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Kuwait US Consular Information Sheet
September 2, 2008
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.

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.

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, 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
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 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

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 For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at Further health information for travelers is available at

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 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 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

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.

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
* * *
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]
[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: <>. - 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."

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.
[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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General Information
India is bounded by the Himalayas in the north and extends 2000 miles southwards into the Indian Ocean, between the Bay of Bengal on the East and the Arabian Sea on the West. The cou

try has three main geographic regions: the Himalaya Mountains on the Nepal-Tibet border; the Gangetic Plain lying below the Himalayas; the Deccan Plateau south of the Gangetic Plain. The climate throughout India is determined, to a large extent, by the massive Himalayan mountainous barrier in the northeastern part of the country. Many Irish travellers to India spend a significant period of time within the country but even those on short holidays or business trips need to take care to maintain their general health.

Most of the country is tropical or sub-tropical and subject to seasonal monsoon winds. This is especially true in the southwestern regions. * New Delhi There are three distinct seasons in New Delhi. Between mid-April to mid-July there is the hot dry season with dust storms. From mid-July to September there is a rainy season and a cooler season from October to March. * Bombay Bombay has a tropical climate and has an annual average temperature of about 270C. The hot humid season occurs in April and May. A monsoon occurs from June to September with about 70" of rainfall. A cool season extends from November to February when the temperatures can drop somewhat. * Calcutta Humidity remains high throughout most of the year. This is especially true between May to October when humidity levels of 90% are common. Most of the rainfall occurs during the monsoon season between June to October. * Madras The climate remains tropical throughout the year. December and January are relatively cool months and the heat increases rapidly from March to June. Premonsoon rains bring relief in July and the temperatures decrease slowly until the cooler season returns in November.

Safety & Security:
For most Irish travellers this will not be a major concern. However, the experience of travelling through any of the major cities is something many tourists will not forget. Taking care on Indian roads is a constantly essential activity. Parts of the country are unstable and recent earthquakes have led to disruptions to the transport infrastructure. As in many other countries travelling alone or late at night is unwise. In Kashmir tourists have been targeted and it is sensible to check you itinerary carefully before you travel throughout the country. In the northeastern part of the country (Assam, Manipur, Nagaland, Tripura, and Meghalaya) there have been sporadic incidents of violence by ethnic insurgent groups, including the bombing of buses and trains reported.

General Health Issues
It is essential that travellers recognise that there is a higher risk to their health while travelling in India. These risks are mainly associated with malaria and food and water borne diseases but conditions like accidents, rabies, tuberculosis and cholera are also present in many regions.

Food Borne Disease
A vegetarian diet is common throughout the country. Frequently the care taken with food preparation will be below standards usually seen in Western Europe. Work surfaces may be contaminated and food handlers may themselves infect the food before it is served. Cold foods should be avoided, where possible, and travellers should only consume hot food which has been freshly prepared. Stir fries may not reach sufficient cooking temperatures and need to be treated with great care. Shell fish and lettuce should always be avoided as they are one of the main ways food borne diseases are transmitted.

Water Borne Disease
Tap water should NOT be used for drinking or brushing teeth unless the smell of chlorine is obvious. Don’t use water from a jug in the hotel bedroom for anything except general washing. Sealed mineral water bought from your hotel should be used for all consumption and for brushing teeth.

Malaria is usually transmitted through the bite of an infected mosquito. This may occur throughout India, including all the major cities. The highest risk time is during the monsoon season (May to October approximately) but there is risk throughout the year. Travellers should take care against mosquito bites and maintain their prophylactic tablets during their time in India and also for a further four weeks after leaving the country.

This viral disease is transmitted by any infected warm-blooded animal. Dogs, cats, monkeys etc are frequently involved. Travellers should avoid all contact with animals and any bite (lick or scratch) should be treated by immediately washing out the area, applying an antiseptic and then seeking urgent medical attention. India reports many thousand deaths each year from this dreadful disease.

Most short term travellers should consider vaccination cover against Poliomyelitis, Typhoid, Tetanus and Hepatitis A. Malaria tablets will also be required. For longer trips please contact the Tropical Bureau at the numbers below.

Other Health Information
A full range of information on healthy travelling overseas can be obtained from the educational department of the Tropical Medical Bureau.

Travel News Headlines WORLD NEWS

Date: Sun 2 Dec 2018
Source: The Covai Post [edited]

Two persons died of [influenza A/H1N1] (swine flu) in the Government Hospital [in Coimbatore, Tamil Nadu] in the last 18 hours, taking the toll of such deaths to 20.

According to hospital sources, a 61-year old [male] was admitted to the hospital on [30 Nov 2018], after he was diagnosed with symptoms of swine flu. However, [the patient], hailing from Nilambur on the outskirts, succumbed late last night [1 Dec 2018] without responding to the treatment, they said on [Sun 2 Dec 2018].

Similarly, a 65-year old [male] of Podanur in the city was undergoing treatment in the hospital since [11 Nov 2018] and he was tested H1N1 positive and being provided treatment. [He] also succumbed late last evening [1 Dec 2018], they said.

A total of 85 persons are undergoing treatment for various types of fever -- 21 swine flu, 4 dengue, and the remaining for viral fever.
[Maps of India:

Influenza activity is increasing in the northern hemisphere as expected, and reports of fatal cases create public anxiety with overburdening of the health system. An important public health measure is to develop health information bulletins and messages to be disseminated through healthcare providers and facilities, ahead of the influenza season, and encourage vaccination, particularly in the high-risk groups. - ProMED Mod.UBA]
Date: Sat 1 Dec 2018 15:07:52 IST
Source: Devdiscourse [edited]

The Maharashtra government has told the Legislative Assembly that 101 persons died of swine flu [influenza A/H1N1] in the state till September this year [2018].

The minister informed the House that an Epidemic Management System was set up in April 2015. In a written reply to another question, Sawant said infant mortality rate due to malnutrition in the state had come down by 11 points from 24 in 2008 to 13 in 2016.
Date: Mon 3 Dec 2018 04:03 PM IST
Source: Mathrubhumi [edited]

Congo fever has been reported in the state for the 2nd time causing concern. A man from Malappuram [Kerala], who had come home from UAE [United Arab Emirates] for holidays has been tested positive for Congo fever. His condition was reported as stable.

Currently, the man is undergoing treatment at a private hospital in Thrissur. His bodily fluids have been sent for specialized tests. The health department has directed hospital staff to exercise caution as the disease can spread through bodily fluids.

Congo fever or Crimean-Congo haemorrhagic fever (CCHF), is caused by a tick-borne virus. The virus is primarily transmitted to people from ticks and livestock animals. Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons.

Symptoms include sudden fever with muscle ache, dizziness, neck pain and stiffness, backache, headache, sore eyes, and sensitivity to light. There may be nausea, vomiting, diarrhoea, abdominal pain, and sore throat early on, followed by sharp mood swings and confusion. After 2 to 4 days, the agitation may be replaced by sleepiness, depression and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable liver enlargement.

The mortality rate from CCHF is approximately 30 percent, with death occurring in the 2nd week of illness. In patients who recover, improvement generally begins on the 9th or 10th day after the onset of illness.
[It is not clear from the report above whether the case had any history of tick bite or contact with livestock. The interval between travel from UAE and appearance of disease symptoms is also not mentioned. The incubation period depends on the mode of acquisition of the virus: from 1-3 days (maximum 9 days) following tick bite and from 5-6 days (maximum 13 days) after contact with infected blood or tissues  (<>).

Sporadic human cases and outbreaks of CCHF have been reported from Afghanistan, Iran, Iraq, Kuwait, Oman, Pakistan, Saudi Arabia, Sudan, and the UAE in the eastern Mediterranean region (<>).

CCHF was first reported in the United Arab Emirates (UAE) in 1979, when 6 cases were reported among the staff of a hospital in Dubai. An outbreak of CCHF occurred during 1994-1995 with 35 human infections. A molecular investigation showed that this outbreak was multisource from Pakistan, Madagascar, and Somalia, possibly due to the importation of infected livestock from these areas. Subsequently, 35 clinical CCHF cases were reported in 1994, and between January 1998 and October 2013, another 5 cases and 2 deaths were reported from the UAE.

Based on an analysis of complete or partial sequences of the viral S-segment of CCHFV, 3 virus lineages/clades have been identified to be circulating in UAE: Africa 1 (clade III) and Asia 1 and Asia 2 (clade IV) along with circulation in Iran, Pakistan, Afghanistan, , Oman, and Iraq.

A better understanding of CCHF epidemiology is needed for a comprehensive prevention and control program, encompassing human as well as animal and tick populations. Measures to reduce tick-to-human infection, animal-to-human transmission, and human-to-human transmission are recommended to reduce the risk of infection in people. - ProMED Mod.UBA]

[HealthMap/ProMED-mail maps:
Date: Sun 25 Nov 2018
Source: Millennium Post [edited]

City based doctors and virologists suspect that the nature of larval mites, a kind of insect [that] causes diseases like scrub typhus, might have changed, as a result of which they are now found within the city. Earlier, the insects were only found in forest areas.

Two persons from Ultadanga's Basanti Colony area reportedly died of scrub typhus in November [2018], triggering panic among other residents of the area. The disease is spread among people through the bites of infected chiggers (larval mites).

Scrub typhus, also known as bush typhus, is a disease caused by bacteria called _Orientia tsutsugamushi_, and it commonly occurs in rural areas. The most common symptoms of scrub typhus include fever, headache, body aches and sometimes rash. Most cases of scrub typhus have so far been reported in rural areas of Southeast Asia, Indonesia, China, Japan, India and Northern Australia. Anyone living in or traveling to areas where scrub typhus is found, could get infected.

Meanwhile, it may be mentioned here that the health workers of KMC [Kolkata Municipal Corporation] on Sunday [25 Nov 2018] morning conducted an awareness campaign at the Basanti Colony area, stating what precautionary measures can be taken in this regard. Deputy Mayor designate Atin Ghosh, who is in charge of the Health department of KMC, said that medicines are available at all the health units run by the civic body. No new cases of scrub typhus have been found.

Virologists in the city, however, believe that the bacteria can be found in urban areas if there is a change in its nature. Due to rapid deforestation in various parts of the country, the bacteria might have been appearing in the city. In the past 10-15 years, they were not commonly found in the city and its adjoining areas.

[A] 26-year-old died earlier this month [November 2018], while [another person] died on 18 Nov [2018]. Both of them had been suffering from fever and other flu-like symptoms for a few days before finally succumbing to their ailments. The Health department officials of KMC suspect that the victims might have died due to the attack of the scrub typhus bacteria. Basanti Colony falls under Ward 32 of KMC. The civic officials and senior officials of the Beliaghat ID Hospital collected samples of blood from some other patients who were down with fever and similar symptoms.

A senior virologist of the School of Tropical Medicine in Kolkata said that the symptoms of scrub typhus usually begin within 10 days of being bitten. Signs and symptoms may include fever, headache, body aches, muscle pain and a dark, scab-like patch. Lymph nodes become enlarged, and rashes appear on the body. The disease can be treated with antibiotics, which are effective if given soon after symptoms appear. People who are treated early with antibiotics usually recover quickly. No vaccine is available to prevent scrub typhus.
[ProMED-mail previously reported on scrub typhus in several Indian states, including West Bengal, where the city of Kolkata is located.

Scrub typhus is caused by _Orientia tsutsugamushi_, a rickettsia-like microorganism that is transmitted by chiggers, the larval stage of trombiculid mites, which feed on the skin cells of animals, including humans and rodents. After feeding on their hosts, chiggers drop to the ground and become nymphs, which then mature into adults that feed only on plant materials.

Rodents may serve as reservoirs, although transovarial transmission in mites is the dominant mechanism for maintenance of _Orientia tsutsugamushi_ (<>). Humans become infected when they accidentally encroach in an area where the chigger-rodent cycle is occurring, most often areas of low-lying scrub brush or transitional vegetation.

How the diagnosis of scrub typhus was made in these patients is not stated. Scrub typhus presents clinically with chills, fever, headache, muscle pain, and sometimes with a macular or maculopapular rash and eschar at the site of the chigger bite; confirmation requires laboratory testing, usually by indirect fluorescent antibody (IFA) assay, but this will require a 4-fold rise in antibody titer between acute and convalescent specimens. Results from a single acute serum sample are unreliable, as it takes 7-10 days for IgG antibody to be detectable and antibody will be present in a high percentage of healthy people in an endemic region. The Weil-Felix test, an agglutination test for the diagnosis of rickettsial disease, is based on the detection of antibodies to various _Proteus_ species, which contain antigens that cross-react with rickettsial antigens. The Weil-Felix test is unreliable, but continues to be used in resource-poor regions (<>). Molecular methods like polymerase chain reaction (PCR) are likely not available in endemic regions.

Kolkata, formerly called Calcutta, with a population of 4.5 million residents in 2011, is the capital of the Indian state of West Bengal, located within the lower Ganges Delta on the east bank of the Hooghly River approximately 75 km (47 mile) west of the border with Bangladesh (<>).

Kolkata can be found on a map of West Bengal at

Basanti Colony is a slum in Ultadanga, a newly developed neighbourhood on the northeast fringe of Kolkata district

[HealthMap/ProMED map available at:
Date: Sat 24 Nov 2018
Source: The Hindu [edited]

Following India's 1st outbreak of Zika infections in Rajasthan in September 2018, Madhya Pradesh has now reported a 2nd one, with 6 districts affected.

The virus has been linked to birth defects in 5-15 percent of children of infected mothers. Such birth defects include an abnormally small head (microcephaly), eye damage, shortened muscles and joints, and hearing damage. This is why the World Health Organisation (WHO) recommends that in areas with ongoing Zika transmission, pregnant women should be made aware of Zika's dangers. They must use mosquito nets and repellent. Given that Zika can spread through sexual activity, they should avoid unprotected sex, while couples planning to have children should consider delaying pregnancies.

The Madhya Pradesh Public Health and Family Welfare Department's reluctance to counsel citizens quickly is due to an odd misinterpretation of Zika research. On 3 Nov 2018, a press release from the Ministry of Health and Family Welfare cited the Indian Council of Medical Research's (ICMR) findings to say that the Zika strain -- which had earlier caused an outbreak in Rajasthan -- did not have "known mutations" for microcephaly. M.P.'s health officials are now waiting for the ICMR to genetically sequence the local Zika strain, as they believe it may also lack those mutations, and so, may not be dangerous to foetuses. Only if the strain turns out to have the dangerous genetic changes, health officials said, would they begin explicitly warning couples about delaying pregnancies during the outbreak. Pallavi Govil Jain, M.P.'s Health Commissioner, says: "Because we still don't know from the Health Ministry whether the strain can cause microcephaly, we have to be cautious about what we tell women. If we tell them that it will impact their children, it will cause panic among the public."

This delay in launching intensive communication campaigns can cost lives, according to Zika researchers, because all Zika strains can probably cause birth defects. Contrary to what the Health Ministry's press release suggests, there is no "known mutation" for microcephaly. "People have got to stop saying this," says Nathan Grubaugh, an epidemiologist at the Yale School of Public Health. "It's going to drive complacency within the general population if they don't believe Zika can cause birth defects," he adds. Grubaugh studied the Brazil and U.S. Zika epidemics in 2015.

Anant Bhan, a Bhopal-based bioethics researcher, says the State government's concern about causing alarm can be tackled with a good communications strategy. "Contextualise the communication, so that it is done sensitively. But not sharing or withholding information is not acceptable," he says.

One reason why the State Health Department cannot drag its feet about informing people is that Zika epidemics are typically larger than they appear. Nearly 80 percent of the infected people do not show symptoms. Therefore, surveillance systems detect only a fraction of the cases. This means that even though diagnostic tests have so far uncovered not more than 127 cases with 35 pregnant women in M.P. [Madhya Pradesh state], the actual number could be many times as much. In such a situation, says Grubagh, telling women that Zika is linked to birth defects can motivate them to protect themselves, softening the impact of the virus. "If I were in such a situation, and if there was information that I could use to my benefit, I would want to know it. I don't want people to tell me: Oh, it's not an issue, when it actually is," he adds.

India's 1st major Zika outbreak began in September 2018 in Rajasthan. Until then, a surveillance programme run by the ICMR at 35 sites across the country had detected only 3 isolated cases in Gujarat in 2016-17, and one in Tamil Nadu.

Then, in September [2018], the surveillance system, which randomly tests a fixed number of fever patients for Zika each month, found an 85-year old woman from Jaipur to be carrying the virus. Over the next few days, more and more cases turned up. Rajasthan then began testing all pregnant women living in a 3-km [1.5 mile] radius around the index case. This effort uncovered a total of 154 cases, with over 60 pregnant women among them. Of these, 2 women have given birth, and the babies are healthy, officials say.

Around mid-November [2018], State officials declared that their extensive larvicidal and fogging activities had "controlled" the outbreak. According to Govind Pareek, Deputy Director, Public Relations for the Government of Rajasthan, no new cases were found in the 2 weeks leading up to the announcement.

However, by this time, the ICMR's surveillance system in Bhopal had picked up a 2nd outbreak. As this story goes to print, M.P.'s officials say that there are 127 infections in 6 districts of the State. But according to B.N. Chouhan, the State's Director of Health Services, the outbreak seems to be slowing down due to intensive mosquito-control activities.

Yet, there are several questions about whether the outbreaks in Rajasthan and M.P. have truly been extinguished. Zika cases typically rise and drop with the seasonal prevalence of the _Aedes_ mosquito, which means the drop in November 2018 may have as much to do with the weather as with antilarval activity. Says Grubagh: "Control of an outbreak is quite hard to define. 1st, not detecting Zika cases doesn't necessarily mean that transmission stopped, because the vast majority of cases are asymptomatic."

2nd, the ICMR's surveillance system relies on a technique called Reverse Transcription-Polymerase Chain Reaction (RT-PCR), which looks for Zika's genetic signature in patient blood samples. But RT-PCR tends to throw up false-negatives when there is too little virus in the patient's blood, something that happens frequently with Zika, says Grubaugh. Such barriers mean that the best of surveillance systems catch only a fraction of the incidence. After an outbreak in Salvador, Brazil during 2015, researchers found that the number of people who had Zika antibodies -- indicating that they had been infected in the past -- was roughly 40 times the number of detected cases. If the same multiple is applied to MP, then, given its 127 detected cases, the potential number of infections could be as high as 5080.

Sometimes outbreaks may escape notice altogether. Grubaugh describes one such suspected outbreak in Cuba in 2017. When his team analysed the number of Zika cases among travellers entering Florida, US and several European countries, they found a spike in both regions during the summer of 2017. All cases were those of recent travel to the Caribbean nation. The researchers estimated that Cuba likely saw an outbreak in 2016-2017, with around 2000-20 000 cases. Yet, local reporting systems in the Caribbean country detected only 187 cases in 2016 and none the next year. The virus, which had seemingly stopped in its tracks in the dry season of 2016, had re-emerged the next year.

If epidemics can persist quietly long after surveillance systems suggest they have ended, they can also begin before surveillance picks them up. During Brazil's 1st Zika outbreak in 2015, for example, genetic sequencing of the circulating strains suggested that the virus had entered the country more than a year before the 1st case was detected.

This could well be the case in M.P. and Rajasthan too. If so, the number of pregnant women infected would be even larger, and communicating Zika's danger to them would become even more crucial.

The M.P. government's approach to counselling people in the affected areas seems to be driven by the Ministry of Health press release, highlighting the importance of clear communication by premier research agencies such as ICMR (whose work was cited). But why did the press release suggest that the Rajasthan strain had no known mutations for microcephaly? Responding to a questionnaire from The Hindu, Nivedita Gupta, a virologist at the ICMR, referred to a Science study in 2017 to support the claim. Here, Chinese researchers found that when they infected new-born mice with a Zika strain that contained a mutation called S139N, the mice had more damaged brain cells when compared to animals infected with other strains. This suggested that the mutation had a role to play in making the Zika virus more virulent to foetal brain cells.

When the ICMR sequenced the virus that triggered the Rajasthan outbreak, they did not find the S139N mutation. This led to the Health Ministry announcing that the Rajasthan virus did not have "known mutations" for microcephaly.

The problem, according to Grubaugh and other researchers, is that the hypothesis of the Science study has not stood the test of time. Later studies have found microcephaly cases associated with strains that lacked the S139N mutation. Meanwhile, researchers who repeated the mouse experiments did not get the same results.

This is why the ICMR's claim about "known mutations" is misleading, according to him. Other scientists agree. "It is still too early to conclude that any particular strain cannot cause microcephaly," says Scott C. Weaver, a microbiologist at the University of Texas, who worked on the Brazilian outbreak. When asked if the ICMR would issue a clarification, Gupta responded that there were no errors in the press release.

The good news is that even though M.P. is slow in its public-communication campaign, it is implementing mosquito-control measures. "Our initial plan of action is vector control," says Pallavi Govil Jain. But the challenge is a steep one.

Due to persistent neglect by local municipal bodies, says Praveen Kumar Tiwari, most Zika-affected villages were in a bad state at the beginning of the outbreak. When Tiwari, an entomologist from the Regional Office of Health and Family Welfare was deputed to Sehore's Kothari village earlier this month, dozens of houses were found to have mosquito larvae-infested water.

One reason for all the stagnant water in Kothari is the lack of a sewerage system. Open drains line the narrow streets, which are dotted with potholes. Moreover, the village suffers from chronic water shortages. "We don't have tap water at home. We have to bring it [water] from the public tap. So, we fill buckets and store water for days," says SS, who is in her 2nd trimester of her pregnancy and also diagnosed as Zika positive. Some homes have built septic tanks for their toilets but are using them to store water instead.

As a result, the Breteau index (BI) -- a measure of the number of containers such as tyres and buckets containing larva per every 100 households -- was between 10 and 15 in Kothari. Any index above 5 increases the chances that larvae will turn into adults, Tiwari explains.

With intensive insecticide use, he says, the BI in the village has come down to below 5. The problem is that as long as the Kothari Nagar Panchayat does not prohibit water storage in open tanks and fill potholes, the mosquitoes will return. Tiwari is frustrated because, according to him, the upcoming State elections have drawn field staff away. Standing astride one of the many water-filled potholes on the village street, he exclaims, "I can put larvicide in the water, but what can do I about these potholes? When the larvicidal activity stops, the mosquitoes will come back."

It is tough to say how big a risk Zika will be to Indians in the coming days. For now, the 2 outbreaks, in Rajasthan and Madhya Pradesh, appear to be relatively small, with 154 and 127 detected cases, respectively. But given the number of asymptomatic cases, it is difficult to rule out the possibility of Zika cases elsewhere in India. "I would not be surprised if the Zika virus were already present in other parts of the region but has remained undetected due to the lack of active surveillance in the absence of an overt outbreak," says Weaver.

On the other hand, one speed-breaker for the epidemic could be herd immunity. If Zika has already been in India for some time, and Indians have antibodies to it, the virus would not move as quickly. But as on today, there is no data on herd immunity in the Indian population. In a 1954 survey of people, from across the country, researchers had found 33 of 196 people to have antibodies that neutralised the Zika virus, suggesting that the virus was circulating here.

What researchers did not know then was that flaviviruses -- a genus to which the Zika, dengue and Japanese encephalitis viruses belong -- are notorious for a phenomenon called cross-reactivity. This means that human antibodies to one flavivirus, such as dengue, can neutralise another one, such as Zika. So, the 1954 study was not conclusive evidence of Zika's presence in India, because it could just as well have been evidence of dengue.

In other words, if Zika hasn't been widespread in India before, the lack of herd-immunity would mean it would blaze its way quickly to other States. Says Weaver, "Without good information on herd immunity, I think we should assume that there is risk wherever _Aedes aegypti_ is present and temperatures are permissive." One good way to visualise how Zika will spread is to think of the mid 2000s chikungunya epidemic in India. After not being recorded in the country for nearly 32 years, the virus, which is also spread by _Ae. aegypti_, showed up in 2005. Within the next 12 months, it had infected 1.4 million people in 15 States. Says Grubaugh: "Think of what chikungunya did, and the number of cases it caused. Now replace the name with Zika, and there you have the epidemic."

If Zika spreads, India's antenatal health-care systems will be critical in screening pregnant women for foetal abnormalities and helping them decide if they want to terminate the pregnancy. The good news is that birth defects such as microcephaly, contractures, and clubfoot can be picked up during sonography at around 17 to 18 weeks of pregnancy, according to Vijay Sadasivam, a radiologist at SKS Hospital, in Salem, Tamil Nadu. Ideally, around 5 sonographies should be done to find any anomalies, he adds.

M.P. State officials have begun tracking pregnant women diagnosed with Zika, and say they are drawing up guidelines for monitoring them. But if the outbreak returns or grows larger next year, the State's antenatal health-care system will have to gear up substantially, because it does not reach enough women today.

According to National Family Health Survey-4 data, 80 percent of pregnant women deliver in hospitals in M.P.'s urban areas, while only 76 percent do so in the rural areas. Out of the women who do deliver in hospitals, estimates Archana Mishra, Deputy Director, Maternal Health at National Health Mission in M.P., only around half receive at least one sonography during pregnancy.

At this rate, it is likely that pregnant women who ought to get screened will not be. This is another reason to inform all women of reproductive age of Zika's dangers so that they may seek care on their own. "Why should health officials be shielding the populace from a truly scary scenario by withholding information? This is our paternalistic healthcare approach at its worst," says Sadasivam.  [Byline: Priyanka Pulla]
[Although ProMED-mail does not usually post long, detailed reports like this one, it is of interest because it illustrates the challenges and conflicts that can arise when outbreaks are newly recognized. Intensification of case surveillance, increased sonography of pregnant women, and more vigorous mosquito vector control bring with them the need for more professional personnel and public education. These steps require additional commitment of funds and of trained personnel, a difficult policy decision to make when it is not certain that the virus is still present in the outbreak areas, and even more challenging to implement in areas where the virus has not yet been detected. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
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World Travel News Headlines

Date: Thu, 13 Dec 2018 06:41:40 +0100

Hanoi, Dec 13, 2018 (AFP) - Floods caused by heavy downpours have killed 13 people in central Vietnam, officials said Thursday, as farmers scrambled to save crops and livestock ahead of more bad weather forecast for this week.   Torrential rains have lashed six provinces in the centre of the country since Saturday, killing thousands of cows and chickens and flooding several cities -- including the coastal resort town of Danang.    More than 50 centimetres (20 inches) of rain hit some areas, with more downpours expected in the coming days, the disaster management office said Thursday.   "Thirteen people were killed, while one remains missing in Quang Ngai province," the office said.    Around 12,000 hectares of crops were destroyed, and some 160,000 livestock killed, it added.

One farmer in Quang Nam province said he lost all his chickens in the flooding, costing him tens of thousands of dollars.       "The water receded but thousands of our chickens were dead. We had to collect them for burial as the smell was so bad," Nguyen Thanh said, quoted by state-run Tuoi Tre newspaper.    Several areas in Quang Nam and Quang Ngai provinces were still inundated on Thursday after hydropower plants discharged reservoir waters.    Vietnam is frequently hit by heavy downpours during the typhoon season from May to October, but forecasters said the rains arrived late this year.     More than 200 people have been killed in weather-related disasters in 2018, down from 389 last year.
Date: Wed, 12 Dec 2018 08:14:22 +0100

Bangkok, Dec 12, 2018 (AFP) - A French tourist was gunned down early Wednesday by an off-duty Thai cop after a drunken bar fight in a seedy Bangkok district, police said.   The 41-year-old Parisian was shot dead at a downtown apartment block after an altercation with the police sergeant major who had approached the tourist's Thai girlfriend.     "They were drunk... they started to argue and then had a fist fight but the policeman couldn't fight back," the Chief of Thailand's Immigration Police Surachate Hakpan told AFP.   "The policeman followed him back to his place and shot him twice," he said, adding the victim had been in Thailand for several months.

The officer has been arrested and "will be fired... and prosecuted on a murder charge", Surachate added.   Police are hunting a second suspect seen on CCTV.    Gruesome pictures circulated on Thai media showed the victim lying in a pool of blood in front of a doughnut shop at his apartment block.    Bangkok is one of the world's most visited cities, famed for its food and racy nightlife, much of it around Nana district where the murder took place.    Thailand as a grim reputation for its gun culture, with drunken arguments, business disputes and soured romances frequently resolved by violence.
Date: Wed, 12 Dec 2018 02:09:59 +0100

Mexico City, Dec 12, 2018 (AFP) - A massive fireworks explosion during a procession at a Mexican church killed eight people Tuesday and left some 50 wounded, authorities said.   Two children aged 11 and 12 were among those killed in the accident, which occurred around dawn at the San Jose parish atrium in Tequisquiapan, some 145 kilometres (90 miles) northwest of Mexico City.

Parishioners had donated the fireworks for a festival, but "something went wrong and they exploded," said Gabriel Bastarrachea, emergency response official for the state of Queretaro.   A video posted on social media showed people marching toward the church in a festive procession when suddenly a giant, fiery blast sent them running and screaming.

It was the latest in a string of deadly fireworks accidents in Mexico, where a thriving but dangerous cottage industry supplies a seemingly endless array of colourful explosives to celebrate holidays and festivals.   At least 24 people were killed in a series of fireworks explosions last July in the town of Tultepec in central Mexico, and 42 people were killed there when a rocket exploded in December 2016 at the height of the Christmas fireworks rush.
Date: Tue, 11 Dec 2018 22:14:43 +0100

Bogota, Dec 11, 2018 (AFP) - The abandoned building where Colombian drug lord Pablo Escobar lived will be covered in posters paying tribute to the victims of his Medellin Cartel before it is torn down next year.   The exhibition is part of a move by municipal authorities to tell the other side of Escobar's story -- that of his victims -- to counter a surge of television series glamorizing his life and that of his cartel.   "Respect our pain, honour our victims (1983-1994). 46,612 fewer lives," reads the message on one of the posters that now greet Medillin's "narco-tourists" flocking to the Monaco apartment block.

Portraits of slain journalist Guillermo Cano, gunned down in 1986, former presidential candidate Luis Carlos Galan and police chief Valdemar Quintero -- both murdered in 1989 -- are emblazoned over a message that reads, in English: "It is not fiction, it is reality."   Mayor Federico Gutierrez told reporters that the tourist site had become a "symbol of illegality."   "Now, there are messages that should lead us to reflect," he said.   The posters will remain affixed to the building until municipal workers tear it down on February 22, more than 25 years after Escobar was shot dead by police in 1993.     The former luxury block will be replaced by a municipal park.
Date: Tue, 11 Dec 2018 19:29:44 +0100

Beni, DR Congo, Dec 11, 2018 (AFP) - Children account for a third of Ebola cases in an outbreak of the disease in the Democratic Republic of Congo, with hundreds orphaned or isolated, the United Nations said on Tuesday.   Nearly 300 people have died from the highly contagious disease since August in the restive east around the city of Beni.

The UN children's agency UNICEF said the organisation and its partners had identified more than 400 children who have been orphaned or isolated during the outbreak.    "We are deeply concerned by the growing number of children confirmed to have contracted Ebola," said UNICEF's Regional Director for West and Central Africa, Marie-Pierre Poirier, returning from Beni.    "The earlier children infected with Ebola receive treatment in a specialised health facility, the greater their chances of survival. Community mobilisation and public awareness activities are also crucial."

After it was declared on August 1 -- the tenth outbreak in DR Congo since 1976 -- at least 285 people have died, according to the last health ministry update on December 9.   Nearly 44,000 people have been vaccinated.   The outbreak has hit an area already struggling with violence from armed groups.   In November, medical and vaccination efforts were briefly suspended and health workers evacuated after clashes between UN peacekeepers and fighters from the local Allied Democratic Forces militia.
Date: Tue, 11 Dec 2018 14:28:55 +0100

Paris, Dec 11, 2018 (AFP) - The soaring Arc de Triomphe at the top of the Champs-Elysees in Paris will reopen Wednesday after being covered in graffiti and ransacked during anti-government protests which rocked the capital on December 1, the French monuments commission said.   The arc, under which lies the tomb of the unknown soldier, commemorating France's war dead, has been a focal point of the "yellow vest" rallies against fuel tax increases and the cost of living which began on November 17.   But the demonstrations degenerated into daylong clashes with police early this month, with protesters spray-painting the arc with slogans such as "the yellow vests will win."

The protesters later managed to break into the monument where they smashed sculptures and display cases in an underground gallery and snatched commemorative medals and other items.   They also snuffed out the eternal flame burning on the tomb of the unknown soldier.    Some protesters were also seen on the top of the landmark building which offers panoramic views of the capital.   "All the networks and equipment essential for the security and proper functioning of the monument will have been restored and repaired," the commission said in a statement Tuesday.   "Some furniture, notably in the gift shop and library, have been temporarily repaired while awaiting new installations," it added.   It said the damage was estimated at several hundred thousands of euros (dollars).   Thirteen people were charged last week over the looting and destruction and investigations are continuing to identify other suspects.
Date: Tue, 11 Dec 2018 13:30:30 +0100

Madrid, Dec 11, 2018 (AFP) - Spanish railway workers will stage a nationwide strike on December 21 and January 7 during the busy Christmas holiday period over job cuts and working conditions, a union said Tuesday.   The "main reason" for the strike is the "continued reduction in the number of staff" at state train operator Renfe and state rail infrastructure company Adif, the CCOO union, one of the main trade unions representing rail workers, said in a statement.   "We are mobilising to recover the jobs which have been lost, improve purchasing power and ensure agreed pay increases come into effect," said Manuel Nicolas Taguas, general secretary of the railway workers sector at the CCOO.   The union says that since 2005 the workforce employed by the two companies in charge of Spain's rail network has been slashed by around 5,000 workers to roughly 26,000 employees.   The union representing Renfe rail guards has called a one day strike on December 14 to protest working conditions.
Date: Mon, 10 Dec 2018 14:05:06 +0100

Nairobi, Dec 10, 2018 (AFP) - South Sudan will vaccinate key health workers against Ebola close to the border with the Democratic Republic of Congo, which faces a new epidemic, the World Health Organization said Monday.   The ministry of health's vaccination campaign, with cooperation from the WHO, will target healthcare and frontline workers in the high-risk states of Juba, Yei, Yambio and Nimule, the UN agency said in a statement.   South Sudan is one of several countries bordering the vast DRC, where the new outbreak of the highly contagious viral disease had since August claimed 271 lives by December 6, according to Congolese Health Minister Oly Ilunga Kalenga.

A total of 2,160 doses of the experimental vaccine rVSV-ZEBOV have been allocated to South Sudan for a programme starting on December 19. This trial vaccine is not yet licenced but is considered safe and provided "under the compassionate-use guidelines in response to the ongoing Ebola outbreak in DRC", the WHO said.   Like neighbouring Uganda, where similar measures have been taken for health personnel, South Sudan has declared a state of alert because of the risk that Ebola may be carried into its territory. At present, no cases have been reported, according the WHO.   The experimental vaccine first went on trial during the terrible epidemic of Ebola that ravaged parts of West Africa between the end of 2013 and 2016, at a cost of more than 11,300 lives. The disease spreads through contact with bodily fluids from other people or infected animals.

The vaccine was created by Canadian public health specialists at the National Microbiology Laboratory and is considered highly effective by the WHO, but it works only against the Ebola virus-Zaire strain, confirmed in the outbreak in the DRC.   South Sudan has been torn by civil war for five years in a conflict that has left nearly 400,000 dead. More than four million people -- about a third of the population -- have fled.   The main belligerents signed a peace accord in September, but the work of humanitarian organisations remains complicated and dangerous.   Participants in the vaccination programme have been trained on rVSV-ZEBOV and undertaken a simulation exercise. Meanwhile, the Ebola preparedness contingency plan covers measures ranging from screening travellers, community engagement and provision for safe and dignified funerals, the WHO said.
Date: Mon, 10 Dec 2018 11:42:55 +0100

Bangkok, Dec 10, 2018 (AFP) - An Iranian man has been arrested after using travel freebies to lure an unsuspecting Japanese tourist into smuggling a bag of clothes laced with crystal meth, Thai police said Monday.   The tourist, whose name has not been disclosed, found the deal on a travel website that offered free getaways to Thailand, Shanghai and Frankfurt, complete with thousands in spending money.

But after arriving in Thailand last week, he was handed "suspicious" luggage for his next trip to Shanghai, Itthipol Itthisarnronnachai, deputy chief of Thailand's immigration department, told reporters.   "Inside the bag, he found clothes that felt more solid than usual. He then contacted the Japanese embassy," Itthipol said.   Police said the clothes had been coated with crystal methamphetamine -- known as ice.

Four bags of the drug were also found, adding up to 2.2 kilogrammes (4.9 pounds) in total.    Thailand gets 35 million tourists a year and some fall prey to low-level scams or robbery, but few are swept up in transnational drug-running.   "It's a never-seen-before method, luring tourists to traffick drugs out of the country," Itthipol added.

Demand for meth is surging in the region at a time when authorities are attempting to crack down on the lucrative business.   Police said the Iranian national was arrested when he went to retrieve the luggage after the Japanese man pretended to be sick and said he wanted to cancel the trip.   They found 10 kilogrammes of ice and ice-coated clothing in the suspect's apartment.   "We will pursue this case and investigate networks in Thailand and Japan to take down this scam," Itthipol said.
Date: Mon, 10 Dec 2018 08:53:28 +0100

Frankfurt am Main, Dec 10, 2018 (AFP) - Germany was plunged into transport chaos Monday as most train services were halted by a railworkers' strike over pay, affecting millions of passengers.   Inter-city and regional services as well as many urban commuter trains were cancelled throughout Europe's biggest economy by the four-hour stoppage from 5:00 am (0400 GMT), Deutsche Bahn (DB) said.   The strike halted all high-speed ICE trains and other inter-city services as well as most cargo trains, and its ripple effects and delays were expected to continue well into the afternoon.   In the capital Berlin, where additionally the entire public announcement system broke down, frustrated commuters were asked to switch from S-Bahn commuter trains operated by DB to subways, buses or trams.

The strike came after talks broke down Saturday between the DB and the EVG rail workers' union, which is demanding a 7.5-percent salary rise for 160,000 employees.   "The employer made offers which did not correspond to the demands of our members," said EVG negotiator Regina Rusch-Ziemba.   DB shot back and described the strike as a "completely unnecessary escalation", insisting its offer was "attractive and met the main demands" of employees.   DB had offered a pay rise of 5.1 percent in two phases, with an option for staff to take extra time off instead, and a one-off payment of 500 euros ($570), the DPA national news agency reported.   Deutsche Bahn in a tweet also denied it had broken off the negotiations, charging that "the EVG left the talks and went on strike".   "DB remains ready to continue the negotiations at any time. There is an open invitation for today."

The strike also impacted DB customer services offices, meaning that in many stations passengers were left without information over loudspeakers or display boards.   DB said that purchased tickets would remain valid until next Sunday or could be refunded and urged passengers to delay travel where possible.   It also called on the union -- which threatened follow-up strikes if necessary -- to return to the negotiating table quickly.   A DB spokeswoman said: "Parties that negotiate must be prepared to make concessions. DB has asked the EVG to continue the talks this afternoon."