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Greece

Background
Greece offers a great variety of attractions for the international traveller. A beautiful climate linked with great beaches, a vibrant nightlife and historical monuments to rival any other location throughout the world. All of this located
within western Europe and a short flight away from many of the cooler northern destinations - like Ireland. Travellers from these regions descent on Greece in very significant numbers each year and for the vast majority of them they will have a splendid and healthy time. However for some this may not be the case and serious illness and accidents are regularly reported. Following some commonsense rules would go a long way to avoiding disaster and ensuring that this trip is truly one to be remembered for all the right reasons.
Climate
Situated in southern Europe the country enjoys mild winters but very hot summers. There may be occasional cool breezes (meltemia) but these can serve only to fool the traveller into thinking that they are unlikely to burn. Rain is very uncommon during the height of summer (July and August) and all travellers should be advised to use very adequate sun-block lotion at all times.
Slip, Slop, Slap
Following the Australian mantra of Slip, Slop and Slap makes perfect sense. Slip on a shirt, slop on sunscreen and slap on a hat when out and about during the day and this should help protect against the intense suns rays. Nevertheless, despite all their best intentions, travellers get burnt. This is particularly a problem in the first few days after their arrival when they do not realise the intensity of the suns rays and how easily they can be exposed. Falling asleep beside the hotel's swimming pool or on the beach is a very common problem and must be avoided against. The tips of the ears, shoulders (especially along the bra-strap line, ankles and behind the knees are commonly exposed and forgotten areas.
After Sun care
To treat significant sunburn it is important to increase fluid intake but also to take extra salt on your food (unless medically contraindicated for some specific condition like high blood pressure etc). Soothing water soluble lotions (especially ones containing a mild anaesthetic and/or steroid cream) are probably best but certainly avoid any of the ones which paste the skin with a thick layer - which is almost impossible to remove without causing serious pain! The more severe sunburn cases may need medical care and even hospitalisation which really ruins a holiday.
Food & Water
As a European destination Greece has a good level of food and water hygiene. Unfortunately this can vary - especially as you move away from the main tourist destinations and also as the summer temperatures rise and food goes 'off' more quickly. Eating hot food, avoiding cold foods (side-salads, lettuce etc) and never eating undercooked bivalve shellfish (mussels, oysters, clams etc) makes perfect sense. Eating food or taking fruit juice drinks from street vendors is a risk just not worth taking.
Insect bites
There may be both mosquitoes and sandflys about so having good repellents (DEET based ones) is worthwhile. The biggest problem will be early in the morning and towards the end of the daylight hours. However sitting in the shade while having lunch may be nice and cool but it is also often a place where these insects tend to hover looking for their next meal. Just don't allow that meal to be the blood in your unguarded ankle!
Seeing the Monuments
As mentioned previously Greece is covered with ancient monuments and these attract many thousands of tourists each year. The ruins are often not the most hospitable places for sun-sensitive tourists so taking care against the suns rays is essential - especially while standing carefully listening to the tour guide explain some complicated piece of history while the back of your legs get roasted! The other issue, for those trekking through the ruins, is the distinct possibility of a nasty twisted ankle.
Laser Night shows
Many of the ancient sites have beautiful night shows which depict something of the past splendour and are definitely worth seeing. However it is wise to wear good shoes as stumbling across loose stones is a particular problem at night and also bring a small torch, if possible, to guide your way. Getting separated from your travelling companions, or not being able to find your return bus, can lead to some understandable panic so listen carefully to any instructions and look out for some land marks before you get too far away into the night time crowd.
Animal bites
Some tourists may forget that rabies is a problem in many countries throughout the world and, even though Greece is regarded as rabies-free', there is always a problem if someone should get bitten. The possibility that this animal could have been recently smuggled into the country cannot be out ruled and so many would advise full post exposure treatment should this contact occur. Children may be at particular risk due to their inquisitive nature.
Swimming
Sunburn and swimming go hand in hand but drowning can also occur all too frequently within this region. Strong currents, swimming after meals (or alcohol) and the ever popular romantic midnight swim are all serious risk factors. Also children running around the deep end of the pool may lose their footing and topple in without warning. Unfortunately a very small child sinks instantly with very little sign of the emergency to those close by. Parents need to keep aware of this risk at all times.
The summer working holiday
Many of our students head towards Greece for 2 to 3 months during the summer to work. The attractions are obvious but commonsense and sensible life-style choices are needed throughout their stay to lessen the risk of illness or them returning home with an infection they had not bargained for. Unfortunately many return home with life-long illnesses which have been contracted from a single unprotected sexual contact.
Vaccinations for Greece
As a general rule the usual travel vaccines are not recommended for most short-term travellers to this region. However for the student planning to spend a more prolonged period it would be sensible to consider cover against both Hepatitis A and Hepatitis B and also to check that their Tetanus cover is up-to-date.
Summary
This is still one of the most popular destinations for northern European travellers and, in the vast majority of cases, they will have a fantastic time with only good memories. Unfortunately some less prepared folks will end up with serious sunburn and other illnesses or diseases which perhaps are frequently associated with their own lack of care and protection rather than anything specific to this beautiful country.

Travel News Headlines WORLD NEWS

6th December, 2019
HSE Health Protection Surveillance Centre

On 27/11/2019, a possible case of diphtheria was reported to the Department of Epidemiological Surveillance and Intervention through the Mandatory Notification System in Greece. It concerned an 8 years old boy of Greek nationality, who was hospitalized in the ICU of General Children's Hospital  where he died.  This child had underlying conditions (severe pulmonary hypertension) and was admitted to ICU  on 22/11/2019 with clinical presentation of laryngitis (without the presence of characteristic pseudo membranes) and pneumonia, immediately intubated, covered with double antibiotic regimen and died due to deterioration of his clinical presentation on 26/11/2019.
 
According to the epidemiological data given , there is no travel history, group living, no connection to another case and the child does not belong to a specific population group. Regarding his immunization status, the child was vaccinated with at least 3 doses against diphtheria-tetanus-pertussis.
 
Laboratory investigation of bronchial exudate isolated Corynebacterium diphtheriae via VITEK. Further laboratory testing was performed by the Public Health England  reference Laboratory for Corynebacteria. On Thursday 5/12/2019, the National Public Health Organization was informed that multiplex PCR testing was positive for C. Diphtheriae and positive for the diphtheria toxin gene. The Elek test was also positive for toxin production. The results of the child's post-mortem exam are pending.

Contact tracing and management is ongoing and has identified most of the close contacts of the patient. The National Public Health Organization provided recommendations on obtaining nasopharyngeal cultures in close contacts to evaluate carriage as well as the necessary preventive measures to protect the child's close contacts as well as the medical staff involved in direct patient care (i.e. awareness for potential compatible with diphtheria symptoms and administration of antibiotic prophylaxis together with booster or complete vaccination series as appropriate) according to the WHO’s Diphtheria Surveillance Standards (September 2018). In addition we have initiated the procedure for the procurement of a limited stockpile of DAT.
Date: Wed, 27 Nov 2019 09:20:47 +0100 (MET)

Athens, Nov 27, 2019 (AFP) - A strong 6.1-magnitude undersea earthquake shook the Greek island of Crete on Wednesday and was felt in other parts of the country, officials said.   "It was a major earthquake, the whole island shook but fortunately so far no damage has been reported," Crete regional governor Stavros Arnaoutakis told state TV ERT.   The Athens observatory said the quake struck at 9:23 am (0723 GMT) and had a depth of over 70 kilometres (44 miles).

The tremor occurred a day after a 6.4-magnitude earthquake in Albania that has left more than 20 dead and hundreds injured.   Shortly after the Albania tremor, a 5.4-magnitude shock hit Bosnia, the European-Mediterranean Seismological Center reported on Tuesday.   Greece lies on major fault lines and is regularly hit by earthquakes but they rarely cause casualties.   In July 2017, a 6.7-magnitude earthquake killed two people on the island of Kos in the Aegean sea, causing significant damage.
Date: Wed, 2 Oct 2019 12:31:30 +0200 (METDST)

Athens, Oct 2, 2019 (AFP) - Greek workers staged a fresh 24-hour strike Wednesday against government plans to deregulate the labour market, paralysing road and rail transport, closing banks and shutting down news outlets.   Buses and trams stayed in their depots, the Athens metro was shut down and ferries serving islands on both sides of Greece stayed in port. The action also hit rail services, including to Athens airport.   Banks were closed Wednesday and Poesy, the journalists' union, said there would be no news bulletins over the 24-hour strike period.

The strike caused long traffic jams in Athens as the GSEE, the largest union representing private-sector workers, organised a rally in the city centre to protest the planned legislation.    It denounced "the suppression of collective conventions" and what it said was an assault on the unions.   This was the second strike in a week against the planned reforms of conservative Prime Minister Kyriakos Mitsotakis, which he argues will open the way to investment and encourage growth of more than two percent.   A strike last week hit transport, hospitals, schools and the courts.   The unions say the proposed reforms will undermine collective agreements and make it harder to organise strikes.

The proposed law would require a more-than 50 percent turn-out of the workforce in any strike vote for it to be valid.   Union leaders have also denounced a law passed in August which they say makes it easier to sack people in the private sector.   Adedy, the federation of public-sector unions, which organised last week's strike, called on its members to join Wednesday's action.   Mitsotakis came to power in July, replacing the left-wing government of Alexis Tsipras.
Date: Thu 12 Sep 2019, 7:54 PM
Source: Ekathimerini [edited]

The death toll from the West Nile virus since June this year has risen to 20, according to this week's report by the National Health Organization (EODY).

Up until [12 Sep 2019], authorities had diagnosed a total of 176 cases of the mosquito-borne virus. Of these, 109 developed illnesses affecting the central nervous system such as encephalitis or meningitis.

EODY is urging the public to spray insect repellent on bare skin and clothing, to install mosquito nets and screens, to remove stagnant water from basins, vases and gutters, to regularly mow lawns and to water plants in the morning.
=============================
[The first report mentions 20 fatal human cases as compared to the latest ECDC update that mentions 19 and the total case number is 176 versus 171 (ECDC report).

West Nile fever is a disease caused by West Nile Virus (WNV), which is a _Flavivirus_ related to the viruses that cause St. Louis encephalitis, Japanese encephalitis, and yellow fever. It causes disease in humans, horses, and several species of birds. Most infected individuals show few signs of illness, but some develop severe neurological illness which can be fatal. West Nile Virus has an extremely broad host range. It replicates in birds, reptiles, amphibians, mammals, mosquitoes and ticks <https://www.oie.int/doc/ged/D14013.PDF>.

The reservoir of the virus is in birds. Mosquitoes become infected when they bite an infected bird ingesting the virus in the blood. The mosquitoes act as carriers (vectors) spreading the virus from an infected bird to other birds and to other animals. Infection of other animals (e.g. horses, and also humans) is incidental to the cycle [as also evident in the ECDC update above] in birds since most mammals do not develop enough virus in the bloodstream to spread the disease.

Key to preventing the spread of West Nile fever is to control mosquito populations. Horses should be protected from exposure to mosquitoes. Likewise, people should avoid exposure to mosquitoes especially at dusk and dawn when they are most active, use insect screens and insect repellents, and limit places for mosquitoes to breed. - ProMED Mod.UBA]

[HealthMap/ProMED maps available at:
Date: Sun, 15 Sep 2019 15:38:29 +0200 (METDST)

Athens, Sept 15, 2019 (AFP) - More than 160 firefighters on Sunday battled to contain a large fire near Athens blazing for a second day amid gale force winds, officials said.   And in another emergency, authorities evacuated dozens of people from two villages and a hotel on the island of Zakynthos after a new fire broke out on Sunday.

The fire department said the blaze near Athens burned in the mountains above Loutraki, a coastal resort some 60 kilometres (35 miles) west of Athens.   "The fire is burning near the top of the mountain," Stefanos Kolokouris, the fire department's deputy chief of operations, told state TV ERT.   "We are trying to create a perimeter but the terrain is very difficult, with ravines," he said.   Four water bombers and six helicopters were participating in operations. Given a lack of roads in the area, two squads of firefighters had to be carried to the mountaintop by Super Puma helicopter, state agency ANA said.   Officials had already evacuated 50 people from a local monastery when the fire broke out on Saturday, but stressed that other inhabited areas were not in danger.

On Zakynthos, officials ordered the evacuation of the villages of Agalas and Keri in the south of the island. Some 120 tourists were also relocated to a safe area.   The Greek fire department on Sunday said it had been called to nearly 80 fires over the past 24 hours.   It has already faced more than 9,600 rural and urban fires this year.
More ...

Indonesia

*****
Information for Bali
*******
General
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Bali is one of the main tourist destinations for many Irish travellers to Indonesia. The island is well developed for the tourist industry and genera
ly the climate is tropical and humid throughout the year. Many Irish travellers will use the island as a stopover. If this is for only 24 to 28 hours the extent of your jetlag may leave you little time to enjoy the country and its people.
Safety & Security
************************************
Throughout Indonesia there are many regions where it is unsafe to travel. The Parliament in Indonesia may impeach the President in the near future. Civil disturbance with student demonstrations in the capital Jakarta, earthquakes in the island of Sumatra, unrest regarding the independence of Timor and profound warring fractions on the island of Borneo has the potential to spill over into Bali. Nevertheless during the past years Bali has remained stable and there have been few reports of serious disturbances that have affected tourists or business travellers. Lombok is an island close to Bali often visited by tourists. It is regarded as more unstable and recently (Dec 2000) four explosions during fighting between two villages (Bongor & Parampuan). The main tourist region around Senggigi has remained quiet.

Local Customs
************************************
The laws against illegal drugs are severe and travellers should ensure that they carry sufficient well-marked medication that they may require for their time in Indonesia. Travellers are required to show identification at any time and so carrying photocopies of your passport is a wise precaution. Keep all valuable documents in a safe place and do not flaunt personal wealth while travelling around the island.
Night Activities
************************************
The nightlife in Bali is one of the main attractions for many tourists but sensible precautions are required. Travelling alone is unwise. Take care to ensure that your drink could not be spiked at any stage and do not walk at night, use an authorised taxi where possible. The level of HIV infection among the bar workers is high and close personal contact is very unwise.
Medical Facilities
************************************
The level of available health facilities varies greatly through Bali and other parts of Indonesia. In general most of the main hotels will have English speaking doctors but care would be required if your illness requires hospitalisation.
Food and Water
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It is wise to maintain a high level of care with regard to your food and water while in Indonesia. This includes even those in high quality hotels but also particularly for those eating from street vendors. Bivalve shellfish (e.g. oysters, mussels, clams etc) should be avoided at all times due to inadequate cooking. Bottled water should be purchased from your hotel or good quality shops to ensure that it is pure.
Mosquitoes and Insect Bites
************************************
Malaria transmission occurs throughout Indonesia all year but the risk in Bali is so low that prophylaxis is not generally recommended for most tourists. Nevertheless for those visiting Lombok (overnight visits) the risk exists and prophylaxis should be considered. Other mosquito borne diseases also occur throughout Indonesia and care must be taken to avoid insect bites. In Jakarta and other main cities there is a particular problem with a viral disease called Dengue Fever. The mosquito, which transmits this disease, typically bites during the day and in main urban centres.
Sun Exposure
************************************
The strength of the sun in Bali is considerable higher than that experienced in Ireland at any time of the year. Sufficient head covering should be worm when exposed and travellers should ensure that their fluid intake is sufficient. Salt depletion also needs to be replaced in times of significant perspiration.
Swimming
************************************
If swimming in pools, make sure that sufficient chlorination has been used. Take care with small children when close to the deep end of the pool. If sea swimming make sure that there are always others around and that you heed any local advice and warning signs. Never swim soon after alcohol or for an hour after mealtime.
Jet Lag
************************************
The extent of jet lag, which you will experience, depends on the duration of your flight and the amount of rest you were able to get before arrival. Try to rest for the first 24 hours to allow your body to acclimatise and make sure you do not fall asleep beside the swimming pool during this initial period.
Vaccinations for Bali
************************************
There are no essential vaccines or entry to Bali from Western Europe. However for your personal protection travellers are recommended to consider vaccination cover against;
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food & water disease)
*
Hepatitis A (food & water disease)
Other travellers planning a more rural or extensive trip may need to consider other vaccine cover against diseases like Hepatitis B, Japanese B Encephalitis, Rabies.
Summary
************************************
The majority of those visiting Bali will enjoy the many tourist attractions on the island. However commonsense and care is required to ensure that you do not expose yourself to unnecessary risk. The staff of the Tropical Medical Bureau can be contacted at either of the numbers below if you require further information.

Travel News Headlines WORLD NEWS

Date: Tue, 7 Jan 2020 08:03:39 +0100 (MET)

Banda Aceh, Indonesia, Jan 7, 2020 (AFP) - A strong earthquake jolted Indonesia's northwest on Tuesday, but no tsunami warning was issued and there were no immediate reports of injuries or damage.   The 6.2 magnitude quake struck at a depth of 20 kilometres (12.5 miles) just off the coast of Simeulue island, west of Sumatra, according to the US Geological Survey.   Indonesia's weather and geophysics bureau said there was no tsunami threat.   People panicked and ran outside their homes when the quake hit.    "We are now watching at the beach to monitor the movement of seawater," Simeulue resident Ahmadi told AFP.

No casualties or infrastructure damage have been reported so far.   Indonesia suffers frequent seismic and volcanic activity due to its position on the Pacific "Ring of Fire", where tectonic plates collide.   More than 2,200 people died and another 1,000 were declared missing in 2018 after a 7.5 magnitude quake and subsequent tsunami on Sulawesi island.   A 9.1 magnitude earthquake on Boxing Day in 2004 struck Aceh province, causing a tsunami that claimed the lives of more than 170,000 people in Indonesia alone.
Date: Mon, 6 Jan 2020 09:59:14 +0100 (MET)

Jakarta, Jan 6, 2020 (AFP) - Indonesians were told on Monday to brace for more heavy downpours after record rains triggered flooding and landslides that authorities said had killed at least 66 people in and around Jakarta.   Whole neighbourhoods in the capital -- a megalopolis home to around 30 million people -- were submerged last week by floodwaters that forced tens of thousands into temporary shelters.

Authorities have warned residents to take precautions and safeguard their possessions ahead of more pounding storms over the coming weeks.   "There is still potential for mid to heavy rainfall with lightning, thunder and strong winds" in greater Jakarta, Indonesia's weather bureau said in a statement Monday.   Last week's deluge was the heaviest in the capital since record keeping began in the 19th century, the agency said, leading to the city's deadliest flood disaster in years.   Some 377 millimetres (14.8 inches) of rain pounded sections of the vast city, with floodwaters reaching up to the second floor of some buildings after rivers overflowed.

At least two people in Jakarta's west were hospitalised on Monday after the collapse of a five-storey building, which Indonesia's search and rescue agency said may have been caused by a build-up of rainwater.    Authorities said Monday the death toll had climbed again to 66 with two more reportedly missing in Lebak, west of the capital.

Flash flooding killed more than half a dozen people in Lebak, including a seven-year-old boy who was reportedly swept away by the water.   Thousands remained in cramped Jakarta shelters Monday as authorities pushed to reach isolated communities outside the city affected by the disaster.   A day earlier, health workers and soldiers sprayed ravaged parts of the capital with disinfectant in a bid to prevent disease outbreaks.
Date: Wed, 1 Jan 2020 13:29:14 +0100 (MET)

Jakarta, Jan 1, 2020 (AFP) - Nine people died after Indonesia's capital was hit by its deadliest flooding in years, authorities said Wednesday, as torrential rains on New Year's Eve left vast swathes of the megalopolis submerged.   Thousands were evacuated to temporary shelters as electricity was switched off in scores of waterlogged neighbourhoods across greater Jakarta, home to about 30 million people, with some train lines and one of the city's airports also shut.   Indonesia's National Disaster Mitigation Agency called on residents to leave flood-hit areas.   "The first priority is saving lives," said agency head Doni Monardo.

A 16-year-old was electrocuted by a power line, while three more people died of hypothermia, according to the disaster agency.   "My son's body was covered with newspaper when my two other children passed by," said Fadrid, who identified himself as the dead teen's father.   "People asked them whether they knew the victim. If they hadn't been passing by, we wouldn't have known my son had been killed," he told AFP.

Among the victims was an elderly couple trapped inside their home in a district where floodwaters reached as high as four metres (13 feet) after a river burst its banks.   Another victim drowned while four people were killed after the Tuesday evening downpour triggered landslides in the city's outskirts.    "We have shut down power (in many areas) to avoid more electrical shocks," Ikhsan Asaad, an official at state firm PLN, told AFP.

Asaad said he could not estimate how many residents had been affected by the power shutdown.   "We're currently focusing on taking measures to ensure people's safety," he added.   Angelina Widiyanti was among scores of residents whose houses were flooded with their possessions ruined by the disaster.   "We've had flooding several times before but it was never this high," she said from her home, where the power had been cut.   "We weren't prepared for this."

Authorities said about 19,000 people were evacuated, but that figure did not include residents in Jakarta's satellite cities.   "We're evacuating people right now," Jakarta governor Anies Baswedan told reporters.   "Everyone living near rivers should anticipate (more) flooding," he added.   Images from across the region showed waterlogged homes and cars submerged in muddy floodwaters, while some people took to paddling in small rubber lifeboats or tyre inner-tubes to get around.

The disaster marked Jakarta's worst flooding since 2013 when several dozen people were killed when the city was inundated by monsoon rains.   Jakarta is regularly hit by floods during Indonesia's rainy season, which started in late November.   On Wednesday, service at Halim Perdanakusuma airport, which handles commercial and military planes, was temporarily shut due to severe flooding on its runways, according to the transport ministry.   Many flights were transferred to Jakarta's main Soekarno-Hatta International Airport.
Date: Mon 23 Dec 2019
From: A source known to ProMED-mail [edited]

A cluster of cases from Perth, Western Australia (WA), has been identified as having _Legionella pneumophila_ serogroup 1 (laboratory confirmed), with all 4 cases having holidayed in Bali, Indonesia, and stayed at the same hotel in Central Kuta, during their incubation period -- the Ramayana Resort and Spa, located on Jalan Singosari.

A media statement can be found at

Onset dates for the 4 WA cases were [4 Feb to 30 Nov 2019], after their return to Australia. All 4 cases became unwell with severe pneumonia requiring hospitalisation. It seems most probable that they were infected in Bali, most likely at their hotel. Information provided by the cases and those with whom they travelled has not identified places that all frequented other than the hotel and airports. An additional 2 cases of legionnaires' disease have been identified from elsewhere in Australia in 2019, both of whom travelled to Bali independently of each other; one stayed at the same hotel as the WA cases and the other at the hotel adjacent to it.

The same hotel was implicated in a previous international outbreak of legionnaires' disease between August 2010 and November 2011, which affected a total of 13 Australians, including 9 people from WA.

Please consider the diagnosis of legionellosis in people with consistent illness recently returned from Bali.
====================
[ProMED-mail previously posted several news reports in 2010 and 2011 of an outbreak of legionnaires' disease due to _Legionella pneumophila_ serogroup 1 that involved 10 Australians (6 from Western Australia and 4 from Victoria) who visited Bali, 9 of whom stayed at the Ramayana Hotel in Central Kuta (Legionellosis - Australia (03): ex Indonesia (Bali) alert http://promedmail.org/post/20110610.1759 Legionellosis - Australia (02): ex Indonesia (Bali) alert http://promedmail.org/post/20110119.0226 Legionellosis - Australia: (WA,VI) ex Indonesia (Bali) http://promedmail.org/post/20110115.0173 Legionellosis - Australia: (WA) ex Indonesia (Bali) alert http://promedmail.org/post/20100826.3021). There were said to be at least 2 additional cases in Europeans linked to Bali in the same time-frame, one of whom stayed in this hotel.

The current post above reports 4 cases of legionnaires' disease in Western Australians who stayed at the same hotel (Ramayana Resort and Spa) in 2019 in Central Kuta.

_Legionella_ are Gram-negative bacilli that are found in both natural freshwater environments, like lakes and streams, and in manufactured plumbing systems, such as showerheads and sink faucets, cooling towers, decorative fountains, and hot tubs/spas and hot water tanks and heaters. Eradication of these bacteria from plumbing systems is often difficult. Long-term persistence within these water systems is favored by the intracellular location of _Legionella_ within several species of protozoa, where _Legionella_ replicate and which provide protection from environmental stressors, like biocides and heat treatment; the formation of biofilms allows adherence of _Legionella_ to the inner surfaces of the plumbing systems (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835138/>). _L pneumophila_ have been shown to persist for long periods after exposure to a biocide or heat treatment in biofilms in a viable but nonculturable (VBNC) state (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515819/>). Monitoring _L. pneumophila_ in water systems usually done by culture would miss VBNC [viable but nonculturable] _Legionella_, which can be revived by the subsequent addition of ameba (<https://www.ncbi.nlm.nih.gov/pubmed/18839249>). The persistence of _Legionella_ over many years in the water system at the Kuta facility could perhaps be due to VBNC organisms.

According to the US CDC, about 20-25% of all legionnaires' disease reported to CDC is travel-associated (<https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5648a2.htm> and <http://wwwnc.cdc.gov/travel/yellowbook/2016/conveyance-transportation-issues/cruise-ship-travel>). Travellers typically disperse to their homes widely separated from one another and perhaps at a very great distance from the source of infection before developing symptoms, so that a cluster of cases of legionnaires' disease in travellers associated with the same source may not be readily appreciated. A travel history is essential and should be actively sought from patients with community-acquired pneumonia, and _Legionella_ testing should be performed for those diagnosed with community-acquired pneumonia who have traveled in the 2 weeks before onset of symptoms.

Genotyping the clinical isolates from the 4 cases of legionnaires' disease will help confirm if this is a common source outbreak, if the genotypes match. Matching the genotypes of clinical and environmental isolates of _Legionella_ will identify the environmental source for the individual cases. However, if the diagnosis of legionnaires' disease in these patients was based only on a positive urinary antigen assay for _Legionella pneumophila_ serogroup 1, there will be no clinical isolates for genotyping.

Kuta, the capital of Kuta District, in Badung Regency, southern Bali, Indonesia is a tourist beach resort, with many restaurants and bars, located near Bali's Ngurah Rai Airport (<https://en.wikipedia.org/wiki/Kuta>).

A map of the island of Bali can be accessed at
<https://capturetheatlas.com/bali-map/>.

Kuta, on the island of Bali and Perth in the Australian state of Western Australia can be seen on the HealthMap/ProMED-mail interactive maps at <http://healthmap.org/promed/p/3047> and <http://healthmap.org/promed/p/456>, respectively. - ProMED Mod.ML]
Date: Fri 29 Nov 2019
Source: Tempo [edited]

The local administration of Depok has finally elevated the status of its hepatitis A outbreak and considers it to be a full-blown extraordinary occurrence (KLB), compared to its previous partial KLB.

The head of Depok Health Agency, Novarita, said the increased health warning was mainly attributed to the fact that hepatitis A still loomed over SMPN-20 junior-high students in the City of Depok. "Based on our data, the spread is not limited to SMPN-20 students but has also spread further. That is why we changed the outbreak's status to KLB," said Novarita during her visit to the school today, 29 Nov 2019.

This has effectively pushed the city to provide a budget to overcome the outbreak. She said that every sufferer of hepatitis A under the KLB status would receive medical treatment for free from 20 Nov 2019 - 20 Jan 2020. "The bills will be paid by the Depok City administration," she said.

Depok's records state that 9 hepatitis A patients were receiving treatment at the Depok City General Hospital from the 15 SMPN-20 students who were initially admitted to the hospital.
====================
[It is unusual to see outbreaks of hepatitis A in the developing world, as sero-surveys suggest close to 100% seropositivity by age 10 from asymptomatic infection earlier in childhood. The diagnosis of acute HAV infection is made by finding anti-HAV IgM in suspected cases. A cluster in a single school would suggest a food or water exposure in the school, and the report suggests cases occurring outside the student body. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
West Java, Indonesia: <http://healthmap.org/promed/p/547>]
More ...

Libya

Libya - US Consular Information Sheet
August 13, 2008
COUNTRY DESCRIPTION:
Officially known as the Great Socialist People's Libyan Arab Jamahiriya, Libya has a developing economy. Islamic ideals and beliefs provide the conservative foundat
on of the country's customs, laws, and practices. Tourist facilities are not widely available. Read the Department of State Background Notes on Libya for more information.

ENTRY/EXIT REQUIREMENTS:
Passports and visas are required. The restrictions on the use of U.S. passports for travel to, in, or through Libya were lifted in February 2004. Please see the section below on Special Circumstances.
Without prior notice, the Libyan government on November 11, 2007 “reinstated” a requirement that all foreign travelers must have an Arabic translation of their personal biographic data added to their passport in order to apply for a Libyan visa, or to enter Libya. This requirement includes foreigners who already received visas before the requirement was put into place, including those foreigners currently resident in Libya. Since that date, foreign travelers whose passports do not have Arabic translations have been denied entry into Libya or refused boarding by airlines on flights into Libya.
The U.S. passport is a U.S. travel document that meets all generally recognized international standards. While the Libyan government has the right to impose its own requirements for travelers in connection with obtaining a Libyan visa, it also has the responsibility to give travelers information on where and how to meet these requirements. Travelers should be aware that in some cases, Libyan officials may ask that U.S. citizens obtain translations from U.S. Government-approved translation services. However, U.S. consular officers have no authority to designate or certify private translations; nor do they have authority to place a consular authentication stamp over a privately-obtained translation.

American citizens who hold Libyan visas or who intend to apply for a visa are advised to contact the nearest Libyan embassy or consulate for information on how to obtain an acceptable translation. Information from Libyan embassies and consulates may differ from country to country. American citizens may also contact the Consular Section at the U.S. embassy or consulate for additional information.
The Government of Libya does not allow persons with passports bearing an Israeli visa or entry/exit stamps to enter the country. At this time, neither Libya nor the U.S. provides visa services to the general public in each other’s countries; U.S. visitors to Libya should therefore plan to obtain a visa via a third country. Libyan visas require an invitation or sponsor, can take up to several months to process, and should be obtained prior to travel. All visas are vetted and approved by immigration departments in Tripoli and only issued by the appropriate Libyan Embassy upon receipt of that approval. There may be another wait for actual visa issuance once approval has been received. For tourists, the visa application procedure in most cases requires a letter of invitation from an accredited tour company in Libya; for business travelers, a letter of invitation is needed from the Libyan business entity. Americans who apply for Libyan visas are experiencing significant delays, often waiting several weeks or months if their applications are approved at all. Inconsistent Libyan visa practice is subject to change without notice and visa service to American citizens is often blocked without warning. With few exceptions, Libya has stopped issuing tourist visas to Americans. It is recommended that Americans always obtain individual Libyan visas prior to travel, rather than group visas. Americans who expected to enter on group tour visas or individual airport visas arranged by Libyan sponsors have routinely been denied entry at the air and sea ports and have been forced to turn back at the airport or remain onboard ship at the port while other nationals disembark. The U.S. Embassy in Tripoli cannot provide assistance to American citizens seeking Libyan visas.
Inquiries about obtaining a Libyan visa may be made through the Libyan Embassy in Washington, D.C. The Embassy is located at 2600 Virginia Avenue NW – Suite 705, Washington, DC 20037, phone number 202-944-9601, fax number 202-944-9606, website www.libyanbureau-dc.org. Neither the Libyan Mission to the UN in New York nor the Libyan Embassy in Washington, DC accepts visa applications from the general public. The closest Libyan visa-issuing office to the continental United States is the Libyan People’s Bureau in Ottawa, Canada; however, that office frequently declines to accept visa applications from American citizens. The land borders with Egypt and Tunisia are subject to periodic closures even to travelers with valid Libyan visas. Short-term closures of other land borders may occur with little notice. Within three days of arrival, visitors must register at the police station closest to where they are residing or they may encounter problems during their stay or upon departure.
Women and children in Libya are often subject to strict family controls.
This can be a particular problem for young single women of marriageable age. Although a woman does not need her father’s or husband's explicit consent every time she wishes to leave Libya, a Libyan husband may take legal action to prevent his wife from leaving the country, regardless of her nationality. While not illegal, it is unusual for women and children to travel alone. Children under 18 whose fathers are Libyan must have the father's permission to depart Libya, even if the mother has been granted full custody by a Libyan court.
The Libyan Government requires all its citizens, including dual nationals of Libyan descent, to enter and depart Libya on Libyan documents. In some cases American citizens of Libyan descent have entered Libya on old or expired Libyan identity document and then discovered that they cannot depart Libya without obtaining a valid Libyan passport, which can be a cumbersome process.
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: As Libya has taken steps to cooperate in the global war on terrorism, the Libyan Government’s designation as a state sponsor of terrorism was rescinded on June 30, 2006. Recent worldwide terrorist alerts have stated that extremist groups continue to plan terrorist attacks against U.S. interests in the region. Therefore, any American citizen who decides to travel to Libya should maintain a strong security posture by being aware of surroundings, avoiding crowds and demonstrations, keeping a low profile, and varying times and routes for all required travel.
Security personnel may at times place foreign visitors under observation. Hotel rooms, telephones, and fax machines may be monitored, and personal possessions in hotel rooms may be inspected. Taking photographs of anything that could be perceived as being of military or security interest may result in problems with the authorities.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ website at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: Crime against foreigners is a growing problem in Libya. The most common types of crime are property crimes of opportunity, to include vehicle burglaries. Pick-pocketing and residential burglaries are also on the increase. Women routinely face verbal harassment. While physical violence is not common, there have been instances of assault against women. These assaults can range from sexual groping or assault/battery, to attempted rape.

In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm
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.

The local equivalent to the “911” emergency line in Libya is: 193.
This number is generally monitored only in Arabic.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
While some health care providers have been trained in the United States or Europe, basic modern medical care and/or medicines may not be available in Libya. Many Libyan citizens prefer to be treated outside of Libya for ailments such as heart disease and diabetes. A representative list of healthcare providers is available at the U.S. Embassy Tripoli’s web site at http://libya.usembassy.gov/medical_information.html.

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.
Some HIV/AIDS entry restrictions exist for visitors to and foreign residents of Libya.
All positive HIV/AIDS tests made in country must be reported to the government.

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 Libya is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Paved roads in rural areas are satisfactory; however, many rural roads are unpaved (i.e. dirt roads). Also, major highways along the seacoast and leading south merge into single-lane highways once they are outside the cities. These roads are heavily trafficked and precarious to navigate, especially at night and during the winter rainy season. The presence of sand deposits, and domestic and wild animals that frequently cross these highways and rural roads, makes them even more hazardous.

Availability of roadside assistance is extremely limited and offered only in Arabic. In urban areas and near the outskirts of major cities there is a greater possibility of assistance by police and emergency ambulance services, although they are usually ill equipped to deal with serious injuries or accidents.

Driving in Libya may be hazardous, and there is a high accident rate. Police enforcement of traffic signs and laws is rare. As a result, it is often difficult to anticipate the actions of other drivers on Libyan streets and highways. Wind-blown sand can reduce visibility without warning. Road conditions are poor, and public transportation, which is limited to occasional bus service, is poor. Taxis are available, but many taxi drivers are reckless and untrained, and English-speaking drivers are extremely rare.
The sidewalks in urban areas are often in bad condition and cluttered, but pedestrians are able to use them.

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 Libya, the U.S. Federal Aviation Administration (FAA) has not assessed Libya’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: Libya's economy operates on a “cash-only" basis for most transactions, even though U.S. law now permits the use in Libya of credit cards and checks drawn on U.S. banks. Some hotels, restaurants, and major airlines are the only businesses known to accept credit cards (Visa more often than MasterCard). It is recommended that travelers consult their credit card entity prior to travel to ensure that transactions from Libya can be accepted by that entity. A very limited number of ATM machines are being put into service at a few large hotels, major office complexes, the airport, and one or two markets. Service is sporadic and sometimes unreliable. Foreign visitors should be aware that the penalties for use of unauthorized currency dealers are severe. Foreign visitors should also be aware that their passports might be confiscated in business disputes and/or they may not be permitted to depart Libya until the dispute has been settled. The workweek is Sunday-Thursday. Most U.S. economic sanctions against Libya were terminated effective September 21, 2004. For further information, please contact the Office of Foreign Assets Control at http://www.treas.gov/offices/enforcement/ofac/.
On June 30, 2006, the U.S. Department of State officially rescinded Libya’s designation as a State Sponsor of Terrorism. On August 31, 2006, the U.S. Commerce Department’s Bureau of Industry and Security (BIS) published an amendment to the Export Administration Regulations (EAR) in the Federal Register. This amendment updated BIS’ license requirements for Libya under the EAR due to its removal from the State Sponsors’ List. For further information specific to Libya, contact BIS’ Office of Nonproliferation and Treaty Compliance/Foreign Policy Controls Division at (202) 482-4252. Libya-related information is also found on the BIS web site: http://www.bis.doc.gov/PoliciesAndRegulations/regionalconsiderations.htm.
Libyan customs authorities enforce strict regulations concerning the introduction into Libya or removal from Libya of firearms, religious materials, antiquities, medications, and currency. Importation of pornographic materials is illegal. The importation and consumption of alcohol and pork products are illegal in Libya. At times, passengers arriving in Libya have been required to bring varying amounts of convertible currency into Libya.
This requirement is subject to a border check, and the passenger faces possible deportation if this requirement is not met. It is advisable to contact any Libyan Embassy abroad for specific information regarding customs requirements. Please see our Customs Information.
In addition to being subject to all Libyan laws, U.S. citizens of Libyan origin may also be subject to other laws that impose special obligations on Libyan citizens.
The Government of Libya considers all children born to Libyan fathers to be Libyan citizens even if they were not issued a Libyan birth certificate or a passport. Dual Libyan-American nationals may not enter and leave Libya on their U.S. passports, and must obtain a Libyan travel document before traveling to Libya.
Persons with dual nationality who travel to Libya on their Libyan passports are normally treated as Libyan citizens by the local government.
The ability to provide U.S. consular assistance to those traveling on Libyan passports is extremely limited.
For additional information, please see our dual nationality flyer.

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 Libyan laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Libya 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 Libya are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Libya.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The Consular Section of U.S. Embassy is located in the Seraj District of Tripoli.
Their phone number is (+218) 91-220-0125.
This number may also be used for emergencies after-hours by American citizens. General information, including forms, is available on the U.S. Embassy’s web site at http://libya.usembassy.gov/.
*

*

*
This replaces the Country Specific Information for Libya dated January 16, 2008, to update the sections on Entry/Exit Requirements, Crime, Medical Facilities and Health Information, Traffic Safety and Road Conditions, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Thu, 26 Dec 2019 20:35:51 +0100 (MET)

Tripoli, Dec 26, 2019 (AFP) - An air strike Thursday on a shopping area during rush hour near Libya's capital killed at least two civilians and wounded 20 others, a local official said.   The air strike on the town of Zawiya, 45 kilometres (30 miles) west of Tripoli, hit a pharmacy, a bakery and cars parked on the street, the mayor of the town, Jamal Baher, told AFP.   "Two people were killed and 20 others were wounded," he said.   The air strike took place as the area was busy with shoppers ahead of the weekend, which starts Friday in the North African country.   It comes amid fighting between the Tripoli-based, UN-recognised Government of National Accord (GNA) and rival forces answering to strongman Khalifa Haftar, who is based in the country's east.

Tensions have further spiked in recent weeks as Turkey said it could deploy troops in Libya to support the GNA.   Earlier on Thursday, GNA Interior Minister, Fathi Bashaga, said his government may officially seek Turkish military support to counter an offensive on Tripoli launched by Haftar in April.   Haftar has "provided foreign forces with military bases in Libya," Bashagha told journalists in the Tunisian capital Tunis.   "If this position continues, we have the right to defend Tripoli and we will officially ask the Turkish government for its military support," he added.   Turkish President Recep Tayyip Erdogan, who is in Tunisia to discuss the conflict in Libya, said his country's parliament will vote in January on a motion to send troops to Libya to support the GNA.   "God willing, we will pass it in parliament on January 8-9 and thus respond to an invitation" from the GNA, said Erdogan.

His comments come after the Turkish parliament on Saturday ratified a security and military cooperation deal with the GNA.   Libya was plunged into chaos with the toppling and killing of longtime dictator Moamer Kadhafi in a 2011 NATO-backed uprising.    It has since become divided between two main camps: the GNA and a rival administration in the country's east, backed by Haftar.   The GNA on Thursday accused Haftar's forces of carrying out the deadly air strike on Zawiya.   There was no immediate comment from Haftar's self-styled Libyan National Army.   At least 284 civilians have been killed and 363 wounded since Haftar launched his offensive to seize Tripoli, according to UN figures. Tens of thousands have been displaced from their homes.
Date: Sun 13 Oct 2019
Source: Libya Observer [edited]

150 persons with leishmaniasis disease arrived in Tawergha hospital on Friday [11 Oct 2019], and the number of affected people is increasing, the hospital said.

On Facebook, the hospital called on all medical staffers from all across Libya to provide assistance to the hospital in Tawergha to treat the patients with leishmaniasis.

Member of Tawergha local council Abdelnabi Abu Araba said Saturday [12 Oct 2019] that 500 leishmaniasis cases have been registered in the city since last July [2019]. He told reporters that the leishmaniasis cases started after the people of Tawergha returned to their city in July 2018, saying 410 cases were registered since last year [2018] and 500 from July to October 2019, adding that sewage water across the city is behind the disease.

Abu Araba called on the residents not to take heed of media reports that urge them to leave the city, saying fighting this disease needs the people to remain in their locations to get treatment.

He indicated that public service companies are removing garbage to terminate the rodents that cause leishmaniasis, calling on the Health Ministry to speed up repairing the hospitals in Tawergha so people can receive medical care.

Last Sunday, the Anti-Disease National Center said it had started distributing medical treatment for leishmaniasis across Libya.  [Byline: Abdulkader Assad]
==================
[We assume that these are cases of cutaneous leishmaniasis [CL].  CL is caused by the protozoan leishmania parasite, which is transmitted by sandflies. Outbreaks occur when vector and reservoir control activities break down, as is the case in Tawergha (see sections below).

Zoonotic CL is endemic in Libya, with sporadic outbreaks. In 2006, over 7000 cases were recorded in 8 districts, with an outbreak of 3961 cases in Misratah, and the disease spread to non-endemic areas (el-Buni AA et al. (2000). "Cutaneous leishmaniasis in the Libyan Arab Jamahiriya: a study of the Yafran area. East Mediterr Health J 2000;6:884-7).

In 2009, the prevalence of CL was 7.1 per 10,000 population. There is a vector control program that involves insecticide spraying, and regular rodent control is performed (Alvar J. et al. Leishmaniasis Worldwide and Global Estimates of Its Incidence. PLoS One. 2012; 7(5): e35671, supporting file S54).

From other reports about the Tawergha displaced populations, it appears that the residents have been returning only sporadically to Tawergha since 2018 due to a blockade and intimidation by Misratah militias and that the local infrastructure has been destroyed (<https://www.hrw.org/news/2019/01/24/libya-displaced-population-cant-go-home>).

Tawargha is, as of August 2011, a ghost town in Libya that is under administrative jurisdiction of the city of Misratah, which is 38 km away. It was the site of intense fighting during the Libyan Civil War before its capture and ethnic cleansing by anti-Gaddafi forces in August 2011. By the end of the war in October 2011, the town was largely cleared of its population by NTC militias (<https://en.wikipedia.org/wiki/Tawergha>). - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Misratah District, Libya: <http://healthmap.org/promed/p/5116>]
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: Wed, 3 Jul 2019 21:54:46 +0200

Tripoli, July 3, 2019 (AFP) - The Libyan capital's only functioning airport suspended flights on Wednesday after an air raid claimed by strongman Khalifa Haftar's forces, airport authorities said in a statement.   The attack did not cause casualties or damage, a security source at Mitiga airport said.   But Ahmad al-Mesmari, a spokesman for Haftar's self-styled Libyan National Army, said that a "command centre for drones at Mitiga" was destroyed in the raid.

Haftar launched an offensive in early April to take the capital Tripoli, seat of the rival Government of National Accord.   The GNA is recognised by the international community.   Over the past three months his self-styled Libyan National Army (LNA) has repeatedly targeted Mitiga airport.   It says it is targeting "Turkish drones" which it claims take off from Mitiga to carry out strikes on LNA forces south of Tripoli.

On Sunday the LNA said it had destroyed a Turkish drone in a strike on Mitiga, which prompted aviation authorities to temporarily suspend flights there.   Haftar's forces, which hold much of eastern and southern Libya, last month lost a key town to forces loyal to the unity government in an operation the strongman has accused Ankara of backing.   Afterwards Haftar ordered his forces to target Turkish companies, ban flights and arrest Turkish nationals in Libya, his spokesman said Friday.
WorldHealthOrganizationNews@who.int
Thu 09/05/2019 12:26
http://www.emro.who.int/lby/libya-news/who-denounces-attack-on-health-workers-and-ambulance-in-libyan-capital.html

Tripoli, 9 May – The World Health Organization today condemned in the strongest terms an attack on an ambulance in Tripoli, Libya, on Wednesday 8 May, that left 3 health workers injured, one severely.

“This attack on an ambulance with visible logos is a shocking and intolerable violation of international humanitarian law,” said Dr Syed Jaffar Hussain, WHO Representative in Libya. “Not only did this attack injure key personnel, but the ambulance itself was taken away, thereby depriving patients of future care.”

Since the conflict in Libya escalated in early April, 11 additional ambulances have been impacted or suffered collateral damage. In April, 3 health workers were killed in Tripoli, and numerous first-line responders have struggled to reach the wounded without being injured themselves. As the conflict continues into its second month, more than 400 people have died and over 2000 have been wounded.

WHO has been supporting field hospitals and field ambulance teams in Libya since the beginning of the conflict. The Organization has also deployed emergency medical teams to key referral hospitals to perform surgeries in hospitals in and around Tripoli. WHO is also providing health facilities with medical supplies, including trauma kits with medicines for war injuries.

“This flagrant breach of the basic rules of warfare could jeopardize the operations of field hospitals and ambulance teams, and deter dedicated health staff from performing their life-saving duties,” said Dr Ahmed Al-Mandhari, WHO’s Regional Director for the Eastern Mediterranean. “WHO cannot accept any actions that put health workers in harm’s way. Health staff in Libya are working to save lives and must be allowed to work without additional risk to their safety or well-being.”
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Niger

Niger US Consular Information Sheet
March 03, 2008
COUNTRY DESCRIPTION: Niger is a developing, landlocked African nation whose northern area includes the Sahara Desert. Tourism facilities are minimal, particularly outside the capital city, Niam
y, and the ancient caravan city of Agadez. Ecotourism and adventure tourism opportunities are plentiful. Read the Department of State Background Notes on Niger for additional information.
ENTRY/EXIT REQUIREMENTS: A passport, visa, and proof of yellow fever inoculation are required. Travelers from countries without a Nigerien Embassy may be able to obtain a visa at the airport. Travelers from the United States should obtain a visa before arriving in Niger. Failure to do so could result in being denied entry to Niger. Travelers should obtain the latest information on entry/exit requirements from the Embassy of the Republic of Niger, 2204 R Street NW, Washington DC 20008; telephone: (202) 483-4224.
Visit the Embassy of Niger web site at http://www.nigerembassyusa.org/ the most current visa information. Outside the U.S., inquiries should be made at the nearest Nigerien embassy or consulate.
See our information about dual nationality and the prevention of international child abduction. Please refer to our Customs Information to learn more about customs regulations.
SAFETY AND SECURITY:
U.S. citizens are advised to avoid street demonstrations and maintain security awareness at all times.
Large and small street demonstrations occur regularly in Niger. These demonstrations tend to take place near government buildings, university campuses, or other gathering places such as public parks. Although demonstrations can occur spontaneously, large student demonstrations typically begin in January and February and continue through May. American citizens are, therefore, urged to be particularly vigilant at these times. During previous student demonstrations, NGO and diplomatic vehicles bearing "IT"or "CD" plates have been targeted by rock throwing demonstrators. Many past demonstrations have featured rock throwing and tire burning, especially at key intersections in the city of Niamey.

Due to the abrupt nature of street demonstrations, it is not possible for the U.S. Embassy to notify American citizens each time a demonstration occurs. Consequently, Americans are reminded to maintain security awareness at all times and to avoid large public gatherings and street demonstrations. Americans are reminded that even demonstrations intended to be peaceful can turn confrontational without much advanced warning. While the U.S. Embassy will endeavor to inform citizens of ongoing demonstrations through the warden system when possible, local radio and television stations are good sources for information about local events.

As of May 17, 2007, the U.S. Embassy in Niamey prohibits official personnel from traveling into areas of Niger to the north of Abalak.
All American citizens are strongly urged to follow the same guidelines due to the escalation of violence by the local rebel group, Movement for Justice in Niger (MNJ). Northern Niger, particularly in and around the cities of Iferouane, Arlit, and Agadez, is affected by MNJ activities. In July 2007, MNJ ambushed a convoy in the Agadez region, kidnapping a Chinese citizen and holding him for ten days. Futhermore, landmines have been placed in the region and several have exploded killing military and civilian personnel.
There were several landmine incidents in the south of Niger with the most recent on January 9, 2008 in Niamey.
They are disturbing because they were the first to occur outside the northern region where MNJ has operated. MNJ did not take responsibility for these landmines.
Most recently, MNJ attacked the town of Tanout, killing several troops and capturing arms and several people, including the prefet.
Several international organizations, including private and nongovernmental groups, have temporarily relocated personnel from these areas. On August 27, 2007, the President of Niger declared a State of Alert for the region of Agadez, to include the cities of Agadez, Arlit, and Iferouane. This State of Alert means that all travelers in and around these cities are liable to be stopped and held for questioning.
Moreover, the Nigerien military now has the authority to hold individuals for questioning, without cause, for more than the standard 48-hours.
Foreigners who elect to travel in northern Niger despite the current security situation must submit an approved travel plan through the office of the Governor of Agadez. Travelers should first contact the Syndicat de Tourisme in Agadez (telephone: 96 98 78 81) to enlist the services of a registered tour operator, who will formally coordinate with Nigerien government and security officials on tourist safety and security in the North and who can facilitate the submission of the required itinerary and intended route.
For travel in any remote area of the country, the Department of State urges U.S. citizens to use registered guides, to travel with a minimum of two vehicles equipped with global positioning systems (GPS) and satellite phones. Travelers are advised to avoid restricted military areas and to consult local police authorities regarding their itinerary and security arrangements.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Public Announcements, including the Worldwide Caution , can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
NOTE TO NON GOVERNMENTAL ORGANIZATION (NGO) WORKERS: Following the murder of a French tourist in the region of Agadez in December 2005, the Government of Niger (GON) began requiring that NGOs not only be registered and officially recognized but that they inform the GON of each mission they plan to undertake in Niger. To avoid detainment and/or expulsion by Nigerien authorities, Embassy Niamey strongly recommends that NGO workers:
* Make sure that their NGO has registered and received official recognition from the Government of Niger. For details on how to do this please visit the Managing Office of Decentralised Cooperation and Non Governmental Organizations (Direction De La Cooperation Decentralisee Et Des Organisations Non Gouvernementales) in the Ministry of Foreign Affairs (Ministre des Affaires Etrangères).
* Carry with them a copy of the official recognition (Arrêté) of the right of their NGO to operate in Niger.
* If their international NGO sponsor is without a permanent presence in Niger, American citizens should verify that their NGO group has informed the Ministry of Foreign Affairs at least two weeks prior to the start of a mission in Niger. This notice should be in written form and should include the purpose of the mission, names of the individuals who will be working for the NGO on the mission, the dates of the mission, where the mission will take place and the types & license plate numbers of the vehicles involved in the mission. The Ministry of the Interior should be copied on this notice of mission.
* If their NGO is a national NGO, i.e., has a headquarters operation in Niger, the American citizens should verify that their group has informed the Ministry of Territorial and Community Development (Minstre de l’Aménagement du Territoire et du Développement Communautaire) at least two weeks prior to the start of a mission in Niger. This notice should be in written form and should include the purpose of the mission, the names of the individuals who will be working for the NGO on the mission, the dates of the mission, where the mission will take place and the types & license plate numbers of the vehicles involved in the mission. The Ministry of the Interior should be copied on this notice of mission.
* NGOs should ask for receipt of their notification provided to the Ministry of Foreign Affairs, Ministry of the Interior and Ministry of Territorial and Community Development.
Embassy Niamey strongly recommends that in addition to the above, NGO workers present themselves at the Regional Governor’s office prior to beginning their mission in a particular portion of Niger. Again, NGO workers should ask for receipt of their presentation to the Regional Governor. It would also be wise to provide the Regional Governor with the same written notification that was provided to the Ministries listed above.
CRIME: Crime is at a critical level due primarily to thefts, robberies, and residential break-ins. Foreigners are vulnerable to attempts of bribery and extortion by law enforcement authorities. Thefts and petty crimes are common day or night. However, armed attacks are normally committed at night by groups of two to four persons, with one assailant confronting the victim with a knife while the others provide surveillance or a show of force. Tourists should not walk alone around the Gaweye Hotel, National Museum, and on or near the Kennedy Bridge at any time, or the Petit Marche after dark. These areas are especially prone to muggings and should be avoided. Walking at night is not recommended as streetlights are scarce and criminals have the protection of darkness to commit their crimes. Recent criminal incidents in Niger have included carjackings, sexual assaults, home invasions, and muggings. In December 2000, an American was killed in a carjacking incident in Niamey, and another American was gravely wounded in a carjacking incident outside of Niamey in 2004. In 2007, two American citizens were raped and two others attacked with a machete. Travelers should always keep their doors locked and windows rolled up when stopped at stoplights.
In August 2004, an attack against 2 buses on the Agadez-Arlit road left 3 dead and numerous persons wounded. A French tourist was murdered by bandits in the Agadez region in December 2005 during a robbery attempt. In August 2006, several Italian tourists were abducted near the Niger-Chad border. They were robbed of some of their possessions and later released. Due to continued sporadic incidents of violence and banditry and other security concerns, the Department of State urges U.S. citizens visiting or residing in Niger to exercise caution when traveling within the northern and eastern parts of the country, especially along the borders of Mali, Libya, Algeria and Chad. Given the insecurity along these border regions, the Department of State recommends that American citizens in Niger avoid traveling overland to Algeria and Libya.
In previous attacks, groups of foreign travelers, including Americans, have been robbed of vehicles, cash and belongings. The government of Niger is taking steps to address crime/banditry but operates under severe resource constraints.
Use caution and common sense at all times to avoid thieves and pickpockets. An information sheet on safety and security practices is available from the Consular Section of the U.S. Embassy in Niamey.
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 provide an attorney list if needed.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Health facilities are extremely limited in Niamey and urban centers, and completely inadequate outside the capital. Although physicians are generally well trained, even the best hospitals in Niamey suffer from inadequate facilities, antiquated equipment and shortages of supplies (particularly medicine). Emergency assistance is limited. Travelers must carry their own properly labeled supply of prescription drugs and preventative medicines.
Malaria is prevalent in Niger. Plasmodium falciparum malaria, the serious and sometimes fatal strain in Niger, is resistant to the anti-malarial drug chloroquine. Because travelers to Niger 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™). The CDC has determined that a traveler who is on an appropriate antimalarial drug has a greatly reduced chance of contracting the disease. Other personal protective measures, such as the use of insect repellents, also help to reduce malaria 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, protection from insect bites, and antimalarial drugs, please visit the CDC travelers’ health web site at http://wwwn.cdc.gov/travel/contentDiseases.aspx#malaria.
Tap water is unsafe to drink throughout Niger and should be avoided. Bottled water and beverages are safe, although visitors should be aware that many restaurants and hotels serve tap water. Ice made from tap water is also unsafe to consume.

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 Niger is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Road safety throughout Niger is a concern, and visitors are strongly urged to avoid driving at night outside of major cities. The public transportation system, urban and rural road conditions, and the availability of roadside assistance are all poor. U.S. travelers should exercise caution on Niger's roads, as traffic accidents are frequent. The main causes of accidents are driver carelessness, excessive speed, poorly maintained vehicles, and poor to non-existent road surfaces. Other factors include the hazardous mix of bicycles, mopeds, unwary pedestrians, donkey carts, farm animals, and buses on roads that are generally unpaved and poorly lighted. Overloaded tractor-trailers, "bush taxis," and disabled vehicles are additional dangers on rural roads, where speeds are generally higher. Travel outside Niamey and other cities often requires four-wheel-drive vehicles, which creates an additional security risk since these vehicles -- especially Toyota Land Cruisers — are high-theft items. Driving at night is always hazardous and should be avoided. Banditry is a continuing problem in northern and eastern Niger. There have been occasional carjackings and highway robberies throughout the country.
While taxis are available at a fixed fare in Niamey, most are in poor condition, and do not meet basic U.S. road safety standards. Inter-city "bush-taxis" are available at negotiable fares, but these vehicles (minibuses, station wagons, and sedans) are generally older, unsafe models that are overloaded, poorly maintained, and driven by reckless operators seeking to save time and money. A national bus company (SNTV) operates coaches on inter-city routes and, since being reorganized in 2001, has provided reliable service and experienced no major accidents. Air Transport, Rimbo and Garba Messagé are private bus companies operating in Niger. There is some concern regarding the youth of drivers and the speed with which the private bus companies travel the Nigerien roads.
Please refer to our Road Safety page for more information. Visit the National Tourism Office on Rue de Grand Hotel in Niamey.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service between the United States and Niger, the U.S. Federal Aviation Administration (FAA) has not assessed Niger’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: Dress Restrictions - Local culture and Islamic tradition encourage conservative dress for both men and women. There have been incidents of groups of men assaulting women who are, or appear to be, African and who are wearing other than traditional garments.
Photography Restrictions - Tourists are free to take pictures anywhere in Niger, except near military installations, radio and television stations, the Presidency Building, airport, or the Kennedy Bridge. Tourists should not photograph political and student demonstrations.
Currency Regulations - The West African Franc (FCFA) is the currency Niger shares with several other West African francophone countries, and is fully convertible into Euros. Foreign currency exchange over 1 million CFA (about $2,000 at 500 CFA/$1) requires authorization from the Ministry of Finance (available from all major banks).
Telephone Service - Due to poor line quality, callers often experience delays in getting a telephone line, and faxes are often garbled. Cellular phone service is available in Niamey and in many major cities.
Please see our Customs Information.
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Nigerien laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Niger 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 Niger are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Niger.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located on Rue des Ambassades, Niamey, Niger.
The U.S. Embassy mailing address is B.P. 11201, Niamey, Niger.
Telephone numbers are: (227) 20-72-26-61 through 64 and fax numbers (227) 20-73-31-67 or 20-72-31-46. The Embassy’s after hours emergency number is (227) 20-72-31-41. Embassy’s Internet address is http://niamey.usembassy.gov.
* * *
This replaces the Country Specific Information dated September 6, 2007 to update the section on ”Safety and Security.

Travel News Headlines WORLD NEWS

Date: Sun, 20 Oct 2019 06:45:19 +0200 (METDST)

Niamey, Oct 20, 2019 (AFP) - Floods in southeast Niger have forced 23,000 people to flee their homes since early October, officials said Saturday, threatening a new humanitarian crisis in a region already wracked by Boko Haram Islamist violence.   Heavy rains have caused the Komadougou Yobe river that flows through the semi-desert Diffa region into Lake Chad to burst its banks, inundating villages, flooding fields and damaging crops.   Two villages near the city of Diffa were "completely submerged" and 2,500 households have been forced to move, according to national radio the Voice of the Sahel.

Some 400 families were sheltering in a gym in the city, it added.   "We have been fighting for days to stop the water rising, but it's not working," Amadou Issa, a rice farmer, told AFP. "The sandbags we've been using to keep the water out are completely under water."   Extreme weather events are common in Niger, one of the world's poorest countries.   Between June and September 57 people were killed and more than 130,000 affected by flooding according to government figures.

The capital Niamey was hit badly in September, with the waters of the Niger river -- the third biggest in Africa -- rising to a level not seen in more than 50 years and swamping parts of the city.   Last year, drought and flooding led to food shortages in a crisis which, exacerbated by jihadist violence, left more than 10 percent of the population needing humanitarian aid.   Niger, along with neighbouring Burkina Faso, Chad, Mali and Mauritania is also struggling against escalating attacks by armed Islamists.   According to the UN's human rights agency UNHCR, the Diffa region is home to almost 120,000 refugees and 109,000 internally displaced people.
Date: Mon, 16 Sep 2019 16:24:55 +0200 (METDST)
By Boureima HAMA

Niamey, Sept 16, 2019 (AFP) - "At last, we're here!" Amina and Halima, who live in Niger's capital Niamey, exulted after reaching high ground following the worst floods to hit the city in 50 years.   Two weeks ago, authorities in Niamey declared a red alert when the waters of the Niger river -- the third biggest in Africa -- rose to a level "not seen in more than 50 years".

The floods have affected more than 6,300 people in the traditionally dusty city.   Nearly 60 have been killed and 130,000 displaced across the nation this rainy season, officials say.    Amina and Halima are among those who have been evacuated to tent shelters at Saguia in the highlands overlooking Niamey.   The women travelled in a van, but officials have been chartering all kinds of transport to move people in trouble, while others hire taxis, ride motorbikes and even walk.

Saguia is a patch of land owned by the army and usually off limits to the public.    In 2012, it was used to house about 400 soldiers from neighbouring Mali who had fled an offensive by Tuareg rebels.   For access to the site, people need "tickets" that are distributed in schools serving as transit centres for flood victims, according to the armed paramilitary police checking new arrivals.   The heights give a panoramic view of the homes and rice paddies largely submerged by the water.

- 'Surprised in our sleep' -
Inside the camp, the fire brigade and municipal employees have put up dozens of white tents supplied by the Red Cross and the United Nations.   "When people arrive here, they are installed in tents (...) and we have enough food for them all," Niamey governor Issaka Assane Karanta told AFP.   A generator and a fresh-water well have both been repaired, lamp posts will soon be installed and a medical centre is open "for the treatment of emergency cases", the governor said.

Some 122 households, comprising 854 people, have been allocated tents and the site can take in a total of 1,200 flood victims, he added.   "They gave us rice, millet, mosquito nets, blankets and drinking water," said Aissa Salifou, putting on makeup in her tent, her head and shoulders covered in a broad veil.   "The water surprised us in our sleep," added the woman from one of Niamey's hardest-hit districts, Kirkissoye. "We had to demolish the walls in neighbouring houses to scramble out."   "We live on the low ground where we were trapped by the water, but this place is spacious, well-aired and above all safe," said Fatouma Boubacar, another Kirkissoye resident, watching her cooking pot on the fire.

- 'I was lucky' -
Though Boubacar arrived only two days earlier, she has resumed her customary job, selling vegetables.   "I was lucky," said Ramatou Abdou, reclining in an armchair with a toothpick stuck between her teeth.   "I barely got out of the house before the roof fell in. I'm expecting my first baby in a month and I shall call it Saguia."    In the shade of a huge tree, a dozen new arrivals awaited the completion of their shelters before moving in.    Barefoot children meanwhile made up football teams and chased a rag ball on a makeshift pitch in the baking heat.

On the far side of the camp, a policeman with a gun slung over his shoulder watched over a bunch of children carrying plates and queuing for a hot meal provided by an NGO.   "We're trying to live here and waiting to see what Allah has in store for us," Boubacar said.    The level of the Niger has fallen slightly after bursting its banks, but governor Karanta is urging people from affected areas to be watchful and "to keep well away from the bed of the river".   Upstream in Mali, technicians have opened floodgates on a major dam and the extra water is "slowly but surely" flowing down to Niger, Karanta said.
Date: Fri, 13 Sep 2019 16:44:33 +0200 (METDST)

Niamey, Sept 13, 2019 (AFP) - Niger launched a campaign on Friday to vaccinate more than four million children against measles, one of the biggest causes of child mortality in the country, the health ministry said.

The one-week nationwide vaccination programme aims to "eliminate measles by the end of 2020", Health Minister Illiassou Mainassara said, adding, it "will reach 4.254 million children" aged from 9 months up to the age of five.   "Despite all the efforts made in the fight against communicable diseases, we still note the persistence of localised measles epidemics (in Niger)," Mainassara said on his way to the capital Niamey to launch the campaign.    But some experts say the vaccination programme should have kicked in sooner    "The delay of this campaign which should have happened in 2018 has resulted in ...the emergence of epidemics in several health districts," said Niger's UNICEF representative, Felicite Tchibindat.

Since January this year, 9,741 suspected cases have been documented in Niger resulting in 53 deaths, she said.   "Measles is a serious and extremely contagious viral disease and remains one of the leading causes of early childhood death, while it can be prevented by vaccination," TchibiNdat said.    She believes the children of migrants, refugees and displaced people will especially benefit from the campaign.    Niger's vaccination programme is supported by the World Health Organization (WHO), UNICEF (United Nations Children's Fund) and the Gavi vaccine Alliance.
Date: Wed, 4 Sep 2019 21:12:00 +0200 (METDST)
By Boureima HAMA

Niamey, Sept 4, 2019 (AFP) - "That's it, time to go!" As a rising swell of muddy water creeps towards his house in Niger's capital Niamey, Mamoudou Barkire is finally leaving.   Deadly floods have swamped several parts of the city and the rest of the country, forcing thousands to flee as it demolished homes and turned streets into rivers.   And the 63-year-old retiree, propped on crutches, is joining them.   But leaving was not an easy choice. Barkire, whose neighbours left weeks ago, spent the past two days piling sandbags onto a clay wall he built in a futile bid to keep the water away.   "I barely have enough to feed my family on this measly pension, and now I risk losing my home".

Extreme weather is an all-too-common phenomenon in Niger. Last year, drought and flooding led to food shortages in a crisis which, exacerbated by jihadist violence, left over 10 percent of the population needing humanitarian aid.   But the World Health Organisation (WHO) has warned that the current floods -- sparked by exceptionally high water levels in the river Niger -- could lead to a cholera epidemic.   The waterborne disease killed dozens last year in the southern Maradi region, currently the worst-hit by floods.

- Red alert -
The disaster has already claimed 42 lives. Only 25,000 of the 70,000 people affected by the crisis have received aid, said Lawan Magadji, Niger's minister for humanitarian affairs.   Niger, one of the world's poorest countries, is in the midst of its annual rainy season, which lasts three to four months over summer.   At the start of the week, water rose to 6.38 metres (21 feet) in Niamey, levels "not seen in more than 50 years", the city's governor Assane Issaka Karanta said.

It prompted authorities to trigger a "red alert", which they renewed on Wednesday.   Even the arid Agadez region -- home to a UNESCO-protected historic centre -- has been hit.   In Niamey inhabitants have clubbed together in the struggle to save their neighbourhoods.   Children drag carts piled with dam-building materials through the streets, while women try their best to clean up courtyards brimming with water.    With more heavy rain predicted in coming weeks, authorities have asked humanitarian agencies for help.   The vast majority of the city's inhabitants live on the banks of the river Niger, and some even built their homes on the river bed.   But "the worst has been avoided" for now, as dams surrounding the city "are holding up", Niamey's Mayor Mouctar Mamoudou said.

- Sleepless nights -
Watching over the city, a "brigade" of locals are tasked with keeping an eye on the river banks at night.   "We haven't been sleeping. If the water levels rise again, we'll let people know," says Ali, who hasn't slept for two nights.   And in the capital's Kirkissoye district -- one of the worst affected -- firefighters patrol the streets, assessing damage and registering victims on a list.   Saouda Abdoulaye is one of those who decided to stay, despite authorities warning residents to pack their bags and ration food and water.    Abdoulaye says she had underestimated the damage the flooding would cause.   "Kirkissoye has suddenly turned into a swamp. At night, it's a ghost town," she says.
Date: Sun 31 Mar 2019
Source: BrandSpur Ng [edited]

The National Agency for Food and Drug Administration and Control (NAFDAC) [Nigeria] alerts the public, especially the health care providers, on the circulation of fake MencevaxTM ACWY and MencevaxTM ACW vaccines circulating in the Niger Republic. The Health Authorities of the Republic of Niger issued an alert on the fake vaccines discovered during routine inspections of the pharmacies in Niamey, the Niger Republic on [14 Mar 2019].

The lot number of the fake MencevaxTM ACW vaccine is AMEN A020 AA while the Lot number of the fake MencevaxTM ACWY is AMEH A020 AA. The fake MencevaxTM ACWY vaccine has a manufacturing date of December 2016 and an expiring date of November 2021.

Genuine MencevaxTM ACW and MencevaxTM ACWY vaccines are used to control the outbreak of meningococcal infection. The genuine vaccines were registered by NAFDAC [Nigeria] in favour of Glaxo SmithKline Beecham (GSK). Pfizer acquired the vaccines from GSK in 2015.

Pfizer Specialties Limited, 7th Floor, Heritage Place, 21 Lugard Avenue, Ikoyi Lagos discontinued commercialization of Mencevax Vaccines in Nigeria in June 2018. As a result of the discontinuation of commercialization of the vaccines, Pfizer Specialities Limited no longer import the vaccines into Nigeria.

NAFDAC implores all importers, wholesalers, and retailers not to illegally import, distribute and sell the fake Mencevax vaccines. Surveillance has been strengthened by NAFDAC at all ports of entry to prevent importation of the fake vaccines from the Niger Republic. The agency has also heightened surveillance to prevent distribution and sales of the fake vaccines.

Health care providers and other members of the public are advised to be vigilant and contact the nearest NAFDAC office with any information on the fake vaccines. Anybody in possession of the fake vaccines should submit it to the nearest NAFDAC office.

Consumers are advised to report adverse events related to the use of vaccines to the nearest NAFDAC office, NAFDAC PRASCOR (20543 TOLL-FREE for all Network) or via pharmacovigilance@nafdac.gov.ng.  [Byline: Bolaji Samuel]
===========================
[The genuine meningococcal vaccine manufactured by GlaxoSmithKline, Mencevax ACWY, is a lyophilized preparation of purified polysaccharides from _Neisseria meningitidis_ (meningococcus) of serogroups A, C, W and Y, that must be reconstituted with the sterile diluent that is supplied in another glass vial or pre-filled syringe for subcutaneous injection  (<http://www.gsk.com.au/resources.ashx/vaccineproductschilddataproinfo/114/FileName/0D20DC52BDDA8B361FA1AA0D654B93C5/PI_Mencevax.pdf>).

The previous ProMED-mail post said that a fake meningococcal vaccine, Mencevax ACWY, marked as having been manufactured in December 2016, with an end-date for use by November 2021, was being distributed in Niger (See Meningitis, meningococcal - Niger: counterfeit vaccine http://promedmail.org/post/20190317.6372003.) The news report above adds that the fake meningococcal meningitis vaccines include both the quadrivalent Mencevax ACWY (lot number AMEH A020 AA) and a trivalent Mencevax ACW (lot number also AMEN A020 AA). However, we are not told how these fake vaccines differ from the genuine meningococcal vaccine products in Niger.

WHO issued a report in May 2015 for Niger of falsified Mencevax ACWY, 50 doses per vial, with false batch number (AMEHA020AA), manufacturing date (December 2013) and expiry date (November 2016); falsified Mencevax ACW, 50 doses per vial, with a genuine batch number (AMENA020AA), but with false manufacturing date (December 2014) and expiry date (November 2017) - the genuine version of this batch expired in 2011; and falsified diluent, 50 doses, with false batch number (A003B128AA), manufacturing date (February 2013) and expiry date (January 2019)  (<https://www.who.int/medicines/publications/drugalerts/AlertWHO2.2015MENCEVAX_EN.pdf>).

Use of fake vaccines will leave a substantial portion of the population susceptible to meningococcal disease and engender further loss of confidence in the utility of vaccines. It will also undermine public confidence in the ability of government to safeguard the public. - ProMED Mod.ML]

[HealthMap/ProMED map available at:
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World Travel News Headlines

Date: Thu, 16 Jan 2020 02:59:31 +0100 (MET)
By Nicolas DELAUNAY

Cousin Island, Seychelles, Jan 16, 2020 (AFP) - Giant tortoises amble across Cousin Island as rare birds flit above.   The scene attests to a stunning success for BirdLife International, a conservation group that bought the tiny Seychelles isle in 1968 to save a songbird from extinction.   Thick vegetation smothers ruins that are the only reminder of the coconut and cinnamon plantations that covered the island when the group stepped in to protect the Seychelles Warbler.

Now teeming with flora and fauna and boasting white beaches, Cousin Island is firmly on the tourist map, with managers scrambling to contain visitor numbers and soften their negative environmental impact.    More than 16,000 people visited the island in 2018, compared with 12,000 a decade earlier.   "Tourism is important for Cousin. That's what allows us to finance the conservation projects we run here.    "But 16,000 tourists... that was too much," said Nirmal Shah, director of Nature Seychelles, which is charged with running the special reserve.

Before the island was in private hands, the population of Seychelles Warblers was thought to have shrunk to just 26, barely hanging on in a mangrove swamp after much of their native habitat had been destroyed.    Now, they number more than 3,000 and the greenish-brown bird has been reintroduced to four other islands in the archipelago.   The former plantations have transformed into native forests, teeming with lizards, hermit crabs and seabirds, and the island is the most important nesting site for hawksbill turtles in the western Indian Ocean.   The International Union for Conservation of Nature (IUCN) waxes lyrical about the "unique biodiversity and conservation achievements" of Cousin, "the first island purchased for species conservation", a model since replicated around the world.

- Nature first -
Tourists have been allowed onto the island since 1972, but the message is clear: nature comes first.   In a well-oiled routine, every morning a handful of luxury sailboats and small motorboats anchor off the island, where their occupants wait for Nature Seychelles to skipper them ashore on their boats.   "Tourist boats cannot land directly on the island, the biohazard risk is too big," Shah said.   "Non-indigenous animals who may accidently be on board could come to the island and threaten its (ecological) balance."   Too many tourists can also upset this balance.

Nature Seychelles in July increased the price of visits from 33 to 40 euros ($36 to $44) and removed a free pass for children under 15, resulting in a welcome 10-percent reduction in visitor numbers.   "Something had to be done, there was too much pressure on the environment," said Dailus Laurence, the chief warden of the island.   "When there are too many tourists it can bother nesting birds and turtles who want to come and lay their eggs on the island."

One guide said that some tourists, bothered by the island's ubiquitous mosquitos, would "leave the paths, move away from the group and walk where they are not supposed to", putting fragile habitats at risk.   Shah said that if they wanted to increase the number of tourists, it would require hiring more wardens and guides who live on the island, which would also have a negative impact on nature.   "Our absolute priority is nature, and it comes before tourists. If we have to take more steps to protect it and reduce the number of tourists, we will," he said.
Date: Thu, 16 Jan 2020 02:45:27 +0100 (MET)
By Ivelisse RIVERA, con Leila MACOR en Miami

Yauco, Puerto Rico, Jan 16, 2020 (AFP) - Living out in the open, their nerves on edge after a series of earthquakes that have shaken Puerto Rico, some 5,000 people are hoping that their president, Donald Trump, will heed the island's plea to be designated a disaster zone and free up much-needed aid.   Since December 28, more than 1,000 tremors have rattled the US island territory in the Caribbean, which just two years ago was devastated by two powerful hurricanes in quick succession.

In Yauco, one of the areas worst hit by the earthquakes, dozens of people were sitting on cot beds Wednesday in the parking lot of a municipal stadium, sheltered from the sun by white tents and blue tarps handed out by the federal disaster management agency, known as FEMA.  "The most difficult thing is the psychological aspect," said Wilfredo Rodriguez, 31. His house had been fractured by the seismic movement and he has spent a week living with his kids, aged six and 10, under an awning.    "We are living in constant fear of another powerful tremor," he said.

He only returns to his house to wash, then hurries back to the shelter. "We worry that there'll be a more powerful tremor while we are inside the house," he said.   Throughout the day, volunteers arrive to hand out food and toys for the children who fill the shelters: schools have been suspended because the buildings are not sturdy enough to withstand another quake.    The island's earthquake detection system has registered 1,104 tremors in the past two weeks alone, of which 186 could be felt by the population. By comparison, during the whole of 2019 there were 6,442 tremors, of which just 62 could be felt by people on the island.

Further south, in Guanico, Juan Santiago decided to move into a shelter on Saturday after a tremor of 5.9 on the Richter scale hit the island. "The mountain shook and rocks and earth started to come down," said the 30-year-old.  "My house has a crack in it and is about to fall down," he added. His home had weathered the Category Five winds of Hurricane Maria in September 2017 and of Hurricane Irma which followed it just two weeks later.   "It's different to a hurricane. What is happening now is much nastier," he said.

As he was talking the earth shook again, a tremor of 5.2 magnitude. Vehicles rocked like hammocks in the wind, but the quake-hardened victims barely reacted.   The houses in this part of the island are mostly rudimentary constructions built by the people who live in them with scant resources available in the mountains, where no regulations stipulate that buildings should be earthquake resistant.    The government of Puerto Rico said that as of Monday, there were 4,924 people living in 28 shelters in 14 municipalities. There were no figures on how many buildings had been damaged or destroyed.

- Seeking disaster designation -
Puerto Rico's governor Wanda Vazquez Garced called on Trump to declare the earthquake a disaster and clear the way for desperately needed aid. Trump had declared an emergency days before, but the governor wanted more.   The declaration of an emergency frees up to $5 million dollars in aid for the island, although Congress can bump that figure up. But if the situation is designated a disaster, there is no ceiling on funding, a FEMA spokesman said.   On Wednesday, the government said it would release $8.2 billion in delayed hurricane relief that had been stalled after the president threatened to divert Puerto Rico's emergency funds to help pay for his wall on the US-Mexico border.

In the past few days there have been growing calls among Democratic lawmakers for Trump to declare the situation in Puerto Rico a disaster.   It is a delicate subject, as Trump has accused the government of Puerto Rico of incompetence and of siphoning off hurricane relief money, triggering a public spat between the president and the mayor of San Juan, Carmen Yulin Cruz, as well as the former governor Ricardo Rossello, who was forced to step down last summer amid massive protests.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
Date: Wed, 15 Jan 2020 23:16:11 +0100 (MET)

Malabo, Equatorial Guinea, Jan 15, 2020 (AFP) - Firefighters battled to bring a blaze at Malabo's cathedral under control on Wednesday, as flames engulfed parts of the historic building, considered the most important Christian church in Equatorial Guinea.     Dozens of people gathered in silence near the cathedral in the early evening as the fire service sprayed water jets onto the century-old structure.

It was not immediately known whether anyone was hurt in the fire, in which huge flames consumed part of the facade of the building.       "We have just extinguished the fire, it's finished. The roof is gone, it is a catastrophe," firefighter Alfredo Abeso told AFP.   Another firefighter at the scene said: "The whole roof is gone, the interior is burned."   The cause of the fire is not known but the cathedral has been closed to the public since January 7 for restoration work.    Built in a neo-gothic style between 1897 and 1916, the cathedral is one of the central African country's main tourist attractions.

The blaze brought comparisons to the devastating fire that ravaged the 13th century Notre-Dame cathedral in Paris in April 2019.     The French Embassy in Malabo said the fire was a "cruel reminder" of the fire at Notre Dame.    "We share the emotion of our friends in Malabo and Equatorial Guinea and hope that the fire can be brought under control quickly," it said on Twitter.      Paris engineers are still working to stabilise the 13th century cathedral in the French capital after fire tore through its roof and dramatically toppled its spire last year.
Date: Wed, 15 Jan 2020 21:55:41 +0100 (MET)

Rio de Janeiro, Jan 15, 2020 (AFP) - Widespread complaints over foul-smelling drinking water in Rio de Janeiro have triggered a run on supermarket bottled water, though the public utility denied any health risk Wednesday.   Rio governor Wilson Witzel set alarm bells ringing in a Twitter post on Tuesday, saying the situation -- fuelled by social media rumours -- was "unacceptable" and calling for a "rigorous investigation."

Moving to calm growing fears, public water utility Cedae attributed the problems to the presence of geosmin, a harmless organic compound, insisting the resulting earthy-tasting tap water was safe to drink.   "The results of the analyses show the presence of geosmin, at a rate sufficient to change the taste. But there is no risk to health," Sergio Marques, the official in charge of water quality, told a press conference.   Cedae later said it had fired the head of the Guandu treatment plant, which supplies nearly 80 percent of Rio's drinking water.   It said the supply from Guandu would be treated with carbon in the coming days to get rid of the geosmin.

According to O Globo newspaper, nearly 70 districts of the capital have been affected.   It reported that more than 1,300 cases of gastroenteritis were recorded over the last 15 days in Santa Cruz in the west of Rio, where water quality complaints were rife.   Cedae's president Helio Cabral apologized "to the whole population for the problems in the water supply," which began earlier this month.

The problem has been exacerbated by false rumours circulating on social media that the water was toxic.   Despite assurances, many Rio citizens were taking no chances. In supermarkets, mineral water stocks have been selling out and long queues are formed as soon as they are replenished.   Geosmin is also responsible for the earthy taste in some vegetables.
Date: Wed, 15 Jan 2020 21:25:04 +0100 (MET)

Lima, Jan 15, 2020 (AFP) - Five tourists arrested for damaging Peru's iconic Machu Picchu site will be deported to Bolivia later on Wednesday, police said.   A sixth was released from custody and ordered to remain in Machu Picchu pending trial after paying bail of $910.   The six tourists -- four men and two women -- were arrested for damaging Peru's "cultural heritage" after being found in a restricted area of the Temple of the Sun on Sunday.   They were also suspected of defecating inside the 600-year-old temple, an important edifice in the Inca sanctuary.   "We've got the order. Today the five foreign tourists will be expelled," Cusco police official Edward Delgado told AFP.   "We're going to take them by road to the city of Desaguadero, on the border with Bolivia."   The border town, a nine-hour drive away, is the nearest frontier point to the southern Cusco region where Machu Picchu is located.

The sixth tourist, 28-year-old Nahuel Gomez, must sign at a local court every 10 days while awaiting trial.   He admitted to removing a stone slab from a temple wall that was chipped when it fell to the ground, causing a crack in the floor.   He could face four years in prison if found guilty of damaging Peru's cultural heritage.   Several parts of the semicircular Temple of the Sun are off limits to tourists for preservation reasons.   Worshipers at the temple would make offerings to the sun, which was considered the most important deity in the Inca empire as well as other pre-Inca civilizations in the Andean region.   The group -- made up of a Chilean, two Argentines, two Brazilians, including one of the women, and a French woman -- allegedly entered the Inca sanctuary on Saturday and hid on site so they could spend the night there -- which is prohibited.

A source with the public prosecutor's office told AFP that Nahuel admitted to the damage but said "it wasn't intentional, he only leant against the wall."   The Machu Picchu complex -- which includes three distinct areas for agriculture, housing and religious ceremonies -- is the most iconic site from the Inca empire, which ruled over a large swath of western South America for 100 years before the Spanish conquest in the 16th century.   Machu Picchu, which means "old mountain" in the Quechua language indigenous to the area, is at the top of a lush mountain and was built during the reign of the Inca emperor Pachacuti (1438-1471).
Date: Wed, 15 Jan 2020 20:53:05 +0100 (MET)

Alicante, Spain, Jan 15, 2020 (AFP) - A fire broke out Wednesday on the roof of the airport in Alicante, a city on the eastern Mediterranean coast which is a tourism hotspot, forcing its closure to air traffic.   "The fire is under control but it has not been extinguished. Firefighters are continuing to work," a spokesman for Spanish airport operator Aena told AFP, adding the airport will remain closed to air traffic until noon on Thursday.

Ten flights which were due to land at Alicante were cancelled, as were 12 which were supposed to depart from the airport, he said.    Another four flights which were due to land at Alicante were diverted to other Spanish airports.   The flames were visible from inside the terminal, according to an AFP photographer at the scene.   Passengers and workers stood outside as dense smoke rose from the terminal building.   No one was injured and the authorities are still not sure what caused the fire.

The airport serves the eastern region of Valencia, which is home to several popular resorts such as Benidorm. It handled just under 14 million passengers last year, making it Spain's fifth busiest airport.   Aena recommended in a tweet that passengers contact their airline before heading to Alicante airport to see what the status of their flight was.   "We are coordinating with airlines. Consult your company to know if your flight is cancelled or will operate from an alternative airport," it said.
Date: Wed, 15 Jan 2020 11:12:40 +0100 (MET)

Beijing, Jan 15, 2020 (AFP) - A new virus from the same family as the deadly SARS pathogen could have been spread between family members in the Chinese city of Wuhan, local authorities said Wednesday.   The outbreak, which has killed one person, has caused alarm because of the link with SARS (Sudden Acute Respiratory Syndrome), which killed 349 people in mainland China and another 299 in Hong Kong in 2002-2003.   One of the 41 patients reported in the city could have been infected by her husband, Wuhan's health commission said in a statement on Wednesday.   The announcement follows news that a Chinese woman had been diagnosed with the novel coronavirus in Thailand after travelling there from Wuhan.

No human-to-human transmission of the virus behind the Wuhan outbreak has been confirmed so far, but the health commission said the possibility "cannot be excluded".   The commission said that one man who had been diagnosed worked at Huanan Seafood Wholesale Market, which has been identified as the centre of the outbreak, but his wife had been diagnosed with the illness despite reporting "no history of exposure" at the market.   At a press conference on Wednesday following a fact-finding trip to Wuhan, Hong Kong health officials also said that the possibility of human-to-human transmission could not be ruled out despite no "definitive evidence".

Dr Chuang Shuk-kwan, from Hong Kong's Centre for Health Protection, said there were two family group cases among the recorded cases in Wuhan, including the husband and wife and a separate case of a father, son and nephew living together.   However, he said mainland doctors believed the three men were most likely to have been exposed to the same virus in the market.   The market has been closed since January 1.   The woman diagnosed in Thailand, who is currently in a stable condition, had not reported visiting the seafood market, the World Health Organization (WHO) said on Tuesday.

WHO doctor Maria Van Kerkhove said Tuesday that they "wouldn't be surprised if there was some limited human-to-human transmission, especially among families who have close contact with one another".   The US Centers for Disease Control and Prevention issued a Level 1 "Watch" alert for travellers to Wuhan after the patient was diagnosed in Thailand, saying they should practice normal precautions and avoid contact with animals and sick people.

Wuhan's health commission said on Wednesday that most of the patients diagnosed with the virus were male, and many were middle-aged or elderly.   In Hong Kong, hospitals have raised their alert level to "serious" and stepped up detection measures including temperature checkpoints for inbound travellers.   Hong Kong authorities said on Tuesday that the number of people hospitalised with fever or respiratory symptoms in recent days after travelling to Wuhan had grown to 71, including seven new cases since Friday.   Sixty of that total, however, have already been discharged. None have yet been diagnosed with the new coronavirus.
Date: Wed, 15 Jan 2020 03:48:17 +0100 (MET)
By Emile Kouton with Celia Lebur in Lagos

Lome, Jan 15, 2020 (AFP) - After he was struck down by malaria and typhoid, Togolese tailor Ayawo Hievi thought he was set to recover when he started taking drugs prescribed by his doctor.   But far from curing him, the medication he was given at the neighbourhood clinic made him far worse -- eventually costing him one of his kidneys.    The drugs were fake.   "After four days of care, there was no improvement, but I started to feel pain in my belly," Hievi, 52, told AFP.

After two weeks of suffering he became unable to walk and was rushed into the university hospital in the West African nation's capital Lome.    "The doctors told me that my kidneys had been damaged... the quinine and the antibiotics used to treat me in the medical office were fake drugs."   Now, over four years later, he remains crippled by chronic kidney failure and has to go to hospital for dialysis regularly.    Hievi's horror story is far from unique in a continent awash with counterfeit medicines.    The World Health Organization (WHO) estimates that every year some 100,000 people across Africa die from taking "falsified or substandard" medication.

The American Society of Tropical Medicine and Hygiene estimated in 2015 that 122,000 children under five died due to taking poor quality anti-malaria drugs in sub-Saharan Africa.   Weak legislation, poor healthcare systems and widespread poverty have encouraged the growth of this parallel -- and deadly -- market. Since 2013, Africa has made up 42 percent of the fake medicine seized worldwide.    The two drugs most likely to be out-of-date or poor, ineffective copies are antibiotics and anti-malarials, say experts.    And bogus drugs not only pose a risk to the patient -- they also play a worrying part in building resistance to vital frontline medications.

- 'Difficult to trace' -
In a bid to tackle the scourge, presidents from seven countries -- the Republic of Congo, Gambia, Ghana, Niger, Senegal, Togo and Uganda -- meet Friday in Lome to sign an agreement for criminalising trafficking in fake drugs.    The goal is to bolster cooperation between governments and encourage other African nations to join the initiative.   But even if leaders put pen to paper, the task of stamping out the flows of counterfeit medication is huge.    Medicines spread out on plastic sheets or offered at ramshackle stalls are for sale at markets across West Africa.

Those hawked on the streets are often a fraction of the price of what's available in more reputable pharmacies where controls are stricter and supplies often have to come through official channels.    "It is very difficult to trace where the fake medicines come from," said Dr Innocent Kounde Kpeto, the president of Togo's pharmacist association.    "The countries which are mentioned on the boxes are often not the countries of origin or manufacture of these drugs. The manufacturers cover their tracks so as not to be identified".

It is estimated that between 30 and 60 percent of medicine sold in Africa is fake and Kpeto said most of it comes from China or India.    Efforts to staunch the deadly torrents of counterfeits have made some headway.    Some trafficking hubs have been dismantled, such as Adjegounle market in Cotonou that served as a key gateway for fakes heading to giant neighbour Nigeria.   In mid-November, the police in Ivory Coast made a record seizure of 200 tonnes in Abidjan and arrested four suspects including a Chinese national.

Togo is one of the pioneer countries trying to stop the flow.    It changed the law in 2015 and now traffickers can face 20 years in jail and a fine of some $85,000 (75,000 euros).   In a show of force in July the authorities burnt over 67 tonnes of counterfeit pharmaceuticals discovered between     But even given these recent successes, those in the industry like Dr Kpeto insist that the threat is still grave and involves "highly organised criminal networks".    "The phenomenon remains major," he said.    Traffickers can turn an investment of just $1,000 (900 euros) into a profit of $500,000, he claimed.   The fake medicines are smuggled in the same way as guns or narcotics and often bring higher returns.

- 'Die for nothing' -
Nigeria, Africa's most populous country with a market of 200 million people, is the number one destination on the continent for fake drugs and a showcase of difficulties being faced.    In September 2016 the World Customs Organization seized tens of millions of fake pills and medicines at 16 ports around Africa: 35 percent were intended for Nigeria.    Across the vast nation there are tens of thousands of vendors selling the counterfeits.   Competition between traffickers is fierce and the official agency meant to combat the problem is overwhelmed.

In a bid to improve the situation, Vivian Nwakah founded in 2017 start-up Medsaf and raised $1.4 million to help Nigerians track their medication from producer to user.    "The country doesn't have a reliable and centralised distribution network," she said.    "A hospital sometimes has to deal with 30 or 40 distributors for all the medications it needs. How can you have quality control with so many suppliers?"   As a result, fake or faulty medicine has not just flooded markets but also pharmacies and hospitals -- both state and private.    Sometimes, without hospital administrators even being aware, that means the drugs that reach the patients can be expired, poorly stored or the wrong doses. 

Medsaf works to ensure the quality control of thousands of products at over 130 hospitals and pharmacies in Nigeria. It looks forward to expanding deeper into Nigeria as well as Ivory Coast and Senegal.   The company uses technology, database management and analytics to monitor the movement of medications and verifies their official registration number, the expiry dates and storage conditions.   "Technology we use can help to solve most of the issues related to fake drugs," Nwakah said. "People die for nothing. We can change that."
Date: Mon 13 Jan 2020, 00.45 IST
Source: The Hindu [edited]

A 58-year-old woman from Seegemakki village in Tumari Gram Panchayat limits in Sagar taluk died due to Kyasanur Forest Disease (KFD), also known as monkey fever, at a private hospital in Manipal in Udupi district on [Sat 11 Jan 2020].

The deceased, H, who had complained of high fever and aches in joints was admitted to government sub-divisional hospital in Sagar city for treatment on [Tue 7 Jan 2020]. Her blood tested positive for KFD.

Rajesh Suragihalli, District Health Officer, told The Hindu that as her health condition had worsened, she was shifted to a private hospital in Manipal on [Thu 9 Jan 2020] for advanced treatment. She failed to respond to the treatment and breathed her last on [Sat 11 Jan 2020], he said.

Following the death, the Department of Health and Family Welfare has sounded an alert in Sagar and Tirthahalli taluks from where 7 positive cases have been reported since [1 Jan 2020]. The vaccination drive has been stepped up in the villages from where positive cases are reported. Three advanced life support ambulances have been stationed in government sub-divisional hospital in Sagar to shift KFD patients with health complications to private hospitals in Shivamogga city or Manipal for additional treatment, he said.
====================
[Kyasanur Forest disease (KFD) is an acute febrile illness caused by Kyasanur Forest disease virus (KFDV), a member of the family _Flaviviridae_, characterized by severe muscle pain, gastrointestinal symptoms, and bleeding manifestations. The virus was 1st identified in 1957 after it was isolated from a sick monkey from the Kyasanur Forest in Karnataka state of India. The disease is transmitted to humans following a tick bite or contact with an infected animal, especially a sick or recently dead monkey. There is no evidence of person-to-person transmission (<https://www.cdc.gov/vhf/kyasanur/index.html>).

The case fatality of Kyasanur Forest disease (KFD) is 2-10% and mortality is higher in the elderly and in individuals with comorbid conditions. There is no specific treatment for KFD. Prompt symptomatic and supportive treatment can reduce morbidity and mortality. Surveillance (human, monkey, and tick), personal protection against tick bites, and vaccination are the key measures for prevention and control of KFD (<https://idsp.nic.in/WriteReadData/l892s/60398414361527247979.pdf>).

As per the media report above, 7 confirmed KFD cases have been reported from Sagar and Tirthahalli taluks in Karnataka state so far in 2020. KFD typically occurs during the dry season from November through May, which correlates with the increased activity of the nymphs of ticks. Exposure to adult ticks and nymphs in rural or outdoor settings increases the risk of infection; herders, forest workers, farmers, and hunters are particularly at increased risk of contracting the disease. Vaccination and personal protective measures against tick bites are keys to prevent KFD.

The recommended preventive measures include using tick repellents, walking along clear trails, avoiding contact with weeds, and wearing full sleeved clothes and long pants to reduce exposed skin to reduce contact with ticks and subsequent tick bites. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Karnataka State, India: <http://healthmap.org/promed/p/307>]
Date: Mon 13 Jan 2020
Source: Food Safety News [edited]

An emergency committee to control the sale of food has been created in a city in northwest Argentina after a spike in _Salmonella_ cases in early 2020. There have been 51 confirmed cases of salmonellosis in Salta so far in 2020. At least 5 people have been hospitalized but recovered after treatment.

The committee will be responsible for controlling food sold on public roads at street stalls and at commercial premises. It includes experts from the National University of Salta (UNSA) and Catholic University of Salta (Ucasal). Officials hope by increasing controls they can bring the rise in infections under control and minimize the risk to the public. The group, created by the Mayor of Salta Bettina Romero and Undersecretary of Health and Human Environment Monica Torfe, held a meeting with Juan Jose Esteban, manager of the Hospital Senor del Milagro, and teams from the department of epidemiology of the province on preventive measures to tackle the salmonellosis rise this past week.

Norma Sponton, head of the microbiology sector; Teresita Cruz, of the epidemiological surveillance program of the province; Paula Herrera, from the Ministry of Health, and Jose Herrera, from the hospital also participated. Experts from the 2 universities are involved in training the inspectors who will be in charge of carrying out the control tasks.

Food contaminated with _Salmonella_ bacteria does not usually look, smell, or taste spoiled. Symptoms of salmonellosis infection can include diarrhoea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for 4 to 7 days. In some cases, however, diarrhoea may be so severe that patients require hospitalization.
===================
[The serotype of _S. enterica_ is not stated and it is not clear what the food reservoir for this ongoing outbreak is. A food diary of affected persons may be helpful.

The city of Salta is located in north-western Argentina in the province of the same name which can be found on a map at

[HealthMap/ProMED-mail map of Argentina: