WORLD NEWS

Getting countries ...
Select countries and read reports below or

Armenia

Armenia US Consular Information Sheet
January 05, 2009
COUNTRY DESCRIPTION:
Armenia is a constitutional republic with a developing economy. Tourist facilities, especially outside Yerevan, the capital, are not highly developed, and many of
he goods and services taken for granted in other countries may be difficult to obtain. Read the Department of State’s Background Notes on Armenia for additional information.
ENTRY/EXIT REQUIREMENTS: A passport and visa are required. U.S. citizens may purchase visas in advance for a stay of up to 120 days online at http://www.armeniaforeignministry.am/ for the fee of USD 60; however, this visa is valid only for entry at Zvartnots airport in Yerevan. At this time a visa valid for 120 days may also be obtained upon arrival at the port of entry for the fee of 15,000 Armenian Drams (approx. USD 50). Visas for up to 120 days may be purchased at the Armenian Embassy in Washington, D.C. or the Consulate General in Los Angeles for the fee of USD 69. For further information on entry requirements, contact the Armenian Embassy at 2225 R Street NW, Washington, DC 20008, tel. (202) 319-1976 and (202) 319-2983; the Armenian Consulate General in Los Angeles at 50 N. La Cienega Blvd., Suite 210, Beverly Hills, CA 90211, tel. (310) 657-7320, or visit the Armenian Embassy’s web site at http://www.armeniaemb.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:
A cease-fire has been in effect since 1994 around the self-proclaimed “Republic of Nagorno-Karabakh,” an unrecognized ethnic Armenian enclave within Azerbaijan. However, intermittent gunfire along the cease-fire line and along the border with Azerbaijan continues. Because of the existing state of hostilities, consular services are not available to Americans in Nagorno-Karabakh. Travelers should exercise caution near the Armenia-Azerbaijan border and consult the Country Specific Information for Azerbaijan if considering travel to Nagorno-Karabakh from Armenian territory. Armenia's land borders with Turkey, Azerbaijan, and the Nakhichevan Autonomous Republic of Azerbaijan remain closed and continue to be patrolled by armed troops who stop all people attempting to cross. There are still land mines in numerous areas in and near the conflict zones.

Political rallies in the aftermath of the February 2008 presidential elections turned violent. Clashes between government security forces and opposition demonstrators resulted in dozens of casualties, including 10 fatalities, in early March 2008. While the opposition continued to hold periodic protests over the summer and early fall, there have been no violent confrontations since the March events.
Americans should be mindful that even demonstrations intended to be peaceful could turn confrontational and possibly escalate into violence. American citizens are urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations.

Armenia is an earthquake- and landslide-prone country. In addition to these natural disasters, there exists the possibility of chlorine gas spills and radiation poisoning due to industrial accidents.
The Soviet-era Armenia Nuclear Power plant is located in Metsamor, approximately 30 kilometers southwest of Yerevan.
Armenia is currently under international pressure to close the plant permanently, due to safety concerns.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State‘s 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. 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: Crime against foreigners is relatively rare in Armenia. Break-ins, particularly of vehicles, and theft are the most common crimes, but there have been instances of violent crime as well.
While the incidence of violent crime remains lower than in most U.S. cities, American citizens are urged to exercise caution and to avoid traveling alone after dark in Yerevan. Several American investors have also reported being involved in disputes over property ownership, and have had to seek legal recourse through a long, and in the majority of cases, unsuccessful court proceeding.
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. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest 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. For information on assistance in the U.S. including possible compensation, see our Victims of Crime.
The local equivalents to the “911” emergency line in Armenia are: 101 - fire emergency; 102 - police emergency; 103 - medical emergency; and 104 - gas leak.
MEDICAL FACILITIES AND HEALTH INFORMATION: Though there are many competent physicians in Armenia, medical care facilities are limited, especially outside the major cities. The U.S. Embassy maintains a list of English-speaking physicians in the area. Most prescription medications are available, but the quality varies. Elderly travelers and those with existing health problems may be at risk due to inadequate medical facilities.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Armenia.

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 Armenia is provided for general reference only and may not be totally accurate in a particular location or circumstance.
Travel in Armenia requires caution. Public transportation, while very inexpensive, may be unreliable and uncomfortable. Travel at night is not recommended, and winter travel can be extremely hazardous in mountain areas and higher elevations.
Travelers should avoid the old highway between the towns of Ljevan and Noyemberyan in the Tavush region, as well as the main highway between the towns of Kirants and Baghanis/Voskevan. The U.S. Embassy has designated this portion of the road off-limits to all U.S. Government personnel because of its proximity to the cease-fire line between Armenian and Azerbaijani forces, a line which has seen numerous cease-fire violations over the years.

On weekends, there are an increased number of intoxicated drivers on Armenian roads. American citizens are urged to exercise particular vigilance while traveling on the main highway from Yerevan to the resort areas of Tsaghkadzor and Sevan. Traffic police will attempt to stop individuals driving erratically and dangerously, but police presence outside of Yerevan is limited.

Armenia does have emergency police and medical services, but they may take time to reach remote regions.
With the exception of a few major arteries, primary roads are frequently in poor repair, with sporadic stretches of missing pavement and large potholes. Some roads shown as primary roads on maps are unpaved and can narrow to one lane in width, while some newer road connections have not yet been marked on recently produced maps.
Secondary roads are normally in poor condition and are often unpaved and washed out in certain areas. Street and road signs are poor to nonexistent. Truck traffic is not heavy except on the main roads linking Yerevan to Iran and Georgia, i.e. the roads virtually all travelers need to use when traveling overland to those countries. Minibuses are considered more dangerous than other forms of public transportation. Travelers who choose to ride minibuses should exercise caution because these vehicles are often overcrowded and poorly maintained, commonly lack safety measures including seatbelts, and are frequently involved in accidents.

People driving in Armenia should be aware that “road rage” is becoming a serious and dangerous problem on Armenian streets and highways.
For safety reasons drivers are encouraged to yield to aggressive drivers.
Incidents of physical aggression against drivers and pedestrians have occurred

Though crime along roadways is rare, the police sometimes seek bribes during traffic stops. Drivers in Armenia frequently ignore traffic laws, making roadways unsafe for unsuspecting travelers.
Pedestrians often fail to take safety precautions and those driving in towns at night should be especially cautious. In cities, a pedestrian dressed in black crossing an unlit street in the middle of the block is a common occurrence.

The quality of gasoline in Armenia ranges from good at some of the more reliable stations in cities to very poor. The gasoline and other fuels sold out of jars, barrels, and trucks by independent roadside merchants should be considered very unreliable.

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Armenia, the U.S. Federal Aviation Administration (FAA) has not assessed Armenia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
Travelers on Armavia International Airways may experience prolonged delays and sudden cancellations of flights. Air travel to Armenia via European carriers is typically more reliable. Ticketed passengers on flights leaving Yerevan should reconfirm their reservations 24 hours prior to departure.
SPECIAL CIRCUMSTANCES:
Armenia remains largely a cash-only economy. Credit cards are accepted at some businesses, including major hotels and restaurants in Yerevan, but rarely outside of the capital. Limited facilities exist for cashing traveler's checks and wiring money into the country. There are a number of ATMs in the center of Yerevan. Dollars are readily exchanged at market rates. Travelers may experience problems with local officials seeking bribes to perform basic duties.

Armenian customs authorities may enforce strict regulations concerning temporary importation into or export from Armenia of items such as firearms, pornographic materials, medication, and communications equipment. For export of antiquities and other items that could have historical value, such as paintings, carpets, old books, or other artisan goods, a special authorization is required in advance from the Armenian Ministry of Culture. It is advisable to contact the Embassy of Armenia in Washington, DC or Consulate General in Los Angeles for specific information regarding customs requirements.

Please see our Customs Information.

Dual Nationals: Changes to Armenian legislation now permit Armenian citizens to hold dual citizenship. This means that U.S. citizens who emigrated from Armenia to the U.S. and subsequently acquired U.S. citizenship without explicitly giving up their Armenian citizenship may be able to (re)acquire Armenian citizenship along with all the associated rights and duties, e.g. the right to vote in Armenian elections and/or the duty for certain males to perform military service. The new law also means that dual citizens need to enter and leave Armenia on their Armenian passport, i.e. they would no longer need an Armenian visa. U.S. citizens interested in obtaining Armenian citizenship must register their dual citizenship with Passport and Visa Department of the Police of the Republic of Armenia (formerly OVIR) by simply presenting proof of their other citizenship (e.g. passport). For more information, please consult with Passport and Visa Department of the Police (tel.: +37410-501439) and/or http://www.armeniaforeignministry.am.

Compulsory Military Service: In addition to being subject to all Armenian laws affecting U.S. citizens, dual nationals are also subject to other laws that impose special obligations on Armenian citizens. Male U.S. citizens over the age of 18 who are also considered to be Armenian citizens may be subject to conscription and compulsory military service upon arrival, and to other aspects of Armenian law while in Armenia.
Armenian authorities have regularly detained U.S. citizens on these grounds upon their arrival in or departure from Armenia. In most cases, ethnic Armenian travelers who are accused of evading Armenian military service obligations are immediately detained and later found guilty of draft evasion. Penalties for those convicted are stiff and include jail time or a substantial fine. Those who may be affected are strongly advised to consult with Armenian officials and inquire at an Armenian embassy or consulate to their status before traveling. For additional information on dual nationality, see our dual nationality flyer.
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 offences. Persons violating Armenian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Armenia 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 LOCATION:
Americans living or traveling in Armenia 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 Armenia. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. The American Citizen Services section of the U.S. Embassy in Yerevan maintains a computer terminal in the consular waiting room available to U.S. citizens for registration. The U.S. Embassy provides Internet access to the general public through the American Corners program and through the U.S. Embassy's Information Resource Center. American Corners are located in Yerevan (2 Amiryan Street, tel. +374-10-56-13-83), Gyumri (68 Shirakatsi Street, tel. +374-312-22153), Vanadzor (25, Vardanants Street, tel. +374-322-21672), and Kapan (6, Shahumyan Street, tel. +374-285-22151). By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy in Yerevan is located at 1 American Avenue, tel. +374-10-46-47-00 and fax: +374-10-46-47-42. The Consular Section is open from 9:00 a.m. until 5:00 p.m., with time reserved for American citizen services from 1:30 p.m. until 4:30 p.m., Monday through Friday, except for official U.S. Embassy holidays. For more information, see the Embassy's web site at http://yerevan.usembassy.gov/
*
*
*
*
*
*
This replaces the Country Specific Information dated June 9, 2008 to update sections on Entry and Exit Requirements, Safety and Security, Traffic Safety and Road Conditions, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Fri 8 Mar 2019
Source: Nouvelles Armeni Magazine [in French, trans. ProMED Corr SB, abridged, edited]

A 2nd case of measles infection was reported in Armenia on Wednesday [6 Mar 2019], the country's Ministry of Health press office reported. A person infected with this disease arrived on 20 Feb [2019] in Armenia through the territory of Georgia. Clinical symptoms became visible on 25 and 26 Feb [2019], which was initially explained as drug intolerance, but later, on 6 Mar [2019], a laboratory test diagnosed measles disease.

According to the Ministry of Health, the 1st measles infection was reportedly found in Armenia by a Ukrainian citizen who arrived in Yerevan by plane from Kiev on 24 Feb [2019].

The 2 infected people had contact with many people, particularly those in the airport lobby and at the hospital.
17th February 2019

- National. 14 Feb 2019. 57 cases of dengue in Armenia [have been] recorded to date; the figure increased in 2019 compared to the year 2018. The increase in records so far in 2019 is 25.
Date: Sun, 29 Jul 2018 12:23:52 +0200
By Mariam HARUTYUNYAN

Arinj, Armenia, July 29, 2018 (AFP) - When Tosya Gharibyan asked her husband to dig a basement under their house to store potatoes, she had little idea the underground labyrinth he would eventually produce would prove to be one of Armenia's major tourist draws.   Their one-storey house in the village of Arinj outside the capital Yerevan may not look like much but today it brings in visitors from all over the globe after a 23-year labour of love by Tosya's late husband, Levon Arakelyan.   They come to see a twisting network of subterranean caves and tunnels known as "Levon's divine underground."

In the cold and quiet, Tosya leads tourists through corridors that connect seven chambers adorned with Romanesque columns and ornaments like those on the facades of mediaeval Armenian churches.   "Once he started digging, it was impossible to stop him," she said of the project that began in 1995. "I wrangled with him a lot, but he became obsessed with his plan."   A builder by training, Levon would toil for 18 hours a day -- only pausing to take a quick nap and then rush back to the cave, confident that he was being guided "by heaven".   "He never drew up plans and used to tell us that he sees in his dreams what to do next," his widow told AFP.

Over more than two decades he hammered out the 280-square-metre (3,000 square-foot) space, 21 metres deep into strata of volcanic rocks -- only using hand tools.   "My primary childhood recollection is the loud knock of my father's hammer heard at night from the cave," said his 44-year-old daughter Araksya.   At the start he had to break through a surface layer of black basalt, but at the depth of a few metres Levon reached much softer tufa stone and the work progressed.   He pulled out 600 truckloads of rocks and earth, using only hand-held buckets.   Levon died in 2008 at the age of 67 from a heart attack after destroying the last wall that separated two tunnels.

- 'Amazing place' -
A decade on from the project's completion, Tosya also runs a small museum commemorating her husband's work in the village of some 6,000 people.   The underground complex has several analogues in the world.   An eccentric man named William Henry "Burro" Schmidt spent more than three decades digging a half-a-mile tunnel to transport gold through a granite mountain in California, beginning his work in the early 1900s during the state's gold rush.

In Ethiopia a man named Aba Defar began carving churches on a mountainside after claiming divine inspiration from years of dreams.   Today the Armenian cave features prominently in travel brochures, regularly drawing busloads of visitors.   Milad, a 29-year-old Iranian tourist, called the maze an "amazing place".   He said it made him realise just "how boundless the spiritual and physical capabilities of a person can be".
Date: Fri 18 May 2018
Source: Armenpress [edited]

The investigation into a foodborne incident in Armenia's Armavir province continues. The suspected cause -- food poisoning -- has been confirmed through lab tests. Salmonellosis has been discovered in all victims.

63 from the overall 88 victims of the food poisoning have already been treated and discharged. The healthcare ministry says they confirm that the cause was food poisoning. Earlier, the state service for food safety has dispatched agents to Armavir province to probe the suspected food poisoning incident in the plant of Tierras de Armenia, a viticulture and winemaker known for its Karas wines. Earlier, doctors said they suspected the cause of the poisoning to be a lunchtime snack, which all of the employees consumed in the cafeteria of the plant.

Agents have taken samples from the facility and sent them for laboratory analysis. Food safety agents also ceased the operation of a businesswoman's food supply business in relation to the incident as a precaution. The businesswoman, Alvina Melkonyan, supplied Tierras de Armenia with lunch-time food on the day when the incident happened. A company, who in turn is supplying Melkonyan, is also under investigation. All patients are in satisfactory states, doctors say.

The likely cause of the mass poisoning in Armavir province is thought to be lunch-time snacks containing chicken, cheese and potatoes, which the victims have consumed in the cafeteria of the plant, a doctor of the Armavir medical center told Armenpress. Earlier, it was unclear whether the poisoning was food-related.
======================
[The specific food is not yet stated, but chicken is a common vehicle, either undercooked or cross-contaminated after cooking. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Armavir Province, Armenia: <http://healthmap.org/promed/p/46276>]
Date: Tue, 1 May 2018 11:13:05 +0200

Yerevan, May 1, 2018 (AFP) - Armenia's hugely popular protest leader Nikol Pashinyan warned lawmakers of the prospect of major unrest if they did not elect him prime minister during a parliamentary vote on Tuesday.   "There is information that (former presidents) Serzh Sarkisian and Robert Kocharyan -- the famous tandem -- are planning to take back power," Pashinyan said during a nail-biting session of parliament in the capital Yerevan.   "I want to warn them -- gentlemen, the mistaken interpretation of people's leniency as weakness can lead to a genuine political tsunami."

"I call on everyone to take to the streets because once again they want to steal the people's victory," he added.   Pashinyan, the leader of mass protests that forced former president turned prime minister Sarkisian from power in the impoverished South Caucasus nation, is the only candidate for the post of prime minister.   He however is a handful of votes short of a majority and lacks the crucial support of the ruling party to get elected.

Speaking to his supporters in the early hours of Tuesday, Pashinyan said that the ruling party planned to derail the vote and urged hundreds of thousands to take to the streets.   A source familiar with the negotiations told AFP on Tuesday that the situation was febrile, saying Pashinyan could still be elected prime minister if several lawmakers from the Republican Party defected and voted for him.

Pashinyan is six votes short of the 53 he needs from the 105-seat legislature, where the Republican Party has a majority.   Ex-Soviet Armenia has been in the grip of a severe political crisis for the past few weeks, with leader Sarkisian stepping down last week after a decade in power in the face of peaceful protests.
More ...

Japan

General
***************************
Japan is a highly developed country with excellent tourist facilities. The country covers a number of islands and the population is estimated at over 125 million. English is widely spoken in the main tourist a
d urbanised centres.
Weather Profile
***************************
Due to the strong influence from the sea, Japan tends to have a high rainfall but milder winters than the adjacent mainland of China. This is similar to the climate experienced in Ireland by comparison to the rest of Europe. Spring and Autumn are usually the most pleasant months but during the Summer the climate can be significantly humid and tiring. During this time it will be essential that fluid intake is increased and that salt (lost through perspiration) is replaced - usually by increasing the amount eaten on your food providing this is not contraindicated by any personal medical condition such as blood pressure etc.
Alcohol Consumption
***************************
The Japanese authorities have limited patience with those arrested while under the influence of alcohol. For some travellers visiting the country this may mean a prolonged stay in the local jail and the subsequent missing of important appointments.
Natural Disasters
***************************
Japan is situated in a region of the world which regularly experiences earthquakes and other climatic changes including typhoons. A number of relatively small earthquakes are reported each year but, to date, this has seldom affected any tourist itinerary. However, further information is available at http://www.tokyoacs.com
Safety and Security
***************************
The risk to personal security for tourists while travelling throughout Japan is small though commonsense care of personal belongings is always essential. Where available, use the hotel safety boxes to store valuables and your passport, return air tickets. During the mid 1990’s a number of terrorist incidents occurred but no recent serious problems are being reported.
Airport Taxes
***************************
Many countries now include the cost of their ‘departure tax’ within the ticket. In Japan this will depend on which airport you leave from. The fee is collected in Yen at Kansai - Osaka International Airport but usually included in the ticket cost if flying via Narita - Tokyo International Airport.
Cost of living
***************************
Japan is not a cheap country for tourists. The cost of living is one of the highest throughout the world. Credit cards may be used in main cities but the ATM’s machines may not be available at all hours. Before taking a taxi from the airport it would be wise to check the costs and then assess whether or not it might be more prudent to use the local bus transport!
Medical Care
***************************
The level of medical care throughout most tourist regions in Japan is excellent. However, there may be limited English-speaking doctors in some more rural areas and even where this facility is available in the main cities the cost of healthcare can be very expensive. It is wise to carefully check your travel health insurance premium before you leave home.
Local Medications
***************************
Some commonly used European over-the-counter medications
may not be available in Japan. Also, there are strict laws governing the importation of certain medications which can be strictly enforced. Certain inhalers, sinus preparations etc may be confiscated on arrival. If you are taking any personal medications it may be wise to check before you leave. Obviously never carry packages for anybody else while travelling unless you are certain of the contents.
Avoiding Prickly Heat
***************************
The term prickly heat is used in a variety of ways but the cause is generally the same. In a hot climate the body perspires to maintain the internal temperature at a correct level. In the perspiration there will be fluid and your personal salts. The fluid evaporates but the salt dries against the skin. It is your individual reaction to this salt that leads to the ‘prickly heat rash’. The reaction to these salts can be minimised by removing the salts from the skin surface as soon as possible. Change your clothes regularly, use plenty of talcum powder to absorb the perspiration and dry off well after showering.
Food & Water Care in Japan
***************************
Any international traveller should recognise the risks of a ruined trip from unwise indulgence in local food and beverages. In Japan the level of food hygiene is high but the consumption of Sushi (uncooked raw fish) is unwise. Bivalve shellfish also carry a significant risk due to the limited level of sterilisation during the cooking process.
Malaria & Mosquitoes
***************************
No malaria transmission occurs throughout Japan although avoiding mosquito bites during the humid months is wise.
Airborne Disease
***************************
In any situation where you will be crowded together with many others the risk of a variety of airborne diseases will be higher. This will include serious diseases such as Meningococcal Meningitis but also others such as Influenza and the common cold. The risk of Meningococcal Meningitis in Japan is regarded as small and vaccine is not routinely recommended. However, having the Flu vaccine may be a wise precaution. It is also sensible to carry a small supply of lozenges to treat the inevitable sore throat which may occur.
Driving in Japan
***************************
The road system throughout Japan is excellent but unfortunately the road signs may prove too much of a hurdle for those unfamiliar with the language! The congestion within the cities tends to be high and tolls on some of the major roads may be quite expensive. The traffic moves on the left side of the road but for many tourists it will be wiser to consider using local transportation rather than risking a ruined holiday.
English Help Lines
***************************
Tourists can obtain important information and assistance in English while visiting Japan through the following numbers;
In Tokyo - 03-3968 4099
Rest of Japan - 0120-461 997
Vaccines for Japan
***************************
For the majority of short-term travellers visiting Japan no particular vaccines will be recommended. Those planning to live for longer periods within the country will need to discuss this through in greater detail.

Travel News Headlines WORLD NEWS

Date: Mon 6 May 2019
Source: Stars and Stripes [abridged, edited]

Anyone who travelled through Terminal 2 at Narita International Airport in Tokyo on 22, 24, and 26 Apr 2019 and is not vaccinated against measles should get to their primary care provider or local immunization clinic, according to a Facebook post by US Forces Japan.

An airport employee may have exposed travellers to the disease on those days, the message said. American Forces Network Pacific is running a similar public service announcement.

"Active-duty troops are supposed to be inoculated; we're at 99.9 percent in Japan," he said. "Dependents should be inoculated, but they're not held to the active-duty standard. "  [Byline: Christian Lopez]
==========================
[See ProMED-mail Measles update (31) http://promedmail.org/post/20190505.6455679 for more information on the airport employees who were infected with measles. Airports and airplanes have become a common source of risk for unvaccinated travellers passing through. - ProMED Mod.LK]

[HealthMap/ProMED-mail map of Japan:
Date: Wed 1 May 2019
Source: Japan Today [abridged, edited]

Two workers at Narita airport are confirmed to have been infected with measles, the local government said Tue [30 Apr 2019], warning about the risk of possible exposure to the highly contagious virus at one of the busiest airports in Japan.

The local government of Chiba Prefecture, where the airport is located, said a male worker in his 30s fell ill with a fever of 39 C [102 F] on Tue 30 Apr 2019 last week.

Another worker, a teenage woman, became sick on 20 Apr 2019 but did not go into work and is not believed to have spread the virus.

Japan was declared measles-free by the World Health Organization in 2015, but over 200 cases of infection have been reported this year [2019] after an outbreak of the disease in Okinawa Prefecture and some other regions last year [2018].

Medical experts say infections increased in line with a surge in foreign tourists.

Narita International Airport employs about 43 000 people and services approximately 118,000 customers daily. The airport had been experiencing a rush of travellers flying overseas ahead of the 10-day Golden Week holiday.
Date: Tue 26 Feb 2019
Source: NHK News Web [Google translated, abridged, edited]

The number of measles patients has increased, and in Osaka prefecture, the number of new patients reported in one week was 24 people; the number of measles patients across the country reached 222 people. It has already reached more than 70% of the number of patients in the last year.

According to the National Institute of Infectious Diseases, there are 48 measles patients reported from medical institutions nationwide in the week to 17 Feb 2019, of which 24 are in Osaka prefectures and half from the metropolitan. By prefecture: 77 people in Osaka prefecture, 49 people in Mie prefecture, 20 people in Aichi prefecture, 14 people in Tokyo, 9 people in Kyoto prefecture, etc.
Date: Sat, 26 Jan 2019 05:56:37 +0100

Tokyo, Jan 26, 2019 (AFP) - A French man has been killed in an avalanche while skiing on a Japanese mountain, local police said Saturday.   Marc-Olivier Gariou-Pouillas, 49, was skiing off-piste on Mt Ogenashi in Myoko City, some 200 kilometres (125 miles) north of Tokyo on Friday afternoon when an avalanche occurred, according to police.   "His two friends saw him engulfed by the avalanche and called for help," Myoko police spokesman Takahiro Chiba said.   "The ski resort patrol there and other skiers managed to dig him up... A police helicopter airlifted him to a hospital but he was pronounced dead," he told AFP.   The avalanche was some 300 metres (1000 feet) long and 30 metres wide, he added.   Gariou-Pouillas had been on a skiing trip in Japan since mid-January with two other Frenchmen, according to police.
Date: Sat 12 Jan 2019
Source: Outbreak News Today [edited]

In 2018, Japanese health officials battled 3 infectious disease outbreaks of note -- the vaccine-preventable diseases of measles and rubella and the sexually transmitted infection, syphilis.

Measles
--------
While Japan saw 282 measles cases total, an outbreak in Okinawa that started in March 2018 accounted for more than one-third of the total annual cases (101). The outbreak began on 20 Mar 2018 and has been linked to an imported case from Taiwan. It had spread to Aichi and Kanagawa prefectures and Tokyo. The Okinawa outbreak was declared over in June 2018.

Japan has successfully eliminated endemic measles transmission and sustained this status since March 2015 through both high vaccination coverage and rapid detection of and response to every case of measles.

Rubella
--------
Due to health regulations in place from 1977 to 1995, which required that only junior high school girls be vaccinated for rubella, making men who are now between the ages of 30 and 60 years vulnerable to infection, Japan saw a significant outbreak in 2018, particularly in men in this age-group. Through 30 Dec 2018, the National Institute of Infectious Diseases in Tokyo reported 2917 rubella, or German measles, cases. Tokyo saw 945 cases, followed by Kanagawa (402) and Chiba (383) prefectures.

Syphilis
--------
Japan saw a dramatic syphilis outbreak in 2018. With nearly 7000 cases reported as of 30 Dec 2018 (6923), this is the most cases reported in the country in decades. A total of 1759 cases were reported in Tokyo, and Osaka saw 1186 cases in 2018. This was an increase on 2017's numbers, 5534 syphilis cases, the 1st time that happened in more than 4 decades.
========================
[See the following:
IDWR Surveillance Data Table 2019 week 01 Updated 15 Jan 2019 surveillance data as of week 01 (31 Dec 2018-6 Jan 2019)
National Institute of Infectious Diseases, Japan

Notifiable diseases, number of cases of the week, and total number of cases by prefecture. Total number of cases was updated with delayed reported and discarded cases.

Table 1. Provisional cases of notifiable diseases by prefecture in Japan, 1st week, 2019, and Notifiable diseases, number of cases of the week, and total number of cases by prefecture. Total number of cases was updated with delayed reported and discarded cases.

Table 1. Provisional cases of notifiable diseases by prefecture in Japan, 52nd week, 2018.

[HealthMap/ProMED-mail map:
More ...

Guyana

Guyana US Consular Information Sheet
June 09, 2008
COUNTRY DESCRIPTION:
Guyana is a developing nation on the north coast of South America. Tourist facilities are not developed, except for hotels in the capital city of Georgetown and a limi
ed number of eco-resorts. The vast majority of Guyanese nationals live along the coast, leaving the interior largely unpopulated and undeveloped. Travel in the interior of Guyana can be difficult; many interior regions can only be reached by plane or boat and the limited roads are often impassable in the rainy seasons. Read the Department of State Background Notes on Guyana for additional information.

ENTRY/EXIT REQUIREMENTS: A valid U.S. passport is required for U.S. citizens to enter and depart Guyana. On arrival, Guyanese Immigration normally grants U.S. visitors a stay of up to 3 months. U.S.-Guyanese dual nationals may be granted an indefinite stay. Extensions of stay may be obtained from the Ministry of Home Affairs at 60 Brickdam Street, Georgetown. The Central Office of Immigration located on Camp Street, Georgetown, must note the extension in the visitor's passport. Travelers for purposes other than tourism should check with the Ministry of Home Affairs for information about requirements for work permits and extended stays. U.S.-Guyanese dual nationals departing Guyana for the United States using a Guyanese passport must present to Guyanese authorities a U.S. Certificate of Naturalization or other document establishing that they may legally enter the United States. For further information about entry, exit and customs requirements, travelers may consult the Embassy of Guyana at 2490 Tracy Place NW, Washington, DC 20008, telephone (202) 265-6900, the Consulate General in New York, or honorary consuls in California, Florida, Ohio, and Texas. Visit the Embassy of Guyana web site at www.guyana.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: Driving in Guyana can be particularly dangerous, with a significant number of accidents and road fatalities occurring. See the section below on “Traffic Safety and Road Conditions” for additional information. In the past, demonstrations and protests occasionally occurred in Georgetown; however, these are increasingly rare. Past demonstrations have not been directed at U.S. citizens and violence against Americans in general is not common. Visitors should nevertheless remain alert and take prudent personal security measures to deal with the unexpected while in Guyana. It is advisable to avoid areas where crowds have congregated and to maintain a low profile when moving about Georgetown and other Guyanese cities. Most major eco-tourist resorts and hotels in Guyana do not have written emergency plans in place, and many of them have safety deficiencies, including a lack of easily identifiable lifeguards or no lifeguards at all. Many of these resorts also do not have adequately stocked first aid supplies. For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs web site, where the current Travel Warnings and Public Announcements, 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 United States 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: Serious crime, including murder and home invasion, continues to be a major problem; the murder rate in Guyana is three times higher than the murder rate in the United States. In early 2008, an attack in the Georgetown suburb of Lusignan and in the Essequibo River town of Bartica by heavily armed gangs resulted in the deaths of more than 20 persons, mostly innocent Guyanese civilians. An investigation into these attacks is continuing, but most of the perpetrators are still at large. In addition, there have been several instances of random shootings at night at police headquarters or police stations in Georgetown. U.S. citizens are encouraged to maintain a high level of vigilance, consider security issues when planning activities throughout Guyana, minimize movement when possible, and avoid traveling at night, when possible.

Armed robberies continue to rise, especially in major business and shopping districts. Hotel room strong-arm break-ins are also increasing, so travelers should use caution when opening their hotel room doors and should safeguard valuables left in hotel rooms. Criminals may act brazenly, and police officers themselves have been the victims of assaults and shootings. Vehicle occupants should keep their doors locked and be aware of their surroundings at all times. Robbery and theft occur with some frequency in Georgetown and New Amsterdam. U.S. citizens should avoid stopping in or traveling through the village of Buxton, which lies along the road between Georgetown and New Amsterdam, and Agricola, which is located on the East Bank highway. The Department of State recommends that Embassy staff using the public golf course at Lusignan, next to Buxton, do so in groups and only during daylight hours. Pickpocketing, purse snatching by thieves on bicycles, assault, and theft can occur in all areas of Georgetown. The areas adjacent to the sea wall and the National Park in Georgetown, although frequented by joggers, dogwalkers, and families are generally considered safe during daylight hours, have been the scenes of crimes in the past. Travelers should exercise extra care when visiting these areas after dusk. Pickpockets and thieves also frequent Stabroek and Bourda, the two major markets, and great care should be taken to safeguard personal property when shopping in these markets. U.S. passports and permanent residency cards are prized by thieves as they may be used for smuggling and identity theft. There have been numerous incidents of piracy in recent months in and around the waters of Guyana. Mariners are advised to be vigilant and take appropriate precautions. Travelers should avoid walking alone around Georgetown, even in the main areas and especially at night. Although bandits have been known to attack taxis, they are generally safe and remain the safest means of getting about town and to and from the airport for visitors. Only taxis from reputable companies should be used. Exercise constant vigilance. Do not dress ostentatiously, as there have also been reports of gold chains or other jewelry being snatched off of pedestrians. The response of local law-enforcement authorities to the increase in violent crime has been largely ineffectual; the police are cooperative but lack the resources to respond effectively to serious criminal incidents. Nevertheless, Americans who are victims of crime are encouraged to contact the police as well as the American Citizens Services Unit of the U.S. Embassy's Consular Section.

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 in finding appropriate medical care, contact family members or friends and explain how funds may be transferred. Although the investigation and prosecution of the crime are 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: Medical care is available for minor medical conditions. Emergency care and hospitalization for major medical illnesses or surgery are limited, due to a lack of appropriately trained specialists, below standard in-hospital care, and poor sanitation. Ambulance service is limited to transportation without any medical care and is frequently not available for emergencies. An MRI (linked to the United States for interpretation) has been installed and is operational, but results may take up to 4 days. Visitors are advised to bring prescription medicine sufficient for their length of stay and should be aware that Guyana's humid climate may affect some medicines. Some prescription medicines (mainly generic rather than name-brand) are available. Special attention should be paid to HIV/AIDS in Guyana. In addition to infection rates as high as 45% in high-risk populations such as commercial sex workers and mobile populations such as miners or loggers, data from the World Health Organization estimate that 1.6% of the general population is infected with HIV; this is among the highest prevalence rates in Latin America and the Caribbean. 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 Guyana is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
In 2007, road fatalities increased more than 40% from the previous year. The rate of traffic accident fatalities in Guyana is 70% higher than in the United States. The Traffic Division of Guyana's National Police Force is responsible for road safety but is ill-trained and ill-equipped. Driving in Guyana is hazardous because of very poor road surfaces; farm animals sleeping or wandering on the roads; pedestrians walking on the road; and poor driving habits, including speeding, reckless driving, tailgating, cell phone use, quick stops without signaling, failure to dim headlights, and weaving in and out of traffic. Traffic lights installed in Georgetown are often ignored or simply flash, posing a risk to drivers and pedestrians. Visitors should exercise caution at all times while driving and avoid driving at night, when possible. The Department of State recommends that Embassy staff travel in groups of two or more vehicles when traveling outside Georgetown at night.
Travelers are advised to use caution traveling to and from Cheddi Jagan International Airport, especially at night. The Embassy requires its staff to use official vehicles when traveling this route between dusk and dawn due to a combination of most of the aforementioned characteristics of driving in Guyana.
Penalties for drivers involved in an accident resulting in injury or death are severe, including life imprisonment. If involved in an accident, call 911 for police and 913 for an ambulance. Please note that police may be slow to respond and an ambulance may not be available.
Drivers use the left side of the road in Guyana. Seatbelt use is required by law and is enforced; failure to use a seatbelt can result in a fine. There presently are no laws in Guyana concerning use of child car seats, but the use of age-appropriate seats is strongly recommended for child passengers. Both drivers and passengers on motorcycles must wear protective helmets that meet certain specifications.
Mini-buses (small 12- to 15-passenger vans) ply various routes both within and between cities. Mini-bus drivers have come under severe criticism from the government, press, and private citizens for speeding, aggressive and reckless driving, overloading of vehicles, poor vehicle maintenance and repair, and offensive remarks directed at passengers, but little change in their driving behavior has been noted. Mini-buses have been involved in the majority of fatal vehicular accidents in recent years.
Please refer to our Road Safety page for more information. Visit the web site of the country’s national tourist office and national authority responsible for road safety.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Guyana’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Guyana’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:
Air Travel: Flights on all airlines can be delayed, rerouted, or canceled without notice. Air travel within Guyana generally depends on demand. Flights that are not full may be canceled or passengers may be expected to pay for the empty seats. Travelers to the United States from Guyana have found narcotics planted in their luggage, both in bags registered under their names and in items they were carrying for others. Travelers should not carry any items they did not purchase and pack themselves and should take care that no additional bags are registered in their names. Travelers should hand carry medications, valuables, and perishable items.
Flooding: The coastal plain, which occupies about 5% of the country's area, is home to more than 90% of its inhabitants. The plain extends from the Corentyne River in the east to the Venezuelan border in the northwest. This coastal plain was created through the polder system, a technique that dams and then drains a water-covered area. The polder system consists of a front dam (the sea wall along the east coast) and a back dam (the freshwater conservancy) that is approximately 5 to 6 kilometers inland from the sea wall. The system is in a fragile state due to a chronic lack of maintenance. In addition, a dozen major drainage canals run from the base of the dam to the Atlantic Ocean across the polder itself. These main canals are, in turn, fed by literally thousands of lateral canals that run along both sides of almost every street and road. Seasonal rains (December-January and May-July), combined with the lack of maintenance and improper new construction, led to significant flooding in Greater Georgetown and along the East Coast in January 2005 and in the Mahaica-Mahaicony Abrary area, Canals 1 and 2, on the West Coast Demerara and the Pomeroon River catchment area in January 2006.
Drinking Water: An inadequate garbage removal system has resulted in illegal residential and commercial dumping on the roadside and into the drainage system. Decaying animal carcasses are periodically discovered in the intake canals for the Georgetown water supply. The water supply system throughout the country should be considered contaminated and travelers should treat or boil water before consumption, or purchase bottled water.
Changing Currency and Credit Card Use: Travelers should have enough cash or travelers checks to meet their expenses. With few exceptions, credit cards and ATM cards should not be used to withdraw cash from an overseas account, due to a high risk of stolen PIN data. Although credit cards are accepted at certain institutions in Georgetown, travelers should be careful when using them and check their receipts and statements to ensure that additional unauthorized purchases have not been made to their card. American citizens are advised to exchange currency only with banks, hotels, and licensed money exchange houses (“cambios”). Many foreigners who opt to exchange money on the streets, lured by promises of higher exchange rates, become victims of fraud or receive counterfeit currency. Foreigners have been mugged after completing bank transactions. There is no legal recourse unless the police are successful in apprehending the perpetrator; even then there is no guarantee that the money will be recovered.
Firearms: Guyanese customs authorities may enforce strict regulations concerning temporary importation into or export from Guyana of items such as firearms. If you plan to take your firearms or ammunition to or through Guyana, you should contact officials at the Embassy of Guyana to learn about its regulations and fully comply with those regulations before traveling. You may consult http://www.customs.gov for information on importing firearms into the United States.
Wildlife: Many plants and animals common in Guyana are globally threatened or endangered species protected by the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES at www.cites.org). The Guyanese Ministry of Agriculture will grant an export permit for taking an exotic bird out of the country only to those persons who have been legally residing in Guyana for more than one year. There have been several U.S. citizens arrested for attempting to leave Guyana carrying birds without having obtained an export permit. Americans who have legally resided in Guyana for more than a year and who would like to take back to the United States any birds or animals, including pets, that are listed in CITES Appendices I, II, and III, must also have an appropriate U.S. import permit from the U.S. Fish and Wildlife Service (USFWS). This is a U.S. regulation that applies regardless of distinctions among the three CITES Appendices. Individuals can obtain fact sheets and permit applications from the USFWS Office of Management Authority, Branch of Permits, 4401 N. Fairfax Drive, Arlington, VA 22203, telephone (703) 358-2104, fax (703) 358-2281, http://www.fws.gov/permits/.

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 Guyanese laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Guyana are severe, and convicted offenders can expect long jail sentences and heavy fines. Possession of unlicensed guns can result in fines and imprisonment. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime in Guyana and also prosecutable in the United States.

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 Guyana are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Guyana. 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 100 Young and Duke Streets, telephone 011-592-225-4900 through 225-4909, fax 011-592-225-8497, web site http://georgetown.usembassy.gov/. Hours of operation are Monday-Friday, 7:30 am to 4:00 pm, except local and U.S. holidays. For emergencies after hours, on weekends and on holidays, U.S. citizens are requested to call the U.S. Embassy duty officer at 011-592-623-1992.
* * *
This replaces the Country Specific Information dated November 21, 2007, to reflect changes to Safety and Security, Crime, and Wildlife.

Travel News Headlines WORLD NEWS

Date: Tue 16 Apr 2019
Source: Kaieteur News Online [edited]

The mystery illness, which was erroneously assumed to be H1N1 (swine flu) and as leptospirosis in 2 cases, affecting employees working in the Guyana Manganese Inc. tunnel in Matthew's Ridge, Region One, Barima-Waini has finally been determined to be histoplasmosis, an infection by a fungus found in the droppings of birds, bats and rats in humid areas. [Histoplasmosis is caused by a fungus _Histoplasma capsulatum_ that lives in soil enriched by bird or bat, not rat, droppings. - ProMED Mod.ML]

This was confirmed when the Ministry of Public Health held a press conference yesterday [15 Apr 2019] in its Mental Health Unit Boardroom to provide an update on the recent outbreak and related issues.

Samples were collected from all patients, and initially some testing was done at the National Public Health Reference Laboratory (NPHRL). Further samples were sent to the Caribbean Public Health Agency Laboratory (CARPHA) in Trinidad for confirmation.

The results initially were negative for influenza A and B inclusive of H1N1, chikungunya, Zika and dengue. All patients underwent malaria tests in Matthews Ridge, and they were also negative.

Chief Medical Officer (CMO) Dr. Shamdeo Persaud provided a detailed update.

Relating the developments sequentially, the CMO said that the 1st 4 cases were reported on 28 Mar [2019]; one died while receiving care at Pakera District Hospital in Region One. The following day, 4 more were brought in to Pakera District Hospital complaining of similar symptoms (fever, headaches, joint pains, mild shortness of breath). Subsequently, the 7 Chinese workers were transferred to the Georgetown Public Hospital Corporation (GPHC).

An additional 6 employees, including one Guyanese, were attended to at the Port Kaituma Hospital but later transferred to the GPHC. One of the 6 persons visited the hospital on his own. He was evaluated but not admitted.

Once the cases were reported, several teams visited the site from the regional level. The teams included the Regional Health Officer and the Regional Environmental Health Officer, along with some supporting medical staff.

"In the initial stage, we weren't sure what we were dealing with, but since it was a febrile illness with respiratory symptoms, we took all the necessary precautions to restrict access to both the site and the hospital where the patients were being kept. The additional staffers that were sent to the region set up a temporary facility at the community centre in Matthews Ridge where they were seeing the regular patients," the CMO recounted. "Following the transfer of the patients on 3 Apr [2019], they cleaned up the Pakera District Hospital and closed down the temporary sites. Work resumed as normal at the hospital for Maternal Child Health and other services."

"Two persons are dead; one died at Pakera District Hospital and one at GPHC. Of those admitted at the GPHC, 2 were discharged. An additional person was discharged from Pakera District Hospital. Ten workers were transferred to China on Mon 9 Apr [2019]. 16 Chinese workers were under care and treatment. Following the transfer, 2 more were admitted to Pakera Hospital bringing it to a total of 18."

Blood, sputum and urine samples were collected from those that were under care, while tissue samples were collected during the post mortem from the 2 deceased. Testing for these samples was done locally at the National Public Health Reference Laboratory (NPHRL), and confirmation was done at Caribbean Public Health Agency (CARPHA) in Trinidad.

"All tests were negative for influenza A & B, dengue, chikungunya and Zika. Even though [it was] reported we had 2 positive for leptospirosis, according to the NPHRL, those were later found negative through confirmation from CARPHA. On the weekend of 7 Apr [2019], a team was flown in to Matthews Ridge. The team included officers from the Environmental Protection Agency and Occupational Safety and Health, and they did an evaluation of the work site and looked at some of the risk factors relating to the environment. A community meeting was also held with residents," Dr. Persaud said.

It was disclosed that from 8-10 Apr [2019], 2 consultants from the Pan American Health Organization/World Health Organization (PAHO/WHO) along with the Chief Medical Officer and a team from the Ministry of Public Health visited the area. A team of 9 officers from the Centre for Disease Control (CDC), China was also part of the visiting team. "During the visit, the team met with the hospital staff. We reviewed their procedures for infectious disease control and prevention, and we met with company officials. Interviews were conducted with the persons who were working in the mine." A total of 23 Chinese workers were interviewed. They were working in the 4 different tunnels.

The CMO continued: "On 10 Apr [2019], we received word from CARPHA that 5 samples were tested for histoplasmosis; 4 were positive. The Chinese CDC tested an additional 6 persons, and 5 were positive for histoplasmosis.  One person tested showed weak positive hantavirus, but this may have been because of a past exposure to that germ. "Currently, we are monitoring persons at Matthews Ridge. During the last 2 days, 2 persons developed fever, and they were admitted to Pakera District Hospital and are under close observation and treatment for hantavirus, which is a fungal infection. [Hantavirus infection is a viral, not fungal infection. - Mod.ML] We also took samples from them, and they are presently being processed for shipment to CARPHA."

Meanwhile, the absence of safety gear for workers was highlighted. Interviews were done with employees who had not developed any illness. And this revealed the shortcomings. Officials were told that the safety gear was in the country but was not on site. They had not cleared customs at the wharf at that time. However, that claim was never confirmed. Occupational Safety and Health (OSH) Consultant Gwyneth King said, "Our information to date is that the workers were not wearing [any] personal safety gear. That is to say that they were not wearing respirators, so they were exposed to breathing in the fungus. If you have to do a job like that, you need to wear personal safety gear; otherwise, you could expose yourself."

King said that officials will be working within the confines of the Occupational Safety and Health Act to see what action, if any, can be taken against the company for this major inadequacy. However, they are only now going through their findings and preparing the report.
=====================
[As I assumed in my ProMED moderator comments in the last ProMED-mail post on this outbreak, the cause of the acute respiratory illness in workers in manganese mine tunnels in Guyana is apparently histoplasmosis.

We were initially told (ProMED-mail post (Undiagnosed resp. illness - Guyana: (Barima-Waini) manganese mine, fatal, RFI http://promedmail.org/post/20190401.6396933) that workers at a manganese mining company in Guyana, owned by a subsidiary of Chinese company Bosai Minerals Group Guyana Company Limited, developed what was said to be an influenza-like illness with "respiratory discomfort, rash, and high-grade fever." More than a dozen miners were affected, and 2 of the workers died. Post-mortem examinations on the 2 dead miners initially were said to have "revealed that they died from haemorrhagic pneumonia as a result of leptospirosis;" we now learn the diagnosis of leptospirosis was erroneous.

Initially, we were told that all infected persons were exposed to one common area, without evidence of person-to-person transmission (that is, presumably there were no secondary cases), but we were not told what that common area was. We were subsequently told the common area is the "Matthews Ridge tunnel site."

Manganese mines are usually open pits, which are subject to flooding that could lead to exposure to leptospirosis if there is also rat infestation. However, tunnels could be infested with bats and their guano, which would place mine workers at risk for histoplasmosis, a fungal pulmonary infection that follows unprotected inhalation of large inocula of _Histoplasma capsulatum_ spores. The fungus lives in soil fertilized by bird or bat droppings. Contaminated soil can remain potentially infectious for years. Microconidia spores become airborne when the contaminated soil is disturbed, for example, by digging in contaminated soil. Most infected individuals remain asymptomatic. Symptomatic illness is primarily caused by an intense exposure, and the severity of disease is related to the number of spores inhaled.

ProMED-mail previously reported on a histoplasmosis outbreak in tunnel workers in the Dominican Republic (see "See Also's" below).

Symptoms of histoplasmosis usually include non-specific flu-like symptoms (fever, chills, muscle aches, dry cough, and chest discomfort); potentially fatal adult respiratory distress syndrome (ARDS) may occur when larger inocula are inhaled (<http://journal.publications.chestnet.org/article.aspx?articleid=1047573> and <http://www.ncbi.nlm.nih.gov/pubmed/7244706?dopt=Abstract>). The pulmonary infection can disseminate throughout the body, and immunocompromised individuals may develop a severe form of histoplasmosis called progressive disseminated disease.

Histoplasmosis cannot be transmitted from person to person or from animals to people. The diagnosis can be made by culture of the organism from sputum or tissues, by serology, or by tests for antigen in urine and serum specimens. For treatment guidelines, see Clinical Practice Guidelines for the Management of Patients with Histoplasmosis: 2007 Update by the Infectious Diseases Society of America. Clin Infect Dis 2007; 45(7): 807-25. Available at <http://cid.oxfordjournals.org/content/45/7/807.full>. - ProMED Mod.ML]

[HealthMap/ProMED map available at:
Date: Sat 6 Apr 2019
Source: Outbreak News Today [edited]

Health officials in Guyana have reported a leptospirosis outbreak among Guyana Manganese Inc. (GMI) workers on [Fri 5 Apr 2019].  According to authorities, 2 Chinese nationals have been treated and released, while another mining employee, who was also tested positive for leptospirosis, is in "critical but stable condition".

One individual died from complications associated with leptospirosis on [Wed 3 Apr 2019] night while undergoing treatment at the Georgetown Public Hospital Corporation (GPHC). Chief Medical Officer (CMO) Dr. Shamdeo Persaud said that "all precautionary measures are still in place at the Matthews Ridge tunnel site and immediate surroundings and essential medical supplies are in stock to treat employees of the mining firm and residents of the area.

Since last week's outbreak, the area has been deemed a 'Red Zone' by Ministry of Public Health (MOPH) authorities and "no one is allowed to enter the site," Dr. Persaud reminded on [Thu 4 Apr 2019].
Date: Mon 1 Apr 2019
Source: DPI Guyana [edited]

Public health officials have ruled out swine flu (H1N1), Zika, Chikungunya, dengue, and influenza A and B as possible causes of the recent spate of illnesses and death in Matthew's Ridge. Thus far, there has been no evidence of person-to-person transmission of infection. It is noted that only persons who were directly exposed to one common area became ill.

As of Sunday, 31 Mar [2019], a response team comprising the Environmental Protection Agency (EPA), Surveillance, EH, doctors, and nurses were dispatched to region 1 to support the efforts taken in theregion to address the illnesses. The fortified health response focuses on providing uninterrupted health services to the residents of Matthew's Ridge, as well as on conducting health assessments of all persons working in the mining area.

The decision was taken to transfer all the patients with the acute respiratory illness, rash, and fever to our tertiary institution, the Georgetown Public Hospital (GPHC), where critical care can be provided should the need arise. While the specialists continue to work on the 7 patients admitted on Saturday [30 Mar 2019], results have shown that 2 patients tested positive for leptospirosis, which is known to be spread by direct contact with rat urine or faeces. Further tests are being conducted locally, and samples will be sent overseas with support from PAHO and CARPHA to get further tests done to rule out other possible infections.

The Public Health Ministry is taking all necessary precautions to ensure staff and members of the community at Matthew's Ridge are kept safe.

The mining company has been instructed to halt further exploration until the ministry and a team from the Occupational Health and Safety department of the Ministry of Social Protection can advise further. The Ministry of Public Health, along with partners, will continue to monitor the situation closely until resolution.
========================
[Leptospirosis is a bacterial disease that affects humans and animals. It is caused by bacteria of the genus _Leptospira_. In humans, it can cause a wide range of symptoms, some of which may be mistaken for other diseases. Some infected persons, however, may have no symptoms at all.

Without treatment, leptospirosis can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, respiratory distress, and even death  (<https://www.cdc.gov/leptospirosis/index.html>).

Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, such as farmers, mine workers, sewer workers, slaughterhouse workers, veterinarians and animal caretakers, fish workers, dairy farmers, and military personnel. The disease has also been associated with swimming, wading, kayaking, and rafting in contaminated lakes and rivers. As such, it is a recreational hazard for campers or those who participate in outdoor sports. The risk is likely greater for those who participate in these activities in tropical or temperate climates.

According to the above report, appropriate public health measures are being taken to contain the above "outbreak" and confirm any new cases as early as possible. - ProMED Mod.UBA]

[We were told in the initial ProMED-mail post (Undiagnosed resp. illness - Guyana: (Barima-Waini) manganese mine, fatal, RFI http://promedmail.org/post/20190401.6396933) that 8 individuals working at a manganese mining company in Guyana, owned by a subsidiary of Chinese company Bosai Minerals Group Guyana Company Limited, developed what was said to be an influenza-like illness with "respiratory discomfort, rash, and high-grade fever." One of the individuals died.

A subsequent update from Guyana Department of Public Information (above) says that swine flu (H1N1), Zika, chikungunya, dengue, and influenza A and B have been ruled out as possible causes of this outbreak, although 2 patients tested positive for leptospirosis, without specifying what tests were done to make that determination. All infected persons are said to have been exposed to one common area, without evidence of person-to-person transmission (that is, presumably there are no secondary cases), but we are not told what that common area is.

Leptospirosis is an infection transmitted to humans by exposure to soil or fresh water contaminated with the urine of wild and domestic animals (including dogs, cattle, swine, and especially rodents) that are chronically infected with pathogenic _Leptospira_. The Bosai mine is an open pit mine, the usual way manganese is mined (<https://demerarawaves.com/2017/01/27/manganese-mining-in-north-west-district-to-create-hundreds-of-jobs-improved-infrastructure/>). Open pit mines are subject to flooding, which could lead to exposure to leptospirosis if there is also rat infestation.

The clinical presentation of leptospirosis is frequently nonspecific, with fever, headache, and myalgias. Patients often have a dry cough, which is usually mild and without any sequelae, that accompanies the other symptoms. Severe leptospirosis, known as Weil's disease, is characterized by liver damage (causing jaundice), renal failure, and bleeding. Meningoencephalitis and myocarditis may also be present. However, pulmonary involvement, which manifests itself as pulmonary hemorrhage, can be severe, with massive hemoptysis, respiratory insufficiency, and death (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519021/>). The diagnosis of leptospirosis can be made by PCR assays during the acute illness and ELISA (enzyme-linked immunosorbent assay) for the detection of _Leptospira_-specific IgM antibodies. The microscopic agglutination test (MAT), which detects antibodies to specific serovars using several reference strains, confirms the diagnosis.

Another disease transmitted by rodents is hantavirus infection. Infected rodents shed the virus in feces, urine, and saliva. Dr. Jan Clement in previous ProMED-mail posts (e.g., Leptospirosis - South Africa (02): (WC) fatal, prisoners, rat infestation, comment http://promedmail.org/post/20151004.3690652) has pointed out the need to consider hantavirus infection in the differential diagnosis of rodent-borne diseases such as leptospirosis. ProMED-mail moderator TY [ProMED Mod.TY] has indicated the presence of hantaviruses in this region of northeastern South America. See ProMED-mail post Hantavirus update 2010 - Americas (40): Chile, French Guiana http://promedmail.org/post/20101224.4542. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Barima-Waini region, Guyana: <http://healthmap.org/promed/p/3849>]
Date: Sun 31 Mar 2019
Source: Kaieteur News [edited]

One of several afflicted manganese workers is now dead, after exhibiting symptoms of a viral influenza, yesterday [30 Mar 2019]. The other 7, who are also Chinese nationals, are currently being treated at the Georgetown Public Hospital Corporation (GPHC).

A team of medical personnel was deployed to Matthews Ridge [Barima-Waini region] yesterday, from the Mabaruma Hospital after the members received these reports.

The 7 men were airlifted to Eugene F Correia International Airport, Ogle, and transported to GPHC for treatment.

A medical practitioner on the team informed this publication that the team has been extremely cautious, both, in its transport of the patients and with the level of care they're currently receiving.

This publication was informed that 2 floors of the Male Medical Ward of GPHC were cleared and restricted yesterday, to quarantine the victims of the undetermined illness.

The 7 workers had initially been taken to Pakera Hospital, Matthews Ridge, for treatment.

The medical personnel at the hospital have been running a battery of tests. Further testing is expected to be done to ascertain the exact nature of the illness. One doctor involved has dismissed speculation that swine flu [influenza A(H1N1)] is the cause of the symptoms.

The workers were reportedly stationed at a manganese mine owned by Guyana Manganese Inc. (GMI), a subsidiary of Chinese company, Bosai Minerals Group Guyana Company Limited, when they began showing signs of respiratory discomfort, rash, and [high grade fever].

Just [Fri 29 Mar 2019], Ministers of Natural Resources and Public Affairs, Raphael Trotman, and Dawn Hastings-Williams, visited the mine to inspect it, since operations there are expected to restart soon.

To date, 113 Guyanese and 23 expatriates have already been employed with GMI.

According to health officials, they are up on the alert for measles and immunisable diseases.
===================
[According to the report above, the clinical presentation of the cases includes high grade fever with a rash and respiratory symptoms. The report mentions 8 workers who developed symptoms but does not provide information on epidemiological factors such as whether the workers lived in close proximity prior to developing symptoms, any travel history or new arrivals to the mine, or any co-morbid conditions. Detection of the responsible pathogen or toxin is necessary to provide appropriate treatment and to protect the other workers. Any further information in this regard will be highly appreciated. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map of Guyana:
Date: Wed 13 Sep 2017
Source: Stabroek News [edited]

Residents of Wakapoa, in Region Two (Pomeroon-Supenaam), suspect that there is a typhoid outbreak in the community, where the absence of medical professionals and drugs at the community health centre has become the norm. At least 8 people from the village have been reported as having typhoid.

A resident sought to highlight the plight of those in her village in a recent Facebook post by calling on those in authority to look into the matter. "Hello my friends, with a feeling of anxiety and frustration I reach out to you this evening to ask if anyone can refer me to the relevant authorities for help for the folks of Wakapoa. Presently, there seems to be an outbreak of typhoid in my community! With 6 people from my family already sick and in need of treatment!! There's no doctor or medex at our health centre and it is apparent we do not have any treatment here right now... 4 members in my family [are] presently at Suddie Hospital talking treatment... But it is very expensive to travel to that hospital and the required tests are also expensive," she wrote, while asking for assistance to notify the Public Health Minister and other organizations that could help the community.
======================
[Typhoid fever, so-called enteric fever caused by _Salmonella enterica_ serotype Typhi, often has a totally different presentation from that of the commoner kinds of salmonellosis. Epidemiologically, usually spread by contaminated food or water, typhoid is not a zoonosis like the more common types of salmonellosis. Clinically, vomiting and diarrhoea are typically absent; indeed, constipation is frequently reported. As it is a systemic illness, blood cultures are at least as likely to be positive as stool in enteric fever, particularly early in the course of the infection, and bone marrow cultures may be the most sensitive.

The symptoms of classical typhoid fever typically include fever, anorexia, lethargy, malaise, dull continuous headache, non-productive cough, vague abdominal pain, and constipation. Despite the frequently high fever, the pulse is often only slightly elevated. During the 2nd week of the illness, there is protracted fever and mental dullness, classically called coma vigil. Diarrhoea may develop but usually does not. Many patients develop hepatosplenomegaly [both liver and spleen enlarged]. After the 1st week or so, many cases develop a maculopapular rash on the upper abdomen. These lesions ("rose spots") are about 2 cm [0.78 in] in diameter and blanch on pressure. They persist for 2-4 days and may come and go. Mild and atypical infections are common.

The word typhoid (as in typhus-like) reflects the similarity of the louse-borne rickettsial disease epidemic typhus and that of typhoid fever; in fact, in some areas, typhoid fever is still referred to as abdominal typhus.

Pomeroon-Supenaam (Region 2) is a region in Guyana, bordering the Atlantic Ocean to the north, the region of Essequibo Islands-West Demerara to the east, the region of Cuyuni-Mazaruni to the south and the region of Barima-Waini to the west. Pomeroon-Supenaam contains the towns of Anna Regina, Charity, Pickersgill, Spring Garden and Suddie. It can be seen on a map of the country at <https://en.wikipedia.org/wiki/Pomeroon-Supenaam>. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
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.