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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, 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]
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[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]
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[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]
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[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>]
Date: Thu 12 Jul 2018
Source: Doctors Without Borders [edited]

More than 10 people have died following an outbreak of Rift Valley fever [RVF] in Kenya, with more than 120 cases reported countrywide. On [Thu 12 Jun 2018], international medical-humanitarian organisation Medecins Sans Frontieres (MSF) sent a team to Wajir County, the most affected county, to support the Kenyan Ministry of Health (MoH) in containing and managing the disease.

RVF is caused by a virus transmitted by mosquitoes and blood-feeding flies that usually affects animals (commonly cattle, camels, and sheep), but it can also affect humans. In humans, the disease ranges from a mild flu-like illness to severe haemorrhagic fever that can be lethal.

The outbreak was confirmed on [Thu 7 Jun 2018] after 4 patients who had died in Wajir tested positive with the disease. So far, 85 cases, including 3 patients who were readmitted, have been reported in the county, with 6 having died since the beginning of the outbreak.

"We 1st assessed the situation on the ground, then worked together with the Ministry of Health to identify gaps in the response," said Ahmed Garat, MSF's Emergency Field Coordinator leading the response.

The team set up an isolation centre in which patients can be managed at the Wajir County Referral Hospital. So far, 6 patients have been treated at the facility. "MSF will continue monitoring the situation and responding where necessary, and we are hopeful that the situation will improve with better contingencies in place, although RVF tends to be quite unpredictable," adds Garat. MSF is also providing medical supplies to the county to aid in containing the disease.

MSF is working closely with the MoH, training staff on patient management and diagnosis of cases, enhancing their capacity to detect and rapidly respond and contain the outbreak. In a training that involves patients and their caretakers as well, the staff will also be trained on prevention aspects, vector control, and use of mosquito nets.
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[The number of human Rift Valley fever cases continues to slowly increase. Since Fri [11 May 2018], the beginning of the outbreak, a cumulative total of 90 cases and 10 deaths (case fatality rate 11 percent) was reported as of Wed [27 Jun 2018]. The nationwide case count for all of Kenya now stands at more than 120 with more than 10 deaths. The [Fri 29 Jun 2018] WHO summary reported that the most affected age group was 21-30 years, with men making up 70 percent of the ProMED-mail cases. At that time, 3 counties were affected: Wajir (78 cases, 6 deaths), Marsabit (11 cases, 3 deaths), and Siaya (1 case, 1 death) (see ProMED-mail archive Rift Valley fever - Eastern Africa (10): Kenya, WHO, livestock vaccination http://promedmail.org/post/20180704.5886934). Increased surveillance by the Ministry of Health with the collaboration of MSF will be important in case-finding and timely treatment.

In the previous ProMED-mail post, ProMED Mod.AS pointed out that, so far, the virus has been shown as active 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. The loss of hundreds of camels, sheep, and goats is a significant economic and cultural loss for their owners, many of whom depend on these animals for their livelihoods. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
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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.
==============================
[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>]