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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: Thu 12 Sep 2019, 7:54 PM
Source: Ekathimerini [edited]

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

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

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

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

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

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

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

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

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

On Zakynthos, officials ordered the evacuation of the villages of Agalas and Keri in the south of the island. Some 120 tourists were also relocated to a safe area.   The Greek fire department on Sunday said it had been called to nearly 80 fires over the past 24 hours.   It has already faced more than 9,600 rural and urban fires this year.
Date: Tue, 13 Aug 2019 11:40:19 +0200 (METDST)

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

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

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

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

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

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

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

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

Another speedboat on Friday injured a 32-year-old swimmer at the Athens coastal suburb of Glyfada. The driver was arrested.   In 2016, four people including a four-year-old girl were killed when a speedboat sliced into their wooden tourist vessel near the island of Aegina.   Nobody was sanctioned as the prime suspect, an elderly Greek man, died a year after the accident.
Date: Sat, 10 Aug 2019 19:32:52 +0200 (METDST)

Athens, Aug 10, 2019 (AFP) - Greece on Saturday battled over 50 wildfires nationwide, including a major blaze near Athens, in a dangerous mix of high temperatures and strong winds unseen in nearly a decade.   The fire department said it had mobilised more than 450 firemen and 23 aircraft nationwide to tackle the fires, including one on the island of Elafonissos and two around Marathon, near Athens.   A camping site and a hotel on Elafonissos and a children's summer camp near Marathon were evacuated as a precaution, state news agency ANA reported.

Marathon is a short distance from Mati, the coastal resort where last year 102 people died in Greece's worst fire disaster.   Temperatures in some areas are expected to hit 40 degrees Celius (104 degrees Fahrenheit) on Sunday, accompanied by gale force winds.   On Friday, civil protection chief Nikos Hardalias said it was the first time since 2012 that the country had faced such a mix of high temperatures, strong winds and low humidity.   "We are called upon to manage extreme weather conditions over the next three days... we must all be careful," Hardalias told reporters as he placed emergency services on high alert.
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Travel News Headlines WORLD NEWS

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Anguilla

Anguilla US Consular Information Sheet
March 03, 2009
COUNTRY DESCRIPTION: Anguilla is a British overseas territory in the Caribbean, part of the British West Indies. It is a small but rapidly developing island with particularly well-developed
ourist facilities.

ENTRY/EXIT REQUIREMENTS:
The Intelligence Reform and Terrorism Prevention Act of 2004 requires all travelers to and from the Caribbean, Bermuda, Panama, Mexico and Canada to have a valid passport to enter or re-enter the United States. U.S. citizens must have a valid U.S. passport if traveling by air, including to and from Mexico.
If traveling by sea, U.S. citizens can use a passport or passport card. We strongly encourage all American citizen travelers to apply for a U.S. passport or passport card well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

In addition to a valid passport, U.S. citizens need onward or return tickets, and sufficient funds for their stay.
A departure tax is charged at the airport or ferry dock when leaving. For further information, travelers may contact the British Embassy, 19 Observatory Circle NW, Washington, DC
20008; telephone (202) 588-7800; or the nearest consulate of the United Kingdom in Atlanta, Boston, Chicago, Dallas, Los Angeles, New York, Denver, Houston, Miami, Orlando, Seattle, or San Francisco. Visit the British Embassy web site 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:
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

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

CRIME:
While Anguilla's crime rate is relatively low, both petty and violent crimes
do occur. Travelers should take common-sense precautions to ensure their personal security, such as avoiding carrying large amounts of cash or displaying expensive jewelry. Travelers should not leave valuables unattended in hotel rooms or on the beach. They should use hotel safety deposit facilities to safeguard valuables and travel documents. Similarly, they should keep their lodgings locked at all times, whether they are present or away, and should not leave valuables in their vehicles, even when locked.

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 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 emergency line in Anguilla is 911.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
There is only one hospital, Princess Alexandra Hospital (telephone: 264-497-2551), and a handful of clinics on Anguilla, so medical facilities are limited.
Serious problems requiring extensive care or major surgery may require evacuation to the United States, often at considerable expense.

There are no formal, documented HIV/AIDS entry restrictions for visitors to and foreign residents of Anguilla, but there have been anecdotal reports of exclusion.
Please verify this information with the British Embassy before you travel.

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

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

Unlike the U.S., traffic in Anguilla moves on the left. The few roads on the island are generally poorly paved and narrow. While traffic generally moves at a slow pace, with the increasing number of young drivers in Anguilla, there are occasional severe accidents caused by excessive speed. Although emergency services, including tow truck service, are limited and inconsistent, local residents are often willing to provide roadside assistance. For police, fire, or ambulance service dial 911.

Please refer to our Road Safety page for more information.
Visit the Government of Anguilla web site for further road safety information.

AVIATION SAFETY OVERSIGHT:
Civil aviation operations in Anguilla fall under the jurisdiction of British authorities. The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Kingdom’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Anguilla’s air carrier operations.
For more information, travelers may visit the FAA web site.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Anguilla laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Anguilla 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 Anguilla are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration web site and to obtain updated information on travel and security within Anguilla. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy with consular responsibility over Anguilla is located in Bridgetown, Barbados in the Wildey Business Park in suburban Wildey, southeast of downtown Bridgetown.
The main number for the Consular Section is (246) 431-0225; after hours, the Embassy duty officer can be reached by calling (246) 436-4950.
Visit the U.S. Embassy Bridgetown online for more information.
Hours of operation are 8:30 a.m. – 4:30 p.m. Monday through Friday, except Barbadian and U.S. holidays.
* * *
This replaces the Country Specific Information for Anguilla dated April 2, 2008, to update sections on Country Description, Entry/Exit Requirements, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Sat, 9 Sep 2017 19:31:32 +0200

Paris, Sept 9, 2017 (AFP) - France's meteorological agency on Saturday issued its highest warning for the Caribbean islands of St Martin and St Barts as Hurricane Jose bore down, three days after they were hit by Hurricane Irma.   The alert warned of a "dangerous event of exceptional intensity," with winds that could reach 120 kilometres (75 miles) per hour, and strong rains and high waves.

St Barts is a French overseas territory, as is the French part of St Martin, which is divided between France and the Netherlands.   Twelve people were killed on the two islands by Hurricane Irma, thousands of buildings were flattened and the authorities are struggling to control looting.   The French state-owned reinsurer CCR on Saturday estimated the damage at 1.2 billion euros ($1.4 billion).   Irma is now heading for Florida, where a total of 6.3 million people have been ordered to evacuate, according to state authorities.
Date: Tue 29 Apr 2014
Source: National Institute for Public Health and the Environment [edited]

1 Oct 2013-29 Apr 2014 (week 18) St Maarten - Since the last report (week 15 [17?]) 52 new cases have been confirmed among St Maarten residents. Up to 29 Apr 2014, now a total of 343 confirmed cases have been reported. One of these confirmed cases was hospitalized.

The median age of the confirmed patients was 44 years, range 4-92 years. Of those cases for which gender was available, 201 were female and 130 were male.

- On 6 Dec 2013, the 1st indigenous chikungunya [virus infection] case of St Maarten was reported. Retrospectively, the 1st patient with suspected complaints was reported in mid-October 2013 in St Martin.
------------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
=====================
[The report also has graphs showing case numbers over time.

Maps of St Martin/St Maarten can be accessed at
Date: 5-11 May 2014
Source: Institut de Veille Sanitaire (French Institute for Public Health Surveillance, InVS) [edited]

Cases since the beginning of the outbreak in December 2013:
- St Martin: (susp) 3240 cases; deaths 3; stable.
- St Barthelemy: (susp) 500 cases; stable.
- Martinique: (susp) 24 180; deaths 3; increasing.
- Guadeloupe: (susp) 13 600 cases; deaths 1; increasing.
- French Guiana: (susp) not available; (probable or confirmed) 122 cases with 83 locally acquired; increasing, with a new cluster in Kourou and 2 near Cayenne.
======================
[The 16 May 2014 report from Guyaweb (<http://www.guyaweb.com/actualites/news/sciences-et-environnement/le-chik-revient-kourou-setend-cayenne-desormais-saint-laurent/>) states that there are 2 new cases in Saint-Laurent-du-Maroni, overlooking the Suriname River, of which one is certainly autochthonous, and a new focal point occurred in Kourou with 4 cases.

Maps of the area can be seen at
and <http://healthmap.org/promed/p/35574>. - ProMed Mod.TY]
Date: 7-13 Apr 2014
Source: INVS Point Sanitaire No. 14 [in French, trans. ProMed Mod.TY, edited]

Cases since the beginning of the outbreak in December, 2013:
- St. Martin: (susp.) 2980 cases, (probable and conf.) 793 cases; Deaths 3; Decreasing.
- Saint Barthelemy: (susp.) 460 cases, (probable or confirmed) 135 cases; Decreasing.
- Martinique: (susp.) 16 000, (probable or confirmed) 1473 cases; Deaths 2; Increasing.
- Guadeloupe: (susp.) 4710 cases, (probable or confirmed) 1261 cases; Deaths 1; In epidemic status.
- French Guiana: (susp.) 7 cases with 4 locally acquired, (probable or confirmed) 39 cases with 26 locally acquired) 30 cases; (imported) 16 cases; Moderate to increasing; Half of probable and confirmed cases are located in Kourou; however indigenous cases have also been recorded from the Cayenne Matoury, Remire and Macouria communities.
=================
[Maps showing case distributions on each island can be accessed at the above URL. - ProMed Mod.TY]
Date: Thu 27 Mar 2014
Source: The Daily Herald [edited]

As St. Maarten continues to take measures to combat the spread of the chikungunya virus, the number of cases continues to climb.

Health Minister Cornelius de Weever announced on Wednesday [26 Mar 2014], that the total number of confirmed chikungunya cases thus far stood at 224.

De Weever also announced that government will be signing a Memorandum of Understanding (MOU) with French St. Martin as a means of collectively responding to the mosquito threat that puts the population at risk. He said both sides have been working closely together to address the dengue and chikungunya threats.

The MOU will cover, amongst other things, a regular exchange of epidemiological information on vector-borne diseases and collectively publishing and representing data collected under the agreement.

The need for collective information campaigns and enhancement of the mosquito vector-control programme will also be included in the MOU. The MOU also describes the need for planning execution and evaluation of collective responses to the chikungunya threat.
=========================
[The increase in the number of chikungunya virus infections over the past week in St. Maarten is of concern, rising from 123 cases to 224 cases. This number is confirmed in another report that also indicates that there are an additional 325 suspected cases (<http://www.rivm.nl/dsresource?type=pdf&disposition=inline&objectid=rivmp:239786>).  - ProMed Mod.TY]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/35574>.]
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Bulgaria

Bulgaria US Consular Information Sheet
September 20, 2007
COUNTRY DESCRIPTION: Bulgaria is a quickly developing European nation undergoing significant economic changes.
Tourist facilities are widely available, although conditions vary and
ome facilities may not be up to Western standards.
Goods and services taken for granted in other European countries may not be available in many areas of Bulgaria.
Read the Department of State Background Notes on Bulgaria for additional information.
ENTRY/EXIT REQUIREMENTS:
A United States passport is required for U.S. citizens who are not also Bulgarian nationals.
As of September 1, 2006, U.S. citizens who enter the country without a Bulgarian visa are authorized to stay for a total of 90 days within a six-month period.
This law is strictly enforced.
An application to extend one’s stay beyond the original 90 days can be filed for urgent or humanitarian reasons, but must be submitted to regional police authorities no later than five days prior to the end of the original 90-day period.
Travelers who have been in the country for 90 days, and then leave, will not be able to reenter Bulgaria before the six-month period expires.
Travelers using official or diplomatic passports must secure visas prior to arrival.
Upon entering the country, Bulgarian immigration authorities request that all foreigners declare the purpose of their visit and provide their intended address.
U.S. citizens intending to live or work in Bulgaria for more than 90 days within six months (or more than six months within a year) must obtain a “D” visa prior to arrival.
The practice of switching from tourist status to long-term status when already in Bulgaria is no longer allowed.
Those wanting to do so must leave Bulgaria and apply for a “D” visa at a Bulgarian embassy or consulate.
This procedure takes from two to four weeks.
American citizens who marry Bulgarian nationals and want to switch to long-term status must also leave the country, present their marriage license at a Bulgarian embassy or consulate in a neighboring country, and apply for a “D” visa.

The Bulgarian authorities do not consider presentation of a copy of the passport sufficient for identification purposes.
Visitors should carry their original passports with them at all times.
For further information concerning entry requirements, travelers should contact the Embassy of the Republic of Bulgaria at 1621 22nd St. N.W., Washington, D.C. 20008; http://www.bulgaria-embassy.org; tel. (202) 387-7969 (main switchboard (202) 387-0174), or the Bulgarian Consulate in New York City at 121 East 62nd Street, New York, NY 10021; http://www.consulbulgaria-ny.org; tel. (212) 935-4646.
See our Foreign Entry Requirements brochure for more information on Bulgaria and other countries.
Visit the Embassy of Bulgaria web site at http://www.bulgaria-embassy.org for the most current visa information.
Traveling with Bulgarian minors: Bulgarian authorities are particularly strict in matters involving the travel of Bulgarian children.
Adults, other than a child’s parents, departing Bulgaria with a Bulgarian national (including dual or multi-national Bulgarian) child, must present to authorities a certified/legalized declaration signed by the child’s parents authorizing custody for travel purposes.
This holds true even if the adult is otherwise related to the child.
If the declaration is signed in Bulgaria, certification by a Bulgarian notary public is required.
If signed in the U.S., the declaration must be certified by a notary public and the court in the jurisdiction where the notary is licensed.
The declaration must then be legalized with an apostille issued by the individual state's Department of State or the Governor’s office.
Please note Bulgarian authorities do not require such documentation for minors who are not Bulgarian.
Find more information about dual nationality and the prevention of international child abduction on our web site. For further information about customs regulations, please read our Customs Information.

SAFETY AND SECURITY:
Bulgaria’s accession to the European Union has enhanced the overall security environment for tourist and business travelers.
However, the country still suffers from many of the ills of a former Eastern Bloc country in transition.
Organized crime groups and criminals who specialize in petty crimes and credit card fraud are highly prevalent in Bulgaria’s largely cash economy.
Petty criminals such as pick-pockets and purse snatchers operate in crowded public areas and on public transportation.
Also, technology exists in Bulgaria to clone credit cards and trap ATM cards for later retrieval.
Suspected organized crime members often travel in convoys of late-model SUVs and luxury sedans, accompanied by armed men, and frequent expensive restaurants, hotels, and nightclubs.
For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site at http://travel.state.gov, where the current Worldwide Caution Public Announcement, Travel Warnings and Public Announcements can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Petty street crime, much of which is directed against persons who appear to have money or to be foreign, continues to be a problem.
Pocket picking and purse snatching are frequent occurrences, especially in crowded markets and on shopping streets.
Con artists operate on public transportation and in bus and train stations.
Credit cards and ATMs should be used with caution.
Be wary of people who approach you at an ATM and offer assistance.
Do not give your PIN number to anyone under any circumstances. (See the Special Circumstances section below.) Travelers should be suspicious of "instant friends" and should also require persons claiming to be government officials to show identification.
There have been incidents in which tourists have been drugged or assaulted and robbed after accepting offers of coffee or alcoholic beverages from "friendly” individuals met by “chance” at hotels, the airport, or at bus or train stations.
Travelers should be wary of unfamiliar individuals who encourage them to drink or eat products, as these may be tainted with strong tranquilizers (such as valium) that can lead rapidly to unconsciousness.
Reporting a crime immediately to the police has helped recover money and valuables on more than one occasion and is recommended.
To avoid becoming a victim of more serious crimes, one should use the same personal safety precautions that they would use in large urban areas of the United States.

Travelers should pay special attention to the drink prices at high-end bars and nightclubs.
There have been instances of travelers being charged exorbitant prices, especially for champagne and hard alcohol.
Bills have been as high as several thousand dollars for drinks, and in some establishments the management may use force to assure payment.

On occasion, taxi drivers overcharge unwary travelers, particularly at Sofia Airport and the Central Train Station.
We recommend travelers use taxis with meters and clearly marked rates displayed on a sticker on the passenger side of the windshield.
Travelers should be aware that there is no official commission that sets taxi cab rates.
Taxi drivers are within their full rights to charge passengers any price they want, provided that it corresponds with the price shown on the windshield sticker.
At the airport, there is a clearly marked booth within the arrivals terminal, which arranges for metered taxis at a fair rate.
Finding reputable taxis at the Central Train Station is more difficult.
It is recommended to inquire about the fare first, to avoid excessive payment if a metered taxi cannot be found.
Always ensure that you have and account for all luggage, packages and hand-carried items before you pay and release a taxi.
The likelihood of retrieving articles left behind in a taxi is remote.
Because pilferage of checked baggage may occur at Sofia Airport, travelers should not include items of value in checked luggage.
Automobile theft is a concern, with four-wheel-drive vehicles and late model European sedans the most popular targets.
Very few vehicles are recovered.
Thieves smash vehicle windows to steal valuables left in sight.
Break-ins at residential apartments occur as frequently as in major cities everywhere.
Persons who plan to reside in Bulgaria on a long-term basis should take measures to protect their dwellings.
Long-term residents should consider installation of window grilles, steel doors with well-functioning locks, and an alarm system that alerts an armed response team.

Travelers should also be cautious about making credit card charges over the Internet to unfamiliar websites.
As recent experience has shown, offers for merchandise and services may be scam artists posing as legitimate businesses.
A recent example involves Internet credit card payments to alleged tour operators via Bulgaria-based web sites.
In several cases, the corresponding businesses did not actually exist.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
While Bulgarian physicians are trained to a very high standard, most hospitals and clinics, especially in village areas, are generally not equipped and maintained to meet U.S. or Western European standards.
Basic medical supplies and over-the-counter and prescription medications are widely available, but highly specialized treatment may not be obtainable.
Pediatric facilities are in need of funding and lack equipment.
Serious medical problems requiring hospitalization and/or medical evacuation to the United States may cost thousands of dollars.
Doctors and hospitals often expect immediate cash payment for health services.
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 Internet 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.
All foreign citizens traveling to Bulgaria should be prepared to present valid evidence of health insurance to the Bulgarian border authorities in order to be admitted into the country.
The insurance should be valid for the duration of the traveler’s stay in Bulgaria.
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 Bulgaria is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
The Bulgarian road system is largely underdeveloped.
There are few sections of limited-access divided highway.
Some roads are in poor repair and full of potholes.
Rockslides and landslides may be encountered on roads in mountainous areas.
Livestock and animal-drawn carts present road hazards throughout the country, especially during the agricultural season.
Travel conditions deteriorate during the winter as roads become icy and potholes proliferate.
The U.S. Embassy in Sofia advises against driving at night because road conditions are more dangerous in the dark.
Some roads lack pavement markings and lights, and motorists often drive with dim or missing headlights.
Driving in Bulgaria is extremely dangerous.
Aggressive driving habits, the lack of safe infrastructure, and a mixture of late model and old model cars on the country’s highways contribute to a high fatality rate for road accidents.
Heavy traffic conditions have led to a significant increase in “road-rage” accidents.
Motorists should avoid confrontations with aggressive drivers in Bulgaria.
In particular, drivers of late-model sedans (BMW, Mercedes, Audi) are known to speed and drive dangerously.
Motorists should exercise caution and avoid altercations with the drivers of such vehicles, which may be driven by armed organized crime figures.
In some cities traffic lights late at night blink yellow in all directions, leaving rights-of-way unclear and contributing to frequent accidents.
Heavy truck traffic along the two-lane routes from the Greek border at Kulata to Sofia and from the Turkish border at Kapitan Andre to Plovdiv creates numerous hazards.
Motorists should expect long delays at border crossings.
A U.S. state driver's license is valid in Bulgaria only when used in conjunction with an International Driving Permit.
For information on how to obtain a permit, please see our road safety information.
If pulled over by a police officer, motorists should remember that, under Bulgarian law, police officers may not collect fines on the spot; they may only issue a ticket with the fine to be paid at the motorist’s local regional tax office.
Buses, trams, and trolleys are inexpensive, but they are often crowded and of widely varying quality.
Passengers on the busiest lines have reported pick pocketing, purse slashing, and pinching. The use of seat belts is mandatory in Bulgaria for all passengers, except pregnant women.
Children under 10 years of age may ride in the front seat only if seated in a child car seat.
In practice, these rules are often not followed.
Speed limits are 50 km/h in the cities/towns, 90 km/h out of town, and 130 km/h on the highways.
For motorcycles, speed limits are 50 km/h in the cities/towns, 80 km/h out of town, and 100 km/h on the highways.
Motorcyclists must drive with helmets and with lights on at all times.
At crossings that are not regulated, the driver who is on the right has the right-of-way, but this rule, too, is frequently ignored.
Drivers may be charged with driving under the influence of alcohol with a blood level as low as 0.05 percent.
Right turns on red lights are not permitted unless specifically authorized.
The penalties for drivers involved in an accident resulting in injury or death range from a 25 U.S. Dollar fine up to imprisonment for life.
A new law requires the use of headlights day and night from November 1st through March 31st.
The most generally encountered local traffic custom is a driver flashing high beams, which usually means that a traffic police post is ahead.
In case of emergency, drivers should contact the police at telephone number 166 and/or Roadside Assistance at telephone number 146.
For an ambulance, please call 150.
The fire department can be reached at 160.
For specific information concerning Bulgarian driving permits, vehicle inspection, road tax, and mandatory insurance, please contact the Bulgarian Embassy via the Internet at http://www.bulgaria-embassy.org.
Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office at http://www.bulgariatravel.org/eng/index.php and the web site of the Bulgarian national authority responsible for road safety at http://www.kat.mvr.bg.
[Note: the latter web site is available in the Bulgarian language only.]
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Bulgaria’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Bulgaria’s air carrier operations.
For more information, travelers may visit the FAA’s Internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Bulgaria is still largely a cash economy.
Due to the potential for fraud and other criminal activity, credit cards should be used sparingly and with extreme caution.
There have been reports of false ATM fronts on bona fide machines that capture cards and PINs for later criminal use, including unauthorized charges or withdrawals.
In connection with such scams, travelers should be extremely wary of friendly bystanders near ATMs who offer assistance.
Any time a card is not returned the traveler should immediately report the card as lost/stolen to the card-issuing company.

Visitors may exchange cash at banks or Exchange Bureaus, but they should know that Exchange Bureaus sometimes post misleading rate quotations that confuse travelers.
People on the street who offer high rates of exchange are usually con artists intent on swindling the unwary traveler.
Damaged or very worn U.S dollar bank notes are often not accepted at banks or Exchange Bureaus.
Major branches of the following Bulgarian banks will cash travelers' cheques on the spot for Leva, the Bulgarian currency, or another desired currency:
Bulbank, Bulgarian Postbank, Biochim, First Investment Bank, and United Bulgarian Bank (UBB).
UBB also serves as a Western Union agent and provides direct transfer of money to travelers in need.
There are also many Western Union branches in major towns and cities.
Most shops, hotels, and restaurants, with the exception of the major hotels, do not accept travelers' cheques or credit cards.
Only some local banks can cash U.S. Treasury checks and the payee may need to wait up to a month to receive funds.
Corruption remains an important concern of the Government.
The Commission for Coordinating of the Activity for Combating Corruption manages the efforts of each government agency’s internal inspectorate in fighting public corruption and engages in public awareness campaigns.
Complaints of public corruption can be made to it at the Ministry of Justice, 2A Knyaz Dondukov Blvd., 1055 Sofia, Bulgaria, email: acc@government.bg, 359-2-980-9213, 359-2-923-7595, 359-2-940-3630 or to the Ministry of Finance hotline: 0800180018.
Please see our Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Bulgaria’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Bulgaria 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 Bulgaria are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, and to obtain updated information on travel and security within Bulgaria.
Americans without Internet access may use a public computer at the U.S. Embassy to register.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at 16, Kozyak St., Sofia1407; tel.: (+359 2) 937-5100; fax (+359 2) 937-5209; web site: http://sofia.usembassy.gov/.
Questions regarding consular services may be directed via email to: niv_sofia@state.gov (for non-immigrant visa matters); iv_sofia@state.gov (for immigrant visa matters) and acs_sofia@state.gov (for American Citizen Services matters).
*

*

*
This replaces the Consular Information Sheet dated March 28, 2007, to update the sections on Entry and Exit
Requirements, Safety and Security, Crime, Traffic Safety and Road Conditions, Children’s Issues, and Registration/Embassy.

Travel News Headlines WORLD NEWS

Date: Fri 23 Aug 2019
Source: Ekathimerini [edited]

Two cases of the West Nile Virus [WNV] have been confirmed in Bulgaria, with one of the patients said to have lived in Cyprus during a part of the summer.

The Ministry of Foreign Affairs in Bulgaria has not issued an update as of [Thu 22 Aug 2019] morning, but according to Philenews, the health ministry in Bulgaria had issued a statement regarding a 48-year-old Bulgarian man who was diagnosed with WNV [infection]. The man, said to be from Pazardzhik in southern Bulgaria, is a construction worker who had been living for the last 2 months in Cyprus.

Upon his return to his country, according to Bulgarian officials, the worker started running a fever and generally feeling unwell. He was then immediately admitted to hospital with a known WNV infection.

Other towns were also on alert in Bulgaria, with an official statement saying clinics for infectious diseases in Belgrade and Nis have reported infected people. Most cases were associated with summer flu symptoms while the nervous system was affected in a number of other cases.

Based on additional media reports, there were other places besides Cyprus on the radar of Bulgarian officials regarding possible WNV infections.

According to State Medical Services of the Republic of Cyprus, 9 WNV cases have been confirmed in the south this year up until [16 Aug 2019]. All cases involved the neuroinvasive disease of the virus, with 2 patients remaining critical and 4 others being discharged from hospital.

Earlier this week, one confirmed WNV death was recorded in greater Nicosia with officials saying the patient was very senior.
Date: Mon 5 Aug 2019, 11:33 AM
Source: Novinite.com [edited]

Mosquitoes carry viral meningitis in Bulgaria. There are nearly 1/3 more cases of meningitis since the beginning of the year [2019] than the previous year [2018]. The state has allocated another BGN 2 million [USD 1 783 680] to deal with mosquitoes.

The disease is not typical for Bulgaria's latitudes, but has started to manifest itself with climate change, said Prof. Dr. Tatyana Chervenyakova of the Infectious Diseases Hospital in Bulgaria. The infection is transmitted through mosquitoes, and if there are complications, hospitalisation may be needed. However, the complications are only about 1% of the cases, said Prof. Chervenyakova.

Most of the cases pass the disease slightly - with fever and general malaise. It usually goes away after 2-3 days.

"It is very difficult to control the mosquitoes in these rainfalls. After every rainfall it must be sprayed. We shouldn't think that all mosquitoes are infected with the virus. The individual protection is the availability of repellents, the other is within the reach of the state " Dr. Tatiana Chervenyakova, said in an interview for Bulgaria ON ON AIR.
=======================
[This report deals with mosquito-borne virus infections, but does not indicate which one, nor is the number of cases to date given. There are 2 possible arboviruses involved as the etiological agents of these cases: West Nile virus or Usutu virus. Both have been found in Central Europe. As noted in a previous ProMED-mail post, "West Nile virus (WNV) and Usutu virus (USUV) are phylogenetically closely related mosquito-borne members of the family _Flaviviridae_, and belong to the Japanese encephalitis antigenic complex of the _Flavivirus genus_ (1,2). Both viruses have been isolated from numerous ornithophilic mosquito species, mainly _Culex_ spp. (1,2). In the enzootic cycle of WNV and USUV, avian species are also involved and serve as amplifying hosts. Mosquitoes facilitate virus transmission to humans and equids which then remain incidental hosts as they are not able to produce a level of viraemia sufficient for further virus transmission by mosquito bites (2)." (see  <https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2019.24.28.1900038>  for complete reference list, including those cited here).

ProMED-mail would appreciate a response indicating which virus or viruses are involved in these cases in Bulgaria. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: 30 Aug 2018
Source: Euro Surveillance [summarized, edited]

In June 2018, Crimean-Congo haemorrhagic fever (CCHF) was diagnosed in a Greek construction worker who returned home after becoming ill with fever and haemorrhagic symptoms in south-western Bulgaria. Here, we describe the case along with the epidemiological investigation and phylogenetic analysis.

On 30 May 2018, a Greek male in his late 40s returned to Greece after spending 23 days in a forested area in Blagoevgrad province, south-western Bulgaria, where he was working in bridge construction. Three days earlier (27 May 2018, day 1), while in Bulgaria, he developed fever, severe headache, myalgia (mainly in the lower extremities), malaise and loss of appetite; on 28 May 2018 he visited a local hospital and received symptomatic treatment as an outpatient. As his condition deteriorated (onset of photophobia and abdominal pain) he returned to his permanent residence in northern Greece. On 31 May 2018 (day 5), the patient was admitted to a local hospital.

He was transferred to the university hospital in Alexandroupolis the next day because he presented severe thrombocytopenia and leukopenia; elevated levels of liver enzymes, creatine phosphokinase (CPK) and lactate dehydrogenase (LDH); and prolonged activated partial thromboplastin time (aPTT) (Table). On day 6, his headache was resolved, but his fever (38.2 C [101 F]), malaise and myalgia were ongoing. The main laboratory findings were thrombocytopenia, prolonged aPTT (82 s) and increased level of aminotransferases. His laboratory parameters indicated rhabdomyolysis (CPK 1739 U/L) and slightly elevated urea and creatinine levels (Table). A bone marrow biopsy showed haemophagocytosis. ...

Based on the patient's clinical presentation, and as he was bitten by a tick in an area of Bulgaria where CCHF cases have been reported previously, CCHF was highly suspected. Typically, the incubation period of CCHF after a tick bite is short (1-3 days), but the exact date of the bite was unknown in this case. The treating physician contacted the National Reference Centre for Arboviruses and Haemorrhagic Fever Viruses in Thessaloniki, and the suspected case was immediately notified to the Hellenic Center for Disease Control and Prevention (HCDCP). ...

The HCDCP investigated the case immediately after the diagnosis of CCHF (through telephone interviews with a close family member and with the patient, after recovery, to confirm the dates) and his contacts while he was ill (household members, co-workers, roommates in Bulgaria and relatives who visited him in the hospitals). Close contacts were tested for CCHF and monitored for 14 days for any symptom development. The risk for further transmission was also assessed. The HCDCP promptly informed the Bulgarian health authorities about the case; they also informed the patient's Greek co-workers in Bulgaria about prevention and proper management of tick bites (informative material in Greek was sent to them) advising them to seek medical care in case they develop symptoms.

No other cases were reported among the patient's co-workers in Bulgaria, up to the end of July 2018. The regional and local public health authorities were also informed about the case, and they performed further contact investigation in Greece. No secondary cases were detected. The HCDCP raised awareness for CCHF among health professionals working in local health centres and hospitals in northern Greece, especially in areas with populations travelling to Bulgaria for occupational reasons.

The patient and his laboratory samples, apparel, waste and cleaning procedures were managed in accordance with the national guidelines for viral haemorrhagic fevers (available in Greek from HCDCP website: <http://www.keelpno.gr/>). In particular, upon the suspicion of CCHF (day 8), the patient was immediately isolated, and strict barrier precautions were utilised (waterproof gowns, gloves, FFP3 respiratory masks, goggles), and personal protective equipment was used by healthcare workers (HCWs) and visitors; however, visitors were discouraged from entering the isolation room. The HCDCP sent guidelines for contact tracing and active surveillance of symptoms in HCWs possibly exposed to CCHFV. Patients who were hospitalised in the same room with the patient before the suspicion of CCHF (2 patients in the 1st hospital (days 5-6), and 3 patients in the 2nd hospital (days 6-8)), were also monitored for symptoms for 14 days after their last contact with the patient. No secondary cases were observed. ...

Discussion
---------
CCHF was 1st recognised in Bulgaria in 1952; since then, several cases have been reported. Genetic characterisation of the Bulgarian strains showed that they cluster into the clade Europe 1. Our patient was infected in an area that was considered at low risk for CCHF outbreaks up to 2008, when a cluster of cases was observed in the region. Although the seroprevalence in the human population in Blagoevgrad province is low (1 percent), a seroprevalence of 41.9 percent in livestock was reported recently. Since CCHFV is transmitted mainly by bites of infected Ixodid ticks, persons living in rural areas are at increased risk for acquiring the infection. This was the reason that information about preventive measures was sent to our patient's Greek co-workers in Bulgaria, and all related public health authorities were informed about the case.

Regarding Greece, no other imported cases have been reported so far, and the only autochthonous CCHF case was observed in 2008. A review of travel-associated CCHF cases published during 1960-2016 reported 21 cases; 2 imported cases have been reported within Europe: Bulgaria to Germany in 2001 and Bulgaria to the United Kingdom in 2014.

Due to the high pathogenicity of CCHFV, the absence of a specific drug treatment or vaccine, and the risk of person-to-person transmission, rapid diagnosis is crucial to ensure that appropriate infection control measures (e.g. isolation of patient and barrier precautions) can be implemented in a timely manner. A detailed medical history of the patient, including travel history and possible risk factors, is important for the timely diagnosis of the disease. In our case, information regarding the tick bite was not provided immediately, and this, in combination with the non-specific initial symptoms, meant that CCHF was 1st suspected on day 8 of illness. Despite this delay, the patient fully recovered, and no secondary cases of CCHF have been reported. Since the northern part of Greece is close to CCHF-endemic countries, HCWs in this region should be made aware of CCHF, including the provision of training to better help them address questions from patients about travel history (to identify potential risk of exposure). Physicians should include CCHF in the differential diagnosis for patients with haemorrhagic syndromes, especially if patients report a tick bite, outdoor activities, or occupation in rural areas and recent travel to an endemic area.
=======================
[The above report provides an excellent example of CCHF transmission in a case with no history of conventional professional contact with infected cattle, such as cattle rearing or butchering. History of travel to a location that has reported human cases, presence of the vector, and the clinical picture should raise suspicions in health care providers, with appropriate diagnostic tests conducted as soon as possible. - ProMED Mod.UBA]

[HealthMap/ProMED maps available at:
Date: Thu, 8 Mar 2018 12:10:48 +0100
By Diana SIMEONOVA

Bansko, Bulgaria, March 8, 2018 (AFP) - "Unlimited Ski and Fun!" promises a pamphlet touting the Bansko ski resort, a magnet for bargain-hunting holidaymakers in southwest Bulgaria.   But nature lovers are demanding limits to the growth of the bustling resort carved into the majestic pine forests of Pirin National Park, a UNESCO World Heritage site since 1983.

The clearance of more than 160 hectares (400 acres) of centuries-old forest to build the ski zone already prompted UNESCO in 2010 to remove the area from the World Heritage designation, labelling it a "buffer zone".   Now a much larger area could come under threat after a government decision in December opened 48 percent of the park's 40,000 hectares for construction, sparking weekly protests attended by thousands across the country.

Protestors accuse the government of favouring business interests in a country ranked by watchdog Transparency International as the EU's most graft-prone, with one huge banner at a recent rally in the capital Sofia reading: "Corruption! Save Pirin".   But the resort is the area's biggest employer and locals have responded with their own demonstrations in favour of expansion.   At issue in particular is a plan to build a second ski lift to ease persistent queues at the sole six-person lift, which currently takes 2,200 skiers per hour up to the 75 kilometres (46 miles) of runs.

- 'Horrific' queue -
British holidaymaker Carolyn Bennett, 30, is among the skiers who come in droves to Bansko from Britain, Russia and Bulgaria's Balkan neighbours, attracted by the cheap food and lift passes as well as budget flights.   But even on a supposedly quiet day, she was among scores of people at the foot of the ski lift, where queues form from early morning and waits can last up to three hours.

"Another gondola is going to have a huge impact environmentally but I imagine coming here in peak season, that queue would probably be horrific," she shrugged in the crammed gondola cabin.    "With a daily lift pass costing 28 euros ($34), Bansko is the cheapest resort of its capacity in Europe, and even if our queues have become notorious, people keep pouring in," Bansko's marketing chief Ivan Obreykov told AFP.   Daily lift passes at ski resorts in France and Austria typically cost twice as much.

Bansko hosts some 35,000 to 40,000 visitors per month during the winter season. On a busy day, up to 7,000 people could hit the ski lift at the same time in the mornings.   Booming construction in the once quiet town of 9,500 inhabitants has seen its two-storey houses and cobbled streets surrounded by hotels and luxury apartments with space for 18,000 guests.   While ugly concrete skeletons of a number of hotel projects abandoned after the 2008 financial crisis mar the landscape, pressure is mounting to expand both the town and the ski zone.

- Trojan horse claim -
Obreykov praised the government's green light for the second ski lift, adding that its construction was the resort's "first and most pressing task".   But those opposed to the plan say it is a Trojan horse to cover up previous unauthorised building and encourage even more expansion.   "If they wanted to do just a second gondola, they would not have opened almost half of the territory of Pirin National Park for construction," WWF's Konstantin Ivanov said at a rally in Sofia.   "We don't buy their promises that nothing more will be built there," he added.   WWF claims the ski zone has already grown to cover 60 percent more territory than initially agreed and points to as yet unapproved plans for huge expansion of the resort.    Obreykov denied the charge, adding that new ski runs could be built only within the current area of the ski zone.

A recent study for the WWF concluded that the resort has already inflicted "irreparable damage" on the reserve, calling for UNESCO to inscribe Pirin on its List of World Heritage in Danger if new construction begins.    A report by the International Union for Conservation of Nature (IUCN) in November also said the conservation outlook for Pirin National Park -- home to bears, chamois and wolves -- was of "significant concern" and just one step away from the final "critical" stage.   IUCN also underlined the "threats of disturbance and fragmentation of the site associated with the exclusion of the skiing areas as incompatible with its World Heritage status."

- 'Deepening mistrust' -
For economist Petar Ganev, of the Sofia-based Institute for Market Economics, the row is an example of "deepening mistrust in Bulgaria's institutions".   On the one hand, Ganev said Bansko is "a positive example of a very poor place which grew into a prosperous resort" and that building a second ski lift could be justified for that reason.   But, he added, suspicions that development is not being regulated fairly will "continue to bring people out on the streets".   "The problem is not the second gondola but the corruption in the country," Ganev said.
Date: Fri 1 Dec 2017 15:26
Source: Focus News Agency [edited]

The hepatitis A outbreak in the Kosharnik, an all-Roma neighbourhood of Montana, is spreading, the number of people infected has reached 15, Dr. Mariya Kamenova, Deputy Director of Montana Regional Health Inspectorate (RHI) told FOCUS Radio . Another 8 cases were registered for the period from [Fri 27 Oct 2017] until the end of November 2017, adding up to the 7 cases registered by [Thu 26 Oct 2017]. Those 1st 7 cases were children under 14, while the newly infected are 4 children under 4 years of age, 2 children aged 5 to 9, and 2 children aged 15 to 19.

A 51-year-old male from the neighborhood is also probably hepatitis A infected, but his tests are pending. The Montana municipality has taken measures and the streets in Kosharnik and the yards of the infected families have been disinfected every month. The RHI has said that they will continue to monitor the situation.
=====================
[The location of Montana in Bulgaria is north and west of Plovdiv where HAV is being reported in the Roma community there. Montana's location can be seen on a map at <https://en.wikipedia.org/wiki/Montana,_Bulgaria>. Since most ca es of
HAV in children are unrecognized, being either asymptomatic or anicteric (without jaundice), the total number of cases are likely to be much higher. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
More ...

World Travel News Headlines

Date: Tue 17 Sep 2019
Source: Boston Globe [edited]

Rhode Island officials announced Tuesday [17 Sep 2019] that 2 more human cases of eastern equine encephalitis [EEE] were confirmed in the state.

The 2 people -- one a Coventry child younger than 10 and the other a person in their 50s from Charlestown -- have been discharged from the hospital and are recovering, according to a statement from the state's Department of Public Health.

Authorities think the 2 people contracted EEE in late August [2019]. The cases were confirmed by tests done at the Centers for Disease Control and Prevention. There have been 3 confirmed EEE cases in Rhode Island this year [2019]. A West Warwick resident diagnosed with the mosquito-borne illness died this month [September 2019].

All 3 people contracted EEE before areas at critical risk for the disease were aerially sprayed with pesticide, state officials said.

EEE is a rare but potentially fatal disease that can cause brain inflammation and is transmitted to humans bitten by infected mosquitoes, according to federal authorities. About 1/3 of infected people who develop the disease will die, officials have said, and those who recover often live with severe and devastating neurological complications. There is no treatment for EEE.

"This [2019] has been a year with significantly elevated EEE activity, and mosquitoes will remain a threat in Rhode Island until our 1st hard frost, which is still several weeks out," said Ana Novais, the deputy director for the state's health department. "Personal mosquito-prevention measures remain everyone's 1st defence against EEE. If possible, people should limit their time outdoors at sunrise and sunset. If you are going to be out, long sleeves and pants are very important, as is bug spray [repellent]."

EEE was also confirmed in a deer in Exeter this week [week of Mon 16 Sep 2019].

In Massachusetts, 8 human cases of EEE have been confirmed this year [2019]. Last month [August 2019], a Fairhaven woman with EEE died.
========================
[The 1st Rhode Island case died. Now there are 2 additional EEE cases who have recovered sufficiently to have been discharged from the hospital. Although most reported cases of EEE this year [2019] have occurred in horses, there have been several recent human cases as well. Individuals living in areas where human or equine EEE cases have occurred should heed the above recommendations to prevent mosquito bites. Avoidance of mosquito bites is the only preventive measure available. Fortunately, horses can be vaccinated, but there is no vaccine available for humans.

The risk of EEE virus infection for humans and horses will continue in Rhode Island and the other affected states until the 1st killing frosts occur, likely in October (2019). - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Rhode Island, United States: <http://healthmap.org/promed/p/241>]
Date: Tue 17 Sep 2019
Source: Detroit Free Press [edited]

State health officials said Tuesday [17 Sep 2019] that 3 Michiganders have died from the rare and dangerous mosquito-borne virus eastern equine encephalitis [EEE], and 4 others have been sickened by the disease, amid the biggest outbreak in more than a decade.

Those who live in all 8 of the affected counties -- Kalamazoo, Cass, Van Buren, Berrien, Barry, St. Joseph, Genesee, and Lapeer counties -- are urged to consider canceling, postponing, or rescheduling outdoor events that occur at or after dusk, especially those that involve children, according to the Michigan Department of Health and Human Services. This would include events such as late-evening sports practices or games or outdoor music practices "out of an abundance of caution to protect the public health, and applies until the 1st hard frost of the year [2019]," according to an MDHHS news release.

The 3 people who died were all adults and lived in Kalamazoo, Cass, and Van Buren counties, [respectively], said Bob Wheaton, a spokesman for the Michigan Department of Health and Human Services. The 4 other confirmed cases are in Kalamazoo, Berrien, and Barry counties.

Animals have also been confirmed to have the virus in St. Joseph, Genesee, and Lapeer counties.

The Kalamazoo County Health and Community Services Department also issued a recommendation to local communities and school districts to consider canceling outdoor events at dusk or after dark, when mosquitoes are most active, or move [the events] indoors.  "Michigan is currently experiencing its worst eastern equine encephalitis outbreak in more than a decade," said Dr. Joneigh Khaldun, MDHHS chief medical executive and chief deputy for health. "The ongoing cases reported in humans and animals and the severity of this disease illustrate the importance of taking precautions against mosquito bites."

EEE is one of the deadliest mosquito-borne viruses in the US. One in 3 people who are infected with the virus die. The only way to prevent it is to avoid mosquito bites. The MDHHS says residents should
- apply insect repellents that contain the active ingredient DEET or other US Environmental Protection Agency-registered product to exposed skin or clothing, and always follow the manufacturer's directions for use;
- wear long-sleeved shirts and long pants when outdoors. Apply insect repellent to clothing to help prevent bites;
- maintain window and door screening to help keep mosquitoes outside;
- empty water from mosquito breeding sites around the home, such as buckets, unused kiddie pools, old tires, or similar sites where mosquitoes may lay eggs; and
- use nets and/or fans over outdoor eating areas.

Symptoms of EEE include
- sudden onset of fever, chills;
- body and joint aches, which can progress to a severe encephalitis;
- headache;
- disorientation;
- tremors;
- seizures;
- paralysis; and
- coma.

Anyone experiencing these symptoms should visit a doctor.

[Byline: Kristen Jordan Shamus]
=======================
[The number of human cases remains at 7. However, 3 of these have died since the 6 Sep 2019 report (see Eastern equine encephalitis - North America (18): USA human, horse, deer http://promedmail.org/post/20190910.6667626). However, even among the survivors, there is a significant risk of permanent neurological damage following clinical encephalitis. CDC reports that many individuals with clinical encephalitis "are left with disabling and progressive mental and physical sequelae, which can range from minimal brain dysfunction to severe intellectual impairment, personality disorders, seizures, paralysis, and cranial nerve dysfunction. Many patients with severe sequelae die within a few years" (<https://www.cdc.gov/easternequineencephalitis/tech/symptoms.html>). - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Michigan, United States: <http://healthmap.org/promed/p/225>
Michigan county map:
Date: Mon 16 Sep 2019
Source: Patch [edited]

The state Department of Public Health is warning that an adult resident of East Lyme has tested positive for eastern equine encephalitis (EEE). This is the 1st human case of EEE identified in Connecticut this season [2019].  The patient became ill during the last week of August [2019] with encephalitis and remains hospitalized. Laboratory tests, which were completed today at the Centers for Disease Control and Prevention (CDC) Laboratory in Ft. Collins, Colorado, confirmed the presence of antibodies to the virus that causes EEE.  "EEE is a rare but serious and potentially fatal disease that can affect people of all ages," said DPH commissioner Renee Coleman Mitchell in a release. "Using insect repellent, covering bare skin, and avoiding being outdoors from dusk to dawn are effective ways to help keep you from being bitten by mosquitoes."  The EEE virus has been identified in mosquitoes in 12 towns and in horses in 2 other towns.

Towns where mosquitoes have tested positive for EEE include Chester, Haddam, Hampton, Groton, Killingworth, Ledyard, Madison, North Stonington, Plainfield, Shelton, Stonington, and Voluntown. Horses have tested positive for EEE virus in Colchester and Columbia this season, and the virus has been detected in a flock of wild pheasants.  Other states throughout the northeast are also experiencing an active season for EEE. In addition to the virus being found in mosquitoes, there have been a total of 8 human cases of EEE infection in Massachusetts and one human case in Rhode Island, with one case in each state resulting in a fatality. "This is the 2nd human case of EEE ever reported in Connecticut," said Dr. Matthew Cartter, director of infectious diseases for the DPH. "The 1st human case of EEE reported in Connecticut occurred in the fall of 2013."

The DPH advises against unnecessary trips into mosquito breeding grounds and marshes, as the mosquitoes that transmit EEE virus are associated with freshwater swamps and are most active at dusk and dawn. Overnight camping or other substantial outdoor exposure in freshwater swamps in Connecticut should be avoided. Even though the temperatures are getting cooler, the DPH is advising that mosquito season is not over, and residents should continue to take measures to prevent mosquito bites, including wearing protective clothing and using repellents.  Although EEE-infected mosquitoes continue to be detected in the south-eastern corner of the state, the numbers are declining, and we are not experiencing the excessively high levels of activity seen in Massachusetts. There are currently no plans to implement widespread aerial pesticide spraying in the state.

Severe cases of EEE virus infection (involving encephalitis, an inflammation of the brain) begin with the sudden onset of headache, high fever, chills, and vomiting. The illness may then progress into disorientation, seizures, and coma. Approximately 1/3 of patients who develop EEE die, and many of those who survive have mild to severe brain damage, according to the DPH.

There is no specific treatment for EEE. Antibiotics are not effective against viruses, and no effective anti-viral drugs have been discovered. Severe illnesses are treated by supportive therapy, which may include hospitalization, respiratory support, IV fluids, and prevention of other infections. It takes 4-10 days after the bite of an infected mosquito to develop symptoms of EEE.

The management of mosquitoes in Connecticut is a collaborative effort involving the Department of Energy and Environmental Protection, the Connecticut Agricultural Experiment Station, and the DPH, together with the Department of Agriculture and the Department of Pathobiology at the University of Connecticut. These agencies are responsible for monitoring and managing the state's mosquito population levels to reduce the potential public health threat of mosquito-borne diseases.

Information on what can be done to prevent getting bitten by mosquitoes and the latest mosquito test results and human infections is available online.  [Byline: Rich Kirby]
===========================
[This has been an active year for EEE virus transmission in the eastern USA from the upper Midwest to the northeastern states and south to Florida. Although historically, EEE human cases in Connecticut have been very rare, the occurrence of a human case in the state this year (2019) is not surprising. There have been equine and/or human EEE cases this summer (2019) in the 3 bordering states: Rhode Island, Massachusetts, and New York. Interestingly, pheasants are mentioned in the above report. They are susceptible and, after being infected with the virus from the bite of an EEE-carrying mosquito, become ill or moribund with viremia titers that can reach 10^9 per ml. Ill or moribund pheasant can be attacked and cannibalized by pen mates that, in turn, are infected orally and may become ill and die as well. As the above report cautions, the only way to avoid infection is for people to avoid mosquito bites. Although the incidence of EEE cases and virus-positive mosquitoes may be declining, there is a risk of infection until the 1st killing frost occurs in autumn, when the mosquitoes are no longer active. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Connecticut, United States: <http://healthmap.org/promed/p/210>]
Date: Wed 11 Sep 2019
Source: BBC Afrique [In French, trans. Mod.LXL, edited]

At least 18 people died in 10 days after eating pesticide-contaminated food in 2 localities in Burkina Faso. A dozen still remain under observation in hospitals, according to the Minister of Health.  The 1st cases were reported on [1 Sep 2019] in the town of Didyr in the centre-west of the country, said Professor Claudine Lougue, Minister of Health.  About 15 members of the same families felt unwell after eating local dishes made from bean leaves and small millet seeds, which are actually seed remains. Thirteen died later despite medical care.

On Monday [2 Sep 2019], the ministry received another alert, this time from the central-eastern region. Here again, 14 people from the same family were admitted to the health centres. Five have lost their lives. After analysis, doctors diagnosed massive food poisoning, said the minister. Complementary examinations incriminate pesticides, she said.  "Investigations have been made on samples of biological products such as blood and urine, and we found an unusually high level of pesticides in foods that were consumed. There was an abnormally high level of pesticides, and these pesticides were strongly incriminated," said the minister.

The remains of food have been secured, announced Professor Lougue, who calls on citizens to observe strict hygiene measures in the use of plant leaves for consumption. Pesticides are used for the needs of field work, especially in the countryside during this period of wintering.
Date: Wed, 18 Sep 2019 16:44:19 +0200 (METDST)

London, Sept 18, 2019 (AFP) - British Airways pilots on Wednesday cancelled a strike that had been due September 27, the British Airline Pilots Association union said after two walkouts last week that cost the company dear.   "Someone has to take the initiative to sort out this (pay) dispute and with no sign of that from BA the pilots have decided to take the responsible course," BALPA General Secretary Brian Strutton said in a statement.    The union chief added that the airline's "passengers rightly expect BA and its pilots to resolve their issues without disruption and now is the time for cool heads and pragmatism to be brought to bear.    "I hope BA and its owner IAG show as much responsibility as the pilots," he added.   It was now "time for a period of reflection before the dispute escalates further and irreparable damage is done to the (BA) brand."

However the union added that should the airline "refuse meaningful new negotiations, BALPA retains the right to announce further strike dates".   British Airways, which likes to call itself "the world's favourite airline", flew into turbulence last week as pilots staged a costly and historic two-day strike, tarnishing its global reputation according to aviation analysts.   Pilots walked out for the first time in the company's 100-year history, sparked by a bitter and long-running feud over pay.   BA faced the embarrassment of grounding its entire UK fleet on September 9 and 10, causing the cancellation of about 1,600 flights.   The move sparked travel chaos for about 200,000 passengers who had been due to fly in and out of London's Gatwick and Heathrow airports.

The disruption continued into September 11 because half of BA's 300 aircraft and more than 700 pilots were mostly in the wrong place.   As a result, BA was forced to cancel approximately ten percent of its daily 850 flights in and out of Britain that day.    BALPA and its members are demanding a bigger share of British Airways profits.   The airline has offered a salary increase of 11.5 percent over three years, which it argues would boost the annual pay of some captains to £200,000 ($250,000 or 226,000 euros).   However, the union has rejected the proposal made in July.   BALPA meanwhile estimates that last week's 48-hour strike cost the airline £80 million.   BA is owned by IAG, which was formed in 2011 with the merger of British Airways and Spain's Iberia. IAG has since added other carriers, including Austria's Vueling and Ireland's Aer Lingus.
Date: Wed, 18 Sep 2019 12:26:37 +0200 (METDST)
By Sam Reeves

Kuala Lumpur, Sept 18, 2019 (AFP) - Toxic haze from Indonesian forest fires closed schools and airports across the country and in neighbouring Malaysia Wednesday, while air quality worsened in Singapore just days before the city's Formula One motor race.   Illegal fires to clear land for agriculture are blazing out of control on Sumatra and Borneo islands, with Jakarta deploying thousands of security forces and water-bombing aircraft to tackle them.

Indonesian blazes belch smog across Southeast Asia annually, but this year's are the worst since 2015 and have added to concerns about wildfire outbreaks worldwide exacerbating global warming.   On Wednesday, air quality deteriorated to "very unhealthy" levels on an official index in many parts of peninsular Malaysia, to the east of Sumatra, with the Kuala Lumpur skyline shrouded by dense smog.    Nearly 1,500 schools were closed across Malaysia due to the air pollution, with over one million pupils affected, according to the education ministry.

A growing number of Malaysians were suffering health problems due to the haze, with authorities saying there had been a sharp increase in outpatients at government hospitals -- many suffering dry and itchy eyes.   Indonesian authorities said hundreds of schools in hard-hit Riau province on Sumatra were shut, without providing a precise number, while about 1,300 were closed in Central Kalimantan province on Borneo.    Borneo is shared between Indonesia, Malaysia and Brunei.   Poor visibility closed seven airports in the Indonesian part of Borneo, the transport ministry in Jakarta said. Scores of flights have already been diverted and cancelled in the region in recent days due to the smog.

- Singapore smog race? -
Air quality in Singapore worsened to unhealthy levels and a white smog obscured the striking waterfront skyline, featuring the Marina Bay Sands casino resort with its three towers and boat-shaped top level.    The worsening pollution increased fears that this weekend's Formula One race may be affected. Organisers say the possibility of haze is one of the issues in their contingency plan for Sunday's showpiece night race, but have not given further details.

The city-state's tourism board said spectators would be able to buy masks as protection from the haze if conditions did not improve and assistance would be provided for those who feel unwell, the Today news portal reported.   The fires have sparked tensions between Indonesia and Malaysia.    Indonesia's environment minister initially suggested the haze was from Malaysian fires despite satellite data showing hundreds of blazes in Indonesia and only a handful in its neighbour, prompting anger from her Malaysian counterpart.

Indonesia later sealed off dozens of plantations where it said fires were blazing, including some owned by Malaysia-based firms, deepening the row.   But Prime Minister Mahathir Mohamad, who has struck a diplomatic tone throughout the crisis, said Malaysia may pass legislation forcing its companies to tackle fires on plantations abroad.   Malaysia wants its firms with sites overseas to put out blazes contributing to the haze, he said, adding: "Of course, if we find they are unwilling to take action, we may have to pass a law to make them responsible."

The Indonesian government has insisted it is doing all it can to fight the blazes. But this year's fires have been worsened by dry weather and experts believe there is little chance of them being extinguished until the onset of the rainy season in October.   Indonesia's meteorology, climate and geophysics agency said Wednesday that over 1,000 hotspots -- areas of intense heat detected by satellite that indicate a likely fire -- had been sighted, most of them on Sumatra.
Date: Wed, 18 Sep 2019 12:14:44 +0200 (METDST)
By Aishwarya KUMAR

New Delhi, Sept 18, 2019 (AFP) - India announced on Wednesday a ban on the sale of electronic cigarettes, as a backlash gathers pace worldwide due to health concerns about a product promoted as less harmful than smoking tobacco.   The Indian announcement, also outlawing production, import and distribution, came a day after New York became the second US state to ban flavoured e-cigarettes following a string of vaping-linked deaths.   "The decision was made keeping in mind the impact that e-cigarettes have on the youth of today," Finance Minister Nirmala Sitharaman told reporters in New Delhi.

E-cigarettes do not "burn" but instead heat up a liquid -- tasting of everything from bourbon to bubble gum and which usually contains nicotine -- that turns into vapour and is inhaled.   The vapour is missing the estimated 7,000 chemicals in tobacco smoke but does contain a number of substances that could potentially be harmful.   They have been pushed by producers, and also by some governments including in Britain, as a safer alternative to traditional smoking -- and as a way to kick the habit.

However critics say that apart from being harmful in themselves, the flavours of e-cigarette liquids appeal particularly to children and risk getting them addicted to nicotine.   Some 3.6 million middle and high school students in the United States used vaping products in 2018, an increase of 1.5 million on the year before.   The New York emergency legislation followed an outbreak of severe pulmonary disease that has killed seven people and sickened hundreds.   President Donald Trump's administration announced last week that it would soon ban flavoured e-cigarette products to stem a rising tide of youth users.

- Big E-Tobacco -
Although few Indians vape at present, the Indian ban also cuts off a vast potential market of 1.3 billion consumers for makers of e-cigarettes.   Tobacco firms have been investing heavily in the technology to compensate for falling demand for cigarettes due to high taxes and public smoking bans, particularly in the West.

In 2018 Altria, the US maker of brands such as Marlboro and Chesterfield, splashed out almost $13 billion on a stake in one of the biggest e-cigarette makers, Juul.   A few Indian states have already banned e-cigarettes although the restrictions have been ineffective since online sale of vaping products continue.   The new ban does not cover traditional tobacco products in India.   According to the World Health Organization, India is the world's second-largest consumer of tobacco products, killing nearly 900,000 people every year.

Nearly 275 million people over 15, or 35 percent of adults, are users, although chewing tobacco -- which also causes cancer -- is more prevalent than smoking.   India is also the world's third--largest producer of tobacco, the WHO says, and tobacco farmers are an important vote bank for political parties.   According to the Associated Chambers of Commerce and Industry, an estimated 45.7 million people depend on the tobacco sector in India for their livelihood.   Tobacco is also a major Indian export, and the government holds substantial stakes, directly or indirectly, in tobacco firms including in ITC, one of India's biggest companies.
Date: Wed, 18 Sep 2019 03:56:31 +0200 (METDST)

Washington, Sept 18, 2019 (AFP) - Hurricane Humberto strengthened to a major Category 3 storm on Tuesday and was expected to pass near Bermuda, threatening it with dangerous waves and heavy rain, the US National Hurricane Center said.   "Hurricane conditions are expected to reach Bermuda by Wednesday night and continue into early Thursday morning," the Miami-based NHC said.   "Some fluctuations in intensity are likely during the next day or so, but Humberto should remain a powerful hurricane through Thursday," it said.   As of 8:00 pm (0000 GMT), the storm had maximum sustained winds of 115 miles per hour (185 kilometers per hour) and was moving east-northeast at 12 miles per hour.
Date: Wed, 18 Sep 2019 01:36:21 +0200 (METDST)

Dakar, Sept 17, 2019 (AFP) - Four people died after a boat carrying dozens of tourists capsized during heavy storms in Senegal, authorities and emergency services said Tuesday.   The death toll could rise as three passengers were said to be missing after the accident.  The boat was carrying several Senegalese nationals, six French people, two Germans, two Swedes and one person from Guinea-Bissau, when it turned over Monday in driving rain and a heavy swell, fire department chief Papa Angel Michel Diatta said.   All the dead were Senegalese, officials and emergency services said.

Two worked in a national park, one was a woman and the other victim was a child, Diatta said.   The boat was heading for the Madeleine islands, site of an offshore national park popular with tourists who travel from Dakar, coastal capital of the West African country.   Senegalese President Macky Sall appealed for "greater caution and respect for existing security norms duing the rainy season" in a tweet.

Emergency services continued to look for those missing on Tuesday. AFP journalists saw a dozen divers at the scene. Distressed families were waiting on the shore to get news of their loved ones.    "The gendarmerie called us at 5:00 am (GMT and local time). My brother was on the boat. The worst thing is not knowing," said Aminata Diop, who was among the relatives on the beach.   There are "four dead bodies and between three and four people are missing. Thirty-five people were on the boat. Search and rescue operations are continuing this morning," Interior Minister Aly Ngouille Ndiaye told AFP by telephone.

The causes of the accident were unclear. The interior minister told Senegalese media overnight that several tourists were worried about the heavy rains and wanted to return to the pier but others wanted to stay on the boat.   The survivors spent the night on the island, Ndiaye told local radio on Tuesday. Blankets and food were sent to them and they were to be ferried back to the mainland in the morning, he added.   The rainy season arrived late this year and heavy storms have resulted in several casualties this month.    Two fishermen were killed on their canoe in the same area nearly two weeks ago.
Date: Tue, 17 Sep 2019 15:38:37 +0200 (METDST)

Jakarta, Sept 17, 2019 (AFP) - Massive forest fires in Indonesia that have caused a toxic haze to spread as far as Singapore and peninsular Malaysia are also seriously affecting endangered orangutans and their habitat, a rescue foundation said Tuesday.   Jakarta has deployed thousands of troops as temporary fireman and deployed dozens of water-bombing aircraft to battle blazes that are turning pristine forest into charred landscape in Sumatra and Borneo islands.   The fires -- usually started by illegal burning to clear land for farming -- have unleashed a choking haze across parts of southeast Asia.

The Borneo Orangutan Survival Foundation said Tuesday that the haze was affecting hundreds of great apes in its care at rescue centres and wildlife re-introduction shelters.   "The thick smoke does not only endanger the health of our staff... but also it affects the 355 orangutans we currently care for", the foundation said in a statement, referring to just once cetre in Kalimantan   "As many as 37 young orangutans are suspected to have contracted a mild respiratory infection," it added.   Conditions were so bad at their Samboja Lestari facility in East Kalimantan that outdoor activities for the animals had been restricted to a few hours a day.

Orangutans have been particularly vulnerable to commercial land clearances and have seen their natural habitat shrink dramatically in the last few decades.   The population of orangutan in Borneo has plummeted from about 288,500 in 1973 to about 100,000 today, according to the International Union for Conservation of Nature.   The toxic smoke caused by the forest fires is an annual problem for Indonesia and its neighbours, but has been worsened this year by particularly dry weather.   On Borneo island, which Indonesia shares with Malaysia and Brunei, pollution levels were "hazardous", according to environment ministry data.   Hundreds of schools across Indonesia and Malaysia were shut.