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Cameroon

Cameroon - US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
Cameroon is a developing country in central Africa.
Although there are many natural and cultural attractions in Cameroon, facilities catering to Western-styl
tourism are quite limited.
The capital is Yaoundé, though Douala, the country's largest city, is its main port and commercial center.
Official languages are French and English, though French predominates in most of the country.
English may be used in Cameroon's two Anglophone provinces of Southwest and Northwest, and the larger cities.
The staff of major hotels in Cameroon’s large cities is usually bilingual.
In February 2008, social and political unrest led to civil unrest, although the immediate threat of violence has now receded.
For general information on Cameroon, read the Department of State Background Notes on Cameroon.

ENTRY/EXIT REQUIREMENTS:
A valid passport, visa, evidence of yellow-fever vaccination, and current immunization records are required, and travelers may be denied entry if they lack the proper documentation.
Travelers should obtain the latest information and details from the Embassy of the Republic of Cameroon, 2349 Massachusetts Avenue, NW, Washington D.C. 20008, tel: (202) 265-8790, fax: (202) 387-3826.
Visit the Embassy of Cameroon’s web site at http://www.ambacam-usa.org/ for the most current visa information.

Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
During the week of February 25, 2008, Cameroon experienced significant civil unrest in half of its ten provinces, most notably in the port city of Douala.
Demonstrators clashed violently with police and then military personnel, resulting in the reported deaths of forty persons and arrest of over 1,600 individuals.
The unrest was marked by widespread road blockages, attacks on public and private vehicles, looting, burning of government and other buildings, and roaming crowds of malcontents.
This disturbance created shortages of fuel, food and other supplies throughout the country, and was ended through the deployment of military units and the use of significant force.

Following the restoration of order, some efforts have been made to address fuel and food prices that were among the key grievances of the demonstrators.
However, economic conditions, notably the high unemployment rate, remain difficult without the prospect for rapid improvement.
Political tensions also remain, particularly over a possible amendment to the Constitution that would allow President Biya to serve again.
Although a rapid resumption of violence is considered unlikely, Americans living in or visiting Cameroon are encouraged to stay abreast of local political and social developments that could signal additional difficulties for the country.

Embassy employees have been instructed to refrain from travel outside of city limits after dusk, and to monitor their movements in centrally located areas within cities and towns.
Private American citizens are urged to follow the same guidelines and are strongly advised against nighttime travel.
Armed highway bandits (most notably in border areas); poorly lit roads; hazardous, poorly maintained vehicles; and unskilled, aggressive and/or intoxicated drivers pose a threat to motorists.
Attacks and accidents are most common outside major towns, especially in the provinces bordering Chad and the Central African Republic but occur in all areas of the country.

The U.S. Department of State continues to warn U.S. citizens against travel to neighboring Central African Republic (CAR).
On occasion, conflict between insurgents and government security forces in CAR has spilled across the border into Cameroon, affecting outposts in both Adamawa and East Provinces.
Humanitarian and religious workers in eastern Cameroon are strongly encouraged to coordinate their efforts with the Embassy and the Office of the United Nations High Commission for Refugees (UNHCR) in Yaoundé.

In February 2008, an attack by rebel insurgents on Ndjamena, the capital of Chad, forced the evacuation of the Embassy in Chad and sent up to 50,000 refugees across the border into the town of Kousseri in Cameroon.
Although the attack was ultimately repelled, the possibility of further military action by the rebel forces remains.

In late 2006, inter-ethnic clashes were reported in the town of Kye-Ossi near the Cameroonian border with Gabon.
These confrontations were a result of a discord between moto-taxi drivers and the security forces, which resulted in demonstrations and roadblocks.
According to security authorities, tensions in the area are still high, despite the deployment of a large security force to the region.

Following a ruling from the International Court of Justice defining a section of the Cameroon-Nigeria border, Cameroon assumed administrative control of most of the Bakassi Peninsula, in August 2006, with Nigerian military forces withdrawing across the border.
Although the transition has generally gone smoothly, there was an attack on Cameroonian military forces in November 2007, reportedly by criminal elements from the Niger Delta not connected to the Nigerian government.
It is very difficult to reach Bakassi, but travelers thinking of going near there should exercise extreme caution as there is the potential for violence if tensions rise.

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 Worldwide Caution, Travel Warnings, and Travel Alerts can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME:
Crime is a serious and growing problem throughout Cameroon and U.S. citizens should exercise caution when traveling in Cameroon.
Internet-based crime is escalating rapidly, and Americans should be extremely skeptical of financial
transactions --
e.g. adoptions, hiring a service worker, such as a nanny, to come to the U.S., or purchasing a pet -- that involve sending money for goods or services not yet delivered (see below).
In February 2008, two European nationals were kidnapped by criminals posing as businessmen seeking to establish a palm oil export business. Although several perpetrators were arrested and the individuals were not harmed, the incident highlights a dangerous new confluence of internet-based and violent crime.
If you have concerns about the legitimacy of a transaction, such as adoption, in Cameroon contact the U.S. Embassy in Cameroon – see Registration/Embassy Location section below.
All foreigners are potential targets for theft with possible attendant violence.
Petty crimes, crimes against persons, thefts from vehicles, and of vehicles are the most common criminal activities.
Armed banditry is a growing problem throughout all ten provinces in Cameroon.
Specifically, incidents of armed highway-robbery have been reported in the North West, West, South West and East provinces.
Armed bandits have erected road barricades on major routes that link rural towns to provincial headquarters, and have taken as many as 100 cars in a single attack.
To curb banditry, security personnel may request persons to show their passport, residence card, driver's license, and/or vehicle registration at random checkpoints.
Certified copies of these important documents should be kept in a secure location separate from the originals.
Security personnel have been known to ask for bribes and may hurt citizens who refuse to pay.
The U.S. Government does not condone bribery or corruption of any kind.

Due to the frequency of criminal incidents involving public transportation, American citizens are advised that use of public taxis can be dangerous.
In April 2007, two American women were assaulted and robbed in a taxi.
Public taxis in Cameroon function more like the U.S. bus system with drivers stopping to pick up additional passengers as long as there is space left in the vehicle.
There have been numerous reports of assaults and robberies committed by "passengers" in shared taxis since crimes – rape and robbery being among the most common – are often a collaborative effort between the driver and "passengers."
If a traveler must use a taxi, the use of a private taxi – or a taxi hired for exclusive use by the individual for that particular trip – where the driver is known to the passenger is a better alternative to the use of shared taxis.
Taxi passengers should be particularly vigilant at night.

The risk of street and residential crime is high, and incidents of violent crime are on the rise throughout the country.
During the last year, the number of carjacking and armed burglary incidents in residences and restaurants, particularly in Yaoundé and Douala, continued to increase.
Carjacking and robbery has also been reported on rural highways, especially in the Northern provinces and regions near Cameroon's border with the Central African Republic.

On March 27, 2006, 11 armed men attacked a group of four U.S. citizens in a private residence (adjacent to a hotel frequented by expatriates) in Kribi, located in the Southern province.
A group of five armed bandits held up and robbed staff and guests of a hotel in Ngaoundere (Adamawa Province) on December 20, 2006.
Similar incidents occurred in the middle of the night at hotels in Bertoua (East Province) on April 22, 2007, and in Yaoundé (Central Province) on May 15, 2007 when assailants broke into hotel rooms and robbed the residents.
Americans were among the victims.
Crimes against property, such as carjacking and burglaries, have often been accompanied by violent acts and have resulted in fatalities.
There were four incidents of armed robberies in the month of April 2007, involving American citizens in or near restaurants in Yaoundé and Bertoua.

In January 2007, a French expatriate was fatally shot in the upscale Bastos neighborhood of Yaoundé.
The woman was dropping off a friend to her residence and interrupted an attempted home invasion.
Upon realizing what was happening, the friend returned to the vehicle and both women attempted to flee the scene.
As they were leaving, an armed bandit shot and fatally wounded the driver of the vehicle.

In September 2007, several expatriates suffered armed attacks.
In one incident, an Israeli citizen giving a ride to a friend was attacked in Bastos by two men with knives.
In the ensuing scuffle, the Israeli was critically wounded.
A Moroccan diplomat was fatally injured while walking near his residence.
Found unconscious by security guards, he was taken to a local hospital where he died the following day.
A Chinese business woman was also robbed and killed outside her home in a neighborhood near Bastos.
All incidents occurred late at night.

In December 2007, a police officer was arrested and jailed in Yaoundé after he and his accomplices surprised a couple returning from Europe and stole a briefcase and jewelry.

In January 2008, three bandits posing as passengers on a bus to Douala – and carrying locally made guns - were intercepted at Bafoussam and apprehended.
In Douala, armed bandits robbed a soap company at gun point, surprising the employees.
They attempted to loot the company’s computers, but were intercepted by a SWAT team and ran off.
Also in January, an Embassy employee using public transportation in the Northwest Province was the victim of highway robbers, who robbed the passengers (including a local mayor) and roughed-up those who did not have enough money.
In February 2008, Cameroon experienced a brief period of civil unrest during a taxi strike that involved road blockages, attacks on public and private vehicles, looting, burning of government and other buildings, and roaming crowds of malcontents.
This period was attended by a sharp increase in reported crimes, including the stabbing death of a night watchman at a residence in Yaoundé, an attack at the Brussels Airline travel agency in the Bonapriso district of Douala, an attack by a group of armed bandits on a motorbike rider who suffered a gunshot wound to the head, and numerous reports of rape and armed attacks with firearms and machetes in Douala.

Recently, many American citizens have become victims of Cameroonian advance-fee fraud and other scams offering antiques, exotic and domesticated animals, and even adoption services through the Internet.
Americans should be very cautious about sending money or traveling to Cameroon to meet someone contacted via the Internet.
Commercial scams targeting foreigners, including many U.S. citizens, continue to be a problem.
The scams generally involve phony offers of lucrative sales and repeated requests for additional funds to pay for unforeseen airport and/or customs fees.
No one should provide personal financial or account information to unknown parties.
The ability of U.S. Embassy officers to extricate U.S. citizens from unlawful business deals and the consequences is limited.
For more information on international financial scams, including those involving Internet dating, a promise of an inheritance windfall, a promise of a work contract overseas, overpayment for goods purchased on-line, or money-laundering, see the Department of State's publication International Financial Scams.

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 facilities in Cameroon are extremely limited.
Even in large cities, emergency care and hospitalization for major illnesses and surgery are hampered by the lack of trained specialists, outdated diagnostic equipment, and poor sanitation.
Medical services in outlying areas may be completely nonexistent.
Doctors and hospitals often require immediate payment for health services in cash.
Pharmacies in larger towns are well stocked, but in other areas many medicines are unavailable.
Travelers are advised to carry their own supply of needed prescription and anticipated over-the-counter medicines.

Malaria is a serious and sometimes fatal disease.
Plasmodium falciparum malaria, the type that predominates in Cameroon, is resistant to the antimalarial drug chloroquine.
Because travelers to Cameroon are at high risk for contracting malaria, the Centers for Disease Control and Prevention (CDC) advises that travelers should take one of the following antimalarial drugs: mefloquine (Lariam™), doxycycline, or atovaquone/proguanil (Malarone™) as prophylaxis to reduce this risk.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area, and up to one year after returning home, should seek prompt medical attention and tell the physician their travel history and what antimalarials they have been taking.
For additional information on malaria, including protective measures, see the CDC Travelers’ Health web site at http://www.cdc.gov/malaria/.
There are periodic outbreaks of cholera in Cameroon.
Yellow fever can cause serious medical problems, but the vaccine, required for entry, is very effective in preventing the disease.

In March 2006, avian influenza (H5N1) was confirmed in wild ducks in northern Cameroon.
There have been no reports of avian influenza among humans in Cameroon.
Avian influenza has been reported in both birds and humans in neighboring Nigeria.
For additional information on avian influenza as it affects American citizens residing abroad, please visit the U.S. Department of State’s Avian Influenza Fact Sheet.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s website at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) website at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas .

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Cameroon is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Cameroon's road networks, both paved and unpaved, are poorly maintained and unsafe at all times of the year.
Vehicles are poorly maintained and there is no mechanism or requirement to inspect for roadworthiness.
During the rainy season, many roads are barely passable with four-wheel-drive vehicles.
Livestock and pedestrians create constant road hazards (especially at night) and road safety rules are frequently ignored.
There are few road and traffic signs; speed limits are neither posted nor enforced.
Buses and logging trucks travel at excessive speed and are a constant threat to other road traffic.

Travelers on roads near the borders with CAR and Chad should ensure that their vehicles are fully fueled, and that they have adequate cooking fuel, food, and water for several days as well as a reliable means of communication, such as a satellite or cell phone, or radio.

Visitors who are not in possession of a valid passport and a visa may experience difficulties at police roadblocks or other security checkpoints.
It is not uncommon for a uniformed member of the security forces to stop motorists on the pretext of a minor or non-existent violation of local motor vehicle regulations in order to extort small bribes.
Visitors are advised not to pay bribes and to request that the officer provide a citation to be paid at the local court.

Local law states that vehicles involved in an accident should not be moved until the police arrive and a police report can be made.
If an accident results in injury, drivers should be aware of the possibility that a "village justice" mentality may develop.
If an angry crowd forms, drive directly to the U.S. Embassy or another location where you can receive assistance.
Contact the local police once you are safely away from danger.
Cameroon has no real equivalent to 911-type service or roadside emergency telephone numbers, but you can dial 112 in major cities to contact ambulance services.
American citizens should contact the U.S. Embassy (237) 2220-1500 if emergency assistance is needed.
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 Cameroon, the U.S. Federal Aviation Administration (FAA) has not assessed Cameroon’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
While visiting game parks and reserves, tourists should bear in mind that they are ultimately responsible for maintaining their own safety.
Tourists should use common sense when approaching wildlife, maintain a safe distance from animals, and heed all instructions given by guides or trackers.
Even in the most serene settings, the animals in Cameroon's game parks are wild and can pose a threat to life and safety.

Cameroonian Customs authorities may enforce strict regulations concerning temporary importation into or export from Cameroon of items such as large quantities of medicine or wood products.
Customs regulations also restrict the importation of ivory.
Please see our information on customs regulations.

Cash in local currency, the Central African franc (CFA), is the only form of payment accepted throughout the country.
Larger hotels in Yaoundé and Douala will change U.S. dollars and cash traveler's checks, though at a disadvantageous rate.
Credit card cash advances are not available, and most banks do not cash personal or traveler's checks for non-clients.
While credit cards are accepted at some larger hotels and shops in Yaoundé and Douala, caution is urged, as identity theft is endemic in the region.
Some larger banks in Yaoundé and Douala have ATM facilities, and several banks in Cameroon have wire transfer services through Western Union.
The U.S. Embassy does not provide currency exchange, check cashing or other financial services.
Tourists and business travelers should also note that there is an increasing circulation of counterfeit U.S. and Cameroonian currency in the country.
In recent years, business travelers have experienced difficulty in obtaining adequate services from Cameroon's banking sector.
Business travelers are also advised that using the services of a local agent is strongly recommended in establishing a presence in the Cameroonian market.

While photography is not officially forbidden, security officials are sensitive about photographs taken of government buildings, military installations, and other public facilities, many of which are unmarked.
Photography of these subjects may result in seizure of photographic equipment by Cameroonian authorities.
Due to the threat of harassment and the lack of signs designating sites prohibited for photography, photography should be limited to private homes and among friends.
U.S. citizens are advised to seek proper permission before taking a photograph of a specific subject or location.

The government of Cameroon has recently started enforcing laws against homosexuality.
Charges of homosexuality and/or of corruption are also made and enforced indiscriminately in the course of business or personal disputes.

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.
Cameroonian law does not afford many of the protections to which Americans are accustomed, and legal proceedings tend to be complex, lengthy, and subject to inappropriate influence.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Additionally, the condition of detention centers, while improving, is poor.
Persons violating Cameroonian laws, even unknowingly, may be expelled, arrested or imprisoned.
During the February 2008 civil unrest, there were reports that people were arrested arbitrarily by law enforcement officials quelling the civil disorder that ensued.
Although no expatriates were known to have been arrested, the Department of State cautions Americans against venturing out during such periods of unrest.

Penalties for possession, use, or trafficking in illegal drugs in Cameroon are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Cameroon 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 and security within Cameroon.
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 in Yaoundé is located on Avenue Rosa Parks in the Mbankolo Quartier, adjacent to the Mount Febe Golf Club; mailing address P.O. Box 817; embassy tel. (237) 2220-1500, fax: (237) 2220-1572.
The Embassy Branch Office in Douala is located on the corner of Rue Ivy and Rue French in the Ecobank Building in Bonanjo, tel: (237) 3342-5331, fax: (237) 3342-7790.
Further information, including the U.S. Embassy's business hours, is available at the U.S. Embassy's web site: http://yaounde.usembassy.gov.
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This replaces the Country Specific Information for Cameroon dated 7 June 2007, to update sections on Country Description, Entry and Exit Requirements, Safety and Security, Crime, Aviation Safety Oversight, Criminal Penalties, Children’s Issues, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Tue 9 Jul 2019
Source: Agence Cameroun Presse [in French, trans. Corr.SB, edited]

A highly contagious disease with faecal-oral transmission, cholera is transmitted by dirty hands or by food contamination and water (contaminated water). According to our colleague, [Journal du Cameroun], 48 deaths due to cholera have been recorded in the northern part of Cameroon.

According to figures compiled on Mon 8 Jul 2019 by the Ministry of Public Health (Minsante), the cholera epidemic, which is raging in the northern part of Cameroon, has already killed 48 people. The northern region, which has been particularly affected by this epidemic for almost a year, has a fatality rate of 6.2%.

Outside the North, the neighbouring Far North region is also affected by the disease, which raises fears of a spread of the disease with the onset of rains in this part of the country. Cholera had also been reported in the southern part of the country, particularly in the Central and Littoral regions, where one death had been registered.

According to the Journal du Cameroun, since the reappearance of the disease last February 2019, 775 reported cases have been counted and confirmed, revealing "an alarming epidemiological situation".

It should be noted that cholera 1st appeared in Cameroon in 1971. Since 1990, major epidemics have been recorded, particularly in 1991, 1996, 1998, 2004, 2010 and 2011. The general trend shows an annual increase in the number of cases. Between 2004 and 2016, epidemiological surveillance reported 50 007 cases with 2052 deaths, a high case fatality rate of 4.1%.

The main epidemics were recorded in the north, in the northern regions and the Far North and in the south of the country in the Littoral region, which is home to the economic capital Douala.  [Byline: Danielle Ngono Efondo]
Date: Thu, 30 May 2019 19:24:40 +0200

Yaoundé, May 30, 2019 (AFP) - Cameroon has declared a public emergency after reporting a polio case in its far north, four years after the virus disappeared from the country, the health ministry said on Thursday.   The confirmed case of polio type 2 was found in the Mada area in the remote north bordering Chad and Nigeria, the ministry said in a statement.   It declared a "new polio epidemic following the confirmation of a case of poliovirus type 2 detected in samples."

A source at the ministry said the outbreak may have been caused in part by a refusal of vaccinations and the cross-border movement of people in the area.   Polio is a highly infectious viral disease which mainly affects young children and can result in permanent paralysis. There is no cure and it can only be prevented through immunisation.   International polio vaccination efforts have run into problems in Pakistan and Afghanistan. Militants and religious leaders in rural areas often tell locals immunisation is part of a shadowy conspiracy to weaken their faith.
Date: Wed, 28 Nov 2018 11:40:16 +0100

Yaoundé, Nov 28, 2018 (AFP) - At least 29 people were wounded Wednesday when a women bomber blew herself up in a border town in Cameroon's Far North, a region frequently hit by Boko Haram jihadists, security sources said.    But a second bomber was shot dead by troops deployed in the town before she could detonate her explosives, the source said.    "A suicide bomber blew herself up this morning in Amchide" on the Nigerian border, a regional security source said, speaking on condition of anonymity and giving a toll of 29 wounded.

The attack occurred on market day when the town was filling up with early-morning shoppers, a local civil defence group official said.    "There were many people hurt, I saw about 20," he said. "After the attack, the market emptied."   A once-bustling trade hub, in 2014 Amchide was thrust into the forefront of a major battle between Cameroonian troops and Boko Haram militants who held the nearby Nigerian town of Banki for several months.    The violence forced most residents to flee the town, although some have now begun to return.    After pushing back Boko Haram, the Cameroonian army dug long trenches around Amchide and even inside the town to foil new incursions by the jihadists, with Wednesday's attack the first in many months.
Date: Fri 26 Oct 2018
Source: PLoS Negl Trop Dis 2018;12:e0006750 [edited]

Wanji S, Chounna Ndongmo WP, Fombad FF, et al. Impact of repeated annual community-directed treatment with ivermectin on loiasis parasitological indicators in Cameroon: implications for onchocerciasis and lymphatic filariasis elimination in areas co-endemic with _Loa loa_ in Africa. PLoS Negl Trop Dis 2018;12:e0006750.

Abstract
---------
Background
Loiasis is a filarial infection endemic in the rainforest zone of west and central Africa, particularly in Cameroon, Gabon, Republic of Congo, and Democratic Republic of the Congo. Repeated treatments with ivermectin have been delivered using the annual community-directed treatment with ivermectin (CDTI) approach for several years to control onchocerciasis in some _Loa loa_ and _Onchocerca volvulus_ co-endemic areas. The impact of CDTI on loiasis parasitological indicators is not known. Therefore, we designed this cross-sectional study to explore the effects of several rounds of CDTI on parasitological indicators of loiasis.

Methodology/principal findings
The study was conducted in the East, Northwest, and Southwest 2 CDTI projects of Cameroon. Individuals who consented to participate were interviewed for ivermectin treatment history and enrolled for parasitological screening using thick smears. Ivermectin treatment history was correlated with loiasis prevalence/intensity. A total of 3684 individuals were recruited from 36 communities of the 3 CDTI projects, and 900 individuals were from 9 villages in a non-CDTI district. In the East, loiasis prevalence was 29.3% (range, 24.2% to 34.6%) in the non-CDTI district but 16.0% (3.3% to 26.6%) in the CDTI district with 10 ivermectin rounds (there were no baseline data for the latter).

In the Northwest and Southwest 2 districts, reductions from 30.5% to 17.9% (after 9 ivermectin rounds) and from 8.1% to 7.8% (not significantly different after 14 rounds) were registered post-CDTI, respectively. Similar trends in infection intensity were observed in all sites. There was a negative relationship between adherence to ivermectin treatment and prevalence/intensity of infection in all sites. None of the children (ages 10 to 14 years) examined in the East CDTI project harboured high (8000 to 30,000 mf/mL) or very high (more than 30,000 mf/mL) microfilarial loads. Individuals who had taken more than 5 ivermectin treatments were 2.1 times more likely to present with no microfilaraemia than those with fewer treatments.

Conclusion
In areas where onchocerciasis and loiasis are co-endemic, CDTI reduces the number of and microfilaraemia in _L. loa_-infected individuals, and this, in turn, will help to prevent non-neurological and neurological complications post-ivermectin treatment among CDTI adherents.
====================
[Onchocerciasis (African River blindness) is a neglected tropical disease, but the invasive nematode _Loa loa_ is not on the list. The study clearly demonstrates that scheduled regular ivermectin against onchocerciasis also reduced the nematode burden of _L. loa_.

_L. loa_, the African eye worm, is a nematode transmitted by tabanid flies (Order: Diptera; Family: Tabanidae) of the genus _Chrysops_. _L. loa_ may cause skin oedema (Calabar swellings) and may occasionally invade the eye. As far as it is known, there is no animal reservoir. - ProMED Mod.EP]

[HealthMap/ProMED map:
Date: Sat, 6 Oct 2018 04:59:35 +0200
By Gregory WALTON

Buea, Cameroon, Oct 6, 2018 (AFP) - "For the peak season I would have about 280 persons climbing Mount Cameroon," said John Ngomba, a tour guide in the town of Buea, which has been at the forefront of Cameroon's anglophone separatist insurgency.   "But now there are no tourists coming. It's really crazy. The reason tourists are not coming is because of the crisis."

Since an independence declaration a year ago, Buea -- once a tourist hotspot -- has suffered near-daily clashes and visitors have all but disappeared.   The violence has claimed the lives of at least 420 civilians, 175 members of the security forces and an unknown number of separatists, according to the International Crisis Group think-tank.   "Sometimes I would receive 600 Germans a year. They would come through the cruise ships. I could have about 30 to 50 tourists a week who came to visit," said Ngomba in his hut in the town's Bismarck Fountain gardens.

Cameroon was once a German colony but was divided between Britain and France after World War I -- a separation that lies at the heart of the current conflict.   France's colony won independence in 1960, becoming Cameroon, and in 1961 the British-ruled Southern Cameroons was merged into it, giving the new state English-speaking majorities in the northwest and southwest.   "I am a father of five children. How am I living with them? It's impossible," said Ngomba, who has appealed for help from the German embassy, which assists with the upkeep of the garden containing a bust of Bismarck.

- Empty hotels -
"The fountain is not even working," he said, looking out over the restive town below and the former German governor's residence, which is now an army base.   But Ngomba insisted that the foothills above Buea remained safe.   "If the tourists arrive and get to this point, they are safe," he said.   "I tell people: after the election, things will be OK," he added of polls due on unday at which President Paul Biya will seek a seventh term.

But several countries including Germany, Britain, Canada and the United States have issued security advisories to their citizens about the anglophone regions.   "We used to have customers coming from many countries -- America, Europe, Nigeria," said Janet Nkowo, 30, a receptionist at the Eta Palace Hotel in downtown Buea.   "I think it's because of the crisis. The difference is really clear," she said.   "We have one-quarter of what we had, I don't know how the director does it. I think things will hopefully get better on Sunday."

Most of Buea's hotels are sitting empty, the majority of shops are shuttered and only a handful of students queued up at the town's university to register for the new academic term.   A total of 246,000 people have fled their homes in the southwest region that includes Buea -- and 25,000 have left the country altogether for Nigeria, according to UN figures.

At the town's weekly market, one of the few retail outlets still functioning, many stalls sat empty.   A man in a white vest shouted "French bastards" at passers-by, in French.   "Maybe if voting passes well, they will come back," said Fidelis Kum, a stallholder selling hair extensions, as customers haggled over live chickens nearby and women sat shelling snails.
More ...

World Travel News Headlines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Swimming-associated transmission is illustrated in the following references:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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