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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]
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[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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South Africa

General Introduction: The Republic of South Africa lies at the Southern tip of the African continent, flanked between the Indian and Atlantic oceans. Although it lies close to the tropic of Capricorn, the inland areas are tempered by the relatively high a
titudes. Summers and winters are opposite to that found in Ireland. In South Africa the summer extents from October to March. Although South Africa is basically a developed country, much of its population, particularly in rural parts, live in poverty. However facilities for tourists in urban areas and game parks are generally excellent. Despite all the well documented reports overall violence against tourists is usually low but obviously care should always be taken. Travelling late at night is usually unwise and take particular care if visiting nightclubs etc.
Climate: There is generally a moderate climate with sunny days and cool nights. The Cape Town region has a mean yearly temperature of 170C while Johannesburg has an annual mean temperature of 160C. This is mainly because Johannesburg is at 5,700 feet altitude. Throughout South Africa, summer extends between October and March and winter is between June and September. In Johannesburg the winter months tend to be dry and cool while the rainy season tends to occur during the warmer summer months.
Health Facilities: In the larger cities of Johannesburg, Cape Town, Durban & Pretoria and many others there will be no difficulty in receiving excellent medical attention. However when travelling throughout the more isolated rural regions the same situation does not occur. Travellers should always ensure that they are up-to-date in their routine travel vaccinations. World Travel Medicine Consultants (WTMC) in South Africa offer excellent medical facilities in many of the main centres. Contact by email their head office at for further information.
Jet Lag: Even though the hour changes from Ireland are not great after flying for approximately 13 hours you will arrive tired. On the plane journey take some exercise by walking around and occasionally stretching your calf muscles to lessen any risk of blood clots. If you are on the contraceptive pill (women only!) this will increase your risk on a long haul flight and you should talk this through with the doctor looking after your health care advice and vaccines. On arrival, try and rest for the first 24 hours to allow your body to catch up with itself. If lying by the pool remember not to fall asleep and wake some hours later with significant sunburn!
Mosquito-Borne Disease: Mosquitoes are most often associated with Malaria, however it is not the only disease which the insect may carry. Insect repellents which contain more than 30% DEET are effective for keeping mosquitoes away but remember to cover your arms and legs when they are biting. This is mainly in the hours between dusk and dawn. The risk of malaria can be reduced by taking malarial prophylaxis on a regular basis if you are planning to visit the risk areas. Anti malaria tablets are advised for those visiting low altitude areas especially areas around the Kruger National Park, north, east and western Transvaal, and the costal lowlands of Natal. Large towns and cities and high altitudes are more likely to be free of mosquitoes.
Effects of Heat: Extreme climate conditions can also lead to gastrointestinal difficulties but don't forget that when you perspire you will loose both water and salt. Replacing the lost water is easy but many travellers forget to replace the salt in their diet. This can lead to muscular cramps, tiredness and lethargy, a dull headache and generally feeling cross and out of sorts. Replacing depleted salt is most easily achieved by sprinkling it on your meals. Salt tablets can be dangerous and are best avoided except in expert hands. If you have any blood pressure difficulties then it will be important to talk this whole issue through with your doctor before leaving Ireland.
Waterborne diseases: Water sources in well developed urban areas of South Africa are generally safe. Outside the main cities caution must always be exercised with regard to drinking water. Safe water should be well chlorinated and so will have a distinct chlorine odour. Sealed bottled water is more preferable especially in less developed areas. Avoid ice in your drinks as its source may be unknown and don't brush your teeth in water you wouldn't want to drink. If unsure be careful and use sealed bottled water from one of the hotels.
Food-Borne Disease: Again, in the larger cities and tourist resorts, the food and its preparation is generally of an excellent standard and you should experience no problems. It is advised however to avoid eating shellfish and cold/rare meats. In particular, Capetown is famous for its various shellfish meals. Personally I would strongly encourage travellers to avoid them even in the best hotels and restaurants. It is just not worth the risk. As in any hot climate it is also wise to choose only the type of fruit you can peel yourself. Above all avoid buying or consuming food from roadside stalls or street vendors.
Rabies in South Africa: Travellers need to be aware that this potentially fatal viral condition occurs throughout Africa. The risk to any tourist or business traveller is very small but common sense needs to be maintained at all times. The disease is mainly transmitted through the bite of an infected warm blooded animal. Usually dogs and cats are involved but also be very careful of monkeys. If bitten by any potentially at risk animal wash out the wound immediately, apply a strong antiseptic and seek medical attention urgently
Yellow Fever: A yellow fever vaccination certificate is only required for travellers coming from endemic zones in Africa and the Americas. Travellers on scheduled airlines whose flights have originated outside the areas regarded as infected (or who are only in transit through these areas) are NOT required to possess a certificate.
If the flight originated from within a Yellow fever endemic area a certificate is then required.

Vaccination Schedule: Apart from Yellow Fever vaccine in certain circumstances, as mentioned above, there are no other vaccinations required for entry into South Africa from Ireland. Nevertheless there are a number of recommended vaccines for most travellers which need to be discussed. For trekking holidays or extended visits Rabies and Hepatitis B may need to be considered. Most travellers should start their vaccines at least 4 to 6 weeks before departure.
Further Information: South Africa is a beautiful destination with much to offer. Further general health information on staying healthy while travelling abroad may be obtained from the Tropical Medical Bureau. www.tmb.ie

Travel News Headlines WORLD NEWS

Date: Tue 22 Jan 2019
Source: Review Online [abridged, edited]

The Limpopo Department of Health is alerting people, particularly those who regularly work or handle livestock and animals, to be cautious following confirmation of a case of brucellosis in the Giyani area, where a livestock farmer died after having been diagnosed with the disease.

Brucellosis is an infectious disease caused by a type of bacteria called _Brucella_. The bacterium can spread from animals to humans. The infection is acquired through ingestion or direct contact such as touching, splashes onto mucous membranes, and inhalation (breathing in) of contaminated animal products. The infection with _Brucella_ species is not spread from person to person.

Spokesperson for the department, Neil Shikwambana, says the farmer contracted the disease after he was reported to have drank unpasteurized (unboiled) milk from his cattle.

Brucellosis can be contracted through eating undercooked/uncooked meat or consuming unpasteurized/raw dairy products (milk, cheese, ice cream), or coming into contact with an infected animal. Bacteria can also enter wounds in the skin/mucous membranes through contact with infected animals. This includes people who have close contact with animals or animal excretions (new-born animals, foetuses, and excretions that may result from birth) such as slaughterhouse workers, meat-packing plant employees, veterinarians, farmers and hunters (inhaling the bacteria while dressing their game).

People most at risk include infants and young children, older adults, pregnant women, and people with weakened immune systems, such as people with cancer, an organ transplant, or HIV.
=======================
[The species generally associated with cattle is _Brucella abortus_. Brucellosis is one of the classical zoonoses linked to ingestion of unpasteurized milk and dairy products. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps:
Limpopo Province, South Africa: <http://healthmap.org/promed/p/2947>]
Date: Tue 11 Dec 2018
Source: National Institute for Communicable Diseases, Johannesburg:

Malaria cases in South Africa are increasing as expected during the summer months. As at the end of October 2018, more than 16,000 cases with 110 deaths have been reported. This is fewer than during the large upsurge in malaria seen in the 2017-2018 season, but still more than the average over the 10-year period 2007-2016, which was around 7600 cases per year.

During the holiday season, many people will be exposed because of their travel to higher transmission areas, both internally and outside the country borders, particularly in Mozambique.

There has been some recent expansion of low or very low malaria transmission to some districts previously regarded as non-malaria areas in South Africa, such as parts of the Waterberg district. People who are planning to travel are urged to take adequate measures to protect themselves from malaria.

All people in malaria risk areas should reduce contact with mosquitoes by limiting outdoor activity after dark, covering up bare skin (not forgetting feet and ankles), using mosquito repellents, ensuring mosquito screens on windows are closed, and using bed nets, fans, or air-conditioning, if available. Consider antimalarial prophylaxis in higher risk areas -- doxycycline and atovaquone-proguanil are available without prescription from pharmacies. Public sector travel clinics will also supply prophylaxis to travellers. It is important to understand that while these precautions will substantially reduce the chance of acquiring malaria, the risk is never completely abolished.

All travellers returning from malaria transmission areas, including very low risk ones, should get medical advice about 'flu-like' illness (headache, fever, chills, muscle and joint pain) that occurs up to 4 to 6 weeks after 1st possible exposure, in case it is malaria. Please [go to <http://www.nicd.ac.za/wp-content/uploads/2017/03/Malaria-FAQ-NICD-Nov-2018.pdf> for further information on malaria prevention.
=====================
[The South Africa National Institute for Communicable Diseases risk map updated December 2018 can be found at
Malaria prophylaxis is recommended in high risk areas (see map). - ProMED Mod.EP]

[HealthMap/ProMED-mail map of South Africa:
Date: Tue 23 Oct 2018
Source: News24 (South Africa) [edited]

Early this month [October 2018], a crossbreed puppy of approximately 12 weeks old was brought into the Kloof and Highway SPCA reception by a kind member of the public who had found it in her garden in Wyebank. The puppy was brought in a box, and the reception staff immediately noticed that there was something wrong with the puppy. When examined, it was observed to have neurological issues and was extremely vocal.  The decision was immediately made to humanly euthanise the puppy, and it was sent to the state vet for rabies testing. Once the test was conducted, a positive rabies result was confirmed. This is the 13th positive rabies result this year at the Kloof and Highway SPCA.

This puppy was suffering and could have infected other animals and people with the rabies virus; we are so grateful to the lady and her son who rushed the puppy to our SPCA and saved it from further suffering.  When the staff received the positive rabies result, the woman was immediately contacted and informed of the seriousness of the situation. She also confirmed that 5 people had been in contact with the puppy before it was brought into the Kloof and Highway SPCA.

The Kloof and Highway SPCA are urging members of the public to make sure their pets are vaccinated against rabies as well as exercise caution when approaching stray animals.  "If you find a stray animal you are not familiar with, approach it only if it is safe to do so and absolutely necessary. In the event of being bitten or scratched, immediately wash the area very well, flush under running water, and immediately seek medical attention. "If you are bitten or scratched by an animal with no proof of vaccination, you will be required to go for a costly course of rabies vaccinations treatment.  "Rabies is fatal, and the threat of it should not be taken lightly. We strongly advise against keeping any stray animals with the rising threat of rabies," said Brigitte Ferguson of the SPCA.
=========================
[The serious hazard of rabies in puppies has been repeatedly addressed in ProMED-mail's rabies postings. Collecting stray puppies may pose a life-endangering threat, in particular for children who commonly deal with them. Do keep in mind that the clinical signs in puppies may be easily missed. - ProMED Mod.AS]
Date: Wed 17 Oct 2018
From: John Frean <johnf@nicd.ac.za> [edited]

We report the 1st human case of melioidosis detected in South Africa. A 36-year-old man in Pietermaritzburg, KwaZulu-Natal province, presented with dizziness, nausea, weakness, coughing, and inability to walk. He was admitted to a hospital on 9 Jul 2018. He was HIV positive with a CD4 count of 18. His condition deteriorated and despite intensive medical care, he died on 20 Jul 2018. The pathogen was identified from blood culture by the local National Health Laboratory Service microbiology laboratory and confirmed at the National Institute for Communicable Diseases, Johannesburg, by MALDI-TOF and electron microscopy. Subsequent whole genome sequencing indicated a new sequence type.

Melioidosis is a disease of animals and humans caused by the environmental bacterium _Burkholderia pseudomallei_. Infected animals (horses, pigs, sheep, goats, and rodents) may spread it to new areas, where it persists in water and soil. Barefoot farming in wet conditions, flooding, and travel in endemic areas are some exposure risk factors. Typical predisposing medical conditions are diabetes, renal or liver disease, malignancy and immunosuppression. Human-to-human transmission does not occur. Clinical presentation includes pneumonia, cutaneous or visceral abscesses, and septicaemia, and case fatality is high (40-75 percent), despite antimicrobial therapy. Prolonged incubation periods (days to years) can make it difficult to identify the source of exposure.

Melioidosis is endemic in tropical or subtropical regions of Australia, Western Pacific, Asia, Indian Ocean islands, and South and Central America. Sporadic cases have occurred in West and East Africa, but there is no sound epidemiological data about the burden or distribution of disease in Africa. The only previous case of melioidosis reported in South Africa was that of a goat, in 1995.

The predicted environmental suitability for _B. pseudomallei_ in South Africa is low, and is more favourable in parts of the neighbouring countries of Botswana and Mozambique. However, as this case and the previous animal case suggest, improved local awareness of melioidosis is needed.

References
----------
1. Van der Lugt JJ, Henton MM: Melioidosis in a goat. J S Afr Vet Assoc 1995; 66(2): 71-3; [abstract available at <https://www.ncbi.nlm.nih.gov/pubmed/8544164>].
2. Limmathurotsakul D, Golding N, Dance DA, et al. Predicted global distribution of _Burkholderia pseudomallei_ and burden of melioidosis. Nat Microbiol. 2016;1:15008. doi: 10.1038/nmicrobiol.2015.8; [abstract available at <https://www.nature.com/articles/nmicrobiol20158>]. 3. Steinmetz I, Wagner GE, Kanyala E, et al. Melioidosis in Africa: time to uncover the true disease load. Trop Med Infect Dis. 2018 Jun 10;3(2). pii: E62. doi: 10.3390/tropicalmed3020062; [available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073667/>].  [Byline: J Frean, D Wilson, S Haffejee, J Rossouw, M Birkhead, A Ismail, M Ali]
---------------------------------------------
John Frean and colleagues
National Institute for Communicable Diseases
Johannesburg
South Africa
==========================
[ProMED thanks Dr Frean and his colleagues for this report.

Although a classical infection in eastern Asia and Northern Australia, cases have been acquired in Africa, Central and South America, and the Caribbean basin. Reference 2 above is a 2016 paper (Limmathurotsakul D, Golding N, Dance DA, et al. Predicted global distribution of _Burkholderia pseudomallei_ and burden of melioidosis. Nat Microbiol. 2016;1:15008. doi: 0.1038/nmicrobiol.2015.8; abstract available at <https://www.nature.com/articles/nmicrobiol20158>) that estimates -- for 2015 -- the burden of melioidosis for the areas of major and some risk as follows:

Area / Population at risk in millions / Melioidosis cases in thousands / Melioidosis deaths in thousands
South Asia / 1525 / 73 / 42
East Asia and Pacific / 858 / 65 / 31
Sub-Saharan Africa / 602 / 24 / 15
Latin America and Caribbean / 246 / 2 / 1
Middle East and North Africa / 49 / less than 1 / less than 1

Melioidosis is a disease of the rainy season in its endemic areas. It mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (commonest risk factor), renal disease, cirrhosis, thalassemia, alcohol dependence, immunosuppressive therapy, chronic obstructive lung disease, cystic fibrosis, and excess kava consumption. Kava is a herbal member of the pepper family that can be associated with chronic liver disease.

Melioidosis may present at any age, but peaks in the 4th and 5th decades of life, affecting men more than women. In addition, although severe fulminating infection can and does occur in healthy individuals, severe disease and fatalities are much less common in those without risk factors.

The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, chest pain, and -- although the cough can be nonproductive -- respiratory secretions can be purulent, significant in quantity, and associated with on-and-off bright, red blood. The lung infection can be rapidly fatal -- with bacteremia and shock -- or somewhat more indolent.

Acute melioidosis septicemia is the most severe complication of the infection. It presents as a typical sepsis syndrome with hypotension, high cardiac output, and low systemic vascular resistance. In many cases, a primary focus in the soft tissues or lung can be found. The syndrome, usually in patients with risk factor comorbidities, is characteristically associated with multiple abscesses involving the cutaneous tissues, the lung, the liver, and spleen, and a very high mortality rate of 80 to 95 percent. With prompt optimal therapy, the case fatality rate can be decreased to 40 to 50 percent.
The melioidosis bacillus is intrinsically insensitive to many antimicrobials. It should be noted that bioterrorism strains may be engineered to be even more resistant. _Burkholderia pseudomallei_ is usually inhibited by tetracyclines, chloramphenicol, trimethoprim-sulfamethoxazole (SXT), antipseudomonal penicillins, carbapenems, ceftazidime, and amoxicillin/clavulanate or ampicillin/sulbactam. Ceftriaxone and cefotaxime have good in vitro activity but poor efficacy; and cefepime did not appear, as well, to be equivalent to ceftazidime in a mouse model. The unusual antimicrobial profile of resistance to colistin and polymyxin B and the aminoglycosides but sensitivity to amoxicillin/clavulanate is a useful tool to consider in treatment of infection with the organism.

The randomized and quasi-randomized trials comparing melioidosis treatment have been reviewed, and it was found that the formerly standard therapy of chloramphenicol, doxycycline, and SXT combination had a higher mortality rate than therapy with ceftazidime, imipenem/cilastatin, or amoxicillin/clavulanate (or ampicillin/sulbactam). The betalactam-betalactamase inhibitor therapy, however, seemed to have a higher failure rate.

Source: Tolaney P, Lutwick LI: Melioidosis. In: Lutwick LI, Lutwick SM (eds). Bioterror: the weaponization of infectious diseases. Totowa NJ: Humana Press, 2008 pp 145-58.

For the microbiologists among our readers, a new (and 5th) member of the _B. pseudomallei_ complex has been described, _B. humptydooensis_, from the Northern Territory of Australia and named after the small town of Humpty Doo near to where the isolate was found (Tuanyok A, Mayo M, Scholz H, et al. _Burkholderia humptydooensis_ sp nov, a new species related to _Burkholderia thailandensis_ and the 5th member of the _Burkholderia pseudomallei_ complex. App Environ Microbiol 2017; 83(5): e02802-16; available at <https://aem.asm.org/content/83/5/e02802-16.long>. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of South Africa:
Date: Tue, 25 Sep 2018 14:28:55 +0200

Pretoria, Sept 25, 2018 (AFP) - South Africa on Tuesday announced visa reforms aimed at luring investment and tourists to help lift the continent's most advanced economy out of recession.   Home Affairs Minister Malusi Gigaba unveiled a raft of regulations allowing frequent visitors and foreign business travellers to have long-term multiple-entry visas of up to 10 years.

The rules will take effect from next month.   "Changes to our visa architecture have the potential to boost tourism and make business travel more conducive," Gigaba told reporters.   "We are simplifying visa requirements for countries such as China and India."   Applicants from those two countries will be able to have a 10-year visa processed within five days.   "This arrangement is meant to attract business people and prospective investors," he said.

Anti-trafficking rules requiring parents to travel with birth certificates of their children will be simplified, he added.   Tourism contributes 10 percent of South Africa's total Gross Domestic Product (GDP).   Visa reforms are part of an economic stimulus plan announced by President Cyril Ramaphosa on Friday to boost investor confidence after South Africa entered a recession in the second quarter of this year.   The plan also includes large-scale infrastructural development.   Data showing that South Africa had slipped into recession dealt a blow to Ramaphosa who came to office in February ahead of elections next year.
More ...

World Travel News Headlines

Date: Thu, 21 Feb 2019 07:52:47 +0100
By Amelie BARON

Port-au-Prince, Feb 21, 2019 (AFP) - With flaming barricades and widespread looting, 10 days of street violence in Haiti have all but buried a tourism industry that managed to resurrect itself after a devastating earthquake in 2010.   Ugly, violent footage beamed around the world has again sent the message that this impoverished Caribbean country is politically unstable and no place to go on vacation.

The final straw was the helicopter evacuation last week of 100-odd Canadian tourists trapped as angry protesters demanded the resignation of the president, whom they accuse of corruption.   "We have been through 12 days of hell. We managed the crisis but today we are suffering from the aftershocks," said Tourism Minister Marie-Christine Stephenson.

- Blacklist -
Beside the direct effects of the demonstrations, the United States delivered another crushing blow on February 14 when it urged its citizens not to travel to Haiti, which thus joined a no-go list with war-torn countries like Syria, Yemen and Afghanistan.

The minister said the US travel alert for Haiti was too harsh, calling the riots something that flared up unexpectedly and are now over.   "OK, they lasted 12 days but I am not sure that other Caribbean countries, which have had riots of their own, have been punished as severely and quickly as we have," said Stephenson.   Overnight, the decision by the US State Department hit the tourism industry hard. Travel web sites simply stopped offering flights to Haiti's two international airports.   Hotels are reporting cancellation of reservations and many empty rooms.

Officials in the industry have yet to tally up the damage but say that for the second time in less than a year, they will have to lay off workers.   In July of last year, three days of riots over a government attempt to raise fuel prices ruined the summer vacation season for Haiti's tourism industry.   It is not just hotels that will suffer again, said Beatrice Nadal-Mevs, president of the Haitian Tourism Association.   "This is going to affect everyday people because these are direct jobs that are going to be lost and supply chains will be threatened: farming, fishing, crafts, transport," Nadal-Mevs said.

- Mardi Gras cancelled -
With the opposition planning more demonstrations to seek the resignation of President Jovenel Moise, the sector got yet more bad news with word that Carnival celebrations have been called off in the Haitian capital, Port-au-Prince.   City Hall said it could not guarantee revelers' safety.   The festivities, which this year were planned for March 3-5, usually draw many Haitians living abroad and fleeing the winter cold in Canada and the eastern US.

Another major Carnival celebration is scheduled to take place in the city of Gonaives, but the government has not said if it will go ahead.   As grim as things are, some foreign tourists have gone ahead with visits to Haiti.   On Wednesday, a group of Australians under police escort visited a square featuring statues of heros of Haiti's independence from France. Days ago, demonstrators at the same plaza were throwing rocks at police, who responded with volleys of tear gas grenades.

A woman named Carole, who did not want to give her last name, said, "I trust the company we're traveling with. They not only want to take us but they want to bring us back."   Kevin McCue, another of the people in the group of 20, said he was glad that their tour operator had not opted for Plan B, which would have meant skipping Haiti and spending the whole week in the neighboring Dominican Republic.   "Tourism is alive and well here. People should come. The more they come, the better they spread some money among people who need it and the better for Haiti," said McCue.
Date: Thu, 21 Feb 2019 07:20:54 +0100
By Shafiqul ALAM

Dhaka, Feb 21, 2019 (AFP) - At least 70 people were killed when fire tore through crumbling apartment blocks in a historic part of Dhaka, setting off a chain of explosions and a wall of flames down nearby streets, officials said Thursday.    It started in one building where chemicals for deodorants and other household uses were illegally stored and spread at lightning speed to four nearby buildings, the fire service said.    People became trapped by the flames at a nearby bridal party and a restaurant. TV images showed the gates to one building were chained up so residents were unable to escape.

Traffic jams in the clogged narrow streets held up the rescue operation.   Bangladesh fire chief Ali Ahmed said at least 70 people were killed but that the toll would likely rise.    "The number of bodies may increase. The search is still going on," he told AFP.   Doctors said at least 10 of the scores of injured were in critical condition.   Firefighters who took almost 12 hours to bring the fire under control, went through the blackened floors of the building, littered with spray cans, looking for bodies.

The fire started at about 10.40pm (1640 GMT) on Wednesday at Chawkbazar in the old Mughal part of the capital.   Ahmed said it may have been started by a gas cylinder and quickly spread through the building where chemicals were stored in rooms alongside the apartments.   Chemicals used for household products were also stored in the nearby buildings. They exploded as the fire spread, witnesses said.     "There was a traffic jam when the fire broke out. It spread so quickly that people could not escape," the fire chief said.   Another fire official told reporters the blaze was under control but was not extinguished despite the efforts of more than 200 firefighters.   "It will take time. This is not like any other fire," he said, adding that the inferno had been made more devastating by the "highly combustible" chemicals.   Fire trucks had struggled in the narrow streets to reach the scene and there was also a lack of water for the battle, officials said.   The main gate of one five storey building was chained up, trapping residents inside, according to images shown on Bangladesh television.

- 'Flames were everywhere' -
Members of a bridal party in a nearby community centre were also caught in the fire and many were injured. Others were caught in small restaurants.   Dhaka deputy police commissioner Ibrahim Khan said at least two cars and 10 cycle rickshaws were burned in the fire.   "The victims included passersby, some people who were eating food at a restaurants and some members of the bridal party," he told AFP.   "I saw the charred body of a woman who was holding her daughter in her lap as their rickshaw was caught in the fire," said one witness.

Haji Abdul Kader, whose shop was destroyed, said he only survived the blaze as as he had left to go to a pharmacy.   "When I was at the pharmacy, I heard a big bang. I turned back and saw the whole street, which was jam packed with cars and rickshaws, in flames. Flames were everywhere," he told AFP.   "I got burned and rushed to hospital," he said.

Doctors at Dhaka Medical College Hospital said at least 55 people were injured, including 10 in a critical condition.   Hundreds of people rushed to the hospital looking for missing relatives.  However, most of the bodies of the dead were charred beyond recognition.    Sohag Hossain, one of the injured, told the Daily Star that he and two friends were working at a plastic factory in one of the buildings at the time of the fire.    They heard an explosion and could not escape the flames.

A similar blaze in 2010 in an old Dhaka building, which was also used as a chemical warehouse, killed more than 120 people in one of the worst fire disasters in the city of 20 million people.      Dhaka authorities launched a crackdown on chemical warehouses in residential areas following the blaze, but efforts to rein in the practice have waned.   Many buildings in Bangladesh lack adequate fire safety measures and the enforcement of fire regulations in factories and apartment buildings is lax.  
Date: Wed 20 Feb 2019, 2:13 PM CET
Source: El Pais in English [edited]
<https://elpais.com/elpais/2019/02/20/inenglish/1550655774_604104.html>

An investigation has been opened to determine the cause of death of a 46-year-old woman, who became ill after eating at a one-star Michelin restaurant called RiFF in Valencia. A total of 23 other patrons, including the victim's husband and 12-year-old son, also fell sick after the meal but their symptoms were mild and they have reportedly all recovered. The case was confirmed by regional health chief Ana Barcela, who expressed her condolences to the family and said that an investigation was already underway. "We've conducted a primary inspection of the establishment and everything appears to be normal," she said. "Analytical tests will now be carried out on the food products."

Barcela explained that the regional public health department will be in charge of the investigation and for determining the causes behind the woman's death. According to sources from the regional health department, the food poisoning outbreak was reported on [Sun 17 Feb 2019], after the 3 family members fell ill. They began to show symptoms of food poisoning - vomiting and diarrhoea - on [Sat 16 Feb 2019]. According to Europa Press, the father and son recovered but the woman's symptoms were more severe, and she died in her home early on the following morning. The investigation into the death revealed that a total of 9 patrons had experienced illness, mainly vomiting, after eating at the same restaurant.

Subsequently, it emerged that a further 14 people had also suffered light symptoms. "17 people have been interviewed, of whom 14 stated that they had some kind of mild symptoms," explained regional health chief Ana Barceló today, [Wed 20 Feb 2019]. "The samples that have been collected over the last few days have been sent to the National Toxicology Institute to be analyzed." Public health officials inspected the restaurant on [Mon 18 Feb 2019], but did not find any problems that could have contributed to the food poisoning. Investigators also collected samples of ingredients and raw food products that were part of the menu, and are currently analyzing them.

Barcela added that at this point she could not confirm whether the sickness had been caused by morel mushrooms that were on the restaurant's menu. "We will have to wait for the autopsy to be carried out on the woman before we can determine whether it was the ingestion of a food that directly caused her death, or whether it prompted a state that led to this fatal outcome, or if she had an existing condition," she explained on [Wed 20 Feb 2019].

Forensic teams are working to determine whether she could have been poisoned by something she ate, or whether she may have choked on her own vomit. In a statement, the owner of RiFF, Bernd H. Knaller, announced that the restaurant will remain closed until the cause of the food poisoning outbreak is determined and "activities can resume with full assurances for the staff and the patrons." The owner said he has been cooperating with the regional health department on the investigation and pointed out that the inspection "showed that the restaurant complies with all sanitary regulations." He added: "Regardless of what caused the situation, I want to convey my deep regret for what happened, and I hope all of the facts will be clarified shortly." [Byline: Cristina Vazquez]
Date: Mon 18 Feb 2019
Source: The News International [edited]

An elderly man died due to complications of the Crimean-Congo haemorrhagic fever (CCHF), commonly known as Congo virus, at the Jinnah Postgraduate Medical Centre (JPMC) on early [Sun 17 Feb 2019] morning, becoming the 2nd victim of the deadly tick-borne disease in the city [Karachi] in 2019.

"MUY, an elderly person of 75 years of age, died due to CCHF complications at JPMC on early [Sun 17 Feb 2019] morning," said JPMC Executive Director Dr. Seemin Jamali while taking to The News. She added that the deceased had earlier been taken to a private hospital from where he was shifted to Jinnah hospital.

It is the 2nd death in the city caused by the CCHF within a week as earlier on [Tue 12 Feb 2019] morning, a 35-year old woman from Orangi Town had died of Congo virus at an isolated ward of the JPMC.

CCHF is a tick-borne viral disease, which is caused when a person comes in contact with an animal infected with the Congo virus due to the presence of the parasite on its skin. Mostly butchers, sheep and animal herders and those who are associated with cattle farming become victims of the CCHF, which has a 40 to 50% mortality rate.

Dr. Jamali said both the woman from Orangi Town and the latest CCHF victim, who lived in the Landhi area of the city, were brought to the JPMC from Liaquat National Hospital where they had tested positive for the lethal disease.

She said the 2nd victim had a history of dealing with cattle and was in a serious condition when brought to the JPMC. He was suffering from high grade fever as well as internal and external bleeding, low platelets count and other comorbidities.

"We had moved both the patients to an isolation ward where they were given antiviral drugs, mega units [blood/platelets?] and other symptomatic treatment, but they could not survive due to the complications of the lethal ailment. All precautionary measures had also been adopted to prevent other patients and the medical staff from contracting the viral infection," she said.

"There were many people who contracted this disease in Karachi during their interaction with cattle, but they survived due to their strong immunity and the medical care they received at hospitals, including the JPMC. People should take precautionary measures while dealing with cattle and livestock," Dr. Jamali said. She added that in case the symptoms of red spots on the body, high-grade fever and blood oozing from mouth and nose are found in any patient, they should be rushed to a major hospital.

According to Dr. Kamran Rizvi, district officer (preventive) of Karachi Metropolitan Corporation, around 16 people died at various hospitals in Karachi last year [2018] due to CCHF, a majority of whom were residents of different areas of Balochistan, including Quetta, as people from the province are now regularly brought to Karachi for treatment.

He said a total of 41 Congo virus patients were brought to different hospitals in Karachi last year [2018], of whom 16, mostly males, could not survive while the others were successfully cured.
=====================
[The CCHF virus is now endemic in both rural and urban parts of the country, and he best safeguard on the human side is to inform the public regarding the risks and provide education on the use of appropriate practices and protection measures.

Persons working in close contact with animals are at risk for CCHF due to presence of ticks that can transmit the virus through bites or crushing during removal through skin cuts, etc. The animals do not show clinical disease during viraemia and the virus can be transferred in butchering, handling of meat and hides, etc.  The veterinary aspect of the problem requires establishment of animal screening with measures for tick control. Collaborative work by health and veterinary sectors with support of entomologists for setting up CCHF surveillance can help plan prevention and control programs - ProMED Mod.UBA]
[HealthMap/ProMED map available at:
Date: Tue 19 Feb 2019, 1:32 PM
Source: KCRG-TV9 [edited]

TV9 has learned the Johnson County Public Health Department and the Iowa Department of Public Health are investigating reports of food poisoning following an event in Swisher, Iowa.

The illnesses have been linked to the Swisher Men's Club's Game Feast Dinner this past weekend [16-17 Feb 2019]. The group's Facebook page says the fundraiser has been going on for 15 years and features dishes that include meat from animals that are often hunted. The health departments are looking for anyone who may have attended the meal to try to track down the source of the illnesses. It's asking attendees to email <diana.vonstein@idph.iowa.gov> with their contact information.

Johnson County Public Health Director Dave Koch tells TV9 part of their investigative efforts have included taking part in a conference call with officials from the Iowa Department of Public Health on [Tue 19 Feb 2019]. Koch says part of the investigation will also include testing samples of the food that was served along with conducting tests on any individuals who think they may have contracted an illness.

It is unclear how many people may be claiming to be sick however the club posted the following message to their Facebook page which reads in part: "The Swisher Men's Club is aware of a number of illnesses as a result of our Game Feast Dinner. We are actively working with the county and state health departments to determine the cause of these illnesses."

TV9 has reached out to the Swisher Men's Club for comment. President Mike Brown, Jr. referred back to the statement provided on Facebook. Brown declined TV9's offer for an on-camera interview, but did say they are relaying all necessary information to the Iowa Department of Public Health.  [Byline: Josh Scheinblum & Aaron Scheinblum]
Date: January 2019
Source: Nigeria CDC: Nigeria monkeypox monthly situation report

Nigeria monkeypox -- monthly situation report
---------------------------------------------
Key indicators / Numbers
New suspected cases reported / 6
New confirmed cases / 3
Total deaths / 0
Healthcare worker infection / 0

Epidemiological summary
- Nigeria continues to report sporadic cases of monkeypox after the index case reported in September 2017.
- In the reporting month (January 2019), 6 new suspected monkeypox cases were reported in 4 states (Bayelsa - 2; Rivers - 1; Bauchi - 1; Lagos - 1; Borno - 1; Delta - 1) out of which 3 confirmed cases were recorded in 2 states (Rivers - 1, Bayelsa - 2). - No death recorded.
- All reported cases (suspected and confirmed) are males.
- The confirmed cases are all between 32-39 years of age.
- The South-South region of the country has the highest burden of monkeypox.
- Since the beginning of the outbreak in September 2017, 311 suspected cases and 7 deaths have been reported in 26 states. Of this, 132 were confirmed in 17 states (Rivers, Bayelsa, Cross River, Imo, Akwa Ibom, Lagos, Delta, Edo, FCT [Federal Capital Territory], Abia, Oyo, Enugu, Ekiti, Nasarawa, Benue, Plateau, Anambra)
- Results of animal surveillance carried out in 2 states are awaited.

[Available at the source URL above]:
Figure 1 [graph]: weekly trend of Nigeria monkeypox cases as at 31 Jan 2019
Figure 2 [graph]: line graph of Nigeria monkeypox cases weeks 31-52, 2017; 1-52, 2018 and 1-2, 2019
Figure 2 [map]: map of Nigeria showing distribution of monkeypox cases by LGA [local government area], September 2017-January 2019
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[The number of monkeypox cases in Nigeria continues to increase slowly but steadily, with 6 new suspected and 3 new confirmed cases in January 2019. Interestingly, all cases are male individuals. Monkeypox virus transmission continued over a broad geographic area in Nigeria last year (2018). The report above provides the most recent update of the monkeypox situation in Nigeria. This outbreak has been unusual. Rather than sporadic or rare cases, there have been over 100 cases scattered over a large geographic area since 2017 and again this year (2019). The reasons for this relatively sudden appearance are not clear. Perhaps there has been an epizootic of monkeypox virus infections among its rodent hosts, with spill-over to people. As mentioned earlier, prevention will require a proactive public education effort to convince local people to take measures to prevent contact with the infected rodents and their excreta to avoid transmission, a difficult task involving so many local people over such a large geographic area.

Interested readers can see the graphs of cases by week and a map showing the location of cases by state.

Non-human primates are not monkeypox virus reservoirs. The main reservoirs of monkeypox virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp, an arboreal rodent) and terrestrial rodents (genera _Cricetomys_ and _Graphiurus_). - ProMED Mod.TY]

[Maps of Nigeria:
Date: Wed 20 Feb 2019
Source: Daily Times [edited]

The Sindh Health Department, on Tue 19 Feb 2019, admitted its failure to formulate an action plan to prevent the spread of the extensively drug-resistant (XDR) strain of typhoid fever in the province. The provincial minister for health, Dr Azra Fazal Pechuho, sighed that the health department still awaited vaccines for XDR typhoid from the federal government as the province battles the outbreak caused by a bacterial strain resistant to most known antimicrobials. She added that the strain had claimed 4 lives since its outbreak from Hyderabad [Sindh] in November 2016, which later spread to Karachi and other cities and towns of the province.

Dr Pechuho said that the Sindh Health Department had asked the local governments to improve the chlorination in water supplies, noting that the disease had spread due to the lack of sanitation and the presence of open garbage dumps in Karachi and other places. More than 5000 children have been affected by this typhoid strain, she continued. XDR typhoid is caused by antimicrobial resistant (AMR) strains of _Salmonella enterica_ serotype Typhi (or _S._ Typhi) and has been declared by WHO as a notable public health concern.

A report by the Provincial Disease Surveillance and Response Unit (PDSRU) reported 5274 cases of XDR typhoid out of 8188 typhoid fever cases in Sindh from 1 Nov 2016 through 9 Dec 2018. 69 percent of these cases was reported in Karachi, while 27 per cent in Hyderabad district, and 4 percent in other districts across the province.

The WHO recommended typhoid vaccination in response to confirmed outbreaks of typhoid fever. These vaccinations should be implemented in combination with other efforts to control the disease. At present, azithromycin remains the only affordable first-line oral therapeutic option to manage patients with XDR typhoid in low-resource settings.
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[The following is extracted from the CDC notice regarding this multiply-resistant typhoid strain in Pakistan

"The XDR strain of _Salmonella_ Typhi is resistant to most antibiotics (ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ciprofloxacin, and ceftriaxone) used to treat typhoid fever. Healthcare providers should:
- Obtain a complete travel history (asking about travel to South Asia, including Pakistan) from patients with suspected typhoid fever.
- Collect stool and blood cultures from patients with suspected typhoid fever and request antimicrobial susceptibility testing on isolates.
- Be aware that the Pakistan outbreak strain remains susceptible to azithromycin and carbapenems. Azithromycin is effective for uncomplicated (diarrhea or bacteremia without secondary complications) typhoid fever and should be used to treat patients with suspected uncomplicated typhoid fever who have traveled to Pakistan. When culture and sensitivity results are available, adjust treatment accordingly. Adult azithromycin dosage is usually 1000 mg orally once, then 500 mg orally daily OR 1000 mg orally once daily for at least 5-7 days. Pediatric azithromycin dose is 20 mg/kg orally, once then 10-20 mg/kg orally once per day (maximum 1000 mg per day) for at least 5-7 days.
- Carbapenems should be used for patients with suspected severe or complicated typhoid fever who have traveled to Pakistan. Severe or complicated typhoid fever would include, but not be limited to, patients with gastrointestinal complications (such as typhoid-related intestinal perforation, peritonitis, intestinal haemorrhage, hepatitis), neurologic complications (such as typhoid encephalopathy, including altered consciousness, delirium, confusion), or bacteraemia with sepsis or shock. When culture and sensitivity results are available, adjust treatment accordingly. Consider getting an infectious diseases consultation for these patients.
- Be aware that relapses can occur, often 1-3 weeks after clinical improvement.
- Be aware that most (90%) _S._ Typhi isolates from patients coming from South Asia have decreased susceptibility or resistance to fluoroquinolones, including ciprofloxacin; therefore, fluoroquinolones should not be used as empiric treatment for suspected typhoid fever in patients who have traveled to this area.
- Report all cases of confirmed typhoid fever to the appropriate local or state health departments." - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Pakistan:
Date: Tue, 19 Feb 2019 21:26:43 +0100

Geneva, Feb 19, 2019 (AFP) - An avalanche left four skiers injured Tuesday at a resort in the Swiss Alps where rescue operations went on after dark with police fearing people could still be trapped under the snow.   The authorities held a press conference to announce the injuries, including one person seriously hurt, after local reports said up to a dozen people were engulfed by the avalanche.   Police officers said that based on witness reports other skiers could still be buried and the search would continue into the night.

Swiss RTS television said the army had set up lighting to aid the 240 rescue workers at the site.   The police had earlier tweeted that several people were under the avalanche that hit early afternoon on a slope 2,600 metres (8,600 feet) up at Crans-Montana, which was busy with skiers during school holidays.   A local newspaper, Le Nouvelliste, had quoted the head of Crans-Montana's municipal government, Nicolas Feraud, as estimating that "between 10 and 12 people" were buried under the snow.   "We are shocked and hope for good news about these people," Feraud was quoted as saying. 

A first attempt at locating victims using sniffer dogs was unsuccessful, a rescue worker told Le Nouvelliste, with four helicopters joining the search from the air.   Pierre Huguenin, of the Institute for Snow and Avalanche Research, described the snow in the area as damp and dense.   According to statistics from his institute, after 15 minutes under an avalanche, the chances of survival are no more than 50 percent.   Le Nouvelliste said the avalanche swept over 300 to 400 metres (yards) of the lower section of the Kandahar piste.   It quoted rescue workers as saying the snow was compacted and more than two metres (seven feet) thick.

Crans-Montana's website had listed the risk of an avalanche at two on a scale that runs from one (lowest risk) to five.    As the victims were on a designated ski slope, they were unlikely to have detector equipment to help rescue workers locate them.   The vast majority of deadly avalanches in the Alpine nation hit people skiing off-piste.    "We don't know yet whether the avalanche detached by itself or was set off by skiers, or a rockfall," Swiss avalanche expert Robert Bolognesi told the daily 20 Minutes.
Date: Wed, 20 Feb 2019 16:17:29 +0100

Prague, Feb 20, 2019 (AFP) - Czech authorities said Wednesday they would slap checks on beef imported from Poland after veterinarians found the dangerous Salmonella bacteria in a 700-kilogramme batch of Polish beef.   "Tests have shown the presence of Salmonella enteritidis, which can cause serious diarrhoea and affect human health, in beef imported from Poland on February 13," Agriculture Minister Miroslav Toman told reporters.

Czech veterinary authorities have warned the European Commission and Polish authorities through a rapid warning system, he said, adding that they are also checking whether any of the meat has been consumed.   "The State Veterinary Administration (SVS) will immediately adopt an extraordinary measure -- all beef imported from Poland must be tested in a lab before hitting the market," Toman added.

SVS head Zbynek Semerad said meat from the 700-kilo (1,500-pound) batch had been distributed to five "places" in the Czech Republic and one in Slovakia.   "I will inform my Slovak counterpart. As far as we know, not all of the meat has been distributed to the end customer," Semerad said.   The case comes on the heels of a scandal which saw Poland export a total of 2.7 tonnes of suspect beef to around a dozen fellow EU members, triggering an EU probe.

The scandal erupted in January when the TVN24 commercial news channel aired footage of apparently sick or lame cows being butchered at a small slaughterhouse in northeast Poland in secret late at night when veterinary authorities were unlikely to visit.   Poland is a leading producer and exporter of meat in Europe, turning out around 600,000 tonnes of beef per year and exporting most of it mainly to the EU, according to meat producer associations.
Date: Wed, 20 Feb 2019 09:56:54 +0100

Kuala Lumpur, Feb 20, 2019 (AFP) - Six people, including three foreigners, were killed when a fire broke out Wednesday in a Malaysian karaoke centre, with rescuers describing scenes of chaos as the blaze engulfed the building.   The fire erupted before dawn on the fourth floor of an eight-storey building in the city of Ipoh, northern Perak state.

Firefighters rushed to the scene and found the bodies of six people who had died of smoke inhalation, Perak fire department acting director Sayani Saidon told AFP.   "We came across two locals, two Vietnamese women and a Bangladeshi man. We are still determining the identity of the sixth person," she said.

Firefighters rescued eight people alive, including two in critical condition, she added.     People inside were unable to find the way out after the fire erupted as exit lights did not come on, she said. Those that survived had run to an upper level to escape the flames.   "When the fire happened, all the electricity went out, and it was dark, so the exit signs weren't clear," she said.   The building was originally an office block, and had 30 karaoke rooms on the fourth and fifth floors.