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Angola

Angola - US Consular Information Sheet
June 20, 2008
COUNTRY DESCRIPTION:
Angola is a large, developing country in south-west central Africa.
The capital city is Luanda.
Portuguese, the official language, is widely spoken through
ut the country.
Despite its extensive oil and mineral reserves and arable land suitable for large-scale production of numerous crops, Angola has some of the world's lowest social development indicators.
Development was severely restricted by a 27-year long civil war that broke out upon independence in 1975, which destroyed the majority of the country's infrastructure.
Since the conflict's conclusion in 2002, the government has initiated extensive infrastructure reconstruction and development projects, and there are growing signs of economic recovery.
However, Angola still faces challenges with its infrastructure and with providing government services, especially in basic social services, aviation and travel safety, accommodation availability and quality and communications. Facilities for tourism, particularly outside the capital of Luanda, are often rudimentary. Read the Department of State Background Notes on Angola for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required and must be obtained in advance.
An International Certificate of Vaccination is required.
Visitors should allow several weeks for the processing of their visa application.
Angola does not issue airport visas.
Persons arriving without visas are subject to arrest or exclusion.
Travelers may also encounter delays if they do not have at least one completely blank visa page in their passports for entry stamps.
As of November 1, 2007, Angola no longer requires travelers to have an exit visa.
Travelers whose international immunization cards do not show inoculations against yellow fever within the past ten years may be subject to exclusion, on-the-spot vaccination, and/or heavy fines.
Visitors remaining in Angola beyond their authorized visa duration are subject to fines and arrest.
It is illegal to attempt to carry local currency out of Angola and persons found attempting to carry local currency out of Angola are subject to having this currency confiscated by customs officers.
Current information on entry requirements may be obtained from the Embassy of Angola at 2100-2108 16th Street NW, Washington, DC, tel. (202) 785-1156, fax (202) 785-1258. See our information on dual nationality, the prevention of international child abduction and customs regulations.
SAFETY AND SECURITY:
The overall security situation in Angola has improved markedly since the end of the civil war; however, Americans should still exercise caution when traveling in Angola.
Although the war has ended, ground travel throughout Angola can be problematic due to land mines, which were used extensively during the war.
Travelers should not touch anything that resembles a mine or unexploded ordinance.
Frequent checkpoints and poor infrastructure contribute to unsafe travel on roads outside of the city of Luanda.
Police and military officials are sometimes undisciplined, but their authority should not be challenged.
Travel in many parts of Luanda is relatively safe by day, but car doors should be locked, windows rolled up, and packages stored out of sight.
Visitors should avoid travel after dark, and no travel should be undertaken on roads outside of cities after nightfall.

Americans located in, or planning to visit, the northern province of Cabinda should be aware of threats to their safety outside of Cabinda city.
In 2007 and 2008 armed groups specifically targeted and attacked expatriates in Cabinda; these armed attacks resulted in the rape, robbery and murder of a small number of expatriates working in Cabinda.
Those responsible have declared their intention to continue attacks against expatriates.
Occasional attacks against police and Angolan Armed Forces (FAA) convoys and outposts also continue to be reported.
These incidents, while small in overall numbers, have occurred with little or no warning.
American citizens are, therefore, urged to exercise extreme caution when traveling outside of Cabinda city and limit travel to essential only.

Americans are advised to undertake only essential travel to Lunda North and South provinces.
As the government of Angola is sensitive to the travel of foreigners in the diamond producing areas of the provinces, proper permission and documentation is required to frequent these areas.
One can be subject to restriction or detention.
There have been reports of crime or banditry in these areas, especially on roads leading into these areas.

Visitors to Angola are advised not to take photographs of sites and installations of military or security interest, including government buildings, as this can result in fines and possibly arrest.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s web site, where the current Travel Warnings and Public Announcements, including the Worldwide Caution, can be found.
Up-to-date information on security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or, for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 AM to 8:00 PM Eastern Standard Time, Monday through Friday (except on 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:
Crime is a serious problem throughout Angola.
While most violent crime occurs between Angolans, foreigners have occasionally been attacked as well.
Street crime is a regular occurrence in Luanda.
The most common crimes are pick-pocketing, purse-snatching, vehicle theft, and vehicle break-ins.
Armed muggings, robberies, and carjacking involving foreigners are not frequent but do occur.
Americans are advised to avoid Roque Santeiro and Rocha Pinto, and to only travel the “Serpentine Road” in front of the U.S. Embassy by car.
In general, movement around Luanda is safer by day than by night.
Touring after dark should be avoided.
Police and military officials are sometimes undisciplined, but their authority should not be challenged.
Air travelers arriving in Luanda are strongly advised to arrange reliable and secure ground transportation in advance; there is no regular taxi service.
American citizens are advised to avoid the use of the public transportation known as “candongueiros” or “taxistas”; these multi-passenger vans are largely unregulated and often dangerous.

Motorists should stop at all police checkpoints if so directed.
Police officers may solicit bribes or request immediate payment of "fines" for alleged minor infractions.
American citizens asked for bribes by the police should politely ask the traffic police to write them a ticket if the police allege a moving violation.
If the police officer writes the ticket, then the motorist would pay the fine at the place indicated on the ticket.
If no moving violation is alleged and the officer is asking for a bribe, the motorist should, without actually challenging the officer's authority, politely ask the officer for his/her name and badge number.
Officers thus engaged will frequently let motorists go with no bribe paid if motorists follow this advice.
Motorists are reminded to have all proper documents in the vehicle at all times (i.e. vehicle registration, proof of insurance, and driver's license), as the lack of documentation is a violation and can also be a reason an officer would solicit a bribe.
Local law requires that every driver in Angola have the proper permission to drive.
Further information on driving in Angola can be obtained from the Embassy of Angola.
Police are not always responsive to reports of crime or requests for assistance.
Most police are on foot and are assigned to designated stationary posts.
The Rapid Intervention Police (PIR) unit is frequently seen patrolling various areas of the city.
This unit, which is well trained and organized, will respond to major criminal incidents.

There have been police operations against illegal aliens and private companies resulting in deportation of illegal resident foreign nationals and loss of personal and company property.
Independent entrepreneurs in Angola should carry relevant immigration and business documents at all times.

Travelers should be alert to fraud occasionally perpetrated by Luanda airport personnel.
Immigration and customs officials sometimes detain foreigners without cause, demanding gratuities before allowing them to enter or depart Angola.
Airport health officials sometimes demand that passengers arriving without proof of current yellow fever vaccination accept and pay for a vaccination at the airport.
Travelers are advised to carry their yellow fever vaccination card and ensure their yellow fever vaccine is up-to-date.
If travelers forget to bring their yellow fever vaccination card and do not wish to receive the vaccine offered at the airport, they should be prepared to depart the country on the next available flight.
Searches of travelers' checked baggage is common; travelers are advised to take precautions against this possibility.
Travelers should also be aware that criminals sometimes attempt to insert items into baggage at the airport, particularly for flights from Luanda to South Africa.
It is important that travelers maintain control of their carry-on baggage at all times, and if they believe something has been inserted into their baggage, they should report the incident immediately to airport authorities.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends, and explain how funds could be transferred.
Although the investigation and prosecution of crimes 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.

In addition to reporting crime to local police and the U.S. Embassy in Angola, victims of crime who are residing in Angola are also encouraged to report the crime to the security department of their employer.
Short-term visitors are encouraged to report the crime to the management of the hotel where they are staying if the crime occurred in or near the hotel.
The local equivalent to the “911” emergency line in Angola for police is 113; for fire fighters: 115, and for ambulance services: 112.
Please be advised that the emergency numbers listed may or may not have an English speaking operator available.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities and services are available in Angola, but are limited and often do not meet U.S. standards.
Adequate care for medical emergencies is limited to Luanda, where there are some good private clinics that usually have a 24-hour service provided by a general practice physician and with specialists on call.
A list of such facilities can be found at http://angola.usembassy.gov/medical_information.html.
Routine operations such as appendectomies can be performed.
Local pharmacies provide a limited supply of prescriptions and over-the-counter medicines/drugs.
Travelers are, therefore, urged to carry with them an adequate supply of properly-labeled medications they routinely require for the duration of their projected stay in Angola.
Malaria is endemic in most areas of Angola.

An outbreak of Marburg hemorrhagic fever, a severe and often fatal disease, occurred in Uige province in the spring of 2005; however, on November 7, 2005, the Ministry of Health of the Republic of Angola and the World Health Organization (WHO) declared that the Marburg outbreak in Angola had ended.
This announcement came after 45 consecutive days without a new case of the illness.

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 Angola is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Since the end of the civil war in 2002, overland access to the interior has increased.
However, fighting in most of the country damaged or destroyed many roads and bridges, and services for motorists outside urban areas cannot be counted on.

Road travel can be dangerous, especially during the rainy season (October - March), which can cause large potholes and erosion and due to the presence of landmines.
Road conditions vary widely outside the capital from acceptable paved surfaces to virtually impassable dirt roads, particularly secondary routes.
Many secondary roads, including secondary roads in urban areas, are impassable during the rainy season.
Overloaded, poorly marked, and disabled vehicles, as well as pedestrians and livestock, pose hazards for motorists.
Ground travel in rural areas should be undertaken during daylight hours only.
Landmines also pose a continuing hazard to travelers.
Many areas were heavily mined during the war, including roads, bridges, and railroad tracks.
Areas with suspected landmines are generally clearly marked and travelers should heed these warnings.
Primary roads are considered to be landmine free in most provinces, but travelers should not venture far from the margins of the road.
Extensive government, commercial, and NGO demining projects continue throughout the country.

Traffic in Luanda is heavy and often chaotic, and roads are often in poor condition.
Few intersections have traffic lights or police to direct vehicles.
Drivers often fail to obey traffic signals and signs, and there are frequent vehicle breakdowns.
Itinerant vendors, scooters and pedestrians often weave in and out of traffic, posing a danger to themselves and to drivers.
Most public transportation, including buses and van taxis, should be avoided as the vehicles are generally crowded and may be 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 Angola, the U.S. Federal Aviation Administration (FAA) has not assessed Angola’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 www.faa.gov/safety/programs_initiatives/oversight/iasa/. The U.S. Embassy in Luanda prohibits its employees from using TAAG, Angola’s national airline, for domestic or international flights due to concerns regarding safety and maintenance.
SPECIAL CIRCUMSTANCES:
Customs Regulations:
Angolan customs authorities may enforce strict regulations concerning temporary importation into or export from Angola of sensitive items including firearms, antiquities, and currency.
It is advisable to contact the Embassy of Angola in Washington, DC or one of Angola's consulates in the United States for specific information regarding customs requirements.

Financial Transactions:
Angola is generally a cash-only economy; neither traveler’s checks nor credit cards are used outside the capital of Luanda.
In Luanda, credit cards are accepted in extremely limited circumstances, namely large hotels.
Although, in April 2007 a major campaign was launched to expand credit card acceptance this effort has yet to expand beyond the capital city.
In general, Automated Teller Machine’s (ATM’s) are only accessible to those individuals who hold accounts with local banks.
Dollars are generally accepted in all provincial capitals; travelers should carry a sufficient supply of U.S. dollars with them.
Only the newer series U.S. dollar bills (with large faces) are accepted.
U.S. dollars can be converted to local currency at exchange businesses authorized by the Angolan government.
Angolan currency (the Kwanza) may not be taken out of the country and travelers, who attempt to carry currency out of Angola, are subject to having the currency confiscated.

Personal Identification: U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available.
The Consular Section of the U.S. Embassy in Luanda can prepare copies of American passports at no charge for individuals who register with the Embassy.
To avoid the risk of theft of or confiscation of original documentation, the U.S. Embassy recommends that Americans keep their passport in a secure place and carry a copy to avoid the possibility of authorities confiscating identity and travel documents.

Labor Disputes: American performers traveling to Angola to perform in concerts and/or other events should be aware that there have been several serious allegations made against talent agencies making arrangements for foreign performers.
These allegations include, among other things, several charges of breach of contract and the forcible retention of passports and persons.
Performers should assure themselves of the reputation of any agency they may contract with before traveling.
Many find it useful to contact performers who have previously worked in Angola and are familiar with agencies in Angola.
Persons experiencing any incidents of this nature in Angola should report these to the local Angolan police and the U.S. Embassy.

Long Delays in Renewal of Visas: U.S. citizens who opt to renew their work or other visa while in Angola should expect delays of 2-10 weeks or more, during which time the Angolan immigration authorities will retain one's passport and one will not be able to travel.
U.S. citizens are advised to plan accordingly, and if travel during this time cannot be avoided, one should apply for a second U.S. passport PRIOR to turning over the primary passport to Angolan authorities for visa renewal.
To apply for a second U.S. passport, you must write a letter explaining the need for the second passport, as well as meet all the requirements for a normal application for passport renewal, including being able to show a current valid passport.
Receiving a second passport will take 7-10 business days.
Expatriates who stay beyond their visa expiration date are subject to steep fines.

Hotel Availability:
Hotels are limited in Angola, and demand for the limited number of rooms is high.
Hotels are often booked months in advance, especially in the capital city of Luanda.
Only a few large hotels in Luanda accept credit cards; hotels in the provinces generally do not accept credit cards.
Adequate hotels are found in most provincial capitals, but some provide limited amenities.
Please see our information on Customs Regulations.

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 Angolan laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in Angola are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sex 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 Angola 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 Angola.
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 Consular Section is located at the American Embassy Complex, Rua Houari Boumedienne #32, in the Miramar area of Luanda, P.O. Box 6468, tel. (244) 222-641-000,
(244) 222-447-028, (244) 222-445-481, (244) 222-446-224; 24-hour duty officer (244) 923-404-209; fax (244) 222-641-259.
The Consular Section may be contacted by e-mail at consularluanda@state.gov.
Further information on travel to Angola is also available at the Embassy web site at http://angola.usembassy.gov/.
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This replaces the Consular Information Sheet dated April 29, 2008, to update the Country Description, Entry/Exit Requirements, Safety and Security, Crime, Traffic Safety and Road Conditions, Aviation Safety Oversight, and Special Circumstances.

Travel News Headlines WORLD NEWS

26th December 2018

Angola (Cunene province). 29 Nov 2018. (reported) 25 cases of microcephaly. Samples sent to the central laboratory in Luanda to determine if they are Zika virus related. There were no cases of microcephaly during the same period in 2017.

[HealthMap/ProMED-mail map Angola:
Date: Sat 11 Aug 2018
Source: World Health Organization [edited]
<http://www.who.int/neglected_diseases/news/Surveillance-presence-of-dracunculiasis-in-Angola/en/>

Disease surveillance confirms the presence of dracunculiasis in Angola. The World Health Organization (WHO) has received confirmation of a human case (29 Jun 2018) of dracunculiasis (guinea worm disease) in Angola -- a country not known to have had any cases in the past. "The patient is an 8 year old girl from Cunene Province.

Signs of worm emergence in April this year [2018] were characteristic of guinea worm disease and the worm appeared identical to _Dracunculus medinensis_," said Dr Maria Cecília de Almeida of the Angolan Guinea Worm Eradication Programme and who is also director of Control Programmes for Neglected Tropical Diseases, Ministry of Health. "The case-management protocol was observed, including the preservation of the worm specimen, and we are investigating further to determine the extent of transmission and burden of the disease." The case was detected through a nationwide guinea worm case search during the national immunization campaign against measles and rubella.

The specimen was sent to the WHO Collaborating Center for Dracunculiasis Eradication at the US Centers for Disease Control and Prevention, where a polymerase chain reaction (PCR) [1] test confirmed the worm as _Dracunculus medinensis_ [2]. "This is the first confirmed case of human infection in Angola. The discovery is part of measures taken by the Ministry of Health, following a WHO evaluation mission to Angola in 2016 to assess the country's level of readiness to finalize its dossier requesting a WHO certification," said Dr Dieudonné Sankara, team leader of WHO's guinea worm eradication programme.

After the evaluation mission of 2016, the International Commission for the Certification of Dracunculiasis Eradication recommended that Angola should use all available opportunities to gather robust evidence of absence of guinea worm disease in the country before submitting its certification request. WHO is supporting Angola through all 3 of its operating levels -- Country Office, Regional Office and Headquarters -- to implement its roadmap for certification of dracunculiasis-free status. "With the discovery of this new case, measures are being put up to strengthen surveillance, reporting and investigation of all suspicious cases through the country's Integrated Disease Surveillance and Response," said Dr Nzuzi Katondi, field officer, WHO Country Office, Angola. "Intelligence and alerts are being reported and rumours are being followed up and investigated."

Efforts are also being made through the country's broader mapping exercise of other neglected tropical diseases. To achieve global certification of dracunculiasis eradication, WHO must formally certify every individual country even if no transmission has ever taken place in that particular country. Confirmation of the 1st case in Angola comes as the global guinea worm eradication programme is tackling _Dracunculus medinensis_ infection in both humans and dogs, mainly in Chad. From 1 Jan to 31 May 2018, Chad reported 3 human cases and 534 infected dogs. Ethiopia and Mali, 2 other countries with recent cases, reported zero human cases.

South Sudan, which reported its last human case in November 2016, declared interruption of dracunculiasis transmission in March 2018. The latest confirmation from Angola brings the global total, so far this year [2018], to 4 human cases. Dracunculiasis is a crippling parasitic disease caused by a long threadlike worm. The infection is transmitted mostly when people drink water contaminated with parasite-infected water fleas. When the eradication campaign began in 1986, there were an estimated 3.5 million cases.  PCR is a technique used in medical and biological research laboratories. It is used in the early stages of processing DNA for sequencing, for detecting the presence or absence of a gene to help identify pathogens during infection, and when generating forensic DNA profiles from tiny samples of DNA.  _Dracunculus medinensis_, a nematode (worm), is the causative agent of guinea worm disease.
============================
[According to the latest guinea worm update from WHO (Weekly Epidemiology Report 2018;32:409-16. 10 Aug 2018; <http://apps.who.int/iris/bitstream/handle/10665/273782/WER9332.pdf>) the reported numbers for other countries in 2018 are Chad, 5544; Ethiopia, 5044; Mali, 91; Sudan, 0. South Sudan did not file a report. Even though this is just a single case, the finding indicates that there is a focus. - ProMED Mod.EP]

[Cunene province is in the south of Angola bordering Namibia (<https://en.wikipedia.org/wiki/Cunene_Province>).

HealthMap/ProMED map available at: Angola: <http://healthmap.org/promed/p/165>.]
Date: Tue 8 May 2018
Source: AllAfrica.com [edited]

A total of 21 positive cases of sleeping sickness were diagnosed in the last 2 weeks in the municipality of Banga, Kwanza Norte province, during the prospecting campaign held by the Provincial Department of the Institute of Combat and Control of Trypanosomiasis (Icct).

Angelino Francisco Correia, the supervisor of the campaign, said that 2800 had been examined, and 21 cases were diagnosed, of which 5 were confirmed as sleeping sickness patients.

The official called the active participation of the population in the campaigns of prospection of the disease.
=====================
[A review of human trypanosomiasis (sleeping sickness) in Africa (Fevre EM, Wissmann Bv, Welburn SC, Lutumba P (2008) The Burden of Human African Trypanosomiasis. PLoS Negl Trop Dis 2(12): e333. <https://doi.org/10.1371/journal.pntd.0000333>) found that Angola is a highly endemic country with more than a 1000 cases annually. For background information on human trypanosomiasis in Africa see the ProMED posting "Trypanosomiasis - Angola http://promedmail.org/post/20110709.2081".

A map of Kwanza Norte Province, Angola:
Monday 16th April 2018

- Ndalatando. 11 Apr 2018. At least 78 suspected cases recorded in the period 4-9 Apr 2018 in northern Cuanza Norte Province.
Date: Wed, 7 Mar 2018 04:20:53 +0100
By Daniel GARELO PENSADOR

Luanda, March 7, 2018 (AFP) - Heavy rains, filthy conditions, medicine shortages and endemic corruption have combined to make a lethal malarial cocktail for Angola.   Since the start of the year more than 300,000 cases of the disease have been reported across the country, leading to at least a thousand deaths.   The toll, say experts, is a clear sign of the poverty and failings of governance in a country which, paradoxically, is one of Africa's top oil producers.   "The number is frightening," said Jose Antonio, the director of public health in Kilamba Kiaxi, a poor neighbourhood of the capital.  

Luanda province, which includes the capital, has been the hardest hit with more than 75,225 cases and 117 deaths followed by Benguela in the west of the country where 43,751 cases and 213 deaths have been reported.   In 2017, 7,000 people died from the disease.   Sub-Saharan Africa accounts for 90 percent of malaria cases worldwide and 92 percent of deaths caused by the condition that is spread by infected mosquitoes. Malaria remains one of the leading causes of premature death in Angola and every year public hospitals are deluged with patients battling the disease.

- 'She is dead' -
In the Cajueiros clinic, in the heart of the densely populated Cazenga neighbourhood in Luanda, dozens of mothers and their children queued for medical consultations.   "Every day we record at least 15 to 20 cases of malaria in our hospital," said paediatrician Miguel Sebastiao. That compared to just one or two in the dry season.   "They don't give us any medicine here. You can have a free consultation but they just give you a prescription to go and buy drugs at a pharmacy," complained Rosa Eduarte, who had come to seek a diagnosis for her five-year-old daughter.

Because of her precarious financial position, she had no other choice than to visit a public hospital, which typically lacks even basic supplies like cotton wool, syringes, latex gloves and, crucially, medicines.   "We don't have any tablets here," said Marcelina Paulina, a nurse at the Palanca Dona Paulina hospital in Luanda.   Ana Joaquina lost her sister at the end of February.   "The doctors diagnosed malaria. The hospital didn't have any money to buy medicines. She is dead," said Joaquina matter-of-factly.

Like all of Angola's other public services, health care has been starved of resources by the economic crisis that has plagued the country since oil prices collapsed in 2014.   In 2016 an outbreak of yellow fever killed almost 400 people and shone a light on the risible state of government-run healthcare.   The system has also suffered from chronic corruption, according to doctors and opposition politicians.

- 'Easier to buy luxury cars' -
"It's easier to buy luxury cars for the hospital managers than it is to buy medical supplies," said Maurilio Luyele, a medical doctor who is also a lawmaker for the opposition Unita party.   Last month, three senior officials were sentenced to eight years imprisonment after embezzling $2 million (1.6 million euros) that was intended for the fight against malaria.   Even if Angola had the "best medicine in the world," the issue of malaria will persist "while we don't resolve the problem of rubbish piling up in the streets, of stagnant water and a lack of hygiene," said Sebastiao, the paediatrician.   Refuse collectors have not visited some parts of Luanda for months, another service that is also afflicted by corruption.

Some quarters of Luanda have been transformed into open-air dumps as local authorities grapple with limited budgets and the small number of companies providing refuse services.   During the rainy season from September to May, roads and public spaces are transformed into marshes with floating detritus -- a paradise for mosquitoes.    Faced with a growing crisis, the government of new president Joao Lourenco who took office in September last month launched an emergency plan to fight the malaria epidemic with mass insect fumigation and the distribution of mosquito nets.
More ...

South Africa

General Introduction: The Republic of South Africa lies at the Southern tip of the African continent, flanked between the Indian and Atlantic oceans. Although it lies close to the tropic of Capricorn, the inland areas are tempered by the relatively high a
titudes. Summers and winters are opposite to that found in Ireland. In South Africa the summer extents from October to March. Although South Africa is basically a developed country, much of its population, particularly in rural parts, live in poverty. However facilities for tourists in urban areas and game parks are generally excellent. Despite all the well documented reports overall violence against tourists is usually low but obviously care should always be taken. Travelling late at night is usually unwise and take particular care if visiting nightclubs etc.
Climate: There is generally a moderate climate with sunny days and cool nights. The Cape Town region has a mean yearly temperature of 170C while Johannesburg has an annual mean temperature of 160C. This is mainly because Johannesburg is at 5,700 feet altitude. Throughout South Africa, summer extends between October and March and winter is between June and September. In Johannesburg the winter months tend to be dry and cool while the rainy season tends to occur during the warmer summer months.
Health Facilities: In the larger cities of Johannesburg, Cape Town, Durban & Pretoria and many others there will be no difficulty in receiving excellent medical attention. However when travelling throughout the more isolated rural regions the same situation does not occur. Travellers should always ensure that they are up-to-date in their routine travel vaccinations. World Travel Medicine Consultants (WTMC) in South Africa offer excellent medical facilities in many of the main centres. Contact by email their head office at for further information.
Jet Lag: Even though the hour changes from Ireland are not great after flying for approximately 13 hours you will arrive tired. On the plane journey take some exercise by walking around and occasionally stretching your calf muscles to lessen any risk of blood clots. If you are on the contraceptive pill (women only!) this will increase your risk on a long haul flight and you should talk this through with the doctor looking after your health care advice and vaccines. On arrival, try and rest for the first 24 hours to allow your body to catch up with itself. If lying by the pool remember not to fall asleep and wake some hours later with significant sunburn!
Mosquito-Borne Disease: Mosquitoes are most often associated with Malaria, however it is not the only disease which the insect may carry. Insect repellents which contain more than 30% DEET are effective for keeping mosquitoes away but remember to cover your arms and legs when they are biting. This is mainly in the hours between dusk and dawn. The risk of malaria can be reduced by taking malarial prophylaxis on a regular basis if you are planning to visit the risk areas. Anti malaria tablets are advised for those visiting low altitude areas especially areas around the Kruger National Park, north, east and western Transvaal, and the costal lowlands of Natal. Large towns and cities and high altitudes are more likely to be free of mosquitoes.
Effects of Heat: Extreme climate conditions can also lead to gastrointestinal difficulties but don't forget that when you perspire you will loose both water and salt. Replacing the lost water is easy but many travellers forget to replace the salt in their diet. This can lead to muscular cramps, tiredness and lethargy, a dull headache and generally feeling cross and out of sorts. Replacing depleted salt is most easily achieved by sprinkling it on your meals. Salt tablets can be dangerous and are best avoided except in expert hands. If you have any blood pressure difficulties then it will be important to talk this whole issue through with your doctor before leaving Ireland.
Waterborne diseases: Water sources in well developed urban areas of South Africa are generally safe. Outside the main cities caution must always be exercised with regard to drinking water. Safe water should be well chlorinated and so will have a distinct chlorine odour. Sealed bottled water is more preferable especially in less developed areas. Avoid ice in your drinks as its source may be unknown and don't brush your teeth in water you wouldn't want to drink. If unsure be careful and use sealed bottled water from one of the hotels.
Food-Borne Disease: Again, in the larger cities and tourist resorts, the food and its preparation is generally of an excellent standard and you should experience no problems. It is advised however to avoid eating shellfish and cold/rare meats. In particular, Capetown is famous for its various shellfish meals. Personally I would strongly encourage travellers to avoid them even in the best hotels and restaurants. It is just not worth the risk. As in any hot climate it is also wise to choose only the type of fruit you can peel yourself. Above all avoid buying or consuming food from roadside stalls or street vendors.
Rabies in South Africa: Travellers need to be aware that this potentially fatal viral condition occurs throughout Africa. The risk to any tourist or business traveller is very small but common sense needs to be maintained at all times. The disease is mainly transmitted through the bite of an infected warm blooded animal. Usually dogs and cats are involved but also be very careful of monkeys. If bitten by any potentially at risk animal wash out the wound immediately, apply a strong antiseptic and seek medical attention urgently
Yellow Fever: A yellow fever vaccination certificate is only required for travellers coming from endemic zones in Africa and the Americas. Travellers on scheduled airlines whose flights have originated outside the areas regarded as infected (or who are only in transit through these areas) are NOT required to possess a certificate.
If the flight originated from within a Yellow fever endemic area a certificate is then required.

Vaccination Schedule: Apart from Yellow Fever vaccine in certain circumstances, as mentioned above, there are no other vaccinations required for entry into South Africa from Ireland. Nevertheless there are a number of recommended vaccines for most travellers which need to be discussed. For trekking holidays or extended visits Rabies and Hepatitis B may need to be considered. Most travellers should start their vaccines at least 4 to 6 weeks before departure.
Further Information: South Africa is a beautiful destination with much to offer. Further general health information on staying healthy while travelling abroad may be obtained from the Tropical Medical Bureau. www.tmb.ie

Travel News Headlines WORLD NEWS

Date: Tue 22 Jan 2019
Source: Review Online [abridged, edited]

The Limpopo Department of Health is alerting people, particularly those who regularly work or handle livestock and animals, to be cautious following confirmation of a case of brucellosis in the Giyani area, where a livestock farmer died after having been diagnosed with the disease.

Brucellosis is an infectious disease caused by a type of bacteria called _Brucella_. The bacterium can spread from animals to humans. The infection is acquired through ingestion or direct contact such as touching, splashes onto mucous membranes, and inhalation (breathing in) of contaminated animal products. The infection with _Brucella_ species is not spread from person to person.

Spokesperson for the department, Neil Shikwambana, says the farmer contracted the disease after he was reported to have drank unpasteurized (unboiled) milk from his cattle.

Brucellosis can be contracted through eating undercooked/uncooked meat or consuming unpasteurized/raw dairy products (milk, cheese, ice cream), or coming into contact with an infected animal. Bacteria can also enter wounds in the skin/mucous membranes through contact with infected animals. This includes people who have close contact with animals or animal excretions (new-born animals, foetuses, and excretions that may result from birth) such as slaughterhouse workers, meat-packing plant employees, veterinarians, farmers and hunters (inhaling the bacteria while dressing their game).

People most at risk include infants and young children, older adults, pregnant women, and people with weakened immune systems, such as people with cancer, an organ transplant, or HIV.
=======================
[The species generally associated with cattle is _Brucella abortus_. Brucellosis is one of the classical zoonoses linked to ingestion of unpasteurized milk and dairy products. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps:
Limpopo Province, South Africa: <http://healthmap.org/promed/p/2947>]
Date: Tue 11 Dec 2018
Source: National Institute for Communicable Diseases, Johannesburg:

Malaria cases in South Africa are increasing as expected during the summer months. As at the end of October 2018, more than 16,000 cases with 110 deaths have been reported. This is fewer than during the large upsurge in malaria seen in the 2017-2018 season, but still more than the average over the 10-year period 2007-2016, which was around 7600 cases per year.

During the holiday season, many people will be exposed because of their travel to higher transmission areas, both internally and outside the country borders, particularly in Mozambique.

There has been some recent expansion of low or very low malaria transmission to some districts previously regarded as non-malaria areas in South Africa, such as parts of the Waterberg district. People who are planning to travel are urged to take adequate measures to protect themselves from malaria.

All people in malaria risk areas should reduce contact with mosquitoes by limiting outdoor activity after dark, covering up bare skin (not forgetting feet and ankles), using mosquito repellents, ensuring mosquito screens on windows are closed, and using bed nets, fans, or air-conditioning, if available. Consider antimalarial prophylaxis in higher risk areas -- doxycycline and atovaquone-proguanil are available without prescription from pharmacies. Public sector travel clinics will also supply prophylaxis to travellers. It is important to understand that while these precautions will substantially reduce the chance of acquiring malaria, the risk is never completely abolished.

All travellers returning from malaria transmission areas, including very low risk ones, should get medical advice about 'flu-like' illness (headache, fever, chills, muscle and joint pain) that occurs up to 4 to 6 weeks after 1st possible exposure, in case it is malaria. Please [go to <http://www.nicd.ac.za/wp-content/uploads/2017/03/Malaria-FAQ-NICD-Nov-2018.pdf> for further information on malaria prevention.
=====================
[The South Africa National Institute for Communicable Diseases risk map updated December 2018 can be found at
Malaria prophylaxis is recommended in high risk areas (see map). - ProMED Mod.EP]

[HealthMap/ProMED-mail map of South Africa:
Date: Tue 23 Oct 2018
Source: News24 (South Africa) [edited]

Early this month [October 2018], a crossbreed puppy of approximately 12 weeks old was brought into the Kloof and Highway SPCA reception by a kind member of the public who had found it in her garden in Wyebank. The puppy was brought in a box, and the reception staff immediately noticed that there was something wrong with the puppy. When examined, it was observed to have neurological issues and was extremely vocal.  The decision was immediately made to humanly euthanise the puppy, and it was sent to the state vet for rabies testing. Once the test was conducted, a positive rabies result was confirmed. This is the 13th positive rabies result this year at the Kloof and Highway SPCA.

This puppy was suffering and could have infected other animals and people with the rabies virus; we are so grateful to the lady and her son who rushed the puppy to our SPCA and saved it from further suffering.  When the staff received the positive rabies result, the woman was immediately contacted and informed of the seriousness of the situation. She also confirmed that 5 people had been in contact with the puppy before it was brought into the Kloof and Highway SPCA.

The Kloof and Highway SPCA are urging members of the public to make sure their pets are vaccinated against rabies as well as exercise caution when approaching stray animals.  "If you find a stray animal you are not familiar with, approach it only if it is safe to do so and absolutely necessary. In the event of being bitten or scratched, immediately wash the area very well, flush under running water, and immediately seek medical attention. "If you are bitten or scratched by an animal with no proof of vaccination, you will be required to go for a costly course of rabies vaccinations treatment.  "Rabies is fatal, and the threat of it should not be taken lightly. We strongly advise against keeping any stray animals with the rising threat of rabies," said Brigitte Ferguson of the SPCA.
=========================
[The serious hazard of rabies in puppies has been repeatedly addressed in ProMED-mail's rabies postings. Collecting stray puppies may pose a life-endangering threat, in particular for children who commonly deal with them. Do keep in mind that the clinical signs in puppies may be easily missed. - ProMED Mod.AS]
Date: Wed 17 Oct 2018
From: John Frean <johnf@nicd.ac.za> [edited]

We report the 1st human case of melioidosis detected in South Africa. A 36-year-old man in Pietermaritzburg, KwaZulu-Natal province, presented with dizziness, nausea, weakness, coughing, and inability to walk. He was admitted to a hospital on 9 Jul 2018. He was HIV positive with a CD4 count of 18. His condition deteriorated and despite intensive medical care, he died on 20 Jul 2018. The pathogen was identified from blood culture by the local National Health Laboratory Service microbiology laboratory and confirmed at the National Institute for Communicable Diseases, Johannesburg, by MALDI-TOF and electron microscopy. Subsequent whole genome sequencing indicated a new sequence type.

Melioidosis is a disease of animals and humans caused by the environmental bacterium _Burkholderia pseudomallei_. Infected animals (horses, pigs, sheep, goats, and rodents) may spread it to new areas, where it persists in water and soil. Barefoot farming in wet conditions, flooding, and travel in endemic areas are some exposure risk factors. Typical predisposing medical conditions are diabetes, renal or liver disease, malignancy and immunosuppression. Human-to-human transmission does not occur. Clinical presentation includes pneumonia, cutaneous or visceral abscesses, and septicaemia, and case fatality is high (40-75 percent), despite antimicrobial therapy. Prolonged incubation periods (days to years) can make it difficult to identify the source of exposure.

Melioidosis is endemic in tropical or subtropical regions of Australia, Western Pacific, Asia, Indian Ocean islands, and South and Central America. Sporadic cases have occurred in West and East Africa, but there is no sound epidemiological data about the burden or distribution of disease in Africa. The only previous case of melioidosis reported in South Africa was that of a goat, in 1995.

The predicted environmental suitability for _B. pseudomallei_ in South Africa is low, and is more favourable in parts of the neighbouring countries of Botswana and Mozambique. However, as this case and the previous animal case suggest, improved local awareness of melioidosis is needed.

References
----------
1. Van der Lugt JJ, Henton MM: Melioidosis in a goat. J S Afr Vet Assoc 1995; 66(2): 71-3; [abstract available at <https://www.ncbi.nlm.nih.gov/pubmed/8544164>].
2. Limmathurotsakul D, Golding N, Dance DA, et al. Predicted global distribution of _Burkholderia pseudomallei_ and burden of melioidosis. Nat Microbiol. 2016;1:15008. doi: 10.1038/nmicrobiol.2015.8; [abstract available at <https://www.nature.com/articles/nmicrobiol20158>]. 3. Steinmetz I, Wagner GE, Kanyala E, et al. Melioidosis in Africa: time to uncover the true disease load. Trop Med Infect Dis. 2018 Jun 10;3(2). pii: E62. doi: 10.3390/tropicalmed3020062; [available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073667/>].  [Byline: J Frean, D Wilson, S Haffejee, J Rossouw, M Birkhead, A Ismail, M Ali]
---------------------------------------------
John Frean and colleagues
National Institute for Communicable Diseases
Johannesburg
South Africa
==========================
[ProMED thanks Dr Frean and his colleagues for this report.

Although a classical infection in eastern Asia and Northern Australia, cases have been acquired in Africa, Central and South America, and the Caribbean basin. Reference 2 above is a 2016 paper (Limmathurotsakul D, Golding N, Dance DA, et al. Predicted global distribution of _Burkholderia pseudomallei_ and burden of melioidosis. Nat Microbiol. 2016;1:15008. doi: 0.1038/nmicrobiol.2015.8; abstract available at <https://www.nature.com/articles/nmicrobiol20158>) that estimates -- for 2015 -- the burden of melioidosis for the areas of major and some risk as follows:

Area / Population at risk in millions / Melioidosis cases in thousands / Melioidosis deaths in thousands
South Asia / 1525 / 73 / 42
East Asia and Pacific / 858 / 65 / 31
Sub-Saharan Africa / 602 / 24 / 15
Latin America and Caribbean / 246 / 2 / 1
Middle East and North Africa / 49 / less than 1 / less than 1

Melioidosis is a disease of the rainy season in its endemic areas. It mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (commonest risk factor), renal disease, cirrhosis, thalassemia, alcohol dependence, immunosuppressive therapy, chronic obstructive lung disease, cystic fibrosis, and excess kava consumption. Kava is a herbal member of the pepper family that can be associated with chronic liver disease.

Melioidosis may present at any age, but peaks in the 4th and 5th decades of life, affecting men more than women. In addition, although severe fulminating infection can and does occur in healthy individuals, severe disease and fatalities are much less common in those without risk factors.

The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, chest pain, and -- although the cough can be nonproductive -- respiratory secretions can be purulent, significant in quantity, and associated with on-and-off bright, red blood. The lung infection can be rapidly fatal -- with bacteremia and shock -- or somewhat more indolent.

Acute melioidosis septicemia is the most severe complication of the infection. It presents as a typical sepsis syndrome with hypotension, high cardiac output, and low systemic vascular resistance. In many cases, a primary focus in the soft tissues or lung can be found. The syndrome, usually in patients with risk factor comorbidities, is characteristically associated with multiple abscesses involving the cutaneous tissues, the lung, the liver, and spleen, and a very high mortality rate of 80 to 95 percent. With prompt optimal therapy, the case fatality rate can be decreased to 40 to 50 percent.
The melioidosis bacillus is intrinsically insensitive to many antimicrobials. It should be noted that bioterrorism strains may be engineered to be even more resistant. _Burkholderia pseudomallei_ is usually inhibited by tetracyclines, chloramphenicol, trimethoprim-sulfamethoxazole (SXT), antipseudomonal penicillins, carbapenems, ceftazidime, and amoxicillin/clavulanate or ampicillin/sulbactam. Ceftriaxone and cefotaxime have good in vitro activity but poor efficacy; and cefepime did not appear, as well, to be equivalent to ceftazidime in a mouse model. The unusual antimicrobial profile of resistance to colistin and polymyxin B and the aminoglycosides but sensitivity to amoxicillin/clavulanate is a useful tool to consider in treatment of infection with the organism.

The randomized and quasi-randomized trials comparing melioidosis treatment have been reviewed, and it was found that the formerly standard therapy of chloramphenicol, doxycycline, and SXT combination had a higher mortality rate than therapy with ceftazidime, imipenem/cilastatin, or amoxicillin/clavulanate (or ampicillin/sulbactam). The betalactam-betalactamase inhibitor therapy, however, seemed to have a higher failure rate.

Source: Tolaney P, Lutwick LI: Melioidosis. In: Lutwick LI, Lutwick SM (eds). Bioterror: the weaponization of infectious diseases. Totowa NJ: Humana Press, 2008 pp 145-58.

For the microbiologists among our readers, a new (and 5th) member of the _B. pseudomallei_ complex has been described, _B. humptydooensis_, from the Northern Territory of Australia and named after the small town of Humpty Doo near to where the isolate was found (Tuanyok A, Mayo M, Scholz H, et al. _Burkholderia humptydooensis_ sp nov, a new species related to _Burkholderia thailandensis_ and the 5th member of the _Burkholderia pseudomallei_ complex. App Environ Microbiol 2017; 83(5): e02802-16; available at <https://aem.asm.org/content/83/5/e02802-16.long>. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of South Africa:
Date: Tue, 25 Sep 2018 14:28:55 +0200

Pretoria, Sept 25, 2018 (AFP) - South Africa on Tuesday announced visa reforms aimed at luring investment and tourists to help lift the continent's most advanced economy out of recession.   Home Affairs Minister Malusi Gigaba unveiled a raft of regulations allowing frequent visitors and foreign business travellers to have long-term multiple-entry visas of up to 10 years.

The rules will take effect from next month.   "Changes to our visa architecture have the potential to boost tourism and make business travel more conducive," Gigaba told reporters.   "We are simplifying visa requirements for countries such as China and India."   Applicants from those two countries will be able to have a 10-year visa processed within five days.   "This arrangement is meant to attract business people and prospective investors," he said.

Anti-trafficking rules requiring parents to travel with birth certificates of their children will be simplified, he added.   Tourism contributes 10 percent of South Africa's total Gross Domestic Product (GDP).   Visa reforms are part of an economic stimulus plan announced by President Cyril Ramaphosa on Friday to boost investor confidence after South Africa entered a recession in the second quarter of this year.   The plan also includes large-scale infrastructural development.   Data showing that South Africa had slipped into recession dealt a blow to Ramaphosa who came to office in February ahead of elections next year.
More ...

World Travel News Headlines

Date: Thu, 21 Mar 2019 16:10:28 +0100

Kinshasa, March 21, 2019 (AFP) - A six-month-old baby in the eastern DR Congo city of Bunia has died of Ebola, becoming the first fatality of the disease in a provincial capital, the heath ministry said Thursday.   Bunia, which has a population of 300,000, is the capital of Ituri province, which along with neighbouring North Kivu province has been battling an epidemic of Ebola since last August.

The baby is among 610 fatalities out of 980 recorded cases, the ministry said in a statement.   "The parents are apparently in good health," it said.   "Extensive investigations are underway and will include, among other things, analysis of the maternal milk to identify the source of contamination."   The ministry added that it had also registered 97 new cases in the previous three weeks.   This increase "was expected" given the impact of an attack on two Ebola treatment centres by armed groups in the troubled region, it said.
Date: Thu, 21 Mar 2019 22:32:17 +0100

Blantyre, Malawi, March 21, 2019 (AFP) - Heavy rains could cause a dam in southern Malawi to give way if there is no let-up, authorities said Thursday, urging local residents to take shelter.   The warning came after cyclone Idai battered neighbouring Mozambique last Friday killing 242 people    Hurricane-force winds and rains have also ravaged hit eastern Zimbabwe where over 100 have died.

In Malawi, the storm has affected nearly a million people with over 80,000 displaced, according to the WHO.   The Chagwa dam "has had one of its major embankments eroded due to heavy rains," the interior security ministry said in a statement. "(It) is likely to burst in the event of heavy and incessant rains."   The statement advised local residents in the southern African country to evacuate "in case of an emergency".
Date: Thu, 21 Mar 2019 12:27:11 +0100
By Abhaya SRIVASTAVA

New Delhi, March 21, 2019 (AFP) - Walls draped in lush vertical gardens and air filtered through purifiers insulate diners at a swanky New Delhi food court from the choking haze outside in one of the most polluted places on earth.   But these eco-eateries, offering cleaner air as well as modern menus to the well heeled are beyond reach for the poor, who have little means of escaping the deadly smog which coats the city for much of the year.   Air pollution kills more than one million Indians every year, according to a study by Lancet Planetary Health, and Delhi is ranked one of the most toxic urban centres to live, regularly exceeding World Health Organisation (WHO) limits.

But for Ramavtar Singh there is no escape: like many of the city's poorest, he eats, sleeps, and works outside.   "I work for six to eight hours every day and my children eat and sleep outside most times of the year," the father of five tells AFP at a roadside food stall, gulping down a 50-cent dish of rice and lentils.   Singh earns a living by cycling passengers and cargo around Delhi on his rickshaw, a strenuous activity that means he's inhaling dangerous concentrations of tiny pollutants deep into his lungs.    At best, he can wrap a rag over his mouth on smoggy days, a low-cost approach taken by labourers and rickshaw drivers that does little to prevent the most dangerous particles entering the bloodstream.   Delhi's smog peaks from October to February, routinely exceeding WHO recommendations for PM2.5 -- tiny and harmful airborne particles -- and some days registers levels more than 20 times safe limits.   Experts warn the long term health consequences of living enveloped in pollution are disastrous, often causing chronic sickness and in some cases early death.

- ' A quick oxygen shot' -
Across town, Abhimanyu Mawatwal is settling down for lunch at a food court in Worldmark Aerocity, a grand commercial centre boasting purified air.   A meal here could cost twice Singh's monthly salary, but it is a price Mawatwal is willing to pay because outside the smog is at hazardous levels.   "I love to come here for my meals. It is like getting a quick oxygen shot," the office worker says, surrounded by creeper vines and a faux stream as he breathed lungfuls of filtered air circulating through expensive filters.   "We need to bring greenery to concrete jungles and create places where everybody can come for a breath of fresh air," insists S. K. Sayal, CEO of Bharti Realty which owns Worldmark Aerocity.   Delhi's affluent, who are often better informed about the dangers of pollution, increasingly expect the same safety measures they have in place at home, to be available when they are out.

High-end eateries, bars and cinemas are tapping into that demand -- installing electronic air purifiers and creating dedicated areas of rich vegetation to help filter airborne toxins.   But for Singh, and the one in five Indians living on less than $2 a day, visiting such places is nothing more than a fantasy.   "What will I do if I spend all the money on one meal? How will I feed my family?" said the rickshaw cyclist, who earns about 1,200 rupees ($17) a month.   He cannot dream of buying the foreign-made air purifiers to protect his family at home -- machines favoured by Delhi's elite, expat communities and office workers -- that easily cost Singh's annual wage.    "The rich and the poor have to breathe the same poisonous air. But the poor are more exposed to pollution," explains Sunil Dahiya, a campaigner for Greenpeace India.    He adds: "Most of the time, they don't even know the effects the toxic air is having on their health. Poor communities are definitely at the losing end."
Date: Thu, 21 Mar 2019 12:17:21 +0100

Geneva, March 21, 2019 (AFP) - The number of people in Zimbabwe affected by a devastating cyclone and flooding has jumped to 200,000, with most of the damage occurring near the Mozambique border, the UN said Thursday.    The initial estimate of those hit in Zimbabwe was 15,000 but World Food Programme (WFP) spokesman Herve Verhoosel told reporters in Geneva that the numbers had surged following an overnight assessment.
Date: Wed, 20 Mar 2019 09:25:29 +0100
By Vishal MANVE

Mumbai, March 20, 2019 (AFP) - India's Jet Airways was fighting multiple crises Wednesday after grounding six planes, leaving it with only a third of its fleet flying, while pilots have threatened to walk out and a major shareholder is reportedly looking to offload its huge stake.   The problems at India's number-two carrier come as other airlines struggle to turn a profit despite the sector rapidly expanding in the country over recent years.   Jet, which employs more than 20,000 people, is gasping under debts of more than $1 billion and has now been forced to ground a total of 78 of its 119 aircraft after failing to pay lenders and aircraft lessors.   In a statement late Tuesday announcing its latest grounding, the firm it said it was "actively engaging" with lenders to secure fresh liquidity and wanted to "minimise disruption".

But with hundreds of customers left stranded, Jet's social media accounts have been flooded with often suddenly stranded passengers demanding information, new flight tickets and refunds.   "@jetairways We book our flights in advance so that we save on travel cost and you are sending cancellation (message) now?", read one irate tweet on Wednesday.   "I have sent a DM (direct message) regarding my ticket details. Please respond!", said Sachin Deshpande, according to his Twitter profile a design engineer.   Another, Ankit Maloo, wrote: "Received an email for all together cancellation of flight days before departure without any prior intimation or communication over phone!"   The firm is also facing pressure from its many pilots who have not been paid on time, with unions threatening they will walk off the job if salaries do not arrive soon.

- Alarm bells -
"Pilots will stop flying jet planes from 1st April 2019 if the company does not disburse due salaries and take concrete decisions," a spokesperson for the National Aviator's Guild, a pilots union, told AFP.   India's aviation regulator on Tuesday warned Jet Airways to ensure that staffers facing stress are not forced to operate flights.   Meanwhile, Bloomberg reported that Etihad Airways of the United Arab Emirates has offered to sell its 24 percent stake in Jet to State Bank of India (SBI).   A collapse would deal a blow to Prime Minister Narendra Modi's pragmatic pro-business reputation ahead of elections starting on April 11.   India's passenger numbers have rocketed six-fold over the past decade with its middle-class taking advantage of better connectivity and cheaper flights.    The country's aviation sector is projected to become the world's third-largest by 2025.

But like other carries, Mumbai-based Jet has been badly hit by fluctuating global crude prices, a weak rupee and fierce competition from budget rivals.   Alarm bells for Jet first rang in August when it failed to report its quarterly earnings or pay its staff, including pilots, on time. It then later reported a loss of $85 million.   In February, it secured a $1.19 billion bailout from lenders including SBI to bridge a funding gap, but the crisis has since deepened.   "Jet Airways is rapidly reaching a point of no return and running out of assets to keep itself afloat," Devesh Agarwal, editor of the Bangalore Aviation website, told AFP.   "The only solution is equity expansion by diluting its stakes but Jet is just trying to cut losses and running out of options," Agarwal said.    Shares in Jet Airways were down more than five percent on Wednesday.
Date: Tue 19 Mar 2019
Source: Pragativadi [edited]

Three members of a family, including 2 minor girls, fell sick after consuming toxic wild mushrooms in Mirigikhoji village under Patana block in Keonjhar district.

According to sources, some members of the family complained of vomiting and nausea after consuming the wild mushroom. They were rushed to the Keonjhar district headquarters hospital where their health condition is stated to be critical.

Although the actual reason behind the illness has not been ascertained, the doctor suspected it to be a case of food poisoning, sources said.
=====================
[In India, mushrooms have been a source of diet and article of commerce for a long time and across many cultures. Poisoning results from unintentional consumption of wild poisonous mushrooms. The cases however remain undiagnosed, underreported and unpublished. A large number of suspected cases are reported in lay press. There have been small epidemics of mushroom poisoning culminating in mortality especially during monsoon. The published literature from India is sparse and mostly in the form of case reports  (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298634/#bib2>).

There is no way to tell which mushrooms were consumed, and no clinical signs are reported. - ProMED Mod.TG]

[A map showing the location of the Keonjhar can be found at

[HealthMap/ProMED map available at:
Keonjhar, Orissa, India: <http://healthmap.org/promed/p/13795>]
Date: Thu 14 Mar 2019, 12:50 PM
Source: The Indian Awaaz [edited]

Over 100 schools have been closed after the dumping of toxic waste into a river caused hundreds of people to fall ill, including many children, authorities said in Malaysia. Over 500 people, many of them school pupils, have received medical treatment after inhaling the fumes.

A lorry [truck] is believed to have dumped the waste in southern Johor state last week, sending hazardous fumes across a wide area.

Education Minister Maszlee Malik said his Ministry has decided to close all 111 schools in the Pasir Gudang area immediately.
=========================
[It is very difficult to comment on what the toxin might have been. We know it produced fumes which were inhaled and resulted some individuals being treated, possibly for respiratory issues.

It is sad, and since it was dumped in a water way, we may see other individuals, and/or animals affected by the toxin. - ProMED Mod.TG

[HealthMap/ProMED map available at:
Date: Mon 18 Mar 2019
Source: Abidjan.net [in French, trans. ProMED Corr.SB, edited]

Two people, including a 70-year-old woman, died on [Sun 17 Mar 2019] in the village of Yrouzon and 4 other people were admitted to the general hospital of Duekoue (West, region of Guemon), after having consumed a decoction of herbal tea, supposed to cure malaria.

According to information collected from the victims, a decoction of herbal tea was prepared the day before by the wife of the young -30 years old- BN, that passed away instantly. [BN may have been trying to relieve the pain of what he believed to be chronic malaria]. BN, affected with chromatic [chronic?] malaria took a sip of the product with the hope of relieving his pain.

Also, his family members of who came to visit him, each took a sip, which was supposed to mitigate their "palu" [pain]. But unfortunately, the following events were; BN, having consumed the first liquid, lost consciousness and died during his evacuation. The old woman, aged about 70, fell on her way home and died on the spot. The other 4 affected people were fortunate enough to be admitted to the general hospital.  An investigation is opened to determine the causes of the tragedy.
======================
[Herbs can be healing, or dangerous. They become dangerous when the plant is misidentified, or mistaken. When a toxic plant is incorrectly identified as non-toxic beneficial herb, then disastrous consequences can follow. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Date: Fri 15 Mar 2018
Source: WJHG [edited]

A rabies alert has been expanded to all of Bay County. The Florida Department of Health in Bay County is expanding a rabies alert issued in March [2019]. Health officials say there were 4 confirmed rabies cases in the span of a month.

Health officials say the most recent case involved a rabid raccoon killed by dogs off Oakenshaw Drive between Highway 2301 and Camp Flowers Road in Youngstown. Florida law requires pets 4 months or older to be vaccinated. If an animal is not vaccinated, keep the pet inside. Health officials say cats are the most likely to be infected with rabies.

Rabies is a fatal viral infection of the nervous system transmitted from animal to animal or animal to human by bite, scratch, or mucous membrane exposure. If your pet fights a wild animal, contact the Florida Department of Health in Bay County. The wild animal will need to be tested for rabies. Health official ask you do not shoot the wild animal in the head.  The alert will last 60 days.
==========================
[In the eastern USA, the main terrestrial reservoir of rabies is raccoons (see map of distribution of major rabies virus variants among carnivores at

A strategy that has been developed to control and contain the spread of rabies in raccoons is the use of oral rabies vaccination [ORV], which can be implemented by distributing bait. Florida has not been included in recent ORV actions, but the northwestern part of the state has been established as a zone needing enhanced rabies surveillance (see <https://doi.org/10.3390/tropicalmed2030034>). - ProMED Mod.PMB]

[HealthMap/ProMED-mail map:
Florida, United States: <http://healthmap.org/promed/p/212>]
Date: Wed 20 Mar 2019
From: Lucille Blumberg, John Frean, Evan Shoul <lucilleb@nicd.ac.za>,
<johnf@nicd.ac.za>, <evan.shoul@gmail.com> [edited]

A game hunter working in an area close to the South Luangwa National Park, Zambia has been admitted to a Johannesburg hospital with laboratory confirmed East African trypanosomiasis (EAT) [_Trypanosoma rhodesiense_] following an acute febrile illness.

He has a typical trypanosomal chancre on the dorsum of his hand, and a scanty parasitaemia was noted on a Giemsa- stained blood smear in Lusaka and Johannesburg laboratories.

On admission, he was moderately hypotensive with a tachycardia, had a mild acidosis, but no definite myocarditis, no ARDS, or clinical CNS pathology. He had a profound leucopaenia (WBC: 1.5) and thrombocytopenia (but no bleeding), moderately deranged hepatic transaminases (chronic hepatitis B infection) but normal renal function.

Suramin treatment was commenced promptly after admission. A CSF examination will be carried out later this week once the peripheral parasitaemia has cleared and the thrombocytopaenia has improved.

This is the 3rd case of EAT admitted to the unit in the past 4 months, one person working in game park, Malawi reserve (fatal case) and one person working in a game management area close to the Lower Zambezi National Park, Zambia.
-----------------------------------------------
Prof Lucille Blumberg
John Frean
Centre for Emerging Zoonotic and Parasitic Diseases
GeoSentinal Site
National Institute for Communicable Diseases
Johannesburg, South Africa
<lucilleb@nicd.ac.za>
<johnf@nicd.ac.za>
and
Dr Evan Shoul
Infectious Diseases Specialist
Johannesburg, South Africa
===========================
[ProMED thanks Lucille Blumberg, John Frean, and Evan Shoul for this report.

The South Luangwa National Park is in eastern Zambia, the southernmost of 3 national parks in the valley of the Luangwa River (see map at: <https://en.wikipedia.org/wiki/South_Luangwa_National_Park>).  African trypanosomiasis is a zoonotic disease with a reservoir in wild game animals and is a risk throughout game parks in Africa including Zambia. More information can be found on the FAO (Food and Agricultural Organization of the United Nations) website on African trypanosomiasis: <http://www.fao.org/paat/en/>.
The case story presented here shows that trypanosomiasis is a differential diagnosis to malaria and indeed haemorrhagic fever in endemic areas. Thus, such patients with a negative malaria blood film should be suspected and investigated for trypanosomiasis, also called African sleeping sickness. - ProMED Mod.EP]

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