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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: Sat, 2 May 2020 17:14:39 +0200 (METDST)

Athens, May 2, 2020 (AFP) - A 6.0 magnitude quake struck off the Greek island of Crete on Saturday but there were no immediate reports of casualties or damage.   The Athens Geodynamic Institute said the epicentre was about 55 kilometres (35 miles) south of the city of Ierapetra. It hit at 1251 GMT (15:51 pm).   "No victims or serious damage has been reported so far," a local police officer told AFP by telephone.

Tremors were felt across the island and landslides were reported on some roads in Lasithi, where Ierapetra is located, the fire service said.    "Luckily the quake happened at a depth of 19 kilometres in the sea and there has not been any serious damage so far," said Giorgos Aspadrakis, the head of the fire brigade in Lasithi.   "The quake went on for a long time," said Georgia Santamouri, 29, who lives at Heraklion -- almost 100 km from Ierapetra.   "I was in bed. I was really scared in the beginning and I couldn't move initially but then I ran out," she said.

Greece is prone to earthquakes, with many occurring offshore.   The last deadly quake occurred on the island of Kos in the Aegean Sea in July 2017. The 6.7-magnitude quake killed two people.   The deadliest temblor in recent years struck the Athens region in 1999, killing 143 people.
Date: Thu, 23 Apr 2020 12:20:54 +0200 (METDST)

Athens, April 23, 2020 (AFP) - Greece is extending coronavirus lockdown measures by a week to May 4, the government said Thursday.   The country has managed to keep fatalities at a low level after registering its first virus death on March 12, despite a decade of cuts imposed on its public health system during the post-2010 debt crisis.

Supermarkets, banks and food delivery restaurants are among the few businesses still operating, and Greeks must inform authorities when leaving their homes for necessities, or risk fines.   "Restrictive measures that apply until April 27 are extended by a week to May 4," government spokesman Stelios Petsas told reporters.

Prime Minister Kyriakos Mitsotakis next week will be announcing steps to remove some of the nationwide lockdown measures imposed on March 22, Petsas added.   The relaxation of the restrictions is set to begin with a partial reopening of courts and land registers on April 27.   The education ministry has also announced plans for final-year school pupils to hold university entry exams in June.   Greece has so far officially announced 121 deaths, with 55 people still in intensive care.
Date: Tue, 7 Apr 2020 12:55:32 +0200 (METDST)

Athens, April 7, 2020 (AFP) - Hundreds of Greek healthcare workers demonstrated on Tuesday to protest at working conditions and lack of manpower and equipment in public hospitals during the coronavirus pandemic.   The demonstrations were staged to coincide with World Health Day, according to the federation of hospital personnel.   "You only saw us when we covered our faces," proclaimed a poster printed by hospital trade unions, bearing a picture of doctors wearing anti-coronavirus masks.    Demonstrators at the large Evangelismos hospital in central Athens held up signs demanding job hiring, virus testing and hospital equipment.

Police tried to enter the hospital courtyard where the rally was taking place before being forced back by demonstrators, an AFP photographer said.   A similar protest was held at the main hospital in Larissa in central Greece, according to images from public television ERT.    Despina Tossonidou, president of the doctors' union at Voula hospital in southern Athens, said that in addition to the hiring of medical staff, intensive care units in private clinics should be requisitioned "to overcome the shortcomings of the public sector" during the virus crisis.   Health care in Greece was drastically affected by the country's 2010-2018 financial crisis and tough austerity required by creditors in exchange for bailouts.

As part of its measures to deal with the pandemic, the government has offered clinics 30 million euros ($32.6 million) and announced the hiring on short-term contracts of 2,000 doctors and 2,000 nursing staff.    "These measures are just a drop in the ocean," said Tossonidou, a radiologist.    "The hospital system needs 30,000 additional permanent doctors," she said, also citing the lack of protective equipment and COVID-19 testing in hospitals.    "The majority of tests are currently carried out in private hospitals at costs ranging from 150 to 300 euros ($163-326)," said Tossonidou.    Greece, a country of around 10.7 million people, has suffered relatively less than other European nations in the pandemic, recording 81 deaths out of 1,755 cases.
Date: Sun, 22 Mar 2020 18:02:51 +0100 (MET)

Athens, March 22, 2020 (AFP) - Greece will impose a nationwide lockdown to stem the spread of the coronavirus, limiting people to their homes except for essential outings, Prime Minister Kyriakos Mitsotakis said Sunday.    "I have given orders that all appropriate action be taken to enforce the ban on all unnecessary movement across the country," Mitsotakis said in a televised address to the nation.   The restrictions will come into force from 6:00 am local time (0400 GMT) on Monday, and will require citizens to carry proof of identity to leave their homes. 

Outings are only permitted for people "going to work, the doctor, or to visit someone who needs help, or those who are buying food or medication", the prime minister said.    Citizens are also permitted to leave the house to walk their pets or exercise outdoors alone or with one other person.

There are 15 recorded deaths and 624 infections from the coronavirus in Greece, which has a population of 11 million.    Since reporting its first death from the virus on March 12, the country has gradually rolled out measures to limit gatherings and non-essential travel along with closing schools, shops and entertainment venues.
Date: Sat, 21 Mar 2020 10:59:18 +0100 (MET)

Athens, March 21, 2020 (AFP) - A strong 5.6 magnitude earthquake struck early Saturday in northwest Greece, damaging property in the city of Parga, authorities said.   The quake struck at 0049 GMT (0249 local time), with the epicentre 11 kilometres (around six miles) from Parga in Kanalaki district, and 316 kilometres northwest of Athens, the Athens geodynamic observatory said.   "No casualties have been reported at the moment," Parga mayor Nikolas Zacharias told AFP by telephone.

"Some old abandoned houses in Kanalaki collapsed and some houses suffered significant damage in this district of 2,500 inhabitants," Zaharias said, adding the temblor was strong throughout the area.   Landslides partially damaged the region's roads, he added.   Greece lies on major fault lines and is regularly hit by earthquakes, but they rarely cause casualties.   In 2017, a 6.7-magnitude earthquake killed two people on the island of Kos in the Aegean sea, causing significant damage.   In 1999, a 5.9-magnitude quake left 143 people dead in Athens and the region northwest of the capital.
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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: Wed, 6 May 2020 18:33:44 +0200 (METDST)

Jakarta, May 6, 2020 (AFP) - A 6.8 magnitude earthquake jolted a remote part of eastern Indonesia late Wednesday, the United States Geological Survey said, but there was no tsunami warning issued and no immediate reports of damage.    The undersea quake struck at a depth of some 107 kilometres (66 miles) in the sea between Indonesia's Maluku and East Timor at 22:50 local time (13:50 GMT).   The epicentre was about 390 kilometres south of the city of Ambon in the archipelago's Maluku province.   "We have not received any reports of damages so far as a result of the quake. The result of our modeling also shows that the earthquake did not trigger any potential tsunami," said Taufan Maulana, the spokesman of Indonesia's weather and geophysics bureau.

The bureau further reported that the tremors were strongly felt by people on nearby small islands, as well as those in some cities in Papua, the easternmost province of Indonesia.   Researcher Fawwaz Rifasya told AFP that he was on the fourth floor of a hotel in Manokwari, Papua, when he felt the building swaying.   Meanwhile, Andika Baskoro in Merauke, Papua, said that he noticed the quake after he saw hanging lamps and water in a gallon swaying.   An AFP journalist in Dili, East Timor, roughly 400 kilometres away, reported feeling a slight tremor.    Indonesia is one of the most disaster-prone nations on Earth. In 2018, a 7.5-magnitude quake and a subsequent tsunami in Palu on Sulawesi island left more than 4,300 people dead or missing.
Date: Wed, 29 Apr 2020 09:54:33 +0200 (METDST)
By Agnes ANYA, Safrin Labatu

Jakarta, April 29, 2020 (AFP) - From shirtless soldiers to teens sun tanning on their parents' driveways, Indonesians are soaking up rays like never before in the hope that plentiful sunshine will ward off coronavirus.   The rush to take up a practice usually associated with Bali-bound foreigners has been driven by unfounded claims on social media that sunlight -- and the vitamin D it supplies -- can slow or kill the virus.

That hope got a boost last week when a senior US official said new research showed sunlight quickly destroys the virus. The study has yet to be evaluated independently, but US President Donald Trump spoke about it enthusiastically during a press conference.   "I always avoided the sun before because I didn't want to get tanned," said Theresia Rikke Astria, a 27-year-old housewife in Indonesia's cultural capital Yogyakarta.   "But I'm hoping this will strengthen my immune system," she added.

Medics have their doubts, but say a 15-minute burst of morning sunshine can be good for you.   "Exposing the body to direct sunlight is good to get vitamin D, not to directly prevent the disease," said Dr. Dirga Sakti Rambe at Jakarta's OMNI Pulomas Hospital.    Vitamin D, which comes from fish, eggs, milk and sunlight exposure, is important in maintaining a healthy immune system, he said, but added: "Sunbathing does not kill the virus that causes COVID-19."

Whatever the science, one thing is for sure: there is no shortage of sunshine in the tropical 5,000-kilometre- (3,100-mile-) long Southeast Asian archipelago.   The rush outdoors has led to an Indonesian government warning about the dangers of skin cancer, and calls for novice sun-seekers to slap on protection.   It was a rare caution in a place where sunbathing is not practised widely and beauty product commercials extol the virtues of fair skin.    Across Asia, pale skin has long been associated with a higher social class and skin-lightening products are big sellers.   Muslim majority Indonesia's relatively conservative dress codes -- especially for women -- mean skimpy swimwear isn't a feature of the new craze.

- 'Asian skin tone' -
But the pandemic has made a convert of Rio Zikrizal, even if he struggles with the idea of soaking his shirtless torso in the sun.   "In normal times I'd be reluctant to sunbathe," the Jakarta resident said.   "I've got an Asian skin tone which gets dark easily so I often use products to make my skin lighter."   Nabillah Ayu, who lives on the outskirts of the capital Jakarta, starts her newly adopted sunbathing routine around 10 am -- when she used to be in the office -- in the hopes of avoiding the deadly respiratory disease.   "Sunlight can't directly kill coronavirus, but it can boost the immune system and stop you from getting it," the 22-year-old said.   Bare-chested suntan sessions have been incorporated into morning exercise routines for some military and police units.

And in major cities, residents are flocking from neighbourhoods crammed with narrow, dark alleyways to open areas -- including commuter train tracks -- where they can catch some unobstructed rays.   It is a motley mix of women in head-covering hijabs with rolled up sleeves and pants, shirtless male teens and wrinkly pensioners all clamouring for a bit of sunshine as the odd train zips by.   "I've just started sunbathing regularly since the pandemic hit," Alfian, who goes by one name, told AFP near train tracks in Tangerang on the edge of Jakarta.   "Afterwards I take a shower and my body feels fitter."   Pensioner Wadianto Wadito, who suffers from heart disease and diabetes, figures he can use all the help he can get.   "I'm already taking a lot of medicines anyway, so now I'm sunbathing to get all my vitamins without taking more pills," the 65-year-old said.
Date: Thu, 23 Apr 2020 18:37:35 +0200 (METDST)

Jakarta, April 23, 2020 (AFP) - Indonesia will ban all air and sea travel until June, officials said Thursday, in an apparent effort to contain the spread of the coronavirus during the holiest period on the Islamic calendar.    The temporary ban takes effect Friday, the first day of the fasting month of Ramadan for the Muslim-majority country, and lasts until June 1.    It comes a day after the government, fearing an explosion in virus cases, banned the annual exodus for Eid al-Fitr, the holiday marking the end of Ramadan, when millions travel to their hometowns and ancestral villages.

The latest measure will not apply to emergency, diplomatic or cargo transport, the government said.    The repatriation of Indonesian citizens from abroad and foreigners living in the Southeast Asian archipelago will also be exempt.   "It applies to both domestic and international commercial travel but there are some exceptions,"  Transportation Ministry spokeswoman Adita Irawati told AFP.   The country's biggest airlines Garuda and Lion Air had already scaled backed their commercial flights as the tourism market shrivelled up. 

But the ban on sea travel could hamper the movement of millions in a country of some 17,000 islands where passenger ferries are a key mode of transportation.   The government had already called on residents of major cities, including the capital Jakarta, to stay put.   As of Thursday, Indonesia had confirmed 7,775 cases of COVID-19 and 647 deaths.   But the toll is widely believed to be much higher in a country with one of the lowest testing rates in the world.
Date: Thu, 16 Apr 2020 10:45:32 +0200 (METDST)

Jakarta, April 16, 2020 (AFP) - Reduced to sharing goggles and cheap raincoats, Indonesia's under-equipped doctors are battling a tide of coronavirus infections that is overwhelming its creaky health-care system -- and killing their colleagues.   Two dozen doctors have died since the pandemic began in the Southeast Asian nation, and critics warn that the official death toll of 459 is way below reality in a country with some of the lowest virus testing rates in the world.   Hospitals don't have enough basic protective gear -- never mind sophisticated ventilators -- leaving many poorly paid doctors to battle the virus with little more than plastic rain ponchos.

Jakarta doctor Muhammad Farras Hadyan said supplies are running so low at his hospital that some colleagues rely on donations from family members to buy the few available certified hazardous material suits.   "The rest rely on the hospital's supply and they've got to wait," he said.   Handoko Gunawan, a 79-year-old pulmonary specialist, was on the front lines until he was forced into quarantine on suspicion he had contracted the virus.   "I was shaking so bad, and the nurse was trembling," Gunawan, who later tested negative for the illness, said of treating patients.   "These young health workers have spouses and children at home, but they still brave the challenges.   "Doctors are scarce in Indonesia and if they die we'll have fewer people to treat patients," he added.

Indonesia has fewer than four doctors for every 10,000 people, according to World Health Organization data -- far below hard-hit Italy (around 40) or South Korea (about 24).   The Indonesian Doctors' Association has warned that the coronavirus crisis is much worse than reported and the government's response is "in tatters".   Latest official figures say Indonesia had some 5,136 confirmed cases, but only 36,000 people have been tested across a sprawling archipelago of more than 260 million -- the world's fourth most populous nation.   The health ministry revealed this week that nearly 140,000 Indonesians are being monitored on suspicion they may have the virus.   "The government's official data doesn't reflect the real picture of infections across the country," said Halik Malik, a spokesman for the doctors' association.

Jakarta municipal figures show more than 1,000 suspected or confirmed victims buried in local cemeteries under COVID-19 protocols that require bodies to be quickly interned -- about five times the government toll in the capital, the epicentre of the outbreak in Indonesia.   Burials in Bandung, a city in West Java that borders the capital region, have doubled to about 400 a month since the outbreak, the province's governor Ridwan Kamil told AFP.   "It is the same phenomenon as in Jakarta," Kamil said.   "We can't confirm these are all COVID-19, but the number of deaths is higher than usual."   The surge has left doctors like Raditya Nugraha and colleagues at a West Java hospital struggling to keep up, and having to share equipment.   "We don't have enough goggles so we take turns wearing them," he said.
Date: Tue, 31 Mar 2020 13:10:45 +0200 (METDST)

Jakarta, March 31, 2020 (AFP) - Indonesian leader Joko Widodo declared a state of emergency Tuesday as coronavirus deaths in the world's fourth most populous country jumped again, but he resisted calls for a nationwide lockdown.   Widodo's administration has been heavily criticised for not imposing lockdowns in major cities, including the capital Jakarta, a vast megalopolis home to about 30 million people where most of the country's virus deaths have been reported.

Indonesia's leader offered few details of the state of emergency beyond calling for stricter social distancing, but announced $1.5 billion in beefed-up social assistance and subsidies for low-income workers.   Tens of millions eke out a living on poorly-paid jobs in Southeast Asia's biggest economy.   "To overcome the impact of COVID-19, we've chosen the option of large-scale social distancing," Widodo told reporters.   "We must learn from the experience in other countries, but we cannot copy them because every country has its own characteristics," he added.

On Tuesday, authorities said 136 people had died after contracting the virus, with 1,528 confirmed cases of infection.   But the latter figure is widely thought to be well below the real number in the archipelago of more than 260 million.  The Indonesian Doctors' Association has warned that the coronavirus crisis is far worse than has been officially reported and that the government's response is "in tatters".

Jakarta's governor has said nearly 300 suspected or confirmed victims of the virus have been wrapped in plastic and quickly buried in the city since the start of March.   The capital's top politician has been pushing for a total lockdown of the city.   Also Tuesday, Indonesia's corrections agency said it is set to offer early release to about 30,000 inmates to help stem the spread of the virus in over-crowded prisons. The number amounts to more than 10 percent of Indonesia's 272,000 inmate population.
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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.
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Mali

Mali - US Consular Information Sheet
December 19, 2008
COUNTRY DESCRIPTION:
Mali is a developing country in western Africa with a stable and democratic government.
The official language is French.
The capital is Bamako.
Faci
ities for tourism are limited.
Read the Department of State Background Notes on Mali for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
All travelers must have international vaccination cards with a current yellow fever immunization.
Travelers should obtain the latest visa information and entry requirements from the Republic of Mali Embassy at 2130 R Street NW, Washington, DC
20008, telephone (202) 332-2249.
Inquiries can be made at the nearest Malian embassy or consulate.
Visit the Embassy of Mali web site at http://www.maliembassy.us/ for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY: The U.S. Embassy in Bamako strongly advises American citizens to avoid traveling to the northern regions of Mali.
U.S. Government employees serving in Mali, including those on temporary duty, are required to have approval from the Chief of Mission prior to traveling to areas north of the Niger River, including Timbuktu and areas or north of Timbuktu.
Travelers should exercise caution when traveling in any isolated areas.

In August 2007, Tuareg dissidents attacked and kidnapped civilian and military convoys near the Mali-Niger border.
On January 3, 2008, four Italians were robbed at gunpoint near Araouane, 150 miles north of Timbuktu, by assailants whose affiliation remains unknown.
Tuareg rebels in the Kidal region attacked Malian military units in Tinzawaten and Boughessa in March 2008, in Abeibara in May 2008, and in Tessalit in July 2008.
On October 16, 2008, bandits in the Kidal region of Mali carjacked two vehicles belonging to the International Committee for the Red Cross.

Al-Qaeda in the Land of the Islamic Maghreb (AQIM) has a presence in northern Mali.
AQIM began as a terrorist group seeking the overthrow of the Algerian government, and has been designated as a terrorist organization by both the United States and the European Union.
On October 31, 2008, in northern Mali, AQIM freed two Austrian tourists kidnapped in Tunisia eight months earlier.
The group has declared its intention to attack Algerian and Western targets.

This recent activity and the porous nature of Mali’s northern borders with Mauritania and Algeria, as well as its eastern border with Niger, reinforce long-standing concerns about security for travel in northern Mali.
The Department of State strongly urges citizens to reconsider traveling to northern Mali, including Timbuktu and Essakane.
Northern Mali hosts several annual music festivals in the desert, including one north of Timbuktu at Essakane, one north of Kidal at Essouk, and another near Menaka.
These are official events sanctioned by the Government of Mali.
Americans planning to attend these festivals or otherwise travel to the northern regions of Mali, despite this caution, are urged to notify the U.S. Embassy about their plans by e-mail at consularbamako@state.gov.
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.
Current information on safety and security can also be obtained by calling 1-888-407-4747 toll-free within the U.S. and Canada, or, for callers outside of the U.S. and Canada, on 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:
Violent crime in Mali is infrequent, but petty crimes, such as pick pocketing and simple theft, are common in urban areas.
Passports and wallets should be closely guarded when in crowded outdoor areas and open-air markets.
Individuals traveling on the Bamako-Dakar railroad are advised to be vigilant for pickpockets, especially at night.
Criminals will not hesitate to use violence if they encounter resistance from their victims.
There are sporadic reports of nighttime robberies occurring on the roads outside of the capital; tourists should not drive outside of Bamako at night.
Travelers should stay alert, remain in groups, and avoid poorly lit areas after dark.

Sporadic banditry and random carjacking have historically plagued Mali's vast desert region and its borders with Mauritania and Niger.
While banditry is not seen as targeting U.S. citizens specifically, such acts of violence cannot be predicted.

On July 1, 2008, six people working as USAID contractors were robbed of their vehicle and all belongings, at gunpoint, by three bandits between the villages of Temera and Bourem, approximately 120 km (75 miles) northeast of Gao along the Niger River.

From May 2008 until July 2008, there were a series of attacks at various Malian government installations.
While most of these have been in eastern Mali, on May 6, bandits attacked a military outpost in Diabali, 175 km (110 miles) north of Segou.
While these actions appear directed exclusively at government security facilities, including military, gendarmerie and national guard bases, bandits have been known to stop cars at gunpoint while making their escape.
Those traveling or living in Mali are strongly encouraged to register with the Embassy to allow e-mail notification should further attacks occur.
Please see the Registration/Embassy Location information at the end of this article.

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 Mali is:
1212
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Mali are limited, especially outside of the capital, Bamako.
Psychiatric care is non-existent.
The U.S. Embassy in Bamako maintains a list of physicians and other healthcare professionals who may see U.S. citizen patients.
The Embassy cannot guarantee these services or specifically recommend any physicians.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to, or foreign residents of, Mali.
Many American medicines are unavailable; French medications are more easily found.
Available medications can be obtained at pharmacies throughout Bamako, and are usually less expensive than those in the U.S.
Travelers should carry with them an adequate supply of needed medication and prescription drugs, along with copies of the prescriptions, including the generic names for the drugs.
Caution should be taken to avoid purchasing potentially dangerous counterfeit medications when buying on the local market in Mali.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Mali is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
U.S. citizens traveling by road in Mali should exercise caution.
Mali has paved roads leading from Bamako to Segou, Mopti and Sikasso.
During the rainy season from mid-June to mid-September, some unpaved roads may be impassable.
On many roads outside of the capital, deep sand and ditches are common.
Four-wheel drive vehicles with spare tires and emergency equipment are recommended.
The Embassy strongly urges all travelers to avoid traveling after dark on roads outside of urban centers.
The roads from Gao to Kidal and Menaka, and the roads around Timbuktu, are desert tracks with long isolated stretches.
Travelers must be prepared to repair their vehicles should they break down or become stuck in the sand.
Travelers should also carry plenty of food and water.
Drivers drive on the right-hand side of the road in Mali.
Speed limits range from 40-60 km per hour (25-40 miles per hour) within towns, to 100 km per hour (60 miles per hour) between cities.
Road conditions often require lower speeds.
Due to safety concerns, the Embassy recommends against the use of motorbikes, van taxis, and public transportation.
Excessive speeds, poorly maintained vehicles, lack of street lighting and roving livestock pose serious road hazards.
Many vehicles are not maintained well and headlights are either extremely dim or not used.
Driving conditions in the capital of Bamako can be particularly dangerous due to limited street lighting, the absence of sidewalks for pedestrians, and the number of motorcycles, mopeds and bicycles.
Please refer to our Road Safety page for more information.
The Malian authority for road safety is the Compagnie Nationale de Circulation Routiere in Bamako at telephone (223) 20-22-38-83.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Mali, the U.S. Federal Aviation Administration (FAA) has not assessed Mali’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Mali is signatory to the Treaty on Cultural Property, which restricts exportation of Malian archeological objects, in particular those from the Niger River Valley.
Visitors seeking to export any such property are required by Malian law to obtain an export authorization from the National Museum in Bamako.
It is advisable to contact the Embassy of Mali in Washington or the nearest Malian consulate for specific information regarding customs requirements.
U.S. Customs and Border Protection may impose corresponding import restrictions in accordance with the Convention on Cultural Property Implementation Act.
Currency exchange facilities are slow and often involve out-of-date rates.
The U.S. Embassy cannot provide exchange facilities for private Americans.
There are a few ATMs in Bamako that accept American credit cards and debit cards with a Visa logo only.
Maximum withdrawals are generally limited to $400, and local banks charge up to $20 per transaction for use of their ATMs.
There are no ATMs outside of Bamako.
Credit cards are accepted only at major hotels, a few travel agencies, and select restaurants.
Cash advances on credit cards are available from only one bank in Mali, the BMCD Bank in Bamako, and the only card they accept for this is Visa.

The U.S. Embassy does not always receive timely notification by Malian authorities of the arrest of Americans.
U.S. citizens are encouraged to carry a copy of their passport with them at all times, so that proof of identity and citizenship are readily available in the event of questioning by local authorities.
If arrested, U.S. citizens should always politely insist they be allowed to contact the U.S. Embassy (see section on Registration/Embassy Location below).
Photographing military subjects is restricted.
One should also obtain explicit permission from the Malian government before photographing transportation facilities and government buildings.
Taking a photograph without permission in any public area may provoke a response from security personnel or offend the people being photographed.
Taking photos of the U.S. Embassy is also prohibited.
International telephone calls are expensive, and collect calls cannot be made from outside of Bamako.
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 that are available to individuals under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Mali’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Mali 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 Mali are encouraged to register with the U.S. Embassy or through the State Department’s travel registration web site so that they can obtain current information on travel and security within Mali.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located in ACI 2000 at Rue 243, Porte 297.
The Embassy's mailing address is B.P. 34, Bamako, Mali.
The telephone number is (223) 20-70-2300.
The consular fax number is (223) 20-70-2340.
The Embassy web page is at http://mali.usembassy.gov
* * *
This replaces the Country Specific Information for Mali dated February 7, 2008, to update the sections on Safety and Security, Crime, Information for Victims of Crime, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Tue, 12 May 2020 19:25:36 +0200 (METDST)

Bamako, May 12, 2020 (AFP) - Three people have been killed in the western Malian city of Kayes, a police official said Tuesday, in unrest that began after an off-duty officer shot a youngster dead.   Protests have been ongoing since late Monday, when a police officer attempted to stop a group of youngsters from riding their motorbikes, and subsequently shot and killed an 18-year-old named Seyba Tamboura.

Mamadou Zoumana Sidibe, the governor of the Kayes region, said Tamboura's friends torched a police station during the night in response.   They then barricaded themselves on a bridge in the city, where they remained on Tuesday.    An official in Kayes police force, who declined to be named, said three people had been killed in total -- including Tamboura -- in circumstances that remain unclear.

Earlier in the day, Security Minister Salif Traore said he had asked police "not to use force" in resolving the situation, as he travelled to city to oversee the operation.   The unrest in Kayes follows a string of anti-government protests in the city concerning both Mali's legislative election and its coronavirus restrictions.    The West African state held a long-delayed parliamentary election in March in which the results for dozens of seats were disputed.

Protesters took to the streets in several cities, including Kayes, when the Supreme Court declared the winners of the contested seats in late April.    City residents had also demonstrated against a night-time curfew meant to stem the spread of coronavirus, which the government lifted on Saturday.    Seydou Diallo, the regional director of Kayes police force, apologised for the killing of Tamboura and said the offending officer had not been on patrol during the incident and was now in custody.   "We cannot tolerate such indiscipline," he said. "This is an unfortunate incident for the police".
Date: Mon, 11 May 2020 00:56:22 +0200 (METDST)

Bamako, May 10, 2020 (AFP) - Three UN troops were killed and four more wounded when their convoy hit a roadside bomb early Sunday, officials said, in the latest violence to hit the war-torn West African state.   UN chief Antonio Guterres condemned the attack and called on the perpetrators to be brought to justice.   Chadian peacekeepers were on a routine patrol in Aguelhok commune in the north of the country, the UN peacekeeping mission in Mali, known as MINUSMA, said in a statement.

Three soldiers were killed and four were seriously wounded in the blast, it added.   "We will have to make every effort to identify and apprehend those responsible for these terrorist acts so that they can be brought to justice," said MINUSMA mission head Mahamat Saleh Annadif.    "I bow before the remains of these brave blue helmets who died in the service of peace in Mali".

UN Secretary-General Guterres also condemned what he described as a "cowardly" attack.   Guterres called on the authorities in Mali to spare no effort to identify those responsible "so that they can be brought to justice swiftly".   The statement from his office also said that attacks targeting United Nations peacekeepers could constitute war crimes under international law.   The UN mission has some 13,000 troops drawn from several nations deployed across the vast semi-arid country.

Mali is struggling to contain an Islamist insurgency that erupted in 2012 and which has claimed thousands of military and civilian lives since.   Despite the presence of thousands of French and UN troops, the conflict has engulfed the centre of the country and spread to neighbouring Burkina Faso and Niger.     Laying roadside bombs is a favoured tactic of jihadists active in the Sahel.    Also known as improvised explosive devices, they kill and maim scores of victims every year in Mali.
Date: Wed, 5 Feb 2020 21:28:44 +0100 (MET)

Bamako, Feb 5, 2020 (AFP) - Seven people have died in an outbreak of Crimean-Congo haemorrhagic fever, also known as Congo fever, in a village in central Mali, an official said.  Yacouba Maiga, the spokesperson for the regional government of the central Mopti region, said that a shepherd "contracted the illness from an ox" in the village of Samoa in late January.   He was treated but the disease surfaced again on February 1 infecting 14 people and killing five, the official said.    Two other patients died while being transported to the town of Sevare, in central Mali, for treatment.     "It's different to coronavirus," said Maiga, referring to the deadly SARS-like virus currently sweeping China. 

Congo fever is a tick-borne viral disease which causes severe haemorrhaging, according to the World Health Organization.   People are often infected after they come into contact with the blood of infected animals, often after slaughtering livestock.   Humans in very close contact with each other, however, can also transmit the disease.   "It's a rare pathology in Mali. There have been cases around 10 years ago," Health Minister Michel Sidibe told AFP.

Health officials were preparing for an "investigative mission in the area with the support of security forces," according to a health ministry report from Monday, which was seen by AFP on Wednesday.    However, an official in Mopti said the fact-finding team had not yet left on Wednesday.    The Mopti region in Mali is hit by regular jihadist attacks, as a conflict between the militant and government and foreign forces is raging in the area.  The violence has its roots in a 2012 rebellion in northern Mali, which has since spread to the centre of the country, and also to neighbouring Burkina Faso and Niger.
Date: Thu 26 Dec 2019
Source: WHO Emergencies preparedness, response [edited]

From 3 Nov through 8 Dec 2019, 3 laboratory-confirmed cases of yellow fever including 2 deaths (case fatality rate = 67%) were detected through the national surveillance system in Mali. The 1st case-patient was a 15-year-old girl from a village in Kati district, Koulikoro region, Mali. The 2nd and 3rd cases were in 17- and 25-year-old men, nationals from Cote d'Ivoire, living in the district of Bouguimi, Sikasso region, Mali. All 3 cases tested positive for yellow fever by immunoglobulin M (IgM) and reverse-transcriptase polymerase chain reaction (RT-PCR) on 3 Dec 2019 at Institute Pasteur Dakar (IPD). The 1st case was not vaccinated against yellow fever and had no travel history outside of Kati district. Meanwhile, the vaccination status for the other 2 cases was unknown.

Additionally, there were 9 suspected and 3 probable cases reported from the Bouguimi district, including 3 deaths among the probable cases. The age of the suspected, probable, and confirmed cases ranges between 1 and 33 years, and the male-to-female ratio is 2:1. Among the reported symptoms, fever, jaundice, and vomiting were the most common. There are 8 health areas of Bouguimi health district that have been affected, with Manakoro (4 cases) and Mafele (3 cases) reporting the highest number. One suspected case is pending for confirmation at the Institute Pasteur Dakar laboratory.

On 5 Dec 2019, the government of Mali officially declared a yellow fever outbreak in 2 regions of Sikasso and Koulikoro.

Public health response
- An emergency operations centre (EOC) for public health coordination of the outbreak in the regions of Sikasso, Koulikoro, and the affected districts has been set up. In addition, an EOC has been activated in
Bamako city.
- A multidisciplinary rapid response team was deployed to conduct investigations in the affected districts of Sikasso and Koulikoro regions. A plan to conduct an in-depth entomological survey is underway.
- Enhanced epidemiological surveillance, including active case finding in both the affected districts, has been strengthened.
- A comprehensive response plan is being developed with specific objectives, including the preparation for an international-coordination-group (ICG) request to conduct a yellow fever reactive mass-vaccination campaign.
- Risk communication capacity through involvement of relevant stakeholders [is being provided], as well as public communication and awareness efforts on yellow fever (signs, symptoms, and vaccinations), including prevention measures.
- On 3 Dec 2019, a joint investigation team (WHO Country Office and Ministry of Health) was deployed to characterize the risk and develop an intervention plan. Field investigations indicate vaccination coverage under 80% in Kati and 88% in Manakoro districts.

WHO risk assessment
Although population immunity in the southern regions of Mali has benefited from large-scale preventive mass vaccination campaigns in 2008 (5.8 million people protected) combined with nationwide children routine immunization since 2002, the overall national routine immunization coverage for yellow fever in 2018 was estimated to be 67%, with estimates nearly 80% in the non-desert areas (including the recently affected Koulikoro and Sissako regions). This is below herd immunity thresholds and may indicate the presence of pockets of low immunity in the country. Kati district in Koulikoro region is located proximal to the capital city, Bamako, an urban city with more than 2 million inhabitants, and Bouguimi district in Sikasso region borders with Cote d'Ivoire.

The high population movements within Mali and across borders increases the risk of national and regional spread, and this may have diluted the population immunity. The geographical distribution of the virus, coupled with suboptimal vaccination coverage, and the presence of susceptible populations presents a risk of amplification. Furthermore, the protracted humanitarian crisis and concomitant ongoing outbreaks of epidemic-prone diseases (measles, dengue) may impact the response due to competing limited resources.

Based on available information, WHO assesses the overall risk as high at the national level, moderate at the regional level, and low at the global level.

WHO advice
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes and has the potential to spread rapidly and cause serious public health impact. There is no specific treatment, although the disease is preventable using a single dose of yellow fever vaccine, which provides immunity for life. Supportive care to treat dehydration, respiratory failure, and fever, and antibiotic treatment for associated bacterial infections, is recommended.

Mali is a high-priority country for the Eliminate Yellow Fever Epidemic (EYE) strategy. Vaccination is the primary intervention for prevention and control of yellow fever. In urban centres, targeted vector control measures are also helpful to interrupt transmission. WHO and partners will continue to support local authorities to implement interventions necessary to control the current outbreak.

WHO recommends vaccination against yellow fever for all international travellers more than 9 months of age going to areas south of the Sahara Desert in Mali. The vaccine is contraindicated in children aged less than 6 months and is not recommended for those aged 6-8 months, except during epidemics when the risk of infection with yellow fever virus may be very high. Other contraindications for yellow fever vaccination are severe hypersensitivity to egg and severe immunodeficiency. Caution is recommended before vaccinating people aged above 60 years against yellow fever.

WHO does not recommend vaccination for travellers whose itineraries are limited to areas within the Sahara Desert. Vaccination is recommended, if indicated, for pregnant or breastfeeding women travelling to endemic areas when such travel cannot be avoided or postponed. Mali requires as a condition of entry a yellow fever vaccination certificate for all travellers aged one year or over.

Yellow fever vaccines recommended by WHO are safe and highly effective and provide life-long protection against infection. In accordance with the IHR (2005) 3rd edition, the validity of the international certificate of vaccination against yellow fever extends to the life of the person vaccinated with a WHO-approved vaccine. For both existing or new certificates, revaccination or a booster dose of yellow fever vaccine cannot be required of international travellers as a condition of entry into a state party, regardless of the date their international certificate of vaccination was initially issued.

On 1 Jul 2019, WHO updated the areas at risk of yellow fever transmission and the corresponding recommendations for vaccination of international travelers. The list of countries at risk and revised recommendations for vaccination against yellow fever are available on the WHO website (International travel and health (ITH),  <https://www.who.int/ith/en/>).

WHO encourage its member states to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination. Travellers should also be made aware of yellow fever signs and symptoms and instructed to seek rapid medical advice should they develop signs of illness. Travellers returning to Mali who may be infected with possible high levels of the virus in the blood may pose a risk for the establishment of local cycles of yellow fever transmission in areas where the competent vector is present.

WHO does not recommend any restrictions on travel or trade to Mali on the basis of the information available on this outbreak.
=======================
[This updated report includes information about 9 suspected and 3 probable yellow fever (YF) cases that were not mentioned in previous reports, indicating that the outbreak was more extensive than originally stated, with an outbreak declared by government authorities in the 2 regions. These additional cases may have been a result of the additional surveillance that has been undertaken. Since vaccination coverage has been found to be less than 80% and 88% in Kati and Manakoro districts, respectively, presumably the preventive measures mentioned will include vaccination. The entomological survey will be an important factor in risk assessment. The presence of abundant populations of the mosquito vector, _Aedes aegypti_, would be of concern, raising the possibility of urban transmission of YF virus that might get out of hand quickly. - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
Date: Sun 8 Dec 2019
Source: WHO Weekly Bulletin on Outbreaks and Other Emergencies [edited]

On 3 Dec 2019, WHO was informed through internal communication of 3 yellow fever cases in Mali, including one death. Of these, 2 of the cases are from Wogouna and Keregoura villages, Bougoni district, Sikasso region in the South of Mali and one from Nanakenieba village, Kati district, Koulikoro region in the south west of Mali.

The reported cases are young adults (15-25 years), one female and 2 males, with onset of symptoms in early November 2019.

The cases tested yellow fever IgM and PCR positive at Institute Pasteur Dakar on 3 Dec 2019.

The vaccination status of the cases is being investigated (2 of the cases reported vaccination in the past). The latest vaccination campaign in the country was performed in 2008 including the affected areas where the vaccination coverage was reported to be between 50 and 9% in 2008. The average national vaccination coverage for 2017 has been reported at 65% (data from Imperial College). The YF routine vaccination in the country was introduced in 2002.

A field investigation is ongoing. According to historical data, 10 cases were detected in Mali in 2015.
======================
[This report provides some additional details in that 2 patients were male and one female along with their vaccination status, which were not included in the original post (see Yellow fever - Africa (25): Mali (BA, SK), Cote d'Ivoire http://promedmail.org/post/20191207.6827680). As in the original report, no mention is made of plans to vaccinate in the localities where the cases became infected. Vaccination in those areas is an effective preventive measure especially since, as the report notes, the mosquito vector, _Aedes aegypti_, is abundant enough to transmit dengue viruses. Yellow fever can spread rapidly and quickly get out of hand in susceptible populations with abundant mosquito vectors, as it did in Angola in 2016. - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
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Brazil

General

 Brazil is the largest country in South America and extends from the Atlantic Ocean to the Caribbean to the depths of the Amazon basin. The climate varies throughout the country but generally it experiences a humid

tropical climate.

Safety & Security

The level of crime in many of the main urban centres is certainly rising and tourists need to be aware of the risks involved in travelling particularly in the evening hours. It is wise to use an official taxi for any journeys after dark. It is sensible not to flaunt any personal wealth and to use the hotel safety boxes for any valuables and your travel documents. The amount of crime against tourists tends to be greater in areas surrounding hotels, discotheques, bars, nightclubs and other similar establishments that cater to visitors, especially at dusk and during the evening hours. There are frequent reports of theft on city buses and such transportation should be avoided. A number of the main cities have established specialised tourist police units to patrol areas frequented by tourists. Rio de Janeiro, Sao Paulo and Brasilia all continue to experience a high incidence of crime.

Road Safety

Throughout this huge country the state of the roads varies greatly. In many regions the roads are dirt tracks and assistance would be hard to obtain for those travelling off from the main tourists routes. Bag snatching from traffic lights occurs in the main cities. If considering hiring a car make certain that your travel insurance is sufficient.

Jet Lag

After your flight you will experience a degree of jet lag. Travelling from Europe this will be less than when you travel home but nevertheless it will still cause your body to complain for 24 to 48 hours. Try to have a more relaxing time for the first few days (and also after returning home if possible!). Be careful not to fall asleep by the pool and then awaken with sunburn which could ruin your time abroad.

Medical Facilities

In any country of this size the level of medical care will vary greatly. This is particular true out side the main tourist resorts. English speaking doctors should be available but the level of hospital care can be worrisome. Make certain you carry sufficient supplies of any medication you may require for your entire holiday. Essential drugs (asthma, diabetes, epilepsy etc) should be divided for security.

Sun Exposure and Dehydration

The hot humid tropical climate often leads to quite significant problems for the Irish traveller. Make sure you cover your head when out in the sunlight and drink plenty of fluids to replenish that lost through perspiration. Replace the salt you loose by eating crisps etc orby putting salt on your meal (providing there is no contraindication).

Visiting the Iguassu Falls

These huge waterfalls border Argentina, Brazil and Paraguay. There is only minimal risk of malaria and so malaria prophylaxis is not generally recommended. Also, Yellow fever is not transmitted in this area but mosquitoes can abound. Sensible insect bite precautions should be followed at all times.

Food & Water

Many tourists who visit Brazil stay in the main resorts along the southern coast. The food and water preparation in the hotels is normally excellent but eating food from street vendors is generally unwise. Shell fish (bivalve oysters, mussels, clams etc) are unwise even in a five star hotel. Check the water from the cold water tap in your room. If you can’t easily smell chlorine (swimming pool style) don’t use it even for brushing your teeth. If travelling around the country (Caribbean coast or into the Amazon regions) take significantly more care.

Rabies 

This viral disease occurs throughout Brazil and it is usually transmitted through the bite from an infected warm-blooded animal (eg dogs, cats & monkeys). Any contact should be avoided but if it occurs treat it very seriously and seek competent medical attention immediately after you wash out the area and apply an antiseptic.

Malaria

The risk of malaria is significant all year throughout the Amazon regions. There is insignificant risk for those staying along the coast up as far as Fortaleza and for those remaining in this region prophylaxis is not usually recommended. The risk in the region of Brasilia is also thought to be minimal though this is an area which has unusually experience an outbreak of Yellow Fever recently, and so the situation will require review.

Mosquito Borne Diseases  Apart from malaria the other two main diseases transmitted by mosquitoes which cause problems in Brazil are Dengue Fever (mainly along Caribbean Coast but has been reported much further south) and Yellow Fever (mainly in the Amazon Basin but thought to be spreading to other regions). Avoidance techniques are important at all times throughout the day. Swimming **************************************** Most of the main tourist swimming pools will be well maintained and the smell of chlorine will be evident. If sea swimming is on your agenda make sure you go where there are plenty of others and never swim alone. Look for warning signs and pay attention to local advice. Be very careful of local currents which can be dangerous. Vaccinations **************************************** The Brazilian Embassy is advising all travellers to Brazil to have vaccination cover against Yellow Fever. Also for your personal protection it is wise to consider some further vaccines. Generally we would recommend the following vaccination cover; * Yellow Fever (mosquito borne) * Tetanus (childhood booster) * Typhoid (food & water borne) * Hepatitis A (food & water borne) For those travelling more extensively or staying in the country for longer periods we would usually suggest that further vaccines are considered including Hepatitis B, Meningitis and Rabies. Summary **************************************** Many travellers to Brazil will remain perfectly healthy and well providing they follow some sensible precautions. Further information is available from either of our centres regarding any recent disease outbreaks.

Travel News Headlines WORLD NEWS

Date: Mon, 6 Apr 2020 22:58:13 +0200 (METDST)

Sao Paulo, April 6, 2020 (AFP) - The epicentre of the coronavirus outbreak in Latin America, Brazil's Sao Paulo state, said Monday it expects 111,000 deaths in the next six months, and extended its stay-at-home measures another two weeks.   The forecast -- an official projection, the state government said -- would appear to put Brazil on track to become one of the worst-hit countries in the world.   The global death toll from the virus currently stands at 70,000, according to a tally compiled by AFP.

Sao Paulo, the teeming industrial hub where the new coronavirus first appeared in Latin America, has confirmed 4,620 cases and 275 deaths so far.   Governor Joao Doria, who closed non-essential businesses on March 24 and advised people to stay home, said containment measures would be needed for at least two more weeks or the situation would get far worse.   "If we continue seeing people in the streets and gathering unnecessarily, we will go to more restrictive measures," he told a news conference.   Police are already authorized to break up crowds by force if necessary, he said.

Without containment measures, Sao Paulo -- whose capital is the mega-city of the same name -- would register 270,000 deaths in the next six months, said the head of the state's public health research institute, Dimas Covas.   Brazil has been the Latin American country hit hardest by the new coronavirus, with 553 deaths and more than 12,000 confirmed cases so far.   Health experts warn under-testing means the real number is likely much higher.

Sao Paulo, a state whose population of 46 million makes it about the size as Spain, has seen more infections and deaths than any other.   The state is probably facing another 1,300 deaths this week, Covas said.   The governor has openly clashed over containment measures with far-right President Jair Bolsonaro, who claims they are needlessly wrecking the economy over a disease he has compared to a "little flu."
Date: Thu 26 Mar 2020
Source: Mongabay.com [edited]

In April 2018, workers with the Associacao Mico-Leao-Dourado, a Brazilian non-governmental organisation [NGO] dedicated to the protection of the golden lion tamarin, found one of the endangered primates, apparently sick and unable to climb trees, lying on the forest floor in Aldeia, some 80 km (50 mi) north east of Rio de Janeiro city. The following day, field staff searched for the animal but could not find it within the sprawling tropical forest. But later that month, the dead bodies of 2 others were discovered in nearby forest in Cambucaes and Imbau.

The stricken animals immediately set off alarm bells in Brazil's conservation community. By 17 May 2018, their worst fears were realized, as the 1st confirmed death of a golden lion tamarin due to yellow fever was announced by the Brazilian Ministry of Health and Ministry of the Environment.  "Until this report we didn't know if the [animals] were susceptible to the disease, even after 4 decades of working with the tamarins, but we now understand that they are even more susceptible to it than humans," explains Dr Carlos Ruiz, president of the Associacao Mico-Leao-Dourado (the Golden Lion Tamarin Association).

Known for their distinctive, lion-like manes and gold-orange pelage, the golden lion tamarin, or _Leontopithecus rosalia_, is a primate endemic to the Atlantic Forest biome that once stretched uninterrupted for hundreds of miles along Brazil's eastern coast, but which has since been reduced to only patches. By the 1980s, _L. rosalia_ was critically endangered due to habitat loss and extremely high levels of poaching.

By then, the population was down to just a few hundred individuals in isolated forest fragments scattered around the Sao Joao river basin in Rio de Janeiro state. However, a hugely successful campaign of intensively focused conservation action, including the introduction of zoo-born tamarins to wild populations, raised that number to 3700 by 2014.

Then came the outbreak of yellow fever, in late 2017-2018, Brazil's largest human epidemic since mass vaccinations began in the 1940s. The mosquito borne disease, normally found in remote reaches of the Amazon, spread to the populous southern states of Minas Gerais, Rio de Janeiro and Sao Paulo, killing hundreds of people and infecting thousands more.

Scientists, alerted by the 1st yellow fever casualties in 2018 among the golden lion tamarin, were astonished to see the species decline by 32% due to the disease, a terrible setback for an animal already classified as Endangered by the International Union for Conservation and Nature (IUCN).

Compounding the crisis was a misinformed reaction to the yellow fever outbreak by local people who made a spurt of attacks on all monkeys, apparently based on the false belief that tamarins, rather than mosquitoes, were capable of directly transmitting the disease to humans. Some primates were illegally killed by poisoning and others shot dead with rifles.

More bad news: Research published by Strier and colleagues in 2018 found that muriqui (woolly spider monkey) numbers also suffered "catastrophic" declines in the Atlantic Forest's Reserva Particular do Patrimonio Natural due to yellow fever, declining 10% and 26% for 2 separate populations.

"The impact of yellow fever has been absolutely devastating" on these primates, especially the tamarins, says Dr Ruiz. "It could set us back 30 years of conservation efforts." He does report some good news: Charity service volunteers are now continuously monitoring the surviving tamarin populations, aiding local health officials to ensure near 100% vaccination of people in stricken areas, and the regular exchange of information with government bodies to help prevent further significant outbreaks.

Yellow fever is believed to have originated in Africa and spread to Brazil as a result of the transatlantic slave trade. The disease first appeared in Recife, north east Brazil, in 1685, according to historical records. However, yellow fever is not endemic to the majority of the country, and therefore most monkeys have not developed resistance [or tolerance] to it, leaving them particularly vulnerable, according to the Brazilian Society of Primatology.

How, or whether, tamarin populations will bounce back after such significant losses remains unknown. "The biggest problem is how these species then recover from crashes," says Karen Strier, an anthropologist at the University of Wisconsin who has studied Atlantic Forest monkeys since the 1980s. "Either they must reproduce within the surviving group...or they must look to recruit from other populations. But the more fragmented the landscape, the more difficult [recruiting] is." The trouble with reproducing within just one group is that "if the population is small that may not work, and it also produces low genetic diversity."

Ominously, primate experts now fear that yellow fever outbreaks could become a regular occurrence in the Atlantic Forest biome, and that disease could be a looming new threat to the golden lion tamarin, even as illegal trafficking remains a serious concern. "From time to time, [yellow fever] reemerges...and may affect regions beyond the Amazon, if it has viability of transmission," says a spokesperson for the Brazilian Society of Primatology. "But it could become an endemic disease also of the Atlantic Forest."

A combination of climate change and deforestation in areas that serve as buffer zones between tropical forest and urban areas has allowed yellow fever to spread, the society representative added. Logging and charcoal production, agriculture and urbanization have devastated the tamarin's habitat, reducing it to only 2% of its original area in the Atlantic Forest, home to 22 of Brazil's 77 primate species.

Hope is now focused on a newly developed vaccine for non-human primates that could immunize species like the golden lion tamarin and perhaps save them from disease and help them evade extinction. Marcos Freire, a researcher at the Oswaldo Cruz Foundation in Rio de Janeiro, who previously worked on a team producing a human yellow fever vaccine, has been seeking an alternative for primates since 2017, and thinks he now has one that could work. "We would like to vaccinate some of these animals and then transport them back to areas where there have been mortalities," he says. "But nobody has ever vaccinated a species of monkey before and so there are a lot of challenges." Freire says that he is currently applying to the nation's Ministry of Health and Ministry of Agriculture for permission to capture and immunize wild populations of tamarins. "In Brazil, there have not yet been any licenses to administer vaccines for non-human primates," he says. "Dogs, cats and cows, yes -- but not primates."

The vaccine, which he initially hopes to use on 500 primates, is based on a dilution of the yellow fever vaccine administered to humans and uses a similar process and formula. "We applied different quantities of dosage to species in our primate center in Rio de Janeiro, and the results have been effective," he reveals. But practical challenges remain: How, for example, "would you test it on animals that are critically endangered?" asks Strier, who supports the vaccine's development. "And how do you administer it to animals in the wild in a cost-effective way? And what about the fact that there are humans that still haven't been vaccinated?"

Even if these hurdles are overcome, vaccination won't entirely eliminate the disease because some female mosquitoes pass the virus directly to their eggs. Meanwhile, other solutions offer promise, such as neutralizing mosquitoes by means of genetic modification, as explored in the case of the Zika virus, or using mathematical models to anticipate the arrival of the virus in various locales in order to immediately combat it.

The vaccine, should it prove efficacious, could offer important relief to these endangered primates, even as other human disruptions put heightened pressure on ecosystems in south eastern Brazil. No matter what the results, ongoing vaccine research will offer "a good opportunity to learn what happens," concludes Freire. "Do the [tamarins] survive because they are immune, or not infected? Any kind of [observed] result will be important. Because if every year we get another episode [of yellow fever and lack an effective response], then we'll have to go back to captive reproduction."  [byline: Peter Yeung]
====================
[The current expansion of yellow fever in South America raises concern for public health and also about potential conservation problems for susceptible non-human primate species in the continent. The virus is endemic in much of central and northern South America and makes sporadic incursions to southern areas of the continent, like the states of Santa Catarina, Parana and Rio Grande do Sul in Brazil, Misiones in Argentina, or Paraguay.

The yellow fever virus was introduced into the Americas approximately 400 years ago, yet the complex interactions that were established after its introduction are far from being elucidated. There is need for more research on the eco-epidemiology of the disease in the continent, specifically on the role of each non-human primate species, and especially in the presence of the persistent anthropogenic global environmental change.
Developing a vaccine to be used in golden lion tamarins can be a powerful tool, but there are some issues that need to be considered. First, applying the vaccine to 500 wild tamarins may be risky, as it involves capturing and restraining wild animals, so this should be fine-tuned to minimize the probability of seriously injuring the tamarins in the process. Using an effective vaccine in 500 individuals would preserve those individuals during an outbreak, but yellow fever is not a transient problem for South American non-human primates of the Atlantic rainforest, so in parallel non-vaccinated tamarins should be monitored to evaluate the evolution of resistance or tolerance, or otherwise they will be dependent on vaccination in aeternum.

For a picture of a golden lion tamarin, go to

[HealthMap/ProMED-mail map of Brazil:
Date: Thu, 19 Mar 2020 17:36:17 +0100 (MET)

Brasília, March 19, 2020 (AFP) - Brazil on Thursday announced it was closing its land borders for 15 days to nearly all its neighbours to prevent the spread of the coronavirus.   A ministerial decree said it was blocking entry "by road or land" from all neighbouring countries with the exception of Uruguay to the south.   It shut its border with Venezuela on Tuesday.
Date: Tue, 3 Mar 2020 22:38:28 +0100 (MET)

Sao Paulo, March 3, 2020 (AFP) - At least 21 people have been killed in torrential rain that hit the Brazilian states of Sao Paulo and Rio de Janeiro, triggering flash floods and destroying homes, authorities said Tuesday.   Another 32 people are missing in Sao Paulo, raising fears the toll could rise further.   Violent storms in recent days have dumped a month's worth of rain on some areas in a matter of hours, devastating the southern coast of Sao Paulo state and poor neighborhoods on the outskirts of Rio de Janeiro, the country's second most populous city.

At least 16 people were killed early Tuesday in Sao Paulo state after floods and landslides hit the coastal cities of Santos, Sao Vicente and Guaruja, authorities said.   One of the victims was a rescue worker who was killed by a landslide.   "I express my solidarity with those who are suffering from these heavy rains," Sao Paulo Governor Joao Doria wrote on Twitter.   Several highways were blocked by fallen trees and landslides, including some linking Santos, the biggest port in South America, to Sao Paulo, Brazil's largest city and economic capital.

In Rio de Janeiro, authorities said the death toll had risen to at least five after three days of violent rain that destroyed houses, swept away cars, and left some communities covered in water or mud.   The victims were electrocuted, buried in landslides or drowned, emergency officials said.   The disaster turned political in Rio when the city's Mayor Marcelo Crivella, a far-right evangelical Christian bishop, blamed residents for the flooding.   During a visit to an affected community, he complained to journalists that "people can't be throwing trash on hillsides, in storm drains and in the street."

In the middle of the press conference someone pelted Crivella in the face with a mud ball -- which was captured in a video that went viral online.   "The water knocked my granddaughter and I and off the sofa. Dirty water came flooding into my kitchen, bathroom, bedrooms, everything. I lost everything," Ivone Cardoso, 65, a resident of Rio's Realengo neighbourhood, told AFP as she swept mud and water out of her house.   Brazil is having an especially intense rainy season this summer.   In January, more than 50 people were killed in Minas Gerais state, which neighbors Sao Paulo, in several days of violent rain.
Date: Thu 20 Feb 2020
Source: G1 [in Portuguese, trans. ProMED Mod.TY, edited]

The Office of Epidemiological Surveillance (DIVE-SC) confirmed another human yellow fever case this year [2020] in the state. The patient, a resident of Pomerode in the Vale do Itajai, is 45 years old and has not been vaccinated. As of this Thursday (20 [Feb 2020]) he was interned in the intensive care unit of the Nereu Ramos Hospital in Florianopolis. He was in stable condition as of this afternoon. He was sent to the [state] capital the same day since the Nereu Ramos Hospital is the reference facility for infectious diseases.

The other confirmed human yellow fever cases are in Blumenau, also in Vale do Itajai, and 2 other cases are in the north of the state, in Jaragua do Sul and Sao Bento do Sul. In 2019, there were 2 cases, and both died.

Vaccination
Everyone from 9 months of age and above needs to receive a dose of the vaccine that protects for life against the disease. A dose of the vaccine is free of charge and is available in health units in the entire state.

Yellow fever
Yellow fever is a disease caused by a virus that can lead to death in a week if not treated rapidly. It is transmitted by the bite of mosquitoes. In the forest, the vectors are insects of the _Haemagogus_ and _Sabethe_ genera. In the city it is _Aedes aegypti_.

The symptoms of the disease are
- initially, a rapid rise in fever
- chills and fever
- intense headache
- back and body pain
- nausea and vomiting
- weakness and fatigue
- abdominal pain
- yellow skin

Monkeys
In addition to humans, monkeys in the state also have yellow fever. There were 2 cases in Blumenau, another 2 in Pomerode, and one each in the following municipalities: Timbo, Gaspar and Indaial in the Vale do Itajai, and Jaragua do Sul, according to the most recent DIVE-SC bulletin issued on Monday [17 Feb 2020]. All were found dead.

Monkeys do not transmit the disease [directly] to people but are indicators that yellow fever virus is circulating in the region.
=====================
[In 2019, 2 cases of yellow fever [YF] were the 1st since almost one year ago. There were several yellow fever epizootics confirmed in non-human primates in 2020. In other words, it is more than predictable that, without effective and timely preventive actions, cases of yellow fever in humans would reoccur: no surprise. As we have mentioned numerous times, for yellow fever, in the current epidemiological scenario of sylvan transmission, as (or more) important as prioritizing goals of high rates of vaccination coverage in the general population in the short term is vaccinating the right people in the right places at the right time, that is, susceptible individuals residing or visiting the areas at greatest risk. Not infrequently, this is only feasible with differentiated strategies, including active searches. The question: Have the 4 confirmed cases so far not been vaccinated due to refusal, misinformation, or difficult access? - ProMED Mod.RNA]

[The human cases this year (2020) are due to YF virus spill-over from the sylvan (forest) transmission cycle. The dead monkeys indicate that the virus has been circulating in the state for over a year. It is important that the human population YF vaccination coverage reach the 95% goal set by the Ministry of Health. Vaccination is the only way to avoid these sylvan cases, since elimination of the forest YF virus transmission cycle is not feasible. Without prevention of these human sylvan cases, there is the risk that YF virus could be introduced by them into the urban cycle of virus transmitted by _Aedes aegypti_ and spread quickly. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Santa Catarina, Brazil: <http://healthmap.org/promed/p/2975>]
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World Travel News Headlines

Date: Tue, 26 May 2020 09:15:57 +0200 (METDST)

Riyadh, May 26, 2020 (AFP) - Saudi Arabia will end its nationwide coronavirus curfew from June 21, except in the holy city of Mecca, the interior ministry said Tuesday, after more than two months of stringent curbs.   Prayers will also be allowed to resume in all mosques outside Mecca from May 31, the ministry said in a series of measures announced on the official Saudi Press Agency.   The kingdom, which has reported the highest number of virus cases in the Gulf, imposed a full nationwide curfew during Eid al-Fitr, the Muslim holiday that marks the end of the fasting month of Ramadan.

The ministry said it will begin easing restrictions in a phased manner this week, with the curfew relaxed between 6 am and 3 pm between Thursday and Saturday.   From Sunday until June 20, the curfew will be further eased until 8 pm, the ministry added.   The kingdom will lift the lockdown entirely from June 21.   "Starting from Thursday, the kingdom will enter a new phase (in dealing with the pandemic) and will gradually return to normal based on the rules of social distancing," Health Minister Tawfiq Al-Rabiah said on Monday.   Saudi Arabia has reported around 75,000 coronavirus infections and some 400 deaths from COVID-19.

In March, Saudi Arabia suspended the year-round "umrah" pilgrimage over fears of the disease spreading in Islam's holiest cities.   That suspension will remain in place, the interior ministry said.   Authorities are yet to announce whether they will proceed with this year's hajj -- scheduled for late July -- but they have urged Muslims to temporarily defer preparations for the annual pilgrimage.   Last year, some 2.5 million faithful travelled to Saudi Arabia from around the world to participate in the hajj, which Muslims are obliged to perform at least once during their lifetime.
Date: Tue, 26 May 2020 05:52:24 +0200 (METDST)

Santiago, May 26, 2020 (AFP) - Chile registered a new high for coronavirus cases on Monday, with nearly 5,000 infections in 24 hours, including two ministers in President Sebastian Pinera's government.   Health authorities announced 4,895 new infections in the South American country and 43 deaths.

Public Works Minister Alfredo Moreno and Energy Minister Juan Carlos Jobet said they were among those with the disease.   "I have been informed that the COVID-19 test I had a few days ago was positive," Moreno said on Twitter, adding that he had no symptoms so far.   The 63-year-old minister had placed himself in quarantine after one of his staff tested positive.  Jobet also tested positive after starting to quarantine preventatively on Saturday, "when he experienced mild symptoms, which could be associated with the disease," a statement from the Energy Ministry said.

The 44-year-old minister "has had no direct contact with President Sebastian Pinera or other cabinet members in recent days," the statement said, without specifying how he became infected.   Three other ministers, who had self-quarantined after being in contact with infected people, all tested negative and resumed work.

Chile suffered a surge in infections last week, prompting the government to order the lockdown of Santiago.   The capital is the main focus of the pandemic in Chile, with 90 percent of the country's 74,000 cases.   Last week, the Senate was closed after three senators tested positive for the coronavirus. Sessions were held by video conference.
Date: Tue, 26 May 2020 01:15:01 +0200 (METDST)

Quito, May 25, 2020 (AFP) - Demonstrators defied coronavirus restrictions to march in cities across Ecuador on Monday in protest against President Lenin Moreno's drastic economic measures to tackle the crisis.   Moreno last week announced public spending cuts including the closure of state companies and embassies around the world, but trade unions Monday said workers were paying a disproportionate price compared to Ecuador's elite.   "This protest is because the government is firing workers to avoid making the rich pay," Mecias Tatamuez, head of the county's largest union, the Unitary Front of Workers (FUT), told reporters at a march in Quito.

Around 2,000 people marched in the capital, waving flags and banners and shouting anti-government slogans.   The protesters wore masks and respected distancing measures recommended against the spread of the coronavirus that has caused at least 3,200 deaths in the country, making it South America's worst hit nation per capita. Authorities say more than 2,000 further deaths are likely linked to the virus.

Demonstrations took place in several other cities, including Guayaquil, the epicentre of Ecuador's health crisis, where union leaders said hundreds marched through the city.   Moreno ordered the closure of Ecuadoran embassies, a reduction in diplomatic staff and scrapped seven state companies as part of measures designed to save some $4 billion.    He also announced the liquidation of the TAME airline, which has lost more than $400 million over the last five years.

The government says the pandemic has so far cost the economy at least $8 billion.   Public sector working hours have been cut by 25 percent, with an accompanying 16 percent pay cut.   Moreno said on Sunday that 150,000 people had lost their jobs because of the coronavirus.   Ecuador was struggling economically before the pandemic hit, due to high debt and its dependence on oil.   The IMF predicts that the economy will shrink by 6.3 percent this year, the sharpest drop of any country in South America.
Date: Mon, 25 May 2020 22:20:46 +0200 (METDST)

Dublin, May 25, 2020 (AFP) - Ireland recorded no new deaths from the coronavirus on Monday for the first time since March 21.   Prime Minister Leo Varadkar called it a "significant milestone", adding on Twitter: "This is a day of hope. We will prevail."

The announcement came one week after Ireland, which has suffered 1,606 deaths from 24,698 infections, began to ease lockdown measures that had been in place for nearly two months.   Ireland entered lockdown in late March, recording a peak of 77 deaths on a single day on April 20.   "In the last 24 hours we didn't have any deaths notified to us," chief medical officer Tony Holohan said at a daily press briefing.   He warned that the zero figure could be a result of a lag in reporting of deaths over the weekend, but he added: "It's part of the continued trend that we've seen in (the) reduction in the total number of deaths."

Ireland has announced a five-step plan to reopen the nation by August and took the first steps last Monday -- allowing outdoor employees to return to work, some shops to reopen and the resumption of  activities such as golf and tennis.   While the news of no fresh deaths was greeted as progress, officials remain concerned there will be a "second wave" as the lockdown is loosened.   "The number of new cases and reported deaths over the past week indicates that we have suppressed COVID-19 as a country," Holohan added in a statement.   "It will take another week to see any effect on disease incidence that might arise from the easing of measures."
Date: Mon, 25 May 2020 21:59:40 +0200 (METDST)

Luxembourg, May 25, 2020 (AFP) - Luxembourg will ease its coronavirus restrictions on Wednesday, reopening cafes and restaurants and allowing civil and religious ceremonies under strict conditions, the government announced.   The tiny country has so far registered only 3,993 COVID-19 cases, of which 110 have been fatal. Four people are in intensive care and shops were closed on March 18 to slow the spread of the new coronavirus.

Prime Minister Xavier Bettel told a news conference on Monday that eateries could reopen terraces with a maximum of four people at a single table.   Indoor dining in cafes and restaurants will resume on Friday, he said, with social distancing of 1.5 metres (five feet) between groups.   Marriages and funerals will also be allowed if the attendees wore face masks and kept two metres distance from each other.   Bettel however said cafes and restaurants would have to close at midnight.

Francois Koepp, the general secretary of the Horeca federation grouping hotels, restaurants and cafes, welcomed the announcement, saying the sector had "greatly suffered from the confinement".   He said it provided employment to some 21,000 people in this nation of 620,000 inhabitants.   Cinema theatres and gyms will open at the end of the week but children's parks will remain closed.   The government has pledged to give every citizen over 16 a voucher worth 50 euros ( $54) to spend in hotels to provide a boost to the sector.   The vouchers will also be given to some 200,000 cross border workers from Belgium, France and Germany.
Date: Mon, 25 May 2020 20:36:16 +0200 (METDST)

Prague, May 25, 2020 (AFP) - The Czech Republic and Slovakia will reopen their border this week for those travelling to the other country for up to 48 hours, Czech Prime Minister Andrej Babis said Monday.   "This will be possible without tests or quarantine" starting Wednesday, he added in a message posted on Twitter.   The Czech Republic and Slovakia formed a single country until 1993. Babis himself was born in the Slovak capital of Bratislava.

Both countries have fared well in the current pandemic, with Slovakia posting the lowest death toll per capita in the EU and the Czech Republic keeping its COVID-19 figures down as well.   The Czech government will also open border crossings with Austria and Germany on Tuesday but will still require negative COVID-19 tests from those entering the country.   "We have negotiated similar conditions on the other side of the border with our German and Austrian colleagues," Interior Minister Jan Hamacek said.   The interior ministry said blanket border checks would be replaced by random ones and added it would still not allow tourists into the country.

Czech Health Minister Adam Vojtech said the government was working on other measures to ease the travel restrictions adopted in mid-March.   "We would like to introduce them next week," he added.   Vojtech said EU citizens could now come to the Czech Republic "on business or to visit their family for a maximum of 72 hours if they submit a negative coronavirus test."

The country is also accessible to non-EU citizens who do seasonal jobs there, on condition they have tested negative.   Czech restaurants, bars, hotels, castles, zoos and swimming pools have been open since Monday, when the government lifted many anti-virus measures.   Czechs also no longer have to wear face masks outside their homes, except in shops and on public transport.
Date: Mon, 25 May 2020 17:45:38 +0200 (METDST)
By Shafiqul ALAM

Dhaka, May 25, 2020 (AFP) - Some 15,000 Rohingya refugees are now under coronavirus quarantine in Bangladesh's vast camps, officials said Monday, as the number of confirmed infections rose to 29.   Health experts have long warned that the virus could race through the cramped settlements, housing almost a million Muslims who fled violence in Myanmar, and officials had restricted movement to the area in April.

Despite this, the first cases in the camps were detected in mid-May.   "None of the infections are critical. Most hardly show any symptoms. Still we have brought them in isolation centres and quarantined their families," Toha Bhuiyan, a senior health official in the surrounding Cox's Bazar area told AFP.   He said narrow roads to three districts of the camps -- where the majority of the infections were detected -- have been blocked off by authorities.

The 15,000 Rohingya inside these so-called blocks faced further restrictions on their movement, he said.   It comes as charity workers expressed fears over being infected in the camps as they worked without adequate protection.   Two of the areas under isolation are in Kutupalong camp, home to roughly 600,000 Rohingya.   "We are trying to scale up testing as fast as possible to make sure that we can trace out all the infected people and their contacts," Bhuiyan said.

Seven isolation centres with the capacity to treat more than 700 COVID-19 patients have been prepared, he said.   Officials hope to have just under 2,000 ready by the end of May, he added.   Mahbubur Rahman, the chief health official of Cox's Bazar, said authorities hoped this week they would double the number of tests being performed daily from 188.   He said further entry restrictions have been imposed on the camp, with a 14 day quarantine in place for anyone visiting from Dhaka.   "We are very worried because the Rohingya camps are very densely populated. We suspect community transmission (of the virus) has already begun," Rahman told AFP.

- 'Very little awareness' -
Bangladesh on Monday notched up a record single-day spike in coronavirus cases, with 1,975 new infections, taking the toll to 35,585 cases and 501 deaths.   In early April authorities imposed a complete lockdown on Cox's Bazar district -- home to 3.4 million people including the refugees -- after a number of infections.

But a charity worker with one of the many aid organisations active in the camps said Monday he and many others were "very worried".   "Fear and panic has gripped aid workers because many of us were forced to work without much protection," he told AFP without wishing to be named.   "Social distancing is almost impossible in the camps. There is very little awareness about COVID-19 disease among the refugees, despite efforts by aid agencies."

The lack of information is exacerbated by local authorities having cut off access to the internet in September to combat, they said, drug traffickers and other criminals.   More than 740,000 Rohingya fled a brutal 2017 military crackdown in Myanmar to Cox's Bazar, where around 200,000 refugees were already living.
Date: Mon, 25 May 2020 15:25:38 +0200 (METDST)

Antananarivo, May 25, 2020 (AFP) - Madagascar's government has announced it will dispatch troops and doctors to an eastern town after several bodies were found in the streets and where two people died from the novel coronavirus.   Madagascar's cabinet held a special meeting on Sunday to discuss the situation in Toamasina, the country's second largest city.   The Indian Ocean island nation has registered 527 infections and two deaths, both in Toamasina.

Since Thursday, more than 120 new cases were confirmed, and several bodies were found in the city's streets though the cause of death was not clear.   "Doctors must carry out thorough examinations to see if these deaths are caused by another illness (...) or if they are really due to severe acute respiratory problems which is the critical form of COVID-19," Professor Hanta Marie Danielle Vololontiana, spokesperson for the government's virus taskforce, said in a national broadcast on Sunday.   The government will send 150 soldiers to reinforce Toamasina, maintain order and enforce measures against the coronavirus such as mask wearing and social distancing.

The cabinet also fired Toamasina's prefect without providing any explanation.    A team was also ordered to distribute a drink based on artemisia, a plant recognised as a treatment against malaria, which the Malagasy authorities claim cures COVID-19.    The potential benefits of this herbal tea, called Covid-Organics, have not been validated by any scientific study.    The cabinet has also announced an investigation into the death of a doctor in Toamasina. According to local press, the victim was hospitalised after contracting COVID-19 and was found dead hanged in his room on Sunday morning.
Date: Mon, 25 May 2020 09:20:17 +0200 (METDST)
By Bhuvan Bagga with Indranil Mukherjee in Mumbai

New Delhi, May 25, 2020 (AFP) - Domestic flights resumed in India on Monday even as coronavirus cases surge, while confusion about quarantine rules prompted jitters among passengers and the cancellation of dozens of planes.   India had halted all flights within the country, and departing and leaving for abroad, in late March as it sought to stop the spread of coronavirus with the world's largest lockdown.   But desperate to get Asia's third-largest economy moving again, the government announced last week that around 1,050 daily flights -- a third of the usual capacity -- would resume on Monday.

Aviation Minister Hardeep Singh Puri said strict rules would include mandatory mask-wearing and thermal screenings, although middle seats on the aircraft would not be kept empty.   The announcement reportedly caught airlines and state authorities off-guard, with several local governments announcing that passengers would have to go into quarantine for two weeks on arrival.   Maharashtra, the Indian state with the highest number of coronavirus cases, capped at 50 the number of departures and arrivals in and out of its capital Mumbai.

Airlines scrapped dozens of flights on Monday while hundreds of passengers cancelled their bookings, reports said.   The NDTV news channel said 82 flights to and from New Delhi had been cancelled and nine at Bangalore airport.   Other flights from cities including infection hotspots Mumbai and Chennai were struck off, many at short notice, reports said.   At Mumbai airport social distancing was forgotten as irate passengers harangued staff after their flights were cancelled at the last minute.

- 'Really scary' -
At New Delhi airport, hundreds of people anxious to get home but apprehensive about the risks queued from before dawn -- all wearing masks and standing at least one metre (three feet) apart.   Security personnel behind plastic screens verified check-in documents and that passengers had the government contact tracing app, Aarogya Setu, on their phones.

"While I'm looking forward (to flying home), the idea of flying is really scary," student Gladia Laipubam told AFP as she stood in line.   "Anything can happen. It's very risky. I don't really know when I'll be able to come back to Delhi now. There is no clarity from the university too at this time."   One female airline employee wearing gloves, a mask and a protective face shield said she and many other colleagues felt "very nervous" about starting work again.   "Dealing with so many people at this time is so risky. I must have interacted with at least 200 people since this morning," she told AFP, not wishing to be named.

Cabin crew on the planes had to wear full protective suits with masks, plastic visors and blue rubber gloves, and many were also confused about the rules, the Press Trust of India reported.   "There is no clarity on whether I need to go into home quarantine for 14 days after returning to my base or show up for duty on Monday," one pilot told PTI.   New coronavirus cases in India crossed 6,000 for the third consecutive day on Sunday, surging to a record single-day spike of 6,767 infections.   The country has recorded almost 140,000 cases and over 4,000 deaths.   Singh has said that international flights could resume in June, although dozens of special flights have in recent weeks brought back some of the hundreds of thousands of Indians stuck abroad.
Date: Fri, 22 May 2020 11:02:28 +0200 (METDST)

Suva, Fiji, May 22, 2020 (AFP) - A huge fire at one of Suva's largest markets blanketed the Fijian capital in thick smoke before it was brought under control Friday, firefighters said.   The blaze engulfed the Suva Flea Market, a major tourist attraction near the waterfront, sending plumes of acrid black smoke into the air.   The National Fire Authority said an adjoining shop was also badly damaged but there were no reports of injuries.   "It's been stopped now and no one was injured but that's all we can say at the moment," a spokesman told AFP.   The said the cause of the fire was being investigated.