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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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Travel News Headlines WORLD NEWS

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Egypt

Geographical Information:
Egypt has a total area of about 385,000 sq. miles and sits on the North Eastern corner of Africa. It is bounded by the Mediterranean Sea and on the East by Israel and the Red Sea. The Southern border is with Sudan (the large
t country in Africa) and on the West it shares a border with Libya. The country extends about 675 miles from north to south and is widest at its southern border where it covers 780 miles. Egypt is well known for the great Nile river which courses throughout its length. It is the longest river in the world and has historic links stretching back to at least 3200BC.
Climate:
The hot season in Egypt is from May to September. During this time temperatures can easily reach 370C though northern winds can provide a very necessary respite. November to March is the cooler time of the year and typical temperatures reach 140C though, during the evenings, temperatures can occasionally fall to near freezing. The humidity is mainly along the Mediterranean coastline and the average rainfall here is only about 8".
Medical Facilities:
In the main towns and cities the level of medical care is very adequate for the tourist. English speaking doctors will be associated with all the larger hotels but nevertheless care should always before being admitted to a ‘clinic’ for further treatment should this ever become necessary. Travellers are encouraged to contact the Irish Embassy in Cairo for emergency assistance should the need ever arise.
Food & Water Hygiene:
A significant number of tourists visiting Egypt suffer stomach complaints. In many cases this is due to eating food from the market places or using the hotel tap water supply for drinking or brushing teeth. The hotter climate of the country and the poorer level of food hygiene leave the unwary tourist at particular risk. Salads and shellfish meals should particularly be avoided.
Cruising along the Nile:
Over the past number of years many Irish holiday makers have enjoyed themselves cruising along the Nile for a week and then visiting Luxor in the southern part of the country. In most cases these travellers remain very well with no particular health problems. Nevertheless, in a small number they appear to forget the basic rules of food and water hygiene and will sample the local foods in the market places on shore. This practice is frequently associated with a ruined second half of the holiday. Commonsense rules of looking but not touching are much wiser.
Sun Stroke:
The ambient temperatures in Egypt can be very high and tourists are frequently exposed to the strong sunlight during their time in Egypt. It is essential that an adequate fluid intake is maintained (much higher than at home) and that travellers remember they may need to increase their salt intake (if this is not contraindicated because of heart disease or blood pressure). Small children and the elderly are at special risk.
Malaria risk in Egypt:
The risk of malaria in Egypt is small. The disease is usually only found during the warmer summer months (June to October) in the El Faiyûm area. Travellers may require prophylaxis but they should continuously remember to use adequate protection against mosquitoes and other insects.
Swimming in Egypt:
The fresh water rivers of Egypt are commonly infected with a disease called Schistosomiasis (Bilharzia). This parasite penetrates through intact skin and can cause significant health problems. Travellers are encouraged to swim only in the Mediterranean, the Red Sea or in well maintained swimming pools to avoid exposure.
Health Care while Diving:
Many of the world's most beautiful sites for diving are situated along the Red Sea. These are common tourist destinations and generally the risk of significant health worries will be small. However, check out the professionalism of the diving company before you develop too close a relationship. Make sure their equipment is in good working order and that their instructors are insisting on standard safety procedures for any proposed dive. Never dive after a large meal or following alcohol intake. Remember that you can get significantly sunburnt while snorkeling so take care to cover your back and shoulders with either a suit or sufficient water repellent cream.
Diving at night may be a beautiful experience but take extra care. Never dive beyond your personal limits and ensure that the 'buddy system' is fully operational at all times. Even the most experienced divers can have problems at times so never let you guard down and stay alert.
Rabies:
This disease is widespread in Egypt and is normally transmitted through the bite of warm blooded animals. Any bites, licks or scratches from these animals should be treated seriously by washing out the wound, applying an antiseptic and the seeking urgent competent medical attention.
Vaccines for Egypt:
All Irish travellers to Egypt should ensure that their vaccines against Poliomyelitis, Typhoid, Tetanus and Hepatitis A are in date. Those staying for longer periods or trekking through the country may require further protection against diseases like Rabies, Meningitis and Hepatitis B.
Further Information:
Further general health information on staying healthy while travelling abroad may be obtained free-of-charge from the Tropical Medical Bureau at either of our centres. Please always remember that each traveller is distinct and so individual specific information will require a medical consultation.

Travel News Headlines WORLD NEWS

Date: Tue 30 Jul 2019
Source: Food Safety News [edited]

The public health institute in Germany has reported more than 30 people have been sick with _E. coli_ in 2019 after going to Egypt. The Robert Koch Institute (RKI) noted increased reports of enterohemorrhagic _E. coli_ (EHEC) related to or after staying in Egypt. Earlier in July 2019, Public Health England (PHE) also reported an increase in adults and children ill after coming back from Hurghada in Egypt.

In Germany, there are 31 cases of EHEC and 5 people with haemolytic uremic syndrome (HUS), a type of kidney failure associated with this form of _E. coli_ infection. This is significantly more than in the same period of previous years. In 2018, there were 21 EHEC and one HUS case. In 2017, 9 EHEC and 1 HUS case were recorded. The rise cannot be explained by the increase in travel to Egypt alone, according to RKI.

It follows a warning by PHE after 18 people fell ill with EHEC infection and one person developed HUS after returning from Egypt in 2019. 4 people needed hospital treatment. A PHE spokeswoman previously told Food Safety News that it was not a single outbreak as a variety of different EHEC strains had been detected in visitors to Egypt with EHEC O157 and EHEC O26 among them. The agency has told the European Centre for Disease Prevention and Control (ECDC) about the cases.

What caused the German cases is unknown and sick people have stayed at different hotels in separate places, according to RKI, which has informed Egyptian authorities about the increase.

Dr Nick Phin, deputy director of the National Infection Service at PHE, said there are precautions that travellers can take. "These include ensuring meat is cooked thoroughly, not drinking tap water or ice made from tap water and trying to avoid swallowing water when swimming. Anyone suffering from diarrhoea and vomiting should ensure they keep well hydrated and seek medical advice if their symptoms don't improve within 48 hours. They should also avoid preparing or serving food while they have symptoms and thoroughly wash their hands after using the toilet to stop the bug being passed to others" he said.  [Byline: Joe Whitworth]
=======================
[This is the 2nd European country to report a spike to travel-related cases of EHEC related to Egypt. The German report does not specifically relate the cases to the Red Sea area of the country.

As a review, the classical enterohaemorrhagic _E. coli_ is the O157:H7 serotype although some are non-motile, that is, H-. Most O157 strains do not ferment sorbitol and that characteristic was used to screen for the strain using a sorbitol MacConkey agar. However, since non-O157 EHEC strains such as O26, O45, O103, O111, O121, and O145 do ferment sorbitol and, as seen here, some O157 also ferment sorbitol, laboratories now look for these isolates using genetic assays for the Shiga toxin genes.

Around 1903 Smith and Reagh reported on the different behaviour of salmonella strains. Their work was mostly ignored until Weil and Felix, working on _Proteus_ cultures, noted 2 forms, the swarming form called the H form (_mit Hauch_, in English: "with breath") and the non-swarming form, called the O form (_ohne Hauch_, in English: "without breath"). The H form contained both O and H antigens (correctly termed the OH form). These parallels were transposed to other Enterobacteriaceae.

If O antiserum is added to a culture, motility is preserved, whereas if H antiserum is added the culture does not move. Therefore, H antigen was involved with swarming in the agar plate (breathing might have been used to imply the ability to move). (_E. coli_, of course, do not swarm on certain agar plates like _Proteus_ bacteria do). - ProMED Mod.LL]

[HealthMap/ProMED-mail maps:
Date: Wed 17 Jul 2019
Source: Food Safety News [edited]

Public Health England has issued a warning after almost 20 cases of Shiga toxin-producing _Escherichia coli_ infection [also called enterohemorrhagic _E. coli (EHEC)] were found in people returning from Egypt in 2019.

All travellers had been to the Hurghada region [Red Sea governorate] of Egypt. A variety of different EHEC strains have been detected in visitors to Egypt with serotypes O157 and O26 identified among them. One person developed haemolytic uremic syndrome (HUS), a type of kidney failure associated with _E. coli_ infection.

Public Health England (PHE) scientists are investigating to understand the cause of the infections. The agency has given advice to those going to Egypt after 18 people, including children, returned with serious illnesses caused by EHEC infections. In 2018, there were 22 cases of EHEC in the whole year, and 11 infections in 2017. A PHE spokeswoman told Food Safety News that it cannot provide any further information about patients when asked about onset dates and the demographics of those affected.

"So far this year [2019], 4 cases have been hospitalized and 1 case has developed HUS. In 2018, 5 of 22 cases were hospitalized. We use whole genome sequencing to type all strains of EHEC in England, and the results do not indicate this is an outbreak, as multiple different strains of EHEC have been detected," she said. "Each case is individually followed up. We do not know the specific source of these infections in Egypt. However, the most common ways people get infected with EHEC is through eating contaminated food or water, through person to person spread or through contact with animal faeces."

The spokeswoman added the agency has told the European Centre for Disease Prevention and Control (ECDC) about the cases and notified the Egyptian public health authorities to provide them with information for their investigations.

There have been 16 cases of HUS in people, including children, who have been to the Hurghada region of Egypt between 2009 and 2019.

Dr Nick Phin, deputy director of the National Infection Service at PHE, said it was aware of people returning from Egypt with _E. coli_ infections. "We are gathering information about those affected to better understand the cause. There are simple precautions that travellers can take. These include ensuring meat is cooked thoroughly, not drinking tap water or ice made from tap water and trying to avoid swallowing water when swimming," he said. "Anyone suffering from diarrhoea and vomiting should ensure they keep well hydrated and seek medical advice if their symptoms don't improve within 48 hours. They should also avoid preparing or serving food while they have symptoms and thoroughly wash their hands after using the toilet to stop the bug being passed to others."

PHE recommendations to travelers include:
- where possible, avoid eating salads and uncooked vegetables and only eat fruit they can peel;
- avoid unpasteurized milk, cheese and ice cream;
- avoid food left uncovered in warm environments and exposed to flies;
- ensure all meat is cooked thoroughly before eating, avoid meat that is pink or cold;
- only drink bottled water or use ice made from bottled/filtered water;
- wash hands thoroughly after visiting the toilet, and always before preparing or eating food. Alcohol gel can be helpful but not entirely effective when hand washing facilities are not available

The advice also applies to other countries where _E. coli_ infections are common such as Turkey and Spain.
=======================
[Clearly this is not one organism as multiple serotypes of the EHEC have been found. It is not clear what factors involving the tourists have put them at risk for this potentially fatal infection. ProMED-mail previously posted about a case in the UK from this region of Egypt in 2016 (E. coli EHEC - UK (02): (England) ex Egypt http://promedmail.org/post/20160707.4330782).

Hurghada is a beach resort town stretching some 40km along Egypt's Red Sea coast. It is renowned for scuba diving, and has numerous dive shops and schools in its modern Sekalla district. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps
England, United Kingdom: <http://healthmap.org/promed/p/279>
Date: Sun, 19 May 2019 21:55:33 +0200

Giza, Egypt, May 19, 2019 (AFP) - A bomb blast hit a tourist bus near Egypt's famed Giza pyramids on Sunday, wounding some of them, including South Africans, in the latest blow to the country's tourism industry.   The roadside bomb went off as the bus was being driven in Giza, also causing injuries to Egyptians in a nearby car, medical and security sources said.   Security and medical sources in Egypt said 17 people were injured, without giving a breakdown of their nationalities. No deaths were reported.   South Africa said in a statement that the "bus explosion" injured three of its 28 citizens who were part of the tourist group.   They would remain in hospital while the rest would return home on Monday, said the statement from the department of international relations.   "A device exploded and smashed the windows of a bus carrying 25 people from South Africa and a private car carrying four Egyptians," the security source said.

Video footage captured by AFP showed the bus and car with broken windows on the side of the road.   According to the security source, the wounded were being treated for scratches caused by the broken glass.   Sunday's incident comes after three Vietnamese holidaymakers and their Egyptian guide were killed when a roadside bomb hit their bus as it travelled near the Giza pyramids outside Cairo in December.   It also comes just little more than a month before the African Cup of Nations hosted by Egypt is to kick off.   Egypt has been battling an insurgency that surged especially in the turbulent North Sinai region following the 2013 military ouster of Islamist president Mohamed Morsi, who was replaced by former army general Abdel Fattah al-Sisi.   In February 2018, the army launched a nationwide operation against militants, focusing mainly on the North Sinai region.

- Tourism recovery -
Some 650 militants and around 45 soldiers have been killed since the start of the offensive, according to separate statements by the armed forces.   Since first being elected in 2014, Sisi has presented himself as a bulwark against terrorism, promising stability and increased security.   Recently, the country's vital tourism industry has started to slowly rebound after suffering strong blows due to deadly attacks targeting tourists following the turmoil of the 2011 uprising that toppled longtime ruler Hosni Mubarak.   Figures by the official statistics agency showed that tourist arrivals reached 8.3 million in 2017, compared with 5.3 million the previous year.    Authorities have gone at great lengths to lure tourists back, touting a series of archaeological finds and a new museum next to the pyramids, as well as enhanced security at airports and around ancient sites.    But that figure was still far short of the record influx of 2010 when more than 14 million visitors flocked to see the country's sites.
Date: Fri 10 May 2019
Source: ABC News [edited]

The Centers for Disease Control and Prevention (CDC) announced a temporary ban on dogs imported to the USA from Egypt on Friday [10 May 2019], citing multiple instances of dogs that contracted rabies in Egypt being brought to the USA in recent years.

Officials say Americans' appetite for adopting puppies has fuelled what regulators call an international smuggling operation that skirts US regulations. "The motives behind illegal puppy importation are not immediately obvious. However, a closer look reveals a big business driven by profit at the expense of the health and welfare of the underage puppies," the CDC says in a blog post.

"Importers aim to get around these regulations because customers demand puppies as young as 8 weeks. Profits decline by the thousands with each month a puppy ages. The puppy-loving public creating the demand is part of the problem."

The CDC estimates 100,000 dogs are imported from countries at high risk for rabies every year, some of the 1.06 million dogs entering the country through airports or ports of entry according to the agency. Three rabid dogs have been imported to the USA from Egypt since 2015, some with falsified health paperwork.

Animal rescue organization throughout the USA have worked with groups in Egypt and other countries to re-home animals, but federal officials have become increasingly concerned about the accuracy of information provided from overseas. The CDC and animal welfare groups say there's no single database to track what happens to dogs brought into the USA from Egypt once they're in the country.

In 2017, "Operation Dog Catcher" was launched after agents from Customs and Border Protection, the CDC, and USDA veterinarians identified more frequent large shipments of puppies at JFK [airport in New York]. The operation discovered smuggling operations where dogs from overseas "puppy mills" are shipped to the USA as rescue dogs valued at USD 0, then sold to the public online or on social media under false or misleading information claiming they were bred in the USA.

The most recent recorded incident was in February of this year [2019], according to the CDC, when 26 dogs imported from Egypt were adopted or placed in foster homes through a rescue in the Kansas City area. One of the dogs bit a technician and [the dog] tested positive for rabies.

The USA has been free of canine rabies since 2007, according to the CDC, but the agency says even one imported dog with the virus could create a public health threat if they interact with people or other animals that go untreated.

"The importation of just one dog infected with CRVV [canine rabies virus variant] risks the re-introduction of the virus into the United States," the CDC says in a draft of its public notice, which will be officially posted Friday [10 May 2019] (<https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-09654.pdf>).

The CDC says it has worked with international health organizations to try to clear up the problem, but officials in Egypt have not provided enough information to guarantee the health of imported dogs. Imports will be suspended until the CDC and other federal agencies determine appropriate controls are in place in Egypt to prevent exports of rabid dogs.

While US law says dogs coming into the USA have to be healthy and at least 6 months old, Operation Dog Catcher found animals with fraudulent health documents and vaccination records. In addition to rabies, dogs can spread other diseases capable of spreading to humans and other animals, such as parasites or skin infections.

The CDC and animal advocacy groups say members of the public should research breeders and ask to visit facilities or see inspection reports, even though the full records are not publicly available online. The CDC says adopting from credible animal shelters in the USA also helps decrease demand for puppies sold through fraudulent operations.  [Byline: Stephanie Ebbs]
=========================
[Laramie County, Wyoming, is wise to recommend livestock be vaccinated. It is cheap insurance for your other animals and for your help, your family and yourself. Most often our curious livestock want to see what the odd shuffling animal is crossing their pasture domain, so they stick their noses down, only to get bitten by a rabid animal, frequently a skunk. This is a usually unobserved situation until the bovine animal begins to act odd, even aggressive to its pen-mates or those feeding it. Rabid bovine animals have attacked pen-mates, people, feeding trucks and other objects. In the situation when a rabid bovine attacks a human or dog, it usually does not end well for the one attacked. If more than one animal encounters the skunk or raccoon or other source of rabies, there may be multiple herd animals affected with rabies. I have long advocated vaccinating your stock, so it is wonderful to see an official office promoting this. Also vaccinate your pet, whether they are your dog or cat or horse, or your pet steer. Rabies is a fatal disease. While there is a lifesaving post-exposure prophylaxis in humans, one should not procrastinate if bitten, but rather seek treatment immediately. Such a life-saving treatment is not available to our pets or livestock. Therefore, protect your pets and livestock and vaccinate against rabies.

Rabies is a very serious disease, often resulting in death of the animal victim and often expensive treatment for a human. There are several variants of the rabies virus. Some variants are the skunk variant or the racoon variant. The article about dogs from Egypt mentions the canine variant. This is a specific variant of the disease that has not been in the USA for over 10 years. Dogs can still be infected with the skunk variant or the racoon variant or other variants if bitten by one of those animals carrying a particular strain of rabies. The strain of rabies is one issue. The other issues the article addresses are people unexpectedly being exposed to rabies in an animal touted as having its appropriate vaccines. This is a very serious issue to adopt a pet from another country where the paperwork is fraudulent and thus expose yourself/family to a fatal disease that you believed had been prevented.

The article is correct to say investigate the breeder and where the animals are coming from. Let the buyer beware. - ProMED Mod.TG]

[HealthMap/ProMED-mail maps:
Laramie County, Wyoming, United States:
Date: Tue, 29 Jan 2019 12:22:15 +0100
By Bassem ABOUALABASS

Cairo, Jan 29, 2019 (AFP) - Alaa Hilal was out shopping in Cairo when she was attacked by a stray dog in broad daylight -- an increasing problem of daily life in Egypt which is stirring debate.   "I got out of my car and saw an exceptionally large street dog," the 38-year-old housewife told AFP at her home, northeast of Cairo.   "He approached me and bit me without barking or doing anything else," said Hilal, adding that she had been injured in the thigh.     An overpopulated mega-city of more than 20 million people, Cairo is already plagued by monster traffic jams, widespread waste problems and rampant pollution. Packs of stray dogs are only adding to the city's challenges.   Complaints about dog attacks, exposure to rabies and in some cases even deaths over the years have triggered calls for the animals to be brought under control.

- Hounds unleashed -
Commonly referred to as "baladi dogs", strays are widely viewed as unsanitary and dirty. They are typically seen running around the streets and scavenging garbage for food.   According to the agriculture ministry, there were around 400,000 cases of dog bites in 2017, up from 300,000 in 2014.    And 231 people died over the past four years from the wounds they received, mainly as a result of rabies.

A bite from a dog carrying the rabies virus can be fatal within 24 hours as it damages the human's nervous system, said Shehab Abdel-Hamid, the head of Egypt's society for the prevention of cruelty to animals (SPCA).    Hilal, who had never feared dogs having had several pets when growing up, was rushed to a nearby hospital only to discover that she was the ninth person to be bitten by the same dog.   "Due to the trauma caused by this incident, I became worried and I no longer want to be in the same place with them," she said.   There are no official data on the numbers of stray dogs, but activists say they are running loose in their millions.

A survey by the SPCA showed that the number of stray dogs "may reach up to more than 15 million", Abdel-Hamid said.   And though street dogs appear to fear the most crowded areas, they can be loud and aggressive in poorly lit and rubbish-strewn suburbs.    In November, a video widely circulated on social media showed a car hitting a teenager who was being chased by two stray dogs.   "Garbage is the main reason behind the stray dogs' crisis in Egypt," said Abdel-Hamid, highlighting how the problem was exacerbated when the rubbish men stopped working during the 2011 uprising.

- Government mauled -
The SPCA, however, lacks resources. Its headquarters in downtown Cairo was looted during the uprising and has not been renovated since, Abdel-Hamid added.    And Egyptian authorities say they can only intervene on a case by case basis.    "We do not go around the streets looking for dogs to kill them," said the agriculture ministry spokesman Hamed Abdel-Dayem. "We only take measures following complaints."   He didn't specify what measures are taken to bring the stray dog population under control.    But animal rights advocates often lambast the government, accusing it of mass culls.

In 2017, authorities killed more than 17,000 stray dogs following multiple complaints of dog "disturbances" and "biting" in Beni Sueif, south of Cairo, according to an August report by the governorate's veterinary directorate.    The Red Sea governor even offered a 100 Egyptian pounds ($5.58) award to those who capture and hand over at least five strays.   Animal rights defenders also accuse the government of killing dogs using a drug, known as "strychnine", a chemical substance listed as "unacceptable on animal welfare grounds" for euthanasia by the World Organisation for Animal Health.     But Abdel-Dayem denied that the government imported banned substances.   "Is it logical that we (the ministry) allow internationally prohibited substances to enter the country?" he told AFP when asked about the strychnine claim.

- 'Shelter of Hope' -
Animal rights advocates have sought to offer solutions, actively removing dogs from the streets and giving them homes.   Ahmed al-Shorbagi, 35, opened two dog shelters in a desert area west of Cairo, near the famed Giza pyramids.    The buildings with sheer concrete walls have kept more than 250 dogs safe for the past three years. Shorbagi contributes 40 percent to the funding of the shelters while the rest comes from donations.    "At first I followed the animal rescue pages on Facebook," Shorbagi told AFP, rubbing one dog's belly as she wagged her tail in joy.   "I saved a dog that I called 'Hope' and when I opened the shelter, I named it after her."

Shorbagi believes the solution lies in dog sterilisation programmes, providing rabies vaccinations and removing the garbage.    "Instead of the government paying millions of dollars to import poison, it should consider sterilisation," he said.    "We, as associations, proposed to the ministry of agriculture to solve the problem but it refused."   The ministry's spokesman denied however refusing to cooperate with private entities and hailed their work to help resolve the crisis.
More ...

World Travel News Headlines

Date: Tue, 10 Dec 2019 10:50:09 +0100 (MET)

Sydney, Dec 10, 2019 (AFP) - The death toll from New Zealand's White Island volcano eruption rose to six late Tuesday, after an injured person died in an Auckland hospital, police said.   "Police can confirm a further person has died following the eruption on Whakaari/White Island, bringing the official toll to six," a police statement said.   Eight more people who remain missing are presumed dead after the volcano erupted Monday.
Date: Tue, 10 Dec 2019 09:27:57 +0100 (MET)
By Andrew BEATTY, with Daniel de Carteret in Gosford

Sydney, Dec 10, 2019 (AFP) - Toxic haze blanketed Sydney Tuesday triggering a chorus of smoke alarms to ring across the city and forcing school children inside, as "severe" weather conditions fuelled deadly bush blazes along Australia's east coast.   Fire engines raced office-to-office in the city centre with sirens blaring, as inland bushfires poured smoke laden with toxic particles into commercial buildings.   Emergency services responded to an "unprecedented" 500 automatic call-outs inside a few hours according to New South Wales Fire and Rescue's Roger Mentha.

A regional fire headquarters miles from the nearest blazes was itself evacuated while throngs of mask-wearing commuters choked their way through thick acrid air and the organisers of a harbour yacht race declared it was unsafe to proceed.   "The smoke from all the fires is just so severe here on the harbour that you just can't see anything, so it's just too dangerous," said spokeswoman Di Pearson of an event that normally foreshadows the famed Sydney-Hobart yacht race. "The vision is just so poor."   Some of the city's commuter ferries were also cancelled "due to thick smoke" and school kids were kept inside at breaktime and sent home early as pollution levels soared far above "hazardous" levels.

For weeks the east of the country has been smothered in smoke as drought and climate-fuelled bushfires have burned. But the scale of the problem on Tuesday shocked even hardened residents.   Bruce Baker -- an 82-year-old who lives in Gosford, north of Sydney -- said he was skipping his daily morning walk because of the smoke.   "This is the worst it's been, for sure," he told AFP. "It dries your throat. Even if you're not asthmatic, you feel it."   Authorities recommended that the vulnerable cease outdoor activity altogether and that everyone stay inside as much as possible, although one couple braved the toxic air to get married on the waterfront in front of Sydney Harbour Bridge shrouded in smog.

A cricket match between New South Wales and Queensland also went ahead, despite a barely visible ball.   Tuesday had been expected to bring strong winds and high temperatures that made for "severe conditions where embers can be blown ahead of the fire into suburbs and threaten properties."   But New South Wales Rural Fire Service said "deteriorating fire conditions have been delayed by a thick blanket of smoke" over the east of the state.   As the day developed there were nearly 100 bushfire incidents in the state of New South Wales alone and dozens more in Queensland.   Total fire bans were put in place across much of the east of the country and in large parts of western Australia.   Temperatures in some inland areas eased past 44 degrees Celsius (111 Fahrenheit).

- The 'big dry' -
To the northwest of Sydney, several fires already burning for weeks have combined to create a "megafire" that has already destroyed 319,000 hectares (788,000 acres) of land, mostly inside national parks.   Prime Minister Scott Morrison  -- who for weeks has not commented on the smoke haze -- defended his government's handling of the fires and said there were no plans to professionalise the countryside's largely volunteer force.    "Our policy is sensible when it comes to addressing and taking action on climate change. Our actions on climate change are getting the results they're intended to get," he said.   Morrison's conservative coalition has been criticised by former fire chiefs for failing to heed warnings about climate change.   The crisis has been propelled by a prolonged drought that has made vegetation tinder dry.

The Bureau of Meteorology has reported that Australia experienced its driest November on record this year.   The "big dry" has left farmers desperate and small towns facing the prospect of running out of water completely.   A swathe of the east of the country has seen "rainfall deficiencies" since early 2017 -- almost three years.   Many dams in New South Wales are empty and almost all are well below capacity.   Firefighters south of Brisbane recently reported 1,000 litres of water were stolen from tanks at their station.   Amid the shortage, Tuesday also saw the toughest water restrictions in a decade being introduced for Sydney -- with curbs on everything from hosepipe use to washing cars.
Date: Tue, 10 Dec 2019 03:09:17 +0100 (MET)
By Allison JACKSON

Sao Paulo, Dec 10, 2019 (AFP) - Gripping the deadly snake behind its jaws, Fabiola de Souza massages its venom glands to squeeze out drops that will save lives around Brazil where thousands of people are bitten every year.   De Souza and her colleagues at the Butantan Institute in Sao Paulo harvest the toxin from hundreds of snakes kept in captivity to produce antivenom.    It is distributed by the health ministry to medical facilities across the country.

Dozens of poisonous snake species, including the jararaca, thrive in Brazil's hot and humid climate.    Nearly 29,000 people were bitten in 2018 and more than 100 died, official figures show.   States with the highest rates of snakebite were in the vast and remote Amazon basin where it can take hours to reach a hospital stocked with antivenom.   Venom is extracted from each snake once a month in a delicate and potentially dangerous process.

Using a hooked stick, de Souza carefully lifts one of the slithering creatures out of its plastic box and maneuvers it into a drum of carbon dioxide.    Within minutes the reptile is asleep.    "It's less stress for the animal," de Souza explains.    The snake is then placed on a stainless steel bench in the room where the temperature hovers around 27 degrees Celsius (80 degrees Fahrenheit).    De Souza has a few minutes to safely extract venom before the snake begins to stir.      "It's important to have fear because when people have fear they are careful," she says.

- Antivenom 'crisis' -
The snakes are fed a diet of rats and mice that are raised at the leafy institute and killed before being served up once a month.   After milking the snake, de Souza records its weight and length before placing it back in its container.    The antivenom is made by injecting small amounts of the poison into horses -- kept by Butantan on a farm -- to trigger an immune response that produces toxin-attacking antibodies.

Blood is later extracted from the hoofed animals and the antibodies harvested to create a serum that will be administered to snakebite victims who might otherwise die.   Butantan project manager Fan Hui Wen, a Brazilian, says the institute currently makes all of the country's antivenom -- around 250,000 10-15 millilitre vials per year.

Brazil also donates small quantities of antivenom to several countries in Latin America.    There are now plans to sell the life-saving serum abroad to help relieve a global shortage, particularly in Africa.    About 5.4 million people are estimated to be bitten by snakes every year, according to the World Health Organization (WHO). 

Between 81,000 and 138,000 die, while many more suffer amputations and other permanent disabilities as a result of the toxin.   To cut the number of deaths and injuries, WHO unveiled a plan earlier this year that includes boosting production of quality antivenoms.   Brazil is part of the strategy. It could begin to export antivenom as early as next year, Wen says.   "There is interest for Butantan to also supply other countries due to the global crisis of antivenom production," she says.
Date: Mon, 9 Dec 2019 14:14:15 +0100 (MET)

Dec 9, 2019 (AFP) - New Zealand, struck by a deadly volcanic eruption Monday, lies in a zone where Earth's tectonic plates collide, making it a hotspot for earthquakes and volcanic activity.   In one of its worst natural disasters, a huge mass of volcanic debris from the eruption of Mount Ruapehu triggered a mudslide in 1953 that washed away a bridge and caused a passenger train to plunge into a river with the loss of 151 lives.  After Monday's eruption on New Zealand's White Island, here is a recap of some of the deadliest volcanic eruptions around the world in the past 25 years.

- 2018: Indonesia -
In December the Anak Krakatoa volcano, a small island in the Sunda Strait between Java and Sumatra, erupts and a section of its crater collapses, sliding into the ocean and generating a tsunami. More than 420 people are killed and 7,200 wounded.

- 2018: Guatemala -
The June eruption of the Fuego volcano, about 35 kilometres (22 miles) from the capital, unleashes a torrent of mud and ash that wipes the village of San Miguel Los Lotes from the map. More than 200 people are killed.

- 2014: Japan -
The sudden eruption in September of Mount Ontake, in the central Nagano region, kills more than 60 people in Japan's worst volcanic disaster in nearly 90 years. The mountain is packed with hikers at the time. In 1991 an eruption of the southwestern Unzen volcano kills 43.

- 2014: Indonesia -
At least 16 people are killed on the island of Sumatra in February by a spectacular eruption of Mount Sinabung, which had lain dormant for 400 years before roaring back to life five months earlier. In 2016 villages are scorched and farmland devastated after another eruption kills seven.

- 2010: Indonesia -
Indonesia's most active volcano, Mount Merapi on Java island, starts a series of explosions in October, eventually killing more than 320 people. An 1930 eruption of the volcano killed 1,300 people and one in 1994 claimed more than 60 lives.

- 2002: DR Congo -
The eruption in July of Mount Nyiragongo in the eastern Democratic Republic of Congo destroys the centre of Goma town, along with several residential areas, and kills more than 100 people.

- 1997: Montserrat -
The capital of the small British colony, Plymouth, is wiped off the map and 20 are killed or left missing in avalanches of hot rock and ash clouds when its volcano erupts in June.

- 1995: The Philippines -
At least 70 are killed and another 30 missing after the crater of the Parker volcano in the south of the island of Mindanao collapses. Five years earlier the eruption of Mount Pinatubo, 80 kilometres north of the capital Manila, kills more than 800 people.

- Worst ever -
The explosion of Indonesia's Krakatoa volcano in 1883 is considered the worst ever seen. The eruption sent a jet of ash, stones and smoke shooting more than 20 kilometres (12 miles) into the sky, plunging the region into darkness, and sparking a huge tsunami that was felt around the world. The disaster killed more than 36,000 people.

The most famous eruption in history is that of Mount Vesuvius in modern-day Italy in 79 AD, which destroyed the towns of Herculaneum, Stabiae and Pompeii, wiping out an estimated 10 percent of the population of the three cities.
Date: Mon 9 Dec 2019
Source: Fox 29 Philadelphia [edited]

A total of 31 people have been sickened by salmonellosis at 4 health care facilities in south-eastern Pennsylvania. A majority of those cases occurred after individuals ate pre-cut fruit from New Jersey-based Tailor Cut Produce. The Food and Drug Administration (FDA) announced the salmonellosis outbreak in conjunction with the Pennsylvania Department of Health (DOH) on [Fri 6 Dec 2019]. The North Brunswick distributor has recalled its fruit mix with cantaloupe, honeydew, pineapple and grapes as a result.

Tailor Cut Produce reports that its products may be found in restaurants, banquet facilities, hotels, schools and institutional food service establishments in Pennsylvania, New Jersey and New York. "We recommend that any facility who use Tailor Cut Produce pre-cut fruit to immediately stop and throw it away," Pennsylvania Secretary of Health Dr. Rachel Levine said.

Salmonellosis is an infection caused by _Salmonella_ bacteria that generally affects the intestinal tract. People usually become infected by either eating or drinking contaminated food or water, by contact with infected people or animals, or through contact with contaminated environmental sources.
Date: Mon 9 Dec 2019
Source: Sixth Tone [edited]

Dozens of researchers in northwestern China's Gansu province have been infected with brucellosis, an animal-borne disease that causes flu-like symptoms and, potentially, lingering problems. In a statement [Fri 6 Dec 2019], the Lanzhou Veterinary Research Institute, an affiliated institute of the Chinese Academy of Agricultural Sciences, said that the 1st few grad students from the institute's foot-and-mouth disease prevention team tested positive for brucellosis antibodies on [28 Nov 2019]. The labs affected have been closed, the institute said, and national and local health authorities have assembled a team to investigate the outbreak.

Li Hui, an official at the health commission in Lanzhou, the provincial capital, told Sixth Tone on [Mon 9 Dec 2019] that the total number of brucellosis cases at the institute had climbed to 96. None have shown clinical symptoms, according to domestic media, and it remains unclear how they were exposed to the bacteria.

Brucellosis -- also known as Malta, Mediterranean, or undulant fever -- is a zoonotic disease that mainly affects animals, including livestock and dogs, which can in turn transmit the bacteria to humans through direct contact. Symptoms include fever, chills, sweating, lethargy, and aches and pains, according to the WHO. In the absence of early diagnosis and treatment, brucellosis can become a chronic condition that is difficult to cure.

In China, brucellosis is a Class B disease, ranking below a more serious category that includes cholera and plague. Human-to-human transmission has only been known to occur between lactating mothers and their babies. According to state broadcaster China National Radio, the brucellosis outbreak at the Gansu veterinary institute has prompted health checks among local students and staff who fear that they may have come into contact with infected animals.

One of the last brucellosis outbreaks in China occurred in 2011, when an agricultural university in the northeastern Heilongjiang province reported 28 cases stemming from infected goats being used in lab research. The school publicly apologized, fired 2 administrators, and offered each of the students' affected monetary compensation.

Scientific labs are subject to different experimental standards depending on their biosafety level, according to a researcher surnamed Yang at the Shanghai Institutes for Biological Sciences, an affiliate of the Chinese Academy of Sciences.

"If the protection levels don't keep pace (with biosafety levels), there will be a risk of infection," Yang, who studies viruses and works in a Biosafety Level 2+ lab, told Sixth Tone. As a result, labs generally require researchers to undergo safety training or even pass an exam to earn a certification, said Yang, who only used her surname because she was not authorized by her employer to speak to media.

The Lanzhou Veterinary Research Institute describes itself as "China's only authorized research center for working with the live virus that causes foot-and-mouth disease," a highly contagious disease affecting livestock. The institute is reportedly also one of the few in China with Biosafety Level 3 labs, which are required for _brucella_ pathogen studies, according to the National Health Commission.

As the local agriculture department tries to ascertain the source of the recent infections, Lanzhou's health commission said [Fri 6 Dec 2019], it is implementing precautionary measures so that brucellosis does not pose a threat to neighbouring communities. [Byline: Yuan Ye]
=================
[An earlier report suggested that 4 persons were clinically ill but this is not confirmed here.  Brucellosis (<http://www.medicinenet.com/brucellosis/article.htm>) is a disease that is thought to have existed since ancient times, as it was 1st described more than 2000 years ago by the Romans and Hippocrates. It was not until 1887 that a British physician, Dr. David Bruce, isolated the organism that causes brucellosis from several deceased patients from the island of Malta. This disease has had several names throughout its history, including Mediterranean fever, Malta fever, Crimean fever, Bang's disease, and undulant fever (because of the relapsing nature of the fever associated with the disease).

The symptoms and signs of brucellosis may develop from days to months after the initial exposure to the organism. While some individuals may develop mild symptoms, others may go on to develop long-term chronic symptoms. The signs and symptoms of brucellosis are extensive, and they can be similar to many other febrile illnesses, so recognition of potential exposure -- from ingestion of unpasteurized milk or cheese, employment as a veterinarian or veterinary student, in a slaughter house or meat processing plant, or working in a microbiology lab -- is vital. In this outbreak, it is not clear what symptoms the students had or whether they were just seropositive. ProMED would like more information about this episode. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Gansu Province, China: <http://healthmap.org/promed/p/333>]
Date: Tue 3 Dec 2019
Source: Outbreak News Today [edited]

In late November [2019], Uganda health authorities notified the World Health Organization of a fatal Rift Valley fever (RVF) case from Obongi district.  The case was a 35-year-old man from South Sudan who was living in the Palorinya Refugee camp in Obongi district, Uganda. The case had travel history to South Sudan between 12 and 19 Nov 2019 to harvest cassava. While in his home country, he developed fever and other symptoms and was treated for malaria; however, his condition got worse.  He later returned to the refugee camp in Uganda and his symptoms progressed and he was hospitalized. Viral hemorrhagic fever was suspected. Samples were collected and sent to the Uganda Virus Research Institute; however, the patient died. A safe and dignified burial was performed on 22 Nov 2019. As of 24 Nov 2019, a total of 19 contacts were recorded during the active case search including 10 healthcare workers.
===================
[The circumstances and specific location under which the man became infected with Rift Valley fever (RVF) virus in South Sudan is not mentioned. It is worth noting that there was an RVF outbreak in the Eastern Lakes region of South Sudan during the 1st 3 months of last year (2018). At the end of that outbreak, the OIE's follow-up report no. 3 reported: "The event cannot be considered resolved, but the situation is sufficiently stable. No more follow-up reports will be sent. Information about this disease will be included in the next 6-monthly reports."

There were more human cases than animal ones in that outbreak, prompting Mod.AS to comment: "Unfortunately, during the recent South Sudan RVF event, as in most -- if not all -- previous RVF events in other African countries, humans served as sentinels. Improved surveillance in animals is desperately needed in Africa, to allow timely measures applied, predominantly preventive vaccination, before the development of a full-blown epizootic involving secondary infection in humans." Intensified surveillance is needed in South Sudan in those localities where the affected man had been prior to his return to Uganda.

It is likely that RVF virus has persisted in this area in transovarially infected eggs of _Aedes_ mosquito vectors. These eggs can remain viable for long periods of time and hatch when flooded during future rain events, with the subsequent emergence of infected females ready to transmit the virus. This risk provides justification for maintaining livestock of the area well vaccinated into the future. This may have accounted for the reappearance of RVF in South Sudan in 2018, after nearly 2 years without additional reported cases in humans or livestock and again with this human case in 2019. - ProMED Mod.TY]

Obongi district, Uganda is located approximately 50 km (30 mi) from the South Sudan border.
HealthMap/ProMED-mail maps:

According to OIE's data, a total of 2 outbreaks of RVF affecting animals have been reported from Sudan during the event. The 1st outbreak started in the Arabaata dam area, Red Sea state, on 25 Sep 2019, affecting goats. The 2nd (and, so far, last) outbreak started 10 Oct 2019 in the River Nile state, affecting sheep and goats. Both outbreaks have been declared as 'resolved' on 14 Nov 2019.

Outbreak summary:
Total outbreaks = 2 (Submitted)
Species / Susceptible / Cases / Deaths / Killed and disposed of / Slaughtered
Goats / 1700 / 37 / 7 / 0 / 0
Sheep / 1550 / 37 / 5 / 0 / 0

According to the recent (5 Dec 2019) OCHA (UN Office for the Coordination of Humanitarian Affairs) update, the (human) RVF situation in Sudan, as of 26 Oct 2019, was the following: "a total of 345 suspected RVF cases -- including 11 related deaths -- reported in the states of Red Sea (128), River Nile (212), Khartoum (1), White Nile (1), Kassala (2), and Gedaref (1). The most affected age group is 15 to 45 years, which accounts for 83% of the total suspected cases. The male to female ratio is 2.6, with a high proportion of the cases being farmers (37.5 per cent). RVF is endemic in Sudan and 3 outbreaks affecting people have been documented in 1973, 1976, and 2008. During the outbreak in 2008, a total of 747 laboratory-confirmed cases were reported, including 230 deaths."

Egypt suffered its 1st RVF outbreak in 1977/78 with serious human disease and death as well as severe losses in livestock; several additional events have been recorded since. A recent historical review paper [1] concluded: "due to the availability and abundance of the potential vectors, the suitability of environmental conditions, continuous importation of livestock's from Sudan, and the close association of susceptible domestic animals with humans, the RVF virus could possibly occur and circulate in Egypt."   (https://tinyurl.com/whz3pz5)

Reference
---------
1. Kenawy MA, Abdel-Hamid YM, Beier JC. Rift Valley fever in Egypt and other African countries: Historical review, recent outbreaks, and possibility of disease occurrence in Egypt. Acta Trop. 2018; 181: 40-49; <https://doi.org/10.1016/j.actatropica.2018.01.015>  - ProMED Mods.AS/TY]
Date: Fri 6 Dec 2019 5:53 PM MST
Source: CTV News [edited]

A syphilis outbreak is worsening in Alberta [Canada], and the majority of new cases are in the Edmonton zone. Edmonton saw 1186 of the 1753 infectious syphilis [primary, secondary and early latent syphilis] cases reported in Alberta in 2019, a total of 68 per cent.

Alberta Health Services [AHS] declared an outbreak in July 2019, saying cases had 'increased dramatically' in the province since 2014. The number increased again in July [2019]  [<https://edmonton.ctvnews.ca/alberta-declares-province-wide-syphilis-outbreak-1.4510737>].

AHS sent a new public health alert to doctors on [27 Nov 2019], asking for their help to control the outbreak [<https://www.albertahealthservices.ca/assets/info/hp/phys/if-hp-phys-moh-ez-syphilis-outbreak.pdf>]. "It's very significant," said Dr Ameeta Singh, a clinical professor in infectious diseases. "That's an alarming rise in new syphilis cases in Alberta." She said it's the highest number of cases the province has seen since the 1940s.

According to Dr Singh, the increase in cases being reported is partially due to a greater number of people getting tested. "We know more people are coming in to get tested, but if we look a bit closer at the data we have, we do see there's, in fact, a [bigger] rise in the number of cases than we would expect to see," said Singh.

Another factor could be the rise in methamphetamine use in Edmonton. "I believe this is a major factor. Meth also stimulates risky sexual behaviour and increases the chance people will engage in multiple, usually casual or anonymous partners as well and not use precautions such as condoms to protect themselves during sex," she said.

What's also alarming, Singh said, is the spike in cases of congenital syphilis, where the disease is passed on to newborns. According to AHS, there have been 38 cases of congenital syphilis in 2019, 31 of which were in the Edmonton area. That accounts for more than half of the 61 cases of congenital syphilis reported since 2014.

"Those are not numbers we should be talking about in Canada ever...in a country that has universal access to health care, in a major city in Canada where syphilis testing is offered to all pregnant women who access prenatal care," she said. "What we're seeing with the congenital syphilis cases is many of the women are not accessing prenatal care until they come into the hospital to deliver and then the tests are being done."
===================
[A recent ProMED-mail post (Syphilis - Canada (04): (AB) RFI http://promedmail.org/post/20190718.6574300) reported a rise in "infectious syphilis" cases over a 4-year period: from 2014 to 2018 but made no mentioned of contributing factors. As illicit drug use has been cited as a contributing factor to recent increases in syphilis cases in the Canadian provinces of Ontario and Manitoba, I questioned in this prior ProMED-mail post if use of illicit drugs, in particular, methamphetamine, could similarly be contributing to the rise of syphilis cases in Alberta. The news article above reports that the rise in methamphetamine use in Edmonton, as well as increased testing for syphilis, are thought to be contributing factors in Alberta.

Methamphetamine can be swallowed, snorted, smoked or injected by needle and syringe

When methamphetamine is injected, transmission of syphilis may occur as a consequence of sharing a needle/syringe contaminated with infected blood from somebody who has primary or secondary syphilis (<https://ucsdnews.ucsd.edu/archive/newsrel/health/04-28TransmissionSyphilis.asp>); but syphilis can also be acquired by direct contact with an infected lesion during oral, vaginal, or anal sex when the drug is taken by any route of administration. Methamphetamine use is associated with sexual behaviors that increase the risk for acquiring syphilis and other sexually transmitted diseases, including having multiple sex partners, inconsistent condom use, and exchange of sex for drugs or money (<https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a4.htm>).

The linkage of methamphetamine use and syphilis transmission is reminiscent of the increase in syphilis among heterosexuals during the crack cocaine epidemic of the 1980s and 1990s, when the practice of trading sex with multiple partners for drugs, especially crack cocaine, played a major role in the transmission of syphilis. Under these circumstances, the identities of sex partners are often unknown, which weakens the traditional syphilis-control strategy of partner notification.

Bacteremia due to _Treponema pallidum_, the cause of syphilis, which occurs during primary, secondary, and latent syphilis, can result in transplacental transmission of this organism to the fetus during pregnancy and cause congenital syphilis. An increase in the incidence of syphilis in women in the population is commonly accompanied by increasing rates of congenital syphilis.

Edmonton, with a population of 932 546 residents in 2016, is the capital of the Canadian province of Alberta
(<https://en.wikipedia.org/wiki/Edmonton>).

A map showing the location of Edmonton can be found at
<https://goo.gl/maps/Rfq6XC2vvwi19ypb6>. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Alberta, Canada:
9 December 2019
https://www.who.int/bangladesh/news/detail/09-12-2019-cholera-vaccination-campaign-launched-to-protect-635-000-people-in-cox-s-bazar

Cox’s Bazar, Bangladesh

Over 635,000 Rohingya refugees and Bangladeshi host community will be vaccinated against cholera in a 3-week-long campaign beginning today at the refugee camps in Cox’s Bazar and nearby areas, to protect vulnerable population against the deadly disease amidst increasing number of cases of acute watery diarrhoea (AWD).


The Oral Cholera Vaccination (OCV) campaign will be implemented in the refugee camps from 8-14 December to reach 139,888 Rohingya aged 1 year and less than 5 years. In the host community, the campaign will take place from 8-31 December and aims to reach any person older than 1 year (495,197). In total, 635,085 people are expected to be reached.

Led by the Ministry of Health and Family Welfare, with support of the World Health Organization (WHO), UNICEF and other partners, the campaign aims to reach people who missed some or all previous cholera vaccination opportunities. The campaign, including operational costs, is funded by Gavi, the Vaccine Alliance.

“We want to equip these populations with more protection against diarrheal diseases. Despite the progresses made to ensure access to quality water and sanitation, such diseases remain an issue of concern: approximately 80% of host community living near the camps have not been targeted in previous OCV campaigns and are still vulnerable”, says Dr Bardan Jung Rana, WHO Representative in Bangladesh.

Earlier rounds of cholera vaccination, which have taken place since the beginning of the emergency response in 2017, have helped prevent outbreaks of the disease. To this date, over 1 million people were vaccinated against cholera.
6th December 2019
https://www.theguardian.com/world/2019/dec/06/flooding-hits-new-zealand-tourist-hubs-of-wanaka-and-queenstown

Heavy rain has led to rivers bursting their banks, forcing the closure of shops and restaurants

Streets in the South Island tourist towns of Wanaka and Queenstown were slowly going under water on Friday, after Lake Wanaka and Lake Wakatipu burst their banks earlier in the week, flooding businesses and sewerage systems.

Water and large debris closed the main street of Wanaka, a popular spot with Instagrammers thanks to its famous tree that appears to have grown out of the lake. On Friday businesses were sandbagging as heavy rain continued to fall.

Sewerage systems in the town were also at risk of contaminating the lake, with the Queenstown Lakes District council taking the precautionary measure of shutting down the sewer connection to a handful of premises.

Wanaka residents were told to be on “high alert” with heavy rain predicted all weekend.

The streets of the usually bustling tourist town were largely empty, and the popular cafes and restaurants on the lake shore were closed.