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Greece

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

Travel News Headlines WORLD NEWS

Date: Tue, 18 Feb 2020 09:07:42 +0100 (MET)

Athens, Feb 18, 2020 (AFP) - Greece was hit with a 24-hour strike Tuesday over a pension reform encouraging people to stay longer in the workforce.   The labour action paralysed public transport in Athens, intercity trains and ferry ship services.   Civil servants are also walking off the job and journalists will stage a three-hour work stoppage against the pension reform.   "This bill is practically the continuation of (austerity) laws introduced in 2010-2019," civil servants' union ADEDY said.

Unions will hold street protests in Athens, Thessaloniki and other major cities later in the day.   The new conservative government says the reform, to be voted by Friday, will make the troubled Greek pension system viable to 2070.   The labour ministry says the overhaul -- the third major revamp in a decade -- will contain pension increases and reduce penalties for pensioners still working.

Successive governments have attempted to reform the pension system, whose previously generous handouts are seen as one of the causes of the decade-long Greek debt crisis.   Chronic overspending and the inaccurate reporting of the budget deficit spooked creditors in 2010, and required three successive bailouts by the European Union and the International Monetary Fund to avert a Greek bankruptcy.   In return for billions of euros in rescue funds, Greece had to adopt unpopular austerity reforms and pension cuts.
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:
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Travel News Headlines WORLD NEWS

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Anguilla

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

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

In addition to a valid passport, U.S. citizens need onward or return tickets, and sufficient funds for their stay.
A departure tax is charged at the airport or ferry dock when leaving. For further information, travelers may contact the British Embassy, 19 Observatory Circle NW, Washington, DC
20008; telephone (202) 588-7800; or the nearest consulate of the United Kingdom in Atlanta, Boston, Chicago, Dallas, Los Angeles, New York, Denver, Houston, Miami, Orlando, Seattle, or San Francisco. Visit the British Embassy web site for the most current visa information.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Anguilla are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration web site and to obtain updated information on travel and security within Anguilla. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy with consular responsibility over Anguilla is located in Bridgetown, Barbados in the Wildey Business Park in suburban Wildey, southeast of downtown Bridgetown.
The main number for the Consular Section is (246) 431-0225; after hours, the Embassy duty officer can be reached by calling (246) 436-4950.
Visit the U.S. Embassy Bridgetown online for more information.
Hours of operation are 8:30 a.m. – 4:30 p.m. Monday through Friday, except Barbadian and U.S. holidays.
* * *
This replaces the Country Specific Information for Anguilla dated April 2, 2008, to update sections on Country Description, Entry/Exit Requirements, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

General
**********************************************
This southern African country is a popular destination for travellers from Ireland. Victoria Falls must be one of the main tourist attractions but many other visitors will explore the rich s
fari parks and many other attractions, which Zimbabwe has to offer. Unfortunately the stability throughout the country has decreased considerably during the past two years and it will be essential that travellers stay within well defined itineraries agreed with recognised tour operators.
Safety & Security
**********************************************
The level of petty crime is increasing throughout the country as stability decreases. Muggings and pickpocketing occur too often in the main urban areas and especially in the capital - Harare. Care should be taken when getting money from ATM’s or when leaving the banks. Try to have a companion with you and avoid busy market places and crowded local transport. Use hotel safe boxes and don’t leave personal belongings on view where possible. Avoid flaunting personal wealth, only use authorised taxis and take care if visiting late-night bars etc. Credit care fraud is becoming more common so ensure that your card never leaves your sight.
Travel in Zimbabwe
**********************************************
Hiring cars or motorbikes is unwise as the number of serious accidents involving tourists is considerable. Many hazards occur along the roads including unlit abandoned trucks, stray livestock and pedestrians and poor fuel supplies. Many roads are in a poor state of repair and those requiring assistance may have to wait many hours in a deserted location. Car jacking and theft from cars is increasing. If driving long distances you should ensure that you have sufficient fuel and adequate supplies of food and water in case of emergency. A torch and sensible medical kit are also prerequisites.
Health Facilities
**********************************************
Outside of the main urban centres of Harare and Bulawayo the level of healthcare for tourists may be very limited. Even in the cities shortages of some main medications may lead to inadequate treatment and evacuation to South Africa may become necessary. Any tourist on personal medication (asthma, diabetes, contraceptive pill etc) should make certain that they have sufficient supplies with them to complete their journey through Zimbabwe.
Rabies
**********************************************
The risk of rabies occurs throughout the country for those exposed to infected warm-blooded animals. This will be mainly following a bite from an infected dog but cats and monkeys and many other animals also carry the disease. Returning to Harare and possibly to South Africa will be essential to ensure adequate early treatment.
Playing Golf in Zimbabwe
**********************************************
Many tourists visiting Zimbabwe will play golf on some of their many courses. Golf tends to be played during the hours soon after dawn and towards dusk when mosquitoes may abound. They should be aware that there is an increased risk of malaria from mosquito bites (in infected regions) but also of wandering into the rough to retrieve a ball and being bitten by snakes or ticks or stung by scorpions. Avoiding the rough is a wise precaution!

White Water Rafting & Bungee Jumping
**********************************************
Many tourists to the Zambezi region partake of adventure sports including white water rafting and bungee jumping. Check whether of not your travel insurance covers these activities and be aware that both activities can carry significant risks. The bungee jump at Victoria Falls is recognised as one of the highest in the world at 111 metres. Generally the safety and security is good but accidents do occur. The risks of serious injury from white water rafting are also present both from direct trauma (eg bruising, drowning, fractures etc) and also from exposure to Schistosomiasis in the calm fresh water regions along the Zambezi. This parasitic disease is more common in those who swim in Lake Malawi but does occur in Zimbabwe. Serious long-term effects are regularly reported in those returning after fresh water contact in Africa.
Food & Water Facilities
**********************************************
Despite the diminishing security situation throughout the country and the food shortages which have been reported among the local population, the main tourist hotels are still receiving sufficient supplies. This situation may change and travellers should be aware that the level of service may be affected. Lettuce and cold foods may not be adequately treated and should be avoided. Unpeeled fruits should be fine but tap water should not be used for brushing your teeth unless you can easily smell chlorine.
Insect & Mosquito Bites
**********************************************
The Zambezi valley region (including Victoria Falls) is probably the single highest risk region for tourists developing malaria throughout the world. It is essential that adequate malaria prophylaxis is used at all times of the year for those visiting this region. Those remaining in the central highlands (cities of Harare and Bulawayo) will not need prophylaxis as the risk of this mosquito borne disease is very small. Tsetse flies transmit sleeping sickness and this may be a risk for those visiting some of the safari parks. Good repellent and adequate light coloured clothing is essential.
Sun Exposure & Dehydration
**********************************************
It is important to increase your intake of fluids and salt while perspiring significantly in a hot climate. Wearing a wide-brimmed hat is also important.
Vaccines for Zimbabwe
**********************************************
There are no essential vaccines for entry into Zimbabwe from Ireland. However those crossing into Zambia at Victoria Falls (and having their passport stamped) may find that the authorities demand evidence of cover against Yellow Fever before re-entry. Otherwise most tourists are advised to consider adequate cover against:
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food and water disease)
*
Hepatitis A (food and water disease)
Those planning a longer or more rural trip will also need to consider cover against diseases like Hepatitis B and Rabies.
Summary
**********************************************
The majority of tourists visiting Zimbabwe will remain very healthy and well providing they remain conscious of the prevailing local uncertainty and follow some simple precautions against food and water disease, mosquito bites, and accidents.

Travel News Headlines WORLD NEWS

Date: Fri 17 Jan 2020
Source: The Herald [edited]

At least 177 cattle have died from anthrax while 87 people were treated for the disease in various clinics and hospitals after eating meat from cattle that died from the infection during this season. Anthrax is a bacterial disease that affects a wide range of animals and human beings.

Livestock, particularly cattle, take up anthrax bacteria during grazing, while people get infected when they handle or eat anthrax-infected meat. Anthrax disease occurs throughout the year, but in Zimbabwe, most cases start from onset of rainy season. It is rare to see an animal showing signs of the disease; animals are often found dead. [Actually once it gets started, ranchers will start seeing sick animals; watching more carefully, longer incubation periods. - ProMED Mod.MHJ]

Division of Veterinary Field Services, Acting Director, Dr. Wilmot Chikurunhe has told The Herald that anthrax outbreaks have been recorded in Gokwe, Nkayi, Gutu, Bikita, Marondera, Mazowe, Chegutu, Makonde and Sanyati. He said the disease is being detected in traditional outbreak areas and not affecting the whole district as it may seem from information circulating. "Even in the affected dip tanks, the disease is restricted to certain areas, although the vaccination coverage is then extended to a wider area to contain the outbreak.

"Cattle owners in anthrax areas need to ensure that their cattle are vaccinated against the disease once a year before the rainy season starts. The Department of Veterinary Services comes in to prevent massive outbreaks, but the primary responsibility for disease prevention lies with the owner," he said.

Dr. Chikurunhe said anthrax carcasses must be disposed of safely in a manner that does not leave the bacteria exposed to air. "The best method is to burn the carcasses in a pit, then bury the ashes. However, some parts of the country have firewood problems. In these areas it is recommended to dig a pit 6 feet [1.8 m] deep, bury the carcass, cover the carcass completely with soil and apply a layer of agricultural lime before filling the rest of the pit with soil. This is best done under supervision of veterinary personnel," said Dr. Chikurunhe.  [Byline: Elita Chikwati]
==================
[For maps clearly showing the locations of the individual provinces, go to <https://en.wikipedia.org/wiki/Provinces_of_Zimbabwe>. The districts mentioned are in the following provinces: Bikita (Masvingo), Chegutu (Masonaland West), Gotwe (Midlands), Gutu (Masvingo), Makonde (Masonaland West), Marondera (Masonaland East), Mazowe (Masonaland Central), Nkayi (Matabeleland North), and Sanyati (Masonaland West).

The survival of anthrax spores is location dependent, and this facilitates mapping where the disease might be found and where control should be centered. For some relevant maps, see:
1. Carlson CJ, Kracalik IT, Ross N, et al. The global distribution of _Bacillus anthracis_ and associated anthrax risk to humans, livestock, and wildlife. Nat Microbiol 2019;4:1337-43. doi:10.1038/s41564-019-0435-4
2. Blackburn JK, Odugbo MO, Van Ert M, et al. _Bacillus anthracis_ diversity and geographic potential across Nigeria, Cameroon and Chad: further support of a novel West African lineage. PLOS Negl Trop Dis

As Dr. Wilmot Chikurunhe comments, while vaccination should center on these enzootic areas, one should extend the vaccination cover outwards because of the risk from female biting tabanid flies with contaminated mouthparts and non-reporting neighbours. Annual vaccination prior to the anthrax season protects the livestock at a minimal cost, as Sterne vaccine is extraordinarily cheap. And eradication follows from successful control. Country after country, province after province are realising the truth of this. I just wish the ranchers would be as enthusiastic. It is the procrastinators' livestock that come down, demonstrating a local persistence of risk. Experience shows that once you have gone 8-10 years without outbreaks, you can step back to just high awareness of unexpected deaths (for checking).

The spores have a reputation for "immortality", which is exaggerated. Archived spores have a 3% annual mortality. On my 1st field investigation of this disease, Max Sterne told me that in his experience the contaminated soil will present a risk for 3 months to 3 years; we repeatedly sampled the bloody soil site at that outbreak and found no live spores after 90 days, but we might have just run out of contaminated soil thanks to the repeated sampling. A study by one of my students showed the spore count decreasing by 30% per year. But in general this is an aspect of the epidemiology of this disease that is understudied. And another aspect is that over 5 to 6 years the spores in the soil lose their plasmids and become apathogenic.

The genetics of spore survival depend on a matching of the strain with the soil, Darwin again.

See: Mullins JC, Garofolo G, Van Ert M, et al. Ecological niche modeling of _Bacillus anthracis_ on three continents: evidence for genetic-ecological divergence? PLoS One 2013;8:e72451. <https://doi.org/10.1371/journal.pone.0072451>

Remember, graduate students need fresh air and mud on their boots. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map:
Date: Sat, 11 Jan 2020 03:28:20 +0100 (MET)
By Ish MAFUNDIKWA

Hwange, Zimbabwe, Jan 11, 2020 (AFP) - Zimbabwean villager Dumisani Khumalo appeared to be in pain as he walked gingerly towards a chair under the shade of a tree near his one-room brick shack.   The 45-year-old was attacked by a buffalo days earlier, and he was lucky to be on his feet.   Wild animals in Zimbabwe were responsible for the deaths of at least 36 people in 2019, up from 20 in the previous year.    "I thank God that I survived the attack," said Khumalo with a laugh, making light of the fact that the buffalo almost ripped off his genitals.   Authorities recorded 311 animal attacks on people last year, up from 195 in 2018.

The attacks have been blamed on a devastating drought in Zimbabwe which has seen hungry animals breaking out of game reserves, raiding human settlements in search of food and water.   "The cases include attacks on humans, their livestock and crops," said national parks spokesman Tinashe Farawo.   He said elephants caused most fatalities, while hippos, buffalos, lions, hyenas and crocodile also contributed to the toll.   Hwange National Park, which is half the size of Belgium, is Zimbabwe's largest game park and is situated next to the famed Victoria Falls. The park is not fenced off.   Animals breach the buffer and "cross over to look for water and food as there is little or none left in the forest area," Farawo said

- Starving animals -
Khumalo vividly remembers the attack. He was walking in a forest near his Ndlovu-Kachechete village to register for food aid, when he heard dogs barking.   Suddenly a buffalo emerged from the bush and charged, hitting him in the chest and tossing him to the ground.    It went for his groin and used its horn to rip off part of the skin around his penis.   Khumalo grabbed the buffalo's leg, kicked it in the eye and it scampered off.   Villagers in Zimbabwe's wildlife-rich but parched northwestern region are frequently fighting off desperately hungry game.   More than 200 elephants starved to death over three months last year.

Despite suspecting that Khumalo was hunting illegally when he was attacked, Phindile Ncube, CEO of Hwange Rural District Council admitted that wild animals are killing people and that the drought has worsened things.   "Wild animals cross into human-inhabited areas in search of water as … sources of drinking water dry up in the forest," said Ncube.   He described an incident that took place a few weeks earlier, during which elephants killed two cows at a domestic water well.   Armed scouts have been put on standby to respond to distress calls from villagers.   But it was while responding to one such call that the scouts inadvertently shot dead a 61-year-old woman in Mbizha village, close to Khumalo's.   "As they tried to chase them off one (elephant) charged at them and a scout shot at it. He missed, and the stray bullet hit and killed Irene Musaka, who was sitting by a fire outside her hut almost a mile away."

- Chilli cake repellant -
Locals are encouraged to play their part to scare off animals. One way is to beat drums.   But the impact is limited.   "Animals, such as elephants get used to the noise and know it... won't hurt them, so it does not deter them in the long term," said George Mapuvire, director of Bio-Hub Trust, a charity that trains people to respond to animal attacks.   Bio-Hub Trust advocates for a "soft approach" that encourages peaceful co-existence between humans and wildlife.

Mapuvire suggested burning home-made hot chilli cakes to repel wildlife.   "You mix chilli powder with cow or elephant dung and shape it into bricks, once the bricks dry, you can burn them when elephants are approaching. They can't stand the smell!"   Villagers have created an elephant alarm system by tying strings of empty tin cans to trees and poles.   When the cans click, they know an elephant is approaching and they light chilli cakes to keep it away.   Another way of keeping elephants at bay is the chilli gun, a plastic contraption loaded with ping-pong balls injected with chilli oil.    "When it hits an elephant, it disintegrates, splashing the animal with the chilli oil," Mapuvire explained.
Date: Fri 10 Jan 2020
Source: The Herald [edited]

Three people are battling for their lives after consuming meat from animals that died of anthrax in Mahusekwa, Marondera district. The 3 cases were picked at Chimbwanda Clinic last week and were confirmed at Mahusekwa Hospital on Monday [6 Jan 2020].

Marondera District Veterinary Officer Dr. Kramer Manyetu said, on investigation, it was established that the affected 3 people consumed meat from 2 cattle that died on [30 Dec 2019]. "No meat was still available when the affected property was visited. The 2 cattle deaths were reported at Chimbwanda West Dip Tank, which has a census of 800 cattle. The combined census for a 10-kilometre (6.2 mi) radius is 4500 cattle covering a total of 3 dip tanks, namely, Chimbwanda West (800), Chimbwanda communal area (2276) and Nyandoro (1458)," he said. Dr. Manyetu said they had secured 5000 doses required to cover the 3 dip tanks.

"Our staff and the Ministry of Health and Child care are in the area and, so far, we can confirm that it is only one homestead affected. The community has secured poles to build races on 3 dip tanks and vaccinations will start Friday [10 Jan 2020]," he said.

The Department of Veterinary Services has received 811,000 doses of anthrax vaccine from Botswana's Vaccine Institute to deal with outbreaks during the rainy season.

Anthrax is a life-threatening infectious disease caused by bacteria that normally affects animals, especially ruminants. The disease affects all warm-blooded animals, including humans. Signs of anthrax include sudden death of livestock, rapid decomposition of the bloated carcasses and tarry blood coming out of all natural openings. The blood of the carcass is brownish and does not clot. During the rainy season, the country usually experiences more anthrax outbreaks because of the rains that wash away the top soil and expose spores. [If this were the case, the spores would be washed away. The rain, following the dry season, encourages the forage to grow, and, in grazing, cattle consume significant amounts of soil, some of which might be contaminated. Also the rain floats the hydrophobic spores to the soil surface. Tabanid hatch will occur, and these blood-feeding flies will spread the infection to more cattle, increasing the risk. - ProMED Mod.MHJ]

There have been cases of farmers who get infected after eating meat from cattle that would have died of anthrax. People may also get infected thorough contact with the infected animals. "Opening an anthrax carcass will lead to formation of anthrax spores that are resistant to environmental changes, heat, cold and will contaminate the soil or area for [a significant period].

"The public should not handle, buy or eat meat that has not been inspected. Anthrax carcasses should never be opened, skinned or eaten. Instead, they should be buried deep into the ground," said Dr. Manyetu. [Preferably, they should be burnt. - ProMED Mod.MHJ]

"It is also an offense to sell to the public, meat that has not been processed in an abattoir and inspected and certified as unconditionally fit for human consumption."

Farmers were advised to report all cattle deaths to their nearest veterinary officers.  [Byline: Elita Chikwati]
========================
[Marondera is in the center of Mashonaland East

This is an update on the previous report of 2 Jan 2020 (Anthrax - Zimbabwe: (ME) cattle, human cases

"Dip tanks" take us back to Southern Rhodesia, when a major veterinary disease control activity was tick control. Community cattle were swum through the deep pesticide at regular intervals throughout the year. This was tightly supervised. This provided a good opportunity for individual animals to be checked, pregnancy status confirmed, and generally one-on-one contact with the veterinary assistants. Thus, the census centered on these collecting points. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map:
Mashonaland East, Zimbabwe: <http://healthmap.org/promed/p/6141>]
Date: Tue 7 Jan 2020
Source: News Day [edited]

A deadly anthrax outbreak has hit Gokwe North district in the Midlands province, with farmers losing large herds of cattle while several people were reportedly hospitalised after eating infected meat.

Midlands veterinary officer Munyaradzi Chigiji confirmed the development and said his department had since moved in to put the outbreak under control. "We have had great losses of livestock to date, and our tests confirmed that it was anthrax. Farmers have lost huge numbers of cattle due to the outbreak so far. We have also recorded cases of human beings who have been treated of the disease in the affected areas. Although we cannot confirm the number of deaths of the livestock, what we can say is that farmers have lost out," Chigiji said.

"During my visit to the area, I arrived at a homestead which had lost 15 cattle. I also visited another one which had lost 4. We also have several other farmers who have lost their livestock due to anthrax." The hardest hit areas are Nembudziya, Simchembo and Chireya.

Southern Eye yesterday [6 Jan 2020] spoke to farmers at Nembudziya Growth Point who confirmed that the outbreak was wreaking havoc in the area. "I lost a herd of 11 cattle due to the outbreak. In my village alone, over 80 cattle have perished in the recent past due to the outbreak. Here, our main economic activity has been cotton growing, but lately we had shifted to cattle ranching because the cotton has become less profitable due to falling prices," said Nomore Machivenyika, a farmer in Maserukwe village. "This outbreak has, therefore, come as a big blow for us."

Another farmer told this paper that several people in Nembudziya had been hospitalised after eating infected meat. "There are people who have been selling cheap meat around this area, and little did people know that it was from cattle that died of anthrax. Several of them have been going to Nembudziya Hospital for treatment," Nomore Musundire said.

Chigiji said measures to control the outbreak had since been put in place. "As we speak, we have dispatched 10 400 (vials of) vaccines to Gokwe North so that cattle can be vaccinated. We have also been carrying out awareness campaigns in conjunction with the Ministry of Health. In terms of humans, no one has died from anthrax," he said.

Chigiji also revealed that another livestock disease, heartwater, had been wiping out cattle in the same district. "We had shortages of dipping chemicals, so heartwater also caught up with the livestock. However, we are working to normalise the situation," he said.
======================
[For a brief description of Gokwe North & South in Midlands Province west of Harare, go to: <https://en.wikipedia.org/wiki/Gokwe_region>. For a map of Zimbabwe showing the various provinces, click on "Subdivision of Zimbabwe" in the Wikileaks link.

It would appear that this disease has got away from any control efforts by the Midlands veterinary officer and his people. The actual extent and intensity of those efforts is not obvious from the quoted statements. And being the holiday season, a number of owners of sick and dead cattle did not miss the opportunity to sell contaminated meat from their butchered sick stock. To control and stop an anthrax epizootic in livestock, one must be aggressive and have your feet on the ground. - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Midlands Province, Midlands, Zimbabwe:
Date: Wed 1 Jan 2020
Source: Pindula News [edited]

Three people were diagnosed and treated for Anthrax in Mashonaland East's Bosha Clinic in Chikwaka after they had consumed the meat of a dead cattle the Herald reports. DVS chief director, Dr. Josphat Nyika revealed the incident and said they couldn't find a carcass for sample collection because people consumed all the meat.

Suspicion of anthrax was consolidated by human contacts. There were 3 patients who were diagnosed of anthrax after they had consumed the meat of dead cattle. They were admitted and treated at Bosha Clinic.

Meanwhile, the government has received 800 000 doses of anthrax vaccines from Botswana and vaccinations are currently underway according to Dr. Nyika.
More ...

World Travel News Headlines

Date: Thu, 20 Feb 2020 16:20:39 +0100 (MET)

Damascus, Feb 20, 2020 (AFP) - A bomb explosion wounded two people in Damascus Thursday, the state news agency reported, the latest of several such attacks in the Syrian capital.   "An explosive device planted on a pickup truck went off in the Marjeh area" in central Damascus, SANA said, adding that two civilians were wounded by the blast.

The Syrian Observatory for Human Rights war monitor said the device was a "sticky bomb" planted on a military vehicle, although it was not immediately clear what the target was.   There was no immediate claim of responsibility for the blast, nor for a similar explosion that wounded five people in another neighbourhood of Damascus on Tuesday. The Syrian capital was routinely targeted by major car bomb attacks in the course of the nine-year-old conflict but blasts have been less frequent since regime forces reclaimed full control of the Damascus region in 2018.
Date: Thu, 20 Feb 2020 15:40:35 +0100 (MET)
By Laurent Thomet, with Miwa Suzuki in Tokyo

Beijing, Feb 20, 2020 (AFP) - China on Thursday touted a big drop in new virus infections as proof its epidemic control efforts are working, but the toll grew abroad with deaths in Japan and South Korea.   Fatalities in China hit 2,118 as 114 more people died, but health officials reported the lowest number of new cases in nearly a month, including in hardest-hit Hubei province.

More than 74,000 people have been infected by the new coronavirus in China, and hundreds more in over 25 countries.   The number of deaths outside mainland China climbed to 11.   Japan's toll rose to three as a man and a woman in their 80s who had been aboard a quarantined cruise ship died, while fears there mounted about other passengers who disembarked the Diamond Princess after testing negative.

South Korea reported its first death, and the number of infections in the country nearly doubled Thursday to 104 -- including 15 at a hospital in Cheongdo county.   The mayor of Daegu -- South Korea's fourth-largest, with 2.5 million people -- advised residents to stay indoors, while commanders at a major US military base in the area restricted access.   Iran reported two deaths on Wednesday, the first in the Middle East. Deaths have previously been confirmed in France, the Philippines, Taiwan and Hong Kong.

Chinese officials say their drastic containment efforts, including quarantining tens of millions of people in Hubei and restricting movements in cities nationwide, have started to pay off.   "Results show that our control efforts are working," Foreign Minister Wang Yi said at a special meeting on the virus with Southeast Asian counterparts in Laos, citing the latest data.   Wang said the situation was "significantly improving" in Hubei and Wuhan, but an official in a central government team dealing with the epidemic said it was still "very severe".

- 'Not turning point' -
Although more than 600 new infections were reported in Hubei's capital Wuhan, it was the lowest daily tally since late January and well down from the 1,749 new cases the day before.   The national figure has now fallen for three straight days.   Chinese authorities placed the city of 11 million under quarantine on January 23 and quickly locked down the rest of the province in the days that followed.

Wuhan authorities this week carried out a three-day, door-to-door check on residents, with the local Communist Party chief warning that officials would be "held accountable" if any infections were missed.   Cities far from the epicentre have limited the number of people who can leave their homes for groceries, while rural villages have sealed off access to outsiders.   Richard Brennan, a World Health Organization official, said in Cairo that China was making "tremendous progress" and "trends are very encouraging, but we are not at a turning point yet".

- 'Chaotic' cruise quarantine -
While China has boasted progress in its fight against the COVID-19 epidemic, Japan's government has been criticised for the quarantine measures it placed on the Diamond Princess.   The huge vessel moored in Yokohama is easily the biggest coronavirus cluster outside the Chinese epicentre, with 634 cases confirmed among passengers and crew.   Another 13 people on board the ship were diagnosed with the virus Thursday, Japan's health ministry said.   Still, passengers were disembarking after negative tests and having completed a 14-day quarantine period -- packing into yellow buses and leaving for stations and airports.

Questions were asked over the wisdom of allowing them to mingle in Japan's crowded cities.   "Is it really safe to get off?" screamed a headline in the Nikkan Sports tabloid.   The paper quoted one passenger who said he was tested on February 15, but only left four days later.   "I thought I could be infected during the four days. I thought 'Is it really OK'?"

A specialist in infectious diseases at Kobe University slammed as "completely chaotic" the quarantine procedures on board in rare criticism from a Japanese academic.   "The cruise ship was completely inadequate in terms of infection control," said Kentaro Iwata in videos he has since deleted.

South Korea, meanwhile, announced 51 new cases, with more than 40 in a cluster centred on the Shincheonji Church of Jesus, an entity often accused of being a cult.  The infections apparently came from a 61-year-old woman who first developed a fever on February 10 and attended at least four services before being diagnosed.   Local media said she had twice refused to be tested for the coronavirus on the grounds she had not recently travelled abroad.   Authorities were investigating whether she might have visited the hospital where a long-term patient contracted the virus and later died.

Some 15 other patients have now been found to have the virus.   Shincheonji claims its founder, Lee Man-hee, has donned the mantle of Jesus Christ and will take 144,000 people with him to heaven on the day of judgement.   A man in his 60s tested positive for the coronavirus after dying Wednesday following symptoms of pneumonia, South Korean authorities said.
Date: Thu, 20 Feb 2020 10:28:16 +0100 (MET)

Lagos, Feb 20, 2020 (AFP) - An outbreak of Lassa in Nigeria has killed 103 people this year, health authorities said, as the first confirmed case was reported in the economic hub Lagos.    "Cumulatively from week 1 to week 07, 2020, 103 deaths have been reported with a case fatality rate of 17.6%," said the Nigeria Centre for Disease Control (NCDC) in its latest statistics on the virus released on Wednesday.    The overall number of confirmed cases rose by 115 last week to a total of 586 across the country.

Separately, health authorities in Lagos, Nigeria's most populous city with 20 million inhabitants, said an infected person was diagnosed there on February 17 and being treated in isolation in hospital.    "Sixty-three people that may have been in contact with the patient and who may have been infected in the process have been identified and are being monitored," the state government wrote on Twitter on Thursday.

Endemic to Nigeria, Lassa fever belongs to the same family as the Ebola and Marburg viruses, but is much less deadly.   The disease is spread by contact with rat faeces or urine or the bodily fluids of an infected person.    The majority of those infected do not show symptoms but the disease can go on to cause severe bleeding and organ failure in about 20 percent of cases.

An outbreak of Lassa fever killed some 170 people around Nigeria last year.     The number of cases usually climbs around the start of the year linked to the dry season.   While the overall number of confirmed cases and deaths is up this year on the same period in 2019, the mortality rate is lower.    Twenty health workers across the country have been confirmed as contracting the disease so far in 2020.    The virus takes its name from the town of Lassa in northern Nigeria, where it was first identified in 1969.
Date: Thu, 20 Feb 2020 09:58:17 +0100 (MET)
By Nicolas DELAUNAY

Les Mamelles, Seychelles, Feb 20, 2020 (AFP) - On a plain suburban street in Seychelles, far from the idyllic coastline and luxury resorts pampering honeymooners and paradise-seekers, heroin addicts queue anxiously for their daily dose of methadone.   It is a scene few outsiders would associate with the tropical nirvana adrift in the Indian Ocean, and one rarely, if ever, glimpsed by tourists as they shuttle from the airport to five-star luxury on white-sand beaches.

But life for many Seychellois is far from picture perfect: the tiny archipelago nation is battling what officials say are the world's highest rates of heroin addiction.   Nearly 5,000 people are hooked, government figures show, equivalent to nearly 0 percent of the national workforce -- a statistic that has startled the government into action.

In comparison, 0.4 percent of the global population consumed opioids in 2016, half of them in Asia, according to a United Nations report that puts Seychelles among the top consumers alongside producing countries such as Afghanistan.   The Seychelles' heroin boom, which took off over the past decade, gripped young and old alike and cut across class lines.   Among those queueing in the town of Les Mamelles for methadone -- a substitute narcotic used to wean users off heroin -- are parents with young children, an old man leaning on a cane and a taxi driver between shifts.

Graham Moustache, a 29-year-old father of two, described how the arrival of affordable and high-quality heroin in Seychelles swept up his entire family.   "I have four brothers and two sisters, and we have all been heroin addicts at one point," he told AFP, tracing his fingers over the needle scars on his arms.   "I've been to prison twice," he said, adding his mother had turned him in as "she didn't know what to do any more".   "Sometimes, I didn't have enough to eat and I had to choose between eating and buying heroin. I chose heroin."

- Soaring addiction -
The rise of new trafficking routes through East Africa in the late 2000s, coupled with porous borders and relatively high purchasing power among Seychellois, flooded the paradisal islands with heroin.   The average salary in the archipelago is $420 (390) -- high compared to other African nations.   The World Bank considers the Seychelles the only high-income country on the continent, thanks to the growing tourism industry.    But around 40 percent of the population still lives in poverty.

By 2011, around 1,200 people were addicted, prompting a punitive crackdown.   "We did not make a difference between the victim and the trafficker," said Patrick Herminie, director of the state-run Agency for Drug Abuse Prevention and Rehabilitation (APDAR).   By 2017, addiction had risen four-fold, placing Seychelles among the world's most drug-dependent nations.   The government, realising its war on drugs had failed, changed tack and declared a public health emergency.   "The magnitude of the problem is simply because we reacted a bit late," Herminie said.

Money has poured into combating the scourge, with state funds for drug prevention and rehabilitation programmes soaring to 75 million Seychelles rupees ($5.5 million) in 2020 -- almost 10 times the 2016 budget.    APDAR, a specialist drug agency created in 2017 to tackle the problem, employs four times as many staff as the body that preceded it.   A state-run methadone programme has reached 2,500 people, with medical follow-ups helping to track their progress.    But the free availability of methadone has also prompted drug dealers to lower their prices.

Mobile clinics drive around offering methadone to addicts and providing free health checks and advice.    "I've been clean for more than a year. I found a job as a fisherman, and I can see my two kids," said Moustache proudly, as he queued at the white methadone van staffed with healthcare workers.   Others have struggled to stay the course.   "Methadone helps me a lot, but it's difficult not to take heroin at all," said Gisele Moumou, an emaciated 32-year-old addict, drawing ragged breaths and sweating as she waits for her small cup of methadone.

- Stopping the scourge  -
Schoolchildren are being taught about the damage done by drugs through awareness campaigns and billboards in classrooms.    But there is much work to be done, especially among children from families affected by drug use, says Noellie Gonthier from CARE, a local harm-reduction charity.   "Sometimes, four- or five-year-olds at school mimic injecting heroin," she said.   "Our challenge is to make them understand that what they consider normal -- because of their family context -- actually isn't at all."   On Mahe, a small, mountainous island with lush vegetation, most of the population lives near the water. Life is quiet here, without traffic, and the streets are mostly clean.

Poverty is largely hidden, concentrated in a few neighbourhoods behind faded walls or in the hills.   So why do so many Seychellois take drugs? The authorities admit they haven't quite figured it out, but say it appears that while poverty does not quite allow people to live well, it allows them enough money to buy drugs to forget their woes.   "The root of the cause, we're still working on it," said Herminie.   Early studies show that health and social problems associated with heroin use have declined since the government switched its response from punishment to prevention, officials say.

Crime has nearly halved and annual cases of new hepatitis C infections have fallen 60 percent.    Youth unemployment, meanwhile, has shrunk from 6.5 percent to 2.1 percent in recent years.   One recovering addict, a taxi driver who did not want to be named, offered a bleak assessment as he waited for his daily methadone in an empty car park in Les Mamelles.    "We're a small island in the middle of the ocean. What else is there to do here?" he said.
Date: Wed, 19 Feb 2020 16:12:54 +0100 (MET)
By Michael O'HAGAN

Otuke, Uganda, Feb 19, 2020 (AFP) - Under a warm morning sun scores of weary soldiers stare as millions of yellow locusts rise into the northern Ugandan sky, despite hours spent spraying vegetation with chemicals in an attempt to kill them.   From the tops of shea trees, fields of pea plants and tall grass savanna, the insects rise in a hypnotic murmuration, disappearing quickly to wreak devastation elsewhere.   The soldiers and agricultural officers will now have to hunt the elusive fast-moving swarms -- a sign of the challenge facing nine east African countries now battling huge swarms of hungry desert locusts.

They arrived in conflict-torn South Sudan this week, with concerns already high of a humanitarian crisis in a region where 12 million are going hungry, according to the UN's Food and Agriculture Organization (FAO).    "One swarm of 40 to 80 million can consume food" for over 35,000 people in a day, Priya Gujadhur, a senior FAO official in Uganda, told AFP.

In Atira -- a remote village of grass-thatched huts in northern Uganda -- some 160 soldiers wearing protective plastic overalls, masks and goggles sprayed trees and plants with pesticide from before dawn in a bid to kill the resting insects.   But even after hours of work they were mostly able to reach only lower parts of the vegetation.   Major General Kavuma sits in the shade of a Neem Tree alongside civilian officials as locusts sprayed with pesticide earlier that morning fall around them, convulsing as they die.   An intense chemical smell hangs in the air.

- 'They surrounded me' -
Zakaria Sagal, a 73-year-old subsistence farmer was weeding his field in Lopei village some 120 kilometres (75 miles) away, preparing to plant maize and sorghum, when without warning a swarm of locusts descended around him.   "From this side and this side and this side, they surrounded me," Sagal said, waving his arms in every direction.    "We have not yet planted our crops but if they return at harvest time they will destroy everything. We are not at all prepared."

East Africa's regional expert group, the Climate Prediction and Applications Centre (ICPAC), warned Tuesday that eggs laid across the migratory path will hatch in the next two months, and will continue breeding as the rainy season arrives in the region.   This will coincide with the main cropping season and could cause "significant crop losses... and could potentially worsen the food security situation", ICPAC said in a statement.

- 'Panic mode' -
Since 2018 a long period of dry weather followed by a series of cyclones that dumped water on the region created "excessively ideal conditions" for locusts to breed, says Gujadhur.    Nevertheless, governments in East Africa have been caught off guard and are currently in "panic mode" Gujadhur said.   The locusts arrived in South Sudan this week after hitting Ethiopia, Somalia, Kenya, Djibouti, Eritrea, Tanzania, Sudan and Uganda.   Desert locusts take over on a dizzying scale.

One swarm in Kenya reached around 2,400 square kilometres (about 930 square miles) -- an area almost the size of Moscow -- meaning it could contain up to 200 billion locusts.   "A swarm that size can consume food for 85 million people per day," said Gujadhur.   Ugandan authorities are aware that subsequent waves of locusts may pose problems in the weeks to come, but in the meantime they are attempting to control the current generation.

Gujadhur is quick to praise the "quite strong and very quick" response from the Ugandan government but is concerned that while the army can provide valuable personnel, a military-led response may not be as effective as is necessary.    "It needs to be the scientists and (agriculture officials) who take the lead about where the control operations need to be and how and when and what time," she said.

- 'They eat anything green' -
The soldiers have been working non-stop for two days, criss-crossing the plains on the few navigable roads, trying to keep up with the unpredictable swarms.    Major General Kavuma recognises that the biggest threat is from the eggs which are yet to hatch but is confident the army will be able to control this enemy.   "We have the chemicals to spray them, all we need is to map the places they have been landing and sleeping," he said.   "In two weeks time we will come back and by that time they will have hatched and that will be the time to destroy them by praying."

Back in Lopei village, Elizabeth Namoe, 40, a shopkeeper in nearby Moroto had been visiting family when the swarm arrived.   "When the locusts settle they eat anything green, the animals will die because they have nothing to feed on, then even the people (will suffer)," she said.   "The children will be affected by hunger and famine since all life comes from all that is green. I fear so much."
Date: Wed, 19 Feb 2020 12:55:06 +0100 (MET)

Beijing, Feb 19, 2020 (AFP) - China's President Xi Jinping called Wednesday for greater protection of medical staff fighting the new coronavirus after the deaths of prominent doctors sparked national anger at the government's handling of the outbreak.   At least seven medical workers have died from the virus, while 1,716 have been confirmed as infected, most at the epicentre of the epidemic in central Hubei province where hospitals have dealt with a huge influx of patients.

Staff have faced shortages of masks and protective bodysuits, with some even wearing makeshift suits and continuing to work despite showing respiratory symptoms, health workers have told AFP.   Xi said China must "strengthen efforts to relieve the stress of medical workers, provide them with daily necessities, arrange time for their rest and give them encouragement", the official Xinhua news agency reported.   Liu Zhiming, the director of Wuchang Hospital in Hubei's capital Wuhan, died Tuesday, more than a week after the death of whistleblowing ophthalmologist Li Wenliang in the same city prompted nationwide mourning and calls for political reforms.

- 'Majestic spirit' -
A paper published by China's Center for Disease Control and Prevention said an additional 1,300 health workers may have been infected but have yet to receive a diagnosis.   Xi said China must ensure medical teams in Hubei and Wuhan "carry out work in a safe, orderly, coordinated, effective and swift manner", Xinhua reported.   The deaths of frontline medical workers "reflected doctors' humane and majestic spirit", Xi said.   The death toll from the virus jumped past 2,000 on Wednesday, while 74,185 cases of infection have been confirmed in mainland China.
Date: Wed, 19 Feb 2020 12:19:59 +0100 (MET)

Tehran, Feb 19, 2020 (AFP) - Two people in Iran tested positive Wednesday for the deadly new coronavirus, the health ministry said, in the Islamic republic's first cases of the disease.   Kianoush Jahanpour, a ministry spokesman, said the cases were detected in the holy city of Qom, south of the Iranian capital.   "In the past two days, some suspect cases of the new coronavirus were observed in Qom city," he said, quoted by state news agency IRNA.

"Teams were dispatched after receiving the reports, and based on the existing protocols the suspect cases were isolated and tested," said Jahanpour.   "Out of the samples sent, a laboratory tested two of them as positive for coronavirus just minutes ago and some of the other samples were type B influenza."

The health ministry spokesman said additional tests were being done on the two cases and final results would be announced "as soon as possible".   The new coronavirus epidemic has killed more than 2,000 people in China and infected more than 74,000. It has spread to at least two dozen countries.   The United Arab Emirates was the first country in the Middle East to report cases of coronavirus last month.
Date: Tue 18 Feb 2020
Source: CIDRAP (Center for Infectious Disease Research & Policy) News [edited]

The WHO's African regional office said that both Chad and the Central African Republic (CAR) are in the midst of measles outbreaks, with both countries reporting increasing case counts since [1 Jan 2020].

In Chad, 1276 cases, including 14 deaths have been reported since 1 Jan 2020, with 352 suspected measles cases and 4 deaths reported in the week ending on 9 Feb 2020.  "Most, 78%, of the investigated cases never received any vaccination against measles," the WHO said. "60% of the investigated cases were under 5 years of age while 19% were between 5 and 14 years and 14% were 15 years and above."

In CAR, a total of 1498 suspected measles cases, including 15 deaths, have been recorded since [1 Jan 2020]. The outbreak has been ongoing since early 2019. From 1 Jan 2019, through 9 Feb 2020, a total of 5724 suspected measles cases, including 83 deaths (case fatality rate, 1.45%) have been reported in 13 health districts.  Almost 3/4 of the cases (72%) are in children under the age of 5.
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[HealthMap/ProMED-mail maps
Central African Republic: <http://healthmap.org/promed/p/6>]
Date: Wed 19 Feb 2020
Source: Circular/News, Veterinary Services, Israel's Ministry of Agriculture [in Hebrew, trans. Mod.AS, edited]

Rabies, Case No. 6 for 2020, dog, Ramot Naftali, Upper Galilee. Reference: Kimron Vet Institute [KVI] Laboratory Test No. A00373420, dated 19 Feb 2020
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On 17 Feb 2020, a dead dog was brought for examination to the KVI [at Beit-Dagan]. The dog died while being transported to a rabies observation kennel since, as reported, it had attacked grazing cattle and attempted to attack people.  It was also reported that the dog had bitten itself. The tested animal has been diagnosed rabies positive.  [Byline: Dr. Avi Wasserman Head, Field Veterinary Services (acting)]
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[The above and 5 earlier rabies cases in Israel since 1 Jan 2020 are located within a small region along the Lebanese border, facing Lebanon's governorate A-Nabatieh. See the rabies map (2020) at <https://moag.maps.arcgis.com/apps/webappviewer/index.html?id=a6d8aae5cbc04c958d5efefd2724318f>.

The 2019 map, presenting a total of 17 cases, is available at

The 6 cases during 2020 are: 3 jackals, 2 dogs, 1 cow. Most likely, rabies is currently circulating within the Lebanese side of the border.

It would be interesting to note whether the rabid dog was owned and, in case affirmative, whether and when this dog was last vaccinated against rabies, as prescribed by law. Israel's owned dogs are included in the national dog registry, currently counting more than 400,000 dogs. - ProMED Mod.AS]
Date: Tue 18 Feb 2020
Source: Qatari Ministry of Public Health [edited]

The Ministry of Public Health (MOPH) declared that a case of Middle East respiratory syndrome (MERS) has been confirmed. The case is a male citizen aged 65 years who has been suffering from several chronic diseases. The patient has been admitted to the hospital to receive the necessary medical care in accordance with the national protocol to deal with confirmed or suspected cases of the disease.

The Ministry of Public Health, in cooperation with the Ministry of Municipality and Environment, is taking all necessary preventive and precautionary measures to control the disease and prevent it from spreading.

MERS is a viral respiratory disease that is caused by one of the coronaviruses (MERS-CoV), but it differs from the novel coronavirus, known as COVID-19, which has recently spread in several countries. Both viruses differ in terms of the source of infection, mode of transmission, and the disease severity. The Ministry of Public Health confirms that no cases of the novel coronavirus (COVID-19) have been diagnosed in Qatar so far.

Only 3 cases of MERS-CoV were registered in Qatar during the past 2 years. The Ministry of Public Health calls on all members of public, and especially people with chronic diseases or those with immunodeficiency disorders, to adhere to public hygiene measures. This includes washing the hands regularly with water and soap, using hand sanitizers, as well as avoiding close contact with camels and seeking medical advice when experiencing symptoms of fever, cough, sore throat, or shortness of breath.

The Rapid Response Team of the Health Protection and Communicable Disease Control is available round-the-clock to receive notifications or inquiries related to communicable diseases on its hotline numbers 66740948 or 66740951.
======================
[In early December 2019, Qatar reported 3 cases of MERS-CoV infection, a fatal case and 2 asymptomatic contacts of the fatal case. The fatal case denied a history of contact with camels or recent travel. She did have a history of underlying medical conditions (which may have led to contact with the health sector in the 2 weeks prior to onset of illness). Prior to these cases, the most recent report of a case of MERS-CoV infection in Qatar was in 2017 when there were 3 cases reported (see prior ProMED-mail posts listed below.)

The location of residence of this patient was not available, nor were other epidemiological variables, including possible high risk exposures.

The HealthMap/ProMED-mail map of Qatar is available at