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French West Indies US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
The French West Indies consists of the islands of Martinique, Guadeloupe, St. Martin (the French side) and St. Barthélemy. These islands are well develop
d. In St. Martin and St. Barthélemy, English is widely spoken, and U.S. currency is accepted. Read the Department of State Background Notes on France for additional information.

ENTRY/EXIT REQUIREMENTS:
All Americans traveling by air outside the United States are required to present a passport or other valid travel document to enter or re-enter the United States.
This requirement will be extended to sea travel (except closed loop cruises), including ferry service, by the summer of 2009.
Until then, U.S. citizens traveling by sea must have government-issued photo identification and a document showing their U.S. citizenship (for example, a birth certificate or certificate of nationalization), or other WHTI compliant document such as a passport card for entry or re-entry to the U.S.
Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.

Applications for the new U.S. Passport Card are now being accepted.
We expect cards will be available and mailed to applicants in spring 2008.
The card may not be used to travel by air and is available only to U.S. citizens. Further information on the Passport Card is available at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html.
We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

Visas are generally not required for visitors planning to remain for up to 90 days. For further information, travelers can contact the Embassy of France at 4101 Reservoir Road NW, Washington, DC 20007; telephone 1 202 944-6000; or the nearest French consulate in Atlanta, Boston, Chicago, Houston, Los Angeles, Miami, New York, New Orleans or San Francisco. Visit the web site for the Embassy of France at http://www.info-france-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:
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:
Petty street crime, including purse snatching, occurs throughout the French West Indies. Visitors should take care whenever traveling to safeguard valuables and always lock hotel rooms and car doors.

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:
Good medical care is available throughout the French West Indies. Not all doctors speak or understand English. Hyperbaric chambers are available in Guadeloupe at the Centre Hospitalier Universitaire in Abymes, http://www.chu-guadeloupe.fr/fr/fw_index.asp, and, in Martinique at the Centre Hospitalier Universitaire in Fort de France, http://www.chu-fortdefrance.fr/pages/sommaire.html.
Cases of dengue fever have been reported in Martinique and Guadeloupe.

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

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

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning the French West Indies is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving in the French West Indies is on the right side of the road. Children under 12 are not legally allowed in the front seat. Seatbelt laws are strictly enforced.

The roads in the French West Indies are the best in the Eastern Caribbean. Roads are well paved and well maintained. Main roads are well marked; secondary roads and tourist sites are adequately marked. Excellent maps are available and local residents are helpful, especially if greeted in a friendly manner. Both Martinique and Guadeloupe have expressways. Traffic safety is enforced by the police. Night driving can be dangerous, especially in the mountains and on winding rural roads. Public transportation in the form of taxis, vans, and buses is relatively safe. For specific information concerning French West Indies driver's permits, vehicle inspection, road tax and mandatory insurance, contact the French National Tourist Organization offices at: http://www.franceguide.com/.

Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://www.securite-routiere.gouv.fr/index.html.

AVIATION SAFETY OVERSIGHT:
Civil aviation operations in the French West Indies fall under the jurisdiction of French authorities.
The U.S. Federal Aviation Administration (FAA) has assessed the Government of France’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of France’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES: In addition to being subject to all French laws affecting U.S. citizens, dual nationals may also be subject to other laws that impose special obligations on French citizens. Although France recognizes dual nationality, dual nationals are considered French citizens and are subject to French laws without regard to the other nationality. For additional information, please see our Dual Nationality flyer.

French customs authorities may enforce strict regulations concerning temporary importation into or export from the French West Indies of items such as firearms, medications, animals, etc. For questions, travelers may wish to contact the Embassy of France or a French Consulate for specific information regarding customs requirements. Please see our information on customs regulations.

The French West Indies 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) at: http://www.fema.gov/.
Please see 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 French West Indies’ laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the French West Indies 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 the French West Indies are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration web site, and to obtain updated information on travel and security within the French West Indies. Americans without Internet access may register directly with the U.S. Embassy in Barbados, which has jurisdiction over the French West Indies. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located in Wildey Business Park in St. Michael, Barbados; web site: http://barbados.usembassy.gov/.

The Consular Section is open for American Citizens Services from 8:30am to 4:00pm, Monday-Friday, except Barbados and U.S. holidays. For after-hours service, American citizens may contact the U.S. Embassy in Bridgetown, Barbados, telephone 1-246-436-4950. The U.S. Consular Agent in Martinique, Henry Ritchie, is located at the Hotel Valmeniere #615, Avenue des Arawaks, 97200 Fort de France, telephone (011) (596) (596) 75-6754, fax (011) (596) (596) 70-8501, mobile (011) (596) (696) 93-8406, email: hritchie@sbcglobal.net. Consular Agent Henry Ritchie is available Monday through Friday from 9:00am to 12:00pm, except French and U.S. holidays.
* * *
This replaces the Country Specific Information for French West Indies dated June 7, 2007, to update sections on Entry/Exit Requirements, Safety and Security, Traffic Safety and Road Conditions, Medical Facilities and Health Information, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu, 24 May 2018 11:39:42 +0200

Paris, May 24, 2018 (AFP) - The French government is preparing a plan to deal with a new invasion of stinky seaweed that is covering the beaches of some its islands in the Caribbean, causing health problems for residents and threatening key fishing and tourism industries.

The brown sargassum algae "is one more disaster for the West Indies, one which we here probably haven't fully taken into account," Environment Minister Nicolas Hulot told lawmakers in Paris late Wednesday.   Tons of the seaweed began arriving on the islands of Martinique and Guadeloupe several weeks ago, where it has piled up knee deep in some areas over large stretches of shoreline.

It soon begins decaying, producing huge amounts of hydrogen sulphide and other noxious gases which reek of ammonia or rotten eggs and can severely irritate the eyes, nose and throat.   The fumes also damage nearby houses and other property by eating away at metal, while also killing fish and fauna, hurting the local fishing industry.   Officials have closed schools near infested zones, while some islands have been cut off since supply boats and ferries cannot get past the thick banks of seaweed.

The French government has already unlocked three million euros ($3.5 million) of credits for supplying tractors, gas masks and other equipment to remove the seaweed -- though it often returns in a matter of weeks.   "Beyond the urgent response, a new national plan for combatting sargassum will be finalised by mid-June," Hulot said in parliament.   Although researchers are not sure why the seaweed suddenly begins proliferating in the region, "climate change is probably aggravating the problem," Hulot said.

Similar outbreaks have occurred in the Caribbean in recent years, often requiring officials to deploy the army to gather up the seaweed.   But officials then need to figure out what to do with it, since the fumes are so toxic that the algae cannot be used for producing biomass fuel, nor can it be turned into fertiliser.

Currently the only option is to spread it out across acres of isolated land until it fully decays and dries out.   This latest invasion comes as Guadeloupe, Martinique and other French islands are still rebuilding from devastating hurricanes that struck the Caribbean last September, causing millions of euros in damages.
Date: Tue, 19 Sep 2017 19:05:52 +0200

Pointe-à-Pitre, Sept 19, 2017 (AFP) - At least one person was killed as Hurricane Maria battered Guadeloupe, officials said Tuesday, in the first confirmed casualty from the huge storm sweeping the eastern Caribbean.     The person was killed by a falling tree, the local administration said, while two more were reported missing after their ship sank off Desirade, the easternmost island in the French territory's archipelago.   The dead person "did not respect orders to stay inside", authorities said in a statement, adding that "several floods have been signalled" around Pointe-a-Pitre, Guadeloupe's largest city.

Coastal areas around the capital Basse-Terre have also been "submerged".   "All of the archipelago's road networks have been affected by falling trees or branches," it said.   Little damage to buildings had been reported so far, though "some roofs have been ripped off".   Authorities said 40 percent of households in the territory of some 400,000 had no electricity, and 25 percent of landlines had been cut.   The US National Hurricane Center described Maria as "potentially catastrophic" as it pushed northwest towards the Virgin Islands and Puerto Rico.
Date: Wed 7 Jun 2017
From: Aubert Lyderic <lyderic.aubert@santepubliquefrance.fr> [edited]

Since May 2015, the French Caribbean territories experience an outbreak of viral conjunctivitis.

According to the general practitioners (GP) sentinel network, the number of medical consultations due to conjunctivitis during the last 2 weeks (W2017-20 and W2017-21) was estimated between 500 and 600 cases per week in Guadeloupe and 150 and 250 cases per week in Martinique.

The beginning of the outbreak in week 2017-20 [week 14 to 20 May 2017] was confirmed by the GP's network on the 2 territories. Their reports showed that the outbreak had spread in Guadeloupe Archipelago from Marie-Galante island and in Martinique, the center and the south of the island are currently the most affected areas. As of today [Wed 7 Jun 2017], around 35 percent of municipalities of the 2 territories do not report any case. The peak does not seem to have been reached.

In order to determine the etiology of this outbreak, biological samples were performed on conjunctiva and naso-pharynx from cases of conjunctivitis who consulted in emergency departments of the main public hospitals of both territories. The 1st analyses confirmed presence of enteroviruses with significant viral loads. Results from biological investigation of adenovirus are not yet known. Among the conjunctivitis specimens testing positive for enteroviruses, samples were sent to the National Reference Centre for Enteroviruses (Lyon, France) for further characterization.

Outbreaks of viral conjunctivitis occur mainly in tropical countries with high population density, hot and humid climate. They are mostly attributed to adenoviruses and enteroviruses (EV). Enteroviruses are ubiquitous pathogens responsible for a large range of infections. There is no specific antiviral treatment.

In the Caribbean and in the American region, several outbreaks of conjunctivitis have also been reported (Haiti, Dominican Republic, Mexico, French Guiana and Surinam) but the pathogen has not yet been identified.

The source of the week epidemiological bulletin (will be update soon at this link):
-----------------------------------
Aubert Lyderic
National Public Health Agency
Regional Office of French Caribbean Territories
lyderic.aubert@santepubliquefrance.fr
====================
[Conjunctivitis, also known as pinkeye, is an inflammation of the conjunctiva. The conjunctiva is the thin clear tissue that lies over the white part of the eye and lines the inside of the eyelid.

There are a number of different causes, including infectious agents such as Viruses (Adenoviruses, Enteroviruses), Bacteria (gonorrhea or chlamydia), or Allergies to dust, pollen, contact lenses.

Both viral and bacterial conjunctivitis are highly contagious. Each of these types of germs can spread from person to person in different ways. They are usually spread from an infected person to others through:
- close personal contact, such as touching or shaking hands
- the air by coughing and sneezing
- touching an object or surface with germs on it, then touching your eyes before washing your hands. <https://www.cdc.gov/conjunctivitis/about/transmission.html>.

Infectious conjunctivitis caused by some bacteria and viruses can spread easily from person to person, but is not a serious health risk if diagnosed promptly.

As confirmed by laboratory diagnosis in the above report, the causative agent for most of the tested cases was enteroviruses.

Most cases of viral conjunctivitis are mild. The infection will usually clear up in 7 to 14 days without treatment and without any long-term consequences. But in some cases, viral conjunctivitis can take 2 to 3 weeks or more to clear up. An antiviral medication can be prescribed to treat more serious forms of conjunctivitis for which there is a specific treatment, such as those caused by herpes simplex virus or varicella-zoster virus. Antibiotics will not improve viral conjunctivitis. - ProMED Mod.UBA]

[The HealthMap/ProMED maps can be found at:
Guadeloupe, Guadeloupe: <http://healthmap.org/promed/p/57615> and,
Martinique: <http://healthmap.org/promed/p/43638>. - ProMED Mod.MPP]
Date: Sat 8 Mar 2014
Source: European Centre for Disease Prevention and Control (ECDC), [edited]

Communicable Disease Threats Report (CDTR), week 10 (2-8 Mar 2014)
------------------------------------------------------------------
On 6 Dec 2013, France reported 2 laboratory-confirmed autochthonous cases of chikungunya in the French part of the Caribbean island of St Martin. Since then, local transmission has been confirmed in the Dutch part of Saint Martin [St Maarten], on Martinique, St Barthelemy, Guadeloupe, British Virgin Islands, Dominica, Anguilla, and French Guiana. Aruba only reported imported cases. This is the 1st documented outbreak of chikungunya with autochthonous transmission in the Americas. As of 6 Mar 2014, there have been close to 8000 suspected cases in the region. There have been 3 fatalities reported.

Update of the week
------------------
During the past week the number of new cases reported increased in some of the affected areas. No new affected areas or islands were reported. The islands affected are St Martin/St Maarten, Martinique, St Barthelemy, Guadeloupe, Virgin Islands (UK), Anguilla, Dominica, Aruba, Saint Kitts and Nevis, and French Guiana in mainland South America.
===================
[It is good to learn that there are no new localities reporting chikungunya virus infections, either locally acquired or imported. However, with new cases being reported in localities with previously reported cases, the risk of spread to other islands or mainland countries remains real. There is no further information concerning the suspected cases in Merida, Yucatan, Mexico reported in last week's update (see ProMED-mail archive no 20140302.2309812). It is important to know if these cases were confirmed or discarded.

Maps showing the location of the islands mentioned can be accessed at
Date: 3-9 Feb 2014
Source: Pointe Epidemiologique No. 6. French Caribbean Antilles [in French, trans. ProMed Mod.TY, summarized, edited]

Cases since November 2013:
  • St. Martin (susp.) 1450 cases, (probable and conf.) 653 cases.
  • St. Barthelemy (susp.) 270 cases, (probable and conf.) 104 cases
  • Martinique (susp.) 2040 cases, (probable and conf.) 844 cases; increasing
  • Guadeloupe (susp.) 1120 cases, (probable and conf.) 253 cases.

[Weekly graphs and maps for these case locations are provided in the above URL. ProMed Mod.TY]

Other Caribbean localities:
  • British Virgin Islands 6 locally acquired cases
  • St. Maarten 65 locally acquired cases
  • Anguilla 5 locally acquired cases, 1 imported case
  • Dominica 3 locally acquire cases, 1 imported case
  • Aruba 1 imported case from St. Maarten.
More ...

World Travel News Headlines

Date: Thu, 15 Nov 2018 04:25:14 +0100
By Javier TOVAR

Paradise, United States, Nov 15, 2018 (AFP) - The toll in the deadliest wildfires in recent California history climbed to 59 on Wednesday as authorities released a list of 130 people still missing.   Most of those unaccounted for are from the Butte County town of Paradise, in northern California, which was virtually erased from the map by the so-called "Camp Fire" blaze that erupted last week.   Butte County Sheriff Kory Honea told journalists Wednesday evening that 461 search and rescue personnel and 22 cadaver dogs were involved in the effort to locate those missing and DNA testing was being expedited to identify the victims.

"Beginning Thursday, anyone who believes a family member perished can provide a DNA sample" to the sheriff's office, Honea said.    Paradise, a town of around 26,000 in the foothills of the Sierra Nevada mountains, was popular with retirees and many of those reported missing by the sheriff's office are elderly -- in their 70s, 80s and 90s.

Virtually every home in Paradise, located 80 miles (130 kilometers) north of the state capital Sacramento, was destroyed by the fast-moving fire fueled by high winds.   At least 59 deaths have been reported so far from the devastating wildfires and body recovery teams were going house-to-house with cadaver dogs in Paradise on Wednesday.   "We are in the midst of a catastrophe," Governor Jerry Brown told a press conference. "The fire was unprecedented, overwhelming, so a lot of people got caught."

Brock Long, head of the Federal Emergency Management Agency (FEMA), said Paradise was looking at a "total rebuild" with many homes, businesses and infrastructure destroyed.   "This is going to be a very long and frustrating event for the citizens of Paradise," Long said. "We're going to have to find a new normal."   "You're not going to be able to rebuild Paradise the way it was."   An AFP reporter in Paradise on Wednesday saw crews removing trees, repairing fences along roads and towing away cars.    Authorities said livestock owners were being allowed in to restricted areas for brief periods to feed the animals but it was unclear when residents would be allowed back in.

- Tales of courage, survival -
Fifty-six deaths have been reported from the "Camp Fire," mostly in Paradise, while three people have died in the "Woolsey Fire."   Honea said that of the 56 human remains found in his county, 47 had been identified.   While the cause of the "Camp Fire" is still under investigation, a lawsuit has been filed against the local power company, PG&E, by fire victims claiming negligence by the utility.

The complaint alleged that the fire began on November 8 when a high voltage transmission line failed, igniting a vegetation fire.   As thousands of firefighters fought the fires, incredible tales have emerged of courage and survival.   A man who asked to be identified by only his first name, Scott, told the San Francisco Chronicle that when the "Camp Fire" surrounded his home in Concow in Butte County he and his family plunged into a reservoir along with a 90-year-old neighbor, Bruno.   "Bruno was saying, 'Just leave me. I can't do this,'" Scott, 51, told the newspaper. "I said, 'Bruno, we're not going to leave you. And I'm not going to burn, so you better hurry.'"   They remained in the cold water as flames licked the shore and made their way to a small island in the reservoir after finding a pair of rowboats.

- 'I was terrified' -
Allyn Pierce, a nurse in Paradise, told The New York Times and CNN how his life was saved by a bulldozer driver as he fled the town in his pickup truck along with other residents on Thursday.   Pierce said cars were catching fire around him and he dictated a goodbye message to his family, expecting his vehicle to catch fire next.   "I stayed calm but I was terrified," Pierce said.   "Then all of a sudden this bulldozer comes out of nowhere and knocks this burning truck out of the way," he said.   Instead of fleeing to safety, however, Pierce turned around and went back to the Adventist Health Feather River Hospital, where he works as an intensive care nurse, and helped evacuate patients to the hospital's helipad.   Pierce displayed pictures of his Toyota pickup truck which he said was still working despite lights which had melted and a rear passenger door which had been welded shut by the heat from the fire.

The "Camp Fire" has ravaged 135,000 acres (54,632 hectares) of land and is 35 percent contained, according to Cal Fire.   It has destroyed some 7,600 homes and 260 commercial properties. Battling the blaze are more than 5,600 fire personnel, some from as far away as Washington state and Texas.   The "Woolsey Fire" has razed 97,620 acres (39,505 hectares) and has been 47 percent contained.    Cal Fire said more than 3,500 fire personnel were battling the "Woolsey Fire," which has destroyed the Malibu homes of several celebrities including Miley Cyrus, Neil Young, Robin Thicke, Shannen Doherty and Gerard Butler.
Date: Wed, 14 Nov 2018 18:14:50 +0100

Kinshasa, Nov 14, 2018 (AFP) - A cholera epidemic in the Democratic Republic of Congo has claimed 857 lives since the start of the year, the World Health Organization (WHO) said Wednesday.   Health authorities have so far recorded 25,170 cases, occurring in 21 out of the country's 26 provinces, the WHO's office in the DRC said.

The provinces of East Kasai and Lomami, in the centre of the country, and South Kivu, Tanganyika and Upper Katanga in the east, are those most affected.   Last year, the country had 55,000 cases of cholera, resulting in 1,190 fatalities.   Cholera is a highly contagious bacterial infection, which can kill within hours if left untreated. It thrives in conditions of poor sanitation and contaminated water or food.    The DRC is also battling an outbreak of Ebola in two eastern provinces, North Kivu and Ituri, that has killed 212 people since August.
Date: Wed, 14 Nov 2018 18:00:49 +0100

Madrid, Nov 14, 2018 (AFP) - The Spanish government declared war on alternative medicine like acupuncture or homeopathy Wednesday, announcing it plans to eliminate from health centres what it considers a health risk.   The plan, unveiled by the science and health ministers, aims to avoid the "potential harmful effects" of these practices "when they are used as an alternative or a complement to treatment" which itself is based on "proof and scientific rigour," the government said in a statement.   It did not detail what it included as alternative medicine, but gave the examples of acupuncture and homeopathy.   "Many people still believe that some treatments work despite there being no scientific proof available," it read.   According to a 2016 poll, "59.8 percent believe that acupuncture is of therapeutic use and 52.7 percent think that homeopathic products work," the plan read.

The government said it wants to "eliminate" alternative medicine from health centres where all treatment must be given by "recognised" professionals.   The plan also wants to avoid alternative medicine being taught in Spanish universities by developing alliances with deans, chancellors or Spanish regional authorities to not give out diplomas linked to these practices.   Madrid also wants to modify legislation to fight "false advertising" with regard to alternative medicine online.   The issue has taken centre stage in Spain recently, with health and science professionals pressuring the health ministry to take action after several high-profile deaths.

One such case, as reported by Spain's Association to Protect Patients against Pseudo-scientific Therapies, involved 21-year-old Mario Rodriguez who died after dropping his hospital treatment for leukemia in favour of a supposed naturopath who said he could cure cancer with vitamins.   "Dad, I made a mistake," his father Julian Rodriguez quoted him as saying on his deathbed.   The association has a long list of treatment it considers alternative medicine, which includes aromatherapy, acupuncture -- in use in China for centuries -- and even psychoanalysis as created by Sigmund Freud.
Date: Mon 12 Nov 2018, 9.54 AM EST
Source: The Guardian [edited]

A Briton has died after contracting rabies while visiting Morocco, public health officials have said. The UK resident was infected with the disease after being bitten by a cat, Public Health England (PHE) said on [Mon 12 Nov 2018]. PHE did not release any further details but reassured the public there was no wider risk. It said health workers and close contacts of the deceased were being assessed and offered vaccination where necessary.

Jimmy Whitworth, the professor of international public health at the London School of Hygiene and Tropical Medicine, told the Press Association: "My understanding is that this is somebody who had contact with a cat that was behaving abnormally and sought care, I believe in Morocco and in the UK, but unfortunately didn't receive vaccination until it was too late. I believe that the cat bit this person a few weeks ago."

He said that symptoms typically took 2 to 3 months to appear but could materialise in as little as a week. "That's why seeking prompt care and getting vaccination is so important," he said. "In this tragic case the person didn't get the vaccine in time." Given the lack of information, Whitworth said it was impossible to know whether the delay was in the UK or Morocco but it illustrated the importance of health workers being aware of the possibility of the disease.

There are no documented instances of direct human to human transmission of rabies. The disease does not circulate in either wild or domestic animals in the UK, although some species of bats can carry a rabies-like virus.

[Rabies] is common elsewhere, including in parts of Asia and Africa. PHE said the case was a reminder to travellers to rabies-affected countries to avoid contact with dogs, cats and other animals wherever possible, and seek advice about the need for a rabies vaccine prior to travel.

Dr Mary Ramsay, the head of immunisations at PHE, said: "This is an important reminder of the precautions people should take when travelling to countries where rabies is present. If you are bitten, scratched or licked by an animal you must wash the wound or site of exposure with plenty of soap and water and seek medical advice without delay."

It is only the 6th case of human rabies in the UK since 2000, all but one caused by animal exposure overseas. The last was in 2012, when a woman in her 50s died in London after being bitten by a dog in South Asia. She was reportedly turned away twice by doctors at a hospital in Kent before she was finally diagnosed.  [byline: Haroon Siddique]
======================
[According to another media source, the victim, a 58 year old man from Aylesbury Bucks, was staying 30 miles away from the Moroccan capital Rabat, visiting family, when he was infected with the disease. He did receive treatment but allegedly was not given anti-rabies serum in time;  <https://www.dailymail.co.uk/news/article-6382379/PICTURED-British-father-two-died-rabies-UK.html>.

The following statistics on rabies in animals were submitted by
Morocco for 2016 (last available annual report):
Official vaccinations in dogs: 71 759
Rabies outbreaks: 76

species / cases / deaths / killed
dogs / 41 / 28 / 13
cats / 12 / 11 / 1
bovine / 71/ 62 / 9
equine / 44/ 38/ 6
ovine / 6 / 5 / 1

The numbers of human cases, as reported to the OIE for the years 2010-2015, were 19, 18, 19, 24, 20, and 19, respectively. The number of human cases during 2016 (the most recent available data) was 17.

The tourism industry is well developed in Morocco; in 2017, Morocco was Africa's top tourist destination, with 10.3 million tourist arrivals, most of them from Europe, predominantly France and Spain. In the past, cases of rabies in animals illegally introduced from Morocco with returning visitors were recorded in France

The event is being investigated. - ProMED Mod.AS]

[HealthMap/ProMED maps available at:
England, United Kingdom: <http://healthmap.org/promed/p/279>
Date: Tue 13 Nov 2018
Source: BC Centre for Disease Control [edited]

The BC [British Columbia] Centre for Disease Control (BCCDC) is alerting British Columbians to discard or return to the place of purchase any Little Qualicum Cheeseworks' Qualicum Spice cheese that they currently have at home. Products in the marketplace have a best before date up to and including 24 Apr 2019.

A total of 5 people in BC have been affected by an _Escherichia coli_ outbreak between August and October 2018. Qualicum Spice cheese samples were tested and found to be contaminated with _E. coli_. The investigation is ongoing to determine the source and extent of contamination.

Qualicum Spice is an unpasteurized cheese. It is distributed throughout BC and sold in grocery stores, farmers' markets, wineries, restaurants, and at the Little Qualicum Cheeseworks farmgate store. Little Qualicum Cheeseworks has voluntarily recalled the affected product. Little Qualicum Cheeseworks produces several other types of dairy products. No other products are being recalled at this time and consumers do not need to discard them.

People who become ill from _E. coli_ can have a wide range of symptoms. Some may have no symptoms and some may become seriously ill and be hospitalized. The following symptoms can appear within 1 to 10 days after infection:
- severe stomach cramps;
- diarrhea or bloody diarrhoea;
- vomiting;
- headache; and
- little or no fever

If you have eaten this product but have no symptoms, there is no need to do anything. If you become ill after consuming this cheese:
- practice good hand washing with warm water and soap to prevent the spread of illness;
- drink lots of clear fluids to stay hydrated;
- anyone who has bloody diarrhea or is concerned about their symptoms should see a health care provider or call HealthLinkBC at 811;
- antibiotics and anti-diarrhoea medications should not be used to treat this infection unless prescribed by your health care provider.
====================
[Although not specifically stated, the link to unpasteurized cheese and the description of the symptoms make it clear that the pathogen here is a member of the enterohemorrhagic _E coli_ pathotype.

Unpasteurized dairy products remain a potential risk for a variety of pathogens including enterohemorrhagic _E. coli_, either the prototypic serotype or one of the other serotypes. In analyzing the genetic and phenotypic profiles of non-O157 groups of EHEC [enterohemorrhagic _E. coli_], it has been found that they belong to their own lineages and have unique profiles of virulence traits different from the prototypic O157 strain (1). The serogroups appearing to be most prominent are O26, O111, O128, and O103 (2). As noted in the post, suspected cases of EHEC should not be treated with antimicrobials.

The following was extracted from Lutwick LI. Enterohemorrhagic _E. coli_ infections. In: Confronting emerging zoonoses: the One Health paradigm. Yamada A, Kahn LH, Kaplan B, Monath TP, Woodall J, Conti LA (editors). Tokyo, Japan: Springer, 2014, 77-112:

Risk factors for the subsequent development of HUS after EHEC include children less than 10 years of age, elevated white blood cell counts, persistent low platelet counts without reversal and the use of either antimicrobial agents or antimotility agents during the diarrhea stage before or after bloody diarrhea develops. Since fever is generally not part of the presentation but significant abdominal pain is, patients with diarrhea, significant abdominal pain and no fever should be considered to have EHEC infection, and antimicrobial or antimotility agents should be avoided. Additionally, certain strains -- for example, the so-called clade 8 and the chimeric organism _E. coli_ O104:H4 -- can be associated with a higher risk of HUS.

HUS itself is a thrombotic illness primarily caused by the effects of the EHEC produced Shiga toxin acting on the vascular endometrium of organs where the toxin's receptors are expressed, particularly the kidney and brain. The syndrome consists of the combination of prominent low platelet counts (thrombocytopenia), intravascular red blood cell destruction (hemolysis) and diminished kidney function that can require hemodialysis. Neurological involvement occurs mostly in those who develop renal failure and the central nervous system involvement portends much higher mortality. Indeed, most of the acute mortality relates to neurological disease. Most patients will recover, but some, perhaps 10 percent, remain with renal failure and require chronic hemodialysis.

References
----------
1. Schmidt H, Geitz C, Tarr PI, et al. Non-O157:H7 pathogenic Shiga-toxin producing _Escherichia coli_: phenotypic and genetic profiling of virulence traits and evidence for clonality. J Infect Dis. 1999; 179(1): 115-23; available at <https://academic.oup.com/jid/article/179/1/115/877122>.
2. Bettelheim KA. Role of non-O157 VTEC. Symp Ser Soc Appl Microbiol. 2000; (29): 38S-50S; abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/10880178>. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
British Columbia Province, Canada:
Date: Sun 4 Nov 2018
Source: Nigeria Center for Disease Control (NCDC) [edited]

Highlights
===========================
- In the reporting week 44 (29 Oct-4 Nov 2018) 5 new confirmed cases were reported from Edo (3), Ondo (1) and Ebonyi (1) state with 2 new deaths in Edo (1) and Ebonyi (1).
- From 1 Jan-4 Nov 2018, a total of 2950 suspected cases have been reported from 22 states. Of these, 553 were confirmed positive, 17 probable, 2380 negative (not a case).
- Since the onset of the 2018 outbreak, there have been 143 deaths in confirmed cases and 17 in probable cases. Case fatality rate (CFR) in confirmed cases is 25.9%.
- 22 states have recorded at least one confirmed case across 90 Local Government Areas (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo, Plateau, Lagos, Taraba, Delta, Osun, Rivers, FCT, Gombe, Ekiti, Kaduna, Abia, Adamawa and Enugu); 18 states have exited the active phase of the outbreak while 4; Edo, Ondo, Ebonyi and Delta states, remain active - figure 1 [see source URL above].
- In the reporting week 44 (29 Oct-4 Nov 2018), one new health care worker was affected; 42 health care workers have been affected since the onset of the outbreak in 7 states - Ebonyi (16), Edo (15), Ondo (6), Kogi (2), Nasarawa (1), Taraba (1) and Abia (1) with 10 deaths in Ebonyi (5), Kogi (1), Abia (1), Ondo (2) and Edo (1).
- 82% of all confirmed cases are from Edo (46%), Ondo (23%) and Ebonyi (13%) states.
- 10 patients are currently being managed at Irrua Specialist Teaching Hospital (ISTH) treatment Centre (4), Federal Medical Centre (FMC) Owo (4), and Federal Teaching Hospital Abakiliki (2).
- A total of 8587 contacts have been identified from 22 states. Of these 512 (6%) are currently being followed up, 7946 (92.5%) have completed 21 days follow up while 15 (0.2%) were lost to follow up. 114 (1.3%) symptomatic contacts have been identified, of which 36 (0.4%) have tested positive from 5 states (Edo - 20, Ondo - 8, Ebonyi - 3, Kogi - 3, Bauchi - 1 and Adamawa - 1).
- National RRT team (NCDC staff and NFELTP [Nigeria Field Epidemiology and Laboratory Training Program] residents) deployed Ondo state to support response.
- Lassa fever international Conference registration, abstract submission and travel scholarship now open to the public on the conference website <www.lic.ncdc.gov.ng> with the date for abstract submission extended to the 14 Nov 2018.
- Lassa fever national multi-partner, multi-agency Technical Working Group (TWG) continues to coordinate response activities at all levels

Figure 1 [map]: Distribution of confirmed Lassa fever cases in Nigeria as at 4 Nov 2018.
Figure 2 [map]: Distribution of suspected and confirmed Lassa fever cases in Nigeria by LGA.
Figure 3 [graph]: Epicurve of Lassa fever confirmed (548) and probable (17) cases in Nigeria week 1-44, 2018.
Figure 4 [graph]: Weekly trends of Lassa fever confirmed cases in Nigeria, 2016-2018, week 44.
Figure 5 [graph]: Confirmed Lassa fever cases in Nigeria with state-specific case fatality rates (CFR) as at 4 Oct 2018.
=======================
[Although the graphs in the above report clearly show that the Lassa fever virus transmission peak has passed, the 5 new confirmed cases and 2 new deaths indicate that Lassa fever virus transmission continues, and a few more cases might occur. Unfortunately, one health care worker was infected during this reporting period. This outbreak has been widespread, occurring in 22 states and 90 local government areas. It would be interesting to know whether the prevalence of Lassa fever virus has been increasing in populations of rodent hosts in this area.

Images of the rodent reservoirs of Lassa fever virus can be seen as follows:
For _Mastomys natalensis_, see
For _M. erythroleucus_ and _Hylomycus pamfi_, see

The maps and graphs in the report above are interesting and provide a good picture of how the outbreak has progressed over time. They can be accessed at the source URL above.

Maps of Nigeria:
Date: Mon 12 Nov 2018
Source: OIE, WAHIS (World Animal Health Information System), weekly
disease information 2018; 31(46) [edited]

Anthrax, Namibia
----------------
Information received on [and dated] 12 Nov 2018 from Dr Adrianatus Florentius Maseke, chief veterinary officer, Veterinary Services, Ministry of Agriculture, Water and Forestry, Windhoek, Namibia

Summary
Report type: immediate notification
Date of start of the event: 25 Oct 2018
Date of confirmation of the event: 1 Nov 2018
Reason for notification: recurrence of a listed disease
Date of previous occurrence: 13 Feb 2018
Manifestation of disease: clinical disease
Causal agent: _Bacillus anthracis_
Nature of diagnosis: clinical, laboratory (basic)
This event pertains to a defined zone within the country

New outbreaks (3)
Outbreak 1: Omiriu, Opuwo, Sesfontein, Kunene
Date of start of the outbreak: 25 Oct 2018
Outbreak status: continuing (or date resolved not provided)
Epidemiological unit: village
Affected animals
Species / Susceptible / Cases / Deaths / Killed and disposed of / Slaughtered
Goats / 537 / 25 / 23 / 2 / -
===================
[The location of the outbreaks can be seen on the interactive map included in the OIE report at the source URL above. Kunene is in north west Namibia, and Kavango East is between Angola & Botswana in the north east.
========================
[Remember it is summer in the southern hemisphere, which means that it is now their anthrax season. Livestock anthrax is sporadic in Namibia but a constant concern in their national parks. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map of Namibia:
Date: Tue, 13 Nov 2018 20:01:56 +0100

Tampa, Nov 13, 2018 (AFP) - Puzzled by a rise in US children with sudden paralysis in their arms or legs, health officials said Tuesday they are probing whether a virus or auto-immune disorder may be to blame.   A total of 252 cases of the disorder known as acute flaccid myelitis (AFM) are currently under investigation nationwide, an increase of 33 since last week, said Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the US Centers for Disease Control and Prevention (CDC).

With 80 confirmed cases so far this year, 2018 looks to be on pace with prior peak years like 2014 (120 cases) and 2016 (149 cases), Messonnier said.    More than 400 cases have been confirmed through lab tests since 2014, the first year the syndrome emerged.   A couple dozen cases were confirmed in 2015 and 2017.   Messonnier said she understands parents' alarm but stressed that the disorder remains "rare."   Most cases involve children aged two to eight. Almost all complained of fever and respiratory illness three to 10 days before suddenly experiencing paralysis in their arms or legs.   For some, the paralysis went away, but at least half have not recovered, said Messonnier.

The CDC has tested 125 spinal cord fluid samples, and half were positive for rhinovirus or enterovirus, which commonly cause symptoms like fever, runny nose, vomiting, diarrhea and body aches.    Yet scientists are still stumped about the precise cause of the sudden paralysis, since these viruses are common but AFM is not.   "We are trying to figure out what the triggers are that would cause someone to develop AFM," Messonnier told reporters.   "It may be one of the viruses we have already detected. It may be a virus that we haven't yet detected. Or it could be that the virus is kicking off another process that is actually triggering -- through an auto immune process -- AFM," she said.    "CDC is a science-driven agency. Right now, the science doesn't give us an answer."

Perhaps most frustrating for parents, there is no way to prevent it, and no targeted therapies or interventions.   "Parents and caregivers are urged to seek immediate medical care for a child who develops sudden weakness of the arms or legs," said the CDC latest report on AFM, released Tuesday.    Messonnier said the CDC has not been tracking every case of AFM since 2014, leading to gaps in the federal agency's knowledge of the illness, which experts are now trying to fill.   One child with AFM is reported to have died in 2017.
Date: Mon, 12 Nov 2018 15:54:12 +0100

London, United Kingdom, Nov 12, 2018 (AFP) - A Briton has died after being bitten by a cat with rabies in Morocco, officials said Monday, only the seventh known case in the United Kingdom since 2000.   England's health service issued a reminder Monday for travellers to avoid coming into contact with animals when travelling to rabies affected countries, particularly those in Asia and Africa.

Rabies has been effectively eradicated in Britain, although they do still spread among some bats.   "There is no risk to the wider public in relation to this case but, as a precautionary measure, health workers and close contacts are being assessed and offered vaccination when necessary," said Mary Ramsay, the health service's chief of immunisation.   The Press Association news agency said the person was bitten a few weeks ago and not given potentially life-saving treatment early enough.

Rabies is a viral disease that causes an inflammation of the brain. It is usually fatal by the time the first symptoms emerge.   England's health service said that no cases of humans acquiring the disease from any animal other than a bat have been recorded within the country since 1902.   One person acquired it from a bat in Scotland in 2002, and five people contacted while travelling between 2002 and 2017, the health service said.
Date: Tue, 13 Nov 2018 07:02:37 +0100

Hanoi, Nov 13, 2018 (AFP) - Vietnam's newest carrier Bamboo Airways has been granted a licence to fly, officials and the airline said, paving the way for its inaugural flight in a region crowded with competitors.    Run by one of the country's richest men, Bamboo will compete with well-established heavy hitters such as national carrier Vietnam Airlines and budget carrier Vietjet to serve a mushrooming middle class with growing appetites, and budgets, for travel.    Vietnam's Transport Ministry said Bamboo's official aviation license had been approved and that it would aim to operate 100 routes, including to lesser-travelled destinations in Vietnam and elsewhere in Asia, with plans to eventually fly to North America.   "The first domestic flights... are aimed at reducing pressure on aviation infrastructure in major cities, strengthening regional links (and) promoting tourism to Vietnam," the Transport Ministry said in a statement Tuesday.

The airline is owned by Trinh Van Quyet, who heads the FLC property empire that includes lush beachside resorts, golf clubs and luxury condos across Vietnam, a country still under one-party communist rule.   Bamboo has already signed up to buy 20 of Boeing's 787 Dreamliners worth $5.6 billion and committed a further $3.2 billion to buy 24 Airbus A321neo planes.    The airline said its inaugural flight, originally scheduled for last month, should take place before the end of the year.    "We have conducted a flight test, the results show that the aircraft fully meets technical specifications (and is) ready to go into operation," CEO Dang Tat Thang said in a statement.

Bamboo is hoping to steal customers from competitors by luring them to off-the-beaten-path destinations in Vietnam such as Quy Nhon and Thanh Hoa and by offering bundled travel packages to FLC resorts.   But analysts say the outdated model may not work in an era where most travellers can easily tailor holidays online, and wonder whether Bamboo's big bet will pay off in Southeast Asia's busy aviation market.    Quyet told AFP in an interview earlier this year that he is certain the airline "will be huge" and expects to make a profit soon after launch.   Born to a poor rural family near Hanoi where life among bamboo trees inspired the airline's name, he now runs FLC Group with a market capitalisation of around $200 million.

Vietnam's aviation sector has soared in recent years, with passenger numbers jumping to 62 million last year from 25 million in 2012.   There are already six commercial aviation licenses granted in Vietnam, including for a chartered helicopter service and a seaplane carrier.   Faced with increasingly squeezed airport capacity and tough competition across the region, in particular from budget airlines like AirAsia and TigerAir, the market has shown signs of cooling.    In 2009, Vietnam's first operational private airline Indochina Airlines ceased operation after just one year in the market due to financial troubles.