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Greece

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

Travel News Headlines WORLD NEWS

6th December, 2019
HSE Health Protection Surveillance Centre

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Panama - US Consular Information Sheet
June 05, 2008
COUNTRY DESCRIPTION: Panama has a developing economy. Outside the Panama City area, which has many first-class hotels and restaurants, tourist facilities vary in quality. The U.S. dollar is t
e paper currency of Panama, and is also referred to as the Panama balboa. Panama mints its own coinage. Read the Department of State Background Note on Panama for additional information.

ENTRY/EXIT REQUIREMENTS: U.S. citizens traveling by air to and from Panama must present a valid passport when entering or re-entering the United States. Sea travelers must have a valid U.S. passport (or other original proof of U.S. citizenship, such as a certified U.S. birth certificate with a government-issued photo ID). American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on applying for a passport.

Panamanian law requires that travelers must either purchase a tourist card from the airline serving Panama or obtain a visa from a Panamanian embassy or consulate before traveling to Panama. Further information may be obtained from the Embassy of Panama, 2862 McGill Terrace NW, Washington, DC 20009, tel. (202) 483-1407, or the Panamanian consulates in Atlanta, Boston, Chicago, Honolulu, Houston, Los Angeles, Miami, New Orleans, New York, Philadelphia, San Juan, San Diego, San Francisco or Tampa.

U.S. citizens transiting the Panama Canal as passengers do not need to obtain visas, report to customs, or pay any fees. U.S. citizens piloting private craft through the canal should contact the Panama Canal Authority at 011-507-272-1111 or consult the canal’s web page at http://www.pancanal.com.

In an effort to prevent international child abduction, many governments have initiated procedures at entry/exit points. These often include requiring documentary evidence of relationship and permission for the child's travel from the parent(s) or legal guardian not present. Having such documentation on hand, even if not required, may facilitate entry/departure.

Panamanian law requires all persons to carry official identification documents at all times. This law applies to both Panamanian citizens and visitors to the country. Due to an increase in illegal aliens in Panama, the police have been checking documents more frequently, resulting in the detention of people not carrying identification. For this reason, all Americans are encouraged to carry their passports or other official identification at all times.

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.

Visit the Embassy of Panama web site at http://www.embassyofpanama.org/cms/index4.phpfor the most current visa information.

SAFETY AND SECURITY: U.S. citizens are warned not to travel to Darien Province. Embassy personnel are only allowed to travel to Darien Province on official business with prior approval of the Embassy’s Regional Security Officer. This restricted area encompasses the Darien National Park as well as privately owned nature reserves and tourist resorts. While no incidents have occurred at these resorts, U.S. citizens, other foreign nationals and Panamanian citizens have been the victims of violent crime, kidnapping and murder in this general area. Reliable communications and medical infrastructure are not readily available in the region, which makes travel therein potentially hazardous. Moreover, all around the Panama-Colombia border area the presence of Colombian terrorist groups, drug traffickers and other criminals is common, increasing the danger to travelers. Note: The Secretary of State has designated the Revolutionary Armed Forces of Colombia (FARC), the National Liberation Army (ELN) and the United Self-Defense Forces of Colombia (AUC) as Foreign Terrorist Organizations.

There is increasing evidence that the Revolutionary Armed Forced of Colombia (FARC), a designated foreign terrorist organization, has increased its operations in Panama’s Darien Province, including in areas far removed from the immediate vicinity of Panamanian-Colombian border. In February 2008 encounters between six FARC members and the Panamanian police near the city of Jaque resulted in the arrest of the FARC members.

From time to time, there may be demonstrations protesting internal Panamanian issues, or manifestations of anti-American sentiment by small but vociferous groups. While most demonstrations relate to labor disputes or other local issues and are typically non-violent, it is nonetheless a good security practice to avoid demonstrations. U.S. citizens are advised to exercise caution on the campus of the University of Panama, where members of radical, anti-U.S. student groups are active. For updated security information, contact the U.S. Embassy Consular Section at the address below.

Visitors should be cautious when swimming or wading at the beach. Some beaches, especially those on the Pacific Ocean, have dangerous currents that cause drowning deaths every year. These beaches are seldom posted with warning signs.

On the Pacific coast, boaters should be wary of vessels that may be transporting narcotics northward from Colombia. Special permission is needed from the Ministry of Government and Justice and the National Environment Authority to visit the National Park on Coiba Island. At this time, the island, a former penal colony, has fewer than 20 prisoners. Boaters should avoid the southeastern coast of Kuna Yala Comarca (San Blas Islands), south of Punta Carreto, on the Atlantic Coast.

Local maritime search and rescue capabilities are limited and well below U.S. standards.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

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

CRIME: Crime in Panama City is moderate but increasing, particularly because of the activities of youth gangs. The city of Colon is a high crime area. Police checkpoints have become commonplace on weekends on roads in both cities. Based upon reported incidents by local police, the high-crime areas around Panama City are San Miguelito, Rio Abajo, El Chorrillo, Ancon, Curundu, Veracruz Beach, Panama Viejo, and the Madden Dam overlook. Crimes there are typical of those that plague metropolitan areas and range from rapes to armed robberies, muggings, purse-snatchings, "express kidnappings" from ATM banking facilities, in which the victim is briefly kidnapped and robbed after withdrawing cash from an ATM, and petty theft. Tourists recently experienced a problem with armed bandits during an organized canoe trip on the Chagres River. There have been several targeted kidnappings, including in Panama City, one of which involved a U.S. citizen, and one which involved the complicity of corrupt law enforcement officials. If concerned for their safety when being stopped by Panamanian law enforcement, U.S. citizens should consider slowing down and turning on their hazard lights, acknowledging the request to stop, and proceeding deliberately to a safe public place at which to stop.

Panama City has a curfew for persons under 18 years of age. Under the law, students attending night classes must have a carnet or permit, issued by the school or, if employed, a Certificate of Employment. Minors who are picked up for a curfew violation are subject to detention at a police station until parents or legal guardians can arrange for them to be released into their custody. Parents or legal guardians may be fined up to U.S. $50.00 for the violation.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. The Panamanian Government also sponsors a program for Assistance to Victims of Crimes. The program is managed by the Oficina de Asistencia a Víctimas de Crímenes, located at the Policia Tecnica Judicial in the Ancon area of Panama City, telephone number is 011-507-262-1973 or 011-507-512-2222.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Although Panama City has some very good hospitals and clinics, medical facilities outside of the capital are limited. When making a decision regarding health insurance, Americans should consider that many foreign doctors and hospitals require payment in cash prior to providing service and that a medical evacuation to the U.S. may cost well in excess of $50,000. Uninsured travelers who require medical care overseas often face extreme difficulties, whereas travelers who have purchased overseas medical insurance have, when a medical emergency occurs, found it to be life-saving. Some insurance policies also include coverage for psychiatric treatment and for disposition of remains in the event of death. In Panama, most hospitals accept credit cards for hospital charges, but not for doctors' fees.

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

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Panama is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Panama's roads, traffic and transportation systems are generally safe, but traffic lights often do not exist, even at busy intersections. Driving is often hazardous and demanding due to dense traffic, undisciplined driving habits, poorly maintained streets, and a lack of effective signs and traffic signals. On roads where poor lighting and driving conditions prevail, night driving is difficult and should be approached with caution. Night driving is particularly hazardous on the old Panama City – Colon highway.

Buses and taxis are not always maintained in a safe operating condition due to lack of regulatory enforcement. Auto insurance is not mandatory and many drivers are uninsured. If an accident occurs, the law requires that the vehicles remain in place until a police officer responds to investigate. Traffic in Panama moves on the right, as in the U.S., and Panamanian law requires that drivers and passengers wear seat belts.

Flooding during the April to December rainy season occasionally makes city streets impassible and washes out some roads in the interior of the country. In addition, rural areas are often poorly maintained and lack illumination at night. Such roads are generally less traveled and the availability of emergency roadside assistance is very limited. Road travel is more dangerous during the rainy season and in the interior from Carnival through Good Friday. Carnival starts the Saturday prior to Ash Wednesday and goes on for four days.

Traveling on the Pan American Highway: There is often construction at night on Panama's main Pan American highway. There are few signs alerting drivers to such construction and the highway is not well lit at night. When traveling on the highway, travelers should be aware of possible roadblocks. The Pan American Highway ends at Yaviza in the Darien Province of Panama and does not go through to Colombia. The paved portion of the road ends at Santa Fe, with all-weather surface through Canglón. Travelers going to South America by car may wish to ship their cars on a freighter.

Please refer to our Road Safety page for more information. Visit the web site of the country’s national tourist office at http://www.ipat.gob.pa/ and the national authority responsible for road safety at http://www.mop.gob.pa/default0.asp.

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

SPECIAL CIRCUMSTANCES: Panamanian customs authorities may enforce strict regulations concerning temporary importation into or export from Panama of items such as firearms and ammunition, cultural property, endangered wildlife species, narcotics, biological material, and food products. It is advisable to contact the Embassy of Panama in Washington or one of Panama's consulates in the United States for specific information regarding customs requirements. In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines. Please see our Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Panamanian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Panama 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 Panama are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Panama. Americans withoutInternet 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 and U.S. Consular Section are located in Avenida Demetrio Basilio Lakas, Building No.783 in the Clayton section of Panama City. The international mailing address is: Apartado 0816-02561, Zona 5, Panama, Republic of Panama.

The U.S. mailing address is U.S. Embassy Panama, Department of State, Washington, DC 20521-9100. The telephone numbers for the Embassy are 011-507-207-7000, or for after-hours emergencies, 011-507-207-7200; Consular Section 011-507-207-7030 and fax 011-507-207-7278 or 011-507-207-7303. The Embassy web site is http://panama.usembassy.gov/. E-mail inquiries may be addressed to Panama-ACS@state.gov.
* * *
This replaces the Country Specific Information for Panama dated December 2007, to update sections on Security and Information for Victims of Crimes.

Travel News Headlines WORLD NEWS

Date: Tue 25 Jun 2019 10:30 EST
Source: La Prensa [in Spanish trans. Mod.TY, edited]

The Ministry of Health (MINSA) reported this [Tue 25 Jun 2019] 5 cases of equine encephalitis in Darien province. The Minister of Health Designate, Rosario Turner, explained that they are dealing with children.

Meanwhile, the current Minister of this office, Miguel Mayo, signalled that now it is being determined if they are dealing with Venezuelan equine encephalitis or eastern equine encephalitis, since both have circulated in Panama.

Mayo added that currently the patients are being treated in the Hospital del Nino Jose Renan Esquivel and that the ministry will provide more details of these cases in the coming hours.

The disease, transmitted by the bite of infected _Culex_ mosquitoes, attacks the nervous system causing disorientation, reduction in reflexes and movement of arms and legs. The usual hosts are horses and humans.  [Byline: Urania Cecilia Molina]
========================
[This is not the 1st time there have been human cases of encephalitis caused by both Venezuelan equine encephalitis (VEE) and eastern equine encephalitis (EEE) in Darien province of Panama. As noted earlier, both viruses occur in Panama. The case fatality rate for humans infected with VEEV is relatively low -- less than 1 percent, whereas it is much higher in individuals with neurological disease from EEEV infections. Children are more severely affected by VEEV infection than adults.

If VEE virus infection in these children is confirmed, it would be of interest to know which VEEV subtype is involved in these cases, as subtype IAB or IC can cause massive equine epizootics over wide geographic areas with spillover to many humans. Subtype ID usually causes a few sporadic human cases (see ProMED-mail archive no. http://promedmail.org/post/20100617.2034). The results of confirmation of the virus involved in these cases is awaited with interest. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Panama:
Date: Mon, 13 May 2019 06:50:44 +0200

Panama City, May 13, 2019 (AFP) - A 6.1-magnitude earthquake hit Panama on Sunday, injuring at least five people and causing damage to businesses and homes, officials said.   The strong quake struck at a depth of 37 kilometers (23 miles) in the far west of the country near the Costa Rican border, according to the US Geological Survey.

It was followed by a smaller 5.4-magnitude quake in Colon province, on central Panama's Caribbean coast, according to the country's National Civil Protection System (Sinaproc).   Five people were injured in the first quake, which hit 22 km from the town of Puerto Armuelles, said Sinaproc.   Four homes were damaged, including two that collapsed, it said.

President Juan Carlos Varela had said on Twitter earlier that just one person was hurt, in Puerto Armuelles.    He reported damage to homes and businesses in the Central American nation.   School classes were suspended for Monday in Baru district, where the first quake struck.   There was no tsunami alert issued from the Pacific Tsunami Warning Center.

The second quake occurred late Sunday and was not related to the afternoon quake near Puerto Armuelles, Sinaproc said.   So far no damage has been reported from the second quake, it added.   In November 2017 a 6.5-magnitude quake on the Pacific coast of Costa Rica left buildings swaying in the capital San Jose and contributed to the deaths of two people who had heart attacks.   Further north, two months earlier in September 2017 a 7.1-magnitude earthquake killed more than 300 people in Mexico.
Date: Fri 4 Jan 2019
Source: WHO Emergencies preparedness response [edited]

The Panama Ministry of Health has reported an increase in cases of hantavirus infection in Los Santos Province, Republic of Panama, to the Pan American Health Organization/World Health Organization (PAHO/WHO). Between 1 Jan - 22 Dec 2018, a total of 103 confirmed cases of hantavirus [infections] have been reported at the national level, 99 of which were reported in Los Santos Province. In Los Santos Province, 51 cases were classified as hantavirus fever (HF) without pulmonary syndrome, and 48 cases were classified as hantavirus pulmonary syndrome (HPS), including 4 deaths.

Of the 51 HF cases, 41 percent were female, 55 percent aged between 20-59 years, with 76 percent occurring between June 2018 and November 2018.

Of the 48 HPS cases, 56 percent were female, 67 percent aged between 20-59 years, with more than half of the cases occurring in February 2018 (17 percent) and between June 2018 and September 2018 (42 percent).

Of HPS cases, 4 deaths were reported (2 female, 2 male, all aged over 60 years).

Cases were confirmed by serology and polymerase chain reaction (PCR). Sequencing determined that the type of virus associated with this outbreak is Choclo virus. It was 1st isolated in 1999 in the western Republic of Panama.

Hantavirus cases have been reported in the Republic of Panama since 1999 (Figure 1). In the last 5 years, transmission has been documented in Los Santos, Herrera, Veraguas, and Cocle provinces. During 2018, cases have been reported in Los Santos (99 cases, Figure 2), Herrera (2 cases), Cocle (one case) and Veraguas (one case) provinces (Figure 3). Since the reservoir for hantavirus is sylvatic rodents and transmission can occur when people come in contact with rodent habitats, the current increase in hantavirus cases in the Republic of Panama could be related to changes in the abundance and distribution of rodent species, as well as strengthened surveillance and laboratory capacity at the provincial level. Environmental and ecological factors affecting rodent populations can have a seasonal impact on disease trends.

Figure 1 [graph]. Distribution of HF and HPS cases by year, Republic of Panama, 1999-2018 (as of November 2018).
Figure 2 [graph]. Distribution of confirmed hantavirus [infection] cases by epidemiological week, Los Santos Province, Republic of Panama, January-December 2018.
Figure 3 [map]. Geographical distribution of confirmed hantavirus [infection] cases, Republic of Panama, January-November 2018.

Public health response

The public health responses currently being implemented include:
- Investigation and monitoring of cases, including case management.
- Enhanced surveillance and active case finding.
- Rodent control and mitigation measures.
- Increasing awareness and health promotion in the affected areas.

WHO risk assessment
------
HPS is a zoonotic, viral respiratory disease. The causative agent belongs to the genus _Hantavirus_, family Bunyaviridae. Infections are acquired primarily through inhalation of aerosols or contact with the excreta, droppings or saliva of infected rodents. Cases of human hantavirus infection usually occur in rural areas (forests, fields, farms, etc.), where rodents hosting the virus might be found. Infected individuals may experience headache, dizziness, chills, fever and myalgia. They may also experience gastrointestinal (GI) symptoms including nausea, vomiting, abdominal pains, and diarrhoea, followed by sudden onset of respiratory distress and hypotension. Symptoms of HPS typically occur from 2-4 weeks after initial exposure, though symptoms may appear as early as one week to as late as 8 weeks following exposure. The case fatality rate can reach 50 percent.

In the Americas, HPS cases have been reported in several countries. In January 2019, World Youth Day will be hosted in the Republic of Panama. This mass gathering will take place predominantly in Panama City, while side events will occur in other provinces. Though a seasonal increase of hantavirus during the month of January has not been previously documented, increases in cases have been related to outdoor and agricultural activities in rural environments. Nevertheless, participants to the World Youth Day should be provided with recommendations and guidance on how to take appropriate precautionary measures to reduce their risk of infection. Health awareness campaigns for health personnel and the general public are planned for the coming weeks. Organisers and public health authorities should collaborate with travel and tourism sectors in placing educational materials and appropriate signage at strategic locations and points of entry (e.g. airports, public transport stations, travel agent offices). Alternative forms of media including public service announcements on planes, ships and public radio should also be considered.

Based on current epidemiological data and public health response, WHO's risk assessment is that there is no significant risk of international spread of HPS in relation to this event.

WHO advice

PAHO/WHO recommends that Member States continue efforts of detection, investigation, reporting, and case management for the prevention and control of infections caused by hantavirus.

Particular attention should be paid to travellers returning from the affected areas, who are advised to report their travel history, as early identification and timely medical care can improve clinical outcomes.

Care during the initial stages of the illness should include antipyretics and analgesics as needed. In some situations, patients should receive broad-spectrum antibiotics while confirming the etiologic agent. Given the rapid progression of HPS, clinical management should focus on the patient's haemodynamic monitoring, fluid management, and ventilation support. Severe cases should be immediately transferred to intensive care units (ICUs).

Health awareness campaigns should aim to increase detection and timely treatment of the illness and prevent its occurrence by reducing people's contact with rodents. Preventive measures should cover occupational and eco-tourism related hazards. While most usual tourism activities pose little or no risk of exposing travellers to rodents or their excreta, people who engage in outdoor activities such as camping or hiking should take precautions to reduce possible exposure to potentially infectious materials.

HPS surveillance should be part of a comprehensive national surveillance system and must include clinical, laboratory and environmental components. WHO recommends the implementation of integrated environmental management, with the goal of reducing rodent populations. Throughout the World Youth Day event, syndromic surveillance may alert public authorities to increased influenza-like and GI symptoms among mass gathering participants.

At this time, WHO does not recommend any restrictions on travel and/or trade to the Republic of Panama based on available information for the current hantavirus outbreak.

References:
- Pan American Health Organization/World Health Organization (PAHO/WHO). Epidemiological Alert Hantavirus Pulmonary Syndrome (HPS). 17 Oct 2013.
- Hantavirus in the Americas: Guidelines for diagnosis, treatment, prevention and control.
- Hantavirus information: Centers for Disease Control and Prevention (CDC)

[Footnotes]
Hantavirus fever (HF): Cases who present with fever, myalgia, headache, gastrointestinal symptoms, and weakness. This case definition is used for epidemiological surveillance purposes to detect patients potentially exposed to the virus. Source: Guide for Hantavirus Disease Management in Republic of Panama, Gorgas Memorial Institute, Panama Ministry of Health.

Hantavirus pulmonary syndrome (HPS): Cases who present with cardio-respiratory symptoms, classified as mild, moderate, or severe. Source: Guide for Hantavirus Disease Management in Republic of Panama, Gorgas Memorial Institute, Panama Ministry of Health.

National Reference Laboratory, Gorgas Memorial Institute,

World Youth Day Panama 2019. (<https://bit.ly/2KdmDxT>)

For the last 5 World Youth Day events (2016 in Krakow, Poland; 2013 in Rio de Janeiro, Brazil; 2011 in Madrid, Spain; 2008 in Sydney, Australia; and 2005 in Cologne, Germany), the range in the number of attendees was 500 000 in Australia (<https://bit.ly/2rXptP1>) to 3,700,000 in Brazil (<https://bit.ly/2EVxs77>).
====================
[Although ProMED-mail has reported most of the cases of hantavirus infections in Panama during 2018, this WHO summary and the graphs and map may be of interest to subscribers and other readers. It is helpful to note that laboratory diagnosis has been carried out by the Gorgas Memorial Laboratory, the national reference laboratory in Panama. The methods used for diagnosis are mentioned in this report. Interestingly, Choclo is the hantavirus identified in these cases, based on genomic sequence analysis. Curiously, Choclo virus is never mentioned in the popular press reports that come to ProMED-mail from Panama. It is reassuring to know that the virus responsible for these cases, or at least the ones for which samples and diagnostic testing was done, confirm the ProMED conclusion that Chocolo virus was involved. Earlier, Dr. Jan Clement suggested that Seoul hantavirus might be involved in some of the cases in the Americas including Panama. Presumably, genomic analysis by the Gorgas Lab would have detected this virus. Nonetheless, diagnostic laboratories should be aware of this possibility and look for it.

The WHO report indicates that rodents are the reservoir hosts of Choclo virus but does not specify which rodents play that role. The rodent host of Choclo virus is the pygmy rice rat (_Oligoryzomys fulvescens_), a photograph of which can be accessed at <http://www.medwave.cl/medios/perspectivas/Hantavirus/Actualiz/Fig2.jpg>. These rodents live in and around agricultural areas and adjacent houses and buildings. They can be persistently infected with the virus and shed it in urine, feces, and saliva, the source of human infections.

Map of Panama: <http://www.lib.utexas.edu/maps/americas/panama.jpg>. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Mon 2 Jul 2018
Source: La Prensa [in Spanish trans. Mod.TY, edited]

A 9-year-old child, resident of Cambutal de Tonosi, a victim of hantavirus cardiopulmonary syndrome, was moved early this morning, 2 Jul 2018, to the Children's Hospital in the capital city.  The Los Santos regional epidemiology coordinator, Carlos Munoz, stated that as of this Monday morning [2 Jul 2018], the number of cases of hantavirus [infection] is 40.

Munoz indicated that the child was moved because in the area there is no intensive care unit that attends children. He stated that in the month of June [2018], 11 cases of the disease were diagnosed. He added that this month [July 2018] more cases were added.  The Tonosi district has reported 27 cases so far in 2018.  [Byline: Vielka Corro Rios]
==================
[The number of cases of hantavirus infection continues to increase in Los Santos province. Hantavirus infections occur in Los Santos province relatively frequently. The specific situation in which the above patient might have acquired the infection is not mentioned.

There is no indication of which hantavirus is involved in this or in previous cases in Panama. However, as noted in comments in previous posts, Los Santos and adjoining provinces are endemic for Choclo hantavirus. Although no data on this or the previous cases in earlier years include an indication of which hantavirus is responsible, Choclo is the only one of the 3 hantaviruses known to be endemic in Panama that causes HPS (hantavirus cardiopulmonary syndrome) or hantavirus fever. No vaccine is available for Choclo virus.

The rodent host of Choclo virus is the pygmy rice rat (_Oligoryzomys fulvescens_), a photograph of which can be accessed at <http://www.medwave.cl/medios/perspectivas/Hantavirus/Actualiz/Fig2.jpg>. These rodents live in and around agricultural areas and adjacent houses and buildings. They can be persistently infected with the virus and shed it in urine, faeces and saliva, the source of human infections. - ProMED Mod.TY]

[Maps of Panama:

HealthMap/ProMED map available at:
Date: Tue 26 Jun 2018, 10:20 AM
Source: La Prensa [in Spanish, trans., ProMED Mod.TY, edited]
<https://www.prensa.com/provincias/Reportan-nuevos-casos-virus-Santos_0_5062743696.html>

A total of 7 new hantavirus [infection] cases in Los Santos province were reported this [Tue 26 Jun 2018] by health authorities in the province. Delfina Saez, head of Los Santos regional Public Health, indicated that 4 of them remain hospitalized in the Joaquín Pablo Franco Sayas Hospital in Las Tablas. Sa¡ez said that 2 are being attended in intensive care (a 79-year-old woman from La Laguna de Pocra­ and a 73-year-old man from Flores de Tonosa).

The official stated that with these 7 cases the number of people ill from hantavirus [infections] is raised to 38 so far in 2018. She added that with the evident increase in cases of the disease, provincial, local and municipal authorities are involved, as well as rice and corn producers, to seek together new strategies to prevent and promote [measures] in the affected communities and avoid occurrence of new cases. [Byline: Vielka Corro Ríos]
======================
[There is a recent increase in the number of hantavirus infections in Los Santos province. Hantavirus infections occur in Los Santos province relatively frequently. The specific situations in which these patients acquired the infection are not mentioned. There is no indication of which hantavirus is involved in this or in previous cases in Panama.

However, as noted in comments in previous posts, Los Santos and adjoining provinces are endemic for Choclo hantavirus. Although no data on this or the previous cases in earlier years include an indication of which hantavirus is responsible, Choclo is the only one of the 3 hantaviruses known to be endemic in Panama that causes HPS (hantavirus cardiopulmonary syndrome) or hantavirus fever.

No vaccine is available for Choclo virus. The rodent host of Choclo virus is the pygmy rice rat (_Oligoryzomys fulvescens_), a photograph of which can be accessed at <http://www.medwave.cl/medios/perspectivas/Hantavirus/Actualiz/Fig2.jpg>.

These rodents live in and around agricultural areas and adjacent houses and buildings. They can be persistently infected with the virus and shed it in urine, feces and saliva, the source of human infections. - ProMED Mod.TY]
 
[Maps of Panama: <http://www.lib.utexas.edu/maps/americas/panama.jpg>
and <http://healthmap.org/promed/p/41725>]
More ...

Argentina

Irish Diplomatic and Consular Information for Argentina
**********************************************************************
Address:
Embassy of Ireland
Suipacha 1380
2nd Floor
1011 Buenos Aires
Telephone:
+54-1
-4325-8588 / 4325-0849
Fax:
+54-11-4325-7572
Email:

Ambassador:
Her Excellency Paula Ní Shlattara
Secretary:

Jonathan Conlon
***************************************
Argentina - US Consular Information Sheet
October 02, 2008
COUNTRY DESCRIPTION:
Last year, Argentina's charm, natural beauty and diversity attracted more than 400,000 American citizen visitors, and this year's total is expected to be even higher. Buenos Aires and other large cities have well-developed tourist facilities and services, including many four- and five-star hotels. The quality of tourist facilities in smaller towns outside the capital varies. The country suffered a major financial crisis in 2001-2002. While it has made a dramatic recovery, continued economic hardship has been linked to a rise in street crime. Read the Department of State Background Notes on Argentina for additional information.

ENTRY/EXIT REQUIREMENTS: A valid passport is required for U.S. citizens to enter Argentina. U.S. citizens do not need a visa for visits of up to 90 days for tourism and business. U.S. citizens who arrive in Argentina with expired or damaged passports may be refused entry and returned to the United States at their own expense. The U.S. Embassy cannot provide guarantees on behalf of travelers in such situations, and therefore encourages U.S. citizens to ensure their travel documents are valid and in good condition prior to departure from the United States. Different rules apply to U.S. citizens who also have Argentine nationality, depending on their dates of U.S. naturalization. For more information, check the Argentine Ministry of the Interior web site at www.mininterior.gov.ar/migraciones/. Most dual nationals are permitted 60-day visits. Dual nationals who stay beyond their permitted time are required to depart on an Argentine passport.
The application process for an Argentine passport is lengthy, and the U.S. Embassy is not able to provide assistance in obtaining Argentine passports or other local identity documents. Children under 21 years of age who reside in Argentina, regardless of nationality, are required to present a notarized document that certifies both parents' permission for the child's departure from Argentina when the child is traveling alone, with only one parent, or in someone else's custody (click on the "international child abduction" link below for more information). An airport tax is collected upon departure, payable in dollars or Argentine pesos.

American citizens wishing to enter Brazil are required to obtain a visa in advance from the Brazilian Embassy or consulate nearest to the traveler's place of residence. The U.S. Embassy in Buenos Aires cannot assist travelers to obtain Brazilian visas. For more information, see the Country Specific Information for Brazil.
Visit the Embassy of Argentina’s web site at http://www.embassyofargentina.us/ for the most current visa information. Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
Traffic accidents are the primary threat to life and limb in Argentina. Pedestrians and drivers should exercise caution. Drivers frequently ignore traffic laws and vehicles often travel at excessive speeds. The rate and toll of traffic accidents has been a topic of much media attention over the past year. The Institute of Road Safety and Education, a private Buenos Aires organization dedicated to transportation safety issues, reports that Argentina has the highest traffic mortality rate in South America per 100,000 inhabitants.

Care should be exercised when traveling in Brazil and Paraguay, near the Argentine border, where criminal entities are known to operate. These organizations are involved in the trafficking of illicit goods, and some individuals in the area have been designated by the U.S. Treasury Department for financially supporting terrorist organizations.
The U.S. government is supportive of coordinated efforts by Argentina, Brazil, and Paraguay to combat illegal activity in that region. Americans crossing from Argentina into Paraguay or Brazil may wish to consult the most recent Country Specific Information for those countries.

Demonstrations are common in metropolitan Buenos Aires and occur in other major cities as well. Protesters on occasion block streets, highways, and major intersections, causing traffic jams and delaying travel. While demonstrations are usually nonviolent, hooligans in some of the groups sometimes seek confrontation with the police and vandalize private property. Groups occasionally protest in front of the U.S. Embassy and U.S.-affiliated businesses. U.S. citizens should take common-sense precautions and avoid gatherings or any other event where crowds have congregated to protest. Information about the location of possible demonstrations is available from a variety of sources, including the local media. Additional information and advice may be obtained from the U.S. Embassy at the telephone numbers or email address listed at the end of this document.

Domestic flight schedules can be unreliable. Occasional work stoppages, over-scheduling of flights and other technical problems can result in flight delays, cancellations, or missed connections. Consult local media for information about possible strikes or slow-downs before planning travel within Argentina.
Public transportation is generally reliable and safe. The preferred option for travel within Buenos Aires and other major cities is by radio taxi or "remise" (private car with driver). The best way to obtain safe taxis and remises is to call for one or go to an established stand, rather than hailing one on the street. Hotels, restaurants, and other businesses can order remises or radio taxis, or provide phone numbers for such services, upon request. Passengers on buses, trains, and the subway should be alert for pickpockets and should also be aware that these forms of transport are sometimes interrupted by strikes or work stoppages.

Argentina is a geographically diverse country with mountains, forests, expansive deserts, and glaciers, making it a popular destination for outdoor and adventure sports. Despite the best efforts of local authorities, assisting visitors lost or injured in such remote areas can be problematic. American citizens have been killed in recent years while mountain climbing, skiing, trekking, and hunting. Travelers visiting isolated and wilderness areas should learn about local hazards and weather conditions and always inform park or police authorities of their itineraries. Reports of missing or injured persons should be made immediately to the police so that a search can be mounted or assistance rendered.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs' web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the United States, or for callers outside the United States 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 pamphlet A Safe Trip Abroad.

CRIME: Most American citizens visit Argentina without incident. Nevertheless, street crime in the larger cities, especially greater Buenos Aires and Mendoza, is a problem for residents and visitors alike. As in any big city, visitors to Buenos Aires and popular tourist destinations should be alert to muggers, pickpockets, scam artists, and purse-snatchers on the street, in hotel lobbies, at bus and train stations, and in cruise ship ports. Criminals usually work in groups and travelers should assume they are armed. Criminals employ a variety of ruses to distract and victimize unsuspecting visitors.
A common scam is to spray mustard or a similar substance on the tourist from a distance. A pickpocket will then approach the tourist offering to help clean the stain, and while doing so, he or an accomplice robs the victim. Thieves regularly nab unattended purses, backpacks, laptops, and luggage, and criminals will often distract visitors for a few seconds to steal valuables. While most American victims are not physically injured when robbed, criminals typically do not hesitate to use force when they encounter resistance. Visitors are advised to immediately hand over all cash and valuables if confronted. Thieves will target visitors wearing expensive watches or jewelry.

Your passport is a valuable document and should be guarded. Passports and other valuables should be locked in a hotel safe, and a photocopy of your passport should be carried for identification purposes. The U.S. Embassy has observed a notable rise in reports of stolen passports in the past year. Some travelers have received counterfeit currency in Argentina. Unscrupulous vendors and taxi drivers sometimes pretend to help tourists review their pesos, then trade bad bills for good ones. Characteristics of good currency can be reviewed at the Argentine Central Bank web site at www.bcra.gov.ar.
Along with conventional muggings, so-called express kidnappings continue to occur. Victims are grabbed off the street based on their appearance and vulnerability. They are made to withdraw as much money as possible from ATM machines, and then their family or co-workers are contacted and told to deliver all the cash that they have on hand or can gather in a couple of hours. Once the ransom is paid, the victim is usually quickly released unharmed. There have been some foreign victims. Visitors are particularly advised not to let children and adolescents travel alone.
Travelers worldwide are advised to avoid packing valuables in their checked baggage. In Argentina, officials have publicly acknowledged the systematic theft of valuables and money from checked baggage at Buenos Aires airports. Authorities are working to resolve the problem and have made a number of arrests, but travelers should exercise continued care and caution. In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds can 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 Argentine Federal Police have established a special Tourist Police Unit to receive complaints and investigate crimes against tourists. The unit, located at Corrientes 436 in Buenos Aires, responds to calls around the clock at 4346-5748 or toll-free 0800-999-5000 from anywhere in the country. The local equivalent to the "911" emergency line in the city of Buenos Aires or in the surrounding Province of Buenos Aires is 911 for police assistance. In the city of Buenos Aires, dial 100 in case of fire and 107 for an ambulance. In the Province of Buenos Aires, fire and ambulance numbers vary by location. See our information for Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: The public health system in Argentina provides emergency and non-emergency services free of charge to all, regardless of nationality or immigration status. However, the quality of non-emergency care in public hospitals is generally below U.S. standards. Medical care in private hospitals in Buenos Aires is generally good, but varies in quality outside the capital. Serious medical problems requiring hospitalization in private facilities and/or medical evacuation to the United States can cost thousands of dollars or more. Private physicians, clinics, and hospitals often expect immediate cash payment for health services.
HIV/AIDS restrictions. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Argentina.
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 Preventions 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 (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policies apply overseas and will cover prior conditions and emergency expenses such as a medical evacuation, which could cost tens of thousands of dollars. If not covered, visitors are encouraged to consider purchasing travel insurance. No Medicare benefits are available abroad. 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 Argentina is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving in Argentina is generally more dangerous than driving in the United States. By comparison, drivers in Argentina tend to be very aggressive, especially in the capital city of Buenos Aires, and frequently ignore traffic regulations. U.S. driver's licenses are valid in the capital and the province of Buenos Aires, but Argentine or international licenses are required to drive in the rest of the country. For further information, please contact the Argentine Automobile Club, Av. Libertador 1850, 1112 Capital Federal, telephone (011) (54)(11) 4802-6061, or contact the Embassy of Argentina as listed in the above section on Entry Requirements. Please refer to our Road Safety page for more information. Visit the websites of Argentina's national tourist office and national roadways office at www.turismo.gov.ar and www.vialidad.gov.ar.

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

SPECIAL CIRCUMSTANCES: In addition to being subject to all Argentine laws affecting U.S. citizens, dual nationals may also be subject to other laws that impose special obligations on Argentine citizens. In some instances, dual nationality may hamper U.S. Government efforts to provide protection abroad. Please see our information on Customs Regulations.

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 also be more severe than in the United States for similar offenses. Persons violating Argentina's laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Argentina are strict, and convicted offenders can expect lengthy jail sentences and fines. Engaging in sexual conduct with children and using or disseminating child pornography in a foreign country are crimes 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 Argentina are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, so that they can obtain updated information on travel and security within Argentina. Americans without Internet access may register directly with the U.S. Embassy. By registering, American citizens make it much easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at Avenida Colombia 4300 in the Palermo neighborhood of Buenos Aires (near the Plaza Italia stop on the "D" line subway). The main Embassy switchboard telephone is (54) (11) 5777-4533. Recorded consular information, including instructions on whom to contact in case of an American citizen emergency, is available at tel. (54) (11) 4514-1830. The Consular Section fax is (54) (11) 5777-4293. The Consular Section is open to the public from 8:30 a.m. to noon and 2:30 p.m. to 4 p.m. Monday through Friday, except on American and Argentine holidays. Additional information on Embassy services is available on the Internet at http://argentina.usembassy.gov or by e-mail: BuenosAires-ACS@state.gov
* * *
This replaces the Country Specific Information December 28, 2007 to update Sections on Country Description, Safety and Security, Information for Victims of Crime, Medical Facilities, Traffic Safety and Road Conditions, and Registration/Embassy Locations.

Travel News Headlines WORLD NEWS

Date: Sun 22 Sep 2019
Source: La Voz [in Spanish trans. Mod.TY, edited]

Viruses transmitted by mosquitoes are emerging in the Americas. To historic dengue in recent years have been added Zika and chikungunya [viruses], 2 pathogens that before were restricted only to Africa. Madariaga has now been added to that list [of viruses new in the Americas].

Researchers from the Instituto de Medicina Regional of the Universidad Nacional del Nordeste (IMR-Unne) and from the Instituto de Virologia, and J. M. Vanella of the Universidad Nacional de Cordoba (Inviv, UNC) detected its presence in mosquitoes captured in the Chaco. "Madariaga is a virus that causes disease in equine animals and is of low pathogenicity for humans, but in 2010 caused an outbreak in humans in Panama with 10 cases," said Marta Contigiani, who works in the UNC laboratory. It was also isolated in 2015 and 2016 from human samples in Haiti.

Ornella Stechina, of the IMR-Unne, was the person who detected presence of the virus in the mosquitoes. The work was done with the financial support of this institution with Mariana Stein, a researcher from CONICET [the national science agency] as the person in charge.

Contigiani explained that there have been no subsequent cases in horses since 1988. "In other provinces in the country, serological studies have detected [Madariaga] virus infections. There is a vaccine for equine animals, but its application is not obligatory," she said.

However, she warned that global climate change (including deforestation in the Amazon Basin) influences the geographic distribution and emergence of diseases, with appearance of new environments that are favorable for the development of vectors and that favor the development of the [transmission] cycle.

"To this we must add the genetic changes that are observed in these viruses," she stated.

For some time, experts have been issuing alerts about the emergence and reemergence of arboviruses, pathogens that are transmitted by insects.

"West Nile virus rapidly invaded North America, and now cases are being found in Central and South America. Also, Mayaro and eastern equine encephalitis viruses have increased their activity and have been found in new regions," said Raquel Gleiser, a researcher at the Instituto Multidisciplinario de Biologia Vegetal of the UNC (Imbiv) in an article published in the Journal of Medical Entomology.

Madariaga virus is a strain of eastern equine encephalitis virus, which was early on detected in Argentina. Contigiani did not discard the possibility that a variant that had greater capacity to replicate, the proliferation of competent vectors, and propitious environmental conditions could cause an outbreak in the region.

The evidence for warning about Madariaga virus is not at the same level as for chikungunya [virus], although they are in the same family (Togaviridae). "For now, the epidemiological behavior is different. Chikungunya virus has _Aedes aegypti_ as its vector, whereas the vector of Madariaga virus is within the _Culex_ genus," she said.

This study detected the virus in mosquitoes of the _Culex_ genus in wildland areas in Choco province. Thus, they identified this vector in Argentinian territory for the 1st time.

Although the mosquito species or species that had the virus could not be detected, the genus _Culex_ has more than 1000 species, many of which are of urban habits such as _Culex pipiens_ that we hear buzzing at night.

Madariaga virus can infect various mammals that could serve as hosts, such as rats and bats, as well as birds.

In Argentina, it was found for the 1st time in animals in the decade of the 1930s. The strain found in the Chaco belongs to the same lineage discovered in those years, which indicates that the virus is endemic in the region.

For now, the infections studied in humans has been for the most part mild and asymptomatic.

Adrian Diaz of the Cordoba Institute, Griselda Oria (IMR-Unne), and Carolina Torres of the Universidad de Buenos Aires participated as part of the work that was published a week ago in the American Journal of Tropical Medicine and Hygiene [reference below].

The researchers suggest that more epidemiological studies be done to determine the vectors and potential hosts and do deeper studies about the genetic characteristics of the [virus] strains that circulate in the country in order to know whether this virus is endemic in the region or is reintroduced.

"Ideally, studies will be done [in the field] with sentinel animals to detect virus circulation as well. In other countries, they use sentinel chickens for these types of studies," Contigiani commented, and clarified that in case [virus] circulation was detected, animal health officials must take relevant measures.

"There is no human vaccine, so [human] health officials must indicate measures [needed] for prevention and control," she added.

The vector is the most common, _Culex_. However, there is no virus circulation in Cordoba.

_Culex_ is a genus of hematophagous mosquitoes in the Culiidae family, many species of which act as vectors of important diseases, such as West Nile, filariasis, virus encephalitis (Japanese, Venezuelan, equine, and St. Louis) and avian malaria, as well as Madariaga virus. There are more than 80 varieties [of what?].  [Byline: Lucas Viano]
=================
[The isolation of Madariaga virus from Culex mosquitoes in northern Argentina is interesting, but, as the authors point out, merits additional studies to determine whether it is a human or animal (especially equine) pathogen of importance for human or animal health in Argentina. Studies of the Culex species involved in transmission of the virus and determination of the animal hosts are essential to understand cycles of transmission.

Reference:
Ornela Sofia Stechina, Griselda Ines Oria, Carolina Torres, Luis Adrian Diaz, Marta Contigiani and Marina Stein. First Detection of Madariaga virus in Mosquitoes Collected in a Wild Environment of Northeastern Argentina. 2019. Am. J. Trop. Med. Hyg., 00(0), 2019, pp. 1-3 DOI: <https://doi.org/10.4269/ajtmh.19-0475>.

Chaco province is in the far north of Argentina. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Chaco Province, Argentina: <http://healthmap.org/promed/p/54342>]
Date: Sun 4 Aug 2019
Source: Diario Uno [in Spanish, trans. ProMED Mod.JG, edited]

A family living in El Borbollon, Las Heras, ate ham and sausages after fixing pork at their home, but after this, 11 persons needed medical attention because of the occurrence of symptoms related to trichinellosis.

It was reported that the Provincial Livestock Direction confiscated homemade ham and sausages after receiving an alert from the Epidemiology Area of Lagomaggiore Hospital, which stated they received and attended (infected) people with symptoms of thichinellosis.

The operation was carried out last Friday in a household located in El Borbollon, which was pointed out as the infection source after 3 persons (2 of them less than legal age) were brought to Lagomaggiore Hospital seeking medical care. As days went by, 8 additional compatible cases -- presenting with similar symptoms -- were reported in Lencinas Hospital.

Once the protocol involving Food Hygiene, Zoonoses, Livestock Farming, and Epidemiology local departments and also the local municipality was activated, 2 pieces of ham, 2 pork shoulders, one piece of pork tenderloin, dry sausages and Bondiola pork were confiscated. Considering the size of these pieces, it is thought a large animal was involved.

Laboratory tests were immediately performed, and because of positive results, the meat products were destroyed and properly disposed of in a local slaughterhouse, aiming to prevent the dissemination of this disease.

Trichinellosis is a parasitic disease caused by ingesting _Trichinella spiralis_ larvae located in muscles (meat). This condition is characterized by high fever, muscle pain and vomiting or diarrhoea. The disease affects humans and many mammals. This condition is acquired by eating infected pork meat.

Common symptoms are diarrhoea, abdominal pain, fatigue, nausea, vomiting, and in severe cases also fever.
=====================
[Trichinellosis caused by _Trichinella spiralis_ is common in Argentina, especially in northern Argentina (see ProMED reports below). The source of meat is pigs from small farms or even "backyard pigs" slaughtered and processed without proper veterinary control. - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Mendoza, Mendoza, Argentina: <http://healthmap.org/promed/p/5900>]
Date: Wed 24 Jul 2019
Source: Jujuy al Momento [in Spanish, trans. ProMED Mod.TY, edited]

The disease [virus], transmitted by rodents, has now taken the life of a man, and there are 18 confirmed cases [of hantavirus infection]. There is concern in the health sector because of the lack of environmental policies to confront the problem of trash dumps, one of the environments where these animals [rodents] proliferate.

- There are now 18 confirmed cases of hantavirus [infections].
- There are 372 suspected cases.
- The increase in the number of trash dumps in the whole province contributes to aggravation of the situation.

The Ministry of Health indicated that there are 372 suspected cases of hantavirus [infections] in Jujuy, with 18 confirmed cases. An adolescent died in the Talar locality, and 17 patients are recuperating favorably.

The majority of the cases are registered in Palma Sola and San Pedro with 4 in each locality.

There was also a case of hantavirus [infection] very close to San Salvador that occurred in the Palpala rural area. This city is one of those with evidence of the greatest increase in trash dumps, to the point that several of them begin to increase in proximity to the plazas and urban neighborhoods.

_Hantavirus_ is a genus that groups various RNA viruses that are transmitted by rodents and, in humans, generally produces 2 types of afflictions: a type of viral hemorrhagic fever, a hemorrhagic fever with renal syndrome; or hantavirus pulmonary syndrome, a very serious affliction.

The disease has a strict relationship to trash deposits since this is where these [reservoir] animals eat and reproduce. Despite this, the Ministry of the Environment, headed by Maria Ines Zigaran, still has not recognized policies to attack the problem.
=====================
[Cases of hantavirus infections have been increasing in Jujuy province since early April 2019. The number of confirmed hantavirus infections in Jujuy province has increased from 11 cases reported on 8 Apr 2019, in the localities of San Pedro, Palma Sola, Libertador General San Martin, and Calilegua, to 15 cases on 10 May 2019, and now to 18 cases reported above. The above report of 372 suspected cases is a surprisingly large number. It will be interesting to learn how many of these cases are ultimately confirmed as hantavirus infections. The confirmed cases are from a variety of locations, indicating that the virus and its reservoir rodent hosts are widespread in the province. The public is well advised to follow the Ministry's recommendations for avoidance of infection.

The hantaviruses responsible for these 18 confirmed cases are not stated in the earlier reports or the one above. An earlier report from Jujuy province this year (2019) apparently presumed that the hantavirus involved in that case was Laguna Negra, although it is not stated that this virus had been laboratory confirmed. As noted in ProMED-mail archive no. http://promedmail.org/post/20110430.1348, several hantaviruses have been associated with human infection and hantavirus pulmonary syndrome in Argentina: Andes virus (in western Argentina, in the long-tailed pygmy rice rat host, _Oligoryzomys longicaudatus_); related Andes-like viruses Hu39694 (in central Argentina; rodent host unknown); Lechiguana (in central Argentina, in the yellow pygmy rice rat, _O. flavescens_); Oran (in northwestern Argentina, in _O. longicaudatus_); Bermejo (in western Argentina, in _O. flavescens_); and Laguna Negra (in northern Argentina, in _Calomys laucha_). Seoul virus with its brown rat (_Rattus norvegicus_) host (a frequenter of trash dumps) is another possibility. Without laboratory confirmation, it is not possible to say with certainty which hantavirus was involved. Andes virus seems unlikely in these cases in Jujuy province. - ProMED Mod.TY]

[Map of Argentina:

HealthMap/ProMED-mail map:
Jujuy province, Argentina: <http://healthmap.org/promed/p/53166>]
Date: Sat 29 Jun 2019 10:38 ART
Source: La Voz, Argentina [in Spanish, trans. Rapp. Kathryn Soderholm, abridged, edited]

The Ministry of Health of San Luis issued an epidemiological alert after 3 cases of trichinosis were confirmed by laboratory. The cases are one child, his father, and his mother. Another 12 probable cases are under investigation, all from the distant towns of Concaran and Villa Mercedes, 163 [101 mi] and 100 kilometres [62 mi], respectively, from the provincial capital [San Luis].

The affected patients would have contracted the disease after consuming sausages purchased in La Punilla at the beginning of June [2019], and the symptoms were detected 48 hours ago, the News Agency of the provincial state declared.

The head of Epidemiology, Rodrigo Verdugo, confirmed that the analyses were performed last [Thu 27 Jun 2019] after the suspected cases were referred on [26 Jun 2019].

The other 12 cases are being investigated and will be confirmed by blood sample.

The boy, who is 8 years old, remains hospitalized in the San Luis Hospital; another patient hospitalized in Merlo and another in Villa Mercedes.

Representatives from the department of Epidemiology with the Sanitary and Fiscal Control Program (Cosafi) toured La Punilla and Concaran, where the other cases originated, making visits to the premises that may have samples of these foods, explained Claudia Olarte, head of the Epidemiological Surveillance Service.

Verdugo noted that "this is the 1st outbreak" of this year [2019] and recalled that in 2018, 3 cases were detected, one of which also originated in La Punilla, so the Health department is also investigating in nearby towns such as Papagayos and Villa del Carmen.
=====================
[La Punilla is approximately 200 km [about 125 mi] south of Cordoba, in San Luis province. Trichinellosis has been reported often from Argentina. The source is homemade sausages from backyard pigs, slaughtered and used or sold at local markets without veterinary control. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Argentina:
Date: Sat 18 May 2019
Source: Food Safety News [edited>

Two cases of foodborne botulism linked to hummus have been confirmed by Argentinian health authorities. The National Administration of Drugs, Foods and Medical Devices (ANMAT) reported that an investigation confirmed the botulism cases and results of an epidemiological survey determined illness was associated with a hummus product. Hummus was sold under the brand Tsuki Macro Vegan, which is based in Palermo, Buenos Aires.

The general directorate of hygiene and food safety and ANMAT inspected the processing establishment where the product was made and imposed a ban on processing and marketing. It was also detected that the product did not have the relevant sanitary authorization. The processing firm was asked to carry out an immediate withdrawal from the national market of all units of the implicated branded hummus.

ANMAT advised the public to refrain from consuming the product and to keep the containers closed and separated from other foods. The agency also told those who sell the products to stop marketing it.

Botulism is a rare but life-threatening condition caused by toxins produced by _Clostridium botulinum_ bacteria. In foodborne botulism, symptoms generally begin 18-36 hours after eating a contaminated food. However, they can start as soon as 6 hours after, or up to 10 days later. Botulism can cause symptoms including general weakness, dizziness, double vision, and trouble with speaking or swallowing. Difficulty in breathing, weakness of other muscles, abdominal distension, and constipation may also occur. People experiencing these problems should seek immediate medical attention.

The latest incident follows a different outbreak in Rancul, a town in the La Pampa province of Argentina, at the start of May 2019 with 4 suspected cases. Health authorities in La Pampa reported that 4 people older than 57 years old were in a serious condition and needed hospital treatment. The poisoning was a result of a meal shared by 7 friends in Rancul. The suspected source is preserves such as peppers that were prepared in a homemade way by one of the people who fell ill.
===================
[Hummus is an unusual source of botulism but has been reported, also from a commercially produced product.

Mad'arova L, Dorner BG, Schaade L, et al.: Reoccurrence of botulinum neurotoxin subtype A3 inducing food-borne botulism, Slovakia, 2015. Euro Surveill. 2017 Aug 10; 22(32): pii: 30591. doi: 10.2807/1560-7917.ES.2017.22.32.30591.

Abstract
--------
A case of foodborne botulism occurred in Slovakia in 2015. _Clostridium botulinum_ type A was isolated from 3 nearly empty commercial hummus tubes. The product, which was sold in Slovakia and the Czech Republic, was withdrawn from the market, and a warning was issued immediately through the European Commission's Rapid Alert System for Food and Feed (RASFF). Further investigation revealed the presence of botulinum neurotoxin (BoNT) subtype BoNT/A3, a very rare subtype implicated in only one previous outbreak (Loch Maree in Scotland, 1922). It is the most divergent subtype of BoNT/A with 15.4% difference at the amino acid level compared with the prototype BoNT/A1. This makes it more prone to evading immunological and PCR-based detection. It is recommended that testing laboratories are advised that this subtype has been associated with foodborne botulism for the 2nd time since the 1st outbreak almost 100 years ago, and to validate their immunological or PCR-based methods against this divergent subtype. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
More ...

Falkland Islands

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Wed, 30 Oct 2019 02:46:41 +0100 (MET)
By Barnaby CHESTERMAN

Stanley, Falkland Islands, Oct 30, 2019 (AFP) - Waddling up the beach in single file, their heads held high with an almost self-important demeanor, king penguins are a major draw in the Falkland Islands' tourism industry.   Their fluffy brown chicks are nearly fearless of humans, meaning tourists at Volunteer Point, a peninsula on East Falkland Island, might get almost close enough to touch one.    "We're the furthest location north in the world that you can see king penguins," said Tony Heathman, a former sheep farmer who has spent the last 16 years taking tour groups to Volunteer Point, where a thousand pairs of the islands' signature species go to breed.   "We get lots and lots of people who... love to come here and get as close to the king penguins as they possibly can," the 70-year-old told AFP.

Kings are just one of five penguin species in the Falklands, alongside the wacky-looking rockhoppers which have yellow tassels sprouting from the side of their heads, gentoos, macaronis and the burrowing magellanics.    The Falklands have incredibly rich biodiversity, including more than 25 species of whales and dolphins, but it is the guaranteed ability to get up close with penguins that makes it a particularly enticing destination.  Tourism is a growing industry in the Falklands despite their remote location in the South Atlantic some 480 kilometers (300 miles) off Argentina and occasional political and economic hostility from Buenos Aires.

In 2018, there was a 6.3 percent increase in tourist arrivals and a 29.4 percent surge in tourist expenditure to almost £8.8 million ($11.3 million).    "One of the key attractions for us was the king penguins at Volunteer Point, so we saw plenty of those," said Flavia Tang, 29, from London, who came for a week with her partner.    Volunteer Point is one of the islands' most popular destinations, accessible from the capital Stanley by a three-hour ride in a four-wheel drive vehicle, including 11 miles of bumpy, boggy, off-road track.   The peninsula is also home to gentoos and magellanic penguins -- known locally as jackasses because of their braying-like call -- as well as oystercatchers, South American terns and ruddy-headed geese.

- Like a Hitchcock film -
Another of the Falklands' stunning locations for wildlife watching is Kidney Island, where rockhoppers use their claws and beaks to help them get to the top of cliffs where they will mate.   In order to see the birds, visitors must trek a half hour through tall, three-meter (10-foot) tussac grass while avoiding ground bird nests.   But a bird called the sooty shearwater is what makes the island truly unique.   "Kidney Island is home to 140,000 breeding pairs of sooty shearwaters that are just rafting off the coast here ready to come in," Denise Blake, the Falklands government's environmental officer, told AFP during a visit to the outlying island.  "So as night falls you really see them swooping in over the heads a bit like the Hitchcock movie where all the birds start circling in: It's incredible for that."

While many nature-lovers head to places such as Antarctica and South Georgia, an island in the South Atlantic, Sally Ellis, the manager at International Tours and Travel, feels the Falklands are a better option.   "Antarctica and South Georgia are nothing compared to the variety and accessibility of wildlife in the Falkland Islands and it costs about a quarter," she said, adding that there was nearly a "guarantee" to see whatever wildlife is desired.   Beyond birds the endangered sei whale is found off the coast of the Falklands while the distinctive black and white Commerson's dolphins swim near Yorke Bay and Gypsy Cove.

- 'Leap of faith' -
In addition to nature watching, adventure tourism is also growing on the islands, where enterprising locals are branching into the industry.   Tom and Jane Chater recently launched a business offering helicopter trips and tours.    The married couple is hoping to attract some of the 60,000 people a year who arrive in the Falklands from cruise ships by offering the chance to explore the islands from their four-seater Robinson R-44 helicopter.    "It's been a very busy and exciting time for us," said Tom Chater, 43.    "It's something we thought about for a long time," added 46-year-old Jane. "It's a leap of faith but we're keen to see how it works out."
Date: Mon, 25 Nov 2013 09:47:39 +0100 (MET)

WASHINGTON, Nov 25, 2013 (AFP) - A powerful 7.0 magnitude earthquake struck in the south Atlantic ocean 314 kilometers (195 miles) southeast of Stanley, the main city on the Falkland Islands, the US Geological Survey said early Monday.  The underwater quake struck at 0627 GMT at a depth of 10 kilometers in the lightly populated area, the USGS said. The epicenter was also 877 kilometers east of Ushuaia, Argentina, the USGS said.   There were no initial reports of damage or casualties.   The Hawaii-based Pacific Tsunami Warning Center issued a bulletin stating that, despite the power of the quake, "a destructive widespread tsunami threat does not exist."   The Tsunami Warning Center however did say that there was a "small possibility of a local or regional tsunami" that could affect coastlines "located usually no more than a few hundred kilometers from the earthquake epicenter."   The USGS initially said that it was a magnitude 6.6 earthquake, but later revised the quake's strength.
Date: Sun, 13 Jan 2013 00:01:52 +0100 (MET)

LONDON, Jan 12, 2013 (AFP) - British-American owned cruise firm P&O on Saturday announced it would not be stopping at three Argentinian ports due to the continuing row over the Falkland Islands. "As a British cruise company we cannot allow ourselves to be the subject of any political dispute or put our customers and crew into any situation where their enjoyment may be compromised," said a spokesman for the company. "With this in mind, we have had to take the difficult decision to remove all Argentinian ports of call from the itinerary." Its Arcadia and Adonia vessels will now not dock in Buenos Aires, Puerto Madryn or Ushuaia during their round-the-world cruises.

Argentinian port officials have previously turned away liners that have been to the Falklands. President Cristina Kirchner said earlier this month that Argentina was forcibly stripped of the Falklands by Britain in "a blatant exercise of 19th-century colonialism" and demanded they be handed over to Argentina. British Prime Minister David Cameron replied that the 3,000 residents of the Falklands had a strong desire to remain British and would have a chance to express their views in a referendum on their political status to be held in March. The islanders are expected to vote strongly in favour of continued union with Britain.

Argentina invaded the Falklands in 1982, prompting Britain's then prime minister Margaret Thatcher to send a naval taskforce to successfully reclaim the islands in a war that claimed the lives of 255 British and 649 Argentinian soldiers. British defence officials have prepared plans for dealing with aggressive action by Argentina towards the disputed islands, according to a report on the Sunday Telegraph website. A senior defence source told the paper: "Britain needs to be in a situation to respond very quickly to a whole series of threats -- that is why we have contingency plans. Our posture has not changed but neither are we complacent."
Date: Tue, 28 Feb 2012 01:19:14 +0100 (MET)

BUENOS AIRES, Feb 27, 2012 (AFP) - Two British cruise ships that visited the Falkland Islands were refused entry to an Argentine port on Monday, amid tension over the disputed archipelago.  The Adonia, owned by P&O cruises, and the Princess Cruises vessel Star Princess were both blocked from entering Ushuaia in southern Argentina after both ships stopped at the Falklands on Saturday. "We are very concerned to hear the Adonia and Star Princess have been refused access to the port of Ushuaia," a spokesman for Britain's Foreign Office said in London. "There can be no justification for interference in free and legitimate commerce. "British diplomats in Argentina are urgently seeking to clarify the circumstances surrounding this incident, and we are in contact with the company concerned." Tensions are running high between Britain and Argentina over the Falklands, which London controls but Buenos Aires claims, ahead of the 30th anniversary in April of the start of the war between the two nations over the South Atlantic islands.

Argentina has also reacted angrily to the deployment of Prince William to the Falklands as part of his job as a Royal Air Force search and rescue pilot, and to a planned fact-finding trip by British lawmakers next month. The Argentine province of Tierra del Fuego said they "applied the law" in denying port access to the Carnival Corporation ships the Star Princess and the Adonia.  "The Governor of Tierra del Fuego, Antarctica and the South Atlantic Islands, Fabiana Rios, decided not to allow the docking in the port of Ushuaia (3,200 km south of Buenos Aires)" of the two ships, Tierra del Fuego authorities said in a statement. "We've never had a ship stopped from coming into an Argentine port before," Julie Benson, spokeswoman for Carnival affiliate Princess Cruises, told AFP.

Carnival UK, which owns both P&O and Princess Cruises, said in a statement the Adonia was now sailing towards Punta Arenas in Chile, its next port of call on an 87-night tour of South America. The Star Princess was on a 14-night South America cruise which started in Rio de Janeiro on February 18. The Falklands, located off the southern coast of Argentina, have been under British control since 1833. A brief 74-day war in 1982 cost the lives of 649 Argentine troops, 255 British troops and three Falkland Islanders, with Britain retaining control. The United Nations has called on Britain to start talk on decolonization, but London has refused to do so.
Date: Tue, 5 Jan 2010 07:03:15 +0100 (MET)

WASHINGTON, Jan 5, 2010 (AFP) - A major 6.7-magnitude earthquake struck the southern Atlantic ocean early Tuesday east of South Georgia and the South Sandwich Islands, a sparsely populated British territory, a US monitor said.

The quake struck at 3:55 am (04:55 GMT) in waters 685 kilometers (425 miles) east of Bristol Island, part of an chain inhabited mainly by scientists on a series of bases, the US Geological Survey reported.   The earthquake, about 2,800 kilometers (1,740 miles) east of the Falkland Islands, occurred at a depth of 10 kilometers (six miles) according to USGS.

The Pacific Tsunami Warning Center issued an alert stating there was no threat of a destructive widespread tsunami, but warned "there is the small possibility of a local or regional tsunami that could affect coasts" near the epicenter.
More ...

India

General Information
*******************************************
India is bounded by the Himalayas in the north and extends 2000 miles southwards into the Indian Ocean, between the Bay of Bengal on the East and the Arabian Sea on the West. The cou

try has three main geographic regions: the Himalaya Mountains on the Nepal-Tibet border; the Gangetic Plain lying below the Himalayas; the Deccan Plateau south of the Gangetic Plain. The climate throughout India is determined, to a large extent, by the massive Himalayan mountainous barrier in the northeastern part of the country. Many Irish travellers to India spend a significant period of time within the country but even those on short holidays or business trips need to take care to maintain their general health.

Climate
*******************************************
Most of the country is tropical or sub-tropical and subject to seasonal monsoon winds. This is especially true in the southwestern regions. * New Delhi There are three distinct seasons in New Delhi. Between mid-April to mid-July there is the hot dry season with dust storms. From mid-July to September there is a rainy season and a cooler season from October to March. * Bombay Bombay has a tropical climate and has an annual average temperature of about 270C. The hot humid season occurs in April and May. A monsoon occurs from June to September with about 70" of rainfall. A cool season extends from November to February when the temperatures can drop somewhat. * Calcutta Humidity remains high throughout most of the year. This is especially true between May to October when humidity levels of 90% are common. Most of the rainfall occurs during the monsoon season between June to October. * Madras The climate remains tropical throughout the year. December and January are relatively cool months and the heat increases rapidly from March to June. Premonsoon rains bring relief in July and the temperatures decrease slowly until the cooler season returns in November.

Safety & Security:
*******************************************
For most Irish travellers this will not be a major concern. However, the experience of travelling through any of the major cities is something many tourists will not forget. Taking care on Indian roads is a constantly essential activity. Parts of the country are unstable and recent earthquakes have led to disruptions to the transport infrastructure. As in many other countries travelling alone or late at night is unwise. In Kashmir tourists have been targeted and it is sensible to check you itinerary carefully before you travel throughout the country. In the northeastern part of the country (Assam, Manipur, Nagaland, Tripura, and Meghalaya) there have been sporadic incidents of violence by ethnic insurgent groups, including the bombing of buses and trains reported.

General Health Issues
*******************************************
It is essential that travellers recognise that there is a higher risk to their health while travelling in India. These risks are mainly associated with malaria and food and water borne diseases but conditions like accidents, rabies, tuberculosis and cholera are also present in many regions.

Food Borne Disease
*******************************************
A vegetarian diet is common throughout the country. Frequently the care taken with food preparation will be below standards usually seen in Western Europe. Work surfaces may be contaminated and food handlers may themselves infect the food before it is served. Cold foods should be avoided, where possible, and travellers should only consume hot food which has been freshly prepared. Stir fries may not reach sufficient cooking temperatures and need to be treated with great care. Shell fish and lettuce should always be avoided as they are one of the main ways food borne diseases are transmitted.

Water Borne Disease
*******************************************
Tap water should NOT be used for drinking or brushing teeth unless the smell of chlorine is obvious. Don’t use water from a jug in the hotel bedroom for anything except general washing. Sealed mineral water bought from your hotel should be used for all consumption and for brushing teeth.

Malaria
*******************************************
Malaria is usually transmitted through the bite of an infected mosquito. This may occur throughout India, including all the major cities. The highest risk time is during the monsoon season (May to October approximately) but there is risk throughout the year. Travellers should take care against mosquito bites and maintain their prophylactic tablets during their time in India and also for a further four weeks after leaving the country.

Rabies
*******************************************
This viral disease is transmitted by any infected warm-blooded animal. Dogs, cats, monkeys etc are frequently involved. Travellers should avoid all contact with animals and any bite (lick or scratch) should be treated by immediately washing out the area, applying an antiseptic and then seeking urgent medical attention. India reports many thousand deaths each year from this dreadful disease.

Vaccinations
*******************************************
Most short term travellers should consider vaccination cover against Poliomyelitis, Typhoid, Tetanus and Hepatitis A. Malaria tablets will also be required. For longer trips please contact the Tropical Bureau at the numbers below.

Other Health Information
*******************************************
A full range of information on healthy travelling overseas can be obtained from the educational department of the Tropical Medical Bureau.

Travel News Headlines WORLD NEWS

Date: Sat 30 Nov 2019
Source: The New Indian Express, Express News Service [edited]

According to official data, 14 swine flu [influenza A/H1N1] deaths across the state were recorded this year [2019] till [17 Nov 2019]. The figure is slightly less than the previous year's [2018] toll of 17. The total number of H1N1 swine flu-positive cases [has] also come down this year [2019] compared with 2018 from 402 to 325. Health officials are setting up isolation wards in hospitals as a preventive measure.

As the winter season has set in and the minimum temperatures are coming down, health officials are instructing the public to take precautions in order to stay away from being infected by swine flu. The health department has initiated steps to set up district-[wide] swine flu testing facilities and isolation wards in every district hospital, area hospital, and community health centre.

As per the requirement of treatment procedure, the government has to set up special isolation wards in all government hospitals and provide protection kits to the healthcare staff, especially to those who will attend to the patients suffering from the flu. Across the state, Visakhapatnam registered the highest number of positive swine flu cases and deaths. Out of 325 positive cases, 180 alone were reported from Visakhapatnam, of which 8 died. West Godavari district registered 3 deaths, and Anantapur, East Godavari, and Srikakulam registered one death case each.

All the district health officials have been instructed to intensify awareness camps and screening centres. As part of the action plan, isolation wards with 5-10 beds are to be set up in every teaching, district, and area hospital. A sufficient stock of drugs, masks, and PPE [personal protective equipment] kits are to be made available. Currently, there are 18 labs eligible for conducting confirmation test in the state. "We are creating awareness by distributing pamphlets and putting up screening centres at bus stops and railway stations," DMHO [district medical and health officer] Dr. TSR Murthy said.

Symptoms of swine flu are generally similar to that of seasonal flu. These include cough, fever, sore throat, stuffiness, runny nose, body aches, headache, chills, fatigue, diarrhoea, and vomiting. Later on, breathlessness, chest pain, drowsiness, low blood pressure, sputum mixed with blood, and bluish discoloration of nails also develops.

3rd December 2019
https://watchers.news/2019/12/03/at-least-25-dead-as-days-of-heavy-rain-hit-tamil-nadu-india/

At least 25 people were killed in various rain-related incidents in Tamil Nadu, India since November 29, 2019. 17 of the victims died after a wall collapsed following a continuous heavy downpour in Coimbatore on Monday morning, December 2.

Among the fatalities were 10 women. Around 1 305 huts and 465 tiled-roof houses were damaged, while 1,000 people were evacuated to government relief centers in Tuticorin, Cuddalore, and Tirunelveli districts as the north-east monsoon intensifies.

Schools remain closed on Monday including those in the districts of Chennai, Chengalpet, Kancheepuram, Tiruvallur, Cuddalore, and Tuticorin, as the areas received 90 mm (3 inches) rain in the past 36 hours.

A flood alert has been issued to residents near the banks of Bhavani River in this western district of Tamil Nadu as a dam built across it has burst in the wake of torrential rains in catchment areas, officials said on Monday.

Date: Wed 4 Dec 2019
Source: Stock Daily Dish [edited]

Bihar Health Minister Mangal Pandey on [Sat 30 Nov 2019] said the state government is doing its best to save children, as the death toll due to acute encephalitis syndrome [AES] in Muzaffarpur mounted to 73.

Pandey said doctors and nurses are being called in from Patna for additional help. "We are trying everything and anything that can save children's lives. Everything is being made available from medicines to doctors. We have even called doctors and nurses from AIIMS in Patna," he said. "There is a protocol regarding what kind of medicines and facilities should be given and we are doing the same. We are monitoring things regularly and trying to save our children."

Recalling the situation that prevailed 5 years ago, Pandey said a team that was formed to ascertain the cause of this disease concluded that sleeping empty stomach at night, dehydration due to humidity and eating lychee on empty stomach were some of the causes of encephalitis.

"Our government has tried to spread awareness which will be beneficial as well. Advertisement in newspapers, radio jingles, pamphlets and mic [microphone] announcements are going to spread awareness regarding the disease. Health ministry is also working on it," he said.

On being asked about spread of ASE in Gorakhpur last year [2018], he said, "From Gorakhpur to Muzaffarpur region, this disease had spread last year and the Union government had worked on this and we will continue to fight it now."

"This incident in Muzaffarpur is very saddening and we also feel bad when children of our nation die like this. Not the whole district is affected but a large part is suffering from it," he added.

From [1 Jan 2019], until now [5 Dec 2019], 220 children were admitted in Sri Krishna Medical College and Hospital in Muzaffarpur due to AES, out of which 62 lost their lives.

As per the data of SKMCH hospital, 235 children were admitted, of which 89 died; in 2013 - 90 children were admitted, of which 35 died; in 2014 - 334 children were admitted, of which 117 died; in 2015 - 37 children were admitted, of which 15 died; in 2016 - 31 children were admitted, of which 6 died; in 2017 - 44 children were admitted, of which 18 died; and in 2018 - 43 children were admitted, of which 12 died.

Meanwhile, Minister of State for Union ministry for home affairs, Nityanand Rai, visited Sri Krishna Medical College and Hospital to review the situation after the outbreak of AES.

Encephalitis is a viral disease, which causes mild flu-like symptoms such as high fever, convulsions and headaches and has been claiming lives in the district for the past few weeks.
======================
[The dates within which these AES cases have occurred is not stated. The urgency that has prompted Behar health officials to request the aid of physicians and nurses from adjoining Patna suggests that the AES outbreak is going on currently. The uncertainty about the etiology of AES continues. It is curious that the above report makes no mention of negative or positive tests for Japanese encephalitis among the AES patients, although that virus is endemic in northeastern India, including Bihar state. Neighboring Uttar Pradesh state has had JE cases as well this summer (2019) but has intensified its JE vaccination program.

The issue of the aetiology of AES has been under discussion for a long time. Lychee fruit contain toxins. Encephalopathy and hypoglycaemia have been associated with consumption of lychee fruit contains phytotoxins, specifically alpha-(methylenecyclopropyl)glycine (see ProMED-mail archive no. http://promedmail.org/post/20150201.3132842). However, the current cases cannot be due to lychee consumption, since the season for that fruit has passed.

AES has continued to be attributed to a variety of aetiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_). A recent publication (reference below) states that dengue virus is one of the 3 most common agents identified in AES, but existing surveillance for AES does not include routine testing for dengue. Until the etiology (or etiologies) of these AES cases is determined, effective and efficient prevention of these cases will not be possible.

Reference:
Ravi V, Hameed SKS, Desai A, et al. Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): results from a 4-year AES surveillance study of Japanese encephalitis in selected states of India. Int J Infect Dis 2019;84 Suppl:19-24. <https://doi.org/10.1016/j.ijid.2019.01.008>.

Available at:

[Maps of India:
HealthMap/ProMED maps available
at:<http://healthmap.org/promed/p/364>, and Bihar, India:
Date: Tue 26 Nov 2019
Source: Millennium Post [edited]

Taking a serious note of reports of scrub typhus from some parts of the state [West Bengal], the state health department has directed chief medical officers of health (CMOH) of all districts to be alert and vigilant and send details of all cases to the department. "Scrub typhus is a disease that can be treated with antibiotics if it is detected early. So, early detection is of the utmost importance. We have directed all hospitals to conduct blood tests if fever continues for a period of 5 days in a patient," a senior official of the state health department said.

The department has now equipped 19 hospitals across the state with facilities of kits for blood tests related to scrub typhus. The School of Tropical Medicine has been conducting blood tests related to the disease for many years. "If a patient is diagnosed with the disease, then the doctors have been advised to start treatment immediately," the official added.

According to sources in the health department, the Institute of Child Health (ICH) in Park Circus has had 300 cases of scrub typhus since August this year [2019]. The ICH has sent details of all these cases to the department.
======================
[The laboratory method by which the diagnosis of scrub typhus was made in these patients is not stated. Scrub typhus presents clinically with chills, fever, headache, muscle pain, and sometimes with a macular or maculopapular rash and eschar at the site of the chigger bite; confirmation requires laboratory testing, usually by indirect fluorescent antibody (IFA) assay, but this will require a 4-fold rise in antibody titre between acute and convalescent specimens. Results from a single acute serum sample are unreliable, as it takes 7-10 days for IgG antibody to be detectable, and antibody will be present in a high percentage of healthy people in an endemic region. The Weil-Felix test is unreliable (<https://www.ncbi.nlm.nih.gov/pubmed/16941792>) and molecular methods like polymerase chain reaction (PCR) may not be available in endemic regions.

ProMED-mail has posted multiple reports of scrub typhus in several Indian states in the past, especially since 2011. For background information, see ProMED-mail post Scrub typhus - India (05): background http://promedmail.org/post/20111208.3546.

Kolkata, formerly known as Calcutta, with a population of 4.5 million residents in 2011, is the capital of the Indian state of West Bengal; it is the principal commercial, cultural, and educational centre of East India (<https://en.wikipedia.org/wiki/Kolkata>).

Kolkata can be found on a map of West Bengal at
<https://www.google.com/maps/place/Kolkata,+West+Bengal,+India>. - ProMED Mod.ML]

[HealthMap/ProMED map available at:
West Bengal State, India: <http://healthmap.org/promed/p/323>]
Date: Mon, 2 Dec 2019 09:33:36 +0100 (MET)

Chennai, India, Dec 2, 2019 (AFP) - A menacing white foam covered one of India's most famous beaches in Chennai for the fourth straight day Monday creating a new pollution hazard for the country.   Children have been playing and taking selfies in the clouds of white suds on Marina Beach, even though they give off an acrid smell and fishermen have been told not to go into the sea nearby.   Doctors have warned that skin problems could be caused by the foam, which forms every monsoon season but has been particularly bad this year.    Word has not got through to the hundreds of families who throng India's longest urban beach, letting children happily skip in the toxin-filled froth.

The Tamil Nadu Pollution Control Board said it is analysing samples from the foam which has spread several kilometres along the beach.   "It is definitely not good for people to go into the foam but they just do not understand the risks," said Pravakar Mishra, a scientist at the National Centre for Coastal Research in Chennai who has seen the clouds of foam grow in recent years.   Authorities were also on alert for a repeat of a 2017 incident when thousands of fish were killed by pollution that hit beaches around the same time.

Fisherman Jeyaseelan, 30, said customers do not want to buy even the small amount of fish he has been able to catch in recent days.   "Everyone thinks it is contaminated," he said. "My wage has been cut to next to nothing."    Marina Beach has been a centrepiece of Chennai life for more than a century. At weekends, tens of thousands fill the once-pristine sands where the pollution is another sign of India's struggle to keep up with its growing economy.   Experts blame heavy rain in recent days that has carried untreated sewage and phosphate down to the sea.   According to Mishra, much of the foam comes from washing detergent residue that mixes with other waste.

Only 40 percent of sewage in Chennai and other big cities gets proper treatment, the researcher added.    "The rest flows into the sea and this is what happens."   Mishra is setting up a buoy to monitor pollution levels in the sea just as Delhi now has a network of monitoring stations for its notoriously dirty air.   "Pollution is now a bigger threat to India's beaches than the rising seas," said Mishra, highlighting the sewage, micro plastic that is killing fish and the bags and cups that cover the sand.   Mishra said volunteers had collected nearly a tonne of plastic and other waste in just two hours at a Chennai beach during a recent cleanup.
More ...

World Travel News Headlines

Date: Fri, 13 Dec 2019 16:41:23 +0100 (MET)
By Mariëtte Le Roux and Joseph Schmid

Paris, Dec 13, 2019 (AFP) - French commuters gritted their teeth for a ninth day of public transport strikes Friday, with unions vowing to keep up their protest against a pension overhaul through the holidays unless the government backs down.   Officials have said they are ready to negotiate, with Education Minister Jean-Michel Blanquer meeting teachers' representatives on Friday to try and stave off another day of class shutdowns.   "It was an intense and frank meeting... but we still need details, and maintain our call to strike on Tuesday," Stephane Crochet of the SE-Unsa union said.

Unions are hoping for a repeat of 1995, when they forced a rightwing government to back down on pension reforms after three weeks of metro and rail strikes just before Christmas.   The prospect of a protracted standoff has businesses fearing big losses during the crucial year-end festivities, and travellers worried that their Christmas plans may be compromised.   "Right now it's a catastrophe here, but we're hoping there will be a solution before Christmas," Frederic Masse, a foie gras producer at the huge Rungis wholesale food market south of Paris, told AFP on Friday.

The capital city was again choked by huge traffic jams as most metro lines remained shut, only a handful of buses and trams were running, and one in four TGV trains were cancelled.   "I'm sick of this, and I won't be able to keep working if it goes on," Zigo Makango, a 57-year-old security agent, told AFP onboard a bus in the Bobigny suburb northeast of Paris.   To get home at night Makango said he has to use taxis, but "my boss doesn't reimburse me for that".

- 'Historic reform' -
President Emmanuel Macron on Friday expressed his "solidarity" with people impacted by the strike, "but I want the government to continue its work" in forging a single pension system, a key campaign promise.   "It's a historic reform for the country," he told journalists at an EU summit in Brussels. 

The overhaul unveiled by Prime Minister Edouard Philippe would do away with 42 separate regimes, some of which offer early retirement and other benefits to public-sector employees such as train drivers, dockers and even Paris Opera employees.   But Philippe angered unions further by proposing a reduced payout for people who retire at the legal age of 62 instead of a new, so-called "pivot age" of 64.

They have called for new mass demonstrations for next Tuesday, the third since the action started on December 5 in the biggest show of strength in years by France's notoriously militant unions.   Philippe insisted on Twitter that "My door is open and my hand outstretched".   But Laurent Brun of the hard-line CGT union, the largest among public-sector workers including those at rail operator SNCF, has already warned "There won't be any Christmas truce" unless the government drops the plan entirely.

- France divided -
A poll released Thursday by the Elabe institute found France evenly divided on Philippe's plan, with 50 percent for and 49 percent against.  But 54 percent rejected the mooted 64-year cutoff for a full pension, and 54 percent supported the protest.

Staff at four of France's eight oil refineries were on strike Friday, affecting output and raising fears of shortages down the line.   And both Paris operas, the Garnier and the Bastille, again cancelled Friday performances and others through the weekend.   Macron's government insists the changes will make for a fairer system and help erase pension system deficits forecast to reach as much as 17 billion euros ($19 billion) by 2025.   The average French person retires at just over 60, years earlier than most in Europe or other rich OECD countries.
Date: Fri, 13 Dec 2019 14:05:22 +0100 (MET)

Milan, Dec 13, 2019 (AFP) - More than 300 flights were cancelled Friday in Italy due to a planned one-day strike by workers from Alitalia and Air Italy.   Alitalia said in a statement that 315 flights were cancelled on Friday, with another 40 cancelled Thursday night and Saturday morning. It was not immediately clear how many flights were cancelled at Air Italy.   The 24-hours strike, which involves pilots, flight attendants and ground personnel, was called by three unions to draw attention to what they called "the ongoing crisis at Alitalia and Air Italy."

The strike was felt most in Sardinia, with about 30 flights cancelled.    Money-losing Alitalia has been under special administration since 2017 when employees rejected a restructuring plan that would have laid off 1,700 workers out of an approximately 11,000.   The government has so far looked for buyers without success.    Unions plan to meet on Tuesday with Economy Minister Stefano Patuanelli.    A potential consortium of buyers for the ailing carrier fell apart last month after Atlantia, which operates Rome's airports, pulled out.
Date: Fri, 13 Dec 2019 05:24:44 +0100 (MET)
By Neil SANDS

Wellington, Dec 13, 2019 (AFP) - Adventure tourism is a key part of New Zealand's international appeal but the White Island volcano eruption is a tragic reminder that such activities carry genuine risk that must be better explained to travellers, experts say.   The South Pacific nation offers a wealth of adrenaline-fuelled pursuits, from heli-skiiing on snow-capped mountains to ballooning and blackwater rafting through caves.

Some, such as bungee-jumping, jet-boating and zorbing -- where you hurl yourself down a hill inside an inflatable ball -- were invented or popularised in a country that prides itself on catering to intrepid visitors.   The tourism industry as a whole is among New Zealand's biggest earners, generating about NZ$16.2 billion ($10.7 billion) and attracting 3.8 million international visitors annually.     "Adventure tourism is a massive sector in New Zealand. We are promoting ourselves as the adventure capital of the world," professor Michael Lueck, a tourism expert at Auckland University of Technology, told AFP.

New Zealand is also renowned for its rugged landscapes, which feature prominently films such as Kiwi director Peter Jackson's "Lord of the Rings".   Day-trips to White Island combined both, taking tourists including cruise ship passengers to a desolately beautiful island off the North Island coast where they could experience the thrill of standing on an active volcano.   Instead, at least 16 people are believed to have died and dozens suffered horrific burns when 47 tourists and guides were caught on the island during Monday's eruption.

The disaster has raised questions about why tourists were allowed on a volcano where experts had recently raised threat levels, as well as broader issues about the regulation of risky activities in the tourism sector.   "There will be bigger questions in relation to this event," Prime Minister Jacinda Ardern told parliament after the eruption.   "These questions must be asked, and they must be answered."

- 'Slapdash' or world's best? -
The disaster on White Island -- also known as Whakaari -- is not the first mass-fatality accident to affect tourists in New Zealand.   In 2015, seven people were killed when a scenic helicopter flight crashed into Fox Glacier. Two years earlier, a hot-air balloon claimed 11 lives and in 2010 nine died when a plane carrying skydivers plunged into a paddock.

Briton Chris Coker's son Brad, 24, died in the skydive plane crash and since then he has campaigned from afar for tighter regulations in New Zealand's adventure tourism sector.   "In my opinion, the New Zealand authorities... are still slapdash about tourist safety," Coker told news website stuff.co.nz after the White Island eruption.   "To run tourists there is insane. I know they signed a waiver and so on, but it's not really taking care of people."

Trade body Tourism Industry Aotearoa disputes such assessments, saying operators are "working within a world's best regulatory framework", but could not eliminate risk completely.   "Operators put safety first, but adventure activity inherently carries some risk and it's critical that 'adventure' remains in adventure tourism," TIA chief executive Chris Roberts told AFP.   "Operators take all practical actions to minimise the risks and the safety culture of individual operators remains the key factor in preventing accidents."

Roberts said the issue was not tourism operators, but the alert system they relied on at volcanic destinations such as White Island, which attracts about 17,000 visitors a year.   The GeoNet monitoring agency raised White Island's threat level in the week before the eruption but also advised current activity "does not pose a direct hazard to visitors".   "The reviews need to look at the science and specifically the guidance provided about volcanic activity, and whether the operating practices followed for the past 30 years need to change," Roberts said.

- 'Understand the risks' -
Travel companies such as White Island Tours brief customers before setting off and require them to sign a waiver declaring they understand the risk, as well as supplying equipment such as hard-hats and gas masks.   However, some relatives of those affected by the eruption have expressed scepticism that their loved ones truly appreciated the potential danger they faced.   Options for legal redress are limited under New Zealand's Accident Compensation Commission scheme, which covers victims' medical bills and provides modest compensation but does not allow civil suits for damages.

Neither Roberts nor Lueck expected the White Island eruption to hit international arrivals in New Zealand, which have continued to climb despite major earthquakes in 2011 and 2016.   The nature of any review arising from White Island remains uncertain, but Lueck said at the very least tourists needed to be better informed about any risks.   "Operators and tourism boards should have tourists understand what these risks are, and not brush over quickly signing a waiver," he said.   "Only then can tourists make an informed decision and decide whether or not they want to take that particular risk."
Date: Thu, 12 Dec 2019 21:25:36 +0100 (MET)

Kinshasa, Dec 12, 2019 (AFP) - Twenty-three cases of Ebola have been recorded in four days in eastern Democratic Republic of Congo, where deadly violence is hampering efforts to end the 16-month-old epidemic, authorities said on Thursday.   Ten cases were recorded on Tuesday alone in Mabalako in North Kivu province, after six on Monday, according to the Multisectoral Committee for Epidemic Response (CMRE).   Three out of the six were practitioners of traditional medicine, it said.

On Wednesday, three cases were recorded in North Kivu, including one in the Biena neighbourhood -- which has had no new Ebola cases for the last 85 days.   More than 2,200 people have died since the epidemic was declared on August 1, 2018.   As of November 22, the rate of new cases had fallen to 10 per week.   CMRE said "security reasons" -- attacks on Ebola health workers and sites by armed groups and angry youths -- had "paralysed" work in the key zones of Beni, Biakato and Mangina.   The attacks led to a pullout of locally-employed Ebola workers in Biakato by the UN's World Health Organization (WHO) and Doctors Without Borders (MSF).
Date: Thu, 12 Dec 2019 15:59:23 +0100 (MET)

Juba, Dec 12, 2019 (AFP) - Devastating flooding in South Sudan following a fierce drought could tip parts of the country into famine in the next few months, the World Food Programme (WFP) warned on Thursday.   According to the UN refugee agency nearly one million people were affected by floodwaters that submerged entire towns, compounding an already dire humanitarian situation after six years of war.

The WFP said that 5.5 million people are expected to be going hungry in early 2020 -- the time at which the population is generally benefiting from their harvest in October and November of the previous year.   An earlier harvest failed due to drought. This time crops have been washed away.    "The number of people in need is likely to increase because of the catastrophic level of destruction caused by floods since October following a drought that hammered parts of the country earlier in the year," the agency said in a statement.

The floods wiped out 73,000 metric tons of potential harvests as well as tens of thousands of cattle and goats, said the WFP.   "We know the problems that we've been having in South Sudan, but the rains and the floods have led to a national disaster and are much worse than anyone could have anticipated," said WFP Executive Director David Beasley.    "In fact, if we don't get funding in the next few weeks and months, we are literally talking about famine. We need support, we need help and we need it now."   The agency estimated its needs at $270 million (242 million euros) for the first half of 2020.   South Sudan declared a "man-made" famine affecting around 100,000 people in 2017. 

The term "famine" is used according to a scientific system agreed upon by global agencies, when at least 20 percent of the population in a specific area has extremely limited access to basic food; acute malnutrition exceeds 30 percent; and the death rate exceeds two per 10,000 people per day for the entire population.   "Famine in South Sudan was defeated after four months in 2017 by a concerted large-scale humanitarian response," said the WFP.   "Experts now say the country's food security outlook has never been so dire."   Political instability is also high as President Salva Kiir and his rival Riek Machar have again delayed their formation of a power-sharing government, this time by 100 days until February 2020.
Date: Wed, 11 Dec 2019 09:33:13 +0100 (MET)
By Holly ROBERTSON

Sydney, Dec 11, 2019 (AFP) - Up to 20,000 protesters rallied in Sydney on Wednesday demanding urgent climate action from Australia's government, as bushfire smoke choking the city caused health problems to spike.   Sydney has endured weeks bathed in toxic smoke as hundreds of blazes have raged across the countryside, with hospitals recording a 25 percent increase in the number of people visiting emergency departments last week.   On Tuesday smoke alarms rang out across Australia's biggest city, with thick haze triggering smoke alarms and forcing buildings to be evacuated, school children to be kept indoors, and ferries to be cancelled.   The devastating fires have focused attention on climate change, with scientists saying the blazes have come earlier and with more intensity than usual due to global warming and a prolonged drought.   Police estimated the crowd size at 15,000, organisers put the figure at 20,000.

Many of the protestors voiced anger at the government's silence in the face of the crisis.   "The country is on fire" said 26-year-old Samuel Wilkie attending his first climate protest. He described politicians' response as "pathetic".    "Our government is not doing anything about it," said 29-year-old landscape gardener Zara Zoe. "No one is listening, no one is doing anything."   Prime Minister Scott Morrison -- a staunch backer of Australia's vast coal industry -- has said little about the smoke since the crisis began, preferring to focus on fire-hit rural communities.   Organiser Chloe Rafferty said that had created anger at the conservative government's inaction.   "I think the wider public can see that we are not expecting the climate crisis in the future but we are facing the climate crisis now," she told AFP.   "People are experiencing it in their day-to-day lives."   As well as a rise in people visiting hospitals with smoke-related health symptoms, the number of emergency calls for ambulances spiked 30 percent last week.    "For most people, smoke causes mild symptoms like sore eyes, nose and throat," top health department official Richard Broome said.   "However, people with conditions like asthma, emphysema and angina are at greater risk because the smoke can trigger their symptoms."

Smoke from bushfires is one of the biggest contributors to air pollution in Australia, releasing fine particles that can lodge deep within people's lungs and cause "severe" health impacts over time, according to scientist Mick Meyer from government-funded scientific research agency CSIRO.   "The impact of smoke on people remote from the fires may, on occasion, substantially exceed the direct injury to people within the fire zone," he wrote in The Conversation.   "But we currently lack the operational tools to understand the extent of these impacts or to manage them."   Six people have been killed and more than 700 houses destroyed in bushfires this fire season.   Though the human toll has been far lower than the deadliest fire season in 2009 -- when almost 200 people died -- the scale of this year's devastation has been widely described as unprecedented.   Three million hectares (7.4 million acres) of land has been burnt -- the size of some small countries -- and vast swathes of koala habitat scorched.   Official data shows 2019 is on track to be one of the hottest and driest years on record in Australia.
Date: Tue 3 Dec 2019
Source: Trinidad Express [abridged, edited]

The number of local deaths from the influenza virus has risen to 24. At the Health Ministry's update last week, 16 fatalities were reported from the flu, with Health Minister Terrence Deyalsingh appealing to citizens -- especially those considered at-risk -- to get vaccinated.
Date: Sat 30 Nov 2019
Source: The New Indian Express, Express News Service [edited]

According to official data, 14 swine flu [influenza A/H1N1] deaths across the state were recorded this year [2019] till [17 Nov 2019]. The figure is slightly less than the previous year's [2018] toll of 17. The total number of H1N1 swine flu-positive cases [has] also come down this year [2019] compared with 2018 from 402 to 325. Health officials are setting up isolation wards in hospitals as a preventive measure.

As the winter season has set in and the minimum temperatures are coming down, health officials are instructing the public to take precautions in order to stay away from being infected by swine flu. The health department has initiated steps to set up district-[wide] swine flu testing facilities and isolation wards in every district hospital, area hospital, and community health centre.

As per the requirement of treatment procedure, the government has to set up special isolation wards in all government hospitals and provide protection kits to the healthcare staff, especially to those who will attend to the patients suffering from the flu. Across the state, Visakhapatnam registered the highest number of positive swine flu cases and deaths. Out of 325 positive cases, 180 alone were reported from Visakhapatnam, of which 8 died. West Godavari district registered 3 deaths, and Anantapur, East Godavari, and Srikakulam registered one death case each.

All the district health officials have been instructed to intensify awareness camps and screening centres. As part of the action plan, isolation wards with 5-10 beds are to be set up in every teaching, district, and area hospital. A sufficient stock of drugs, masks, and PPE [personal protective equipment] kits are to be made available. Currently, there are 18 labs eligible for conducting confirmation test in the state. "We are creating awareness by distributing pamphlets and putting up screening centres at bus stops and railway stations," DMHO [district medical and health officer] Dr. TSR Murthy said.

Symptoms of swine flu are generally similar to that of seasonal flu. These include cough, fever, sore throat, stuffiness, runny nose, body aches, headache, chills, fatigue, diarrhoea, and vomiting. Later on, breathlessness, chest pain, drowsiness, low blood pressure, sputum mixed with blood, and bluish discoloration of nails also develops.
Date: Thu 28 Nov 2019
Source: GDN Online [edited]

Two expatriates living in Oman died after contracting the seasonal influenza (H1N1) or swine flu in the governorate of Dhofar -- the 1st in July and the 2nd in August [2019]. They were among 78 confirmed cases of swine flu registered at the Sultan Qaboos Hospital over the first 9 months of 2019 in the governorate.

The hospital authorities reported a total of 599 registered suspected cases of H1N1 between January and last September [2019]. Doctors working at Sultan Qaboos Hospital dealt overall with 1779 cases of respiratory infections during the same period.

Patients most vulnerable to the respiratory viruses are those over 18 years, particularly pregnant women; those suffering from chronic illnesses, kidney and heart diseases, liver problems, diabetes, asthma, blood disorders, and HIV/AIDS; and even health workers, according to Muscat Daily.
Date: Wed 11 Dec 2019
Source: UNICEF/WHO Situation report 11 Dec 2019 [edited]

Highlights
- 5 new human cases reported in the past week
- In response to 1st human vaccine-derived poliovirus type 1 (VDPV1) case from the island province of Basilan, in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), outbreak immunization was conducted
in Maluso, Basilan, with bivalent oral polio vaccine (bOPV) against polio type 1, vaccinating 13 547 children under 10 years old (102% of the target).
- Currently 9 human cases confirmed with circulating VDPV type 2 (cVDPV2), 1 case with VDPV1, 1 case with cVDPV1, and 1 case with immunodeficiency-related VDPV type 2 (iVDPV2).
- A case with VDPV1 from Sultan Kudarat is pending genetic analysis; 1 case of cVDPV1 from Malaysia was confirmed as genetically linked to the Basilan case.
- Synchronized polio vaccination campaign conducted on [25 Nov 2019 - 10 Dec 2019] (including 2 days of extension) vaccinated 4 309 566 children under 5, which is 98% of the target total of 4.4 million children under 5. A total of 1 395 365 children under 5 were vaccinated in National Capital Region (NCR), which is 109% of the target, and 2 914 201 (94%) in Mindanao.
- DOH planning to conduct outbreak immunization with bOPV targeting 710,296 children under 10 in the Sulu Archipelago, Zamboanga City, and Lambayong, Sultan Kudarat, on [6-12 Jan 2020].
- Current polio outbreak resulting from persistently low routine immunization coverage, and poor sanitation and hygiene.
- Philippines is affected by both cVDPV1 and cVDPV2. cVDPV is considered a public health emergency of international concern (PHEIC).

cVDPV1
---------
- In response to the 1st human case confirmed with VDPV1 from Maluso, Basilan (BARMM), outbreak immunization was conducted in the area with bOPV for children under 10 years old, vaccinating 13,547 children under 10 years of age (102% of the target).
- A cVDPV1 case in Sabah state, Malaysia, was confirmed to be genetically linked to the Basilan case by the Victorian Infectious Diseases Reference Laboratory (VIDRL) in Australia. Since the 2 viruses are genetically linked, they are both classified as circulating.
- A new VDPV1 case from Sultan Kudarat (Region XII) was confirmed on [6 Dec 2019] and is pending further genetic analysis.
- All 13 cVDPV1 environmental samples found in Manila are genetically linked.

cVDPV2
---------
- All 9 human cases and 17 environmental samples confirmed with cVDPV2 are genetically linked. All human cases were reported from Mindanao (BARMM and Region XII), whereas environmental samples were found in NCR and Davao.
- All samples were tested by the National Polio Laboratory at the Research Institute for Tropical Medicine (RITM), whereas sequencing and genetic analysis is done at the NIID in Japan, and additional genetic characterization is provided by the United States Centers for Disease Control and Prevention (CDC).
=======================
[Given the identification of the cVDPV1 case in Malaysia that is genetically related to the VDPV1 case in Basilan, it is now clear there are at least 2 separate cVDPV outbreaks in the Mindinao region of the Philippines: one of the outbreaks is associated with cVDPV2, and the other with cVDPV1 and one outbreak of cVDPV1 in the Manila Metropolitan area (although only environmental samples have been positive without AFP (acute flaccid paralysis) cases as yet.) What all these areas have in common is pockets of populations with suboptimal vaccination coverages. Clearly, we await further information on the genetic profiling of the newly identified VDPV1 case in Sultan Kudarat, also located in southern Philippines. Note that Basilan Island, Sultan Kudarat, and Sabah state in Malaysia, while all in the same general area, are not contiguous, each being on a different island. In. total, there are 11 cases of AFP in the Philippines that are attributable to infection with a VDPV.

A map showing the provinces in the Philippines can be found at

HealthMap/ProMED-mail map of the Philippines: