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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]
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Bouvet Island

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

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

Travel News Headlines WORLD NEWS

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Ethiopia

Ethiopia - US Consular Information Sheet
November 26, 2008
COUNTRY DESCRIPTION:
The Federal Democratic Republic of Ethiopia is a developing country in East Africa.
It is comprised of nine states and two city administrations (Addis Aba
a and Dire Dawa).
The capital is Addis Ababa.
Tourism facilities can be found in the most populous regions of Ethiopia, but infrastructure is basic.
The ruling EPRDF party and Prime Minister Meles Zenawi maintain strong control of the government and economy.
Despite several years of high economic growth, the country remains vulnerable to external economic shocks and recurring drought.

Read the Department of State Background Notes on Ethiopia for additional information.

ENTRY/EXIT REQUIREMENTS:
To avoid possible confusion or delays, travelers are advised to obtain a valid Ethiopian visa at the nearest Ethiopian Embassy prior to arrival, and must do so if entering across any land port-of-entry.
For example: travelers wishing to enter Ethiopia from Kenya at the land border at Moyale, must obtain an Ethiopian visa first.
Ethiopian visas ARE NOT available at the border crossing point at Moyale.
Travelers should apply for Ethiopian visas at the Ethiopian Embassy in Nairobi or at other Ethiopian embassies in other countries.
Ethiopian visas are available to U.S. citizens upon arrival at Bole International Airport in Addis Ababa.
U.S. citizens may obtain one-month or three month, single-entry tourist visas or 10-day single-entry business visas upon arrival at Bole International Airport.
This service is available only at Bole International Airport and is not available at any other ports of entry in Ethiopia.
The visa fee at Bole International Airport is payable in U.S. dollars.
Such visas can be extended by applying at the Main Immigration Office in Addis Ababa.
Business visas of up to three-months validity can also be obtained at Bole International Airport upon arrival if the traveler has a sponsoring organization in Ethiopia that has made prior arrangements for issuance through the Main Immigration Office in Addis Ababa.
Travelers whose entry visa expires before they depart Ethiopia, must obtain a visa extension and pay a monthly penalty fee of $20 USD per month.
Such travelers may also be required to pay a court fine of up to 4000 ETB (USD $435) before being permitted to depart from Ethiopia.
Travelers are required to pay the penalty fee before they will be able to obtain an exit visa (USD $20) permitting them to leave Ethiopia.

Individuals intending to stay in Ethiopia for a prolonged period of time are advised to contact the Ethiopian Embassy in Washington prior to traveling.
The Ethiopian Embassy is located at 3506 International Drive NW, Washington, DC 20008; telephone (202) 364-1200; fax (202) 587-0195.
For the most current visa information, visit the Embassy’s web site at www.ethiopianembassy.org.
Inquiries by Americans located overseas may be made at the nearest Ethiopian embassy or consulate.

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:
While Ethiopia is generally stable, domestic insurgent groups, extremists from Somalia, and the heavy military buildup along the northern border pose risks to safety and security, particularly along Ethiopia’s border areas and in the Somali region.
In the past year, there has been an increase in targeted bombings in Addis Ababa and in other parts of Ethiopia.
In November 2008, the Government of Ethiopia issued a warning to its citizens alerting them of the potential for terrorist attacks and subsequently increased security measures to unprecedented levels.

Throughout Ethiopia:
Americans are strongly advised to review their personal safety and security posture, to remain vigilant and to be cautious when frequenting prominent public places and landmarks.
Targeted bombings in Addis Ababa and south eastern Ethiopia in 2008 resulted in numerous injuries and deaths.
Americans are advised to avoid public gatherings and public places, including hotels, if possible, and using public transportation and transportation hubs.
They are advised to beware of unattended baggage or packages left in any location, including in mini-buses and taxis.

Ethiopia/Eritrea Border Area:
Ethiopia and Eritrea signed a peace agreement in December 2000 that ended their border war.
However, the border remains an issue of contention between the governments of Ethiopia and Eritrea.
The border area is a militarized zone where there exists the possibility of armed conflict between Ethiopian and Eritrean forces.
American citizens are advised to avoid travel in the areas along the Eritrean/Ethiopian border (within 50 km/30 miles of the Ethiopian/Eritrean border) because of the dangers posed by land mines and because of the possibility of conflict between Ethiopian and Eritrean defense forces.
Due to abductions and banditry, Americans are advised to avoid travel within 30 miles of the Ethiopian-Eritrean border west of Adigrat to the Sudanese border, with the exception of the town of Axum, and within 60 miles east of Adigrat to the Djiboutian border.
Embassy personnel are permitted to travel in these areas only on a case-by-case basis. Travel to the northern Afar Region towards the Eritrean border is also discouraged.
Embassy personnel are permitted to travel there only on a case-by-case basis.

Somali Region:
Since the mid-1990's the members of the Ogaden National Liberation Front (ONLF) have clashed with Ethiopian government forces near the city of Harar and in the Somali regional state, particularly in the Ogaden zones.
In April 2007, the ONLF claimed responsibility for attacking a Chinese oil exploration installation south of Jijiga, in Ethiopia's Somali region.
The attack resulted in deaths, kidnappings and the wounding of dozens of Chinese and Ethiopian citizens.
In 2008, a hotel in the town of Jijiga was bombed and two hotels in the town of Negele Borena were bombed.

American citizens are reminded that the U.S. Embassy strongly discourages travel to Ethiopia's Somali region and that a Travel Warning for Somalia has been issued that advises against all travel to that country.
Armed insurgent groups operate within the Somali, Oromiya and Afar regions of Ethiopia.
In December 2006, the Ethiopian Government, at the invitation of the Transitional Federal Government of Somalia, began military operations against extremists in Somalia.
As of November 2007, military operations continue in Mogadishu, where an African Union peacekeeping force, AMISOM, is deployed.
In 2008, two staff members of a non-governmental organization (NGO) were abducted in the Somali region.

Gambella Region:
Sporadic inter-ethnic clashes remain a concern throughout the Gambella region of western Ethiopia following outbursts of violence there in 2003 - 2004.
There is a heavy military and police presence in the town of Gambella.
While the security situation in the town of Gambella is calm, it remains unpredictable throughout the rest of the region, and violence could recur without warning.
Travel to this region is discouraged.

Travel in Ethiopia via rail is discouraged due to past episodes of derailment, sabotage, and bombings.
In southern Ethiopia along the Kenyan border, banditry and incidents involving ethnic conflicts are also common.
Travelers should exercise caution when traveling to any remote area of the country, including the borders with Eritrea, Somalia, Kenya and Sudan.
Ethiopian security forces do not have a widespread presence in those regions.

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:
Pick-pocketing, “snatch and run” thefts, and other petty crimes are common in Addis Ababa.
These are generally crimes of opportunity rather than planned attacks.
Travelers should exercise caution in crowded areas and should avoid visiting the Mercato in Addis Ababa, a large open-air market.
Violence in the Mercato has been on the rise.
In 2008 an explosion in the Mercato killed several and wounded more than a dozen individuals.
Also in 2008, there was a shooting in the Mercato.
Travelers should limit the amount of cash they carry and leave valuables, such as passports, jewelry, and airline tickets in a hotel safe or other secure place.
Travelers should keep wallets and other valuables where they will be less susceptible to pick-pockets.
Travelers should be cautious at all times when traveling on roads in Ethiopia.
There have been reports of highway robbery, including carjacking, by armed bandits outside urban areas.
Some incidents have been accompanied by violence.
Travelers are cautioned to limit road travel outside major towns or cities to daylight hours and travel in convoys, if possible.

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.

There is no local equivalent to the “911” emergency line in Ethiopia.
Distress calls should be made to the local police station, the telephone number of which can be obtained by calling directory assistance at 997.
This is the number for directory assistance throughout Ethiopia.
In Addis Ababa, the number for police is 991, for the fire brigade 939, and for an ambulance 907.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Health facilities in Addis Ababa are very limited and are generally inadequate outside the capital.
Even the best hospitals in Addis Ababa suffer from inadequate facilities, antiquated equipment, and shortages of supplies (particularly medicines).
There is a shortage of physicians.
Emergency assistance is limited.
Psychiatric services and medications are practically nonexistent.
Serious illnesses and injuries often require travelers to be medically evacuated from Ethiopia to a location where adequate medical attention is available.
Such “medevac” services are very expensive and are generally available only to travelers who either have travel insurance that covers medevac services or who are able to pay in advance the considerable cost of such services (often in excess of USD 40,000).
See Medical Insurance below.
Travelers must carry their own supplies of prescription drugs and preventive medicines, as well as a doctor's note describing the medication.
If the quantity of drugs exceeds that which would be expected for personal use, a permit from the Ministry of Health is required.
Malaria is prevalent in Ethiopia outside of the highland areas.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and explain to the health care provider their travel history and which anti-malarials they have been taking.
For additional information on malaria, protection from insect bites, and anti-malarial drugs, please visit the CDC Travelers' Health web site at http://www.cdc.gov/malaria/index.htm.
Tuberculosis is an increasingly serious health concern in Ethiopia.
For further information, please consult the CDC's Travel Notice on TB at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx

Ethiopia is a mountainous country and the high altitude may cause health problems, even for healthy travelers.
Addis Ababa is located at an altitude of 8,300 feet.
Travelers may experience shortness of breath, fatigue, nausea, headaches, and inability to sleep.
Individuals with respiratory (including asthma) or heart conditions should consult with a health care professional before traveling to Ethiopia.
Travelers to Ethiopia should also avoid swimming in any lakes, rivers, or still bodies of water.
Most bodies of water have been found to contain parasites.
Travelers should be aware that Ethiopia has a high prevalence of HIV/AIDS.
Ethiopia has had outbreaks of acute watery diarrhea, possible cholera, typhoid, or other bacterial diarrhea in the recent past, and the conditions for reoccurrences continue to exist.
Further information on prevention and treatment of cholera and other diarrheal diseases can be found at the CDC web site at http://wwwn.cdc.gov/travel/contentDiseases.aspx.
Ethiopian authorities are monitoring the possibility of avian influenza following the deaths of poultry and birds; preliminary results are negative.
For additional information on avian flu please visit the CDC website at http://www.cdc.gov/flu/avian/.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Ethiopia.
Please verify with the embassy of Ethiopia before you travel.
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.
Specific medevac insurance, which generally covers evacuation of a patient from Ethiopia to a location where adequate medical attention is available, is often inexpensive and available through a variety of companies that can be accessed online.
Medicare and Medicaid recipients are not covered overseas and are advised to purchase supplemental health and medical evacuation insurances.
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 Ethiopia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
According to the World Health Organization (WHO), Ethiopia has the highest rate of traffic fatalities per vehicle in the world.
Roads in Ethiopia are poorly maintained, inadequately marked, and poorly lighted.
Road travel after dark outside Addis Ababa and other cities is dangerous and discouraged due to hazards posed by broken-down vehicles left in the road, pedestrians walking in the road, stray animals, and the possibility of armed robbery.
Road lighting in cities is inadequate at best and nonexistent outside of cities.
Excessive speed, unpredictable local driving habits, pedestrians and livestock in the roadway, and the lack of basic safety equipment on many vehicles are daily hazards on Ethiopian roads.
While travel during daylight hours on both paved and unpaved roads is generally considered safe, land mines and other anti-personnel devices can be encountered on isolated dirt roads that were targeted during various conflicts.
Before undertaking any off-road travel, it is advisable to inquire of local authorities to ensure that the area has been cleared of mines.
Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Ethiopia’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Ethiopia’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/.
The Ethiopian government has closed air routes near the border with Eritrea and has referred to the airspace as a “no-fly zone.”
The FAA currently prohibits U.S. aircraft and U.S. pilots from flying in Ethiopian airspace north of 12 degrees north latitude, the area along the country's northern border with Eritrea.
For complete information on this flight prohibition, travelers may visit the FAA's web site at http://www.faa.gov/airports_airtraffic/air_traffic/publications/notices/2008-11-20/PART3_SEC1.cfm.
SPECIAL CIRCUMSTANCES:
Ethiopia does not recognize dual nationality.
The government of Ethiopia considers Ethiopians who have become naturalized U.S. citizens to be Americans.
Such individuals are not subject to Ethiopian military service.
The Ethiopian government has stated that Ethiopian-Americans in almost all cases are given the same opportunity to invest in Ethiopia as Ethiopians.
Several years ago the government of Ethiopia arrested people of Eritrean origin who initially failed to disclose their U.S. citizenship.
However, this has not occurred in recent years.
Ethiopian officials have recently stated that Eritrean-Americans are treated as U.S. citizens and are not subject to arrest simply because of their ties to Eritrea.
For additional information, see our dual nationality flyer.
Permits are required before exporting either antiques or animal skins from Ethiopia.
Antique religious artifacts, including "Ethiopian” crosses, require documentation from the National Museum in Addis Ababa for export.
Foreign currency should be exchanged in authorized banks, hotels and other legally authorized outlets and proper receipts should be obtained for the transactions.
Exchange receipts are required to convert unused Ethiopian currency back to the original foreign currency.
Penalties for exchanging money on the black market range from fines to imprisonment.
Credit cards are not accepted at most hotels, restaurants, shops, or other local facilities, although they are accepted at the Hilton and Sheraton Hotels in Addis Ababa.
Some hotels and car rental companies, particularly in Addis Ababa, may require foreigners to pay in foreign currency or show a receipt for the source of foreign exchange if paying in local currency.
However, many hotels or establishments are not permitted to accept foreign currency or may be reluctant to do so.

Ethiopian institutions have on occasion refused to accept 1996 series U.S. currency, although official policy is that such currency should be treated as legal tender.
Ethiopian law strictly prohibits the photographing of military installations, police/military personnel, industrial facilities, government buildings, and infrastructure (roads, bridges, dams, airfields, etc.).
Such sites are rarely marked clearly.
Travel guides, police, and Ethiopian officials can advise if a particular site may be photographed.
Photographing prohibited sites may result in the confiscation of film and camera.
There is a risk of earthquakes in Ethiopia.
Buildings may collapse due to strong tremors.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/
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 Ethiopia’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Ethiopia 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 Ethiopia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Ethiopia.
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 Entoto Avenue, P.O. Box 1014, in Addis Ababa; telephone: 251-11-124-2424; emergency after-hours telephone: 251-11-124-2400; consular fax: 251-11-124-2435; web site: http://ethiopia.usembassy.gov/
* * *
This replaces the Country Specific Information for Ethiopia dated April 30, 2008 to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Tue 2 Jul 2019
Source: Anadolu Agency [edited]

Ethiopia has diagnosed 871 people with cholera, an acute infectious diarrheal disease, an official said. "So far, 871 people have been diagnosed with cholera in different areas," the local broadcaster FANA stated, quoting the Director General of Ethiopian Public Health Institute, Getachew Tolera. The cholera cases have spread in Oromia, Amhara, Tigray, Somali and Afar provinces, as well as in 2 major cities of the country. The disease has so far caused deaths of 17 persons, FANA quoted Getachew as saying.

The majority of cases have been reported from Oromia province, with 350 people diagnosed with the infectious disease. As many as 202 people have contracted it in Amhara, 19 in Tigray, 131 in Afar and 33 in Somali regions. Some 125 persons have been diagnosed with the disease in the capital Addis Ababa and one in Dire Dawa city in Eastern Ethiopia. In a bid to control further spread of the disease, 26 quarantine centres have been set up across the nation. Getachew said medicines are being made available to the affected areas. At least 291 000 people have been vaccinated in the West Harerghe zone of Oromia province, according to the local broadcaster.  [Byline: Addis Getachew Tadesse]
Date: Tue 11 Jun 2019
Source: Anadolu Agency [edited]

At least 525 people have been infected with the cholera bacterium in Ethiopia, according to health sources [information released] on [Tue 11 Jun 2019]. The Ethiopian Public Health Institute confirmed that the cause of the death of 16 people by this infectious disease caused by _Vibrio_ bacteria. The deadly epidemic occurred in Oromia, Amhara, Tigray regional states as well as the Addis Ababa city administration.

The majority of the casualties were recorded in Amhara, with 14 people, the local broadcaster FANA quoted, Beyene Moges, the deputy director of the institute, as saying in a press conference. Beyene also cited as saying that 19 samples were examined in a lab to determine the cause. Medicinal supplies were dispatched to the affected areas, according to FANA.

Cholera is an acute epidemic infectious disease and it is characterized by watery diarrhoea, extreme loss of fluid and electrolytes, and severe dehydration.
Date: Thu 23 May 2019 Source: XinHuaNet [edited] <http://www.xinhuanet.com/english/2019-05/23/c_138083427.htm>
An acute watery diarrhoea (AWD) outbreak in Ethiopia's northern Amhara regional state has left 12 people dead, an official said on Thu 23 May 2019. Asaye Gebreselassie, deputy director of Wag Himera zone in Amhara regional state, said the outbreak killed 4 people and sickened 67 others in recent days, according to state media outlet Ethiopia News Agency.
A medical taskforce comprising federal, regional and zonal personnel has been deployed to the affected areas, Gebreselassie said. With the rainy season expected to start in June and continue until mid-September, the government is trying to prevent the spread of the AWD.
Federal and regional health institutions have been combating the diarrhea outbreak by treating unhygienic conditions in factories, health facilities, agricultural areas and eateries.
Date: Sun 19 May 2019
Source: Vax Before Travel [abridged, edited]

The eastern African country of Ethiopia has been reporting measles outbreaks for many years, however, in 2019, new information indicates children are the ones most vulnerable for this infectious disease.

According to reporting by the European Commission, approximately 54% of the 4000 measles cases in Ethiopia reported during 2019 affected children under 5 years of age.

Moreover, over 60% of the children had never received their 1st measles vaccine dose.

This new data estimates that by the end of 2019, about 3.5 million children will be susceptible to the measles virus, mainly because of the failure to achieve the 'herd-immunity' necessary to interrupt transmission.

Moreover, these Ethiopian children are not the only under-vaccinated population.

An estimated 169 million children missed out on the 1st dose of the measles vaccine between 2010 and 2017, or 21.1 million children a year on average, said UNICEF on 25 Apr 2019.

And, the measles virus is one of the leading causes of death among children, particularly in developing countries. An estimated 100,000 measles deaths occurred globally in 2017.

Ethiopia announced it would aggressively confront this under-vaccination issue by integrating the measles vaccine 2nd dose (MCV2) vaccination into the routine immunization program in the 2nd year of life.

The Ethiopian Ministry of Health said about 3 348 363 children will receive measles vaccine 2nd doses.

Dr Chatora Rufaro, World Health Organization (WHO) Ethiopia representative said in a press release, "The introduction of the 2nd dose of measles vaccination in Ethiopia will significantly contribute to a reduction of measles morbidity and mortality as well as the overall child mortality by preventing measles outbreaks."

To notify visitors about Ethiopia's ongoing measles risks, the CDC issued an initial Level 1 Travel Alert in 2015. Since then, the CDC advises all visitors to Ethiopia to ensure they are immunized against the measles virus.  [Byline: Don Ward Hackett]
======================
[HealthMap/ProMED-mail map of Ethiopia:
Date: Mon 13 May 2019
Source: New Business Ethiopia [abridged, edited]

The outbreak of acute watery diarrhoea (AWD) has killed 3 people in the North Gondar Tselemt area in the Amhara region of Ethiopia. The 3 people who were getting medical treatment after acquiring AWD have passed away, according to the state broadcaster ETV. The report indicated that currently 151 people affected by AWD are also identified in 3 locations of Amhara region. Currently in North Gondar, Tselemt area, 90 people infected with AWD have been identified and are being treated. While in Abergele area, 58 people and 4 in Beyeda area are getting treatment after acquiring AWD.

The ETV report indicated that the 152 suspected of acquiring AWD are being treated separately in the 3 localities. It is indicated that a medical team at the national, regional, and zone level is mobilized to contain the outbreak in the areas. In addition, teams from WHO and Doctors Without Borders are also engaged to combat AWD in the areas, according to ETV.

Ethiopia has the poorest sanitation facilities in Africa and has been frequently hit by AWD. In Ethiopia, AWD outbreaks have been reported in different parts at different times. The outbreak in Moyale area in the southern part of the country in 2016 resulted in a total of 268 cases and 2 deaths reported. In 2017, it was also reported that some parts of the Somali region of Ethiopia were also affected by an AWD outbreak resulting in the deaths of many people.
=====================
[Especially in east Africa, AWD is used instead of cholera. - ProMED Mod.LL]

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

Turkey

Geographical Information:
*****************************************
Turkey is officially known as the Republic of Turkey and is bordered on the northwest by Bulgaria and Greece, on the north by the Black Sea and on the south by Syria, Iraq and t
e Mediterranean Sea. The capital is Ankara with a population of about 2.5 million though Istanbul is a much larger city (6.6 million). The population of the country is estimated at 62 million with the majority in the cities and along the costal regions.
Climate:
*****************************************
The Mediterranean and Aegean shores of Turkey have long and hot summers with a milder winter. In Istanbul the average July temperature reaches 230C while in January it can drop to 00C. Throughout the country the annual rainfall is about 29". This is mainly during the months of December and January.

Health Care Facilities:
*****************************************
The level of adequate health facilities vary considerably within the country. Most of the better hotels will have access to English speaking doctors but care may be required if hospital admission is required.
Disease Profile:
*****************************************
Cholera and other water borne diseases are frequently reported from Istanbul. In the southeastern city of Diyarbakir there are regular reports of dysentery, typhoid, meningitis and other contagious diseases.

General Food & Water Hygiene:
*****************************************
There can be little doubt that travellers to Turkey who disregard basic hygiene precautions will run a risk of developing significant illness and a ruined holiday. With simple general care most tourists will remain healthy.

Food Rules:
*****************************************
Always eat in clean restaurants and hotels. Eat freshly cooked hot food. Stay away from cold salads, especially lettuce. Don’t eat any of the bivalve shellfish dishes such as oysters and mussels. Never eat food prepared by street vendors. Always peel your own fruit if at all possible.
Water Rules:
*****************************************
Never use the hotel tap water for drinking or brushing your teeth unless you can easily smell chlorine. Don’t allow ice in your drinks and be wary of the hotel water jug which may be in your room each day. Any of the canned drinks or bottles are usually quite safe. Just check the seal first!
Rabies in Turkey:
*****************************************
This disease is only a particularly risk for travellers who plan to have extended trekking holidays throughout Turkey. Most tourists travelling for a ‘sun’ holiday would be very unfortunate to be exposed but nevertheless care should be taken at all times to ensure that there is no contact with warm blooded animals. This is mainly true for dogs and cats but any infected
warm blooded animal can transmit the disease through its saliva. Any bite, lick or scratch should be treated seriously.
*
Wash out the area
*
Apply an antiseptic
*
Attend for urgent medical attention
Sun Stroke:
*****************************************
The immense strength of the sun in the Middle East can often be underestimated by the Irish traveller. This is especially true for small children and the elderly. Try and stay out of the direct sunlight between 11am to 4pm. Use a wide brimmed hat if possible to protect yourself. Drink plenty of fluid (about 2 or 3 times as much as in Ireland) and remember to increase your salt intake unless this is contraindicated because of high blood pressure or heart disease etc. Any signs of dehydration should be recognised and treated early (dry lips, headache etc.).
Anthrax:
*****************************************
This bacterial disease is sometimes contracted by travellers who purchase untreated leather goods while abroad.
Drug Trafficking:
*****************************************
Remember that Turkey is regarded as a gateway to Europe. Never agree to carry belongings for others unless you are certain of the contents.
Malaria in Turkey:
*****************************************
The risk of malaria in Turkey is very limited and transmission usually only occurs between the months of March to November in the Çukurova / Amikova areas and from mid-March to mid-October in southeast Anatolia. These are mainly away from the standard tourist routes and so prophylaxis will usually not be required. Nevertheless there may be an abundant supply of mosquitoes and other insects around. Travellers should carry insect repellents and wear longer sleeved clothing when at risk.
Vaccinations for Turkey:
*****************************************
There are no compulsory vaccines for entry to Turkey from Ireland. However, travellers are advised to ensure that they are adequately covered against Poliomyelitis, Typhoid, Tetanus and Hepatitis A. Those spending longer in the country or undertaking a trekking holiday may also need to consider vaccination cover against Rabies and Hepatitis B .
Further Information:
*****************************************
Travellers can obtain further health information for overseas travel by contacting either of our offices. Useful web sites for information on Turkey include;

www.WHO.int
www.CDC.gov
www.FCO.gov.uk

Travel News Headlines WORLD NEWS

Date: Mon 5 Aug 2019 20:42 TRT
Source: Daily Sabah [edited]

A group of Turkish scientists has identified 4 rare viruses in Turkey that cause haemorrhagic fever and lead to death due to renal failure, a scientist said [Mon 5 Aug 2019].

A team from the Biology Department of Bulent Ecevit University, led by Professor Mehmet Ali Oktem of Dokuz Eylul University's Medical Virology Department, conducted research on hantavirus types that develop in rodents and small mammals in Turkey and 4 particular subspecies that can cause human disease.

Oktem said he has been doing fieldwork on the hantavirus since 2000, adding that the presence of the virus in rodents was discovered in Turkey for the 1st time in 2004 in the Black Sea region. Meanwhile, the 1st cases in which the viruses developed in humans were reported in 2004 in the Aegean region, and subsequently in Zonguldak and Bartin provinces in the western Black Sea region in 2009.

The newly-identified rare viruses which can be transmitted to humans from rodents, have been named after the provinces or towns they were found in, namely the "Dobrava Hantavirus Igneada", "Dobrava Hantavirus Giresun", "Puumala Hantavirus Bartin", and "Tuula Hantavirus Palandoken."
=====================
[Cases of hantavirus haemorrhagic fever with renal syndrome have been reported in Turkey previously. In January-March 2009 there were 12 laboratory confirmed cases that were serologically positive for Puumala virus subtype.

Reference
---------
Ertek M, Buzgan T; Refik Saydam National Public Health Agency; Ministry of Health, Ankara, Turkey: An outbreak caused by hantavirus in the Black Sea region of Turkey, January-May 2009. Euro Surveill. 2009; 14(20). pii: 19214;  <https://www.eurosurveillance.org/content/10.2807/ese.14.20.19214-en>

Finding Puumala virus in rodents in Turkey is not surprising, since it has caused human cases there in the past. Dobrava-Belgrade orthohantavirus (DOBV) was first isolated from yellow-necked mice (_Apodemus flavicollis_) found in Dobrava village, Republic of Slovenia. It was subsequently isolated in striped field mice in Russia and other parts of Eastern Europe and this rodent occurs in Turkey. The report above indicates that it harbors DOBV in Turkey. It will be interesting to see a genomic comparison of these viruses from Turkey with sequences of these same viruses from other geographic areas. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Turkey:
Date: Tue 30 Jul 2019
Source: Time Turk [in Turkish, machine trans., edited]
<https://www.timeturk.com/mus-ta-15-kisi-brucella-hastaligina-yakalandi/haber-1150899>

A total of 15 people engaged in animal fattening in the town and highlands of Kirkoy have been infected with brucellosis. A resident of the town said that many small ruminants in the town had suffered a miscarriage during the birth season and that 4 people in one family are now being treated for brucellosis. The patients had been seen at the Elazig Ataturk Research Hospital and "the doctors made the examinations and tests and as a result a brucellosis diagnosis was made. The patients were constantly sluggish and sleepy.

Currently, 15 people are receiving treatment for the same disease, "he said. Mus Provincial Health Director Serdal Turkoglu stated that 119 cases were encountered in Muay in 2019 and that the patients were treated in the hospitals in the province and that they made the necessary studies and tests on the subjects in the field. He reminded that the source of animal products should not be consumed in order to prevent the disease: "cheese, cream, butter, cream, ice cream made from pasteurized or well boiled milk should be preferred. Pickled cheeses should be consumed after waiting for at least 3 months. Frequent abortions and stillbirths should be examined by a veterinarian immediately.

The animals' wastes and the feeds that these wastes come into contact with, should be buried in sealed bags. Animals should be vaccinated against brucella," he said. -- Communicated by: ProMED-mail <promed@promedmail.org> [This infection, a bacterial zoonosis, is classified among the category B biowarfare agents. Natural transmission to humans occurs after occupational exposure or through ingestion of contaminated food products. Although brucellosis has become a rare entity in the United States and many industrialized nations because of animal vaccination programs, this condition remains a significant health problem in many developing countries.

Each species of _Brucella_ has a specific animal reservoir in which chronic disease is present. The bacilli tend to localize in the reproductive organs of the animals, causing sterility and abortions, and are shed in large numbers in the animal's urine, milk, and placental fluid. This localization allows for efficient spread to farmers, veterinarians, slaughterhouse workers, and consumers.

Among the 4 species known to cause disease in humans, _Brucella melitensis_ (from goats, sheep, or camels) may be the most virulent, producing the most severe and acute cases of brucellosis with disabling complications. A prolonged course of illness, which may be associated with suppurative destructive lesions, is associated with _B. suis_ (from feral or commercially raised pigs) infection. _B. abortus_ (from cattle, buffalo, and camels) is associated with mild-to-moderate sporadic disease that is rarely associated with complications. - ProMED Mod.LL]

[HealthMap/ProMED map available at: Turkey:
<http://healthmap.org/promed/p/87>]
19th June 2019
https://www.dailysabah.com/turkey/2019/06/18/heavy-rainfall-floods-parts-of-northeastern-turkeys-trabzon-killing-7

emAA Photo/em

At least seven people were killed in north-eastern Turkey's Trabzon province after heavy rainfall triggered flash floods on Tuesday. Interior Minister Süleyman Soylu had previously announced that four people were killed in the province's Araklı district, while three others were injured and six people were missing. Agriculture and Forestry Minister Bekir Pakdemirli said three bodies were found in the area later on Wednesday, bringing the death toll to seven with three others unaccounted for.  Trabzon Governor Ismail Ustaoğlu said search and rescue efforts had been launched by Disaster and Emergency Management Authority (AFAD) units to locate the missing.

The floods hit Araklı's Çamlıktepe and Yeşilyurt neighbourhoods after a nearby stream overflowed following sudden and heavy rainfall.  Firefighters were immediately dispatched to the scene but had difficulty reaching the affected areas as debris brought by the floods blocked the roads.  AFAD and gendarmerie units were also called in to help with the rescue efforts. The governor said the floods also destroyed four houses and offices in the district.  Finance and Treasury Minister Berat Albayrak offered condolences for those that perished in the disaster and said all available resources were being made available to assist the rescue operation.

Date: Sat 23 Feb 2019
Source: Xinhua [abridged, edited]

Turkey's experts recently warned that epidemic diseases such as measles that have been off the grid for years might come back amid decreasing vaccination rates in the country in the past few years under the influence of anti-vaccine discourse. The anti-vaccination trend started with 183 people in 2011, reaching 980 in 2013 and 5091 in 2015. In 2017, a total of 23 600 families declined compulsory vaccine, professor Mehmet Ceylan, head of paediatric infectious diseases at Ankara's Hacettepe Medical Faculty, said.

The expert warned of an epidemic outbreak if vaccination rates falls under 95 per cent, or some 50 000 people in Turkey. Ceylan said that diseases such as diphtheria and tetanus, which have been off the grid in Turkey for years, might show up again.
 
WHO also voiced concern about the increasing anti-vaccination movement in Turkey. An increasing number of groups were "misleading" the public about the effects of vaccines, harming their trust in getting vaccinated, WHO said.
Turkish health ministry has set up a special website to inform the public about vaccines and to fight false facts. But the anti-vaccination movement is increasingly active on social media, with slogans such as "I have no obligation to vaccinate". A great majority is concerned with the content of the vaccines such as use of mercury or aluminum.

It's obligatory in Turkey that a baby be given a total of 16 different types of vaccination in the 1st 24 months. Parents have to sign an official document holding them responsible, if they reject vaccination. Professor Ata Nevzat Yalcin from Akdeniz University's Faculty of Medicine, Infection Diseases and Clinical Microbiology, warned against the latest trend of increasing measles in Turkey. "The worldwide increase in the disease in 2017 was also observed in our country," he said. There were 572 measles cases in 2014, 342 in 2015, 9 cases in 2016, 69 cases in 2017. In the 1st 9 months of 2018, the number of the cases exceeded 500, he added. Measles arises especially in the spring and winter months, and can cause recurrent epidemics every 2 to 3 years, Yalcin said.

According to the Health Ministry's figures, the measles vaccination rate was 97 per cent in 2015, 98 per cent in 2016, and 96 per cent in 2017. Turkey faced a measles outbreak, which was off the grid for many years, compounded by the arrival of millions of refugees after civil war erupted in neighbouring Syria.

Some 7415 people were diagnosed with measles in Turkey in 2013, but the epidemic was prevented after an intense vaccination program. The number of people diagnosed with measles disease reached 510 in the 1st 9 months of 2018 in Turkey, a recent report of WHO said. According to WHO, the number of global measles cases doubled to 229 068 in 2018, and 82 596 of them were in Europe, mostly caused by stalled vaccination levels.
Date: Wed, 13 Feb 2019 13:01:04 +0100

Beijing, Feb 13, 2019 (AFP) - Beijing has warned its citizens in Turkey to "be more vigilant", as bilateral tensions rise after strong Turkish criticism of China's treatment of its minority Uighur community.   Nearly one million Uighurs and other Turkic-speaking minorities are being held in extrajudicial detention in camps in Xinjiang, according to a UN panel of experts, where most of China's more than 10 million Uighurs live.

Beijing has admitted to placing people in "vocational education centres" to prevent radical Islamism. Critics however allege Uighurs in the camps are being brainwashed in a massive campaign to enforce conformity with Chinese society and abandon Islam.   The northwestern Xinjiang region -- home to some 10 million Uighurs -- has long suffered from violent unrest, which China claims is orchestrated by an organised "terrorist" movement seeking the region's independence.

Turkey, which has its own significant Uighur population, said on Saturday China's treatment of the Uighurs was "a great embarrassment for humanity".   It also called on the international community and the UN "to take effective steps to end the human tragedy in Xinjiang region".   China's embassy to Turkey wrote on its website: "We call once more on Chinese citizens in Turkey and Chinese tourists going to Turkey to be more vigilant and pay attention to their personal security as well as the security of their belongings."

The warning was posted on Sunday, the day after the declarations by the Turkish Ministry of Foreign Affairs.   Violent anti-China protests against the county's treatment of the Uighurs have previously broken out in Turkey. In 2015, militant Turkish nationalists burnt a Chinese flag in front of China's embassy in Ankara.   A popular Chinese restaurant in Istanbul also had its windows smashed and a group of South Korean tourists who were visiting the city was attacked because they were mistaken for Chinese.
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China

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 I
ish travellers will be 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
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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
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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
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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
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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
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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: Mon, 12 Aug 2019 07:17:01 +0200 (METDST)

Beijing, Aug 12, 2019 (AFP) - A monster storm that smashed its way up the eastern China coast and forced more than a million residents to flee has killed 44 people, state media said Monday.   Footage on state broadcaster CCTV showed fields and streets flooded by muddy water, submerged vehicles, scattered debris and trees blown over as strong winds and rain from Typhoon Lekima pounded cities along the seaboard.   At least 16 people were still missing as the storm moved further up the coast near Beijing.   Official Xinhua news agency said the toll had risen to 39 in Zhejiang province, where Lekima made landfall on Saturday, packing winds of nearly 190 kilometres per hour (120 miles per hour) and pounding the coast with waves several metres in height.   At least 18 of those were killed in a landslide triggered by torrential downpours in Wenzhou, state media said.   More than a million people were evacuated from their homes ahead of the typhoon, Xinhua reported.

Lekima hit Shandong province later on Sunday, where the local emergency management department reported five dead and seven missing, as well as the relocation of more than 180,000 people and damage to 600 homes.   The natural disaster has inflicted economic losses of more than 24.22 billion yuan (US$3.4 billion) in Zhejiang alone, authorities said.   Rescue workers were shown on CCTV using boats and rope pulleys to carry out stranded residents over the weekend.   More than 3,200 flights have been cancelled due to the typhoon, the state broadcaster reported, as Beijing, Shanghai and other cities grounded planes.    In Shanghai, more than 90 tourist sites including Disneyland were closed ahead of the storm, with most set to re-open Monday or Tuesday.
Date: Thu, 4 Jul 2019 05:42:03 +0200

Beijing, July 4, 2019 (AFP) - A tornado has left six people dead and nearly 200 injured after ripping through a north-eastern Chinese city, local authorities said Thursday.   The tornado hit Kaiyuan in Liaoning province on Wednesday afternoon, tearing down trees and electricity poles, smashing the windows of apartment buildings, and knocking down some brick walls.   More than 190 people were injured and 43 of them were hospitalised, the Kaiyuan public security bureau said on the Weibo social media platform.
Date: Wed 29 May 2019
Source: Healio [edited]

Researchers in north eastern China discovered a new segmented RNA virus associated with febrile illness in dozens of patients, and they suspect that the virus is transmitted by ticks, according to a study published in the New England Journal of Medicine. They named the previously unknown pathogen the Alongshan virus (ALSV).

"ALSV infection can cause clinical disease, and, therefore, it should be differentiated from other tickborne diseases, such as severe fever with thrombocytopenia syndrome, tickborne encephalitis, anaplasmosis, rickettsiosis and babesiosis," Quan Liu, from Foshan University in Guangdong Province and the Academy of Military Medical Sciences in Jilin Province, told Infectious Disease News.

According to the study, routine tickborne disease surveillance identified a 42 year old female farmer who presented to a hospital in Inner Mongolia with symptoms similar to those of infectious tickborne encephalitis virus (TBEV). Liu and colleagues collected a blood sample from the patient but did not find TBEV RNA or antibodies against the virus.

Because of the similarity of the patient's symptoms to those caused by a tickborne pathogen, the hospital initiated a heightened surveillance program to identify patients with a history of tick bites or bite-related symptoms. Liu and colleagues took serum specimens from patients and 100 healthy people living in the area, and collected local ticks and mosquitoes for testing, according to the study.

Reverse transcription-PCR testing confirmed ALSV in 86 patients from Inner Mongolia and Heilongjiang Province who presented with fever, headache and a history of tick bites, the researchers found. Among them, 73% were men, 98% were farmers or forestry workers, and 95% had "a clear history" of prior tick bites before disease onset, Liu and colleagues reported. According to the study, seroconversion occurred in all 19 patients with specimens available from the acute and convalescent phases of their illness.

Liu and colleagues reported that _Ixodes persulcatus_ ticks -- taiga ticks -- collected from areas where patients were bitten also tested positive for ALSV RNA. "We suspect that ALSV is transmitted by the tick _I. persulcatus_," Liu and colleagues wrote. "Common hosts of _I. persulcatus_ include most mammals (such as sheep, cattle, horses, dogs, rabbits, humans) and occasionally some birds. _I. persulcatus_ is widely distributed in Asia and eastern Europe, including China, Korea, Japan, Mongolia, and Russia."

The researchers said they cannot exclude mosquitoes as a possible vector of the virus and that more studies are needed to determine the geographic distribution of ALSV. Thus far, Liu and colleagues said they have found no epidemiologic evidence of person-to-person transmission of the virus.  [byline: Joe Gramigna]
*******************************************
Date: Thu 30 May 2019
Source: N Engl J Med. [edited]

Ze-Dong Wang, Bo Wang, Feng Wei, Shu-Zheng Han, Li Zhang, Zheng-Tao Yang, et al. A new segmented virus associated with human febrile illness in China. N Engl J Med. 2019; 380: 2116-2125, DOI: 10.1056/NEJMoa1805068.

Abstract
======================
Background
In 2017, surveillance for tickborne diseases in China led to the identification of a patient who presented to a hospital in Inner Mongolia with a febrile illness that had an unknown cause. The clinical manifestation of the illness was similar to that of tickborne encephalitis virus (TBEV) infection, but neither TBEV RNA nor antibodies against the virus were detected.

Methods
We obtained a blood specimen from the index patient and attempted to isolate and identify a causative pathogen, using genome sequence analysis and electron microscopy. We also initiated a heightened surveillance program in the same hospital to screen for other patients who presented with fever, headache, and a history of tick bites. We used reverse-transcriptase-polymerase-chain-reaction (RT-PCR) and cell-culture assays to detect the pathogen and immunofluorescence and neutralization assays to determine the levels of virus-specific antibodies in serum specimens from the patients.

Results
We found that the index patient was infected with a previously unknown segmented RNA virus, which we designated Alongshan virus (ALSV) and which belongs to the jingmenvirus group of the family Flaviviridae. ALSV infection was confirmed by RT-PCR assay in 86 patients from Inner Mongolia and Heilongjiang who presented with fever, headache, and a history of tick bites. Serologic assays showed that seroconversion had occurred in all 19 patients for whom specimens were available from the acute phase and the convalescent phase of the illness.

Conclusions
A newly discovered segmented virus was found to be associated with a febrile illness in north eastern China. (Funded by the National Key Research and Development Program of China and the National Natural Science Foundation of China.)
=====================
[This interesting finding of a new flavivirus, Alongshan virus, opens the door for future studies. Although the virus was found in _Ixodes persulcatus_, the authors are prudent in suggesting but not concluding that this tick is the vector. One hopes that transmission studies in the laboratory will establish vector capacity of this tick. Similarly, serological studies of domestic and wild animals may provide clues about the vertebrate hosts of the virus, followed by determination of the magnitude and duration of viremia in suspected hosts. Further clinical studies of infected humans will also be of interest. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Thu, 2 May 2019 13:15:33 +0200

Beijing, May 2, 2019 (AFP) - Two children were killed in China after a tornado flipped over an inflatable bounce house in the northern province of Hebei on Thursday, state media reported, in the second such incident in two months.   A tornado had struck a central plaza in Laiyuan county, overturning the bouncy castle in a freak accident that injured seven others, the Beijing Youth Daily said, citing local authorities.

Pictures posted on social media by the newspaper showed a partially deflated bouncy castle toppled over several cars.    Three people have been detained in connection with the incident and investigations are underway, the Beijing Youth Daily said.    In April, a dust tornado sent an inflatable bounce house flying in central China, killing two children and injuring 18 others.
Date: Mon, 1 Apr 2019 11:11:52 +0200

Beijing, April 1, 2019 (AFP) - At least 24 people died after firefighters were sent to combat a forest blaze in remote mountains in southwest China at the weekend, state media said Monday.   Hundreds of firefighters were deployed to battle the fire, which broke out on Saturday evening on steep terrain at an altitude of around 3,800 metres (12,500 feet), local officials said.   Authorities in Liangshan Autonomous Prefecture said they lost contact with 30 firefighters on Sunday afternoon after a sudden change in wind direction ignited a larger blaze.   Officials were able to speak to two firefighters who confirmed that 24 had died, according to a newspaper group affiliated with the People's Liberation Army.
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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]
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[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.
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[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.
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[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]
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[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]