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Greece

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

Travel News Headlines WORLD NEWS

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

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

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

Successive governments have attempted to reform the pension system, whose previously generous handouts are seen as one of the causes of the decade-long Greek debt crisis.   Chronic overspending and the inaccurate reporting of the budget deficit spooked creditors in 2010, and required three successive bailouts by the European Union and the International Monetary Fund to avert a Greek bankruptcy.   In return for billions of euros in rescue funds, Greece had to adopt unpopular austerity reforms and pension cuts.
6th December, 2019
HSE Health Protection Surveillance Centre

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

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

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

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

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

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

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

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

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

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

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

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

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

[HealthMap/ProMED maps available at:
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Saint Vincent and the Grenadines

St. Vincent and the Grenadines US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
St. Vincent and the Grenadines is an English-speaking developing Caribbean island nation. Tourism facilities are widely available. Read the De
artment of State Background Notes on St. Vincent and the Grenadines for additional information.

ENTRY/EXIT REQUIREMENTS:
For information concerning entry requirements, travelers can contact the Embassy of St. Vincent and the Grenadines, 3216 New Mexico Avenue, N.W., Washington, D.C. 20016, telephone (202) 364-6730, or the consulate in New York.

All Americans traveling by air outside the United States are required to present a passport or other valid travel document to enter or re-enter the United States.
This requirement will be extended to sea travel (except closed loop cruises), including ferry service, by the summer of 2009.
Until then, U.S. citizens traveling by sea must have government-issued photo identification and a document showing their U.S. citizenship (for example, a birth certificate or certificate of nationalization), or other WHTI compliant document such as a passport card for entry or re-entry to the U.S.
Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.

Applications for the new U.S. Passport Card are now being accepted.
It is expected that the cards will be available and mailed to applicants in spring 2008.
The card may not be used to travel by air and is available only to U.S. citizens. Further information on the Passport Card is available at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html.
We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

U.S. citizens should take special care to secure these documents while traveling, as it can be time-consuming and difficult to acquire new proof of citizenship to facilitate return travel should the original documents be lost or stolen.

U.S. citizens traveling to St. Vincent and the Grenadines must also present an onward or return ticket.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.

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

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

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

CRIME:
Petty street crime occurs in St. Vincent and the Grenadines. From time to time, property has been stolen from yachts anchored in the Grenadines. Valuables left unattended on beaches are vulnerable to theft. Persons interested in nature walks or hikes in the northern areas of St. Vincent should arrange in advance with a local tour operator for a guide; these areas are isolated, and police presence is limited.

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 in finding appropriate medical care, contacting family members or friends, and can explain how funds can be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are limited.
The main hospital is Milton Cato Memorial Hospital (Telephone (784) 456-1185). There is a hospital in the capital, Kingstown, but serious medical problems may require evacuation to another island or the United States. There is no hyperbaric chamber; divers requiring treatment for decompression illness must be evacuated from the island. The closest hyperbaric chamber is located in Barbados. Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars. Doctors and the hospital often expect immediate cash payment for health services.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

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

Vehicles travel on the left side of the road. Roads are narrow, and generally poorly paved, with steep inclines throughout the islands. Taxis and buses are relatively safe, but buses are often overcrowded. Vans are generally overcrowded and frequently travel at high rates of speed. Night driving is discouraged in mountainous areas because the roads are not well marked; there are few, if any, guardrails, and roads are steep and winding.

Please refer to our Road Safety page for more information.
For specific information concerning St. Vincent and the Grenadines driving permits, vehicle inspection, road tax and mandatory insurance, please contact the St. Vincent and the Grenadines National Tourist Organization in New York at http://www.svgtourism.com/.

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

SPECIAL CIRCUMSTANCES:
All Caribbean countries can be affected by hurricanes. The hurricane season normally runs from June to the end of November, but there have been hurricanes in December in recent years. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA). Information on hurricane preparedness abroad is provided in Hurricane Season: Know Before You Go.
There is no U.S. Embassy or Consulate in St. Vincent and the Grenadines. The U.S. Embassy in Bridgetown, Barbados is responsible for consular issues on the islands of St. Vincent and the Grenadines, including American Citizens Services. U.S. citizens are encouraged to carry a copy of their citizenship documents with them at all times so that if questioned by local officials, proof of identity and U.S. citizenship are readily available.
Please see the State Department’s Customs Information.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in St. Vincent and the Grenadines are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration web site, and to obtain updated information on travel and security within St. Vincent and the Grenadines. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy in Bridgetown is located in the Wildey Business Park in suburban Wildey, south and east of downtown Bridgetown.
The main number is (246) 431-0225; after hours, the Embassy duty officer can be reached by calling (246) 436-4950.
The web site for Embassy Bridgetown is http://barbados.usembassy.gov/. Hours of operation are 8:30 a.m. to 4 p.m. Monday-Friday, except Barbados and U.S. holidays.
*

*

*
This replaces the Country Specific Information for St. Vincent and the Grenadines dated April 2, 2007, to update sections on Entry/Exit Requirements, Safety and Security, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Tue, 8 Mar 2016 21:55:36 +0100

Kingstown, Saint Vincent and the Grenadines, March 8, 2016 (AFP) - Police on the Caribbean island of St Vincent say they are investigating the murder of a German tourist killed when masked gunmen attacked his yacht last week.   No arrests have been made over the assault, which took place in Wallilabou Bay on the resort island's northwest coast, a popular tourist destination where scenes from the hit Hollywood movie franchise "Pirates of the Caribbean" were filmed.   Martin Griff, 49, died from gunshot wounds to his neck, police say.    The two attackers also wounded the boat's captain, Reinhold Zeller, a 63-year old German who was shot in the arm. He was treated in the hospital in the capital Kingstown.   The assailants stole money and credit cards.

Griff was on vacation with his wife and two children, German media reported.   Writing in a letter to St Vincent Prime Minister Ralph Gonsalves on Tuesday, the German Ambassador to Trinidad and Tobago, Lutz Gorgens -- whose jurisdiction extends to St Vincent and other Caribbean islands -- described the incident as "tragic and gruesome," saying it was "difficult to bear for Germans as well as Vincentians."   Gorgens said he hoped the police "bring to justice those responsible for this cruel crime."   Gonsalves on Friday described the killing as a "terrible stain" on the Caribbean island -- part of the nation St Vincent and the Grenadines, located north of Venezuela -- that could cost it "millions of dollars because we sell peace, security, tranquillity."
Date: Wed 7 May 2014
Source: I-Witness News [edited]

On mainland St Vincent, 2 cases of the mosquito-borne chikungunya virus [infection] have been confirmed, as the total number of confirmed cases in the country has climbed to 39.

The Ministry of Health, Wellness and the Environment said on Wed 7 May 2014 that there are 37 confirmed cases of the virus on the northern Grenadine island of Bequia, where an outbreak began in late April [2014].

The illness was first detected in the Caribbean in December 2013, in St Martin, and Antigua and St Vincent and the Grenadines have become the latest countries to declare an outbreak.

Luis de Shong, permanent secretary in the Ministry of Health, Wellness and the Environment said on Wednesday that his ministry continues to implement vector control activities against the _Aedes aegypti_ mosquito, which causes [transmits] the chikungunya virus.

He said private sector and other key stakeholders such as the National Emergency management Organisation, the Roads, Bridges and General Services Authority, the Ministry of Tourism and the Central Waster and Sewerage Authority are all engaged in the multi-sectorial approach towards fighting this disease.

"The Ministry of Health, Wellness and the Environment will continue active surveillance and island-wide intense vector control campaign. Additionally, several public outreach programmes have been held and more are scheduled throughout St Vincent and the Grenadines to sensitise Vincentians about the virus and the Ministry urges the participation of all individuals in fighting the _Aedes aegypti_ mosquito and the chikungunya virus," de Shong said.

The ministry said it was reiterating the importance of avoiding mosquito bites by implementing vector control measures at the individual and community levels, such as keeping water drums and tanks covered, getting rid of unused tires, keeping the general surroundings clean, the use of appropriate clothing to avoid mosquito bites, and the use of insect repellents.
----------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
====================
[Maps of St Vincent and the Grenadines can be accessed at
and <http://healthmap.org/promed/p/36>. - ProMed Mod.TY]
Date: Fri 1 Nov 2008
Source: The Daily Herald [edited]

As authorities scramble to stem the dengue outbreak in St Maarten, the number of confirmed cases continues to climb.  The Dengue Action Response Team (DART) announced on Thursday [23 Oct 2008] that 90 laboratory-confirmed cases of dengue had been recorded 1-25 Oct [2008]. The results of 48 lab tests are pending, and DART said the figure was expected to surpass 100 this month [November 2008].

Meanwhile, St Maarten Laboratory Services (SLS) has introduced a new laboratory system for dengue testing. The new system will enable Dutch-side health officials to obtain immediate results of laboratory tests carried out by SLS rather than having to send hem to Curasao or the lab on the French side, as was being done in the past.Sector Health Care Affairs (SHCA) Preventive Health Department head Dr Rachel Eersel met with family physicians on Tuesday evening [21 Oct 2008] to inform them about the latest strategies being implemented to fight dengue fever and to inform them about the new laboratory form. "The DART team is requesting every household to take immediate measures as the outbreak continues to (worsen). The only way to stop the dengue outbreak from growing is by every household taking mosquito-breeding preventive action. By taking measures, you are protecting your family from getting dengue fever," the Government Information Service said.

In the meantime, the Hygiene and Veterinary Department is continuing with its fogging campaign in the various districts, weather conditions permitting. The house-to-house/yard inspections are part of the public health response to dengue on the island and are part of an intensified community campaign to eradicate the mosquito that transmits dengue fever.
-------------------
[This report is from the Dutch side of St. Maarten/St. Martin Island. The Daily Herald <http://www.thedailyherald.com/news/daily/l142/dengue142.html> reported that authorities are continuing their efforts to stem the spread of dengue fever in St Maarten with intensified house-to-house inspection around the Island Territory. Inspections will focus on potential breeding grounds for mosquitoes, and inspectors are hoping to inspect some 15 000 households by the end of the campaign.

A number of civil servants who have been reassigned to carry out the inspections will start the inspections, and the final logistics are currently being put into place, the Government Information Service (GIS) said in a press release on Wednesday [22 Oct 2008].  Maps showing the location of St Maarten/St Martin in the Caribbean can be accessed at <http://www.worldatlas.com/webimage/countrys/namerica/caribb/stmartin.htm>, and the HealthMap/ProMED-mail interactive map can be found at <http://healthmap.org/promed?g=3578421&amp;v=18.067,-63.067,10>. - ProMed Mod.TY]
Date: Sat 4 Oct 2008 Source: The Daily Herald [edited] Health experts have concluded that collated information produced by local authorities and Institute Veille de Sanitaire (INVS) confirms St Martin is at the beginning of a fresh outbreak of dengue, that effectively began 10 days ago [23 Sep 2008] and urges preventative treatments be "rigorously" implemented. In a release issued by the Prefecture Thursday [2 Oct 2008], La Cellule Inter-Regionale d'Epidemiologie (CIRE) of Antilles-Guyana met with the Committee of Experts for Infectious Diseases in the Northern Islands on Wednesday [1 Oct 2008] to analyse the current situation. The release contained no statistics or figures, but went on to say "given the favourable climatic conditions for development of mosquitoes, preventative measures already known by the population must be implemented without delay and in a rigorous manner. It is at this early stage that preventative measures can be most effective." In accordance with this information, an intensive fogging campaign begins as of today [4 Oct 2008], Friday. It is advised to leave house doors and windows open when the truck passes for the chemical to be most effective. The dengue management committee is due to meet again on 16 Oct [2008] to assess the local situation. The Prefecture of St. Martin and St. Barths once again reminds the population of the action to be taken to prevent the spread of dengue [virus] which is transmitted by the _Aedes aegypti_ mosquito. Anti-mosquito sprays and creams should be used liberally. Wear long sleeved shirts and long pants in the evenings. Make sure mosquito screens are installed on windows and doors. Young children, babies, and elderly persons should sleep under mosquito netting. Throw out any stagnant water collecting in flower vases, or other receptacles, around the house or in the yard and make sure rain gutters are unblocked after heavy rainfall. Stagnant pools of water are prime breeding grounds for mosquitoes. Cisterns must be covered with mosquito netting. It is also encouraged to breed Guppy fish, which feed on mosquito larvae. Check the septic tank is functioning properly. Currently there is no specific treatment or vaccine for dengue. ================= [Maps showing the location of the French overseas collectivity of Saint Martin in the Caribbean can be accessed at and the Health Map/ProMED interactive map at . - ProMed Mod.TY]
Date: Tue, 7 Sep 2004 18:10:31 +0200 (METDST) PORT-OF-SPAIN, Trinidad Sept 7 (AFP) - Hurricane Ivan Tuesday threatened several Caribbean islands, where residents were urged to rush preparations to safeguard their lives and properties. On Tuesday morning the center of the powerful hurricane, the second in just days, was located 75 kilometers (45 miles) northeast of Trinidad's sister island of Tobago. The two islands, as well as St Vincent, the Grenadines and Grenada were placed under a hurricane warning. The Netherlands Antilles Tuesday morning also put the islands of Aruba, Bonaire and Curacao under a hurricane watch, which means the storm could hit them within 36 hours. "Preparations to protect life and property should be rushed to completion," the Miami-based National Hurricane Center said. It warned that with sustained winds of 185 kilometers (110 miles) per hour and higher gusts, Ivan was "a dangerous" hurricane and that it could strengthen further. On Tuesday morning, Bardados already reported wind gusts of 145 kilometers (90 miles) per hour and pounding rain flooded the streets of Port-of-Spain and roads on Tobago. Long-term forecasts, which have a wide margin of error, have the hurricane slamming into Jamaica on Friday and then into Cuba on Sunday. This would bring the storm dangerously close to Florida, which has just been pounded by Frances, the second hurricane to hit the southeastern US state in three weeks.
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Kenya

General Information:
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Kenya is situated on the east coast of Tropical Africa and is one of the most popular tourist resorts in the continent. The country is bounded by Ethiopia and Somalia in the north, Ugan
a on the west, Tanzania to the south and the Indian ocean to the east. The country has been regarded as one of the more stable in Africa but nevertheless recent events, as they head towards a multiparty democracy, have led to a spiralling devaluation in their currency and general unease and disturbances.
Climate:
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Nairobi is situated at approx. 6000' and has a mild climate throughout the year. Malaria prophylaxis is not usually recommended for those visiting Nairobi city alone. The main rains tend to fall in April and May or October and November. The annual rainfall tends to be about 39 inches but significant variations can occur. Mombasa, on the coast, has a much more tropical climate and travellers will need to take more care with regard to personal hygiene and also serious protection against mosquito bites.
Health Care Facilities:
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In general, travellers to Nairobi find that the level of health care facilities are good. All doctors in Kenya speak English and the level of care they provide is usually excellent for the holiday maker. As in many other countries in central Africa, the screening of blood against various viral agents cannot be assured and so travellers should avoid all but essential of blood transfusions. Sterile needles and syringes are in good supply in the major towns and so a syringe kit is not usually necessary. All of the larger hotels will have their own English speaking medical officer, though travellers are usually asked to pay cash. There are many hotels and restaurants providing excellent menu facilities and food borne disease can usually be traced to eating salads or undercooked bivalve shellfish.
Swimming in Kenya:
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In all the major tourist resorts throughout Kenya there are swimming pools and these are usually the best places to indulge. On the coast the sand is exceptionally fine and it feels as if you are walking on flour. Just be careful of local strong currents and don't swim out to the coral. Watch out for the sea urchins. Their spines are very uncomfortable and may need to be extracted by medical staff. Keep your children in view at all times and warn them to take care. If you are trekking around Kenya or on Safari don't go swimming in any fresh water rivers or lakes. There is a disease called Schistosomiasis (Bilharzia) which will penetrate through your skin and may cause serious problems in the future.
Rabies in Kenya:
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This viral disease occurs throughout Kenya and is a significant risk for travellers who are going away from the major tourist areas. Keep clear of all warm blooded animals and if you are bitten (even licked or scratched) wash out the area immediately, apply an antiseptic and get medical attention. Even though the risk of Rabies for the traveller is very small don't ever disregard a contact of this type. The beach hotels near Mombasa are favourite haunts for monkeys. Don’t feed them and stay clear. Report any bite (lick or scratch) immediately. Watch your children at all times.
Trekking through Kenya:
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Some travellers to Kenya will have no particular itinerary planned and so start their holiday from either Nairobi of Mombasa. Those planning to go off the beaten track should register with the Irish Counsel. Great care should always be exercised as each year too many tourists have significant problems while trekking off the usual routes. The major risks revolve around food and water borne disease, the risk of rabies, altitude sickness on Mount Kenya, being robbed or simply getting lost!

Tips for Trekkers
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Always plan your trip well in advance
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Make sure that you know about personal health and general food & water hygiene.
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Check in frequently
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Never travel alone
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Make sure you have plenty of clean water
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Stick to your itinerary
*
If you are in trouble, admit it!
The Risk of Malaria:
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In Kenya, malaria poses a very real risk outside Nairobi. One of the highest risk areas is Mombasa which is where many travellers will find themselves at some time. Malaria is transmitted by the bite of an infected mosquito and so the first line of defence is to protect yourself against mosquito bites. (see leaflet on Protection against Insect Bites - Tropical Medical Bureau). Also it is essential to take your prescribed malaria tablets on a regular basis. Only stop your tablets under exceptional circumstances. Nevertheless, the traveller must remember that there is no perfect protection against malaria and the disease can still occur even after all the precautions have been taken. So be aware that any peculiar symptoms (especially 'flu) for at least a year after your trip will need to be checked out.
After your Journey:
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Just remember that some tropical diseases may not become evident for weeks or even months after your trip. If you are ill within a year of your journey always seek medical help.
Further Information:
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General travel health information may be obtained from the Tropical Medical Bureau at any of our centres. Please remember, every traveller will require a specialised consultation and this leaflet only contains general guideline information.

Travel News Headlines WORLD NEWS

Date: Mon 3 Feb 2020
Source: The Star [edited]

Six more people on Monday morning [3 Feb 2020] were treated and discharged following a suspected anthrax outbreak in Emityot village in Sotik, Bomet. Health executive member Joseph Sitonik said all the individuals exhibited cutaneous signs where watery wounds appeared on parts of their bodies. Sitonik said they were out of danger.

Those referred on Sunday [2 Feb 2020], he added, were also attended to and discharged. No patient is admitted to any health facility as a result of anthrax, Sitonik said. "We treated and released them after they tested positive for the disease, but we would also like to state that there are no patients admitted to hospitals since their conditions are not severe," Sitonik told journalists in his office.

The number of those who came in contact with the carcasses of the animals was 29: 4 [children] under 5 years old, 17 male adults, and 8 women. Sitonik said the number of animals that died were 7.

While calling on residents from the area to visit the nearest health facilities for a check-up, the CEC said the disease had adverse effects on humans, saying it can cause severe pneumonia.  [byline: Felix Kipkemoi]
====================
[The previous report had 18 villagers affected and treated. With these additional 6 over the weekend, the total is now 24 people with cutaneous lesions. Whether these 24 were all included in the 29 carcass handlers is unclear, though not impossible. How the 4 children under 5 years of age came to be exposed is not described, but it could well have been through playing and coming in contact with a butchered carcass. There would have been ample spilt blood. And we now have 7 dead cattle in this village. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map of Bomet, Rift Valley, Kenya:
Date: Thu 30 Jan 2020
Source: Daily Nation [edited]

A shortage of yellow fever vaccine at City Hall since October [2019] has disrupted plans of many Kenyans seeking to travel abroad.

A spot check by the Business Daily since [Mon 27 Jan 2020] showed that dozens of Kenyans were being turned away and forced to pay more to get the jab at airports.

A nurse at the Nairobi County's inoculation centre, who sought anonymity, said the last time City Hall had supplies for the vaccine was in late October [2019], adding that they had not received any fresh stocks despite making requisitions to health authorities.

City Hall charges Sh 3000 [USD 29.85], up from the previous Sh 2500 [USD 24.88], for the vaccine that is mandatory for all people seeking to travel to countries that are considered to be vulnerable to yellow fever. The same dose goes for USD 50 or about Sh 5043 at the airports.

Kenya is one of the eastern, central, western and southern African countries the World Health Organisation considers to be prone to the disease, making the yellow fever vaccine a must-have for any traveller to or from these nations.  [Byline: Kevin Rotich and John Mutua]
========================
[It is not clear why the yellow fever (YF) vaccine shortage exists. The shortage and higher than previous prices run the risk of driving vaccination efforts underground, administration of fake vaccine, sale of fake vaccination certificates or issuance of the certificates without vaccination. These practices have been a problem in the past.

Not only would these illegal practices pose a risk to the individuals who might be exposed to YF virus and be unprotected, there is a risk to the general public should a viraemic individual introduce the virus into an area where the vector mosquitoes are abundant enough to permit ongoing transmission of the virus. This also damages public confidence in health officials in general. Fortunately, the governor has been aware of these practices, has taken steps to inform the public, and instructing the police to investigate and prosecute the offenders. Close monitoring of the current vaccine situation by Kenya health authorities would be prudent. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Mon 16 Dec 2019
Source: Outbreak News Today [abridged, edited]

Health officials continue to report cases of the parasitic disease, leishmaniasis, in Kenya. During the week ending [8 Dec 2019], officials saw 34 additional cases.

This brings the leishmaniasis outbreak tally this year [2019] to 2822, including 34 deaths.

Most cases of leishmaniasis have been reported from Mandera, Marsabit, Wajir, and Garissa counties.

Leishmaniasis is not a single disease, but a group of syndrome due to a variety of species of this parasite. They affect different populations and are related to a characteristic vector, the sandfly.

The disease can range from asymptomatic infections to those causing significant illness and death. Disease can appear on a spectrum from a single skin ulcer to destructive lesions of the face to terminal organ disease.

The vector for this parasite is a phlebotomine sandfly. There are a few different species implicated depending on the part of the world. Sandflies are very small (about 1/3 the size of a mosquito) and make no noise when flying. Their bites can sometimes be painless; because of these reasons, many people have no idea they were bitten. Even one bite of a sandfly can transmit disease, so travellers on short trips can still get infected.

There are several species of _Leishmania_ that cause disease in humans. The most common are _L. donovani_ (kala-azar), _L. tropica_ (Baghdad boil), and _L. braziliensis_ (espundia, [affects mucous membranes]). After getting bitten by a sandfly, the disease may manifest itself from a week to many months later.

It starts out as a papule that enlarges to an ulcer. The ulcer can give the appearance of a volcano crater. Lesions may appear singly or multiple; many heal spontaneously within weeks to months to years.

Certain species (_L. braziliensis_) can disseminate to the mucosal areas of the face and mouth and cause very destructive and disfiguring disease (espundia [affects the mucous membranes]) that appears similar to leprosy.

Kala-azar, an Indian name given to systemic type of the disease due to the greyish appearance of the body, can result in enlarged spleen and liver, diarrhoea, emaciation, weakness, and death.
=======================
[Leishmaniasis, both cutaneous and visceral, are endemic in Kenya. Please see our review of the situation in Kenya in archive no.

[An image of the phlebotomine sandfly vector can be seen at

[Maps of Kenya: <https://goo.gl/pcUuf4> and
Date: Sat, 23 Nov 2019 16:26:01 +0100 (MET)

Nairobi, Nov 23, 2019 (AFP) - Heavy rains lashing East Africa have caused of dozens of deaths, with 29 buried by landslides in Kenya, and 10 people drowned in a river in Tanzania, officials said Saturday.   The landslides and floods come amid weeks of destructive rains and flooding across the wider East African region.   At least 29 people were killed in Kenya when their homes were swept away in landslides during ferocious overnight rainstorms.   Their homes were hit in the early hours of Saturday amid torrential rains in the Pokot region, 350 kilometres (220 miles) northwest of the capital Nairobi.   "We are saddened to confirm that 12 people from Tapach and Parua in Pokot South, and 17 from Tamkal in Pokot Central lost their lives," Kenya's Interior Minister Fred Matiang'i said in a statement.   "Our profound sympathies go to the families and friends of those who have been affected."

Army and police helicopters have been sent, Matiang'i said, with efforts delayed because roads had been cut and bridges closed after streams turned into raging torrents.   Two children were pulled out alive from the smashed wreckage of their mud-covered homes, and rescue efforts to dig bodies out of the dirt continued.   "Massive landslides reported in various areas of West Pokot County following heavy downpour," Kenya Red Cross said in a message, adding its emergency response teams had deployed to help.

- Extreme weather -
In Tanzania, at least 10 people drowned when they were swept away by a torrential river in the far west, in the Sengerema district of Mwanza.   "We think there is a possibility to find more bodies," said Tanzanian Red Cross official Revocatus Kayanda, part of the team who recovered the victims.   Violent downpours have also displaced tens of thousands in Somalia, submerged whole towns in South Sudan and killed dozens in flash floods and landslides in Ethiopia.    Close to a million people in South Sudan alone are affected with growing fears of disease and starvation.

Floods hit East Africa regularly, but scientists say that it has been exacerbated by a powerful climate phenomenon in the Indian Ocean stronger than any seen in years.   The extreme weather is blamed on the Indian Ocean Dipole -- a climate system defined by the difference in sea surface temperature between western and eastern areas of the ocean.   The ocean off East Africa is currently far warmer than usual, resulting in higher evaporation and consequent rain over the continent.
Date: Thu 31 Oct 2019
Source: Hivisasa [edited]

Nakuru County health executive Dr Gichuki Kariuki has urged Solai residents to visit health facilities in the area for malaria checkup. Addressing the media following reports that 3 people had succumbed to malaria, Dr Gichuki said regular check-up is the only solution. He termed the deaths unfortunate, adding that had the patients visited health facilities on noting the 1st symptoms, they could have been saved. "We urge residents of Solai and Nakuru as a whole to ensure they go for check-ups in our health facilities whenever they spot symptoms" he said.

He acknowledged that the health docket in Nakuru is facing challenges when it comes to malaria, as the national government has not been providing mosquito nets since malaria prevalence is low. According Dr Gichuki, a sensitization campaign on malaria has commenced in Solai to educate residents on the symptoms of the disease. "The other challenge we have is that since our prevalence is low the national government does not distribute mosquito nets in Nakuru. But so far, we have put in place measures," he said.

Earlier this week[week of 28 Oct 2019], panic gripped residents of Arus village in Solai, following the death of 3 people in a week due to malaria.

The symptoms of malaria include; diarrhoea, high fever, chills, headaches, nausea and vomiting, abdominal pain, and profuse sweating. According to the World Health Organization, the early symptoms; fever, headache, and chills may be mild and difficult to recognize as malaria.  [byline: Pristone Mambili]
===================
[Nakuru country is located approximately 1850 m (about 6070 ft) above sea level and is considered a low risk area (see figure 2 in The epidemiology and control profile of malaria in Kenya at <https://pdfs.semanticscholar.org/de6c/664f1723fcf3ed31400b2cb06710a889bedd.pdf>. Ministry of Health, Nairobi, 2016) [Solai is 1952 m (6404 ft) above sea level (https://en.wikipedia.org/wiki/Solai), even higher than the altitude of Nakuru County. - ProMED Sr.Tech.Ed.MJ]. It is unusual to have an outbreak at this altitude but a warmer climate moving the altitude limit of malaria transmission upwards is a possible explanation. - {ProMED Mod.EP]

[Maps of Kenya:
More ...

World Travel News Headlines

Date: Wed, 19 Feb 2020 11:20:59 +0100 (MET)

Dhaka, Feb 19, 2020 (AFP) - Bangladesh on Wednesday kicked off a drive to vaccinate more than a million people against cholera, which infects tens of thousands a year, as part of an international campaign to eliminate transmission by 2030.   The delta nation has sought to reduce the impact of the disease -- which causes acute diarrhoea and spreads through contaminated food and water -- through vaccines and by setting up a dedicated treatment hospital.   "We have brought down the mortality rate in cholera to almost zero in Bangladesh," said senior scientist Firdausi Qadri at the Dhaka-based International Centre for Diarrhoeal Disease Research.   But she admitted that the number of infections was still very high.   According to the World Health Organisation, cholera infects about 1.3 to five million people every year, and kills an estimated 21,000 to 143,000.

Bangladesh has an estimated 100,000 cases a year, according to authorities, but plans to immunise half its 168 million people in the next decade.   Daisy Akter, who lost two sisters and a brother to cholera in the 1970s, was one of the first recipients of the oral vaccine at a Dhaka neighbourhood on Wednesday.   "No villager came to offer funeral prayers for them fearing they might get the disease," she told AFP.   "We had to bury them in the front yard of our home."   UN agencies and Bangladesh authorities have already carried out a massive cholera vaccination drive in the country's southeast, where nearly one million Rohingya refugees have lived in overcrowded camps since 2017.   Some 800,000 Rohingya and 600,000 locals were vaccinated in that campaign.
Date: Tue, 18 Feb 2020 17:16:35 +0100 (MET)

Juba, Feb 18, 2020 (AFP) - Swarms of locusts which are wreaking havoc across East Africa have now arrived in South Sudan, the government said Tuesday, threatening more misery in one of the world's most vulnerable nations.   Billions of desert locusts, some in swarms the size of Moscow, have already chomped their way through Ethiopia, Somalia, Kenya, Djibouti, Eritrea, Tanzania, Sudan and Uganda.   Their breeding has been spurred by one of the wettest rainy seasons in the region in four decades.

Experts have warned the main March-to-May cropping season is at risk. Eggs laid along the locusts' path are due to hatch and create a second wave of the insects in key agricultural areas.    The arrival of the locusts could be catastrophic in South Sudan, where war  followed by drought and floods has already left six million people -- 60 percent of the population -- facing severe hunger.   Agriculture Minister Onyoti Adigo Nyikiwec said the locusts had crossed the eastern border with Uganda on Monday.   "The report came that these are matured. As you know locusts are like human beings, they send their reconnaissance ahead of time to make sure that whether there is food or not and if the area is good for breeding."

Meshack Malo, the Food and Agriculture Organization (FAO) representative in South Sudan, said about 2,000 locusts had been spotted so far, and if not controlled quickly, could have a devastating impact.   "These are deep yellow which means that they will be here mostly looking at areas in which they will lay eggs."    He said the FAO was training locals and acquiring sprayers and chemicals to try and combat the locusts. It is the first locust invasion in 70 years in the country.   Other countries have employed aircraft to spray the swarms, while desperate locals have employed tactics like banging pots and pans or shooting at them.    Nyikiwec said the government had prepared a contingency plan.   "We are training people who will be involved in spraying and also we need chemicals for spraying and also sprayers. You will also need cars to move while spraying and then later if it becomes worse, we will need aircraft."

Earlier this month Somalia declared a national emergency over the invasion.   The FAO says the current invasion is known as an "upsurge," the term for when an entire region is affected.   However, if the invasion cannot be rolled back and spreads, it becomes known as a "plague" of locusts.   There have been six major desert locust plagues in the 1900s, the last of which was in 1987-89. The last major upsurge was in 2003-05.
Date: Tue, 18 Feb 2020 15:26:41 +0100 (MET)
By Ismail BELLAOUALI

AIT-BEN-HADDOU, Morocco, Feb 18, 2020 (AFP) - Millions worldwide may have seen the desert fortress in the hit fantasy series "Game of Thrones", but fewer know they can visit the Moroccan village of Ait-Ben-Haddou.   The fortified old settlement at the foot of the majestic Atlas mountains enchanted audiences in the HBO series and also served as a dusty backdrop in Ridley Scott's epic swords-and-sandals film "Gladiator".

But unlike other famous locations from movie and television history, this UNESCO World Heritage Site has so far missed out on a mass influx of tourism -- something some of its inhabitants are eager to change.    "Several people have told me that they came here to see the filming location of 'Game of Thrones'," said Ahmed Baabouz, a local tour guide. "There is tourism linked to cinema here but frankly we have not developed it to the extent it could be."   Ait-Ben-Haddou is southern Morocco's most famous fortress. Time seems to have stopped at the site overlooking a valley some 30 kilometres (18.6 miles) from the town of Ouarzazate.

After passing through the imposing entrance way, visitors navigate a labyrinth of winding alleys that eventually lead onto a public square where the settlement's inhabitants once gathered.    There is a mosque and two cemeteries -- one for Muslims and one for Jews. Most inhabitants have long since departed though, with a few homes converted into stalls selling handicrafts.    The fortress is an ideal film setting, located a short distance from the studios of Ouarzazate, the "Mecca" of Moroccan cinema. Productions ranging from "Lawrence of Arabia" to "The Mummy" have been filmed here.

More recently, scenes from the cult series "Game of Thrones" were shot at Ait-Ben-Haddou, with the site standing in for the fictional Yellow City of Yunkai which is conquered by Daenerys Targaryen, a key character in the "GOT" universe.   Hammadi, 61, is a privileged witness to the location's cinematic history.   "All of these productions have contributed to the reputation of the region," he said, grinning widely.    Hammadi himself has appeared as an extra in a number of films. And while like most people he lives in a more modern home in a village on the other side of the valley, he continues to return to Ait-Ben-Haddou to welcome tourists.

-'House of the Dragon' -
On a wall at the entrance to Hammadi's former home, photos bear witness to the projects he has worked on.    One shows him dressed as an ancient Roman with director Ridley Scott on the set of "Gladiator".    "We have a very rich cinematic heritage that we hope to use to attract tourists," said tour guide Baabouz, who is 29.   But "nothing indicates that 'Game of Thrones' was shot here," he added.    On Morocco's Atlantic coast, the city of Essaouira also formed the backdrop to scenes from the series.    But there too, Moroccan tourism promoters are yet to capitalise on the connection.

In comparison, Northern Ireland, Malta and Dubrovnik in Croatia have attracted hordes of fans from around the world, drawn by their links to the franchise.    To remedy this, Baabouz and other young people in the village are pooling their limited resources towards an ambitious project: a museum in the fortress, gathering photography from the productions that have been filmed here.    US channel HBO has commissioned a prequel to "GOT", called "House of the Dragon". George R.R. Martin, the author of the books on which the series is based, wrote on his blog that shooting would also take place in Morocco.
Date: Tue, 18 Feb 2020 09:44:12 +0100 (MET)

Macau, Feb 18, 2020 (AFP) - Macau's casinos will reopen Thursday after authorities lifted a city-wide two-week closure aimed at stopping the spread of the deadly new coronavirus.    The resumption of the lynchpin industry comes after the city reported no new infections in the last two weeks, with the number confirmed cases at just ten people.

The former Portuguese colony took the unprecedented step of shutting down almost all of its lucrative entertainment sector earlier in the month, including casinos, nightclubs and many bars.   The vast majority of Macau's tourists are mainland Chinese travellers, drawn to the city's casinos.

As the only place in China where casinos are allowed, Macau's gambling houses account for about 80 percent of government revenue.   But arrivals tanked as the epidemic spread.   Authorities said casinos that don't want to reopen because of low tourist numbers could apply to extend the closure, but they must be up and running within 30 days.

Macau's government has been keen to ensure the casinos keep employing staff through the downturn and are trying to avoid lay-offs.   Officials said all gamblers and casino staff must wear face masks.   First found in the city of Wuhan in central China, the new coronavirus has infected over 72,000 people on the mainland and 60 in Hong Kong.    It has also taken over 1,800 lives on the mainland and one in Hong Kong.
Date: Tue, 18 Feb 2020 09:07:42 +0100 (MET)

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

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

Successive governments have attempted to reform the pension system, whose previously generous handouts are seen as one of the causes of the decade-long Greek debt crisis.   Chronic overspending and the inaccurate reporting of the budget deficit spooked creditors in 2010, and required three successive bailouts by the European Union and the International Monetary Fund to avert a Greek bankruptcy.   In return for billions of euros in rescue funds, Greece had to adopt unpopular austerity reforms and pension cuts.
Date: Tue, 18 Feb 2020 08:50:55 +0100 (MET)

Peshawar, Pakistan, Feb 18, 2020 (AFP) - A policeman was killed and two others wounded Tuesday by a roadside bomb aimed at polio vaccination workers in Pakistan's restive northwest, officials said.    The attack came a day after Islamabad launched a nationwide anti-polio drive, aiming to immunise tens of millions of children in Pakistan -- one of only three countries, along with Afghanistan and Nigeria, where the crippling disease remains endemic.

Opposition to inoculations grew after the CIA organised a fake vaccination drive to help track down Al-Qaeda's former leader Osama Bin Laden in the Pakistani city of Abbottabad.   According to Captain Wahid Mehmood, a district police chief, a police van monitoring the polio team was hit on the outskirts of the north-western city of Dera Ismail Khan.   "It was an IED (improvised explosive device) explosion in which one of our policemen got martyred while two others were wounded", Mehmood told AFP.   Sadaqat Khan, a local police official, confirmed the toll.   There was no immediate claim of responsibility, but the Pakistani Taliban and other militants have targeted polio vaccinators in the past.

The nationwide polio vaccination campaign aims to vaccinate some 39 million children.  Tuesday's attack follows a devastating year in Pakistan's long fight against polio, with at least 17 cases reported in 2020 so far.   In 2019, the number of polio cases jumped to 144 from just 12 in 2018.

Even as Pakistan has tried to eliminate polio, a new challenge has emerged in the form of a growing global movement against vaccinations.   The phenomenon has attracted adherents worldwide, fuelled by medically baseless claims and proliferated on social media resulting in a resurgence of once-eradicated, highly contagious diseases.
Date: Mon, 17 Feb 2020 21:19:05 +0100 (MET)
By Joe JACKSON

London, Feb 17, 2020 (AFP) - Britain on Monday battled the fallout from Storm Dennis after the second severe storm in seven days left one woman dead over the weekend.   Winds of more than 90 miles (140 kilometres) an hour, along with more than a month's worth of rain in 48 hours in some places, led officials to issue rare "danger to life" warnings.   A 55-year-old woman was found dead after being swept away by near the flood-prone town of Tenbury Wells in western England.   "We are all devastated," her family said in a statement after a body was discovered.

James Bevan, chief executive of the Environment Agency, which is responsible for flood protection, said more than 400 homes in England had been flooded while at least 1,000 agency staff were working "to protect and support those communities which have been hit".   "This is not yet over," he told BBC radio.   "We still have many flood warnings in force and we may still see significant flooding in the middle of this week from larger rivers."   The storm also pummelled much of France, with some 20,000 people without electricity on Monday after suffering power cuts in the northwest.

- 'More extreme' -
In Britain, more than 600 warnings and alerts -- a record number -- were issued on Sunday, extending from the River Tweed on the border of England and Scotland to Cornwall in the southwest.   After a day of torrential rain, major flooding incidents were declared in south Wales and parts of west central England.  In northern England, the defence ministry deployed troops in West Yorkshire, which had also been hit by flooding from last weekend's Storm Ciara.   There were fears that rivers there could burst their banks.

Newly appointed environment secretary George Eustice said the government had done "everything that we can do with a significant sum of money" to combat increased flooding.    "We'll never be able to protect every single household just because of the nature of climate change and the fact that these weather events are becoming more extreme," he said.   Youth climate activists gathering for a national conference in Staffordshire, west central England, were forced to cancel the event because of the storm.   "There's a bleak irony in our being beaten back by climate change," 15-year-old attendee Sophia said in a statement released by organisers.

- 'Supercomputer' announced -
Two rivers in south Wales burst their banks on Sunday, prompting rescue workers to launch operations to evacuate hundreds of people and their pets trapped in their homes.   Police said a man in his 60s died after entering the River Tawe, north of the Welsh city of Swansea, but later clarified that the death was not "linked to the adverse weather".

Meanwhile the bodies of two men were pulled from rough seas off the south coast of England on Saturday as the storm barrelled in.   Britain's Coastguard said it had sent a helicopter and rescue team to join navy and other search vessels after receiving reports of a man overboard in the sea near Margate, Kent.   "After many hours of searching, a body was sadly found in the water... and was brought to shore," it added.

Around the same time in nearby Herne Bay, emergency responders discovered another dead man following reports a person had been pulled from the sea, according to Kent police.   In a timely announcement the Met Office, Britain's national weather service, said Monday it would invest £1.2 billion ($1.6 billion) in a state-of-the-art supercomputer to improve forecasting.   The government claims it is the world's "most powerful weather and climate supercomputer".
Date: Sun 16 Feb 2020, 5:00 PM
Source: WHO, Weekly Bulletin on Outbreaks and Other Emergencies, page 9 [abridged, edited]

During week 4 [week ending 26 Jan 2020], a total of 73 suspected cases including one death were reported across the country, compared to 46 suspected cases and no deaths in the previous week. The majority of cases in week 4 were reported from Sankuru province (78%).

In the past 4 weeks (weeks 1 to 4 of 2020) a total of 222 suspected cases with 4 deaths (CFR: 1.8%) were notified in the country, with the majority of cases being reported from the provinces of Sankuru (31%), Bas-Uele (18%), Equateur (15%) and Mai-Ndombe (9%). There has been an increase in the weekly case incidence since week 2 of 2020.

Between weeks 1 and 52 of 2019 a cumulative total of 5288 monkeypox cases, including 107 deaths (CFR 2%) were reported from 133 health zones in 19 provinces.
======================
[Monkeypox (MPX) virus is endemic and widespread geographically in the DR Congo, with cases occurring sporadically in several provinces. January 2020 is off to a similar start with 222 suspected cases and 4 deaths reported in 4 provinces. The 2% CFR is relatively low for the clade of MPX that occurs in the DRC, which can reach 10% or more. The 222 cases are suspected, and there is the possibility that without laboratory confirmation some of them may be varicella cases misdiagnosed as MPX. There is no additional information about the circumstances under which these cases acquired their infection. Monkeys are not the reservoirs of the virus, despite the name that the virus has received. Studies of prevalence of MPX virus in populations of rodent hosts are not mentioned in this or previous reports. The main reservoirs of MPX virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp., an arboreal rodent) and terrestrial rodents in the genera _Cricetomys_ and _Graphiurus_. Halting the bushmeat trade and consumption of wild animals to halt MPX virus exposure will be culturally and economically difficult, so continued occurrence of cases can be expected. MPX virus can be transmitted between people but not readily. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Fri 31 Jan 2020
Source: Nigeria CDC Situation report, yellow fever [edited]

Highlights
----------
In this reporting period:
- A total of 139 suspected cases were reported in 90 LGAs across 27 states
- All 139 suspected cases had blood samples collected
- 2 presumptive positive and 1 inconclusive case were reported; the inconclusive case was reported from Katsina State
- No confirmed case was recorded from Institute Pasteur Dakar
- No death was recorded from all the cases reported

Yellow fever response activities are being coordinated by the multi-agency yellow fever Technical Working Group (YF TWG).

Off-site support is being provided to all states.

Yellow fever preventive mass vaccination (PMVC) campaigns are planned for implementation in Oyo, Delta, Benue, Osun, Bauchi and Borno in the 3rd and 4th quarters.

Graphs and a map accessible at the above URL;
Figure 1 [graph]: Epidemic Curve of All Cases of Yellow Fever in Nigeria from Week 1 - Week 5, 31 Jan 2020
Figure 2 [graph]: Trends of Confirmed Cases in Nigeria - 2018, 2019 and January 2020
Figure 3 [graph]: Yellow fever Attack rate by State in Nigeria from Week 1 - Week 5, 31 Jan 2020
Figure 4: Map of Nigeria Showing States with Suspected and Presumptive confirmed Cases from Week 1 - Week 5, 31 Jan 2020
====================
[This report is not clear about the number of confirmed yellow fever (YF) cases that there have been in Nigeria this year (2020). The above report indicates that there are 139 suspected cases and all have had blood samples taken but does not state if all samples have been tested for YF by the Institute Pasteur in Dakar. The report does state that no confirmed case was recorded by the Institute Pasteur Dakar. The report states that 2 cases are presumptive and 1 is inconclusive. The graph in Figure 2 shows no confirmed cases in 2020.

It is curious that a 19 Jan 2020 report indicated that there were 141 suspected yellow fever cases in Jos North, Wase, Bassa, Kanam and Riyom Local Governments of Plateau State, of which 25 cases had been confirmed (see Yellow fever - Africa (02): Nigeria (PL) http://promedmail.org/post/20200121.6903167). A 29 Dec 2019 The World Health Organization (WHO) report confirmed 13 cases of yellow fever (YF), with 3 deaths in 4 local government areas of Plateau State (see Yellow fever - Africa (01): Nigeria (PL) http://promedmail.org/post/20200101.6862783). It is possible that all of these Plateau state cases occurred in 2019 and, hence, are not included in the above 2020 report which does not mention any cases in Plateau state. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Sat 15 Feb 2020 2:34:10 PM AFT
Source: MENAFN, Afghanistan Times News report [edited]

At least 35 people including women and children have died in the past few weeks due to pneumonia outbreak in Badakhshan Province in the north-western mountainous area, the provincial health department confirmed.

Dr Noor Khawari, head of the provincial public health department, said [Sat 15 Feb 2020] that the people had died in the Wakhan district, a remote area surrounded by high and impassable mountains.

He said that 15 of the dead were children, calling malnutrition and cold weather as the main reasons for the fatalities. A medical team had been dispatched to Wakhan to prevent further outbreak of the disease, according to Dr Khawari.

The provincial council had earlier said that at least 10 people had lost their lives since an unknown disease had broken out in the Yomgan district [Badakhshan Province].

The report caused panic and concerns among the residents as coronavirus [infection, COVID-19] in China that borders Badakhshan takes the lives of people every day.

But the ministry of public health denied outbreak of any unknown disease in Badakhshan, saying that the recent deaths happened only due to pneumonia and pertussis (whooping cough) as well as malnutrition. Badakhshan is one of the provinces where seasonal diseases like pneumonia and whooping cough break out during winter. The diseases claim the lives of people in the remote areas behind high mountains as the roads connecting them to the provincial capital are blocked by heavy snowfalls.

The provincial health department has deployed medical teams to the borders with China and Tajikistan to examine those entering from the neighbouring states and to prevent coronavirus [infection, COVID-9].
===========================
[We are told in the news report above that at least 35 people, including 15 children, died in the past few weeks due to a "pneumonia" outbreak in Wakhan district, a remote area surrounded by high and impassable mountains, with a population of about 14 000 residents. Wakhan is a narrow strip about 350 km (220 mi) long and 13-65 km (8-40 mi) wide that extends from Badakhshan Province in Afghanistan in the west to Xinjiang Autonomous Region in China in the east, separating the Pamir Mountains and Tajikistan to the north and the Karakoram Mountains and Pakistan to the south  (<https://en.wikipedia.org/wiki/Wakhan_Corridor>).

A trade route through this valley has been used by travellers since antiquity
(<https://caravanistan.com/afghanistan/wakhan-corridor/>).

A map of this region can be found at

The local residents are concerned that the novel coronavirus infection, COVID-19, may be the cause of the outbreak of pneumonia in Wakhan district. There are about 70 500 total cases of COVID-19 in China, mainly concentrated in Hubei Province in Central China.

Although Xinjiang in Western China has reportedly 75 confirmed cases of COVID-19 and 1 death (assessed 16 Feb 2020 at 9:43 PM EST) (<https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6>), spread of COVID-19 to this very remote region in Afghanistan, that is easily cut off from the rest of the world especially in winter, seems unlikely. Also, 43% of deaths (15/35) occurred in children, which would be unusual for COVID-19. However, we are not told the clinical presentation of the illness, nor how a diagnosis of "pneumonia" was made in this undeveloped region. Other diagnoses, such as influenza, are also possible. More information from knowledgeable sources would be appreciated. - ProMED Mod.ML]

[Maps of Afghanistan: