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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
************************************
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
************************************
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: Mon 20 Jan 2020
From: Alyssa Pyke <Alyssa.Pyke@health.qld.gov.au> [edited]

Queensland Health has reported an imported case of Japanese encephalitis virus (JEV) infection in an unvaccinated male who travelled from Bali to Australia in late 2019.

JEV is a mosquito-borne flavivirus and a leading cause of encephalitis throughout Asia. The virus is largely endemic in Indonesia, and a JEV vaccination program for children was initiated on the island of Bali in March 2018 (1).

Several reports have previously described encephalitis caused by JEV infections in travellers who contracted their illness in Bali (2, 3), including an unvaccinated, 10-year-old Australian girl, in 1989 (4).

Laboratory diagnostics performed at Forensic and Scientific Services (FSS) detected JEV RNA by real-time TaqMan qRT-PCR in a cerebrospinal fluid (CSF) sample taken from the imported JEV 2019 case. Specific anti-JEV IgM antibodies were detected in the same CSF sample and in an additional serum sample collected 2 days later using a multiplexed flavivirus microsphere immunoassay. Viral culture of the CSF sample yielded a JEV isolate, JEV Bali 2019.

The JEV Bali 2019 isolate was further characterized by massive parallel sequencing using both the NextSeq Illumina and GridION Oxford Nanopore platforms. The complete JEV 2019 genome sequence obtained was most closely related to a JEV Bali 2017 sequence (GenBank accession number LC461961) with which it shared 99.23% nucleotide identity.

Persistence of JEV and associated disease transmission in the popular tourist isle of Bali highlight this pathogen as an ongoing public health threat, and the continued incidence of cases with serious neurological symptoms, as described in this report, emphasize the importance of appropriate health and vaccination advice to prospective travellers to the region. The development of improved surveillance and diagnostics for JEV and other medically important pathogens should also be prioritized. Recently, whole genome sequencing has substantially enhanced these capabilities, affording timely provision of data regarding the types and genetic characteristics of circulating strains.

The diagnosis of the current JEV 2019 case with a history of travel in Bali, and rapid generation of a complete genome sequence from the recovered JEV Bali 2019 isolate, resulted from the combined efforts of the Public Health Virology and Microbiology laboratories at FSS, Queensland Health, which incorporate the Queensland Reference Centre for Microbial and Public Health Genomics; and the Queensland Health Medical staff at the Sunshine Coast University Hospital, Queensland, Australia.

References
1. Im J, Balasubramanian R, Yastini NW, Suwarba IGN, Andayani AR, Bura V, Jeon HJ, Clemens JD, Marks F. 2018. Protecting children against Japanese encephalitis in Bali, Indonesia. Lancet 391:2500-2501.
2. Wittesjo B, Eitrem R, Niklasson B, Vene S, Mangiafico J. 1995. Japanese encephalitis after a 10-day holiday in Bali. Lancet 345:856-857.
3. Buhl MR, Black FT, Andersen PL, Laursen A. 1996. Fatal Japanese encephalitis in a Danish tourist visiting Bali for 12 days. Scand J Infect Dis 28:189.
4. Macdonald WB, Tink AR, Ouvrier RA, Menser MA, de Silva LM, Naim H, Hawkes RA. 1989. Japanese encephalitis after a two-week holiday in Bali. Med J Aust 150:334-336, 339.
------------------------------------
Dr Alyssa Pyke
Public Health Virology
Forensic and Scientific Services
Department of Health, Queensland Government
Australia
=====================
[As Dr. Pyke points out, individuals infected with JE virus and returning to Australia from Bali, Indonesia have appeared before, as recently as 2018 (see Japanese encephalitis - Indonesia: (BA,SW) http://promedmail.org/post/20181108.6132871).

The very thorough and remarkably rapid laboratory testing established the JE virus aetiology in this case. It is interesting that the sequences of their isolate matched 99.23% with the JEV Bali 2017 JE virus sequence. The current condition of the patient is not mentioned but obviously is a clinical case of JE. It will be interesting to learn whether JE vaccination is recommended for visitors to Bali, a popular tourist destination, and whether tourists will heed vaccination advice, given that JE cases are sporadic and less than 1% of JE virus infected individuals develop clinical illness.

The USA CDC notes that among patients who develop encephalitis, 20%-30% die. Although some symptoms improve after the acute illness, 30%-50% of survivors continue to have neurologic, cognitive, or psychiatric symptoms (see <https://www.cdc.gov/japaneseencephalitis/symptoms/index.html>). - ProMED Mod.TY]

[HealthMap/ProMED maps available at:
Date: Thu 16 Jan 2020
Source: Tempo.co [edited]

Anthrax threatens Ponjong and Semanu subdistricts in Gunung Kidul district, Yogyakarta province, after 27 residents were infected from consuming the meat of a dead cow, a local health official said on Wednesday [15 Jan 2020].

On 4 Jan 2020, health workers found that 600 residents of the 2 subdistricts could have been affected by anthrax, and 78 of them were observed to have the clinical features of this disease, Sumitro, head of the Disease Prevention and Control Unit at the Gunung Kidul Health Office, said. The local health authorities sent the blood samples of the victims for tests. The result showed that 27 people had tested positive to the disease, he told journalists in response to the latest anthrax cases in Gunung Kidul district.

The infected residents had been administered antibiotic prophylaxis for 20 days and were required to undergo another blood test at Bogor city's BBVEt facilities in West Java province, Sumitro said.

The residents who were suffering from the general signs and symptoms of this anthrax were just administered an antibiotic, he said, adding that the infected residents were not isolated because the disease was not contagious.

"Anthrax is a major cause of fatal disease in cattle, sheep, goats, camels, horses, and pigs throughout the world," the World Health Organization (WHO) has stated. It had caused the death of the owner of the infected cow because he had consumed the meat and regularly cleaned the cattle [pen], Sumitro further said.

In halting the spread of the disease, the district's health authorities had closely coordinated with those from the Food and Agriculture Office regarding education and public awareness campaign programs. "We have also disseminated information to the people at large urging them to cook any meat properly, and not to consume the meat of ailing animals," he added.

The anthrax poisoning cases have repeatedly occurred in certain parts of Indonesia over these past few years. But according to Widagdo Sri Nugroho, a University of Gadjah Mada (UGM) veterinarian, "Anthrax is actually found in almost all countries." He was quoted by the UGM's official website (2017) as saying that "of 180 states that join veterinary health organizations, anthrax is found in 94% of states. In Indonesia, it has been identified since 1884 in Teluk Betung, Lampung." [In fact, globally, anthrax is becoming less frequent, and an increasing number of countries are freed of it. - ProMED Mod.MHJ]

Some 22 provinces in Indonesia are endemic, Nugroho noted. In handling the disease, farmers need to be aware of their cattle's condition and are urged to contact veterinarians who would examine their cattle for any indications of anthrax, he added.  [Byline: Antara (translator), Petir Garda Bhwana (editor)]
======================
[Yogyakarta in is the middle of the southern coast of Java, Indonesia; see
<https://en.wikipedia.org/wiki/Yogyakarta>.
For a map of the province, see

If there were gastroenteric cases, this report would have listed deaths in an outbreak of this size. The 27 positive cases probably had cutaneous lesions. The lesson to be taken from this incident is how many humans can be put at risk in 2 communities by just butchering one sick and dying cow. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map:
Yogyakarta, Special Region of Yogyakarta, Indonesia:
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.
More ...

Niue

No Profile is available at present

Travel News Headlines WORLD NEWS

20th July 2012

- Niue Island. 20 Jul 2012. Two tourists visiting Niue have been taken to hospital with dengue fever. More than 100 people, or about 8 percent of the population, are believed to be suffering from the fever, and visitors are being warned to use insect repellent during early morning and evening. Dengue, which does not often occur on Niue, has been afflicting  the island since February [2012]. It was originally confined to a small area of Niue's main village but has now spread throughout the island. One local man recently died from a serious form of the virus.
==================
[A HealthMap/ProMED-mail interactive map showing the location of Niue Island in the Pacific Ocean can be accessed at <http://healthmap.org/r/1ZWb>. - ProMed Mod.TY]
Monday 30th April 2012
A ProMED-mail post
<http://www.promedmail.org>

- Niue Island. 24 Apr 2012. The Niue Health Department says it believes the dengue outbreak has peaked. The department says there have been 47 recorded cases of dengue fever, but only one case has been picked up in the last 7 days. The Acting Director of Health, Manila Nosa, says it's a relief to see the wane in cases, but it's too early to say that dengue is completely gone. He said that there has been a lot of rain lately, and it's hoped this won't contribute to a further spread.
======================
[A HealthMap/ProMED-mail interactive map of Niue Island can be accessed at <http://healthmap.org/r/1ZWb>. - ProMed Mod.TY]
Monday 16th April 2012
A ProMED-mail post
<http://www.promedmail.org>

- Niue Island. 12 Apr 2012. Health authorities on Niue are confident that they are on top of the latest dengue outbreak that has infected 20 people to date. The chief medical officer, Dr Eddie Akau'ola, says this outbreak began about 3 weeks ago but they believe they have been able to contain it. He says it is peaking now and they expect a decline in a week or 2. Dr Akau'ola says none of the cases have been too serious.
====================
[A HealthMap/ProMED-mail interactive map showing the location of Niue Island in the Pacific can be accessed at <http://healthmap.org/r/2bMz>. - ProMed Mod.TY]
Tuesday 13th March 2012
A ProMED-mail post
<http://www.promedmail.org/>

- Niue Island. 6 Mar 2012. Niue health authorities are hopeful they've contained a rare outbreak of dengue fever on the island where 3 people were reported with dengue last week, with 2 admitted to hospital.
======================
[A HealthMap/ProMED-mail interactive map showing the location of Niue Island in the Pacific can be accessed at <http://healthmap.org/r/1ZWb>. - ProMed Mod.TY]
Date: Sun, 24 Jul 2011 10:42:49 +0200 (METDST)
by Neil Sands

ALOFI, Niue, July 23, 2011 (AFP) - In a once-thriving village on the Pacific island of Niue, homes lie abandoned, their stucco-clad walls mildewed and crumbling as the jungle slowly reclaims them. "These villages used to be bustling with people -- now you go there in the afternoon and there's no one," says the Niue Tourism Authority chairman Hima Douglas. The number of people living on the lush coral atoll, about 2,500 kilometres (1,550 miles) northeast of New Zealand, has been declining for decades as inhabitants seek a better life overseas.

The population, which peaked at more than 5,000 in the mid-1960s, has dwindled to just 1,200, according to a New Zealand parliamentary report, raising doubts about the island nation's economic viability.  Douglas said a major cyclone in 2004, which destroyed much of Niue's infrastructure, accelerated the exodus, and the threat of future natural disasters was discouraging people from returning. "Of course it's concerning but it's not something we can do too much about until we can build an economy that will give them the confidence to come back," Niue's Premier Toke Talagi told reporters this month. "There aren't simple and easy answers to people leaving. We've got to build a strong economy and hope to attract them back." Known locally as "The Rock", Niue was settled by Polynesian seafarers more than 1,000 years ago and the palm-dotted island's name in the local language means "behold, the coconut".

The British explorer captain James Cook tried to land there three times in 1774 but was deterred by fearsome warriors, eventually giving up to set sail for more welcoming shores and naming Niue "savage island" on his charts. But modern day Niueans are desperate for visitors, with Talagi unveiling plans this month to turn it into a boutique tourism destination in a bid to put his nation on a sound economic footing. Using aid from New Zealand, with which Niue has a compact of free association giving its people dual citizenship, Talagi has overseen construction of a new tourism centre and expansion of the island's Matavai Resort.

Paths have also been cut through the jungle to give visitors access to swimming spots on the rugged limestone coastline, and cruise liners are being encouraged to include Niue on their itineraries. "We can become self-sustaining in the long term (and) reduce New Zealand assistance to Niue," Talagi said, estimating that visitor numbers could quadruple to 20,000 a year in the next decade. Addressing a visiting delegation of New Zealand business executives this month, Talagi acknowledged doubts about the nation's ability to meet the challenge. "I know some of you are a bit sceptical about our ability to become self sustaining... (but) tourism is not going to fail and I don't expect it to fail given the numbers that are being generated," he said.

The New Zealand parliamentary report, released last December, estimates that about 50,000 Niueans and their children now live in Australia and New Zealand, creating a shortage of skilled labour in one of the world's smallest states. "Niue is caught in a vicious cycle, with its economic difficulties both exacerbated by, and reflected in, the long-term decline of its population," it said, adding that 40 years of New Zealand aid "has yielded almost no return". The report's authors suggested Niue should concentrate on promoting itself as a retirement destination for elderly New Zealanders, who could help revitalise the economy. "The climate is excellent, existing buildings could be brought into service, and health facilities are satisfactory," it said. "Retirees would bring steady cash flow and contribute to stable employment options."

Asked about the suggestion, Talangi said "we'll look at everything", although one long-time resident, who asked not to be named, was unenthusiastic at the prospect. "How depressing to think that we might be turned into a major geriatric ward," she said. "Not that I have anything against old people, mind." Another resident said that whatever steps Niue took to improve its economy must result in major changes, pointing out people could earn more by moving to New Zealand and claiming unemployment benefits than working on the island. "It's pretty hard when your cuzzies (cousins) call you and say 'we're getting more on the dole in Auckland than you're getting paid'," he said.
More ...

Bangladesh

Bangladesh - US Consular Information Sheet
June 17, 2008

COUNTRY DESCRIPTION:
Bangladesh is a democratic republic with a parliamentary form of government.
On January 11, 2007, President Iajuddin Ahmed declared a state of emergenc
.
On May 12, 2008, the Chief Adviser announced that national parliamentary elections would be held in the third week of December, 2008.
Bangladesh remains a developing country with poor infrastructure.
Tourist facilities outside major cities and tourist areas are minimal.
Read the Department of State Background Notes on Bangladesh for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport, visa and onward/return ticket are required.
All travelers to Bangladesh, including American citizens, must have a valid visa in their valid passport prior to arrival.
Although airport visas (landing permits) are available upon arrival by air, the U.S. Embassy in Dhaka does not recommend this option for most categories of travelers as working hours may not coincide with flight arrival times and precise formalities can vary.
Additionally, if issued, landing permit validity is usually limited to a maximum of fifteen days.
A valid visa in an expired or cancelled U.S. passport is not acceptable to the Bangladeshi authorities; if you are issued a new U.S. passport, you will need a new visa.

If you intend to use Dhaka as a hub from which to visit other countries in the region, ensure that you obtain a multiple-entry visa before arrival.
If you intend to work for a non-governmental organization (NGO) in Bangladesh, you should ensure that your sponsor has provided you with up-to-date advice on the kind of visa you must obtain before arrival.
It is difficult and time-consuming to change your immigration status once you have arrived in Bangladesh.

Visas to Bangladesh which are expiring may be extended at the Directorate of Immigration and Passport, located at Sher-e-Bangla Nagar, Agargaon, Dhaka.
The phone numbers are (880-2) 913-1891 and 913-4011.

New visa rules, introduced in October 2006, require foreign nationals who come to Bangladesh to work or for long-term visits to have the appropriate work permits and clearances on arrival.
There are increased financial penalties for overstaying visas.
Additionally, those who overstay for more than 90 days face the possibility of being charged with violating the Foreigners Act of 1946.
For further information on these rules, please check with the nearest Bangladeshi Embassy or Consulate (U.S. addresses listed below) before traveling, or visit the Bangadeshi Immigration Police web site at www.immi.gov.bd, which provides further details on rules relating to foreigner registrations.

There are two exit requirements:
A.
When traveling by air, there is a departure tax on all foreigners except children under the age of two.
This tax is often included when air tickets are purchased.
Otherwise, it is collected at the airport at the time of departure.
The amount of the departure tax varies, depending on the destination (e.g., the departure tax for the U.S. is the most expensive, at USD $43).
There is no travel tax for transit passengers transiting Bangladesh without a visa and in country for 72 hours or fewer.
These requirements may be subject to change, and travelers are advised to check with the Embassy of Bangladesh before traveling.

B.
Departing foreign nationals are also required to comply with the income tax ordinance of 1984 and submit an income tax clearance certificate/income tax exemption certificate to local airline offices upon departure from Bangladesh.
More information can be obtained from the Bangladesh Board of Revenue web site at http://www.nbr-bd.org/.

For further information on entry requirements and possible exceptions to the exit requirements, please contact the Embassy of the People's Republic of Bangladesh, 3510 International Drive NW, Washington, DC
20008, telephone 202-244-0183, fax 202-244-5366, web site http://www.bangladoot.org, or the Bangladeshi Consulates in New York at 211 E. 43rd Street, Suite 502, New York, NY 10017, telephone 212-599-6767 or Los Angeles at 10850 Wilshire Boulevard, Suite 1250, Los Angeles, CA 90024, telephone 310-441-9399. Visit the Embassy of Bangladesh web site at http://www.bangladoot.org for the most current visa information.

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

SAFETY AND SECURITY:
Bangladesh is currently under a state of emergency.
As of May, 2008, national parliamentary elections have been scheduled for the third week of December, 2008.
The security situation in Bangladesh is fluid, and Americans are urged to check with the U.S. Embassy for the latest information.
Spontaneous demonstrations take place in Bangladesh from time to time.
American citizens are reminded that even demonstrations intended to be peaceful can turn confrontational and escalate into violence quickly and unexpectedly.
American citizens are therefore urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations.
American citizens should stay up-to-date with media coverage of local events and be aware of their surroundings at all times.
Information regarding demonstrations in Bangladesh can be found on the U.S. Embassy Dhaka’s web site at http://dhaka.usembassy.gov/.

A terrorist bombing campaign in the second half of 2005, political violence throughout the country at the end of 2006, and threats to U.S. and Western interests led to increased security around U.S. Government facilities.
On August 17, 2005, a banned Islamist terrorist group, Jamaatul Mujahideen Bangladesh (JMB), claimed responsibility for nearly 500 coordinated small bomb blasts in virtually every part of Bangladesh that killed two persons and injured several dozen.
The most recent JMB bombing occurred on December 8, 2005, and the Bangladeshi government subsequently apprehended the known senior leadership of JMB.
Six JMB leaders convicted of complicity in JMB attacks were executed on March 29, 2007.
JMB and other extremist groups are small in number but remain active and may resume violent activities.

Demonstrations, political activity, and hartals (nationwide strikes) were initially banned during the state of emergency, but the rules restricting political activity have been slightly relaxed as part of the process leading up to the planned elections in the third week of December 2008.
Prior to the state of emergency, rallies, marches, demonstrations and hartals took place frequently.
In August 2007, violent protests involving thousands of demonstrators occurred in several cities in Bangladesh, including Dhaka.
Authorities imposed a curfew to restore calm.
Protests involving workers from the large garment-manufacturing industry are not uncommon.
Visitors to Bangladesh should check with the Consular Section of the U.S. Embassy in Dhaka for updated information on the current political situation.

U.S. citizens are advised against traveling to the Khagrachari, Rangamati and Bandarban Hill Tracts districts (collectively known as the Chittagong Hill Tracts) due to kidnappings and other security incidents, including those involving foreign nationals.
Foreigners traveling in the Chittagong Hill Tracts are required to register with local authorities.
Additionally, the U.S. Embassy has in the past received reports of incidents of kidnapping, arms and narcotics smuggling and clashes between local Bangladeshis and Rohingyan refugees in areas near Rohingyan refugee camps in the Teknaf, Kutupalong, Ukhia, and Ramu areas of the Cox’s Bazar district.
The U.S. Embassy also recommends against travel to these areas.
Individuals who choose to visit these districts are urged to exercise extreme caution.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs web site at http://travel.state.gov where the current Travel Warnings and Travel Alerts, including the Worldwide Caution, can be found.
Americans traveling to or living in Bangladesh who are registered at the U.S. Embassy will receive updated security information about Bangladesh via e-mail.
All Demonstration Notices and Warden Messages are posted on the Embassy’s web site at http://dhaka.usembassy.gov/.
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:
Urban crime can be organized or opportunistic, conducted by individuals or groups, and commonly encompasses fraud, theft (larceny, pick-pocketing, snatch-and-grab), robbery (armed and unarmed), carjacking, rape, assault, and burglary (home and auto).
Incidents of crime and levels of violence are higher in low-income residential and congested commercial areas, but are on the rise in wealthier areas as well.
Visitors should avoid walking alone after dark, carrying large sums of money, or wearing expensive jewelry.
Valuables should be stored in hotel safety deposit boxes and should not be left unattended in hotel rooms.
Police are generally responsive to reports of crimes against Americans.
Crimes, however, often go unsolved.

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 Bangladesh is 999.
This connects you to the Dhaka Metro Police Exchange.
There is no guarantee that English will be spoken or understood at the Dhaka Metro Police Exchange.
The Police Exchange can only transfer calls to the appropriate police station within the Dhaka metropolitan area, and then the caller will have to speak with that police station in order to actually have any police services performed.
There is similarly no guarantee that English will be spoken or understood at the local police station.

Outside of Dhaka, the caller will need to add the city code for Dhaka, so dial 02-999.
The caller will again be connected to the Dhaka Metro Police Exchange, which should be able to provide the number of the appropriate police station within Bangladesh, but the Dhaka Metro Police Exchange is unlikely to be able to transfer the call to a police station outside Dhaka.
The caller would have to hang up and dial the number provided by the Dhaka Metro Police Exchange.
The ability to speak and/or understand English is even more unlikely at local police stations outside of Dhaka.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Bangladesh do not approach U.S. standards, even in tourist areas.
There is limited ambulance service in Bangladesh.
Several hospitals in Dhaka (e.g., Apollo Hospital and Square Hospital) have emergency rooms that are equipped at the level of a community hospital.
Hospitals in the provinces are less well equipped and supplied.
There have been reports of counterfeit medications within the country, but medication from major pharmacies and hospitals is generally reliable.
Medical evacuations to Bangkok or Singapore are often necessary for serious conditions or invasive procedures.

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 Bangladesh is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Conditions differ around the country.

The Bangladeshi road network is in poor condition and poorly maintained.
The streets of Dhaka are extremely congested; bicycle rickshaws compete with three-wheeled mini-taxis (CNGs), cars, overloaded buses, and trucks on limited road space.
Also, driving on the left-hand side of the road may be confusing to American visitors.
Inter-city roads are narrow.
Driving at night is especially dangerous.
Streetlights are rare even in cities.
Road accidents are common in Bangladesh.
Fatal head-on collisions on inter-city roads are common.
When vehicle accidents occur, a crowd quickly gathers and violence can occur when the crowd becomes unruly.
Travelers are strongly urged not to use public transportation, including buses, rickshaws, and three-wheeled baby taxis due to their high accident rate and crime issues.
An alternative to consider is a rental car and driver.

Please refer to our Road Safety page for more information.
Visit the website of Bangladesh’s National Tourism Organization at http://www.parjatan.org, e-mail bpcho@bangla.net.

SPECIAL CIRCUMSTANCES:
Bangladesh is a country crisscrossed with rivers, and thus uses a wide network of water-based public transportation.
Ferries and other boats compete with the railroads as a major means of public transport.
Typically overloaded and top-heavy, ferries do capsize, particularly during the monsoon season from May to October or during unexpected thunderstorms or windstorms.
Every year there are dozens of fatalities resulting from ferry accidents.

Bangladeshi customs authorities may enforce strict regulations concerning temporary importation into or export from Bangladesh of items such as currency, household appliances, alcohol, cigarettes and weapons.
There is no restriction as to the amount of U.S. currency visitors may bring into Bangladesh; however, they must declare to customs authorities if they are carrying more than USD $5,000 at the time of arrival.
It is advisable to contact the Bangladeshi Embassy or Consulates for specific information regarding customs requirements.

Please see our Customs Information.

Land disputes are extremely common in Bangladesh and are extremely difficult to resolve through legal channels.
Court cases can last for months, and sometimes years, without there ever being a final and accurate determination of which party has legitimate claim to the title.

The U.S. Embassy currently has on file nearly twenty cases of American citizens who claim to be victimized in land-grabbing disputes.
Rarely are these simple cases of a legitimate property owner and an opportunistic land-grabber.
More often, it is a case of disagreement between an owner who believes he has historical ownership of the property and a new owner who has just purchased the same property.
One of them has been swindled, both of them have deeds, and it is next to impossible to determine whose deed is valid.

The dangers in becoming involved in a property dispute range from being threatened by bullies to being involved in a lengthy court dispute.
Those involved in a court dispute run the risk of having cases filed against them, and may be arrested and jailed, sometimes for months.

American Citizens wishing to purchase property in Bangladesh should be thoroughly aware of the risks they take and should only purchase property from a seller whose ownership is beyond doubt.
Additionally, they should recognize the risks associated if they are not physically present to oversee their property.
American Citizens should bear in mind that the U.S. Embassy cannot protect personal property in the absence of owners and cannot take sides in a legal dispute.

A marriage must be entered into with the full and free consent of both individuals.
The parties involved should feel that they have a choice.
If an American citizen is being forced into a marriage against his/her will, help and advice are available.
For more information, please and the U.S. Embassy in Dhaka information on forced marriage at http://dhaka.usembassy.gov/forced_marriage_home.html, or contact the American Citizens Services unit directly at DhakaACS@state.gov, or 011-88-02-885-5500 from the United States, 02-885-5500 from inside Bangladesh, or 885-5500 from anywhere in the city of Dhaka.
All travelers to Bangladesh should retain their passports and their return plane tickets to ensure independence to travel.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Bangladesh’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Bangladesh’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

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 Bangladeshi laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in Bangladesh 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, international parental child abduction and the U.S. Embassy in Dhaka information on forced marriage at http://dhaka.usembassy.gov/forced_marriage_home.html.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Bangladesh 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 Bangladesh.
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 approximately four miles south of Zia International Airport, and five miles north of downtown in the Diplomatic Enclave, Madani Avenue, Baridhara, Dhaka, telephone (88-02) 885-5500, fax number (88-02) 882-3744.
The workweek is Sunday through Thursday.
The Consular Section is open for American Citizens Services Sunday through Thursday from 1:00 p.m. to 4:00 p.m.
For emergency services and general information during business hours, please call (88-02) 882-3805.
For emergency services after hours, please call (88-02) 885-5500 and ask for the duty officer.
The Embassy's Internet home page is http://dhaka.usembassy.gov/
* * *
This replaces the Country Specific Information for Bangladesh dated November 23, 2007 to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Traffic Safety and Road Conditions, Special Circumstances, and Children’s Issues.

Travel News Headlines WORLD NEWS

Date: Fri 17 Jan 2020
Source: Outbreak News Today [edited]

Media sources in Bangladesh are reporting a Nipah virus infection in the city of Khulna. The reported case is a 20-year-old female who has been hospitalized since last Saturday [11 Jan 2020] at the Khulna Medical College Hospital (KMCH).

"A medical board has confirmed her infection by Nipah virus. As her infection is a risk to other patients, she is being treated separately at the hospital's Medicine unit 1," said SM Kamal Hossain, chief of KMCH Medicine Department.

According to the World Health Organization (WHO), in the Bangladesh and India outbreaks, consumption of fruits or fruit products (e.g. raw date palm juice) contaminated with urine or saliva from infected fruit bats was the most likely source of infection. Fruit bats of the family Pteropodidae -- particularly species belonging to the _Pteropus_ genus -- are the natural hosts for Nipah virus. There is no apparent disease in fruit bats.

In more recent outbreaks of the disease, person-to-person transmission has been seen in Bangladesh and India.

The disease in humans can range from asymptomatic infection to fatal encephalitis. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours.

The case fatality rate is estimated at 40% to 75%; however, this rate can vary by outbreak depending on local capabilities for surveillance investigations, according to the WHO.

Those who survive acute encephalitis make a full recovery, but around 20% are left with residual neurological consequences, such as persistent convulsions and personality changes.

There is no treatment or vaccine available for either people or animals.
======================
[Nipah virus infections occur sporadically in Bangladesh in a geographic area termed the Nipah belt and during certain seasons of the year when the reservoir fruit bat is abundant. As noted in the previous comment (ProMED-mail archive no. http://promedmail.org/post/20150204.3143251), giant fruit bats or flying foxes (_Pteropus_ of several species) are reservoirs of Nipah virus, and they contaminate date palm sap or fruit. This is the season for cases of Nipah virus infection to occur. The transmission season is usually January to April.

As noted earlier, it is unfortunate that the public awareness efforts have not prevented these cases from occurring. Perhaps because cases are sporadic and geographically scattered there is little public perception of risk of infection and serious disease. Until effective public education to prevent infection by avoiding eating contaminated fruit or date palm sap is implemented, sporadic cases will continue to occur.

Interestingly, a simple skirt constructed out of locally available materials can prevent access of the bats to the palm sap collecting pots, but apparently they are not commonly used. Boiling the palm sap would inactivate the virus, but local consumers indicated that it alters the flavour of the sap.

An image of a _Pteropus_ fruit bat can be found at

[HealthMap/ProMED map available at:
Khulna, Khulna, Bangladesh: <http://healthmap.org/promed/p/14886>]
Date: Sat 4 Jan 2020
Source: bdnews24 [edited]

The death of Fazilatun Nasa Bappy has triggered fresh fears over swine flu [influenza A/H1N1] in Bangladesh, but experts have urged the people to follow health safety rules instead of panicking.  Bappy, a former Awami League MP [Member of Parliament] from the seats reserved for women, died at the Bangabandhu Sheikh Mujib Medical University [BSMMU] on [Thu 2 Jan 2020], 4 days after the doctors put her on life support. The 49-year-old was admitted to the hospital on [28 Dec 2019] with a combination of pneumonia and other respiratory diseases.

Tests found she was H1N1 positive, according to Professor AKM Akhtaruzzaman, the chairman of the BSMMU's Intensive Care Unit. "She contracted swine flu virus," the doctor told bdnews24.com on [Fri 3 Jan 2020].

The hospital authorities have urged all not to panic, saying that there are vaccines for the disease. Prof. ABM Abdullah, a former dean of the BSMMU's medicine department, told bdnews24.com patients suffering from the disease recover "most of the times."

Patients with problems in the respiratory system or lungs, those who have diabetes, pregnant women, children aged between 6 months and 5 years, and people older than 65 years are more vulnerable to swine flu, he said. "There is nothing to panic over swine flu. But there is also no room to take it lightly," he added.

The H1N1 influenza virus was 1st reported in April 2009 in Mexico before spreading across the globe. The World Health Organization [WHO] declared a global H1N1 flu pandemic on [11 Jun 2009].

Bangladesh's 1st case was detected on [18 Jun 2009] amid a global outbreak, which created panic. When the virus was detected in Bangladesh again in 2013, doctors said swine flu became a "seasonal influenza" (H1N1) in Bangladesh like the other 2 viruses -- influenza B and [influenza A/H3N2].

A combined vaccine against these 3 viruses is available, meaning a single shot can help high-risk groups like pregnant women, [people with] uncontrolled [diabetes], and cancer patients. Fever, runny nose, sore throat, and cough followed by breathing difficulty are some of the symptoms of swine flu.

Maintaining personal hygiene, especially washing hands and the crook of one's elbow with soap, [is] advised to prevent any flu.

Respiratory transmission occurs mainly by droplets disseminated by unprotected coughs and sneezes, according to the WHO. Short-distance airborne transmission of influenza viruses may occur, particularly in crowded enclosed spaces.

Hand contamination and direct inoculation of virus is another possible source of transmission, which is why experts advise caution while taking care of swine flu patients.

Meerjady Sabrina Flora, a director at the government's disease control agency IEDCR [Institute of Epidemiology, Disease Control and Research], said swine flu affects people regularly in Bangladesh now as it transmits from person to person, a way in which Bappy "might have contracted the virus."

She also said those returning from Europe or China or Korea should consult doctors if any symptom of swine flu is found in them, as it is the swine flu season there. "We can do the tests as well and give advice for free. Tests and treatment are also available outside," she added.  [Byline: Obaidur Masum]
9 December 2019
https://www.who.int/bangladesh/news/detail/09-12-2019-cholera-vaccination-campaign-launched-to-protect-635-000-people-in-cox-s-bazar

Cox’s Bazar, Bangladesh

Over 635,000 Rohingya refugees and Bangladeshi host community will be vaccinated against cholera in a 3-week-long campaign beginning today at the refugee camps in Cox’s Bazar and nearby areas, to protect vulnerable population against the deadly disease amidst increasing number of cases of acute watery diarrhoea (AWD).


The Oral Cholera Vaccination (OCV) campaign will be implemented in the refugee camps from 8-14 December to reach 139,888 Rohingya aged 1 year and less than 5 years. In the host community, the campaign will take place from 8-31 December and aims to reach any person older than 1 year (495,197). In total, 635,085 people are expected to be reached.

Led by the Ministry of Health and Family Welfare, with support of the World Health Organization (WHO), UNICEF and other partners, the campaign aims to reach people who missed some or all previous cholera vaccination opportunities. The campaign, including operational costs, is funded by Gavi, the Vaccine Alliance.

“We want to equip these populations with more protection against diarrheal diseases. Despite the progresses made to ensure access to quality water and sanitation, such diseases remain an issue of concern: approximately 80% of host community living near the camps have not been targeted in previous OCV campaigns and are still vulnerable”, says Dr Bardan Jung Rana, WHO Representative in Bangladesh.

Earlier rounds of cholera vaccination, which have taken place since the beginning of the emergency response in 2017, have helped prevent outbreaks of the disease. To this date, over 1 million people were vaccinated against cholera.
Date: Sat, 9 Nov 2019 18:59:25 +0100 (MET)

MOUSOUNI ISLAND, India, Nov 9, 2019 (AFP) - Cyclone Bulbul hit India and southern Bangladesh on Saturday, leaving two dead as authorities in the countries ordered more than two million people to get out of the path of the storm.   The cyclone, packing winds of up to 120 kilometres (75 miles) per hour, has "weakened" and "started crossing" India's West Bengal and Bangladesh's Khulna coast at about 9:00 pm (1500 GMT), Dhaka's Meteorological Department said in a special bulletin.   "It is likely to move in a northeasterly direction" and "weaken gradually, and may complete crossing West Bengal-Khulna coast by midnight tonight," the department said.     Airports and ports were shut down and the deaths were reported before the full force of the cyclone had hit.   One person was killed by an uprooted tree in Kolkata and another by a wall that collapsed under the force of the winds in Odisha state, authorities said.

More than 60,000 people were moved away from the coast on the Indian side of the border.   Bangladesh disaster management secretary Shah Kamal told AFP that "2.028 million" have been evacuated and moved to more than 5,500 cyclone shelters.   He said there was no reports of casualties and rejected reports in local media that dozens of local fishermen were missing on the southern coast.    Bangladeshi troops were sent to some villages, while about 55,000 volunteers went door-to-door and making loudspeaker announcements in the streets to get people away from the danger zone in villages, many of which were below sea level.

- Ports closed, flights halted -
A storm surge up to two metres (seven feet) was predicted along the coast, Bangladesh's Meteorological Department said.   About 1,500 tourists were stranded on the southern island of Saint Martin after boat services were suspended due to bad weather.   Bangladesh's two biggest ports, Mongla and Chittagong, were closed because of the storm, and flights into Chittagong airport were halted.   In India, flights in and out of Kolkata airport were suspended for 12 hours because of the storm.   On the West Bengal island of Mousouni, which lies in the path of the storm, frightened residents took shelter in schools and government buildings because they had not been able to escape.   Military planes and ships have been put on standby to help in emergencies, Indian authorities said.

Bulbul hit the coast at the Sundarbans, the world's largest mangrove forest, which straddles Bangladesh and part of eastern India, and is home to endangered species including the Bengal tiger and the Irrawaddy dolphins.   Bangladesh's low-lying coast, home to 30 million people, is regularly battered by cyclones that leave a trail of destruction.   Hundreds of thousands of people have been killed in cyclones in recent decades.   While the frequency and intensity have increased, partly due to climate change, the death tolls have come down because of faster evacuations and the building of 4,000 cyclone shelters along the coast.   In November 2007, Cyclone Sidr killed more than 3,000 people. In May this year, Fani became the most powerful storm to hit the country in five years, but the death toll was about 12.
Date: Thu 26 Sep 2019, 12:00 AM
Source: Daily Sun [edited]

A new mosquito-borne virus, West Nile Virus (WNV), has been found in Bangladesh. However, detailed information about the virus has not been available yet as the government's concerned department didn't investigate to know its origin.

According to the experts, West Nile is a potentially life-threatening viral infection which can pass to animals and humans if they are bitten by an infected mosquito.

WNV is a virus of the _Flaviviridae_ family, which includes the viruses responsible for Japanese encephalitis and dengue fever. It mainly affects birds, but it can also infect mammals and reptiles. Between 70-80% of people have no symptoms. Up to 1% of those who become ill have serious and potentially fatal complications, they added.

"We have asked the Institute of Epidemiology Disease Control and Research (IEDCR) to investigate the West Nile virus," said Dr. Sanya Tahmina Jhora, Director of the Disease Control unit of Directorate General of Health Services (DGHS) on [Wed 25 Sep 2019].

Asked about the West Nile virus, Prof. Dr Meerjady Sabrina Flora, Director of Institute of Epidemiology of the IEDCR, said: "A report about the West Nile virus has come to us. A study of the ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh) has mentioned the detection the virus in Bangladesh. Our team will go to the spot and carry out investigation about the West Nile virus. We can give details about it after the investigation," she added.

The DGHS sources said the ICDDR,B detected the West Nile virus infected patient in an area near Dhaka city and informed the concerned authorities of the government to this end. However, talking to Daily Sun, the ICDDR,B communication department refused to comment.

According to the Centers for Disease Control and Prevention of the United States (US), West Nile virus (WNV) is the leading cause of mosquito-borne disease in the continental United States.

It is most commonly spread to people by the bite of an infected mosquito. Cases of WNV occur during mosquito season, which starts in the summer and continues through fall. There are no vaccines to prevent or medications to treat WNV in people," it said.

The report also said "most people infected with WNV do not feel sick, but about 1 in 5 people who are infected develop a fever and other symptoms. About 1 out of 150 infected people develop a serious, sometimes fatal, illness. You can reduce your risk of WNV by using insect repellent and wearing long-sleeved shirts and long pants to prevent mosquito bites."

The World Health Organization (WHO) said the West Nile virus can cause a fatal neurological disease in humans, while approximately 80% of people who are infected will not show any symptoms. "West Nile virus is mainly transmitted to people through the bites of infected mosquitoes. The virus can cause severe disease and death in horses. Vaccines are available for use in horses but not yet available for people. Birds are the natural hosts of West Nile virus," it said.

The WHO statement said WNV can cause neurological disease and death in people. "WNV is a member of the _flavivirus_ genus and belongs to the Japanese encephalitis antigenic complex of the family _Flaviviridae_. WNV is maintained in nature in a cycle involving transmission between birds and mosquitoes. Humans, horses and other mammals can be infected," it added. The WHO statement said human infection is most often the result of bites from infected mosquitoes. Mosquitoes become infected when they feed on infected birds, which circulate the virus in their blood for a few days. The virus eventually gets into the mosquito's salivary glands. During later blood meals (when mosquitoes bite), the virus may be injected into humans and animals, where it can multiply and possibly cause illness.

It said the virus may also be transmitted through contact with other infected animals, their blood, or other tissues. A very small proportion of human infections have occurred through organ transplant, blood transfusions and breast milk.

The WHO report further said infection with WNV is either asymptomatic (no symptoms) in around 80% of infected people or can lead to West Nile fever or severe West Nile disease. About 20% of people who become infected with WNV will develop West Nile fever. The report added that symptoms include fever, headache, tiredness, and body aches, nausea, vomiting, occasionally with a skin rash (on the trunk of the body) and swollen lymph glands. The symptoms of severe disease (also called neuroinvasive disease, such as West Nile encephalitis or meningitis or West Nile poliomyelitis) include headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis.

It is estimated that approximately 1 in 150 people infected with the West Nile virus will develop a more severe form of the disease. Serious illness can occur in people of any age; however, people over the age of 50 and some immunocompromised persons (for example, transplant patients) are at the highest risk for getting severely ill when infected with WNV. The incubation period is usually 3 to 14 days.

The WHO further said that treatment is supportive for patients with neuro-invasive West Nile virus disease, often involving hospitalization, intravenous fluids, respiratory support, and prevention of secondary infections. No vaccine is available for humans.  [Byline: Mohammad Al Amin]
=====================
[The news report above indicates the detection of West Nile virus (WNV) by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in a patient near Dhaka city, the Capital in Bangladesh. This is the 1st report of WNV from Bangladesh affecting humans. A further investigation from the health authority concerned in the country seems underway to obtain more information about the reported finding.

Earlier, Islam et al have reported WNV antibody prevalence of approx. 5.4 percent in resident and migratory wild birds in 2015 [Islam, Ariful & Rahman, Mohammad & Paul, Suman & Hannan, M. A. & Hossain, Mohammad Elius & Rahman, Mohammed & Hosseini, Parviez & Dey, T. & Zeidner, N.. (2015). Seroprevalence of West Nile Virus in Wild Birds in Bangladesh].
West Nile virus (WNV) was 1st isolated in a woman in the West Nile district of Uganda in 1937. It was identified in birds (crows and columbiformes) in the Nile delta region in 1953. Before 1997, WNV was not considered pathogenic for birds, but at that time in Israel, a more virulent strain caused the death of different bird species, presenting signs of encephalitis and paralysis.

The largest WNV outbreaks occurred in Greece, Israel, Romania, Russia and the USA, with outbreak sites on major bird migratory routes. In its original range, WNV was prevalent throughout Africa, parts of Europe, Middle East, West Asia, and Australia. Since its introduction in 1999 into the USA, the virus has spread and is now widely established from Canada to Venezuela.

Human infection most often results from bites of infected mosquitoes. Mosquitoes become infected when they feed on infected birds, which circulate the virus in their blood for a few days. The virus eventually gets into the mosquito's salivary glands. During later blood meals (when mosquitoes bite), the virus may be injected into humans and animals, where it can multiply and possibly cause illness. The virus may also be transmitted through contact with other infected animals, their blood, or other tissues. Rarely, human infections have occurred through organ transplant, blood transfusions and breast milk. There is one reported case of transplacental (mother-to-child) WNV transmission (<https://www.who.int/news-room/fact-sheets/detail/west-nile-virus>).

About 20 percent of people who become infected with WNV will develop West Nile fever. Symptoms include fever, headache, tiredness, and body aches, nausea, vomiting, occasionally with a skin rash (on the trunk of the body) and swollen lymph nodes.

Treatment is supportive for patients with neuro-invasive West Nile virus disease, often involving hospitalization, intravenous fluids, respiratory support, and prevention of secondary infections. No vaccine is available for humans. - ProMED Mod.UBA]

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

Date: Thu, 23 Jan 2020 17:57:34 +0100 (MET)
By Eva XIAO

Beijing, Jan 23, 2020 (AFP) - The first fatality of China's new virus would come to represent a common set of traits for those who died to the disease: he was over the age of 60 and in poor health.   Since China reported the emergence of a new coronavirus at the end of December, the SARS-like virus has infected more than 500 and killed 17.   So far, the majority of the victims were elderly individuals with pre-existing health conditions, such as diabetes and liver cirrhosis.   All hailed from central Hubei province, where a local seafood market in the capital city of Wuhan is believed to be the epicentre of the epidemic.   But while older individuals have died from the Wuhan virus, some younger patients -- including a 10-year-old boy -- have since been released from the hospital.   Here's what we know so far about the deaths:

Most victims were over 60
According to details released by China's National Health Commission (NHC) on Thursday, the 17 victims of the virus were between 48 and 89 years old.   Only two were under the age of 60, while the average age of the victims was 73.   Most of them died this week, according to the NHC.   Among those who have been discharged from the hospital were younger patients, including a 35-year-old man from Shenzhen, a bustling tech hub in southern Guangdong province.   He was released from the hospital on Thursday, according to the local health commission, as well as the 10-year-old boy who had visited relatives in Wuhan before falling ill.

Many had pre-existing health conditions
Many of those who died from the virus also had pre-existing health issues before contracting the Wuhan disease, such as diabetes and hypertension.   One man, an 86-year-old who was hospitalised on January 9, had surgery for colon cancer four years prior, on top of suffering from high blood pressure and diabetes.   Another, an 80-year-old woman surnamed Hu, had Parkinson's Disease and more than 20 years of high blood pressure and diabetes in her medical history.

Some were hospitalised for weeks before dying
Several of the 17 victims were hospitalised for weeks before dying -- raising questions on the preparedness of hospitals that may have to treat patients for long periods of time.   The youngest victim of the Wuhan virus, a woman surnamed Yin, was hospitalised for more than a month before succumbing to the virus.   On December 10, the 48-year-old woman reported a fever, coughing, body soreness, and fatigue, and underwent anti-infection treatment for two weeks, according to the NHC.   Later in the end of the month, Yin suffered shortness of breath and chest tightness, and she passed away on January 20.

Not all of them had a fever
Currently, Wuhan authorities are screening passengers for fever at the airport, railway stations, and bus terminals.   At four airports in Thailand, authorities introduced mandatory thermal scans of passengers arriving from high-risk areas of China.   But not all those who died after being infected reported a fever before being hospitalised, according to the NHC.   A 66-year-old man surnamed Luo reported a "mainly dry cough" but no fever on December 22 before suffering from shortness of breath more than a week later.

By mid-January, Luo required a ventilator to help him breathe.   "A major concern is the range of severity of symptoms this virus is causing," said Dr Jeremy Farrar, Director of the Wellcome Trust.   "It is clear some people are being affected and are infectious while experiencing only very mild symptoms or possibly without experiencing symptoms at all," he said in an emailed statement.   "This may be masking the true numbers infected and the extent of person to person transmission," he added.
Date: Thu, 23 Jan 2020 16:05:30 +0100 (MET)

Singapore, Jan 23, 2020 (AFP) - Singapore Thursday confirmed its first case of the new SARS-like virus which has killed 17 people in China and spread to multiple countries including the United States.   The Ministry of Health (MOH) said the patient was a 66-year-old man from Wuhan who arrived in Singapore with his family on Monday.    He was immediately isolated after arriving at a hospital with a fever and cough, and test results later confirmed he was infected with the coronavirus.   One of his travelling companions, a 37-year-old man from Wuhan, has also been admitted to hospital as a suspect case.

Prior to admission, they had stayed at a hotel on the resort island of Sentosa, the ministry said.   It added that Singapore was expecting more cases and alarms "given the high volume of international travel".   Singapore's Changi Airport started screening flights from Wuhan at the beginning of the month, and on Wednesday extended the checks to all flights from China.   The travel hub receives over 430 flights from China every week.   The virus has caused alarm in China and abroad because of its genetic similarities to Severe Acute Respiratory Syndrome (SARS), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.

Singapore was among the hardest hit by SARS with 33 deaths.   Prime Minister Lee Hsien Loong, who is in Davos for the World Economic Forum, said there was "no need to panic".   Speaking to reporters travelling with him, Lee said Singapore has beefed up its hospital facilities and laid out response measures since the SARS epidemic.   "I think we are much better prepared now," he said in remarks carried by the Straits Times newspaper.
Date: Thu, 23 Jan 2020 14:43:33 +0100 (MET)

Barcelona, Jan 23, 2020 (AFP) - The death toll from a violent storm which has wrought havoc on huge swathes of Spain's eastern and southern coastline rose to nine on Thursday as rescuers pressed the hunt for at least five missing people.    The latest death was that of a man whose body was found in a flooded river near Jorba, some 70 kilometres (45 miles) northwest of Barcelona, the emergency services said.    Rescuers in Catalonia had been searching for a missing person in the same area but said it was too early to confirm if it was him.

Catalan rescuers had late on Wednesday found another body of a man who died after falling into the water in Palamos, a port town about 100 kilometres up the coast from Barcelona.    They are also searching for a man who went missing from a merchant ship in the same area, as well as a person in Cadaques near the French border.   Earlier on Thursday, regional officials confirmed the death of a 75-year-old woman whose house collapsed because of heavy rain in Alcoi, a town in the eastern Alicante region.

Storm Gloria hit the region on Sunday, bringing strong winds, torrential rains and heavy snow, battering Spain's southern and eastern flanks before moving north.   Gale-force winds and huge waves smashed into seafront towns, with dramatic images showing massive flooding that has damaged shops, houses and restaurants.   National weather agency Aemet had on Wednesday said the storm was starting to abate although it kept Catalonia and the Balearic Islands on alert.   As the storm eased, Prime Minister Pedro Sanchez was on Thursday visiting some of the worst-hit areas, overflying parts of Catalonia before heading to the Balearic Islands which on Tuesday were hit by record waves, the port authority said.

Rescuers on the islands are still searching for three people, including a 25-year-old Briton who went missing on a beach in northern Ibiza, and a 27-year-old Spaniard who disappeared in Mallorca while practising canyoning -- a mix of rappelling, climbing and watersliding through deep gorges.   Rescuers had found three other bodies on Wednesday, including that of a 67-year-old man who went missing in his car near the southeastern resort town of Benidom.    They also found two bodies in the southern Andalusia region, one of a 77-year-old man who died when a greenhouse collapsed on him in a hailstorm in Nijar as well as that of a homeless man who died of hypothermia.
Date: Wed 22 Jan 2020 1:04 PM EAT
Source: Uganda Red Cross Twitter [edited]

One confirmed case of Crimean-Congo haemorrhagic fever, 4 others suspected, in Kagadi [western Uganda]

A district Task Force has been formed to manage and coordinate the cases across the district @MinofHealthUG @robert_kwesiga @inakasiita1
========================
[Crimean-Congo haemorrhagic fever (CCHF) can cause serious disease in humans, with a case fatality rate of 10-40%. It can be responsible for severe outbreaks in humans, but it is not pathogenic for ruminants, their amplifying hosts. WHO states that the onset of symptoms in humans is sudden, with fever, myalgia, (muscle ache), dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). There may be nausea, vomiting, diarrhoea, abdominal pain, and sore throat early on, followed by sharp mood swings and confusion. After 2-4 days, the agitation may be replaced by sleepiness, depression, and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly (liver enlargement). Other clinical signs include tachycardia (fast heart rate), lymphadenopathy (enlarged lymph nodes), and a petechial rash (a rash caused by bleeding into the skin) on internal mucosal surfaces, such as in the mouth and throat, and on the skin.

Public education, especially among individuals in contact with livestock or their products, is needed to prevent cases of CCHF infection. A One Health approach is needed for effective surveillance, with effective communication between animal health and human health professionals.

The information in the tweet above indicates that there is one confirmed and at least 4 suspected cases of CCHF in Kagadi district, in the western region of Uganda.  Any updates on the epidemiology of these cases, occupational exposure, and public health response measures to control the transmission will be highly appreciated. - ProMED Mod.UBA]

[Maps of Uganda:
Date: Mon 20 Jan 2020
Source: Global News [edited]

A doctor working with Indigenous Services Canada (ISC) in Saskatchewan is urging caution to residents in and around Onion Lake First Nation following 2 people contracting a rare, deadly bacterial infection. Medical health officer Dr. Ibrahim Khan wrote a letter to the chief of the Onion Lake First Nation that said both patients were admitted to medical facilities shortly after New Years Day with diphtheria. He said one patient is under 18, while the other is an adult and was suffering from skin abrasions [? cutaneous diphtheria], which Khan said is rare for that disease.

In the letter, he said the disease is very uncommon in the province and can lead to "severe complications like breathing problems, heart failure, and paralysis, and without appropriate treatment can result in death." He applauded the medical team in Onion Lake, saying they contained the infection and made sure everyone in the community was aware of the risk and vaccinated.

"Everybody gets that vaccination, and they have that protection. That's why we don't see it. We don't see that many measles cases. We don't see that many prostatitis [pertussis?] cases, and we do not see any tetanus cases, because there is a good immunization for it. A good vaccination for it (and) people are aware of it," he told Global News. He said other local agencies, like pharmacies, made sure those on the front lines were supplied if they came across someone who wasn't vaccinated.

The letter to Chief Henry Louis said vaccination is the best method for preventing diphtheria and that the disease could virtually be eradicated if everyone who could be vaccinated received the shot. He said the target is for 97% of the population to receive the vaccination to prevent further spread in the community and noted the rates in Onion Lake are below that benchmark.  [Byline: Kyle Benning]
=====================
[Although the news report above says that one of the 2 patients with diphtheria was an adult "suffering from skin abrasions, which is rare for that disease," perhaps implying that this patient had cutaneous diphtheria, we are not told specifically the patients' clinical manifestations, i.e., whether they had respiratory diphtheria, cutaneous diphtheria, or both; if the strains of _Corynebacterium diphtheriae_ were toxin-producers; or if the patients were vaccinated against diphtheria.

Diphtheria became nationally notifiable in Canada in 1924, and that year 9057 cases were reported, the highest annual number of cases ever recorded in Canada  (<https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/diphtheria/health-professionals.html>).

The diphtheria vaccine was 1st introduced in 1926, and routine immunization in infancy and childhood has been widely practiced since 1930 in Canada. By the mid-1950s, routine immunization had resulted in a remarkable decline in the morbidity and mortality of the disease. Another steep decline in cases occurred in 1980, which has been attributed, in part, to a change in case definition to exclude carriers from reported cases in all provinces and territories. Since 1993, a total of 19 cases have been reported with a range of 0-4 cases annually  (<https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/diphtheria/health-professionals.html>).

In the USA, the case definition for reporting to the National Notifiable Diseases Surveillance System includes only respiratory diphtheria
(<https://wwwn.cdc.gov/nndss/conditions/diphtheria/case-definition/2010/>).

Similarly, the WHO case definition for reporting diphtheria only includes clinical respiratory diphtheria. Although no longer reportable, cutaneous diphtheria still occurs in the USA and has been most often associated with homelessness, poor sanitation, poverty, and crowded living conditions  (<https://www.cdc.gov/vaccines/pubs/pinkbook/dip.html>).

However, the Canadian case definition includes both respiratory diphtheria and infection at another site (e.g., wound, cutaneous)
(<https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/diphtheria/health-professionals/national-case-definition.html>).

Cutaneous diphtheria is contagious and can be a source of both respiratory and cutaneous infections in contacts. Acquisition of _Corynebacterium diphtheriae_, the cause of diphtheria, can occur even in vaccinated contacts, as vaccine-induced immunity is anti-toxin. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Saskatchewan province, Canada: <http://healthmap.org/promed/p/262>]
Date: Wed, 22 Jan 2020 17:37:27 +0100 (MET)
By Helen ROXBURGH

Beijing, Jan 22, 2020 (AFP) - A new SARS-like virus has killed 17 people in China, infected hundreds and reached as far as the United States, with fears mounting about its spread as hundreds of millions travel for Lunar New Year celebrations, which start Friday.   Many countries have stepped up screening of passengers from Wuhan, the Chinese city identified as the epicentre, and the World Health Organization has called an emergency meeting.   Here's what we know so far about the virus:

- It's entirely new -
The pathogen appears to be a never-before-seen strain of coronavirus -- a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS), which killed 349 people in mainland China and another 299 in Hong Kong between 2002 and 2003.   Arnaud Fontanet, head of the department of epidemiology at the Institut Pasteur in Paris, told AFP the current virus strain was 80 percent genetically identical to SARS.   China has already shared the genome sequencing of this novel coronavirus with the international scientific community.   It has been named "2019-nCoV".

- It's being passed between humans -
The WHO said Monday it believed an animal source was the "primary source" of the outbreak, and Wuhan authorities identified a seafood market as the centre of the epidemic.   But China has since confirmed that there was evidence the virus is now passing from person to person, without any contact with the now-closed market.

The virus has infected more than 400 people across the country, with most cases in Wuhan, according to officials. Li Bin of China's National Health Commission on Wednesday said 1,394 people were still under medical observation.   Doctor Nathalie MacDermott of King's College London said it seems likely that the virus is spread through droplets in the air from sneezing or coughing.   Doctors at the University of Hong Kong published an initial paper on Tuesday modelling the spread of the virus which estimated that there have been some 1,343 cases in Wuhan -- similar to a projection of 1,700 last week by scientists at Imperial College, London.   Both are much higher than official figures.

- It is milder than SARS -
Compared with SARS, the symptoms appear to be less aggressive, and experts say the death toll is still relatively low.   "It's difficult to compare this disease with SARS," said Zhong Nanshan, a renowned scientist at China's National Health Commission at a press conference this week. "It's mild. The condition of the lung is not like SARS."   However, the milder nature of the virus can also cause alarm.

The outbreak comes as China prepares for the Lunar New Year Holiday, with hundreds of millions travelling across the country to see family.   Professor Antoine Flahault, director of the Institute of Global Health at the University of Geneva, told AFP that the fact that the virus seems milder in the majority of people is "paradoxically more worrying" as it allows people to travel further before their symptoms are detected.   "Wuhan is a major hub and with travel being a huge part of the fast approaching Chinese New Year, the concern level must remain high," said Jeremy Farrar, Director of the Wellcome Trust.

- International public health emergency? -
The WHO will hold a meeting on Wednesday to determine whether the outbreak constitutes a "public health emergency of international concern" and if so, what should be done to manage it.   Cases have so far been confirmed in Thailand, Japan, Taiwan, South Korea, Macau and the United States.

The WHO has only used the rare label a handful of times, including during the H1N1 -- or swine flu -- pandemic of 2009 and the Ebola epidemic that devastated parts of West Africa from 2014 to 2016.   The Chinese government announced Tuesday it was classifying the outbreak in the same category as the SARS outbreak, meaning compulsory isolation for those diagnosed with the disease and the potential to implement quarantine measures on travel.   But if the WHO decides to take this step, it would put the Wuhan virus in the same category as a handful of very serious epidemics.

- Global precautions -
As the number of confirmed deaths and infections has risen, so has concern worldwide about the disease spreading to other countries.   In Thailand, authorities have introduced mandatory thermal scans of passengers arriving at airports in Bangkok, Chiang Mai, Phuket and Krabi from high-risk areas in China.

In Hong Kong, where hundreds died during the SARS outbreak of 2002-2003, authorities have said they are on high alert, carrying out scans at the city's airport -- one of the world's busiest -- and at other international land and sea crossing points.

The United States also ordered the screening of passengers arriving on direct or connecting flights from Wuhan, including at airports in New York, San Francisco and Los Angeles.   Taiwan has issued travel advisories, and went to its second-highest alert level for those travelling to or from Wuhan. Vietnam has also ordered more border checks on its border with China.
Date: Wed, 22 Jan 2020 16:53:32 +0100 (MET)
By Beiyi SEOW

Beijing, Jan 22, 2020 (AFP) - The death toll from a new SARS-like virus that has infected hundreds in China rose to 17 on Wednesday, as authorities urged people to steer clear of the city at the centre of the outbreak.   The coronavirus has caused alarm because of its similarity to SARS (Severe Acute Respiratory Syndrome), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.   With hundreds of millions of people travelling across China this week for the Lunar New Year holiday, the National Health Commission announced measures to contain the disease -- including sterilisation and ventilation at airports and bus stations, as well as inside planes and trains.

In Wuhan, the epicentre of the epidemic, large public events were cancelled and international football matches were moved to a new location. Visitors were urged to stay away, while residents were advised to not to leave the central city, which is home to 11 million people.   "If it's not necessary we suggest that people don't come to Wuhan," Wuhan Mayor Zhou Xianwang told state broadcaster CCTV.    The illness is mainly transmitted via the respiratory tract and there "is the possibility of viral mutation and further spread of the disease", health commission vice minister Li Bin told a news conference in Beijing.   More than 500 cases have now been reported, with the majority in Wuhan, capital of Hubei province.

The virus has now infected at least 444 people in Hubei province alone, said provincial officials at a press conference, adding that the death toll had risen from nine to 17.   Major cities, including Beijing, Shanghai, and Chongqing have also reported cases, as well as provinces in northeastern, central, and southern China.   The World Health Organization started an emergency meeting Wednesday to decide whether or not to declare a rare global public health emergency over the disease, which has now been detected in the United States, Taiwan, Thailand, Japan, South Korea and Macau.

The Chinese government has classified the outbreak in the same category as the SARS epidemic, meaning compulsory isolation for those diagnosed with the illness and the potential to implement quarantine measures.   But they still have not been able to confirm the exact source of the virus.   "We will step up research efforts to identify the source and transmission of the disease," Li said, adding that "the cases are mostly linked to Wuhan".   Countries have intensified efforts to stop the spread of the pathogen -- known by its technical name 2019 Novel Coronavirus (2019-nCoV).   Passengers are facing screening measures at five US airports and a host of transport hubs across Asia. Britain and Italy on Wednesday also announced enhanced monitoring of passengers from Wuhan.

- Virus source -
A prominent expert from China's National Health Commission confirmed this week that the virus can be passed between people.   However, animals are suspected to be the primary source of the outbreak.   A Wuhan market is believed to be the epicentre of the outbreak.

A price list circulating online in China for a business there lists a menagerie of animals or animal-based products including live foxes, crocodiles, wolf puppies and rats. It also offered civets, the animal linked to SARS.   "We already know that the disease originated from a market which conducted illegal transaction of wild animals," said Gao Fu, director of the Chinese centre for disease control and prevention.   He said it was clear "this virus is adapting and mutating".   Hong Kong and British scientists have estimated that between 1,300 and 1,700 people in Wuhan may have been infected.

- Containment -
Health authorities are urging people to wash their hands regularly, avoid crowded places, get plenty of fresh air and wear a mask if they have a cough.   Anyone with a cough or fever was urged to go to hospital.   In Wuhan, city authorities made it mandatory to wear a mask in public places on Wednesday, according to state-run People's Daily.

In response to skyrocketing demand for masks -- which were starting to sell out at pharmacies and on some popular websites -- China's industry and information technology ministry said it would "spare no effort in increasing supply", state media reported.   "These days, I wear masks even in places that are not too crowded, although I wouldn't have done so in the past," said Wang Suping, 50, who works at a Beijing arts school.   At the capital's main international airport, the majority of people were wearing masks.

Hong Kong flag carrier Cathay Pacific said it had agreed to allow staff to wear surgical masks on mainland China flights, and that passengers from Wuhan would be offered masks and antiseptic wipes.   In Wuhan, police were conducting vehicle spot checks for live poultry or wild animals leaving and entering the city, state media said.   Officials also screened people on roads, the airport and the train station for fever.   The local government has cancelled major public activities and banned tour groups from heading out of the city.   Women's Olympics football qualifiers scheduled for February 3-9 in Wuhan have been moved to the eastern city of Nanjing.
Date: Wed, 22 Jan 2020 15:49:25 +0100 (MET)

Montreal, Jan 22, 2020 (AFP) - A Canadian guide died and five French tourists were missing after at least one snowmobile plunged through ice in northern Quebec, police said Tuesday.   The group were riding close to where a river exits the Saint-Jean lake, and were outside the approved area for snowmobiles, police spokesman Hugues Beaulieu told AFP.   Nine people, including the guide, were on the trip on Tuesday evening when the ice broke underneath them.   Police said they were alerted by two of the tourists who had rescued a third tourist from the freezing water.

The 42-year-old guide was pulled out by emergency response teams and taken to hospital, but he died overnight, Beaulieu said, adding "five French tourists are still missing."   The police and army were searching the area on Wednesday, assisted by divers.   "This sector was not part of a marked trail, they were off-piste," said the spokesman.
Date: Wed, 22 Jan 2020 04:55:57 +0100 (MET)

Hong Kong, Jan 22, 2020 (AFP) - Macau on Wednesday reported its first confirmed case of the new SARS-like coronavirus as authorities announced all staff in the city's bustling casinos had been ordered to wear face masks.   The former Portuguese colony is a huge draw for mainland tourists as the only place in China that allows gambling.

With the Lunar New Year approaching this weekend, a huge influx of mainland tourists is expected in the city.   Asian countries have ramped up measures to block the spread of the new virus, which emerged in the Chinese city of Wuhan and has so far killed at least nine people.

On Wednesday, Macau announced its first confirmed case -- a 52-year-old businesswoman from Wuhan who arrived in the city by high-speed rail on Sunday, via the neighbouring city of Zhuhai.    "A series of tests found that she was positive for the coronavirus and had symptoms of pneumonia," Lei Chin-lon, the head of Macau's health bureau, told reporters.    The woman had been staying at the New Orient Landmark Hotel with two friends who were being monitored since her admission to hospital on Tuesday.

Ao Ieong Iu, Macau's Secretary for Social Affairs and Culture, said staff in all casinos would be required to wear masks while anyone arriving at entry ports along the city's border with the mainland would need to fill out health declaration forms.    "We have not banned tourism groups from Wuhan but we are not encouraging them," Ao Ieong said.    "We will stay in close contact with tourism agencies and require them to notify us of all groups going to and coming from Wuhan," she added.
Date: Tue, 21 Jan 2020 22:23:22 +0100 (MET)
By Issam Ahmed with Helen Roxburgh

Washington/Beijing, Jan 21, 2020 (AFP) - The United States on Tuesday announced its first case of a new virus that has claimed six lives in China and sickened hundreds, joining countries around the world in ramping up measures to block its spread.   The man, a US resident in his 30s who lives near Seattle, is in good condition, according to federal and state officials, and approached authorities himself after reading about the SARS-like virus in news reports.   He is "currently hospitalized out of an abundance of precaution, and for short term monitoring, not because there was severe illness," said Chris Spitters, a Washington state health official.  "This is an evolving situation and again, we do expect additional patients in the United States and globally," added Nancy Messonier, a senior official at the Centers for Disease Control and Prevention (CDC), but stressed that the overall risk to Americans remained low.

The man entered the country on January 15 after traveling to Wuhan, two days before the US began deploying health officials at major airports to screen passengers arriving from that central Chinese city which is at the heart of the outbreak. The efforts are to be extended now to a total of five US airports.   It came as countries ramped up measures to block the spread of the virus -- known by its technical name 2019 Novel Coronavirus or 2019-nCoV -- as the number of cases surpassed 300, raising concerns in the middle of a major Chinese holiday travel rush.

Fears of a bigger outbreak rose after a prominent expert from China's National Health Commission confirmed late Monday that the virus can be passed between people.   That conclusion is shared by the CDC, which said "person-to-person spread is occurring, although it's unclear how easily the virus spreads between people," even as the World Health Organization (WHO) adopted a more cautious approach, saying it is still investigating.   The UN agency will hold an emergency meeting Wednesday to determine whether to declare a rare global public health emergency over the disease, which has also been detected in Thailand, Japan and South Korea and Taiwan.

- Holiday rush -
Authorities previously said there was no obvious evidence of person-to-person transmission and animals were suspected to be the source, as a seafood market where live animals were sold in Wuhan was identified as the center of the outbreak.   Hundreds of millions of people are criss-crossing China this week in packed buses, trains and planes to celebrate the Lunar New Year with relatives.

More than 80 new cases have been confirmed, bringing the total number of people hit by the virus in China to 315, with the vast majority in Hubei, the province where Wuhan lies, according to officials.   But cases have also been confirmed around the country, including Beijing and Shanghai.   The first case on the self-ruled island of Taiwan was also confirmed Tuesday, with a woman taken to hospital on arrival at the airport from Wuhan.   Wuhan mayor Zhou Xianwang told state broadcaster CCTV Tuesday that the death toll had risen from four to six.   The coronavirus has caused alarm because of its genetic similarities to Severe Acute Respiratory Syndrome (SARS), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.

- Fever checks -
At four airports in Thailand, authorities introduced mandatory thermal scans of passengers arriving from high-risk areas of China.   In Hong Kong, authorities said they were on "extreme high alert," with passengers from Wuhan required to fill out health declarations and face possible jail time if they do not declare symptoms.   Enhanced screening measures have also been set up at airports in Australia, Bangladesh, Nepal, Singapore and Russia, Malaysia and Vietnam.   A man showing symptoms of the disease who had travelled to Wuhan has been put in isolation in Australia as health officials await test results, authorities said Tuesday.   In China, the government announced it was classifying the outbreak in the same category as SARS, meaning compulsory isolation for those diagnosed ith the disease and the potential to implement quarantine measures on travel.

In Wuhan, authorities banned tour groups and police were conducting spot checks for animals in vehicles leaving and entering the city, state media said.   It added that city health authorities had scheduled 800 beds to be made available in three hospitals and 1,200 more would soon be ready, and passengers were being screened for fever at the airport, railway stations and bus terminals.   Doctors at the University of Hong Kong released a study on Tuesday estimating that there have been 1,343 cases of the new virus in Wuhan.   The WHO has only called a global public health emergency a handful of times, including during the H1N1 -- or swine flu -- pandemic of 2009 and the Ebola epidemic that devastated parts of West Africa from 2014 to 2016.