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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
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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: Wed 24 Oct 2018
Source: Daily Nation [edited]

One person has died, and 8 others received treatment of suspected anthrax at the Chuka County Referral Hospital in Tharaka-Nithi County. The patients and the victim, who come from Mubukuro village, are said to have come into contact with meat of a sick cow.

Speaking to journalists from his hospital bed, F.G. said he was called by the owner of the cow 2 weeks ago after the animal fell sick and together with the victim slaughtered it. [There is a picture of Mr. G. with a bandage on the back of his right hand, and a swollen area below his left eye. - ProMED Mod.MHJ]

"The animal was almost dying when we slaughtered it," said Mr. G. He said they hanged the meat in a house and the following day called a veterinary officer who after inspecting the meat advised them to bury it. Mr. G. noted that 4 days later he started developing a swell on his left eye and went to the hospital where he was admitted.

County Health director Dr. Tony Njoka said the man who died admitted to hospital on [Mon 22 Oct 2018] with a severe headache and loss of consciousness, adding that the hospital is yet to confirm if he died of anthrax.

County chief officer in charge of medical services Mr. Kimathi Njeru said a team of veterinary and public health officers have already visited the village for further investigation and public sensitisation.

"We have disinfected the area and advised the locals to report any case of a sick animal and avoid eating uninspected meat," he said.  [Byline: Alex Njero]
=========================
[I checked the other Kenyan newspapers and so far this is the only report of suspected anthrax in Chuka. Chuka is a town on the eastern slopes of Mount Kenya, in Kenya about 65 km (approx. 40 mi) south of Meru Town. It falls within Tharaka-Nithi County and the former Eastern Province. Between 1992 and 2009, Chuka was the capital of Tharaka Nithi District.

Tharaka Nithi is in what was Eastern Province (<http://legacy.lib.utexas.edu/maps/africa/kenya_pol88.jpg>) and is pretty much in the centre of Kenya. (<https://en.wikipedia.org/wiki/Tharaka-Nithi_County>). The last report we have of anthrax in Tharaka Nithi was in December 2017; see: 27 Dec 2017 Anthrax - Kenya (09): (NT) livestock http://promedmail.org/post/20171227.5524389. Like this one, it was related to careless handling of an infected carcass. - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Tharaka - Nithi, Kenya: <http://healthmap.org/promed/p/46041>]
Date: Wed, 8 Aug 2018 19:22:50 +0200

Nairobi, Aug 8, 2018 (AFP) - Five Kenyan soldiers were killed Wednesday when their vehicle was blown up by an improvised explosive device in the eastern Lamu county, police sources said.   "The officers were on a light truck that ran over the IED and was badly destroyed and the officers died on the spot. Six others have been injured," a senior police officer in Lamu told AFP on condition of anonymity.   Another police officer in Lamu confirmed the deaths but did not give any further information: "Yes it is true five soldiers were killed and six injured."

The attack, which the police blame on al-Qaeda aligned Somali Shabaab militants, took place on the road to the town of Bodhei near the Boni Forest, which the Islamists use as a refuge.   The use of homemade explosives against police and army patrols in the border areas of northern and eastern Kenya near Somalia is relatively common.   The Shabaab claimed to have killed 11 soldiers in Lamu County as well as a Somali soldier in Lower Shabelle, the SITE Intelligence Group, monitoring the Shahada News Agency, said in an email.   The organisation has claimed several such attacks in the past, in which dozens of Kenyan policemen and soldiers have died.

The Shabaab has been fighting to overthrow the internationally-backed government in Mogadishu for over a decade.   They were expelled from the Somali capital in 2011 and lost most of their strongholds, but they still control large rural areas from where they carry out guerrilla operations and suicide bombings, including in Mogadishu.   Wednesday's blast came a day after the 20th anniversary of the attacks against the US embassies in Nairobi and Dar es Salaam in 1998, which killed 224 people and marked the emergence of Al-Qaeda on the international stage.
Date: Sun 5 Aug 2018, 00:00
Source: Standard Media (Kenya) [summ. ProMED Mod.AS, edited]

The county government plans to vaccinate at least 70,000 cattle against Rift Valley fever [RVF] in Baringo South Constituency. The disease has so far killed over 500 livestock, mostly goats and sheep, at Kiserian in the past 2 months. This has left many families that rely on livestock without a source of livelihood.

Baringo South veterinary officer Julius Cheruiyot yesterday [Sat 4 Aug 2018] said vaccination was started after samples taken to government laboratories were positive for Rift Valley fever (RVF). "We have started a vector control programme [...] to prevent its further spread," said Dr Cheruiyot.

Before RVF was diagnosed livestock were being treated for blue [tongue] disease. However, the high number of abortions, especially in goats and sheep, raised the alarm, prompting testing for RVF.

Cheruiyot said veterinary officers were working with local administrators to educate residents about the disease. He warned against consuming meat from uninspected carcasses. "Dead animals should be buried," he said. Livestock get infected by RVF through mosquitoes that breed higher during heavy rains.  [byline: Mercy Kahenda]
==========================
[The above media report is somewhat confusing. While Baringo South Constituency is one of 6 constituencies in Baringo County, one of Kenya's 47 counties, Kiserian is a settlement in another county, Kajiado county. Both counties, Baringo and Kajiado, are located in the former Rift Valley Province.

The information may be interpreted as follows: while heavy losses are said to have been caused by RVF in the Kajiado county, mass preventive vaccinations are planned to be applied in the Baringo South Constituency, probably not (yet) affected by the disease. Confirmation or otherwise would be welcomed.

The total number of reported RVF outbreaks in Kenya's animals since the start of the event (3 Jun 2018) is 10, according to the 6 official reports submitted so far to the OIE. The most recent follow-up report was submitted on 6 Aug 2018, informing absence of new outbreaks (since 2 Jul 2018). The outbreaks were reported from the following counties (number of outbreaks in brackets): Mandera (1), Wajir (2), Marsabit (1), Isiolo (2), Meru (1), Baringo (1), Tara River (1), and Siaya (1).

Links to all reports and a map presenting their locations is available at
<http://www.oie.int/wahis_2/public/wahid.php/Reviewreport/Review/viewsummary?fupser=&dothis=&reportid=26827>.

The above list might be subject to updates/modifications. In contrast with the media report above, Kajiado county is not included among the counties officially reported as infected. For Kenya's counties map, see <https://en.wikipedia.org/wiki/Counties_of_Kenya>.

The media report also highlights a diagnostic challenge. The simultaneous circulation of other animal diseases, such as bluetongue in sheep, deserves to be considered. Bluetongue, endemic throughout Africa, is a seasonal vectorborne disease, clinically seriously affecting mainly sheep of exotic breeds (most cases in goats and cattle are subclinical). Bluetongue is not zoonotic.

Other abortifacient infectious agents, including zoonotic ones such as brucellosis, chlamydiasis, toxoplasmosis, Q fever and salmonellosis, deserve to be excluded as well. The striking difference between them and RVF is the higher mortality rates in the latter, particularly in offspring, and the acute, influenza-like disease in man. - ProMED Mod.AS]

[HealthMap/ProMED map available at:
Date: Sat 21 Jul 2018
Source: Precision Vaccinations [edited]

If you are traveling to Kenya, which is located on the central-east coast of Africa the Centers for Disease Control and Prevention (CDC) have issued a Level 1 Alert regarding an ongoing Rift Valley fever outbreak.

The Ministry of Health (MoH) for Kenya confirmed on Wed 4 Jul 2018, a total of 94 human cases of Rift Valley fever (RVF) have been reported from Wajir (82) and Marsabit (11) counties, including 10 fatalities. This is a case fatality ratio of 11 percent. [There is also one case in Siaya county, which brings the total to 94. - ProMED Mod.TY]

Rift Valley fever is an illness that is primarily spread by direct contact with blood, fluids, or tissues of infected animals such as cattle, buffalo, sheep, goats, and camels.  Less commonly, it can also be spread through mosquito bites.

According to the CDC, if think you may have RVF while traveling, see a doctor and do not take pain relievers that contain aspirin or ibuprofen, which may lead to a greater tendency to bleed.

Additionally, the CDC says if you are traveling to Kenya, you should be up to date on routine vaccinations. These vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine, yearly flu shot, as well as a Hepatitis A vaccine. CDC recommends this vaccine because you can get hepatitis A through contaminated food or water in Kenya, regardless of where you are eating or staying.

Typhoid is another vaccine that travelers should consider. Typhoid is contracted through contaminated food or water in Kenya. CDC recommends this vaccine for most travelers, especially if you are staying with friends or relatives, visiting smaller cities or rural areas, or if you are an adventurous eater.

Moreover, Yellow fever virus is a risk in certain parts of Kenya. Which means, the CDC recommends the yellow fever vaccine for travellers 9 months of age or older to these areas.

And the government of Kenya requires proof of yellow fever vaccination if you are traveling from a country with risk of yellow fever, which does not include the USA.

For a complete list, see countries with risk of yellow fever virus (YFV) transmission.

If you need to be vaccinated before your trip, you may need to travel some distance since Yellow fever vaccine availability in the USA is currently limited.

To schedule a travel vaccination appointment, please visit Vax-Before-Travel.

The CDC Vaccine Price List provides private sector vaccine prices for general information.

Vaccines, like any medicine, can have side effects, says the CDC. You are encouraged to report negative side effects of vaccines to the FDA or CDC.  [Byline: Don Ward Hackett]
=======================
[A [Thu 12 Jul 2018] report from Doctors Without Borders (MDF) indicated that more than 10 people [how many more? - Mod.TY] have died following an outbreak of Rift Valley fever [RVF] in Kenya although the above report, apparently based on Kenya Ministry of Health statistics, indicate 10 deaths. The more than 120 cases reported countrywide by MSF is more than the 94 cases indicated above but may include unconfirmed, suspected cases.

In a previous ProMED-mail post, Mod.AS pointed out that, so far, the virus has been shown to cause cases in domestic animals in 7 out of Kenya's 47 counties. In addition to the 6 above, the following counties have been recognized as currently at high risk for RVF: Tana River, Tharaka Nithi, Garissa, Lamu, Baringo, Mombasa, and Nairobi. Obviously, preventive measures, including mass vaccination of susceptible animal species, are urgently required in the counties above and by others at-risk who are not yet infected (see ProMED-mail archive Rift Valley fever - Eastern Africa (10): Kenya, WHO, livestock vaccination http://promedmail.org/post/20180704.5886934).

The prolonged rains mentioned in earlier reports have doubtless provided breeding sites for RVF virus vector mosquitoes. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Tue 17 Jul 2018
Source: PML Daily [edited]

Residents of Ibanda and Isingiro are on high alert after 3 cases of Rift Valley fever were reported in the 2 districts. The cases were discovered by doctors at Mbarara Regional Referral Hospital (MRRH) after one patient from Isingiro died at the facility and 2 others presented symptoms of the viral disease that affects animals as well as humans who meat from the dead animals.

"In the past 2 weeks, we have received 3 patients from Ibanda and Isingiro. Initially they were presenting normal medical conditions of fever and headache but when they started bleeding we had to investigate further and that's when we confirmed it was Rift Valley fever," Dr Rose Muhindo, the head of medical ward at MRRH, told journalists on [Mon 16 Jul 2018]. Dr Muhindo said one patient is from Nakivale Refugee Settlement in Isingiro and another is from Ibanda and that they are responding to treatment.

The executive director MRRH, Dr Celestine Barigye, said: "I challenge the public to stop eating meat from dead animals, let them be buried because sickness from these animals are so serious and kill human beings too."

In January [2018], the Ministry of Health confirmed sporadic outbreaks of Crimean-Congo hemorrhagic fever (CCHF) and Rift Valley fever (RVF) in Kiboga, Buikwe and Mityana districts. [The minister] Dr [Jane] Aceng said a team of experts had been dispatched to tackle the outbreaks, and spraying of ticks and biting insects, some of the key transmitters of the fevers, had started in the cattle corridor of Nakaseke, Sembabule, Kyegegwa, Lyantonde, Mubende, and Gomba districts.

Rift Valley fever (RVF) is a viral zoonosis that primarily affects animals but also has the capacity to infect humans. Infection can cause severe disease in both animals and humans. The disease also results in significant economic losses due to death and abortion among RVF-infected livestock. Outbreaks of RVF in animals can be prevented by a sustained programme of animal vaccination.  [byline: Conrad Ahabwe]
=========================
[Of the 3 above cases, 2 may have been included in the ProMED-mail post of a [Fri 6 Jul 2018] WHO report (see: Rift Valley fever - Eastern Africa (13): Uganda, WHO http://promedmail.org/post/20180711.5898523). Although people can become infected through contact with sick animals or their tissues and secretions, Rift Valley fever virus can also be transmitted by mosquitoes. As noted in the previous post, a [Sun 24 Jun 2018] report from a meeting of 11th meeting of the Sectoral Council on Agriculture and Food Security (SCAFS) that just concluded in Dar es Salaam, has directed the East African Community (EAC) secretariat to address the issue of Rift Valley fever promptly. It stated that this year's [2018] heavy rainfall has resulted in widespread flooding in low-lying grasslands. Flooding and standing water enabled a higher number of mosquito eggs than usual to hatch and thus increased the potential for RVF to spread among people and animals.

The RVF virus is endemic in the EAC region and has caused repeated outbreaks in the past. It affects primarily ruminant livestock, such as cattle, sheep, goats, and camels and also wildlife such as buffalos. In these animals, it causes abortions and deaths and significant economic loss.

The RVF virus can also affect humans. Most infections are mild, but some people fall severely ill and even die, with symptoms such as fever, weakness, and bleeding from gums and mouth. The majority of human infections result from direct or indirect contact with the blood, body fluids, or tissues of infected animals. This can happen during slaughtering or butchering, while assisting with animal births, treating the animals, and from contact with disposed carcasses or fetuses. - ProMED Mod.TY]
[HealthMap/ProMED maps available at:
Ibanda District, Uganda: <http://healthmap.org/promed/p/24890>
Isingiro District, Uganda: <http://healthmap.org/promed/p/3008>]
More ...

World Travel News Headlines

Date: Thu, 15 Nov 2018 04:25:14 +0100
By Javier TOVAR

Paradise, United States, Nov 15, 2018 (AFP) - The toll in the deadliest wildfires in recent California history climbed to 59 on Wednesday as authorities released a list of 130 people still missing.   Most of those unaccounted for are from the Butte County town of Paradise, in northern California, which was virtually erased from the map by the so-called "Camp Fire" blaze that erupted last week.   Butte County Sheriff Kory Honea told journalists Wednesday evening that 461 search and rescue personnel and 22 cadaver dogs were involved in the effort to locate those missing and DNA testing was being expedited to identify the victims.

"Beginning Thursday, anyone who believes a family member perished can provide a DNA sample" to the sheriff's office, Honea said.    Paradise, a town of around 26,000 in the foothills of the Sierra Nevada mountains, was popular with retirees and many of those reported missing by the sheriff's office are elderly -- in their 70s, 80s and 90s.

Virtually every home in Paradise, located 80 miles (130 kilometers) north of the state capital Sacramento, was destroyed by the fast-moving fire fueled by high winds.   At least 59 deaths have been reported so far from the devastating wildfires and body recovery teams were going house-to-house with cadaver dogs in Paradise on Wednesday.   "We are in the midst of a catastrophe," Governor Jerry Brown told a press conference. "The fire was unprecedented, overwhelming, so a lot of people got caught."

Brock Long, head of the Federal Emergency Management Agency (FEMA), said Paradise was looking at a "total rebuild" with many homes, businesses and infrastructure destroyed.   "This is going to be a very long and frustrating event for the citizens of Paradise," Long said. "We're going to have to find a new normal."   "You're not going to be able to rebuild Paradise the way it was."   An AFP reporter in Paradise on Wednesday saw crews removing trees, repairing fences along roads and towing away cars.    Authorities said livestock owners were being allowed in to restricted areas for brief periods to feed the animals but it was unclear when residents would be allowed back in.

- Tales of courage, survival -
Fifty-six deaths have been reported from the "Camp Fire," mostly in Paradise, while three people have died in the "Woolsey Fire."   Honea said that of the 56 human remains found in his county, 47 had been identified.   While the cause of the "Camp Fire" is still under investigation, a lawsuit has been filed against the local power company, PG&E, by fire victims claiming negligence by the utility.

The complaint alleged that the fire began on November 8 when a high voltage transmission line failed, igniting a vegetation fire.   As thousands of firefighters fought the fires, incredible tales have emerged of courage and survival.   A man who asked to be identified by only his first name, Scott, told the San Francisco Chronicle that when the "Camp Fire" surrounded his home in Concow in Butte County he and his family plunged into a reservoir along with a 90-year-old neighbor, Bruno.   "Bruno was saying, 'Just leave me. I can't do this,'" Scott, 51, told the newspaper. "I said, 'Bruno, we're not going to leave you. And I'm not going to burn, so you better hurry.'"   They remained in the cold water as flames licked the shore and made their way to a small island in the reservoir after finding a pair of rowboats.

- 'I was terrified' -
Allyn Pierce, a nurse in Paradise, told The New York Times and CNN how his life was saved by a bulldozer driver as he fled the town in his pickup truck along with other residents on Thursday.   Pierce said cars were catching fire around him and he dictated a goodbye message to his family, expecting his vehicle to catch fire next.   "I stayed calm but I was terrified," Pierce said.   "Then all of a sudden this bulldozer comes out of nowhere and knocks this burning truck out of the way," he said.   Instead of fleeing to safety, however, Pierce turned around and went back to the Adventist Health Feather River Hospital, where he works as an intensive care nurse, and helped evacuate patients to the hospital's helipad.   Pierce displayed pictures of his Toyota pickup truck which he said was still working despite lights which had melted and a rear passenger door which had been welded shut by the heat from the fire.

The "Camp Fire" has ravaged 135,000 acres (54,632 hectares) of land and is 35 percent contained, according to Cal Fire.   It has destroyed some 7,600 homes and 260 commercial properties. Battling the blaze are more than 5,600 fire personnel, some from as far away as Washington state and Texas.   The "Woolsey Fire" has razed 97,620 acres (39,505 hectares) and has been 47 percent contained.    Cal Fire said more than 3,500 fire personnel were battling the "Woolsey Fire," which has destroyed the Malibu homes of several celebrities including Miley Cyrus, Neil Young, Robin Thicke, Shannen Doherty and Gerard Butler.
Date: Wed, 14 Nov 2018 18:14:50 +0100

Kinshasa, Nov 14, 2018 (AFP) - A cholera epidemic in the Democratic Republic of Congo has claimed 857 lives since the start of the year, the World Health Organization (WHO) said Wednesday.   Health authorities have so far recorded 25,170 cases, occurring in 21 out of the country's 26 provinces, the WHO's office in the DRC said.

The provinces of East Kasai and Lomami, in the centre of the country, and South Kivu, Tanganyika and Upper Katanga in the east, are those most affected.   Last year, the country had 55,000 cases of cholera, resulting in 1,190 fatalities.   Cholera is a highly contagious bacterial infection, which can kill within hours if left untreated. It thrives in conditions of poor sanitation and contaminated water or food.    The DRC is also battling an outbreak of Ebola in two eastern provinces, North Kivu and Ituri, that has killed 212 people since August.
Date: Wed, 14 Nov 2018 18:00:49 +0100

Madrid, Nov 14, 2018 (AFP) - The Spanish government declared war on alternative medicine like acupuncture or homeopathy Wednesday, announcing it plans to eliminate from health centres what it considers a health risk.   The plan, unveiled by the science and health ministers, aims to avoid the "potential harmful effects" of these practices "when they are used as an alternative or a complement to treatment" which itself is based on "proof and scientific rigour," the government said in a statement.   It did not detail what it included as alternative medicine, but gave the examples of acupuncture and homeopathy.   "Many people still believe that some treatments work despite there being no scientific proof available," it read.   According to a 2016 poll, "59.8 percent believe that acupuncture is of therapeutic use and 52.7 percent think that homeopathic products work," the plan read.

The government said it wants to "eliminate" alternative medicine from health centres where all treatment must be given by "recognised" professionals.   The plan also wants to avoid alternative medicine being taught in Spanish universities by developing alliances with deans, chancellors or Spanish regional authorities to not give out diplomas linked to these practices.   Madrid also wants to modify legislation to fight "false advertising" with regard to alternative medicine online.   The issue has taken centre stage in Spain recently, with health and science professionals pressuring the health ministry to take action after several high-profile deaths.

One such case, as reported by Spain's Association to Protect Patients against Pseudo-scientific Therapies, involved 21-year-old Mario Rodriguez who died after dropping his hospital treatment for leukemia in favour of a supposed naturopath who said he could cure cancer with vitamins.   "Dad, I made a mistake," his father Julian Rodriguez quoted him as saying on his deathbed.   The association has a long list of treatment it considers alternative medicine, which includes aromatherapy, acupuncture -- in use in China for centuries -- and even psychoanalysis as created by Sigmund Freud.
Date: Mon 12 Nov 2018, 9.54 AM EST
Source: The Guardian [edited]

A Briton has died after contracting rabies while visiting Morocco, public health officials have said. The UK resident was infected with the disease after being bitten by a cat, Public Health England (PHE) said on [Mon 12 Nov 2018]. PHE did not release any further details but reassured the public there was no wider risk. It said health workers and close contacts of the deceased were being assessed and offered vaccination where necessary.

Jimmy Whitworth, the professor of international public health at the London School of Hygiene and Tropical Medicine, told the Press Association: "My understanding is that this is somebody who had contact with a cat that was behaving abnormally and sought care, I believe in Morocco and in the UK, but unfortunately didn't receive vaccination until it was too late. I believe that the cat bit this person a few weeks ago."

He said that symptoms typically took 2 to 3 months to appear but could materialise in as little as a week. "That's why seeking prompt care and getting vaccination is so important," he said. "In this tragic case the person didn't get the vaccine in time." Given the lack of information, Whitworth said it was impossible to know whether the delay was in the UK or Morocco but it illustrated the importance of health workers being aware of the possibility of the disease.

There are no documented instances of direct human to human transmission of rabies. The disease does not circulate in either wild or domestic animals in the UK, although some species of bats can carry a rabies-like virus.

[Rabies] is common elsewhere, including in parts of Asia and Africa. PHE said the case was a reminder to travellers to rabies-affected countries to avoid contact with dogs, cats and other animals wherever possible, and seek advice about the need for a rabies vaccine prior to travel.

Dr Mary Ramsay, the head of immunisations at PHE, said: "This is an important reminder of the precautions people should take when travelling to countries where rabies is present. If you are bitten, scratched or licked by an animal you must wash the wound or site of exposure with plenty of soap and water and seek medical advice without delay."

It is only the 6th case of human rabies in the UK since 2000, all but one caused by animal exposure overseas. The last was in 2012, when a woman in her 50s died in London after being bitten by a dog in South Asia. She was reportedly turned away twice by doctors at a hospital in Kent before she was finally diagnosed.  [byline: Haroon Siddique]
======================
[According to another media source, the victim, a 58 year old man from Aylesbury Bucks, was staying 30 miles away from the Moroccan capital Rabat, visiting family, when he was infected with the disease. He did receive treatment but allegedly was not given anti-rabies serum in time;  <https://www.dailymail.co.uk/news/article-6382379/PICTURED-British-father-two-died-rabies-UK.html>.

The following statistics on rabies in animals were submitted by
Morocco for 2016 (last available annual report):
Official vaccinations in dogs: 71 759
Rabies outbreaks: 76

species / cases / deaths / killed
dogs / 41 / 28 / 13
cats / 12 / 11 / 1
bovine / 71/ 62 / 9
equine / 44/ 38/ 6
ovine / 6 / 5 / 1

The numbers of human cases, as reported to the OIE for the years 2010-2015, were 19, 18, 19, 24, 20, and 19, respectively. The number of human cases during 2016 (the most recent available data) was 17.

The tourism industry is well developed in Morocco; in 2017, Morocco was Africa's top tourist destination, with 10.3 million tourist arrivals, most of them from Europe, predominantly France and Spain. In the past, cases of rabies in animals illegally introduced from Morocco with returning visitors were recorded in France

The event is being investigated. - ProMED Mod.AS]

[HealthMap/ProMED maps available at:
England, United Kingdom: <http://healthmap.org/promed/p/279>
Date: Tue 13 Nov 2018
Source: BC Centre for Disease Control [edited]

The BC [British Columbia] Centre for Disease Control (BCCDC) is alerting British Columbians to discard or return to the place of purchase any Little Qualicum Cheeseworks' Qualicum Spice cheese that they currently have at home. Products in the marketplace have a best before date up to and including 24 Apr 2019.

A total of 5 people in BC have been affected by an _Escherichia coli_ outbreak between August and October 2018. Qualicum Spice cheese samples were tested and found to be contaminated with _E. coli_. The investigation is ongoing to determine the source and extent of contamination.

Qualicum Spice is an unpasteurized cheese. It is distributed throughout BC and sold in grocery stores, farmers' markets, wineries, restaurants, and at the Little Qualicum Cheeseworks farmgate store. Little Qualicum Cheeseworks has voluntarily recalled the affected product. Little Qualicum Cheeseworks produces several other types of dairy products. No other products are being recalled at this time and consumers do not need to discard them.

People who become ill from _E. coli_ can have a wide range of symptoms. Some may have no symptoms and some may become seriously ill and be hospitalized. The following symptoms can appear within 1 to 10 days after infection:
- severe stomach cramps;
- diarrhea or bloody diarrhoea;
- vomiting;
- headache; and
- little or no fever

If you have eaten this product but have no symptoms, there is no need to do anything. If you become ill after consuming this cheese:
- practice good hand washing with warm water and soap to prevent the spread of illness;
- drink lots of clear fluids to stay hydrated;
- anyone who has bloody diarrhea or is concerned about their symptoms should see a health care provider or call HealthLinkBC at 811;
- antibiotics and anti-diarrhoea medications should not be used to treat this infection unless prescribed by your health care provider.
====================
[Although not specifically stated, the link to unpasteurized cheese and the description of the symptoms make it clear that the pathogen here is a member of the enterohemorrhagic _E coli_ pathotype.

Unpasteurized dairy products remain a potential risk for a variety of pathogens including enterohemorrhagic _E. coli_, either the prototypic serotype or one of the other serotypes. In analyzing the genetic and phenotypic profiles of non-O157 groups of EHEC [enterohemorrhagic _E. coli_], it has been found that they belong to their own lineages and have unique profiles of virulence traits different from the prototypic O157 strain (1). The serogroups appearing to be most prominent are O26, O111, O128, and O103 (2). As noted in the post, suspected cases of EHEC should not be treated with antimicrobials.

The following was extracted from Lutwick LI. Enterohemorrhagic _E. coli_ infections. In: Confronting emerging zoonoses: the One Health paradigm. Yamada A, Kahn LH, Kaplan B, Monath TP, Woodall J, Conti LA (editors). Tokyo, Japan: Springer, 2014, 77-112:

Risk factors for the subsequent development of HUS after EHEC include children less than 10 years of age, elevated white blood cell counts, persistent low platelet counts without reversal and the use of either antimicrobial agents or antimotility agents during the diarrhea stage before or after bloody diarrhea develops. Since fever is generally not part of the presentation but significant abdominal pain is, patients with diarrhea, significant abdominal pain and no fever should be considered to have EHEC infection, and antimicrobial or antimotility agents should be avoided. Additionally, certain strains -- for example, the so-called clade 8 and the chimeric organism _E. coli_ O104:H4 -- can be associated with a higher risk of HUS.

HUS itself is a thrombotic illness primarily caused by the effects of the EHEC produced Shiga toxin acting on the vascular endometrium of organs where the toxin's receptors are expressed, particularly the kidney and brain. The syndrome consists of the combination of prominent low platelet counts (thrombocytopenia), intravascular red blood cell destruction (hemolysis) and diminished kidney function that can require hemodialysis. Neurological involvement occurs mostly in those who develop renal failure and the central nervous system involvement portends much higher mortality. Indeed, most of the acute mortality relates to neurological disease. Most patients will recover, but some, perhaps 10 percent, remain with renal failure and require chronic hemodialysis.

References
----------
1. Schmidt H, Geitz C, Tarr PI, et al. Non-O157:H7 pathogenic Shiga-toxin producing _Escherichia coli_: phenotypic and genetic profiling of virulence traits and evidence for clonality. J Infect Dis. 1999; 179(1): 115-23; available at <https://academic.oup.com/jid/article/179/1/115/877122>.
2. Bettelheim KA. Role of non-O157 VTEC. Symp Ser Soc Appl Microbiol. 2000; (29): 38S-50S; abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/10880178>. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
British Columbia Province, Canada:
Date: Sun 4 Nov 2018
Source: Nigeria Center for Disease Control (NCDC) [edited]

Highlights
===========================
- In the reporting week 44 (29 Oct-4 Nov 2018) 5 new confirmed cases were reported from Edo (3), Ondo (1) and Ebonyi (1) state with 2 new deaths in Edo (1) and Ebonyi (1).
- From 1 Jan-4 Nov 2018, a total of 2950 suspected cases have been reported from 22 states. Of these, 553 were confirmed positive, 17 probable, 2380 negative (not a case).
- Since the onset of the 2018 outbreak, there have been 143 deaths in confirmed cases and 17 in probable cases. Case fatality rate (CFR) in confirmed cases is 25.9%.
- 22 states have recorded at least one confirmed case across 90 Local Government Areas (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo, Plateau, Lagos, Taraba, Delta, Osun, Rivers, FCT, Gombe, Ekiti, Kaduna, Abia, Adamawa and Enugu); 18 states have exited the active phase of the outbreak while 4; Edo, Ondo, Ebonyi and Delta states, remain active - figure 1 [see source URL above].
- In the reporting week 44 (29 Oct-4 Nov 2018), one new health care worker was affected; 42 health care workers have been affected since the onset of the outbreak in 7 states - Ebonyi (16), Edo (15), Ondo (6), Kogi (2), Nasarawa (1), Taraba (1) and Abia (1) with 10 deaths in Ebonyi (5), Kogi (1), Abia (1), Ondo (2) and Edo (1).
- 82% of all confirmed cases are from Edo (46%), Ondo (23%) and Ebonyi (13%) states.
- 10 patients are currently being managed at Irrua Specialist Teaching Hospital (ISTH) treatment Centre (4), Federal Medical Centre (FMC) Owo (4), and Federal Teaching Hospital Abakiliki (2).
- A total of 8587 contacts have been identified from 22 states. Of these 512 (6%) are currently being followed up, 7946 (92.5%) have completed 21 days follow up while 15 (0.2%) were lost to follow up. 114 (1.3%) symptomatic contacts have been identified, of which 36 (0.4%) have tested positive from 5 states (Edo - 20, Ondo - 8, Ebonyi - 3, Kogi - 3, Bauchi - 1 and Adamawa - 1).
- National RRT team (NCDC staff and NFELTP [Nigeria Field Epidemiology and Laboratory Training Program] residents) deployed Ondo state to support response.
- Lassa fever international Conference registration, abstract submission and travel scholarship now open to the public on the conference website <www.lic.ncdc.gov.ng> with the date for abstract submission extended to the 14 Nov 2018.
- Lassa fever national multi-partner, multi-agency Technical Working Group (TWG) continues to coordinate response activities at all levels

Figure 1 [map]: Distribution of confirmed Lassa fever cases in Nigeria as at 4 Nov 2018.
Figure 2 [map]: Distribution of suspected and confirmed Lassa fever cases in Nigeria by LGA.
Figure 3 [graph]: Epicurve of Lassa fever confirmed (548) and probable (17) cases in Nigeria week 1-44, 2018.
Figure 4 [graph]: Weekly trends of Lassa fever confirmed cases in Nigeria, 2016-2018, week 44.
Figure 5 [graph]: Confirmed Lassa fever cases in Nigeria with state-specific case fatality rates (CFR) as at 4 Oct 2018.
=======================
[Although the graphs in the above report clearly show that the Lassa fever virus transmission peak has passed, the 5 new confirmed cases and 2 new deaths indicate that Lassa fever virus transmission continues, and a few more cases might occur. Unfortunately, one health care worker was infected during this reporting period. This outbreak has been widespread, occurring in 22 states and 90 local government areas. It would be interesting to know whether the prevalence of Lassa fever virus has been increasing in populations of rodent hosts in this area.

Images of the rodent reservoirs of Lassa fever virus can be seen as follows:
For _Mastomys natalensis_, see
For _M. erythroleucus_ and _Hylomycus pamfi_, see

The maps and graphs in the report above are interesting and provide a good picture of how the outbreak has progressed over time. They can be accessed at the source URL above.

Maps of Nigeria:
Date: Mon 12 Nov 2018
Source: OIE, WAHIS (World Animal Health Information System), weekly
disease information 2018; 31(46) [edited]

Anthrax, Namibia
----------------
Information received on [and dated] 12 Nov 2018 from Dr Adrianatus Florentius Maseke, chief veterinary officer, Veterinary Services, Ministry of Agriculture, Water and Forestry, Windhoek, Namibia

Summary
Report type: immediate notification
Date of start of the event: 25 Oct 2018
Date of confirmation of the event: 1 Nov 2018
Reason for notification: recurrence of a listed disease
Date of previous occurrence: 13 Feb 2018
Manifestation of disease: clinical disease
Causal agent: _Bacillus anthracis_
Nature of diagnosis: clinical, laboratory (basic)
This event pertains to a defined zone within the country

New outbreaks (3)
Outbreak 1: Omiriu, Opuwo, Sesfontein, Kunene
Date of start of the outbreak: 25 Oct 2018
Outbreak status: continuing (or date resolved not provided)
Epidemiological unit: village
Affected animals
Species / Susceptible / Cases / Deaths / Killed and disposed of / Slaughtered
Goats / 537 / 25 / 23 / 2 / -
===================
[The location of the outbreaks can be seen on the interactive map included in the OIE report at the source URL above. Kunene is in north west Namibia, and Kavango East is between Angola & Botswana in the north east.
========================
[Remember it is summer in the southern hemisphere, which means that it is now their anthrax season. Livestock anthrax is sporadic in Namibia but a constant concern in their national parks. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map of Namibia:
Date: Tue, 13 Nov 2018 20:01:56 +0100

Tampa, Nov 13, 2018 (AFP) - Puzzled by a rise in US children with sudden paralysis in their arms or legs, health officials said Tuesday they are probing whether a virus or auto-immune disorder may be to blame.   A total of 252 cases of the disorder known as acute flaccid myelitis (AFM) are currently under investigation nationwide, an increase of 33 since last week, said Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the US Centers for Disease Control and Prevention (CDC).

With 80 confirmed cases so far this year, 2018 looks to be on pace with prior peak years like 2014 (120 cases) and 2016 (149 cases), Messonnier said.    More than 400 cases have been confirmed through lab tests since 2014, the first year the syndrome emerged.   A couple dozen cases were confirmed in 2015 and 2017.   Messonnier said she understands parents' alarm but stressed that the disorder remains "rare."   Most cases involve children aged two to eight. Almost all complained of fever and respiratory illness three to 10 days before suddenly experiencing paralysis in their arms or legs.   For some, the paralysis went away, but at least half have not recovered, said Messonnier.

The CDC has tested 125 spinal cord fluid samples, and half were positive for rhinovirus or enterovirus, which commonly cause symptoms like fever, runny nose, vomiting, diarrhea and body aches.    Yet scientists are still stumped about the precise cause of the sudden paralysis, since these viruses are common but AFM is not.   "We are trying to figure out what the triggers are that would cause someone to develop AFM," Messonnier told reporters.   "It may be one of the viruses we have already detected. It may be a virus that we haven't yet detected. Or it could be that the virus is kicking off another process that is actually triggering -- through an auto immune process -- AFM," she said.    "CDC is a science-driven agency. Right now, the science doesn't give us an answer."

Perhaps most frustrating for parents, there is no way to prevent it, and no targeted therapies or interventions.   "Parents and caregivers are urged to seek immediate medical care for a child who develops sudden weakness of the arms or legs," said the CDC latest report on AFM, released Tuesday.    Messonnier said the CDC has not been tracking every case of AFM since 2014, leading to gaps in the federal agency's knowledge of the illness, which experts are now trying to fill.   One child with AFM is reported to have died in 2017.
Date: Mon, 12 Nov 2018 15:54:12 +0100

London, United Kingdom, Nov 12, 2018 (AFP) - A Briton has died after being bitten by a cat with rabies in Morocco, officials said Monday, only the seventh known case in the United Kingdom since 2000.   England's health service issued a reminder Monday for travellers to avoid coming into contact with animals when travelling to rabies affected countries, particularly those in Asia and Africa.

Rabies has been effectively eradicated in Britain, although they do still spread among some bats.   "There is no risk to the wider public in relation to this case but, as a precautionary measure, health workers and close contacts are being assessed and offered vaccination when necessary," said Mary Ramsay, the health service's chief of immunisation.   The Press Association news agency said the person was bitten a few weeks ago and not given potentially life-saving treatment early enough.

Rabies is a viral disease that causes an inflammation of the brain. It is usually fatal by the time the first symptoms emerge.   England's health service said that no cases of humans acquiring the disease from any animal other than a bat have been recorded within the country since 1902.   One person acquired it from a bat in Scotland in 2002, and five people contacted while travelling between 2002 and 2017, the health service said.
Date: Tue, 13 Nov 2018 07:02:37 +0100

Hanoi, Nov 13, 2018 (AFP) - Vietnam's newest carrier Bamboo Airways has been granted a licence to fly, officials and the airline said, paving the way for its inaugural flight in a region crowded with competitors.    Run by one of the country's richest men, Bamboo will compete with well-established heavy hitters such as national carrier Vietnam Airlines and budget carrier Vietjet to serve a mushrooming middle class with growing appetites, and budgets, for travel.    Vietnam's Transport Ministry said Bamboo's official aviation license had been approved and that it would aim to operate 100 routes, including to lesser-travelled destinations in Vietnam and elsewhere in Asia, with plans to eventually fly to North America.   "The first domestic flights... are aimed at reducing pressure on aviation infrastructure in major cities, strengthening regional links (and) promoting tourism to Vietnam," the Transport Ministry said in a statement Tuesday.

The airline is owned by Trinh Van Quyet, who heads the FLC property empire that includes lush beachside resorts, golf clubs and luxury condos across Vietnam, a country still under one-party communist rule.   Bamboo has already signed up to buy 20 of Boeing's 787 Dreamliners worth $5.6 billion and committed a further $3.2 billion to buy 24 Airbus A321neo planes.    The airline said its inaugural flight, originally scheduled for last month, should take place before the end of the year.    "We have conducted a flight test, the results show that the aircraft fully meets technical specifications (and is) ready to go into operation," CEO Dang Tat Thang said in a statement.

Bamboo is hoping to steal customers from competitors by luring them to off-the-beaten-path destinations in Vietnam such as Quy Nhon and Thanh Hoa and by offering bundled travel packages to FLC resorts.   But analysts say the outdated model may not work in an era where most travellers can easily tailor holidays online, and wonder whether Bamboo's big bet will pay off in Southeast Asia's busy aviation market.    Quyet told AFP in an interview earlier this year that he is certain the airline "will be huge" and expects to make a profit soon after launch.   Born to a poor rural family near Hanoi where life among bamboo trees inspired the airline's name, he now runs FLC Group with a market capitalisation of around $200 million.

Vietnam's aviation sector has soared in recent years, with passenger numbers jumping to 62 million last year from 25 million in 2012.   There are already six commercial aviation licenses granted in Vietnam, including for a chartered helicopter service and a seaplane carrier.   Faced with increasingly squeezed airport capacity and tough competition across the region, in particular from budget airlines like AirAsia and TigerAir, the market has shown signs of cooling.    In 2009, Vietnam's first operational private airline Indochina Airlines ceased operation after just one year in the market due to financial troubles.