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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 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:
Date: Fri 10 May 2019 11:20 ART
Source: Jujuy al Momento [in Spanish trans. ProMED Mod.TY, edited]

Hantavirus [infections]: 1 dead and 14 confirmed cases confirmed by the provincial Ministry of Health. The only fatal case is from the El Talar locality, [a young man] between 15 and 19 years of age. Of the cases, 2 were registered from rural areas in Palpala.

- The government confirmed that a young man died of [a] hantavirus [infection]
- There are another 14 cases that are progressing well.
- The general concern is the large number of trash dumps that could lead to new cases.

The [Jujuy] provincial Ministry of Health, through its Provincial Sub-Directorate of Epidemiology, confirmed that to date there were 15 confirmed cases of hantavirus [infections]: 14 progressing favourably and 1 dead who was between 15 and 19 years of age from the El Talar locality.

The other 14 cases are from the following localities: 3 in San Pedro, 3 in Libertador General San Martin, 3 in Palma Sola, 1 in El Remate (Palpala), 2 in la Mendieta, 1 in Aguas Calientes, and 1 in Forestal (Palpala).

Hantavirus [causes] an emergent zoonotic disease transmitted by rodents including mice and rats.

It should not be surprising that the total number of suspected cases is 241 [over what period of time? - Mod.TY] given that in the province the problem of garbage dumps has increased markedly in the absence of state policies: companies dump pathogenic waste in the open, there are garbage dumps on the side of the roads, and more and more small dumps are found in downtown neighborhoods.

One of the most serious pictures is in Palpala (where 2 of the confirmed cases are located), where the accumulation of trash has gotten onto the plazas and sports centers.

Recommendations:
- avoid living with rodents and contact with their secretions;
- avoid that rodents enter or make nests in houses;
- close openings in doors, walls, and around pipes;
- carry out cleaning (floors, walls, doors, tables, drawers, and cupboards) with one part bleach with 9 of water (leave for 30 minutes and later rinse). Wet floors before sweeping in order to not raise dust;
- locate vegetable gardens and fire wood piles at least 30 meters (33 yards) around houses;
- ventilate places that had been closed (houses, sheds) for at least 30 minutes. Cover the mouth and nose with a mask before entering;
- camp far from weeds and trash dumps, do not sleep directly on the ground, and drink potable water;
- when encountering a live rodent: do not touch it and inform the municipality;
- when encountering a dead rodent: wet it down with bleach together with everything with which it could have been in contact and wait for a minimum of 30 minutes. Pick it up using gloves and bury it at least 30 cm [12 inches] deep or burn it;
- people who present with symptoms of the disease must go quickly to a health facility for a [medical] consultation.
======================
[The number of confirmed hantavirus infections in Jujuy province has increased from 11 cases in the localities of San Pedro, Palma Sola, Libertador General San Martin, and Calilegua reported on 8 Apr 2019 to the 15 cases mentioned above. These cases are from a variety of locations indicating that the virus and its reservoir rodent hosts are wide-spread in the province. The public is well advised to follow the Ministry's recommendations for avoidance of infection.

The hantaviruses responsible for these 15 cases are not stated in the report 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 (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 (western Argentina in _O. flavescens_); and Laguna Negra (in northern Argentina in _Calomys laucha_). 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]

[Maps of Argentina:
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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

Date: Tue, 13 Aug 2019 22:42:07 +0200 (METDST)

Khartoum, Aug 13, 2019 (AFP) - Heavy rain in Sudan has caused extensive flooding that killed at least seven people in the country's south Tuesday, the state news agency reported.   "Seven citizens were killed, two injured and 10 villages affected by rain and flooding in Jazira state," SUNA said.    The downpours, which have battered parts of Sudan for days now, destroyed hundreds of homes in the capital Khartoum.   At least six other people were killed over the past week in Jazira and in the western region of Darfur where thousands of people were affected by flooding.
Date: Wed, 3 Jul 2019 15:33:33 +0200

Juba, July 3, 2019 (AFP) - South Sudan has stepped up surveillance along its porous southern border after an Ebola case was detected just inside DR Congo, an health official in Juba told AFP Wednesday.   The case of the deadly virus was confirmed in Ariwara, in Congo's north-eastern Ituri province, just 70 kilometres (43 miles) from the frontier with Yei River State in South Sudan.

It is the closest Ebola is known to have come to South Sudan since a major outbreak began in Congo last August.   Dr Pinyi Nyimol, the director general of South Sudan's Disease Control and Emergency Response Centre, said a team of reinforcements had been sent to the region to bolster surveillance after the case was confirmed.   "We are very worried because it is coming nearer, and people are on the move so contact (with Ebola) could cross to South Sudan," he told AFP.

South Sudan has already declared a state of high alert and vaccinated health workers.   There are screening centres at border crossings in high-risk areas and an Ebola treatment unit and laboratory in the capital Juba, Nyimol said.   But the world's youngest country is considered particularly vulnerable to the notorious virus.

Years of ruinous civil war have left its health system in tatters.   The border with the Democratic Republic of Congo has many unofficial crossing points, posing challenges for detection.   Fighting in and around Yei River State since September has also driven nearly 20,000 civilians into DR Congo and Uganda, both countries that have detected Ebola.

The outbreak in the eastern Congo provinces of North Kivu and Ituri has already claimed more than 1,500 lives since August.    Two people also died in Uganda in June after a family returned from eastern Congo where they buried an Ebola-stricken relative.   Ebola spreads among humans through close contact with the blood, body fluids, secretions or organs of an infected person, or objects contaminated by such fluids.
Date: Wed, 5 Jun 2019 23:49:47 +0200

Washington, June 5, 2019 (AFP) - The United States on Wednesday warned its citizens in Sudan to exercise "extreme caution" and prepare to leave the country as the death toll in a crackdown on protests topped 100.   The United States had already in April warned its citizens against non-essential travel and ordered the departure of all but vital US embassy personnel as demonstrations swelled in the capital Khartoum.

Updating its guidance after the army forcibly ended protests, the United States said that the embassy was closed to the public and that US citizens still present should "make plans to leave Sudan."   "Shelter in place at home or another safe location," the State Department said. "Exercise extreme caution if you must go outside."

Protesters, led by students and ordinary residents alarmed by the cost of living, have staged months of demonstrations that led to the army sacking veteran leader Omar al-Bashir in April.   The protesters kept up their sit-in, urging a transition to civilian rule, but Sudanese forces this week forcibly dispersed them, prompting strong condemnation by Western nations.
Date: Tue, 28 May 2019 04:55:43 +0200
By Abdelmoneim Abu Idris Ali and Aziz EL Massassi

Khartoum, May 28, 2019 (AFP) - Sudan is bracing for a two-day nationwide strike from Tuesday called by protesters to pile pressure on the military to hand power to a civilian administration as talks remain deadlocked.   Leaders of the umbrella protest movement, the Alliance for Freedom and Change, and army generals who seized power after ousting president Omar al-Bashir last month, have so far failed to iron out differences over who should lead a new governing body -- a civilian or soldier.   The new governing body is expected to install a transitional civilian government, which in turn would prepare for the first post-Bashir elections after a three-year interim period ends.

In a bid to step up pressure on the generals, the protest movement has called for a two-day general strike starting on Tuesday.   "The response to the call for a strike has been better than we expected," said Siddiq Farukh, a leader of the protest movement.   "The two-day strike aims to deliver a message to the whole world that the Sudanese people want a real change and they don't want the power to be with the military," he told AFP.   Protest leader Wajdi Saleh told reporters late Monday that there was "still no breakthrough" in negotiations but the protest movement was ready to negotiate if the generals offer fresh talks.

Saleh did not rule out an "indefinite strike" at a later date if the deadlock continues.   "But we hope that we reach an agreement with the military council and won't have to go on an indefinite strike," he said.    Protest leaders said medics, lawyers, prosecutors, employees in the electricity and water sectors, public transport, railways, telecommunication and civil aviation were set to participate in the strike.   They said that the strike in the telecommunication and aviation sectors will not affect operations.   But the protest movement's plan has been dealt a blow after a key member, the National Umma Party, said it opposed the strike plan as there had been no unanimous decision over it.   "We have to avoid such escalated measures that are not fully agreed," the party said on Sunday.

- 'Let the people decide' -
Umma and its chief Sadiq al-Mahdi have for decades been the main opponents of Bashir's iron-fisted rule.   The party threw its weight behind the protest movement after nationwide demonstrations erupted against him in December.   Mahdi's elected government was toppled by Bashir in an Islamist-backed coup in 1989.   In a recent interview with AFP, Mahdi warned protesters not to "provoke" the army rulers as they had been instrumental in Bashir's removal.   Protester Hazar Mustafa said a civilian government was the only solution to Sudan's problems.   "We see the military council as part of the former regime. We don't see it upholding any rights and building a just state," she said.   The army ousted Bashir after tens of thousands of protesters camped outside military headquarters from April 6 demanding an end to his autocratic rule.   Five days later the generals removed Bashir and since then have resisted calls from protesters and Western powers to hand over power to a civilian administration.

- Regional backing -
Thousands of protesters remain camped outside the army complex round-the-clock, demanding the generals step down.   Ahead of the strike, the chief of the ruling military council General Abdel Fattah al-Burhan and his deputy General Mohamed Hamdan Dagalo have been touring Khartoum's regional allies Egypt, Saudi Arabia and the United Arab Emirates.   The oil-rich Gulf states Saudi Arabia and the UAE along with Egypt are seen backing the generals even as the United States leads Western calls to swiftly establish civilian rule in the country.   Talks between the generals and protest leaders remain deadlocked.   Protest leaders insist a civilian must head the new sovereign council and that civilians should make up the majority of its members, proposals rejected by the ruling generals.   Before suspending talks on May 20, the two sides had agreed on several key issues, including the three-year transition and the creation of a 300-member parliament, with two thirds of lawmakers coming from the protesters' umbrella group.
Date: Tue, 21 May 2019 12:37:30 +0200

Khartoum, May 21, 2019 (AFP) - Sudanese protest leaders called on their supporters Tuesday to prepare for a general strike after talks with the country's military rulers stalled on who will lead an agreed three-year transition.   Protest leaders had reached agreement with the ruling military council on the other main aspects of the transition.   But early on Tuesday, the generals who overthrew veteran president Omar al-Bashir last month baulked at protesters' demands for a civilian head and a civilian majority for an agreed new sovereign council to lead the transition.

"In order to achieve a full victory, we are calling for a huge participation in a general political strike," said the Sudanese Professionals Association, which took the lead in organising the four months of nationwide protests that led to Bashir's ouster.   "The strike is our revolutionary duty and the participation in the sit-in ... is a crucial guarantee to achieve the goals of the revolution."

Protest leader Madani Abbas Madani told AFP the preparations for a "general political strike and civil disobedience" were already under way.   "Whenever we will decide on applying these plans, we will make an announcement," said Madani, a prominent leader of protest umbrella group the Alliance for Freedom and Change.   The two sides launched what had been billed as a final round of talks on the transition late on Sunday.

The military council has faced pressure from Western government and the African Union to agree to a civilian-led transition -- the central demand of the thousands of demonstrators who have spent weeks camped outside army headquarters in Khartoum.   When talks broke up early on Tuesday, neither side said when they would resume.

Protest leader Siddiq Yousef told reporters they had been suspended.   "The main point of dispute that remains is concerning the share of representatives of the military and the civilians in the council and who will be the head of the new body," the two sides said in a joint statement.   The military council has been pushing for its chairman General Abdel Fattah al-Burhan to head the new sovereign council but protest leaders want a civilian.
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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 ...

Turks and Caicos Islands

Turks & Caicos US Consular Information Sheet
November 17, 2008
COUNTRY DESCRIPTION:
The Turks and Caicos Islands are a British Overseas Territory comprising a small archipelago of eight major islands and numerous uninhabited keys, 500 mile
southeast of Miami.
Most tourist facilities are located on Providenciales ("Provo") Island.
The U.S. dollar is the unit of currency and the larger hotels and shops accept credit cards.
The U.S. Embassy in Nassau, Bahamas, has jurisdiction for consular matters in the Turks and Caicos.
ENTRY/EXIT REQUIREMENTS:
U.S. citizens do not need to obtain visas to visit the Turks and Caicos Islands.
All Americans traveling by air outside the United States are required to present a passport or other valid travel document to enter or re-enter the United States.
This requirement will be extended to sea travel (except closed-loop cruises), including ferry service, by the summer of 2009.
Until then, U.S. citizens traveling by sea must have either a WHTI-compliant document (such as a valid U.S. passport or passport card) or both a government-issued photo identification and a document showing their U.S. citizenship (for example, a certified U.S. birth certificate or certificate of nationalization).
Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.
Applications for the new U.S. Passport Card are now being accepted.
The card may not be used to travel by air and is available only to U.S. citizens. Further information on the passport card is available at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html.
We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

Visit the British Embassy web site at http://ukinusa.fco.gov.uk/en for the most current entry information, including any visa requirements.
Information about dual nationality or the prevention of international child abduction can be found on our website.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
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 and Canada, 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’s pamphlet A Safe Trip Abroad.

CRIME:
Petty street crime does occur.
Visitors should not leave valuables unattended in their hotel rooms or on the beach.
Visitors should make sure that their hotel room doors are securely locked at all times.
In the Turks and Caicos, carrying illegal/undeclared firearms or ammunition is a very serious crime, as is possession of illegal narcotics.

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 are solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

The local equivalent to the “911” emergency line in the Turks and Caicos Islands is 999 or 911.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are available but limited in the Turks and Caicos Islands.
There is a small public hospital on Grand Turk and a private clinic on Provo, which has a hyperbaric chamber.
Most serious medical problems require medical evacuation by air from the Turks and Caicos to the United States.

The Turks and Caicos Islands do not have a pathologist to perform services in cases of death.
Medical examiners from neighboring countries visit the island regularly to provide this service.
It can take up to two weeks for the Government of the Turks and Caicos Islands to release the remains of the deceased under normal circumstances, and severe weather during the hurricane season could delay the process even more.The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of the Turks and Caicos Islands.

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 website 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 the Turks and Caicos Islands is provided for general reference only, and may not be totally accurate in a particular location or circumstance. Driving in the Turks and Caicos Islands is on the left.
Traffic tends to be light, and the terrain is flat.
When entering roundabouts and other intersections without signs or traffic signals, drivers are required to give way to those on their immediate right.
Driving under the influence of alcohol is illegal, and drivers convicted of the offense may face fines, detention, or both.
Wild donkeys are a common sight and often walk on the roads, presenting a hazard to drivers, especially at night.
Road signs are not prevalent, but as there are few roads on the island, finding one's way with a tourist map is generally not a problem.
Drivers should be alert for unmarked hazards such as blind intersections or changes in road conditions.
Primary roads are generally drivable in both urban and rural areas.
Secondary roads are often unpaved, and have ruts and potholes.
Be aware that, in the event of a breakdown, roadside assistance is generally not available.
For emergencies, drivers may call 999 or 911 for police, fire, or medical assistance.
Visitors require a valid driver's license from their country of residence.
Safety of public transportation in the Turks and Caicos is generally good.
Most car and motor scooter rental agencies will not rent to anyone under the age of 21.
A government tax is levied on all car and motor scooter rentals (insurance is extra).Please refer to our Road Safety page for more information.
Visit the website of the country’s national tourist office at http://www.turksandcaicostourism.com.

AVIATION SAFETY OVERSIGHT:
Civil aviation operations in the Turks and Caicos Islands fall under the jurisdiction of British authorities.
The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Kingdom’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the UK’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:
The importation of firearms to the Turks and Caicos is strictly forbidden without prior approval in writing from the Commissioner of Police.
U.S. citizens may contact the Turks and Caicos Customs Department at (649) 946-2867 for specific information regarding customs requirements. Please see our Customs Information.

The Turks and Caicos Islands, like all countries in the Caribbean basin, are vulnerable to hurricanes.
Hurricane season officially runs from June 1 to November 30, although hurricanes have been known to occur outside that time period.
Visitors to the Turks and Caicos Islands during hurricane season are advised to monitor weather reports in order to be prepared for any potential threats.
General information about disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov
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 Turks and Caicos laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the Turks and Caicos 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 residing or traveling in the Turks and Caicos Islands 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 the Turks and Caicos Islands.
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 42 Queen Street, Nassau, The Bahamas.
It is next to the McDonald’s Restaurant on Queen Street and may be reached Monday-Friday at telephone (242) 322-1181 x4406; after-hours (242) 328-2206; fax (242) 356-7174.
The U.S. Embassy web site is http://nassau.usembassy.gov.
Office hours are from 9:00 a.m. to 11:00 a.m. and 1:00 p.m. to 3:00 p.m. Monday-Thursday; 9:00 a.m. to 11:00 a.m. Friday (except for U.S. and Bahamian holidays).
* * *
This replaces the Country Specific Information for the Turks and Caicos Islands dated March 14, 2008, without substantive changes.

Travel News Headlines WORLD NEWS

Date: Tue, 6 Aug 2019 20:04:36 +0200 (METDST)

St. John's, Antigua and Barbuda, Aug 6, 2019 (AFP) - Three American tourists have drowned in the Turks and Caicos Islands after apparently getting caught in a fast-moving tide fueled by high winds, authorities and local residents said Tuesday.   The victims -- two men and a woman -- were from two families from Texas who were spending the holidays together, along with their two girls, police said.

They had been exploring scenic Bambarra Beach on the sparsely populated island of Middle Caicos when disaster struck on Monday, police and local residents said.   The children were plucked from the ocean by rescuers and were being cared for by local social welfare services.   The body of a 34-year-old woman washed ashore shortly after the incident. Searchers scouring the beaches recovered the second body a few hours later. The third was discovered early this morning with assistance from the US Coast Guard.   Residents said the families may have been attempting to cross the half-mile distance through shallow water from Bambarra Beach to nearby Pelican Cay.

Police Commissioner Trevor Botting described the incident as a "terrible tragedy."   "Five tourists from two families got into difficulties in the waters off Middle Caicos. Whilst two children were thankfully recovered alive from the water, two adults related to one of the girls were recovered but sadly they had died. One other man, related to the other child, was found early today and has also died," he said.   The tragedy has triggered calls locally for increased warning signs on the islands' often deserted beaches.   The Turks and Caicos Islands is British overseas territory that consists of two island chains southeast of the Bahamas.
Date: 12 Jun 2017
Source: TC weekly News [edited]

The Ministry of Health is advising the public of an increase in the number of cases of conjunctivitis in the Turks & Caicos Islands [TCI].

Conjunctivitis, also called "pink eye," is defined as an inflammation of the conjunctiva and can be caused by viruses, bacteria, or an allergy. It can affect children and adults.

Viral conjunctivitis is typically caused by a virus that can also cause the common cold. A person may have symptoms of conjunctivitis alone or as part of a general cold syndrome like fever, a sore throat and runny nose.

Viral conjunctivitis is highly contagious; usually people catch it from touching something that has been in contact with an infected person's eye (e.g. door handle, towel or pillow case), and then that person touches his or her eyes.

Some of the most common symptoms of conjunctivitis are pink or red eyes; the eyes might secrete a gooey liquid or become itchy or burn, get stuck shut, especially when you 1st wake up. These symptoms tend to last for several days.

The ministry stated in a press release: "The treatment depends on the cause. When pink eye is caused by a virus, antibiotics will not help. You can use warm or cool compresses to relieve the pain and irritation in the eyes.

"Most cases of pink eye go away on their own without treatment, but it is best to see your primary care physician if you are experiencing these symptoms so that you can be treated properly.

"Simple hygiene measures can help minimise transmission to others. Adults or children with bacterial or viral conjunctivitis should not share handkerchiefs, tissues, towels, cosmetics, or bed sheets/pillows with uninfected family or friends. Hand washing is an essential and highly effective way to prevent the spread of infection. Hands should be wet with water and plain soap, and rubbed together for 15 to 30 seconds.

"Teach children to wash their hands before and after eating and after touching the eyes, coughing or sneezing. Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available."

Anyone with viral conjunctivitis should remain home from school and work to avoid spreading the virus to others.
================
[The report above does not specify any laboratory confirmation of the conjunctivitis cases.

Conjunctivitis can result from many causes, including viruses, bacteria, allergens, contact lens use (especially the extended-wear type), chemicals, fungi, and certain diseases. Viral conjunctivitis can be caused by the following viruses, with adenoviruses being the most common cause: adenoviruses, picornaviruses (particularly enterovirus 70 and coxsackievirus A24), measles virus, and several herpes viruses.

Viral conjunctivitis is highly contagious. Most viruses that cause conjunctivitis are spread through hand-to-eye contact by hands or objects that are contaminated with the infectious virus. Hands can become contaminated by coming into contact with infectious tears, eye discharge, faecal matter, or respiratory discharges.

Many of the viruses that cause conjunctivitis may be associated with an upper respiratory tract infection, cold, or sore throat. - ProMED Mod.UBA]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Mon 9 May 2016
Source: Outbreak News Today [edited]

Health officials on the Caribbean island group, Turks and Caicos (TCI), are reporting a significant increase in chickenpox [varicella] cases during the 1st 4 months of 2016.

As of the end of the week of 23 Apr 2016, a total of 327 cases have been reported for the year. Of these, 41 (13 percent) were reported by persons younger than 5 years old and 296 (87 percent) were reported by persons older 5 years old.

These cases were reported by TCI Hospital on Providenciales 234 (72 percent) and Grand Turk 5 (1 percent); with 28 cases in North Caicos and 60 (18 percent) cases in clinics in Providenciales. In summary, the majority cases are being reported from Providenciales (90 percent).

By comparison, in all of 2015, a total of 98 cases of chickenpox were reported by TCI Hospital in Providenciales.

Chickenpox is a common, usually benign childhood disease caused by the varicella-zoster virus (VZV), a member of the herpes family. This virus causes 2 distinct diseases; varicella (chickenpox) is the primary infection, and later when VZV reactivates, herpes zoster (shingles).

Chickenpox is highly contagious and is spread by coughing and sneezing, by direct contact, and by aerosolization of the virus from skin lesions. You can also get it by contact with the vesicle secretions from shingles.

The disease is characterized by fever and a red, itchy skin rash of that usually starts on the abdomen, back, or face and then spreads to nearly all parts of the body. The rash begins as small red bumps that appear as pimples or insect bites. They then develop into thin-walled blisters that are filled with clear fluid which collapse on puncture. The blisters then breaks, crusts over, and leaves dry brown scabs.

The chickenpox lesions may be present in several stages of maturity and are more abundant on covered skin rather than exposed. Lesions may also be found in the mouth, upper respiratory tract, and genitals.

Chickenpox is contagious from 1-2 days before the rash forms and continues until all the lesions are crusted over (usually about 5 days).

This disease is more serious in adults than in children. Complications of chickenpox are rare, but include pneumonia, encephalitis, and secondary bacterial infections.

Infection with this virus usually gives lifelong immunity, although 2nd attacks have been documented in immunocompromised people. The viral infection remains latent, and disease may recur years later as shingles.

The TCI Ministry of Health strongly advises persons affected with chickenpox to remain at home during their sick leave period to prevent further spread of this illness within the community and schools.  [Byline: Robert Herriman]
=====================
[Varicella-zoster virus, a member of the herpesvirus family is the causative agent for chickenpox. Humans are the only reservoir of the virus, and disease occurs only in humans. After primary infection as varicella (chickenpox), the virus remains dormant in the sensory-nerve ganglia and can reactivate at a later time, causing herpes zoster (shingles).

Varicella occurs worldwide. In temperate climates, varicella tends to be a childhood disease, with peak incidence among preschool and school-aged children during late winter and early spring. In these countries, less than 5 percent of adults are susceptible to varicella. In tropical climates, the highest incidence was described in the driest, coolest months; overall, infection tends to be acquired later in childhood, resulting in higher susceptibility among adults than in temperate climates, especially in less densely populated areas.

All people, including those traveling or living abroad, should be assessed for varicella immunity, and those who do not have evidence of immunity or contraindications to vaccination should receive age-appropriate vaccination. Vaccination against varicella is not a requirement for entry into any country (including the United States), but people who do not have evidence of immunity should be considered at risk for varicella during international travel.

Varicella vaccine contains live, attenuated varicella-zoster virus. Single-antigen varicella vaccine is licensed for people aged 12 months and older, and the combination measles-mumps-rubella-varicella (MMRV) vaccine is licensed only for children 1-12 years. CDC recommends varicella vaccination for all people aged 12 months and older without evidence of immunity to varicella who do not have contraindications to the vaccine: 1 dose for children aged 1-4 years and 2 doses for people aged 4 years and older. The minimum interval between doses is 3 months for children aged less than 13 years and 4 weeks for people aged 13 years and older. Contraindications for vaccination include allergy to vaccine components, immune-compromising conditions or treatments, and pregnancy. When evidence of immunity is uncertain, a possible history of varicella is not a contraindication to varicella vaccination. Vaccine effectiveness is approximately 80 percent after 1 dose and 95 percent after 2 doses.

(Excerpted and edited from

Maps of the Turks and Caicos Islands may be accessed at
and <http://healthmap.org/promed/p/48358>. - ProMED Mod.LK]
Date: 7 Jul 2014
Source: TC Weekly News [edited]

Pet owners are being cautioned about a tick disease which is becoming a problem in dogs in the Turks and Caicos Islands. Licensed veterinarian Mark Woodring said that the disease, babesiosis, can be transmitted by bites from ticks.

Infected dogs show a number of signs, including decreased appetite, weight loss, fever, an enlarged abdomen, and dark orange or yellow skin and urine. The disease causes the dog's red blood cells to be destroyed, leading to pale gums and fatigue due to anemia. All dogs, including potcakes, (the local indigenous dog of the islands) can be infected. Some breeds are more susceptible to infection, especially greyhounds and all pitbull breeds, both purebred and mixed.

Woodring said that this disease can develop in a dog without ticks after an infected dog bites him or her, even playfully. He said that an infected female will pass along the disease to her puppies before birth.

"Accurate testing for babesiosis can be done with blood sent to the US for DNA studies, but most cases in the TCI are diagnosed by experienced veterinarians based on signs and physical exam. Although the disease is treatable with antibiotics, not every dog responds."

Early treatment is best, but even then, the disease can be fatal. The veterinarian said that another problem is that since 2012, the antibiotics most commonly used to treat tick-borne diseases have tripled in cost.

"Some antibiotics are in very short supply worldwide, to the point of restricting veterinarians from even ordering the medication. Preventing babesiosis means treating dogs and their environments to limit tick exposure."

He said that many prescription and non-prescription flea and tick prevention medications as well as yard treatments like Diatomaceous Earth and chemical preparations are available.

"This can be a difficult, expensive and frustrating task, as ticks eventually can become resistant to most products. To stop the spread of babesiosis, infected dogs should be treated with a full course of antibiotics."

Even after a dog recovers, he or she may still carry the disease. Females who have had the disease, even healthy-appearing ones, should not be bred. Adopting puppies from previously infected dogs or dogs with an unknown infection history is risky. Puppies are more likely to die from it than adult dogs.

Woodring said that the good news is that dogs cannot transmit this to humans.
===============
[Canine babesiosis is a disease caused by the intra-erythrocytic protozoan parasites _Babesia canis_ and _Babesia gibsoni_. Babesiosis is transmitted by ticks to susceptible canine hosts. _Rhipicephalu ssanguineus_ is the most common tick vector in the United States. Splenectomized dogs, immunocompromised dogs and young dogs between the ages of 2 and 8 months are most susceptible to infection. Canine babesiosis occurs worldwide. Within the United States, it is most common in the southeast. Although canine babesiosis is considered uncommon in the U.S., it is of clinical significance due to its morbidity and mortality. It is an important differential when history and clinical signs are consistent with infection and other more common diseases have been ruled out.

Hemolytic anemia and hypotensive shock are typical clinical syndromes of infection. Hemolytic anemia results from direct erythrocyte damage by the parasite, and both intravascular and extravascular immune-mediated destruction of red blood cells. Infection can produce thrombocytopenia, the mechanism of which consists of immune-mediated destruction and sequestration in the spleen. Physical examination reveals splenomegaly, lymphadenomegaly, fever and, less frequently, lethargy, vomiting, hematuria, and icterus. Hypotensive shock results from the release and production of vasoactive amines and cytokines which produce vasodilation. It most often occurs in puppies with the peracute form of the disease. Death may occur and is seen most often in _B. gibsoni_ infections and in puppies affected with _B. canis_ and _B.gibsoni_. Chronic infections, subclinical carrier states and atypical canine babesiosis may also occur.

Infection with _B. canis_ or _B. gibsoni_ is definitively diagnosed by demonstration of the parasites on red cells. Blood smears may be stained with Diff-Quik or preferably Wright's or Giemsa stain.

The most effective drugs used in the treatment of canine babesiosis include diminazene aceturate, phenamidine isethionate, and imidocarb dipropionate, which are not available or approved for use in the United States. Treatment of canine babesiosis in the U.S. is, therefore, mostly aimed at treating signs. The majority of babesia cases diagnosed in dogs in the U.S. are caused by the less virulent strains of _B. canis_, and dogs frequently recover from these infections naturally with supportive therapy. Clindamycin has been successfully used to treat canine babesiosis and may be considered in refractory or more severe and virulent infections.

Prevention of canine babesiosis is mostly aimed at controlling the vector. It is an important aspect since treatment is not always successful. The environment should be treated to decrease tick numbers, dogs should be treated to control tick infestations, and ticks should be removed from parasitized animals as quickly as detected.

Recently, a vaccine which minimizes the severity of infection was developed. The vaccine is reported to be 70 to 100 percent effective in diminishing the pathologic effects which typically ensue upon infection. The vaccine is currently available in Europe where canine babesiosis is a more common life-threatening disease.

Blood transfusion poses a significant risk to recipient animals; therefore, it is recommended that donor animals be tested for infection with babesia organisms. Splenectomy prior to testing significantly improves the likelihood of finding organisms in a blood sample from an infected donor.

Portions of this comment were extracted from:

Turks and Caicos Islands, a British Overseas Territory, may be located on the interactive HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/6007>. - ProMed Mod.TG]
Date: Mon 18 Mar 2013
Source: Turks & Caicos Weekly News [abbrev., edited]
-------------------------------------------------
The nation capital has seen an increase in the number of diarrhoea and vomiting cases this week. Premier, Dr. Rufus Ewing, told the media on Wednesday [13 Mar 2013] that the last reported number was 74, of which two-thirds have direct linkages to operations at a major restaurant establishment on Grand Turk. Ewing holds the portfolio of Health Minister. The Premier noted that officials from the Pan American Health Organisation (PAHO), here on other businesses, were on hand to support the Ministry of Health. According to him, samples have been collected and sent to the Caribbean Public Health Agency (CARPHA) for testing. Ewing, at Parliament on Thursday, also addressed the issue and said: "Tourism is our main revenue earner and we have to do all that is necessary to protect the industry...the pathological agent causing the diarrhea and vomiting is unknown at this time.

"But the Communicable Disease Surveillance and outbreak response team are vigilantly working and collaborating with the Caribbean Public Health Agency to establish the cause and implement public health measures to control and contain the outbreak. It is uncertain at this time whether this is a viral outbreak initiated by a cruise ship passenger or a point food source outbreak from the restaurant." The Premier acknowledged that the ministry of health staff within the various departments and units are doing a tremendous job in communicable disease surveillance and control with respect to this outbreak, but noted that much strengthening of the system is needed.

The Ministry has stressed the importance of minimising the opportunities to spread illness-causing germs by practicing proper food safety and personal hygiene measures at all times. It is also reminding all stakeholders to educate clients and patients about proper food safety and hygiene practices as well as of their obligations to report cases of diarrhoea or vomiting to the Ministry in a timely manner. Anyone who experiences diarrhoea and or vomiting has been urged to report to their nearest health care provider and avoid going to work until their symptoms have resolved. The situation continues to be monitored.
******
Date: Wed 27 Mar 2013
Source: ABC News, Associated Press report [edited]

T&C Cruise Terminal Closes After Illness Outbreak
------------------------------------------
The tourist board in the Turks & Caicos Islands announced Tuesday [26 Mar 2013] that the cruise terminal on Grand Turk has been temporarily closed. Cruise lines starting cancelling port calls to Grand Turk on 11 Mar 2013 after passengers suffered from symptoms of gastroenteritis after visiting the Grand Turk Cruise Center in the British Caribbean territory. In its Tuesday statement, the British territory's tourist board didn't say why or when the nearly 18-acre Grand Turk Cruise Center closed. Board Director Ralph Higgs said local authorities were addressing the problem and hoped to reopen the terminal soon.

In Turks & Caicos, the general manager of the Grand Turk Cruise Center declined comment and referred queries to Carnival Corp., which opened the terminal in 2006. Carnival spokesman Vance Gulliksen said the Miami-based company was "investigating whether there may be a link with consumption of food and beverages while guests were ashore in Grand Turk." Gulliksen said Carnival and other cruise lines cancelled port calls to Grand Turk to be cautious and are monitoring the situation while authorities try to determine the cause of the illness. Various cruise lines rerouted their ships or extended their stays in ports in Puerto Rico, Bahamas and other locales.

A Florida-based spokesman for the cruise center said Tuesday [26 Mar 2013] afternoon that numerous experts, working with local health officials, have been examining and testing food and water at the cruise terminal over the last 2 weeks.

"Multiple measures are currently being taken to ensure the quality of all food, water and sanitation systems going forward," spokesman Buck Banks wrote in an e-mail. He said he works for a public relations company hired by the cruise terminal. The Grand Turk Cruise Center declined to provide information about when the terminal closed to ships, but the terminal's port schedule listed no arrivals after 13 Mar 2013. The port includes a 45 000-square-foot shopping center, a big swimming pool and numerous food and beverage outlets.
******
Date: Tue 26 Mar 2013
Source: Cruise news [edited]

As Precaution, Cruise Lines Skip Calls to Grand Turk
--------------------------------------------
Cruise lines are continuing to pull out of their calls in Grand Turk after passengers reported feeling ill following visits to the Caribbean port in early March [2013]. Carnival Cruise Lines, Holland America Line and Princess Cruises have replaced planned stops in Grand Turk next week. Several lines canceled calls last week after passengers on previous cruises to the port reported gastrointestinal issues. While no link between illness and food and beverage consumption on the island has been confirmed, Holland America, Carnival and Princess report they are investigating.

As a precaution, Carnival has canceled Freedom's 25 Mar 2013, Breeze's 26 Mar 2013 call, and Glory's 29 Mar 2013 call. Instead, Freedom will visit Freeport and Breeze will call on Key West, according to spokesman Vance Gulliksen. Glory will have an extra sea day and will extend port times in St. Thomas and San Juan. Holland America's Eurodam will forgo its scheduled 25 Mar 2013 call to Grand Turk and will sail directly to San Juan, its next scheduled port of call. Eurodam will arrive 5 hours earlier than scheduled, so passengers will have more time in port. Ruby Princess also was scheduled to call on Grand Turk on 29 Mar 2013 but instead will call on Nassau, according to Princess Cruises spokeswoman Karen Candy. Spokespeople for the lines have said the companies will continue to monitor the situation.

"Scheduled calls to Grand Turk on future Caribbean sailings through the end of the season in early April will be assessed, as the call dates get closer," Holland America spokesman Erik Elvejord said in a statement. Eurodam and Nieuw Amsterdam each has one scheduled call to Grand Turk the 1st week of April [2013]. The port's online calendar shows no ships scheduled in Grand Turk for the rest of the month.   [Byline: Colleen McDaniel]
=======================
[The absence of a diagnostic test result from the gastroenteritis outbreak inked to a particular shore-based restaurant 14 days ago limits interpretation of this outbreak. But the predominant symptoms of gastroenteritis and vomiting are suggestive of an outbreak of norovirus infection. Outbreaks of norovirus infection have been frequently associated with cruise ships trading mostly, but not exclusively, in the Caribbean.

The Turks and Caicos Islands outbreak is unusual in that the source of the infection appears to have been land-based and not associated with the cruise ship. Prudently cruise ships are presently avoiding the Turks and Caicos Islands until the source and identification of the causative agent have been established.

The Turks and Caicos Islands are a British Overseas Territory consisting of 2 groups of tropical islands in the West Indies. The larger Caicos Islands and the smaller Turks Islands are popular destinations for tourists, and also trade as offshore financial centres. The total population is about 45,000.

A map of the Turks and Caicos islands can be accessed at:
<http://www.turksandcaicos.tc/turks/index.htm> - ProMed Mod.CP]
More ...

World Travel News Headlines

Date: Fri, 16 Aug 2019 03:38:45 +0200 (METDST)
By Paulina ABRAMOVICH

Santiago, Aug 16, 2019 (AFP) - Once deep in powder this time of year, Chile's ski stations are fighting the ravages of climate change and pollution that have brought less and less snow to the central Andes.   Just a few decades ago, the Andes mountain range could be buried under four meters of snow, forcing the closure of access roads and requiring the use of tractors to get around.

But this year, it's snowed only three times in the Chilean Andes, and never more than 30 centimetres.   It's not just Chile affected, but the whole of the Andes where the area of snow cover in the central zone has diminished by five to 10 percent each decade, according to Raul Cordero, an academic at the University of Santiago.   "But it's not just snow cover that's decreasing, the thickness of the snow cover is also reducing," he said.   "So when we talk about a decrease of the cover of five to 10 percent, this probably signifies a much greater reduction in the volume of available snow over the Andes."

Rising temperatures mean the snow line -- above which snow never melts all year round -- keeps creeping upwards.   The snow melt is even more pronounced in the central zone due to pollution from the Chilean capital, one of the most contaminated urban areas in the region.   A recent study led by Cordero found that soot, or black carbon, from Santiago was settling in the Andes and accelerating the snow melt.   As it's black, it absorbs more solar radiation and heats up quicker.   "When this pollution is over the cities it poisons people and when the wind blows, this pollution goes and is deposited on the mountains and contributes to the snow melt," said Cordero.

- Essential snow cannons -
The upshot is that Chile's ski stations have had a difficult season.    But thanks to the snow cannons, the erection of fences and a tailored piste management policy, the resorts have managed to stay open throughout a winter in which there has been almost no snow.   "All the ski centers in the central zone are without natural snow. However, thanks to the fabrication of snow we've been able to keep open pistes that without this fabrication would not have been able to stay open," Fernando Montenegro, the operations director at Andacor, which operates the El Colorado and Parque Farellones ski stations, told AFP.

El Colorado is 50 kilometers from Santiago and sits at 2,800-meters. It pumps out snow whenever the conditions allow it.   Low temperatures and high humidity is what's needed for the snow cannons to chug into gear and churn out snowflakes from water.   This technology has been around since 1994, but it's never before been in use as much as it is now -- and even then the ski station is only operating at 70 percent capacity.   But even if the situation gets worse, the ski stations will manage, according to Montenegro.   "There's no risk. However, we need to manage the snow and manage the water in the mountain range in a good way."   El Colorado has already invested almost $4 million in buying snow cannons and hopes to increase that to $10 million over the coming years.

- 'Variety so important' -
Last weekend, some 7,000 people descended on El Colorado where ski and snowboard national teams come to train -- although, they're not necessarily happy.   "If there's not enough snow, there's not as many hills. We don't get the variety, we don't get steepness, (or) different slopes: it's so important for us to have that variety," Megan Farrell, a member of the Canadian snowboard team, told AFP.   Amateur skiers also noticed the difference from previous years.   "You can see that the snow is harder. It's not very deep, there are a lot of stones and snow made by the cannons, which makes it feel like you're skiing on a different type of snow," said Chilean Rado Milosevic, 24.
Date: Thu, 15 Aug 2019 20:21:28 +0200 (METDST)

Tokyo, Aug 15, 2019 (AFP) - A powerful tropical storm lashed Japan on Thursday, bringing strong winds and torrential rain that claimed at least one life, prompted warnings of landslides and flooding, and sparked evacuation advisories and travel chaos at a peak holiday period.   Severe Tropical Storm Krosa -- one notch below a typhoon -- slammed into the southern Hiroshima region, packing wind gusts of up to 126 kilometres (78 miles) per hour.   Dramatic television footage showed violent winds uprooting trees, snapping lampposts and spinning pods on a Ferris wheel.

Meanwhile, high waves smashed into a breakwater, engulfing a 10-metre lighthouse, while swollen rivers broke their banks and swamped nearby roads.  Authorities issued a voluntary evacuation advisory to around 430,000 people in the storm's path, although few appeared to have heeded the warning.

A 82-year-old man was confirmed dead after he fell in the sea in Hiroshima while trying to moor his boat, a local government spokesman said.    Japanese news agency Kyodo reported that a total of 49 people were injured from Wednesday to Thursday.   "We still have intermittent downpours," said Takayoshi Sugimoto, a disaster management official in the southwestern province of Tokushima.   "We will remain vigilant," he told AFP.

The national disaster management agency said a party of 18 people, including children, were stranded during a barbeque in a valley when a river rose rapidly on Wednesday. They were rescued Thursday morning.   Krosa also sparked travel chaos as people battled to return to major cities following the Obon holiday.   More than 800 domestic flights were cancelled to and from cities in western Japan, and bullet train services were either scrapped or sharply reduced.   Ferries connecting the southern Shikoku island and other parts of Japan were also cancelled as high waves lashed the coast.

The storm brought strong winds and downpours to the capital Tokyo.   Several ceremonies commemorating the end of World War II were cancelled in western Japan due to bad weather.    Krosa weakened significantly from earlier in the week as it stalled in the Pacific Ocean but it boasts an unusually large eye, meaning it is likely to dump rain over a wide area.   It was moving north at 35 kilometres (22 miles) per hour and the rain was expected to last for an extended period.   The storm crossed Japan's mainland and hit the Sea of Japan late Thursday.
Date: Thu, 15 Aug 2019 15:36:40 +0200 (METDST)

Tripoli, Aug 15, 2019 (AFP) - Flights at the Libyan capital's sole functioning airport were suspended Thursday after deadly overnight rocket fire, a spokesman for the country's unity government said.   Wednesday night's rocket fire "killed a guard and wounded several security agents tasked with protecting the airport," said Moustafa al-Mejii, spokesman for the Tripoli-based Government of National Accord (GNA).   He blamed the attack on "the militias of (Khalifa) Haftar" whose forces launched an offensive on the Libyan capital in April.   Arrivals and departures at Mitiga airport were suspended as a result, Mejii said.   Located east of Tripoli, Mitiga is a former military airbase that has been used by civilian traffic since Tripoli international airport suffered severe damage during fighting in 2014.

Mitiga is in a zone under the control of forces loyal to the GNA and has often been targeted, leading to repeated suspensions of flights.   United Nations envoy Ghassan Salame, in a report to the UN Security Council last month, urged "authorities in Tripoli to cease using the (Mitiga) airport for military purposes and for the attacking forces to halt immediately their targeting of it."   The GNA protested at what it said were "untruths" in the envoy's report.   Haftar's self-styled Libyan National Army (LNA) has encountered fierce resistance from pro-government forces in the battle for Tripoli.   A stalemate on the ground in the capital's southern outskirts has led to a greater reliance on air strikes by both sides.

The fighting since April has killed 1,093 people and wounded 5,752 others, according to the World Health Organization.   More than 120,000 people have been displaced.   The LNA said Thursday its air force carried out a strike against an airfield in Zuwara, a town west of Tripoli, and destroyed two hangars allegedly used to house Turkish drones.   "The runway and terminals were spared" at the airfield, which is not open to commercial flights, LNA spokesman General Ahmed al-Mesmari wrote on Facebook.   The GNA, however, posted pictures of a huge crater and debris on the tarmac.   Libya has been mired in chaos since a NATO-backed uprising that toppled and killed dictator Moamer Kadhafi in 2011.
Date: Thu, 15 Aug 2019 14:11:31 +0200 (METDST)

Hong Kong, Aug 15, 2019 (AFP) - Hong Kong's government unveiled HK$19.1 billion (US$2.44 billion) worth of economic relief measures and downgraded its growth forecasts on Thursday as the international hub reels from simmering pro-democracy protests and the US-China trade war.   Last week city leader Carrie Lam warned that 10-weeks of anti-government protests were hitting businesses like a "tsunami".    On Thursday, financial chief Paul Chan predicted the city's economy would grow by a miserly zero to one percent this year, the worst rate since 2009 after the global crash hit.

But as he announced a raft of sweeteners in a surprise "mini-budget", he denied the move was linked to the roiling unrest.   "The measures that we have just announced... trying to tackle the current economic difficulties and the coming economic headwinds, is not related to the political difficulties that we are facing," Chan told reporters.   Instead, he said, the primary headwinds remained ongoing trade tensions between Washington and Beijing -- two major markets for Hong Kong -- and the possible impact of Brexit.    "Based on the latest developments and assessments on the outlook, the Hong Kong economy will continue to face an austere environment for the rest of the year," he said.

Nonetheless, the sweeteners seemed to be aimed at winning over support from moderate Hong Kongers as the city reels from the protests.    The measures included financial breaks for small businesses, more generous student subsidies and goodies for low-income households.  Ten weeks of unprecedented rallies, demonstrations and occupations in Hong Kong have seen millions of people take to the streets in the biggest challenge to China's rule of the semi-autonomous city since its 1997 handover from Britain.   The social and political unrest was triggered by a controversial bill which would have allowed extraditions to mainland China, but has evolved into a call for wider democratic reforms and a halt to sliding freedoms.

The retail and tourism sectors have been especially hit by the drop in arriving visitors to the city, but the property market remains strong.   At a "citizens press conference" on Thursday, one protest group blamed the city's economic woes on the local leaders who they accused of undermining the city's business appeal by kowtowing to Beijing.
Date: Thu, 15 Aug 2019 11:07:44 +0200 (METDST)

Johannesburg, Aug 15, 2019 (AFP) - South Africa on Thursday announced visa waivers for four countries in a bid to boost tourism amid an economic crisis and falling visitor numbers.   Visitors from Qatar, Saudi Arabia, United Arab Emirates and New Zealand will no longer require a visa to visit for holiday, conferencing and business purposes, Home Affairs Minister Dr Aaron Motsoaledi said.

The unilateral decision comes as official tourism figures released in May reflected a dip in the overall number of visitors to South Africa from Europe and the Middle East in the first financial quarter of the year, normally one of the most popular times to visit.   Foreign traveller arrivals decreased by more than 10 percent between April and May 2019 alone.   Motsoaledi said the South African government was engaging with Qatar, Saudi Arabia, United Arab Emirates and New Zealand about a similar relaxation of entry requirements for SA citizens.   He argued the move by his department would boost tourism "and by extension growing the economy and creating jobs".

South Africa's economy has hit trouble, with gross domestic product (GDP) contracting by 3.2 percent in the first three months of 2019 and unemployment at a record high of 29 percent.   The government estimates there is potential to create 2.1 million jobs in the tourism sector by 2028.   South Africa is in talks to extend the visa waiver to Ghana, Cuba and Principe and Sao Tome.    The country has already waived the visa requirement for 82 of the 193 countries who are UN members.
Date: Tue 13 Aug 2019, 18:22 PM
Source: The News Minute (TNM) [edited]

In early July [2019], 2 children from Sathyamangalam in Tamil Nadu's Erode district succumbed to diphtheria. Around this time, several other cases of diphtheria were being reported from the state. The latest information shows that at least 50 people have been admitted to the Coimbatore Medical College and Hospital with diphtheria.

Health officials in the state have begun stepping up measures to ensure that the spread of the disease is contained and that more people are vaccinated. The Directorate of Public Health (DPH) even issued an alert to doctors in Chennai to treat all children presenting with sore throat with an antibiotic used to treat the disease, without waiting for the confirmation of a diagnosis.

Despite several campaigns to raise awareness about the importance of vaccination and ensuring that children are vaccinated according to the immunisation schedule, officials note that discrepancies in immunisation have played a large role in the current outbreak of diphtheria.

Tamil Nadu's Deputy Director of Public Health, Dr. K Kolandaswamy, had earlier told TNM that the current spike in the number of cases had to do with lack of immunisation. While several parents had skipped vaccinating their children at a young age, many others had not ensured that the booster dose was taken at a later age. However, in light of the recent outbreak in which both young people and adults have been affected, preventive measures have been stepped up. Not only are children being given the vaccine and booster doses (as deemed necessary), but so are adults.

Diphtheria is a disease caused by the organism _Corynebacterium diphtheriae_ and is highly contagious. Symptoms of diphtheria are often very similar to that of a common cold or any mild respiratory infection, which makes it difficult to differentiate between diphtheria and a more generic infection.

An infected individual may begin to present with symptoms anywhere from 2 to 10 days after exposure to the bacteria. The infected person usually develops a sore throat, which aggravates and will generally develop other respiratory issues as well, if left untreated. While the treatment for diphtheria consists of antibiotics and supportive measures as necessary (painkillers, fluids, etc), it has been determined that the best course of action is to take preventive measures.

The vaccine against diphtheria is given as a pentavalent vaccine (offers immunisation against 5 diseases: diphtheria, pertussis, tetanus, hepatitis B and Hib-Haemophilus influenza type b). It is given at 1.5, 2.5 and 3.5 months of age. The DPT vaccine (trivalent, covers 3 diseases: diphtheria, pertussis and tetanus) is given between 16 to 24 months of age. When the child is around 6 years old, another booster dose is required. In addition, the Centre has also advised that children be given the Td vaccine (covers tetanus and diphtheria) at age 10 and age 15.  [Byline: Dr Nimeshika Jayachandran]
========================
[Erode, with a population of about 2.25 million residents in 2011, is the largest district in the Indian state of Tamil Nadu, located in the state's westernmost region; its headquarters is the city of Erode (<https://en.wikipedia.org/wiki/Erode_district>).

A map showing the location of Erode District in south-central India can be found at
<https://www.google.com/maps/place/Erode,+Tamil+Nadu,+India>.

Diphtheria is caused by toxin-producing strains of _Corynebacterium diphtheriae_, an aerobic Gram positive bacillus. _C. diphtheriae_ causes respiratory tract or cutaneous diphtheria. Toxin production occurs only when the bacillus is infected (lysogenized) by a specific bacteriophage that carries the gene encoding the toxin. The most common sites of diphtheria infection are the pharynx and the tonsils, where an adherent pseudomembrane forms, which may result in respiratory obstruction. The toxin is responsible for the major complications, myocarditis (such as cardiac arrhythmias and heart failure) and neuritis (such as paralysis of the soft palate, eye muscles, limbs, and diaphragm). The overall case fatality rate for diphtheria is 5-10% but is higher (up to 20%) among persons younger than 5 and older than 40 years of age.

Close contacts, especially household contacts, should receive a diphtheria booster, appropriate for age, and antibiotics, such as benzathine penicillin G or a 7-10-day course of oral erythromycin. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of India:
Date: Tue 13 Aug 2019 2:21 AM CDT
Source: MPR [Minnesota Public Radio] News [edited]

[Minnesota] state health officials said [Tue 13 Aug 2019], 3 children are sick from _E. coli_ bacteria after swimming in a Minneapolis lake. The children have tested positive for the same strain of _E. coli_ after swimming at Lake Nokomis beaches between [26 Jul and 2 Aug 2019]. 2 beaches of the lake are closed until further notice, the Minnesota Department of Health said. The children, all under the age of 10, were not hospitalized.

Minneapolis Park Board Superintendent Al Bangoura said it's the 1st time someone has fallen ill after swimming in a Minneapolis lake in more than 20 years. "We take this very seriously and are working closely with the Minnesota Department of Health as they conduct their investigation," Bangoura said in a news release.

Symptoms of illness caused by _E. coli_ bacteria include stomach cramps and diarrhea, with mild or no fever. People typically become ill 1 to 8 days after exposure. It's rare, but the infections sometimes lead to a serious complication involving kidney failure. Health officials say children younger than 10 years old, the elderly, and those with weakened immune systems have a higher chance of developing complications from _E. coli_ infections.

"This is also an important reminder that anyone who is experiencing diarrhoea should not go swimming while they are sick," said Trisha Robinson, waterborne disease supervisor at the Health Department.

Officials also want to hear from anyone else who may have become ill after swimming in Lake Nokomis.

"If there are other people who have gone swimming and are concerned about their symptoms of illness, we very much encourage them to contact their health care providers," Robinson said.
===================
[It is important to understand that there are many different kinds of _E coli_. The organism is an important component of the human intestinal tract and can perform important functions helpful to its host. These strains can cause human infections if they "escape" from the usual location into the urinary tract, gall bladder, or abdominal cavity. They are also what are mentioned when a beach is closed for _E. coli_ contamination. In this circumstance, officials are measuring the organism or "coliforms" in the water to reflect human sewage contamination.

Additionally, there are some strains of _E. coli_ that can produce toxins that can produce diarrhea, and much of so-called travellers' diarrhoea is caused by these strains. All of these strains are human bacteria, not zoonotic organisms, that is, not spread from animal hosts. One _E. coli_ group called Shiga toxin producing or enterohemorrhagic _E. coli_ (EHEC) is the organism likely to be involved here, are zoonotic. Spread in a number of ways, including via undercooked ground beef, contaminated vegetables, and direct or direct contact with farm animals including contaminated water, EHEC can cause significant disease and even death.

In the spring of 2000, in Walkerton, a town of 5000 in southern Ontario, an outbreak of _E. coli_ O157:H7 infection claimed 7 lives -- 6 adults and a child -- and over 200 were seen at local area hospitals.

Swimming-associated transmission is illustrated in the following references:

1. Keene WE, McAnulty JM, Hoesly FC, et al. A swimming-associated outbreak of hemorrhagic colitis caused by _Escherichia coli_ O157:H7 and _Shigella sonnei_. N Engl J Med. 1994; 331(9): 579-84; available at <http://www.nejm.org/doi/full/10.1056/NEJM199409013310904>.
2. CDC. Lake-associated outbreak of _E. coli_ O157:H7 - Illinois. MMWR 1996; 45(21): 437-9; available at <https://www.cdc.gov/mmwr/preview/mmwrhtml/00042070.htm>.
3. Ackman D, Marks S, Mack P, et al. Swimming-associated hemorrhagic colitis due to _Escherichia coli_ O157:H7 infection: evidence of prolonged contamination of a fresh water lake. Epidemiol Infect. 1997;119:1-8; available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808815/>. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Minnesota, United States:
Date: 13 Aug 2019
Source: RFI France [edited]

38 children in France, including babies, living near what was once Europe's largest gold mine have tested positive for arsenic poisoning.

Children in the Orbiel Valley, in the southern department of Aude, were examined when families became concerned that flooding in October last year [2018] had carried arsenic and heavy metals from the nearby Salsigne mine.

After testing 103 children aged under 11 years, the Occitanie Regional Health Agency confirmed on Tue [13 Aug 2019] that 38 of them had returned positive test results for above-average levels of arsenic.

Salsigne, the world's largest arsenic mine, had been operating for almost a century when it closed in 2004. Millions of tons of toxic waste, which local NGOs say have not been properly sealed, are in storage at 5 nearby sites.

In October 2018, 14 people were killed when the Aude was hit by violent floods. Media reports say the Orbiel river and its tributaries have spread pollutants from the old mine.  [Byline: Eric Cabanis]
=========================
[There are a number of ways products can enter the body: inhalation, absorption, ingestion, and injection. Absorption is often thought of as products being absorbed through the GI tract, but it is also most significantly through the skin (such as a bath if arsenic is in the water). The integument (skin) is one of the largest organs of the body.

There are different forms of arsenic. There are 2 forms of inorganic arsenic: the reduced or trivalent arsenic (+3) or arsenite, and the oxidized or pentavalent (+5) form known as arsenate. Both of these forms can be absorbed and accumulated in tissues and body fluids.

There are also organic arsenics, but these are generally regarded as less harmful, by orders of magnitude.

Arsenic is a known carcinogen. The article does not tell us whether the exposure was to organic or inorganic arsenic. The form of arsenic is important with regard to toxicity. We are not told the specific ages of the children or babies. However, children, babies, and even pregnant women metabolize arsenic differently than non-pregnant adults.

Exposure to higher than average levels of arsenic occur mostly in the workplace, near hazardous waste sites, or in areas with high natural levels. At high levels, inorganic arsenic can cause death. Exposure to lower levels for a long time can cause a discoloration of the skin and the appearance of small corns or warts. In the United States, arsenic has been found in at least 1149 of the 1684 National Priority List sites identified by the Environmental Protection Agency (EPA).

Arsenic is a naturally occurring element widely distributed in the earth's crust. In the environment, arsenic is combined with oxygen, chlorine, and sulfur to form inorganic arsenic compounds. Arsenic in animals and plants combines with carbon and hydrogen to form organic arsenic compounds.

Inorganic arsenic compounds are mainly used to preserve wood. Copper chromated arsenate (CCA) is used to make "pressure-treated" lumber. CCA is no longer used in the U.S. for residential uses; it is still used in industrial applications. Organic arsenic compounds are used as pesticides, primarily on cotton fields and orchards.

What happens to arsenic when it enters the environment?
- Arsenic occurs naturally in soil and minerals and may enter the air, water, and land from wind-blown dust and may get into water from runoff and leaching.
- Arsenic cannot be destroyed in the environment. It can only change its form.
- Rain and snow remove arsenic dust particles from the air.
- Many common arsenic compounds can dissolve in water. Most of the arsenic in water will ultimately end up in soil or sediment.
- Fish and shellfish can accumulate arsenic; most of this arsenic is in an organic form called arsenobetaine that is much less harmful.

How might I be exposed to arsenic?
- Ingesting small amounts present in your food and water or breathing air containing arsenic.
- Breathing sawdust or burning smoke from wood treated with arsenic.
- Living in areas with unusually high natural levels of arsenic in rock.
- Working in a job that involves arsenic production or use, such as copper or lead smelting, wood treating, or pesticide application.

How can arsenic affect my health?
Breathing high levels of inorganic arsenic can give you a sore throat or irritated lungs.

Ingesting very high levels of arsenic can result in death. Exposure to lower levels can cause nausea and vomiting, decreased production of red and white blood cells, abnormal heart rhythm, damage to blood vessels, and a sensation of "pins and needles" in hands and feet.

Ingesting or breathing low levels of inorganic arsenic for a long time can cause a darkening of the skin and the appearance of small "corns" or "warts" on the palms, soles, and torso. Skin contact with inorganic arsenic may cause redness and swelling.

Almost nothing is known regarding health effects of organic arsenic compounds in humans. Studies in animals show that some simple organic arsenic compounds are less toxic than inorganic forms. Ingestion of methyl and dimethyl compounds can cause diarrhea and damage to the kidneys.

Several studies have shown that ingestion of inorganic arsenic can increase the risk of skin cancer and cancer in the liver, bladder, and lungs. Inhalation of inorganic arsenic can cause increased risk of lung cancer. The Department of Health and Human Services (DHHS) and the EPA have determined that inorganic arsenic is a known human carcinogen. The International Agency for Research on Cancer (IARC) has determined that inorganic arsenic is carcinogenic to humans.

There is some evidence that long-term exposure to arsenic in children may result in lower IQ scores. There is also some evidence that exposure to arsenic in the womb and early childhood may increase mortality in young adults.

There is some evidence that inhaled or ingested arsenic can injure pregnant women or their unborn babies, although the studies are not definitive. Studies in animals show that large doses of arsenic that cause illness in pregnant females, can also cause low birth weight, fetal malformations, and even fetal death. Arsenic can cross the placenta and has been found in fetal tissues. Arsenic is found at low levels in breast milk.

How can families reduce their risk for exposure to arsenic?
- If you use arsenic-treated wood in home projects, you should wear dust masks, gloves, and protective clothing to decrease exposure to sawdust.
- If you live in an area with high levels of arsenic in water or soil, you should use cleaner sources of water and limit contact with soil. - If you work in a job that may expose you to arsenic, be aware that you may carry arsenic home on your clothing, skin, hair, or tools. Be sure to shower and change clothes before going home.

There are tests available to measure arsenic in your blood, urine, hair, and fingernails. The urine test is the most reliable test for arsenic exposure within the last few days. Tests on hair and fingernails can measure exposure to high levels of arsenic over the past 6-12 months. These tests can determine if you have been exposed to above-average levels of arsenic. They cannot predict whether the arsenic levels in your body will affect your health.

The EPA has set limits on the amount of arsenic that industrial sources can release to the environment and has restricted or cancelled many of the uses of arsenic in pesticides. EPA has set a limit of 0.01 parts per million (ppm) for arsenic in drinking water.

The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit (PEL) of 10 micrograms of arsenic per cubic meter of workplace air (10 ug/m3) for 8 hour shifts and 40 hour work weeks.

Reference:
Agency for Toxic Substances and Disease Registry (ATSDR). 2007. Toxicological Profile for Arsenic (Update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Portions extracted from Agency for Toxic Substance and Disease Registry;
<https://www.atsdr.cdc.gov/toxfaqs/tf.asp?id=19&tid=3>. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Date: Sat 10 Aug 2019
Source: Nigeria CDC [edited]

The Nigeria Centre for Disease Control (NCDC) is aware of a suspected outbreak of yellow fever in Ebonyi state and has had a rapid response team supporting Ebonyi state's response since [Tue 30 Jul 2019], in partnership with the World Health Organization (WHO).

Following a report of cases and deaths from fever of unknown origin in Izzi local government area (LGA) in Ebonyi state, the state public health team commenced an investigation. As at [Wed 31 Jul 2019], 3 cases had tested positive for yellow fever at NCDC's national reference laboratory, which triggered an immediate response.

The Ebonyi State Epidemiology Team is leading the response with support from the Nigeria Centre for Disease Control (NCDC), the National Primary Health Care Development Agency (NPHCDA), and the World Health Organisation (WHO). In the course of investigation, it was discovered that between 1 May-7 Aug 2019, there had been cases that fit into the case definition for yellow fever and 20 deaths in Izzi LGA, Ebonyi state, indicating that the outbreak may have been going on for a few months, undetected by local health authorities. It was too late to collect samples for confirmation from these cases.

Immediately [after] it was notified, NCDC deployed a rapid response team to support Ebonyi state with contact tracing, case finding, risk communications, and the management of cases. Detailed analysis and plans are in advanced stages to apply to the international vaccine stockpile to enable a reactive vaccination campaign in Ebonyi state, in response to the cluster of cases.

Yellow fever virus is spread through bites of an infected mosquito. There is no human-to-human transmission of the virus. Yellow fever is a completely vaccine-preventable disease, and a single shot provides immunity for a lifetime. The yellow fever vaccine is available for free in primary health care centres in Nigeria as part of the routine immunisation schedule. Every child is protected for life if vaccinated. We encourage every family to ensure that children receive all their childhood vaccines.

In addition to the vaccine, the public is advised to keep their environments clean and free of stagnant water to discourage the breeding of mosquitoes and to use insecticide-treated mosquito nets as well as screens on windows and doors to prevent mosquito bites. It is important to avoid self-medication. Visit a health facility immediately if you feel ill.

Since September 2017, Nigeria has recorded suspected cases of yellow fever in all states in the country. As at [Wed 31 Jul 2019], 78 cases have been laboratory confirmed in Nigeria in 2019 alone. A multi-agency yellow fever technical working group coordinated by NCDC has been leading the investigation and response to yellow fever cases. The National Primary Health Care [Development] Agency is leading efforts to provide an additional opportunity of vaccination through preventive vaccination campaigns across the country.

Healthcare workers are reminded that the symptoms of yellow fever include yellowness of the eyes, sudden fever, headache, and body pain. If you have these symptoms or notice someone in your community displaying them, please contact your nearest health centre.
=====================
[The yellow fever [YF] virus is endemic in Nigeria, and cases occur there sporadically. This has been an active year (2019) for YF in Nigeria. The previous ProMED-mail post indicated that 930 suspected cases have been reported this year from 1 Jan-30 Apr 2019. There are 332 suspected cases during the April 2019 reporting period, up from 254 suspected cases on 19 Feb 2019. There are 3 new presumptive and 3 new confirmed yellow fever cases during the April 2019 reporting period.

The current focus of transmission is in Ebonyi state. The above report indicates that YF vaccine is available without cost in primary healthcare centers but does not mention if an organized vaccination campaign is underway or being planned, nor the proportion of the Ebonyi state population that is unvaccinated and, hence, at risk for YF. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Ebonyi state, Nigeria: <http://healthmap.org/promed/p/1306>]
Source: Arutz Sheva 7 [edited]
Date: Tue 13 Aug 2019

A stewardess of Israel's El Al airline died Tuesday [13 Aug 2019], following a months-long battle with measles. The 43-year-old stewardess was infected with the measles virus during a flight from New York to Israel 5 months ago.

After she was infected, the stewardess was hospitalized in serious condition at Meir Medical Center in Kfar Saba in central Israel after she was found unconscious and struggling to breathe. During her hospitalization, the stewardess' condition deteriorated, and she was transferred to the quarantine section of the hospital's intensive care wing.

On Tuesday [13 Aug 2019], doctors at Meir hospital declared her death, following the 5-month struggle.  [Byline: Orly Harari]
===========================
[This is a very sad outcome, and our condolences go out to the family of the flight attendant, who worked for El Al, the Israeli national airline. It is not clear whether she contracted the virus in New York, in Israel, or on a flight between the two locations. The flight attendant received only one dose of the measles vaccine when she was a child. It wasn't discovered until later that one dose is only about 93% effective. More recently -- in the USA, starting in 1989 -- children have been given 2 doses, which is about 97% effective, according to the CDC. See Measles update (27) http://promedmail.org/post/20190418.6429834 for an earlier report on the flight attendant. - ProMED Mod.LK]