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Marshall Islands

Introduction
 
After almost four decades under US administration as the easternmost part of the UN Trust Territory of the Pacific Islands, the Mar
hall Islands attained independence in 1986 under a Compact of Free Association. Compensation claims continue as a result of US nuclear testing on some of the atolls between 1947 and 1962. The Marshall Islands hosts the US Army Kwajalein Atoll (USAKA) Reagan Missile Test Site, a key installation in the US missile defense network.
 
Geography
 
Located in the Oceania region its consists of two archipelagic island chains of 29 atolls, each made up of many small islets, and five single islands in the North Pacific Ocean, about half way between Hawaii and Australia
 
Climate
 
tropical; hot and humid; wet season May to November; islands border typhoon belt

Travel News Headlines WORLD NEWS

Date: Mon, 28 May 2018 01:20:00 +0200

Majuro, Marshall Islands, May 27, 2018 (AFP) - Haze from the Kilauea volcano eruption in Hawaii blanketed the Marshall Islands 3,700 kilometres (2,300 miles) away on Sunday, as officials warned it would continue moving west.   The haze, a phenomenon known as "vog" or volcanic smog, "is spreading across Micronesia," the US National Weather Service based in Guam said.

The volcano on Hawaii's Big Island is now in its fourth week of eruptions.   Meteorologists advised residents on the Marshall Islands with respiratory problems to stay indoors while airlines and shipping companies were warned to be aware of "lower visibilities".

The Guam weather office said haze produced by Kilauea would spread farther westward and reach Kosrae, Pohnpei and possibly Chuuk in the Federated States of Micronesia over the next few days.   Kilauea is the world's most active volcano and one of five on Hawaii's Big Island.   It started erupting on May 3, prompting about 2,000 people to flee from their mountainside homes.   Scientists believe the volcanic activity may be a precursor to a major eruption similar to the one that shook the island in the mid-1920s.
Date: Fri 4 May 2018
Source: CDC. MMWR Morb Mortal Wkly Rep 2018; 67(17):504-5 [edited]

ref: Hofmeister MG, McCready JA, Link-Gelles R, et al. Notes from the field: Increase in hepatitis A virus infections -- Marshall Islands, 2016-2017. MMWR Morb Mortal Wkly Rep 2018; 67:504-5. doi: 10.15585/mmwr.mm6717a5
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In mid-September 2016, a case of hepatitis A virus (HAV) infection was reported to the Marshall Islands Ministry of Health and Human Services (MOHHS). On 4 Nov 2016, MOHHS received laboratory confirmation of 4 additional cases, prompting activation of an outbreak investigation by the MOHHS Exposure Prevention Information Network (EPINet) team and solicitation of technical assistance from the Pacific Island Health Officers' Association, the WHO, and CDC. CDC began participating in the investigation by providing technical assistance remotely at that time. CDC provided remote assistance throughout the course of the investigation. In April 2017, the CDC-affiliated coauthors traveled to the Marshall Islands to provide in-person technical assistance.

To characterize the outbreak, the MOHHS EPINet Team, with assistance from CDC, conducted an investigation through in-person interviews and medical chart abstractions. A probable HAV outbreak case was defined as an acute illness with onset of any signs or symptoms consistent with acute viral hepatitis (such as fever, anorexia, nausea, vomiting, diarrhoea, fatigue, dark urine, clay-colored stool, or abdominal pain) on or after 1 Sep 2016, and either jaundice or elevated serum aminotransferase levels; a confirmed case met the probable case definition and also had either a positive immunoglobulin M (IgM) antibody to HAV on laboratory testing or an epidemiologic link to a confirmed case.

>From September 2016 (epidemiologic week 37) through July 2017 (epidemiologic week 28), 194 outbreak-associated hepatitis A cases (168 confirmed and 26 probable) were reported by MOHHS (Figure [available at the source URL above. - ProMED Mod.LL]). Illness onset dates ranged from 12 Sep 2016 through 11 Jul 2017. The median age of infected persons was 8 years (range equal to 2-76 years), 57 percent of patients were male, 91 percent were Marshallese, and 11 percent were hospitalized. No deaths were reported. Persons younger than 25 years accounted for 90 percent of cases, and 92 percent of patients were residents of the capital, Majuro. The most commonly reported signs and symptoms were jaundice (92 percent), nausea (76 percent), anorexia (75 percent), and dark urine (68 percent). Clay-colored stool (10 percent) was less commonly reported.

Complete contact information was available for 102 (53 percent) patients. A total of 1143 contacts were identified, with a mean of 11 contacts identified per patient (range equal to 2-60). Among the identified contacts, 902 (79 percent) received post-exposure prophylaxis (PEP) with hepatitis A vaccine. Some contacts were identified outside the recommended PEP window of 14 days after exposure, and 14 contacts were infants who were too young to be vaccinated (1). 7 contacts refused vaccination.

The EPINet team disseminated public information about the outbreak and recommendations on hygiene and vaccination through radio shows, mass text messages, posters, and school presentations; developed standardized case reporting and interview tools; and expanded case finding through investigation of contacts. Hepatitis A vaccine is not currently included in the Marshall Islands routine childhood immunization schedule. Marshall Islands began immunization of contacts of patients with hepatitis A in January 2017 and then launched a comprehensive immunization campaign targeting school-aged children on Majuro in February 2017, which ultimately covered approximately 70 percent of the total kindergarten through 8th grade student population. Once the vaccine supply was replenished in April 2017, a 2nd immunization campaign was directed at high school students aged 14-19 years on Majuro. In total, approximately 12,500 doses of hepatitis A vaccine were administered to school-aged children and adult contacts of patients in response to the outbreak. No additional cases were reported as of 30 Aug 2017.

Before this outbreak, the last HAV outbreak in the Marshall Islands occurred approximately 25 years ago. Since then, approximately 5 hepatitis A cases per year have been reported (MOHHS, unpublished data, 2017). HAV infection is typically acquired through faecal-oral transmission, either from direct person-to-person contact or consumption of contaminated food or water. In this outbreak, transmission occurred primarily through direct person-to-person contact, and despite extensive measures, the initial source of HAV infection was not identified.

HAV infection occurs in 3 distinct epidemiologic patterns (high, intermediate, and low endemicity) associated with hygiene and sanitation, access to clean drinking water, household crowding, and socioeconomic conditions (2). As socioeconomic conditions and sanitation improve, areas transition from high to intermediate endemicity, which is associated with an increased incidence of symptomatic clinical disease and potential for outbreaks. Hepatitis A-related hospitalizations and mortality also increase as the age of infection shifts from early childhood, when disease is typically asymptomatic or mild, to adolescence and adulthood, when illness is more likely to be severe (2).

Before this outbreak, HAV was thought to be endemic in the Marshall Islands; however, this outbreak demonstrates that the country might be undergoing an epidemiologic transition toward intermediate endemicity (3). Health officials are evaluating the potential costs and benefits of incorporating routine hepatitis A vaccination in Marshall Islands as a means of reducing ongoing transmission and preventing outbreaks.

References
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1. Advisory Committee on Immunization Practices, CDC: Update: prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR Morb Mortal Wkly Rep 2007; 56(41): 1080-84; available at
2. Wasley A, Fiore A, Bell BP: Hepatitis A in the era of vaccination. Epidemiol Rev 2006; 28: 101-11; available at
3. Jacobsen KH: The global prevalence of hepatitis A virus infection and susceptibility: a systematic review. Geneva, Switzerland: World Health Organization; 2009; available at
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[This posting underscores the importance of the kind of epidemiologic pattern of HAV in an area and certainly suggests that this island nation has improved hygiene and sanitation to transition to intermediate endemicity where routine childhood HAV vaccination bears consideration. The current outbreaks in a variety of areas in the USA (including parts of Michigan, Utah, and Kentucky) affecting certain cohorts of adults (who were old enough not to be immunized as children) underscore immunization.

The Marshall Islands (<https://en.wikipedia.org/wiki/Marshall_Islands>), officially the Republic of the Marshall Islands, is an island country located near the equator in the Pacific Ocean, slightly west of the International Date Line. Geographically, the country is part of the larger island group of Micronesia. The country is spread out over 29 coral atolls, comprising 1156 individual islands and islets. Politically, the Marshall Islands is a presidential republic in free association with the United States, with the USA providing defense, subsidies, and access to USA-based agencies such as the Federal Communications Commission and the United States Postal Service. - ProMED Mod.LL]

[HealthMap/ProMED-mail map
Date: Sat, 3 Feb 2018 05:50:34 +0100

Majuro, Marshall Islands, Feb 3, 2018 (AFP) - Emergency services were put on standby Saturday in Majuro, as rising king tides threatened to flood the capital of the low-lying Marshall Islands.

The national weather service warned "major inundation" was possible from Saturday evening through to Tuesday at peak tide periods in the Pacific island nation, highlighting its vulnerability to rising sea levels.   "We're on stand-by through Tuesday," Public Works Minister Tony Muller said Saturday as the 30,000 population of Majuro Atoll braced for the expected floods.    Heavy equipment, including bulldozers, was being positioned at critical locations around Majuro so emergency crews can respond quickly in the event of flooding, he said.

Majuro is barely a metre above sea level and the single road along the 30-mile (50-kilometre) length of the coral atoll is often blocked during serious flooding by coral, rocks, sand and garbage tossed up by waves.   The National Disaster Management Office has been placed on high alert and used its mass text messaging system for the first time Friday to issue a high tide advisory.

The US National Weather Service in nearby Guam issued an advisory Saturday morning warning "major inundation of one to two feet is possible, especially during high tides inside the lagoon".   King tides, which are extremely high tides, are a natural phenomenon early in the year in the Marshall Islands caused by the strong gravitational pull from a new or full moon when the moon is at its closest to the earth.
Date: Sat 1 Apr 2017
Source: Outbreak News Today [edited]

The World Health Organization (WHO) on Thursday [30 Mar 2017] congratulated the Republic of the Marshall Islands on eliminating lymphatic filariasis -- also known as elephantiasis -- as a public health problem.

Lymphatic filariasis is a mosquito-borne disease that damages the lymphatic system, leading to severe disfigurement, pain, and disability. For people affected by this disease, the impacts of disfigurement and the associated stigma are profound: people often lose their livelihoods and suffer from psychological impacts such as depression and anxiety.

"Lymphatic filariasis is a terrible disease, causing untold suffering for those who are affected by it. I sincerely congratulate the Republic of the Marshall Islands for eliminating this disease as a public health threat; this is an enormously important achievement for the health of your people," said Dr Shin Young-Soo, WHO Regional Director for the Western Pacific.

The Republic of the Marshall Islands joins 6 other countries in WHO's Western Pacific Region that have been validated as having achieved elimination of lymphatic filariasis as a public health problem since WHO launched the Global Programme to Eliminate Lymphatic Filariasis in 2000: Cambodia, China, Cook Islands, Niue, the Republic of Korea, and Vanuatu.

Lymphatic filariasis is classified by WHO as a neglected tropical disease (NTD). NTDs are a diverse group of communicable diseases that thrive mainly among the poorest populations in tropical and subtropical areas. NTDs cause serious illness and in some cases death, but they are preventable. Through a series of public health strategies, including preventive treatment of communities, intensive case management, vector control, controlling diseases in animals that can spread to humans through vaccination, and provision of safe water, sanitation and hygiene, many NTDs can be controlled, and eventually, eliminated.

The fight against lymphatic filariasis in the 17 countries and areas where it remains endemic in the Western Pacific Region is an important priority for WHO's work in this region.

Following the initiation of the Global Programme to Eliminate Lymphatic Filariasis, many of these countries and areas are making progress towards elimination. WHO works directly with countries and partners to support large-scale mass drug administration campaigns and better access to effective medicines and diagnostic tests. These efforts are paying off as more countries -- like the Republic of the Marshall Islands -- are approaching the elimination threshold for lymphatic filariasis.

"The Republic of the Marshall Islands has shown that with commitment and creativity, and despite significant geographic challenges in reaching people in many far-flung islands, it can be done. WHO is committed to supporting Member States to rid our region of the scourge of lymphatic filariasis so no one need suffer from this awful disease," concluded Dr Shin.
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[ProMED-mail congratulates the Marshall Islands for reaching this important milestone.  Nearly 25 years ago, lymphatic filariasis was endemic (see: Kimura E et al. Parasitological and clinical studies on _Wuchereria bancrofti_ infection in Chuuk (formerly Truk) State, Federated States of Micronesia. Trop Med Parasitol. 1994;45:344-6). The study found a microfilaria rate of 6-10 percent in males over 20 years of age. - ProMED Mod.EP]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Fri, 29 Apr 2016 09:48:21 +0200

Majuro, Marshall Islands, April 29, 2016 (AFP) - The Marshall Islands on Friday hailed a US decision to declare a drought disaster in the parched Pacific nation, welcoming much-needed aid from Washington to cope with one of the worst dry spells in its history.   US President Barack Obama signed a disaster declaration Thursday as the drought in the Marshalls enters its fourth month, with residents scrambling to find fresh water amid mounting concerns over food crops.   Marshalls and its Pacific neighbours are in the grips of a drought caused by one of the strongest El Nino events in recorded history, according to US weather officials.   Obama's declaration will trigger $3.0 to 4.0 million in aid from Washington, according to a US official in Majuro. 

The money is expected to be put toward drought damaged crops that support subsistence islanders in remote parts of the Pacific nation, according to the Marshall's government.   "The president's action makes federal funding available for US government emergency relief and reconstruction assistance to the Republic of the Marshall Islands," a White House statement said.   Kino Kabua, Marshalls' deputy chief secretary overseeing the drought response, said the US declaration would boost resources and provide much needed reverse osmosis (RO) water-filtration units.    "Obviously we cannot provide RO units to all islands at the moment but... once the additional ones arrive, we will send out more," he said.   The Marshalls declared a drought emergency in February, then elevated it to a disaster and appealed to the United States and other countries for aid.    Australia, India, the European Union and the Asian Development Bank have provided funding in recent weeks to buy water filtration units, water delivery trucks and catchment tanks.

About a third of the Marshalls' population of 56,000 rely on subsistence farming on remote, difficult to access islands, eating fish, breadfruit, pandanus, coconuts and bananas.   Crops began wilting in March, several months into the drought.   "I can tell you that the water situation is getting worse," said Ota Kisino, the mayor of Wotje atoll in the northern islands.   In the capital Majuro, water is being rationed to four hours, just one day per week and the supply of water in the city reservoir has dwindled to less than half its capacity.    Elsewhere in the region, the Federated States of Micronesia and Palau have declared states of emergency, while Guam and the Northern Marianas are experiencing low rainfall.
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World Travel News Headlines

Date: Tue, 20 Aug 2019 05:21:07 +0200 (METDST)

Bangkok, Aug 20, 2019 (AFP) - At least 13 Chinese tourists were killed and dozens injured when their bus skidded off the road and plunged 30 metres into a ravine in Laos, a police officer said Tuesday.   The bus was carrying more than 40 Chinese nationals heading towards the tourist town of Luang Prabang when the accident occurred late on Monday.   "At this moment, 13 bodies have been recovered... while two are still missing," police officer Xaiyaphon Chitavong told AFP, blaming brake failure for the accident.   He added that 31 people were receiving medical treatment.    Chinese state media showed photos of rescuers wading through ankle-deep floodwaters.

Traffic accidents in Laos, Thailand, Cambodia and Myanmar are common, with safety regulations often flouted and law enforcement low.    The monsoon season from June to October also drenches rural roads with heavy rains creating slippery conditions.   Tourism to communist-run Laos has grown in recent years, and visitors from China increased by 13 percent in the first half of 2019 compared to the year before, according to the state-backed Vientiane Times.
Date: Mon, 19 Aug 2019 20:57:15 +0200 (METDST)

Bukavu, DR Congo, Aug 19, 2019 (AFP) - A child has died from Ebola in DR Congo's South Kivu, health authorities said Monday, the second person to succumb to the virus since the epidemic spread to the eastern province.   The announcement last week of the first confirmed cases in South Kivu revived concerns that the highly contagious disease could cross the porous borders of the central African country, where it has claimed more than 1,900 lives since August last year.   "A seven-year-old child died yesterday (Sunday) of Ebola" in South Kivu's Mwenga region, said Claude Bahizire, communication officer of South Kivu's provincial health division.

The first death in South Kivu was a woman in her twenties who evaded movement controls to travel from the North Kivu town of Beni, the epicentre of the outbreak, to South Kivu's capital Bukavu and then Mwenga.    She died on Wednesday, and her seven-month-old son has been diagnosed with the virus and is receiving treatment.   Bahizire said that "two other suspected cases, two women, have been detected and admitted to Bukavu's transit centre".   The two women "were in contact with the woman who died last week while she was staying in Bukavu on the way to Mwenga," he added.

The outbreak of the haemorrhagic virus began in North Kivu on August 1, 2018 and spread to Ituri province.   The health ministry also announced that "a new health zone had been assigned in North Kivu".   A confirmed case of Ebola has been recorded in North Kivu's Pinga region, in Walikale territory, a source said without providing further details.   According to the latest numbers published on Sunday, 1,934 people have since died, while 862 have been cured.

The latest outbreak is the second-deadliest on record after more than 11,000 people were killed in Guinea, Sierra Leone and Liberia between 2014-2016.   Also on Monday, World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus called on the nine countries that share a border with DR Congo to show solidarity to stop the spread of Ebola.   "We now have an Ebola vaccine that is more than 97 percent effective and treatments that are more than 90 per cent effective if used early enough," he said in Republic of Congo capital Brazzaville.
Date: Mon, 19 Aug 2019 19:48:07 +0200 (METDST)
By Alain JEAN-ROBERT

Paris, Aug 19, 2019 (AFP) - French construction workers wearing protective masks returned to the site of stricken Notre-Dame cathedral on Monday after a three-week pause due to the risk of lead contamination.   Labour Minister Muriel Penicaud was given a tour of the scorched monumet wearing a white protective suit while workers could again be seen surveying the structure which was left damaged and weakened in a massive fire in April.

Restoration of the cathedral has yet to begin with efforts focused entirely on securing the building. The culture ministry has warned it is still at risk of collapse.   Efforts to remove lead from the area around Notre-Dame began last week after alarm grew over the presence of the toxic metal.   Hundreds of tonnes of lead in the roof and steeple melted during the April 15 blaze that nearly destroyed the gothic masterpiece, with winds spreading the particles well beyond the church grounds.

Residents have accused the Paris authorities of underplaying the risk from the lead although the culture ministry insists safety is the top priority.   But prefect Michel Cadot, the government's top official for the Paris region, approved the resumption of the works after visiting the site.   "I saw that the different recommendations of the labour inspectors had been implemented," he said, adding the decontamination work would help keep contractors safe.   Securing the structure is required before the restoration work can start.    The culture ministry said that stones had fallen from the nave vault during a heatwave in July.   "It is only the urgency linked to the persistent risk of a collapse that justifies the rhythm of work undertaken" since the fire, it said in a statement Wednesday.

President Emmanuel Macron has set an ambitious target of five years for the restoration to be finished. But the ministry said the work would not even begin until next year.   Paris prosecutors said in June that a poorly stubbed-out cigarette or an electrical fault could have started the fire and opened an investigation into criminal negligence, without targeting any individual.

French investigative news site Mediapart published a report this week accusing the ministry of repeatedly ignoring warnings by labour inspectors about the dangers posed by the lead until work was finally suspended on July 25.   Critics have accused the city of failing to notify the public about the test results, while an environmental group has filed a lawsuit alleging that officials failed to sufficiently contain the contamination.   The ministry rejected Mediapart's allegations it had failed to pay attention to the risks encountered by workers on the site.
Date: Mon, 19 Aug 2019 13:26:06 +0200 (METDST)

Jalalabad, Afghanistan, Aug 19, 2019 (AFP) - Scores of people including children were wounded Monday after a series of explosions shook the eastern Afghan city of Jalalabad, as the country's independence day was marred by bloodshed.

As many as 10 blasts were reported in and around the city in Nangarhar province, authorities said, and casualty numbers rose as the day wore on.   "The explosions were caused by IEDs in different parts of the city and as groups of people were celebrating independence day," the Nangarhar governor's spokesman Attaullah Khogyani said, referring to improvised explosive devices.   Jalalabad is the scene of frequent bomb attacks, and the surrounding terrain is home to both Taliban fighters and the Islamic State group's local affiliate.

At least 52 people were wounded, Khogyani said. Zaher Adel, a spokesman for a local hospital, said 66 wounded people had been brought in. An AFP correspondent saw children among the victims.   This year's August 19 celebrations mark 100 years of Afghan independence from British influence.   The day was supposed to be one of national pride and unity, but was overshadowed by an IS suicide attack Saturday on a crowded Kabul wedding hall that killed at least 63 people.

In Kabul, locals took to the streets to wave the black-red-and-green Afghan flag, but several public events to commemorate the date were scrapped as Kabul mourns and due to fears of a fresh attack.    "We postponed the celebrations to honour the victims, but we will definitely take revenge for our people," Afghan President Ahraf Ghani said.   "We will avenge the blood of our people, every drop of it."

Mayhem from Afghanistan's war continues to wreak havoc on Afghans every day, even though the US and the Taliban are in final negotiations for a deal that would see US troops begin to quit Afghanistan and could potentially lead to a reduction in violence.
Date: Wed 14 Aug 2019
Source: Universitat Hohenheim [in German, trans. Britta Lassmann, edited]

The University of Hohenheim and the Bundeswehr Institute of Microbiology [IMB] have detected spotted fever in a hyalomma tick, the 1st time such a tick is suspected to have caused disease in a human in Germany.

This tick feeds on humans and can transmit a form of spotted fever in Germany. What were still unanswered questions about the tropical giant tick hyalomma is now certainty. At the beginning of August [2019], it was suspected that for the 1st time, a human in Germany had contracted a disease with the typical symptoms of rickettsiosis from the bite of a hyalomma tick. Experts from the University of Hohenheim in Stuttgart and the IMB in Munich were able to detect the pathogen _Rickettsia aeschlimannii_ in the tick. The number of hyalomma ticks in Germany increased significantly in 2019 compared to the previous year [2018]. In nearly half of the hyalomma ticks, _R. aeschlimannii_ can be detected. The tick researchers continue to ask the population to send them suspicious ticks.

It was probably no coincidence that this 1st case was in a horse owner. Tropical ticks of the genus _Hyalomma_ feed on large mammals. For several years, these ticks have been on the rise in Germany. Now tick researchers report the 1st suspected case of spotted fever transmitted in Germany. "Not only do we now know for sure that the hyalomma tick is also targeting humans," says Prof Dr Med Ute Mackenstedt, a parasitologist at the University of Hohenheim, "but also that there is the urgent suspicion that the transmission of spotted fever by these ticks is actually possible here in Germany."

The case: At the end of July [2019], the horse owner from near Siegen was bitten by a hyalomma tick. He sent the tick to the tick researcher in Hohenheim. He then presented to the hospital only a few days later with severe symptoms. Spotted fever caused by the bacterium _R. aeschlimannii_ was suspected. The tick was sent by courier service to the IMB in Munich, where the pathogen was detected in the tick. Thereafter, the patient received targeted antibiotic therapy, and his symptoms rapidly improved.

"We are talking about a suspected case, because direct detection of the pathogen from the patient was not possible," explains PD Dr Med Gerhard Dobler, medical doctor at the IMB. "The treatment of the patient came 1st. But the preceding tick bite, the typical symptoms
and, above all, the proof of the pathogen in the tick suggest that the case was spotted fever. The fact that the patient responded to targeted antibiotic therapy further supports this."

_R. aeschlimannii_ causes a feverish infection with headache and muscle pain, extreme joint pain, and a burning sensation. Typical for the disease, however, is the rash that gave the disease its name. This classic sign shows mainly on the extremities. The incubation period is about one week.

"If spotted fever is suspected after a hyalomma bite, a swab should be taken from the bite site and sent for examination," advises PD Dobler. "If there are questions, you are welcome to contact us. Ideally, we would also like to examine the tick."

About half of the hyalomma ticks, the researchers say, are infected with rickettsia. Transmission takes place exclusively via tick bite. "The number of hyalomma ticks in Germany is significantly higher this year [2019] than in the previous year [2018]," reports Prof Dr Med Mackenstedt, referencing the publication in which the situation was presented in 2018. The Hohenheim parasitologist not only cooperates closely with the IMB in Munich, but also with the working group of Prof Dr Med Christina Strube at the Veterinary University (TiHo) Hannover. "Together they already have found 50 such ticks in Germany in 2019. Last year [2018] there were a total of 35." Last year, these ticks had survived the winter in Germany for the 1st time.

"Rickettsia are the only pathogens that we have been able to detect so far," explains PD Dr. Dobler. "We have not found the virus that causes the dangerous Crimean Congo hemorrhagic fever, nor the pathogens _Theileria equi_ and _Babesia caballi_, both of which can be transmitted from ticks to horses."

The research team continues to ask the population for support to further explore the spread and potential dangers. In case of a tick bite, it's best to remove the tick with a tick remover, TickCard, or tweezers. Then send the animal in a small, tightly closed container to:
University of Hohenheim
Prof. Dr. Ute Mackenstedt
Department of Parasitology
Emil-Wolff-Strasse 34
70599 Stuttgart

Background: Tick genus _Hyalomma_
_Hyalomma marginatum_ and _Hyalomma rufipes_ are native to the dry and semi-arid areas of Africa, Asia, and southern Europe. Until recently, they did not occur in central and northern Europe. Their striped legs are striking, and they are much larger than the native ixodes ticks.

The adult ticks feed on large animals. They are active hunters and move quickly towards their host. They cover a distance of up to 100 m [328 ft]. Humans can serve as hosts. In contrast, tick larvae and nymphs mainly infest birds and small mammals and can stay up to 28 days with their hosts. Migratory birds can introduce larvae and nymphs to Germany.

In Eurasia, both _Hyalomma_ species are considered transmitters of the Crimean Congo hemorrhagic fever virus and the Arabic hemorrhagic fever virus (Alkhumra virus). They also transmit the bacterium _Rickettsia aeschlimannii_, which causes a form of spotted fever.

Reference:
Chitimia-Dobler L, et al. Imported _Hyalomma_ ticks in Germany in 2018. Parasites & Vectors. 2019; 12 (134).

More information:
Picture and video material [in German]
Press release: Tropical ticks in Germany: University of Hohenheim asks to send conspicuous tick finds [in German]
Press release: Tropical ticks: New immigrant species winters in Germany for the 1st time [in German]
-----------------------------------
communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
====================
[Given that the ticks were found last year (2018) and that they overwintered and were found again this year (2019), it is likely that this genus of tick is becoming established in Germany. Although the species of _Hyalomma_ that infected the man with _Rickettsia aeschlimannii_ was not determined, there is a clear association of this rickettsia with the 2 species of _Hyalomma_ that were tested. The published report cited above states, "35 ticks with an unusual appearance or behaviour were reported to us during summer-autumn 2018. For 17 of them, the description or photos implied that they belong to the hard tick genus _Hyalomma_. The remaining 18 ticks were sent to us and were identified as adult _Hyalomma marginatum_ (10 specimens) or adult _Hyalomma rufipes_ (8 specimens). All ticks tested negative for CCHF virus, _Coxiella burnetii_, _Coxiella_-like organisms, _Babesia_ spp. and _Theileria_ spp. The screening for rickettsiae gave positive results in 9 specimens. The _Rickettsia_ species in all cases was identified as _R. aeschlimannii_." Given that these ticks can be transported by birds migrating from Africa, continued surveillance in Germany for the rickettsia and the other pathogens that were not found currently is prudent. - ProMED Mod.TY]

The first human case of _R. aeschlimannii_ infection was identified in a patient who had fever, rash, and an eschar similar to _R. conori_ infection (Mediaterrian spotted fever) after travel in Morocco (1). _R. aeschlimannii_ infections in humans have been previously confirmed in South Africa, in Algeria, and in Tunisia (2). To our knowledge, the first human case of _R. aeschlimannii_ infection reported in Europe occurred in Greece and was reported in 2013 (3).

1. Raoult D, Fournier PE, Abboud P, Caron F. First documented human Rickettsia aeschlimannii infection. Emerg Infect Dis. 2002; 8: 748-9. doi: 10.3201/eid0807.010480
2. Demoncheaux JP, Socolovschi C, Davoust B, Haddad S, Raoult D, Parola P. First detection of _Rickettsia aeschlimanii_ in _Hyalomma dromedarii_ ticks in Tunisia. Ticks Tick Borne Dis. 2012; 3: 398-402.
3. Germanakis A, Chochlakis D, Angelakis E, Tselentis Y, Psaroulaki A. _Rickettsia aeschlimannii_ infection in a man, Greece. Emerg Infect Dis. 2013; 19: 1176-7.  - ProMED Mod. LL]

[HealthMap/ProMED-mail map of Germany:
Date: Wed 19 Aug 2019, 12:48 PM
Source: Kazakh Telegraph Agency [edited]

A total of 4 anthrax cases have been confirmed in the Akmola region, reports the health care department. "Up to [now] 5 [suspected cases of] anthrax have been recorded; lab tests have confirmed 4. The cause of contamination was cow butchering without a veterinary certificate in a private yard," said the interlocutor.

"Epidemiological situation in the Akmola region and Nur-Sultan is stable," said the department. "The situation is being constantly monitored by the committee," said Ludmila Burabekova, chairfigure of the committee of quality control and goods safety. "Anti-epidemic and anti-epizootic arrangements have been organized in the area," she added.
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Date: Wed 19 Aug 2019, 12:04 PM GMT
Source: Radio Free Europe [edited]

A village near the Kazakh capital, Nur-Sultan, is under quarantine after lab tests confirmed anthrax infections in several people.

The Health Ministry said on [19 Aug 2019] that 5 residents of the village of Olginka, 100 km [about 62 mi] east of Nur-Sultan, have been hospitalized in recent days with anthrax symptoms, 4 of whom tested positive for _Bacillus anthracis_ -- the bacterium that causes the infectious disease. According to the statement, the situation in the village in the Aqmola region is under the control of the authorities and all necessary measures are being taken to prevent the possible spread of the disease.

In 2016, in nearby Qaraghandy Oblast, 2 people died as a result of anthrax infections.

According to the United States Centers for Disease Control and Prevention (CDC), domestic and wild animals -- such as cattle, sheep, goats, antelope, and deer -- can become infected by inhaling or ingesting spores in contaminated soil, plants, or water. CDC says all types of anthrax infections can cause death if they are not treated with antibiotics.
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[Olginka is in north-central Kazajhstan; see:

There is a measure of rural poverty in northern half of Kazakhstan, with the result that sick and moribund animals get butchered and eaten. Fortunately, as this village is within 100 Km [about 62 mi] of the Kazakh capital the affected have had the advantage of hospital care and proper laboratory confirmation. The coincident 5th person may have just shown a fever when the medical authorities were looking for clinical cases or it may be a false negative.

Folk have a habit of self-treating with antibiotics and this would have reduced the number of circulating vegetative cells available to testing. My friend Benyamin Cherkasskyi, the Soviet anthrax expert, used to tell me that only some 30%-40% of cutaneous cases would test positive. You have to know to insert your needle in under the lesion to draw out the fluid there which will contain cells, blood, and toxins. - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Date: Mon, 19 Aug 2019 03:45:54 +0200 (METDST)

Lomo del Pino, Spain, Aug 19, 2019 (AFP) - A raging wildfire on the Spanish holiday island of Gran Canaria forced the evacuation of some 5,000 people, authorities said Sunday, warning it could take days for the blaze to be brought under control.   The fire, which has spread to the mountainous Cruz de Tejeda region popular with tourists for its breathtaking views, is "extremely fierce" and "unstable", said Canary Islands president Angel Victor Torres in a statement.   No fatalities have been reported.

More than 600 firefighters and 14 aircraft battled to contain the flames, hampered by strong winds and high temperatures.   With the temperature set to rise Monday, authorities estimate it could take days before the blaze is brought under control.   "The next few hours will be very important because the weather forecast for the night is not good," Torres said.   The fire broke out days after another wildfire in the same region forced the evacuation of hundreds.

Gran Canaria is the second most populous of the Canary Islands in the Atlantic off the northwest coast of Africa.   The Canary Islands received 13.7 million foreign visitors last year, over half of them from Britain and Germany.   Spain is frequently plagued by huge forest fires because of its arid summer climate.
Date: Sun, 18 Aug 2019 23:01:00 +0200 (METDST)

Lisbon, Aug 18, 2019 (AFP) - Portuguese fuel tanker drivers whose strike has caused fuel shortages at the summer holiday season on Sunday ended their industrial action.   Drivers have been staging a strike since Monday to demand further wage increases in 2021 and 2022, prompting the government to declare an energy crisis.   "Since all the conditions are now in place to negotiate, we decided to end the strike," Pedro Pardal Henriques, spokesman for the National Union of Dangerous Goods Carriers (SNMMP), told reporters.

A meeting is scheduled for Tuesday, the union President Francisco Sao Bento said, adding that the union did not "rule out new strikes being called if Antram (the employers association) adopts an uncompromising attitude".   Police had launched an operation to escort fuel tankers with extra supplies and Portugal also mobilised about 500 members of the security forces to replace the strikers and drive the trucks.   Despite the shortages, Energy Minister Joao Pedro Matos Fernandes said about two-thirds of the country's 3,000 or so petrol stations had not run dry.
Date: Sun, 18 Aug 2019 11:47:26 +0200 (METDST)
By By Emal Haidary and Mushtaq Mojaddidi

Kabul, Aug 18, 2019 (AFP) - Joy and celebration turned into horror and carnage when a suicide bomber targeted a packed Afghan wedding hall, killing at least 63 people in the deadliest attack to rock Kabul in months, officials and witnesses said Sunday.   The massive blast, which took place late Saturday in west Kabul, came as Washington and the Taliban finalise a deal to reduce the US military presence in Afghanistan and hopefully build a roadmap to a ceasefire.   The groom recalled greeting smiling guests in the afternoon, before seeing their bodies being carried out hours later.

The attack "changed my happiness to sorrow", the young man, who gave his name as Mirwais, told local TV station Tolo News.   "My family, my bride are in shock, they cannot even speak. My bride keeps fainting," he said.   "I lost my brother, I lost my friends, I lost my relatives. I will never see happiness in my life again."   Interior ministry spokesman Nasrat Rahimi said at least 63 people had been killed and 182 injured.   "Among the wounded are women and children," Rahimi said. Earlier he stated a suicide bomber carried out the attack.

Afghan weddings are epic and vibrant affairs, with hundreds or often thousands of guests celebrating for hours inside industrial-scale wedding halls where the men are usually segregated from the women and children.   "The wedding guests were dancing and celebrating the party when the blast happened," recounted Munir Ahmad, 23, who was seriously injured and whose cousin was among the dead.   "Following the explosion, there was total chaos. Everyone was screaming and crying for their loved ones," he told AFP from his bed in a local hospital, where he is being treated for shrapnel wounds.

Images from inside the hall showed blood-stained bodies on the ground along with pieces of flesh and torn clothes, hats, sandals and bottles of mineral water. The huge blast ripped parts of the ceiling off.   The wedding was believed to be a Shia gathering. Shia Muslims are frequently targeted in Sunni-majority Afghanistan, particularly by the so-called Islamic State group, which is also active in Kabul but did not immediately issue any claim of responsibility.

Wedding guest Hameed Quresh told AFP the young couple were saying their vows when the bomb went off.    "We fainted following the blast, and we don't know who brought us to the hospital," sobbed Quresh, who lost one brother and was himself wounded.   Another guest told Tolo that some 1,200 people had been invited. With low security, weddings are seen as easy targets.   The attack sent a wave of grief through a city grimly accustomed to atrocities. President Ashraf Ghani called it "barbaric", while Afghanistan's chief executive Abdullah Abdullah described it as a "crime against humanity".

- Withdrawal deal expected -
The attack underscores both the inadequacy of Afghanistan's security forces and the scale of the problem they face. While the police and army claim they prevent most bombings from ever happening, the fact remains that insurgents pull off horrific attacks with chilling regularity.   On July 28, at least 20 people were killed when attackers targeted Ghani's running mate Amrullah Saleh as he campaigned in presidential elections.    The incident showed how even amid tight security and known threats, insurgents can conduct brazen attacks.   The issue also goes to the heart of a prospective deal between the US and the Taliban that would see Washington begin to withdraw its approximately 14,000 soldiers from Afghanistan.

The deal relies on the Taliban providing guarantees they will stop jihadist groups such as Al-Qaeda and IS from using Afghanistan as a safe haven. Saturday's attack suggests any such promise would be tough to keep.   The "Taliban cannot absolve themselves of blame, for they provide platform for terrorists," Ghani said.   Few believe such a deal will bring quick peace.

Many Afghans fear the Taliban could return, eroding hard-won rights for women in particular and leading to a spiralling civil war.   Meanwhile, in the northern province of Balkh, 11 members of the same family were killed when their car hit a roadside bomb, officials said. The provincial governor blamed the Taliban for planting the device.
Date: Sun, 18 Aug 2019 05:28:47 +0200 (METDST)
By Amélie BOTTOLLIER-DEPOIS

Paris, Aug 18, 2019 (AFP) - Seafood lovers who prize the mussel for its earthy taste and succulent flesh may be unaware of its growing potential in the fight against water pollution.   The mussel is the hoover of the sea, taking in phytoplankton for nourishment along with microplastics, pesticides and other pollutants -- which makes it an excellent gauge.

One day, it may also be pressed into service to cleanse water.   "It's a super-filter in the marine world, filtering up to 25 litres of water a day," says marine biologist Leila Meistertzheim.   "It's a real model of bioaccumulation of pollutants generally speaking."   As they pump and filter the water through their gills in order to feed and breathe, mussels store almost everything else that passes through -- which is why strict health rules apply for those destined for human consumption.

Like canaries in a coal mine, mussels have long been used as "bio-indicators" of the health of the seas, lakes and rivers they inhabit.   Little-known pollutants can turn up to join the usual suspects, with increasing attention paid to microplastics containing bisphenol A and phthalates, both thought to be endocrine disruptors.

Meistertzheim heads a study for France's Tara Ocean Foundation using mussels to gauge the health of the estuaries of the Thames, Elba and Seine rivers.   The mussels, placed in fish traps, are submerged in the waters for a month before researchers dissect them to determine what chemical substances lurk in their tissues.   The idea of deploying mussels across the oceans to absorb ubiquitous microplastics is just a dream for now, but for other pollutants, the bivalves are already at work.   "In some places, mussels are used, as well as oysters, to cleanse the sea of pesticides, for example," Meistertzheim notes.

- E. coli busters -
Richard Luthy, an environmental engineer from California's Stanford University, says that, in most cases, mussels harvested from contaminated waters should not be eaten.   But if the contaminant is E. coli, mussels can be thanked for the "removal and inactivation" of the faecal material, he says, calling the service a "public health benefit".   The mussels are edible because they "excrete the bacteria as faeces or mucus," he says.   Mussels living in waterways affected by eutrophication -- often marked by abundant algae -- are also fit for human consumption, researchers say.   The phenomenon is often the result of waste dumped into the waterway containing phosphates and nitrites, such as detergents, fertilisers and sewage.   The nutrients in these substances encourage the proliferation of algae, which in turn starves the water of oxygen, upsetting the ecosystem.

Mussels "recycle" these nutrients by feeding on the algae, says Eve Galimany, a researcher of the US National Oceanic and Atmospheric Administration's Milford Laboratory who has experimented with mussels in the Bronx River in New York.   The recycling principle is already at work in a pilot project titled Baltic Blue Growth in Sweden, Denmark and the Baltic countries which grows mussels to be fed to animals such as poultry, fish and pigs.   "Eutrophication... is the biggest problem of the Baltic Sea, the most urgent one," says project head Lena Tasse. Mussels "could be part of a solution".   Why feed them to animals if they are safe for humans? Because Baltic mussels are too small to be of interest to seafood lovers, says Tasse, adding: "Swedes like big mussels."

Meanwhile, the jury is still out on the effects of microplastics on human health.   A recent report by WWF said that humans ingest an average of five grammes of microplastics a week -- about the weight of a credit card.   A 2018 study published in the journal Environmental Pollution, based on samples from British coastlines and supermarkets, estimated that every 100 grammes (3.5 ounces) of mussels contained 70 tiny pieces of plastic.   Should we be worried? Meistertzheim thinks not.   "I eat them," she says. "A dish of mussels is not necessarily worse than organic hamburger meat wrapped in plastic."