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American Samoa

Samoa US Consular Information Sheet
January 23, 2008
COUNTRY DESCRIPTION:
Samoa consists of the two large islands of Upolu and Savai’i and seven small islets. The country has a stable parliamentary democracy with a developing economy. To
rist facilities are accessible by bus, taxi and car and are within walking distance of access roads. Infrastructure is adequate in Apia, the capital, but it is limited in other areas. Nearly all Internet connections use a relatively slow dial-up method. Samoa has two digital telephone service providers, and visitors can easily purchase prepaid phones that cover virtually the entire country. The Samoa Tourism Authority, at http://www.visitsamoa.ws/, provides a wide range of information of interest to travelers. Read the Department of State Background Notes on Samoa for additional information.

ENTRY/EXIT REQUIREMENTS:
U.S. nationals who are not U.S. citizens, and who are resident in American Samoa, must obtain a visitor permit prior to all travel to Samoa. U.S. nationals have not been permitted to travel to Samoa on certificates of identity since May 2005 except on a case by case basis. (U.S. law distinguishes between individuals who are citizens and those who are nationals. The U.S. passport bio-page shows one’s status as either a citizen or a non-citizen national.) As of March 22, 2006, visitor permits to travel to Samoa can be applied for at the new Samoa Consulate General office in Pago Pago, American Samoa. A valid passport and an onward/return ticket are required for all Americans (both citizens and nationals) to travel to Samoa. Visitor permits are not required for U.S. citizens (only for U.S. nationals) seeking to stay in Samoa for up to 60 days. All visitors are required to pay a departure tax of 40 Tala (approximately 17.50 USD) upon leaving the country. Further information about entry requirements and the departure tax may be obtained from the Samoa Mission to the United Nations at 800-2nd Avenue, Suite 400J, New York, NY 10017, telephone (212) 599-6196, fax (212) 599-0797. Visit the Embassy ofSamoa web site at http://www2.un.int/public/Samoa/ 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:
In Apia and many villages, stray dogs wander the streets. Visitors should not approach or feed them; they can become aggressive in the presence of food or if they feel threatened.

Although there have been no major accidents involving the ferry service linking Upolu and Savai’i, vessels are sometimes overloaded. One of the ferries, a multi-deck automobile ferry, sometimes transports passengers on its automobile deck. Americans who choose to use this ferry are encouraged not to remain in the automobile deck during the crossing and to ride only in the passenger compartment in order to avoid injury from shifting vehicles.

Samoa has numerous “blowholes” (lava tubes open to the sea where wave action produces, often spectacular, geysers). These blowholes are popular tourist attractions. The footing around the mouths of most blowholes is very slippery. To avoid being swept in, visitors should not approach too closely and should never stand between the opening of the blowhole and the sea.

Snorkeling and diving in ocean lagoons is a popular activity for many visitors to Samoa. Tide changes can produce powerful currents in these lagoons. Visitors are encouraged to consult local residents and tour operators about hazards and conditions at a particular location before venturing into the water.

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:
Overall, Samoa is considered a low threat environment. Nevertheless, visitors should remain aware of their surroundings, lock their doors at night, and not leave their belongings unattended. Incidents of petty theft/robberies of personal effects are common. Some such incidents have involved residential break-ins. While rare, violent assaults, including sexual assaults have occurred in Samoa. No specific groups have been targeted, nor have there been any racially motivated or hate crimes against Americans. Police responsiveness in Apia is generally good. Because of the very limited police presence elsewhere in Samoa (where order is maintained primarily by local village authorities), police responsiveness elsewhere is problematic.

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:
Health care facilities in Samoa are adequate for routine medical treatment, but are limited in range and availability; complex illnesses and life-threatening emergencies generally need to be treated elsewhere. Dental facilities do not meet U.S. standards, but good dental treatment and some emergency care can be obtained nearby at the LBJ Tropical Medical Center in Pago Pago, American Samoa. The national hospital and a small private hospital are located in Apia, and there are several small district hospitals on Savai'i and in outlying areas of Upolu. There are no hyperbaric chambers on any of the islands for the treatment of scuba diving related injuries. Serious cases of decompression sickness are evacuated to the nearest treatment center in Suva, Fiji, or Auckland, New Zealand. Serious medical conditions and treatments that require hospitalization and/or medical evacuation to the United States can cost thousands of dollars. Travelers should carry emergency evacuation insurance. Doctors and hospitals often expect immediate cash payment for health services. There is no reported incidence of malaria or rabies in Samoa. Occasional outbreaks of typhoid and non-hemorrhagic dengue do occur.

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

Safety of public transportation and rural road conditions in Samoa, are considered fair, while urban road conditions/maintenance is considered good. Taxis in particular are widely available and used by Samoans and visitors alike; buses are slow, generally crowded and uncomfortable, and rarely utilized by visitors. Rental cars can also be obtained. No roadside assistance is available. Most major roads are tar-sealed, but secondary roads are predominantly dirt and gravel and may be overgrown with vegetation. A four-wheel drive vehicle is recommended for travel on these roads. Travelers should be aware that vehicle safety regulations are rarely enforced and traffic violations occur routinely. Roads outside Apia are often narrow, winding, relatively steep, with narrow or no shoulders, and poorly lighted. Pedestrians as well as vehicles and livestock regularly travel these roads. Due to poor and deteriorating road conditions, night driving on unlit rural roads can be dangerous and should be avoided if possible. Roads in Samoa often traverse small streams. Drivers are urged to exercise extreme caution when fording these streams, which can become swollen and dangerous with little warning. Vehicles should never enter a stream if the roadbed is not visible or if the water’s depth exceeds the vehicle’s clearance.

Speed limits in Samoa are 25 miles per hour in the Apia area and 35 miles per hour outside Apia, with certain exceptions. At unmarked intersections, traffic on the left has the right of way. As in the United States, vehicular traffic moves on the right side of the road; although right-hand-drive vehicles (mainly from New Zealand) do exist in Samoa. Importing right hand drive vehicles to Samoa is currently legally forbidden.

Please refer to our Road Safety page for more information. Visit the web site of the country’s national tourist office at Samoa Tourism Authority at http://www.visitsamoa.ws/.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government ofSamoa’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Samoa’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:
Some overseas treatment centers, known as Behavior Modification Facilities, operate in Samoa. Though these facilities may be operated and staffed by U.S. citizens, the Samoan government is solely responsible for compliance with local safety, health, sanitation and educational laws and regulations, including all licensing requirements of the staff in country. These standards, if any, may not be strictly enforced or meet the standards of similar facilities in the U.S. Parents should be aware that U.S. citizens and non-citizen nationals 14 years of age and older have a right to apply for a passport and to request repatriation assistance from the U.S. government, both without parental consent. Any U.S. citizen or non-citizen enrollee has the right to contact a representative from the U.S. Embassy. For further information, consult the Department of State's Fact Sheet on Behavior Modification Facilities, available via the Bureau of Consular Affairs home page. Parents may also contact the U.S. Embassy in Apia or the country officer in the Office of American Citizens Services, Bureau of Consular Affairs at 202-647-5226.

Financial Transactions:
Although some businesses (especially those in Apia or those frequented by tourists) do accept credit cards, many (including gas stations) do not. Major credit cards (Visa, Master Card, and American Express) are accepted at major hotels and some restaurants and stores. Samoan currency can be obtained from ATMs, which are located in Faleolo Airport and in many locations in Apia. For more information on ATM locations and banking services see ANZ web site at http://www.anz.com/samoa/overview.asp and WESTPAC web site at http://www.westpac.com.ws/pacific/publish.nsf/Content/PFSA+HomePage.

Disaster Preparedness: Samoa is located in an area of high seismic activity. Although the probability that a major earthquake would occur during an individual trip is remote, earthquakes can and will continue to happen. Major cyclones have occurred in the past and are always a concern. Strong winds and very heavy rains are common, especially during the rainy season from November to April. During this period, Samoa receives most of its annual average of over 130 inches of rain. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency’s (FEMA) web site at http://www.fema.gov/.

Customs: Samoa customs authorities may enforce strict regulations concerning temporary importation into or export from Samoa of items such as firearms, fruits, pets and other animals, and drugs. It is advisable to contact the Samoan Mission to the United Nations at 800 2nd Avenue, Suite 400J, New York, NY 10017, telephone (212) 599-6196 for specific information regarding customs requirements. Please see our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Samoa’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Samoa 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:
Samoa is not a member of the Hague Convention on the Civil Aspects of International Child Abduction. 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 Samoa 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 withinSamoa. 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 in the Accident Compensation Board (ACB) Building, Fifth Floor, Apia. The Embassy is open to the public from 8:15 a.m. to 5:00 p.m. Monday - Friday. The Embassy's mailing address is U.S. Embassy, P.O. Box 3430, Apia, Samoa 0815. The telephone numbers are (685) 21436/21631/22696 and 21452. The fax number is (685) 22030. An Embassy officer can be reached after hours in an emergency involving the welfare of a U.S. citizen or non-citizen national at (685) 21514 or (685) 777-1776. Visit the U.S. Embassy’s web site at http://samoa.usembassy.gov/.
* * *
This replaces the Consular Information Sheet (now known as Country Specific Information) dated May 21, 2007, to update sections on Country Description and Crime.

Travel News Headlines WORLD NEWS

American Samoa. 8 Mar 2017.
(susp) as of mid-February 30 cases of Dengue.

A HealthMap/ProMED-mail map showing the location of American Samoa in the Pacific can be accessed at <http://healthmap.org/promed/p/380>
and a map of the island at <http://www.nationsonline.org/maps/tutuila-island-map.jpg>. - ProMED Mod.TY
Date: Sat 20 Sep 2014
Source: Radio New Zealand [edited]

Latest figures from Samoa's Ministry of Health show an increase of suspected and confirmed cases of chikungunya [virus infections] from 400 to 626 since the outbreak of the acute fever, rash and joint pain disease was reported in July [2014].

However, the ministry says so far presentation of the main signs and symptoms of those affected have largely been mild.

The highest number of people affected is recorded in the districts of Vaimauga west in the urban area with 151 cases; Faleata east, 139 cases; and 113 in Faleata west.  The majority of patients is young.

In American Samoa, the chikungunya outbreak is on the wane. Health officials say there are now 823 probable cases of the mosquito-borne illness, with 15 people requiring hospital care.
===========
[The chikungunya outbreak continues to grow in Samoa, from 269 cases reported on 25 Aug 2014 to 433 reported on 8 Sep 2014 and now to 626 cases. One hopes that a prompt and aggressive clean up of breeding sites will reduce the vector mosquito population enough to halt, or at least reduce, transmission.

On 26 Jul 2014, it was reported that American Samoa had about 100 cases, with 3 laboratory confirmed as chikungunya virus infections (see ProMED-mail archive no. 20140727.2638925). This is a sharp outbreak, with over 700 cases in a little over one month, apparently peaking at 823 probable cases reported above. Once introduced into American Samoa, spread of the virus is not surprising, because it has had dengue virus transmission in the past, and the same mosquitoes that transmit dengue viruses can transmit chikungunya virus as well.

A map showing the location of Samoa in the Pacific Ocean can be accessed at <http://www.worldatlas.com/webimage/countrys/oceania/wsnewz.gif>. A HealthMap/ProMED-mail map showing the location of both Samoa and American Samoa in the Pacific Ocean can be accessed at <http://healthmap.org/promed/p/380>. - ProMed Mod.TY]
Date: Mon 9 Sep 2014
Source: Radio New Zealand [edited]
<http://www.radionz.co.nz/international/pacific-news/253977/chikungunya-related-cases-reach-over-700-in-american-samoa

The latest reports from American Samoa reveal that chikungunya-related [febrile] cases have now reached over 700, and there is now one probable case in Ofu, Manua. The virus was discovered in the territory in July 2014, but there have been no reported cases in Manua until now.

Health officials are urging residents not to travel to Manua if they have chikungunya, and testing is being done to determine whether the case in Ofu is due to the virus. Since July 2014, there have been 11 hospitalisations with the virus but no deaths.

Health officials continue to urge those with symptoms to drink plenty of fluids, get a lot of rest, and visit the emergency department if symptoms become serious.
=======================
[On 26 Jul 2014, it was reported that American Samoa had about 100 cases, with 3 laboratory confirmed as chikungunya virus infections (see ProMED-mail archive no. 20140727.2638925). This is a sharp outbreak, with over 700 cases in a little over one month. Once introduced into American Samoa, spread of the virus is not surprising, because it has had dengue virus transmission in the past, and the same mosquitoes that transmit dengue viruses can transmit chikungunya virus as well.

A HealthMap/ProMED-mail map showing the location of American Samoa in the Pacific Ocean can be accessed at
Date: Tue 5 Aug 2014
Source: Radio New Zealand International [edited]

The American Samoan Department of Health says there are now more than 300 confirmed cases of chikungunya or 'chik' virus in the territory.

The Health Director Motusa Tuileama Nua says his department and LBJ hospital have confirmed the outbreak of fever, rashes, and joint pains among people on the main island of Tutuila is due to chikungunya.

He says there have been 343 recorded cases, with 6 patients hospitalised and no deaths, since the beginning of July [2014].

He recommends those who are ill with fever and body aches do not travel off island.
--------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
===============
[CHIKV has been circulating in Pacific islands this year (2014).

Maps showing the location of American Samoa in the Pacific Ocean can be accessed at
<http://healthmap.org/promed/p/380>. - ProMed Mod.TY]
****************************
American Samoa: confirmed
Date: Fri 8 Aug 2014
Source: Samoa News [edited]

The American Samoa Department of Health and the LBJ hospital have created a 24 hour a day hotline for the CHIK virus. The CHIK hotline number is 731-7511.

The Health Alert issued yesterday [7 Aug 2014] confirms chikungunya (CHIK) virus as the cause of fever, rash, and joint pains outbreak on Tutuila and there have been more than 390 recorded cases, with 7 patients hospitalized and no deaths since 1 Jul 2014.

According to the health alert, there is no cure for CHIK virus [infection, and] it can usually be treated at home by drinking lots of fluids, taking pain medicine like Tylenol, ibuprofen, or Aleve as needed but only as much and with cautions as recommended on the package.

The health alert urges not to work while your joints are painful, let them rest and apply ice or cold packs on the joints and this may protect against prolonged joint pain.

DOH notes you should go to the Emergency Room to see a doctor if symptoms persist more than 10 days, or if you have bleeding from any part of the body or bruised skin. Call the hotline "or come to the ER or clinic if you are worried about your condition getting worse."

The alert once again urges that people stay indoors in air-con, behind screens, or under bed nets while you are ill, because if you are bitten by mosquitoes while you are ill, you can spread the disease to your family and neighbors.

For travelers, the DOH urges those who are ill not to travel off island, including to Manu'a. "If you travel and become ill when you arrive, tell the doctor who sees you that you may have been exposed to the CHIK virus."  [Byline: B. Chen]
----------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
-----------------------------------
[Interestingly, the 5 Aug 2014 report above indicated that there were 343 reported cases, and in the subsequent report of 8 Aug 2014 above, that number has increased to 390 cases, indicating that transmission of CHIK virus is continuing. - ProMed Mod.TY]
******
Samoa: suspected cases
Date: Fri 8 Aug 2014
Source: Island Business [edited]

Samoa's Ministry of Health has reported 2 deaths from acute fever and rash, saying it is now an outbreak. A press statement from the Director General, Leausa Toleafoa Dr Take Naseri, says there have been 21 recorded cases as of earlier this week with 4 people hospitalised.

The cases are suspected to be chikungunya virus, similar to dengue fever, but results are yet to be confirmed and 3 children and one man have been admitted to the intensive care unit.

The ministry says collaboration with other government agencies, and media campaigns, aim to raise awareness of the outbreak and help its containment.

Samoa has also sought assistance from the Ministry of Health's development partners including the Secretariat of the Pacific Community and the World Health Organisation.

In neighbouring American Samoa, there have been more than 300 confirmed cases of chikungunya.
======================
[This is the 1st ever ProMED-mail report of a chikungunya outbreak in Samoa. Concerning the current outbreak, it would be unusual to have 2 deaths from chikungunya virus infections of a total of 21 recorded cases. One explanation for the high proportion of fatal cases could be significant underreporting of non-fatal cases. No mention is made indicating that there were contributory underlying medical conditions in these 2 fatal cases. ProMED-mail will be interested in receiving results of the laboratory tests when they become available.

Maps showing the location of Samoa in the Pacific Ocean can be accessed at
at <http://healthmap.org/promed/p/2>. - ProMed Mod.TY]
Date: Wed 14 May 2014
Source: Radio New Zealand International [edited]

Health officials in American Samoa are warning the public about an amoebic dysentery outbreak which has so far affected 26 people, half of which have been admitted to the LBJ hospital. A Pacific Island Health Officers' Association Epidemiologist, Mark Duran, says the department of health is leading an investigation into the source of the parasite.

Dr Duran says amoebic dysentery is spread through contamination of human waste. "It especially attacks the intestines and invades its way into the wall of the intestines; it causes abdominal pain, it causes bloody diarrhoea, fever." Dr Duran says in serious cases the parasite can travel through the body and cause abscesses especially in the liver.
===================
[Maps of American Samoa can be seen at
<http://healthmap.org/promed/p/380>. - ProMed Sr.Tech.Ed.MJ]
More ...

World Travel News Headlines

Date: Thu, 21 Feb 2019 07:52:47 +0100
By Amelie BARON

Port-au-Prince, Feb 21, 2019 (AFP) - With flaming barricades and widespread looting, 10 days of street violence in Haiti have all but buried a tourism industry that managed to resurrect itself after a devastating earthquake in 2010.   Ugly, violent footage beamed around the world has again sent the message that this impoverished Caribbean country is politically unstable and no place to go on vacation.

The final straw was the helicopter evacuation last week of 100-odd Canadian tourists trapped as angry protesters demanded the resignation of the president, whom they accuse of corruption.   "We have been through 12 days of hell. We managed the crisis but today we are suffering from the aftershocks," said Tourism Minister Marie-Christine Stephenson.

- Blacklist -
Beside the direct effects of the demonstrations, the United States delivered another crushing blow on February 14 when it urged its citizens not to travel to Haiti, which thus joined a no-go list with war-torn countries like Syria, Yemen and Afghanistan.

The minister said the US travel alert for Haiti was too harsh, calling the riots something that flared up unexpectedly and are now over.   "OK, they lasted 12 days but I am not sure that other Caribbean countries, which have had riots of their own, have been punished as severely and quickly as we have," said Stephenson.   Overnight, the decision by the US State Department hit the tourism industry hard. Travel web sites simply stopped offering flights to Haiti's two international airports.   Hotels are reporting cancellation of reservations and many empty rooms.

Officials in the industry have yet to tally up the damage but say that for the second time in less than a year, they will have to lay off workers.   In July of last year, three days of riots over a government attempt to raise fuel prices ruined the summer vacation season for Haiti's tourism industry.   It is not just hotels that will suffer again, said Beatrice Nadal-Mevs, president of the Haitian Tourism Association.   "This is going to affect everyday people because these are direct jobs that are going to be lost and supply chains will be threatened: farming, fishing, crafts, transport," Nadal-Mevs said.

- Mardi Gras cancelled -
With the opposition planning more demonstrations to seek the resignation of President Jovenel Moise, the sector got yet more bad news with word that Carnival celebrations have been called off in the Haitian capital, Port-au-Prince.   City Hall said it could not guarantee revelers' safety.   The festivities, which this year were planned for March 3-5, usually draw many Haitians living abroad and fleeing the winter cold in Canada and the eastern US.

Another major Carnival celebration is scheduled to take place in the city of Gonaives, but the government has not said if it will go ahead.   As grim as things are, some foreign tourists have gone ahead with visits to Haiti.   On Wednesday, a group of Australians under police escort visited a square featuring statues of heros of Haiti's independence from France. Days ago, demonstrators at the same plaza were throwing rocks at police, who responded with volleys of tear gas grenades.

A woman named Carole, who did not want to give her last name, said, "I trust the company we're traveling with. They not only want to take us but they want to bring us back."   Kevin McCue, another of the people in the group of 20, said he was glad that their tour operator had not opted for Plan B, which would have meant skipping Haiti and spending the whole week in the neighboring Dominican Republic.   "Tourism is alive and well here. People should come. The more they come, the better they spread some money among people who need it and the better for Haiti," said McCue.
Date: Thu, 21 Feb 2019 07:20:54 +0100
By Shafiqul ALAM

Dhaka, Feb 21, 2019 (AFP) - At least 70 people were killed when fire tore through crumbling apartment blocks in a historic part of Dhaka, setting off a chain of explosions and a wall of flames down nearby streets, officials said Thursday.    It started in one building where chemicals for deodorants and other household uses were illegally stored and spread at lightning speed to four nearby buildings, the fire service said.    People became trapped by the flames at a nearby bridal party and a restaurant. TV images showed the gates to one building were chained up so residents were unable to escape.

Traffic jams in the clogged narrow streets held up the rescue operation.   Bangladesh fire chief Ali Ahmed said at least 70 people were killed but that the toll would likely rise.    "The number of bodies may increase. The search is still going on," he told AFP.   Doctors said at least 10 of the scores of injured were in critical condition.   Firefighters who took almost 12 hours to bring the fire under control, went through the blackened floors of the building, littered with spray cans, looking for bodies.

The fire started at about 10.40pm (1640 GMT) on Wednesday at Chawkbazar in the old Mughal part of the capital.   Ahmed said it may have been started by a gas cylinder and quickly spread through the building where chemicals were stored in rooms alongside the apartments.   Chemicals used for household products were also stored in the nearby buildings. They exploded as the fire spread, witnesses said.     "There was a traffic jam when the fire broke out. It spread so quickly that people could not escape," the fire chief said.   Another fire official told reporters the blaze was under control but was not extinguished despite the efforts of more than 200 firefighters.   "It will take time. This is not like any other fire," he said, adding that the inferno had been made more devastating by the "highly combustible" chemicals.   Fire trucks had struggled in the narrow streets to reach the scene and there was also a lack of water for the battle, officials said.   The main gate of one five storey building was chained up, trapping residents inside, according to images shown on Bangladesh television.

- 'Flames were everywhere' -
Members of a bridal party in a nearby community centre were also caught in the fire and many were injured. Others were caught in small restaurants.   Dhaka deputy police commissioner Ibrahim Khan said at least two cars and 10 cycle rickshaws were burned in the fire.   "The victims included passersby, some people who were eating food at a restaurants and some members of the bridal party," he told AFP.   "I saw the charred body of a woman who was holding her daughter in her lap as their rickshaw was caught in the fire," said one witness.

Haji Abdul Kader, whose shop was destroyed, said he only survived the blaze as as he had left to go to a pharmacy.   "When I was at the pharmacy, I heard a big bang. I turned back and saw the whole street, which was jam packed with cars and rickshaws, in flames. Flames were everywhere," he told AFP.   "I got burned and rushed to hospital," he said.

Doctors at Dhaka Medical College Hospital said at least 55 people were injured, including 10 in a critical condition.   Hundreds of people rushed to the hospital looking for missing relatives.  However, most of the bodies of the dead were charred beyond recognition.    Sohag Hossain, one of the injured, told the Daily Star that he and two friends were working at a plastic factory in one of the buildings at the time of the fire.    They heard an explosion and could not escape the flames.

A similar blaze in 2010 in an old Dhaka building, which was also used as a chemical warehouse, killed more than 120 people in one of the worst fire disasters in the city of 20 million people.      Dhaka authorities launched a crackdown on chemical warehouses in residential areas following the blaze, but efforts to rein in the practice have waned.   Many buildings in Bangladesh lack adequate fire safety measures and the enforcement of fire regulations in factories and apartment buildings is lax.  
Date: Wed 20 Feb 2019, 2:13 PM CET
Source: El Pais in English [edited]
<https://elpais.com/elpais/2019/02/20/inenglish/1550655774_604104.html>

An investigation has been opened to determine the cause of death of a 46-year-old woman, who became ill after eating at a one-star Michelin restaurant called RiFF in Valencia. A total of 23 other patrons, including the victim's husband and 12-year-old son, also fell sick after the meal but their symptoms were mild and they have reportedly all recovered. The case was confirmed by regional health chief Ana Barcela, who expressed her condolences to the family and said that an investigation was already underway. "We've conducted a primary inspection of the establishment and everything appears to be normal," she said. "Analytical tests will now be carried out on the food products."

Barcela explained that the regional public health department will be in charge of the investigation and for determining the causes behind the woman's death. According to sources from the regional health department, the food poisoning outbreak was reported on [Sun 17 Feb 2019], after the 3 family members fell ill. They began to show symptoms of food poisoning - vomiting and diarrhoea - on [Sat 16 Feb 2019]. According to Europa Press, the father and son recovered but the woman's symptoms were more severe, and she died in her home early on the following morning. The investigation into the death revealed that a total of 9 patrons had experienced illness, mainly vomiting, after eating at the same restaurant.

Subsequently, it emerged that a further 14 people had also suffered light symptoms. "17 people have been interviewed, of whom 14 stated that they had some kind of mild symptoms," explained regional health chief Ana Barceló today, [Wed 20 Feb 2019]. "The samples that have been collected over the last few days have been sent to the National Toxicology Institute to be analyzed." Public health officials inspected the restaurant on [Mon 18 Feb 2019], but did not find any problems that could have contributed to the food poisoning. Investigators also collected samples of ingredients and raw food products that were part of the menu, and are currently analyzing them.

Barcela added that at this point she could not confirm whether the sickness had been caused by morel mushrooms that were on the restaurant's menu. "We will have to wait for the autopsy to be carried out on the woman before we can determine whether it was the ingestion of a food that directly caused her death, or whether it prompted a state that led to this fatal outcome, or if she had an existing condition," she explained on [Wed 20 Feb 2019].

Forensic teams are working to determine whether she could have been poisoned by something she ate, or whether she may have choked on her own vomit. In a statement, the owner of RiFF, Bernd H. Knaller, announced that the restaurant will remain closed until the cause of the food poisoning outbreak is determined and "activities can resume with full assurances for the staff and the patrons." The owner said he has been cooperating with the regional health department on the investigation and pointed out that the inspection "showed that the restaurant complies with all sanitary regulations." He added: "Regardless of what caused the situation, I want to convey my deep regret for what happened, and I hope all of the facts will be clarified shortly." [Byline: Cristina Vazquez]
Date: Mon 18 Feb 2019
Source: The News International [edited]

An elderly man died due to complications of the Crimean-Congo haemorrhagic fever (CCHF), commonly known as Congo virus, at the Jinnah Postgraduate Medical Centre (JPMC) on early [Sun 17 Feb 2019] morning, becoming the 2nd victim of the deadly tick-borne disease in the city [Karachi] in 2019.

"MUY, an elderly person of 75 years of age, died due to CCHF complications at JPMC on early [Sun 17 Feb 2019] morning," said JPMC Executive Director Dr. Seemin Jamali while taking to The News. She added that the deceased had earlier been taken to a private hospital from where he was shifted to Jinnah hospital.

It is the 2nd death in the city caused by the CCHF within a week as earlier on [Tue 12 Feb 2019] morning, a 35-year old woman from Orangi Town had died of Congo virus at an isolated ward of the JPMC.

CCHF is a tick-borne viral disease, which is caused when a person comes in contact with an animal infected with the Congo virus due to the presence of the parasite on its skin. Mostly butchers, sheep and animal herders and those who are associated with cattle farming become victims of the CCHF, which has a 40 to 50% mortality rate.

Dr. Jamali said both the woman from Orangi Town and the latest CCHF victim, who lived in the Landhi area of the city, were brought to the JPMC from Liaquat National Hospital where they had tested positive for the lethal disease.

She said the 2nd victim had a history of dealing with cattle and was in a serious condition when brought to the JPMC. He was suffering from high grade fever as well as internal and external bleeding, low platelets count and other comorbidities.

"We had moved both the patients to an isolation ward where they were given antiviral drugs, mega units [blood/platelets?] and other symptomatic treatment, but they could not survive due to the complications of the lethal ailment. All precautionary measures had also been adopted to prevent other patients and the medical staff from contracting the viral infection," she said.

"There were many people who contracted this disease in Karachi during their interaction with cattle, but they survived due to their strong immunity and the medical care they received at hospitals, including the JPMC. People should take precautionary measures while dealing with cattle and livestock," Dr. Jamali said. She added that in case the symptoms of red spots on the body, high-grade fever and blood oozing from mouth and nose are found in any patient, they should be rushed to a major hospital.

According to Dr. Kamran Rizvi, district officer (preventive) of Karachi Metropolitan Corporation, around 16 people died at various hospitals in Karachi last year [2018] due to CCHF, a majority of whom were residents of different areas of Balochistan, including Quetta, as people from the province are now regularly brought to Karachi for treatment.

He said a total of 41 Congo virus patients were brought to different hospitals in Karachi last year [2018], of whom 16, mostly males, could not survive while the others were successfully cured.
=====================
[The CCHF virus is now endemic in both rural and urban parts of the country, and he best safeguard on the human side is to inform the public regarding the risks and provide education on the use of appropriate practices and protection measures.

Persons working in close contact with animals are at risk for CCHF due to presence of ticks that can transmit the virus through bites or crushing during removal through skin cuts, etc. The animals do not show clinical disease during viraemia and the virus can be transferred in butchering, handling of meat and hides, etc.  The veterinary aspect of the problem requires establishment of animal screening with measures for tick control. Collaborative work by health and veterinary sectors with support of entomologists for setting up CCHF surveillance can help plan prevention and control programs - ProMED Mod.UBA]
[HealthMap/ProMED map available at:
Date: Tue 19 Feb 2019, 1:32 PM
Source: KCRG-TV9 [edited]

TV9 has learned the Johnson County Public Health Department and the Iowa Department of Public Health are investigating reports of food poisoning following an event in Swisher, Iowa.

The illnesses have been linked to the Swisher Men's Club's Game Feast Dinner this past weekend [16-17 Feb 2019]. The group's Facebook page says the fundraiser has been going on for 15 years and features dishes that include meat from animals that are often hunted. The health departments are looking for anyone who may have attended the meal to try to track down the source of the illnesses. It's asking attendees to email <diana.vonstein@idph.iowa.gov> with their contact information.

Johnson County Public Health Director Dave Koch tells TV9 part of their investigative efforts have included taking part in a conference call with officials from the Iowa Department of Public Health on [Tue 19 Feb 2019]. Koch says part of the investigation will also include testing samples of the food that was served along with conducting tests on any individuals who think they may have contracted an illness.

It is unclear how many people may be claiming to be sick however the club posted the following message to their Facebook page which reads in part: "The Swisher Men's Club is aware of a number of illnesses as a result of our Game Feast Dinner. We are actively working with the county and state health departments to determine the cause of these illnesses."

TV9 has reached out to the Swisher Men's Club for comment. President Mike Brown, Jr. referred back to the statement provided on Facebook. Brown declined TV9's offer for an on-camera interview, but did say they are relaying all necessary information to the Iowa Department of Public Health.  [Byline: Josh Scheinblum & Aaron Scheinblum]
Date: January 2019
Source: Nigeria CDC: Nigeria monkeypox monthly situation report

Nigeria monkeypox -- monthly situation report
---------------------------------------------
Key indicators / Numbers
New suspected cases reported / 6
New confirmed cases / 3
Total deaths / 0
Healthcare worker infection / 0

Epidemiological summary
- Nigeria continues to report sporadic cases of monkeypox after the index case reported in September 2017.
- In the reporting month (January 2019), 6 new suspected monkeypox cases were reported in 4 states (Bayelsa - 2; Rivers - 1; Bauchi - 1; Lagos - 1; Borno - 1; Delta - 1) out of which 3 confirmed cases were recorded in 2 states (Rivers - 1, Bayelsa - 2). - No death recorded.
- All reported cases (suspected and confirmed) are males.
- The confirmed cases are all between 32-39 years of age.
- The South-South region of the country has the highest burden of monkeypox.
- Since the beginning of the outbreak in September 2017, 311 suspected cases and 7 deaths have been reported in 26 states. Of this, 132 were confirmed in 17 states (Rivers, Bayelsa, Cross River, Imo, Akwa Ibom, Lagos, Delta, Edo, FCT [Federal Capital Territory], Abia, Oyo, Enugu, Ekiti, Nasarawa, Benue, Plateau, Anambra)
- Results of animal surveillance carried out in 2 states are awaited.

[Available at the source URL above]:
Figure 1 [graph]: weekly trend of Nigeria monkeypox cases as at 31 Jan 2019
Figure 2 [graph]: line graph of Nigeria monkeypox cases weeks 31-52, 2017; 1-52, 2018 and 1-2, 2019
Figure 2 [map]: map of Nigeria showing distribution of monkeypox cases by LGA [local government area], September 2017-January 2019
=======================
[The number of monkeypox cases in Nigeria continues to increase slowly but steadily, with 6 new suspected and 3 new confirmed cases in January 2019. Interestingly, all cases are male individuals. Monkeypox virus transmission continued over a broad geographic area in Nigeria last year (2018). The report above provides the most recent update of the monkeypox situation in Nigeria. This outbreak has been unusual. Rather than sporadic or rare cases, there have been over 100 cases scattered over a large geographic area since 2017 and again this year (2019). The reasons for this relatively sudden appearance are not clear. Perhaps there has been an epizootic of monkeypox virus infections among its rodent hosts, with spill-over to people. As mentioned earlier, prevention will require a proactive public education effort to convince local people to take measures to prevent contact with the infected rodents and their excreta to avoid transmission, a difficult task involving so many local people over such a large geographic area.

Interested readers can see the graphs of cases by week and a map showing the location of cases by state.

Non-human primates are not monkeypox virus reservoirs. The main reservoirs of monkeypox virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp, an arboreal rodent) and terrestrial rodents (genera _Cricetomys_ and _Graphiurus_). - ProMED Mod.TY]

[Maps of Nigeria:
Date: Wed 20 Feb 2019
Source: Daily Times [edited]

The Sindh Health Department, on Tue 19 Feb 2019, admitted its failure to formulate an action plan to prevent the spread of the extensively drug-resistant (XDR) strain of typhoid fever in the province. The provincial minister for health, Dr Azra Fazal Pechuho, sighed that the health department still awaited vaccines for XDR typhoid from the federal government as the province battles the outbreak caused by a bacterial strain resistant to most known antimicrobials. She added that the strain had claimed 4 lives since its outbreak from Hyderabad [Sindh] in November 2016, which later spread to Karachi and other cities and towns of the province.

Dr Pechuho said that the Sindh Health Department had asked the local governments to improve the chlorination in water supplies, noting that the disease had spread due to the lack of sanitation and the presence of open garbage dumps in Karachi and other places. More than 5000 children have been affected by this typhoid strain, she continued. XDR typhoid is caused by antimicrobial resistant (AMR) strains of _Salmonella enterica_ serotype Typhi (or _S._ Typhi) and has been declared by WHO as a notable public health concern.

A report by the Provincial Disease Surveillance and Response Unit (PDSRU) reported 5274 cases of XDR typhoid out of 8188 typhoid fever cases in Sindh from 1 Nov 2016 through 9 Dec 2018. 69 percent of these cases was reported in Karachi, while 27 per cent in Hyderabad district, and 4 percent in other districts across the province.

The WHO recommended typhoid vaccination in response to confirmed outbreaks of typhoid fever. These vaccinations should be implemented in combination with other efforts to control the disease. At present, azithromycin remains the only affordable first-line oral therapeutic option to manage patients with XDR typhoid in low-resource settings.
====================
[The following is extracted from the CDC notice regarding this multiply-resistant typhoid strain in Pakistan

"The XDR strain of _Salmonella_ Typhi is resistant to most antibiotics (ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ciprofloxacin, and ceftriaxone) used to treat typhoid fever. Healthcare providers should:
- Obtain a complete travel history (asking about travel to South Asia, including Pakistan) from patients with suspected typhoid fever.
- Collect stool and blood cultures from patients with suspected typhoid fever and request antimicrobial susceptibility testing on isolates.
- Be aware that the Pakistan outbreak strain remains susceptible to azithromycin and carbapenems. Azithromycin is effective for uncomplicated (diarrhea or bacteremia without secondary complications) typhoid fever and should be used to treat patients with suspected uncomplicated typhoid fever who have traveled to Pakistan. When culture and sensitivity results are available, adjust treatment accordingly. Adult azithromycin dosage is usually 1000 mg orally once, then 500 mg orally daily OR 1000 mg orally once daily for at least 5-7 days. Pediatric azithromycin dose is 20 mg/kg orally, once then 10-20 mg/kg orally once per day (maximum 1000 mg per day) for at least 5-7 days.
- Carbapenems should be used for patients with suspected severe or complicated typhoid fever who have traveled to Pakistan. Severe or complicated typhoid fever would include, but not be limited to, patients with gastrointestinal complications (such as typhoid-related intestinal perforation, peritonitis, intestinal haemorrhage, hepatitis), neurologic complications (such as typhoid encephalopathy, including altered consciousness, delirium, confusion), or bacteraemia with sepsis or shock. When culture and sensitivity results are available, adjust treatment accordingly. Consider getting an infectious diseases consultation for these patients.
- Be aware that relapses can occur, often 1-3 weeks after clinical improvement.
- Be aware that most (90%) _S._ Typhi isolates from patients coming from South Asia have decreased susceptibility or resistance to fluoroquinolones, including ciprofloxacin; therefore, fluoroquinolones should not be used as empiric treatment for suspected typhoid fever in patients who have traveled to this area.
- Report all cases of confirmed typhoid fever to the appropriate local or state health departments." - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Pakistan:
Date: Tue, 19 Feb 2019 21:26:43 +0100

Geneva, Feb 19, 2019 (AFP) - An avalanche left four skiers injured Tuesday at a resort in the Swiss Alps where rescue operations went on after dark with police fearing people could still be trapped under the snow.   The authorities held a press conference to announce the injuries, including one person seriously hurt, after local reports said up to a dozen people were engulfed by the avalanche.   Police officers said that based on witness reports other skiers could still be buried and the search would continue into the night.

Swiss RTS television said the army had set up lighting to aid the 240 rescue workers at the site.   The police had earlier tweeted that several people were under the avalanche that hit early afternoon on a slope 2,600 metres (8,600 feet) up at Crans-Montana, which was busy with skiers during school holidays.   A local newspaper, Le Nouvelliste, had quoted the head of Crans-Montana's municipal government, Nicolas Feraud, as estimating that "between 10 and 12 people" were buried under the snow.   "We are shocked and hope for good news about these people," Feraud was quoted as saying. 

A first attempt at locating victims using sniffer dogs was unsuccessful, a rescue worker told Le Nouvelliste, with four helicopters joining the search from the air.   Pierre Huguenin, of the Institute for Snow and Avalanche Research, described the snow in the area as damp and dense.   According to statistics from his institute, after 15 minutes under an avalanche, the chances of survival are no more than 50 percent.   Le Nouvelliste said the avalanche swept over 300 to 400 metres (yards) of the lower section of the Kandahar piste.   It quoted rescue workers as saying the snow was compacted and more than two metres (seven feet) thick.

Crans-Montana's website had listed the risk of an avalanche at two on a scale that runs from one (lowest risk) to five.    As the victims were on a designated ski slope, they were unlikely to have detector equipment to help rescue workers locate them.   The vast majority of deadly avalanches in the Alpine nation hit people skiing off-piste.    "We don't know yet whether the avalanche detached by itself or was set off by skiers, or a rockfall," Swiss avalanche expert Robert Bolognesi told the daily 20 Minutes.
Date: Wed, 20 Feb 2019 16:17:29 +0100

Prague, Feb 20, 2019 (AFP) - Czech authorities said Wednesday they would slap checks on beef imported from Poland after veterinarians found the dangerous Salmonella bacteria in a 700-kilogramme batch of Polish beef.   "Tests have shown the presence of Salmonella enteritidis, which can cause serious diarrhoea and affect human health, in beef imported from Poland on February 13," Agriculture Minister Miroslav Toman told reporters.

Czech veterinary authorities have warned the European Commission and Polish authorities through a rapid warning system, he said, adding that they are also checking whether any of the meat has been consumed.   "The State Veterinary Administration (SVS) will immediately adopt an extraordinary measure -- all beef imported from Poland must be tested in a lab before hitting the market," Toman added.

SVS head Zbynek Semerad said meat from the 700-kilo (1,500-pound) batch had been distributed to five "places" in the Czech Republic and one in Slovakia.   "I will inform my Slovak counterpart. As far as we know, not all of the meat has been distributed to the end customer," Semerad said.   The case comes on the heels of a scandal which saw Poland export a total of 2.7 tonnes of suspect beef to around a dozen fellow EU members, triggering an EU probe.

The scandal erupted in January when the TVN24 commercial news channel aired footage of apparently sick or lame cows being butchered at a small slaughterhouse in northeast Poland in secret late at night when veterinary authorities were unlikely to visit.   Poland is a leading producer and exporter of meat in Europe, turning out around 600,000 tonnes of beef per year and exporting most of it mainly to the EU, according to meat producer associations.
Date: Wed, 20 Feb 2019 09:56:54 +0100

Kuala Lumpur, Feb 20, 2019 (AFP) - Six people, including three foreigners, were killed when a fire broke out Wednesday in a Malaysian karaoke centre, with rescuers describing scenes of chaos as the blaze engulfed the building.   The fire erupted before dawn on the fourth floor of an eight-storey building in the city of Ipoh, northern Perak state.

Firefighters rushed to the scene and found the bodies of six people who had died of smoke inhalation, Perak fire department acting director Sayani Saidon told AFP.   "We came across two locals, two Vietnamese women and a Bangladeshi man. We are still determining the identity of the sixth person," she said.

Firefighters rescued eight people alive, including two in critical condition, she added.     People inside were unable to find the way out after the fire erupted as exit lights did not come on, she said. Those that survived had run to an upper level to escape the flames.   "When the fire happened, all the electricity went out, and it was dark, so the exit signs weren't clear," she said.   The building was originally an office block, and had 30 karaoke rooms on the fourth and fifth floors.