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Burundi

Burundi US Consular Information Sheet
April 21, 2008
COUNTRY DESCRIPTION:
One of the poorest countries in the world, Burundi is a small, densely populated central African nation bordering Lake Tanganyika, Rwanda, Tanzania and the Democrati
Republic of Congo. After more than 12 years of civil and ethnic strife, an electoral process deemed free and fair resulted in the installation of a democratic government in 2005. Years of fighting have devastated a historically fragile economy that depends largely on subsistence agriculture. Poor public health and education, weather disasters such as drought and floods, crop diseases and lack of infrastructure exacerbate the effects of conflict and delay recovery. Facilities for tourism, particularly outside the capital, are limited. Read the Department of State Background Notes on Burundi for additional information.

ENTRY/EXIT REQUIREMENTS: A passport, visa and evidence of immunization against yellow fever are required for entry. Travelers with an expired visa are not permitted to leave the country without acquiring an exit visa prior to departure. The latest information about visas may be obtained from the Embassy of the Republic of Burundi, Suite 212, 2233 Wisconsin Avenue NW, Washington, DC 20007, telephone (202) 342-2574, or from the Permanent Mission of Burundi to the United Nations in New York at telephone (212) 499-0001 thru 0006.
For information about dual nationality or the prevention of international child abduction, please refer to related web pages at http://travel.state.gov. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
See the Department of State’s Travel Warning for Burundi.
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 personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME: Crime, often committed by groups of armed bandits, poses a high risk for foreign visitors to Bujumbura and Burundi in general. Common crimes include mugging, purse-snatching, pick pocketing, burglary, automobile break-ins and carjacking. Many criminal incidents involve armed attackers. Armed criminals often ambush vehicles, particularly on the roads leading out of Bujumbura. Criminals in Bujumbura often operate in pairs or in small groups involving six or more individuals. Due to insufficient resources, local authorities in any part of Burundi are often unable to provide timely assistance in case of need.
U.S. Government personnel are prohibited from walking on the streets during the hours of darkness and using local, public transportation. Foreigners, whether in vehicles or at home, are always potential crime targets. Americans should exercise common sense judgment and take the same precautions as one would in any major city.

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 the local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, help 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: Medical facilities in Burundi generally do not meet Western standards of care. Travelers should carry an ample supply of properly-labeled prescription drugs and other medications with them, as certain medications and prescription drugs are unavailable or in short supply. Sterility of equipment is questionable, and treatment is unreliable. Ambulance assistance is non-existent. Hospital care in Burundi should be considered in only the most serious cases and when no reasonable alternatives are available.
Malaria prophylaxis is recommended for travel to all parts of Burundi.

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 companies prior to traveling abroad to confirm whether their policies apply overseas and/or cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS: When in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Burundi is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
While travel on most roads is generally safe during the day, travelers must maintain constant vigilance. There have been regular reports of violent attacks on vehicles traveling the roads throughout the country outside of Bujumbura. U.S. Government personnel are required to travel upcountry via two-vehicle convoys and have their trips pre-approved by the Regional Security Officer. The Embassy recommends that Americans not travel on the national highways from dusk to dawn. Drivers without valid permits, and the ease with which a driver's license can be acquired without training, make Burundian drivers less careful, predictable, or mindful of driving rules than Western drivers may expect.
There are no traffic signals in Bujumbura, and virtually nothing of the kind elsewhere in the country. Roadways are not marked, and the lack of streetlights or shoulders makes driving in the countryside at night especially dangerous. Additionally, drivers may encounter cyclists, pedestrians, and livestock in the roadway, including in and around the capital. Mini-vans used as buses for 18 persons should be given a wide berth as they start and stop abruptly, often without pulling to the side of the road.
Large holes or damaged portions of roadway may be encountered anywhere in the country, including in Bujumbura; when driving in the countryside, it is recommended that travelers carry multiple spare tires. During the rainy season, many side roads are passable only with four-wheel drive vehicles. Burundi’s supply of gasoline and diesel fuel are imported predominantly from Kenya and Tanzania, and are relatively expensive due to high transportation costs. Service stations are rare outside of the major cities.

Third-party insurance is required, and it will cover any damages (property, injury, or death). If you are found to have caused an accident, you automatically will be fined 10,000 Burundian francs (approximately $10 U.S.) and your driver's license will be confiscated until the police investigation is completed. Although the law provides for the arrest of drunk drivers, in practice, the police do not act on this law. In the city of Bujumbura, the number for police assistance is 22-22-37-77; there is no comparable number outside the capital. If you are involved in an accident causing death, it is advised that you leave the scene of the accident and proceed to the nearest police station.

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Burundi, the U.S. Federal Aviation Administration (FAA) has not assessed Burundi’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
There are no ATMs located in the country and most Burundian hotels and businesses do not accept credit cards. Many hotels in Bujumbura accept payment in U.S. dollars or Euros from non-Burundians. Travelers should be aware that Burundian banking practices prohibit acceptance of U. S. currency printed before the year 2003.
The Embassy recommends that visitors do not photograph airports, military installations, or other government buildings, and obtain permission from individuals before taking their photographs. 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 Burundian laws, even unknowingly, may be expelled from the country, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Burundi 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 on intercountry adoption and international parental child abduction see our Office of Children’s Issues web pages

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Burundi are encouraged to register with the U.S. Embassy through the State Department’s travel registration website so that they can obtain updated information on travel within Burundi and the Embassy’s current security policies, including areas that are off-limits to U.S. Government personnel for security reasons. Americans without Internet access may register directly with the U.S. Embassy. By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy is located on Avenue des Etats-Unis, telephone (257) 22-22-34-54, fax (257) 22-22-29-26. The Embassy's web site is http://burundi.usembassy.gov/.
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This replaces the Country Specific Information for Burundi dated July 18, 2007, to update sections on Country Description, Entry/Exit Requirements, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Wed, 14 Aug 2019 17:49:51 +0200 (METDST)

Nairobi, Aug 14, 2019 (AFP) - The World Health Organization (WHO) said Wednesday that Burundi had begun vaccinating frontline workers against Ebola at its border with the Democratic Republic of Congo, where an outbreak of the virus has killed close to 1,900 people.   The campaign to vaccinate at-risk staff against the deadly hemorrhagic fever started Tuesday at Gatumba, the main crossing point from Burundi to its much-larger neighbour, WHO said.

Burundi has received doses of the rVSV-ZEBOV vaccine, an unlicensed product that has been shown to be effective against the Zairian strain of the virus raging in DR Congo.   It would be administered to those at greatest risk such as health workers along the border, laboratory staff and burial teams, WHO said.   "The vaccination of health and frontline staff is a significant step forward in preparing for the response to this disease," said Dr Kazadi Mulombo, WHO representative in Burundi. 

The vaccine, developed by US pharmaceutical group Merck, proved "highly effective" in a trial conducted in Guinea in 2015 during the Ebola epidemic in West Africa, he added.    The vaccination campaign will be overseen by WHO and Burundi's health ministry.   The Ebola outbreak in eastern DR Congo is the second-worst in history. A total of 1,892 deaths have been recorded since the outbreak began on August 1 2018.   No cases of Ebola have been recorded so far in Burundi, a tiny nation of 11 million.    But its border with DR Congo is 236 kilometres (147 miles) long and considered highly porous, and the whole region is on high alert.

In June, three people from one family died in Uganda from Ebola after returning from DR Congo via an unofficial crossing point.   Burundi also shares a border with Rwanda and Tanzania.   The Congo outbreak is the first where vaccines have been rolled out on a large-scale.   The rVSV-ZEBOV vaccine has already been administered to some 170,000 people, especially frontline workers, in DR Congo.   This week, US researchers announced that two prototype drugs being tested among Ebola patients in eastern DR Congo boost chances of surviving the disease.
Date: Thu 8 Aug 2019 05.00 BST
Source: The Guardian [edited]

A serious outbreak of malaria in Burundi has reached epidemic proportions, killing almost as many people as the Ebola crisis in the nearby Democratic Republic of the Congo.  The outbreak in the tiny Great Lakes country has infected almost half the total population, killing about 1800 people since the beginning of the year [2019].  According to figures gathered by the World Health Organisation, almost 6 million cases have been recorded since the 1st week of January to the end of July [2019], with infections reaching crisis levels in May. The figures look on course to outstrip the epidemic of 2017, when more 6 million cases were recorded for the whole year. The situation has continued to worsen as the government of Burundi has refused to declare an emergency.

The scale of the outbreak was described in the latest report for the UN's office for the Coordination of Humanitarian Affairs, which warned that the outbreak had reached "epidemic" proportions.  "The national malaria outbreak response plan, which is currently being validated, has highlighted a lack of human, logistical, and financial resources for effective response," reported the organisation.  The organisation and other experts have blamed a number of issues for the crisis, including low use of preventative measures and a vulnerable population with low levels of resistance. Experts have also noted an increase in drug resistant strains of the disease in common with other parts of the world.

The climate crisis has been cited as a contributing factor. Mosquitoes, which spread the disease, are reaching higher altitudes in the mountainous country, and have displayed behavioural changes including more aggressive feeding habits.  The country's agricultural policies have also encouraged an increase in rice production that has seen farmers encroach on mosquito-infested areas.  While Burundi has long struggled with malaria, the figures for the current outbreak suggest a 50% increase compared to the equivalent period last year [2018]. The UN organisation noted bleakly that the number of health districts that have passed the epidemic threshold had continued to increase.

Although Burundi declared a national health emergency in 2017 after 1.8 million cases and 700 deaths were recorded, it has declined to declare one for the current outbreak, apparently concerned of the potential impact ahead of elections slated for next year [2010]…  [Byline: Peter Beaumont]
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[The WHO profile of malaria in Burundi can be found at

In 2017, the entire population of an estimated 10.9 million people lived in _Plasmodium falciparum_ high-endemic areas. In 2017 the annual incidence of _P. falciparum_ was estimated at 800 cases per 1000 population (WHO 2017 as above).

In 2017 there was an estimated 2.1M [range: 1.3M, 3.4M] cases with an estimated number of deaths of 5300 [range: 4300, 6200] (WHO). The 1st line treatment is artesunate-amodiaquine (AS-AQ) introduced in 2003. Malaria control relies on insecticide treated nets (ITN) but only around 30% of the population used a net the previous night one survey found (WHO 2017 as above) and it was also found that 80% of the mosquitoes were resistant to pyrethroids, the usual class of insecticides used for impregnating nets.

In 2005 the annual incidence was estimated at less than 50 cases per 1000 population (WHO 2017 as above) illustrating that since then the national malaria control programme has failed to improve the situation.

It is particularly worrying that the report above mentions treatment failure and possible drug resistance. With artemisinin resistance spreading in southeast Asia (see ProMED post http://promedmail.org/post/20190723.6583616) any signs of a slow parasite clearance need to be followed up by molecular analysis looking for mutations in key genes. No studies have looked at mutations in key genes predicting reduced susceptibility to the artemisinins or the 4-aminoquinolones (amodiaquine).

Since Burundi's independence in 1962, 2 genocides have taken place in the country: the 1972 mass killings of Hutus by the Tutsi-dominated army (<http://www.preventgenocide.org/edu/pastgenocides/burundi/resources/>), and the mass killings of Tutsis in 1993 by the Hutu majority. Both were described as genocides in the final report of the International Commission of Inquiry for Burundi presented in 2002 to the United Nations Security Council (<https://en.wikipedia.org/wiki/Burundi>). - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Burundi:
Date: Tue, 6 Aug 2019 10:38:45 +0200 (METDST)

Nairobi, Aug 6, 2019 (AFP) - Malaria has killed more than 1,800 people in Burundi this year, the UN's humanitarian agency says, a death toll rivalling a deadly Ebola outbreak in neighbouring Democratic Republic of Congo.   In its latest situation report, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) said 5.7 million cases of malaria had been recorded in Burundi in 2019 -- a figure roughly equal to half its entire population.   Of those cases, a total of 1,801 died from the mosquito-born disease in Burundi between January 1 and July 21, OCHA said.

The tiny country of 11 million people in the African Great Lakes region has still not declared a national emergency, despite OCHA saying the outbreak crossed "epidemic proportions" in May.   "The national malaria outbreak response plan, which is currently being validated, has highlighted a lack of human, logistical and financial resources for effective response," OCHA said in its latest weekly bulletin on humanitarian emergencies.   "All stakeholders, including the national authorities and partners are called upon to provide the requisite resources to mount a robust response to this event before it escalates."   A lack of preventative measures like mosquito nets, climatic changes and increased movements of people from mountain areas with low immunity to malaria were driving the crisis, OCHA said.

- 'Many crises' -
An OCHA official told AFP that "the decision to declare an epidemic is the sovereignty of the Burundian state".   The country declared a malaria epidemic in March 2017, when the country had recorded 1.8 million cases and 700 deaths, but was resisting doing the same now.   A senior government official, who declined to be named, said the government did not want to admit weakness with elections set for 2020.   "We are less than a year away from the presidential election. (President Pierre) Nkurunziza, who is facing many crises, does not want to recognise what could be considered a failure of his health policy," the official told AFP.   Burundi has been in crisis since 2015, when Nkurunziza ran for a third term and was re-elected in elections boycotted by most of the opposition.

At least 1,200 people were killed and more than 400,000 displaced in violence the UN says was mostly carried out by state security forces.   Nkurunziza announced in 2018 that he would not stand again, confounding critics who accused him of working to extend his grip on power.   UN investigators said in July that "drastic" steps were needed to boost democratic freedoms in Burundi if the government wanted the elections to be considered credible.

Burundi, one of the poorest countries in the region, abuts DR Congo, where the second-worst Ebola outbreak in history has killed more than 1,800 people amid fears the infectious fever could spread beyond its borders.   But malaria is a much bigger killer on the continent.   The World Health Organization recorded nearly 220 million cases of the parasitic illness in 2017, with an estimated 435,000 deaths. More than 90 percent of malaria cases and deaths were in Africa.
Date: Fri, 16 Mar 2018 14:39:07 +0100

Nairobi, March 16, 2018 (AFP) - Nine workers at a construction site outside Burundi's capital Bujumbura were killed in a landslide on Friday, police said.   Heavy seasonal rains caused the hillside next to the Gasenyi river, east of the city, to collapse burying the workers who were building a channel to redirect the river's floodwaters.   Police said in a statement that nine bodies had so far been found, while rescue efforts continue.
Date: Sat 7 Oct 2017 11:52:12 CAT
Source: Global Times, Xinhua News Agency report [edited]

At least 5 cases of cholera were reported this week [week of 2 Oct 2017] in Rugombo town in Cibitoke province, 72 km [about 45 mi] northwest of the Burundian capital Bujumbura, the Burundi News Agency reported Fri 6 Oct 2017. All those 5 cholera cases were reported at Rusiga, adding that lack of clean water is the origin of the propagation of cholera in that area, the state-run agency reported.

The Burundi Red Cross has deployed its agents to distribute drugs in infected households at Rusiga to avoid the propagation of the epidemic, it reported. Cibitoke Governor Joseph Iteriteka on [Fri 6 Oct 2017] held a meeting with health and administration officials based in Cibitoke province to look at ways of curbing the propagation of cholera in Rugombo and Cibitoke town, according to the report. During the meeting, they urged the country's Water and Electricity Company (REGIDESO) to supply water to the 2 towns -- Rugombo and Cibitoke -- as they are the worst threatened, reported the agency.

The Burundian Imbo western lowlands extending from the north in Cibitoke province to the south in Makamba Province near Lake Tanganyika are vulnerable to cholera every year in the dry season, especially between August and October. By the end of August 2017, the east African country's health ministry confirmed 24 cholera cases in Nyanza-Lac in the south-western province of Makamba, which originated from a fisherman who had come from the Democratic Republic of the Congo with symptoms of cholera.
===================
[Cibitoke province is one of the 18 provinces of Republic of Burundi. It is located in extreme northwest Burundi and can be seen on a map at <http://www.un.org/Depts/Cartographic/map/profile/burundi.pdf>. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at
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Northern Mariana Islands

General:
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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:
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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:
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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:
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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:
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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:
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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:
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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:
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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:
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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:
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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:
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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;
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Tetanus (childhood booster)
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Typhoid (food & water borne disease)
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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:
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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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Pitcairn Islands

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Fri, 13 Apr 2007 22:07:35 +0200 (METDST) WASHINGTON, April 13, 2007 (AFP) - A strong earthquake shook the bed of the southeast Pacific ocean west of Chile on Friday, the United States Geological survey reported. The quake, measuring 6.1 on the open-ended Moment Magnitude scale, struck the southern part of the East Pacific Rise, an expanse of sea floor lying between South America and the islands of the South Pacific, at 1824 GMT. The epicenter was 6.2 miles (10 kilometers) underwater at a point more than 1,960 miles (3,200 km) west of the Chilean coastal town of Osorno and 1,440 miles (2,320 km) east-southeast of the tiny British territory of Pitcairn Island. The Moment Magnitude scale measures the area of the fault that ruptured and the total energy released.
Date: Tue, 11 Jan 2005 05:32:57 +0100 (MET) AUCKLAND, Jan 11 (AFP) - The British government is seeking social workers for the remote Pitcairn islands, a community riven by sex abuse where six men including the mayor were last year convicted of multiple under-age sex crimes. Safe Overseas Services has placed advertisements in New Zealand newspapers to find social workers for Pitcairn, Britain's last territory in the Pacific and one of the world's most isolated communities. The three-month posting, paid for by the British government, will see successful applicants work in a community of less than 50 people, the New Zealand Herald reported Tuesday. While the advert says applicants should have an understanding of the dynamics of sexual abuse for victims and offenders, it does not specifically refer to the traumas the Pitcairn community faced last year during the trials. In addition to the six found guilty of rapes and indecent assaults on the tiny island's young female community over nearly 40 years, six more Pitcairn men now living offshore also face sex abuse charges. Liz Beddoe, the head of applied social sciences at the University of Auckland Faculty of Education, said the positions offered the opportunity of a lifetime. "If you're in a position to do it, it would be worth it," she was quoted as saying. But she said the job would not be easy and would require compatible people who were able to cope with the isolation and perhaps people with complementary skills. "The reality is, in a community like that everybody will have been affected. It's a bit like the rebuilding effort after the tsunami in some of those remote communities ... While it is nowhere near as extreme as that, socially and emotionally it will have had that kind of impact on the community." The adverts make no mention of the arduous high seas voyage to reach Pitcairn, located halfway between New Zealand and South America, but hint at the isolation and living conditions there. "As this position involves living and working with one other colleague in a remote situation, applications from suitably qualified applicants with experience of working together are especially welcome." Enthusiasm, self-motivation and good health are also requirements, the advert in the New Zealand Herald says. Although Pitcairn is a British territory, lawyers for the convicted men expect to argue before the Privy Council in London that England does not have jurisdiction over the island which was settled in 1790 by Fletcher Christian and his mutineers on board HMS Bounty. The mutineers burnt the ship, and the lawyers have argued that meant they severed their ties with Britain. Another legal challenge is due to be heard in New Zealand next month with lawyers to argue that even if Britain does have jurisdiction over the island, it never declared a law against under-age sex there.
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Virgin Islands

British Virgin Islands US Consular Information Sheet
April 03, 2006
COUNTRY DESCRIPTION: The British Virgin Islands (BVI) are a British overseas territory, part of the British West Indies, lying about 60 miles east of Puerto Rico. There are abo
t 50 islands in the BVI, many of them uninhabited. Tortola is the main island; other islands include Virgin Gorda, Jost Van Dyke, and Anegada. Tourist facilities are widely available.
ENTRY/EXIT REQUIREMENTS: For tourist stays of up to six months, U.S. citizens need a valid U.S. passport or other proof of U.S. citizenship (original or certified birth certificate, Certificate of Naturalization or Certificate of Citizenship as well as photo identification), onward or return tickets, and sufficient funds for their stay. Upon initial entry, no more than 60 days will be granted. At the end of 60 days, visitors must report to the Immigration Department's main office in Road Town for an extension. Extensions of up to 90 days are issued at the discretion of the Immigration Officer subsequent to an interview. For further information on travel to the British Virgin Islands, travelers should contact the BVI Department of Immigration at 1-284-494-3471. Visit the Embassy of the British Government web site at for the most current visa information.
See Entry and Exit Requirements for more information pertaining to dual nationality and the international child abduction . Please refer to our Customs Information to learn more about customs regulations.

SAFETY AND SECURITY For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site, where the current Travel Warnings and Public Announcements , including the Worldwide Caution Public Announcement , 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., 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: Thefts and armed robberies do occur in the BVI. Visitors should take common-sense precautions against petty crime. Avoid carrying large amounts of cash and use hotel safety deposit facilities to safeguard valuables and travel documents. Do not leave valuables unattended on the beach or in cars. Always lock up boats when going ashore.
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: Medical care in the British Virgin Islands consists of a small general hospital with an emergency room staffed 24-hrs/day by physicians, several clinics on Tortola, and one clinic in Virgin Gorda. Ambulances staffed with paramedics serve both islands. There are no medical facilities on the other islands. A volunteer organization, Virgin Islands Search and Rescue (VISAR), responds 24-hrs/day to medical emergencies at sea or on outer islands. VISAR transports casualties to the nearest point for transfer to ambulance. To reach VISAR, dial SOS (767) or call on Marine Channel 16.
There is no hyperbaric chamber in the BVI. Patients requiring treatment for decompression illness are transferred to St. John, U.S. Virgin Islands. Most sensitive medical cases are transferred to San Juan, Puerto Rico.
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 . For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at . Further health information for travelers is available at .
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning the British Virgin Islands is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Vehicles drive on the left (the British side) with most steering wheels on the left (the "American" side). Road signs are limited and seatbelts are required by law. Drivers often fail to yield the right-of-way to pedestrians, even at painted crosswalks. Speeding and reckless driving are fairly common in the BVI. Drivers can encounter nighttime drag racing on main thoroughfares and livestock on roads. Roads in Tortola's interior can be steep and extremely slippery when wet. Travelers planning to drive across the island should consider requesting four-wheel drive vehicles and should ensure that tires and brakes are in good operating condition on any rental vehicle. Please refer to our Road Safety page for more information, as well as the website of the BVI's national tourist office and national authority responsible for road safety at
.
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the British Virgin Islands as being in compliance with ICAO international aviation safety standards for oversight of BVI's air carrier operations. For more information, travelers may visit the FAA's Internet web site at .
CUSTOMS REGULATIONS: BVI customs authorities may enforce strict regulations concerning temporary importation into or export from the British Virgin Islands of items such as drugs and firearms. Visitors to BVI carrying firearms must declare them upon entry into any port in the territory. Firearms must be bonded and are held by the proper authorities until time of departure. Contact BVI Customs & Immigration at 1-284-494-3475, the Embassy of the United Kingdom in Washington, D.C. or one of the UK's consulates in the United States for specific information regarding customs requirements. Please see our information on Customs Information .
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating British Virgin Island laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the BVI 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 .
DISASTER PREPAREDNESS: All Caribbean countries can be affected by hurricanes. The hurricane season normally runs from June to the end of November, but there have been hurricanes in December in recent years. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA).
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website.
REGISTRATION/EMBASSY AND CONSULATE LOCATIONS: Americans living or traveling in the British Virgin Islands are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website , and to obtain updated information on travel and security within the BVI. 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 nearest U.S. Embassy to the BVI is located in Bridgetown, Barbados. The Consular Section is located in the American Life Insurance Company (ALICO) Building, Cheapside, telephone 1-246-431-0225 or fax 1-246-431-0179, email ConsularBridge2@state.gov , or . The U.S. Consular Agent in Antigua, located at Jasmine court, St. John's, tel. 1-268-463-6531, is closer to the BVI and can also assist in some limited non-emergency cases, by previous appointment only.
****
This replaces the British Virgin Islands Consular Information Sheet dated April 26, 2005 to update all sections.

Travel News Headlines WORLD NEWS

Date: Thu 19 Sep 2019
Source: Emerg Infect Dis [edited]

Citation:
Guendel I, Ekpo LL, Hinkle MK, Harrison CJ, Blaney DD, et al.: Melioidosis after Hurricanes Irma and Maria, St. Thomas/St. John District, US Virgin Islands, October 2017. Emerg Infect Dis. 2019; 25(10): 1952-1955. doi: 10.3201/eid2510.180959.

Melioidosis is caused by _Burkholderia pseudomallei_, a saprophytic, gram-negative bacillus endemic to tropical regions worldwide (1). Diagnosis is difficult because of wide-ranging clinical manifestations (2), and this bacterium is innately resistant to many antimicrobial drugs, making treatment options limited, complex, and lengthy (3). Infection occurs by percutaneous exposure, inhalation, or ingestion.

Melioidosis is rare in the USA, and cases are usually travel related (4,5). However, regional endemicity has been documented in Puerto Rico (6), and sporadic human cases have been reported in the Caribbean (5,7). In September 2017, the US Virgin Islands were affected by 2 category 5 hurricanes, Irma and Maria; widespread flooding continued for weeks. We describe the clinical manifestations, management, and outcome of post-hurricane melioidosis cases in 2 women in St. Thomas and St. John, US Virgin Islands.

The study
Despite major damage to the 2 hospitals in the territory during the 2 hurricanes, the Virgin Islands Department of Health (VIDOH) maintained surveillance at both emergency departments. Two isolates were recovered from each patient. Local specimen analysis for organism identification was performed by using the MicroScan WalkAway System (Siemens Healthcare Diagnostics, <https://www.siemens-healthineers.com>). All isolates were confirmed as _B. pseudomallei_ at the CDC. Whole-genome sequencing and single-nucleotide polymorphism analysis were performed (National Center for Biotechnology Information, <https://www.ncbi.nlm.nih.gov>. Genomes from a given patient were clonal to each other. However, representative genomes from both patients had differences (greater than 5600 single-nucleotide polymorphisms), indicating the presence of different strains in these infections. Genomic comparison with a reference panel indicated that the isolates were within the previously described Western Hemisphere clade and subclade associated with the Caribbean (8).

Patient 1 was an 80-year-old female resident of St. Thomas who had a history of cardiomyopathy and type II diabetes mellitus. She came to the emergency department (ED) at Schneider Regional Medical Center (St. Thomas, US Virgin Islands) because of shortness of breath (symptom onset 28 days after Hurricane Irma and 9 days after Hurricane Maria). Her symptoms were worsened orthopnea, increased abdominal girth, and edema, consistent with her symptoms at previous admissions. The patient was admitted for management of acute decompensated heart failure.

The patient had a temperature of 98.5 deg F [36.9 deg C]; diffuse pulmonary crackles; jugular venous distension; normal heart sounds; and bilateral, lower extremity pitting edema. Examination showed a focal area on the anterior left thigh that had a central, firm, warm, erythematous, tender, subcutaneous nodule about 2 cm [approximately 0.8 in] in diameter with a central fluctuant area and a small pinhole. Incision and drainage was performed, and a swab specimen of purulent drainage was sent for culture.

The patient was given intravenous clindamycin (600 mg every 8 h for 5 d) and was discharged while receiving oral clindamycin, but the treatment course was not completed. Cultured wound showed growth of _B. pseudomallei_ at 5 days. However, culture growth was not yet positive before patient discharge. The isolate was susceptible to trimethoprim/sulfamethoxazole (Table 1 [for Tables and Figure, see original URL - ProMED Mod.LL]).

Patient 1 returned to the ED 2 weeks later because of manifestations similar to those at the 1st visit. She was afebrile and admitted for diuresis. The left thigh lesion had progressed into a 2 cm [about 0.8 in], tender, shallow ulcer productive of purulent material surrounded by erythema and a focal area of induration (Figure). Laboratory data reflected a leukocyte count within reference ranges and mild renal insufficiency with estimated glomerular filtration rate of 40.47 mL/min (Table 2). A 2nd wound culture was collected, and the patient was given intravenous meropenem (1 g every 8 h). Culture was presumptively positive for _B. pseudomallei_ and _Serratia marcescens_ after 48 hours, confirmed after 8 days. Both isolates showed the same resistance pattern and were susceptible to meropenem and trimethoprim/sulfamethoxazole: the MIC for meropenem was <1 microgram/mL (Table 2). Meropenem was continued for 8 days, and ulcer improvement was observed. The patient was discharged while receiving oral trimethoprim/sulfamethoxazole (800 mg/160 mg 2x/d) to complete maintenance therapy. The patient completed a 3-month course of trimethoprim/sulfamethoxazole and achieved resolution.

Patient 2 was a 60-year-old female who had diabetes and was a resident of St. John. She was referred to the ED at Schneider Regional Medical Center by her primary care physician because of hyperglycemia, productive cough, and malaise for one week (symptom onset 46 days after Hurricane Irma and 33 days after Hurricane Maria). The patient was admitted to the intensive care unit because of community-acquired pneumonia.

The patient was lethargic and had a temperature of 101 deg F [38.3 deg C]; heart rate was 99 beats/min, respiratory rate 22 breaths/min, and blood pressure 142/81 mm Hg. Blood gas testing showed pO2 of 47.6 mm Hg with an oxygen saturation of 87.2% on 2-liter nasal cannula. A chest radiograph showed a left-sided mild infiltrate, and her leukocyte count was markedly increased (28 300 cells/mm3) (Table 2).

The patient was given intravenous ceftriaxone (1 g/d) and azithromycin (500 mg/d) after blood and sputum cultures were prepared. She required bilevel positive airway pressure but eventually required mechanical ventilation. The patient then became hypotensive and required norepinephrine to maintain a main arterial pressure greater than 65 mm Hg. Ceftriaxone was discontinued, and she was given intravenous piperacillin/tazobactam (3.375 g every 6 h). Trimethoprim/sulfamethoxazole- and ceftazidime-sensitive _B. pseudomallei_ were identified from sputum culture after 72 hours (Table 1). Methicillin-sensitive _Staphylococcus aureus_ and _Candida glabrata_ were also identified. One of 2 blood cultures was positive for gram-negative rods. Piperacillin/tazobactam was discontinued, and the patient was given meropenem (1 g every 8 h).

The patient remained critically ill and was transferred to a tertiary-care hospital in the continental USA. She died in a long-term care facility during October 2018 without showing signs of neurologic improvement.

Isolates from both patients showed susceptibility to routinely tested antimicrobial drugs (10,11). Isolates from patient 1 showed resistance to ceftazidime during preliminary analysis (Table 1). However, broth microdilution confirmatory testing performed at CDC indicated ceftazidime susceptibility, highlighting the need for additional antimicrobial resistance confirmation.

Both patients were interviewed to determine travel history and possible exposure sources. Patient 1 traveled occasionally to the southeastern USA; her last travel date was 3 months before her illness. This patient reported flooding and water damage to her home from the hurricanes but did not report contact with flood waters. Patient 2 reported no travel history before the hurricanes.

VIDOH has investigated and confirmed a subsequent case-patient with pulmonary melioidosis in St. Thomas during December 2018 (I. Guendel et al., unpub. data). This case-patient reported no recent travel and might have had occupational exposure as a professional gardener. This person had 2 risk factors (type II diabetes mellitus and heavy use of alcohol).

Conclusions
Given regional occurrence, detection of melioidosis in the US Virgin Islands is not surprising. Furthermore, emergence of melioidosis after extreme weather events has been well documented, and cases were likely acquired locally from storm-related exposure to flooded soil, surface water runoff, or generation of coarse aerosols (12,13). Although detection of _B. pseudomallei_ has yet to be confirmed in the environment, it might be endemic to the US Virgin Islands, as in Puerto Rico.

In January 2018, melioidosis was listed as a reportable disease in the US Virgin Islands. Future actions include disease education efforts for physicians and laboratory staff because misdiagnosis is common (14). Awareness campaigns highlighting preventive measures for the public are necessary because risk factors are prevalent in the local population (e.g., diabetes and other chronic disease) and might be exacerbated under disaster settings (e.g., respiratory effects and open wounds). VIDOH has implemented rapid diagnostic testing by using Active Melioidosis Detect (InBios International, <https://inbios.com>) on suspected specimens for prompt on-island case identification while routine ED diagnostic cultures are performed (5). All confirmatory testing is conducted at CDC.

References
-------
On Request
======================
[This infection is found primarily in southeast Asia and the Northern Territory of Australia. Despite this, cases of melioidosis have been acquired in other parts of the world including the Americas. Flooding from the increasing number of severe tropical storms related to climate change is increasing.

Melioidosis is a disease of the rainy season in its endemic areas. It mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (most common risk factor), renal disease, cirrhosis, thalassemia, alcohol dependence, immunosuppressive therapy, chronic obstructive lung disease, cystic fibrosis, and excess kava consumption (kava is an herbal member of the pepper family that can be associated with chronic liver disease).

Melioidosis may present at any age but peaks in the 4th and 5th decades of life, affecting men more than women. In addition, although severe fulminating infection can and does occur in healthy individuals, severe disease and fatalities are much less common in those without risk factors.

The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, and chest pain, and -- although the cough can be nonproductive -- respiratory secretions can be purulent, significant in quantity, and associated with on-and-off bright red blood. The lung infection can be rapidly fatal -- with bacteremia and shock -- or somewhat more indolent.

Acute melioidosis septicaemia is the most severe complication of the infection. It presents as a typical sepsis syndrome with hypotension, high cardiac output, and low systemic vascular resistance. In many cases, a primary focus in the soft tissues or lung can be found. The syndrome, usually in patients with risk factor comorbidities, is characteristically associated with multiple abscesses involving the cutaneous tissues, lung, liver, and spleen, and a very high mortality rate of 80-95%. With prompt optimal therapy, the case fatality rate can be decreased to 40-50%.

The melioidosis bacillus is intrinsically insensitive to many antimicrobials, and in fact, bioterrorism strains may be engineered to be even more resistant. _Burkholderia pseudomallei_ is usually inhibited by tetracyclines, chloramphenicol, trimethoprim-sulfamethoxazole (SXT), antipseudomonal penicillins, carbapenems, ceftazidime, and amoxicillin/clavulanate or ampicillin/sulbactam. Ceftriaxone and cefotaxime have good in vitro activity but poor efficacy, and cefepime did not appear, as well, to be equivalent to ceftazidime in a mouse model. The unusual antimicrobial profile of resistance to colistin and polymyxin B and the aminoglycosides but sensitivity to amoxicillin/clavulanate is a useful tool to consider in treatment of infection with the organism.

The randomized and quasi-randomized trials comparing melioidosis treatment have been reviewed, and it was found that the formerly standard therapy of chloramphenicol, doxycycline, and SXT combination had a higher mortality rate than therapy with ceftazidime, imipenem/cilastatin, or amoxicillin/clavulanate (or ampicillin/sulbactam). The betalactam-betalactamase inhibitor therapy, however, seemed to have a higher failure rate.

Source: Tolaney P, Lutwick LI: Melioidosis. In: Lutwick LI, Lutwick SM (eds). Bioterror: the Weaponization of Infectious Diseases. Totowa NJ: Humana Press, 2008. pp 145-58. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
US Virgin Islands: <http://healthmap.org/promed/p/479>]
Date: Fri 31 Jan 2014
Source NBC News [edited]

The Explorer of the Seas outbreak was caused by norovirus, one of the worst outbreaks in 20 years, the Centers for Disease Control and Prevention (CDC) said. The Explorer of the Seas cruise ship returned to port after hundreds of passengers became ill. Federal health officials confirmed on Friday [31 Jan 2014] that norovirus was the culprit that sickened nearly 700 people on a cruise ship this week, and said it was one of the biggest norovirus outbreaks in 20 years. But the source of the outbreak on the Royal Caribbean ship Explorer of the Seas, which returned early to New Jersey on Wednesday [29 Jan 2014], may never be known, CDC said: "CDC has been investigating the outbreak since last Sunday [26 Jan 2014] but no particular source has been identified and it's quite possible a source won't be identified."

The report comes after passengers streamed off the Caribbean Princess on Friday morning [31 Jan 2014], the 2nd cruise cut short this week amid reports of illness on board. The ship, operated by Princess Cruises, returned to Houston [Texas] a day early with a confirmed outbreak of norovirus. "The ship was forced to return to Houston one day early because we were informed that dense fog was expected to close the port for much of the weekend," the company said in a statement. "The ship did not return early because of the increased incidence of norovirus on board, despite some media reports."

At least 178 people on board became ill during the cruise, according to the cruise line and CDC. Sick patients were quarantined to their rooms, and other passengers said they no longer had access to buffet tongs as crew members handed out hand sanitiser. CDC health officials met the Caribbean Princess at the Bayport Cruise Terminal in Pasadena, Texas. The vessel launched on a 7-day cruise to the western Caribbean on [25 Jan 2014] and had been scheduled to return on Saturday [1 Feb 2014]. Princess Cruises said the outbreak was over by the time the ship returned to Houston. "As a result of our actions, case numbers declined significantly and by the end of the cruise there were no passengers with active symptoms," the company said. "Over the course of the cruise 178 passengers (5.7 per cent) and 11 crew (1 per cent) reported ill to the Medical Center."

CDC officials also helped Royal Caribbean clean up the Explorer of the Seas, and said it had been approved to go back out again with a new batch of passengers Friday afternoon [31 Jan 2014]. Royal Caribbean officials say they cleaned the ship, which carried more than 3000 passengers, 3 times. It's the 3rd cruise ship outbreak to occur this year [2014]. A Norwegian Cruise Line ship, the Norwegian Star, reported that 130 passengers and 12 crew members became ill on 2-week cruise that launched [5 Jan 2014] from Miami.

About 20 million passengers take cruises in the US each year, fuelling a USD 37.8 billion annual industry, according to the American Association of Port Authorities. There were 9 vessel outbreaks in 2013 and 16 in 2012, according to the CDC. Norovirus is a common culprit in outbreaks on cruise ships, in nursing homes, and other confined places. It is a fast-moving gut bug typically spread by infected people or contaminated food or water. Norovirus is the most common cause of acute gastroenteritis in the US, resulting in about 21 million illnesses, between 56 000 and 71 000 hospitalizations and as many as 800 deaths, CDC says.

The virus lingers on surfaces and spreads very easily. Thorough hand washing with hot water and soap and meticulous environmental cleaning can help stop the spread. CDC says it's the season for norovirus. "Norovirus outbreaks wit high attack rates are common during this time of year," the agency said. "Most outbreaks occur between January and April."   [byline: Maggie Fox]
*****
Date: Wed 29 Jan 2014
Source: NBC News [edited]

Beleaguered passengers finally fled a Royal Caribbean cruise ship on Wednesday [29 Jan 2014] after a 10-day vacation cut short by a nasty gut bug that sickened nearly 700 people. One woman aboard the Explorer of the Seas yelled, "We made it!" as the ship docked in Bayonne [New Jersey], 2 days ahead of schedule. Other passengers stood on deck wrapped in blankets to watch the ship pull in. One person was removed from the Explorer of the Seas on a stretcher and taken away by ambulance. Others walked under their own power after the vessel arrived. Several passengers recounted a week full of tension and drama, but also professionalism and care from the cruise line crew.

Still, the ordeal on the 1020-foot ship -- whose relaxing voyage to the US Virgin Islands was thwarted by suspected norovirus -- may linger a little longer for people still showing signs of the fast-moving infection, health officials said. "We have passengers who are still exhibiting active disease," said Burnadette Burden, a spokeswoman for the Centers for Disease Control and Prevention. People who are still sick may be too ill to travel home -- and too contagious to use public transportation like trains and buses, health experts say. Royal Caribbean officials said Wednesday [29 Jan 2014] that they'd pay for hotels or make sure that ill passengers get additional medical care. "Should a guest feel sick enough that they want to go to the hospital, we will arrange for transportation," Royal Caribbean spokeswoman Cynthia Martinez said in an email. "We will work with the small number of guests that still feel ill to make them as comfortable as possible."

At least 630 of the ship's 3071 passengers and at least 54 of the 1166 crew members came down with diarrhea and vomiting -- classic signs of norovirus. Most of the cases occurred early in the cruise, which left New Jersey on [21 Jan 2014], and many passengers had already recovered. It's hard to say that the outbreak was the worst on record because of inconsistencies in record-keeping. But it's a bad one, Burden said. "It would be fair to say this is one of the largest numbers in the last 20 years or so," she said. One of the closest outbreaks to compare occurred in 2006, when a Carnival Cruise ship, the Carnival Liberty, was hit with an outbreak of norovirus that sickened 679 passengers and crew on a November trip to the US Virgin Islands.

CDC officials have not confirmed that norovirus is the culprit on the Explorer of the Seas, though it's a common cause of illness on cruise ships. Officials said testing was delayed by a treacherous winter snowstorm that closed the agency's Atlanta headquarters and results aren't expected until Friday [31 Jan 2014]. But if it is the germ, it's highly contagious for the one to 2 days when people are actively sick -- and for a few days afterward. The virus actually lingers in people's stool for 2 weeks or more, according to the CDC. That means that anyone who fell ill -- and those who were around them -- should pay extra attention to washing their hands and other kinds of cleanliness, said Dr Ruth Lynfield, outgoing head of the public health committee of the Infectious Diseases Society of America.

Cleanliness will be the key for the cruise line, too. Officials said they plan another scrub, a so-called "barrier sanitation" program to ensure that any remaining traces of illness are removed from the ship. Norovirus is a notoriously difficult bug to eradicate, health experts say. "It will be the 3rd aggressive sanitizing procedure the ship has undertaken since we became aware of the issue, and will additionally provide a window of more than 24 hours where there are no persons aboard the ship," officials said in a statement.   [byline: JoNel Aleccia]
******
Date: Fri 31 Jan 2014
Source: CDC, National Center for Environmental Health, Division of
Emergency and Environmental Health Services, Vessel Sanitation Program (VSP) [edited]

Cruise ship: Explorer of the Seas -- voyage dates: 21-31 Jan 2014
-----------------------------------------------------------------
- number of passengers who reported being ill during the voyage out of total number of passengers onboard: 634 of 3071 (20.6 per cent)
- number of crew who reported being ill during the voyage out of total number of crew onboard: 55 of 1166 (4.7 per cent)
- predominant symptoms: vomiting, diarrhea
- Causative agent: Norovirus

Actions: in response to the outbreak, Royal Caribbean Cruise Line and the crew aboard the ship took the following actions:
- increasing cleaning and disinfection procedures according to their outbreak prevention and response plan;
- making announcements to both notify onboard passengers of the outbreak and encourage case reporting;
- collecting stool specimens from ill passengers and crew for submission to the CDC lab;
- making multiple daily reports of gastrointestinal illness cases to the VSP [Vessel Sanitation Program];
- preparing additional crew members to join the ship mid-voyage to assist with case management and intensified sanitation procedures;
- consulting with CDC on plans for: passenger notification procedures and the planned delayed embarkation schedule in Bayonne, NJ on [31 Jan 2014], and disembarkation plans for active cases, terminal, and transport infection control procedures.

One CDC Vessel Sanitation Program epidemiologist, one contract epidemiologist, and one VSP environmental health officer boarded the ship in St Thomas, [US Virgin Islands] and are sailing on the ship as it travels back to port in New Jersey. This team is conducting an epidemiologic investigation, environmental health assessment, and evaluating the outbreak and response activities on board. One additional CDC Vessel Sanitation Program environmental health officer will board the ship upon arrival on [29 Jan 2014] to assist with the evaluation of the disinfection process. The team will continue the investigation and evaluation on the ship thru the boarding of new passengers for the next voyage. 5 clinical specimens were shipped to the CDC lab for testing on [26 Jan 2014].
**************************
Date: Fri 31 Jan 2014
Source: CDC, National Center for Environmental Health, Division of
Emergency and Environmental Health Services, Vessel Sanitation Program (VSP) [edited]

Cruise ship: Caribbean Princess -- voyage dates: 25 Jan-1 Feb 2014
------------------------------------------------------------------
- number of passengers who reported being ill during the voyage out of total number of passengers onboard: 181 of 3102 (5.8 per cent)
- number of crew who reported being ill during the voyage out of total number of crew onboard: 11 of 1148 (0.96 per cent)
- predominant symptoms: vomiting, diarrhea
- causative agent: Norovirus

Actions: in response to the outbreak, Princess Cruise Lines and the crew aboard the ship took the following actions:
- increasing cleaning and disinfection procedures according to their outbreak prevention and response plan;
- making announcements to both notify onboard passengers of the outbreak and encourage case reporting;
- collecting stool specimens from ill passengers and crew for submission to the CDC lab. Samples tested with the vessel's onboard rapid norovirus test were positive for norovirus. The specimens will be sent to the CDC lab for confirmatory analysis;
- making multiple daily reports of gastrointestinal illness cases to the VSP;
- consulting with CDC on plans for: passenger notification procedures and the planned delayed embarkation schedule in Houston, TX on [1 Feb 2014], and disembarkation plans for active cases, and terminal and transport infection control procedures.

Two CDC Vessel Sanitation Program environmental health officers will board the ship in Houston, TX on [31 Jan and 1 Feb 2014] to conduct an epidemiologic investigation, environmental health assessment, and evaluate the outbreak and response activities. Specimens are being collected and will be sent to the CDC lab for testing.
=====================
[ProMED-mail does not normally report outbreaks of norovirus-related gastroenteritis because of their ubiquity during the winter months. (Hence the alternate designation 'winter vomiting bug'). Norovirus infection is very contagious and can be contracted from an infected person, contaminated food or water, or by touching contaminated surfaces. The virus causes acute gastroenteritis with stomach pain, nausea, and diarrhea and vomiting. Anyone can be infected with norovirus and acquire norovirus illness repeatedly throughout life. Norovirus is the commonest cause of acute gastroenteritis in the United States. Each year, it causes 19-21 million cases and contributes to 56 000-71 000 hospitalizations and 570-800 deaths. Norovirus is also the commonest cause of foodborne disease outbreaks in the United States. There's no vaccine to prevent norovirus infection and no drug to treat it.

Norovirus illness is usually not serious. Most people get better in 1 to 3 days. But norovirus illness can be serious in young children, the elderly, and people with other health conditions. It can lead to severe dehydration, hospitalisation but rarely death. Most outbreaks of norovirus illness happen when infected people spread the virus to others. But, norovirus can also spread by consumption of contaminated food or water and by touching contaminated surfaces.

Health care facilities, including nursing homes and hospitals, are the most commonly reported places for norovirus outbreaks in the United States. Over half of all norovirus outbreaks reported in the United States occur in long-term care facilities. Outbreaks of norovirus illness appear to be occurring more frequently in cruise ships and similar environments. - ProMed Mod.CP]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/8vcv>.]
Date: Tue 13 Dec 2011
Source: Virgin Islands Daily News [edited]

The Centers for Disease Control and Prevention [CDC] has linked 5 past cases of Legionnaires' disease -- reported between March 2010 and August 2011 -- with stays at Marriott's Frenchman's Reef and Morning Star Beach Resort and Marriott's Frenchman's Cove [in Saint Thomas], prompting remediation work to the resorts' water systems. The VI [Virgin Islands] Health Department has been "working closely" with a team of CDC specialists to monitor the remediation efforts at the resorts, after an investigation into the 5 past cases, according to a statement the Health Department released Monday [12 Dec 2012].

The illness was found in stateside residents who had been guests at the resorts, said Health Department spokeswoman Eunice Bedminster. They required hospitalization but have since recovered, she said. There have been no reports of employees affected at either site, according to the Health Department statement.

The statement indicates that Frenchman's Reef and Morningstar Beach Resort has hired a consultant who led a cleaning project of the affected areas and treated the water system. Test results show no existence of _Legionella_ bacteria, although the Health Department statement said the test results have not yet been evaluated independently by the CDC.

The Health [Department] had asked the resorts to notify those who could potentially be affected by the bacteria: guests and employees, Bedminster said. The properties asked for an extension on a deadline that had been set, and it was granted, but the deadlines passed last week [week of 5 Dec 2011] without the notification to guests and employees going out, Bedminster said. She did not know if, after the deadline, the properties had made the requested notifications, she said.

The hotel provided The Daily News with a written statement that did not address guest notification: "Marriott takes hotel hygiene and cleanliness very seriously. As soon as we were notified of the possibility of the presence of _Legionella_ bacteria we immediately began to work with the USVI Department of Health (DOH) to address the situation. The Frenchman's Reef and Morning Star Beach Resorts hired a consultant who led a cleaning project of affected areas and the treatment of the water system. The latest test results taken after the implementation of these measures show no existence of _Legionella_ bacteria in the samples tested. We have complied with the recommendations provided by the DOH, and we have successfully addressed the issue at the resort. The DOH has allowed the hotel to remain fully open for business and welcome our guests."

The Daily News spoke with Marriott Frenchman's Reef and Morning Star Beach Resort General Manager Jose Gonzalez Espinosa by phone and asked for comment on the Health Department's assertion that the resort did not make the notifications it was supposed to make by the deadline. Gonzalez would not answer the questions unless they were in writing. The Daily News has a policy against submitting questions in writing because written Q and A stifles and slows follow-up and response. The resort underwent a major renovation during the summer, closing 3 May 2011 and reopening on 6 Oct 2011.

Legionnaires' disease is a pneumonia caused by the _Legionella_ bacteria, which live in warm water supplies, said Dr Lauri Hicks, a medical epidemiologist with the CDC. The bacteria that cause the disease do not pass from person to person. "It really requires exposure to water aerosol that contains _Legionella_," she said, Exposure may occur from showering or with time spent in a whirlpool or hot tub where the bacteria that lead to Legionnaires' disease are present, Hicks said.

Only a fraction of people -- typically those with certain risk factors, such as compromised immune systems -- exposed to the bacteria become ill, she said.

According to the Health Department statement, from 2000 through 2009, a total of 22 418 cases of legionellosis were reported to CDC from the 50 states and the District of Columbia. The CDC informed the Health Department in October [2011] of the 5 Legionnaires' disease cases among past guests at the resorts, and the Health Department asked for the agency's help in investigating. From 18 to 22 Oct 2011, CDC specialists conducted testing, and the properties were alerted about the possible _Legionella_ contamination, Bedminster said. On 3 Nov 2011, the Health Department notified each property of the CDC's conclusive findings and ordered them to immediately work on their water systems, including cleansing, superheating, chlorinating, and hiring a private consultant experienced in eliminating _Legionella_ from building water systems, according to the release. More than 6 weeks later, the Health Department notified the public with the statement it released Monday [12 Dec 2011].

Bedminster said that there had been no delay -- and that remediation work began immediately. "We have worked in good faith with both the resorts during what I have said was a monitoring process. We had some agreed-upon deadlines that had not been met, so we had to let the public know," she said.

Bedminster said that Health Department officials had discussed the possibility of enforcement actions with the Department of Labor and the Department of Planning and Natural Resources to get those deadlines met, but she did not know the outcome of the discussions. "Safeguarding the public's health, including that of employees and guests, from exposure and threats are of the utmost importance to the Department of Health," acting Health Commissioner Mercedes Dullum said in the prepared statement. "DOH will continue to monitor this situation with assistance from the CDC. People should not be discouraged from traveling to or within the US Virgin Islands."  [Byline: Joy Blackburn]
---------------------------------------------
Communicated by:
Denis Green
denis@gatesit.com.au
=======================
[The following has been extracted from the US CDC document Travel-Associated Legionnaires' Disease (<http://www.cdc.gov/legionella/faq.htm>):

"About 20-25 percent of all Legionnaires' disease reported to CDC is travel-associated. Legionnaires' disease is important to diagnose and to report because its identification implies the presence of an environmental source to which other susceptible individuals are likely to be exposed. Clusters of Legionnaires' disease associated with travel to hotels or aboard cruise ships are rarely detected by individual clinicians or health departments; travelers typically disperse from the source of infection before developing symptoms. Therefore, a travel history should be actively sought from patients with community-acquired pneumonia and _Legionella_ testing should be performed for those who have traveled in the 2 weeks before onset of symptoms.

"_Because of the multi-state nature of travel in the US, national-level surveillance is necessary to detect outbreaks of travel-associated Legionnaires' disease. CDC relies upon state and local health departments to conduct this surveillance. Surveillance through the National Notifiable Diseases Surveillance System (NNDSS) is still important for monitoring national trends; all cases should be reported through NNDSS."

"Because of the public health importance of timely reporting, inform CDC of travel-associated cases by emailing about the patient's movements in the 2-10 days before onset."

"Environmental sampling/testing should only be conducted after careful consideration of the epidemiologic evidence linking a case(s) to a particular location."

The following article is linked to the CDC document: Barbaree JM, et al: Protocol for Sampling Environmental Sites for Legionellae. Applied Environmental Microbiol 1987; 53(7): 1454-8 (<http://www.cdc.gov/legionella/files/sampling_protocol1987.pdf>): "Since legionellae not related to disease may be found in many of the sites sampled, an epidemiologic association with the probable source should be established before intervention methods, such as disinfection, are undertaken."

"Random sampling without an epidemiologic evaluation and comparing isolates from the environment and from patients could lead to false conclusions about sources of epidemic strains."

Potential environmental sampling sites for _Legionella_ spp that the CDC document suggests include: internal surfaces of faucets, aerators, and shower heads; and water from incoming water main, holding tanks and cisterns, water heater tanks, decorative fountains, irrigation equipment, fire sprinkler system (if recently used), whirlpools, and spas. Because _Legionella_ may be found in water supplies without linkage to any cases, the actual causative source should be demonstrated by matching the genotype of the environmental isolates with that of any clinical isolates to assure frequently costly corrective measures are carried out on the actual source (<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC86783/>; and <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730281/>).

The Virgin Islands are located in the Leeward Islands of the Lesser Antilles, which form the border between the Caribbean Sea and the Atlantic Ocean. Politically, the eastern islands form the British Virgin Islands and the western ones form the United States Virgin Islands. The US Virgin Islands consist of the main islands of Saint Croix, Saint John, and Saint Thomas (<http://en.wikipedia.org/wiki/United_States_Virgin_Islands >). They can be seen on the HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/1xng>. - ProMed Mod.ML]
Date: Sat 18 Sep 2010
Source: Virgin Islands Daily News [edited]
<http://virginislandsdailynews.com/dengue-outbreak-confirmed-in-1.1018284>

After 19 cases of suspected dengue fever -- and at least one death -- reported in the St Thomas-St John District, the VI Health Department issued a statement Friday [17 Sep 2010] saying that the district is experiencing a dengue fever outbreak. According to the Health Department statement released [Fri 17 Sep 2010], 9 of the 19 suspected cases have been laboratory-confirmed as dengue fever in the St Thomas-St John District since June [2010]. On St Croix, there have been 4 suspected cases with no confirmed cases. There is no requirement in the territory that people with suspected dengue fever undergo testing to confirm whether or not they have the mosquito-borne virus, said Health Department epidemiologist Eugene Tull.

His experience with a 2005 outbreak on St Croix leads him to believe that the number of dengue cases this year [2010] is higher than reported, Tull said, adding that he is now receiving anecdotal information about more cases in the community. According to the release, the strain causing the current outbreak is [dengue virus] type 2, which was responsible for the 2005 outbreak on St Croix.
================
[An interactive HealthMap/ProMED-mail map showing the location of the Virgin Islands in the Caribbean can be accessed at
<http://healthmap.org/r/01tp>. - ProMed Mod.TY]
Date: Fri 27 Aug 2010
Source: Virgin Islands Daily News [edited]
<http://virginislandsdailynews.com/news/dengue-fever-possible-cause-of-death-of-st-john-woman-1.977556>

A St John woman who was transferred last week [week of 16 Aug 2010] to a Miami hospital with possible dengue fever symptoms died there 20 Aug [2010] from complications, her husband said. VI [Virgin Islands] Health Department epidemiologist Eugene Tull said earlier this week [week of 23 Aug 2010] that he had no information about a possible death from dengue fever.

Health Department spokeswoman Eunice Bedminster said Thursday [26 Aug 2010] that the department was not aware of any deaths from the territory's dengue fever cases but had been investigating since receiving inquiries from reporters Monday [23 Aug 2010].

Tull said earlier this week that so far this year [2010], there have been 8 confirmed, laboratory positive cases of dengue fever in the territory, 3 probable cases with lab results pending, and 15 suspected cases. All of those were in the St Thomas/St John District, except for 2 of the suspected cases, which were on St Croix, he said. [Byline: Joy Blackburn]
=====================
[The attribution of the woman's death to dengue virus infection is speculative. ProMED-mail awaits confirmation (or not) as further information becomes available. It is clear, however, that locally acquired dengue virus infections are occurring there.

Maps showing the location of the US Virgin Islands can be accessed at <http://www.worldatlas.com/webimage/countrys/carib.htm>. and the HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/01tp> - ProMed Mod.TY]
More ...

World Travel News Headlines

Date: Mon, 18 Nov 2019 08:37:15 +0100 (MET)

Jakarta, Nov 18, 2019 (AFP) - An endangered Sumatran Tiger has mauled to death an Indonesian farmer and seriously injured a domestic tourist, a conservation official said Monday.   The fatal attack happened Sunday at the farmer's coffee plantation on Sumatra island where the 57-year-old wrestled with the big cat before it killed him, according to Genman Hasibuan, head of the South Sumatra conservation agency.   "The farmer was attacked while he was cutting a tree at his plantation," he told AFP on Monday.   The mauling came a day after the same tiger attacked a group of Indonesian tourists who were camping at a local tea plantation in South Sumatra's Mount Dempo region.

One of the tourists was rushed to hospital for wounds to his back after the cat stormed into his tent, Hasibuan said.   The animal, which remains loose in the protected-forest area, is believed to be one of just 15 critically endangered tigers in South Sumatra, which has seen five tiger attacks this year, including two fatal incidents, Hasibuan said.

Human-animal conflicts are common in the vast Southeast Asian archipelago, especially in areas where the clearing of rainforest to make way for palm oil plantations is destroying animals' habitats and bringing them into closer contact with people.   In March last year, a man was killed by a tiger in Sumatra's Riau province while several months earlier a tiger also killed a plantation worker in the area.   Sumatran tigers are considered critically endangered by protection group the International Union for Conservation of Nature, with 400 to 500 remaining in the wild.
Date: Fri, 15 Nov 2019 17:12:24 +0100 (MET)

Karachi, Nov 15, 2019 (AFP) - Pakistan has become the first country in the world to introduce a new typhoid vaccine, officials said Friday, as the country grapples with an ongoing outbreak of a drug-resistant strain of the potentially fatal disease.   The vaccine, approved by the World Health Organization (WHO), will be used during a two-week immunisation campaign in southern Sindh province.

Sindh is where most of Pakistan's 10,000 cases of typhoid have been documented since 2017.    "The two-week campaign beginning from today would target over 10 million children of nine months to 15 years of age," Azra Pechuho, the health minister in Sindh province, said in Karachi on Friday.   The new vaccines have been provided by Gavi, the Vaccine Alliance, to the Pakistani government free of cost.

After the two-week campaign, it will be introduced into routine immunisations in Sindh, and in other areas of Pakistan in the coming years.   Pakistan spends a meagre amount of its national resources on public health and a majority of its population remains vulnerable to contagious diseases such as typhoid.   In 2017, 63 percent of the typhoid cases documented and 70 percent of the fatalities were children, according to a joint press release from the Pakistani government, WHO and Gavi.
Date: Sat, 16 Nov 2019 05:50:25 +0100 (MET)
By Abhaya SRIVASTAVA

New Delhi, Nov 16, 2019 (AFP) - A thick grey smog choked New Delhi for the fifth day Saturday, adding to a mounting pollution health crisis, but retired naval commander Anil Charan is one of the vast majority of the city's 20 million inhabitants who do not wear a mask.   Indian media is packed with warnings about the risk of premature death, lung cancer and particular danger to children from PM2.5 -- tiny particles that get into the bloodstream and vital organs -- carried in the smog.   But the smartly-dressed Charan was among shoppers in Delhi's upmarket Khan Market district browsing the luxury clothes and jewellery stores without a mask, seemingly oblivious to the risk.   Many are too poor to afford protection but others simply do not like the way a pollution mask looks.

Charan, wearing aviator sunglasses, said it did not fit his "rough and tough" image.   "I have been brought up in this kind of atmosphere, the smog and all, so I am kind of used to it. And being a naval officer I think if I wear a mask I will think I am a sissy," he said.   Doctors say face masks must be worn and air purifiers used at home and in offices.   There are a variety of masks to choose from. A basic cloth version can cost as little as 50 rupees (70 US cents) but the protection they offer is debatable.    More reputable types start from 2,500 rupees ($34) while some Khan Market stores charge more than 5,500 rupees ($75) for top of the range imported models.

- Bare-faced bravado -
The mask-look worried a lot of the Khan Market shoppers and diners however. Some said the danger had been overblown.   "I know I am risking my health but I am not very comfortable wearing them (masks)," said Ritancia Cardoz, who works for a private company.   "I don't find it appealing," she told AFP.   Lopa Diwan, on a visit to the capital from the provinces, said the Delhi air was "not as bad as it is being made out to be."   "So many people advised me not to go to Delhi because of the pollution but I don't think it's that bad. I don't see people dying," she said.

Pollution -- blamed on industrial and car emissions mixed with stubble fires on thousands of farms surrounding the city -- has been building up each winter for the past decade. The past five years have been particularly bad.   The toxic air cuts short the lives of one million people in India every year, according to government research published earlier this year.    Concentrations of the most harmful airborne pollutants in Delhi are regularly about 20 times the World Health Organisation safe limit. That rams home the city's reputation as the world's most polluted capital.   Some foreign companies and embassies now do not let families move to Delhi, or at least give strong warnings about the pollution.

The Delhi government has given out hundreds of thousands of masks to children and closed schools for four of the past five days. Construction is banned and cars can only go on the roads on alternate days.   But still only a tiny number of inhabitants follow medical advice when outside. Rickshaw drivers who earn about $7 a day on an average say they cannot afford masks.   Chand Babu, a car park attendant at Khan Market, said he could buy one of the cheaper masks but it was too much of a hassle to wear.   "I have to blow the whistle all the time so it's inconvenient."   Babu does worry, however, about his three children who also do not have masks. "They go outside to play. The problem is real, but what do we do, tell me?"
Date: Sun, 17 Nov 2019 14:28:44 +0100 (MET)
By Filippo MONTEFORTE with Charles ONIANS in Rome

Venice, Nov 17, 2019 (AFP) - Venice's St Mark's Square was closed on Sunday as the historic city suffered its  third major flooding in less than a week, while rain lashing the rest of Italy prompted warnings in Florence and Pisa.   Venice's latest "acqua alta", or high water, hit 150 centimetres (just under five feet) on Sunday, lower than Tuesday's 187 centimetres -- the highest level in half a century -- but still dangerous.   "The water has stopped rising," tweeted mayor Luigi Brugnaro, who has estimated damage so far from the invading salt water at over one billion euros (dollars).   "High of 150 centimetres... Venice is working to restart," Brugnaro said after the sea water swamped the already devastated city where authorities have declared a state of emergency.   To the south, Tuscany president Enrico Rossi tweeted a warning of a "flood wave" on the Arno and said boards were being installed on the swollen river's banks in Pisa "as a precautionary measure".

The Italian army tweeted photos of paratroopers helping to bolster river defences in Pisa, with authorities monitoring the same river in Florence after heavy rain made it rise dramatically overnight.   Arno flooding devastated Renaissance jewel Florence in 1966, killing around 100 people and destroying thousands of priceless works of art. Civil protection units in Florence advised citizens "not to stand near the Arno's riverbanks".   Firefighters tweeted footage of a hovercraft being deployed to rescue stranded citizens in southern Tuscany's Grossetano province.

- Brief respite -
The renewed threat from exceptionally high tides in Venice came after a brief respite on Saturday.   Emergency workers removed temporary walkways from St Mark's Square as the water started to rise on Sunday, with only police and soldiers visible at around midday.   The top tourist site had already been shut for several hours on Friday as strong storms and winds battered the region, leaving it submerged by sea surges.

Churches, shops and homes have also been inundated in the Renaissance city, a UNESCO World Heritage site.   A massive infrastructure project called MOSE has been under way since 2003 to protect the city, but the multi-billion euro project has been plagued by cost overruns, corruption scandals and delays.   "We weren't expecting the high waters to be so exceptionally high," said Guido Fulgenzi, who had planned to open his cafe on St Mark's square this week.   "We're paying the price" for the MOSE project not being completed, he said, sloshing around in his flooded kitchen and pointing to Tuesday's high water mark on the wall.   The crisis has prompted the government to release 20 million euros ($22 million) in funds to tackle the devastation.   Culture Minister Dario Franceschini has warned that the task of repairing the city, where more than 50 churches have suffered damage, will be huge.

- Hotel reservations cancelled -
Residents whose houses have been hit are eligible for up to 5,000 euros in immediate government aid, while restaurant and shop owners can receive up to 20,000 euros and apply for more later.   Most of the city's cash machines were no longer working, making life even more difficult for tourists and Venetians.   "We didn't expect there to be so much water, now we're soaked," said French tourist Magali Mariolou, visiting Venice for her wedding anniversary.   "We'll come back another year when it's a bit drier. The boots are heavy, they're full of water!"

Older residents who remember the infamous "acqua alta" of 1966, when the water rose to 1.94 metres, say they have not seen such frequent flooding before.   Hotels reported cancelled reservations, some as far ahead as December, following the widespread diffusion of images of Venice underwater.   Tuesday's high waters submerged around 80 percent of the city, officials said.   Many, including Venice's mayor, have blamed the disaster on global warming and warned that the country prone to natural disasters must wake up to the risks posed by ever more volatile seasons.   The Serenissima, as the floating city is called, is home to 50,000 residents but receives 36 million visitors each year.
Date: Mon, 18 Nov 2019 06:41:11 +0100 (MET)

Wellington, Nov 18, 2019 (AFP) - Samoa finalised plans for a compulsory measles vaccination programme Monday, after declaring a state of emergency as a deadly epidemic sweeps the Pacific nation.   At least six fatalities, including five children, have been linked to the outbreak of the virus, which has also hit other island states such as Tonga and Fiji.   Samoa is the worst affected with more than 700 cases reported from across all areas of the country, prompting the government on Friday to invoke emergency powers.

Declaring a state of emergency, the government said plans for compulsory measles, mumps and rubella (MMR) immunisations would be published on Monday.   "MMR vaccinations for members of the public who have not yet received a vaccination injection is now a mandatory legal requirement for all of Samoa," it said.   A national emergency operations centre to coordinate the measles response in the nation of 200,000 people was opened on Monday, with children aged six months to 19 years and non-pregnant females aged 20-35 given priority.

However, no information was immediately available on how the vaccinations would be administered or whether those who were not immunised would face sanctions.   Children are the most vulnerable to measles, which typically causes a rash and fever but can also lead to brain damage and death.   Samoa has closed all schools, kindergartens and the country's only university in a bid to halt the spread of the virus.   New Zealand, which is experiencing its own measles outbreak in the Auckland region, will this week send 30 nurses, 10 doctors and 3,000 MMR doses to Samoa.

University of Auckland immunologist Helen Petousis-Harris said even though measles was already widespread, the mass rollout of vaccinations could help limit the number of cases and reduce the death count.   She said it was also important to boost Samoa's low levels of immunisation and help prevent future outbreaks.   "In Samoa, the proportion of people who are immune to measles is very, very low, one of the lowest in the world," she told AFP.   "So if they aren't able to improve that, this is going to happen again."   The country's vaccination programme was briefly suspended last year when two babies died shortly after being given the MMR vaccine.   Subsequent investigations found the problem was not the widely used vaccine but the fact that nurses had prepared it incorrectly.

Neighbouring Tonga last week announced government primary schools and kindergartens would be closed until later this month as the number of measles cases in the kingdom approaches 200.   Fiji has reported four cases but says they are contained to a township west of the capital Suva.
Date: Sun, 17 Nov 2019 18:10:23 +0100 (MET)

Johannesburg, Nov 17, 2019 (AFP) - South African unions on Sunday called on all aviation workers to join striking South African Airways (SAA) staff after the cash-strapped airline failed to meet their demands.   The country's embattled flag carrier has been losing 52 million rand ($3.5 million) per day since more than 3,000 workers started an open-ended strike on Friday -- forcing the airline to cancel hundreds of flights.   Talks with the two unions representing the striking workers ended without resolution on Saturday, prompting threats of further action.   "In response to this deliberate provocation by the SAA board and its executive management, (the) NUMSA (metalworkers' union) is in the process of consulting workers for a secondary strike in aviation," NUMSA spokeswoman Phakamile Hlubi-Majola told reporters outside the SAA headquarters in Johannesburg.

NUMSA and the South African Cabin Crew Association (SACCA) first threatened to strike after SAA announced this week that almost 1,000 employees could lose their jobs as part of a restructuring process.   Initial talks with management deadlocked after they failed to agree on wage hikes, prompting the unions to press on with their threats.   SAA is offering a 5.9 percent pay rise, while unions are demanding an eight percent across-the-board hike and a three-year guaranteeof job security.   They are also asking the airline to in-source more jobs.    "We are fighting against retrenchment, corruption and privatisation," Hlubi-Majola told journalists.   She said discussions with SAA subsidiaries, South Africa's airport management company and airline service providers were under way.   Two transport unions have also been called on to join the action.   "This secondary strike will have the impact of shutting down the entire aviation sector," NUMSA and SACCA said in a joint statement.   SAA CEO Zuks Ramasia voiced "concern" about the unions' intentions and urged them to "reconsider".   "The intent of a secondary strike is to cause disruption, bring all airport operations to a halt and create huge damage to the South African economy," Ramasia said in a statement on Sunday.

- Embattled airline -
The CEO added that SAA could not "afford to pay any salary increases" and reiterated the 5.9 percent rise offer.   "The company has repeatedly communicated the precarious financial position of the company," Ramasia said.      More than 300 SAA flights have been grounded as a result of the open-ended strike.   International flights started slowly resuming on Sunday, while regional and domestic flights remain grounded.   "We hope all our customers understand that the cancellations have been beyond our control," Ramasia said.   South Africa is struggling to get its state-owned companies back on track after nine years of corruption and mismanagement under former president Jacob Zuma.   SAA -- one of Africa's biggest airlines -- is deep in debt and has not posted a profit since 2011, despite several government bailouts.   Finance Minister Tito boweni announced in February that the government would reimburse the company's 9.2 billion rand ($620 million) debt over the next three years.   Ramasia said discussions with unions would resume once the airline had considered "options on the way forward".
Date: Tue, 12 Nov 2019 13:10:01 +0100 (MET)
By Holly ROBERTSON, Andrew BEATTY, with Daniel De Cartert in Hillville

Sydney, Nov 12, 2019 (AFP) - Bushfires raging across eastern Australia singed Sydney's suburbs on Tuesday, with firefighters scrambling planes and helicopters to douse a built-up neighbourhood with water and red retardant.   Experts have described the conditions as the worst on record, as spring temperatures climbed toward 40 degrees Celsius (104 Fahrenheit) and winds topped 80 kilometres (50 miles) per hour across a zone which has been plagued by persistent drought.   Although the bushfire season is in its infancy, scientists predict it to be one of Australia's toughest ever, with climate change and unfavourable weather cycles helping created a tinderbox of strong winds, low humidity and high temperatures.

Twin blazes in the north shore suburb of Turramurra -- around 15 kilometres (nine miles) from the centre of Australia's largest city -- tore through a eucalypt forest park and sparked spot fires in homes, before eventually being brought under control.   As night fell, authorities said they were bringing another "clearly suspicious" blaze in a national park in the city's southern suburbs under control.    Throughout the day, more than 300 bushfires burned up and down Australia's east coast, fanned by gale-force winds, scorching temperatures and tinder-dry bushland that has brought some of the most dangerous conditions the country has seen.

In Turramurra, gardens smouldered, thick smoke hung heavy in the air and cars, houses and roads were caked in raspberry-red retardant as if hit by a giant paintball.   "It was the embers that floated up that actually went across and set off spot fires in the front yards" resident Nigel Lush told AFP, adding that one roof had been set alight.   Another resident, Julia Gretton-Roberts, said the blaze spread shockingly quickly.   "Next thing I know the fire was opposite our house and it was massive and the police came and grabbed our kids and took them away," she said.   "My daughter is pretty freaked out."   Firefighter Andrew Connon told AFP "a number of homes were threatened but it was contained by the aerial bombing".

- 'Catastrophic conditions' -
From early morning thousands of firefighters spread out across New South Wales in anticipation of what they called "off the scale" fire risk and "catastrophic" conditions.   They were unable to prevent several bushfires from breaching containment lines and trapping residents who had not already evacuated.   New South Wales Rural Fire Service Commissioner Shane Fitzsimmons said so far only a dozen buildings had been damaged Tuesday and a handful non-life-threatening injuries were reported, but the crisis was far from over.

Firefighters will be "working on these fires for days and weeks given the enormity of the firegrounds," he said.    Even before unfavourable weather hit, days of fires had killed three people and destroyed at least 150 homes.   "The conditions are expected to get worse," Fitzsimmons said, warning residents in adjacent areas to stay alert.   "Complacency kills," he added.   Up to 600 schools were closed, as well as many national parks, a total fire ban was introduced for the affected area and Rally Australia -- due to be held in Coffs Harbour at the weekend -- was cancelled.   The military pitched in, helping firefighters with logistics and water-dropping sorties using more than 100 aircraft.

- 'We'll fight it first' -
In the town of Hillville a fire that has ripped through an area the size of 25,000 soccer fields approached the home of Daniel Stevens.   Like many, his family -- including his mother nursing a broken leg -- have packed their bags, but have resisted leaving their house and everything they own.    "We'll fight it first," he told AFP, "but if it jumps the fence line into the paddock, we'll go."

In the nearby town of Taree, dozens of people have already moved to a showground that has become a makeshift evacuation centre.   Fifty-nine-year-old Caroline Watson arrived last night with her husband and their dog.    "The fires are just rife. They are absolutely everywhere" she told AFP. "They didn't ask us to get out, but we figured it was coming."

Further south in the Blue Mountains on the outskirts of Sydney, veteran Winmalee firefighter Alan Gardiner said locals were "terrified and on edge".    The town still bears the scars of a 2013 blaze that destroyed 200 homes, and residents are acutely aware that with few roads in and out of the mountains, a decision to leave late can be fatal.   Efforts to burn fuel in a controlled way have been limited by months of drought-like conditions that made it too dangerous.
Date: Tue, 12 Nov 2019 10:03:07 +0100 (MET)

Denpasar, Indonesia, Nov 12, 2019 (AFP) - An Australian tourist who fly-kicked a motorcyclist and assaulted a man in his own home during a drunken rampage was jailed for four months on Tuesday.   The ruling comes after Nicholas Carr's antics were caught in a viral video that saw him carry out a campaign of destruction in Seminyak, a popular tourist area on the Indonesian holiday island.   "The defendant Nicholas Carr is found guilty and is sentenced to four months" in jail, presiding judge Soebandi, who goes by one name, told the Denpasar District Court.    A lawyer for Carr, charged with assault and property damage, said the 26-year-old would not appeal the ruling.    He is expected to be released next month because of time already served.   In August, Carr ran barefoot on to a street and shouted expletives before the apprentice builder slammed into the bonnet of a moving car and then fly-kicked an unsuspecting motorcycle rider.

The biker, who was thrown from the moving scooter, sustained minor injuries -- later the pair embraced during a court hearing as Carr apologised to the victim.   Carr also shattered a convenience store's glass door before stealing a motorcycle.   Later, he broke into a house where he assaulted the sleeping homeowner, leaving him with injuries, police said earlier.    He was eventually caught by locals and police and taken to hospital.    Pictures that circulated on social media showed at the time showed Carr bloodied and bruised, and trussed with hosepipe and rope.   Shortly after his arrest, Carr apologised and admitted drinking more than 10 small bottles of vodka as well as other alcohol.

After a string of embarrassing incidents by tourists, Bali officials recently warned that boorish visitors may be kicked off the island, which attracts millions annually to its palm-fringed beaches, colourful nightlife and ancient temples.   Australian professional rugby league player David Fifita returned home this week after he was briefly arrested in Bali for assaulting a nightclub security guard.   Several days after Carr's arrest, a Czech couple who were slammed for disrespecting a Balinese temple took part in a ritual purification ceremony.
Date: Mon, 11 Nov 2019 16:19:54 +0100 (MET)

Lyon, Nov 11, 2019 (AFP) - An unusually strong earthquake hit south-eastern France on Monday, injuring four people, one of them seriously, authorities said.   A physicist at a geophysics institute the IPGP said that quakes of this strength are rare in that region, but warned of possible aftershocks and said people should leave fragile buildings.   The quake, with a magnitude of 5.4, was felt in a vast area between the cities of Lyon and Montelimar which are about 150 kilometres (93 miles) apart, the national seismological office said.   "I was leaning against the oven in my mother's bakery when I felt the tremor," said Victoria Brielle, a resident in Privas, some 25 kilometres from the quake's epicentre.   "A customer said her sideboard had moved and all her crockery was broken,"  she said.

Another resident in the area, Didier Levy, who lives in a 15th century castle, told AFP that "chandeliers were still trembling" several minutes after the quake.   Levy, who said his dog starting barking even before humans felt the tremors, added: "I have never experienced anything like it, I could feel the trembling even though these wall are one metre thick."   One person was seriously hurt when some scaffolding collapsed, the regional prefect's office said.   Three other people in the neighbouring Ardeche region were slightly injured.

Quakes in this region are rarely higher than Magnitude 5, said Mustapha Meghraoui of the IPGP's office in Strasbourg.   "We can say that this is a rare one," he added. But he said there might be an aftershock of around 4.5.   "If people are in a fragile house, they would be better leaving it" for something more robust for a while, he said.   The scale of the damage suggested the quake happened at a depth of between five and 10 kilometres, he added. But they were working on a more accurate reading.
Date: Mon, 11 Nov 2019 13:19:54 +0100 (MET)

Goma, DR Congo, Nov 11, 2019 (AFP) - A local radio station that has been involved in the fight against Ebola in eastern DR Congo said Monday it was closing down after one of its broadcasters was murdered.   Joel Musavuli, head of Lwemba radio in Mambasa in Ituri province, told AFP that the station had been targeted by armed groups hostile to the campaign to roll back the Ebola epidemic.

"Each of us have received threats since last month. We have now decided to stop broadcasting, Musavuli said, adding that he himself had escaped two kidnap attempts.   "We are victims of our commitment to the awareness campaign about the spread of Ebola virus disease. We don't know why the militiamen are targeting us."   Nearly 2,200 people have died since the notorious haemorrhagic disease erupted in eastern Democratic Republic of Congo in August 2018, according to the latest official figures.

The fight against the outbreak has been hampered by local fears and superstititions, exploited by militia groups that are rampant in the remote region.   Several health workers have been killed and media that have supported the campaign have received threats.

Several radio stations in the Mambasa area say they have stopped broadcasting anti-Ebola messages because of intimidation.   On November 2, Lwemba broadcaster Papy Mahamba was killed at his home by unidentified men. His wife was injured and their house set ablaze.    The station said the authorities had failed to take action against the threats. It said it would resume broadcasts after "the state has restored authority in the area".