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Bulgaria

Bulgaria US Consular Information Sheet
September 20, 2007
COUNTRY DESCRIPTION: Bulgaria is a quickly developing European nation undergoing significant economic changes.
Tourist facilities are widely available, although conditions vary and
ome facilities may not be up to Western standards.
Goods and services taken for granted in other European countries may not be available in many areas of Bulgaria.
Read the Department of State Background Notes on Bulgaria for additional information.
ENTRY/EXIT REQUIREMENTS:
A United States passport is required for U.S. citizens who are not also Bulgarian nationals.
As of September 1, 2006, U.S. citizens who enter the country without a Bulgarian visa are authorized to stay for a total of 90 days within a six-month period.
This law is strictly enforced.
An application to extend one’s stay beyond the original 90 days can be filed for urgent or humanitarian reasons, but must be submitted to regional police authorities no later than five days prior to the end of the original 90-day period.
Travelers who have been in the country for 90 days, and then leave, will not be able to reenter Bulgaria before the six-month period expires.
Travelers using official or diplomatic passports must secure visas prior to arrival.
Upon entering the country, Bulgarian immigration authorities request that all foreigners declare the purpose of their visit and provide their intended address.
U.S. citizens intending to live or work in Bulgaria for more than 90 days within six months (or more than six months within a year) must obtain a “D” visa prior to arrival.
The practice of switching from tourist status to long-term status when already in Bulgaria is no longer allowed.
Those wanting to do so must leave Bulgaria and apply for a “D” visa at a Bulgarian embassy or consulate.
This procedure takes from two to four weeks.
American citizens who marry Bulgarian nationals and want to switch to long-term status must also leave the country, present their marriage license at a Bulgarian embassy or consulate in a neighboring country, and apply for a “D” visa.

The Bulgarian authorities do not consider presentation of a copy of the passport sufficient for identification purposes.
Visitors should carry their original passports with them at all times.
For further information concerning entry requirements, travelers should contact the Embassy of the Republic of Bulgaria at 1621 22nd St. N.W., Washington, D.C. 20008; http://www.bulgaria-embassy.org; tel. (202) 387-7969 (main switchboard (202) 387-0174), or the Bulgarian Consulate in New York City at 121 East 62nd Street, New York, NY 10021; http://www.consulbulgaria-ny.org; tel. (212) 935-4646.
See our Foreign Entry Requirements brochure for more information on Bulgaria and other countries.
Visit the Embassy of Bulgaria web site at http://www.bulgaria-embassy.org for the most current visa information.
Traveling with Bulgarian minors: Bulgarian authorities are particularly strict in matters involving the travel of Bulgarian children.
Adults, other than a child’s parents, departing Bulgaria with a Bulgarian national (including dual or multi-national Bulgarian) child, must present to authorities a certified/legalized declaration signed by the child’s parents authorizing custody for travel purposes.
This holds true even if the adult is otherwise related to the child.
If the declaration is signed in Bulgaria, certification by a Bulgarian notary public is required.
If signed in the U.S., the declaration must be certified by a notary public and the court in the jurisdiction where the notary is licensed.
The declaration must then be legalized with an apostille issued by the individual state's Department of State or the Governor’s office.
Please note Bulgarian authorities do not require such documentation for minors who are not Bulgarian.
Find more information about dual nationality and the prevention of international child abduction on our web site. For further information about customs regulations, please read our Customs Information.

SAFETY AND SECURITY:
Bulgaria’s accession to the European Union has enhanced the overall security environment for tourist and business travelers.
However, the country still suffers from many of the ills of a former Eastern Bloc country in transition.
Organized crime groups and criminals who specialize in petty crimes and credit card fraud are highly prevalent in Bulgaria’s largely cash economy.
Petty criminals such as pick-pockets and purse snatchers operate in crowded public areas and on public transportation.
Also, technology exists in Bulgaria to clone credit cards and trap ATM cards for later retrieval.
Suspected organized crime members often travel in convoys of late-model SUVs and luxury sedans, accompanied by armed men, and frequent expensive restaurants, hotels, and nightclubs.
For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site at http://travel.state.gov, where the current Worldwide Caution Public Announcement, Travel Warnings and Public Announcements 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:
Petty street crime, much of which is directed against persons who appear to have money or to be foreign, continues to be a problem.
Pocket picking and purse snatching are frequent occurrences, especially in crowded markets and on shopping streets.
Con artists operate on public transportation and in bus and train stations.
Credit cards and ATMs should be used with caution.
Be wary of people who approach you at an ATM and offer assistance.
Do not give your PIN number to anyone under any circumstances. (See the Special Circumstances section below.) Travelers should be suspicious of "instant friends" and should also require persons claiming to be government officials to show identification.
There have been incidents in which tourists have been drugged or assaulted and robbed after accepting offers of coffee or alcoholic beverages from "friendly” individuals met by “chance” at hotels, the airport, or at bus or train stations.
Travelers should be wary of unfamiliar individuals who encourage them to drink or eat products, as these may be tainted with strong tranquilizers (such as valium) that can lead rapidly to unconsciousness.
Reporting a crime immediately to the police has helped recover money and valuables on more than one occasion and is recommended.
To avoid becoming a victim of more serious crimes, one should use the same personal safety precautions that they would use in large urban areas of the United States.

Travelers should pay special attention to the drink prices at high-end bars and nightclubs.
There have been instances of travelers being charged exorbitant prices, especially for champagne and hard alcohol.
Bills have been as high as several thousand dollars for drinks, and in some establishments the management may use force to assure payment.

On occasion, taxi drivers overcharge unwary travelers, particularly at Sofia Airport and the Central Train Station.
We recommend travelers use taxis with meters and clearly marked rates displayed on a sticker on the passenger side of the windshield.
Travelers should be aware that there is no official commission that sets taxi cab rates.
Taxi drivers are within their full rights to charge passengers any price they want, provided that it corresponds with the price shown on the windshield sticker.
At the airport, there is a clearly marked booth within the arrivals terminal, which arranges for metered taxis at a fair rate.
Finding reputable taxis at the Central Train Station is more difficult.
It is recommended to inquire about the fare first, to avoid excessive payment if a metered taxi cannot be found.
Always ensure that you have and account for all luggage, packages and hand-carried items before you pay and release a taxi.
The likelihood of retrieving articles left behind in a taxi is remote.
Because pilferage of checked baggage may occur at Sofia Airport, travelers should not include items of value in checked luggage.
Automobile theft is a concern, with four-wheel-drive vehicles and late model European sedans the most popular targets.
Very few vehicles are recovered.
Thieves smash vehicle windows to steal valuables left in sight.
Break-ins at residential apartments occur as frequently as in major cities everywhere.
Persons who plan to reside in Bulgaria on a long-term basis should take measures to protect their dwellings.
Long-term residents should consider installation of window grilles, steel doors with well-functioning locks, and an alarm system that alerts an armed response team.

Travelers should also be cautious about making credit card charges over the Internet to unfamiliar websites.
As recent experience has shown, offers for merchandise and services may be scam artists posing as legitimate businesses.
A recent example involves Internet credit card payments to alleged tour operators via Bulgaria-based web sites.
In several cases, the corresponding businesses did not actually exist.
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:
While Bulgarian physicians are trained to a very high standard, most hospitals and clinics, especially in village areas, are generally not equipped and maintained to meet U.S. or Western European standards.
Basic medical supplies and over-the-counter and prescription medications are widely available, but highly specialized treatment may not be obtainable.
Pediatric facilities are in need of funding and lack equipment.
Serious medical problems requiring hospitalization and/or medical evacuation to the United States may cost thousands of dollars.
Doctors and hospitals often expect immediate cash payment for health services.
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 Internet 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.
All foreign citizens traveling to Bulgaria should be prepared to present valid evidence of health insurance to the Bulgarian border authorities in order to be admitted into the country.
The insurance should be valid for the duration of the traveler’s stay in Bulgaria.
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 Bulgaria is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
The Bulgarian road system is largely underdeveloped.
There are few sections of limited-access divided highway.
Some roads are in poor repair and full of potholes.
Rockslides and landslides may be encountered on roads in mountainous areas.
Livestock and animal-drawn carts present road hazards throughout the country, especially during the agricultural season.
Travel conditions deteriorate during the winter as roads become icy and potholes proliferate.
The U.S. Embassy in Sofia advises against driving at night because road conditions are more dangerous in the dark.
Some roads lack pavement markings and lights, and motorists often drive with dim or missing headlights.
Driving in Bulgaria is extremely dangerous.
Aggressive driving habits, the lack of safe infrastructure, and a mixture of late model and old model cars on the country’s highways contribute to a high fatality rate for road accidents.
Heavy traffic conditions have led to a significant increase in “road-rage” accidents.
Motorists should avoid confrontations with aggressive drivers in Bulgaria.
In particular, drivers of late-model sedans (BMW, Mercedes, Audi) are known to speed and drive dangerously.
Motorists should exercise caution and avoid altercations with the drivers of such vehicles, which may be driven by armed organized crime figures.
In some cities traffic lights late at night blink yellow in all directions, leaving rights-of-way unclear and contributing to frequent accidents.
Heavy truck traffic along the two-lane routes from the Greek border at Kulata to Sofia and from the Turkish border at Kapitan Andre to Plovdiv creates numerous hazards.
Motorists should expect long delays at border crossings.
A U.S. state driver's license is valid in Bulgaria only when used in conjunction with an International Driving Permit.
For information on how to obtain a permit, please see our road safety information.
If pulled over by a police officer, motorists should remember that, under Bulgarian law, police officers may not collect fines on the spot; they may only issue a ticket with the fine to be paid at the motorist’s local regional tax office.
Buses, trams, and trolleys are inexpensive, but they are often crowded and of widely varying quality.
Passengers on the busiest lines have reported pick pocketing, purse slashing, and pinching. The use of seat belts is mandatory in Bulgaria for all passengers, except pregnant women.
Children under 10 years of age may ride in the front seat only if seated in a child car seat.
In practice, these rules are often not followed.
Speed limits are 50 km/h in the cities/towns, 90 km/h out of town, and 130 km/h on the highways.
For motorcycles, speed limits are 50 km/h in the cities/towns, 80 km/h out of town, and 100 km/h on the highways.
Motorcyclists must drive with helmets and with lights on at all times.
At crossings that are not regulated, the driver who is on the right has the right-of-way, but this rule, too, is frequently ignored.
Drivers may be charged with driving under the influence of alcohol with a blood level as low as 0.05 percent.
Right turns on red lights are not permitted unless specifically authorized.
The penalties for drivers involved in an accident resulting in injury or death range from a 25 U.S. Dollar fine up to imprisonment for life.
A new law requires the use of headlights day and night from November 1st through March 31st.
The most generally encountered local traffic custom is a driver flashing high beams, which usually means that a traffic police post is ahead.
In case of emergency, drivers should contact the police at telephone number 166 and/or Roadside Assistance at telephone number 146.
For an ambulance, please call 150.
The fire department can be reached at 160.
For specific information concerning Bulgarian driving permits, vehicle inspection, road tax, and mandatory insurance, please contact the Bulgarian Embassy via the Internet at http://www.bulgaria-embassy.org.
Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office at http://www.bulgariatravel.org/eng/index.php and the web site of the Bulgarian national authority responsible for road safety at http://www.kat.mvr.bg.
[Note: the latter web site is available in the Bulgarian language only.]
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Bulgaria’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Bulgaria’s air carrier operations.
For more information, travelers may visit the FAA’s Internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Bulgaria is still largely a cash economy.
Due to the potential for fraud and other criminal activity, credit cards should be used sparingly and with extreme caution.
There have been reports of false ATM fronts on bona fide machines that capture cards and PINs for later criminal use, including unauthorized charges or withdrawals.
In connection with such scams, travelers should be extremely wary of friendly bystanders near ATMs who offer assistance.
Any time a card is not returned the traveler should immediately report the card as lost/stolen to the card-issuing company.

Visitors may exchange cash at banks or Exchange Bureaus, but they should know that Exchange Bureaus sometimes post misleading rate quotations that confuse travelers.
People on the street who offer high rates of exchange are usually con artists intent on swindling the unwary traveler.
Damaged or very worn U.S dollar bank notes are often not accepted at banks or Exchange Bureaus.
Major branches of the following Bulgarian banks will cash travelers' cheques on the spot for Leva, the Bulgarian currency, or another desired currency:
Bulbank, Bulgarian Postbank, Biochim, First Investment Bank, and United Bulgarian Bank (UBB).
UBB also serves as a Western Union agent and provides direct transfer of money to travelers in need.
There are also many Western Union branches in major towns and cities.
Most shops, hotels, and restaurants, with the exception of the major hotels, do not accept travelers' cheques or credit cards.
Only some local banks can cash U.S. Treasury checks and the payee may need to wait up to a month to receive funds.
Corruption remains an important concern of the Government.
The Commission for Coordinating of the Activity for Combating Corruption manages the efforts of each government agency’s internal inspectorate in fighting public corruption and engages in public awareness campaigns.
Complaints of public corruption can be made to it at the Ministry of Justice, 2A Knyaz Dondukov Blvd., 1055 Sofia, Bulgaria, email: acc@government.bg, 359-2-980-9213, 359-2-923-7595, 359-2-940-3630 or to the Ministry of Finance hotline: 0800180018.
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 Bulgaria’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Bulgaria 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 Bulgaria are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, and to obtain updated information on travel and security within Bulgaria.
Americans without Internet access may use a public computer at the U.S. Embassy to register.
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 16, Kozyak St., Sofia1407; tel.: (+359 2) 937-5100; fax (+359 2) 937-5209; web site: http://sofia.usembassy.gov/.
Questions regarding consular services may be directed via email to: niv_sofia@state.gov (for non-immigrant visa matters); iv_sofia@state.gov (for immigrant visa matters) and acs_sofia@state.gov (for American Citizen Services matters).
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This replaces the Consular Information Sheet dated March 28, 2007, to update the sections on Entry and Exit
Requirements, Safety and Security, Crime, Traffic Safety and Road Conditions, Children’s Issues, and Registration/Embassy.

Travel News Headlines WORLD NEWS

Date: 30 Aug 2018
Source: Euro Surveillance [summarized, edited]

In June 2018, Crimean-Congo haemorrhagic fever (CCHF) was diagnosed in a Greek construction worker who returned home after becoming ill with fever and haemorrhagic symptoms in south-western Bulgaria. Here, we describe the case along with the epidemiological investigation and phylogenetic analysis.

On 30 May 2018, a Greek male in his late 40s returned to Greece after spending 23 days in a forested area in Blagoevgrad province, south-western Bulgaria, where he was working in bridge construction. Three days earlier (27 May 2018, day 1), while in Bulgaria, he developed fever, severe headache, myalgia (mainly in the lower extremities), malaise and loss of appetite; on 28 May 2018 he visited a local hospital and received symptomatic treatment as an outpatient. As his condition deteriorated (onset of photophobia and abdominal pain) he returned to his permanent residence in northern Greece. On 31 May 2018 (day 5), the patient was admitted to a local hospital.

He was transferred to the university hospital in Alexandroupolis the next day because he presented severe thrombocytopenia and leukopenia; elevated levels of liver enzymes, creatine phosphokinase (CPK) and lactate dehydrogenase (LDH); and prolonged activated partial thromboplastin time (aPTT) (Table). On day 6, his headache was resolved, but his fever (38.2 C [101 F]), malaise and myalgia were ongoing. The main laboratory findings were thrombocytopenia, prolonged aPTT (82 s) and increased level of aminotransferases. His laboratory parameters indicated rhabdomyolysis (CPK 1739 U/L) and slightly elevated urea and creatinine levels (Table). A bone marrow biopsy showed haemophagocytosis. ...

Based on the patient's clinical presentation, and as he was bitten by a tick in an area of Bulgaria where CCHF cases have been reported previously, CCHF was highly suspected. Typically, the incubation period of CCHF after a tick bite is short (1-3 days), but the exact date of the bite was unknown in this case. The treating physician contacted the National Reference Centre for Arboviruses and Haemorrhagic Fever Viruses in Thessaloniki, and the suspected case was immediately notified to the Hellenic Center for Disease Control and Prevention (HCDCP). ...

The HCDCP investigated the case immediately after the diagnosis of CCHF (through telephone interviews with a close family member and with the patient, after recovery, to confirm the dates) and his contacts while he was ill (household members, co-workers, roommates in Bulgaria and relatives who visited him in the hospitals). Close contacts were tested for CCHF and monitored for 14 days for any symptom development. The risk for further transmission was also assessed. The HCDCP promptly informed the Bulgarian health authorities about the case; they also informed the patient's Greek co-workers in Bulgaria about prevention and proper management of tick bites (informative material in Greek was sent to them) advising them to seek medical care in case they develop symptoms.

No other cases were reported among the patient's co-workers in Bulgaria, up to the end of July 2018. The regional and local public health authorities were also informed about the case, and they performed further contact investigation in Greece. No secondary cases were detected. The HCDCP raised awareness for CCHF among health professionals working in local health centres and hospitals in northern Greece, especially in areas with populations travelling to Bulgaria for occupational reasons.

The patient and his laboratory samples, apparel, waste and cleaning procedures were managed in accordance with the national guidelines for viral haemorrhagic fevers (available in Greek from HCDCP website: <http://www.keelpno.gr/>). In particular, upon the suspicion of CCHF (day 8), the patient was immediately isolated, and strict barrier precautions were utilised (waterproof gowns, gloves, FFP3 respiratory masks, goggles), and personal protective equipment was used by healthcare workers (HCWs) and visitors; however, visitors were discouraged from entering the isolation room. The HCDCP sent guidelines for contact tracing and active surveillance of symptoms in HCWs possibly exposed to CCHFV. Patients who were hospitalised in the same room with the patient before the suspicion of CCHF (2 patients in the 1st hospital (days 5-6), and 3 patients in the 2nd hospital (days 6-8)), were also monitored for symptoms for 14 days after their last contact with the patient. No secondary cases were observed. ...

Discussion
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CCHF was 1st recognised in Bulgaria in 1952; since then, several cases have been reported. Genetic characterisation of the Bulgarian strains showed that they cluster into the clade Europe 1. Our patient was infected in an area that was considered at low risk for CCHF outbreaks up to 2008, when a cluster of cases was observed in the region. Although the seroprevalence in the human population in Blagoevgrad province is low (1 percent), a seroprevalence of 41.9 percent in livestock was reported recently. Since CCHFV is transmitted mainly by bites of infected Ixodid ticks, persons living in rural areas are at increased risk for acquiring the infection. This was the reason that information about preventive measures was sent to our patient's Greek co-workers in Bulgaria, and all related public health authorities were informed about the case.

Regarding Greece, no other imported cases have been reported so far, and the only autochthonous CCHF case was observed in 2008. A review of travel-associated CCHF cases published during 1960-2016 reported 21 cases; 2 imported cases have been reported within Europe: Bulgaria to Germany in 2001 and Bulgaria to the United Kingdom in 2014.

Due to the high pathogenicity of CCHFV, the absence of a specific drug treatment or vaccine, and the risk of person-to-person transmission, rapid diagnosis is crucial to ensure that appropriate infection control measures (e.g. isolation of patient and barrier precautions) can be implemented in a timely manner. A detailed medical history of the patient, including travel history and possible risk factors, is important for the timely diagnosis of the disease. In our case, information regarding the tick bite was not provided immediately, and this, in combination with the non-specific initial symptoms, meant that CCHF was 1st suspected on day 8 of illness. Despite this delay, the patient fully recovered, and no secondary cases of CCHF have been reported. Since the northern part of Greece is close to CCHF-endemic countries, HCWs in this region should be made aware of CCHF, including the provision of training to better help them address questions from patients about travel history (to identify potential risk of exposure). Physicians should include CCHF in the differential diagnosis for patients with haemorrhagic syndromes, especially if patients report a tick bite, outdoor activities, or occupation in rural areas and recent travel to an endemic area.
=======================
[The above report provides an excellent example of CCHF transmission in a case with no history of conventional professional contact with infected cattle, such as cattle rearing or butchering. History of travel to a location that has reported human cases, presence of the vector, and the clinical picture should raise suspicions in health care providers, with appropriate diagnostic tests conducted as soon as possible. - ProMED Mod.UBA]

[HealthMap/ProMED maps available at:
Date: Thu, 8 Mar 2018 12:10:48 +0100
By Diana SIMEONOVA

Bansko, Bulgaria, March 8, 2018 (AFP) - "Unlimited Ski and Fun!" promises a pamphlet touting the Bansko ski resort, a magnet for bargain-hunting holidaymakers in southwest Bulgaria.   But nature lovers are demanding limits to the growth of the bustling resort carved into the majestic pine forests of Pirin National Park, a UNESCO World Heritage site since 1983.

The clearance of more than 160 hectares (400 acres) of centuries-old forest to build the ski zone already prompted UNESCO in 2010 to remove the area from the World Heritage designation, labelling it a "buffer zone".   Now a much larger area could come under threat after a government decision in December opened 48 percent of the park's 40,000 hectares for construction, sparking weekly protests attended by thousands across the country.

Protestors accuse the government of favouring business interests in a country ranked by watchdog Transparency International as the EU's most graft-prone, with one huge banner at a recent rally in the capital Sofia reading: "Corruption! Save Pirin".   But the resort is the area's biggest employer and locals have responded with their own demonstrations in favour of expansion.   At issue in particular is a plan to build a second ski lift to ease persistent queues at the sole six-person lift, which currently takes 2,200 skiers per hour up to the 75 kilometres (46 miles) of runs.

- 'Horrific' queue -
British holidaymaker Carolyn Bennett, 30, is among the skiers who come in droves to Bansko from Britain, Russia and Bulgaria's Balkan neighbours, attracted by the cheap food and lift passes as well as budget flights.   But even on a supposedly quiet day, she was among scores of people at the foot of the ski lift, where queues form from early morning and waits can last up to three hours.

"Another gondola is going to have a huge impact environmentally but I imagine coming here in peak season, that queue would probably be horrific," she shrugged in the crammed gondola cabin.    "With a daily lift pass costing 28 euros ($34), Bansko is the cheapest resort of its capacity in Europe, and even if our queues have become notorious, people keep pouring in," Bansko's marketing chief Ivan Obreykov told AFP.   Daily lift passes at ski resorts in France and Austria typically cost twice as much.

Bansko hosts some 35,000 to 40,000 visitors per month during the winter season. On a busy day, up to 7,000 people could hit the ski lift at the same time in the mornings.   Booming construction in the once quiet town of 9,500 inhabitants has seen its two-storey houses and cobbled streets surrounded by hotels and luxury apartments with space for 18,000 guests.   While ugly concrete skeletons of a number of hotel projects abandoned after the 2008 financial crisis mar the landscape, pressure is mounting to expand both the town and the ski zone.

- Trojan horse claim -
Obreykov praised the government's green light for the second ski lift, adding that its construction was the resort's "first and most pressing task".   But those opposed to the plan say it is a Trojan horse to cover up previous unauthorised building and encourage even more expansion.   "If they wanted to do just a second gondola, they would not have opened almost half of the territory of Pirin National Park for construction," WWF's Konstantin Ivanov said at a rally in Sofia.   "We don't buy their promises that nothing more will be built there," he added.   WWF claims the ski zone has already grown to cover 60 percent more territory than initially agreed and points to as yet unapproved plans for huge expansion of the resort.    Obreykov denied the charge, adding that new ski runs could be built only within the current area of the ski zone.

A recent study for the WWF concluded that the resort has already inflicted "irreparable damage" on the reserve, calling for UNESCO to inscribe Pirin on its List of World Heritage in Danger if new construction begins.    A report by the International Union for Conservation of Nature (IUCN) in November also said the conservation outlook for Pirin National Park -- home to bears, chamois and wolves -- was of "significant concern" and just one step away from the final "critical" stage.   IUCN also underlined the "threats of disturbance and fragmentation of the site associated with the exclusion of the skiing areas as incompatible with its World Heritage status."

- 'Deepening mistrust' -
For economist Petar Ganev, of the Sofia-based Institute for Market Economics, the row is an example of "deepening mistrust in Bulgaria's institutions".   On the one hand, Ganev said Bansko is "a positive example of a very poor place which grew into a prosperous resort" and that building a second ski lift could be justified for that reason.   But, he added, suspicions that development is not being regulated fairly will "continue to bring people out on the streets".   "The problem is not the second gondola but the corruption in the country," Ganev said.
Date: Fri 1 Dec 2017 15:26
Source: Focus News Agency [edited]

The hepatitis A outbreak in the Kosharnik, an all-Roma neighbourhood of Montana, is spreading, the number of people infected has reached 15, Dr. Mariya Kamenova, Deputy Director of Montana Regional Health Inspectorate (RHI) told FOCUS Radio . Another 8 cases were registered for the period from [Fri 27 Oct 2017] until the end of November 2017, adding up to the 7 cases registered by [Thu 26 Oct 2017]. Those 1st 7 cases were children under 14, while the newly infected are 4 children under 4 years of age, 2 children aged 5 to 9, and 2 children aged 15 to 19.

A 51-year-old male from the neighborhood is also probably hepatitis A infected, but his tests are pending. The Montana municipality has taken measures and the streets in Kosharnik and the yards of the infected families have been disinfected every month. The RHI has said that they will continue to monitor the situation.
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[The location of Montana in Bulgaria is north and west of Plovdiv where HAV is being reported in the Roma community there. Montana's location can be seen on a map at <https://en.wikipedia.org/wiki/Montana,_Bulgaria>. Since most ca es of
HAV in children are unrecognized, being either asymptomatic or anicteric (without jaundice), the total number of cases are likely to be much higher. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu 23 Nov 2017 10:13
Source: Sofia News Agency [edited]

There is a boom of infected patients with hepatitis A in Rakovski. There are sick children in several schools and kindergartens. The 1st diseases have been since the beginning of September 2017. Everyone has gone through the infectious clinic in Plovdiv, say the city's health
inspection.

"This is an infection that is transmitted by faecal-oral route and the problem is that the incubation period of the disease is quite long -- up to 45 days, a person is infectious before he becomes yellow," health inspectors warn.

In the Roma neighbourhood of Rakovski, almost every house has a hepatitis A sufferer. Residents of the neighbourhood admit they do not know how to protect themselves. There are a total of 35 reported cases of infected children at Hristo Smirnenski School in Rakovski. Parents of students are worried and threaten to stop their children from school if no action is taken.
****************************
Date: Fri 24 Nov 2017 15:30
Source: Focus News Agency [edited]

>From the beginning of July 2017 to the end of October 2017, there have been 2 outbreaks of type A viral hepatitis with a total of 144 cases in the municipality of Rakovski, said minister of health Kiril Ananiev during [Fri's 24 Nov 2017] parliamentary control session, FOCUS News Agency reports.

"The 1st outbreak started on [Sun 23 Jul 2017] and included a total of 50 cases from the villages of Belozem, Shishmantsi and Chalakovi. The infection was transmitted from the village of Milevo, where in April 2017, 16 cases were reported. The 2nd outbreak was reported on [Wed 16 Aug 2017], and up to now there have been 62 cases in the town of Rakovski. In addition, in the village of Katunutza, Sadovo municipality, from [Fri 18 Aug 2017] to date, a total of 32 cases have been reported. Out of a total of 144 cases from Rakovski and Sadovo, 105 or 72.9 per cent are children under 15 with mild symptoms.

Since the beginning of 2017, 568 cases of viral hepatitis A have been reported in the region of Plovdiv. The infection was caused by inadequate sanitation and poor personal hygiene, not by unsafe water or food," the minister said.
==================
[The source in this outbreaks is unclear but appears related to general defects in poor sanitary conditions. Hepatitis A infection in children is primarily asymptomatic or anicteric (without jaundice). With a spate of children recognized with the acute infection, it is certainly likely that many more cases will have occurred. - ProMed Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu, 7 Sep 2017 16:05:20 +0200

Sofia, Sept 7, 2017 (AFP) - Other European holiday spots may be getting fed up with tourists, but not Bulgaria, where the government is sending thank-you postcards to some of the record numbers of visitors to the country this year.   The "Thank you for choosing Bulgaria!" cards, showing the Thracian tomb in Kazanlak or the Rila Monastery, will be sent to 400,000 tourists chosen randomly from the five million who visited as of July 31.

Tourism Minister Nikolina Angelkova said on her ministry's website that the cards would be personally signed by her as a sign of her "gratitude". The addresses were obtained from hotels.   Bulgaria is a cheap winter and summer holiday hotspot bordering Greece and the Black Sea, and tourism accounts for 13 percent of its economic output.   The country, the European Union's poorest member, posted a 7.2 percent rise in visitors through July 31.
More ...

Egypt

Geographical Information:
Egypt has a total area of about 385,000 sq. miles and sits on the North Eastern corner of Africa. It is bounded by the Mediterranean Sea and on the East by Israel and the Red Sea. The Southern border is with Sudan (the large
t country in Africa) and on the West it shares a border with Libya. The country extends about 675 miles from north to south and is widest at its southern border where it covers 780 miles. Egypt is well known for the great Nile river which courses throughout its length. It is the longest river in the world and has historic links stretching back to at least 3200BC.
Climate:
The hot season in Egypt is from May to September. During this time temperatures can easily reach 370C though northern winds can provide a very necessary respite. November to March is the cooler time of the year and typical temperatures reach 140C though, during the evenings, temperatures can occasionally fall to near freezing. The humidity is mainly along the Mediterranean coastline and the average rainfall here is only about 8".
Medical Facilities:
In the main towns and cities the level of medical care is very adequate for the tourist. English speaking doctors will be associated with all the larger hotels but nevertheless care should always before being admitted to a ‘clinic’ for further treatment should this ever become necessary. Travellers are encouraged to contact the Irish Embassy in Cairo for emergency assistance should the need ever arise.
Food & Water Hygiene:
A significant number of tourists visiting Egypt suffer stomach complaints. In many cases this is due to eating food from the market places or using the hotel tap water supply for drinking or brushing teeth. The hotter climate of the country and the poorer level of food hygiene leave the unwary tourist at particular risk. Salads and shellfish meals should particularly be avoided.
Cruising along the Nile:
Over the past number of years many Irish holiday makers have enjoyed themselves cruising along the Nile for a week and then visiting Luxor in the southern part of the country. In most cases these travellers remain very well with no particular health problems. Nevertheless, in a small number they appear to forget the basic rules of food and water hygiene and will sample the local foods in the market places on shore. This practice is frequently associated with a ruined second half of the holiday. Commonsense rules of looking but not touching are much wiser.
Sun Stroke:
The ambient temperatures in Egypt can be very high and tourists are frequently exposed to the strong sunlight during their time in Egypt. It is essential that an adequate fluid intake is maintained (much higher than at home) and that travellers remember they may need to increase their salt intake (if this is not contraindicated because of heart disease or blood pressure). Small children and the elderly are at special risk.
Malaria risk in Egypt:
The risk of malaria in Egypt is small. The disease is usually only found during the warmer summer months (June to October) in the El Faiyûm area. Travellers may require prophylaxis but they should continuously remember to use adequate protection against mosquitoes and other insects.
Swimming in Egypt:
The fresh water rivers of Egypt are commonly infected with a disease called Schistosomiasis (Bilharzia). This parasite penetrates through intact skin and can cause significant health problems. Travellers are encouraged to swim only in the Mediterranean, the Red Sea or in well maintained swimming pools to avoid exposure.
Health Care while Diving:
Many of the world's most beautiful sites for diving are situated along the Red Sea. These are common tourist destinations and generally the risk of significant health worries will be small. However, check out the professionalism of the diving company before you develop too close a relationship. Make sure their equipment is in good working order and that their instructors are insisting on standard safety procedures for any proposed dive. Never dive after a large meal or following alcohol intake. Remember that you can get significantly sunburnt while snorkeling so take care to cover your back and shoulders with either a suit or sufficient water repellent cream.
Diving at night may be a beautiful experience but take extra care. Never dive beyond your personal limits and ensure that the 'buddy system' is fully operational at all times. Even the most experienced divers can have problems at times so never let you guard down and stay alert.
Rabies:
This disease is widespread in Egypt and is normally transmitted through the bite of warm blooded animals. Any bites, licks or scratches from these animals should be treated seriously by washing out the wound, applying an antiseptic and the seeking urgent competent medical attention.
Vaccines for Egypt:
All Irish travellers to Egypt should ensure that their vaccines against Poliomyelitis, Typhoid, Tetanus and Hepatitis A are in date. Those staying for longer periods or trekking through the country may require further protection against diseases like Rabies, Meningitis and Hepatitis B.
Further Information:
Further general health information on staying healthy while travelling abroad may be obtained free-of-charge from the Tropical Medical Bureau at either of our centres. Please always remember that each traveller is distinct and so individual specific information will require a medical consultation.

Travel News Headlines WORLD NEWS

Date: Tue, 29 Jan 2019 12:22:15 +0100
By Bassem ABOUALABASS

Cairo, Jan 29, 2019 (AFP) - Alaa Hilal was out shopping in Cairo when she was attacked by a stray dog in broad daylight -- an increasing problem of daily life in Egypt which is stirring debate.   "I got out of my car and saw an exceptionally large street dog," the 38-year-old housewife told AFP at her home, northeast of Cairo.   "He approached me and bit me without barking or doing anything else," said Hilal, adding that she had been injured in the thigh.     An overpopulated mega-city of more than 20 million people, Cairo is already plagued by monster traffic jams, widespread waste problems and rampant pollution. Packs of stray dogs are only adding to the city's challenges.   Complaints about dog attacks, exposure to rabies and in some cases even deaths over the years have triggered calls for the animals to be brought under control.

- Hounds unleashed -
Commonly referred to as "baladi dogs", strays are widely viewed as unsanitary and dirty. They are typically seen running around the streets and scavenging garbage for food.   According to the agriculture ministry, there were around 400,000 cases of dog bites in 2017, up from 300,000 in 2014.    And 231 people died over the past four years from the wounds they received, mainly as a result of rabies.

A bite from a dog carrying the rabies virus can be fatal within 24 hours as it damages the human's nervous system, said Shehab Abdel-Hamid, the head of Egypt's society for the prevention of cruelty to animals (SPCA).    Hilal, who had never feared dogs having had several pets when growing up, was rushed to a nearby hospital only to discover that she was the ninth person to be bitten by the same dog.   "Due to the trauma caused by this incident, I became worried and I no longer want to be in the same place with them," she said.   There are no official data on the numbers of stray dogs, but activists say they are running loose in their millions.

A survey by the SPCA showed that the number of stray dogs "may reach up to more than 15 million", Abdel-Hamid said.   And though street dogs appear to fear the most crowded areas, they can be loud and aggressive in poorly lit and rubbish-strewn suburbs.    In November, a video widely circulated on social media showed a car hitting a teenager who was being chased by two stray dogs.   "Garbage is the main reason behind the stray dogs' crisis in Egypt," said Abdel-Hamid, highlighting how the problem was exacerbated when the rubbish men stopped working during the 2011 uprising.

- Government mauled -
The SPCA, however, lacks resources. Its headquarters in downtown Cairo was looted during the uprising and has not been renovated since, Abdel-Hamid added.    And Egyptian authorities say they can only intervene on a case by case basis.    "We do not go around the streets looking for dogs to kill them," said the agriculture ministry spokesman Hamed Abdel-Dayem. "We only take measures following complaints."   He didn't specify what measures are taken to bring the stray dog population under control.    But animal rights advocates often lambast the government, accusing it of mass culls.

In 2017, authorities killed more than 17,000 stray dogs following multiple complaints of dog "disturbances" and "biting" in Beni Sueif, south of Cairo, according to an August report by the governorate's veterinary directorate.    The Red Sea governor even offered a 100 Egyptian pounds ($5.58) award to those who capture and hand over at least five strays.   Animal rights defenders also accuse the government of killing dogs using a drug, known as "strychnine", a chemical substance listed as "unacceptable on animal welfare grounds" for euthanasia by the World Organisation for Animal Health.     But Abdel-Dayem denied that the government imported banned substances.   "Is it logical that we (the ministry) allow internationally prohibited substances to enter the country?" he told AFP when asked about the strychnine claim.

- 'Shelter of Hope' -
Animal rights advocates have sought to offer solutions, actively removing dogs from the streets and giving them homes.   Ahmed al-Shorbagi, 35, opened two dog shelters in a desert area west of Cairo, near the famed Giza pyramids.    The buildings with sheer concrete walls have kept more than 250 dogs safe for the past three years. Shorbagi contributes 40 percent to the funding of the shelters while the rest comes from donations.    "At first I followed the animal rescue pages on Facebook," Shorbagi told AFP, rubbing one dog's belly as she wagged her tail in joy.   "I saved a dog that I called 'Hope' and when I opened the shelter, I named it after her."

Shorbagi believes the solution lies in dog sterilisation programmes, providing rabies vaccinations and removing the garbage.    "Instead of the government paying millions of dollars to import poison, it should consider sterilisation," he said.    "We, as associations, proposed to the ministry of agriculture to solve the problem but it refused."   The ministry's spokesman denied however refusing to cooperate with private entities and hailed their work to help resolve the crisis.
Date: Sat, 29 Dec 2018 20:35:18 +0100
By Menna Zaki

Giza, Egypt, Dec 29, 2018 (AFP) - Crowds of tourists stared in awe at the towering pyramids of Giza near Cairo Saturday undaunted by a nearby bomb attack a day earlier that killed holidaymakers from Vietnam.    A roadside bombing claimed the lives of three tourists and their Egyptian guide Friday when it ripped through the bus they were on as it travelled near the world-famous attraction.

The attack comes as Egypt's vital tourism sector has begun to recover after years of instability and jihadist violence that scared visitors away.    "I think terrorism can strike anywhere in the world," Somand Yang from South Korea told AFP.    "You have to be careful but it is also like luck."   Security forces guarded the entrance to the sprawling site and Yang, 32, said she had no qualms about visiting.   "Lightning never strikes twice in the same place. So I figured it will be even safer today," she said.

- 'Completely devastated' -
Excited holidaymakers rode camels and queued to enter a tomb as they snapped pictures of the Great Pyramid, the only surviving structure of the seven wonders of the ancient world.   Hawkers followed the tourists, doggedly trying to sell trinkets and souvenirs.   Despite the steady flow of visitors, Egyptians working at the site said they were shaken by the attack -- and concerned that it could hit their livelihoods.    "I knew the guide who died yesterday," said Dalia Sadaka, as she accompanied a group of sightseers.    "I completely broke down yesterday, but I had to get to work in the morning," she said, pointing to her visibly swollen eyes.

- 'Truly regrettable' -
Earlier hit hard by a string of bloody attacks and unrest, visitor numbers to Egypt have more recently staged a partial recovery.    In October 2015, a bomb claimed by a local affiliate of the Islamic State jihadist group killed all 224 people on board a passenger jet carrying Russian tourists over the Sinai peninsula.     That incident dealt a severe blow to Egypt's tourism industry, which was still reeling from the turmoil set off by the 2011 uprising that forced veteran leader Hosni Mubarak from power.

The official statistics agency says arrivals reached 8.2 million in 2017, up from 5.3 million the year before.   But that figure was still far short of the record influx in 2010 when over 14 million came.    "I fear yesterday's incident may have an impact on our source of income," said an elderly man who offers camel rides, declining to give his name.    "It is very regretable," he said. "We were finally happy that tourism started picking up a bit."
Date: Thu, 13 Dec 2018 16:07:04 +0100

Cairo, Dec 13, 2018 (AFP) - Egyptian authorities Thursday arrested a camel driver and a woman accused of having helped two Danes scale the Great Pyramid of Giza to take a video and naked photograph, sparking outrage in the country.   The interior ministry said the woman had put the pair into contact with the camel driver who took them to the site illegally at night on November 29 for 4,000 Egyptian pounds ($225, 200 euros).   The two had acknowledged their role in the incident and would be put on trial.

In a video called "Climbing the Great Pyramid of Giza", Danish photographer Andreas Hvid appears to scale the 4,500-year-old tomb on the outskirts of Cairo with a woman who is later seen removing her top.   Hvid says the video was shot in late November and posted on YouTube on December 8, setting in motion an investigation by Egypt's public prosecutor.   A photograph also released by Hvid appears to show the pair completely naked on top of each other while looking in the direction of a nearby pyramid.

The nearly three-minute video has so far notched up 4.5 million views on YouTube, while stirring a public outcry in Egypt.   "A 7,000-year-old civilisation has turned into a bed sheet," a Twitter user in Egypt lamented.   Hvid, 23, has explained back home to the Danish newspaper Ekstra Bladet that he had "dreamed for many years of climbing the Great Pyramid" as well as of taking a naked photograph.   The young Dane, who runs his own YouTube channel, said the woman in the video was not his girlfriend. "It was just a pose. We did not have sexual relations," he said.

The Great Pyramid is the largest in Giza, standing 146 metres (480 feet) tall, and the only surviving structure of the seven wonders of the ancient world.   Climbing pyramids is forbidden in Egypt.   In 2016, a German tourist was barred from entering the country for life after he posted online footage of climbing one of the ancient structures.
Date: Fri, 24 Aug 2018 10:22:25 +0200

London, Aug 24, 2018 (AFP) - British tour operator Thomas Cook said it is removing all its customers from a hotel in Egypt after a UK couple staying there died in unexplained circumstances and other guests fell ill.   The company said late Thursday it was unclear what caused the deaths of the Britons, reportedly in their 60s, who had been staying at the Steigenberger Aqua Magic Hotel in the Red Sea resort of Hurghada.

Thomas Cook added in a statement that all of its other customers staying at the Steigenberger, reported to be 301 by the BBC, had the choice of relocating to another hotel in Hurghada or returning home.   It said it was "deeply saddened" by the deaths of the two guests.   "The circumstances of their deaths are still unclear," Thomas Cook said.   "We have also received further reports of a raised level of illness among guests. Safety is always our first priority, so as a precautionary measure we have taken a decision to remove all our customers from this hotel."   Red Sea governor Ahmad Abdallah told AFP that the couple, who were on holiday with their daughter, had died on Tuesday.

The BBC identified them as John Cooper, 69, and his wife Susan, 63, a Thomas Cook employee. The couple were from the town of Burnley, northwest England.   Abdallah said the man died in hospital after suffering exhaustion, followed by his wife who collapsed at the hotel on hearing the news.     The governor ruled out "criminal motive".

Thomas Cook said customers due to travel in the coming weeks to the hotel -- which the tour operator gave a 96-percent rating in an audit last month -- would be offered alternative holidays.   Egypt's key tourism industry has been recovering from a devastating blow in 2015 when jihadists bombed a Russian airliner carrying holidaymakers from the Red Sea resort of Sharm el-Sheikh, killing all 224 on board.
Date: Mon, 20 Aug 2018 13:04:55 +0200

Cairo, Aug 20, 2018 (AFP) - An Egyptian army captain has been killed by an improvised explosive device blast in North Sinai during a campaign to eliminate jihadists, medics said on Monday.   The officer died Sunday evening after an explosion hit his vehicle west of the coastal city of El-Arish, a local medical source said.   The Egyptian army has since February been conducting a major operation focused on the Sinai Peninsula to wipe out jihadists from the Islamic State group.

The military says that over 250 suspected jihadists and at least 35 soldiers have been killed in its "Sinai 2018" operation.   Jihadists launched an insurgency in Sinai after the 2013 military overthrow of Egypt's Islamist president Mohamed Morsi, who was forced out by the military in the face of mass protests against his rule.
More ...

World Travel News Headlines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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