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Luxembourg

Luxembourg - US Consular Information Sheet
October 03, 2008
COUNTRY DESCRIPTION:
Luxembourg is a highly developed, stable constitutional monarchy and parliamentary democracy. Tourist facilities are widely available.
Read the Departmen
of State Background Notes on Luxembourg for additional information.

ENTRY/EXIT REQUIREMENTS: A passport is required. Luxembourg is a party to the Schengen agreement. As such, U.S. citizens may enter Luxembourg for up to 90 days for tourist or business purposes without a visa. The passport should be valid for at least three months beyond the period of stay. Sufficient funds and a return airline ticket are required. For further details about travel into and within Schengen countries, please see our fact sheet. No immunization is necessary. For further information concerning entry requirements for Luxembourg, travelers may contact the Embassy of Luxembourg at 2200 Massachusetts Avenue NW, Washington, DC 20008, phone: (202) 265-4171 or 4172, or the Luxembourg Consulate General in New York, phone: (212) 888-6664 or in San Francisco, phone: (415) 788-0816. Visit the Embassy of Luxembourg web site at http://www.luxembourg-usa.org for the most current visa information.

Find more information about Entry and Exit Requirements pertaining to dual nationality and the prevention of international child abduction. Please refer to our Customs Information to learn more about customs regulations.

SAFETY AND SECURITY:
Terrorist incidents are rare in Luxembourg. However, like other countries in the Schengen area, Luxembourg’s open borders with its Western European neighbors could allow the possibility of terrorist groups to enter/exit the country unnoticed.

Prior police approval is required for public demonstrations in Luxembourg, and police oversight is routinely provided to ensure adequate security for participants and passers-by. Nonetheless, situations may develop which could pose a threat to public safety. U.S. citizens are advised to avoid areas where public demonstrations are taking place.

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 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 pamphletA Safe Trip Abroad.

CRIME: The crime rate in Luxembourg is moderate compared to other European countries. The predominant form of crime in Luxembourg is non-violent theft of valuables through the snatching of purses/bags or more sophisticated breaking and entering of unoccupied homes. Travelers should take common-sense precautions while in Luxembourg. In particular, travelers should be especially cautious in public areas, the airport and train terminals, where pickpockets can be a problem. Luxembourg has many public parks that are safe during the daylight hours, though the volume of low-level drug vending has increased in some of the city parks. Tourists should avoid these parks after dark due to the higher risk at night. During the summer season, Americans should be particularly alert to purse snatchings and confidence scams against tourists. Incidents of petty crime spike during the annual “Schueberfoire”, a traveling fun fair that visits the country every year for 3 weeks in the summer.

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 in finding appropriate medical care, contacting family members or friends and explaining 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. Luxembourg judicial authorities provide information, legal advice and psychological counseling at no charge to victims of crime (adults and children). Address: Service d’aide aux victimes, Parquet General, Galerie Kons, 24-26, place de la Gare, L-1616 Luxembourg. Phone: (352) 475821, extension 625, 627 or 628 Monday-Friday 8am-12pm and 2pm-6pm, in an emergency call (352) 621326595 Monday-Friday 8am-7pm.

The local equivalent to the “911” emergency line in Luxembourg is: 113
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities are widely available. In an emergency, dial 112 for an ambulance or in case of fire; dial 113 for the police. Hospitals in Luxembourg operate on a 24-hour rotation system. The on-call emergency room can be determined by calling 112. Patients may self-refer to any clinic Monday-Friday between 8am-5pm. In Luxembourg City, three major hospitals offer comprehensive general medical and surgical treatment, as well as specialized care in orthopedics, cardiology and psychiatry. In addition, there are two pediatric clinics and two obstetric clinics in Luxembourg City. Hospitals also exist in the south of the country (Esch-sur-Alzette) and in the north (Wiltz). For more specialized care, including major burns, transfer to a regional burn center in Belgium or France is necessary.

Most drugstores are located in the city of Luxembourg but can also be found throughout the country in all major communes. Drugstores operate on a 24-hour rotation system for after-hours services, including emergency prescriptions. The on-call pharmacy is listed daily in the local newspaper or can be determined by calling 112. A doctor's prescription is sometimes necessary for drugs that are sold over the counter in the United States.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Luxembourg.
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/
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 Luxembourg is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Luxembourg has a modern, well-maintained system of highways and secondary roads. Road signs and markings are clear and, as applicable, worded in French. Streets in the city, construction sites and crossroads are well illuminated at night. On highways, a digital alert system warns drivers of incidents or detours. Roads towards and out of Luxembourg City are congested during the morning and evening rush hour. Visitors should drive defensively in high-volume commuter traffic. During the fall and winter, fog and ice can cause sudden slowdowns on highways and secondary roads.

In case of a car accident involving injury or dispute, it is advisable for a foreigner to call the police at 113. The police will make an official assessment of the accident’s circumstances that can consequently be used if further legal action becomes necessary.

The daily mix of drivers from Luxembourg and its three neighboring countries results in a variety of driving practices and courtesies. While most drivers respect speed limits, traffic signals, and rules, others do not. Vehicle maintenance for cars registered in Luxembourg is controlled by the mandatory yearly car inspection; police can perform random road checks at any time. The possibility of encountering an intoxicated driver increases on weekends, especially during the late evening hours. Driving while intoxicated may result in penalties including imprisonment from 8 days up to two years plus a fine of 251 to 5000 Euros (approximately US$300 to US$6,000).

Public transportation throughout the country, including bus services and taxis, is highly developed and is considered very safe.

Emergency road services in Luxembourg are excellent. For breakdown and towing service call the ACL (Automobile Club Luxembourg) at 26000, www.acl.lu. In case of an accident, call 112 for a medical emergency and 113 for the police.

Please refer to our Road Safety page for more information. Visit the web site of Luxembourg’s national tourist office at www.ont.lu and national authority responsible for road safety at www.police.public.lu
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government ofLuxembourg’s Civil Aviation Authorityas being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Luxembourg’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: Luxembourgcustoms authorities may enforce strict regulations concerning temporary importation into or export from Luxembourg of items such as live animals, plants, endangered species, medication (except for personal use), firearms and ammunition, cultural artifacts, alcoholic beverages and tobacco products. It is advisable to contact the Embassy of Luxembourg in Washington or one of Luxembourg’s consulates in the United States for specific information regarding customs requirements. The amount of imported currency is not limited. The euro is the official currency in Luxembourg. Please see our information on customs regulations.

Luxembourg does not yet allow dual nationality. When obtaining Luxembourg nationality either through option or naturalization, the former nationality must be renounced.

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 Luxembourg’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Luxembourg 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 on international adoption of children and international parental child abduction, see the Office of Children’s Issues web pages.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Luxembourg are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov, and to obtain updated information on travel and security within Luxembourg. Americans withoutInternet 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 is located at 22, Blvd Emmanuel Servais, L-2535 Luxembourg City, phone: (352) 46 01 23 (available 24/7), fax: (352) 46 14 01. Consular Section phone: (352) 46 01 23 -22 13, Consular Section fax: (352) 46 19 39, email: LuxembourgConsular@state.gov.

The U.S. Embassy’s web page is http://luxembourg.usembassy.gov
* * *
This replaces the Consular Information Sheet dated March 17, 2008 to update the sections on Entry/Exit Requirements, Safety and Security, Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: 28 May 2018
Source: Food Navigator [edited]
<https://www.foodnavigator.com/Article/2018/05/28/Tuna-linked-to-foodborne-outbreak-in-Luxembourg>

Five people were sickened in Luxembourg last month [April 2018] by sashimi tuna fillets from the Netherlands, with raw material from Sri Lanka. Cactus, a supermarket in the country, recalled 2 tuna products and informed authorities following the suspicion of histamine. L'Administration des Services Vatarinaires (ASV) told us that initially 2 people fell sick, and investigations revealed 3 more illnesses.

The link was made as all people with symptoms had eaten tuna from the same Cactus store. High levels of histamine in fish may cause an allergic reaction after consumption. In the product, histamine can be detected and quantified by laboratory analysis, and in people, it is mainly based on symptoms.

ASV said such poisoning is rare but sporadic and unpredictable, which makes it difficult to exclude future outbreaks. Filet de Thon sashimi and brochettes de poisson mixte nature et marinées were sold in bulk or packaged trays between 12 and 14 Apr 2018 with expiry dates of 14, 15 or 16 Apr 2018. Products were distributed in Luxembourg in Cactus stores. ASV analysed some of the remaining tuna from the same batch sold in the store that customers complained about and from another Cactus store from the same lot, and analyses were mostly compliant. The agency said the presence of histamine was not due to poor quality, but concentration at high levels was limited to a specific location of the tuna. It added that previous analysis on the supplier confirmed the compliance of tuna delivered to Cactus.

There is no connection between the Luxembourg outbreak and the EU investigation involving 11 countries of tuna intended for canning being sold as fresh. Europol, Interpol, and the EU Food Fraud Network discovered that Spain, Italy, France, Germany, Portugal, Netherlands, UK, Hungary, Liechtenstein, Norway, and Switzerland were involved. More than 51 tons of tuna was seized.

Tuna for canning was illegally treated with vegetable extracts containing a high concentration of nitrites to alter colour and to give the impression of freshness. This can represent a risk to health, as modification of colour can mask spoilage, allowing development of biological amines (histamine) responsible for scombroid syndrome. In 2017, more than 150 people in Spain were affected after consuming illegally treated tuna. Spain and France are continuing to investigate tuna destined for canning and sold as fresh and the illegal use of additives. [Byline: Joseph James Whitworth]
========================
[There seem to be 2 situations at play here. One is the scromboid poisoning from tuna, the 2nd is a high concentrations of nitrates, possibly masking spoilage allowing the development of biological amines (histamine) responsible for scrombroid syndrome. While these appear to be 2 situations, the result is the same: scrombroid syndrome.

Two good reviews on the subject can be found at:

1. Taylor SL, Stratton JE and Nordlee JA: Histamine poisoning (scombroid fish poisoning): an allergy-like intoxication. J Toxicol Clin Toxicol. 1989;27(4-5):225-40.
Abstract
-------------------------------
"Histamine poisoning results from the consumption of foods, typically certain types of fish and cheeses that contain unusually high levels of histamine. Spoiled fish of the families, Scombridae and Scomberesocidae (e.g. tuna, mackerel, bonito), are commonly implicated in incidents of histamine poisoning, which leads to the common usage of the term, "scombroid fish poisoning", to describe this illness. However, certain non-scombroid fish, most notably mahi-mahi, bluefish, and sardines, when spoiled are also commonly implicated in histamine poisoning.

Also, on rare occasions cheeses, especially Swiss cheese, can be implicated in histamine poisoning. The symptoms of histamine poisoning generally resemble the symptoms encountered with IgE-mediated food allergies. The symptoms include nausea, vomiting, diarrhoea, an oral burning sensation or peppery taste, hives, itching, red rash, and hypotension.

The onset of the symptoms usually occurs within a few minutes after ingestion of the implicated food, and the duration of symptoms ranges from a few hours to 24 h. Antihistamines can be used effectively to treat this intoxication. Histamine is formed in foods by certain bacteria that are able to decarboxylate the amino acid, histidine. However, foods containing unusually high levels of histamine may not appear to be outwardly spoiled.

Foods with histamine concentrations exceeding 50 mg per 100 g of food are generally considered to be hazardous. Histamine formation in fish can be prevented by proper handling and refrigerated storage while the control of histamine formation in cheese seems dependent on insuring that histamine-producing bacteria are not present in significant numbers in the raw milk."

2. Hungerford JM: Scombroid poisoning: a review. Toxicon. 2010;56(2):231-43. doi: 10.1016/j.toxicon.2010.02.006.
Abstract
-----------------------------
"Scombroid poisoning, also called histamine fish poisoning, is an allergy-like form of food poisoning that continues to be a major problem in seafood safety. The exact role of histamine in scombroid poisoning is not straightforward. Deviations from the expected dose-response have led to the advancement of various possible mechanisms of toxicity, none of them proven. Histamine action levels are used in regulation until more is known about the mechanism of scombroid poisoning. Scombroid poisoning and histamine are correlated but complicated. Victims of scombroid poisoning respond well to antihistamines, and chemical analyses of fish implicated in scombroid poisoning generally reveal elevated levels of histamine.

Scombroid poisoning is unique among the seafood toxins since it results from product mishandling rather than contamination from other trophic levels. Inadequate cooling following harvest promotes bacterial histamine production and can result in outbreaks of scombroid poisoning. Fish with high levels of free histidine, the enzyme substrate converted to histamine by bacterial histidine decarboxylase, are those most often implicated in scombroid poisoning. Laboratory methods and screening methods for detecting histamine are available in abundance but need to be compared and validated to harmonize testing.

Successful field testing, including dockside or on-board testing needed to augment HACCP efforts will have to integrate rapid and simplified detection methods with simplified and rapid sampling and extraction. Otherwise, time-consuming sample preparation reduces the impact of gains in detection speed on the overall analysis time." Thanks to my ProMED colleague Mod.LL for portions of this comment. - ProMED Mod.TG]

[HealthMap/ProMED-mail map: Luxembourg: <http://healthmap.org/promed/p/103>]
Date: Mon, 20 Oct 2014 11:14:02 +0200 (METDST)
by Bryan McManus

LUXEMBOURG, Oct 20, 2014 (AFP) - European Union foreign ministers thrashed out measures to help halt Ebola's deadly spread on Monday, as Nigeria -- Africa's most populous country -- was expected to be declared free of the disease.   The meeting in Luxembourg underlined the heightened concern in Europe about the virus.

A Spanish nurse who was the first case of transmission outside Africa has been shown by tests to apparently be finally clear of her Ebola infection.   A civilian EU mission was one of the options being discussed by the EU ministers to aid the worst affected countries of Liberia, Sierra Leone and Guinea, as diplomats talked of a "tipping point" in the crisis, which has claimed more than 4,500 lives so far.   Liberian President Ellen Johnson Sirleaf warned Sunday that a generation of Africans were at risk of "being lost to economic catastrophe" because of the crisis.

The "time for talking or theorising is over," she said in an open letter published by the BBC. "This fight requires a commitment from every nation that has the capacity to help -- whether that is with emergency funds, medical supplies or clinical expertise."   The EU foreign ministers will look closely at current efforts and what more needs to be done, not least in getting more skilled staff on the ground in Africa.

One proposal is to reassure medical workers on the Ebola frontline that they will get the back-up and, crucially, Western-level care if they fall sick with a disease for which there is no vaccine nor marketed cure.  Another priority was to ensure that the scattered cases reported so far in the United States and Europe are quickly contained, to prevent Ebola getting a foothold outside of west Africa.   "This is a serious and significant problem that we should not underestimate. It's not a problem that will stay in one part of the globe," EU foreign affairs chief Catherine Ashton told reporters on the way into the meeting in Luxembourg.

German Foreign Minister Frank-Walter Steinmeier said the bloc should consider setting up "a civilian EU mission" to west Africa, which would serve as a platform for sending medical staff.   Another diplomat said there were plans for three nations to spearhead global aid to the worst-hit countries: the United States for Liberia, Britain for Sierra Leone and France for Guinea.

A global UN appeal for nearly $1 billion (780 billion euros) has so far fallen short, with only $386 million given by governments and agencies, and a further $226 million promised.   "This is a major health crisis. We have only a short time to get on top of it," British Foreign Secretary Philip Hammond said.   "The only way to stop its spread is to make sure people are isolated and treated earlier."

- Spanish nurse tests negative -
The Spanish authorities said Sunday that Teresa Romero, a nurse hospitalised on October 6, had now tested negative but must take a second test before she can be declared free of Ebola.   Romero fell ill after caring for two Ebola patients who died of Ebola at Madrid's Carlos III hospital, in the first known case of transmission outside Africa.   "I am very happy because we can say Teresa beat the disease," Romero's husband Javier Limon said. 

In Nigeria, Africa's most populous nation, authorities are expected to declare the country free of the disease on Monday after 42 days without any new case.   The Nigeria cases sparked huge alarm amid fears the highly contagious Ebola virus would spread quickly in its teeming cities, making the apparent success in containment even more significant.   US President Barack Obama has cautioned about the danger of panic in Western countries following a series of false alarms in America in the wake of two nurses at a Texas hospital falling ill after treating a Liberian patient who died.

France and Belgium have joined the United States, Britain and Canada in screening air passengers from Ebola-hit countries.   For the moment, however, they have no plans to halt flights, fearing it would be counter-productive as travellers would seek other means of going abroad and possibly hide any exposure, making it harder to monitor and control the virus's spread.
Date: Thu 24 Jul 2014
Source: Luxemburger Wort [edited]

A pesto pasta salad has been officially blamed for a food poisoning outbreak at a horse-riding event in Roeser [Luxembourg District]. The conclusion was drawn by Luxembourg's Health Ministry following an investigation into the foodborne infection, which spread among people who ate from the buffet of a VIP area at the event from 12 to 13 Jun 2014.

Analysis of the stools of 10 people admitted to emergency services were found to contain _Staphylococcus aureus_ bacteria. The bacterium can grow on food which is not refrigerated and, in sufficient concentrations, causes acute abdominal cramps, vomiting, nausea and diarrhoea in humans. Food hygiene inspections of the caterers who prepared the buffet showed minor deficiencies in procedures for producing and storing food at the event.

Initially, the smoked salmon was blamed for the food poisoning outbreak. But the investigation found that among those who fell ill, 82 per cent reported having eaten the pesto pasta salad. At the time of the investigation, however, no sample of the actual food served was available for testing.
======================
[Classical food poisoning due to _Staphylococcus aureus_ presents with a short incubation period of 4-6 hours as acute nausea and vomiting usually without fever or diarrhoea. The illness generally lasts less than 24 hours.

The following information regarding this entity is extracted from the US Food and Drug Administration's Bad Bug Book at

"In the diagnosis of staphylococcal foodborne illness, proper interviews with the victims and the gathering and analysing of epidemiological data, are essential. Incriminated foods should be collected and examined for staphylococci. The presence of relatively large numbers of enterotoxigenic staphylococci is good circumstantial evidence that the food contains toxin. The most conclusive test is the linking of an illness with a specific food, or, in cases where multiple vehicles exist, the detection of the toxin in the food sample(s).

"In cases where the food may have been treated to kill the staphylococci, as in pasteurization or heating, direct microscopic observation of the food may be an aid in the diagnosis. A number of serological methods for determining the enterotoxigenicity of _S. aureus_ isolated from foods, as well as methods for the separation and detection of toxins in foods, have been developed, and used successfully, to aid in the diagnosis of the illness. Phage typing may also be useful when viable staphylococci can be isolated from the incriminated food, from victims, and from suspected carriers, such as food handlers.

"A toxin dose of less than 1.0 microgram in contaminated food will produce symptoms of staphylococcal intoxication. This toxin level is reached when _S. aureus_ populations exceed 100 000 per gram.

"Foods that are frequently incriminated in staphylococcal food poisoning include meat and meat products; poultry and egg products; salads such as egg, tuna, chicken, potato, and macaroni; bakery products such as cream-filled pastries, cream pies, and chocolate éclairs; sandwich fillings; and milk and dairy products. Foods that require considerable handling during preparation, and that are kept at slightly elevated temperatures after preparation, are frequently involved in staphylococcal food poisoning." - ProMed Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Fri, 8 Feb 2013 19:50:23 +0100 (MET)

CAPELLEN, Luxembourg, Feb 08, 2013 (AFP) - Horsemeat discovered in lasagne meals sold in Britain was of French origin and was falsely labelled beef, according to health authorities in Luxembourg where the dishes were prepared.   Luxembourg company Tavola, which makes the products for the Findus brand, imported the meat from France but it was "fraudulently labelled" as beef, the country's director of veterinary services Felix Wildschutz told AFP.   "It was clearly fraudulently labelled since we sold (Tavola) horsemeat that should have been beef," Wildschutz said.    "We were not able to ascertain the country of origin from the labelling, which should be very precise. It was only marked as originating from the European Community but that is insufficient," he added.   Wildschutz declined to give the name of the supplier but said that Luxembourg had asked French authorities to launch an inquiry.   He said no action had been taken against Tavola, who had blocked "the rest of the incriminating meat" and recalled meals from stores.
Date: Wed 19 Sep 2012
From: Marcella Mori <Marcella.Mori@coda-cerva.be> [edited]

On Mon 20 Aug 2012, the Veterinary and Agrochemical Research Centre in Brussels (CODA-CERVA) was contacted by the official Health Inspectorate (Control of infectious diseases) of the Walloon region to investigate an outbreak of leptospirosis in boys attending a scout camp. The camp was located on the banks of the Semois River, in the province of Luxembourg. 10 out of 25 boys participating developed clinical symptoms. The diagnosis of leptospirosis was confirmed by the microscopic agglutination test (MAT) in the 3 boys that were hospitalized.

Contamination from an infected wildlife reservoir was immediately suspected because boy-scouts deemed to have played with a rat, most probably a muskrat considering the dimensions (information is scarce due to the discomfort of the patients). On site investigations were conducted by CODA-CERVA in association with the environmental unit of the Walloon region to collect water samples and muskrats. Animals were captured from 2 nests in the vicinity of the scout camp.

Pathogenic _Leptospira_ spp. was found in the liver and kidney of these animals and antibodies against _Leptospira_ were demonstrated by MAT in the body fluids. Water samples were negative, which could be explained by the absence of stagnant water. The definitive link between the human infections and the infected animals requires further investigations.

Leptospirosis is a pandemic zoonosis and may affect various species, including domestic animals and humans. The natural hosts are wild animals particularly rats where the pathogenicity is not manifested but whose role is expressed as carriers. Those animals are important determinants for leptospirosis and their control can positively impact the wellness at veterinary and public health levels.

In Belgium, leptospirosis is present in domestic animals (particularly dogs and horses) but it is infrequent in humans. The human cases are the result of direct contact with animal reservoirs or contaminated water sources in Belgium or result from recreational activities in (sub)tropical regions.

Combination of both climate change and increased uncontrolled water sports is certainly playing a role in driving favorable conditions for leptospirosis spreading worldwide. Under beneficial weather conditions the rodent population is growing fast. These premises suggest rodent surveillance programs to complement the control of leptospirosis, particularly in regions with opportunities for water sports and recreation.
-------------------------------
Dr Marcella Mori
Dr David Fretin
Belgian Reference Laboratory for Leptospirosis in animals
CODA-CERVA, Brussels

Dr Sylvia Depoorter
Pediatrics Department in AZ-Sint Jan, Brugge

Dr Marjan Van Esbroeck
Belgian Reference Laboratory for Leptospirosis in humans
Institute of Tropical Medicine, Antwerp

Dr Carole Schirvel
Directeur Generale de la Sante,
Direction Surveillance et Protection de la Sante
Federation Wallonie-Bruxelles
Belgium
================
[ProMED very much appreciates this outbreak report direct from the Belgium authorities. It serves as a warning to people who operate campsites that may be contaminated with bat guano in any country. - ProMed Mod.JW]

[Leptospirosis is a zoonotic spirochetal infection that is distributed throughout the world in warm climates and is transmitted to humans by direct contact of abraded skin or mucous membranes with the urine of infected animals or by contact with wet soil, vegetation, or water that has been contaminated with infected animal urine. These animals are mostly asymptomatic, but chronically infected with one of the several hundred serovars of pathogenic _Leptospira_. Different leptospiral serovars are prevalent in particular geographical regions. In carrier animals with chronic renal infections, leptospiruria persists for long periods or for life. _Leptospira_ bacteria shed in urine may survive in water or moist soil for weeks to months. Many species of wild and domestic animals (including dogs, cattle, swine, and especially rodents) are susceptible to chronic urinary infection with pathogenic leptospira. Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers.

Leptospirosis is an occupational hazard for people who work outdoors or with animals -- for example, farmers, sewer workers, veterinarians, dairy farmers, rice and sugarcane field workers, and military personnel. It is a recreational hazard for those who participate in outdoor water sports such as swimming, rowing, or whitewater rafting in contaminated lakes and rivers.

Because of the relatively nonspecific nature of the clinical presentation of leptospirosis, its diagnosis cannot be made confidently without laboratory confirmation. The United States Centers for Disease Control and Prevention can provide _Leptospira_ Dip-S-Tick (DST) IgM dot-ELISA test kits (PanBio Integrated Diagnostics) to local laboratories for serological testing of suspected leptospirosis cases in support of the response to a disaster. The DST is suitable for in-the-field testing of suspected patients. Confirmatory testing uses the microscopic agglutination test (MAT).

The muskrat, the apparent wildlife reservoir for this leptospirosis outbreak in Belgian boy scouts, is a medium-sized semiaquatic rodent (<http://en.wikipedia.org/wiki/Muskrat>).

Belgium is a federal state with 3 regions: the Brussels-Capital Region, the Dutch-speaking region of Flanders in the north, and the landlocked French-speaking region of Wallonia in the south (for a map showing these 3 regions of Belgium, see <http://ssy.org.uk/wp-content/uploads/2010/04/belgium.gif>.) Wallonia consists of the provinces of Walloon Brabant, Hainaut, Liege, Luxembourg, and Namur (<http://www.yurtdisiegitimim.net/sites/default/files/belgium_regions_map.jpg>). The source of the Semois River, where this leptospirosis outbreak occurred, is in the province of Luxembourg, close to the border with the Grand Duchy of Luxembourg; it flows westerly to France and joins the Meuse River (<http://en.wikipedia.org/wiki/Semois>). For a map of Semois River see <http://en.wikipedia.org/wiki/File:KaartSemois.jpg>.

The HealthMap/ProMED-mail interactive map of Belgium is available at
<http://healthmap.org/r/3wCR>. - ProMed Mod.ML]

[Muskrat photo at:
More ...

World Travel News Headlines

Date: Mon, 10 Sep 2018 07:28:56 +0200

Wellington, Sept 10, 2018 (AFP) - A strong 6.9 magnitude earthquake struck New Zealand's remote Kermadec Islands on Wednesday but authorities said there was no tsunami threat.   The quake struck at 4.19pm (0419GMT) at a depth of 111 kilometres (69 miles), with its epicentre 770 kilometres northeast of Auckland, the US Geological Survey said.   "Based on all available data, there is no tsunami threat from this earthquake," the Hawaii-based Pacific Tsunami Warning Center said.   The uninhabited Kermadecs are New Zealand's northernmost islands.   They are part of the Pacific Ring of Fire, a hotbed of volcanic and earthquake activity at the intersection of several tectonic plates.
Date: Mon, 10 Sep 2018 07:17:20 +0200

Tokyo, Sept 10, 2018 (AFP) - The death toll from a powerful earthquake that triggered massive landslides in northern Japan rose to 44 on Monday with tens of thousands of police and troops still on the ground to support survivors.   Chief Cabinet Secretary Yoshihide Suga said no one was left on a missing list, which suggested the figure could be the final death toll.   Around 40,000 police, fire fighters, troops and maritime safety officials were providing assistance, with more than 2,700 people still forced to stay in shelters after the killer quake struck the northern Japanese island of Hokkaido last week.

The majority of the dead are from the small rural town of Atsuma, where a cluster of dwellings were wrecked when a hillside collapsed from the force of the 6.6-magnitude quake, causing deep brown scars in the landscape.   "The government will strive to get hold of what is needed on the ground and take every possible measure so that people can return to a normal, safe life as soon as possible," Suga told a news conference.   He also warned that islanders should remain on alert as rainfall was forecast in the region, which could trigger fresh landslides.

The quake was the latest in a string of natural disasters to batter the island nation.   Western parts of the country are still recovering from the most powerful typhoon to strike Japan in a quarter of a century, which claimed 11 lives and shut down the main regional airport.   Launching a campaign for another term as head of his ruling party, Prime Minister Shinzo Abe reiterated his government will "do its best" to restore the disasters-hit regions.
Date: Mon, 10 Sep 2018 07:13:22 +0200
By Gregory DANEL, Romain FONSEGRIVES

Paris, Sept 10, 2018 (AFP) - Seven people including two British tourists were wounded in Paris late Sunday by a knife-wielding man, a terrifying attack that bystanders tried to stop by throwing petanque balls at the assailant.   Four of the victims were in a critical condition, police said, after the man brandishing a large blade and and iron bar went on the rampage next to a canal in the northeast of the capital.   The suspect is believed to be an Afghan national and has been arrested, said a source close to the enquiry, adding he had targeted "strangers" but that "nothing at this stage shows signs of a terrorist nature".

Chaos erupted on the banks of the Bassin de la Villette, an area popular with locals and visitors who frequent the cafes, cinemas and other cultural venues along its banks, just after 11:00pm (2100 GMT).   Eyewitness Youssef Najah, 28, said he was walking beside the canal when he saw a man running and holding a knife about 25-30 cm (10-11 inches) long.   "There were around 20 people chasing him. They started throwing petanque balls at him," Najah said, referring to the sport popular in France also known as boules.   "Around four or five balls hit him in the head, but they weren't able to stop him," he added.

According to the same witness, the attacker then dived into an alleyway, where the man "tried to hide behind two British tourists. We said to them: 'Watch out, he has a knife". But they didn't react".    The pair were then attacked, he said.   A security guard at one of two cinemas on either side of the water said he had seen the attacker running away from two men who were trying to stop him.   "He had an iron bar in his hand which he threw at the men chasing him, then he took out a knife," he told AFP.   The UK foreign office said it was aware of reports of the attack and was "urgently investigating this incident" in cooperation with French authorities, British media reported.

- High alert -
A police investigation has been launched for attempted murder, according to a judicial source.   It is the latest of several knife attacks France has seen in recent months, with terrorism being ruled out in most cases.   On August 23, a man stabbed his mother and sister to death and seriously injured another person in a town near Paris before being shot dead by police.

The motive for the violence remained unclear despite a claim by the Islamic State (IS) group that it was an attack by one of its fighters responding to the terror organisation's propaganda.   Authorities said the 36-year-old had serious mental health problems and had been on a terror watch list since 2016.   That attack came days after an Afghan asylum-seeker was arrested in town of Perigueux for a drunken rampage with a knife in which four people were wounded, one seriously.   Police said investigators had "very quickly" dismissed a terrorist motive after the August 13 incident.

And on June 17, two people were hurt in another southern town when a woman shouting "Allahu akbar" (God is greatest) attacked them in a supermarket with a boxcutter knife.   France has been on high alert following a string of jihadist attacks in recent years, often by people who have become radicalised or claim to have acted in the name of the IS group.   More than 240 people have been killed by Islamist extremists since a massacre at the Charlie Hebdo satirical magazine in Paris in January 2015.
Date: Mon, 10 Sep 2018 06:41:23 +0200

Miami, Sept 10, 2018 (AFP) - Hurricane Florence is expected to become a dangerous "major hurricane" by late Monday as it heads toward the US East Coast, the National Hurricane Center said, as states of emergency were declared in preparation for the storm.   The center of Florence was located about 685 miles (1,100 kilometres) southeast of Bermuda, the NHC in its 0300 GMT Monday advisory.   Florence had maximum sustained winds of 90 miles per hour, making it a Category 1 storm on the five-level Saffir-Simpson hurricane scale.

The NHC warned that Florence "is forecast to rapidly strengthen to a major hurricane by Monday night, and is expected to remain an extremely dangerous major hurricane through Thursday."   The storm is moving towards the west at seven miles per hour, and is forecast to drench a large swath of the US East Coast running from northern Florida to New Jersey.   On its current track Florence is expected to slam the Carolinas and Virginia the hardest -- and all three states have issued emergency declarations to speed preparations.

Virginia Governor Ralph Northam's office described Florence as possibly the state's "most significant hurricane event in decades," warning of "catastrophic inland flooding, high winds and possible widespread power outages."   It added: "The largest threat to life from hurricanes is not the high winds. Flooding is the deadliest result of these storms."   The US navy has ordered ships at its major base in Hampton Roads, Virginia, base to put to sea, saying "the forecasted destructive winds and tidal surge are too great to keep the ships in port."

- Two more hurricanes -
North Carolina Governor Roy Cooper's office said that Florence is already being felt along the state's coast, with large sea swells resulting in life-threatening rip currents and surf.   "Everyone in North Carolina needs to keep a close eye on Florence and take steps now to get ready for impacts later this week," Cooper said.

The storm "is too powerful and its path is too uncertain to take any chances," South Carolina Governor Henry McMaster said in issuing his state's emergency declaration.   Florence was producing large swells expected to reach from the northern Caribbean to the southern coasts of Canada's Maritime provinces.   At this statistical height of the Atlantic hurricane season, Florence was being trailed on east-to-west paths by two hurricanes, Helene and Issac.   Helene -- currently just southeast of the Cabo Verde islands off the African coast -- had winds of 85 miles per hour, and was expected to turn northwest and then north into the open Atlantic by midweek, the NHC said.

Hurricane Isaac -- which late Sunday became the fifth hurricane of the season -- is heading west towards the Caribbean.   At 0300 GMT Issac was about 1,305 miles east of the Windward Islands -- a region still recovering from last year's powerful Hurricane Maria -- with winds of 75 miles per hour.   Issac is expected to gain strength in the next days, but then weaken by the middle of the week when it approaches the Caribbean.   Maria -- which killed at least 3,057 people, most in Puerto Rico -- is elieved to be the third costliest tropical cyclone on record.
Date: 9 Sep 2018
Source: ProMED-mail promed@promedmail.org

[There has been significant chatter on social media from individuals working in Haiti and their colleagues, friends and family, suggesting there is a "new, as yet undiagnosed outbreak," possibly of a mosquito-borne disease, in the expat and local Haitian communities. Some of the content of this social media chatter is excerpted below [edited for clarity/readability - CopyEd.MSP]. - ProMED Mod.MPP]

"...there is some sort of new mosquito-borne virus in Haiti. Do I know for sure that it is a virus caused by a flying insect? No. Do I have a lot of unqualified and under-documented personal research to back up my belief nonetheless? Yes. If you know a guy or gal at the CDC, tell them to come chat with me. Something is going around, and many people are not well. It is eerily similar to chikungunya and malaria."

"Mayaro virus?"

"I have been saying the same thing! Well, when my fever brain has been capable of putting thoughts together this week. 2014 was ChikV; 2016 was Zika, so it does seem time for a new one. This new one is no fun at all."

"My person is negative for everything, Zika, chikV, malaria, dengue. It started with high fever, aches, joint pain, then progressed to stomach ache, headache. Now it's just persistent joint aches and sharp stabbing pain."

"We have this all over Mirebalais as well. Here, it also seems to be often accompanied by severe lower abdominal pain."

"Yes! My son just asked me if there is another mosquito borne illness yesterday!"

"Several of our girls have been sick with these same symptoms! It's awful."

"We all had it too and are seeing a lot of patients at our clinic with it!"

"I was sick for days before the uprising in July [2018] ... totally felt like malaria but tested negative. My BP was 80/40 at best, and it was pa bon [not good]."

"Yes! I've been sick this week as well as a few others I know! Lots of body pain."

"People thought that I was crazy!"

"You're not crazy! Several cases showing up at the Maternity Center here, and I also think there is influenza A going around. Some cases have respiratory stuff (to me that is the flu/influenza A), and several cases have nothing respiratory but have the fever and aches and terrible headache."
======================
[According to Wikipedia (in an unsubstantiated report without references) "Mirebalais is a commune in the Centre department of Haiti, approximately 60 km northeast of Port-au-Prince on National Road 3. The city was established in 1702. During the United Nations occupation of 2005, Nepalese troops were stationed in the city, using the city jail as their headquarters,"  (<https://en.wikipedia.org/wiki/Mirebalais>).

"Mirebalais is served by the teaching hospital Hopital Universitaire de Mirebalais, the largest solar-operated hospital in the world," a hospital that is run by the US-based Partners in Health,  (<https://www.pih.org/pages/mirebalais>).

>From the sound of the social media chatter, there is an as yet undiagnosed outbreak affecting parts of Haiti. Trying to connect the dots, there is concern that it is malaria-like (fever, chills and headaches), but in those that have been tested for malaria, laboratory results have not supported the diagnosis, and possibly dengue- or chikungunya-like (fever, headache, joint pains) with the addition of complaints of lower abdominal pain (notably described in Mayaro virus disease.

If the symptoms are similar to those of dengue, chikungunya, and Zika virus infections, they need to be ruled out by laboratory testing. There is the possibility that Mayaro virus (MAYV) may be circulating in Haiti. Mayaro virus was isolated from a child with acute febrile illness in rural Haiti. The case report stated that "on 8 Jan 2015, an 8-year-old boy was examined at the school clinic because of fever and abdominal pain. His temperature was 100.4 F [38 C]; lung sounds were clear, and his abdomen was soft and not tender. He had no rash and no conjunctivitis. On the basis of this clinical presentation, the clinic physician empirically diagnosed typhoid and administered co-trimoxazole... MAYV was detected in viral RNA extracted from infected Vero cells.

A question now is: if this is another MAYV infection, is this a continuation of the 2015 transmission or a new introduction into Haiti? Clearly, laboratory follow up is needed to establish the etiology of the current cases of febrile disease to determine an etiology and rule out other pathogens. If MAYV presence is established, surveillance is needed to determine the extent of its distribution, and health care providers and laboratories in Haiti, the Dominican Republic, and other countries in the Caribbean Basin need to be informed to be on the alert and to be prepared to make a diagnosis should any cases occur there.

Of additional curiosity is a recent media report in the Jamaican Star relating a tale of 3 Haitians recently arrived claiming illness, with malaria suspected in one of them. Testing is still pending, but given the social media chatter, one can't help but wonder whether this isn't malaria. Could it be part of the same as of yet undiagnosed outbreak reported in the above chatter? ...

References:
1- Lednicky J, De Rochars V, Elbadry M, Loeb J, Telisma T, Chavannes S, et al. Mayaro Virus in Child with Acute Febrile Illness, Haiti, 2015. Emerg Infect Dis. 2016;22(11):2000-2002.

2- Mavian C, Rife BD, Dollar JJ, Cella E, Ciccozzi M, Prosperi MCF, Lednicky J, Morris JG, Capua I, Salemi M. Emergence of recombinant Mayaro virus strains from the Amazon basin. Sci Rep. 2017 Aug 18;7(1):8718. doi: 10.1038/s41598-017-07152-5.

A HealthMap/ProMED map of Haiti can be found at:

More information from knowledgeable sources would be greatly appreciated, especially results of laboratory testing on individuals presenting with the above-mentioned symptoms, and results of clinical as well as epidemiologic investigations. - ProMED Mods.MPP/TY]
Date: Sun, 9 Sep 2018 14:04:57 +0200

Rome, Sept 9, 2018 (AFP) - Authorities have issued health alert after 150 cases of pneumonia were recorded in a week, mainly in towns near the northern Italian city of Brescia.   Suspecting the presence of a pneumonia-causing virus in the water supply, they have taken samples from the distribution network for analysis.   Results are expected in several days.

Autopsies will be conducted on a 69-year-old woman and an 85-year-old man who died this week to determine whether they died from pneumonia, according to local media reports.   Pneumonia is usually caused when bacteria, viruses or fungi infect the lungs.   It can be life-threatening, especially among the elderly and those with serious health conditions.

Provincial health services have called on residents to take precautions, including disinfecting tap filters and shower hoses and to let hot water run for a period of time with the windows open before using it.   Hospital emergencies in several municipalities to the south and east of Brescia identified 121 cases of pneumonia, the health officer in the Lombardy region Giulio Galera said on television.   A survey of general practitioners found at least 30 other people had been affected.
Date: Sun, 9 Sep 2018 10:04:14 +0200

Tokyo, Sept 9, 2018 (AFP) - Japan is suffering its first outbreak of pig cholera in more than 25 years, authorities said Sunday after culling more than 600 animals and suspending pork exports.    A farm in central Japan saw 80 pigs die last week after catching the highly-contagious disease, an agricultural ministry official told AFP.

Early tests showed negative results for classical swine fever, as the illness is officially known.   But follow-up tests came out positive Sunday, prompting the cull of all 610 pigs at the farm, he added.   "We are now processing the livestock there and disinfecting the farm," he said, adding that officials had set up sterilisation points on access roads to the affected farm.

The government has set up a team of specialists to analyse possible infection routes, the agricultural ministry said in a statement.   Tokyo halted pork exports after the outbreak was confirmed. The nation sold roughly $9 million in raw pork meat to foreign markets last year.   Japan saw its last case of classic swine fever, which does not affect humans, in 1992.   The disease continues to rage in many parts of Asia, Europe and Latin America.
Date: Sat, 8 Sep 2018 21:58:47 +0200

Kinshasa, Sept 8, 2018 (AFP) - Health authorities in Kinshasa declared the Ebola virus under control five weeks after the latest outbreak left 89 people dead in eastern Democratic Republic of Congo.   The health ministry announced the outbreak on August 1 in North Kivu province and on Thursday revealed that it had spread to Butembo, a city of a million people.

But Health Minister Dr Oly Ilunga Kalenga said: "Since August 13, there have been practically no more cases, we can say that the situation has been brought under control at the epicentre (of Mabalako)."   The latest outbreak of the virus is 10th to strike DR Congo since 1976, when the disease was first identified and named after a river in the country's north.   "To date, we have 129 cases (31 probable and 98 confirmed), 89 deaths and 33 patients cured," Dr Oly Ilunga said.   Fears that the disease might  spread further had been expressed Thursday after news of two deaths in Butembo, a commercial hub and popular transit point for neighbouring Uganda.

A woman and one of the medical staff who had been treating her died ini the city.   "Even at Butembo, the situation is not critical," the minister told a news conference also attended by Congolese professor and leading Ebola researcher Professor Jean-Jacques Muyembe, who urged people to report any sign of the disease.   "The Ebola virus is circulating here and in Africa in general ... we must be vigilant," Muyembe said.

Complicating the battle against the spread of the disease is the fact it is afflicting an area of Congo wracked by insecurity owing to the presence of armed groups.   Even so, Dr Oly Ilunga said teams treating sufferers had enjoyed army and police backing as well as support from the UN mission Monusco.   The previous outbreak of Ebola, which left 33 people dead in the northwestern province of Equateur, was decreed over on July 24.
Date: Sat, 8 Sep 2018 13:02:52 +0200

Seoul, Sept 8, 2018 (AFP) - South Korea reported its first case of Middle East Respiratory Syndrome (MERS) in three years, health officials said on Saturday.   A 61-year-old businessman was diagnosed with the highly contagious viral respiratory illness, according to officials at the Korea Centers for Disease Control and Prevention (KCDC).   He returned to South Korea Friday from a business trip in Kuwait where he stayed for three weeks, the KCDC said a statement.

"Authorities have traced and separated 20 people who have come in close contact with the infected person," KCDC head Chung Eun-gyeong told journalists.   They include medical staff, flight attendants and passengers of the plane the man flew back to South Korea on, she said.    He was hospitalised with fever and phlegm and has been quarantined at a university hospital, she added.   It is the first case of MERS diagnosed in South Korea since 2015, when an outbreak killed 38 people and triggered widespread panic.
Date: Wed 5 Sep 2018
Source: El Comercio [in Spanish, machine trans. edited]
<https://elcomercio.pe/mundo/latinoamerica/chile-brote-hepatitis-suma-201-casos-region-antofagasta-noticia-nndc-554166>

Health authorities in the region of Antofagasta in northern Chile are on alert for an outbreak of hepatitis A that adds 201 cases so far in 2018, 2 more than those recorded throughout 2017, they said today, 5 Sep 2018. "Unfortunately, we are having about 5 cases every 2 weeks, which means that we are facing an epidemic," Cooperativa Rossana Díaz, ministerial regional Secretary of Health, told Radio. It is a situation "that is controllable with the help of the community," which, in his opinion, has a fundamental role in the prevention of this disease, which can "be fulminating, create a risk to life, and require organ transplantation." Diaz stressed that hepatitis A can be prevented with simple measures, such as constant hand washing and optimal handling and preparation of food.

The authorities must combat street food sales and control businesses, "but we do not get anything if people continue to consume food on the street or in places that do not have sanitary authorization for that," he said. The profusion of cases, according to the official, corresponds to the increase in the consumption of food in unauthorized places and the lack of vaccinated personnel or strict hygiene regulations in establishments that do have a permit.

The authorities have set up an Outbreak Response Committee in the region and questioned contacts of the confirmed cases and of the suspects in order to find the origin of transmission. The cases registered in Antofagasta range from 2 to 60 years, with an average of 23 years, of which 62% are men and 38% are women, and although the presence of immigrants is large in the region, 98% of the cases are Chileans, the regional authorities reported.

Hepatitis A, according to the Institute of Public Health, can be prevented with a vaccine, and its detection requires a medical diagnosis in addition to laboratory tests or diagnostic imaging studies. It is transmitted through water, contaminated food, or through contact with an infected person. It is considered a disease with worldwide distribution that occurs sporadically or epidemically with a seasonal cycle, which in Chile is an intermediate endemic, with epidemic outbreaks every 4 or 5 years, and there are no chronic carriers.
==============================
[It seems to be the case that the cases are occurring at a low, steady rate rather than from a specific recent exposure.

Antofagasta (<https://en.wikipedia.org/wiki/Antofagasta>) is a port city in northern Chile, about 1100 km (700 mile) north of Santiago. It is the capital of Antofagasta province and the Antofagasta region. Formerly part of Bolivia, Antofagasta was captured by Chile in the War of the Pacific (1879-83), and the transfer of sovereignty was finalized in the 1904 Treaty of Peace and Friendship between the 2 countries. - ProMED Mod.LL]

[HealthMap/ProMED map available at: Antofagasta, Antofagasta, Chile:
<http://healthmap.org/promed/p/11048>]