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Argentina

Irish Diplomatic and Consular Information for Argentina
**********************************************************************
Address:
Embassy of Ireland
Suipacha 1380
2nd Floor
1011 Buenos Aires
Telephone:
+54-1
-4325-8588 / 4325-0849
Fax:
+54-11-4325-7572
Email:

Ambassador:
Her Excellency Paula Ní Shlattara
Secretary:

Jonathan Conlon
***************************************
Argentina - US Consular Information Sheet
October 02, 2008
COUNTRY DESCRIPTION:
Last year, Argentina's charm, natural beauty and diversity attracted more than 400,000 American citizen visitors, and this year's total is expected to be even higher. Buenos Aires and other large cities have well-developed tourist facilities and services, including many four- and five-star hotels. The quality of tourist facilities in smaller towns outside the capital varies. The country suffered a major financial crisis in 2001-2002. While it has made a dramatic recovery, continued economic hardship has been linked to a rise in street crime. Read the Department of State Background Notes on Argentina for additional information.

ENTRY/EXIT REQUIREMENTS: A valid passport is required for U.S. citizens to enter Argentina. U.S. citizens do not need a visa for visits of up to 90 days for tourism and business. U.S. citizens who arrive in Argentina with expired or damaged passports may be refused entry and returned to the United States at their own expense. The U.S. Embassy cannot provide guarantees on behalf of travelers in such situations, and therefore encourages U.S. citizens to ensure their travel documents are valid and in good condition prior to departure from the United States. Different rules apply to U.S. citizens who also have Argentine nationality, depending on their dates of U.S. naturalization. For more information, check the Argentine Ministry of the Interior web site at www.mininterior.gov.ar/migraciones/. Most dual nationals are permitted 60-day visits. Dual nationals who stay beyond their permitted time are required to depart on an Argentine passport.
The application process for an Argentine passport is lengthy, and the U.S. Embassy is not able to provide assistance in obtaining Argentine passports or other local identity documents. Children under 21 years of age who reside in Argentina, regardless of nationality, are required to present a notarized document that certifies both parents' permission for the child's departure from Argentina when the child is traveling alone, with only one parent, or in someone else's custody (click on the "international child abduction" link below for more information). An airport tax is collected upon departure, payable in dollars or Argentine pesos.

American citizens wishing to enter Brazil are required to obtain a visa in advance from the Brazilian Embassy or consulate nearest to the traveler's place of residence. The U.S. Embassy in Buenos Aires cannot assist travelers to obtain Brazilian visas. For more information, see the Country Specific Information for Brazil.
Visit the Embassy of Argentina’s web site at http://www.embassyofargentina.us/ 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:
Traffic accidents are the primary threat to life and limb in Argentina. Pedestrians and drivers should exercise caution. Drivers frequently ignore traffic laws and vehicles often travel at excessive speeds. The rate and toll of traffic accidents has been a topic of much media attention over the past year. The Institute of Road Safety and Education, a private Buenos Aires organization dedicated to transportation safety issues, reports that Argentina has the highest traffic mortality rate in South America per 100,000 inhabitants.

Care should be exercised when traveling in Brazil and Paraguay, near the Argentine border, where criminal entities are known to operate. These organizations are involved in the trafficking of illicit goods, and some individuals in the area have been designated by the U.S. Treasury Department for financially supporting terrorist organizations.
The U.S. government is supportive of coordinated efforts by Argentina, Brazil, and Paraguay to combat illegal activity in that region. Americans crossing from Argentina into Paraguay or Brazil may wish to consult the most recent Country Specific Information for those countries.

Demonstrations are common in metropolitan Buenos Aires and occur in other major cities as well. Protesters on occasion block streets, highways, and major intersections, causing traffic jams and delaying travel. While demonstrations are usually nonviolent, hooligans in some of the groups sometimes seek confrontation with the police and vandalize private property. Groups occasionally protest in front of the U.S. Embassy and U.S.-affiliated businesses. U.S. citizens should take common-sense precautions and avoid gatherings or any other event where crowds have congregated to protest. Information about the location of possible demonstrations is available from a variety of sources, including the local media. Additional information and advice may be obtained from the U.S. Embassy at the telephone numbers or email address listed at the end of this document.

Domestic flight schedules can be unreliable. Occasional work stoppages, over-scheduling of flights and other technical problems can result in flight delays, cancellations, or missed connections. Consult local media for information about possible strikes or slow-downs before planning travel within Argentina.
Public transportation is generally reliable and safe. The preferred option for travel within Buenos Aires and other major cities is by radio taxi or "remise" (private car with driver). The best way to obtain safe taxis and remises is to call for one or go to an established stand, rather than hailing one on the street. Hotels, restaurants, and other businesses can order remises or radio taxis, or provide phone numbers for such services, upon request. Passengers on buses, trains, and the subway should be alert for pickpockets and should also be aware that these forms of transport are sometimes interrupted by strikes or work stoppages.

Argentina is a geographically diverse country with mountains, forests, expansive deserts, and glaciers, making it a popular destination for outdoor and adventure sports. Despite the best efforts of local authorities, assisting visitors lost or injured in such remote areas can be problematic. American citizens have been killed in recent years while mountain climbing, skiing, trekking, and hunting. Travelers visiting isolated and wilderness areas should learn about local hazards and weather conditions and always inform park or police authorities of their itineraries. Reports of missing or injured persons should be made immediately to the police so that a search can be mounted or assistance rendered.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs' web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the United States, or for callers outside the United States 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 pamphlet A Safe Trip Abroad.

CRIME: Most American citizens visit Argentina without incident. Nevertheless, street crime in the larger cities, especially greater Buenos Aires and Mendoza, is a problem for residents and visitors alike. As in any big city, visitors to Buenos Aires and popular tourist destinations should be alert to muggers, pickpockets, scam artists, and purse-snatchers on the street, in hotel lobbies, at bus and train stations, and in cruise ship ports. Criminals usually work in groups and travelers should assume they are armed. Criminals employ a variety of ruses to distract and victimize unsuspecting visitors.
A common scam is to spray mustard or a similar substance on the tourist from a distance. A pickpocket will then approach the tourist offering to help clean the stain, and while doing so, he or an accomplice robs the victim. Thieves regularly nab unattended purses, backpacks, laptops, and luggage, and criminals will often distract visitors for a few seconds to steal valuables. While most American victims are not physically injured when robbed, criminals typically do not hesitate to use force when they encounter resistance. Visitors are advised to immediately hand over all cash and valuables if confronted. Thieves will target visitors wearing expensive watches or jewelry.

Your passport is a valuable document and should be guarded. Passports and other valuables should be locked in a hotel safe, and a photocopy of your passport should be carried for identification purposes. The U.S. Embassy has observed a notable rise in reports of stolen passports in the past year. Some travelers have received counterfeit currency in Argentina. Unscrupulous vendors and taxi drivers sometimes pretend to help tourists review their pesos, then trade bad bills for good ones. Characteristics of good currency can be reviewed at the Argentine Central Bank web site at www.bcra.gov.ar.
Along with conventional muggings, so-called express kidnappings continue to occur. Victims are grabbed off the street based on their appearance and vulnerability. They are made to withdraw as much money as possible from ATM machines, and then their family or co-workers are contacted and told to deliver all the cash that they have on hand or can gather in a couple of hours. Once the ransom is paid, the victim is usually quickly released unharmed. There have been some foreign victims. Visitors are particularly advised not to let children and adolescents travel alone.
Travelers worldwide are advised to avoid packing valuables in their checked baggage. In Argentina, officials have publicly acknowledged the systematic theft of valuables and money from checked baggage at Buenos Aires airports. Authorities are working to resolve the problem and have made a number of arrests, but travelers should exercise continued care and caution. In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds can be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. The Argentine Federal Police have established a special Tourist Police Unit to receive complaints and investigate crimes against tourists. The unit, located at Corrientes 436 in Buenos Aires, responds to calls around the clock at 4346-5748 or toll-free 0800-999-5000 from anywhere in the country. The local equivalent to the "911" emergency line in the city of Buenos Aires or in the surrounding Province of Buenos Aires is 911 for police assistance. In the city of Buenos Aires, dial 100 in case of fire and 107 for an ambulance. In the Province of Buenos Aires, fire and ambulance numbers vary by location. See our information for Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: The public health system in Argentina provides emergency and non-emergency services free of charge to all, regardless of nationality or immigration status. However, the quality of non-emergency care in public hospitals is generally below U.S. standards. Medical care in private hospitals in Buenos Aires is generally good, but varies in quality outside the capital. Serious medical problems requiring hospitalization in private facilities and/or medical evacuation to the United States can cost thousands of dollars or more. Private physicians, clinics, and hospitals often expect immediate cash payment for health services.
HIV/AIDS restrictions. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Argentina.
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 Preventions hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC's Internet site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad, consult the World Health Organization (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policies apply overseas and will cover prior conditions and emergency expenses such as a medical evacuation, which could cost tens of thousands of dollars. If not covered, visitors are encouraged to consider purchasing travel insurance. No Medicare benefits are available abroad. 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 Argentina is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving in Argentina is generally more dangerous than driving in the United States. By comparison, drivers in Argentina tend to be very aggressive, especially in the capital city of Buenos Aires, and frequently ignore traffic regulations. U.S. driver's licenses are valid in the capital and the province of Buenos Aires, but Argentine or international licenses are required to drive in the rest of the country. For further information, please contact the Argentine Automobile Club, Av. Libertador 1850, 1112 Capital Federal, telephone (011) (54)(11) 4802-6061, or contact the Embassy of Argentina as listed in the above section on Entry Requirements. Please refer to our Road Safety page for more information. Visit the websites of Argentina's national tourist office and national roadways office at www.turismo.gov.ar and www.vialidad.gov.ar.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Argentina’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Argentina’s air carrier operations. For more information, travelers may visit the FAA web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES: In addition to being subject to all Argentine laws affecting U.S. citizens, dual nationals may also be subject to other laws that impose special obligations on Argentine citizens. In some instances, dual nationality may hamper U.S. Government efforts to provide protection abroad. 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 also be more severe than in the United States for similar offenses. Persons violating Argentina's laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Argentina are strict, and convicted offenders can expect lengthy jail sentences and fines. Engaging in sexual conduct with children and using or disseminating child pornography in a foreign country are crimes 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 Argentina are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, so that they can obtain updated information on travel and security within Argentina. Americans without Internet access may register directly with the U.S. Embassy. By registering, American citizens make it much easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at Avenida Colombia 4300 in the Palermo neighborhood of Buenos Aires (near the Plaza Italia stop on the "D" line subway). The main Embassy switchboard telephone is (54) (11) 5777-4533. Recorded consular information, including instructions on whom to contact in case of an American citizen emergency, is available at tel. (54) (11) 4514-1830. The Consular Section fax is (54) (11) 5777-4293. The Consular Section is open to the public from 8:30 a.m. to noon and 2:30 p.m. to 4 p.m. Monday through Friday, except on American and Argentine holidays. Additional information on Embassy services is available on the Internet at http://argentina.usembassy.gov or by e-mail: BuenosAires-ACS@state.gov
* * *
This replaces the Country Specific Information December 28, 2007 to update Sections on Country Description, Safety and Security, Information for Victims of Crime, Medical Facilities, Traffic Safety and Road Conditions, and Registration/Embassy Locations.

Travel News Headlines WORLD NEWS

Date: Sun 22 Sep 2019
Source: La Voz [in Spanish trans. Mod.TY, edited]

Viruses transmitted by mosquitoes are emerging in the Americas. To historic dengue in recent years have been added Zika and chikungunya [viruses], 2 pathogens that before were restricted only to Africa. Madariaga has now been added to that list [of viruses new in the Americas].

Researchers from the Instituto de Medicina Regional of the Universidad Nacional del Nordeste (IMR-Unne) and from the Instituto de Virologia, and J. M. Vanella of the Universidad Nacional de Cordoba (Inviv, UNC) detected its presence in mosquitoes captured in the Chaco. "Madariaga is a virus that causes disease in equine animals and is of low pathogenicity for humans, but in 2010 caused an outbreak in humans in Panama with 10 cases," said Marta Contigiani, who works in the UNC laboratory. It was also isolated in 2015 and 2016 from human samples in Haiti.

Ornella Stechina, of the IMR-Unne, was the person who detected presence of the virus in the mosquitoes. The work was done with the financial support of this institution with Mariana Stein, a researcher from CONICET [the national science agency] as the person in charge.

Contigiani explained that there have been no subsequent cases in horses since 1988. "In other provinces in the country, serological studies have detected [Madariaga] virus infections. There is a vaccine for equine animals, but its application is not obligatory," she said.

However, she warned that global climate change (including deforestation in the Amazon Basin) influences the geographic distribution and emergence of diseases, with appearance of new environments that are favorable for the development of vectors and that favor the development of the [transmission] cycle.

"To this we must add the genetic changes that are observed in these viruses," she stated.

For some time, experts have been issuing alerts about the emergence and reemergence of arboviruses, pathogens that are transmitted by insects.

"West Nile virus rapidly invaded North America, and now cases are being found in Central and South America. Also, Mayaro and eastern equine encephalitis viruses have increased their activity and have been found in new regions," said Raquel Gleiser, a researcher at the Instituto Multidisciplinario de Biologia Vegetal of the UNC (Imbiv) in an article published in the Journal of Medical Entomology.

Madariaga virus is a strain of eastern equine encephalitis virus, which was early on detected in Argentina. Contigiani did not discard the possibility that a variant that had greater capacity to replicate, the proliferation of competent vectors, and propitious environmental conditions could cause an outbreak in the region.

The evidence for warning about Madariaga virus is not at the same level as for chikungunya [virus], although they are in the same family (Togaviridae). "For now, the epidemiological behavior is different. Chikungunya virus has _Aedes aegypti_ as its vector, whereas the vector of Madariaga virus is within the _Culex_ genus," she said.

This study detected the virus in mosquitoes of the _Culex_ genus in wildland areas in Choco province. Thus, they identified this vector in Argentinian territory for the 1st time.

Although the mosquito species or species that had the virus could not be detected, the genus _Culex_ has more than 1000 species, many of which are of urban habits such as _Culex pipiens_ that we hear buzzing at night.

Madariaga virus can infect various mammals that could serve as hosts, such as rats and bats, as well as birds.

In Argentina, it was found for the 1st time in animals in the decade of the 1930s. The strain found in the Chaco belongs to the same lineage discovered in those years, which indicates that the virus is endemic in the region.

For now, the infections studied in humans has been for the most part mild and asymptomatic.

Adrian Diaz of the Cordoba Institute, Griselda Oria (IMR-Unne), and Carolina Torres of the Universidad de Buenos Aires participated as part of the work that was published a week ago in the American Journal of Tropical Medicine and Hygiene [reference below].

The researchers suggest that more epidemiological studies be done to determine the vectors and potential hosts and do deeper studies about the genetic characteristics of the [virus] strains that circulate in the country in order to know whether this virus is endemic in the region or is reintroduced.

"Ideally, studies will be done [in the field] with sentinel animals to detect virus circulation as well. In other countries, they use sentinel chickens for these types of studies," Contigiani commented, and clarified that in case [virus] circulation was detected, animal health officials must take relevant measures.

"There is no human vaccine, so [human] health officials must indicate measures [needed] for prevention and control," she added.

The vector is the most common, _Culex_. However, there is no virus circulation in Cordoba.

_Culex_ is a genus of hematophagous mosquitoes in the Culiidae family, many species of which act as vectors of important diseases, such as West Nile, filariasis, virus encephalitis (Japanese, Venezuelan, equine, and St. Louis) and avian malaria, as well as Madariaga virus. There are more than 80 varieties [of what?].  [Byline: Lucas Viano]
=================
[The isolation of Madariaga virus from Culex mosquitoes in northern Argentina is interesting, but, as the authors point out, merits additional studies to determine whether it is a human or animal (especially equine) pathogen of importance for human or animal health in Argentina. Studies of the Culex species involved in transmission of the virus and determination of the animal hosts are essential to understand cycles of transmission.

Reference:
Ornela Sofia Stechina, Griselda Ines Oria, Carolina Torres, Luis Adrian Diaz, Marta Contigiani and Marina Stein. First Detection of Madariaga virus in Mosquitoes Collected in a Wild Environment of Northeastern Argentina. 2019. Am. J. Trop. Med. Hyg., 00(0), 2019, pp. 1-3 DOI: <https://doi.org/10.4269/ajtmh.19-0475>.

Chaco province is in the far north of Argentina. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Chaco Province, Argentina: <http://healthmap.org/promed/p/54342>]
Date: Sun 4 Aug 2019
Source: Diario Uno [in Spanish, trans. ProMED Mod.JG, edited]

A family living in El Borbollon, Las Heras, ate ham and sausages after fixing pork at their home, but after this, 11 persons needed medical attention because of the occurrence of symptoms related to trichinellosis.

It was reported that the Provincial Livestock Direction confiscated homemade ham and sausages after receiving an alert from the Epidemiology Area of Lagomaggiore Hospital, which stated they received and attended (infected) people with symptoms of thichinellosis.

The operation was carried out last Friday in a household located in El Borbollon, which was pointed out as the infection source after 3 persons (2 of them less than legal age) were brought to Lagomaggiore Hospital seeking medical care. As days went by, 8 additional compatible cases -- presenting with similar symptoms -- were reported in Lencinas Hospital.

Once the protocol involving Food Hygiene, Zoonoses, Livestock Farming, and Epidemiology local departments and also the local municipality was activated, 2 pieces of ham, 2 pork shoulders, one piece of pork tenderloin, dry sausages and Bondiola pork were confiscated. Considering the size of these pieces, it is thought a large animal was involved.

Laboratory tests were immediately performed, and because of positive results, the meat products were destroyed and properly disposed of in a local slaughterhouse, aiming to prevent the dissemination of this disease.

Trichinellosis is a parasitic disease caused by ingesting _Trichinella spiralis_ larvae located in muscles (meat). This condition is characterized by high fever, muscle pain and vomiting or diarrhoea. The disease affects humans and many mammals. This condition is acquired by eating infected pork meat.

Common symptoms are diarrhoea, abdominal pain, fatigue, nausea, vomiting, and in severe cases also fever.
=====================
[Trichinellosis caused by _Trichinella spiralis_ is common in Argentina, especially in northern Argentina (see ProMED reports below). The source of meat is pigs from small farms or even "backyard pigs" slaughtered and processed without proper veterinary control. - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Mendoza, Mendoza, Argentina: <http://healthmap.org/promed/p/5900>]
Date: Wed 24 Jul 2019
Source: Jujuy al Momento [in Spanish, trans. ProMED Mod.TY, edited]

The disease [virus], transmitted by rodents, has now taken the life of a man, and there are 18 confirmed cases [of hantavirus infection]. There is concern in the health sector because of the lack of environmental policies to confront the problem of trash dumps, one of the environments where these animals [rodents] proliferate.

- There are now 18 confirmed cases of hantavirus [infections].
- There are 372 suspected cases.
- The increase in the number of trash dumps in the whole province contributes to aggravation of the situation.

The Ministry of Health indicated that there are 372 suspected cases of hantavirus [infections] in Jujuy, with 18 confirmed cases. An adolescent died in the Talar locality, and 17 patients are recuperating favorably.

The majority of the cases are registered in Palma Sola and San Pedro with 4 in each locality.

There was also a case of hantavirus [infection] very close to San Salvador that occurred in the Palpala rural area. This city is one of those with evidence of the greatest increase in trash dumps, to the point that several of them begin to increase in proximity to the plazas and urban neighborhoods.

_Hantavirus_ is a genus that groups various RNA viruses that are transmitted by rodents and, in humans, generally produces 2 types of afflictions: a type of viral hemorrhagic fever, a hemorrhagic fever with renal syndrome; or hantavirus pulmonary syndrome, a very serious affliction.

The disease has a strict relationship to trash deposits since this is where these [reservoir] animals eat and reproduce. Despite this, the Ministry of the Environment, headed by Maria Ines Zigaran, still has not recognized policies to attack the problem.
=====================
[Cases of hantavirus infections have been increasing in Jujuy province since early April 2019. The number of confirmed hantavirus infections in Jujuy province has increased from 11 cases reported on 8 Apr 2019, in the localities of San Pedro, Palma Sola, Libertador General San Martin, and Calilegua, to 15 cases on 10 May 2019, and now to 18 cases reported above. The above report of 372 suspected cases is a surprisingly large number. It will be interesting to learn how many of these cases are ultimately confirmed as hantavirus infections. The confirmed cases are from a variety of locations, indicating that the virus and its reservoir rodent hosts are widespread in the province. The public is well advised to follow the Ministry's recommendations for avoidance of infection.

The hantaviruses responsible for these 18 confirmed cases are not stated in the earlier reports or the one above. An earlier report from Jujuy province this year (2019) apparently presumed that the hantavirus involved in that case was Laguna Negra, although it is not stated that this virus had been laboratory confirmed. As noted in ProMED-mail archive no. http://promedmail.org/post/20110430.1348, several hantaviruses have been associated with human infection and hantavirus pulmonary syndrome in Argentina: Andes virus (in western Argentina, in the long-tailed pygmy rice rat host, _Oligoryzomys longicaudatus_); related Andes-like viruses Hu39694 (in central Argentina; rodent host unknown); Lechiguana (in central Argentina, in the yellow pygmy rice rat, _O. flavescens_); Oran (in northwestern Argentina, in _O. longicaudatus_); Bermejo (in western Argentina, in _O. flavescens_); and Laguna Negra (in northern Argentina, in _Calomys laucha_). Seoul virus with its brown rat (_Rattus norvegicus_) host (a frequenter of trash dumps) is another possibility. Without laboratory confirmation, it is not possible to say with certainty which hantavirus was involved. Andes virus seems unlikely in these cases in Jujuy province. - ProMED Mod.TY]

[Map of Argentina:

HealthMap/ProMED-mail map:
Jujuy province, Argentina: <http://healthmap.org/promed/p/53166>]
Date: Sat 29 Jun 2019 10:38 ART
Source: La Voz, Argentina [in Spanish, trans. Rapp. Kathryn Soderholm, abridged, edited]

The Ministry of Health of San Luis issued an epidemiological alert after 3 cases of trichinosis were confirmed by laboratory. The cases are one child, his father, and his mother. Another 12 probable cases are under investigation, all from the distant towns of Concaran and Villa Mercedes, 163 [101 mi] and 100 kilometres [62 mi], respectively, from the provincial capital [San Luis].

The affected patients would have contracted the disease after consuming sausages purchased in La Punilla at the beginning of June [2019], and the symptoms were detected 48 hours ago, the News Agency of the provincial state declared.

The head of Epidemiology, Rodrigo Verdugo, confirmed that the analyses were performed last [Thu 27 Jun 2019] after the suspected cases were referred on [26 Jun 2019].

The other 12 cases are being investigated and will be confirmed by blood sample.

The boy, who is 8 years old, remains hospitalized in the San Luis Hospital; another patient hospitalized in Merlo and another in Villa Mercedes.

Representatives from the department of Epidemiology with the Sanitary and Fiscal Control Program (Cosafi) toured La Punilla and Concaran, where the other cases originated, making visits to the premises that may have samples of these foods, explained Claudia Olarte, head of the Epidemiological Surveillance Service.

Verdugo noted that "this is the 1st outbreak" of this year [2019] and recalled that in 2018, 3 cases were detected, one of which also originated in La Punilla, so the Health department is also investigating in nearby towns such as Papagayos and Villa del Carmen.
=====================
[La Punilla is approximately 200 km [about 125 mi] south of Cordoba, in San Luis province. Trichinellosis has been reported often from Argentina. The source is homemade sausages from backyard pigs, slaughtered and used or sold at local markets without veterinary control. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Argentina:
Date: Sat 18 May 2019
Source: Food Safety News [edited>

Two cases of foodborne botulism linked to hummus have been confirmed by Argentinian health authorities. The National Administration of Drugs, Foods and Medical Devices (ANMAT) reported that an investigation confirmed the botulism cases and results of an epidemiological survey determined illness was associated with a hummus product. Hummus was sold under the brand Tsuki Macro Vegan, which is based in Palermo, Buenos Aires.

The general directorate of hygiene and food safety and ANMAT inspected the processing establishment where the product was made and imposed a ban on processing and marketing. It was also detected that the product did not have the relevant sanitary authorization. The processing firm was asked to carry out an immediate withdrawal from the national market of all units of the implicated branded hummus.

ANMAT advised the public to refrain from consuming the product and to keep the containers closed and separated from other foods. The agency also told those who sell the products to stop marketing it.

Botulism is a rare but life-threatening condition caused by toxins produced by _Clostridium botulinum_ bacteria. In foodborne botulism, symptoms generally begin 18-36 hours after eating a contaminated food. However, they can start as soon as 6 hours after, or up to 10 days later. Botulism can cause symptoms including general weakness, dizziness, double vision, and trouble with speaking or swallowing. Difficulty in breathing, weakness of other muscles, abdominal distension, and constipation may also occur. People experiencing these problems should seek immediate medical attention.

The latest incident follows a different outbreak in Rancul, a town in the La Pampa province of Argentina, at the start of May 2019 with 4 suspected cases. Health authorities in La Pampa reported that 4 people older than 57 years old were in a serious condition and needed hospital treatment. The poisoning was a result of a meal shared by 7 friends in Rancul. The suspected source is preserves such as peppers that were prepared in a homemade way by one of the people who fell ill.
===================
[Hummus is an unusual source of botulism but has been reported, also from a commercially produced product.

Mad'arova L, Dorner BG, Schaade L, et al.: Reoccurrence of botulinum neurotoxin subtype A3 inducing food-borne botulism, Slovakia, 2015. Euro Surveill. 2017 Aug 10; 22(32): pii: 30591. doi: 10.2807/1560-7917.ES.2017.22.32.30591.

Abstract
--------
A case of foodborne botulism occurred in Slovakia in 2015. _Clostridium botulinum_ type A was isolated from 3 nearly empty commercial hummus tubes. The product, which was sold in Slovakia and the Czech Republic, was withdrawn from the market, and a warning was issued immediately through the European Commission's Rapid Alert System for Food and Feed (RASFF). Further investigation revealed the presence of botulinum neurotoxin (BoNT) subtype BoNT/A3, a very rare subtype implicated in only one previous outbreak (Loch Maree in Scotland, 1922). It is the most divergent subtype of BoNT/A with 15.4% difference at the amino acid level compared with the prototype BoNT/A1. This makes it more prone to evading immunological and PCR-based detection. It is recommended that testing laboratories are advised that this subtype has been associated with foodborne botulism for the 2nd time since the 1st outbreak almost 100 years ago, and to validate their immunological or PCR-based methods against this divergent subtype. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
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Sudan

Sudan US Consular Information Sheet
August 29, 2008
COUNTRY DESCRIPTION:
Sudan is a diverse, developing country in northeastern Africa. The capital city is Khartoum. The civil war between the northern and southern regions, which began in 1
83, ended in 2005. A multi-party conflict continues in the west in Darfur, and the armed Ugandan group known as The Lord’s Resistance Army is present in the south. Security conditions are adverse in these and some other regions. Transportation networks and other forms of infrastructure are poor and do not meet western standards. Even where available, water and electric services suffer frequent outages. Read the Department of State Background Notes on Sudan for additional information.

ENTRY/EXIT REQUIREMENTS: The Government of Sudan requires all travelers to present a passport and an entry visa. Most travelers must obtain the entry visa before arrival; only American citizens who also possess a Sudanese national identification document (such as a Sudanese passport or national identification card) may apply for an entry visa at Khartoum International Airport. The Government of Sudan routinely denies visas to travelers whose passports contain visas issued by the Government of Israel or other evidence of travel to Israel such as exit or entry stamps.

Travelers must obtain an exit visa before departure from Sudan as well as pay any airport departure tax not included in the traveler’s airline ticket. Visitors may obtain the latest information and further details from the Embassy of Sudan, 2210 Massachusetts Avenue NW, Washington, DC 20008, tel.: 202-338-8565.

Travel permits issued by the semi-autonomous Government of Southern Sudan (GOSS) or by the South Sudan Relief and Rehabilitation Commission (SSRRC) are not adequate for entry to the country, although travelers may find these documents useful to present to local authorities when in the south. Personal baggage, including computers, is routinely searched upon arrival to and departure from Sudan. The authorities will seize material deemed objectionable, such as alcohol or pornography, and may detain or arrest the traveler. Travelers intending to bring electronic items should inquire about entry requirements when they apply for a visa; restrictions apply to many devices, including video cameras, satellite phones, facsimile machines, televisions, and telephones. Travelers are not allowed to depart Sudan with ivory, some other animal products, or large quantities of gold.

All visitors must register with the authorities within three days of arrival. Travelers must register within 72 hours of arrival in Sudan at the Ministry of Interior. All foreigners traveling more than 25 kilometers outside of Khartoum must obtain a travel permit from the Ministry of Humanitarian Affairs in Khartoum. This applies to all travel, including private, commercial, and humanitarian activities. Americans risk detention by Sudanese authorities when traveling more than 25 kilometers outside of Khartoum without a travel permit issued by the Ministry of Humanitarian Affairs. Travelers must register again with the police within 24 hours of arrival. The government requires a separate travel permit for travel to Darfur. These regulations are strictly enforced and even travelers with proper documentation may expect delay or temporary detention from the security forces, especially outside the capital. Authorities expect travelers to strictly respect roadblocks and other checkpoints.

Travelers who wish to take any photographs must obtain a photography permit from the Government of Sudan, Ministry of Interior, Department of Aliens.

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:
On January 1, 2008, unknown assailants shot and killed two U.S. Embassy employees - an American USAID officer and a Sudanese national driver. Terrorists are known to operate in Sudan and continue to seek opportunities to carry out attacks against U.S. interests. Terrorist actions may include suicide operations, bombings, or kidnappings. U.S. citizens should be aware of the risk of indiscriminate attacks on civilian targets in public places, which include tourist sites and locations where westerners are known to congregate, and commercial operations associated with U.S. or Western interests. Terrorists are known to have targeted both official facilities and residential compounds. Anti-American sentiment is prevalent and Americans should exercise utmost caution at all times.

The U.S. Embassy’s ability to provide consular services in Sudan, including emergency assistance, is severely limited. Many areas outside the capital of Khartoum are extremely difficult to access.

Travel in many parts of Sudan is hazardous. Outside the major cities infrastructure is extremely poor, medical care is limited, and very few facilities for tourists exist.

Conflict among various armed groups and government forces continues in western Sudan, in the states of North Darfur, South Darfur, and West Darfur. Banditry and lawlessness are also common in the west. Many local residents are in camps for internally-displaced persons, and receive humanitarian assistance for basic needs such as food, water, and shelter. Expatriate humanitarian workers have been the targets of carjackings and burglaries.

Land mines remain a major hazard in southern Sudan, especially south of the city of Juba. Visitors should travel only on main roads unless a competent de-mining authority such as the UN has marked an area as clear of mines. The armed Ugandan group known as The Lord’s Resistance Army is present along the southern border and reportedly has announced it will target Americans.
Occasional clashes between armed groups representing communal interests continue to occur in the centrally-located states of Upper Nile, Blue Nile, and Bahr al Ghazal. Banditry also occurs.
Sudan shares porous land borders with nine other countries, including Chad, the Central African Republic, Uganda, Democratic Republic of Congo, Ethiopia, and Eritrea. Conflict in these countries occasionally spills over into Sudan.

Americans considering sea travel in Sudan's coastal waters should exercise caution as there have been incidents of armed attacks and robberies by unknown groups in recent years, including one involving two American vessels. Exercise extreme caution, as these groups are considered armed and dangerous. When transiting in and around the Horn of Africa and/or in the Red Sea near Yemen, it is strongly recommended that vessels convoy in groups and maintain good communications contact at all times. Marine channels 13 and 16 VHF-FM are international call-up and emergency channels, and are commonly monitored by ships at sea. 2182 Mhz is the HF international call-up and emergency channel. Wherever possible, travel in trafficked sea-lanes. Avoid loitering in or transiting isolated or remote areas. In case of emergency, contact the nearest U.S. Embassy or Consulate. In the event of an attack, consider activating Emergency Position Indicating Radio Beacons.

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

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

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

CRIME: Crime is on the increase throughout Sudan. Additional security measures should be taken at places of residence to protect life and property. Anti-American sentiments can be found throughout the country. Americans should exercise caution by avoiding crowded public areas and public gatherings. Americans should avoid traveling alone. Report all instances of anti-American acts and crime targeting westerners to the American Embassy, and report incidents of crime to the Sudanese Police.

Americans should guard their backpacks or hand luggage. When traveling by air, travelers should maintain constant contact with their baggage and assure that they do not contain illicit items, such as alcohol or military ordinance. Americans have been removed from international airlines and detained when suspect items have been detected in checked baggage.

Carjacking and armed robbery continue to occur in western and southern Sudan. Sexual assault is more prevalent in the areas of armed conflict. Travelers who do not use the services of reputable travel firms or knowledgeable guides or drivers are especially at risk. Travel outside of Khartoum should be undertaken with a minimum of two vehicles so that there is a backup in case of mechanical failure or other emergency. Solo camping is always risky.

The Sudanese mail system can be unreliable. International couriers provide the safest means of shipping envelopes and packages, although anything of value should be insured.

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Individuals with medical conditions which may require treatment are discouraged from traveling to Sudan. Medical facilities in Khartoum fall short of U.S. standards; outside the capital, very few facilities exist and hospitals and clinics are poorly equipped. Travelers must pay cash in advance for any medical treatment. Ambulance services are not available. Medicines are available only intermittently; travelers should bring sufficient supplies of needed medicines in clearly-marked containers.

Malaria is prevalent in all areas of Sudan. The strain is resistant to chloroquine and can be fatal. Consult a health practitioner before traveling, obtain suitable anti-malarial drugs, and use protective measures, such as insect repellent, protective clothing, and mosquito nets. Travelers who become ill with a fever or a flu-like illness while in Sudan, or within a year after departure, should promptly seek medical care and inform their physician of their travel history and the kind of anti-malarial drugs used. For additional information about malaria and anti-malarial drugs please see the Center for Disease Control travelers’ health web site, http://www.cdc.gov/malaria/index.htm.

Officially, people with HIV are not granted a visa and are not permitted to enter Sudan. A negative HIV test result must be presented at a Sudanese embassy or at Khartoum airport in order to obtain a visa. However, anecdotal reports indicate this requirement is not enforced in practice. Please confirm this requirement with the Embassy of Sudan at www.sudanembassy.org.

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 Sudan is provided for general reference only, and may not be accurate in a particular location or circumstance.

Road conditions throughout Sudan are hazardous due to erratic driver behavior, pedestrians and animals in the roadways, and the lack of basic safety equipment on many vehicles. Only major highways and some streets in the cities are paved; many roads are narrow, rutted, and poorly maintained. Local drivers do not observe conventions for the right-of-way, stop in the road without warning, and frequently exceed safe speeds for road, traffic, and weather conditions. Driving at night is dangerous and should be avoided if possible; many vehicles operate without lights.

In the north and west, dust storms and sand storms, known locally as haboobs, greatly reduce visibility when they occur. Roads in these areas can be quickly covered with shifting sand at any season of the year. Roads in southern Sudan often are impassable during the rainy season, from March to October.
U.S. citizens are subject to the laws of the country in which they are traveling, including traffic laws. In Sudan vehicles have the steering wheel on the left side and drivers use the right side of the road.

Traffic from side streets on the right has the right-of-way when entering a cross street, including fast-moving main streets. Traffic on the right has the right-of-way at stops. Right turns on a red light are prohibited. Speed limits are not posted, but the legal speed limit for passenger cars on inter-city highways is 120 kph (about 70 mph), while in most urban areas the limit is 60 kph (about 35 mph.) The speed limit in congested areas and school zones is 40 kph (about 25 mph).

Many local drivers carry no insurance despite the legal requirement that all motor vehicle operators purchase third-party liability insurance from the government. Persons involved in an accident resulting in death or injury must report the incident to the nearest police station or police officer as soon as possible. Persons found at fault can expect fines, revocation of driving privileges, and jail sentences, depending on the nature and extent of the accident. Persons convicted of driving under the influence of alcohol face fines, jail sentences, and corporal punishment.

Americans may use their U.S. driver's licenses for up to 90 days after arrival in Sudan, and then must carry either an International Driving Permit (IDP) or a Sudanese driver's license. There are no restrictions on vehicle types, including motorcycles and motorized tricycles.

Public transportation is limited to within and between major urban areas. Passenger facilities are basic and crowded, especially during rush hours and periods of seasonal travel. Schedules are unpublished and subject to change without notice. Vehicle maintenance does not meet U.S. standards. There is routine passenger train service on the route from Khartoum to Wadi Halfa (on the border with Egypt) and to Port Sudan (on the Red Sea.) Bus service between major cities is regular and inexpensive. Intra-city bus service in the major urban areas is regular, but most buses and bus stops are privately-operated and unmarked. Taxis are available in the major cities at hotels, tourist sites, and government offices. The motorized rickshaws in common use in Khartoum are unsafe. Travelers are encouraged to hire cars and drivers from reputable sources with qualified drivers and safe vehicles. Irregularly-scheduled mini-buses provide some public transit to rural communities; many areas lack any public transportation.

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 Sudan, the U.S. Federal Aviation Administration (FAA) has not assessed Sudan’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.

Enforcement of aviation safety standards in Sudan is uneven; civil aviation in Sudan continues to experience air incidents and accidents, including 5 crashes with at least 64 fatalities between November 8, 2007, and June 30, 2008. Incidents included engine failures, collapsed landing gear, and planes veering off the runway. Whenever possible, Americans traveling to Sudan despite the ongoing travel warning are advised to travel directly to their destinations on international carriers from countries whose civil aviation authorities meet international aviation safety standards for the oversight of their air carrier operations under the FAA’s International Aviation Safety Assessment (IASA) program. Adverse seasonal weather conditions, such as dust or sand storms in the north between April and June and severe rain storms in the south between March and October, cause frequent flight cancellations.

Two hijackings originated in Sudan in 2007; no passengers were harmed.

SPECIAL CIRCUMSTANCES: In November 1997, the U.S. imposed comprehensive financial and commercial sanctions against Sudan, prohibiting U.S. transactions with Sudan. Travelers intending to visit Sudan despite the Travel Warning should contact the Department of the Treasury, Office of Foreign Assets Control (OFAC), Office of Compliance, telephone 1-800-540-6322 or 202-622-2490, regarding the effect of these sanctions.

Travelers must be prepared to pay cash for all purchases, including hotel bills, airfares purchased locally, and all other travel expenses. Major credit cards, including Visa, MasterCard, or American Express, cannot be used in Sudan due to U.S. sanctions. Sudan has no international ATMs. Local ATMs draw on local banks only.

Travelers, including journalists, must obtain a photography permit before taking any photographs. Even with a photography permit, photographing military areas, bridges, drainage stations, broadcast stations, public utilities, slum areas, and beggars is prohibited.

Sudan is a conservative society, particularly in the capital and other areas where the Muslim population is the majority. Alcohol is prohibited by law and modest dress is expected. Loose, long-sleeved shirts and full-length skirts or slacks are recommended attire for women visitors. Women who are not Muslim are not expected or required to cover their heads. Men may wear short-sleeved shirts but short pants are not acceptable in public.

Please see our information on Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Sudanese laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in alcohol or illegal drugs in Sudan 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 as well in Sudan.

Sudan’s Public Order Courts have continued to serve as the state mechanism for morality enforcement since the early 1980's. Today the court still issues punishments ranging from fines, to lashings, to lengthy prison sentences for offences such as drinking alcohol, wearing inappropriate clothing, or associating with unmarried women.

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 Sudan 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 Sudan. 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 Sharia Ali Abdel Latif, Khartoum, Sudan; tel: 249 1 83 774-701, http://sudan.usembassy.gov/.
* * *
This replaces the Country Specific Information dated March 12, 2008, to update sections on Entry/Exit Requirements, Medical Facilities and Health Information, Aviation Safety Oversight, and Criminal Penalties.

Travel News Headlines WORLD NEWS

Fri 11/10/2019 14:43
WorldHealthOrganizationNews@who.int

Attributable to the Federal Ministry of Health in Sudan, WHO and UNICEF

KHARTOUM, 11 October 2019 -  "Sudan has launched an oral cholera vaccination campaign in response to the ongoing outbreak of cholera. More than 1.6 million people aged one year and above in the Blue Nile and Sinnar states will be vaccinated over the coming five days.  “The announcement of the Federal Ministry of Health in Sudan on the cholera outbreak last month allowed national and state authorities, and health partners, to act quickly and respond to the outbreak.

“Since the announcement on 8 September, 262 cases of suspected cholera and eight related deaths have been reported as of 9 October in the Blue Nile and Sinnar states. No cholera-related deaths have been reported since mid-September. “The vaccines were procured and successfully shipped using funding from Gavi, the Vaccine Alliance. In addition, Gavi is providing nearly US$ 2 million to cover operational costs for the campaign.

“We joined efforts to respond as quickly as possible to contain the current outbreak of cholera and prevent it from spreading further in Sudan. The vaccination campaign kicking off today in combination with other measures including scaling up water, sanitation and hygiene activities, enhancing surveillance, prepositioning supplies and case management, will help protect people who are at highest risk.

“The first round of the campaign will conclude on 16 October and will be followed by a second round in four to six weeks to provide an additional dose to ensure people are protected for at least the next three years.  “As part of the campaign, over 3,560 vaccinators, more than 2,240 social mobilizers, and almost 70 independent monitors have been trained and deployed to the two affected states.”
Date: Wed 9 Oct 2019
Source: Dabanga [edited]

Arbaat in El Ganeb locality in Sudan's Red Sea state reported 10 new cases of suspected Rift Valley fever* on Monday and Tuesday [7 and 8 Oct 2019], bringing the total number of registered cases to 5, and 3 deaths.  Doctor Ahmed Dereir told Radio Dabanga about the spread of the disease in 8 villages in the area of Arbaat, pointing out that the cases were transferred to Port Sudan for treatment. He explained that the governor formed an emergency room of 35 people representing various government agencies, medical committees, and members of the Forces for Freedom and Change.

Ali Bayrak, head of the Community Support Committee for the residents of Arbaat called on the government for the explicit announcement of the results of laboratory testing of samples.  The state Ministry of Health committed to provide 2 doctors to the villages of the Arbaat Administrative Unit and training 10 medical staff, and 3 midwives, in addition to the distribution of water chlorination tablets and the provision of 3 spraying vehicles.

As reported by Radio Dabanga on Sunday [6 Oct 2019], one man and more than 20 head of cattle died in Arbaat on Thursday and Friday [3 and 4 Oct 2019], and that to date, so far, 3 people and 420 cows have died of the disease, now suspected to be Rift Valley fever, that hit the area of Arbaat, north of Port Sudan, over the past weeks, medical doctor Ahmed Dereir told Radio Dabanga.

According to the UN World Health Organisation (WHO) Rift Valley fever (RVF) is a viral zoonosis that primarily affects animals but also has the capacity to infect humans. Infection can cause severe disease in both animals and humans. The disease also results in significant economic losses due to death and abortion among RVF-infected livestock.

RVF virus was 1st identified in 1931 during an investigation into an epidemic among sheep on a farm in the Rift Valley of Kenya, and most cases occur in Sub-Saharan Africa.

Key facts:
- Rift Valley fever (RVF) is a viral zoonosis that primarily affects animals but can also infect humans.
- The majority of human infections result from contact with the blood or organs of infected animals.
- Human infections have also resulted from the bites of infected mosquitoes.
- To date, no human-to-human transmission of RVF virus has been documented.
- The incubation period (the interval from infection to onset of symptoms) for RVF varies from 2-6 days.
- Outbreaks of RVF in animals can be prevented by a sustained programme of animal vaccination.
==================
[On Wed 9 Oct 2019, villages in the area of Arbaat in El Ganeb locality in Red Sea state reported 9 new cases suspected to be Rift Valley fever, bringing the total number of reported cases to 65 (<https://www.dabangasudan.org/en/all-news/article/nine-more-cases-of-rift-valley-fever-in-sudan-s-red-sea-state>). In addition to the Red Sea state outbreak mentioned above, a separate report indicates that Rift Valley fever is occurring in Sudan's River Nile state (see Rift Valley fever - Sudan: (RS,NR) human, animal, alert, OIE Archive Number: http://promedmail.org/post/20191014.6726088). These 2 Sudan states mentioned above are adjoining, so it is not surprising that suspected or confirmed Rift Valley fever (RVF) outbreaks are occurring there simultaneously. The Ministry of Health is investigating the outbreaks in both states. Not only are these outbreaks a human health problem, they are clearly an animal health problem as well, with 420 cattle reported dying of the disease. A One Health response is urgently needed, with participation of physicians, veterinarians and entomologists. There was evidence of RVF virus in the neighbouring Central African Republic this year (2019). Last year (2018), human and animal cases occurred in neighboring South Sudan (see Valley fever - South Sudan (09): (EL) human, animal, WHO http://promedmail.org/post/20180410.5735975).

If focal geographic areas of transmission are identified in this Sudan situation, increased surveillance of people and livestock should be initiated and livestock vaccination considered. RVF-infected livestock can pose a significant risk to humans in contact with them, often livestock owners and veterinarians. Abortions in livestock with a loss in productivity present an economic problem for many ethnic groups that depend on them for livelihoods.

The above report mentions abortion storms in a River Nile state outbreak that could have had serious economic, social and public health consequences. It is likely that RVF virus will persist in this area in transovarially infected eggs of _Aedes_ mosquito vectors. These eggs can remain viable for long periods and hatch when flooded during future rain events, with subsequent emergence of infected females ready to transmit the virus. This risk provides justification for maintaining livestock of the area well vaccinated into the future. - ProMED Mod.TY]

[A media (radio) report on an event of human and animal disease, in Sudan's area of Arbaat, north of Port Sudan, Red Sea state, caused by an "unknown fever" killing 3 people and 420 cows, was posted by ProMED-mail on 6 Oct 2019 as "undiagnosed," RFI (http://promedmail.org/post/20191006.6712623). The commentary suggested RVF as possible etiology, requesting further information. According to Sudan's official OIE report, dated 13 Oct 2019, an event of RVF has been diagnosed in "Arabaata dam area, Alghunub Wa Alolaib, Red Sea state" (http://promedmail.org/post/20191014.6726088), the animals affected being goats, which are thus considered, in this event, the virus' primary victims and main source of human infection, directly or through vectors. The samples from the goats were found RVF-infected by ELISA. In difference with the earlier media (radio) report, the OIE report indicated that there are "no cattle and sheep in this area." A media report dated 12 Oct 2019 (<https://khartoumstar.com/en/2019/10/12/ministry-of-health-rift-valley-fever-in-northern-sudan/>) reported RVF "emerging" in Sudan's River Nile state, naming the locations Berber, north of Bawqa, Ftouar, Joule and Sulaimaniya, and the Artoli region of the East Bank. The report cited Hatem Fadl, an official in the epidemiology and emergency department at the Federal Ministry of Health, saying that "4 cases of Rift Valley fever were diagnosed among 17 samples taken last week, [which] were sent to the Central Laboratory in Khartoum." Hatem pointed out that the Federal Minister of Health commissioned a team to investigate the injuries, [which] arrived in the villages of Artoli, Al-Bawqa, and Fatwwar [Fri 11 Oct 2019], before the disease was officially announced (12 Oct 2019). Additional data were included in the same media source on 13 Oct 2019 (<https://khartoumstar.com/en/2019/10/13/attempts-to-control-rift-valley-fever-in-the-nile-river-state/>). No details on animal cases in River Nile state have become available, nor specific lab results of the human samples. Additional information from Sudan, and clarification on the discrepancies between the media reports as far as animal species are concerned, will be welcomed. - ProMED Mod.AS]

[A map showing the location of the 2 states mentioned above can be accessed at:

HealthMap/ProMED map available at:
Date: Thu 19 Sep 2019
Source: Dabang Sudan [edited]

The Ministry of Health has reported 22 suspected cases of haemorrhagic fever in Kassala in eastern Sudan.

In a press statement, the director of emergencies and epidemics, Emtiaz Ata, told reporters that the ministry is examining suspected cases to make sure of the suspicion and to find out more about the disease.

The director-general of the Ministry of Health, Nureldin Hussein, said that the health situation in Kassala is not reassuring, and there must be measures and considerable precautions to adequately address the health issue and avoid epidemics.
========================
[It is not clear what is the cause of these suspected cases of hemorrhagic fever or whether epidemiological investigations have been carried out, laboratory tests conducted, the clinical course of the illness determined, or any specific response measures taken. Any updates from the public health personnel and physicians on the ground will be highly appreciated. - ProMED Mod.UBA]

25 September, 2019 – A shipment of 36 tons of cholera treatment medicines and supplies have arrived in Khartoum and are being prepared for distribution as part of the World Health Organization’s response activities supporting the Federal Ministry of Health in Sudan to contain and halt a cholera outbreak.

The shipment includes 5000 rapid diagnostic tests (RDTs) for immediate detection and screening of cholera patients at health facilities and high-risk areas. RDTs are an essential part of early detection and response activities as their use ensures timely management and reporting of cholera cases.

The shipment also contains medicines that can treat 2500 severely dehydrated patients, and which will be distributed to cholera treatment centres in Blue Nile and Sinnar states, where cases have been confirmed, as well as in the neighbouring at-risk states of White Nile, Kassala, Gedaref and Khartoum.

“Even with the rapid depletion of our resources, we are accelerating our coordinated response, including delivering more medicines and supplies,” said Dr Naeema Al Gasseer, WHO Representative in Sudan. “We are working around the clock with the Federal Ministry of Health, state authorities and partners to control the outbreak and prevent more deaths.”

As of 24 September, a total of 184 cholera cases have been reported, including 128 cases from Blue Nile State and 56 cases in Sinnar state. Eight cholera-related deaths have been recorded by the Federal Ministry of Health, including 6 in Blue Nile State and 2 in Sinnar State.

Open defecation, lack of clean water outside the capital city and a dilapidated health sector are serious threats in a country of about 40 million people. Cholera, a bacterial disease usually contracted from contaminated water supplies, can be fatal if not treated early.

As part of an overall integrated cholera response plan, WHO is working with the Ministry, state-level health ministries, United Nations agencies and nongovernmental organizations on surveillance of cases to monitor and control spread of the disease; maintain clean water, sanitation and nutrition; and raise awareness among at-risk communities.

To date, WHO has deployed international experts to support the ongoing response activities and has trained and deployed 9 rapid response teams, each consisting of at least 3 members, for assessment and surveillance of high-risk areas. 18 health volunteers have also been trained and deployed to conduct water quality assessments in the 2 affected States. WHO is also actively disseminating awareness messages on health and sanitation through focus group discussions with community leaders, especially women, and training workshops are ongoing for volunteers on conducting house-to-house and community visits to deliver relevant health messages.
Date: Thu, 26 Sep 2019 11:57:24 +0200 (METDST)

Khartoum, Sept 26, 2019 (AFP) - Eight people have died from cholera in Sudan including six in the war-torn state of Blue Nile, according to the World Health Organisation, amid a surge in the number of reported cases.   A total of 184 cases of cholera have been reported in the northeast African country over the past month, including 128 cases from Blue Nile and 56 in Sinnar state, WHO said in a statement late Wednesday citing health ministry records.

"Eight cholera-related deaths have been recorded by the federal ministry of health, including six in Blue Nile state and two in Sinnar state," WHO said.   "We are working around the clock with the federal ministry of health, state authorities and partners to control the outbreak and prevent more deaths," WHO Sudan head Naeema al-Gasseer said in the statement.

WHO said a shipment of 36 tonnes of cholera treatment medicines and supplies have arrived in Khartoum and are being prepared for distribution as part of the organisation's response activities.   The shipment also contains medicine to treat 2,500 severely dehydrated patients, which is set to be distributed to cholera treatment centres in Blue Nile and Sinnar states, as well as other neighbouring high-risk states.

Cholera, a bacterial disease usually contracted from contaminated water supplies, can be fatal if not treated early.   Open defecation, lack of clean water outside Khartoum, and a dilapidated health sector further increases the threats from such diseases in a country of about 40 million people.   Dozens of people died from acute diarrhoea in Sudan in 2016 after thousands of cases were reported nationwide.   Blue Nile state, which has a large ethnic minority population, has been the focus of a rebellion by the Sudan People's Liberation Army-North since 2011.   The army declared a ceasefire after the overthrow of veteran president Omar al-Bashir earlier this year.
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Liechtenstein

Switzerland and Liechtenstein US Consular Information Sheet
December 01, 2008
COUNTRY DESCRIPTION:
Switzerland is a highly developed democracy.
Liechtenstein is a democratically run constitutional monarchy.
Read the Department of
State Background Notes on Switzerland for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport is required for travel to both Switzerland and Liechtenstein.
A visa is not required for stays up to 90 days in either country.
For more information on entry requirements for both countries, travelers may contact the Embassy of Switzerland at 2900 Cathedral Avenue, NW, Washington, DC 20008, telephone (202) 745-7900, or the nearest Swiss Consulate General in Atlanta, Chicago, Los Angeles, New York, or San Francisco.
Visit the Embassy of Switzerland’s web site at http://www.swissemb.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:
Although there have been no recent terrorist attacks in Switzerland, violence by anti-globalization, anti-Semitic, and anti-establishment (anarchist) groups does occur from time to time.
This violence is typically in the form of property damage and clashes between these groups and the police.
The potential for specific threats of violence involving American citizens in Switzerland is remote.
Nevertheless, the Consular Agencies in Zurich and Geneva may close periodically to assess their security situation.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

CRIME:
Switzerland has a low rate of violent crime.
However, pick-pocketing and purse snatching do occur in the vicinity of train and bus stations, airports, and some public parks, especially during peak tourist periods (such as summer and Christmas) and when conferences, shows, or exhibits are scheduled in major cities.
Liechtenstein has a low crime rate.
Travelers may wish to exercise caution on trains, especially on overnight trains to neighboring countries.
Thieves, who steal from passengers while they sleep, can enter even locked sleeping compartments.
Thieves have been known to work in pairs to target train passengers; while one member of the pair creates a diversion at a train window or on a platform, the other steals items left briefly unattended.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, 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.

Switzerland, through its 26 cantons (states), has programs to assist victims of crime and their immediate relatives.
Medical, psychological, social, financial, and legal assistance are available throughout the country.
These programs also protect the rights of the victim during criminal proceedings.
The victim may receive compensation for some damages, if requested during the criminal procedure.
Information is available at the Swiss Department of Justice located on Bundesrain 20, 3003 Bern, telephone: 41-31-322-4750, as well as on the Internet at http://www.bj.admin.ch/bj/en/home.html
The local equivalent to the “911” emergency line in Switzerland is fire 118; police 117; medical 144.
For additional assistance, including possible U.S. compensation, see our information for Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Good medical care is widely available.
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 .

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Switzerland.
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 Switzerland is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Although many roads are mountainous and winding, road safety standards are high.
In some mountain areas, vehicle snow chains are required in winter.
Road travel can be more dangerous during summer, winter holidays, the Easter break, and Whitsunday weekend (late spring) because of increased traffic.
Travel on expressways (indicated by green signs with a white expressway symbol) requires purchase of a sticker or “vignette,” which must be affixed to the car’s windshield.
Vignettes can be purchased at most border crossings points, gas stations and at Swiss post offices.
Drivers using the highway system without a vignette are subject to hefty fines levied on the spot.
Public transportation in Switzerland and Liechtenstein is excellent.

Please refer to our Road Safety page for more information.
Visit the website of Switzerland’s national tourist office at http://www.myswitzerland.com/en.cfm/home.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Switzerland’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Switzerland’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:
Travelers who plan to participate in mountain activities (summer and winter) are strongly encouraged to buy mountain search and rescue insurance. Costs of search and rescue operations are the responsibility of the victim. Search and rescue insurance is available inexpensively in Switzerland and may be purchased at many Swiss post offices.
Information can be obtained from the Swiss National Tourist Office, at http://www.myswitzerland.com, at most tourist information offices or with the Swiss Air Rescue Organization at http://www.rega.ch/en/start_en.aspx .
Such insurance has proved useful as uninsured rescues can easily cost $25,000.

Switzerland’s customs authorities encourage the use of an ATA (Admission Temporaire/Admission) Carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes.
ATA Carnet Headquarters located at the U.S. Council for International Business, 1212 Avenue of the Americas, New York, N.Y. 10036, and issues and guarantees the ATA Carnet in the United States.
For additional information call (212) 354-4480, send an email to atacarnet@uscib.org, or visit http://www.uscib.org for details.
Please see our information on Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Switzerland’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Switzerland 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 Switzerland are encouraged to register with the U.S. Embassy in Bern, with the Consular Agencies in Geneva or Zurich, or through the State Department’s travel registration web site, and to obtain updated information on travel and security within Switzerland and Liechtenstein.
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, Consulate, or Consular Agent to contact them in case of emergency.
The U.S. Embassy is located at Sulgeneckstrasse 19, 3007 Bern; Tel. (41)(31) 357-7011 (2 p.m. – 5 p.m.); fax (41)(31) 357-7280.
The Embassy’s email address is bernacs@state.gov.
The U.S. Embassy website at http://bern.usembassy.gov answers many questions of interest to Americans visiting and residing in Switzerland.

The U.S. Consular Agency in Zurich is located at the American Center of Zurich, Dufourstrasse 101, 8008 Zurich; Tel: (41)(43) 499-2960 (10 a.m. – 1 p.m.), fax (41)(43) 499-2961.
The U.S. Consular Agency in Geneva is located at rue Versonnex 7, CH-1207 Geneva, Tel: 022-840-51 60 (10 a.m. – 1 p.m.); fax 022-840-51 62.
There is no U.S. Embassy or Consulate in Liechtenstein.
For assistance and information on travel and security in Liechtenstein, U.S. citizens may contact or register at the U.S. Embassy in Bern at the address above.
*
*
*
This replaces the Consular Information Sheet dated March 3, 2008 with changes to the sections on Crime and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Wed, 15 Jan 2014 18:09:10 +0100 (MET)

GENEVA, Jan 15, 2014 (AFP) - Liechtenstein will close its only maternity ward, where some 200 babies are born each year, after all the gynaecologists working there quit at the same time, the government said Wednesday.    "The government regrets the closure of the maternity ward," Health Minister Mauro Pedrazzini said in a statement.

The doctors had decided to leave amid uncertainty over the future of the establishment, the authorities in the tiny landlocked country between Switzerland and Austria explained, saying the ward would close for good during the spring.   The citizens of Liechtenstein in 2011 rejected by popular vote to dish out the cash needed to build a new hospital building and replace the ageing infrastructure.

Since then, the authorities in the country of fewer than 37,000 people, have been struggling to push through a modernisation plan for the maternity ward to bring it up to the standards demanded by the doctors working there.   Each year, some 200 babies are born at the ward, while another some 200 babies are born to Liechtenstein citizens who decide to travel abroad to give birth, mainly to neighbouring Switzerland and Austria.   Once the Liechtenstein ward closes, all young Liechtensteiners will be born abroad.
Date: Tue, 17 Nov 1998 12:14:59 -0500 From: ProMED-mail
14 Mar 2000 VADUZ, Liechtenstein (AP) - Liechtenstein's government Tuesday approved a package of measures to tighten rules against money laundering, insisting that this tiny country has no wish to attract dirty money. The bill, which has been sent to parliament for immediate action, would increase the obligations of financial institutions to report suspicious deposits and expand bribery sanctions to cover payoffs to foreign officials. Banks would have to make more thorough checks on the origin of funds. The government has appointed a special prosecutor to investigate allegations - reported last year in the German news magazine Der Spiegel - that the Alpine principality has become an international money laundering center. See http://www.infobeat.com/stories/cgi/story.cgi?id=2564961602-dc8
More ...

Timor-Leste

General Information:

The People’s Republic of China is the world’s third largest nation in land mass and shares borders with 16 other countries. It is the worlds most populated country. Nowadays many Irish travellers will b

going to China for business or holiday trips. Much of the country is mountainous or semidesert and the country lies almost entirely in the temperate zone. Only portions of the southern-most area - the provinces of Yunnan and Guangdong, and the Zhuang autonomous region of Guangxi - lie within the tropics. The monsoon climate is a major influence in the south, but the north and west have a typical continental climate.

Weather Profile: 

During the summer, warm moist maritime air masses bring heavy rains to eastern China, and hot humid summer weather is typical. Winter offers a sharp contrast when Siberian air masses dominate. In late winter and spring strong north winds sweep across north China and hazy days caused by dust storms are common. Beijing’s spring is mostly dry. In July and August the weather turns hot and humid. Autumn is the nicest time of the year with many warm, clear days and little wind usually. Chest Complaints  Because of the prevailing dust, increased transportation and the burning of soft coal during the winter, Beijing and other major cities in China have a high rate of pollution. This may exacerbate bronchial and/or sinus complaints. The dust level in Lhasa is also very high and this may lead to respiratory problems.

Safety & Security:

The risk of crime against tourists is low but care of personal belonging should be observed at all times. Maintenance of buildings and general safety precautions may not always be in place and so checking for fire exits (and that they are unblocked) is wise. Use the hotel safety boxes and carry photocopies of any important documents rather than the originals where possible.

Local Medications:

Western brand-name drugs or non-prescription medicines are seldom available locally although some Chinese equivalents are to be found at reasonable prices. Always carry your own medication (well marked) on your person and bring enough for your trip.

Rabies:

Rabies is a serious problem throughout China. Reports indicate that as many as five million people are bitten each year by rabid dogs and that approximately 5,000 of these patients die. Travellers should stay well clear of any warm blooded animals, especially dogs. Any contact (lick, bite or scratch) should be treated seriously and immediately by washing out the wound, applying an antiseptic and then seeking urgent medical attention.

River Boat Travel:

Many of the older river boats in China use untreated river water for washing dishes and in the bathrooms. This increases the risk of illnesses such as traveller’s diarrhoea and a parasitic disease called schistosomiasis (Bilharzia). Also be careful that the ferry is not overcrowded and be aware of any sharp corners or rusty edges due to lack of maintenance.

Altitude Sickness in Tibet:

Virtually all of the Tibetan Autonomous region, much of Quinghai and Xinjiang, parts of Sichuan, Yannan and Gansu are above 13,000 feet in altitude. Some main roads in Tibet, Qinghai and Xinjiand go above 17,000 feet. At these levels the available oxygen is very low and altitude sickness may occur. Travellers may experience severe headaches, nausea, dizziness, shortness of breath or a dry cough. These symptoms usually settle over a few days with rest, but if not travellers should seek medical assistance and, if possible, descend to a lower altitude. Travellers with a history of cardiac problems or respiratory difficulties should avoid such high altitudes where possible.

Insect Bites and Malaria:

During the summer months, carry a supply of insect repellent ointments for your trip and use sensible, light coloured clothing to cover yourself when there are mosquitoes or sandflies about. The risk of malaria in most of China is limited but prophylactic tablets may be prescribed depending on your actual itinerary. Other serious mosquito borne diseases do occur so these will need to be considered.

Sunlight:

The sunlight during the summer months and in Tibet at high elevations can be intense so travellers should bring sun screen and sun-glasses and a sensible wide-brimmed hat.

Acupuncture:

Many tourists are tempted to experience this oriental art in its homeland while visiting China. It is essential to ensure that sterile needles are used at all times as otherwise there may be a risk of transmission of a blood borne disease such as the HIV virus or Hepatitis B.

AIDS risk in China:

Official figures suggest that AIDS is a very limited risk in China. Only 707 cases were reported up to October 2000. These very low figures are very difficult to verify and so all travellers should take care not to place themselves at risk where possible.

Customs Regulations: 

Never carry any medication for another individual unless they are part of your family. The Chinese authorities have strict drug regulations which may be enforced.

Vaccination Requirements: 

 There are no vaccination requirements for entry / exit purposes but travellers on short trips should consider the following ... * Poliomyelitis (childhood booster) * Typhoid (food & water disease) * Tetanus (childhood booster) * Hepatitis A (food & water disease) Those planning to spend a longer time in China should consider additional vaccination against conditions like Rabies, Hepatitis B, Japanese B Encephalitis, Meningococcal Meningitis, Diphtheria and Mantoux Test / BCG vaccination.

Summary: 

China is teeming with people and a culture very different to ours. It is a land of many contrasts. Travellers generally stay healthy if they follow standard commonsense healthcare advice.

Travel News Headlines WORLD NEWS

Date: Thu, 5 Mar 2015 13:53:47 +0100 (MET)

Dili, East Timor, March 5, 2015 (AFP) - An American tourist has returned to the United States after six months trapped in East Timor over the discovery of drugs in a taxi that she was sharing.    Stacey Addison arrived back in Portland, Oregon, on Wednesday, embracing her mother tightly during an emotional reunion at the city's airport, TV reports showed.    "It's a great feeling, it's a relief to finally be back home, be out of there," she told a local station, adding her experience in East Timor, a tiny half-island nation bordering Indonesia, had been an "emotional rollercoaster".   A Facebook group set up to advocate for her release carried a celebratory message on Tuesday announcing that she had left East Timor: "IT'S FINALLY HAPPENED! STACEY IS ON HER WAY HOME!!!!"   Addision was arrested on September 5 after methamphetamine was found in the shared taxi that was en route to the capital Dili, but denied any wrongdoing.

The veterinarian, who had just crossed from Indonesia when she was arrested, wrote on Facebook that another passenger -- who was a stranger -- picked up a package containing the drugs, and police later detained everyone in the car.   She was initially released from jail after several days but was later re-arrested, although no charges were laid against her.    Addison was released again in December, but East Timor authorities hung on to her passport while they continued to investigate her case.    Her lawyer had warned that the probe could take two years but last week the East Timor government announced that prosecutors had decided not to pursue her case and "Ms. Addison is now free to leave".   The State Department had supported Addison and pressed for her release.   East Timor, a poor half-island nation that was occupied by Indonesia for over two decades, imposes tough punishments for drugs cases, including the death penalty for traffickers.
Date: Tue, 4 Feb 2014 00:59:28 +0100 (MET)

JAKARTA, Feb 03, 2014 (AFP) - A strong 6.1-magnitude earthquake hit eastern Indonesia Tuesday but there was no tsunami alert, seismologists said.   The quake struck at 7:36 am local time (2236 GMT Monday), 318 kilometres (197 miles) east-northeast of the East Timor capital Dili in the Banda Sea at a depth of 18 kilometres, the US Geological Survey said.

The Pacific Tsunami Warning Center did not issue any alerts following the tremor in the remote region at the eastern end of the Indonesian archipelago between East Timor and the Maluku islands.   In an initial assessment, the USGS said there was a low likelihood of damage or casualties.

Indonesia sits on the Pacific "Ring of Fire", where tectonic plates collide, causing frequent seismic and volcanic activity.   A 6.1-magnitude quake struck Indonesia's main island of Java in January, damaging dozens of buildings.   Another 6.1 quake that hit Aceh province on Sumatra island in July 2013 killed at least 35 people and left thousands homeless.
Date: Sun, 1 Dec 2013 04:07:58 +0100 (MET)

AMBON, Indonesia, Dec 01, 2013 (AFP) - A 6.3-magnitude quake hit off eastern Indonesia and East Timor Sunday, seismologists said, but there was no tsunami alert or reports of damage or casualties.   The quake struck at 10:24 am local time (0124 GMT), 351 kilometres (217 miles) east-northeast of the East Timor capital Dili at a relatively shallow depth of 10 km, the US Geological Survey said.

The Pacific Tsunami Warning Center did not issue any alerts following the tremor in the remote region at the eastern end of the Indonesian archipelago between the islands of Timor and New Guinea.   In an initial assessment, the USGS said there was a low likelihood of damage or casualties.   Indonesian officials said they had not received any reports of casualties or damage so far.   "From data, the epicentre is quite a distance from the nearest cities and the intensity of shaking is not destructive," Suharjono, the technical head of Indonesia's geophysics and meteorology agency, told AFP.

An AFP correspondent in Dili said no tremor was felt.   Johanes Huwae, a police official in the Maluku provincial capital Ambon, one of the cities closest to the epicentre, said "there was no shaking, everything's safe", while the national disaster management agency reported "slight shaking for three to five seconds" in Southwest Maluku.   Indonesia sits on the Pacific "Ring of Fire", where tectonic plates collide, causing frequent seismic and volcanic activity.   A 6.1-magnitude quake that struck Aceh province on Sumatra island in July killed at least 35 people and left thousands homeless.
Date: Tue 20 Mar 2012
From: Helen Hanson <helenjhanson@gmail.com> [edited]

Re: Meng Ling Moi's post from Japan re: DENV-3 in 3 Japanese travelers returning from East Timor in March [see ProMED-mail archives 20120319.1074013 and 20120306.1060914]

I am the Australian Embassy's doctor in Dili, East Timor. Our clinic sees expatriates and some locals.

It is likely that I saw one or more of the travellers concerned prior to their return to Japan.

Our small one-doctor clinic saw 45 test-confirmed cases of dengue in February [2012] alone, mostly expatriates. These are not included in the 161 test confirmed cases for East Timor quoted in the previous post. Serotyping is not available in Dili, however reports from my colleagues at the ASPEN military medical facility, where blood samples have been sent to Australia for analysis, have also shown DEN-3 to be the circulating serotype.
-------------------------------------------------
Dr Helen Hanson
Australian Embassy Clinic
Dili, East Timor
helenjhanson@gmail.com
=========================
[ProMED-mail thanks Dr Helen Hanson for this 1st hand report. These types of reports from health professionals in the field who are dealing with outbreaks are especially valuable sources of reliable, current information. Her report confirms the circulation of dengue virus 3 in East Timor.

A HealthMap/ProMED-mail interactive map of East Timor can be accessed at
<http://healthmap.org/r/1KlU>. - ProMed Mod.TY]
Tuesday 6th March 2012
A ProMED-mail post
<http://www.promedmail.org>

- East Timor (national). 2 Mar 2012. As of 24 Feb [2012], the Ministry of Health had received 563 reports of dengue (161 confirmed by laboratory tests) in every district except one, including 192 reports of DHF that causes severe abdominal pain, vomiting, and in worst cases, death. This is a 36 per cent increase over reports for the 1st 2 months of 2011. As of 1 Mar [2012], 10 people had died from dengue, according to the government.
=====================
[A HealthMap/ProMED-mail interactive map of East Timor can be accessed at <http://healthmap.org/r/1KlU>. - ProMed Mod.TY]
More ...

Northern Mariana Islands

General:
**********************************
Cuba is an independent island country situated in the Caribbean. It is the largest of the islands and covers 42,000sq miles. The climate is sub tropical throughout the year with most of the rainfall in
the northern parts of the country. Temperatures of between 20C to 35C are fairly standard throughout the year. Generally the winter effects of the American continent only last for short periods.
Safety & Security:
**********************************
The majority of tourists visiting Cuba will have no difficulty but bag snatching and other street crime appears to be increasing. The old Havana area and other major tourist resorts may be particular areas of concern in this regard. On arrival be careful to only use your recognised tour operator. If you are taking a taxi at any stage make sure it is a registered one and not a private vehicle. It is unwise to carry large quantities of money or jewellery away from your hotel and try not to flaunt wealth with your belongings. Pickpockets are too common an occurrence on buses and trains and at train stations so be careful with your essential documents and credit cards. Valuables should not be stored in suitcases when arriving in or departing from Havana as there have been a number of thefts from cases during the time the cases are coming through baggage handling. There is an airport shrink-wrap facility for those departing Havana which reduces the risk of tampering. Remember to carry a photocopy of your main documents (passport, flight tickets etc).
Road Safety:
**********************************
Following a number of serious road accidents involving tourists, you are advised not to use mopeds for travelling around Cuba or in Havana. Also, if you are involved in any accident a police investigation will be required to clear you and this may significantly delay your travel plans. On unlit roads at night there have been a number of accidents associated with roaming cattle (sounds like Ireland!). The traffic moves on the right side of the roads. There is a main highway running the length of the country but many of the country roads are in poor repair.
Local Laws & Customs:
**********************************
When arriving into Cuba make sure you are not carrying any items which could be considered offensive. Any illicit drug offense is treated very seriously and Cuban law allows for the death penalty to be used under these circumstances. If you require personal medication for your health, make sure it is in original packing and carry a letter from your doctor describing the medication. Never agree to carry any item for another individual and always secure your cases once they are packed. Taking photographs of military or police installations or around harbours, rail and airport facilities is strictly forbidden.

Currency:
**********************************
Since 1993 it is now possible to use US dollars for all transactions within Cuba. Remember, there is a 20$ airport departure tax. Certain travellers cheques and credit cards may not be acceptable within Cuba. This is particularly true of American Express cheques and cards but check your situation with the travel operator before departure.
Health Facilities:
**********************************
Generally healthcare facilities outside of Havana are limited and many standard medications may not be available. It is important to carry sufficient quantities of any medications which may be required for the duration of your time in Cuba.
Food & Water:
**********************************
The level of food and water hygiene varies throughout the country and between resorts. On arrival check the hotel cold water supply for the smell of chlorine. If it is not present then use sealed bottled water for both drinking and brushing your teeth throughout your stay. Cans and bottles of drinks are safe but take care to avoid pre-cut fruit. Peel it yourself to make sure it is not contaminated. Food from street vendors should be avoided in most cases. Bivalve shellfish are also a high risk food in many countries and Cuba is no exception in this regard. (Eg Mussels, Oysters, Clams etc)
Malaria & Mosquito Borne Diseases:
***********************************************
Malaria transmission does not occur within Cuba and so prophylaxis is not required. However, a different mosquito borne disease called Dengue has begun to reoccur in the country over the past few years. This viral disease can be very sickening and even progress to death. It is rare for tourists to become infected but avoiding mosquito bites is a wise precaution.
Swimming, Sun & Dehydration:
************************************
The extent of the Cuban sun (particular during the summer months (April to October) can be very excessive so make sure your head and shoulders are covered at all times when exposed. Watch children carefully as they will be a significant risk. Drink plenty of fluids to replace what will be lost through perspiration and, unless there is a reason not to,
take extra salt either on your food or in crisps, peanuts etc. Take care if swimming in the Caribbean to stay with others and to listen to local advice. Never swim after a heavy meal or alcohol.
Rabies Risk in Cuba:
**********************************
This viral disease does occur throughout Cuba and it is essential that you avoid any contact with all warm blooded animals. Dogs, cats and monkeys are the most commonly involved in spreading the disease to humans. Don't pick up a monkey for a photograph! If bitten, wash out the wound, apply an antiseptic and seek urgent medical attention.
Vaccinations for Cuba:
**********************************
There are no essential vaccines for entry / exit if coming from Ireland. However, for your own personal protection travellers are advised to have cover against the following;
*
Tetanus (childhood booster)
*
Typhoid (food & water borne disease)
*
Hepatitis A (food & water borne disease)
For those planning a longer or more rural trip vaccine cover against conditions like Hepatitis B and Rabies may also need to be considered.
Summary:
**********************************
Cuba is becoming a popular destination for tourists and generally most will stay very healthy. However commonsense care against food and water borne disease is essential at all times. Also take care with regard to sun exposure, dehydration and mosquito bites.

Travel News Headlines WORLD NEWS

More ...

Mongolia

Mongolia US Consular Information Sheet
November 21, 2008
COUNTRY DESCRIPTION:
Mongolia is a vast country of mountains, lakes, deserts and grasslands approximately the size of Alaska.
It peacefully abandoned its communist system in 199
and has been successfully making the transition to a parliamentary democracy.
Economic reforms continue, although the country’s development will depend on considerable infrastructure investment, particularly in the mining, energy, transportation, and communication sectors.
Travelers to Mongolia should be aware that shortcomings in these areas might have an impact on travel plans.
Read the Department of State Background Notes on Mongolia for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid passport is required for American visitors.
No visa is required for Americans visiting for fewer than 90 days; however, visitors planning to stay in Mongolia for more than 30 days are required to register with the Office of Immigration, Naturalization and Foreign Citizens in Ulaanbaatar within the first seven days of arrival.
American visitors who fail to register and who stay longer than 30 days, even for reasons beyond their control, will be stopped at departure, temporarily denied exit, and fined.
It is recommended that visitors who will be in Mongolia beyond 30 days register with the Office of
Immigration, Naturalization and Foreign Citizens within the first seven days of their arrival.

Americans planning to work or study in Mongolia should apply for a visa at a Mongolian embassy or consulate outside of Mongolia.
Failure to do so may result in authorities denying registration, levying a fine, and requiring that the visitor leave the country.
Travelers arriving or departing Mongolia through China or Russia should be aware of Chinese and Russian visa regulations (transiting twice will require a double- or multiple-entry visa) and note that some land-entry points have varying days and hours of operation. Many small land border posts do not operate on a fixed schedule.
Travelers need to check with immigration authorities to make certain the post they intend to use will be open when they want to enter. Travelers planning travel to Russia should get visas prior to arriving in Mongolia, because they are difficult to obtain at the Russian Embassy in Mongolia. For more information on these requirements, see the Country Specific Information for Russia and China.

Travelers without Mongolian visas are subject to an exit tax payable either in U.S. dollars or Mongolian Tugrugs upon departure.
American citizen visitors to Mongolia do not require a visa if they stay less than 30 days and no fee is payable if they depart within the 30 day period.
If they stay longer without having registered with immigration, a penalty fee will be assessed at time of departure.
Travelers should inquire whether the exit tax is included with the price of the airline ticket at the time of purchase. In an effort to prevent international child abduction, many governments have initiated procedures at entry/exit points.
These often include requiring documentary evidence of relationship and permission for the child’s travel from the parent(s) or legal guardian if not present.
Having such documentation on hand, even if not required, may facilitate entry/departure.

Visit the Embassy of Mongolia web site at http://www.mongolianembassy.us for the most current visa information.
Travelers can also contact the Embassy of Mongolia at 2833 M Street NW, Washington, DC
20007, telephone (202) 333-7117 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:
There have been no significant acts of terrorism or extremism in Mongolia. There are no regions of instability in the country.
U.S. citizens are advised to avoid all protests, including political protests, and street demonstrations that occur occasionally in Ulaanbaatar, as the demonstrations may become violent.

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

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

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

CRIME:
Over the past few years there has been a significant rise in street crime in Mongolia, particularly in Ulaanbaatar, the capital.
Violent crime, particularly aggravated assault, is increasing, and it is not advisable to walk alone through the city after dark.
The most common crimes against foreigners are pick pocketing and bag snatching.
There are reports of organized groups operating in open areas, usually after dark, who surround, grab, and choke an individual in order to search the victim’s pockets.
Thieves have also sliced victims’ clothing in attempts to reach wallets, cell phones and other valuables.
U.S. citizens who detect pick pocket attempts should not confront the thieves, as they may become violent.
Caution is advised when using public transportation and in crowded public areas, such as open-air markets, the Central Post Office and the Gandan Monastery.
Crime rises sharply before, during and after the Naadam Summer Festival in July and throughout the summer tourist season, as well as during and after Tsagaan Sar, the Winter Festival, in January or February.

Travelers should be extremely cautious at these specific locations:
Chinggis Khan International Airport in Ulaanbaatar: tourists arriving at and departing from this airport are frequently targeted for robbery and pick pocketing by organized groups.
The State Department Store:
tourists are targeted by organized pick pocket gangs at the entries/exits/elevators and the area surrounding the store.
Naran Tuul Covered Market:
Organized criminal groups look for and target foreigners for robbery and pick pocketing.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. embassy or consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. embassy or consulate for assistance.
The embassy/consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
American victims of crime in Mongolia should be prepared to hire their own translators and lawyers if they intend to pursue a criminal complaint against a Mongolian.

The local equivalent to the “911” emergency line in Mongolia are 102 to contact the police department and 103 for a medical emergency.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Mongolia are very limited and do not meet most Western standards, especially for emergency health care requirements.
Many brand-name Western medicines are unavailable.
Ulaanbaatar, the capital, has the majority of medical facilities inside the country; outside of Ulaanbaatar, medical facilities and treatment are extremely limited or non-existent.
Specialized emergency care for infants and the elderly is not available.
Infectious diseases, such as plague, meningococcal meningitis, and tuberculosis, are present at various times of the year. Sanitation in some restaurants is inadequate, particularly outside of Ulaanbaatar.
Stomach illnesses are frequent.
Bottled water and other routine precautions are advisable.

Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost tens of thousands of dollars.
A June 2005 medical evacuation from Ulaanbaatar to Seoul, Korea, cost the patient $87,000.
Doctors and hospitals usually expect immediate payment in cash for health services.
Medical evacuation companies will not initiate an evacuation without a fee guarantee beforehand and in full.
Please see Medical Information for Americans traveling abroad.

Local hospitals generally do not contact the Embassy about ill or injured Americans in their care; hospitalized American citizens who need Consular assistance from the Embassy should ask the doctor or hospital to contact the U.S. Embassy in Ulaanbaatar.
For more information, please contact the U.S. Embassy in Ulaanbaatar, which has a list of medical facilities available to foreigners (also available on the U.S. Embassy web site at http://mongolia.usembassy.gov/) or the Centers for Disease Control and Prevention’s international traveler’s hotline (see below).
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Mongolia.

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 Mongolia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Driving in Ulaanbaatar can be extremely difficult due to poorly maintained streets, malfunctioning traffic lights, inadequate street lighting, a shortage of traffic signs, and undisciplined pedestrians.
There has been a dramatic increase in the number of vehicles on the roads in recent years, but the knowledge and skills of the driving population have not kept pace with the growth in the number of automobiles on the streets. There are many metered taxis in Ulaanbaatar.
There are a few car rental companies, but safety and maintenance standards are uncertain, and rental vehicles should be utilized with caution.
Cars with drivers can be obtained from local tourist companies.
Public transportation within the capital is extensive, cheap, and generally reliable, but it is also extremely crowded (see Information on Crime above), with the result that pickpockets often victimize foreigners.
For specific information concerning Mongolian drivers permits, vehicle inspection, road tax, and mandatory insurance, contact the Embassy of Mongolia at: 2833 M Street NW, Washington, DC
20007, telephone (202) 333-7117.

Please refer to our Road Safety page for more information.
Visit the web site of Mongolia’s national tourist office and national authority responsible for road safety at http://www.mongolianembassy.us/default.php.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Mongolia, the U.S. Federal Aviation Administration (FAA) has not assessed Mongolia’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.

The U.S. Embassy prohibits U.S. government personnel from using the domestic services of Mongolian International Air Transport (MIAT) for official travel because of uncertainties regarding service and maintenance schedules, aircraft certification and insurance status.
This prohibition does not extend to MIAT’s international flights or to the domestic flights of other carriers.
SPECIAL CIRCUMSTANCES:
Traveler’s checks in U.S. dollars are accepted at some hotels and may be converted to dollars or Tugrugs at several banks.
Credit cards can be used at a variety of hotels, restaurants, and shops in Ulaanbaatar.
Outside of the capital, travelers should have cash.
Cash advances against credit cards are available at some commercial banks such as Trade and Development Bank, Golomt Bank, Khan Bank, and Xac Bank.
International bank wire transfers are also possible.
There are a handful of VISA and Maestro/Cirrus ATM machines in Ulaanbaatar, but they do not always function and are not reliable.
ATM machines do not exist outside the capital.

U.S. consular offiers may not always receive timely notification of the detention or arrest of a U.S. citizen, particularly outside of Ulaanbaatar.
American citizens are encouraged to carry a copy of their passport with them at all times, so that, if questioned by local officials, evidence of identity and citizenship are readily available.
Severe fuel shortages and problems with central heating and electrical systems may cause seriously reduced heating levels and power outages in Ulaanbaatar and other cities during the winter.
Smaller towns in the countryside may have no heat or electricity at all.
The Embassy advises all American residents in Mongolia to be prepared to depart if there is a complete energy failure.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.

Mongolian customs authorities enforce strict regulations concerning import and export of items such as firearms, ammunition, and antiquities.
Import of firearms or ammunition requires prior approval from the Government of Mongolia.
Export of antiquities requires a special customs clearance certificate issued by authorized antique shops at the time of purchase. For additional information contact the Embassy of Mongolia at: 2833 M Street NW, Washington, DC
20007, telephone: (202) 333-7117.
Please see our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than those in the United States for similar offenses.
Persons violating Mongolia’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in Mongolia 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 Mongolia 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 Mongolia.
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: at Micro Region 11, Big Ring Road, Ulaanbaatar.
The telephone number is (976) 11-329-095, the Consular Section fax number is (976) 11-353-788, and the Embassy’s web site is http://mongolia.usembassy.gov/.
The Consular Section can be emailed directly at cons@usembassy.mn.
The Consular Section is open for American Citizens Services Monday and Thursday from 1-3 p.m., except on U.S. and Mongolian holidays.
*

*

*
This replaces the Country Specific Information for Mongolia dated September 22, 2008 to update the sections on Safety and Security, and Aviation Safety Oversight.

Travel News Headlines WORLD NEWS

Date: Mon, 6 May 2019 17:00:57 +0200

Ulaanbaatar, May 6, 2019 (AFP) - A Mongolian couple has died of the bubonic plague after eating raw marmot kidney, triggering a quarantine that left tourists stranded in a remote region for days, officials said Monday.

The ethnic Kazakh couple died on May 1 in Mongolia's westernmost province of Bayan-Ulgii, which borders Russia and China.   "The two dead were local people," said local governor Aipiin Gilimkhaan. "There were no cases reported after them."   A six-day quarantine was declared on residents in the region, preventing nine tourists from Russia, Germany and Switzerland from leaving.   "We are all fine. No one is ill," said a German tourist named Teresa, who did not want to give her last name.

Sebastian Pique, a 24-year-old American Peace Corps volunteer who has lived in the region for two years, said he and the tourists were invited to the governor's office on Friday to be informed about the situation.    "After the quarantine (was announced) not many people, even locals, were in the streets for fear of catching the disease," Pique told AFP.   The quarantine was expected to be lifted late Monday after no other cases of the plague were reported.   Authorities have warned people against eating raw marmot meat because it can carry Yersinia pestis, the plague germ.

At least one person dies of the plague every year in Mongolia, mostly due to consuming such meat, according to the National Center for Zoonotic Disease.   Some people ignore the warnings as they believe that consuming the innards of the large rodent is good for their health.   The Black Death wiped out millions of people in the Middle Ages but cases are now very rare.    Its most common form is bubonic, which is spread by fleas and causes swelling of the lymph node. The more virulent form is pneumonic plague, which can be transmitted between humans through coughing.
Date: Fri 3 May 2019
Source: Mirror [edited]

A married couple has died, leaving their 4 children orphaned after an outbreak of the bubonic plague, which sparked plane panic.

The man, 38, named only as Citizen T, and his pregnant wife, 37, are thought to have fallen ill after hunting and eating contaminated marmot, a large species of squirrel, in Mongolia. The man died on 27 Apr [2019], and the woman died 3 days later, reports the Siberian Times.

The highly contagious bacterial disease is spread by fleas living on wild rodents. It has sparked fears of an outbreak, and urgent measures and precautions have been put in place to stop the infection spreading. Around 158 people have been put under intensive medical supervision after coming into contact directly or indirectly with the couple.

There were dramatic scenes when a flight from Bayan, Ulgii and Khovd in Mongolia -- the area where the couple fell ill -- was met by workers in white anti-contamination suits as [the plane] landed in the country's capital of Ulaanbaatar. Eleven passengers from the west of the country were held at the airport and sent immediately for hospital checks. Others were examined in a special facility at the airport. Paramedics in anti-contamination boarded the flight as soon as it landed.

Some frontier checkpoints with Russia are reported to have been closed, leading to foreign tourists being stranded in Mongolia.

Dr N. Tsogbadrakh, director of National Centre for Zoonotic Dermatology and Medicine, said, "Despite the fact that eating marmots is banned, Citizen T hunted marmot. He ate the meat and gave it to his wife, and they died because the plague affected his stomach. Four children are orphaned."

Bubonic plague is believed to be the cause of the Black Death that spread through Asia, Europe, and Africa in the 14th century, killing an estimated 50 million people.

The plague is a bacterial disease that is spread by fleas living on wild rodents such as marmots. The disease can kill an adult in less than 24 hours if not treated in time, according to the World Health Organisation.  [Byline: Will Stewart and Amber Hicks]
========================
[HealthMap/ProMED-mail map:
Bayan-Olgiy Aymag, Bayan-Olgiy, Mongolia:
Date: Fri, 15 Mar 2019 02:55:29 +0100
By Khaliun Bayartsogt

Bornuur, Mongolia, March 15, 2019 (AFP) - In the world's coldest capital, many burn coal and plastic just to survive temperatures as low as minus 40 degrees -- but warmth comes at a price: deadly pollution makes Ulaanbataar's air too toxic for children to breathe, leaving parents little choice but to evacuate them to the countryside.   This exodus is a stark warning of the future for urban areas in much of Asia, where scenes of citizens in anti-pollution masks against a backdrop of brown skies are becoming routine, rather than apocalyptic.   Ulaanbaatar is one of the most polluted cities on the planet, alongside New Delhi, Dhaka, Kabul, and Beijing. It regularly exceeds World Health Organisation recommendations for air quality even as experts warn of disastrous consequences, particularly for children, including stunted development, chronic illness, and in some cases death.

Erdene-Bat Naranchimeg watched helplessly as her daughter Amina battled illness virtually from birth, her immune system handicapped by the smog-choked air in Mongolia's capital.   "We would constantly be in and out of the hospital," Naranchimeg told AFP, adding that Amina contracted pneumonia twice at the age of two, requiring several rounds of antibiotics.   This is not a unique case in a city where winter temperatures plunge towards uninhabitable, particularly in the districts that rural workers moved to in search of a better life.   Here row upon row of the traditional tents -- known as gers -- are warmed by coal, or any other flammable material available. The resulting thick black smoke shoots out in plumes, blanketing surrounding areas in a film of smog that makes visibility so poor it can be hard to see even a few metres ahead.   Hospitals are packed and young children are vulnerable, common colds can quickly escalate into life-threatening illness.

- Birth defects -
The situation was so bad that doctors told Naranchimeg the only solution was to send her little girl to the clean air of the countryside.   Now aged five, Amina is thriving. She lives with her grandparents in Bornuur Sum, a village 135 kilometres away from the capital.   "She hasn't been sick since she started living here," said Naranchimeg, who makes the three-hour round trip to see Amina every week.   "It was very difficult in the first few months," she said. "We used to cry when we talked on the phone."   But like many parents in Ulaanbaatar, she felt the move was the only way to protect her child.

The levels of PM2.5 -- tiny and harmful particles -- in Ulaanbaatar reached 3,320 in January, 133 times what the World Health Organisation (WHO) considers safe.   The effects are terrible for adults but children are even more at risk, in part because they breathe faster, taking in more air and pollutants.   As they are smaller, children are also closer to the ground, where some pollutants concentrate, and their still-developing lungs, brains, and other key organs are more vulnerable to damage.   Effects to prolonged exposure range from persistent infections and asthma to slowed lung and brain development.   The risks apply in utero, too, because gases and fine particles can enter a mother's bloodstream and placenta, causing miscarriage, birth defects and low birth weights, which can also affect a child for the rest of their lives.   Researchers are now investigating whether pollution, like exposure to tobacco smoke, has health effects that could even be passed down to the next generation.

- 'Terribly afraid' -
Buyan-Ulzii Badamkhand and her husband need to stay in capital for work, but they have decided to send their two-year-old son Temuulen more than 1,000 kilometres away.   The 35-year-old mother-of-three struggled with the decision, even moving from one ger district to another in the hope her son's health would improve.   But successive bouts of illness, including bronchitis that lasted a whole year, finally convinced her to send Temuulen to his grandparents.   Hours after he arrived, she called her mother-in-law to discuss her son's medicines.   "But my mother-in-law asked me 'does he still need medicine? He isn't coughing anymore," she said.   "I tell myself that it doesn't matter that I miss him and who raises him, as long as he is healthy, I am content."   Respiratory problems are the most obvious effect of air pollution, but research suggests dirty air can also put children at greater risk for diabetes and cardiovascular disease later in life.   And the WHO links it to leukaemia and behavioural disorders.   When air pollution peaks in winter, Ulaanbaatar's playgrounds empty and those who are able to are increasingly travelling abroad to wait out the smog.

In desperation, Luvsangombo Chinchuluun, a civil society activist, borrowed money to take her granddaughter to Thailand for all of January.   "We can't let her play outside (in Ulaanbaatar) because of the air pollution, so we decided to leave," she said.   The persistent smog has caused tensions in the city, with those living in wealthier areas blaming the ger residents for the pollution and even calling for the tent districts to be cleared.   But the ger residents say coal is all they can afford.   "People come to the capital because they need sustainable income," said Dorjdagva Adiyasuren, a 54-year-old mother of six.   "It's not their fault," she added.    In a bid to tackle the problem, the local government banned domestic migration in 2017, and a ban on burning coal comes into force from May.   But it is unclear whether the moves will be enough to make a difference.   For Naranchimeg, the problems are serious enough to make her consider whether she wants more children.    She explained: "Now, I am terribly afraid of to give birth again. It is risky to carry a child and what will happen to the child after it is born in this amount of pollution?"
Date: Tue 19 Feb 2019
Source: AFP [edited]

Mongolian authorities have temporarily closed all KFC restaurants in the country after more than 200 customers suffered food poisoning symptoms, and dozens were hospitalized.

The 1st cases emerged earlier this month [February 2019], with 16 people showing symptoms of food poisoning, including diarrhoea, vomiting and high fever after eating at the fried chicken franchise. Ulaanbaatar's Metropolitan Professional Inspection Department said 247 similar cases have been reported, and 42 people have been hospitalized.

The department decided to shut down the country's 11 KFC restaurants, all based in the capital, while it investigates what happened.

A preliminary investigation found that 35 employees at a restaurant were not thoroughly vetted to handle food, with most of them having blank medical examination reports, which is illegal. The restaurant also lacked internal hygiene management.

A bacterium known as _Klebsiella_ spp was detected in water at the restaurant. Traces of _E. coli_ were also found in a soda machine, and 4 people contracted _Shigella, -- which causes diarrhoea and fever -- after coming into contact with KFC staff.
=========================
[The aetiology is not directly stated, but if contacts of the cluster have been diagnosed with shigellosis, the primary illness may well be the same.

Ulaanbaatar, formerly anglicized as Ulan Bator (literally "Red Hero"), is the capital and largest city of Mongolia. The city is not part of any aimag (province) (<https://en.wikipedia.org/wiki/Ulaanbaatar>). - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Ulan Bator, Ulaanbaatar, Mongolia:
Date: Tue, 19 Feb 2019 11:40:36 +0100

Ulaanbaatar, Feb 19, 2019 (AFP) - Mongolian authorities have temporarily closed all KFC restaurants in the country after more than 200 customers suffered food poisoning symptoms and dozens were hospitalised.   The first cases emerged earlier this month, with 16 people showing symptoms of food poisoning, including diarrhoea, vomiting and high fever after eating at the fried chicken franchise.   Ulaanbaatar's Metropolitan Professional Inspection Department said 247 similar cases have been reported and 42 people have been hospitalised.   The department decided to shut down the country's 11 KFC restaurants -- all based in the capital -- while it investigates what happened.

A preliminary investigation found that 35 employees at a restaurant were not thoroughly vetted to handle food, with most of them having blank medical examination reports, which is illegal. The restaurant also lacked internal hygiene management.   A strong bacteria known as Klebsiella spp was detected in water at the restaurant. Traces of E-coli were also found in a soda machine, and four people contracted the Shigella germ -- which causes diarrhoea and fever -- after coming into contact with KFC staff.
More ...

Malta

Malta US Consular Information Sheet
November 26, 2008

COUNTRY DESCRIPTION:
Malta is a small, developed, democratic Mediterranean island nation, positioned as a cultural stepping-stone between Europe and North Africa.
Malta became
a member of the European Union with nine other new member states on May 1, 2004, and became a full member of the Schengen area in March 2008.
Tourist facilities of all categories are widely available.
Read the Department of State Background Notes on Malta for additional information.

ENTRY/EXIT REQUIREMENTS:
Malta is a party to the Schengen agreement.
As such, U.S. citizens may enter Malta for up to 90 days for tourist or business purposes without a visa.
The passport should be valid for at least three months beyond the period of stay.
For further details about travel into and within Schengen countries, please see our fact sheet.
For further information concerning entry requirements for Malta, travelers should contact the Embassy of Malta at 2017 Connecticut Avenue, NW, Washington DC
20008, tel.: (202) 462-3611, web site: http://www.foreign.gov.mt/default.aspx?MLEV=47&MDIS=505, or the Maltese Consulate in New York City, tel.: (212) 725-2345.

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:
Malta remains largely free of terrorist incidents. No indigenous terrorist or extremist groups are known to be active in Malta, and no foreign terrorist organization has carried out an attack against U.S. interests in Malta in recent years.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s 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:
Malta has a low rate of violent crime.
Theft of unattended personal property and car stereos from vehicles is a common problem.
Visitors are strongly encouraged to secure their valuables, and be aware of pickpockets and purse snatchers.
Such criminals focus on areas and establishments frequented by tourists.
Caution is particularly urged in the Paceville nightclub area, where excessive drinking and poor crowd control have led to instances of violent behavior.
Poverty, homelessness, and panhandling are almost non-existent in Malta.
All visitors to Malta should practice the same good, common sense personal security precautions that are part of everyday life in urban areas within the U.S., particularly when spending time in areas frequented by tourists.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. The crime victim’s assistance agency is ‘APPOGG’- Support Line, tel: 179;
web site: www.appogg.gov.mt.
To learn about resources in the U.S. if you are the victim of a violent crime overseas, please also see our information on Victims of Crime.

The local equivalents to the “911” emergency line in Malta are: Police 191; Ambulance 196; Fire 199.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is available through public and private hospitals.
The quality of medical care in Malta is excellent.
Private hospitals generally offer a higher standard of service than the public hospitals, and the majority of the best doctors practice in private medical facilities.

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
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Malta.
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 Malta is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Traffic in Malta flows on the left, requiring attentiveness and caution from visitors from right-hand drive countries such as the United States.
In addition, drivers may be erratic or undisciplined. Roads flood easily, and are often narrow, winding, and congested, with poor visibility around curves.
Traffic arteries are prone to bottlenecks and accidents.
Buses are the primary means of public transportation.
Though the bus fleet is being modernized, most buses are old, cramped, and not air-conditioned.
Taxis are safe but expensive and are not metered; it is a good practice to agree with the driver in advance on the charge.

Please refer to our Road Safety page for more information.
There is a Malta Tourist Information Office located at Freedom Square Valletta, tel. 21-237-747, web site: http://www.visitmalta.com/getting-around
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Malta’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Malta’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:
Malta customs authorities may enforce strict regulations concerning currency restrictions and temporary importation into or export from Malta of items such as firearms, antiquities, and any item that might be deemed to have resalable value.
It is advisable to contact the Embassy of Malta in Washington or the Consulate of Malta in New York City for specific information regarding customs requirements.
Malta’s customs authorities encourage the use of an ATA (Admission Temporaire/Temporary Admission) Carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes.
ATA Carnet Headquarters located at U.S. Council for International Business, 1212 Avenue of the Americas, New York, N.Y. 10036, issues and guarantees the ATA Carnet in the United States.
For additional information call (212) 354-4480, send an e-mail to atacarnet@uscib.org or visit http://uscib.org for details.

For more information, please see our Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Malta’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Malta are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in illicit 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 Malta 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 Malta.
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 on the third floor of the Development House, St. Anne Street, Floriana, Valletta, telephone (356) 2561-4000.
The Consular Section’s telephone number is (356) 2156-4115, fax: (356) 2124-3229, web site: http://malta.usembassy.gov/uscit_intro.html.
The Consular Section is open to the public Monday, Wednesday, and Friday from 8:00 a.m. to 11:00 a.m.
* * *
This replaces the Country Specific Information for Malta dated April 29, 2008, to update sections on Safety and Security and Exit and Entry Requirements.

Travel News Headlines WORLD NEWS

Date: Fri 16 Aug 2019
Source: Times of Malta [abridged, edited]

The number of measles cases in Malta has soared to an unprecedented level this year [2019], with 30 cases reported in the 1st 6 months, according to the World Health Organisation.

Data recently published by the health body showed that the figures until June 2019 are in stark contrast to those for the previous years. According to the WHO data, between 2011 and 2018, there were only 11 cases reported. There were no cases reported in a number of these years, and, between 2012 and 2017, there were only 2 cases reported, one in 2013 and another 2 years later.

Earlier this year [2019], the WHO had flagged the issue [slipping vaccine rates] with a rapid increase in measles cases on a global level. At the time, preliminary figures had shown that measles cases rose 300% worldwide through the 1st 3 months of 2019 when compared to the same period last year [2018].

According to the Superintendent of Public Health, Charmaine Gauci, after a number of years with no cases of the disease, in 2018, there were 5 imported cases and one local transmission.

Most of the cases occurred in adults who were not vaccinated. "This year [2019], we have already seen over 15 locally acquired cases. Most of the cases occurred in adults who were not vaccinated," Dr Gauci said when the preliminary figures came out.

In its report on this year's [2019] data, the WHO noted a "dramatic resurgence of measles compared to previous years" in the European region, with 49 of the 53 countries in the region together having reported over 160 000 measles cases and over 100 measles-related deaths by the end of May 2019.

"High national-level coverage can mask pockets of low coverage at the local level, resulting in an accumulation of susceptible individuals that often goes unrecognised until outbreaks occur. An enhanced response is needed to protect all populations in the region from this dangerous disease," WHO said. It has set the ambitious goal of achieving measles and rubella elimination in at least 5 of its regions by 2020.  [Byline: Claire Caruana]
Date: Sun 29 Jul 2018 17:28 CEST
Source: Times of Malta [summ., edited]

The number of salmonellosis cases reported to the health authorities so far in July 2018 has surpassed that in previous years, peaking at 20 cases in July alone.

Figures supplied to The Sunday Times of Malta by the health authorities showed that so far this month [July 2018], 20 cases of the food poisoning infection have been reported, up from 11 in 2017. Since the beginning of 2018, 67 cases have been brought to the authorities' attention.

Salmonellosis is a type of foodborne illness caused by bacteria and is often more common in summer. The infection is contracted when food contaminated with the bacteria is consumed, with young children, older adults, and those with impaired immune systems being more susceptible to severe infection. Symptoms include diarrhoea, fever, and abdominal cramps and usually develop 12 to 72 hours after the infection is contracted. It usually lasts 4 to 7 days.

Just this week, the health authorities confirmed _Salmonella_ had been found in eggs from St Joseph Farm [Southern region] during sampling by the veterinary authorities as part of the Veterinary National Control programme for _Salmonella_. Eggs packed by this farm have since been recalled, with the public being advised not to consume them. The Superintendent of Public Health warned that food that has been listed as recalled should not be consumed, while the general handling of eggs should also be done with caution.

Eggs, she said, should always be cooked until both the yolk and the white are firm, while egg dishes should be cooked to an internal temperature of 71 deg C [160 deg F] or hotter. The eggs used in sauces or any other items that contain raw or lightly-cooked eggs should be pasteurized, Dr Gauci said. Hands, and any implements that come in direct contact with raw eggs, should always be thoroughly washed.  [Byline: Claire Caruana]
============================
[While undercooked eggs are a common source for human salmonellosis, it is not unclear if the finding of contaminated eggs on Malta is related to the upswing of human cases. No information is given regarding the human and egg isolates to assess if they are related. - ProMED Mod. LL]

[HealthMap/ProMED-mail map of Il-Hamrun, Malta:
Date: Mon 13 Mar 2018
From: Christian Lenart <christian@lenart.at> [edited]

We report a case of _Leishmania donovani_/_L. infantum_ in a 56-year-old man from Austria. He travelled to Malta in June 2017 and complained about itchy, partly exulcerated papules in November 2017. His wife too was suffering from the same lesions but did not consult a dermatologist, since the lesions regressed spontaneously.

The patient first contacted a dermatologist, who performed an excision showing _Leishmania_ negative granulomatous inflammation as a histological result. He was then referred to the dermatological ward of the municipal hospital. The lesions were up to 2 cm [0.8 in] in size, disseminated on all extremities.

Another excision was performed, showing plenty of amastigotes affected macrophages. He then was checked for signs of visceral manifestation, but showed no hepatosplenomegaly. The blood sample showed no conspicuity with normal haematological results and normal CRP [C-reactive protein]. The PCR test for _Leishmania_ sp. DNA was positive.

The Western blot (IgG) was positive as well, whilst immunoaffinity chromatography was negative. Skin biopsy genotyping proved a diagnosis of _Leishmania infantum_/_L.donovani_. Since the patient had multiple lesions treatment with miltefosine was initiated.

Leishmania in Malta
-----------------------------------------
While especially leishmaniasis was quite common in the early 20th century in Malta, there were hardly any cases of cutaneous leishmaniasis at the end of the century. For the last years the incidence has been stable with about 3 to 4 cases of visceral leishmaniasis, VL, per year (1).  In 2012, 3 VL and no CL cases were reported (2). All cases of leishmaniasis are caused by _L. infantum_ in Malta, transmitted from dogs to humans by _Phlebotomus perniciosus_. The 2 identified zymodemes in Malta are MON 1, causing visceral and MON 78, causing cutaneous leishmaniasis (3).

References
---------------------------------------
1. Alvar J, Vélez ID, Bern C, et al and the WHO Leishmaniasis Control Team. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012; 7(5): e35671. doi: 10.1371/journal.pone.0035671; available at <http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035671>.
2. Government of Malta, Ministry for Health, the Elderly and Community Care: Annual report 2012; p. 46; available at <https://www.gov.mt/en/Government/Publications/Documents/Annual%20Reports/MHEC.pdf>.
3. Pace D, Williams TN, Grochowska A, et al. Manifestations of paediatric _Leishmania infantum_ infections in Malta. Travel Med Infect Dis. 2011; 9(1):37-46. doi: 10.1016/j.tmaid.2010.11.005; available at <http://www.travelmedicinejournal.com/article/S1477-8939(10)00196-1/fulltext>.
--------------------------------------
Dr Christian Lenart
Department of Emergency Medicine
Krankenhaus Hietzing (Municipal Hospital Vienna-Hietzing)
Austria
christian@lenart.at
===============================
[Leishmaniasis is endemic in Malta and cases imported from Malta to other countries are not unusual. _Leishmania infantum_ usually results in visceral leishmaniasis and the genotyping in this case could not distinguish between _L. donovani_/_L. infantum_. Miltefosine is the drug of choice for cutaneous leishmaniasis. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps: Austria: <http://healthmap.org/promed/p/63886> Malta: <http://healthmap.org/promed/p/77>]
Date: Tue, 20 Feb 2018 18:18:07 +0100

Valletta, Feb 20, 2018 (AFP) - Malta International Airport was brought to a standstill on Tuesday by a fire that left flights suspended and hundreds of passengers stranded.   Passengers were evacuated from the airport as smoke billowed through the arrivals and departure lounges, an AFP reporter at the scene said.   Firefighters worked for two hours to put out the small blaze, which began at around 1:15 pm and caused no injuries.

Airport operators said 10 outbound international flights were delayed. They added later in an online statement that operations at the terminal were resuming.   The airport said the blaze broke out in the pump room for the airport's small aquarium, located in the arrivals concourse.   "Terminal operations are now resuming, and Malta International Airport's recovery plan has been activated," it said in a statement in the late afternoon.

Hundreds of passengers were left standing outside the airport and some even on the apron.   One flight to nearby Catania in Sicily was expected to take off 11 hours later than scheduled, according to the departures timetable.   Flights to Stockholm, Cyprus, Krakow, London Gatwick and Dublin were also delayed.   Flights from British airports Heathrow and Gatwick were diverted to Catania.
Date: Fri 24 Feb 2017
Source: Times of Malta [edited]

The meningitis B vaccine shortage [is] likely to persist. Malta will have to wait its turn, manufacturers say. Global demand for the vaccine outstrips supply, manufacturers say.

A one-year-old baby died of [meningococcal] meningitis [serogroup] B, a disease against which vaccines are currently unavailable, this newspaper is informed. Sources said the baby died last month [January 2017] after contracting the disease that affects the lining around the brain and spinal cord. The Central Procurement and Supplies Unit (CPSU) was informed that the local agent for the meningitis B vaccine had a stock of vaccines available in a number of local pharmacies, a Health Ministry spokeswoman said.

The representatives of international pharmaceutical company GlaxoSmithKline (GSK) in Malta were in liaison with their suppliers to hasten further delivery, and the CPSU was in liaison with both companies to monitor the situation, the spokeswoman added.

The ministry was also asked about the baby's death, but no reference was made to it in its reply late yesterday [23 Feb 2017] evening.

The government does not supply the vaccine against the specific strain that affected the infant, which can, however, be purchased from private hospitals and pharmacies. Paediatricians said private hospitals had purchased the vaccine from pharmacies abroad, but these too had since run out.

According to one paediatrician, the unavailability of such a vaccine in light of the baby's death was very worrying, particularly to parents. Another paediatrician, however, warned against the matter getting out of hand, saying the issue was not as worrying as parents were making it out to be. Babies who were not vaccinated were not in any immediate danger, he said.

A spokeswoman for the local representative of GSK confirmed that the vaccine was not available and it would not be for some time. She said no fixed date had yet been given as to when a supply would be made available to the local market. According to the spokeswoman, the vaccine was in high demand all over the world, and as GSK [GlaxoSmithKline] had agreements with a number of governments abroad, supplies would be shipped to these countries 1st. At present, demand exceeded the quantity manufactured.

"It's important to understand that, in these cases, we need to stock enough for boosters, so before sufficient doses are available, this will not be made available," the GSK spokeswoman said.

According to the Maltese Paediatric Association, about 10 cases of meningitis have been reported among children. The signs of meningitis are fever, severe headache, neck stiffness, vomiting, dislike of bright light and drowsiness. Infants and younger children may not always show such symptoms but, instead, feed poorly or become very lethargic.  [Byline: Claire Caruana]
===================
[Although there are at least 13 _ Neisseria meningitidis_ serogroups, based on the antigenic specificity of their capsular polysaccharides, disease due to serogroups A, B, C, Y, and W is most common. Meningococcal vaccines contain capsular polysaccharide for _Neisseria meningitidis_ serogroups A, C, Y, and W, either alone or conjugated to protein. The conjugate capsular polysaccharide vaccines are preferable, because, unlike the polysaccharide vaccines, conjugate vaccines immunize infants, reduce the carriage of meningococci in the throat and thus its transmission, as well as confer a more sustained immune response, and, therefore, longer-term protection than the polysaccharide vaccines.

Serogroup B vaccines are based upon meningococcal B outer membrane vesicle protein antigens, because group B polysaccharide is poorly immunogenic in humans and is a potential auto-antigen. At least 2 serogroup B meningococcal vaccines -- Bexsero (GlaxoSmithKline, GSK) and Trumenba (Pfizer) -- are available.

Meningococcal disease often occurs without warning and frequently progresses rapidly to death, even when it is treated appropriately. In addition, about 10-20 percent of survivors of meningococcal disease will suffer disabilities such as hearing loss, brain damage, and amputations. Vaccines are used to prevent meningococcal disease, not treat someone already ill from the disease. Immunity following use of a meningococcal vaccine is specific for the type of capsular polysaccharide the vaccine contains regarding the A, C, Y, and W polysaccharide or conjugate vaccines or the surface proteins regarding serogroup B vaccines, with no cross-protection against infection due to other meningococcal groups.

Vaccines are frequently used to prevent spread of meningococcal disease in the face of an institutional or community outbreak (<https://www.cdc.gov/meningococcal/downloads/interim-guidance.pdf>). Antibiotics are also used to prevent spread of meningococcal disease in persons who are at high risk because they have been in close contact (coughing or kissing) or lengthy contact, especially among people living in the same household.

According to the 2017 Malta National Immunization Schedule, meningococcal vaccines are not included in the series of vaccines for infants and children (<https://health.gov.mt/en/phc/pchyhi/Pages/National-Immunisation-Schedule.aspx>). In the U.S., vaccination against meningococcal disease due to serogroups A, C, Y, and W is only recommended for children aged 2 months through 10 years who are at increased risk for meningococcal disease, i.e., have complement component deficiencies, have functional or anatomic asplenia (including sickle cell disease), are in the risk group for an outbreak for which vaccination is recommended, or are traveling to or residing in regions where meningitis is epidemic or hyper-endemic (for specifics, see Table at <https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6324a2.htm#Tab>). The serogroup B vaccines Bexsero and Trumenba have been licensed by the U.S. Food and Drug Administration (FDA) only for individuals aged 10 through 25 years. However, the European Medicines Agency has approved Bexsero for use in individuals of 2 months of age and older, and Bexsero has been added to the routine childhood immunization schedule in the UK and Ireland (<http://www.meningitis.org/menb-vaccine>).

Malta, a member of the EU, is a southern European island country consisting of an archipelago in the Mediterranean Sea, 80 km (50 miles) south of Italy, with a population of just under 450,000 residents (<https://en.wikipedia.org/wiki/Malta>). - ProMED Mod.ML]

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

World Travel News Headlines

Date: Tue, 22 Oct 2019 13:43:23 +0200 (METDST)

Capriata d'Orba, Italy, Oct 22, 2019 (AFP) - A taxi driver has drowned in Italy during violent storms in the north which flooded towns and destroyed a bridge, the fire service said Tuesday.   Farmers in the sweltering south meanwhile sounded the alarm over a draught expected to hit crops hard.   Over 100 people were evacuated Monday across the Alessandria province in the Liguria region, while firefighters carried out 900 operations across the north from Milan to Genoa, as rising waters surged across roads and railways.

The taxi was swept away in the town of Capriata d'Orba, where a bridge had also given way as the river burst its banks.   "There's water everywhere", driver Fabrizio Torre, 52, told his bosses before his phone line cut out, media reported.   His passenger managed to escape the vehicle and survived by clinging to a tree, the reports said.   Two men, aged 61 and 84, were found alive by firefighters after going missing in another part of the storm-hit region.   Rescue workers also pulled young children, their grandmother and the family's dog out of a house submerged by a landslide.   The Po river rose by more than 3.5 metres (11 feet) over a 24-hour period, according to Coldiretti, Italy's main agricultural association.   Lake Maggiore was also nearing a historic level.

Italy has seen "over three storms a day since the start of autumn, 18 percent more than the same period last year," it said.   "And while the north is under rain clouds... in the south, record heat and lack of rainfall has triggered a drought alarm."   Italy was seeing "the effects of climate change, with exceptional weather events becoming the norm".   It noted a "clear endency to tropicalisation" in the Mediterranean country, which was experiencing "a crazy autumn that ranks in the top ten of the hottest since 1800, with a temperature of 1.27 degrees above the average".   The high frequency of violent events was expected to continue, with the north pummelled by rains while farmers in the south risk losing crops.
Date: Tue, 22 Oct 2019 09:57:15 +0200 (METDST)
By Tupad POINTU

La Paz, Oct 22, 2019 (AFP) - Bolivia braced for a general strike on Tuesday hours after violence broke out in several cities when the main opposition candidate rejected presidential election results that seemed set to hand a controversial victory to long-time incumbent Evo Morales.   Opposition supporters reacted with fury, torching electoral offices in the southwestern cities of Sucre and Potosi, while rival supporters clashed in the capital La Paz.    Incidents were reported in cities across the South American country.   Carlos Mesa, who came a close second to Morales in Sunday's polls -- forcing a run-off, according to preliminary results -- denounced revised results released by election authorities as a "fraud."   "We are not going to recognize those results that are part of a shameful, consumated fraud, that is putting Bolivian society in a situation of unnecessary tension," said Mesa.

International monitors from the Organization of American States voiced "deep concern" at sudden changes to the election count to show Morales closing in on an outright victory in the first round.   Preliminary results released late Sunday showed neither Morales, 59, nor 66-year-old Mesa with a majority and "clearly indicated a second round," the OAS mission said.   The partial results put Morales in the lead with 45 percent of the votes, with Mesa on 38 percent, meaning Morales would have to contest a run-off for the first time.   But results released late Monday, after a long and unexplained delay, showed Morales edging towards an outright victory with 95 percent of the votes counted.   Mesa, a former president of the country between 2001-2005, accused Morales of colluding with the Supreme Electoral Tribunal (TSE) to tweak delayed results and avoid a run-off.

- Opposition call general strike -
The call for a general strike was issued by Fernando Camacho, head of an influential civil society organization in Bolivia's biggest city, Santa Cruz, where transport and businesses were expected to shut down from noon.   "Tomorrow we start at 12:00 to block this country," Camacho told opposition demonstrators late Monday, before holding talks with leaders from other regions.   Long lines formed at gas stations amid fears of shortages.   Riot-police dispersed a crowd who tried to storm the electoral offices in the Andean city of Oruro, south of La Paz.    Clashes were also reported in Tarija in the south, Cochabamba in the center and Cobija in the north.

- 'Subverting democracy' -
The United States' top diplomat for Latin America said the Electoral Tribunal was attempting "to subvert Bolivia's democracy by delaying the vote count and taking actions that undermine the credibility of Bolivia's elections."   "We call on the TSE to immediately act to restore credibility in the vote counting process," the official, Michael Kozak, said on Twitter.   The OAS observer mission in the country expressed "surprise at the drastic and hard-to-explain change in the trend of the preliminary results revealed after the closing of the polls," it said in a statement.   It urged the election authority to "firmly defend the will of the Bolivian people" and called for calm on the streets.   "It is extremely important that calm is maintained and any form of violence is avoided in this delicate situation."

- Longest serving president -
Morales, Latin America's longest-serving president, is controversially seeking a fourth term.   He obtained Constitutional Court permission in 2017 to run again for president even though the constitution allows only two consecutive terms.   The former coca farmer and leftist union leader has led the poor but resource-rich Latin American country for the past 13 years, though his popularity has waned amid allegations of corruption and authoritarianism.   He has led the country since taking office in 2006, when he became its first indigenous president.

A new mandate would keep him in power until 2025.   As leader of his Movement for Socialism Party (MAS), Morales points to a decade of economic stability and considerable industrialization as his achievements, while insisting he has brought "dignity" to Bolivia's indigenous population, the largest in Latin America.   He has come under severe criticism this year as wildfires in August and September ravaged Bolivia's forests and grasslands, with activists saying his policies encouraged the use of blazes to clear farmland.
Date: Tue, 22 Oct 2019 06:44:29 +0200 (METDST)

Papeete, Oct 22, 2019 (AFP) - A French tourist has been seriously injured in a rare shark attack in the palm-fringed Pacific islands of Polynesia, emergency services said Tuesday.   The 35-year-old woman was swimming during a whale-watching trip on Monday in the French overseas territory when the oceanic whitetip shark tore into her chest and arms.   "Luckily for her, there were two nurses on the scene who could deliver first aid," firefighter Jean-Jacques Riveta told AFP.   The woman lost both hands and a lot of blood in the attack and was airlifted to hospital, he said.
Date: Tue, 22 Oct 2019 05:13:16 +0200 (METDST)

Wellington, Oct 22, 2019 (AFP) - A huge fire at a construction site sent clouds of acrid black smoke billowing over Auckland on Tuesday, forcing large parts of the downtown area to be cordoned off as firefighters battled the blaze.   The fire broke out on the roof of the SkyCity convention centre site shortly after 1:10pm (0010 GMT) and quickly spread, Fire and Emergency NZ said.   Office workers were warned to stay inside and turn off air conditioning as a thick pall of smoke engulfed the centre of New Zealand's largest city, but there were no reports on injuries.   Unconfirmed reports said the fire was started by a construction worker using a blowtorch on the building, which is one of the venues for the 2021 APEC summit being held in Auckland.
Date: Mon, 21 Oct 2019 18:48:23 +0200 (METDST)

Harare, Oct 21, 2019 (AFP) - At least 55 elephants have died in a month in Zimbabwe  due to a lack of food and water, its wildlife agency said Monday, as the country faces one of the worst droughts in its history.   More than five million rural Zimbabweans -- nearly a third of the population -- are at risk of food shortages before the next harvest in 2020, the United Nations has warned.

The shortages have been caused by the combined effects of an economic downturn and a drought blamed on the El Nino weather cycle.   The impact is being felt at Hwange National Park, Zimbabwe's largest game reserve.   "Since September, we have lost at least 55 elephants in Hwange National Park due to starvation and lack of water," Zimbabwe National Parks spokesman Tinashe Farawo told AFP.   Farawo said the park was overpopulated and that food and water was scarce "due to drought".

Africa's elephant numbers have dropped from around 415,000 to 111,000 over the past decade, mainly due to poaching for ivory, according to the International Union for Conservation of Nature (IUCN).   But Zimbabwe, like other countries in the southern African region, is struggling with overpopulation.   "Hwange was meant for 15,000 elephants but at the moment we are talking of more than 50,000," Farawo said.   "The situation is dire. We are desperately waiting for the rains."   An adult elephant drinks 680 litres (180 gallons) of water per day on average and consumes 450 kilogrammes (990 pounds) of food.

Hungry elephants have been breaking out of Zimbabwe's game reserves and raiding human settlements in search for food, posing a threat to surrounding communities.   Farawo said 200 people have died in "human-and-animal conflict" in the past five years, and "at least 7,000 hectares (17,300 acres) of crop have been destroyed by elephants".   The authorities took action earlier this year by selling nearly 100 elephants to China and Dubai for $2.7 million.   Farawo said the money had been allocated to anti-poaching and conservation projects.   Botswana, Namibia, Zambia and Zimbabwe have called for a global ban on elephant ivory trade to be relaxed in order to cull numbers and ease pressure on their territories.
Date: Mon, 21 Oct 2019 13:34:35 +0200 (METDST)

Santiago, Oct 21, 2019 (AFP) - Chile, reeling from its worst social unrest in decades, has since the 1990s been considered a Latin American hub of political stability and economic growth after 17 years of dictatorship.   Here is some background.

- From dictatorship to democracy -
In 1973 General Augusto Pinochet toppled Socialist President Salvador Allende in a military coup. Allende committed suicide in the presidential palace as troops closed in.   Pinochet imposed a right-wing dictatorship that lasted for 17 years, during which at least 3,200 people were killed or disappeared as a result of political repression. Around 38,000 were tortured.   In 1988 he lost a plebiscite on remaining in power and handed over to democratically elected Patricio Aylwin in 1990, remaining head of the armed forces until 1998.    Pinochet died in 2006 without standing trial for atrocities under his regime.   In 2006 Socialist Michelle Bachelet became Chile's first female president. Re-elected in 2013, she was barred constitutionally from standing again immediately and appointed UN right commissioner in 2018.   The 2017 elections were won by conservative billionaire Sebastian Pinera, who had already been president in 2010-2014.

- Model economy -
Pinochet applied neo-liberal free-market methods, privatising healthcare, education and pensions.   Chile turned to exports and in the 1980s became the preferred Latin American host for foreign investors.   With this economic model still largely in place, growth reached a strong 4% in 2018. The country of 18 million people also has the highest per capita income of Latin America at $20,000.   GDP, however, fell to 1.8% in the first half of 2019 -- due to a challenging external context, adverse climatic conditions and a delay in reforms -- and is expected at 2.5 percent for the year.   Despite slashing poverty from 30% in 2000 to 8.6% in 2019, the country has high social inequalities including in healthcare, education and pensions.   It is the world's biggest producer of copper, with lithium, timber, fisheries, gold, silver, avocados and oil also driving exports.

- Paedophile priests scandal -
The staunchly Roman Catholic country has been rocked by allegations of sexual abuse within the church going back decades.   In May 2018 Pope Francis summoned all 34 Chilean bishops to Rome over the crisis and all tendered their resignations, although only a handful have been accepted.   Since 2000 about 80 priests have been reported to authorities in Chile for alleged sexual abuse, including of children and adolescents.   Prosecutors said in August 2018 they were investigating 158 members of the church, both priests and lay people.   Ultra-conservative Chile allowed divorce only from 2004 and legalised abortion in certain cases in 2017.

- World's most seismic -
Bordered by the Pacific Ocean to the west and the Andes mountain range to the east, long and narrow Chile is the world's most seismic country.   In 1960 it was struck by the most powerful earthquake ever registered which measured 9.5 and struck at Valdivia. More than 5,700 people were killed.   In 2010 a 8.8-magnitude quake in the south and centre unleashed a tsunami that swept away entire villages, leaving around 520 people dead.

- Astronomy heaven -
Benefitting from a totally clear sky for most of the year, northern Chile is home to some of the world's most powerful telescopes.   The construction of the planet's biggest telescope was launched in May 2017 in the Atacama desert by ESO, the European Organisation for Astronomical Research in the Southern Hemisphere.
Date: Sun 20 Oct 2019
Source: Pakistan today [edited]

The death toll from a mysterious throat virus has reached 9 children in Seerani and its surrounding localities in Badin district as one more child infected by the virus died, affected people said on [Sun 20 Oct 2019].

A child, R, son of RM, died after contracting the disease. The most affected areas are reported to be Seerani and its surrounding localities. Teams of the health department and other organizations reached Seerani and took blood samples of at least 30 children who were infected by the virus. The blood samples will be sent to Islamabad for the tests.

The people of the area are worried about this new throat viral disease and have demanded authorities to provide immediate health cover to them.
====================
[There is little information to go on other than the throats of children are affected and the case fatality rate is high (10 of at least 30). No other symptoms are provided, nor is the basis for concluding that a virus is involved or what the epidemiological data are (dates, ages, sex of children involved, and local conditions). ProMED-mail would welcome additional information. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: 21 Oct 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/polio-cases-reported-in-zambia-chad-and-togo-73820/>

Circulating vaccine-derived polio virus (cVDPV) type cases have been confirmed in 10 African countries through [16 Oct 2019] this year [2019]. Now, the World Health Organization (WHO) is reporting 3 additional countries from the continent that more recently reported circulating vaccine-derived polio virus type 2 (cVDPV2) cases: Zambia, Chad and Togo.

Zambia
The Ministry of Health of Zambia reported last week on a confirmed case of circulating vaccine-derived polio virus type 2 (cVDPV2) in a 2-year-old child in Chienge district, Luapula province on the border with Democratic Republic of the Congo. This is the 1st case of cVDPV2 reported from Zambia in 2019. [Date of onset of paralysis reported to be 16 Jul 2019 according to another media report <https://www.lusakatimes.com/2019/10/21/polio-case-has-been-recorded-in-zambias-luapula-province/>.

In addition to the initial case-patient, 34 stool samples were collected from healthy contacts, and 2 samples tested positive for VDPV2, which were genetically linked to the case-patient. No established links have so far been found with the ongoing outbreak of cVDPV2 in Democratic Republic of the Congo, where 37 cases have been reported in 2019. The last recorded case of indigenous polio in Zambia was in 1995, while between 2001 and 2002, 5 cases of wild polio virus were identified among Angolan refugees in the Western province of the country.

Chad
Last week, WHO was informed about cVDPV2 in Chad. A cVDPV2 was isolated from a 13-month-old case of acute flaccid paralysis (AFP), with onset of paralysis on [9 Sep 2019] in Chari Baguirmi province, bordering Cameroon. The isolated virus has 32 nucleotide changes from Sabin 2, and is genetically linked to a cVDPV2 detected in Borno, Nigeria and is part of the Jigawa emergence. The last indigenous wild poliovirus cases were reported in 2000 in Chad.

Togo
In addition, last week WHO was informed about cVDPV2 in Togo. A cVDPV2 was isolated from a 30-month-old case of AFP with onset of paralysis on [13 Sep 2019] in Plateaux province, bordering Benin and Ghana. The isolated virus has 32 nucleotide changes from Sabin 2 and is genetically linked to a cVDPV2 detected in Irewole state, Nigeria and is part of the Jigawa emergence as well. The last indigenous wild poliovirus case was reported in 1999 in Togo.
======================
[Three more countries are joining the list of cVDPV outbreak countries, all with cVDPV2 isolates. Two of the 3 countries (Togo and Chad) have viruses related to the Jigawa, Nigeria cVDPV2 outbreak. The case in Zambia is suspected to be associated with the ongoing cVDPV2 transmission in the Democratic Republic of the Congo (DR Congo), but genetic testing is presumably still pending or has been negative. See my comments below after the following section, as they are relevant to what is ongoing globally with respect to cVDPVs.

Below are the HealthMap/ProMED map links to countries where cVDPV cases/outbreaks have occurred in the past 12 months, a total of 20 countries.

Angola: <http://healthmap.org/promed/p/165>
Benin: <http://healthmap.org/promed/p/59>
Cameroon: <http://healthmap.org/promed/p/65>
Central African Republic: <http://healthmap.org/promed/p/66>
Chad: <http://healthmap.org/promed/p/57>
China: <http://healthmap.org/promed/p/155>
Democratic Republic of the Congo: <http://healthmap.org/promed/p/194>
Ethiopia: <http://healthmap.org/promed/p/95>
Ghana: <http://healthmap.org/promed/p/53>
Indonesia: <http://healthmap.org/promed/p/184>
Kenya: <http://healthmap.org/promed/p/174>
Mozambique: <http://healthmap.org/promed/p/177>
Myanmar: <http://healthmap.org/promed/p/148>
Niger: <http://healthmap.org/promed/p/58>
Nigeria: <http://healthmap.org/promed/p/62>
Papua New Guinea: <http://healthmap.org/promed/p/188>
Philippines: <http://healthmap.org/promed/p/158>
Somalia: <http://healthmap.org/promed/p/125>
Togo: <http://healthmap.org/promed/p/64>
Zambia: <http://healthmap.org/promed/p/170> - ProMED Mod.MPP]
Date: Fri 18 Oct 2019 07:32 PM EDT
Source: WSPA [edited]

North Carolina health officials say a 4th person has died from an outbreak of legionnaires' disease linked to a hot tub display at the North Carolina Mountain State Fair, which is held at the Western North Carolina Agricultural Center.

We've also learned another person, who did not attend the NC Mountain State Fair, was diagnosed with legionnaires' after attending a quilt show that was held inside the same building as the hot tub exhibit. That building is the Davis Event Center.

7 News spoke with folks who have been impacted by the outbreak. "We were like 'Oh no, I hope nobody gets sick,'" [LP] said. He attended the North Carolina Mountain State Fair-an event tied to at least 140 cases of legionnaires'. He said 2 people he knows, including his uncle, got sick after the fair. "They didn't actually have legionnaires', but they had respiratory problems that did come out of it," he said. [Perhaps Pontiac fever?] Even so, [LP] was back at the WNC Agricultural Center on [Fri 18 Oct 2019] to help host his club's annual Antique Tractor Show.

And while everything appeared to be business as usual, [LP] was concerned as another person was just diagnosed with the disease and didn't attend the fair. Instead, they were at a quilt show held at the WNC Agricultural Center 2 weeks later. "Anytime there's an outbreak of something, it's always going to have a thing in the back of your mind that says, 'I don't know if I want to do this or not,'" he said.

The Davis Event Center has since been closed; but health officials say it's possible the source for the newest case of legionnaires' may not have been at the WNC Agricultural Center. "There are other possible exposures that this person had, so it's hard. At this point, we can't pinpoint," Jennifer Mullendore with Buncombe County Health and Human Services said.

According to a statement by the WNC Agricultural Center, the hot water system in the Davis Event Center, and every other building on the grounds, went through a disinfecting process as a precautionary measure. "They did some cleaning and doing some real hot high-powered water through the water system here, and so we do have a clean bill of health," Phillips said.  It's unclear at this time when the Davis Event Center will re-open.  [Byline: Scottie Kay]
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[The latest status, as of 18 Oct 2019, of the legionellosis outbreak associated with the Mountain State Fair that was held in western North Carolina between 6 and 15 Sep 2019 at the Western North Carolina Agricultural Center (WNC Ag Center) in Fletcher, a town in Henderson County, can be found at <https://epi.dph.ncdhhs.gov/cd/legionellosis/outbreak.html>.

The source of the outbreak has still not as yet been confirmed. However, hot tub displays in one of the buildings (Davis Event Center) has been linked to the outbreak. A site map of the WNC Ag Center that shows the location of the Davis Event Center building can be found at <https://www.wncagcenter.org/p/mountainstatefair/competitions/map>.

One more case and an additional death have been reported since the last ProMED-mail post on this outbreak, but no cases linked to the outbreak had a symptom onset date more than 2 weeks after the end of the fair, that is, within the incubation period for legionnaires' disease (<https://www.cdc.gov/legionella/clinicians/clinical-features.html>). The latest case of legionnaires' disease didn't attend the fair, but instead attended a quilt show held 2 weeks later at the Davis Event Center, but the source for this case is thought possibly to have not been at the WNC Agricultural Center. The Davis Event Center has since been closed.

The number of confirmed cases of legionellosis by county are as follows: Buncombe, 49; Burke, 1; Caswell, 1; Cherokee, 1; Gaston, 1; Granville, 1; Haywood, 12; Henderson, 34; Jackson, 3; Madison, 6; McDowell, 5; Mecklenburg, 5; Mitchell, 2; Polk, 1; Rutherford, 3; Transylvania, 3; Union, 1; Watauga, 1; and Yancey, 1. 10 cases occurred out of state (in South Carolina). Total cases: 141. A map showing the location of the North Carolina counties can be found at <https://geology.com/county-map/north-carolina.shtml>.

Male, 82 (59%)*; female, 58 (41%)*. Median age in years (range): 61 (24-91). Hospitalizations: 94 (69%)*; deaths 4. *Some cases reported with unknown gender or hospitalization status.

A total of 133 (94%) have legionnaires' disease, the pneumonic form of the infection, and 8 (6%) have Pontiac fever, the non-pneumonic form of the infection.

The species of _Legionella_ detected in patients is not specified; however, the usual pathogen in the USA is _L. pneumophila_ serogroup 1 and one sample of water collected from the women's restroom in the Davis Event Center was previously reported to be positive for _L. pneumophila_. Genotyping clinical and environmental isolates will help identify clusters of cases with a common source and identify the source responsible for infection in these clusters. - ProMED Mod.ML]
 
[HealthMap/ProMED-mail map of North Carolina, United States:
Date: Sun 20 Oct 2019 12:52 AM IST
Source: Deccan Chronicle [edited]

The respite from cases of dengue, notwithstanding, the city [Hyderabad] is now caught in the grip of viral encephalitis, or brain fever. There is an alarming increase in the number of viral encephalitis cases being reported across city hospitals. This is ironic as October is medically termed as 'fair-weather' season. The rise in the number of cases has been worrisome and those getting inflicted include children and elders.

Many are complaining of fever of the brain with body temperature touching [106-107 deg F/41.1-41.6 deg C].

According to doctors, at least 3 cases are reported each week in the tertiary hospitals of which 7 major ones are in the city.

Dr Shyam Jaiswal, neurologist at Care Hospitals, explains, "Of late, we have been admitting viral encephalitis-affected children in the hospital. Most fall sick because of the body's low immunity. Immediate hospital care is a must as most complain of severe headache, delirium, and in some cases even loss of memory. The treatment takes between 2-3 days."

It is a medical nightmare that some elders are suffering from both chikungunya and viral encephalitis.

Dr Hari Kishan B, general physician with Apollo Hospitals, explains, "The combination of chikungunya and viral encephalitis has been noted earlier too. These are rare cases but do occur from time to time. The viral infections have been very high this year [2019] and those suffering from diabetes, hypertension, and other cardiovascular ailments, will suffer more when infected with these viruses."  [Byline: Kaniza Garari]
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[This report does not provide total case numbers, nor indicate how long 2-3 cases per week have been occurring. The virus suspected or confirmed as the etiology of these cases is not mentioned, but the comment that October is termed "a fair weather season" suggests that Japanese encephalitis virus may be involved with the usual transmission season declining in October. No mention is made of acute encephalitis syndrome, a clinical designation with a variety of suggested Aetiologies in other cases in north-eastern India. - ProMED Mod.TY]

[Maps of India: