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Indonesia

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Information for Bali
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General
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Bali is one of the main tourist destinations for many Irish travellers to Indonesia. The island is well developed for the tourist industry and genera
ly the climate is tropical and humid throughout the year. Many Irish travellers will use the island as a stopover. If this is for only 24 to 28 hours the extent of your jetlag may leave you little time to enjoy the country and its people.
Safety & Security
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Throughout Indonesia there are many regions where it is unsafe to travel. The Parliament in Indonesia may impeach the President in the near future. Civil disturbance with student demonstrations in the capital Jakarta, earthquakes in the island of Sumatra, unrest regarding the independence of Timor and profound warring fractions on the island of Borneo has the potential to spill over into Bali. Nevertheless during the past years Bali has remained stable and there have been few reports of serious disturbances that have affected tourists or business travellers. Lombok is an island close to Bali often visited by tourists. It is regarded as more unstable and recently (Dec 2000) four explosions during fighting between two villages (Bongor & Parampuan). The main tourist region around Senggigi has remained quiet.

Local Customs
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The laws against illegal drugs are severe and travellers should ensure that they carry sufficient well-marked medication that they may require for their time in Indonesia. Travellers are required to show identification at any time and so carrying photocopies of your passport is a wise precaution. Keep all valuable documents in a safe place and do not flaunt personal wealth while travelling around the island.
Night Activities
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The nightlife in Bali is one of the main attractions for many tourists but sensible precautions are required. Travelling alone is unwise. Take care to ensure that your drink could not be spiked at any stage and do not walk at night, use an authorised taxi where possible. The level of HIV infection among the bar workers is high and close personal contact is very unwise.
Medical Facilities
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The level of available health facilities varies greatly through Bali and other parts of Indonesia. In general most of the main hotels will have English speaking doctors but care would be required if your illness requires hospitalisation.
Food and Water
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It is wise to maintain a high level of care with regard to your food and water while in Indonesia. This includes even those in high quality hotels but also particularly for those eating from street vendors. Bivalve shellfish (e.g. oysters, mussels, clams etc) should be avoided at all times due to inadequate cooking. Bottled water should be purchased from your hotel or good quality shops to ensure that it is pure.
Mosquitoes and Insect Bites
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Malaria transmission occurs throughout Indonesia all year but the risk in Bali is so low that prophylaxis is not generally recommended for most tourists. Nevertheless for those visiting Lombok (overnight visits) the risk exists and prophylaxis should be considered. Other mosquito borne diseases also occur throughout Indonesia and care must be taken to avoid insect bites. In Jakarta and other main cities there is a particular problem with a viral disease called Dengue Fever. The mosquito, which transmits this disease, typically bites during the day and in main urban centres.
Sun Exposure
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The strength of the sun in Bali is considerable higher than that experienced in Ireland at any time of the year. Sufficient head covering should be worm when exposed and travellers should ensure that their fluid intake is sufficient. Salt depletion also needs to be replaced in times of significant perspiration.
Swimming
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If swimming in pools, make sure that sufficient chlorination has been used. Take care with small children when close to the deep end of the pool. If sea swimming make sure that there are always others around and that you heed any local advice and warning signs. Never swim soon after alcohol or for an hour after mealtime.
Jet Lag
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The extent of jet lag, which you will experience, depends on the duration of your flight and the amount of rest you were able to get before arrival. Try to rest for the first 24 hours to allow your body to acclimatise and make sure you do not fall asleep beside the swimming pool during this initial period.
Vaccinations for Bali
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There are no essential vaccines or entry to Bali from Western Europe. However for your personal protection travellers are recommended to consider vaccination cover against;
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Poliomyelitis (childhood booster)
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Tetanus (childhood booster)
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Typhoid (food & water disease)
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Hepatitis A (food & water disease)
Other travellers planning a more rural or extensive trip may need to consider other vaccine cover against diseases like Hepatitis B, Japanese B Encephalitis, Rabies.
Summary
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The majority of those visiting Bali will enjoy the many tourist attractions on the island. However commonsense and care is required to ensure that you do not expose yourself to unnecessary risk. The staff of the Tropical Medical Bureau can be contacted at either of the numbers below if you require further information.

Travel News Headlines WORLD NEWS

Date: Tue, 28 Aug 2018 10:31:17 +0200

Kupang, Indonesia, Aug 28, 2018 (AFP) - A strong 6.2 magnitude earthquake struck eastern Indonesia on Tuesday, the US Geological Survey said, but there was no tsunami warning or immediate reports of damage.   The offshore tremor struck at a shallow depth of eight kilometres (five miles), about 100 kilometres southeast of Kupang on the Indonesian portion of Timor island, the USGS said.   It was followed by a shallow 5.6 magnitude quake nearby.

Witnesses described a powerful jolt from the first tremor which lasted a few seconds.   "I was on the second floor of my office and suddenly everybody ran outside because of the earthquake," said an AFP reporter in Kupang.   "All the chairs were shaking... we were traumatised by all the earthquakes in Lombok."   A string of deadly earthquakes that rocked Lombok island this summer killed some 555 people.   Indonesia's disaster agency said things had quickly returned to normal.   "Local disaster mitigation agency officials are still monitoring the impact of the earthquake," agency spokesman Sutopo Purwo Nugroho said in a statement.   "There are no victims or damage."

Indonesia, one of the most disaster-prone nations on earth, straddles the so-called Pacific "Ring of Fire", where tectonic plates collide and many of the world's volcanic eruptions and earthquakes occur.   In 2004 a tsunami triggered by a magnitude 9.3 undersea earthquake off the coast of Sumatra in western Indonesia killed 220,000 people in countries around the Indian Ocean, including 168,000 Indonesians.
Date: Fri, 24 Aug 2018 06:14:48 +0200

Jakarta, Aug 24, 2018 (AFP) - A string of deadly earthquakes that rocked Indonesia's Lombok island this summer killed 555 people and injured nearly 1,500, the disaster agency said Friday, with hundreds of thousands left homeless.   The picturesque island next to holiday hotspot Bali was hit by two deadly quakes on July 29 and August 5. On Sunday it was shaken by a string of fresh tremors and aftershocks, with the strongest measuring 6.9 magnitude.   Indonesia's disaster agency said Friday most of the deaths occured in the northern part of Lombok, with several also killed in neighbouring Sumbawa island.   Many victims were killed by falling debris as the tremors rippled across the island, causing widespread devastation.   Whole communities were flattened, leaving cracked streets lined with rubble, caved-in roofs and collapsed buildings.   Some 390,000 people remain displaced after the quakes, the disaster agency said.

Aid organisations have vowed to step up humanitarian assistance on the island as devastated residents struggle in makeshift displacement camps.   They warned that access to food, shelter and clean water has been insufficient for some residents displaced by the disasters.   "We've deployed troops to isolated villages that are difficult to reach," disaster agency spokesman Sutopo Purwo Nugroho said in a statement.   "There are many villages... that are hard to access with motorbikes. Some aid has to be delivered on foot."   Rebuilding costs are estimated to top seven trillion rupiah ($478 million).   Indonesia sits on the so-called Pacific "Ring of Fire", where tectonic plates collide and many of the world's volcanic eruptions and earthquakes occur.   In 2004, a massive 9.1 magnitude quake struck off the coast of Sumatra and triggered a tsunami that killed 220,000 throughout the region, including 168,000 in Indonesia alone.
Date: Mon, 20 Aug 2018 13:39:55 +0200
By Aman Alief

Mataram, Indonesia, Aug 20, 2018 (AFP) - At least 10 people are dead after a string of powerful quakes rocked the Indonesian holiday island of Lombok, authorities said Monday, in a fresh blow just weeks after earlier tremors left hundreds dead and thousands more homeless.   The latest quakes struck Sunday, with the first measuring 6.3 shortly before midday. It triggered landslides and sent people fleeing for cover as parts of Lombok suffered blackouts.   It was followed nearly 12 hours later by a 6.9-magnitude quake and a string of powerful aftershocks.   The picturesque island next to holiday hotspot Bali was already reeling from two deadly quakes on July 29 and August 5 that killed nearly 500 people.

Ten people were killed in the strong quake Sunday evening, mostly by falling debris, including six people on the neighbouring island of Sumbawa, according to the national disaster agency.   Some two dozen people were injured in Lombok and more than 150 homes and places of worship damaged, the agency said.   Tens of thousands of homes, mosques and businesses across Lombok had already been destroyed by the quake earlier this month.   Most people caught in the latest tremor had been outside their homes or at shelters when it struck which kept casualties low, said national disaster agency spokesman Sutopo Purwo Nugroho.   "The trauma because of the earlier quake on Sunday (morning) made people prefer to stay outside," he added.   Aid agencies vowed to boost humanitarian assistance on the island as devastated residents struggle in makeshift displacement camps.   Indonesia's disaster agency said it was accelerating efforts to rebuild destroyed homes, hospitals and schools, while Save the Children pledged to escalate its humanitarian response.    "We are gravely concerned about the repeated distress caused to children by the multiple shocks," the relief agency said.

- 'Too scared at home' -
Video images from an evacuation camp in Lombok showed children and adults taking cover inside makeshift tents.   "I'm too scared to stay at my house because it's damaged," said resident Saruniwati, who like many Indonesians goes by one name.   "I've been here since the quake (earlier this month). I went home two days ago and now I'm back here again."

Local Agus Salim said the powerful tremor jolted him awake Sunday evening.   "The earthquake was incredibly strong. Everything was shaking," he told AFP.   "Everyone ran into the street screaming and crying."   There were landslides in a national park on Mount Rinjani where hundreds of hikers had been briefly trapped after the quake in late July. The park has been closed since then.   Sunday's tremors were also felt on Bali but there were no reports of damage there.

- 'Ring of Fire' -
The latest tremor follows the a shallow 6.9-magnitude quake on August 5 that killed at least 481 people and left thousands more injured.   The hardest-hit region was in the north of the island, which has suffered hundreds of aftershocks.   A week before that quake, a tremor surged through the island and killed 17.   The disasters have raised fears that Lombok's key tourism industry would take a beating, but the international airport was operating normally Monday with no exodus of frightened tourists.

Indonesia sits on the so-called Pacific "Ring of Fire", where tectonic plates collide and many of the world's volcanic eruptions and earthquakes occur.   The Australian and Eurasian plates, which sit under the archipelago, have been colliding and putting stress on key area fault lines, according to a geologist.   "Clearly there are different parts of the fault that are moving at the moment releasing those stressors," said Chris Elders, an expert in plate tectonics and structural geology at Curtin University in West Australia.   In 2004 a tsunami triggered by a magnitude 9.3 undersea earthquake off the coast of Sumatra in western Indonesia killed 220,000 people in countries around the Indian Ocean, including 168,000 in Indonesia.
Date: Thu, 9 Aug 2018 13:29:32 +0200
By Kiki Siregar

Mataram, Indonesia, Aug 9, 2018 (AFP) - The death toll from a devastating earthquake on the Indonesian island of Lombok jumped to 319 Thursday, as strong aftershocks triggered panic among traumatised survivors waiting for aid in the worst-hit regions.    The shallow 6.9-magnitude quake Sunday levelled tens of thousands of homes, mosques and businesses across Lombok, with relief agencies only just starting to reach survivors in some of the worst-hit areas four days later.   "Our latest update is that 319 people died," said Indonesia's chief security minister Wiranto, who like many Indonesians goes by one name, adding that rescue efforts were ongoing and complicated by aftershocks.   The number forced from their homes in the disaster has soared to 270,000, national disaster agency spokesman Sutopo Purwo Nugroho said, with around 1,000 people severely injured.

Most of the displaced are sleeping under tents or tarpaulins near their ruined homes or in evacuation shelters that are short of food, clean water and medical help.   Makeshift medical facilities have been set up to treat the injured.   Survivors of the quake have also been shaken by hundreds of aftershocks, including a shallow 5.9-magnitude quake Thursday which caused people to flee evacuation shelters crying and screaming.   Motorcycles parked on the street in northern Lombok's Tanjung district toppled over and the walls of some nearby buildings collapsed.   "We were stuck in the traffic while delivering aid, suddenly it felt like our car was hit from behind, it was so strong," witness Sri Laksmi told AFP.   "People in the street began to panic and got out of their cars, they ran in different directions in the middle of the traffic."   Twenty-four people were injured by falling debris in the tremor, Nugroho said.

- 'Exceptionally destructive' -
Authorities and international relief groups have begun organising aid, but badly damaged roads have slowed efforts to reach survivors in the mountainous north of Lombok, which bore the brunt of the quake.   Aid had begun trickling into some of the most isolated regions by midday Thursday, officials said, but many displaced people still lack basic supplies.   In some parts of northern Lombok, survivors can be seen standing on the road with cardboard boxes asking for donations and food.   "It is already clear that Sunday's earthquake was exceptionally destructive," Christopher Rassi, the head of a Red Cross assessment team on Lombok, said in a statement.   "I visited villages yesterday that were completely collapsed."

Workers with heavy machinery are searching the rubble of homes, schools and mosques, with hope of finding any survivors fading.   There are fears that two collapsed mosques in north Lombok had been filled with worshippers.   Rescuers have found three bodies and also managed to pull one man alive from the twisted wreckage of one mosque in Lading Lading village, while at least one body has been spotted under the rubble in Pemenang.   Authorities are gathering information from family members with missing relatives to determine how many more people may have been in the buildings when they collapsed, national search and rescue agency spokesman Yusuf Latif told AFP.

- Waiting for aid -
Across much of the island, a popular tourist destination, once-bustling villages have been turned into virtual ghost towns.   Evacuees in some encampments say they are running out of food, while others are suffering psychological trauma after the powerful quake, which struck just one week after another tremor surged through the island and killed 17.   There is a dire need for medical staff and "long-term aid", especially food and medicine in the worst-hit areas, government officials said.   About 200 cars packed with food, medicine and basic supplies were sent to heavily impacted regions in the north and west Thursday morning, Agung Pramuja, a spokesman for Mataram mitigation disaster agency, told AFP.   But some evacuees have complained of being ignored or experiencing long delays for supplies to arrive at shelters.

At a shelter in hard-hit Kayangan, new mother Rusnah, who like many Indonesians goes by one name, said she needed basic supplies for her children.   "I'm still in pain from giving birth," she told AFP. "I need diapers, I need milk."   Other evacuees said they were subsisting on a diet of instant noodles and needed clean water and bedding.   The Indonesian Red Cross said it had set up 10 mobile clinics in the north of the island.   A field hospital has also been established near an evacuation centre catering to more than 500 people in the village of Tanjung.   Kurniawan Eko Wibowo, a doctor at the field hospital, said most patients had broken bones and head injuries.   "We lack the infrastructure to perform operations because (they) need to be performed in a sterile place," Wibowo told AFP.   Aid groups say children are particularly vulnerable, with many sleeping in open fields and suffering illnesses from lack of warm clothing and blankets.
Date: Wed, 8 Aug 2018 13:34:50 +0200
By Kiki Siregar

Tanjung (West Nusa Tenggara), Indonesia, Aug 8, 2018 (AFP) - The death toll from a powerful earthquake on the Indonesian island of Lombok rose above 130 on Wednesday, as authorities appealed for food, clean water and medical help for some 156,000 people forced from their homes.   Many frightened, displaced villagers are staying under tents or tarpaulins dotted along roads or in parched rice fields, and makeshift medical facilities have been set up to treat the injured.

Evacuees in some encampments say they are running out of food, while others are suffering psychological trauma after the 6.9-magnitude quake, which struck just one week after another tremor surged through the island and killed 17.   "We still need long-term aid, even though we have already received help from various (regional) governments," national disaster agency spokesman Sutopo Purwo Nugroho said.   Around 1,477 people were severely injured in the disaster, with tens of thousands of homes damaged, and authorities say the toll of 131 is likely to rise.

Workers with heavy machinery are searching the rubble of homes, schools and mosques, with hope of finding any survivors fading.   "The corpses are starting to smell and we believe some people buried are still alive -- that's why it's a critical time," Nugroho said.   Local authorities, international relief groups and the central government have begun organising aid, but shattered roads have slowed efforts to reach survivors in the mountainous north and east of Lombok, which bore the brunt of the quake.   Muhammad Zainul Majdi, governor of the West Nusa Tenggara region which covers Lombok, said there was a dire need for medical staff, food and medicine in the worst-hit places.

Hundreds of bloodied and bandaged victims have been treated outside damaged hospitals in the island's main city of Mataram and other badly affected areas.   "We have limited human resources. Some paramedics have to be at the shelters, some need to be mobile," Majdi told AFP.   "The scale of this quake is massive for us here in West Nusa Tenggara, this is our first experience."   Some evacuees are grappling with the traumatic scenes of death and destruction that accompanied the quake.   "I saw my neighbour get stuck in the rubble and die. He asked me for help, but I couldn't help him, we just ran to help ourselves," Johriah, who like many Indonesians goes by one name, told AFP tearfully.

- 'Destruction almost 100 percent' -
The Indonesian Red Cross said it had set up 10 mobile clinics in the north of the island.   A field hospital has also been established near an evacuation centre catering to more than 500 people in the village of Tanjung.   Kurniawan Eko Wibowo, a doctor at the field hospital, said most patients had broken bones and head injuries.   "We lack the infrastructure to perform operations because (they) need to be performed in a sterile place," Wibowo told AFP.

Across much of the island, a popular tourist destination, once-bustling villages have been turned into virtual ghost towns.   "In some villages we visited the destruction was almost 100 percent, all houses collapsed, roads are cracked and bridges were broken," said Arifin Muhammad Hadi, a spokesman for the Indonesian Red Cross.

Many farmers were reluctant to move far from their damaged homes and leave precious livestock behind, he added.   The Indonesian military said that three Hercules transporter planes packed with food, medication, blankets, tents and water tanks had arrived in Lombok.   The West Sumatra government has donated one tonne of its most famous culinary export, beef rendang -- a slow-cooked coconut curry.

- 'We have no clean water' -
But some evacuees have complained of being ignored or experiencing long delays for supplies to arrive at shelters.   "There has been no help at all here," said 36-year-old Multazam, staying with hundreds of others under tarpaulins on a dry paddy field outside West Pemenang village.   "We have no clean water, so if we want to go to the toilet we use a small river nearby," he said, adding they needed food, bedding and medicine.

At an orphanage in West Lombok, some 80 children -- including a one-year-old -- were huddling under two large tents after their dorms were destroyed.   "We still have supplies for the next few days, but I'm not sure about after that," Billa Rabbani, a spokeswoman from the Peduli Anak orphanage, told AFP.    The quake struck as evening prayers were being said across the Muslim-majority island and there are fears that one collapsed mosque in north Lombok had been filled with worshippers.

Rescuers have found three bodies and also managed to pull one man alive from the twisted wreckage of the mosque, reduced to a pile of concrete and metal bars, with its towering green dome folded in on itself.   Meanwhile, the evacuation of tourists from the Gili Islands -- three tiny, coral-fringed tropical islands off the northwest coast of Lombok -- has finished, officials said.
More ...

World Travel News Headlines

Date: Mon, 10 Sep 2018 07:28:56 +0200

Wellington, Sept 10, 2018 (AFP) - A strong 6.9 magnitude earthquake struck New Zealand's remote Kermadec Islands on Wednesday but authorities said there was no tsunami threat.   The quake struck at 4.19pm (0419GMT) at a depth of 111 kilometres (69 miles), with its epicentre 770 kilometres northeast of Auckland, the US Geological Survey said.   "Based on all available data, there is no tsunami threat from this earthquake," the Hawaii-based Pacific Tsunami Warning Center said.   The uninhabited Kermadecs are New Zealand's northernmost islands.   They are part of the Pacific Ring of Fire, a hotbed of volcanic and earthquake activity at the intersection of several tectonic plates.
Date: Mon, 10 Sep 2018 07:17:20 +0200

Tokyo, Sept 10, 2018 (AFP) - The death toll from a powerful earthquake that triggered massive landslides in northern Japan rose to 44 on Monday with tens of thousands of police and troops still on the ground to support survivors.   Chief Cabinet Secretary Yoshihide Suga said no one was left on a missing list, which suggested the figure could be the final death toll.   Around 40,000 police, fire fighters, troops and maritime safety officials were providing assistance, with more than 2,700 people still forced to stay in shelters after the killer quake struck the northern Japanese island of Hokkaido last week.

The majority of the dead are from the small rural town of Atsuma, where a cluster of dwellings were wrecked when a hillside collapsed from the force of the 6.6-magnitude quake, causing deep brown scars in the landscape.   "The government will strive to get hold of what is needed on the ground and take every possible measure so that people can return to a normal, safe life as soon as possible," Suga told a news conference.   He also warned that islanders should remain on alert as rainfall was forecast in the region, which could trigger fresh landslides.

The quake was the latest in a string of natural disasters to batter the island nation.   Western parts of the country are still recovering from the most powerful typhoon to strike Japan in a quarter of a century, which claimed 11 lives and shut down the main regional airport.   Launching a campaign for another term as head of his ruling party, Prime Minister Shinzo Abe reiterated his government will "do its best" to restore the disasters-hit regions.
Date: Mon, 10 Sep 2018 07:13:22 +0200
By Gregory DANEL, Romain FONSEGRIVES

Paris, Sept 10, 2018 (AFP) - Seven people including two British tourists were wounded in Paris late Sunday by a knife-wielding man, a terrifying attack that bystanders tried to stop by throwing petanque balls at the assailant.   Four of the victims were in a critical condition, police said, after the man brandishing a large blade and and iron bar went on the rampage next to a canal in the northeast of the capital.   The suspect is believed to be an Afghan national and has been arrested, said a source close to the enquiry, adding he had targeted "strangers" but that "nothing at this stage shows signs of a terrorist nature".

Chaos erupted on the banks of the Bassin de la Villette, an area popular with locals and visitors who frequent the cafes, cinemas and other cultural venues along its banks, just after 11:00pm (2100 GMT).   Eyewitness Youssef Najah, 28, said he was walking beside the canal when he saw a man running and holding a knife about 25-30 cm (10-11 inches) long.   "There were around 20 people chasing him. They started throwing petanque balls at him," Najah said, referring to the sport popular in France also known as boules.   "Around four or five balls hit him in the head, but they weren't able to stop him," he added.

According to the same witness, the attacker then dived into an alleyway, where the man "tried to hide behind two British tourists. We said to them: 'Watch out, he has a knife". But they didn't react".    The pair were then attacked, he said.   A security guard at one of two cinemas on either side of the water said he had seen the attacker running away from two men who were trying to stop him.   "He had an iron bar in his hand which he threw at the men chasing him, then he took out a knife," he told AFP.   The UK foreign office said it was aware of reports of the attack and was "urgently investigating this incident" in cooperation with French authorities, British media reported.

- High alert -
A police investigation has been launched for attempted murder, according to a judicial source.   It is the latest of several knife attacks France has seen in recent months, with terrorism being ruled out in most cases.   On August 23, a man stabbed his mother and sister to death and seriously injured another person in a town near Paris before being shot dead by police.

The motive for the violence remained unclear despite a claim by the Islamic State (IS) group that it was an attack by one of its fighters responding to the terror organisation's propaganda.   Authorities said the 36-year-old had serious mental health problems and had been on a terror watch list since 2016.   That attack came days after an Afghan asylum-seeker was arrested in town of Perigueux for a drunken rampage with a knife in which four people were wounded, one seriously.   Police said investigators had "very quickly" dismissed a terrorist motive after the August 13 incident.

And on June 17, two people were hurt in another southern town when a woman shouting "Allahu akbar" (God is greatest) attacked them in a supermarket with a boxcutter knife.   France has been on high alert following a string of jihadist attacks in recent years, often by people who have become radicalised or claim to have acted in the name of the IS group.   More than 240 people have been killed by Islamist extremists since a massacre at the Charlie Hebdo satirical magazine in Paris in January 2015.
Date: Mon, 10 Sep 2018 06:41:23 +0200

Miami, Sept 10, 2018 (AFP) - Hurricane Florence is expected to become a dangerous "major hurricane" by late Monday as it heads toward the US East Coast, the National Hurricane Center said, as states of emergency were declared in preparation for the storm.   The center of Florence was located about 685 miles (1,100 kilometres) southeast of Bermuda, the NHC in its 0300 GMT Monday advisory.   Florence had maximum sustained winds of 90 miles per hour, making it a Category 1 storm on the five-level Saffir-Simpson hurricane scale.

The NHC warned that Florence "is forecast to rapidly strengthen to a major hurricane by Monday night, and is expected to remain an extremely dangerous major hurricane through Thursday."   The storm is moving towards the west at seven miles per hour, and is forecast to drench a large swath of the US East Coast running from northern Florida to New Jersey.   On its current track Florence is expected to slam the Carolinas and Virginia the hardest -- and all three states have issued emergency declarations to speed preparations.

Virginia Governor Ralph Northam's office described Florence as possibly the state's "most significant hurricane event in decades," warning of "catastrophic inland flooding, high winds and possible widespread power outages."   It added: "The largest threat to life from hurricanes is not the high winds. Flooding is the deadliest result of these storms."   The US navy has ordered ships at its major base in Hampton Roads, Virginia, base to put to sea, saying "the forecasted destructive winds and tidal surge are too great to keep the ships in port."

- Two more hurricanes -
North Carolina Governor Roy Cooper's office said that Florence is already being felt along the state's coast, with large sea swells resulting in life-threatening rip currents and surf.   "Everyone in North Carolina needs to keep a close eye on Florence and take steps now to get ready for impacts later this week," Cooper said.

The storm "is too powerful and its path is too uncertain to take any chances," South Carolina Governor Henry McMaster said in issuing his state's emergency declaration.   Florence was producing large swells expected to reach from the northern Caribbean to the southern coasts of Canada's Maritime provinces.   At this statistical height of the Atlantic hurricane season, Florence was being trailed on east-to-west paths by two hurricanes, Helene and Issac.   Helene -- currently just southeast of the Cabo Verde islands off the African coast -- had winds of 85 miles per hour, and was expected to turn northwest and then north into the open Atlantic by midweek, the NHC said.

Hurricane Isaac -- which late Sunday became the fifth hurricane of the season -- is heading west towards the Caribbean.   At 0300 GMT Issac was about 1,305 miles east of the Windward Islands -- a region still recovering from last year's powerful Hurricane Maria -- with winds of 75 miles per hour.   Issac is expected to gain strength in the next days, but then weaken by the middle of the week when it approaches the Caribbean.   Maria -- which killed at least 3,057 people, most in Puerto Rico -- is elieved to be the third costliest tropical cyclone on record.
Date: 9 Sep 2018
Source: ProMED-mail promed@promedmail.org

[There has been significant chatter on social media from individuals working in Haiti and their colleagues, friends and family, suggesting there is a "new, as yet undiagnosed outbreak," possibly of a mosquito-borne disease, in the expat and local Haitian communities. Some of the content of this social media chatter is excerpted below [edited for clarity/readability - CopyEd.MSP]. - ProMED Mod.MPP]

"...there is some sort of new mosquito-borne virus in Haiti. Do I know for sure that it is a virus caused by a flying insect? No. Do I have a lot of unqualified and under-documented personal research to back up my belief nonetheless? Yes. If you know a guy or gal at the CDC, tell them to come chat with me. Something is going around, and many people are not well. It is eerily similar to chikungunya and malaria."

"Mayaro virus?"

"I have been saying the same thing! Well, when my fever brain has been capable of putting thoughts together this week. 2014 was ChikV; 2016 was Zika, so it does seem time for a new one. This new one is no fun at all."

"My person is negative for everything, Zika, chikV, malaria, dengue. It started with high fever, aches, joint pain, then progressed to stomach ache, headache. Now it's just persistent joint aches and sharp stabbing pain."

"We have this all over Mirebalais as well. Here, it also seems to be often accompanied by severe lower abdominal pain."

"Yes! My son just asked me if there is another mosquito borne illness yesterday!"

"Several of our girls have been sick with these same symptoms! It's awful."

"We all had it too and are seeing a lot of patients at our clinic with it!"

"I was sick for days before the uprising in July [2018] ... totally felt like malaria but tested negative. My BP was 80/40 at best, and it was pa bon [not good]."

"Yes! I've been sick this week as well as a few others I know! Lots of body pain."

"People thought that I was crazy!"

"You're not crazy! Several cases showing up at the Maternity Center here, and I also think there is influenza A going around. Some cases have respiratory stuff (to me that is the flu/influenza A), and several cases have nothing respiratory but have the fever and aches and terrible headache."
======================
[According to Wikipedia (in an unsubstantiated report without references) "Mirebalais is a commune in the Centre department of Haiti, approximately 60 km northeast of Port-au-Prince on National Road 3. The city was established in 1702. During the United Nations occupation of 2005, Nepalese troops were stationed in the city, using the city jail as their headquarters,"  (<https://en.wikipedia.org/wiki/Mirebalais>).

"Mirebalais is served by the teaching hospital Hopital Universitaire de Mirebalais, the largest solar-operated hospital in the world," a hospital that is run by the US-based Partners in Health,  (<https://www.pih.org/pages/mirebalais>).

>From the sound of the social media chatter, there is an as yet undiagnosed outbreak affecting parts of Haiti. Trying to connect the dots, there is concern that it is malaria-like (fever, chills and headaches), but in those that have been tested for malaria, laboratory results have not supported the diagnosis, and possibly dengue- or chikungunya-like (fever, headache, joint pains) with the addition of complaints of lower abdominal pain (notably described in Mayaro virus disease.

If the symptoms are similar to those of dengue, chikungunya, and Zika virus infections, they need to be ruled out by laboratory testing. There is the possibility that Mayaro virus (MAYV) may be circulating in Haiti. Mayaro virus was isolated from a child with acute febrile illness in rural Haiti. The case report stated that "on 8 Jan 2015, an 8-year-old boy was examined at the school clinic because of fever and abdominal pain. His temperature was 100.4 F [38 C]; lung sounds were clear, and his abdomen was soft and not tender. He had no rash and no conjunctivitis. On the basis of this clinical presentation, the clinic physician empirically diagnosed typhoid and administered co-trimoxazole... MAYV was detected in viral RNA extracted from infected Vero cells.

A question now is: if this is another MAYV infection, is this a continuation of the 2015 transmission or a new introduction into Haiti? Clearly, laboratory follow up is needed to establish the etiology of the current cases of febrile disease to determine an etiology and rule out other pathogens. If MAYV presence is established, surveillance is needed to determine the extent of its distribution, and health care providers and laboratories in Haiti, the Dominican Republic, and other countries in the Caribbean Basin need to be informed to be on the alert and to be prepared to make a diagnosis should any cases occur there.

Of additional curiosity is a recent media report in the Jamaican Star relating a tale of 3 Haitians recently arrived claiming illness, with malaria suspected in one of them. Testing is still pending, but given the social media chatter, one can't help but wonder whether this isn't malaria. Could it be part of the same as of yet undiagnosed outbreak reported in the above chatter? ...

References:
1- Lednicky J, De Rochars V, Elbadry M, Loeb J, Telisma T, Chavannes S, et al. Mayaro Virus in Child with Acute Febrile Illness, Haiti, 2015. Emerg Infect Dis. 2016;22(11):2000-2002.

2- Mavian C, Rife BD, Dollar JJ, Cella E, Ciccozzi M, Prosperi MCF, Lednicky J, Morris JG, Capua I, Salemi M. Emergence of recombinant Mayaro virus strains from the Amazon basin. Sci Rep. 2017 Aug 18;7(1):8718. doi: 10.1038/s41598-017-07152-5.

A HealthMap/ProMED map of Haiti can be found at:

More information from knowledgeable sources would be greatly appreciated, especially results of laboratory testing on individuals presenting with the above-mentioned symptoms, and results of clinical as well as epidemiologic investigations. - ProMED Mods.MPP/TY]
Date: Sun, 9 Sep 2018 14:04:57 +0200

Rome, Sept 9, 2018 (AFP) - Authorities have issued health alert after 150 cases of pneumonia were recorded in a week, mainly in towns near the northern Italian city of Brescia.   Suspecting the presence of a pneumonia-causing virus in the water supply, they have taken samples from the distribution network for analysis.   Results are expected in several days.

Autopsies will be conducted on a 69-year-old woman and an 85-year-old man who died this week to determine whether they died from pneumonia, according to local media reports.   Pneumonia is usually caused when bacteria, viruses or fungi infect the lungs.   It can be life-threatening, especially among the elderly and those with serious health conditions.

Provincial health services have called on residents to take precautions, including disinfecting tap filters and shower hoses and to let hot water run for a period of time with the windows open before using it.   Hospital emergencies in several municipalities to the south and east of Brescia identified 121 cases of pneumonia, the health officer in the Lombardy region Giulio Galera said on television.   A survey of general practitioners found at least 30 other people had been affected.
Date: Sun, 9 Sep 2018 10:04:14 +0200

Tokyo, Sept 9, 2018 (AFP) - Japan is suffering its first outbreak of pig cholera in more than 25 years, authorities said Sunday after culling more than 600 animals and suspending pork exports.    A farm in central Japan saw 80 pigs die last week after catching the highly-contagious disease, an agricultural ministry official told AFP.

Early tests showed negative results for classical swine fever, as the illness is officially known.   But follow-up tests came out positive Sunday, prompting the cull of all 610 pigs at the farm, he added.   "We are now processing the livestock there and disinfecting the farm," he said, adding that officials had set up sterilisation points on access roads to the affected farm.

The government has set up a team of specialists to analyse possible infection routes, the agricultural ministry said in a statement.   Tokyo halted pork exports after the outbreak was confirmed. The nation sold roughly $9 million in raw pork meat to foreign markets last year.   Japan saw its last case of classic swine fever, which does not affect humans, in 1992.   The disease continues to rage in many parts of Asia, Europe and Latin America.
Date: Sat, 8 Sep 2018 21:58:47 +0200

Kinshasa, Sept 8, 2018 (AFP) - Health authorities in Kinshasa declared the Ebola virus under control five weeks after the latest outbreak left 89 people dead in eastern Democratic Republic of Congo.   The health ministry announced the outbreak on August 1 in North Kivu province and on Thursday revealed that it had spread to Butembo, a city of a million people.

But Health Minister Dr Oly Ilunga Kalenga said: "Since August 13, there have been practically no more cases, we can say that the situation has been brought under control at the epicentre (of Mabalako)."   The latest outbreak of the virus is 10th to strike DR Congo since 1976, when the disease was first identified and named after a river in the country's north.   "To date, we have 129 cases (31 probable and 98 confirmed), 89 deaths and 33 patients cured," Dr Oly Ilunga said.   Fears that the disease might  spread further had been expressed Thursday after news of two deaths in Butembo, a commercial hub and popular transit point for neighbouring Uganda.

A woman and one of the medical staff who had been treating her died ini the city.   "Even at Butembo, the situation is not critical," the minister told a news conference also attended by Congolese professor and leading Ebola researcher Professor Jean-Jacques Muyembe, who urged people to report any sign of the disease.   "The Ebola virus is circulating here and in Africa in general ... we must be vigilant," Muyembe said.

Complicating the battle against the spread of the disease is the fact it is afflicting an area of Congo wracked by insecurity owing to the presence of armed groups.   Even so, Dr Oly Ilunga said teams treating sufferers had enjoyed army and police backing as well as support from the UN mission Monusco.   The previous outbreak of Ebola, which left 33 people dead in the northwestern province of Equateur, was decreed over on July 24.
Date: Sat, 8 Sep 2018 13:02:52 +0200

Seoul, Sept 8, 2018 (AFP) - South Korea reported its first case of Middle East Respiratory Syndrome (MERS) in three years, health officials said on Saturday.   A 61-year-old businessman was diagnosed with the highly contagious viral respiratory illness, according to officials at the Korea Centers for Disease Control and Prevention (KCDC).   He returned to South Korea Friday from a business trip in Kuwait where he stayed for three weeks, the KCDC said a statement.

"Authorities have traced and separated 20 people who have come in close contact with the infected person," KCDC head Chung Eun-gyeong told journalists.   They include medical staff, flight attendants and passengers of the plane the man flew back to South Korea on, she said.    He was hospitalised with fever and phlegm and has been quarantined at a university hospital, she added.   It is the first case of MERS diagnosed in South Korea since 2015, when an outbreak killed 38 people and triggered widespread panic.
Date: Wed 5 Sep 2018
Source: El Comercio [in Spanish, machine trans. edited]
<https://elcomercio.pe/mundo/latinoamerica/chile-brote-hepatitis-suma-201-casos-region-antofagasta-noticia-nndc-554166>

Health authorities in the region of Antofagasta in northern Chile are on alert for an outbreak of hepatitis A that adds 201 cases so far in 2018, 2 more than those recorded throughout 2017, they said today, 5 Sep 2018. "Unfortunately, we are having about 5 cases every 2 weeks, which means that we are facing an epidemic," Cooperativa Rossana Díaz, ministerial regional Secretary of Health, told Radio. It is a situation "that is controllable with the help of the community," which, in his opinion, has a fundamental role in the prevention of this disease, which can "be fulminating, create a risk to life, and require organ transplantation." Diaz stressed that hepatitis A can be prevented with simple measures, such as constant hand washing and optimal handling and preparation of food.

The authorities must combat street food sales and control businesses, "but we do not get anything if people continue to consume food on the street or in places that do not have sanitary authorization for that," he said. The profusion of cases, according to the official, corresponds to the increase in the consumption of food in unauthorized places and the lack of vaccinated personnel or strict hygiene regulations in establishments that do have a permit.

The authorities have set up an Outbreak Response Committee in the region and questioned contacts of the confirmed cases and of the suspects in order to find the origin of transmission. The cases registered in Antofagasta range from 2 to 60 years, with an average of 23 years, of which 62% are men and 38% are women, and although the presence of immigrants is large in the region, 98% of the cases are Chileans, the regional authorities reported.

Hepatitis A, according to the Institute of Public Health, can be prevented with a vaccine, and its detection requires a medical diagnosis in addition to laboratory tests or diagnostic imaging studies. It is transmitted through water, contaminated food, or through contact with an infected person. It is considered a disease with worldwide distribution that occurs sporadically or epidemically with a seasonal cycle, which in Chile is an intermediate endemic, with epidemic outbreaks every 4 or 5 years, and there are no chronic carriers.
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[It seems to be the case that the cases are occurring at a low, steady rate rather than from a specific recent exposure.

Antofagasta (<https://en.wikipedia.org/wiki/Antofagasta>) is a port city in northern Chile, about 1100 km (700 mile) north of Santiago. It is the capital of Antofagasta province and the Antofagasta region. Formerly part of Bolivia, Antofagasta was captured by Chile in the War of the Pacific (1879-83), and the transfer of sovereignty was finalized in the 1904 Treaty of Peace and Friendship between the 2 countries. - ProMED Mod.LL]

[HealthMap/ProMED map available at: Antofagasta, Antofagasta, Chile:
<http://healthmap.org/promed/p/11048>]