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Kuwait

Kuwait US Consular Information Sheet
September 2, 2008
COUNTRY DESCRIPTION:
Kuwait is a small, oil-rich constitutional monarchy with 10% of proven world oil reserves. Foreign workers constitute approximately 90% of the labor force. Kuwaiti
citizens constitute only 34% of the country's population of three million, and enjoy the benefits of a generous social welfare system that guarantees employment, housing, education and medical care. Facilities for travelers are widely available. Read the Department of State Background Notes on Kuwait for additional information.

ENTRY/EXIT REQUIREMENTS:
Passports and visas are required for U.S. citizens traveling to Kuwait. U.S. citizens can obtain visitor visas for a fee at the port of entry in Kuwait. Travelers who overstay their visas may be required to pay large fines before leaving Kuwait. Travelers who leave Kuwait without completing Kuwaiti exit procedures may also be required to pay large fines if they return to and attempt to depart from Kuwait. This includes travelers proceeding via Kuwait to and from Iraq and Afghanistan. Effective May 15, 2007, the Government of Kuwait no longer admits travelers with a contractor identification card. All contractors entering or transiting the State of Kuwait should have a valid passport. Visas can be obtained upon arrival in Kuwait for a fee of 3 Kuwaiti Dinar (KD). For further information on entry and exit requirements, travelers may contact the Embassy of Kuwait at 2940 Tilden Street NW, Washington, DC 20008, telephone (202) 966-0702, or the Kuwaiti Consulate in New York City, telephone (212) 973-4318.

Kuwaiti officials are extremely sensitive about travel to Iraq. There have been instances in which Americans, especially those of Iraqi descent, have been detained for questioning at ports of entry/exit. Americans seeking to travel to Iraq through Kuwait have also on occasion been turned around and/or detained. On a number of occasions the border between Iraq and Kuwait has been closed without notice, stranding Americans on either side of the border.

Kuwaitis and non-Kuwaitis, including Americans, who have been charged with criminal offenses, placed under investigation, or involved in unresolved financial disputes with local business partners are subject to travel bans. These bans, which are rigidly enforced, prevent the individual from leaving Kuwait for any reason until the matter is resolved. Travel bans can be initiated by any person for almost any reason and may remain in place for a substantial period of time while the case is being investigated. Expatriates have been detained in Kuwait for cases with seemingly little or no evidence or legal merit. A person who has influence with the Kuwaiti government can ensure that a travel ban remains in place even if a judge or government official states the ban should be lifted. In the case of purely financial disputes, it may be possible to depart the country if a local sponsor pledges funds equal to the amount in dispute. Once such legal orders are in place, the U.S. Embassy can assist American citizens in obtaining legal representation, but cannot overcome the ban on exit from the country until the matter is resolved.

Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
Americans in Kuwait should exercise a high level of security awareness. The Department of State remains concerned about the possibility of further terrorist actions against U.S. citizens and interests abroad, specifically in the Middle East, including the Persian Gulf and Arabian Peninsula. Americans considering travel to Kuwait should review the Worldwide Caution.

All U.S. citizens in Kuwait should exercise caution, maintain a low profile, and avoid areas where Westerners are known to congregate. Heightened security awareness should be exercised at all hotels and residential complexes, as terrorists in the past have specifically targeted hotel chains perceived as Western along with a variety of Western housing facilities. Military members, as well as civilians and contractors related to military interests, are also potential targets.

Terrorists do not distinguish between official and civilian targets. Terrorist actions may include bombings, hijackings, hostage taking, kidnappings and assassinations. Increased security at official U.S. facilities may lead terrorists and their sympathizers to seek softer targets such as public transportation, residential areas and apartment complexes, schools and places of worship, oil-related facilities and personnel, and public areas where people congregate including restaurants, hotels, clubs, and shopping areas. U.S. citizens are advised to immediately report any unusual or suspicious activity in Kuwait to the Kuwaiti police or to the U.S. Embassy.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found. Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The U.S. Embassy in Kuwait has an active warden program and records warden notices in both English and Arabic for audio playback. The English-language notices can be heard by calling +965-259-1048; Arabic-language notices are available at +965-259-1049.

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

Additional information regarding security and crime in Kuwait can be found in the Overseas Security Advisory Council’s Crime and Safety Report.
This document can be found at www.osac.gov.
CRIME: The crime threat in Kuwait is assessed as low. Violent crimes against expatriates are rare, but do occur. The U.S. Embassy advises all U.S. citizens to take the same security precautions in Kuwait that one would practice in the United States or any other large city abroad. Physical and verbal harassment of women are continuing problems. The Kuwaiti police accept crime reports at the police station with jurisdiction where the crime occurred. If filing a crime report, it is advisable that an American citizen be accompanied by a person who speaks Arabic or a local attorney. The Embassy’s List of Attorneys is available on the Embassy web site at http://kuwait.usembassy.gov/attorneys.html. Filing a crime report can take several hours as a police investigator will take the victim’s statement orally while composing his investigative report. In all cases of abuse, the victim must obtain a medical report from a Kuwaiti hospital in order to file a police report.

In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm.

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

The local equivalent of the “911” emergency line in Kuwait is “777” and can be reached 24 hours a day, seven days a week.
The quality and range of services provided by the emergency line are not equivalent to those provided in the U.S. and response times may vary greatly depending on the time of day and the location of the emergency.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: The health care system continues to develop, with many government and private medical facilities available in Kuwait. Medical care at government-run clinics and hospitals is provided at low cost to residents of Kuwait. Private physicians and hospitals charge fees for services, and some do not accept local health insurance. Many hospital and clinic services do not compare to U.S. standards, and staff often have no U.S. experience or training. For information on avian influenza (bird flu), please refer to the Department of State's Avian Influenza Fact Sheet.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

The government of Kuwait has strict regulations regarding certain diseases such as HIV/AIDS and Hepatitis.
Medical examinations are required for all residency applications and any applicants who are found positive for these restricted diseases will be asked to leave the country immediately and will be permanently barred from re-entry.
Please inquire directly with the Embassy of Kuwait at http://www.embassy.org/embassies/kw.html before you travel.
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

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

Driving in Kuwait is hazardous. Although Kuwait has an extensive and modern system of well-lit roads, excessive speeding on both primary and secondary roads, coupled with lax enforcement of traffic regulations and a high density of vehicles (one vehicle for every 2.8 residents), leads to frequent and often fatal accidents. In 2006, the government of Kuwait reported 60410 vehicular accidents with 460 deaths and 9100 serious injuries.
However, these numbers are approximations and the actual numbers are believed to be much higher.
The average age of death was between 21 and 30 years. There are now over one million motor vehicles registered in Kuwait. Incidents of road rage, inattention and distraction on the part of drivers, poor driving skills, and highway brinksmanship are common in Kuwait, and can be unsettling to Western drivers in Kuwait who are accustomed to more rigid adherence to traffic laws.

The government-owned Kuwait Public Transportation Company operates bus services throughout the Kuwait City metropolitan area on 50 different routes, which are widely used by the low-income expatriate labor force. Taxis are available at major hotels and pick up passengers at other locations upon telephonic request. Unaccompanied women should not use taxis after dark. It is now possible to hail taxis on streets. Taxis have meters, but fares are more commonly negotiated.

Visitors can use international driving permits issued by their respective countries within the time limit of their visas; however, the visitor must also have liability insurance. It is illegal to drive in Kuwait without a license and car registration documents. If you are stopped and cannot produce them, you may be taken to a police station and held until they are presented on your behalf.

The Government of Kuwait may provide American citizens with a Kuwaiti driver’s license if their valid American driver’s license is first certified by the American Embassy. This service costs 9 KD and is available from the American Citizens Services Unit of the Consular Section. The Embassy’s certification must be authenticated by the Ministry of Foreign Affairs and the American permit must be translated by an approved translation service. Additional information is available at the Embassy’s Consular Section.

If you are in an accident, Kuwaiti law mandates that you must remain at the scene until the police arrive. The use of front seat belts is mandatory in Kuwait. Driving is on the right side of the road. Speed limits are posted. Making a right turn on a red light is not permitted unless there is a special lane to do so with a yield sign. Parking is not allowed where the curb is painted black and yellow. Digital cameras for registering traffic violations, including speeding, are in use on Kuwaiti roads.

Driving while under the influence of alcohol (possession and consumption of alcohol is illegal in Kuwait) is a serious offense, which may result in fines, imprisonment, and/or deportation. Repeat traffic violations or violations of a serious nature may also result in the deportation of an expatriate offender. When a driver flashes his/her high beams in Kuwait, it is meant as a request to move your car into a slower lane to allow the driver with the flashing beams to proceed ahead.

Kuwait has one of the highest per capita rates of cellular telephone ownership in the world and using a cellular telephone while driving remains legal. Local emergency service organizations may be contacted by dialing 777. Ambulance crews do not respond as quickly as in the United States and do not often include trained paramedics.

Please refer to our Road Safety page for more information. Visit the web site of the Kuwaiti Ministry of Interior at www.moi.gov.kw for information and statistics in Arabic about traffic safety and road conditions in Kuwait.

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

SPECIAL CIRCUMSTANCES:
The workweek in Kuwait is Sunday through Thursday for most businesses, government offices and commercial banks.

Kuwaiti customs authorities may enforce strict regulations concerning temporary importation into or export from Kuwait of items such as firearms, religious materials, pornography, and alcohol. Alcohol, pork products, and pornography are illegal in Kuwait. Travelers with prescription medications should carry them in their original packaging or bottle, as dispensed, and carry a copy of their prescription in case customs authorities question their importation into Kuwait. Kuwaiti customs authorities screen the baggage of all travelers entering Kuwait. It is advisable to contact the Embassy of Kuwait in Washington, D.C. or Kuwait's Consulate in New York for specific information regarding customs requirements.

Photographing government and public buildings, military installations and economic infrastructure, particularly that related to the oil industry, is against the law and can result in arrest, investigation, and prosecution. Also, some traditionally-dressed women find being photographed to be offensive and may complain to the local police. If photographing public scenes or persons, visitors should take care to ask permission beforehand and not to inadvertently cause offense that could lead to an official complaint to the authorities.

Humiliating a person, including a police officer or a public official, is a crime in Kuwait similar to disorderly conduct or harassment in the United States. A person charged with humiliating another is subject to police investigation and possible prosecution. Persons under investigation can be prevented from departing Kuwait. Proselytizing is prohibited for all religions except Islam.

Please see our Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Kuwaiti laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Kuwait are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.

Please see our information on Criminal Penalties.

CHILDREN'S ISSUES: For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Kuwait are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Kuwait. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy in Kuwait is located at Al-Masjid Al-Aqsa Street, Block 6, Plot 14, Bayan, Kuwait. The mailing address is PO Box 77, Safat 13001, Kuwait. The primary telephone numbers are 965-259-1001 or 259-1002. The fax number is 965-259-1438 or 538-0282. The after-hours number is 965-538-2097. Additional information may also be obtained through the Embassy's web site at http://kuwait.usembassy.gov
* * *
This replaces the Country Specific Information for Kuwait dated January 16, 2008 to update the sections on Information for Victims of Crime and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Thu 12 Apr 2018
Source: Arab Times Kuwait English Daily [edited]

Almost 270 cases of scabies disease have been recorded lately in the country. Among them, 200 cases were recorded in Adan Hospital and the remaining 70 were recorded in Jahra Hospital.

The recorded cases are within Ahmadi and Jahra governorates, while it is widespread in Khafji and Hafr Al-Baten areas along Saudi border. This revelation coincided with a series of cases recorded in several regions of Saudi Arabia, especially along the border of Kuwait.

There are growing concerns that the disease could spread massively across the country if not handled properly in accordance with the rules and regulations. This includes providing necessary treatment to the affected people and raising awareness among citizens and expatriates.

According to spokesperson of Ministry of Health Dr. Ahmad Al-Shatti, individual cases within the country cannot be regarded as an epidemic.

He [Dr. Ahmad Al-Shatti] assured that the authority will take necessary steps to wipe out the disease, raise the level of awareness and instruct doctors to treat affected people with authorized medications. Dr Al-Shatti did not rule out the possibility that several cases could be recorded without reaching the level of epidemic, especially since the ministry has enough medicines to deal with the disease.  [Byline: Stephanie McGehee]
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[Just a week ago [week of Sun 1 Apr 2018] ProMED reported a widespread outbreak of Scabies in schools in Mecca, which was not related to the Umrah. This report suggests that at least some cases have links to Saudi Arabia. Further epidemiological mapping is needed. As discussed in our posting the [Fri 6 Apr 2018], scabies is highly contagious and outbreaks are usually seen in cramped conditions with poor hygiene. It is important to treat both patients and close contacts for instance the entire household. Classical treatment with for instance a whole body cream containing a pyrethroid has been replaced by treatment with oral ivermectin.

A map of Kuwait: <http://healthmap.org/promed/p/129>. - ProMED Mod.EP]
Date: Mon, 6 Feb 2017 14:40:12 +0100

Kuwait City, Feb 6, 2017 (AFP) - A fire broke out Monday at a cultural centre in Kuwait that houses the Gulf state's opera house, the fire department said.   The blaze started during maintenance work on the titanium roof, the department said in a statement on Twitter.   It said the fire was put out and caused no injuries.

Parts of the roof were seen to be missing after the blaze but it was unclear if that was the result of the maintenance work or the fire.   The centre was launched in October with a performance at the 2,000-seat opera house by Italian tenor Andrea Bocelli.   The sprawling 214,000-square-metre (2.3 million square feet) centre, located in the heart of the capital Kuwait City, cost $750 million.
Date: Thu 14 Apr 2016
Source: Arab Times [edited]

Assistant Undersecretary for Public Health Affairs at Ministry of Health Dr Majdah Al-Qattan revealed that Kuwait recorded 5 cases of cholera in people who came from Iraq and they have been treated. On the sidelines of the inaugural ceremony of the Scientific Conference on Latest Surgeries for Breast and Kidney Cancers, Dr Al-Qattan affirmed that the precautionary measures taken so far for preventing the spread of cholera in the country are being closely monitored to complement the previous steps.

She said it was decided during that meeting of the GCC [Gulf Cooperation Council] Epidemic Committee last month [March 2016] that the GCC member states must take proactive steps to prevent incursion and spread of cholera, indicating that this is the reason why the Customs officers have been screening travelers from Iraq and other affected countries.

Dr Al-Qattan revealed that the import of food items from these countries has also been banned till further notice. She stressed the ministry's keenness to bring new vaccines for the disease and take all necessary steps in that regard, stating that the Higher Committee on Vaccination follows certain procedures with the concerned companies and storage facilities for approving the import of new vaccines.  [Byline: Marwa Al-Bahrawi]
====================
[A map showing Kuwait and Iraq is available at

The mortality from cholera is related to non-replacement of fluid and electrolytes from the diarrheal illness.

As cited in Lutwick LI, Preis J: Cholera. In: Tropical Pediatrics. Roach RR, Greydanus DE, Patel DR, Homnick DN, Merrick J (eds), 2014, Nova Science Publishers, 2015, oral rehydration therapy can be life-saving in outbreaks of cholera and other forms of diarrhea:

"As reviewed by Richard Guerrant and colleagues (1), it was in 1831 that cholera treatment could be accomplished by intravenous replacement and, although this therapy could produce dramatic improvements, not until 1960 was it 1st recognized that there was no true destruction of the intestinal mucosa, and gastrointestinal rehydration therapy could be effective, and the therapy could dramatically reduce the intravenous needs for rehydration. Indeed, that this rehydration could be just as effective given orally as through an orogastric tube (for example, references 2 and 3) made it possible for oral rehydration therapy (ORT) to be used in rural remote areas and truly impact on the morbidity and mortality of cholera. Indeed, Guerrant (1) highlights the use of oral glucose-salt packets in war-torn Bangladeshi refugees, which reduced the mortality rate from 30 percent to 3.6 percent (4) and quotes sources referring to ORT as "potentially the most important medical advance" of the 20th century. A variety of formulations of ORT exist, generally glucose- or rice powder-based, which contain a variety of micronutrients, especially zinc (5).

The assessment of the degree of volume loss in those with diarrhea to approximate volume and fluid losses can be found in reference 6 below. Those with severe hypovolemia should be initially rehydrated intravenously with a fluid bolus of normal saline or Ringer's lactate solution of 20-30 ml/kg followed by 100 ml/kg in the 1st 4 hours and 100 ml/kg over the next 18 hours with regular reassessment. Those with lesser degrees of hypovolemia can be rehydrated orally with a glucose or rice-derived formula with up to 4 liters in the 1st 4 hours, and those with no hypovolemia can be given ORT after each liquid stool with frequent reevaluation."

References
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1. Guerrant RL, Carneiro-Filho BA, Dillingham RA: Cholera, diarrhea, and oral rehydration therapy: triumph and indictment. Clin Infect Dis 2003; 37: 398-405.
2. Gregorio GV, Gonzales MLM, Dans LF, Martinez EG: Polymer-based oral rehydration solution for treating acute watery diarrhoea. Cochrane Database Syst Rev. 2009; (2): CD006519. doi: 10.1002/14651858.CD006519.pub2.
3. Gore SM, Fontaine O, Pierce NF: Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials. BMJ 1992; 304(6822): 287-91.
4. Mahalanabis D, Choudhuri AB, Bagchi NG, et al: Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med 1973; 132(4): 197-205.
5. Atia AN, Buchman AL: Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol 2009; 104(10): 2596-604.
6. WHO: The treatment of diarrhoea, a manual for physicians and other senior health workers. 4th ed. 2005.

An illustration (supplied by ProMED Mod.JW) of how to make a "home brew" oral rehydration solution can be found at
Date: Mon 23 Nov 2015
Source: Kuwait Times [edited]

Minister of Health Dr Ali Saad Al-Obaidi yesterday [22 Nov 2015] said the incidence of swine flu in Kuwait is nothing to worry about, according to WHO global health estimates, stressing the ministry's keenness to speak frankly with citizens and residents about all similar situations.

Speaking after opening the Haya Abdulrahman Al-Mujil Kidney Center yesterday [22 Nov 2015], Obaidi said the ministry is seeking to apply the strategies and protocols developed by the World Health Organization (WHO) in order to ensure the safety and health of citizens and residents. He explained that swine flu has been widespread since 2009, adding that the number of casualties began to decline after a global fight against the virus. He said the ministry of health is taking all preventive precautions to halt the spread of infection, pointing to the success of the ministry's efforts in dealing with more serious diseases such as Ebola and MERS. The minister said flu vaccinations given in August and November [2015] have reduced much of the incidence of the disease.
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[Excerpted from WHO

Most swine influenza viruses (SIVs) do not cause disease in humans. However, some countries have reported cases of human infection with SIVs. Most of these human infections have been mild and the viruses have not spread further to other people. The H1N1 virus that caused the influenza pandemic in 2009-2010, thought to have originated in swine, is an example of an SIV that was able to spread easily among people and also cause disease.

Because pigs can become infected with influenza viruses from a variety of different hosts (such as birds and humans), they can act as a "mixing vessel," facilitating the reassortment of influenza genes from different viruses and creating a "new" influenza virus. The concern is that such "new" reassortant viruses may be more easily spread from person to person, or may cause more severe disease in humans than the original viruses. WHO and animal health sector partners are working at the human-animal interface to identify and reduce animal health and public health risks within national contexts.

Manifestations of H1N1 influenza are similar to those of seasonal influenza. Patients present with symptoms of acute respiratory illness, including at least 2 of the following: fever, cough, sore throat, body aches, headache, chills and fatigue, diarrhea and vomiting.

There is no evidence that this current set of cases of H1N1, most likely H1N1pdm09, originated with pigs. This influenza strain is now a seasonal flu that spreads from human to human. - ProMed Mod.LK]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu 19 Nov 2015
Source: Gulf News [edited]

Public schools in Kuwait have been put on alert after the discovery of 4 cases of the swine flu [H1N1; probably not truly a swine flu, see below - ProMed Mod.LM] at facilities in the Hawalli and Adeiliya areas, said Minister of Education Dr Bader Al Eisa on Thu [19 Nov 2015].

Those who contracted the disease are being given treatment, and the necessary precautions have been taken to prevent the spread of the disease, the minister told the Kuwait News Agency (Kuna). The cases were reported by the families.

"The Ministry of Education will continue to coordinate with the Ministry of Health, and schools that record more than 5 swine flu [H1N1] cases will be shut down," he said. "There are steady and regular contacts with the health ministry for advice and guidance, and doctors are visiting all the schools," he said. Reports said there is not enough vaccine available for all students.

On 10 Nov [2015], Al Eisa said there was one confirmed case of swine flu [H1N1] in a 6-year-old student in a private school.

Reports emerging from Kuwait said that a University of Kuwait teacher tested positive for the swine flu.

The case at the social sciences college triggered an alert among the teachers and staff and the preparation of a special room for suspected cases. A hotline was set up to help with queries and assistance. However, the college dean denied rumours that courses were being suspended, insisting that the staff were working normally.

According to Kuwaiti daily Al Jareeda, several parents have refused to allow their children to go to school citing concerns about health risks. Schools where suspected cases were noticed have not been willing to inform parents for fear they will keep their children at home. However, several parents have been exchanging information on social media and agreed that the school has suspected cases and that their children should not attend classes.

A hospital in Kuwait City has received 69 swine flu [H1N1] cases in the last 2 months, reports said. Health officials told local daily Al Jareeda that 58 patients left Al Adan Hospital after receiving the necessary treatment while the remaining 11 are still being treated. Some of the cases are in the intensive care unit, while others are in isolated rooms, the officials said.

One patient, a 68-year-old Kuwaiti, died on Wed [18 Nov 2015] from the disease, while an Indian expatriate passed away 3 days earlier, the officials said.

However, the hospital is taking all the measures possible whenever they are dealing with any suspected case, including contacting families and friends and providing them with the necessary vaccine while monitoring their health for 10 days, the officials added.  Byline: Habib Toumi
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Hungary

Hungary US Consular Information Sheet
April 07, 2008
COUNTRY DESCRIPTION:
Hungary is a stable democracy with a market economy. Tourist facilities outside Budapest are widely available, if not as developed as those found in Western Europe.
isitors considering a trip are encouraged to read the Embassy’s consular web site at http://budapest.usembassy.gov/information_for_travelers.html.
Please read the Department of State Background Notes on Hungary.

ENTRY/EXIT REQUIREMENTS:
A passport is required. A visa is not required for tourist stays of up to ninety (90) days as of May 1, 2004. American citizen tourists may remain in Hungary for up to ninety days during any six-month period from the date of first entry. If you plan to reside or study in Hungary for a period of more than ninety days, a visa must be obtained from the Embassy of the Republic of Hungary at 3910 Shoemaker Street NW, Washington, DC 20008, telephone (202) 362-6730. More information can be found on the Hungarian Embassy’s web site, http://www.huembwas.org, or at the nearest Hungarian Consulate in Los Angeles or New York.

Information about dual nationality or the prevention of international child abduction can be found on the State Department’s web site.
For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
Prior police approval is required for public demonstrations in Hungary and police oversight is routinely provided to ensure adequate security for participants and passersby. Nonetheless, situations may develop which could pose a threat to public safety. This has been the case several times since 2006, as large demonstrations continue to occur in protest of various domestic political issues. While demonstrations have occurred throughout the country, demonstrations often occurred at Budapest’s Kossuth Lajos ter, outside the Hungarian Parliament Building and very close to the U.S. Embassy. On several occasions the demonstrations turned violent, resulting in local law enforcement response that included the use of water canons and tear gas. Domestic politics also appears to be the impetus behind a recent rash of Molotov cocktail and “white powder” incidents across the country. While Americans and U.S. interests are not specifically targeted by these incidents, many take place in areas popular with tourists. As a result, U.S. citizens are advised to avoid areas in which public demonstrations are taking place.

While Hungary does not appear to be experiencing the wave of race or ethnic-based violence associated with other countries in East and Central Europe, there has been an increase in the profile of a number of small groups espousing religious, ethnic and social intolerance. One such group, calling itself the Magyar Garda (Hungarian Guard), gained prominence in 2007 due to its radical nationalist message of intolerance and its efforts to intimidate opponents by adoption of imagery reminiscent of Hungary’s fascist regime of the 1940’s. Although such groups are not avowedly anti-American, their targeting of people based on their ethnicity, race or sexual orientation should be noted by Americans traveling in Hungary, and steps should be taken to avoid confrontations with the group and its members.

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

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

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

CRIME:
Hungary has a low rate of violent crime. However, street crime occasionally involving violence has been reported, especially near major hotels and restaurants and on public transportation. Theft of passports, currency, and credit cards is a frequent problem, especially in train stations and on public transportation.

The U.S. Embassy’s Consular Section offers an informational brochure for tourists in Hungary, including a section on crimes and scams that have been encountered by other tourists. To consult the advisory, please visit the Embassy’s consular web site at http://budapest.usembassy.gov/tourist_advisory.html.

Drivers should be cautious when stopping at gas stations and highway parking lots, or fixing flat tires or other mechanical problems, especially at night. There have been reports of scams perpetrated on unsuspecting victims while traveling the highways. One reported scam involves someone who attracts the driver’s attention by saying that there is something wrong with his/her car (e.g. a smoking hood or flat tire) in order to encourage the driver to pull over to the side of the road. Once pulled over, the people participating in the scam will remove purses, passports, etc., from the car and drive away. Luggage and valuables should not be left unattended inside any vehicle.

A common scam involves young women asking foreign men to buy them drinks. When the bill arrives the drinks cost hundreds of dollars each. Americans should avoid bars and restaurants promoted by cab drivers or people on the street. Every bar and restaurant should provide a menu with prices before ordering.

In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm.

INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy or Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
Tourists who become victims of a crime in Hungary are strongly encouraged to call a 24-hour multilingual crime reporting telephone number. The number from 8 a.m. to 8 p.m. is 01-438-8080; from 8 p.m. to 8 a.m., the number is 06-8066-0044. There is also a 24-hour police Tourist Information office that provides service in English and German and is located in one of downtown Budapest’s busiest tourist area: 1051 Budapest.

For more information, see Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical treatment in Hungary is adequate, but hospital facilities and nursing support are not comparable to those in the United States. Physicians are generally well trained, but there is a lack of adequate emergency services. Some doctors, particularly in Budapest, speak English. Doctors and hospitals usually expect immediate cash payment for health services.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith..

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.

Please see our information on medical insurance overseas.

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

In Hungary, fatal traffic accidents number approximately 1,200 per year, with about 7,000 traffic accidents per year resulting in serious injuries. While this may seem low compared to the United States, Hungary has a much higher rate of accidents per mile driven. Americans should drive with caution and always be alert for other vehicles that may be violating traffic laws. Road travel is more dangerous during the Christmas season, summer months, and at night. Roadside assistance, including medical and other services, is generally available. English is usually spoken at the emergency numbers listed below. In case English is not spoken, dial 112.

Ambulance: 104 or 350-0388
Police: 107
Fire: 105
24-hour English speaker: 112

Bus, train and taxi services are readily available for inter-city travel.
Hungarian motorways and highways are generally in good condition.
Urban roads and road maintenance are also good although areas under construction are not always adequately marked or blockaded. In Budapest, many roads are often under construction. In rural areas, however, roads are often narrow, badly lit, and can be in a state of poor repair in some areas. Pedestrians, agricultural machinery, and farm animals often use these small rural roads. This requires increased caution on the part of drivers. Additional information on road conditions is available from “Utinform” at phone number (38) (1) 336-2400.

Hungary has a policy of zero tolerance for driving under the influence of alcohol. Police often conduct routine roadside checks where breath-analyzer tests are administered. Persons found to be driving while intoxicated face jail and/or fines. Possible penalties for a car accident involving injury or death are one to five years in prison. Police have instituted a widespread practice of stopping vehicles, particularly in Budapest, to check driver identity documents in a search for illegal aliens and residents in Hungary, and to check vehicle registration and fitness documentation. It is against the law to use a hand-held cell phone while driving anywhere in Hungary.

Hungary recognizes international driver’s permits (IDP) issued by the American Automobile Association (AAA) and the American Automobile Touring Alliance when presented in conjunction with a state driver’s license. American driver’s licenses will be accepted in Hungary for one year after arrival provided that a certified Hungarian translation has been attached to the license. Those with IDPs do not need to have the license translated, but must present both IDP and state driver’s license together. After one year in Hungary, U.S. citizens must obtain a Hungarian driver’s license. For further information on this procedure visit the embassy’s consular web site at http://budapest.usembassy.gov/information_for_travelers.html.

The speed limit for cars and motorcycles on the motorway is 130 km per hour (approximately 80 mph); on highways, the limit is 110 km per hour (approximately 65 mph);
and in town and village areas, the speed limit is 50 km per hour (approximately 30 mph). Many drivers, however, do not observe the speed limits, and extra care should be taken on two-way roads.
Special seats are required for infants. Children under age 12 may not sit in the front seat of an automobile. Seats belts are mandatory for everyone in the car. Unless another instruction sign is displayed, yielding the right of way to cars approaching from the right is the general rule. Turning right on a red light is prohibited. The police write up tickets for traffic violations and levy any applicable fine(s) on the spot. The police will give the offender a postal check (money order) on which the amount of the fine to be paid is written, and this postal check may be presented and paid at any Hungarian post office. Sometimes in disputes about fines or the offense, the police will confiscate the person’s passport and issue a receipt for the passport with an “invitation letter” to appear at the police station the ext day or day after to resolve the dispute. The passport is returned after resolution and/or the payment of the fine.

For specific information about Hungarian driver’s permits, vehicle inspection, road taxes and mandatory insurance, visit the Hungarian National Tourist Organization Office in New York web site at http://www.gotohungary.com.

Please refer to our Road Safety page for information.

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

SPECIAL CIRCUMSTANCES: The acceptance of traveler’s checks is not universal in Hungary. The presence of ATMs is increasing in Budapest and other major cities.

Hungary’s custom authorities may enforce strict regulations concerning temporary importation into or export from Hungary of items such as firearms, antiquities, and prescription medications. It is advisable to contact the Embassy of Hungary in Washington or one of Hungary’s consulates in the United States for specific information regarding customs requirements.

Please see our information on Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Hungarian laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Hungary are strict and convicted offenders can expect jail sentences and heavy fines.
Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.

Please see our information on Criminal Penalties.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION/EMBASSY AND CONSULATE LOCATIONS:
Americans living in Hungary are encouraged to register with the nearest U.S. Embassy of Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov, and to obtain updated information on travel and security within Hungary.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy in Budapest is located at 1054 Budapest 12; telephone (36) (1) 475-4703 or (36) (1) 475-4929. The Consular Section’s fax is (36) (1) 475-4188 or (36) (1) 475-4113, and the Consular Section’s web site is located at http://hungary.usembassy.gov/.
*
*

*
This replaces the Consular Information Sheet dated August 23, 2007 with updated information on Safety and Security.

Travel News Headlines WORLD NEWS

Date: Thu, 30 May 2019 08:06:11 +0200

Budapest, May 30, 2019 (AFP) - Seven South Korean tourists died and 21 others were missing after a sightseeing boat capsized and sank on the Danube in Budapest, Hungarian and South Korean officials said Thursday.   The accident happened near the parliament building in the heart of the Hungarian capital after a collision with a larger river cruise boat during torrential rain around 09:15 pm (1915 GMT) on Wednesday, according to officials.   A total of 33 South Koreans were on board, Seoul's foreign ministry said, confirming the seven dead were Korean.   The youngest was a six-year-old girl, travel agency officials said.

The 26-metre tourist boat, called the "Mermaid," was also carrying two Hungarian crew members.   "Our services have recorded the death of seven people," Pal Gyorfi, a spokesman for Hungarian emergency services, said early Thursday morning.   "Seven people have been taken to hospital in a stable condition with hypothermia and shock symptoms," Gyorfi added.   "A further 21 people are missing," a Hungarian police spokesman Kristof Gal told AFP.   "Police are searching the river throughout the entire length of the Danube in Hungary south of where the incident took place," he said.

- All night search -
Local media reported that one of the bodies was found several kilometres south of the collision location, although Gal declined to confirm.   The temperature of the river water is between 10 and 15 degrees, according to local media.   The search for the missing with the help of divers and police shining lights continued through the night, said an AFP photographer at the scene.   A film crew working from a bridge south of the accident site also used reflector lights to help light up the water through the gloom and pouring rain, reported local media.   Heavy rainfall since the beginning of May has led to high water levels and a fast-moving river current, complicating rescue efforts.

The accident happened on a popular part of the Danube river for pleasure trips, from where passengers can view the city and parliament building illuminated at night.   The boat was regularly serviced and had no apparent technical faults, Mihaly Toth, a spokesman for Panorama Deck that owned the vessel, told the Hungarian news agency MTI.     "It was a routine sightseeing trip," said Toth.   "We know nothing about how it happened, the authorities are investigating, all we know is that it sank quickly," he said. 

- Hit by bigger cruise boat -
An eye-witness told the Index.hu news-site that the Mermaid, which could hold 60 people on board, had been hit from behind by a large cruise boat.   Web camera footage from a hotel rooftop posted on local news-sites appeared to show the bigger boat colliding with the Mermaid.     The wreckage of the Mermaid was found on the riverbed after several hours of searching near the Margaret Bridge, one of the main bridges connecting the two parts of the Hungarian capital, local media said.   Access to the river has been blocked by the authorities, according to public television.

South Korea's President Moon Jae-in instructed the government to "deploy all available resources" for the rescue, the presidential office said.   Seoul planned to send a team of 18 officials to assist the authorities in Budapest, South Korea's Yonhap news agency reported.   The foreign ministry said minister Kang Kyung-wha would leave for Budapest later Thursday as head of a government taskforce.   Embassy staff have also been assisting the emergency services in the identification of victims.   The Hungarian interior and health ministers visited the scene and expressed condolences to the families of the victims.
Date: Thu, 30 Aug 2018 05:07:31 +0200
By Géza MOLNAR

Siófok, Hungary, Aug 30, 2018 (AFP) - With its inviting turquoise waters, white sandy banks, picturesque mountainous landscapes and resort towns, Hungary's Lake Balaton has plenty for tourists to write home about.   But a labour shortage exacerbated by low salaries and Hungary's
anti-immigration policies is making life difficult for the lake's tourism industry.   Already popular under communism, visitors still flock in increasing numbers to central Europe's largest lake to soak up its warm summer climate and enjoy the beaches, bars and eateries, as well as locally produced wines.

But that's proving a headache for restaurant and hotel owners, who struggle to find workers, as unemployment in Hungary is historically low at 3.6 percent, while nationalist firebrand Prime Minister Viktor Orban is strongly against immigration.   "It's impossible to find a gardener, or a waitress or a cook," said Balazs Banlaki, the owner of Kali-Kapocs, a restaurant nestled in the hills of Mindszentkalla on the northern shore of the lake, which lies about 80 kilometres (50 miles) southwest of the capital, Budapest.   Banlaki usually needs about 10 employees to run his restaurant, which he only opens during the summer months, but he has to do more and more himself.   "Before each new season, we repaint the restaurant, but even for that kind of work, it's me who takes up the brush now," he told AFP.

- 'Young people don't stay' -
With a national average salary of less than 530 euros ($610) per month and half a million people having left the country to work in western Europe over the past decade, Hungary lacks workers.   Despite having one of the lowest fertility rates in the OECD (Organisation for Economic Co-operation and Development) and a population currently of less than 10 million, its government has not heeded appeals from businesses to open its borders to qualified workers.

Banlaki recalled how last year he could only offer drinks, coffee and sandwiches because he could not find a cook.    After raising salaries, he is glad to have at least a handful of workers this year.   "But even when we find someone, there is a high chance that he or she will quit again quickly. With festivals, holiday plans with friends and other occasions, young people don't stay. I don't dare to criticise our workers for fear they will just leave," he said.   On the other side of the lake -- known also for its big beach parties and discotheques -- the high-end Plazs Siofok beach complex that can hold close to 10,000 people faces similar challenges.   "We advertise (job openings) everywhere and all the time... The lack of qualified workers is a constant problem," manager Erzsebet Mazula said.

- Online check-in? -
Due to its trendy image -- with numerous restaurants, an outdoor gym, beach bars and a concert stage drawing Hungary's best DJs and singers -- Plazs Siofok can attract student workers, Mazula said.   "They are certainly not professionals, but we train them before the season starts. Being involved and friendly and smiling is more important than knowing how to make complicated cocktails," she told AFP.   "But even with this system, you can see there are not enough waiters and waitresses to serve our clients."   At Siofok, mother-of-two Petra Lisztes, 39, said they spent several weeks at the lake every year and she had noticed that many of the small food and drinks stands had remained shut this time and that service in restaurants was slower.   The problem extends far beyond Lake Balaton.

Seen as a relatively cheap holiday destination, the number of tourists to Hungary has climbed seven percent this year so far, according to official data released by the KSH Hungarian Central Statistical Office, after already reaching a record 29.5 million hotel overnight stays last year.   To compensate for a lack of workers, several Budapest hotels have started to simplify reception services inspired by airline companies' online check-in systems.   But the problem is hard to solve for jobs that require expertise, such as cooks, head waiters and waitresses or managers.   Seeking to offer a solution, the government is trying to convince pensioners to return to work by exempting them from having to pay social contributions and capping taxes at 15 percent.    Since last year, Budapest has permitted workers from neighbouring non-EU countries Ukraine and Serbia to work in Hungary for up to 90 days without a work permit.   But, so far, the measures have failed to solve the shortage.
Date: Tue 3 Jul 2018
Source: Food Poison Journal [edited]

Frozen corn and possibly other frozen vegetables are the likely source of an outbreak of _Listeria monocytogenes_ that has been affecting Austria, Denmark, Finland, Sweden, and the United Kingdom since 2015.

Experts used whole genome sequencing to identify the food source, which initially was thought to be limited to frozen corn. As of 8 Jun 2018, 47 cases including 9 deaths had been reported.

The same strains of _L. monocytogenes_ have been detected in frozen vegetables produced by the same Hungarian company in 2016, 2017, and 2018. This suggests that the strains have persisted in the processing plant despite the cleaning and disinfection procedures that were carried out.

The available information confirms the contamination at the Hungarian plant. However, further investigations, including thorough sampling and testing, are needed to identify the exact points of environmental contamination at the Hungarian plant. The same recommendation applies to other companies belonging to the same commercial group if environmental contamination is detected.

On 29 Jun 2018, the Hungarian Food Chain Safety Office banned the marketing of all frozen vegetable and frozen mixed vegetable products produced by the affected plant between August 2016 and June 2018, and ordered their immediate withdrawal and recall. This last measure is likely to significantly reduce the risk of human infections and contain the outbreak. All freezing activity at the plant has been stopped.

New cases could still emerge due to the long incubation period of listeriosis (up to 70 days); the long shelf-life of frozen corn products; and the consumption of frozen corn bought before the recalls and eaten without being cooked properly.

To reduce the risk of infection, consumers should thoroughly cook non ready-to-eat frozen vegetables, even though these products are commonly consumed without cooking (such as in salads and smoothies). This applies especially to consumers at highest risk of contracting listeriosis -- such as the elderly, pregnant women, newborns and adults with weakened immune systems.  [Byline: Josh Fensterbush]
======================
[When last reported by ProMED-mail in March 2018 (Listeriosis - EU: fatal, ST6, frozen corn, 2015-18, recall http://promedmail.org/post/20180325.5708506), there was a total of 32 confirmed listeriosis cases, including 6 deaths, between December 2015 and 8 Mar 2018, in a multi-country outbreak in 5 EU member states (Austria, Denmark, Finland, Sweden, and the United Kingdom) linked by whole genome sequencing (genotyping) of clinical isolates of _Listeria monocytogenes_ to frozen corn that was packed in Poland and processed/produced in Hungary. As of 8 Jun 2018, there are now 47 reported cases, including 9 deaths.

Possibly other frozen vegetables produced by the Hungarian facility are also being implicated and on 29 June 2018, the Hungarian Food Chain Safety Office ordered recall and banned further the marketing of all frozen vegetable and frozen mixed vegetable products produced by the affected facility between August 2016 and June 2018. All freezing activity at the plant has been stopped.

_Listeria monocytogenes_ is widely distributed in the environment where it can form biofilms, which enables them to attach to solid surfaces and become extremely difficult to remove, especially in parts of equipment that are difficult to access. In a prior ProMED-mail report of a listeriosis outbreak in Canada, the design of a commercial meat slicer responsible for contamination of deli meat made its regular cleaning difficult and costly for the food processor (Listeriosis - South Africa (04): comment http://promedmail.org/post/20180126.5586393). The contamination occurred in parts of the machinery "well beyond the [manufacturer's] recommended sanitation process" and was "found only after the devices were completely disassembled" (<https://www.theglobeandmail.com/news/national/maple-leaf-eyes-meat-slicers-in-outbreak/article1060898/>).  Perhaps a similar situation is responsible for this prolonged multicountry EU outbreak.

Serotyping of _L. monocytogenes_ strains, based on variations in the somatic (O) and flagellar (H) antigens, has determined that only 3 (1/2a, 1/2b, and 4b) of the 12 serotypes of _L. monocytogenes_ cause 95 per cent of human cases; serotype 4b is most commonly associated with outbreaks (<https://www.cdc.gov/listeria/pdf/listeriainitiativeoverview_508.pdf>). The serotype of the strain of _L. monocytogenes_ responsible for this multi-country European outbreak is 4b, multi-locus sequence type 6 (ST6). Whole genome sequence (WGS) analysis of _L. monocytogenes_ isolates from 2 different samples of mixed frozen vegetables and an isolate from a surface where various vegetables could have been processed closely matched that of the clinical isolates (ProMED-mail post Listeriosis - EU: fatal, ST6, frozen corn, 2015-18, recall http://promedmail.org/post/20180325.5708506).

HealthMap/ProMED-mail map of Europe:
Date: Tue, 19 Dec 2017 04:32:51 +0100
By Peter MURPHY

Budapest, Dec 19, 2017 (AFP) - Bigger than Prague and some say more beautiful, Budapest's belle epoque boulevards, cafes and locals playing chess in steaming outdoor thermal spas have long attracted tourists.    But for some locals the city's tourism sector is booming too literally.   "My walls shake from music at night, it's impossible to sleep," says Dora Garai, a weary resident of the Hungarian capital's inner seventh district, these days called the "party quarter".

"In the morning I often have to clean vomit off my car," she says, the flat where she has lived all her life a beer can's throw away from a raucous 2,000-capacity all-night bar complex.   The 32-year-old now fronts a residents' group that has held marches in protest at the situation, mirroring unease in other European cities from Barcelona to Amsterdam.   The main attraction for the revellers is that Budapest gives more bang for your buck, Melanie Kay Smith, a Budapest-based academic at the Corvinus University, told AFP.

Hundreds of visitors interviewed for an upcoming report by Smith's students said they chose Budapest, within easy reach on dozens of budget flights daily, for the "cheap alcohol" and "the party".    "We get so much here for so little," a group of young Danes told AFP, beaming, on a recent night out.   Beer rarely costs more than 1.50 euros ($2.50), while a glut of Airbnb flats are on offer for under 30 euros a night.   Hedonistic thermal bath parties, and all-night opening hours add to the lure for thirsty youth, mostly hailing from expensive northern Europe, and often Brits on stag nights.   Offers on the pissup.com website, for example, include the "Killer Attila Warrior Weekend", or steaks and beers followed by a "sensational lesbian show".

- Moving out -
Annual arrivals have almost doubled since 2009 to 3.5 million last year, with Athens the only large city forecast to grow faster in 2017, according to Euromonitor.  Even in winter the neighbourhood is choked with taxis and rickshaws transporting revellers. The Corvinus study counted 800 bars and restaurants, double the number just five years ago.   "Are you ready to party?!" roared a young Hungarian through a megaphone at his foreign student pub-crawl group.    "People can always move out if it bothers them," he shrugged.   Some of the estimated 15,000 residents of the area's compact grid of 19th-century streets, traditionally called the Jewish district after its many synagogues, have done just that.

No official data exist yet but one in five people of some 300 residents told Corvinus that they were "considering moving out" due to noise, litter and public urination.    "People used to live here," reads an ominous bronze plaque put up near a party hostel in the heart of the zone.   Despite soaring property prices driven by investor demand for rental apartments many live in council accommodation and cannot sell, said Dora Garai, or, like her, refuse to budge.   "Why should I move out just because people come here for a few days to behave how they like," she said.

- Midnight closing? -
Garai's group, set up in April, now has over 1,000 members who share experiences on Facebook.    "Last night a drunk Englishman looking for his Airbnb apartment rang every doorbell in our building," one said.   Bars should shut by midnight, not the current 6:00 am, the group demands, while City Hall should create a party zone outside the downtown.

But midnight closing would put him out of business, said Abel Zsendovits, manager of the popular Szimpla Kert (a grungy "ruin bar" in a formerly derelict building), dubbed one of the world's best pubs by Lonely Planet in 2014.   "Yes, the situation outside is unsustainable now," he admitted. "So bring in fines for anti-social behaviour, more police, street cleaning and public toilets". 

At weekends his colleagues don green jackets and try to calm down street noise, part of a "Night Mayor" idea launched by an association of bars.   The residents though are unconvinced that such a business-led initiative will end their woes.    Nor would a proposed local referendum on midnight closing that would likely see low turnout given the outer part of the district is unaffected by the problems.   Ultimately, Budapest needs to upgrade from low-budget "laissez-faire" tourism, says Smith. "Prices will have to go up somehow".
Date: Wed, 19 Jul 2017 16:02:04 +0200

Budapest, July 19, 2017 (AFP) - Hungarian police on Wednesday inspected all international trains entering the country after receiving an anonymous bomb threat, sparking major travel delays.   "An unidentified male called to say that he had placed a bomb on an international train travelling through Hungary," police said in a statement.

As many as 20,000 Hungarian and international travellers were affected by the delays lasting up to three hours, according to the national railway station company (MAV).   By Wednesday afternoon, more than 18 trains had already been searched before being allowed to continue their journeys, with no explosives found so far.   The checks will be carried out until midnight, MAV said.
More ...

Peru

General Information:
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The number of Irish holiday makers heading to Peru to complete the Inca Train is increasing. This is partly due to easier travel arrangements but the beauty of this region is also attracti
g many. Overall the majority will remain healthy but some will become sick by exposure to a variety of situations which should be protected against. The Inca Trail is situated in southern Peru and the most commonly visited regions include Lima (the capital), Cusco, Machu Picchu and Lake Titicaca. This includes some high mountainous regions of the country and many of the trekking paths are poorly maintained.
Personal Health:
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Generally those planning a holiday along the Inca Trail will be trekking for a part of their time abroad. It is essential that these individuals realise that they may reach significant altitude and that this is not a ‘restful’ holiday. Good general health is required and those with heart problems or respiratory conditions may find that they will be unable to complete the journey. Having a general medical check before booking your ticket may be worth considering for any patient with a chronic illness.
Travelling Alone:
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If you are travelling alone or in a small group it will be essential to take care at all times. In Lima, the level of crime is high and resistance to violent crime often provokes greater violence, while those who do not resist usually do not suffer serious physical harm. Street crime is also prevalent in tourist cities in Peru's interior, including Cusco, Arequipa, Puno and Juliaca, and pickpockets frequent the market areas.
In Cusco, "choke and grab" muggings are common, particularly on streets leading off the main square and in the area around the train station.
Travellers should use only registered taxis in Cusco and should not accept offers of transportation or guide services from individuals seeking clients on the streets.
The number for the tourist police in Lima is (51-1) 225-8698 or 225-8699, or fax 476-7708.
There are also tourist police offices in 15 other cities, including all major tourist destinations such as Cusco, Arequipa, and Puno.
Altitude problems:
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Along the Inca Trail the elevation above sea level can be significant. For instance Cusco is at 10,000 feet and Lake Titicaca is at 13,000 feet. Those visiting these regions should be aware that it is essential to take time to adjust to the altitude, which can adversely affect blood pressure, digestion and energy level.
In 1999, several U.S. citizens died in Peru from medical conditions exacerbated by the high altitude. (See separate TMB leaflet on Altitude Sickness). Adventure travellers should be aware that rescue capabilities in the region are limited.
In recent years, several hikers have died and others have had to be rescued after serious accidents in the Huaraz region of the Cordillera Blanca mountains, where Peru's highest peaks are located.
Coca Tea:
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On arriving in many of these regions you will find street vendors and restaurants selling Coca tea to relieve altitude sickness. Generally this is safe providing the water is boiling but take care of the hygiene for the cup which is used to drink from. Advice would usually be to avoid chewing the leaves of the Coca plant.
Avoiding Insect Bites:
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One of the biggest problems facing travellers to this region is the risk of insect bites. Along the Inca Trail you will often find that many travellers have been bitten significantly by both mosquitoes and sandflys. There are a number of diseases transmitted by these insects in this region and so it is essential to protect yourself. Wearing long sleeved pale coloured clothing and applying good insect repellent (with DEET 30-50% at least) will help. This will be particularly important on the day that you visit Machu Picchu.
Leishmaniasis:
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This is a parasitic disease transmitted by sandflys. The skin ulcers associated with this condition can take months to heal.
Malaria:
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Fortunately this dangerous disease does not occur in southern Peru along the Inca Trail. Those visiting the jungle areas east of the Andes will need protection.
Food and Water:
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It is essential to take care to ensure that all food is fresh and well prepared. Eating from street vendors is a high risk activity and bivalve shellfish should be avoided at all times.
Rabies:
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The risk of this viral disease occurs throughout the country. Avoid all warm blooded animals and seek adequate medical treatment after any bite, lick or scratch. Dogs, cats and monkeys commonly transmit the disease but it can be from any warm blooded animal.
Vaccines:
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For entry/exit purposes it is recommended that all travellers receive cover against Yellow Fever. Having cover also against Typhoid, Tetanus and Hepatitis A is well worthwhile for personal protection. Those planning a longer trip or more extensive trekking will need to consider cover against conditions like Hepatitis B and Rabies.
Summary:
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Make sure you are fit enough for this trip. Trek within your limits and have good shoes and clothing. Bring plenty of insect repellent!
Further Information:
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Contact the Tropical Medical Bureau at the numbers below. This leaflet must not be used in place of a detailed medical consultation.

Wanderlust April/May 2001
Web. www.wanderlust.co.uk
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Visiting Machu Picchu is almost a rite of passage for Latinophiles and for the adventurous there is only one way - along the Inca Trail. While romantics and old-timers lament the loss of independent trekking this remains one of the world’s classic walks. If you want to see Machu Picchu and you like trekking, the euphoric jubilation of passing through the Gate of the Sun is close to unbeatable.
The dry season in the highlands runs from May to October and makes for clearer skies and generally better views. Off-season the weather can be risky, but there are far fewer people.
To be fair this is not the only trek in Peru. Scribes from Pizarro to Parris have waxed lyrical about the breathtaking beauty of the Cordilleras Blanca and Huayhuash. Sheer walls of ice and granite hang precariously above scrubby grassland basking in the warm equatorial sun. As one of the most popular trekking areas in South America, the central cordilleras are ideal for hiking, with most activities starting from the mountain-fringed setting of Huaraz at almost 3,lOOm.
Whitewater rafting is also popular and most is based out of Cuzco; a quick and complete drenching in the River Apurimac takes in awesome scenery and exhilarating Class IV rapids. Trips also head to the source of the Amazon and down to the dramatic Colca Canyon which is twice as deep as the Grand Canyon.
Mountain biking is popular in the central cordilleras along with some challenging opportunities through dramatic Andean scenery in the Cuzco area.
Manu National Park in the Amazon lowlands north of Cuzco is one of the continent’s great untouched wildernesses. Set aside for research and ecotourism, Manu is one of the best places to visit the rainforest and sightings of big cats, although not common, are regular. The nearby town of Puerto Maldonado, close to the famous macaw salt lick in the Tambopata-Candamo Reserve, is a popular spot for jungle tours mixing short hikes with river trips; they generally last a few days.
Adventurous independent travellers may want to join the locals and travel down the Amazon in a hammock on a cargo boat from Pucallpa. Short jungle treks and canoe trips from the northern Amazon town of Iquitos explore small tributaries and indigenous villages to help you encounter the natural wonders of the Amazon rainforest face to face.
Peter Hutchison is editor of Footprint’s
Mexico & Central America Handbook 2001
*******************************************************

Travel News Headlines WORLD NEWS

Date: Mon 10 Jun 2019
Source: Peruvian Times [edited]

More than 100 cases of Guillain-Barre syndrome have been reported in Lima and several other regions of the country, prompting the Health Ministry to issue a 90-day emergency health warning and increase the health services budget to cover treatment.

There are 3 fatal cases, 2 in Piura and one in Trujillo on the north coast. The National Institute of Neurological Sciences reported that the current cases show unusual and atypical features that require rapid and immediate treatment.

According to the minister of health, Zulema Tomas, the report of cases is usual at this time of year when cases of influenza and bronchial infections increase. In 2018, the Health Ministry reported 205 cases. Tomas said up to 300 cases may be expected this year [2019].

Guillain-Barre syndrome, GBS, is a rare but serious autoimmune disorder that attacks the peripheral nervous system and leads to weakness, tingling, and numbness, initially in the limbs and expanding to the rest of the body, and can eventually cause paralysis.

Although the precise cause of the disease is unknown, according to the US Centers for Disease Control and Prevention, people who develop GBS do so several days or weeks after they have been sick with diarrhea or a respiratory illness. Although rare, some may develop the symptoms days or weeks after getting a vaccination.
Treatment consists of cleaning or immunizing the blood, according to Dr. Hugo Umeres of the Neurological Service at the Cayetano Heredia university hospital. One of the treatments is plasmapheresis, a procedure that removes the plasma from the blood and replaces it with other fluids. The treatment can cost up to [USD] 15,000, but the increased budget will allow all state hospitals to provide free treatment for GBS cases.

According to the World Health Organization (WHO), symptoms last a few weeks, and most cases recover without any serious or long-term complications.

The Health Ministry has emphasized that GBS is not contagious. It is a virus, and the best prevention is to wash hands frequently, avoid street food, and treat respiratory diseases promptly.
***************************************
Date: Mon 10 Jun 2019
Source: France 24 [edited]

Peru has declared a health emergency in 5 regions, including Lima, after the deaths of at least 4 people linked to Guillain-Barre syndrome, an autoimmune disorder that attacks the nervous system.

Health minister Zulema Tomas said Sunday [9 Jun 2019] that in addition to the deaths there were currently 206 cases of the disease.

"We have an outbreak; there has been a brusque increase" since 5 Jun [2019], Tomas said on state-run TV Peru, adding that health authorities were taking steps to control and contain the disease.

While the syndrome is not contagious, a 90-day health emergency was declared because the current cases "have unusual and atypical characteristics that require rapid or immediate initial treatment," Peru's Institute of Neurological Sciences said.

The precise cause of the disorder is unknown, but most cases develop after a person has been sick with diarrhea or a respiratory infection.

The Centers for Disease Control and Prevention in the US says its research suggests that the syndrome is "strongly associated" with the Zika virus, a mosquito-borne illness.

The regions affected by GBS include 3 on the country's northern coast -- Piura, Lambayeque, La Libertad -- tourist destinations known for their archaeological sites and beaches. Also included was the central region of Junin and Lima, which has 9 million inhabitants.

There are 2 deaths reported in Piura, one in La Libertad, and another in Junin.
=====================
[Guillain-Barre syndrome (GBS) can occur following infections. GBS has also been reported following Zika virus infections in other localities. A report in 2018 described a 2-year clinical course of Zika virus infection-related GBS. In that study, clinical and demographic characteristics of the 18 patients infected during the Colombian Zika epidemic with serologically diagnosed Zika infection with GBS are reported (see Zika virus (09): Americas, Asia, research, observations http://promedmail.org/post/20180909.6016422). No mention is made in the above report about the measures that will be used to contain the occurrence of GBS. - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
Lambayeque, Lambayeque, Peru: <http://healthmap.org/promed/p/33583>
La Libertad region, Peru: <http://healthmap.org/promed/p/35305>
Date: Mon, 10 Jun 2019 14:24:43 +0200

Lima, June 10, 2019 (AFP) - Peru has declared a health emergency in five regions, including Lima, after the deaths of at least four people linked to Guillain-Barre syndrome, an autoimmune disorder that attacks the nervous system.   Health Minister Zulema Tomas said Sunday that in addition to the deaths there were currently 206 cases of the disease.   "We have an outbreak, there has been a brusque increase" since June 5, Tomas said on state-run TV Peru, adding that health authorities were taking steps to control and contain the disease.

While the syndrome is not contagious, a 90-day health emergency was declared because the current cases "have unusual and atypical characteristics that require rapid or immediate initial treatment," Peru's Institute of Neurological Sciences said.   The precise cause of the disorder is unknown, but most cases develop after a person has been sick with diarrhoea or a respiratory infection.

The Centers for Disease Control and Prevention in the US says its research suggests that the syndrome is "strongly associated" with the Zika virus, a mosquito-borne illness.   The regions affected by GBS include three on the country's northern coast -- Piura, Lambayeque, La Libertad -- tourist destinations known for their archaeological sites and beaches.   Also included was the central region of Junin and Lima, which has nine million inhabitants.   Two deaths were reported in Piura, one in La Libertad and another in Junin.
Date: Tue, 4 Jun 2019 20:24:14 +0200

Lima, June 4, 2019 (AFP) - Peruvian police on Tuesday were searching for a British tourist who went missing last week in the forests of a national park in the centre of the country, officials said.   Mary Elizabeth Orchard disappeared on Friday after entering the Yanachaga-Chemillen national park with her sister and brother-in-law, local media reported.    Orchard got separated from the group, and her sister reported her disappearance, triggering a search by police, firefighters and park rangers.

Locals reported the missing tourist had slipped into a ravine in a remote and hilly area of the park.   Peruvian media reports said a helicopter had been deployed in the search, but had been hampered by dense cloud cover.   Yanachaga-Chemillen is a nature reserve of 122,000 hectares (300,000 acres) known for its cloud forests and diverse flora and fauna, some of which is under threat of extinction.
Date: Mon, 27 May 2019 05:16:24 +0200
By Carlos MANDUJANO

Lima, May 27, 2019 (AFP) - A powerful 8.0-earthquake toppled houses, blocked roads and knocked out power in parts of Peru on Sunday, killing one person and injuring at least 26 others as the shockwave extended into neighbouring Ecuador.   The quake hit in a sparsely populated region of Peru's Amazon basin region but was felt over a wide area. In Lima and other cities, frightened residents rushed into the streets.   "There are many old houses that have collapsed after this strong earthquake," said Hugo Araujo, the mayor of Yurimaguas, a town near the epicentre.

Peru's civil defense coordinator Ricardo Seijas told RPP radio that a man was killed by falling debris in his house in Cajamarca.   Danilo Munoz, the 48-year-old victim, was asleep when the quake struck at 2:41 am (0741 GMT).   Seijas said 11 people were injured in Peru, and more than 50 houses were left uninhabitable.   Reports said 15 people had been hurt in Ecuador.

The quake blocked roads, damaged a bridge and knocked down houses, said Peru's President Martin Vizcarra, adding that it was the most powerful quake to hit the country in 12 years.   "It is an earthquake affecting the entire Peruvian jungle," he said.   "We are working on establishing an air bridge to transport people who have an emergency," he said.   The quake struck about 75 kilometers (45 miles) southeast of the town of Lagunas at a depth of at least 110 kilometres.   The US Geological Survey and Peruvian geophysicists said the quake registered 8.0 in magnitude. They said it lasted just over two minutes.

The mayor of Lagunas, Arri Pezo, said many residents who fled from their homes later stayed in the streets for fear of aftershocks.   "You could not walk at the time of the earthquake, things were falling," Pezo told RPP. Power was knocked out, making it difficult to assess the damage, he said.   One of the most dramatic moments captured on social media happened in Yurimaguas. Video from the police station shows the police chief shouting at his subordinates to quickly open the jail cells and get inmates outside.   "The earthquake is strong!" he is heard yelling. "Open the cells! Help with the detainees, get one each!"

- Power cuts in Ecuador -
The shockwave of Sunday's tremor also extended to neighboring Ecuador, where power cuts were reported in parts of its Amazon basin region.    Peruvian media said the tremor was also felt in parts of Colombia and Venezuela.   Peru lies on the so-called Ring of Fire -- an arc of fault lines that circles the Pacific Basin and is prone to frequent earthquakes and volcanic eruptions.

The South American country records about 200 earthquakes a year, most of them going unnoticed by the public.   In February, a quake measuring 7.5 with its epicenter in Ecuador rattled the coast and Amazon region of northern Peru.   It left nine people injured and caused damage in Ecuador, but Peru was unscathed.
Date: Sat, 11 May 2019 03:17:40 +0200

Lima, May 11, 2019 (AFP) - Peru announced on Friday a two-week restriction to three important areas at Machu Picchu to prevent greater degradation to the iconic Inca citadel.   From May 15-28, access to the Temple of the Sun, Temple of the Condor and Intihuatana Stone will be strictly controlled at the UNESCO World Heritage Site, the government said.   "These measures are necessary to conserve Machu Picchu, given the evidence of deterioration" on stone surfaces caused by visitors to the three areas, the culture ministry said.

Almost 6,000 visitors a day are permitted onto the 15th century site in two waves.   The new plan will give tourists just three hours to visit the three emblematic areas.   Authorities will evaluate the impact of the measures before applying new permanent rules from June 1.

Machu Picchu, which means "old mountain" in the Quechua language indigenous to the area, is at the top of a lush mountain and was built during the reign of the Inca emperor Pachacuti (1438-1471).   It lies around 100 kilometres (60 miles) from the Andean city of Cusco, the old Inca capital in south-eastern Peru.   It was rediscovered in 1911 by the American explorer Hiram Bingham. UNESCO declared it a World Heritage Site in 1983.
More ...

World Travel News Headlines

Date: Tue 17 Sep 2019
Source: Boston Globe [edited]

Rhode Island officials announced Tuesday [17 Sep 2019] that 2 more human cases of eastern equine encephalitis [EEE] were confirmed in the state.

The 2 people -- one a Coventry child younger than 10 and the other a person in their 50s from Charlestown -- have been discharged from the hospital and are recovering, according to a statement from the state's Department of Public Health.

Authorities think the 2 people contracted EEE in late August [2019]. The cases were confirmed by tests done at the Centers for Disease Control and Prevention. There have been 3 confirmed EEE cases in Rhode Island this year [2019]. A West Warwick resident diagnosed with the mosquito-borne illness died this month [September 2019].

All 3 people contracted EEE before areas at critical risk for the disease were aerially sprayed with pesticide, state officials said.

EEE is a rare but potentially fatal disease that can cause brain inflammation and is transmitted to humans bitten by infected mosquitoes, according to federal authorities. About 1/3 of infected people who develop the disease will die, officials have said, and those who recover often live with severe and devastating neurological complications. There is no treatment for EEE.

"This [2019] has been a year with significantly elevated EEE activity, and mosquitoes will remain a threat in Rhode Island until our 1st hard frost, which is still several weeks out," said Ana Novais, the deputy director for the state's health department. "Personal mosquito-prevention measures remain everyone's 1st defence against EEE. If possible, people should limit their time outdoors at sunrise and sunset. If you are going to be out, long sleeves and pants are very important, as is bug spray [repellent]."

EEE was also confirmed in a deer in Exeter this week [week of Mon 16 Sep 2019].

In Massachusetts, 8 human cases of EEE have been confirmed this year [2019]. Last month [August 2019], a Fairhaven woman with EEE died.
========================
[The 1st Rhode Island case died. Now there are 2 additional EEE cases who have recovered sufficiently to have been discharged from the hospital. Although most reported cases of EEE this year [2019] have occurred in horses, there have been several recent human cases as well. Individuals living in areas where human or equine EEE cases have occurred should heed the above recommendations to prevent mosquito bites. Avoidance of mosquito bites is the only preventive measure available. Fortunately, horses can be vaccinated, but there is no vaccine available for humans.

The risk of EEE virus infection for humans and horses will continue in Rhode Island and the other affected states until the 1st killing frosts occur, likely in October (2019). - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Rhode Island, United States: <http://healthmap.org/promed/p/241>]
Date: Tue 17 Sep 2019
Source: Detroit Free Press [edited]

State health officials said Tuesday [17 Sep 2019] that 3 Michiganders have died from the rare and dangerous mosquito-borne virus eastern equine encephalitis [EEE], and 4 others have been sickened by the disease, amid the biggest outbreak in more than a decade.

Those who live in all 8 of the affected counties -- Kalamazoo, Cass, Van Buren, Berrien, Barry, St. Joseph, Genesee, and Lapeer counties -- are urged to consider canceling, postponing, or rescheduling outdoor events that occur at or after dusk, especially those that involve children, according to the Michigan Department of Health and Human Services. This would include events such as late-evening sports practices or games or outdoor music practices "out of an abundance of caution to protect the public health, and applies until the 1st hard frost of the year [2019]," according to an MDHHS news release.

The 3 people who died were all adults and lived in Kalamazoo, Cass, and Van Buren counties, [respectively], said Bob Wheaton, a spokesman for the Michigan Department of Health and Human Services. The 4 other confirmed cases are in Kalamazoo, Berrien, and Barry counties.

Animals have also been confirmed to have the virus in St. Joseph, Genesee, and Lapeer counties.

The Kalamazoo County Health and Community Services Department also issued a recommendation to local communities and school districts to consider canceling outdoor events at dusk or after dark, when mosquitoes are most active, or move [the events] indoors.  "Michigan is currently experiencing its worst eastern equine encephalitis outbreak in more than a decade," said Dr. Joneigh Khaldun, MDHHS chief medical executive and chief deputy for health. "The ongoing cases reported in humans and animals and the severity of this disease illustrate the importance of taking precautions against mosquito bites."

EEE is one of the deadliest mosquito-borne viruses in the US. One in 3 people who are infected with the virus die. The only way to prevent it is to avoid mosquito bites. The MDHHS says residents should
- apply insect repellents that contain the active ingredient DEET or other US Environmental Protection Agency-registered product to exposed skin or clothing, and always follow the manufacturer's directions for use;
- wear long-sleeved shirts and long pants when outdoors. Apply insect repellent to clothing to help prevent bites;
- maintain window and door screening to help keep mosquitoes outside;
- empty water from mosquito breeding sites around the home, such as buckets, unused kiddie pools, old tires, or similar sites where mosquitoes may lay eggs; and
- use nets and/or fans over outdoor eating areas.

Symptoms of EEE include
- sudden onset of fever, chills;
- body and joint aches, which can progress to a severe encephalitis;
- headache;
- disorientation;
- tremors;
- seizures;
- paralysis; and
- coma.

Anyone experiencing these symptoms should visit a doctor.

[Byline: Kristen Jordan Shamus]
=======================
[The number of human cases remains at 7. However, 3 of these have died since the 6 Sep 2019 report (see Eastern equine encephalitis - North America (18): USA human, horse, deer http://promedmail.org/post/20190910.6667626). However, even among the survivors, there is a significant risk of permanent neurological damage following clinical encephalitis. CDC reports that many individuals with clinical encephalitis "are left with disabling and progressive mental and physical sequelae, which can range from minimal brain dysfunction to severe intellectual impairment, personality disorders, seizures, paralysis, and cranial nerve dysfunction. Many patients with severe sequelae die within a few years" (<https://www.cdc.gov/easternequineencephalitis/tech/symptoms.html>). - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Michigan, United States: <http://healthmap.org/promed/p/225>
Michigan county map:
Date: Mon 16 Sep 2019
Source: Patch [edited]

The state Department of Public Health is warning that an adult resident of East Lyme has tested positive for eastern equine encephalitis (EEE). This is the 1st human case of EEE identified in Connecticut this season [2019].  The patient became ill during the last week of August [2019] with encephalitis and remains hospitalized. Laboratory tests, which were completed today at the Centers for Disease Control and Prevention (CDC) Laboratory in Ft. Collins, Colorado, confirmed the presence of antibodies to the virus that causes EEE.  "EEE is a rare but serious and potentially fatal disease that can affect people of all ages," said DPH commissioner Renee Coleman Mitchell in a release. "Using insect repellent, covering bare skin, and avoiding being outdoors from dusk to dawn are effective ways to help keep you from being bitten by mosquitoes."  The EEE virus has been identified in mosquitoes in 12 towns and in horses in 2 other towns.

Towns where mosquitoes have tested positive for EEE include Chester, Haddam, Hampton, Groton, Killingworth, Ledyard, Madison, North Stonington, Plainfield, Shelton, Stonington, and Voluntown. Horses have tested positive for EEE virus in Colchester and Columbia this season, and the virus has been detected in a flock of wild pheasants.  Other states throughout the northeast are also experiencing an active season for EEE. In addition to the virus being found in mosquitoes, there have been a total of 8 human cases of EEE infection in Massachusetts and one human case in Rhode Island, with one case in each state resulting in a fatality. "This is the 2nd human case of EEE ever reported in Connecticut," said Dr. Matthew Cartter, director of infectious diseases for the DPH. "The 1st human case of EEE reported in Connecticut occurred in the fall of 2013."

The DPH advises against unnecessary trips into mosquito breeding grounds and marshes, as the mosquitoes that transmit EEE virus are associated with freshwater swamps and are most active at dusk and dawn. Overnight camping or other substantial outdoor exposure in freshwater swamps in Connecticut should be avoided. Even though the temperatures are getting cooler, the DPH is advising that mosquito season is not over, and residents should continue to take measures to prevent mosquito bites, including wearing protective clothing and using repellents.  Although EEE-infected mosquitoes continue to be detected in the south-eastern corner of the state, the numbers are declining, and we are not experiencing the excessively high levels of activity seen in Massachusetts. There are currently no plans to implement widespread aerial pesticide spraying in the state.

Severe cases of EEE virus infection (involving encephalitis, an inflammation of the brain) begin with the sudden onset of headache, high fever, chills, and vomiting. The illness may then progress into disorientation, seizures, and coma. Approximately 1/3 of patients who develop EEE die, and many of those who survive have mild to severe brain damage, according to the DPH.

There is no specific treatment for EEE. Antibiotics are not effective against viruses, and no effective anti-viral drugs have been discovered. Severe illnesses are treated by supportive therapy, which may include hospitalization, respiratory support, IV fluids, and prevention of other infections. It takes 4-10 days after the bite of an infected mosquito to develop symptoms of EEE.

The management of mosquitoes in Connecticut is a collaborative effort involving the Department of Energy and Environmental Protection, the Connecticut Agricultural Experiment Station, and the DPH, together with the Department of Agriculture and the Department of Pathobiology at the University of Connecticut. These agencies are responsible for monitoring and managing the state's mosquito population levels to reduce the potential public health threat of mosquito-borne diseases.

Information on what can be done to prevent getting bitten by mosquitoes and the latest mosquito test results and human infections is available online.  [Byline: Rich Kirby]
===========================
[This has been an active year for EEE virus transmission in the eastern USA from the upper Midwest to the northeastern states and south to Florida. Although historically, EEE human cases in Connecticut have been very rare, the occurrence of a human case in the state this year (2019) is not surprising. There have been equine and/or human EEE cases this summer (2019) in the 3 bordering states: Rhode Island, Massachusetts, and New York. Interestingly, pheasants are mentioned in the above report. They are susceptible and, after being infected with the virus from the bite of an EEE-carrying mosquito, become ill or moribund with viremia titers that can reach 10^9 per ml. Ill or moribund pheasant can be attacked and cannibalized by pen mates that, in turn, are infected orally and may become ill and die as well. As the above report cautions, the only way to avoid infection is for people to avoid mosquito bites. Although the incidence of EEE cases and virus-positive mosquitoes may be declining, there is a risk of infection until the 1st killing frost occurs in autumn, when the mosquitoes are no longer active. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Connecticut, United States: <http://healthmap.org/promed/p/210>]
Date: Wed 11 Sep 2019
Source: BBC Afrique [In French, trans. Mod.LXL, edited]

At least 18 people died in 10 days after eating pesticide-contaminated food in 2 localities in Burkina Faso. A dozen still remain under observation in hospitals, according to the Minister of Health.  The 1st cases were reported on [1 Sep 2019] in the town of Didyr in the centre-west of the country, said Professor Claudine Lougue, Minister of Health.  About 15 members of the same families felt unwell after eating local dishes made from bean leaves and small millet seeds, which are actually seed remains. Thirteen died later despite medical care.

On Monday [2 Sep 2019], the ministry received another alert, this time from the central-eastern region. Here again, 14 people from the same family were admitted to the health centres. Five have lost their lives. After analysis, doctors diagnosed massive food poisoning, said the minister. Complementary examinations incriminate pesticides, she said.  "Investigations have been made on samples of biological products such as blood and urine, and we found an unusually high level of pesticides in foods that were consumed. There was an abnormally high level of pesticides, and these pesticides were strongly incriminated," said the minister.

The remains of food have been secured, announced Professor Lougue, who calls on citizens to observe strict hygiene measures in the use of plant leaves for consumption. Pesticides are used for the needs of field work, especially in the countryside during this period of wintering.
Date: Wed, 18 Sep 2019 16:44:19 +0200 (METDST)

London, Sept 18, 2019 (AFP) - British Airways pilots on Wednesday cancelled a strike that had been due September 27, the British Airline Pilots Association union said after two walkouts last week that cost the company dear.   "Someone has to take the initiative to sort out this (pay) dispute and with no sign of that from BA the pilots have decided to take the responsible course," BALPA General Secretary Brian Strutton said in a statement.    The union chief added that the airline's "passengers rightly expect BA and its pilots to resolve their issues without disruption and now is the time for cool heads and pragmatism to be brought to bear.    "I hope BA and its owner IAG show as much responsibility as the pilots," he added.   It was now "time for a period of reflection before the dispute escalates further and irreparable damage is done to the (BA) brand."

However the union added that should the airline "refuse meaningful new negotiations, BALPA retains the right to announce further strike dates".   British Airways, which likes to call itself "the world's favourite airline", flew into turbulence last week as pilots staged a costly and historic two-day strike, tarnishing its global reputation according to aviation analysts.   Pilots walked out for the first time in the company's 100-year history, sparked by a bitter and long-running feud over pay.   BA faced the embarrassment of grounding its entire UK fleet on September 9 and 10, causing the cancellation of about 1,600 flights.   The move sparked travel chaos for about 200,000 passengers who had been due to fly in and out of London's Gatwick and Heathrow airports.

The disruption continued into September 11 because half of BA's 300 aircraft and more than 700 pilots were mostly in the wrong place.   As a result, BA was forced to cancel approximately ten percent of its daily 850 flights in and out of Britain that day.    BALPA and its members are demanding a bigger share of British Airways profits.   The airline has offered a salary increase of 11.5 percent over three years, which it argues would boost the annual pay of some captains to £200,000 ($250,000 or 226,000 euros).   However, the union has rejected the proposal made in July.   BALPA meanwhile estimates that last week's 48-hour strike cost the airline £80 million.   BA is owned by IAG, which was formed in 2011 with the merger of British Airways and Spain's Iberia. IAG has since added other carriers, including Austria's Vueling and Ireland's Aer Lingus.
Date: Wed, 18 Sep 2019 12:26:37 +0200 (METDST)
By Sam Reeves

Kuala Lumpur, Sept 18, 2019 (AFP) - Toxic haze from Indonesian forest fires closed schools and airports across the country and in neighbouring Malaysia Wednesday, while air quality worsened in Singapore just days before the city's Formula One motor race.   Illegal fires to clear land for agriculture are blazing out of control on Sumatra and Borneo islands, with Jakarta deploying thousands of security forces and water-bombing aircraft to tackle them.

Indonesian blazes belch smog across Southeast Asia annually, but this year's are the worst since 2015 and have added to concerns about wildfire outbreaks worldwide exacerbating global warming.   On Wednesday, air quality deteriorated to "very unhealthy" levels on an official index in many parts of peninsular Malaysia, to the east of Sumatra, with the Kuala Lumpur skyline shrouded by dense smog.    Nearly 1,500 schools were closed across Malaysia due to the air pollution, with over one million pupils affected, according to the education ministry.

A growing number of Malaysians were suffering health problems due to the haze, with authorities saying there had been a sharp increase in outpatients at government hospitals -- many suffering dry and itchy eyes.   Indonesian authorities said hundreds of schools in hard-hit Riau province on Sumatra were shut, without providing a precise number, while about 1,300 were closed in Central Kalimantan province on Borneo.    Borneo is shared between Indonesia, Malaysia and Brunei.   Poor visibility closed seven airports in the Indonesian part of Borneo, the transport ministry in Jakarta said. Scores of flights have already been diverted and cancelled in the region in recent days due to the smog.

- Singapore smog race? -
Air quality in Singapore worsened to unhealthy levels and a white smog obscured the striking waterfront skyline, featuring the Marina Bay Sands casino resort with its three towers and boat-shaped top level.    The worsening pollution increased fears that this weekend's Formula One race may be affected. Organisers say the possibility of haze is one of the issues in their contingency plan for Sunday's showpiece night race, but have not given further details.

The city-state's tourism board said spectators would be able to buy masks as protection from the haze if conditions did not improve and assistance would be provided for those who feel unwell, the Today news portal reported.   The fires have sparked tensions between Indonesia and Malaysia.    Indonesia's environment minister initially suggested the haze was from Malaysian fires despite satellite data showing hundreds of blazes in Indonesia and only a handful in its neighbour, prompting anger from her Malaysian counterpart.

Indonesia later sealed off dozens of plantations where it said fires were blazing, including some owned by Malaysia-based firms, deepening the row.   But Prime Minister Mahathir Mohamad, who has struck a diplomatic tone throughout the crisis, said Malaysia may pass legislation forcing its companies to tackle fires on plantations abroad.   Malaysia wants its firms with sites overseas to put out blazes contributing to the haze, he said, adding: "Of course, if we find they are unwilling to take action, we may have to pass a law to make them responsible."

The Indonesian government has insisted it is doing all it can to fight the blazes. But this year's fires have been worsened by dry weather and experts believe there is little chance of them being extinguished until the onset of the rainy season in October.   Indonesia's meteorology, climate and geophysics agency said Wednesday that over 1,000 hotspots -- areas of intense heat detected by satellite that indicate a likely fire -- had been sighted, most of them on Sumatra.
Date: Wed, 18 Sep 2019 12:14:44 +0200 (METDST)
By Aishwarya KUMAR

New Delhi, Sept 18, 2019 (AFP) - India announced on Wednesday a ban on the sale of electronic cigarettes, as a backlash gathers pace worldwide due to health concerns about a product promoted as less harmful than smoking tobacco.   The Indian announcement, also outlawing production, import and distribution, came a day after New York became the second US state to ban flavoured e-cigarettes following a string of vaping-linked deaths.   "The decision was made keeping in mind the impact that e-cigarettes have on the youth of today," Finance Minister Nirmala Sitharaman told reporters in New Delhi.

E-cigarettes do not "burn" but instead heat up a liquid -- tasting of everything from bourbon to bubble gum and which usually contains nicotine -- that turns into vapour and is inhaled.   The vapour is missing the estimated 7,000 chemicals in tobacco smoke but does contain a number of substances that could potentially be harmful.   They have been pushed by producers, and also by some governments including in Britain, as a safer alternative to traditional smoking -- and as a way to kick the habit.

However critics say that apart from being harmful in themselves, the flavours of e-cigarette liquids appeal particularly to children and risk getting them addicted to nicotine.   Some 3.6 million middle and high school students in the United States used vaping products in 2018, an increase of 1.5 million on the year before.   The New York emergency legislation followed an outbreak of severe pulmonary disease that has killed seven people and sickened hundreds.   President Donald Trump's administration announced last week that it would soon ban flavoured e-cigarette products to stem a rising tide of youth users.

- Big E-Tobacco -
Although few Indians vape at present, the Indian ban also cuts off a vast potential market of 1.3 billion consumers for makers of e-cigarettes.   Tobacco firms have been investing heavily in the technology to compensate for falling demand for cigarettes due to high taxes and public smoking bans, particularly in the West.

In 2018 Altria, the US maker of brands such as Marlboro and Chesterfield, splashed out almost $13 billion on a stake in one of the biggest e-cigarette makers, Juul.   A few Indian states have already banned e-cigarettes although the restrictions have been ineffective since online sale of vaping products continue.   The new ban does not cover traditional tobacco products in India.   According to the World Health Organization, India is the world's second-largest consumer of tobacco products, killing nearly 900,000 people every year.

Nearly 275 million people over 15, or 35 percent of adults, are users, although chewing tobacco -- which also causes cancer -- is more prevalent than smoking.   India is also the world's third--largest producer of tobacco, the WHO says, and tobacco farmers are an important vote bank for political parties.   According to the Associated Chambers of Commerce and Industry, an estimated 45.7 million people depend on the tobacco sector in India for their livelihood.   Tobacco is also a major Indian export, and the government holds substantial stakes, directly or indirectly, in tobacco firms including in ITC, one of India's biggest companies.
Date: Wed, 18 Sep 2019 03:56:31 +0200 (METDST)

Washington, Sept 18, 2019 (AFP) - Hurricane Humberto strengthened to a major Category 3 storm on Tuesday and was expected to pass near Bermuda, threatening it with dangerous waves and heavy rain, the US National Hurricane Center said.   "Hurricane conditions are expected to reach Bermuda by Wednesday night and continue into early Thursday morning," the Miami-based NHC said.   "Some fluctuations in intensity are likely during the next day or so, but Humberto should remain a powerful hurricane through Thursday," it said.   As of 8:00 pm (0000 GMT), the storm had maximum sustained winds of 115 miles per hour (185 kilometers per hour) and was moving east-northeast at 12 miles per hour.
Date: Wed, 18 Sep 2019 01:36:21 +0200 (METDST)

Dakar, Sept 17, 2019 (AFP) - Four people died after a boat carrying dozens of tourists capsized during heavy storms in Senegal, authorities and emergency services said Tuesday.   The death toll could rise as three passengers were said to be missing after the accident.  The boat was carrying several Senegalese nationals, six French people, two Germans, two Swedes and one person from Guinea-Bissau, when it turned over Monday in driving rain and a heavy swell, fire department chief Papa Angel Michel Diatta said.   All the dead were Senegalese, officials and emergency services said.

Two worked in a national park, one was a woman and the other victim was a child, Diatta said.   The boat was heading for the Madeleine islands, site of an offshore national park popular with tourists who travel from Dakar, coastal capital of the West African country.   Senegalese President Macky Sall appealed for "greater caution and respect for existing security norms duing the rainy season" in a tweet.

Emergency services continued to look for those missing on Tuesday. AFP journalists saw a dozen divers at the scene. Distressed families were waiting on the shore to get news of their loved ones.    "The gendarmerie called us at 5:00 am (GMT and local time). My brother was on the boat. The worst thing is not knowing," said Aminata Diop, who was among the relatives on the beach.   There are "four dead bodies and between three and four people are missing. Thirty-five people were on the boat. Search and rescue operations are continuing this morning," Interior Minister Aly Ngouille Ndiaye told AFP by telephone.

The causes of the accident were unclear. The interior minister told Senegalese media overnight that several tourists were worried about the heavy rains and wanted to return to the pier but others wanted to stay on the boat.   The survivors spent the night on the island, Ndiaye told local radio on Tuesday. Blankets and food were sent to them and they were to be ferried back to the mainland in the morning, he added.   The rainy season arrived late this year and heavy storms have resulted in several casualties this month.    Two fishermen were killed on their canoe in the same area nearly two weeks ago.
Date: Tue, 17 Sep 2019 15:38:37 +0200 (METDST)

Jakarta, Sept 17, 2019 (AFP) - Massive forest fires in Indonesia that have caused a toxic haze to spread as far as Singapore and peninsular Malaysia are also seriously affecting endangered orangutans and their habitat, a rescue foundation said Tuesday.   Jakarta has deployed thousands of troops as temporary fireman and deployed dozens of water-bombing aircraft to battle blazes that are turning pristine forest into charred landscape in Sumatra and Borneo islands.   The fires -- usually started by illegal burning to clear land for farming -- have unleashed a choking haze across parts of southeast Asia.

The Borneo Orangutan Survival Foundation said Tuesday that the haze was affecting hundreds of great apes in its care at rescue centres and wildlife re-introduction shelters.   "The thick smoke does not only endanger the health of our staff... but also it affects the 355 orangutans we currently care for", the foundation said in a statement, referring to just once cetre in Kalimantan   "As many as 37 young orangutans are suspected to have contracted a mild respiratory infection," it added.   Conditions were so bad at their Samboja Lestari facility in East Kalimantan that outdoor activities for the animals had been restricted to a few hours a day.

Orangutans have been particularly vulnerable to commercial land clearances and have seen their natural habitat shrink dramatically in the last few decades.   The population of orangutan in Borneo has plummeted from about 288,500 in 1973 to about 100,000 today, according to the International Union for Conservation of Nature.   The toxic smoke caused by the forest fires is an annual problem for Indonesia and its neighbours, but has been worsened this year by particularly dry weather.   On Borneo island, which Indonesia shares with Malaysia and Brunei, pollution levels were "hazardous", according to environment ministry data.   Hundreds of schools across Indonesia and Malaysia were shut.