WORLD NEWS

Getting countries ...
Select countries and read reports below or

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.
More ...

Travel News Headlines WORLD NEWS

More ...

Slovenia

Slovenia US Consular Information Sheet
March 02, 2009
COUNTRY DESCRIPTION:
Slovenia operates under a parliamentary democracy.
In May 2004, Slovenia became a member of the European Union.
Tourist facilities are widely available th
oughout the country.
Read the Department of State’s Background Notes on Slovenia for additional information.

ENTRY/EXIT REQUIREMENTS:
Slovenia is a party to the Schengen agreement.
As such, U.S. citizens may enter Slovenia for up to 90 days for tourist or business purposes without a visa.
The passport should be valid for at least three months beyond the period of stay.
For further details about travel into and within Schengen countries, please see our Schegen fact sheet.

Slovene authorities may confiscate passports with signs of damage, such as missing pages, as suspicious documents, potentially causing travel delays.
American citizens entering and exiting Slovenia by personal vehicle are required to have a valid U.S. and International Driver’s License (See our Road Safety page for further information) or they may be refused entry into the country and/or fined.

All non-EU citizens staying longer than 3 days in Slovenia must register with the local police within 3 days of arrival and inform the office about any change in their address. Registration of foreign visitors staying in hotels or accommodations rented through an accommodation company is done automatically by the hotelier or accommodation company, but visitors staying with family members must register themselves.
Registration is available 24 hours a day at police stations and is free of charge. Failure to register can result in a significant fine of up to 400 euros.

For further information on entry requirements for Slovenia, travelers may contact the Embassy of Slovenia at 2410 California Street, NW, Washington, DC
20008, tel. (202) 386-6610; the Consulate General of Slovenia in New York City, tel. (2l2) 370-3006; or the Consulate General in Cleveland, Ohio, tel. (216) 589-9220.
Visit the Embassy of Slovenia’s 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:
Slovenia remains largely free of terrorist incidents.
This assessment takes into account historical data relevant to terrorist activities and recent reporting indicating whether acts could be conducted without prior advance warnings.
However, like other countries in the Schengen area, Slovenia shares open borders with its Western European neighbors, allowing the possibility of terrorist groups entering/exiting the country with anonymity.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

There are occasional political demonstrations in city centers in Slovenia.
They occur most often in central Ljubljana in areas around Kongresni Trg (Congress Square), in front of the Parliament building, around other government facilities, and, at times, near the American Embassy.
These demonstrations are usually peaceful and generally are not anti-American in nature.
However, there have been demonstrations that voiced anti-American sentiments.
American citizens should keep in mind that even demonstrations intended to be peaceful can turn confrontational and possibly escalate into violence.
American citizens are therefore urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations.
For additional information, Americans are encouraged to check the Embassy’s website or call the Embassy at 386-1-200-5595 or 200-5599 (200-5556 after hours and on weekends/holidays).

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:
Slovenia’s overall crime rate is low and violent crimes are relatively uncommon.
Most crimes tend to be non-violent and directed towards obtaining personal property, such as purse-snatching, pick-pocketing, and residential and vehicle break-ins.
Visitors should take normal security precautions and are requested to report any incidents to the local police.

Vehicle break-in/theft is a continuous problem in Slovenia.
Individuals should always lock vehicles, use vehicle anti-theft devices, park in well-lighted areas, and secure vehicles in residential or hotel garages.

Residential burglaries occur where there are security vulnerabilities and/or where residents are not implementing residential security practices.
American citizens should ensure their residence is properly secured at all times, as recent burglary reports indicate access was gained when doors were not secured with an appropriate lock.

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

The local equivalent to the “911” emergency line in Slovenia is: 113.
Please see our information on Victims of Crime, including possible victim compensation programs in the United States.

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 Slovenian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Slovenia 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.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Adequate medical care is readily available.
Travelers to Slovenia may obtain a list of English-speaking physicians at the U.S. Embassy.
Antibiotics, as well as other American-equivalent prescription medications are available at local pharmacies.
In Slovenia all medications, including drugs considered over-the-counter and first aid supplies, are dispensed through pharmacies (“lekarna”).
For those persons who engage in outdoor activities, a vaccine to prevent tick-borne encephalitis is recommended.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Slovenia.
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 (CDC) 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 Slovenia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Slovenia has a well-developed road network that is safe for travel.
Highways connect to neighboring cities and countries and are clearly sign-posted; road signs and traffic rules are consistent with those used throughout Europe.
As the number of cars in Slovenia continues to rise, roads are becoming more heavily congested during the weekends on major routes and during rush hours.
Parking is difficult and can be expensive in the center of Ljubljana.
Traffic moves on the right.
Third-party liability insurance is required for all vehicles; coverage is purchased locally.
Travelers should be alert to aggressive drivers both in cities and on highways.
Many of the serious accidents in Slovenia occur as a result of high-speed driving.
Emergency roadside help and information may be found by dialing 1-987 for vehicle assistance and towing services, 112 for an ambulance or fire brigade, and 113 for police.
By Slovene law, the maximum legal blood-alcohol content limit for drivers is 0.05%.

U.S. visitors or U.S. residents in Slovenia must be in possession of both a valid U.S. driver’s license and an International Driver’s License in order to drive in Slovenia.
International Driver’s Licenses are valid for a maximum of one year, after which residents of Slovenia are required to obtain a Slovene driver's license.
Current information about traffic and road conditions is available in English by calling (01) 530-5300 and online from the Automobile Association of Slovenia and the Traffic Information Center for Public Roads.

The speed limit is 50kph/30 mph in urban areas, 130 kph/80 mph on expressways (the avtocesta).
Motorists are required to have their headlights on during the daytime; drivers and passengers alike must wear seat belts; motorcyclists and their passengers must wear approved helmets.
The use of handheld cellular telephones while driving is prohibited in Slovenia.

Highway vignettes are obligatory for all vehicles with the permissible maximum weight of 3,500 kg on motorways and expressways in Slovenia.
A one-year vignette costs EUR 55; a half-year vignette costs EUR 35; for motorcycles, the one-year vignette is EUR 27,50 and the half-year vignette is EUR 17,50.

A one-year vignette for the current year is valid from December 1st of the previous year to January 31st of the next year (a total of 14 months). The half-year vignette is valid for six months following the day of its purchase.
Using motorways and expressways without a valid and properly-displayed vignette in a vehicle is considered a violation of the law; violators may be fined between EUR 300 and 800. In addition to this fine, a new sticker must be purchased and displayed on the vehicle.
Vignettes can be purchased in Slovenia at petrol stations, newsstands, automobile clubs, post offices (Posta Slovenije), and some toll stations, and also at petrol stations in neighboring countries.

Please refer to our Road Safety page for more information.
Current information is also available at the website of Slovenia’s national tourist office, which is the national authority responsible for road safety.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Slovenia, the U.S. Federal Aviation Administration (FAA) has not assessed Slovenia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s website.

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 Slovenia are encouraged to register with the U.S. Embassy or through the State Department’s travel registration website so that they can obtain updated information on travel and security within Slovenia.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located at Presernova 31, Ljubljana 1000, Tel: (386)(1) 200-5500 or Fax: (386)(1) 200-5535.
*

*

*
This replaces the Country Specific Information for Slovenia dated July 29, 2008, to update the
Entry/Exit Requirements and Traffic Safety and Road Conditions sections.

Travel News Headlines WORLD NEWS

Date: Mon, 6 Aug 2018 12:06:36 +0200
By Bojan KAVCIC

Markovec, Slovenia, Aug 6, 2018 (AFP) - When he used to go hunting, Miha Mlakar would dream of killing a bear. But today the 33-year-old from Slovenia makes his living watching the animals, peacefully, in their natural forest environment.   The turnaround to shooting bears with a camera, not a rifle, puts Mlakar, who runs bear observation tours, in step with wider efforts in the small Alpine nation to promote the coexistence of humans and bears.

Once on the verge of extinction, Slovenia's brown bear population is booming, with the number roaming the sprawling forests having doubled in the last decade to around 1,000.   As a result, encounters with bears have increased -- not that it seems to unduly worry everyone.   "If you run into a bear, you have to step back... (But) there is no danger. The bear also prefers to move away," Ljubo Popovic, a 67-year-old pensioner who lives in the village of Banja Loka in the southern Kocevje region, told AFP.   Lying an hour to the west, near Markovec village, Mlakar has built 20 hides in a remote patch of forest reachable only by off-road vehicle and takes visitors, including foreign tourists, to observe the bears.   "I cannot imagine this forest without bears. Bears make the forest wild and pristine, natural, like it was a few hundred or thousand years ago... I feel a connection with bears," he tells AFP.

- Managing bears -
Slovenian bears are even sought after abroad.    Between 1996 and 2006, eight Slovenian bears were released in the French Pyrenees, and France currently has a population of about 40 bears, whose presence divides opinion in regions where they live.   In Slovenia, more than 60 percent of respondents in a 2016 survey carried out in areas where bears live said they were in favour of the bears' presence, even if many also said they would like to see the numbers regulated.   "We have an average of one to three cases of physical contact between bears and humans per year," Rok Cerne, of the Slovenia Forest Service in charge of wildlife, told AFP.

"Fortunately, we haven't registered any serious incident over the last years," he added, stressing they were "very active in preventive measures".   Removing food sources that could attract bears has been one such step.    In villages close to bear habitats, local authorities have replaced regular plastic waste and compost bins, which can be easily opened or flipped by the animals, with containers protected by heavy metal cages.

Meanwhile, damage to cattle from bear forays has remained stable, at up to 200,000 euros ($231,500) a year, despite the bear population increasing, Cerne said.   Farmers are entitled to an 80-percent subsidy for using electric fences to protect flocks and the loss of cattle due to bears is compensated.   If a bear becomes a habitual visitor to a village, special intervention groups step in to kill or relocate the animal with the help of local hunters.   Regular culling also keeps the population under control to ensure long-term cohabitation, Cerne said. This year, authorities have proposed culling 200 bears, twice as many as last year.

- Romania's 'Van Damme' bear -
Slovenia's approach could inspire neighbouring Romania, home to about 6,000 bears or 60 percent of Europe's estimated bear population, where tourists to villages in the Carpathian Mountains often post pictures online of bears waiting to be hand-fed.   Bears rummaging through waste containers on the outskirts of cities, such as Brasov in central Romania, have become a common sight.   And on a central motorway construction site, workmen have christened a regularly spotted sturdy male bear Van Damme after the Hollywood star.

Beyond tourists' anecdotes however, Romania has seen a "growing number of attacks" by bears, highlighted in a conservation plan published last month that recommends hunting to keep numbers at optimum levels.   Use of reinforced bins, as well as a proposal for building work to be limited in regions where bears live, are also included in the government plan.   Since the beginning of last year, 31 people, mostly shepherds, have been attacked, one of them fatally. 

Meanwhile, some 940 forays by bears into populated areas were registered last year, including attacks on sheep flocks and entry into gardens; so far this year, the figure is 120.   But environmental campaigners fear that "hunting will be the main instrument to keep bear populations under control", when other measures could work, said Livia Cimpoeru, of the WWF Romania.   The government has proposed 4,000 bears as the ideal number in the country of 20 million people.   Learning simple rules, such as how to avoid startling bears and not feeding them, as well as efficient management like accurate counting to ascertain trends, is crucial for reducing conflicts with humans, said Mareike Brix, of German-based EuroNatur foundation.   "There is a risk, and there can be problems... But it's also great (to have bears). Wild nature has become so rare in Europe," she tells AFP.
Date: Thu 13 Jun 2018
Source: STA [not open access; edited]

The UKC Maribor hospital has registered 3 new cases of measles infection, including a doctor and a nurse who treated 1 of the 3 patients who got measles earlier.

The rest of this story is by subscription....
===================
[A HealthMap/ProMED-mail map of Slovenia can be found at
Date: Mon 17 Oct 2016
Source: Outbreak News Today [edited]

The vaccine-preventable disease, tetanus, has been considered eradicated among children in the Central European country of Slovenia for the past 20 years; health officials report a case in an unvaccinated child as reported in local media Fri, 14 Oct 2016.

The National Public Health Institute (NIJZ) says while the disease has been considered eradicated among children for the past 2 decades, a few cases are reported every year among the elderly, who grew up before systemic vaccination against the disease was introduced. Tetanus vaccination has been available in Slovenia since 1951.

Tetanus is caused by a very potent toxin produced by the anaerobic bacterium, _Clostridium tetani_. The spores of this organism are very resistant to environmental factors and are found widely distributed in soil and in the intestines and feces of horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. Manure-treated soil may contain large numbers of spores. In agricultural areas, a significant number of human adults may harbor the organism.

These spores are usually introduced into the body through a puncture wound contaminated with soil, street dust, animal bites or animal or human feces, through lacerations, burns or trivial unnoticed wounds or by injecting contaminated drugs. So many times you hear about concern over stepping on a rusty nail; however the rust has nothing to do with tetanus. At this point the spores germinate into bacteria which multiply and produce toxin. Depending on the extent of the wound, the incubation of tetanus is around 10-14 days.

Some of the common symptoms of tetanus are lockjaw, followed by stiffness of the neck, difficulty swallowing, and rigidity of abdominal muscles. Other symptoms include fever, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes. Spasms continue for 3-4 weeks. The typical features of a tetanus spasm are the position of opisthotonos and the facial expressions known as "risus sardonicus". The death rate for this disease ranges from 10 to 80 percent depending on age and quality of care.

There are really no laboratory findings that are characteristic of tetanus. The diagnosis is entirely clinical and does not depend upon bacteriologic confirmation. This disease in not transmitted from person to person. Even if you had tetanus and recovered, this potent toxin produces no immunity.  [Byline: Robert Herriman]
======================
[Tetanus is a potentially fatal disease characterized by skeletal muscle rigidity and painful convulsive spasms, which are caused by a potent neurotoxin, tetanospasmin, produced by the vegetative form of _Clostridium tetani_, an anaerobic spore-forming Gram-positive bacillus. _C. tetani_ is a member of the normal intestinal flora of animals, including humans. Tetanus usually occurs following contamination of wounds by soil or animal feces in which the spores of _C. tetani_ can be found.

A newly published article demonstrates that the extracellular matrix proteins called nidogens (or entactins) appear to be the receptor for the tetanus neurotoxin to enter the neuromuscular junction (Bercsenyi K, Schmieg N, Bryson JB, et al: Tetanus toxin entry. Nidogens are therapeutic targets for the prevention of tetanus. Science. 2014;346(6213):1118-23. doi: 10.1126/science.1258138, abstract available at:  <http://science.sciencemag.org/content/346/6213/1118.long>).

Abstract:
"Tetanus neurotoxin (TeNT) is among the most poisonous substances on Earth and a major cause of neonatal death in nonvaccinated areas. TeNT targets the neuromuscular junction (NMJ) with high affinity, yet the nature of the TeNT receptor complex remains unknown. Here, we show that the presence of nidogens (also known as entactins) at the NMJ is the main determinant for TeNT binding. Inhibition of the TeNT-n idogeninteraction by using small nidogen-derived peptides or genetic ablation of nidogens prevented the binding of TeNT to neurons and protected mice from TeNT-induced spastic paralysis. Our findings demonstrate the direct involvement of an extracellular matrix protein as a receptor for TeNT at the NMJ, paving the way for the development of therapeutics for the prevention of tetanus by targeting this protein-protein interaction."

Tetanus may follow surgical procedures, burns, deep puncture wounds, crush wounds, otitis media, dental infection, animal bites, abortion, and pregnancy. The presence of necrotic tissue and/or foreign bodies increases risk for tetanus because they favor growth of _C. tetani_. Tetanus can also follow injection of contaminated illicit drugs. Neonatal tetanus occurs usually in developing countries in infants with infection of the umbilical stump who are born to a non-immune mother. Infants of actively immunized mothers acquire passive immunity that protects them from neonatal tetanus. Tetanus is not directly transmitted from person to person.

Tetanus occurs in people who are inadequately immunized, i.e., people who have not completed the primary series and received appropriate boosters. Recovery from tetanus is not necessarily associated with immunity, and primary immunization is indicated after recovery from tetanus. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Tue, 12 Jan 2016 20:27:43 +0100

Ljubljana, Jan 12, 2016 (AFP) - The Slovenian army on Tuesday began removing sections of a razor-wire border fence, erected to control the inflow of migrants from Croatia, due to flooding by the Kolpa river, local media reported.   Slovenian soldiers removed 200-300 metres of the fence in the Griblje and Dragatus areas, villages some 110 kilometres (70 miles) south of Ljubljana, after the Kolpa burst its banks and floodwaters threatened to tear down the fence, the STA news agency reported.

Since mid-November Slovenia has built over 150 kilometres of razor-wire fence along its border with Croatia, hoping to prevent an uncontrolled inflow of migrants across the "green border".   Over 400,000 migrants have crossed into Slovenia since mid-October, most hoping to carry on to Austria or Germany.

The Slovenian government's information office said Monday that the border fence would be removed in areas where the stream of the Kolpa river was strongest and replaced, in the near future, by a more resistant fence.   Situated in one of Slovenia's most attractive natural parks, the Kolpa river marks over 100 kilometres of the 670 kilometre-long Slovenia-Croatia border.   The fence has been criticised by environmentalists and civil groups in Slovenia and Croatia which claim the razor wire is a threat to wildlife.
Date: 4 Jan 2016
From: Maja Socan, M.D. Maja.Socan@nijz.si

In response to the request for information in the ProMED mail post "Undiagnosed gastroenteritis - Slovenia (GO): international athletes, RFI http://promedmail.org/post/20151228.3896510, the following information was received 4 Jan 2016 [edited]:

As a response to the ProMED request for information on 28 Dec 2015 quoting izvestia.ru from 19 Dec [2015] that 3 teams were affected by a viral epidemic during Biathlon World Cup in Pokljuka, Slovenia, an investigation has been carried out. Regional epidemiologists contacted the organizers, the hotel where athletes were staying, local outpatient clinics/emergency teams and both hospitals nearby. 
 
The organizers of the Biathlon World Cup in Slovenia were not aware of any communicable diseases affecting biathlon teams during the cup. One of the athletes was admitted to the hospital but the reason for the admission was non-infectious. Another athlete lost consciousness during the competition.
 
Neither emergency medical teams nor nearby hospitals were contacted for any health intervention except for the above-mentioned situations.
 
The hotel where the teams were staying was not informed about any gastrointestinal problems among its guests during the competition.
 
The findings of our investigation do not preclude that some of the athletes had health problems during the competition but apparently not severe enough to contact local health services. We assume that if high numbers of athletes had become ill with gastrointestinal problems the organizer would have been informed. According to the national algorithm for mass gatherings (with emphasis on the international ones), the National Institute of Public Health is obligated to provide in advance the information to the organizers about possible health issues during mass gatherings and measures which must be taken to stop the spread of communicable diseases or at least to mitigate the outbreak.
 
To conclude, we were not able to identify an outbreak of acute gastrointestinal or respiratory infection among competing athletes during the Biathlon World Cup in Pokljuka, Slovenia.
-------------------------------------------
Maja Socan, M.D.
Senior consultant
Communicable Diseases Centre
National Institute of Public Health
Ljubljana, Slovenia
========================
[ProMED thanks Dr. Socan for the thorough investigation into this report and for sharing the information with the ProMED community.

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

World Travel News Headlines

Date: Fri 17 Jan 2019
Source: Front Page Africa [edited]

The Surveillance Officer of Grand Bassa County Health team has confirmed to FrontPage Africa that there is a Lassa fever outbreak in District 4, Grand Bassa County leading to 3 deaths and 20 others confirmed infected with the virus.

Gabriel B. Kassay said over 60 specimens were taken to Monrovia for testing as a result of the outbreak.  "Out of the 60 plus, over 20 specimens were confirmed affected with Lassa fever," he said, adding that 3 persons have died from the disease at the Liberia Agricultural Company (LAC) concession area in Wee Statutory District.

Kassay said there were several incidents of Lassa fever in the LAC plantation area in 2019.  "According to the Liberia health law, one confirmed case of Lassa fever is considered an outbreak, and so since August 2019, there have been lots of people affected in the LAC area," he said while expressing concern that "the lack of awareness is a major factor" for the frequent cases of the virus in the county.  "The Grand Bassa Health Team has been very instrumental in helping to curtail the spread of the disease in the affected area, but there is a need for awareness in the entire county."

Kassay said the spread of Lassa fever might increase if the citizens are not trained to know the cause and effects of Lassa fever.
=====================
[The number of cases has increased from 9 on 2 Dec 2019 (See Lassa fever - West Africa (43): Liberia http://promedmail.org/post/20191207.6828798) to 20 confirmed cases now. The reported number of deaths remains at 3. The previous ProMED-mail post (see Lassa fever - West Africa (31): Liberia http://promedmail.org/post/20190902.6653653) reported that according to MoH data, a total of 92 suspected cases between 1 Jan-25 Aug 2019, including 21 deaths, have been reported. Of these, 25 cases have been confirmed by RT-PCR (Nimba (9), Bong (10), Grand Bassa (5), and Grand Kru (1)), while 9 remain suspected cases, the release recorded. The case-fatality rate among confirmed cases in that report was stated as 36% (9 deaths out of 25 confirmed cases). Males are mostly affected by the disease (56%) of confirmed cases as compared to females.

Occurrence of Lassa fever cases in areas outside the usual "Lassa fever belt" is of concern, and the Ministry of Health is wise to increase public information and advize citizens about measures that should be taken to avoid infection with the virus. Occurrence of Lassa fever in Liberia is not new, and cases have occurred there sporadically for several years. Between 1 Jan and 27 Jun 2018, 20 cases were laboratory confirmed (see archive no. http://promedmail.org/post/20180711.5898495). Apparently, all those Lassa fever virus infections were acquired by contact with infected rodents or their excretions. Lassa fever virus can be acquired from infected rodents or patients in the hospital. Transmission can occur in health facilities when personal protective equipment is not employed or barrier-nursing practices or biocontainment facilities in the laboratory are not adequate to protect staff from blood and secretions of infected patients.

As mentioned in previous posts, Lassa fever virus transmission to humans occurs when people are in contact with the reservoir rodent host, the multimammate mouse (_Mastomys natalensis_ and _M. erythroleucus_) and the African wood mouse (_Hylomycus pamfi_) or their excreta, as was likely the situation in many of these cases. Rodent control has to be undertaken at the village level with individual households employing the preventive measures listed above. This requires an extensive and continuous public education effort.

Images of the _Mastomys natalensis_ mouse, the rodent reservoir of Lassa fever virus, can be seen at
_M. erythroleucus_ and _Hylomycus pamfi_ at

Date: Sun 19 Jan 2019
Source: Outbreak News Today [edited]

With the arrival of summer when the occurrence of diseases transmitted by mosquitoes, such as yellow fever, increases, the Brazilian Ministry of Health is alerting the population to get vaccinated against the disease.  The alert is mainly focused on the population that lives in the South and Southeast regions of the country due to the confirmation of 38 monkey deaths in the states of Parana (34), Sao Paulo (3), and Santa Catarina (1). In total, 1087 reports of suspected monkey deaths were recorded in the country.

The alert is given because the regions have a large population and a low number of people vaccinated, which directly contributes to the cases of the disease.

The target public for vaccination is people from 9 months of age and 59 years of age who do not have proof of vaccination.

Regarding human cases, 327 suspected yellow fever cases were reported in the same period, of which 50 remain under investigation and one has been confirmed.

The yellow fever vaccine is offered in the National Vaccination Calendar and distributed monthly to the states. In 2019, more than 16 million doses of the yellow fever vaccine were distributed throughout the country. Despite this availability, there is a low demand from the population for vaccination. For 2020, the portfolio acquired 71 million doses of the vaccine, enough to serve the country for more than 3 years.

In 2020, the Ministry of Health will gradually expand yellow fever vaccination to 1101 municipalities in the Northeast states that were not yet part of the vaccination recommendation area. Thus, the whole country now has a vaccine against yellow fever in the routine of services.

Another change in the calendar was that the children started to have a booster vaccine at the age of 4. The decision came because recent scientific studies have shown a decrease in the child's immune response, which is vaccinated very early, at 9 months, as predicted in the child's National Vaccination Calendar. Since 2017, the Ministry of Health has followed the guidelines of the World Health Organization (WHO) to offer only one dose of the yellow fever vaccine in a lifetime.
=========================
[The current expansion of yellow fever in South America raises concern for public health and also about potential conservation problems for susceptible non-human primate species in the continent. Yellow fever virus was introduced into the Americas approximately 400 years ago, yet the complex interactions that were established after its introduction are far from being elucidated. There is a need for more research on the eco-epidemiology of the disease in the continent, especially in the presence of the persistent anthropogenic global environmental change. - ProMED Mod.PMB]

[HealthMap/ProMED-mail map of Brazil:
Date: Sat 18 Jan 2020 03:15 WAT
Source: Actualita [in French, machine trans., edited]
<https://actualite.cd/2020/01/18/rdc-une-maladie-inconnue-fauche-des-vies-kiri-5-morts>

An unknown disease has already killed 5 people at Kiri General Hospital, in the province of Mai-Ndombe, in the west of the Democratic Republic of the Congo (DRC), according to the authorities. The provincial minister of public health has said that all measures are underway to detect [diagnose?] the mysterious disease. "Admittedly, this was an abnormal situation; however, the situation is manageable because we have just gone into this health facility and we have tried to carry out investigations. My collaborators and I took some samples which have quickly been sent to the National Institute for Biomedical Research (INRB) in Kinshasa for the appropriate medical tests which can give us accurate [diagnosis] on this abnormal situation," declared the minister Jean Claude Bola. First, added the same official, "it is not an Ebola epidemic, contrary to the rumour circulating in the Kiri territory and in the social networks."

In an exclusive interview with actualita.cd, the provincial authority also confirmed the deaths. "However, I warn all those who broadcast through the various media and social networks that there is Ebola in Mai-Ndombe that they have neither qualification nor competence to do so, because the only authority having jurisdiction in the provinces to declare an epidemic is the provincial governor," declared Paul Mputu Boleilanga. "Severe and disciplinary sanctions will be reserved against usurpers of power," he threatened. According to provincial authorities, a team from the National Institute of Biomedical Research (INRB), a team is expected in the Kiri territory for "rapid" management of all patients and to determine the disease underlying deaths in this region.
=============================
[Other than the number of deaths and the geographical location of the cases there is no additional information to permit reasonable speculation as to the aetiology or dates of illnesses. ProMED Mod.MPP noted that Ebola denial leads one to suspect this is a viral haemorrhagic fever.

Laboratory tests should confirm or rule out diseases such as yellow fever or Lassa fever. However, there is no indication that these cases are due to a virus or other infectious agent. Toxicants should also be ruled out. Additional information about these or new cases would be appreciated. - ProMED Mod.TY]

[Maps of DR Congo: <http://goo.gl/DM2AT8> and
<http://healthmap.org/promed/p/194> and
<http://healthmap.org/promed/p/65284>]
Date: Fri, 17 Jan 2020 17:48:09 +0100 (MET)

Barcelona, Jan 17, 2020 (AFP) - Spain's Balearic Islands passed a bill Friday aimed at clamping down on alcohol-fuelled holidays in the Mediterranean archipelago which bans happy hours when drinks are offered a discount and open bars.   "This is the first law adopted in Europe which restricts the sale and promotion of alcohol in certain touristic areas," the regional government of the Balearic Islands which have long been a magnet for young German and British tourists, who often drink heavily and enjoy rowdy late-night clubbing.

The restrictions will apply to three areas with a reputation for excess: San Antoni on the island of Ibiza and El Arenal and Magaluf -- which has been nicknamed "Shagaluf" because of its reputation for drunken casual sex -- on Mallorca, the largest of the Balearic's four islands.   The law, which was drawn up in consultation with the tourism industry also bans pub crawls and two-for-one drink offers, prohibits the sale of alcohol in shops between 9:30 pm and 8 am and forbids advertising party boats in the designated areas.   Establishments that break the new rules risk fines of up to 600,000 euros ($669,000) and the threat of being closed down for three years.

The new law also takes aim at the so-called "balconing" craze, the term given to holidaymakers who decide to jump into a swimming pool from a hotel or apartment balcony, a stunt which claims several lives every year.   It bans "balconing" across the entire archipelago and requires hotels to evict anyone who does it. Those caught jumping from balconies face fines of up to 60,000 euros ($67,000).   Up until now only some resorts on the Balearics imposed fines for "balconing".

The regional government of the Balearics said the law, which stiffens measures already introduced in 2015, will "fight excesses in certain tourist zones" and "force a real change in the tourism model of those destinations".   Magaluf made global headlines in 2014 after a video showing a young woman performing oral sex on several men on the dance floor of a nightclub went viral.   Local shops sell souvenir T-shirts with the catchphrase "On it 'till we vomit".

The four islands which make up the Balearics -- Palma de Mallorca, Ibiza, Menorca and Formentera, received nearly fourteen million tourists in 2018, drawn by their crystal clear waters, and in many cases by all-inconclusive package holidays.   The archipelago is Spain's second most visited region. Spain is the world's second most visited country after France.
Date: Fri, 17 Jan 2020 12:55:16 +0100 (MET)

Rennes, France, Jan 17, 2020 (AFP) - Several oyster farmers along France's Atlantic and Mediterranean coasts have been forced to halt sales since December after their sites were contaminated by the highly contagious norovirus, which they blame on overflowing sewage treatment plants.   Authorities ordered the suspensions at 23 of the country's 375 designated fields, and recalls of affected oysters as well as mussels and clams, after tests revealed the virus, which can cause severe vomiting and diarrhoea.

The move came just before the year-end holidays, when oysters are a traditional delicacy on millions of French tables.   "The oysters are not sick. They're carrying the virus because it's in the water they are constantly filtering," Philippe Le Gal, president of France's national shellfish council (CNC), told AFP this week.   "They were in the wrong place at the wrong time," he said, adding the ban had prompted many people to stop eating oysters altogether.   Local officials say oyster farmers are paying the price of insufficient spending on wastewater treatment, with facilities strained to the limit even as development of coastal areas has surged in recent years.

Heavy rains before Christmas prompted treatment basins to overflow, they say, spilling tainted water into rivers.   "This was predictable -- they've kept issuing building permits even though treatment sites are already at full capacity," said Joel Labbe, a senator for the Morbihan region in Brittany.   Oyster farmers are demanding compensation, and a delegation met with agriculture ministry officials in Paris last week warning that more than 400 businesses had been impacted by the sales ban.

This week, angry growers dumped trash bins full of oysters and mussels in front of the offices of the regional ARS health authority in Montpellier over the decision to halt sales from a nearby basin on the Mediterranean coast.   "We're the victims, and we shouldn't have to suffer any financial damages," Le Gal said.
Date: Fri, 17 Jan 2020 04:44:41 +0100 (MET)

Suva, Fiji, Jan 17, 2020 (AFP) - Fiji opened evacuation centres and warned of "destructive force winds" Friday as a cyclone bore down on the Pacific island nation for the second time in three weeks.   Two people were missing after attempting to swim across a swollen river late Thursday when heavy rain fell ahead of the advancing Cyclone Tino, police said.   On the outer islands, locals prepared to go to emergency shelters while many tourists fled beach resorts and made their way to the capital Suva before regional flights and inter-island ferry services were suspended.

The Fiji Meteorological Service said Tino was strengthening as it headed for Fiji's second-largest island, Vanua Levu, warning of wind gusts of up to 130 kilometres per hour (80 mph), heavy rain, coastal flooding and flash flooding in low lying areas.    "I'm preparing to go to an evacuation centre soon with my family and wait for the cyclone to pass," Nischal Prasad, who lost his home in northern Vanua Legu when Cyclone Sarai struck just after Christmas, told AFP.   "Sarai destroyed my house and almost left my family homeless. My daughters had to hide under their bed from the strong winds. It was a scary experience," he said.

Russian tourist Inna Kostromina, 35, said she sought safety in Suva after being told her island resort was in the path of the cyclone.   "We didn't want to get stuck in there and with the authorities warning of coastal flooding, anything can happen. So we decided to move to Suva for now. I think we will be much safer here."    Police said a man and his daughter, believed to be aged nine or 10, were attempting to swim across a flooded river when they were caught in the strong currents.    The incident happened on Thursday before the storm developed into a tropical cyclone, but a police spokesman linked the tragedy to "heavy rain brought about by the current weather system (which) raised the river level".   Although the Pacific islands are popular tourist destinations in summer it is also the cyclone season, and Fiji is being targeted for the second time in three weeks.

In late December, Tropical Cyclone Sarai left two people dead and more than 2,500 needing emergency shelter as it damaged houses, crops and trees and cut electricity supplies.    On its present track, Tino would hit Tongatapu, the main island of neighbouring Tonga, on the weekend.    Two years ago, Tongatapu was hit by Cyclone Gina, with two people killed and nearly 200 houses destroyed.
Date: Thu, 16 Jan 2020 16:38:39 +0100 (MET)
By Hiroshi HIYAMA

Tokyo, Jan 16, 2020 (AFP) - Japan has confirmed a case of a mystery virus that first emerged in China and is from the same family as the deadly SARS pathogen, authorities said Thursday.   It appears to be only the second time the novel coronavirus has been detected outside China, after the World Health Organization (WHO) confirmed a case in Thailand.   Japan's health ministry said a man who had visited the central Chinese city of Wuhan, the apparent epicentre of the outbreak, was hospitalised on January 10, four days after his return to Japan. He reported a persistent fever.

Tests on the patient, who was released from hospital on Wednesday, confirmed he was infected with the new virus.   "This is the first domestic discovery of a pneumonia case related to the new coronavirus," the ministry said in a statement.   "We will continue active epidemiological research while also coordinating efforts with the World Health Organization and related agencies to conduct a risk assessment."   The outbreak has killed one person so far, with 41 patients reported in Wuhan.

The outbreak has caused alarm because the new virus is from the same family as the pathogen that causes SARS (Severe Acute Respiratory Syndrome), which killed 349 people in mainland China and 299 in Hong Kong in 2002 and 2003.   Authorities in Wuhan said a seafood market was the centre of the outbreak. It was closed on January 1.   Japanese authorities said the man had not visited the market and that it was possible he had been in contact with a person infected with the virus while in Wuhan.

- Outbreak in Japan 'unlikely' -
Health ministry official Eiji Hinoshita told reporters that the risk of the disease spreading from the patient was considered low, with careful checks done on those who had been in close contact with him.   "At this point, we feel it is unlikely this will lead to a dramatic outbreak," he said, adding that the patient was no longer suffering a fever and was recuperating at home.

Officials declined to give further information on the man, including his nationality, citing privacy concerns.   Local media said the patient was a Chinese national in his 30s living in Kanagawa, just southwest of Tokyo.   Public broadcaster NHK said he had already recovered and was resting at home, as quarantine officials at Tokyo's Narita airport boosted health checks on all travellers.

The health ministry urged people who develop a cough or fever after visiting Wuhan to wear a surgical mask and "swiftly visit a medical institution".   Hinoshita said Japan would need to be on guard ahead of the Lunar New Year, a popular travel period in China.   "It is expected that Japan will see many visitors from China," he said.   It is not yet clear whether the mystery virus can be transmitted between humans, but on Wednesday authorities said it was possible it had spread inside a family.

The woman diagnosed in Thailand, who is in a stable condition, also said she had not visited the Wuhan seafood market.   And WHO doctor Maria Van Kerkhove on Tuesday said she "wouldn't be surprised if there was some limited human-to-human transmission, especially among families who have close contact with one another".   Hong Kong authorities on Tuesday said several dozen people had been hospitalised with fever or respiratory symptoms after travelling to Wuhan, but no cases of the new virus have so far been confirmed.
Date: 20 Jan 2020
Source: News Joins [In Korean, machine trans. edited]
----------------------------
An unexplained pneumonia in China caused the Korean quarantine authorities to strengthen the quarantine, and a fever-sensing camera is installed to monitor the body temperature of Chinese tourists who entered Korea at Incheon Port 1 International Passenger Terminal. 

Pneumonia confirmed by the new coronavirus, which is prevalent in Wuhan, China, was confirmed for the first time on [20 Jan 2020]. According to health officials, a Chinese woman, A, who arrived at Incheon International Airport on a plane from Wuhan last weekend, was confirmed with pneumonia. The patient showed signs of pneumonia, including high fever and cough. The health authorities entered the airport at the same time, confirmed the symptoms of high fever, suspected pneumonia, and went into quarantine and testing. The Centers for Disease Control immediately quarantined A and entered treatment with a nationally designated quarantine bed. The Centers for Disease Control will hold an emergency press conference at 1:30 pm on [20 Jan 2020] and release the reporter A.
 
Meanwhile, Beijing's Daxing District Health and Welfare Committee said 2 fever patients who had been to Wuhan were confirmed as a new pneumonia patient on [19 Jan 2020]. They are currently being treated at a designated hospital and said they are stable. Daxing District is where Beijing New Airport opened last year [2019]. The Guangdong Provincial Health and Welfare Committee said on [19 Jan 2020] that a 66-year-old man who had visited a relative's home in Wuhan showed fever and lethargy and was diagnosed with Wuhan pneumonia. Confirmation patients have also emerged in Shenzhen, a neighbouring Hong Kong province in southern China, raising concerns that the new pneumonia has already spread throughout China.
 
The Chinese government has said that "there is no basis for human-to-human propagation," but domestic experts pointed out that "the nature of coronavirus is less likely to prevent human-to-human propagation."   [Byline: Esther Toile]
========================
[This is now the 4th international identification of the 2019-nCoV (novel coronavirus) associated illness reported outside of China.  To date, all 4 cases have reported being in Wuhan China in the 14 days preceding onset of illness.  Illness in each involved a history of fever and dry cough.  Cases were reported by Thailand (2 cases) and Japan, and now South Korea.  An update following a Ministry of Health Korea press conference mentioned that there were 5 individuals accompanying this woman, none of whom were currently showing symptoms. (<http://news1.kr/articles/?3821049>).

As mentioned in an earlier post (see Novel coronavirus (10): China (HU, GD, BJ) http://promedmail.org/post/20200119.6898567), there have also been cases confirmed in China outside of Wuhan City, with cases reported in Beijing, Guangdong and possibly Shanghai. It is becoming more difficult to conclude that there has been limited person-to-person transmission as the case numbers are climbing both inside of Wuhan City, elsewhere in China, and in individuals travelling from Wuhan China to other countries (Japan, Thailand and South Korea).

A map of South Korea can be found at:
Date: 15 Jan 2020
Source: Fox News [edited]

CDC is facing criticism over its response to a polio-like illness. The Centers for Disease Control and Prevention has confirmed 10 additional cases of acute flaccid myelitis.  An Ohio teen is determined to walk again despite doctors' warnings that she may not after she contracted a rare polio-like illness that's left her paralyzed from the waist down.  IK, a catcher on her middle school's softball team, said it started with what felt like a cramp in her leg on Christmas. "I just thought, 'Oh gosh, it's just growing pains or a Charley horse,'" NK, the 13-year-old's mother, told News 5 Cleveland.  But the next day, IK couldn't stand on her own, and her worried parents rushed her to Akron Children's Hospital, where she was diagnosed with acute flaccid myelitis (AFM). It's a rare but serious condition that affects the nervous system, specifically the grey matter of the spinal cord, which weakens the body's muscles and reflexes.

Health officials have noticed an increase of cases in children occurring every 2 years since 2014, according to the Centers for Disease Control and Prevention (CDC). And while it often is referred to as a "polio-like" illness, tests so far have tested negative for poliovirus.  Symptoms typically begin with sudden onset of arm or leg weakness and loss of muscle tone and reflexes, but can also include facial droop or weakness, difficulty moving eyes, drooping eyelids, difficulty swallowing,  slurred speech, and pain in the arms and legs.  Severe symptoms may include respiratory failure, or serious neurological complications, according to the CDC. Parents are encouraged to seek medical care right away if a child is suspected of developing any symptoms

Since her diagnosis, IK has been working in physical therapy and has received steroid treatments as well as multiple plasma exchange, according to the news outlet. Her mother said it's been like "a bad dream" for the family as they watch her struggle to gain strength.  "It's a lot, but I just try to go with the flow, just to push through," IK, who has received support from her teammates, classmates and members of the community, told News 5 Cleveland.  [Byline: Alexandria Hein]
======================
[Acute flaccid myelitis (AFM) is a rare but serious condition. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak.

In 2019, there were 33 total confirmed cases in 16 US states
[<https://www.cdc.gov/acute-flaccid-myelitis/cases-in-us.html>].

The case definition for AFM is based on clinical and lab criteria

Clinical Criteria: An illness with onset of acute flaccid limb weakness.
Laboratory Criteria:
Confirmatory Laboratory Evidence: a magnetic resonance image (MRI) showing spinal cord lesion largely restricted to grey matter and spanning one or more vertebral segments. Supportive Laboratory Evidence: cerebrospinal fluid (CSF) with pleocytosis (white blood cell count over 5 cells/mm3) Case Classification:
- Confirmed: Clinically compatible case AND Confirmatory laboratory evidence: MRI showing spinal cord lesion largely restricted to grey matter and spanning one or more spinal segments.
- Probable: Clinically compatible case AND Supportive laboratory evidence: CSF showing pleocytosis (white blood cell count over 5 cells/mm3)

With the high number of cases reported in 2018 and 2019, CDC enhanced AFM surveillance through collection of data at the national level by encouraging healthcare providers to recognize and report to their health departments all patients whom they suspect may have AFM; health departments are being asked to send this information to CDC to help us understand AFM activity nationwide. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Date: Sat 18 Jan 2020
From: Guido Calleri <guidocalleri@aslcittaditorino.it> [edited]

90 persons presented to the Infectious Diseases Hospital Amedeo di Savoia, Torino, North-West Italy between 24 Dec 2019 and 10 Jan 2020 after consuming raw sausages from a wild boar hunted in the area of Susa Valley, 50 km [31.1 mi] away from Torino, in late November 2019.

All of them either were symptomatic (fever, muscle and/or abdominal pain, nausea) or had peripheral blood eosinophilia over 500/cmm, or both. IgG serology for trichinella was performed by immunoblot (Trichinella E/S IgG kit, EFFEGIEMME, Milan, Italy) and resulted positive in 48/90 (53.3%), allowing a diagnosis of confirmed trichinella infection.

Otherwise, a diagnosis of suspected trichinella infection was made with a negative serology, probably due to performing the test too early, before the development of antibodies or possibly a false negative result. In a few cases (under 10 cases) an alternative diagnosis was considered.

All patients were treated with oral albendazole 400 mg twice daily for 10 days and prednisone 50 mg/day.

Most likely, all patients were infected after eating meat from a single animal, given the low prevalence of the infection in this area: no human case has ever been detected in Torino province, and only one wild boar has been found positive for trichinella at microscopy in Susa valley in the last 10 years.
---------------------------------------
Guido Calleri, Filippo Lipani, Giovanna Paltrinieri, Silvia Faraoni,
Valeria Ghisetti
ASL Citta di Torino, Infectious Diseases Unit and Microbiology Lab,
and ASL TO3,
Department of Prevention
Torino, Piedmonte, Italy
======================
[ProMED thanks Guido Calleri, Filippo Lipani, Giovanna Paltrinieri, Silvia Faraoni, and Valeria Ghisetti for sending us this information. The report underlines that _Trichinella_ are found in wild boars in Europe and should be assessed by a certified laboratory for _Trichinella_ before used for human consumption. Sausages made of smoked meat are especially dangerous, because the temperatures seldom reach what is needed to kill the trichinella larvae. - ProMED Mod.EP]

[HealthMap/ProMED map available at: