers are present.
Travelers should be especially aware of persons standing close enough to see the Personal Identification Number (PIN) being entered into the machine.
Thieves often conduct successful scams by simply observing the PIN as it is entered and then stealing the card from the user in some other location.
If the card becomes stuck, travelers should immediately report it to the bank where the machine is located.

Large criminal operations in Paris involving the use of ATMs that “eat” the user’s ATM card have been reported.
This most often happens during a weekend or at night when the bank is closed.
The frustrated traveler often walks away after unsuccessfully trying to retrieve the card, with plans to return the first day the bank is open.
In such cases, a criminal gang has modified the machine using an add-on device equipped with a microchip that records the user’s PIN when it is typed in, and also prevents the card from being ejected.
The criminal retrieves the card from the device once the visitor departs, downloads the recorded PIN and then goes to other ATMs and withdraws as much cash as possible.
ATM users are strongly encouraged to carry a 24-hour emergency number for their ATM card and bank account that will enable the immediate prevention of withdrawals from the account if difficulties occur.

Pigalle is the “adult entertainment district” of Paris.
Many entertainment establishments in this area engage in aggressive marketing and charge well beyond the normal rate for drinks.
Reports of threats of violence to coerce patrons into paying exorbitant beverage tabs are not uncommon.
There have also been several violent confrontations between rival gangs in the district, including one in August 2007 one block from the famous Moulin Rouge cabaret.
Visitors are encouraged to avoid this area unless touring with a well-organized and reputable tour company.

Normandy:
There has been an increase in break-ins and thefts from vehicles in the parking lots at the Normandy beaches and American cemeteries common.
Valuables should not be left unattended in a car, and locking valuables in the trunk should not be considered a safeguard.
Thieves often pry open car trunks to steal bags inside.

Southern France: Thefts from cars with unlocked doors or open windows stopped at red lights or caught in slow traffic are very common, particularly along the Riviera of the Nice-Antibes-Cannes area, and in Marseille.
Car doors should be kept locked and windows raised at all times to prevent incidents of "snatch-and-grab" thefts.
In this type of scenario, the thief is usually a passenger on a motorcycle. Break-ins of parked cars are also fairly common.
Valuables should not be left in the car, not even in the trunk, when the vehicle is unattended.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends, and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
Under French law, compensation is available to victims of crime committed on French soil under certain circumstances. To learn about resources in the U.S., including possible compensation, see our information on Victims of Crime
The local equivalents to the “911” emergency line in France are as follows: 17 (police emergency), 18 (fire department) and 15 (emergency medical/paramedic team/ambulance).
In Monaco, the numbers are 17 (police emergency), 18 (fire department) and 9375-2525 (medical/paramedic team/ambulance).

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care comparable to that found in the United States is widely available. In France, the phone number for emergency medical services is 15.
In Monaco, the phone number for emergency medical services is 9375-2525.

The U.S. State Department is unaware of any HIV/AIDS related entry restrictions for visitors to or foreign residents of France.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning France and Monaco is provided for general reference only, and it may not be totally accurate in a particular location or circumstance.
Roads in France are generally comparable to those in the United States, but traffic engineering and driving habits pose special dangers.
Usually, lane markings and sign placements are not as clear as in the United States.
Drivers should be prepared to make last-minute maneuvers, as most French drivers do.
The French typically drive more aggressively and faster than Americans, and tend to exceed posted speed limits.
Right-of-way rules in France may differ from those in the United States.
Drivers entering intersections from the right have priority over those on the left (unless specifically indicated otherwise), even when entering relatively large boulevards from small side streets.
Many intersections in France are being replaced by traffic circles, where the right-of-way belongs to drivers in the circle.

On major highways, service stations are situated at least every 25 miles.
Service stations are not as plentiful on secondary roads in France as they are in the United States.
Paris, the capital and largest city in France, has an extensive and efficient public transportation system.
The interconnecting system of buses, subways, and commuter rails serves more than 4 million people a day with a safety record comparable to or better than the systems of major American cities.
Similar transportation systems are found in all major French cities. Between cities, France is served by an equally extensive rail service, which is reliable.
High-speed rail links connect the major cities in France. Many cities are also served by frequent air service.

Please refer to our Road Safety page for more information.
Visit the web site of the French and Monegasque National Tourist Office at http://us.franceguide.com/.
The website contains specific information concerning French and Monegasque driver's permits, vehicle inspection, road tax, and mandatory insurance.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of France's Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of France's air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa
SPECIAL CIRCUMSTANCES:
French and Monegasque customs authorities enforce strict regulations concerning temporary importation into or export from France of items such as firearms, antiquities, medications, business equipment, sales samples, and other items.
It is advisable to contact the Embassy of France in Washington, DC, one of France's consulates in the United States, or the Consulate General of Monaco in New York for specific information regarding customs requirements.
Please see our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating French or Monegasque laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in France or Monaco are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION/EMBASSY AND CONSULATE LOCATIONS:
Americans living or traveling in France or Monaco are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, so they can obtain updated information on travel and security within France and Monaco.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in cases of emergency.

The U.S. Embassy/Consular Section in Paris is located at 4 avenue Gabriel, 75008 Paris (Place de La Concorde, métro stop Concorde), telephone: in country 01-43-12-22-22; from the U.S. 011-33-1-43-12-22-22 (24 hours); fax for Passport Services in country 01-42-96-28-39; from the U.S. 011-33-1-42-96-28-39; for Special Consular Services (emergencies) fax: in country 01-42-61-61-40; from the U.S. 011-33-1-42-61-61-40. Further information can be obtained at the U.S. Embassy's web site at http://france.usembassy.gov/
The Consulate General in Marseille is located at Place Varian Fry, 13006 Marseille, telephone: in country 04-91-54-92-00; from the U.S. 011-33-4-91-54-92-00 (24 hours); Consular Section fax: in country 04-91-55-56-95 and main fax 04-91-55-09-47; Consular Section fax from the U.S. 011-33-4-91-55-56-95, and main fax from the U.S. 011-33-4-91-55-09-47.
Web site: http://france.usembassy.gov/marseille.html.

The Consulate General in Strasbourg is located at 15 Avenue d'Alsace, 67082 Strasbourg, telephone: in country 03-88-35-31-04; from the U.S. 011-33-3-88-35-31-04; fax: in country 03-88-24-06-95; from the U.S. 011-33-3-88-24-06-95.
Web site: http://france.usembassy.gov/strasbourg.html.

The Consulate General in Strasbourg does not produce passports on the premises.
American citizens in this area whose passports are lost or stolen and have urgent travel needs should contact the U.S. Embassy in Paris.

The U.S. Government also has consular representation in Bordeaux, Lyon, Rennes, Nice and Toulouse that provide limited services to Americans, by appointment only.

The American Presence Posts in Bordeaux, Lyon and Rennes do not produce passports on the premises.
American citizens in this area whose passports are lost or stolen and have urgent travel needs should contact the Consular Section of the U.S. Embassy in Paris.

The American Presence Post in Toulouse and the Consular Agency in Nice do not produce passports on the premises.
American citizens in this area whose passports are lost or stolen and have urgent travel needs should contact the U.S. Consulate General in Marseille.

The American Presence Post in Bordeaux is located at 10 place de la Bourse, 33076 Bordeaux (entry on 1 rue Fernand Philippart); telephone: in country 05-56-48-63-80; from the U.S. 011-33-5-56-48-63-80; fax: in country 05-56-51-61-97; from the U.S. 011-33-5-56-51-61-97.
Web site: http://france.usembassy.gov/bordeaux.html
The American Presence Post in Lyon is located at 1, quai Jules Courmont, 69002 Lyon; telephone: in country 04-78-38-33-03; from the U.S. 011-33-4-78-38-33-03; fax: in country 04-72-41-71-81; from the U.S. 011-33-4-72-41-71-81.
Web site: http://france.usembassy.gov/lyon.html
The American Presence Post in Rennes is located at 30, quai Duguay Trouin, 35000 Rennes; telephone: in country 02-23-44-09-60; from the U.S. 011-33-2-23-44-09-60; fax: in country 02-99-35-00-92; from the U.S. 011-33-2-99-35-00-92.
Web site: http://france.usembassy.gov/rennes.html
The American Presence Post in Toulouse is located at 25, Allée Jean Jaures, 31000 Toulouse; telephone: in country 05-34-41-36-50; from the U.S. 011-33-5-34-41-36-50; fax: in country 05-34-41-16-19; from the U.S. 011-33-5-34-41-16-19. Web site: http://france.usembassy.gov/toulouse.html
The Consular Agency in Nice is located at 7, Avenue Gustave V, 3rd floor, 06000 Nice, telephone: in country 04-93-88-89-55; from the U.S.
011-33-4-93-88-89-55; fax: in country 04-93-87-07-38; from the U.S. 011-33-4-93-87-07-38. Web site: http://france.usembassy.gov/nice.html
*
*
*
*
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This replaces the Country Specific Information for France and Monaco dated May 5, 2008, to update the sections on Entry/Exit Requirements, Safety & Security, Crime, Medical Facilities and Health Information, Children’s Issues and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Tue 21 May 2019
Source: Le Dauphin [in French, trans., edited]

Lovers of sushi, maki, sashimi, and other raw fish, beware of your stomach! 7 cases of fish tapeworm, better known as tapeworm [ProMED presumes it is Diphyllobothrium latum], have been reported in 2 years by the Rennes hospital in Ille-et-Vilaine [Brittany].

An exceptional number of cases was counted between July 2016 and September 2018, especially since no case had been detected for at least 20 years.

The infection is acquired by "eating raw or marinated fish which contains larvae of this parasite. The larvae will undergo several moults and develop in our digestive tract," explained Professor Florence Robert-Gangneux to our colleagues in France Bleu Armorique.

The parasite can measure up to 20 meters [66 ft] long and live 10 years in the body. The fish tapeworm can cause digestive disorders, deficiencies, although some patients do not notice.

The only solution to eliminate these parasites of the fish is freezing. This is what a 2004 European regulation imposes on restaurant owners serving raw fish. Freezing should be from -20 deg C [-4 deg F] during 24 hours or -35 deg C [-31 deg F] during 15 hours. And to get rid of the worm once ingested, it is necessary to undergo an unpleasant antiparasitic treatment, often on several occasions.
=====================
[We presume it is the fish tapeworm _Diphyllobothrium latum_, which is a tapeworm found in freshwater fish (<https://www.cdc.gov/parasites/diphyllobothrium/index.html>). In saltwater fish the most common parasite is _Anisakis_, but this is not a tapeworm. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of France:
Date: Thu, 9 May 2019 16:39:54 +0200
By Catherine HOURS

Paris, May 9, 2019 (AFP) - The fire that ravaged the Notre-Dame cathedral in Paris last month released lead particles that have settled in potentially dangerous amounts in areas surrounding the church, officials said Thursday.   Analysis carried out since the April 15 blaze has detected lead dust in "very significant" levels on some streets and pavements outside the cathedral, which remain off limits to the public.   Between 10-20 grammes of lead per kilogramme (g/kg) were detected in soil samples, compared with normal background levels of just 0.3 g/kg, according to a statement from the police and the ARS regional health service.

The fire destroyed the roof and steeple of the 850-year-old landmark, melting the large sheets of lead that covered an intricate wooden framework.   But officials said testing had not revealed any lingering lead pollution in the air, with all atmospheric analyses showing less than the legal limit of 0.25 microgrammes per cubic meter (µg/m3).   And outside the areas immediately surrounding the cathedral, "no sample on the Ile de la Cite or along the banks of the Seine indicated any lead levels in soils above the benchmark level," the statement said.   The Robin des Bois (Robin Hood) environmental NGO estimates the roof and steeple contained more than 300 tons of lead that melted in the blaze, and has urged officials to "decontaminate" the site before carrying out any reconstruction work.   Lead pollution can cause neurological defects for humans, especially children, as well as nervous system and kidney problems.

- Cleaning urged -
Officials said the lead posed little danger to residents, since only "repeated ingestions" of the toxic metal would be harmful to health.   There have been no reports of acute lead poisoning since the fire.   But the statement urged residents to clean all surfaces in their homes with wet cloths or wipes and to avoid the use of vacuum cleaners.

People should also wash their hands regularly and keep their fingernails cut short.   It also advised parents to wash toys often, since the faster metabolism in children under six makes any exposure to lead a particular risk.   Pregnant women should also take precautions to protect their babies from any exposure.   "Additional investigations are under way and testing will be carried out regularly to measure lead levels and ensure that health risks are kept under control," officials said.

The cathedral is expected to remain closed to visitors for years as workers clear away debris before embarking on an ambitious plan to restore the roof within five years.   The government has launched an international architectural competition for the reconstruction, raising the prospect of modern touches to a structure dating from the 13th century.   A YouGov poll this month found that 54 percent of respondents wanted the cathedral rebuilt exactly as it was, with only a quarter supporting the idea of adding a modern architectural touch to the historic building.
Date: Sun, 5 May 2019 14:45:26 +0200

Marseille, May 5, 2019 (AFP) - A German tourist was swept to her death as she walked along a beach in southern Corsica on Sunday as high waves battered the French Mediterranean island, officials said.    The woman, who was in her sixties, "was swept away by the waves as she was walking along the beach at Porto," the emergency services said.

The incident occurred as south-eastern France was battered by unseasonably high winds of up to 138 kilometres per hour (85 miles per hour), the Meteo France weather service said.    In the south-eastern Alpes-de-Haute-Provence region, high winds left nearly 2,000 homes without power with forecasters saying the strong  wind would continue throughout the day.
Date: Tue, 30 Apr 2019 22:55:44 +0200

Berlin, April 30, 2019 (AFP) - Two types of French cheese have been recalled in Germany over fears they could be contaminated with E.coli, just a few days after a similar scare in France, the German food safety authority announced on Tuesday.   French cheesemaker, Fromagerie Alpine, has been asked to recall its cheeses Saint-Felicien and Saint-Marcellin, sold in Germany under the name "Xavier David, tradition of good cheese, Alpine", the authority said.

The decision was a precaution over concerns the brands could have been contaminated with the bacteria E.coli type 026, commonly found in the intestines of humans, livestock and other animals.   It is excreted in faeces and generally spread through contaminated food and water, but also can be passed among humans.   French health authorities recalled the two same two cheeses from Fromagerie Alpine and other producers on April 27 as a precaution after several young children were infected with the bacteria.
Date: Mon 29 Apr 2019
Source: Food Safety News [edited]

French authorities are investigating an _E. coli_ outbreak linked to cheese after young children developed haemolytic uraemic syndrome (HUS). Some Saint-Felicien and Saint Marcellin cheese has been recalled.

The 13 cases of HUS that developed after _E. coli_ O26 infection have occurred in young children since 21 Mar 2019. The patients are from several regions in the country.

HUS is a severe complication of _E. coli_ infection that causes kidney failure and can occur a week or more after the onset of diarrhoea.

Notification of Shiga toxin producing _E. coli_ (STEC) [or enterohaemorrhagic _E. coli_ (EHEC)] infections is voluntary in France and based on HUS surveillance in children under 15 years old. EHEC identification in stool samples is not routinely performed by medical labs.

French authorities said preliminary investigations found several children ate Saint-Felicien and Saint Marcellin cheeses before onset of their symptoms. Among these, 3 have a possible link with the consumption of Saint Felicien and Saint Marcellin cheese manufactured by Fromagerie Alpine, based in Romans-sur-Isere, a town in the Drome department in Southeastern France in the Auvergne-Rhone-Alpes region. Epidemiological, microbiological and food traceability investigations are continuing to determine the source of infection.

Sante publique France, the national public health agency, and the National Reference Center (CNR) for _E. coli_, _Shigella_ and _Salmonella_ at the Pasteur Institute are continuing enhanced surveillance of HUS to detect possible new cases. The implicated cheeses were distributed across France with different brand names. Saint-Felicien 180-gram and Saint Marcellin 80-gram packages with lot numbers from 032 to 116 have been recalled. Affected brand names are Fromagerie Alpine, Carrefour, Reflet de France, Leclerc, Lidl, Auchan, Rochambeau, Prince des bois, Sonnailles and Prealpin.

General precautionary advice from health authorities is that raw, unpasteurized milk and cheese made from it should not be eaten by young children. Older adults, pregnant women and other people with weakened immune systems, such as cancer patients, are also at high risk of contracting bacterial infections from raw dairy products.

The current situation is the latest in a string of French cheese recalls initiated because of various pathogens that can cause illnesses in people. Since the beginning of March 2019, there have been 14 alerts from the Rapid Alert System for Food and Feed (RASFF) for problems with French cheese, although some of those relate to the same incident.

In another incident, Jacquin recalled Pouligny Saint-Pierre raw goat's milk cheese from more than 10 countries because of _E. coli_ O26. A different raw goat's milk cheese with the brand name "EARL Le Moulin de la Fosse," which was sold from 2-20 Apr 2019 in markets at Chateauroux, was recalled due to potential contamination with _E. coli_ O157.

In March 2019, a company called LHT informed consumers that _E. coli_ O26 was found in a batch of its "Crottin de Chavignol" cheese with the best-before date of 5 Apr 2019. Hardy Affineur also recalled Valencay and Petit Valencay raw goat's milk cheese with best-before dates ranging from 1 to 26 Mar 2019 because of _E. coli_ O157.  [Byline: Joe Whitworth]
=====================
[Unpasteurized dairy products remain a potential risk for a variety of pathogens, including enterohemorrhagic _E. coli_ (EHEC), either the prototypic serotype or one of the other serotypes; in this case, O26. In analyzing the genetic and phenotypic profiles of non-O157 groups of EHEC, it has been found that they belong to their own lineages and have unique profiles of virulence traits different from the prototypic O157 strain (1). The serogroups appearing to be most prominent are O26, O111, O128, and O103 (2), the O26 serotype being the implicated strain in this outbreak.

>From the past reports and this follow-up, many of the cases had HUS (6 out of 14 in the June 2018 posting, plus 2 mentioned above, suggesting 8 out of 16). For so many of the reported cases to be associated with HUS is very unusual; I would suspect that more cases are known, or the particular strain is a hyperproducer of Shiga toxin, or the specific toxin is more potent.

The following was extracted from Lutwick LI. Enterohaemorrhagic _E. coli_ infections. In: Confronting emerging zoonoses: the One Health paradigm. Yamada A, Kahn LH, Kaplan B, et al. (editors). Tokyo, Japan: Springer; 2014:77-112:

"Risk factors for the subsequent development of HUS after EHEC include children less than 10 years of age, elevated white blood cell counts, persistent low platelet counts without reversal and the use of either antimicrobial agents or antimotility agents during the diarrhea stage before or after bloody diarrhea develops. Since fever is generally not part of the presentation but significant abdominal pain is, patients with diarrhea, significant abdominal pain and no fever should be considered to have EHEC infection, and antimicrobial or antimotility agents should be avoided. Additionally, certain strains -- for example, the so-called clade 8 and the chimeric organism _E. coli_ O104:H4 -- can be associated with a higher risk of HUS.

HUS itself is a thrombotic illness primarily caused by the effects of the EHEC-produced Shiga toxin acting on the vascular endometrium of organs where the toxin's receptors are expressed, particularly the kidney and brain. The syndrome consists of the combination of prominent low platelet counts (thrombocytopenia), intravascular red blood cell destruction (hemolysis), and diminished kidney function that can require hemodialysis. Neurological involvement occurs mostly in those who develop renal failure and the central nervous system involvement portends much higher mortality. Indeed, most of the acute mortality relates to neurological disease. Most patients will recover, but some, perhaps 10%, remain with renal failure and require chronic hemodialysis."

References
----------
1. Schmidt H, Geitz C, Tarr PI, et al. Non-O157:H7 pathogenic Shiga-toxin producing _Escherichia coli_: phenotypic and genetic profiling of virulence traits and evidence for clonality. J Infect Dis 1999;179(1):115-23; available at
2. Bettelheim KA. Role of non-O157 VTEC. Symp Ser Soc Appl Microbiol 2000;(29):38S-50S; abstract available at

[HealthMap/ProMED map available at:
More ...

Qatar

Qatar - US Consular Information Sheet
February 26, 2008
COUNTRY DESCRIPTION:
Qatar is a monarchy governed by the ruling Al Thani family in consultation with a council of ministers, an appointed advisory council and an elected municipal cou
cil.
Islamic ideals and beliefs provide the foundation of the country’s customs, laws and practices.
Located in the heart of the Persian Gulf, Qatar is a dynamic, modernizing, rapidly developing country that is among the wealthiest per capita in the world.
The capital is Doha.
Tourist facilities are available.
Read the Department of State Background Notes on Qatar for additional information.
ENTRY/EXIT REQUIREMENTS:
Passports and visas are required.
U.S. citizens may obtain a single-entry tourist or business visa at Doha International Airport upon arrival.
Single entry visas cost $28 and must be paid by credit card only.
Cash is not accepted.
Visas are valid for 30 days and may be extended for an additional 30 days for a $28 fee through the Airport Visas Section of the Immigration Department located next to Doha International Airport.
However, U.S.-citizen travelers will be able to clear Qatari immigration more quickly and be granted a longer stay in country by obtaining visas prior to arrival.
If planning to arrive at another port of entry in Qatar, travelers should obtain a tourist or business visa in advance of their arrival from a Qatari embassy or consulate abroad.
Travelers should also note that the Qatari Government charges $55 for each day that an individual overstays a visa, up to a maximum amount of $3,300.

For further information on visas, residence permits and entry requirements, please visit the Qatari Ministry of Interior’s web site at www.moi.gov.qa/English/index.htm.
Travelers may also contact the Embassy of the State of Qatar (www.qatarembassy.net) at 2555 M Street NW, Washington, DC
20037, tel. (202) 274-1600, fax (202) 237-0061.
They may also contact the Consulate General of the State of Qatar, 1990 Post Oak Blvd. Suite 810, Houston TX 77056, telephone (713) 355-8221, fax (713) 355-8184, send email inquiries to info@qatarembassy.org.

Military personnel are subject to different entry/exit requirements and should refer to www.fcg.pentagon.mil for specific information pertaining to their travel requirements.
NOTE FOR DUAL NATIONALS:
Qatari law requires that Qatari citizens only hold Qatari citizenship and enter and exit on a Qatari passport.
Qatari authorities have confiscated the passports of U.S. citizens who acquired Qatari citizenship through marriage to a Qatari national or by virtue of birth in the U.S.
In several cases, Qatari authorities informed U.S. citizens that their U.S. citizenship had been revoked and was no longer valid.
However, foreign governments have no authority to revoke the citizenship of a U.S. citizen.
If this occurs, please contact the U.S. Embassy in Doha immediately.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
Incidents of violence are rare in Qatar, although attacks against Western targets have occurred.
To provide for public security, a large police presence is deployed throughout the country.
American citizens in Qatar are strongly encouraged to maintain a high level of vigilance, be aware of local events and take the appropriate steps to bolster their personal security at all times.

The Department of State remains concerned about the possibility of terrorist attacks against U.S. interests worldwide, including the Middle East.
Both historical and recurring information suggests that al-Qa’ida and affiliated organizations continue to plan strikes against Western targets; these attacks may employ a wide variety of tactics to include assassination, kidnapping, hijacking and bombing.
On March 19, 2005, a suicide bomber detonated a vehicle-borne improvised explosive device (VBIED) at a theater in Doha regularly frequented by westerners; a citizen of the United Kingdom was killed, and several other individuals were injured.

Increased security at official facilities has led terrorists and their sympathizers to seek softer, less fortified targets; the March 2005 theater attack in Doha is one such example.
Other locations of potential concern include any venue where U.S. citizens and other foreigners are known to congregate in large numbers such as public assemblies, sporting events, restaurants, residential areas, clubs, places of worship, schools, hotels, etc.
The Government of Qatar occasionally provides security for such locations and events, but to varying degrees.
In most instances, the Embassy cannot gauge the appropriateness of security for a given event prior to its commencement.
The Embassy strongly encourages American citizens to avoid large crowds and demonstrations whenever possible.
For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site, where the current Worldwide Caution, Travel Warnings and other Travel Alerts and additional resources can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada or, for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
The crime rate in Qatar is generally low.
A large police presence is apparent to travelers throughout the country.
Incidents of violence are rare but have occurred more frequently as Doha’s population and economic pressures on expatriate workers have increased substantially during the past few years.
Local and third country national young men have been known to verbally and physically harass unaccompanied, expatriate women.
Reports of petty theft have been growing, including ATM and credit card theft, purse snatching and pickpocketing.
Travelers are cautioned not to leave valuables such as cash, jewelry, and electronic items unsecured in hotel rooms or unattended in public places.

The Qatari Police can be contacted for emergency assistance by dialing 999 from any telephone in Qatar.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the U.S. Embassy in Doha.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the U.S. Embassy for assistance.
The Embassy staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Good modern medical care and medicines are available in Doha, although only basic or no medical care may be available in Qatar’s smaller cities or outlying areas.
Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars.
Doctors and hospitals expect immediate cash payment for health services.
Information about the Qatari national healthcare system is available at http://www.hmc.org.qa.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Qatar is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Short-term visitors should obtain a valid International Driving Permit prior to arrival and should not drive in Qatar on a U.S. driver’s license.
Short-term visitors and business travelers can also obtain a Temporary Qatari Driving License by presenting their U.S. driver’s license at any branch of Qatar’s Traffic Police.
New and prospective residents should obtain a permanent Qatari Driving License immediately after arrival.
Once an American citizen holds a valid Qatari residence permit, they are no longer permitted to drive in Qatar with an International Driving Permit or a Temporary Qatar Driving License.

Traffic accidents are among Qatar’s leading causes of death.
Safety regulations in Qatar are improving thanks to a more stringent traffic law adopted in October 2007 and a country-wide traffic safety campaign.
However, informal rules of the road and the combination of local and third-country-national driving customs often prove frustrating for first-time drivers in Qatar.
The combination of Qatar’s extensive use of roundabouts, many road construction projects and the high speeds at which drivers may travel can prove challenging.
The rate of automobile accidents due to driver error and excessive speed is declining but remains higher than in the United States.
In rural areas, poor lighting, wandering camels and un-shouldered roads are other hazards.
Despite aggressive driving on Qatar’s roads, drivers should avoid altercations or arguments over traffic incidents, particularly with Qatari citizens who, if insulted, have filed complaints with local police that resulted in the arrest and overnight detention of U.S. citizens.
Drivers can be held liable for injuries to other persons involved in a vehicular accident, and local police have detained U.S. citizens overnight until the extent of the person’s injuries were known.
Due to its conservative Islamic norms, Qatar maintains a zero-tolerance policy against drinking and driving.
Qatar’s Traffic Police have arrested Americans for driving after consuming amounts of alcohol at even smaller levels normally accepted in the U.S.
Any motor vehicle over five years old cannot be imported into the country.
For specific information concerning Qatari driver’s permits, vehicle inspection, road tax and mandatory insurance, please contact either the Embassy of the State of Qatar in Washington, DC or the Consulate General of the State of Qatar in Houston, Texas.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Qatar’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Qatar’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: Qatari customs authorities enforce strict regulations concerning importation into Qatar of items such as alcohol, narcotics, pork products, firearms, or anything deemed pornographic by Qatari authorities.
While importation of religious material for personal use is acceptable, importation of religious material for the purpose of proselytizing is not.
It is advisable to contact the Embassy of the State of Qatar in Washington, DC, or the Consulate General of the State of Qatar in Houston for specific information regarding customs requirements.

Please see our Customs Information.

Pets entering Qatar require an import permit from the Ministry of Agriculture.
Cats with proper documentation are allowed to enter with no difficulty, but some breeds of dogs, especially large dogs, are not admitted.
Application forms for import permits may be obtained from the Ministry of Agriculture through a sponsoring employer.
A copy of the pet's health certificate and vaccination record must be submitted with the application.

Qatari law does not recognize dual nationality.
Persons who possess Qatari citizenship in addition to U.S. citizenship are considered Qatari citizens by the State of Qatar and are subject to Qatar’s laws.
Qatari citizenship imposes special obligations, particularly with regard to child custody and exiting or entering the country.
For additional information, please refer to our dual nationality flyer
or contact the U.S. Embassy in Doha.

All U.S. citizens are encouraged to carry a copy of their passports with them at all times so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available.
Qatari employers/sponsors customarily hold passports of foreign (i.e., non-Qatari) employees during the terms of their employment in Qatar.
Residents carry a Qatari Identification Card (Iqama) for identification in place of a passport.
Foreign nationals, including U.S. citizens, may not leave Qatar without permission in the form of exit visas obtained by their employer/sponsor.
The U.S. Embassy in Doha cannot assist U.S. citizens in Qatar to obtain third country visas for unofficial travel.
Islam provides the foundation of Qatar’s customs, laws and practices.
Foreign visitors are expected to remain sensitive to the Islamic culture and not dress in a revealing or provocative manner, including the wearing of sleeveless shirts and blouses, halter-tops and shorts.
Western bathing attire is worn at hotel pools and beaches.
BUSINESS AND EMPLOYMENT CONTRACTS:
The written, Arabic text of a contract governs employment and business arrangements under Qatari law.
Before signing a contract, U.S. citizens and companies should obtain an independent English translation of the original Arabic to ensure a full understanding of the contract's terms, limits, and agreements.
No U.S. citizen should work in Qatar or make a business arrangement without having seen and understood the full, written contract.
Verbal assurances or side letters are not binding in Qatar.

In the event of a contract or employment dispute, Qatari authorities refer to the Arabic language of a contract.
Since a Qatari sponsor holds the employee's passport and controls the issuance of exit visas, U.S. citizens cannot simply leave Qatar in the event of an employment or business dispute.
Any U.S. citizen who breaks an employment or business contract may have to pay substantial penalties before being allowed to depart Qatar.
Qatari law favors employers over employees, and Qatari sponsors have substantial leverage in any negotiations and may block the departure of the employee or bar future employment in Qatar.

Transferring employment in Qatar requires the permission of the previous employer, which is discretionary, and is subject to approval by the Ministry of the Interior.
The Ministry of the Interior has denied employment transfers in the past, including ordering U.S. citizens deported and barred from re-entry to Qatar for two years.
The U.S. Embassy has no standing in Qatar’s courts, cannot sponsor visas, and cannot adjudicate labor or business disputes.
U.S. consular officers can provide lists of local attorneys to help U.S. citizens settle disputes, but ultimate responsibility for the resolution of disputes through Qatar’s legal system lies with the parties involved.
To obtain a residence permit in Qatar, the Government of Qatar usually requires foreign citizens to provide a police clearance certificate from their home countries.
Prospective residents can obtain a U.S. police clearance certificate two ways: through a local or state law enforcement agency or through the Federal Bureau of Investigations (FBI).
In both cases, the clearance will run against the National Crime Information Center, which contains all federal, state and local criminal records.
This process requires several weeks, and the U.S. Embassy in Doha strongly recommends that prospective residents obtain a U.S. police clearance before they arrive in Qatar.

For more information on business opportunities and practices in Qatar, please visit the Foreign Commercial Service’s Country Commercial Guide for Qatar at http://www.buyusa.gov/qatar.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Criminal offenses are punished according to Qatari laws, which in some cases are based on Islamic law and sometimes more severe than in the United States for similar offenses.
Persons violating Qatari laws, even unknowingly, may be arrested, imprisoned, deported, or subject to a ban from departing Qatar.
Travel bans are not lifted until both parties resolve a dispute and the case is abandoned or, if not, until the matter is resolved by a court, which may require months to process the case.
Qatari law enforcement authorities have detained potential witnesses or relatives without charges or access to legal counsel during the investigation of a crime.
The U.S. Embassy in Doha cautions American citizens that Qatari police can and have arrested American citizens suspected of or witness to a crime, including traffic accidents involving injuries to pedestrians or the occupants of other cars, traffic arguments, slander, and a variety of lesser offenses.
Once arrested, the Qatari Police have no independent authority to grant a release, an authority reserved solely for Qatar’s Public Prosecution and Courts.
As a result, arrested Americans, regardless of the charges, often spend one night in jail awaiting a hearing with Qatar’s Public Prosecution or the appropriate court.
Qatari law enforcement authorities do not routinely notify the U.S. Embassy in Doha of a U.S. citizen’s arrest and, for more serious crimes, may not allow a U.S. Embassy official to visit an arrested U.S. citizen until the initial interrogation is completed.
Upon arrest, U.S. citizens should ask to speak to the U.S. Embassy immediately, and if not allowed, request a friend or family member notify the U.S. Embassy through the contact information below.
Incidents involving insults or obscene language/gestures often result in arrest, overnight imprisonment and/or fines whether the incident occurs between private parties or involves officers of the law.
Drunk driving, public intoxication and other alcohol-related offenses are treated with severity and will result in arrest, heavy fines, imprisonment, or expulsion from the country.
Penalties for possession, use, or trafficking in illegal drugs in Qatar are severe, and convicted offenders can expect long jail sentences and heavy fines.
Homosexual activity is considered to be a criminal offense, and those convicted may be sentenced to lashing and/or a prison sentence, and/or deportation.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.
CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Qatar are encouraged to register with the U.S. Embassy in Doha through the State Department’s travel registration web site to obtain updated information on travel and security within Qatar.
Americans without Internet access may register directly with the U.S. Embassy in Doha.
By registering, American citizens make it easier for the U.S. Embassy in Doha to contact them in case of emergency.
The U.S. Embassy is located in the Al-Luqta District on 22nd February Street, PO Box 2399, Doha; phone (974) 488-4101, extension 0 or 6500.
For after-hours emergencies, U.S. citizens may call (974) 488-4101, extension 0 or 6600, to reach the duty officer.
On the Internet, you may reach the Embassy web site at http://qatar.usembassy.gov for additional information and operating hours.
The embassy observes a Sunday through Thursday workweek.
Government offices and most businesses in Qatar also observe a Sunday through Thursday workweek.
*

*

*
This replaces the Country Specific Information for Qatar dated November 26, 2007, to update the sections on Entry/Exit Requirements, Medical Facilities and Health Information, Traffic Safety and Road Conditions, Special Circumstances, and Criminal Penalties.

Travel News Headlines WORLD NEWS

Date: Wed 24 May 2017
Source: State of Qatar, Ministry of Public Health - News [edited]

Ministry of Public Health (MOPH) has announced that a new Middle East Respiratory Syndrome Corona Virus (MERS-CoV) case has been confirmed for a 29-years-old, resident in Qatar, marking the 3rd MERS-CoV case to be confirmed in the country this year [2017] and bringing the cumulative number of confirmed MERS-CoV cases since 2012 to 21 cases among whom 7 have died.

The patient is a camel worker and had complaints of fever and dry cough for several days. He sought medical attention in Hamad General Hospital where an X-Ray investigation suggested a severe pneumonia. Consequently and as he reported an occupational frequent contact with camels, further samples were withdrawn from the patient. He ultimately tested positive for MERS-CoV according to Hamad Medical Corporation laboratories.

Despite his stable condition, the patient was admitted to hospital; in consistence with the national infection prevention and control protocol for confirmed and suspected MERS-CoV cases to ensure the appropriate medical attention. However, neither a history of contact with similar cases nor a recent travel outside the country was reported for the patient who has no comorbidities.

Once the case has been confirmed, the rapid response team of the Health Protection and Communicable disease Control (HP & CDC) department at the MOPH, accompanied with the team from Animal Health Department, Ministry of Municipality and Environment, have started a field investigation to assess the possible source of the infection and to verify whether any of the patient contacts has suspected symptoms according to the WHO standard case definition. Consequently, all traced contacts will be monitored over a period of 2 weeks, while those who develop suspected symptoms will then be subjected to confirmatory laboratory investigation.

The Ministry of Public Health advices citizens and residents, in particular those with comorbidities or low immunity, to abide to cough etiquette and handwashing with soap and water thoroughly and avoid unnecessary contact with sick animals.

MOPH proclaimed that Health Protection & CDC Hotlines 66740948 & 66740951 are accessible 24/7 to respond to any notification or enquiry related to infectious diseases.
==================
[The above press release mentioned the participation of animal health experts in the investigation of the described case. Information on their observations and findings, including results of laboratory tests (in case animal samples were taken), will be appreciated.

Qatar officially notified the OIE about its 1st event of MERS-CoV in camels, as an emerging disease, on 28 Nov 2013. The start of the event was, reportedly, dated 14 Oct 2013. The 'affected population' was kept on a "small farm with 14 camels, one sheep, one pigeon cage and some chicken" in Al-Shahanya, Ar Rayyan district. The diagnostic laboratory, given as "the Erasmus Medical Center (Rotterdam) and National Institute for Public Health and the Environment (Bilthoven), the Netherlands (OIE Reference Laboratory)", established the diagnosis of MERS-CoV in camels by PCR, on 26 Nov 2013. The report included the following epidemiological comment: "The health authority in Qatar notified the presence of a confirmed human MERS-CoV case. A joint team from both health and veterinary authorities was sent to the patient farm to investigate the health status of animals and the contact person. A farm worker proved to be positive for MERS-CoV and samples were collected from the 14 existing camels in addition to one sheep, some pigeons and chickens and some environmental samples (water, soil, animal food and grass) and all were sent to the Netherlands for testing. All animals were kept under observation and quarantine and all were apparently healthy". The above immediate notification was followed by 3 follow-up reports (29 Dec 2013, 22 Apr 2014 and 09 Jun 2014).

Follow-up report No 1, submitted a month later, namely on 29 Dec 2013, informed: "There are no new outbreaks in this report". The report, however, included the following epidemiological comments: "The samples from the same herd tested, using the same technique were negative and this may show that MERS-CoV infection in camels is a self-limiting disease. The planned massive survey for MERS-CoV in animals is under implementation and the same herd is under systematic retesting. Follow-up reports will be submitted when there will be new data".

Follow-up report No 2, submitted 22 Apr 2014, addressed "A single barn of 26 camels of different ages" in the same location (Al-Shahanyain), Qatar. The diagnostic laboratory was named as "Department of Viroscience, Erasmus Medical Center, Rotterdam (The Netherlands) (Foreign laboratory)"; the tests were performed on 19 Apr 2014, applying PCR and virus isolation, both positive. The report included the following epidemiological comments: "During an existing survey (pilot phase of the survey), nasal swabs were collected from an 8-month-old camel among healthy dromedary camels. The sample was inoculated on Vero cells and cytopathic changes were observed in cells at 48h post-infection. Human hepatoma cells (Huh-7 cells) were inoculated with MERS-CoV to further functionally characterize this viral isolate. After 2 days, virus-induced cytopathic effects were observed in the inoculated cell cultures. Virus production in Huh-7 cells was blocked by pre-incubating MERS-CoV with a 1/200 dilution of serum from MERS-CoV antibody positive camels. Conclusion: these data demonstrate that the MERS-CoV obtained from a dromedary camel is able to replicate in human cells and uses DPP4 as entry receptor, similar as isolates obtained from MERS patients".

Follow-up report No 3, submitted 9 Jun 2014, involved 3 barns with a total number of 12 camels of different ages, similarly in Al-Shahanya. Of the 12 susceptible camels, there were 5 "cases", indicated as an apparent morbidity rate of 41.67 percent. The diagnostic laboratory was "Erasmus Medical Center (Rotterdam) and National Institute for Public Health and the Environment (Bilthoven), The Netherlands (Foreign laboratory)", which applied SNT. This report included the following epidemiological comment: "Milk was collected according to local customs; cria's (dromedary calves) were not weaned after delivery but kept at the farm in paddocks adjacent to their dams throughout lactation. Dams were reunited with their cria to trigger milk production. Once milk production was initiated, the milk samples were collected by the camel owner or caretaker without specific hygienic precautions". The named follow-up report No 3 was the last report of MERS-CoV in camels submitted so far by Qatar to the OIE. It included the statement "continuing". No additional MERS-CoV reports from Qatar have become available since June 2014.

According to WAHID's archive data, the summary of the event since its start, as of June 2014, was:
Total outbreaks = 3 (Submitted)
Species/ Susceptible/ Cases/ Deaths/ Destroyed/ Slaughtered
Camelidae/ 52/ 9/ 0/ 0/ 0
(see at <http://www.oie.int/wahis_2/temp/reports/en_fup_0000015380_20140610_175414.pdf>).

In May 2017, the OIE updated its case definition for the reporting of MERS-CoV, as follows:

"1. Introduction
Dromedary camels have been confirmed by several studies to be the reservoir of the MERS-CoV infection in humans. Zoonotic transmissions of MERS-CoV from dromedary camels to humans were reported in multiple occasions. MERS-CoV has never been reported as a disease in camels though in experimental infections MERS-CoV has been associated with mild upper respiratory signs. Positive PCR results for MERS-CoV or isolation of the virus from camels is notifiable to the OIE because MERS is an emerging disease with a significant public health impact.

2. Confirmed case:
A dromedary camel with laboratory confirmation (*note 1) of MERS-CoV infection, with or without clinical signs.

3. Suspected case:
a) Observed clinical signs of mild respiratory infection (rhinitis in young dromedaries); and
b) Direct epidemiologic link (*note 2) with a confirmed human or camel MERS-CoV case; and
c) Testing for MERS-CoV is unavailable, negative or inconclusive (*note 4) on a single inadequate specimen (*note 3).

Notes
1 A case may be laboratory confirmed by virus isolation or detection of viral nucleic acid. The presence of viral nucleic acid can be confirmed by 1) a positive RT-PCR result on at least 2 specific genomic targets,
2) a single positive target with sequencing of a 2nd target or
3) a single positive target with positive result in a rapid MERS-CoV Ag Test. Serological investigations are of little value as high percentage of tested dromedaries possess antibodies to MERS-CoV.

2. A direct epidemiological link with a confirmed MERS-CoV dromedary camel may include living or traveling together in close proximity or sharing the same environment with individual dromedaries infected with MERS-CoV.

3. An inadequate specimen would include a specimen that has had improper handling, is judged to be of poor quality by the testing laboratory, or was taken too late in the course of illness.

4. Inconclusive tests may include a positive screening test on a single rRT-PCR target without further confirmation. Animals with an inconclusive initial test should undergo additional sampling and testing to determine if the animal can be classified as a confirmed MERS-CoV case. At herd level, having positive single target PCRs in more than one animal could constitute confirmation. Preference should be a repeat nasopharyngeal specimen. Other types of clinical specimens could also be considered for molecular testing if necessary, including blood/serum, and stool/rectal swab. These generally have lower titers of virus than respiratory tract specimens but have been used to confirm cases when other specimens were inadequate or unobtainable".

As commented by Mod.MPP (see http://promedmail.org/post/20170524.5059234), according to a review of cases reported by Saudi Arabia and classified as "primary" cases (N=560), 27.3 percent had a history of camel exposure, and 72.7 percent were reported as still under investigation for high risk exposures at the time of initial confirmation report. The 85th General Session of the World Assembly of OIE Delegates has been held in Paris during this week (21 to 26 May 2017). According to WHO updated information, MERS-CoV has caused, since its initial detection in Sep 2012, at least 1952 human cases, of which at least 693 deaths in 27 countries. It will be interesting to note if the reporting of this disease, according to the OIE criteria, and its possible control in the animal reservoir have been discussed during the General Session.

Subscribers are referred to a recent review paper (Ref 1), and in particular to figure 3 "Hypothesis of MERS-CoV transmission to humans".

A One Health approach to the MERS-CoV issue, its epidemiology and control, will require the active involvement of the 3 relevant international authorities, namely the FAO, OIE and WHO.

References
M. G. Hemida, A. Elmoslemany, F. Al-Hizab, A. Alnaeem, F. Almathen, B. Faye, D. K. W. Chu, R. A. P. M. Perera & M. Peiris. Dromedary Camels and the Transmission of Middle East. Transboundary & Emerging Diseases 64 (2017) 344-353.  <http://agritrop.cirad.fr/580073/7/Hemida_et_al-2017-Transboundary_and_Emerging_Diseases.pdf>. - ProMED Mod.AS]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sat, 26 Nov 2016 20:00:07 +0100

Doha, Nov 26, 2016 (AFP) - Rainfall caused widespread flooding in Qatar on Saturday, potentially raising fresh concerns about infrastructure in the Gulf country due to host the 2022 football World Cup.   Several major roads were flooded, prompting official warnings.   "As the rain continues to pour in most parts of the country, motorists are advised to be cautious," the interior ministry tweeted after earlier calling the rainfall "medium to heavy".   Some apartment buildings on the Pearl Qatar, an artificial island in Doha, estimated to have cost $15 billion (13.5 billion euros) to build, suffered flooding, as did the nearby suburb of Qanat Quartier, built to resemble Venice.

The Doha News website reported that the Qatar Animal Welfare Society pleaded urgently for foster homes to take care of its dogs because of the conditions.   The Peninsula English-language newspaper reported that rain caused leaks at major Doha shopping centre the Landmark Mall.   Many people used social media to post videos and pictures, with some questioning how a relatively small amount of rain -- the first of the winter -- could cause such problems.   The wet weather had been predicted and the government "Rain Emergency Team" had already convened to discuss potential problems.

Last November, the government began an inquiry after rain damaged Doha's Hamad international airport, which opened in 2014, flooded roads and streets and caused some schools to close.   Gas-rich Qatar is spending more than $200 billion on major infrastructure such as roads, the airport, a metro system and a new city ahead of the 2022 World Cup, which will be played at this time of year -- from November 21 to December 18.   World Bank figures show Qatar's average annual rainfall is around 75 millimetres.
Date: Mon 13 Jun 2016 01:58 AM (Qatar)
Source: Gulf Times [edited]

The Ministry of Public Health has announced that a new Middle East Respiratory Syndrome Corona Virus (MERS-CoV) case has been confirmed in a 23-year-old male resident, marking it the 3rd to be confirmed in the country this year [2016].

The person was not in contact with a confirmed case and does not suffer from any chronic diseases that usually cause immunity suppression. The patient was admitted to Hamad General Hospital as he reported fever, cough, runny nose, and backache where he tested positive for Mers-CoV. The patient is now stable and receives medical care in the isolation ward.

The ministry said that Health Protection and Communicable Disease Control Hotlines, 66740948 and 66740951, are accessible round-the-clock to respond to any notification or query related to infectious diseases.

MERS-CoV was 1st identified in Saudi Arabia in 2012.

According to the World Health Organization (WHO), globally, since September 2012, it has been notified of 1652 laboratory-confirmed cases of infection with MERS-CoV, including at least 591 related deaths [the most recent report from WHO on 16 May 2016 gives a global tally of 1733 laboratory-confirmed cases of infection with MERS-CoV, including at least 628 related deaths (<http://www.who.int/csr/don/16-may-2016-mers-saudi-arabia/en/>) - ProMED Mod.MPP].

Mers-CoV is a zoonotic virus that is transmitted from animals to humans.
==================
[As mentioned in the above report, this is now the 3rd case of MERS-CoV infection reported in Qatar in 2016. The 1st case was reported in February 2016 in a 66 year old Qatari male who had been, for 2 months preceding onset of illness, in Saudi Arabia where he had a camel farm (see MERS-CoV (35): Saudi Arabia, Qatar ex Saudi Arabia, WHO http://promedmail.org/post/20160311.4085518 and MERS-CoV (24): Qatar ex Saudi Arabia, Saudi Arabia (RI) RFI http://promedmail.org/post/20160222.4041719). The 2nd case was a 40 year old Qatari national camel worker with non-specific, non-respiratory symptoms (see MERS-CoV (56): Qatar, Saudi Arabia, WHO http://promedmail.org/post/20160503.4198200).

According to the most recent ECDC Communicable Disease Threats Report, as of 9 June 2016, there have been a total of 1753 cases of MERS-CoV infection, including 680 deaths reported by health authorities worldwide. Besides, there have been a total of 15 cases of MERS-CoV infection including 5 deaths reported by Qatar as of 9 Jun 2016, making this current case the 16th case reported by Qatar since April 2012.  (<http://ecdc.europa.eu/en/publications/Publications/Communicable-disease-threats-report-11-june-2016.pdf>).

In addition to the 16 cases reported by Qatar, there have been 2 additional cases reported in Qatari nationals treated in Europe (see Novel coronavirus - Saudi Arabia (03): UK HPA, WHO, Qatar
East. Med. (07): Saudi Arabia, UK, Germany

We await further information on possible high risk transmission exposures.

The HealthMap/ProMED map of Qatar can be found at:
Date: Mon 2 May 2016
Source: Gulf Times

A 40-year old camel worker has tested positive for the Middle East respiratory syndrome coronavirus (MERS-CoV), the Ministry of Public Health (MoPH) announced.

It is the 2nd case confirmed in Qatar so far this year [2016].

The worker, who was neither in contact with a suspected patient nor abroad during the last 2 weeks, is free from chronic diseases that usually cause immunity suppression. He was admitted to Hamad General Hospital [in Doha] with general symptoms where routine investigations tested positive for MERS-CoV, despite him not exhibiting any respiratory related symptoms.

The patient is currently in stable condition and receiving the necessary medical care in the isolation ward, according to the national protocol for infection prevention and control, the ministry said in a statement.

After the tests proved positive, the rapid response team of MoPH carried out extensive search to list all potential contacts to check for their possible consistence with the standard case definition of the suspected cases, based on the World Health Organisation guidelines. All traced contacts will be monitored over a period of 2 weeks, while those who develop suspected symptoms will then be subjected to confirmatory laboratory investigation, the ministry added.

While research efforts continue on a global and local level to determine the modes of transmission of MERS-CoV infection, the MoPH has advised citizens and residents who suffer from chronic diseases to avoid direct contact with camels and to wash hands with soap and water thoroughly. Also recommended are implementing respiratory hygiene and cough etiquette and the need to boil camel milk before drinking.

MoPH added that Health Protection & CDC Hotlines 66740948 and 66740951 are accessible 24/7 to respond to any notification or inquiry related to infectious diseases.
==================
[The text of the media report above is almost verbatim from the MoPH announcement, also released today (2 May 2016 and available at <https://www.moph.gov.qa/news/moph-announces-the-second-mers-cov-case-in-2016?backArt=326&page=2>). On 22 Feb 2016, there was a report of a case of MERS-CoV infection in a 66 year old Qatari male who had a farm (with camels and sheep) in Saudi Arabia. The addition of this newly confirmed case brings the total number of cases of MERS-CoV infection reported by Qatar to 15 since 2012. It is noteworthy that in the absence of respiratory symptoms, the history of camel contact most probably led to testing for MERS-CoV infection in this patient, suggesting a high index of suspicion on the part of the medical community treating this patient.

The HealthMap/ProMED map of Qatar can be found at
Date: Thu, 10 Mar 2016 14:54:28 +0100

Doha, March 10, 2016 (AFP) - A 66-year-old Qatari man has died after contracting the MERS virus, in the first fatal case in the Gulf state for 10 months, health officials announced Thursday.   The public health ministry, quoted by the official Qatar News Agency, said the man "had been suffering from several chronic diseases and died of complications from the disease".

This was the first such case of Middle East Respiratory Syndrome reported in Qatar since May 2015 when it claimed the life of a 73-year-old man, the ministry added in a statement.   The ministry "continues to monitor acute respiratory diseases and is working in cooperation with all the health institutions in the public and private sectors to monitor any suspected case," it said.   The latest victim had been diagnosed with the virus in February. He was hospitalised after returning from a "neighbouring country", according to an official statement last month.

MERS is a viral respiratory illness and considered a deadlier but less infectious cousin of the SARS virus that appeared in Asia in 2003, infecting more than 8,000 people and killing hundreds.   Like SARS, it appears to cause a lung infection, with patients suffering coughing, breathing difficulties and a temperature.

MERS differs in that it also causes rapid kidney failure.   It first appeared five years ago in neighbouring Saudi Arabia, which has been the country worst hit by the virus, with 1,286 cases of infection and 551 deaths, according to official figures.   Globally, there have been 1,644 confirmed MERS cases and 590 deaths, according to the World Health Organization.
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World Travel News Headlines

Date: Mon, 24 Jun 2019 16:11:10 +0200

Kinshasa, June 24, 2019 (AFP) - More than 1,500 people have died in a nearly 10-month-old outbreak of Ebola in the Democratic Republic of Congo, the health ministry said Monday.   As of Sunday, 1,506 people have died out of 2,239 recorded cases, it said.   Earlier this month, the virus claimed two lives in neighbouring Uganda among a family who had travelled to the DRC.   Nearly 141,000 people have been vaccinated in the affected eastern DRC provinces of Ituri and North Kivu, the epicentre of the outbreak.

Ebola spreads among humans through close contact with the blood, body fluids, secretions or organs of an infected person, or objects contaminated by such fluids.   The current outbreak in the DRC is the worst on record after an epidemic that struck mainly in Liberia, Guinea and Sierra Leone between 2014-2016, killing more than 11,300 people.   Chronic violence and militia activity in Ituri and North Kivu as well as hostility to medical teams among locals have hampered the response.

On Monday, a crowd of people opposed to the burial of two Ebola victims in the Beni area burnt the vehicle of a health team, local police chief Colonel Safari Kazingufu told AFP.   He said a member of the medical team had been injured in the attack and taken to hospital.    The United Nations in May nominated an emergency coordinator to deal with the crisis. However, the World Health Organization (WHO) said this month the outbreak currently did not represent a global threat.
Date: Mon, 24 Jun 2019 20:27:21 +0200

Ouagadougou, June 24, 2019 (AFP) - Hundreds of doctors and nurses demonstrated Monday in the Burkina Faso capital Ouagadougou to protest against declining health facilities and to demand better working conditions.   The main doctors' union also warned it would stage a general strike from June 30 to July 7 to demand "concrete responses" to their grievances.

Health professionals staged a series of strikes at the end of May, seriously disrupting work at health centres in the poor West African country.   "We are... asking health authorities not to underestimate the health crisis," said Alfred Ouedraogo, general secretary of the Union of Burkina Doctors.   "For several months, there have been recurring breakdowns in laboratories," he said. "In most health centres, there are no X-ray films."    The protesters marched to the health ministry and submitted their demands.

Health worker Idrissa Compaore said that ever since the introduction of free medical care for children under five and pregnant women, "basic goods were regularly lacking" at health facilities.   "The situation is the same in health centres," he said.   The doctors also want the implementation of an accord signed with the government in 2017 promising better working conditions which they say remains only on paper.   If their demands are not met, the health workers could launch an open-ended strike which would affect consultations and surgeries, Ouedraogo said.
Date: Wed 19 Jun 2019
Source: InSight crime [edited]

Disease outbreaks show desperate Venezuelans have migrated to illegal gold mining areas for work.

Outbreaks of malaria and diphtheria in a region of Venezuela where these diseases are rare has revealed how armed groups are organizing a vast migration to illegal mines.

The outbreaks show that criminals operating in the state of Miranda found a way to make money amid the country's worsening crisis by moving into the illegal gold mines of Bolivar state, in the south of Venezuela.

In the middle of 2017, doctors witnessed an unusual, sustained, and inexplicable malaria outbreak in Valles del Tuy, a region in the state of Miranda located between the coast and the center of Venezuela where the mosquito-borne disease is seldom seen, Efecto Cocuyo reported.

The startling epidemic offered the 1st clue to the changing criminal dynamics in the region.

"Malaria was not a disease native to states in the center of the country, so this caught our attention. We started to ask patients about it to find out how they contracted it. The surprise came when one of the patients told me that he had caught it in the mining region in the state of Bolivar, where they went to work in gold mining," explained a doctor whose practice is in Charallave, the municipal seat in Cristobal Rojas municipality in Miranda state. The doctor asked to remain anonymous for security reasons.

Pressured by the economic situation and massive inflation, residents of the Valles del Tuy region began working during their vacations in the illegal mines in Bolivar, more than 500 kilometers [about 311 mi] away. The doctor said that they were recruited by 'pranes', or prison gang bosses, who had previously been the leaders of local 'megabandas' in Valles del Tuy.

The megabandas' grip on Valles del Tuy began in 2013, when various sites were converted into so-called peace zones, areas where security forces could not enter.

Later, when kidnappings and extortion stopped being profitable in the poor areas where they operated, members of the same megabandas migrated to the mining region in search of other sources of income, and to escape police and military raids.

InSight crime analysis
----------------------
Criminals are not immune to the effects of Venezuela's current economic, political, and social crisis.

Many criminals, primarily pranes and leaders of megabandas, have been forced to abandon their former strongholds and change the pattern of their criminal activities, according to investigations conducted by InSight Crime.

Criminals are trading robbery, petty theft, and kidnappings for drug trafficking and illegal mining. Additionally, they are migrating to states where these illicit economies are strongest: Sucre, Zulia, Tachira, and Bolivar. In the south of Venezuela, Bolivar has become the principal destination for the pranes of Valles del Tuy.

Ramon Teran Rico, alias "Monchi," for example, was the leader of one of the largest criminal organizations in the state of Miranda. Community representatives told InSight Crime that he fled to Bolivar's mines 2 years ago.

Monchi was the 1st crime boss to try his luck at the Orinoco Mining Arc, a transnational mining project created in 2016. He gradually moved his henchmen there from the Valles del Tuy. Sources in his circle of friends say that he even purchased his own dredge to extract gold.

Leaders of other criminal structures operating in the Valles del Tuy have also had to reinvent themselves in order to survive, and have moved into southern Venezuelan states where they operate comfortably.

Hundreds of residents of the towns in Valles del Tuy have migrated to the mining region. "All of the families here have at least one person that has gone to work in the mines," said a resident of Ocumare del Tuy in Miranda state, who reports seeing his neighbors' children and relatives head for the mines.

In November 2016, a case of diphtheria, an acute infectious disease [that most commonly affects the throat and the tonsils], was detected in the Sucuta sector of Ocumare del Tuy, alerting health authorities to the re-emergence of a disease rarely seen in the center of the country.

Follow-up with the patient found that he had contracted the infection in the Bolivar mines.

Health authorities developed prevention plans targeted at the neighborhoods where criminal groups operate. Investigations conducted by health authorities demonstrated that the men that go to work in the mines, as well sex workers or women who work in the kitchens there, carried these diseases back to the Valles del Tuy.

The public health problem shed light on the fact that an illegal gold mining fever had emerged -- an economic lifeline that is now strengthening organized crime.  [Byline: Venezuela Investigative Unit]
=======================
[Malaria has surged in Venezuela over the past 9 years (see ProMED reports below). Control measures have ceased to exist and drugs for treatment have become difficult to find. The association with illegal haphazard mining was reported from Bolivar state in 2012, and the present report underlines that such activities constitute high risk for malaria and other diseases.

The diphtheria outbreak that began in July 2016 remains ongoing. Through February 2019, Venezuela has seen a total of 2726 suspected cases (1612 confirmed), including 164 in 2019 to date (<http://outbreaknewstoday.com/diphtheria-update-venezuela-60872/>). - ProMED Mod.EP]

[Maps of Venezuela:
Date: 23 Jun 2019
Source: Outbreak News [edited]

The Malaysia Ministry of Health is reporting a methanol poisoning cluster believed linked to counterfeit alcohol.

For the period of 11-21 Jun 2019, 3 methanol poisoning clusters were reported to the National Crisis Preparedness and Response Center (CPRC). The incidents involved 19 cases from the following states:
Penang (8), Johor (6) and Negeri Sembilan (5). The cause of the methanol poisoning was believed to be due to the counterfeit liquor branded by Myanmar Whiskey, Miludeer Beer, Whiskey 99 and Martens Extra Strong.

The cluster of methanol poisoning cases in Penang began on 11 Jun 2019 and involved 8 Myanmar citizens. Two of the cases have died. They had been drinking Myanmar branded whiskey. The drink was purchased from the same seller who sells directly at the premises where these poisoning victims work. On 21 Jun 2019, one methanol poisoning case was still being treated at a Penang hospital in critical condition, while 5 others were discharged.

In the state of Johor, reporting of methanol poisoning cases has been received since 18 Jun 2019. It involves 6 cases, 3 Malaysians and one Pakistani, Nepalese and Indian, respectively. Three of the cases involved were found to have consumed a drink believed to be counterfeit branded Miludeer Beer. Four of the cases of methanol poisoning have died. On 21 Jun 2019, one case was still being treated at the Sultanah Aminah Hospital (HSA) in critical condition, and one more reported case of blurred vision was being treated in a regular ward at Sultan Ismail Hospital, Johor Bahru, Johor.

The Negeri Sembilan Health Department (JKNNS) reported one methanol poisoning cluster on 20 Jun 2019 involving 5 cases from the Port Dickson district including 2 deaths. It involves 3 Malaysians, one Indian citizen and one Myanmar citizen. Investigations found cases involved drinking alcoholic beverages allegedly branded Miludeer Beer (2 cases), Whisky 99 (1 case) and Martens Extra Strong (1 case), while one case had no brand information. On 21 Jun 2019, 3 cases were being treated at Port Dickson Hospital, 2 critical cases, and one case in a regular ward.

Clinical samples were taken from all 19 cases for methanol test analysis. The results showed 5 positive cases of methanol and one negative case of methanol but showed symptoms and clinical signs of methanol poisoning. Laboratory results for the remaining 13 cases are still pending.

The Penang State Health Department, Negeri Sembilan and the State of Johor have collaborated with the Royal Malaysian Police and Royal Malaysian Customs in an investigation to identify the sources of the counterfeit alcoholic drink.

The MOH continues to monitor the situation and take preventative and control measures to address these methanol poisoning incidents. Consumers are advised to ensure each purchased alcohol product has a label containing complete manufacturer, importer, agent and listing information.

Consumers are also advised to avoid consuming home-brewed alcoholic beverages or alcohol being sold at low prices.

If individuals have symptoms of methanol intoxication such as stomach-ache, nausea, vomiting, headache, and vision loss within 5 days of consuming an alcoholic drink, MOH advises them to seek immediate treatment at any clinic or the closest hospital.
===========================
[Methanol toxicity initially lacks severe toxic manifestations. Its pathophysiology represents a classic example of lethal synthesis in which toxic metabolites cause fatality after a characteristic latent period. In other words, these people may not realize they are sick or ill until some time after consumption.

Methanol is sometimes used as an ethanol substitute for alcohol. Foods such as fresh fruits and vegetables, fruit juices, fermented beverages, and diet soft drinks containing aspartame are the primary sources of methanol in the human body, but [they contain] minute quantities.

Wood alcohol is also known as methanol. It is a commonly used toxic organic solvent causing metabolic acidosis, neurologic issues, and death when ingested. It is a part of many commercial industrial solvents and of adulterated alcoholic beverages or is mistaken as being the same as alcohol for ingestion. Methanol toxicity remains a common problem in many parts of the developing world, especially among members of lower socioeconomic classes.

Neurological complications are recognized more frequently due to advanced technologies and because of early recognition of the toxicity and advances in supportive care. Hemodialysis and better management of acid-base disturbances remain the most important therapeutic improvements.

Serum methanol levels of greater than 20 mg/dL correlate with ocular injury. Funduscopic changes are notable within only a few hours after methanol ingestion. The mechanism by which the methanol causes toxicity to the visual system is not well understood. Formic acid, the toxic metabolite of methanol, is regarded as being responsible for ocular toxicity, and blindness can occur in humans.

The prognosis in methanol poisoning correlates with the amount of methanol consumed and the subsequent degree of metabolic acidosis; more severe acidosis confers a poorer prognosis. Methanol has a relatively low toxicity. The adverse effects are thought to be from the accumulation of formic acid, a metabolite of methanol metabolism. The prognosis is further dependent on the amount of formic acid that has accumulated in the blood, with a direct correlation existing between the formic acid concentration and morbidity and mortality. Little long-term improvement can be expected in patients with neurologic complications.

The minimal lethal dose of methanol in adults is believed to be 1 mg/kg of body weight. The exact rates of morbidity and mortality from methanol intoxication are not available.

Rapid, early treatment is necessary for survival, but sequelae such as blindness may be permanent.

Metabolic acidosis in methanol poisoning may necessitate the administration of bicarbonate and assisted ventilation. Bicarbonate potentially may reverse visual deficits. In addition, bicarbonate may help to decrease the amount of active formic acid.

Antidote therapy, often using ethanol or fomepizole, is directed towards delaying methanol metabolism until the methanol is eliminated from the patient's system either naturally or via dialysis. Like methanol, ethanol is metabolized by ADH, but the enzyme's affinity for ethanol is 10-20 times higher than it is for methanol. Fomepizole is also metabolized by ADH; however, its use is limited because of high cost and lack of availability.

Hemodialysis can easily remove methanol and formic acid. Indications for this procedure include (1) greater than 30 mL [1 oz] of methanol ingested, (2) serum methanol level greater than 20 mg/dL, (3) observation of visual complications, and (4) no improvement in acidosis despite repeated sodium bicarbonate infusions.

Intravenous administration of ethanol in a 10 percent dextrose solution may be helpful. As ethanol prolongs the elimination half-life of methanol, the treatment may take several days, and the patient should be hospitalized. Dialysis may be necessary to prevent kidney failure as well. Hemodialysis remains an effective treatment.

Portions of this comment were extracted from:

[HealthMap/ProMED map available at:
Date: Fri 21 Jun 2019
Source: WHO/EMRO (Regional Office for the Eastern Mediterranean) [edited]

Situation reports on Al-Hol camp, Al-Hasakah
--------------------------------------------
- Over the past 2 weeks, a total of 633 people have left the camp. This number includes 107 people who returned to their homes in north-east Syria. There were no new arrivals during the reporting period.
- 9 medical points are reporting regularly to the disease Early Warning And Response System (EWARS). Leishmaniasis, acute diarrhoea, bloody diarrhoea, and severe acute malnutrition (SAM) remain the most commonly reported diseases.
- 38 new cases of leishmaniasis were detected. All patients are being treated by a WHO-supported mobile team in coordination with the Al-Hasakeh Directorate of Health.
- 7 suspected cases of measles were reported. No new cases of tuberculosis were detected during the reporting period.
- 30 children with severe acute malnutrition with medical complications were admitted to Al-Hikmah hospital during the reporting period, of whom 22 were discharged, one died, and the remainder are still under treatment. Mortality rates related to severe acute malnutrition remain below the emergency threshold.
- 2 new static health care points have been established, bringing the total number to 12. There is still an acute shortage of health care points in the Foreign Annex.
- 35 water sources were tested for microbial contamination in Al-Hasakeh water national laboratory during the reporting period. All 35 samples tested negative for contamination. WHO continues to test the quality of water from different sources in the camp.
- Stool samples from patients with diarrhoea were tested for
_Salmonella_, _E. coli_, and cholera, with all samples testing negative. Blood samples from patients with suspected measles were also sent for testing, and all samples tested negative.
- Following intensive negotiations by WHO, the local authorities have given their approval in principle to evacuate a patient requiring advanced mental health treatment
===================
[Leishmaniasis has surged throughout Syria during the civil war on all sides and continues to be a health problem in the refugee population. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Syria:
Date: Mon, 24 Jun 2019 05:38:33 +0200

Jakarta, June 24, 2019 (AFP) - A powerful magnitude 7.3 quake struck eastern Indonesia on Monday, US seismologists said, but no tsunami warning was issued and there were no immediate reports of major damage or casualties.   The quake hit at a depth of 208 kilometres (129 miles) south of Ambon island in the Banda Sea at 11:53 local time, the US Geological Survey said.

The Pacific Tsunami Warning Center said there was no threat of a tsunami as the quake was too deep.   The strong temblor came hours after a 6.1-magnitude earthquake hit Papua, also in the eastern part of the Southeast Asian archipelago.   That quake hit about 240 kilometres (150 miles) west of the town of Abepura in Papua province, at a relatively shallow depth of 21 kilometres, according to the USGS.

There were also no immediate reports of casualties after the earthquake.   A shallower 6.3-magnitude hit the area last week, but the damage was not extensive.   Indonesia experiences frequent seismic and volcanic activity due to its position on the Pacific "Ring of Fire", where tectonic plates collide.   Last year, a 7.5-magnitude quake and a subsequent tsunami in Palu on Sulawesi island killed more than 2,200 with a thousand more declared missing.   On December 26, 2004, a 9.1-magnitude earthquake struck Aceh province, causing a tsunami and killing more than 170,000.
Date: Sat, 22 Jun 2019 21:45:46 +0200
By Anna SMOLCHENKO with Irakli METREVELI in Tbilisi

Moscow, June 22, 2019 (AFP) - Russia's government on Saturday banned Georgian airlines from flying into its territory, extending restrictions imposed by President Vladimir Putin as part of growing tensions between Moscow and its ex-Soviet neighbour.   Putin had signed a decree late Friday banning Russian airlines from flying to pro-Western Georgia from July 8 in response to anti-Moscow rallies in the Georgian capital Tbilisi.

The protests broke out after a Russian lawmaker addressed parliament from the speaker's seat earlier this week, a hugely sensitive move for two countries whose relations remain tense after a brief war in 2008.   The rallies have morphed into a broader movement against the Georgian authorities while the Kremlin has branded them a "Russophobic provocation".   On Saturday, protesters took to the streets of the Georgian capital for a third day of rallies, with some 3,000 demanding snap elections and electoral reform.   The crowd sang a profanity-laced, anti-Putin chant and some of the demonstrators held up placards insulting the Russian president.   Demonstrators also shot paper airplanes into the sky in response to the Russian bans.

Russia's transportation ministry said that from July 8 two Georgian airlines would be banned from flying to Russia, citing the need to ensure "aviation safety" and debt owned by the Georgian companies.   The Kremlin has said the ban against travel to Georgia was to "ensure Russia's national security and protect Russian nationals from criminal and other unlawful activities."

Authorities recommended travel companies stop selling holiday packages to Georgia and advised Russian tourists to return home.   Russia's travel industry and ordinary Russians hit out at the decision by the Kremlin, saying it was a politically motivated move that has little to do with safety concerns.   "Tourism in Georgia is on the rise, and the decision has shocked the whole industry," Aleksan Mkrtchyan, head of Pink Elephant, a chain of travel agencies, said in a statement.

- 'This is politics' -
The ban during high season is expected to hit the travel industry in both countries hard and become a major nuisance for Russian holidaymakers.   Russia and Georgia fought a brief but bloody war in 2008 and tensions between the two governments remain high.   But Georgia -- known for its picturesque Black Sea resorts, rich national cuisine and generous hospitality -- has emerged as one of the most popular destinations for Russian tourists over the past few years, with more than 1.3 million visiting last year.

Irina Tyurina, a spokeswoman for the Russian Tourism Union, said that most in the industry believed that Georgia was not a dangerous destination.   "Georgians have traditionally treated Russians well," Tyurina told AFP.    It was too early to estimate potential industry losses from the ban, she said.   More than 7,000 people have signed a petition calling on Moscow to resume flights.

Russian tourists in Tbilisi expressed regret at the restrictions.   "We are against the ban," Nina Guseva told AFP in the Georgian capital. "We are not guilty and we do not have to suffer."   Fellow traveller Mikhail Strelkov added: "This is politics and has nothing to do with people on holidays."   In Russia, many struck a similar note.   Elena Chekalova, a prominent chef and culinary blogger, said the latest Kremlin move "shocked" her.   "Why are they deciding for us what we cannot eat, where we cannot fly, who we cannot be friends with?" she wrote on Facebook.

- Simmering discontent -
Moscow has suspended flights to Georgia before -- during a spike in tensions in October 2006 and in August 2008 following the outbreak of the five-day war over the breakaway regions of Abkhazia and South Ossetia.   "Putin decided to punish Georgia because there are street protests there," opposition leader Alexei Navalny said on Twitter.   A senior government official in Tbilisi said the Kremlin ban was politically motivated.   "Putin's decision is of course political and has nothing to do with safety concerns," the official told AFP on condition of anonymity.

Analysts say the latest restrictions may further fuel simmering discontent with Kremlin policies.   Since 2014, Russians have been chafing under numerous rounds of Western sanctions over Moscow's role in Ukraine and other crises, with real incomes falling for the fifth year in a row.    During an annual phone-in with Russians this week, Putin dismissed calls to "reconcile" with the West to alleviate economic hardship, saying Moscow needed to protect its interests and "nothing" would change anyway.
Date: Sat, 22 Jun 2019 04:35:24 +0200
By Alexandre MARCHAND

Chennai, India, June 22, 2019 (AFP) - Angry residents fight in queues at water taps, lakes have been turned into barren moonscapes and restaurants are cutting back on meals as the worst drought in living memory grips India's Chennai.   The hunt for water in south India's main city has become an increasingly desperate obsession for its 10 million residents after months with virtually no rain.   The bustling capital of Tamil Nadu state usually receives 825 million litres of water a day, but authorities are currently only able to supply 60 percent of that.   With temperatures regularly hitting 40 degrees Celsius (104 Fahrenheit), reservoirs have run dry and other water sources are dwindling each day.

A rainstorm on Thursday night, the first for about six months, brought people out onto the streets to celebrate, but provided only temporary relief.   "We don't sleep at night because we worry that this well will run out," said Srinivasan V., a 39-year-old electrician who starts queueing for water before dawn in his home district near Chennai airport.   The 70 families who use the well are allowed three 25-litre pots each day. Most pay high prices to private companies to get the extra water they need to survive.   Local officials organise a lottery to determine who gets to the front of the queue. The lucky first-comers get clear, fresh water. Those at the end get an earth-coloured liquid.

- Long, hot wait -
Srinivasan said he waits about five hours each day in water queues and spends around 2,000 rupees ($28) a month on bottled water or paying for a tanker truck to deliver water.   It is a big chunk of his 15,000-rupee monthly salary. "I have loans, including for the house, and I can't repay them now," he said.

The desperation has spilled over into clashes in Chennai. One woman who was involved in a water dispute with neighbours was stabbed in the neck.   In another suffering Tamil Nadu city, Thanjavur, an activist was beaten to death by a neighbouring family after he accused them of hoarding water.   Many in Chennai do not have the money to pay for extra supplies, and arguments in queues for free water often turn violent.   The hunt for H2O dominates daily life.   Some Chennai restaurants now serve meals in banana leaves so that they do not have to wash plates. Others have stopped serving lunch altogether to save water.

- Isolated showers -
Families have had to reorganise daily life, setting up schedules for showers and devoting up to six hours a day to line up for water -- three in the morning, three in the afternoon.   Most of those queuing are women, including housewife Nagammal Mani, who said looking for water was like "a full time job".   "You need one person at home just to find and fill up the water while the other person goes to work," she said.   Chennai gets most of its water from four lakes around the city. But it had a poor monsoon last year and levels have not recovered since.   The bones of dead fish now lie on the cracked bottoms of the lakes.   While weak rainfall is a key cause of Chennai's crisis, experts say India's poor record at collecting water does not help, particularly as the country of 1.3 billion people becomes increasingly urbanised.   The drought is seen as a symbol of the growing threat faced in many of India's highly vulnerable states, which have been hit by longer periods each year of sweltering heat that has devastated food production.

Hundreds of villages have already emptied in the summer heat this year because their wells have run dry.   Pradeep John, a local weather expert known online as "Tamil Nadu Weatherman", said if families in the area had spent their money on rain-collection equipment instead of truckloads of water they would be "self-sufficient" now.   "We've got almost 1,300-1,400 millimetres of rainfall every year. So that is a very significant amount of rainfall," he told AFP.   "So we have to find out where the problem lies, where the problem of urbanisation lies -- whether we are encroaching into the (rain) catchment areas -- improve these catchment areas, and then find a long-term solution."   John said there is no immediate hope for rains to end the crisis, with the monsoon not expected before October.   "If the water doesn't come, people will be shedding blood instead of tears," said housewife Parvathy Ramesh, 34, as she endured her daily queue in Chennai's stifling heat.
Date: Fri, 21 Jun 2019 22:49:46 +0200
By Laure FILLON

Paris, June 21, 2019 (AFP) - Forecasters say Europeans will feel sizzling heat next week with temperatures soaring as high as 40 degrees Celsius (104 degrees Fahrenheit) in an "unprecedented" June heatwave hitting much of Western Europe.   From Great Britain to Belgium to Greece, a wave of hot air coming from the Maghreb in North Africa and Spain will push up temperatures starting this weekend and hitting a peak around mid-week.    Spain's meteorological agency (Aemet) has issued a "yellow alert" for severely bad weather for Sunday and says it expects the country to see a "hotter than usual" summer, like last year.

In Germany, forecasters are predicting temperatures up to 37 degrees C on Tuesday and 38 C on Wednesday, with similar hot weather also expected in Belgium and Switzerland.   The British MetOffice said it was particularly concerned that the heatwave could trigger "violent storms" and warned Britons to expect "hot, humid and unstable" weather.   Greece will be one of the countries most affected by the heatwave with temperatures hitting 39 degrees C at the weekend.

In France, meteorologist Francois Gourand said the heatwave is "unprecedented for the month of June" and will no doubt beat previous heat records.    Back in the summer of 2003, France suffered an intense heatwave that led to the deaths of nearly 15,000 mostly elderly people.   Starting on Tuesday, France will see temperatures from 35 to 40 degrees C, which will remain high at night offering little respite from the heat, forecasters predicted.   "Since 1947, only the heatwave of 18 to 28 June, 2005, was as intense," said Meteo France, adding the scorching weather would probably last a minimum of six days.   This latest intense heatwave again shows the impact of global warming on the planet, and such weather conditions are likely to become more frequent, meteorologists said.
Date: Thu, 20 Jun 2019 13:08:42 +0200

Berlin, June 20, 2019 (AFP) - German cabin crew union UFO called Thursday for a strike against airline giant Lufthansa in July, threatening travel chaos during the busy summer holiday season over a wage dispute.   Employees of Lufthansa's subsidiaries Eurowings and Germanwings are expected to vote next week on whether to take action.   Depending on the ballot, dates for the walkout are to be announced for July.   In the coming weeks, UFO union members will also decide whether to go on strike at main company Lufthansa.   "Lufthansa has deliberately managed to escalate wage disputes with its employees," said UFO vice-president Daniel Flohr in a statement.

Lufthansa called off talks with UFO last week and Flohr warned that strike action could cause "flight attendants, passengers and shareholders an additional worry this summer".   With most German schools shut for summer holidays in July, the industrial action could seriously disrupt travel plans in the peak season.   However, a Lufthansa spokesman insisted "there can be no strike, as currently there are neither wage agreements still open nor concrete demands".  The German airline reacted angrily with spokesman Boris Ogursky telling AFP it wants a "reliable collective bargaining partner" to be able to "jointly  develop solutions in the interest of employees and the company.  "At present we cannot see when and how UFO can once again fulfil its role  as a predictable, constructive bargaining partner.    "Therefore, no talks are currently taking place."