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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
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[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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Seychelles

General:
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This group of islands are situated off the eastern coast of Africa in the Indian Ocean. The main Island is Mahe and it has a population of under 100,000. The other two islands with significant popula
ions are Praslin and La Digue. Generally, tourist facilities are well developed throughout these main islands. Elsewhere facilities are poor. The islands enjoy an oceanic tropical climate with only mild variations throughout the year. Rainfall fluctuations do occur with more rainfall occurring between October to April each year.
Safety and Security:
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The majority of tourists visiting the Seychelles will have a very peaceful time and the rate of crime throughout the country is small. However, like many other destinations this situation is changing and there are increasing numbers of reports of petty crime - even on the more popular beaches. Generally it is unwise to leave valuables unattended while you bathe and walking around the main streets in Victoria after dark is not recommended especially for women. All money exchanges must be transacted with official designated dealers and a receipt obtained. Otherwise strict penalties may be enforced.
Health Facilities:
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The level of healthcare in the main tourists resorts is perfectly adequate for most situations but outside these regions the level of care is significantly less. On isolated islands doctors are often unavailable and it may take many hours before you could move to a better equipped location. Always make sure your travel and health insurance is up to date before you leave home.
Food & Water Facilities:
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The level of food and water preparation in the main tourist resorts is excellent but when travelling to isolated regions the standards drop considerably. Consuming foods cooked in local homes will be a significant risk in many circumstances and usually best avoided. However, well cooked fresh fish and other well prepared local delicacies should not present any particular difficulty. As always it is wise to avoid all under cooked bivalve shellfish such as oysters, mussels and clams. Unprepared cold foods like lettuce are also better left untasted and fruit which has been previously peeled will be potentially contaminated. If you peel it yourself it should be fine. Check the tap water smells of chlorine and if not, do not use it for drinking or even brushing your teeth.
Insect Bites and Malaria:
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No malaria risk occurs throughout the Seychelles so prophylaxis will not be required. This is excellent news but you should be aware that mosquitoes can still be a problem and so careful avoidance techniques are required - particularly between dusk and dawn. Dengue Fever has been found on the Islands through there has been no epidemic of the disease for some years.
The risk of Rabies:
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The Seychelles are rabies free but obviously care should still be taken to avoid any contact with warm-blooded animals such as dogs, cats and monkeys. With the difficulties in patrolling the extensive coastline of the Seychelles it is always possible that the disease will be introduced at some stage in the future.
Swimming:
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Take care to listen to local advice before swimming in the sea. Strong currents and various marine life may lead to a severely spoiled holiday. Never swim after a heavy meal or significant intake of alcohol and always swim in the company of others.
Sun Exposure:
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The strength of the sun in the Seychelles throughout the year is significant and this can cause both sunburn and serious dehydration. After a long haul flight it may be tempting to fall asleep beside the hotel pool but this may cause dreadful sunburn and can easily ruin a holiday. Children need to be watched carefully as they are more liable to the effects of the sun, particularly on any fair skinned child. Wearing a light good fitting t-shirt and Increasing their salt intake may be very beneficial.
Road Safety:
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In the Seychelles they drive on the left side of the road but outside the main tourist resorts the roads tend to be very narrow with often shear drops. Barriers are rare and accidents can easily occur. The speed limits are between 25 to 50 mph and both drivers and front seat passengers are required to wear safety belts at all times. There is an ambulance service on the islands of Mahe, Praslin and La Digue which is summonsed by ringing 999.
Local Laws and Customs:
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There are strict regulations regarding import and export of firearms, spear-fishing equipment, fruit and vegetables. When paying for your hotel expenses a credit card must be used in most circumstances. If you have cash you must provide a receipt showing how it was obtained. A casino receipt would be adequate if you have been lucky enough!
Vaccinations for the Seychelles:
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Unless you are entering the islands from tropical Africa there are no essential vaccines for entry or exit. However for your own personal health it is recommended that travellers are covered against the following diseases;
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food and water borne disease)
*
Hepatitis A (food and water borne disease)
For those undertaking a longer more rural trip other vaccines may need to be considered including Hepatitis B.
Summary:
***********************************
Generally most tourists who maintain the usual commonsense rules stay perfectly healthy while in the Seychelles. Just remember the different climate conditions to your home situation and take care with food and water consumption. Further information is available from the Tropical Medical Bureau.

Travel News Headlines WORLD NEWS

18th Oct 2017
http://www.who.int/mediacentre/news/releases/2017/seychelles-plague-negative/en/ 

Samples from patients in Seychelles suspected to be ill with pneumonic plague tested negative at a World Health Organization (WHO) partner laboratory in Paris, France on Tuesday (17 October).
 
The ten samples were shipped by the Seychelles Ministry of Health and WHO to the collaborating centre for Yersinia at the Institut Pasteur to confirm the status of several suspected and one probable case – a 34-year-old Seychelles national who had returned from Madagascar with plague-like symptoms.

WHO is working with the Seychelles health authorities to reduce the risk of plague spreading from neighbouring Madagascar, which faces an unprecedented outbreak that has killed more than 70 people since August. No plague cases have been confirmed in the Seychelles.
Alongside support for laboratory testing, WHO has deployed experts and medical supplies to the 115-island country. The Organization is also providing guidance for the tracing and treatment of contacts of people who are suspected to have been infected.

“We are working with health authorities to reduce the risk of the spread of plague in the Seychelles by improving surveillance and preparedness,” said Dr. Ibrahima Soce Fall, WHO Regional Emergencies Director for the Africa region.

WHO is advising the Government of Seychelles on the implementation of public health measures that are in line with the WHO International Health Regulations, such as enhanced surveillance, isolation and treatment of suspect cases, contact tracing and prophylactic treatment of potential contacts.

WHO currently assesses the risk of spread of plague in the Seychelles to be low.
Date: Fri 13 Oct 2017
Source: Medical Xpress [edited]

The Seychelles government ordered schools to close [Fri 13 Oct 2017], after the discovery of 2 suspected cases of plague thought to have been brought from Madagascar where the disease has killed scores. The health ministry has also put under surveillance 320 people who have come into contact with the 2 patients. A total of 12 people showing plague-like symptoms have been admitted to hospital and given antimicrobials.

Panic gripped parents on the Indian Ocean archipelago after some students developed fevers in recent days, leading to the school closures.

"We made this decision as a precautionary measure to reassure parents," said Merida Delcy, an adviser to the education ministry, noting that they would not reopen until [Wed 18 Oct 2017], at the earliest.

Preliminary tests on the 2 people, including a Seychellois who returned from Madagascar a week ago, showed they could have plague, the health ministry said.

"It has not yet been confirmed that the 2 people are sick due to plague, samples will be sent this weekend to the Institut Pasteur (in France)," said public health commissioner Jude Gedeon. The results are expected next week [week of Sun 15 Oct 2017].

The sick include a student at Anse Boileau Elementary School on the main island of Mahe where all students have since been given antimicrobials.

As fear of plague spreads, there has been a run on surgical masks which people hope will offer protection against the highly infectious disease. Plague outbreaks are common on Madagascar, 1800 kilometres (1120 miles) to the south, where the disease is endemic. But this year [2017] both bubonic plague, spread by infected rats via flea bites, and the pneumonic type, spread person-to-person, have hit urban areas, including the capital Antananarivo, leaving at least 54 dead.

A Seychellois basketball coach who was visiting Madagascar is among the victims. The Seychelles government has begun to quarantine people who have arrived from Madagascar in the last week [week of Sun 1 Oct 2017]. The latest Madagascar health ministry report this week says 500 cases and 54 deaths [now 561 and 57 - ProMED Mod.LL] have so far been recorded, with around half of each occurring in the capital.
=====================
[There is no confirmation about any cases acquired on Seychelles on the Ministry of Health facebook page <https://www.facebook.com/mohseychellesofficial/>. ProMED awaits confirmation of additional cases of _Y. pestis_ infection on Seychelles in addition to the imported case from Madagascar. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Wed 11 Oct 2017
Source: Seychelles Ministry of Health [summ., edited]

Dr Jude Gedeon met with the media on Wed 11 Oct 2017, to give an update on the pneumonic plague situation in Seychelles. Speaking to several media houses, he addressed the case of pneumonic plague that was confirmed yesterday, 10 Oct 2017. He also stressed on current and additional measures being taken by the Ministry of Health to prevent this from spreading.

New measures being implemented against pneumonic plague:
- everyone entering Seychelles from Madagascar will immediately be referred to the isolation centre in Perseverance [Perseverance Island is an artificial island in Seychelles, lying 2 km (1.3 mi) from the capital Victoria]. - ProMED Mod.LL]
- no foreigners coming to Seychelles from Madagascar will be granted entry. Only Seychelles citizens will be allowed to enter the country.
- a Travel Advisory has been issued, in collaboration with Seychelles Tourism Board requesting all transiting points (Mauritius, Kenya, and Reunion) to redirect all passengers who are not a citizen of Seychelles.
- cargo ships will continue to be monitored as before. If anyone presents with symptoms within less than 7 days of leaving Madagascar, the ship will remain in isolation at sea. If anyone on board is sick, they will receive treatment;
- cruise ships are advised to remain at sea for at least 7 days before entering the port after visiting Madagascar. If it is less than 7 days (incubation period) all passengers and crew will remain under surveillance for the recommended time before entering the country.
*******************************
Date: Wed 11 Oct 2017 12:59 SCT
Source: Seychelles News Agency [edited]

Visitors to Seychelles who have visited Madagascar or transited through that island nation in the last 7 days will be placed under observation by health officials upon arrival to Mahe.

The Minister of Health, Jean-Paul Adam, made the statement in the National Assembly on [Wed 11 Oct 2017] when answering an urgent question from the Leader of the Opposition, Wavel Ramkalawan. Adam was called to the National Assembly after the 1st case of pneumonic plague in Seychelles was confirmed on Tue 10 Oct 2017. The patient is a man who returned to Mahe, the main island, last [Fri 6 Oct 2017], on board the last Air Seychelles flight from Madagascar.

The health minister also confirmed that 258 people are currently under observation and receiving treatment after the case of pneumonic plague was detected. "The 258 includes 41 passengers and 7 crew from the flight, 12 close family members, and 18 staff and patients from the Anse Boileau health centre where the man went when he fell ill."

The man disobeyed instructions given upon his arrival to remain at home for a period of time and attended a party that same evening. The minister explained that the result of the tests conducted on the infected man was sent to the Pasteur Institute in Paris, which confirmed the pneumonic plague.

Adam said that "all the 170 people who were at the party including the 13 staff working at the venue are also under passive surveillance. We were already putting Seychellois and tourists under active observation at their homes or at hotels. But as from today [11 Oct 2017], all those arriving from Madagascar will be put in isolation for 6 days," the Minister said.

Adam added that the authority will be using the Seychelles Coast Guard military academy as the isolation centre located at Perseverance, a reclaimed island on the outskirts of Victoria.

The national airline -- Air Seychelles -- had suspended all flights to Madagascar, following guidance and requests of the Seychelles' Public Health Authority amid concerns over the outbreak of the plague in Madagascar. To date, there are 449 cases confirmed in Madagascar and 48 people have died [now 500 cases and 54 deaths - ProMED Mod.LL]. Air Seychelles is the only airline in the region to suspend all its flights to the island.

The health ministry has also liaised with the Seychelles Fishing Authority to get fishermen who may have travelled to Madagascar recently to report their trips and if necessary to seek advice from health professionals. "We are also in contacts with boats, and we want to urge those who may have travelled to Madagascar informally to stop this practice and to report to their nearest health centres." Adam said this is important for assessment and also "for us to decide if they need to be placed under surveillance for treatment. We are also liaising with travel agents to discourage people from visiting the island."

Seychelles, a group of 115 islands in the western Indian Ocean, is on high alert ever since it was confirmed that a Seychellois basketball coach, who died in a hospital in Madagascar in September 2017, had contracted the plague.
====================
[Seychelles seems to have responded in appropriate ways related to the single importation (so far) of a person who developed pneumonic plague after returning from Madagascar. It is not clear if this case had any relationship to the basketball tournament that had occurred on Madagascar. Since there is no comment in this report regarding institution of antimicrobial prophylaxis to any of the contacts. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps can be accessed at
Date: Sat, 14 Oct 2017 16:49:58 +0200

Mogadishu, Oct 14, 2017 (AFP) - More than 20 people were killed when a car bomb exploded on a busy street in Somalia's capital Mogadishu on Saturday, a police official said.   "Initial reports from emergency departments indicate more than 20 bodies picked up off the street and many more are under the wreckage of buildings destroyed by the blast", said Ibrahim Mohamed, a senior police officer.   Government security official Mohamed Aden said that bombing took place in a busy part of the city.    "There was a huge blast caused by a truck loaded with explosives. It went off at the entrance of a hotel alongside the K5 intersection," he said.   There was no immediate claim of responsibility, but the Al-Qaeda aligned Shabaab carries out frequent suicide bombings in the capital and elsewhere as it fights to overthrow the internationally-backed government.
Date: Fri, 13 Oct 2017 16:03:29 +0200

Victoria, Seychelles, Oct 13, 2017 (AFP) - The Seychelles government ordered schools to close Friday, after the discovery of two suspected cases of plague thought to have been brought from Madagascar where the disease has killed scores.   The health ministry has also put under surveillance 320 people who have come into contact with the two patients.

A total of 12 people showing plague-like symptoms have been admitted to hospital and given antibiotics.   Panic gripped parents on the Indian Ocean archipelago after some students developed fevers in recent days, leading to the school closures.   "We made this decision as a precautionary measure to reassure parents," said Merida Delcy, an adviser to the education ministry, noting that they would not reopen until Wednesday at the earliest.
 
Preliminary tests on the two people, including a Seychellois who returned from Madagascar a week ago, showed they could have plague, the health ministry said.   "It has not yet been confirmed that the two people are sick due to plague, samples will be sent this weekend to the Institut Pasteur (in France)," said public health commissioner Jude Gedeon.   The results are expected next week.   The sick include a student at Anse Boileau Elementary School on the main island of Mahe where all students have since been given antibiotics.

As fear of plague spreads, there has been a run on surgical masks which people hope will offer protection against the highly infectious disease.   Plague outbreaks are common on Madagascar, 1,800 kilometres (1,120 miles) to the south, where the disease is endemic. But this year both bubonic plague, spread by infected rats via flea bites, and the pneumonic type, spread person-to-person, have hit urban areas, including the capital Antananarivo, leaving at least 54 dead.

A Seychellois basketball coach who was visiting Madagascar is among the victims. The Seychelles government has begun to quarantine people who have arrived from Madagascar in the last week.   The latest Madagascar health ministry report this week says 500 cases and 54 deaths have so far been recorded, with around half of each occurring in the capital.
More ...

Russia

General Information
***************************************
Russia is one of the largest land masses throughout the world covering an expanse of 6,592,849 sq. miles. The country stretches from the Baltic sea in Europe to the Pacific Ocean in the
east and from the Arctic Ocean in the north to the Black Sea in the south. Moscow, the capital city, is situated in the western region of the country. The nation is undergoing profound political and economic changes. There have been Bank closures and this can make access to funds more difficult for travellers.
Safety & Personal Security
***************************************
Certain regions of the country are closed to travellers and it is important to confirm your itinerary before leaving. Entry to the Caucasus region is restricted. Kidnapping of tourists is well reported in some outlying regions. Good tourist facilities are present in Moscow, St Petersburg and many of the other large cities but many shortages can occur at times. Crime against foreigners can be a problem and it is essential not to flaunt personal wealth and to take care if you need to travel at night. The underground walkways, subway, train stations and airports are particular risk locations. Don’t share a taxi with strangers.
Customs Regulations
***************************************
On entry you will need to complete a form declaring all items of value. Keep this form safe as it will be required on leaving. Take care to obtain receipts for any expensive items to purchase while in Russia.
Stringent controls at Customs when leaving the country may cause significant delays if it is felt that the traveller is trying to export items of historical value.
General Health Precautions
***************************************
The medical services available throughout Russia may not reach Western European standards. Severe shortages of even basic medical supplies are regularly reported. It is wise for travellers to ensure that they are in good general health and that dental work should not be required while abroad. Carry an adequate supply of any medications which you normally take, as these may not be available in many parts of Russia. Adequate travel insurance is essential for your trip.
Diphtheria in Russia
***************************************
Again, according to press reports, over 4000 cases of diphtheria were reported during the outbreak in the early 1990’s. Approximately 104 deaths occurred. At that stage the disease was mainly found in St Petersburg, Moscow and Krasnodar and in the eastern parts of Valdivostok and Saratov. Vaccination (with Tetanus) is usually recommended for all travellers. As Diphtheria is mainly an airborne disease it is usually wise to avoid local public transport if possible.
AIDS risk in Russia
***************************************
The blood supply throughout Russia may not be fully screened against blood borne pathogens and so blood transfusion should be avoided where at all possible. The most common reason that a traveller requires blood is following a road accident. Take special care crossing roads etc. The actual extent of the AIDS problem throughout Russia is uncertain with inaccurate reporting of statistics at this time. Obviously all care should be taken to avoid possible infection. AIDS testing is required for persons staying 3 months or longer.
Hiking in Russia
***************************************
Tick-borne encephalitis has been reported in the vicinity of Novosibirsk, Vladivostok and in the Sverdlovsk Oblast.
Pre-exposure vaccination against this disease is recommended for anyone who will be spending prolonged periods outdoors in the infested areas of Russia. Hikers should wear protective clothing and insect repellent against tick bites throughout rural Russia. Any bite should be reported to competent medical personnel as soon as possible.
Insect Bites
***************************************
Mosquitoes do occur during the summer months. Though there is thought to be no risk of malaria in Russia itself, though there are reports from some of the surrounding CIS countries. Sandflys may also be found during the summer months in the hotter southern areas.
Food Precautions
***************************************
Eat only well cooked foods while they are still hot or fruit that you peel yourself. Always avoid roadside stands and street vendors as the level of hygiene is usually far below acceptable standards. Only purchase ice-cream products from established shops and never from the street side seller. Only pasteurised dairy products should be consumed. Outbreaks of a parasitic disease known as Trichinellosis has been reported from some regions of Russia. This disease is transmitted through eating undercooked meat so all food should never be rare when consumed.
Water Precautions
***************************************
Smell the tap water for a distinct chlorine odour. In many regions the water supply may not be potable and so travellers should where possible drink bottled beverages or beverages made from boiled water (tea/coffee). Do not use ice-cubes in your drinks and never use the mains tap water for drinking or brushing your teeth.
Occasional outbreaks of Typhoid, Cholera are reported and the St Petersburg mains water supply has been closely linked with an intestinal parasite, Giardia lambia.
General Vaccine Information
***************************************
Due to the general economic situation throughout Russia it is reported that there has been a significant shortage of vaccines to combat diseases such as measles, polio, diphtheria, tetanus and pertussis. This has led to a worsening of the risk for the local population and the possibility that travellers may be more exposed.
Vaccines for Travellers
***************************************
Most travellers to Russia will need to consider routine vaccination cover against the following;
Poliomyelitis, Typhoid,
Tetanus & Diphtheria and Hepatitis A.
Longer term travellers or those trekking may also need to consider vaccination cover against Rabies, Hepatitis B, Meningococcal Meningitis and Tick Borne Encephalitis.
Summary
***************************************
The majority of travellers to Russia who exercise due caution will remain in good health. Special care must be taken regarding your food and water consumption. Care against accidents and sensible precautions to avoid petty crime are also essential. If trekking about the country check your itinerary carefully and keep those at home in touch with your plans.

Travel News Headlines WORLD NEWS

Date: Wed, 8 May 2019 11:35:32 +0200

Moscow, May 8, 2019 (AFP) - Seven hikers were missing and feared dead after an avalanche in Russia's Altai mountains, emergency officials said Wednesday, as search parties were dispatched to the area.   Nine people were caught in the avalanche Monday in the so-called Chuya Alps of Russia's Altai republic in southern Siberia, close to Kazakhstan and China.    "Two people managed to get out" and informed authorities on Wednesday, said the head of Altai's emergency services, Andrei Burlakov.   "Since the avalanche is rather large, the search and rescue operations can stretch out to an indefinite amount of time," he said.

The hikers were experienced adults following a complicated mountain route which was approved by the authorities, their instructor Vladimir Yudin told the BFM news website, adding that a comprehensive search would probably have to wait for the summer season.   He said the hikers were part of a group based in the Siberian city of Novosibirsk.
Source: Belsat TV [in Russian, machine trans., edited]

An outbreak [of suspected echinococcosis] among cadets in Ulyanovsk Suvorov Military School, was discovered in early February [2019]. At least, 49 cadets of the military Suvorov school, instead of 26 as reported earlier, are infected with _Echinococcus_.

The Ministry of Defense of Russia excludes that the infection could have been transmitted through the food and believes that it happened by touching contaminated dogs.

Echinococcosis was initially suspected in 5 cadets. Their X-rays showed suspected cysts in the lungs.

On [5 Feb 2019], a criminal case under part 1, article 236 of the criminal code suspected violations of the sanitary and epidemiological rules, which led to mass disease. On [6 Feb 2019], at the Suvorov School, representatives of the Ministry of Defense of the Russian Federation met with the parents of the students. They reported the investigation, rejecting the version of infection through food in the school's canteen. The head of the institution, Vladimir Shkirkov, and the chief parasitologist of the Ministry of Defense, Sergey Kozlov, informed the parents that the cadets could have become ill by stroking an infected dog, Novaya Gazeta newspaper reported. On [14 Feb 2019], the newspaper "Izvestia" published a new version: the students were infected during the use of nasvaya smokeless tobacco mixture made from chicken or camel dung.

The publication refers to an anonymous source close to the investigation, but it gives the opinion of researchers who believe this option unlikely. The newspaper claims to have found several more sick cadets, 2018 graduates. But on [2 Feb 2019] the media reported about disease among staff of the school cafeteria.

The response of the Ministry of Health to [Ulyanovsk Region State Duma Deputy] Alexei Kurinny, it was specified that the ministry had performed a full examination of more than 518 and 305 employees of Suvorov military school.
********************************
Date: Fri 1 Mar 2019
Source: OTR (Public Television of Russia) [in Russian, machine trans.,
abridged, edited]

As of [20 Feb 2019] it is known about 49 cases in the military Suvorov school.

Foci of infection also have been found in the liver, pancreas, brain, eyes, and spleen.
********************************
Date: Mon 4 Feb 2019
Source: Interfax-Russia [in Russian, machine trans., abridged,
edited]

Initially, echinococcosis was detected during routine examination in 5 cadets after X-ray of the lungs. None of them had health complaints. On [4 Feb 2019], Mass Media published information of already 25 cases among cadets.
=====================
[Infection of humans with _Echinococcus granulosis_ happens when eggs are ingested and hatch in the intestines, penetrate the intestinal wall, and migrate to different organs. The infection can happen through eggs from dog feces contaminating water, greens, and berries.

The notions that the subjects has consumed "nasvaya-tobacco mixture made from chicken or camel dung" does not explain infection with _Echinococcus_ and neither camels nor or chickens excrete _Echinococcus_ eggs in their feces. If the "tobacco" was made from dog feces it could be a source of infection.

The incubation period is usually years, and for instance a study from Kirgyzstan estimated an incubation period of 15 years (Usubalieva J et al. Human alveolar echinococcosis in Kyrgyzstan. Emerg Infect Dis. 2013; 19(7): 1095-7. doi: 10.3201/eid1907.121405).

The news report in item [3] above only mentions chest X-rays, but the article in item [1] mentions "suspected cysts in the lungs" and the article in item [2] mentions that foci of infection [cysts?] have been found in multiple other organs. In 95% of human cases the liver is involved because it receives the blood draining the intestines.

Given the long incubation period of _Echinococcus_, an outbreak involving at least 49 persons developing symptoms within a few months with a common source of infection is highly unlikely if not impossible.

What else can it be?
If the lesions were limited to the lungs TB is much more likely, but an outbreak of pulmonary TB would not be associated with multiple lesions in other organs. Foodborne infections could be caused by _Trichinella_, but _Trichinella_ does not result in cystic lesions; it is a multiorgan infection, it is foodborne, and several outbreaks have been reported from Russia.

ProMED will be happy to post more information including more information on the X-ray and CT results, and whether the patients had eosinophilia (sign of a helminth infection). - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Russia:
Date: Fri, 26 Oct 2018 11:57:59 +0200

Moscow, Oct 26, 2018 (AFP) - Six people died in floods in southern Russia which also damaged regional infrastructure including an oil pipeline, authorities said Friday, as emergency workers were struggling to provide food and water to the victims.   Flash floods affected parts of the Krasnodar region, including the area around the Black Sea resort city of Sochi, where Moscow hosted the Winter Olympics in 2014.

Russia's emergencies ministry said it had recovered the bodies of six people while clearing rubble and two people were hospitalised.   Kremlin spokesman Dmitry Peskov told journalists that all the government services are "working in emergency mode" to battle the "ruthless elements."   The emergencies ministry said over 2,300 houses were flooded in the region.   Flash floods frequently cause devastating damage in the area wedged between the Black Sea and the Caucasus mountain range as mountain rivers swell and destroy settlements below.

Similar floods in 2012 killed over 150 people around Krymsk, another town in the region.  A regional subsidiary of Russian oil transport company Transneft said Friday that the flash floods and resulting landslides "damaged a pipeline" in the region's Tuapse district causing "a spill of five cubic metres of oil."   The company is working to keep the oil from getting into the Tuapse river, a major source of water for the town of Tuapse, home to over 60,000 people.

The floods also damaged a major railway line and roads, authorities said. Russian Railways, the country's rail monopoly, said Thursday that 31 passenger trains were stopped due to the damage, and passengers were being bussed to the nearest stations to continue their journeys.
Date: Wed, 25 Jul 2018 18:25:40 +0200

Moscow, July 25, 2018 (AFP) - Russia on Tuesday announced that it will stop running all long-distance trains across its 11 time zones on Moscow time (GMT+3), ending a frequent cause of confusion for travellers.   Russian Railways, the state monopoly, said it made the move to "improve the quality of service for passengers."   From August 1, at all stations, all information boards, clocks and loudspeaker anouncements on the time on arrival and departure of long-distance trains will use the local time, the railway company said.   Since May, the railway company has been printing train tickets for August and beyond showing both the local time and Moscow time.

Currently the time for a train departing from the Pacific city of Vladivostok at the end of the Trans-Siberian route, will be shown on station timetables, display boards and tickets according to Moscow time, even though there is a seven-hour time difference.   This rule was introduced in the Soviet era to achieve consistency across the network and so passengers don't have to keep changing their watches.   But it often causes confusion for passengers joining trains in cities across Russia who may not be familiar with the current Moscow time.   The time difference can even mean that passengers need to buy tickets for a different date than they were expecting.   Under the Soviet Union, all trains across all the republics ran according to Moscow time.    Russia has recently tinkered with its time zones, cutting them down to nine in 2011 and then going back to 11 in 2014.   It has also been on permanent winter time since 2014 after a failed experiment to put the nation on summer time all year round.
Date: Thu 21 Jun 2018
Source: N Engl J Med [edited]
<https://www.nejm.org/doi/full/10.1056/NEJMicm1716138>
Citation Kartashev V and Simon F. Migrating Dirofilaria repens. N Engl J Med. 2018;378(25):e35. doi: 10.1056/NEJMicm1716138.

A 32-year-old woman presented to an ophthalmologist with a 2-week history of nodules that moved around her face. She had first noted a nodule below her left eye (Panel A) [for images see URL]. Five days later, it had moved to above her left eye (Panel B), and 10 days after that to the upper lip (Panel C). She documented these changes by taking photographs of her face (i.e., "selfies"). The nodules occasionally caused a localized itching and burning sensation, but otherwise she had no symptoms.

She had recently travelled to a rural area outside Moscow and recalled being frequently bitten by mosquitoes. A physical examination showed a superficial moving oblong nodule at the left upper eyelid. A parasite was fixed with forceps and removed surgically (Panel D). The parasite was identified by means of a polymerase-chain-reaction assay as _Dirofilaria repens_, which is a zoonotic filarial nematode.

Dogs and other carnivores are the definitive hosts, and mosquitoes serve as vectors. Humans can become aberrant hosts. Surgical excision of the worm is curative. After removal of the worm, the patient had a full recovery. -- Communicated by: ProMED-mail <promed@promedmail.org> [Human infections with _D. repens_ is well known in Russia and a recent review included data from 236 human patients (Ermakova LA, Nagorny SA, Krivorotova EY, Pshenichnaya NY, Matina ON. _Dirofilaria repens_ in the Russian Federation: current epidemiology, diagnosis, and treatment from a federal reference center perspective. Int J Infect Dis. 2014 Jun;23:47-52. doi: 10.1016/j.ijid.2014.02.008).

The reservoir are dogs and the infection is transmitted to humans by mosquitoes and is also described from other European countries (Miterpáková M et al. Heartworm on the rise-new insights into _Dirofilaria immitis_ epidemiology.

Parasitol Res. 2018 Jul;117(7):2347-2350. doi: 10.1007/s00436-018-5912-9;  Blaizot R et al.
Systemic Infection With _Dirofilaria repens_ in Southwestern France.
Ann Intern Med. 2018 Feb 6;168(3):228-229. doi: 10.7326/L17-0426). - ProMED Mod.EP]
===============================
[Until 2014 human dirofilariasis in the Russian Federation was considered as a rare helminthiasis. According to information by the Center of Hygiene and Epidemiology of Rospotrebnadzor, at the end of 2012, 1093 cases infected by _D. repens_ have been recorded in Russian Federation (since 1915, where the 1st case in Russia was recorded). But now, due to the sudden increase of infectious cases, the human dirofilariasis is recording separately from other Helminthiasis in the official statistical reports.

Due to the favorable natural and climatic conditions, as well as the high affection of definitive (dogs and other animals of the family of canines and felines) and intermediate hosts (mosquitoes), the territory of the South of Russia is a risk area for sustainable transmission of infestation. The incidence of human infestation correlated with the extent of infestation in final and intermediate hosts.

Dogs are the most important source for human transmission. The largest number of cases was revealed in the Rostov, Volgograd and Nizhny Novgorod regions. At the beginning of 2013, 242 patients with dirofilariasis were recorded in the Rostov region. This is 22.1 percent of all cases recorded in the Russian Federation. Often patients addressed for medical assistance in hospital due to detection under the skin dense fixed formations, up to 1.5 cm, or in cases of the visualization of thread like moving worms under the skin in various localization.

A migration of the parasite we observed in 43.6 percent of patients. In 17.7 percent of cases, worms moved considerable distances: from the knee to the groin area; lower back, upper eyelid or from periorbital region to shin and buttocks. Common localizations of _Dirofilaria_ were head and neck (most often in the periorbital area, and conjunctivitis (face, scalp and forehead), or more rarely in the area of the trunk and extremities. In 6 patients (2.3 percent), worms were found in the external genitals. - ProMED Mod.NP]
 
[HealthMap/ProMED-mail map Russia:
<http://healthmap.org/promed/p/98>]
More ...

World Travel News Headlines

Date: Sun, 16 Jun 2019 12:02:50 +0200

Patna, India, June 16, 2019 (AFP) - Severe heat has left dozens dead over a 24-hour period in India's Bihar state, as the country enters a third week of searing temperatures, officials said Sunday.   The deaths occurred in three districts of the poor northern state, where temperatures have hovered around 45 degrees Celsius (113 Fahrenheit) in recent days, senior health official Vijay Kumar told AFP.

Forty-nine people died in three districts of the Magadh region that has been hit by drought, he said.   "It was a sudden development on Saturday afternoon. People affected by heatstroke were rushed to different hospitals," Kumar added.   "Most of them died on Saturday night and some on Sunday morning during treatment."   Kumar said about 40 more people were being treated at a government-run hospital in Aurangabad.   "Patients affected by heat stroke are still being brought, the death toll is likely to increase if the heatwave continues."

Most of the victims were aged above 50 and were rushed to hospitals in semi-conscious state with symptoms of high fever, diarrhoea and vomiting.   Twenty-seven people died in Aurangabad district, 15 in Gaya and seven in Nawada district, officials said.    State Chief Minister Nitish Kumar has announced a compensation of 400,000 rupees ($5,700) for the family of each victim.   Harsh Vardhan, India's health minister, said people should not leave their homes until temperatures fall.    "Intense heat affects brain and leads to various health issues," he said.

Large parts of northern India have endured more than two weeks of sweltering heat. Temperatures have risen above 50 degrees Celsius (122 Fahrenheit) in the desert state of Rajasthan.   A heatwave in 2015 left more than 3,500 dead in India and Pakistan.   In 2017, researchers said South Asia, which is home to one fifth of the world's population, could see heat levels rise to unsurvivable levels by the end of the century if no action is taken on global warming.
Date: Sun, 16 Jun 2019 01:30:52 +0200

Wellington, June 15, 2019 (AFP) - A powerful 7.4 magnitude earthquake stuck near the uninhabited Kermadec islands northeast of New Zealand Sunday, the US Geological Survey said as authorities monitored for signs of a tsunami.   New Zealand's civil defence organisation said it was monitoring the situation and if a tsunami was generated it would take at least two hours to reach the country.   The Pacific Tsunami Warning Center said "hazardous tsunami waves from this earthquake are possible within 300 km of the epicentre along the coasts of the Kermadec islands."   The earthquake struck at 10:55am (2255 GMT Saturday) some 928 kilometres (575 miles) north-northeast of the New Zealand city of Tauranga in North Island at a depth of 34 km.
Date: Sun, 16 Jun 2019 00:59:42 +0200

Wellington, June 15, 2019 (AFP) - A magnitude 6.1 earthquake struck Sunday centred 97 kilometres (60 miles) north-east of Ohonua, on the Pacific island of Tonga, the US Geological Survey reported.   The quake hit at 2156 GMT Saturday with an epicentre depth of 10 kilometres, the US global quake monitor said.   The Pacific Tsunami Warning Centre issued no alerts, and there were no immediate reports of damage or casualties.   The reported epicentre lies within the so-called Pacific Ring of Fire, an area of regular seismic activity.   In February 2018, a 7.5 magnitude earthquake in Papua New Guinea killed 150 people and destroyed hundreds of buildings.
Date: Sun, 16 Jun 2019 00:19:43 +0200

Geneva, June 15, 2019 (AFP) - A woman has drowned in Lake Geneva when her sightseeing boat sank as a violent storm battered parts of Switzerland on Saturday, police said.   A man who was in the same boat was able to swim to another vessel from where he fired "two flares", Joanna Matta, police spokeswoman for the canton (region) of Geneva, told AFP.   The man told officers that the woman had been "passing through Geneva" and that the storm had taken them "by surprise", Matta said.   Three police boats and emergency services rushed to the scene. Police divers later retrieved the woman's body from the lake.

The victim, whose nationality remains unknown, was then taken to a hospital in Geneva where she was declared dead.   In a separate incident, the storm also damaged some of the 465 boats taking part in the 81st edition of the Bol d'Or, an annual regatta on Lake Geneva, the event's press service said.   Heavy rain and strong winds lashed the participants on Saturday afternoon, causing boats to capsize although nobody was injured.

However, the storm broke the mast of the ultra-fast "Real Team" catamaran, which had been in the lead and was forced to pull out of the race.   The bad weather struck western Switzerland on Saturday afternoon, bringing hail and winds reaching up to 110 kilometres (70 miles) per hour, according to the national forecaster MeteoSwiss.   In the neighbouring French region of Haute-Savoie the storm also caused damage and left a 51-year-old German tourist dead after a tree came down at a campsite.
Date: Sat, 15 Jun 2019 16:27:09 +0200

Windhoek, June 15, 2019 (AFP) - Drought-hit Namibia has authorised the sale of at least 1,000 wild animals -- including elephants and giraffes -- to limit loss of life and generate $1.1 million for conservation, the authorities confirmed Saturday.   "Given that this year is a drought year, the [environment] ministry would like to sell various type of game species from various protected areas to protect grazing and at the same time to also generate much needed funding for parks and wildlife management," environment ministry spokesman Romeo Muyunda told AFP.

The authorities declared a national disaster last month, and the meteorological services in the southern African nation estimate that some parts of the country faced the deadliest drought in as many as 90 years.    "The grazing condition in most of our parks is extremely poor and if we do not reduce the number of animals, this will lead to loss of an animals due to starvation," Muyunda said.

In April, an agriculture ministry report said 63,700 animals died in 2018 because of deteriorating grazing conditions brought on by dry weather.   Namibia's cabinet announced this week that the government would sell about 1,000 wild animals.   They include 600 disease-free buffalos, 150 springbok, 65 oryx, 60 giraffes, 35 eland, 28 elephants 20 impala and 16 kudus -- all from national parks.   The aim is to raise $1.1 million that will go towards a state-owned Game Products Trust Fund for wildlife conservation and parks management.

The government said there were currently about 960 buffalos in its national parks, 2,000 springbok, 780 oryx and 6,400 elephants.   The auction was advertised in local newspapers from Friday.   Namibia, a country of 2.4 million people, has previously made calls for aid to assist in the drought emergency that has already affected over 500,000 people.   In April the government announced that it will spend about $39,400 (35,200 euros) on drought relief this year to buy food, provide water tankers and provide subsidies to farmers.
Date: Fri, 14 Jun 2019 18:27:56 +0200
By Rosa SULLEIRO

Sao Paulo, June 14, 2019 (AFP) - A nationwide strike called by Brazil's trade unions disrupted public transport and triggered road blocks in parts of the country Friday, ahead of protests against far-right President Jair Bolsonaro's pension reform.   Hours before the opening match of the Copa America in Sao Paulo, some metro lines in the country's biggest city were paralyzed as professors and students also prepared to take to the streets over the government's planned education spending cuts.    It will be the latest mass demonstration against Bolsonaro since he took office in January, but the timing could not be worse for the embattled president as Brazil prepares to play Bolivia in South America's showcase football tournament.

Bolsonaro was expected to attend the opener at Morumbi stadium where police sharpshooters will be deployed as part of increased security for the competition.    One of Brazil's main trade unions estimated 45 million workers had taken part in the strike.   Some 63 cities had been affected by the stoppage, with more than 80 cities recording demonstrations, G1 news site said.   The number of protesters is expected to balloon in the afternoon with demonstrations planned in Brazil's major cities.   Protesters have already blocked some roads in several cities, including Rio de Janeiro and Sao Paulo, where G1 said police had used tear gas to disperse demonstrators and clear the streets.   Brazilians were divided over the partial strike.   "This current government wants to destroy everything that we built decades ago so that's why I'm in favor (of the strike) and I am fighting against social inequality," Vania Santos, 49, told AFP in Rio.    In Sao Paulo, Flavio Moreira opposed the stoppage, however, saying it "hurts the commercial part" of the city.

- Pension savings cut -
Bolsonaro's proposed overhaul of Brazil's pension system -- which he has warned will bankrupt the country if his plan is not approved -- is seen as key to getting a series of economic reforms through Congress.    But the changes, including an increase in the retirement age and workers' contributions, have faced resistance from trade unions and in the lower house of Congress, where Bolsonaro's ultraconservative Social Liberal Party has only around 10 percent of the seats.    A pared-back draft of the reform presented to Congress on Thursday -- which reduces expected savings from 1.2 trillion reais ($300 billion) in 10 years to around 900 billion reais -- did little to appease union leaders, who vowed to go ahead with the shutdown.   Such savings are seen as vital to repairing Brazil's finances and economy, which were devastated by a 2015-2016 crisis.

Economy minister Paulo Guedes, who is spearheading the government's reform agenda, has threatened to resign if the bill is not passed or is watered down significantly.   It caps a tumultuous six months for Bolsonaro, who has seen his popularity nosedive as he struggles to push his signature reform through a hostile Congress and keep Latin America's biggest economy from sliding back into recession.   More than 13 million people are unemployed, the latest data shows, with a record number giving up looking for a job.     Fighting between military and far-right factions of Bolsonaro's government has fueled chaos in his administration where his sons and right-wing writer and polemicist Olavo de Carvalho wield enormous influence.   Bolsonaro sacked his third minister on Thursday -- retired general Carlos Alberto dos Santos Cruz, who had been the government secretary and seen as a moderate voice.   That came on the same day Bolsonaro broke his silence to defend Justice Minister Sergio Moro, who has been accused of wrongdoing while serving as a judge in the sprawling Car Wash anticorruption investigation.
Date: Fri, 14 Jun 2019 06:02:40 +0200
By Clotilde RAVEL

Abidjan, June 14, 2019 (AFP) - "Cover your goods," Diakaria Fofana, a doctor of public health, warns food vendors as a thick cloud of insecticide spray wafts down a street in Abidjan, Ivory Coast's economic capital.   Men in protective clothes, goggles and masks are disgorging plumes of mosquito-killing chemicals in a bid to roll back an outbreak of dengue.   Two people have died and 130 have fallen ill since the fever returned to the West African state last month.

The toll, so far, is tiny compared with other tropical countries, especially in Southeast Asia, where the painful and sometimes deadly disease is an entrenched peril.   But tackling the outbreak is a major challenge for Ivory Coast, a poor country that is having to resort to time-honoured, labour-intensive methods of spraying and neighbourhood awareness campaigns to prevent its spread.   Female mosquitoes carrying the dengue virus transfer the pathogen when they tuck into a blood meal from someone. 

A vaccine does exist, but is not available in Ivory Coast because "it has many secondary effects (and) it's expensive"," explained Joseph Vroh Benie Bi, director of the National Institute for Public Hygiene (INHP).    Developed by French pharmaceutical group Sanofi Pasteur, the vaccine is recommended for use in people aged nine and older, and only for individuals who have already been infected.    Usually accompanied by flu-like symptoms, dengue makes some people very sick indeed, developing into a haemorrhagic fever that can cause difficulty breathing, heavy bleeding or even organ failure. While a first bout of dengue is rarely fatal, subsequent infections are usually worse.

- 'Fighting the mosquito' -
The UN's World Health Organization (WHO) says there are up to 100 million cases of dengue worldwide every year, and almost half the world's population lives in countries where the disease is endemic.   It kills more than 20,000 people each year. Southeast Asia and the Western Pacific are the worst-hit areas.   There is no cure, and the WHO recommends that patients take paracetamol, rest and drinking plenty of fluids.   Five new vaccines are in development, but in the meantime Fofana says: "The only effective means of fighting (dengue) is fighting the mosquito."   In Ivory Coast, most recorded cases have occurred in Abidjan.

Health workers are striving to enlist the public in tackling the mosquito, targeting its life cycle.   "The larvae multiply in stagnant water, for example inside used tyres," said Fofana, deputy director of the vector control unit at the INHP.   "People should never store water in buckets in the open air and they should regularly throw out the water in plates under houseplants."   But he faces an uphill job in a sprawling port city of 4.4 million people in the middle of the rainy season.   What's more, people who are infected, even without knowing it, and can bring the virus to new areas when they are bitten by local mosquitoes.    The WHO has set a goal to halve the number of dengue deaths by 2020, but incidence of the disease has increased 30-fold in the last 50 years.   "Before 1970, only nine countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries," it says.

- 'Malaria's big brother' -
In Ivory Coast, where malaria accounts for a third of all medical consultations, many people self-medicate when they experience symptoms such as high fever, vomiting, nausea or aches and pains.   "This is a real problem, because the symptoms of malaria, dengue, typhus and yellow fever are similar. Doing a blood test is absolutely indispensable," said Fofana.   Treatment with the wrong medicines can worsen the situation, he stressed -- aspirin or ibuprofen can increase the risk of bleeding, for example.   In the meantime, the spraying goes on.    "We know the risks," said Bamba Segbe, an Abidjan resident watching the masked men in action. "It's not for nothing that we call dengue malaria's big brother."
Date: Thu, 13 Jun 2019 17:37:51 +0200
By Grace Matsiko

Mpondwe, Uganda, June 13, 2019 (AFP) - At the bustling Mpondwe border post, a woman crossing from the Democratic Republic of Congo into Uganda is whisked away to an isolation unit after a thermal scanner picks up her high temperature.   Health workers keep Mulefu Kyakimwa, a 32-year-old vegetable oil trader, under observation but later discharge her, once Ebola has been ruled out as the cause of her fever.

The border post is on high alert after a family with suspected Ebola escaped isolation on the Congolese side and entered Uganda, where two of them died this week.   The spread of the deadly virus to Uganda comes after months of efforts in a region of porous borders to contain an outbreak in Congo which has killed 1,400 people, according to the latest official data.    "Since the start of the outbreak, the total number of cases is 2,084, of which 1,990 have been confirmed and another 94 are probable," the Congolese health ministry said in its daily bulletin from Wednesday.   "In all, there have been 1,405 deaths -- 1,311 confirmed and 94 probable -- and 579 people have recovered," the bulletin said, adding that 132,679 people had been vaccinated.

- 'We expected it' -
Few people seem to be surprised that Ebola would eventually make its way to Uganda -- which has experienced outbreaks in the past.   "The outbreak is not a surprise. We expected it. People cross the borders all the time and interact a lot," said Dorcus Kambere, a 29-year-old Ugandan bar attendant who feels her job puts her at risk.

At Mpondwe -- where 25,000 people cross daily -- travellers undergo rigorous health checks to detect the lethal virus, which attacks the organs and leads to internal and external bleeding.   Soldiers carrying automatic rifles guide travellers through the screening process, making sure they wash their hands with disinfectant.   The travellers then pass through a shelter with a thermal scanner that feeds people's body temperatures into a computer.   "This is a situation we go through every day since the Ebola outbreak," said Ambrose Nyakitwe, 34, a Ugandan trader returning from the Congo side.   "It is good. I have a family. I have to see that they don't get affected," he added, after passing through the scan.   Outside the busy border post, business carries on as usual, with children swimming and playing in the muddy Lhubiriha river that draws a natural boundary between the two nations.

- 'Not safe' -
A woman serves pancakes with her bare hands from a bucket as pot-bellied money changers lounging next to her carry out their trade.   However, while some carry on seemingly oblivious to the dangers posed by the virus, others are increasingly suspicious.   "It is not safe. If they say people with Ebola crossed into Uganda, how sure are we there are not many who will infect us and are yet to be got?" asked Bernadette Bwiso, 41, a trader.    "Government must do a house-to-house search," she said.   Meanwhile, Nyakitwe is anxious about how the infected patients managed to cross into Uganda despite heightened surveillance.   A Congolese woman -- who is married to a Ugandan -- her mother, three children and their nanny had travelled to DRC to care for her ill father, who later died of Ebola.

The World Health Organization said 12 members of the family who attended the burial in Congo were placed in isolation in the DRC, but six "escaped and crossed over to Uganda" on June 9.   The next day, a five-year-old was checked into hospital in Bwera vomiting blood. Tests confirmed he had Ebola and the family was placed in an isolation ward.   His three-year-old brother was also confirmed to have Ebola, as was their grandmother who died late Wednesday.   Uganda and the RDC are discussing what can be done to intensify collaboration between the two countries to prevent the spread, the Congolese authorities said.

- No surveillance -
Uganda's health ministry said that the surviving travellers and the Ugandan father -- five people in total -- had agreed to be repatriated to DRC on Thursday for treatment and "family support and comfort" from relatives on the other side of the border.   However, three unrelated patients are still in a Ugandan hospital awaiting the result of Ebola tests.

Uganda's Health Minister Jane Ruth Aceng said challenges remained at "unofficial entry points" between Congo and Uganda, which share a porous 875-kilometre (545-mile) border.   These unauthorised border crossings, known as "panyas" in the local Lukonzo language, are often merely planks laid down across a point in the river, or through forests and mountains where there is no surveillance.   In a bid to contain the spread of the disease the Ugandan government has suspended market days and urged people to stop shaking hands and hugging.
Date: Thu, 13 Jun 2019 16:33:58 +0200

Madrid, June 13, 2019 (AFP) - Spain will launch a campaign to urge young people to "always carry a condom on them" as the number of sexually transmitted infections (STI) surges, the government said Thursday.   The news comes a week after the World Health Organization expressed alarm at the lack of progress on curbing STI or diseases (STD), with one expert warning of complacency as dating apps spur sexual activity.   In Spain, videos and ads will be posted from Monday on social networks, music platforms and media that 14- to 29-year-olds most follow, the health ministry said.   "It's normal that you want to do it in your parents' bed. What isn't normal is that you want to complicate your life," reads one ad, going on to show the number of new cases of HIV and other infections.

In a statement, the health ministry urged "everyone -- and particularly the young -- to always have a condom on them and use it."   "The use of condoms has dropped among the 15- to 18-year-olds over the last few years," Health Minister Maria Luisa Carcedo told reporters.   She said there was complacency over STI, including infection by the HIV virus that causes AIDS.   The campaign is a "first shock measure" to challenge the rise of STI among young people, the statement said.   The number of cases of gonorrhoea, for instance, has risen an average of more than 26 percent annually between 2013 and 2017, according to the ministry.

Syphilis "has risen less but in 2017, it reached its highest peak since the start of statistics in Spain: 10.61 infections per 100,000 residents compared to 2.57 in 1995."   The highest rates of chlamydia, meanwhile, are among 20- to 24-year-olds and particularly women, the ministry said.   In 2017, Spain registered close to 24,000 cases of infection by gonorrhoea, syphilis, chlamydia and LGV, a sexually-transmitted disease, according to the statement.
Date: Thu, 13 Jun 2019 15:12:32 +0200

Vilnius, June 13, 2019 (AFP) - Lithuanian temperatures have hit record June highs, meteorologists said Thursday, as a heatwave forced school closures and threatened to reduce harvests in the draught-hit Baltic region.   Kaisiadorys in central Lithuania was the hottest place at 35.7 degrees Celsius (96.2 degrees Fahrenheit) on Wednesday, the highest-ever temperature recorded for June in the country, weather forecaster Paulius Starkus told AFP.   Six people drowned in the Baltic EU state on Wednesday, the deadliest day of the year to date, while some schools put classes on hold or cut lessons short due to the heatwave.

Scientists say the extreme weather is in part a result of climate change.   "Lithuania used to have heatwaves but now they occur more often and are more intense due to climate change," Vilnius University climatologist Donatas Valiukas told AFP.   Starkus said a downpour with thunder and hail could follow in some areas on Thursday afternoon.   Agriculture Minister Giedrius Surplys told lawmakers that some areas were experiencing "a real climatic draught" threatening harvests, while hydrologists warned that river water levels posed a threat to fish.   Demand for air-conditioning has also soared in recent weeks.   Lithuania's hot weather is expected to last through the week, then temperatures may ease below 30 degrees Celsius starting Monday.   Fellow Baltic state Latvia is also experiencing unusual heat for June, with temperatures over 32 degrees Celsius.

In recent days, Latvia's western region of Kurzeme saw thunderstorms with hail damaging buildings, smashing greenhouses and tearing power lines.   Two people have been hospitalised in the northern Latvian town of Cesis after a tree fell on their camper van while they were inside.    Fellow Baltic state Estonia had a heatwave last week and is now experiencing rainy and windy weather.   Poland has also been experiencing high temperatures this month, which has resulted in increased air-conditioner use. The power transmission system operator PSE said that on Wednesday there was record electricity demand for a summer morning at nearly 24.10 gigawatts (GW).   Forty-two people have already drowned in Poland this month, according to the government security centre RCB.