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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

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.
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[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.
Date: Tue, 13 Aug 2019 11:40:19 +0200 (METDST)

Athens, Aug 13, 2019 (AFP) - Dozens of firefighters Tuesday battled a major wildfire that forced the evacuation of a monastery on the Greek island of Evia as smoke from the blaze reached as far as Athens, authorities said.   Authorities also placed on alert two villages threatened by the blaze on the island, Greece's second largest after Crete and located northeast of Athens.   The fire started at about 3 am (0000 GMT) at the side of a road and was quickly spread by strong winds through the dry and dense vegetation in the centre of the island, the semi-official news agency ANA said.

The monastery of Panagia Makrymallis was evacuated as a precaution and residents of the villages of Kontodespoti and Stavros were told to be ready to leave also, TV SKAI said.   "Everything is ready in case it is necessary to evacuate the villages. The evacuation can be done in a few minutes. We are totally prepared," Fani Spanos, the governor of central Greece who was coordinating the operations, told SKAI.   He warned the fire was not yet under control and was spreading in an area that was inaccessible overland.

Around 80 firefighters were fighting the blaze backed by some 40 fire trucks and two water-bombing helicopters and a plane.   The strong winds blew the smoke from the blazing pine forest north toward the Magnesia region and south to the Attica peninsula and Athens.   ANA said the pine forests on Evia are part of the "Natura 2000" European network of protected areas and habitats.   Greece has been hit by a spate of wildfires since the weekend amid gale-force winds and temperatures of 40 degrees Celsius (104 F).

On Monday, a major forest fire threatening homes in Peania, an eastern suburb of Athens, was brought under control. At least two houses were burned but there were no reports of injuries.   On Sunday, a fire on the small island of Elafonissos, in the Peloponnese region, was brought under control after a two-day battle.   Two more fires were doused on Saturday in Marathon, close to Mati, the coastal resort where last year 102 people died in Greece's worst fire disaster.
Date: Sun, 11 Aug 2019 14:32:21 +0200 (METDST)

Athens, Aug 11, 2019 (AFP) - A French man was charged in Greece on Sunday over a boat accident that left two dead and another person seriously injured, state TV ERT reported.   The 44-year-old was charged with negligent manslaughter by a prosecutor and given 24 hours to prepare his defence, ERT said.  The man's lawyer Nikos Emmanouilidis had earlier told reporters that his client "will assist in every way any request by the Greek authorities."

The suspect has admitted to driving a 10-metre (32-foot) speedboat which struck a smaller wooden fishing boat on Friday evening near the Peloponnese resort of Porto Heli, 170 kilometres (105 miles) southwest of Athens.   The collision killed two elderly Greek men on board. A 60-year-old Greek woman, reportedly their sister, was seriously injured and taken to Athens for treatment.

The suspect could not be located for several hours after the incident before turning himself in on Saturday.   He has denied trying to evade arrest, and claims he was also injured in the incident and had sought first aid.   The suspect has said he did not see the fishing boat, which may have had insufficient lighting, state news agency ANA reported.   He has taken a blood alcohol test, with the results to be available on Monday.   "The first indications point to excessive speed by the powerboat driver," Merchant Marine Minister Yiannis Plakiotakis told ERT on Saturday.

Ten other French nationals who were also on the speedboat -- two men, three women and five children aged three to 14 -- were initially taken to Porto Heli for questioning after helping to bring the injured woman and one of the bodies to shore, the coastguard said.   They were all released on Saturday.   Speedboat accidents involving swimmers or other boats are common in Greece during the busy summer holiday season.

Another speedboat on Friday injured a 32-year-old swimmer at the Athens coastal suburb of Glyfada. The driver was arrested.   In 2016, four people including a four-year-old girl were killed when a speedboat sliced into their wooden tourist vessel near the island of Aegina.   Nobody was sanctioned as the prime suspect, an elderly Greek man, died a year after the accident.
More ...

Indonesia

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Information for Bali
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General
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Bali is one of the main tourist destinations for many Irish travellers to Indonesia. The island is well developed for the tourist industry and genera
ly the climate is tropical and humid throughout the year. Many Irish travellers will use the island as a stopover. If this is for only 24 to 28 hours the extent of your jetlag may leave you little time to enjoy the country and its people.
Safety & Security
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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
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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
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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
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The level of available health facilities varies greatly through Bali and other parts of Indonesia. In general most of the main hotels will have English speaking doctors but care would be required if your illness requires hospitalisation.
Food and Water
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It is wise to maintain a high level of care with regard to your food and water while in Indonesia. This includes even those in high quality hotels but also particularly for those eating from street vendors. Bivalve shellfish (e.g. oysters, mussels, clams etc) should be avoided at all times due to inadequate cooking. Bottled water should be purchased from your hotel or good quality shops to ensure that it is pure.
Mosquitoes and Insect Bites
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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
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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
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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
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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
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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;
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Poliomyelitis (childhood booster)
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Tetanus (childhood booster)
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Typhoid (food & water disease)
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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
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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: Sat, 3 Aug 2019 22:33:09 +0200 (METDST)

Jakarta, Aug 3, 2019 (AFP) - Five people died and several were injured after a powerful undersea earthquake rocked Indonesia's heavily populated Java island, triggering a brief tsunami warning, the national disaster agency said Saturday.   The 6.9 magnitude quake on Friday evening sent residents fleeing to higher ground, while many in the capital Jakarta ran into the streets.

An official from Indonesia's national disaster agency warned the quake could generate a tsunami as high as three metres (10 feet), but the alert was lifted several hours later.   Three people died of heart attacks as the strong quake rocked the region, agency spokesman Agus Wibowo said on Saturday.   Another person fell to his death while trying to flee his house when the jolt happened, he said, while a fifth victim died from a panic attack.   Four more people were injured and more than 200 buildings were damaged, with about 13 houses destroyed, he added.

More than 1,000 people, who had earlier fled to temporary shelters, returned home after authorities convinced them it was safe to do so, Wibowo said.   "There was thundering noise -- it sounded like a plane overhead -- and I was just so scared that I ran," said 69-year-old Isah, who like many Indonesians goes by one name, at an evacuation shelter in Pandeglang at the southwest end of Java.   In December, the area was hit by a volcano-sparked tsunami that killed more than 400 people.

Indonesia experiences frequent seismic and volcanic activity due to its position on the Pacific "Ring of Fire", where tectonic plates collide.   Last year, a 7.5-magnitude quake and a subsequent tsunami in Palu on Sulawesi island killed more than 2,200 people, with another thousand declared missing.   On December 26, 2004, a 9.1-magnitude earthquake struck off the coast of Sumatra and triggered a tsunami that killed 220,000 across the Indian Ocean region, including around 170,000 in Indonesia.
Date: Sun, 14 Jul 2019 12:47:38 +0200

Labuha, Indonesia, July 14, 2019 (AFP) - A major 7.3-magnitude earthquake hit the remote Maluku islands in eastern Indonesia Sunday, sending panicked residents running into the streets, but no tsunami warning was issued.   The shallow quake struck about 165 kilometres (100 miles) south-southwest of the town of Ternate in North Maluku province at 6:28 pm (0928 GMT), according to the US Geological Survey.
 
"The earthquake was quite strong, sending residents to flee outside. They are panicking and many are now waiting on the roadside," said local disaster mitigation official Mansur, who like many Indonesians goes by one name.   Officials were assessing the situation but there were no immediate reports of casualties, he told AFP.

In the town of Labuha, one of the closest to the epicentre, panicked residents took to motorcycles in a bid to flee to higher ground, according to an AFP photographer in town when the earthquake hit.   Local disaster official Ihsan Subur told Metro TV that no damage or casualties had been reported there so far, but residents took to the streets and many evacuated to higher ground.   "Electricity went of during the earthquake, but now it's back to normal," ubur said, adding that at least seven big aftershocks were felt after the initial quake.

The province was also hit by a 6.9-magnitude tremor last week.   Indonesia experiences frequent seismic and volcanic activity due to its position on the Pacific "Ring of Fire", where tectonic plates collide.   Last year, a 7.5-magnitude quake and a subsequent tsunami in Palu on Sulawesi island killed more than 2,200 people, with another thousand declared missing.   On December 26, 2004, a devastating 9.1-magnitude earthquake struck off the coast of Sumatra and triggered a tsunami that killed 220,000 across the Indian Ocean region, including around 170,000 in Indonesia.
Date: Mon, 24 Jun 2019 05:38:33 +0200

Jakarta, June 24, 2019 (AFP) - A powerful magnitude 7.3 quake struck eastern Indonesia on Monday, US seismologists said, but no tsunami warning was issued and there were no immediate reports of major damage or casualties.   The quake hit at a depth of 208 kilometres (129 miles) south of Ambon island in the Banda Sea at 11:53 local time, the US Geological Survey said.

The Pacific Tsunami Warning Center said there was no threat of a tsunami as the quake was too deep.   The strong temblor came hours after a 6.1-magnitude earthquake hit Papua, also in the eastern part of the Southeast Asian archipelago.   That quake hit about 240 kilometres (150 miles) west of the town of Abepura in Papua province, at a relatively shallow depth of 21 kilometres, according to the USGS.

There were also no immediate reports of casualties after the earthquake.   A shallower 6.3-magnitude hit the area last week, but the damage was not extensive.   Indonesia experiences frequent seismic and volcanic activity due to its position on the Pacific "Ring of Fire", where tectonic plates collide.   Last year, a 7.5-magnitude quake and a subsequent tsunami in Palu on Sulawesi island killed more than 2,200 with a thousand more declared missing.   On December 26, 2004, a 9.1-magnitude earthquake struck Aceh province, causing a tsunami and killing more than 170,000.
31st May 2019

A volcano on the Indonesian island of Bali erupted Friday, spewing a plume of ash and smoke more than 2,000 metres (6,500 feet) into the sky. Mount Agung, about 70 kilometres from the tourist hub of Kuta, has been erupting periodically since it rumbled back to life in 2017, sometimes grounding flights and forcing residents to flee their homes.
Mount Agung is about 70 kilometres from the tourist hub of Kuta

The latest shortly before noon on Friday shot a cloud of volcanic ash high into the sky, but caused no disruption to flights, Indonesia's geological agency said.  Agung remained at the second highest danger warning level, and there is a four-kilometre no-go zone around the crater.

Last summer, dozens of flights were cancelled after Agung erupted, while tens of thousands of locals fled to evacuation centres after an eruption in 2017.

The last major eruption of Agung in 1963 killed around 1,600 people.

Indonesia is situated on the Pacific "Ring of Fire", a vast zone of geological instability where the collision of tectonic plates causes frequent quakes and major volcanic activity.

Date: Sat 11 May 2019
Source: The Jakarta Post [edited]

No one really knows what is spreading in the small village of Garonggong in Jeneponto regency, South Sulawesi. However, for the last couple of months, nearly all people living there have been experiencing mysterious symptoms, which started with a fever and pain all over the body, especially in their joints. The unknown disease killed 4 people from a total of 72 people that had experienced similar symptoms. The village administration has declared a health emergency. Several villagers have moved to avoid contagion.  "It has been going on for 2 months. They have experienced the same symptoms, and 4 people have died because of it, including my child, a local, said on Thursday [9 May 2019] as quoted by kompas.com.

The acting head of Jeneponto Health Agency, Syafruddin Nurdin, said it all began in April [2019] when a couple of villagers were infected. By 24 Apr [2019], 17 residents had been admitted to hospitals and community health centers for the same symptoms.  Syafruddin said most of them had experienced similar symptoms, such as a fever, headache, nausea and joint pain. "All of them came from the same village, Garonggong village," Syafruddin told The Jakarta Post on Friday [10 May 2019].

However, the health workers and agency have not been able to identify the disease or the cause of it, or why it had struck many people at the same time.  "The patients gradually lost consciousness. [...] When their blood was tested, all of the suspected diseases such as malaria, dengue fever, Zika, leptospirosis, anthrax, H5N1, were all ruled out. The tests came back negative for all of them," Syafruddin said.

The Health Ministry has yet to provide an explanation on this matter, but the ministry's disease control and prevention director general, Anung Sugihantono, said his side was investigating the outbreak.  A special team consisting of academics, health and environment experts, as well as veterinarians have been deployed to the village to carry out disease surveillance and epidemiology research.

Also, 3 patients have been moved to Makassar, the provincial capital, for further examination and treatment.  "Initial laboratory research had shown indication of typhoid, but further studies are needed," he added. South Sulawesi Health Agency acting head Bachtiar Baso said one of the deceased patients was pregnant. Doctors have been treating the patients using different approaches. "Most doctors treated those admitted to the hospitals for typhoid. Some of them saw their health improve, and some of them did not," he said.

Bachtiar said the investigative team had collected blood samples from the infected patients and animals in the area and had collected soil samples.  The team suspects those affected may have had either leptospirosis, meningitis or the hantavirus, Bachtiar said. "I hope the research results will be revealed soon and the team can gain a better understanding of the disease that has been spreading across Garonggong so we can prepare the necessary medicine and preventative measures," he added.
======================
[A comprehensive laboratory workup is necessary to establish a diagnosis. There is no indication that autopsies were carried out that might provide addition clues about the aetiology. Mention was made of hantaviruses, but no mention was made of supporting laboratory results that might point to Seoul hantavirus infections, but the large number of cases occurring in a single village in a short period of time would be unusual for hantavirus infections or for scrub typhus. There was an outbreak of Japanese encephalitis (JE) in North Sulawesi last year (2018). Although there is no specific mention of encephalitis in these patients, JE should be ruled out.

ProMED-mail would be interested in receiving further information about confirmation of typhus, any new cases, or laboratory results as they become available. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Sulawesi, Indonesia: <http://healthmap.org/promed/p/535>]
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.
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[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.
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[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.
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[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.
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[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 ...

Brunei

Brunei US Consular Information Sheet
October 09, 2008
COUNTRY DESCRIPTION:
Brunei Darussalam is a small Islamic Sultanate on the northwest coast of the Island of Borneo.
It is divided into four districts: Brunei/Muara, Tutong, Belait
nd Temburong.
The capital, Bandar Seri Begawan, is its only major city.
Brunei’s official language is Malay, but English is widely understood and used in business.
Tourist facilities and services are generally available throughout the country.
For more information concerning Brunei, please see the Government of Brunei web site at http://www.brunei.gov.bn.
Read the Department of State Background Notes on Brunei for additional information.

ENTRY/EXIT REQUIREMENTS:
U.S. passport-holders must have at least six months’ validity remaining on their passport before entering Brunei for business or pleasure and are required to obtain a visa prior to arrival in Brunei for visits of 90 days or longer.
Diplomatic and official passport-holders are also required to apply for a visa to enter Brunei Darussalam.
There is an airport departure tax.
For further information about entry or exit requirements, travelers may consult the Consular Section of the Embassy of Brunei, 3520 International Court NW, Washington, DC
20008, tel. (202) 237-1838, or visit the Embassy of Brunei web site at http://www.bruneiembassy.org for the most current visa information.
As of June 12, 2004, immigration offenses are punishable by caning.
Workers who overstay their visas can face jail sentences and three strokes of the cane.
Those associated with violators, such as contractors or employers, are subject to the same penalties if the violator is found guilty.

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:
Following the October 2002, August 2003, September 2004 and October 2005 terrorist bombings in Indonesia, the Department of State continues to be concerned that terrorist groups such as Jemaah Islamiyah (JI) that have transnational capability to carry out terrorist attacks may do so in various Southeast Asian nations, including Brunei.
JI is known to have cells operating in Southeast Asia and to have connections with Al-Qaeda and other regional terrorist groups.
JI also has been tied to previous regional terrorist attacks.
As security is increased at official U.S. facilities, terrorists will seek softer targets.
These may include, but are not limited to, facilities where Americans and other Westerners are known to live, congregate, shop or visit, including, but not limited to, hotels, clubs, restaurants, shopping centers, housing compounds, transportation systems, places of worship, schools or outdoor recreation events.
Americans in Brunei should continue to be vigilant with regard to their personal security, maintain a low profile, vary times and routes during their daily routines and report any suspicious activity to the local police or to the U.S. Embassy's Regional Security Officer, who can be reached at the phone number listed at the end of this information sheet.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for other callers, 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:
Though there is some crime, violent crime is rare.
Burglaries and theft are on the rise. Americans are reminded to be prudent in their own personal security practices.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. embassy or consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. embassy or consulate for assistance.
The embassy/consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and provide a list of attorneys if needed.

In Brunei, the local equivalents to the “911” emergency line are:
993 for Brunei Police, 955 for
Fire
& Rescue and 998 for Search & Rescue.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
There is adequate care for basic medical conditions in Brunei; however, due to unpredictable shortages of materials and uncertain support staff, elective surgery or complicated care is best obtained in Singapore or elsewhere.

Brunei has imposed HIV/AIDS travel restrictions as part of a ban on communicable diseases.
In October 2003, Ministry of Health (MOH) of Brunei Darussalam required all travelers entering Brunei to fill out a Health Declaration Card and submit it to the Officer-In-Charge (MOH) upon disembarkation.
Under Section 7, Infectious Diseases Order 2003 of MOH, travelers may be subjected to a medical examination upon arrival in Brunei Darussalam.
Travelers also may be quarantined if infected or suspected to be infected with infectious disease or in if travelers have had contacted with such a person, under Section 15, Infectious Diseases Order 2003 of Ministry of Health Brunei.
Please inquire directly with the Embassy of Brunei at http://www.bruneiembassy.org before you travel.

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

Brunei has an extensive network of roads throughout the country of generally good, though varying quality.
Holders of foreign driving license are permitted to drive in Brunei Darussalam for 90 days only.
For longer stays, a foreign driving license must be endorsed to a Brunei driving license, available at any Land Transport Department office.
Drivers must obey traffic rules at all times and should take extra caution when approaching traffic signals.
In urban areas, some local drivers have run through red lights, resulting in several deadly accidents in recent years.

Please refer to our Road Safety page for more information.
Visit the website of the Brunei National Tourism at http://www.tourismbrunei.com/ and the web site of Brunei Land Transport Department at http://www.land-transport.gov.bn/ for more details on road safety information.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Brunei’s Department of Civil Aviation as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Brunei’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa
SPECIAL CIRCUMSTANCES:
Immigration Violations:
Americans in Brunei are subject to the laws of the country and may be arrested for violation of immigration regulations, or any other law.
In such cases, the U.S. Embassy will provide consular services to American citizens arrested in Brunei, in accordance with international law and U.S. regulations.
However, the Embassy may not intervene in local judicial matters.
Americans should be aware that the immigration law is stringent and less flexible than the previous one, with harsher penalties.

The Embassy strongly recommends that U.S. citizens on contract in Brunei be fully aware of their immigration status, as well the status of employees and staff and of crucial dates regarding contract extensions and renewals and have employment documents in order.

Dual Nationality:
Brunei does not recognize or permit dual nationality.
Brunei nationals are expected to enter and exit on their Brunei passports.
Should Brunei authorities learn that a person is a dual national, they may require immediate renunciation of either the citizenship of the other nation or Brunei citizenship.

Customs Regulations:
Brunei customs authorities may enforce strict regulations concerning temporary importation into or export of items such as firearms, religious materials, antiquities, medications, business equipment, currency, ivory and alcohol.
For non-Muslims, limited amounts of alcohol for personal consumption are permitted.
It is advisable to contact the Embassy of Brunei in Washington, D.C. for specific information regarding customs requirements.
In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines. Please see our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Brunei laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in Brunei are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Brunei 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 Brunei.
Americans without Internet access may register directly with the nearest U.S. embassy or consulate.
By registering, American citizens make it easier for the embassy or consulate to contact them in case of emergency.
The U.S. Embassy is located on the 3rd floor, Teck Guan Plaza, at the corner of Jalan Sultan and Jalan McArthur, Bandar Seri Begawan BS 8811, Brunei Darussalam.
Mail sent from the United States can be addressed to the Embassy's address:
American Embassy, P.O. Box 2991, Bandar Seri Begawan BS8675, Negara Brunei Darussalam.
The telephone number is 673-222-0384, fax number (673) (2) 225-293 and e-mail address amEmbassy_BSB@state.gov.
The Consular section's e-mail address is: ConsularBrunei@state.gov.
The Embassy's after-hours number for emergency calls is (673) (8) 730-691.
* * *
This replaces the Country Specific Information for Brunei dated February 19, 2008, to update section on Entry/Exit Requirements, Information for Victims of Crime, Medical Facilities and Health Information, Traffic Safety and Road Conditions, Special Circumstances and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Brunei

- National. 9 May 2018. Brunei has recorded 37 dengue cases in the 1st 4 months of 2018, with half of them detected in Kampong Ayer, the Ministry of Health (MoH) said on [Tue 8 May 2018]. MoH expects the number of dengue cases to rise and is urging residents to maintain good hygiene.

[HealthMap/ProMED-mail map
Date: Sat 5 Dec 2015
From: Steve Berger <steve@gideononline.com> [edited]

Recently, ProMED reported that 2 tourists from Singapore acquired _Plasmodium knowlesi_ malaria in Brunei.

Malaria rates reported by both Brunei and Singapore have been strikingly similar since the 1990's, and Singapore has reported both autochthonous and imported cases of _P. knowlesi_ infection since 2007. See graph at <http://www.gideononline.com/wp/wp  content/uploads/BruneiMalaria.png>.

During the 1950's, Brunei reported low levels of malaria from the interior regions and coast adjacent to mountainous areas. The predominant infecting species and vector were _P. falciparum_ and _Anopheles leucosphyrus_, respectively [1]. Brunei was officially declared "malaria-free" by WHO in 1987. A single publication reported a case of _P. knowlesi_ malaria in this country in 2013.

Although official sources do not routinely recommend malaria prophylaxis for travelers, the recent report in ProMED suggests careful review of the current status of the disease in Brunei.

Reference:
[1] Berger SA. Infectious Diseases of Brunei, 2015. 374 pages, 60 graphs, 1448 references. Gideon e-books,
--------------------------------------------
Professor Steve Berger
Geographic Medicine
Tel Aviv Medical Center
Tel Aviv Israel
=========================
[ProMED thanks Steve Berger for this background information. The recent reports from northern Borneo indicate that _P. knowlesi_ may be emerging there. The ProMED report from 18 Nov 2015 "Malaria, P. knowlesi - Malaysia (03): (SA)" reports that _P. knowlesi_ is now the most common malaria species in humans in Sabah province, Malaysia.

_P. knowlesi_ is different from the other 4 plasmodia species infecting humans in that it is primarily a zoonosis, with the reservoir being Macaque monkeys. An increase in the Macaque reservoir, closer proximity to human habitats, or increases in the anopheles vectors are all possible explanations.

The importance of _P. knowlesi_ infections in humans was highlighted by a study published in 2004 (Singh B, et al. A large focus of naturally acquired _Plasmodium knowlesi_ infections in human beings. Lancet. 2004;363:1017-24), and data from before 2004 classified P. knowlesi and _P. malariae_.

Human to human transmission of _P. knowlesi_ has still not been demonstrated. - ProMed Mod.EP]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Wed 2 Dec 2015
From: Hsu Li Yang <hsuliyang@gmail.com> [edited]

_Plasmodium knowlesi_ malaria, human, Temburong National Park, Brunei
---------------------------------------------------------------------
We report 2 cases of _Plasmodium knowlesi_ malaria that occurred after a camping trip involving 24 teenagers and 3 adults in Temburong National Park, Brunei. The trip occurred between 2-9 Nov 2015, and the onset of illness was on 20 Nov 2015 for both individuals. Diagnosis of _P. knowlesi_ was made via PCR speciation. None of the participants of the trip received malaria prophylaxis.
------------------------------
Hsu Li Yang
Saw Swee Hock School of Public Health,
National University of Singapore,
Singapore
======================
[ProMED-mail would like to thank Dr. Hsu Li Yang for submitting this first hand report. - ProMed Mod.MPP]

[The report is in line with previous ProMED reports, especially the last report from 18 Nov 2015 (archive no http://promedmail.org/post/20151118.3801294), that _P. knowlesi_ is the most common malaria parasite found in humans with malaria in Northern Borneo (Malaysia, Sabah, and Sarawak and Brunei). - ProMed Mod.EP]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sun 27 Oct 2013
Source: Bru Direct [edited]

The Ministry of Health (MoH) issued a press release to inform the public about cases of Japanese encephalitis (JE) infections that have been recently detected in Brunei Darussalam.

According to the press release, JE is a viral infection that is transmitted by mosquitoes, similar to other infections such as dengue, malaria, chikungunya and filariasis. The JE [virus] infection is endemic in many countries in Asia.

Medical research has shown that most cases of JE [virus] infection do not present with any symptoms. However, in a small number of cases, infected persons may show signs and symptoms such as fever, headache, nausea and vomiting. After a few days, the infection may cause mental abnormalities, neurological symptoms, weakness and motor disturbances. Convulsions may also occur, especially among children.

JE [virus] infection has never been previously detected and reported in the Sultanate. However, since 17 Oct this year [2013], a total of 12 patients with symptoms of encephalitis have been reported. Of these, 9 cases are from the Belait District, 2 from Tutong and one from Brunei-Muara.

To date, 6 patients have recovered and were discharged home, and 2 patients who also have other pre-existing medical conditions are currently receiving intensive care in hospital. They are, however, in a stable condition.

Following detailed investigations on all patients, only 3 patients from the Belait District have been confirmed by laboratory tests to have been infected by the JE virus.

There are no specific treatments for JE infection. There is only supportive treatment to relieve symptoms, and there is close monitoring in hospital if required. Patients should take their medications as instructed by the doctors and have adequate rest and fluids.

The MoH will continue to monitor the situation and take necessary measures including informing the public of any developments.
=======================
[Brunei (Brunei Darussalam in the Malay language) is a sovereign state on the north coast of Borneo Island. It is geographically within the Japanese encephalitis virus (JEV) endemic area of Asia, so it is not surprising that the virus is there and causing cases of human disease. Rice cultivation was intensified as a governmental agricultural initiative beginning in 2009. An increase in rice paddies would doubtless be accompanied by an increase of the _Culex_ mosquito JEV vectors. Additional cases in the future can be expected.

A map showing the location of Brunei can be accessed at
<http://healthmap.org/r/8UJm>. - ProMed Mod.TY]
More ...

Pakistan

Pakistan - US Consular Information Sheet
October 02, 2008
COUNTRY DESCRIPTION:
Pakistan is a parliamentary federal republic in South Asia, with a population of nearly 170 million people. Following successful elections in February 2008, Pak
stan has a coalition government led by Prime Minister Yousef Gilani. Pakistan is a developing country, with some tourist facilities in major cities but limited in outlying areas. The infrastructure of areas of Kashmir and the Northwest Frontier Province was devastated as a result of the October 8, 2005 earthquake and is not yet recovered. Read the Department of State Background Notes on Pakistan for additional information.

Back to Top
ENTRY/EXIT REQUIREMENTS: All U.S. citizens traveling to Pakistan for any purpose are required to have valid U.S. passports and Pakistani-issued visas. Further information on entry requirements can be obtained from the Embassy of Pakistan at 3517 International Court Avenue NW, Washington, DC 20008; telephone: 202-243-6500; e-mail: info@pakistan-embassy.org; web site: http://www.pakistan-embassy.org/.

Travelers may also contact one of the Consulates General of Pakistan in:
Boston: 20 Chestnut Street, Needham, MA 02492; telephone: (781) 455-8000; fax: (617) 266-6666; email: pakistan@tiac.net
Chicago: 333 North Michigan Ave., Suite 728, Chicago, IL, 60601; telephone: (312) 781-1831; fax: (312) 781-1839; email: parepchicago@yahoo.com
Houston: 11850 Jones Road, Houston, TX, 77070; telephone: (281) 890-2223; fax: (281) 890-1433; email: parephouston@sbcglobal.net
Los Angeles: 10850 Wilshire Blvd., Suite 1100, Los Angeles, CA 90024; telephone: (310) 441-5114; fax: (310) 441-9256; email: info@pakconsulatela.org
New York: 12 East 65th St., New York, NY 10021; telephone: (212) 879-5800; fax: (212) 517-6987; web site: www.pakistanconsulateny.org
If a traveler plans to stay longer than the time listed on the visa, he or she must extend the stay with the local passport office of the Ministry of Interior. Visit the Embassy of Pakistan web site at http://www.pakistan-embassy.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:
A number of extremist groups within Pakistan continue to target American and other Western interests and high-level Pakistani government officials. Terrorists and their sympathizers have demonstrated willingness and capability to attack targets where Americans are known to congregate or visit. Terrorist actions may include, but are not limited to, suicide operations, bombing -- including vehicle-borne explosives and improvised explosive devices -- assassinations, carjacking, assault or kidnapping. U.S. Government personnel are not permitted to stay at or frequent major hotels in Islamabad, Karachi, Lahore and Peshawar.

Government personnel have also been advised to restrict the number and frequency of trips to public markets, and to avoid public restaurants in Islamabad, Karachi, and Peshawar.

In September 2008, over fifty people, including three Americans, were killed and hundreds were injured when a suicide bomber set off a truck filled with explosives outside a major international hotel in Islamabad. In August 2008 gunmen stopped and shot at the vehicle of an American diplomat in Peshawar. In March 2008, a restaurant frequented by westerners in Islamabad was bombed, killing one patron and seriously injuring several others, including four American diplomats. On March 2, 2006, an American diplomat, his locally employed driver, and three others were killed when a suicide bomber detonated a car packed with explosives in front of the U.S. Consulate General in Karachi. Fifty-two others were wounded in the attack.

Sectarian and extremist violence has resulted in fatal bomb attacks in Islamabad, Rawalpindi, Karachi, Peshawar, Quetta, Lahore, and other Pakistani cities since 2006. Since 2007, over 1,000 bombings have killed more than 1,000 people throughout Pakistan and injured many more. Rallies, demonstrations, and processions occur from time to time throughout Pakistan on very short notice and have often taken on an anti-American or anti-Western character. Because of the possibility of violence, Americans are urged to avoid all public places of worship and areas where Westerners are known to congregate.

During the Islamic (Shi’a) religious observance of Moharram, rivalries and hostilities often increase.

In 2007 and 2008, several American citizens throughout Pakistan were kidnapped for ransom or for personal reasons. Kidnappings for ransom are particularly common in some parts of Pakistan, such as the Northwest Frontier Province and Sindh Province.

It is best to avoid public transportation. For security reasons, U.S. Mission personnel are prohibited from using taxis or buses. (See the Traffic Safety and Road Conditions section below.)

Women are advised to dress conservatively, with arms and legs covered, and avoid walking around alone. It is unwise for anyone to travel on the streets late at night. Visitors to Pakistan should attempt to maintain a low profile, blend in, be aware of their surroundings, and seek security with their family or sponsoring organization.

Northern Areas – While we continue to discourage non-essential travel to Pakistan, we advise Americans wishing to trek in Gilgit, Hunza or Chitral to use only licensed guides and tourist agencies. While overall crime is low, there have been occasional assaults on foreign visitors.

Northwest Frontier Province - The Federally Administered Tribal Areas (FATA) along the Afghan border, and certain areas within the Northwest Frontier Province (NWFP), are designated as tribal areas and are not subject to normal government jurisdiction. The Government of Pakistan requires all citizens of countries other than Pakistan and Afghanistan to obtain permission from the Home and Tribal Affairs Department prior to visiting these locations. The permit may stipulate that an armed escort must accompany the visitor. Even in the settled areas of the NWFP there is occasional ethnic, sectarian, and political violence. There have been dozens of bombings in Peshawar of varying sophistication since September 2006. Members of the Taliban and Al-Qaida are known to be in the FATA, and may also be in the settled areas.

Kashmir - While direct military hostilities between India and Pakistan across the Line of Control (LOC) are infrequent, militant groups engaged in a long-running insurgency on the Indian side of the LOC are reported to have bases and supporters operating from the Pakistani side. Most of these groups are anti-American, and some have attacked Americans and other Westerners. The Government of Pakistan restricts access to many parts of this region and requires that visitors obtain a permit from the Ministry of Interior before traveling.

Punjab Province - Violence has increased in Punjab Province. Since September 2007, several suicide operations have taken place, including attacks in Rawalpindi and Lahore. As a precaution against these possible dangers, U.S. citizens are cautioned to avoid public transportation and crowded areas. The Wagah border crossing into India near Lahore remains open daily (from 9:30 a.m. to 3:30 p.m.) for travel to and from India if the passport holder has a valid visa for both countries. Visitors are advised to confirm the current status of the border crossing prior to commencing travel.

Sindh Province - In Karachi and Hyderabad, there has been recurring violence characterized by bombings, violent demonstrations and shootings. An October 2007 suicide attack on former Prime Minister Benazir Bhutto killed more than 130 and injured approximately 375 people in Karachi. In the aftermath of her December 2007 death, rioting in Karachi led to multiple deaths and injuries, as well as widespread property damage. In May 2008, clashing groups of lawyers burned buildings and vehicles in several areas of the city, resulting in at least 11 fatalities. Americans and other westerners continue to be a particular target of hostility and occasional anti-Western mob violence. The Consulate General in particular has been the target of several major terrorist attacks or plots in recent years, including the deadly March 2006 suicide attack described above. Non-essential travel to these cities is strongly discouraged. In rural Sindh Province, the security situation is hazardous, especially for those engaged in overland travel. The Government of Pakistan recommends that travelers limit their movements in Sindh Province.

Balochistan Province - The Province of Balochistan, which borders both Iran and Afghanistan, is notorious for narcotics and other forms of cross-border smuggling. Members of the Taliban and Al-Qaida are also believed to be present there. Tribal unrest sometimes turns violent. Because provincial police presence is limited, travelers wishing to visit the interior of Balochistan should consult with the province’s Home Secretary. Advance permission from provincial authorities is required for travel into many areas. Local authorities have detained travelers who lacked proper permission. Quetta, the provincial capital, has experienced an increase in bombings, occasional gun battles in the streets, and the imposition of curfews. Terrorist attacks against Pakistani government installations and infrastructure have been reported throughout 2005 and 2006.

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, including the Travel Warning for Pakistan, Travel Alerts, as well as the Worldwide Caution, can be found.

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

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

CRIME: Crime is a serious concern for foreigners throughout Pakistan. Carjacking, armed robberies, house invasions, and other violent crimes occur in many major urban areas. Petty crime, especially theft of personal property, is common. American travelers to Pakistan are strongly advised to avoid traveling by taxi and other forms of public transportation, and have members of their host organizations or families meet them at the airport.

In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

The local equivalent to the “911” emergency line in Pakistan is: 15
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Adequate basic non-emergency medical care is available in major Pakistani cities, but is limited in rural areas. Facilities in the cities vary in level and range of services, resources, and cleanliness, and Americans may find them below U.S. standards; facilities in rural areas are consistently below U.S. standards. Medical facilities require prepayment and do not accept credit cards.

Water is not potable anywhere in Pakistan and sanitation in many restaurants is inadequate. Stomach illnesses are common.

Effective emergency response to personal injury and illness is virtually non-existent in Pakistan. Ambulances are few and are not necessarily staffed by medical personnel. Any emergency case should be transported immediately to a recommended emergency receiving room. Many American-brand medications are not widely available, but generic brands from well-known pharmaceuticals usually are. The quality of the locally-produced medications is uneven.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Pakistan.
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. As noted above, emergency medical care in Pakistan is very limited. Medical evacuations from Pakistan may cost in excess of $45,000 for uninsured travelers requiring emergency assistance. 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 Pakistan is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Traffic in Pakistan moves on the left, opposite of U.S. traffic. In addition to this source of potential confusion, travel by road in Pakistan has a variety of other risks. Roads are crowded, drivers are often aggressive and poorly trained, and many vehicles, particularly large trucks and buses, are badly maintained. Donkeys, cattle, horse carts, and even the occasional camel can pose roadside hazards in some areas. Roads, including most major highways, also suffer from poor maintenance and often have numerous potholes, sharp drop-offs and barriers that are not sign-posted. Drivers should exercise extreme caution when traveling at night by road, as many vehicles do not have proper illumination or dimmers nor are most roads properly illuminated or signed. Driving without experienced local drivers or guides is not recommended.

It is best to avoid public transportation. For security reasons, U.S. Mission personnel are prohibited from using taxis or buses. (See Safety and Security section above.)

Please refer to our Road Safety page for more information. Visit the website of Pakistan’s national tourist office at http://www.tourism.gov.pk/ and the national authority responsible for road safety at http://www.nha.gov.pk/.

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

SPECIAL CIRCUMSTANCES:
Pakistan is largely a cash economy. Personal checks are not commonly accepted. Most Pakistanis do not use checking accounts for routine transactions. Outside major cities, even credit cards and travelers’ checks are generally not accepted, and there have been numerous reports of credit card fraud. There are bank branches as well as registered moneychangers in all international airports. ATMs can also be found in major airports. English is widely spoken by professional-level airport staff.

Please see our Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country’s laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Pakistani laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Pakistan are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Pakistan 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 Pakistan. 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 in Islamabad is located at Diplomatic Enclave, Ramna 5; telephone: (92-51) 208-0000; Consular Section telephone: (92-51) 208-2700; fax: (92-51) 282-2632; website: http://islamabad.usembassy.gov/
The U.S. Consulate General in Karachi, located at 8 Abdullah Haroon Road, closed its public operations indefinitely due to security concerns. U.S. citizens requiring emergency assistance should call the Consular Section in Karachi; telephone: (92-21) 520-4200; fax: (92-21) 568-0496; web site: http://karachi.usconsulate.gov/
The U.S. Consulate in Lahore is located on 50 Sharah-E-Abdul Hamid Bin Badees (Old Empress Road), near Shimla Hill Rotary; telephone: (92-42) 603-4000; fax: (92-42) 603-4200; web site: http://lahore.usconsulate.gov/; email: amconsul@brain.net.pk
The U.S. Consulate in Peshawar is located at 11 Hospital Road, Cantonment, Peshawar; telephone: (92-91) 526-8800; fax: (92-91) 528-4171; web site: http://peshawar.usconsulate.gov/
* * *
This replaces the Country Specific Information dated August 7, 2008 to update the section on Safety and Security.

Travel News Headlines WORLD NEWS

Date: Mon 7 Oct 2019
Source: Vax Before Travel [edited]

The US Centers for Disease Control and Prevention (CDC) issued a level 1 travel alert regarding the ongoing outbreak in Pakistan of extensively drug-resistant (XDR) typhoid fever.

This "practice usual precautions" travel alert published on [30 Sep 2019] is very important since XDR infections do not respond to most antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ciprofloxacin, and ceftriaxone. And in rare cases typhoid fever can be fatal.

The CDC says people from the USA, Canada, United Kingdom, Denmark, and Australia with a travel history to Pakistan have reported XDR typhoid infections. According to the Pakistan Tourism Development Corporation, about 1.75 million tourists visited Pakistan in 2017 alone.

Pakistan is the world's 6th-most populous country with a population exceeding 210 million people, located in South Asia.

Pakistan's current XDR typhoid fever outbreak began in Hyderabad, which is a city of Sindh province, during November 2016.

The CDC says, "If you are going to South Asia, including Pakistan, protect yourself against typhoid infection by getting a typhoid fever vaccination." The CDC's Advisory Committee on Immunization Practices (ACIP) recommends 2 typhoid fever vaccines: an oral vaccine, Typhim, and an injectable vaccine, Typbar.

The oral vaccine Typhim is approved for people 6 years old or older, should be taken as directed, at least 1 week before departure. The injectable vaccine is approved for people 2 years old or older. Travelers should receive the injectable vaccine Typbar at least 2 weeks before departure.

Neither vaccine is 100% effective, so travelers should also practice safe eating and drinking while traveling abroad, says the ACIP.

Typhoid fever is a serious disease caused by the bacterium _Salmonella Typhi_ and spread by contaminated food and water. Humans are the only source of these bacteria.

The incubation period of typhoid and paratyphoid infections is 6 to 30 days, says the CDC. Symptoms of typhoid fever often include high fever, weakness, stomach pain, headache, cough, and loss of appetite. People may have diarrhea or constipation.

If you travel abroad and get sick while traveling, seek medical care as soon as possible. If you get sick after returning to the USA, seek medical care and tell your healthcare provider where and when you traveled. Do not prepare food for other people, says the CDC.

An estimated 26 million cases of typhoid fever and 5 million cases of paratyphoid fever occur worldwide each year, causing 215,000 deaths. In the USA from 2008 to 2015, approximately 350 culture-confirmed cases of typhoid fever and 90 cases of paratyphoid fever caused by Paratyphi A were reported each year.

Also, the CDC says to ensure you are up to date on several vaccinations before visiting Pakistan.

>From a security perspective, the US Department of State issued a "reconsider travel to Pakistan" level 3 advisory regarding civil unrest on [9 Apr 2019]. Moreover, some areas of Pakistan have a "do not travel" level 4 advisory, such as Balochistan province and Khyber Pakhtunkhwa (KPK) province, including the former Federally Administered Tribal Areas (FATA), due to terrorism and kidnapping, and the Azad Kashmir area, due to terrorism and the potential for armed conflict.  [Byline: Dani Reiter]
============================
[Multidrug-resistant (MDR) is defined as acquired non-susceptibility to at least one agent in 3 or more antimicrobial categories. Extensively drug-resistant (XDR) is defined as non-susceptibility to at least one agent in all but 2 or fewer antimicrobial categories (i.e., bacterial isolates remain susceptible to only 1 or 2 categories). The typhoid fever strain causing the outbreak in Pakistan remains susceptible to carbapenems and azithromycin. Azithromycin may be used for treatment of uncomplicated typhoid fever caused by this strain, but carbapenems should be used treatment of severe or complicated typhoid fever involving this strain.

As noted in the alert, cases of typhoid fever caused by this strain have occurred in travelers from the USA and from other countries as reported in the See Also section below. - ProMED Mod.DK]

[HealthMap/ProMED-mail map:
Date: Sat 5 Oct 2019
Source: Pakistan Today [edited]

The total number of polio cases climbed to 72 in the country this year [2019] as 3 more cases of the deadly disease surfaced in Sindh, Balochistan and Khyber-Pakhtunkhwa (KP) on Saturday [5 Oct 2019].

In Sindh, a 17-month-old girl from Karachi's Orangi Town became the latest victim of polio, bringing the total number of cases in the city to 4 and the 8th such case across the province. The Emergency Operation Centre for Polio in Sindh, while sharing details about the latest case, said the child developed a fever and slight weakness in the right leg upon which she was taken to the doctors. The case was classified as acute flaccid paralysis (AFP) following which she was tested positive for polio virus, it added.

Meanwhile, the Balochistan Health Department has said the total number of polio cases in the province had reached 6 this year [2019] after a 15-month-old boy was diagnosed with the disease. According to the victim's parents, the infant from Jaffarabad felt weakness in his legs and became paralysed after suffering from high fever.

The Emergency Polio Centre has also kicked off a special polio vaccination campaign after recent spike in the cases and officials are optimistic to control the epidemic. According to the officials, a large number of families still refuse the vaccination, which is a major bottleneck in polio eradication.

In KP [Khyber Pakhtunkhwa], a 21-month-old boy has been diagnosed with the deadly disease in Hazara division's Torghar district, raising the total number of such cases to 53 in Khyber-Pakhtunkhwa. According to the family, the infant, whose blood sample was sent to National Institute of Healthcare in Islamabad on [17 Sep 2019], has now been tested positive for polio virus.

As per the country-wide figures, 72 polio cases have been reported during the current year [2019], including 53 cases from KP, 8 from Sindh, 6 from Balochistan and 5 from Punjab. Prime Minister Imran Khan, last month [September 2019], expressed serious concern over the recent spike in polio cases in the country and directed federal and provincial government officials to undertake effective awareness and immunisation campaigns to eliminate the disease.
=========================
[WPV1 circulation continues in Pakistan. These 3 cases are not as yet included in the weekly global update (see section [2] below) and when added will raise the global tally of WPV1 associated polio to 88 cases during 2019.

Of note, a prior case mentioned in Punjab has not as yet been officially confirmed and may have well been a suspected case pending laboratory results.

A good map of Pakistan showing districts and provinces can be found at
Date: Sat 14 Sep 2019
Source: Outbreak News Today [edited]

Officials with the Jinnah Postgraduate Medical Centre (JPMC) report another fatality due to primary amoebic meningoencephalitis (PAM) from infection with the brain-eating amoeba, _Naegleria fowleri_. The 20-year-old, Malir man is the thirteenth death due to this parasite in Karachi to date this year [2019].

According to the Pakistani news source, The News, Director General Health Sindh Dr. Masood Solangi said their teams of experts had started investigating the case and visited the residence of the deceased to interview his family, who informed that he had gone to a local pool for swimming. He said the swimming pool without having any chlorination could have been a place where he contracted the deadly brain infection. According to the CDC, _Naegleria fowleri_ is a free-living microscopic amoeba, (single-celled living organism). It can cause a rare and devastating infection of the brain called primary amoebic meningoencephalitis (PAM).

The ameba is commonly found in warm freshwater (e.g. lakes, rivers, and hot springs) and soil. _Naegleria fowleri usually_ infects people when contaminated water enters the body through the nose. Once the ameba enters the nose, it travels to the brain where it causes PAM, which is usually fatal. Infection typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers.

In very rare instances, _Naegleria_ infections may also occur when contaminated water from other sources (such as inadequately chlorinated swimming pool water or heated and contaminated tap water) enters the nose. You cannot get infected from swallowing water contaminated with _Naegleria_.
=======================
[According to the above report there have been 13 fatal cases of PAM in 2019. The sub-optimal chlorination of the water sources has been highlighted as a contributing factor which coupled with hot, humid climate in Sindh provides an environment for proliferation of _Naegleria fowleri_ amoebae.

Amoebic meningoencephalitis is an extremely rare and sporadic central nervous system (CNS) infection caused by free-living amoebae, mostly found in freshwater lakes and rivers. The initial symptoms of primary amebic meningoencephalitis (PAM) are indistinguishable from bacterial meningitis, while the symptoms of granulomatous amoebic meningoencephalitis (GAE) can mimic a brain abscess or meningitis. Diagnosis can be made by observing motile amoebae in a wet mount of cerebrospinal fluid (CSF) or visualization on CSF Wright or Giemsa stain. Treatment consists of a combination of systemic and intrathecal antibiotics. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Date: Sun 15 Sep 2019
Source: Pakistan Today [edited]

A Crimean-Congo Haemorrhagic Fever (CCHF) patient died in a private hospital of Karachi. The death toll from the tick-born viral disease has climbed to 17 in the megacity this year (2019). Sindh Health Department confirmed the death of a 52-year old man, [HK], a resident of Lyari area of Karachi who died in private hospital of the city due to CCHF. The patient was brought to hospital a few days ago with fever where he was diagnosed.

The tick-born viral disease had infected 36 people this year (2019) so far out of which 17 died. Currently, a 62 year old man [MD] is under treatment in a private hospital. CCHF is a fatal viral disease that spreads through a tick bite, which is a [arthropod vector and transmits the CCHF virus into the blood of animals]. The CCHF is mainly contracted by people who deal with cattle and livestock. The symptoms include backache, joints pain, pain in the abdomen, high grade fever and bleeding from any part of the body.
Date: Sat, 7 Sep 2019 03:40:09 +0200 (METDST)
By Ashraf KHAN

Karachi, Sept 7, 2019 (AFP) - Swarms of flies are descending on Pakistan's commercial capital in what residents say are record numbers this rainy season, adding to the misery of Karachi's monsoon "hell".   Heavy rains have inundated the sprawling port city of nearly 20 million people for weeks, overwhelming shoddy drainage systems clogged with mountains of uncollected garbage and flooding neighbourhoods with raw sewage.    "I have never seen such a fierce presence of flies in my life," Karachi resident Abdul Aziz, 45, told AFP.    "Clouds of flies keep covering the food at the market. It's repulsive -- they cover the fruit so much that you can't see beneath them."

At a market in Surjani town, meat trader Zahid Ali looked on as flies engulfed the area.    "If the customers come, they impulsively leave after seeing the swarms of flies," said Ali, adding that an increasing number of people working in the market had fallen ill.    Shershah Syed, a health rights activist and prominent surgeon in Karachi, said many illnesses were on the rise because of flies and mosquitoes.   "This time (the flies are) the worst ever as rain water is unable to drain and the garbage heaps are not dealt with," Syed said.    "The number of children entering hospitals for diarrhea or dysentery has jumped several fold this year. The number of children -- who are the most vulnerable to the fly-borne diseases -- has increased by about 10 times."

While Karachi is responsible for 60 percent of Pakistan's economic output, the city has long endured creaky infrastructure, illegal construction and failing municipal services.    This week, the Economist Intelligence Unit ranked Karachi as one of the least liveable cities in the world along with the likes of war-torn Libya's Tripoli and the crisis-hit Venezuelan capital Caracas.    "People in Karachi are numb to the idea of living with medical waste, overflowing gutters, broken down roads, and a complete lack of any kind of respectable public transport system," wrote Saadat Ali Zia on Twitter.    "We live in hell," tweeted Farooq Afridi.
More ...

World Travel News Headlines

Date: Mon, 14 Oct 2019 11:08:10 +0200 (METDST)

Manila, Oct 14, 2019 (AFP) - Parents lined up from sunrise holding sleeping infants as the Philippines launched a campaign on Monday to vaccinate millions of children against polio, which has re-emerged nearly two decades after the nation's last cases.   Years of falling vaccination rates, made worse by the botched rollout of a dengue vaccine, culminated in an outbreak of the preventable disease in September.   "This is for the welfare of my child," Ruth Miranda told AFP after the vaccine was squirted into her child's mouth at the Manila slum they call home.

Miranda's child is among scores who are unprotected in the capital of about 13 million people, where vaccination rates of young children plunged from 77 percent in 2016 to a mere 24 percent in June.   The atmosphere at the event in Manila was festive -- with ice cream vendors and music -- but the stakes for the campaign are high.

Polio, which can cause paralysis and can be fatal in rare cases, has no cure and can only be prevented with several doses of oral and injectable vaccines.   Two cases were detected in September, the first polio infections in the Philippines since 2001, adding to the woes of a country already hit by deadly measles and dengue epidemic.   The risk of the disease spreading within the Philippines is high, according to World Health Organization, due to low immunisation coverage partly blamed to a dengue vaccine scandal.

The Philippines was the first nation to use Dengvaxia in a mass programme in 2016, but a botched rollout led to claims that children had died after being vaccinated.   A dramatic drop in vaccine confidence followed, with trust plunging from 93 percent in 2015 to 32 percent in 2018, according to a study led by the London School of Hygiene and Tropical Medicine.   The Philippines polio outbreak has been traced back to the weakened form of the virus used in vaccines, which is excreted by people for a time after they receive it.   According to the WHO, that form can mutate and spread in the surrounding community when immunisation rates get too low.
Date: Mon, 14 Oct 2019 10:25:38 +0200 (METDST)
By Shingo ITO, Sara HUSSEIN

Tokyo, Oct 14, 2019 (AFP) - Tens of thousands of rescue workers in Japan battled on Monday to find survivors of a powerful typhoon that killed at least 43 people, as fresh rain threatened to hamper efforts.   Typhoon Hagibis crashed into the country on Saturday night, unleashing high winds and torrential rain across 36 of the country's 47 prefectures, and triggering landslides and catastrophic flooding.   "Even now, many people are still unaccounted for in the disaster-hit area," Prime Minister Shinzo Abe told an emergency disaster meeting on Monday.   "Units are trying their best to search for and rescue them, working day and night," Abe said.

But even as rescuers, including troops, combed through debris, the country's weather agency forecast rain in central and eastern Japan that it warned could cause further flooding and new landslides.   "I would like to ask people to stay fully vigilant and continue watching for landslides and river flooding," Chief Cabinet Secretary Yoshihide Suga told a news conference.   In Nagano, one of the worst-hit regions, rain was already falling and was expect to intensify.   "We are concerned about the impact of the latest rain on rescue and recovery efforts," local official Hiroki Yamaguchi told AFP.   "We will continue operations while watching out for secondary disasters due to the current rain."

- 43 dead, 16 missing: NHK -
By late Monday afternoon, national broadcaster NHK said the toll had risen to 43 dead, with 16 others missing and over 200 people injured. The government gave lower figures but was continuing to update its information.   The dead included a municipal worker whose car was overcome by floodwaters and at least seven crew from a cargo ship that sank in Tokyo Bay on Saturday night, a coast guard spokesman said.   Four others, from China, Myanmar and Vietnam, were rescued when the boat sank and the coast guard was still searching for a last crew member.   While Hagibis, one of the most powerful storms to hit the Tokyo area in decades, packed wind gusts of up to 216 kilometres (134 miles) per hour, it was the heavy rains that caused most damage.

A total of 142 rivers flooded, mainly in eastern and northern Japan, with river banks collapsing in two dozen places, local media said.   In central Nagano, a levee breach sent water from the Chikuma river gushing into residential neighbourhoods, flooding homes up to the second floor.   As water slowly receded Monday, television footage showed patients being transferred by ambulance from a Nagano hospital where some 200 people had been cut off by flooding.   Elsewhere, rescuers used helicopters to winch survivors from roofs and balconies, or steered boats through muddy waters to reach those trapped.

- Japan dedicates rugby win to victims -
By Monday afternoon, some 75,900 households remained without power, with 120,000 experiencing water outages.   The disaster left tens of thousands of people in shelters, with many unsure when they would be able to return home.   "Everything from my house was washed away before my eyes, I wasn't sure if it was a dream or real," a woman in Nagano told NHK.   "I feel lucky I'm still alive."   The storm brought travel chaos over the holiday weekend, grounding flights and halting commuter and bullet train services.

By Monday, most subway trains had resumed service, along with many bullet train lines, and flights had also restarted.   The storm also brought havoc to the sporting world, forcing the delay of Japanese Grand Prix qualifiers and the cancellation of three Rugby World Cup matches.   But a crucial decider pitting Japan against Scotland went ahead, with the hosts dedicating their stunning 28-21 win to the victims of the disaster.   "To everyone that's suffering from the typhoon, this game was for you guys," said Japan captain Michael Leitch.
Date: Sun, 13 Oct 2019 23:31:57 +0200 (METDST)

Kinshasa, Oct 13, 2019 (AFP) - Doctors will use a second Ebola vaccine from November in three eastern provinces in the Democratic Republic of Congo to fight the deadly virus, medical officials said Sunday.   "It's time to use the new Ad26-ZEBOV-GP vaccine, manufactured by Johnson & Johnson's Belgian subsidiary," said Dr. Jean-Jacques Muyembe, who leads the national anti-Ebola operation in the DRC.    It will arrive in the eastern city of Goma, in North Kivu province, on October 18 and be used from the beginning of next month, he added.   DRC's latest Ebola epidemic, which began in August 2018, has killed 2,144 people, making it the second deadliest outbreak of the virus, after the West Africa pandemic of 2014-2016.

Muyembe said the communes of Majingo and Kahembe had been selected to receive the vaccine as they were considered the epicentres of the epidemic.   "We will extend this vaccination to our small traders who often go to Rwanda to protect our neighbours," he added.   "If it works well, we will expand vaccination in South Kivu and Ituri."   DR Congo's eastern provinces of Ituri, North Kivu and South Kivu sit on the borders with Uganda, Rwanda and Burundi.   The Belgian laboratory will send a batch of 200,000 doses to neighbouring Rwanda and 500,000 doses in the DRC, Muyembe said.   More than 237,000 people living in active Ebola transmission zones have received a vaccination produced by the pharma company Merck Sharpe and Dohme since August 8, 2018. 

The J&J vaccine had been rejected by DRC's former health minister Oly Ilunga, who cited the risks of introducing a new product in communities where mistrust of Ebola responders is already high.   But Ilunga's resignation in July appears to have paved the way for approval of the second vaccine. He currently faces charges that he embezzled funds intended for the fight against Ebola.   In his letter of resignation Ilunga said "actors who have demonstrated a lack of ethics" want to introduce a second vaccine, but did not elaborate.    Muyembe, who took over the Ebola fight in the DRC in July, said "The Johnson & Johnson vaccine has the most science-based data."
Date: Thu, 10 Oct 2019 20:02:59 +0200 (METDST)
By Robbie COREY-BOULET

Addis Ababa, Oct 10, 2019 (AFP) - A palace that once housed Ethiopia's emperors and also served as a torture site under the communist Derg regime is to open to the public in a controversial government tourism project.    The palace compound in Addis Ababa, which Prime Minister Abiy Ahmed's government has rebranded "Unity Park", was formally launched Thursday and will be open from Friday.    Abiy's office said on Twitter Thursday that the project "symbolises our ability to come together".

But critics have dismissed it as vanity project for Abiy that could prove divisive.   Backed by the United Arab Emirates, the project cost more than $160 million (145 million euros), Ethiopian officials told reporters at a briefing earlier this week.    Built in the late 1800s by Emperor Menelik II, who founded Addis Ababa, the palace was the residence of Ethiopia's rulers for more than a century.   Abiy himself does not live there, and it has seen little activity in recent years.    Abiy's advisers say he has taken a keen interest in transforming the palace into a tourist attraction since coming to power in April 2018 -- visiting the site every day in recent weeks to monitor progress.

The government's "Home-Grown Economic Reform" agenda, unveiled last month, describes tourism as a primary engine of potential job creation.    On Thursday, government officials and the diplomatic corps toured the expansive site before attending a banquet that was expected to draw five regional heads of state and other dignitaries.    The restored rooms feature items like Menelik's sword and a life-size wax replica of former Emperor Haile Selassie, who lived at the palace and was then etained there after the Derg overthrew him in 1974.

The site also includes a sculpture garden with installations representing Ethiopia's nine regions, and a zoo is expected to open by the end of the year.    Aklilu Fikresilassie, an Ethiopian employee of the United Nations who attended the launch Thursday, said he was "really fascinated" to set foot inside a place that had been closed to the public his entire life.    "For us it's like a government house, so now when you enter that palace it tells you that we are getting somehow closer to our leaders," he said.

But not everyone is convinced the palace will succeed in bringing Ethiopians together.   In a country grappling with ethnic divisions, some worry that the palace could alienate ethnic Oromos who contend that their ancestors were forced off their land when Addis Ababa was built.    Journalist and former political prisoner Eskinder Nega said the renovations were undertaken "without consultation from the public", which he called "a huge mistake."    "This is all about heritage, about preserving heritage. The people should have had a say in it," he said.    "Like everything else this was decided from the top and implemented only by the decision of the prime minister."
Date: Thu, 10 Oct 2019 13:13:57 +0200 (METDST)

Hanoi, Oct 10, 2019 (AFP) - Selfie-snapping tourists railed against the closure of Hanoi's 'train street' on Thursday after police blocked off the Instragram-famous tracks for safety reasons.   The narrow railway corridor in central Hanoi has become a hotspot among visitors seeking the perfect holiday snap on the tracks -- often dodging trains that rumble through daily.    But Hanoi authorities said this week they would block people from the tracks to avoid accidents, and police on Thursday erected barricades to keep out disappointed visitors.    "I'm very frustrated because today I can't go in and take a picture," Malaysian tourist Mustaza bin Mustapha told AFP, vowing to come back later.

Dozens of other tourists were turned away, though some managed to get onto still-open sections of the railway, moving out of the way as an afternoon train chugged past.    Built by former colonial rulers, the railway once shipped goods and people across France's former Indochina colony and remains in use today by communist Vietnam's state-run railway company.    The stretch of the tracks was once known as a rough part of town, occupied by drug users and squatters until their recent discovery by camera-wielding holidaymakers who have splashed images of the area across social media.

Cafe owners complained that business would be hurt thanks to the new regulations, and that tourists always moved out of the way for oncoming trains.   "There has never been any regretful accidents here," said Le Tuan Anh, who runs a cafe from his home along the tracks.   "Compared to traffic density elsewhere in the city, this is much safer," he said, referring to Hanoi's chaotic, motorbike-clogged streets.   New signs were installed in the area Thursday, warning passersby not to take photos or videos in the "dangerous area", much to the chagrin of British tourist Harriet Hayes.   "People come from all over the world to Hanoi just to see the train go past," she told AFP.   "It's such a shame that we come and have been told that we have to leave."
Date: Thu, 10 Oct 2019 06:51:42 +0200 (METDST)
By Holly ROBERTSON

Sydney, Oct 10, 2019 (AFP) - Large numbers of tourists are rushing to scale Uluru -- also known as Ayers Rock -- ahead of a looming ban on climbing a site sacred to indigenous Australians.   Photographs of hundreds of people clambering up the giant red monolith have provoked a social media backlash, with critics lashing as "ignorant" those going against the wishes of the traditional Aboriginal owners of the land, the Anangu.   "A mass of morally and ethically bankrupt people," indigenous woman Laura McBride tweeted alongside an image showing a queue of people snaking up the side of Uluru.    "One even hiking a toddler up, teaching the next generation how to be ignorant."   "Imagine rushing to climb Uluru before it closes just so you could brag about disrespecting the oldest living culture in the world," tweeted National Indigenous Television journalist Madeline Hayman-Reber, who called the scenes "embarrassing".

Officials say the ban, which comes into effect on October 26, is intended to show respect for cultural practices, protect the site from further environmental damage and to ensure visitors' safety.    More than 395,000 people visited the Uluru-Kata National Park in the 12 months to June 2019, according to Parks Australia, about 20 percent more than the previous year. Around 13 percent of those who visited during that period made the climb, park authorities said.    More recent figures are not available but Tourism Central Australia CEO Stephen Schwer said there had been a "significant jump" in the number of people visiting in recent weeks, with the period leading up to the ban coinciding in part with school holidays.   "Its been very busy, particularly down in the national park precinct itself," he told AFP.   "We've had quite an issue with accommodation availability, because there's a lot of people want to climb Uluru before it closes. It's been a busier than normal holiday period."   Japanese visitors and Australians on driving holidays were most likely to want to scale Uluru, Schwer said, though he urged them not to do so.

Australian tourist Belinda Moore, 33, drove to Uluru from her home in central Queensland state to ascend the rock, an experience she said she "absolutely loved".   "It's always been something to tick off the bucket list and when we heard it was closing, we knew it was now or never," she told AFP.   Moore said she did not think her climb was disrespectful to traditional owners as she was not Aboriginal.    "It may be for their own people, because it's their sacred site," she said.   "I'm pretty sad that they're closing it, but it's still amazing just to see it. I would still recommend it."   The climb will be permanently closed as of October 26, the anniversary of ownership being handed back to the Anangu people.

Uluru has great spiritual and cultural significance to indigenous Australians, with their connection to the site dating back tens of thousands of years.   Though visitor numbers were expected to decline once the ban was in place, Schwer said local tourism operators were "not particularly concerned" as it would return the area to normality.   "People need to remember that in central Australia we're a very interconnected community," he said. "The people who are requesting the climb closure are our friends and colleagues.   "We're just looking forward to being able to have the climb consigned to the annals of history."
Date: Wed, 9 Oct 2019 22:01:17 +0200 (METDST)

Kinshasa, Oct 9, 2019 (AFP) - Six people were killed in the Democratic Republic of Congo after torrential rains hit the capital Kinshasa, flooding several neighbourhoods. a local official said.    The bodies were found between Tuesday night and Wednesday morning.    Five people were killed in the capital's Selembao municipality where around 30 houses collapsed, local mayor Augustin Mankesi told Top Congo radio station.   One woman died in the Pelende district after she was electrocuted, he added.    "Our community is stricken," Mankesi added, calling on the Congolese authorities for help.   Fatal floods and rains are frequent in Kinshasa. In January last year 48 people were killed in landslides, floods and after houses collapsed, according to authorities.    Residents told AFP the road from the sea port district of Matadi to the Kinshasa turnoff has been closed due to erosion caused by the rain.    The passage is Kinshasa's main supply route for imported goods and also serves as an exit point for exports.
Date: Tue, 8 Oct 2019 04:13:25 +0200 (METDST)
By Margioni BERMÚDEZ

Caracas, Oct 8, 2019 (AFP) - The small waiting room at the home of self-styled healer "Brother Guayanes" in Caracas' rundown Petare district fills up quickly with patients -- business has never been better.   With Venezuela's chronic medicine shortages and hyperinflation, more and more people are turning to alternative medicine to treat common ailments in the crisis-wracked South American country.   "We go to the hospital and there's nothing there. They don't have medicines, or they're too expensive, what are we to do?" said Rosa Saez, 77, who has come to get treatment for a painful arm.   Carlos Rosales -- he uses the more ceremonious "Brother Guayanes" for his business -- is finishing up a "spiritual intervention" on a patient in what passes for his surgery.   The patient lies, eyes closed, on a cot as, in a series of swishes and clicks, the healer waves five pairs of scissors one after another over his prone body.    The healer says he performs 200 such interventions a week in a dim, candle-lit room that features two camp beds and an array of plaster statues that Rosales says represent "spiritual entities".   A regular visitor to the spiritual center, Saez says she has faith in Rosales' methods: "He healed my kidneys."

- Natural healing -
All across Venezuela, but particularly in poor areas like Petare, patients cannot hope to afford the price of medicines that due to the economic crisis, have become exceedingly rare.  Venezuela's pharmacists' federation say pharmacies and hospitals have on average only about 20 percent of the medicine stock needed.   Rosales' clinic is muggy with the smell of tobacco. A crucifix suspended from a chain around his neck, he practices a seeming mixture of smoke-blowing shamanism, plant-based medicine and mainstream religion.    Posters hung near the entrance remind clients to arrive with a candle and tobacco and "Don't forget that payment is in cash".   Much like a general practitioner, Rosales spends time consulting with his patients, examining them with a stethoscope, before offering a diagnosis. Often he prescribes potions based on plants and fruit, such as pineapple and a type of local squash known as chayote.   "We know medicines are necessary," he says. "I'm not against medicine, but my medicine is botany."

- Plants replace drugs -
At her stall in a downtown Caracas market, 72-year-old Lilia Reyes says she has seen her trade in medicinal plants flourish.   "I can't keep up with the demand," she said at her stall, bathed in the aroma of camomile, one of the 150 plants she sells.   Careless consumption of some herbs can be deadly, warns Grismery Morillo. A doctor at a Caracas public hospital, she says she has seen many cases of acute liver failure in people who have eaten certain roots.   According to Venezuela's opposition parties, some 300,000 chronically ill people are in danger of dying from the shortages of medicines.

But despite the risks, people like Carmen Teresa say they have no alternative.    In the kitchen of her restaurant which closed down three years ago as the economic crisis took hold, the 58-year-old Colombian prepares an infusion of fig leaves to treat "diabetic neuropathy".   The painkillers needed for the condition are "too expensive" and prices are going up due to hyperinflation, so she is cutting back on the pills and supplementing her treatment with herbal infusions.   She needs at least four tablets a day to keep her diabetes at bay. Her mother, bedridden since breaking a leg a year ago, suffers from Alzheimer's disease and needs five pills a day for hypertension.   "I'm still taking my pills, but I reduced the dose," says Teresa, who is also replacing cholesterol pills with lemon juice.
Date: Sun, 6 Oct 2019 12:04:37 +0200 (METDST)

Riyadh, Oct 6, 2019 (AFP) - Saudi Arabia announced Sunday it would allow unmarried foreign couples to rent hotel rooms together as the ultraconservative kingdom begins offering up tourist visas for the first time.   The tourism authority said in a statement published on Twitter that Saudi women travelling alone would also be able to check into a hotel by presenting valid ID.

In the past, couples wanting to stay in a hotel had to prove they were married.    "This is no longer required for tourists," the statement said.   Saudi Arabia announced on September 27 it was opening its doors to holidaymakers with the goal of diversifying its oil-dependent economy.   The kingdom had previously only issued visas to Muslim pilgrims, foreign workers, and recently to spectators at sporting or cultural events.

Kickstarting tourism is one of the centrepieces of Crown Prince Mohammed bin Salman's Vision 2030 reform programme to prepare the biggest Arab economy for a post-oil era.   Citizens from 49 countries are now eligible for online e-visas or visas on arrival, including the United States, Australia and several European nations.   On September 28, Saudi authorities warned that tourists who violated "public decency", including with immodest clothing and public displays of affection, would be subject to fines.
Date: Sat, 5 Oct 2019 03:30:17 +0200 (METDST)
By Giovanna FLEITAS

Petorca, Chile, Oct 5, 2019 (AFP) - For Erick Hurtado, the worst thing about the drought that has devastated his family farm in Chile is the dead animals.   "Going out and seeing the animals dead on the ground is so horrible," Hurtado says as he gazes across the dusty paddocks of his farm in Petorca, near the coastal city of Valparaiso.

Farmers are counting the cost of one of the driest austral winters in six decades, which has destroyed crops and left tens of thousands of farm animals dead in the fields of central Chile.   Hurtado's farm, owned by his grandfather, has lost half its 60 head of cattle.   So far, 106,000 animals have died due to lack of water and fodder, mostly goats, cattle and sheep, according to the agriculture ministry.   President Sebastian Pinera, who last month announced a $5 billion plan to improve water distribution, this week set up a crisis group of government agencies to tackle the water crisis, which he said had become "more extensive and more intense."

In Colina, north of the capital Santiago, the drought has been hard on small farmers. Scrawny cattle pick at sprigs of strawy grass on pastures that have turned to dust. Cows, goats and horses roam hungry on hills have turned to a dry muddy brown.   "The drought has been disastrous for us," said Sandra Aguilar. Her family owned about a hundred head of cattle. Today, only half survive thanks to a trickle of water provided by a neighbor who still has some reserves.   "The situation is complicated," said Javier Maldonado, governor of the province of Chacabuco, where several agricultural areas have been hit particularly hard by the drought.    "We have to be realistic, climate change is here to stay," he said.

- Water shortages -
Dominga Mondaca points out the deep fissures that run through the garden behind her house in the village of La Ligua near Valparaiso. The garden used to be full of strawberries and citrus trees; now it's cracked earth.    "We have had many years with little water. But the last year, it didn't rain at all," said the 73-year-old, one of more than 600,000 people the government is supplying by tanker trucks as part of emergency measures.   She says she has had to give up raising chickens, in order to keep what little water she and her husband receive for their own consumption, washing and cleaning. Whatever is left, she uses to sprinkle on herbs in a small kitchen garden.   The agriculture ministry says 37,000 family farms need assistance in the central Chile.

- Thirsty avocados? -
In Petorca, some rivers have run dry, and the landscape has been left parched, but lush avocado and citrus plantations are nevertheless thriving.   Locals in Petorca say the real, long-term problem is the mismanagement of water resources.    "There is an excess of monoculture plantations that consume all the water," said Diego Soto of the Movement for the Defense of Access to Water, Land and Environmental Protection (MODATIMA) told AFP.   Avocados need a lot of water to grow, said Soto.   "An avocado tree needs 600 liters of water per week, whereas humans consume 50 liters a day, or 350 liters a week," he said.   Producers refute these figures and say the real problem is a lack of infrastructure to store water, both above and below ground.    "The avocado is not a crop that needs more water," insisted Francisco Contardo, chairman of the local producers' committee.   Avocados are a key export for Chile, mostly to the US and China, but drought has reduced exports by 25 percent.

- Less snow -
For many though, the changes being wrought by climate change are overwhelmingly obvious. Snow in the highlands of central Chile was relatively scarce this year.    Scientists predict an average decrease of between five and 10 percent snowfall every 10 years in almost the entire Andes mountains, one of the country's main sources of water.   "The central zone of Chile is highly dependent on the summer melt season, its snow and glaciers, which means that if the snow cover is reduced, there is also a reduction in the availability of water resources," said Paul Cordero, climate change expert at the University of Santiago.   Weak snowfall forced the country's main ski resorts to use artificial snow machines much earlier and more often this season than in previous years.    "Chile has been living as if it were a country with an abundance of water," said Pinera.   "Climate change and global warming have changed this situation probably forever."