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Macedonia

Macedonia US Consular Information Sheet
August 15, 2008
COUNTRY DESCRIPTION:
Macedonia is a parliamentary democracy that is steadily transforming its economy. Tourist facilities are available in the capital, Skopje, and other major towns.
In tourist centers, such as Skopje and Ohrid, European-standard hotels and other travel amenities are available, while the standard of facilities throughout the rest of the country varies considerably. Read the Department of State Background Notes on Macedonia for additional information.

ENTRY/EXIT REQUIREMENTS:
Short trip for business or tourism:
A valid passport is required for travel to Macedonia.
A visa is not required for U.S. passport holders for tourist and business trips up to 90 days during a six-month period.
Entry stamps are issued at airports or land border crossing points, which grant permission to remain 90 days.
All foreign citizens must register with local police within 24 hours of arrival.
Those staying in private accommodation or renting an apartment should register in person at the police station nearest his/her place of residence, and should be accompanied to the station by the owner or landlord of the apartment.
Hotels are responsible for the registration of foreign guests.
If the foreigner changes address in Macedonia, he or she should notify the police station where s/he initially registered and reregister with the police station closest to the new place of residence.

An unaccompanied minor U.S. citizen who enters Macedonia should be in possession of a parental or guardian statement of consent to enter and stay in the country.
The statement of consent must be certified by a competent authority of the country from which s/he arrives or by a diplomatic or consular mission of the Republic of Macedonia abroad.

NOTE:
A U.S. citizen who possesses more than one passport is required to leave the country with the travel document used for entry into the country.

Temporary residence:
Individuals intending to work, study or remain longer then 90 (ninety) days in Macedonia, must obtain an entry visa prior to their arrival in Macedonia.
The practice of switching from tourist status to long-term status when already in Macedonia is no longer allowed.
Those wanting to do so must leave Macedonia and apply for a long-term visa at a Macedonian Embassy of Consulate.
Macedonian visas, as opposed to entry stamps, can only be issued at a Macedonian Embassy or Consulate in a foreign country.

American citizens resident in the United States may apply at:
Macedonian Embassy in Washington D.C.2129 Wyoming Avenue, NW, Washington, D.C. 20008, Tel: (202) 667-0501; Fax: (202) 667-2131;
E-mail: washington@mfa.gov.mk; usoffice@macedonianembassy.org, Website: http://www.macedonianembassy.org.

The passport should be valid for at least three months longer than the validity of the visa.
For additional information about the conditions and procedures for visa issuance, the applicant should contact the Embassy or Consulate of the Republic of Macedonia.
Using the list of diplomatic and consular missions of the Republic of Macedonia abroad (which can be found at the Ministry of Foreign Affairs’ website at www.mfa.gov.mk), a visa applicant can choose the most convenient Embassy/Consulate to the submit the visa application.

Travelers should be aware that all
border areas apart from designated border crossings are restricted zones. Presence in these zones is forbidden without prior official permission.

Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY: The security situation in Macedonia is stable, although occasional criminal violence does occur. Americans should avoid areas with demonstrations, strikes, or roadblocks where large crowds are gathered, particularly those involving political causes or striking workers.

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 overseas callers, a regular toll line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: Crime in Macedonia is low by U.S. standards, and violent crime against Americans is rare. Pickpocketing, theft, and other petty street crimes do occur, however, particularly in areas where tourists and foreigners congregate. American travelers are advised to take the same precautions against becoming crime victims as they would in any U.S. city. Valuables, including cell phones and electronic items, should not be left in plain view in unattended vehicles. Windows and doors should be securely locked when residences are not occupied. Organized crime is present in Macedonia; organized criminal activity occasionally results in violent confrontations between members of rival organizations. ATM use is safe, as long as standard safety precautions are taken.
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 a victim of a crime while overseas, in addition to reporting to the local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends, and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and find an attorney if needed.

The local equivalent to the “911” emergency line in Macedonia is:
police 192 and ambulance 194
If you are outside the city of Skopje you need to dial 02 first.

For additional assistance see our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Although many Macedonian physicians are trained to a high standard, and a number of well-equipped private clinics are available especially in Skopje, most public hospitals and clinics are not equipped and maintained at U.S. or Western European standards. Basic medical supplies are usually available, but specialized treatment may not be obtainable. Travelers with previously diagnosed medical conditions may wish to consult their physician before travel.

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

Driving safely in Macedonia requires excellent defensive driving skills. Many drivers routinely ignore speed limits and other traffic regulations, such as stopping for red lights and stop signs. Drivers may make illegal left turns from the far right lane, or drive into oncoming lanes of traffic. The combination of speeding, unsafe driving practices, poor vehicle maintenance, the mixture of new and old vehicles on the roads, and poor lighting contributes to unsafe driving conditions. Pedestrians should exercise extreme caution when crossing the street, even when using crosswalks, as local drivers rarely slow down or stop for pedestrians.

A valid U.S. driver’s license in conjunction with an International Driving Permit is required for Americans driving in Macedonia. Driving is on the right side of the road. Speed limits are generally posted. Most major highways are in good repair, but many secondary urban and rural roads are poorly maintained and lit. Horse-drawn carts, livestock, dead animals, rocks, or other objects are sometimes found in the roadway. Some vehicles are old and lack standard front or rear lights. Secondary mountain roads can be narrow and poorly marked, lack guardrails, and quickly become dangerous in inclement weather. Overall, public transportation in Macedonia is dilapidated. Roadside emergency services are limited.
In case of emergency, drivers may contact the police at telephone 192, the Ambulance Service at telephone 194, and Roadside Assistance at telephone 196.

Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Macedonia, the U.S. Federal Aviation Administration (FAA) has not assessed Macedonia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: Macedonian customs authorities may enforce strict regulations concerning temporary importation to or exportation from Macedonia of certain items, including items deemed to be of historical value or significance. Taking photographs of anything that could be perceived as being of military or security interest may result in problems with authorities. Visitors should always observe “no photographing” signs. If in doubt, please ask permission before taking photographs.

The local currency is the denar. While credit cards are accepted in larger stores and restaurants, cash in local currency is advised for purchases in small establishments.

Upon entry into Macedonia, every foreigner must declare all cash amounts of foreign currency greater than EUR 2,000 at the Customs Control Office. Failure to report funds in excess of this amount may result in the confiscation of the entire amount by the customs service. After going through the court system, an individual is normally required to pay a fine and the National Bank will also keep a certain percentage of the undeclared amount before it is released.
Please also see our Customs Information.
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Macedonian laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Macedonia 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. Prostitution is illegal in Macedonia. Please see our information on Criminal Penalties.
CHILDREN'S ISSUES: For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Macedonia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and to obtain updated information on travel and security within Macedonia. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy in Skopje is located at Ilindenska bb, 1000 Skopje, tel. (389) (2) 311-6180, fax (389) (2) 321-3767, email: consularskopje@state.gov; web site: http://macedonia.usembassy.gov
* * *
This replaces the Country Specific Information for Macedonia dated March 05, 2008 to update the section on Entry/Exit Requirements.

Travel News Headlines WORLD NEWS

Date: Mon 29 Jul 2019
Source: Institute of Public Health of Republic of North Macedonia [abridged, edited]

Information on the situation of measles in the Republic of North Macedonia in 2018-2019, 25 Jul 2019
--------------------------------------------------------------------------------
In the period from 20 Jul-25 Jul 2019, a total of 5 cases of measles were reported. From the total number of newly reported cases, 4 cases are from Skopje, while one is from Kumanovo.

In total, since the onset of the epidemic in December 2018 as of 25 Jul 2019, 1870 cases of measles have been registered in the Republic of North Macedonia with a disease rate of 90.4 per 100,000 inhabitants.

Due to the epidemiological criteria, a measles epidemic is ongoing in the entire territory of the Republic of North Macedonia.

According to the place of permanent living, measles cases are registered in 24 towns, of which 979 cases are from Skopje, Kumanovo 231, Tetovo 194, Struga 112, Kicevo 59, Veles 53, Gostivar 69, Ohrid 35, Gevgelija 19, Debar 22, Prilep 11, Stip 40, and in other cities less than 10 cases were registered (Chart 1). The highest incidence is registered in Skopje (158.5/100 000, Struga (165.1/100 000, Kumanovo 161.9/100 000)

According to the vaccine status, 1501 or 80.3% of diseased people are unvaccinated, incompletely vaccinated or with unknown vaccine status. >From the non-vaccinated persons, 320 (21.3%) are under the age of 12 months and are not subject to vaccination, according to the Immunization Calendar.

According to the results obtained from the samples sent to Luxembourg's reference measles laboratory, the B3 Dublin genotype circulates in the country, which is circulating also in the neighbouring countries.
 
The total number of immunized people aged 14 years with MRP [morbilli, rubella, and parotitis epidemica/MMR measles, mumps, rubella] vaccine since the start of the epidemic in the republic is 33,729.  From the beginning of the epidemic to present date, in the Centers for Public Health, a total of 6032 people have been vaccinated, of which more than 60% are health workers, students, and pupils in secondary medical schools, the rest are persons over 14 years of age.

[Available at the source URL:]
Chart 1. Geographic distribution of measles in N. Macedonia, December 2018-July 2019
----------------------------------------------
Communicated by:
Aleksandar Jovicic
==========================
[HealthMap/ProMED-mail map of Republic of North Macedonia:
Date: Fri 29 Mar 2019
Source: Institute of Public Health of Republic of Macedonia [abridged, edited]

Information on the situation of measles in the Republic of North Macedonia in 2018-2019, 29 Mar 2019
-------------------

In the period 23 Mar-29 Mar 2019, a total of 109 cases of measles (laboratory confirmed or related to the epidemiological link) were reported.

Out of the total number of newly reported cases, 49 cases are from Skopje, with 89.8% of them incomplete vaccinated, unvaccinated, or with unknown vaccine status. The remaining 60 patients are from 11 other cities in North Macedonia:

- From Kumanovo and Struga, 30 cases (15 cases in each) were reported, of which 90% were unvaccinated, incomplete vaccinated, or with unknown vaccine status;
- From Tetovo and Debar: in 7 cases from Tetovo, 6 were unvaccinated, incomplete vaccinated, or with unknown vaccine status; from Debar, one case was unvaccinated and one with unknown vaccine status;
- From Gostivar, there are 6 cases, of which 5 are unvaccinated, incomplete vaccinated, or with unknown vaccine status;
- 4 cases were reported from Kicevo, with 2 of them unvaccinated and incomplete vaccinated;
- From Veles, 2 cases, with 1 unvaccinated and 1 incomplete vaccinated;
- 1 new case each was reported from Stip (unknown vaccine status), Ohrid (incomplete vaccinated), Radovis (not vaccinated), and Prilep (completely vaccinated).

In total, since the onset of the epidemic in Skopje in December 2018, as of 29 Mar 2019, 767 measles cases were registered in the Republic of North Macedonia, of which 575 were epidemiologically related and reported in the epidemic in Skopje.

According to the place of permanent living, measles cases were registered in 20 towns in Macedonia, of which 521 were from Skopje, 63 from Tetovo, 61 from Kumanovo, 27 from Struga, 18 cases from Gevgelija and Debar, 15 from Gostivar, 12 from Veles, 11 from Kicevo, 4 from Kocani and Shtip, and in sporadic cases in the other 9 cities. The highest incidence per 100 000 inhabitants is registered in Struga (97.3), Skopje (84.4), Debar (64.9), Kumanovo (42.8), and Gevgelija (41.8).

The largest number of cases are from the age group over 30 years, with 305 or 39.8% of the total. A high percentage of patients is also registered in the age group of 0-4 years, with 37.9% of the total number of cases (n = 291).

Out of 150 children aged 1-4 years, 137 or 91.3% were unvaccinated or with unknown vaccine status; from 412 patients in persons over 20 years of age, 69.2% (n = 285) were unvaccinated, incomplete vaccinated, or with unknown vaccine status.

Out of the total number of 767 registered cases of measles, the highest number and percentage, 369 or 48.1%, are laboratory confirmed, 193 or 25.2% are epidemiologically linked, while 205 cases (26.7%) are measles with clinical features.

>From the beginning of the epidemic in Skopje, the total number of vaccinated people under 14 years of age who are subject to 1st or 2nd vaccination is 11 475 children. In the rest of the republic, from the beginning of the epidemic, the total number of vaccinated people up to 14 years of age with a 1st or 2nd dose is 6776 children.

The total number of immunized people aged 14 years with the MRI vaccine since the beginning of the epidemic is 18,251.  Submitted by: Aleksandar Jovicic.
=========================
[HealthMap/ProMED map of North Macedonia
http://healthmap.org/promed/p/55666. - ProMED Mod.MPP]
Date: Fri 8 Mar 2019
Source: IPH (Institute of Public Health of Republic of Macedonia) [abridged, edited]

This week [week of Mon 4 Mar 2019], a total of 81 cases of measles have been reported (laboratory confirmed or with an epidemiological link). A total of 45 cases of measles have been reported from Skopje (of whom 73.3% were incompletely vaccinated, unvaccinated, or with unknown vaccine status) while the other 36 are from 9 other cities in Macedonia.

From Gevgelija, 7 cases were reported, 6 of them unvaccinated. From Kumanovo, 8 cases were reported, 7 unvaccinated. From Tetovo, 7 new cases were reported, 6 of which were not vaccinated, with incomplete vaccine status. From Struga, 5 cases were reported, of which 3 were incompletely vaccinated with unknown vaccine status. Three new cases have been reported from [each of] Debar and Veles; [of these,] 5 persons have been incomplete vaccinated or with unknown vaccine status. Also, one new case from [each of] Kriva Palanka (not vaccinated), Kicevo (unknown vaccine status), and Kocani (completely vaccinated) [were reported].

A total of 493 cases of measles have been registered in Macedonia since the beginning of the epidemic in Skopje since December 2018, of which 410 have been linked to the epidemic in Skopje.

According to the place of permanent living, measles cases were registered in 17 towns in Macedonia, of which 366 cases were from Skopje, 39 from Tetovo, 25 from Kumanovo, 16 from Gevgelija, 9 from Debar, 7 from Struga, 6 from Gostivar, 6 from Veles, 5 from Kichevo, and 4 from Kocani, and the other 7 cities are sporadic cases.

The largest number of cases are from the age group 0-4 years: 220, or 44.6% of the total. A high percentage of patients is also registered in elderly groups. Persons older than 30 years account for 36.9% (n = 182) and persons from 20-29 years for 10.3% (n = 51).

Out of a total of 122 cases of children aged 1-4 years, 105 (86%) were unvaccinated, and out of 233 cases in people over 20 years of age, 70.8% (n = 165) were unvaccinated, incompletely vaccinated, or had unknown vaccine status.

From the total number of registered 493 cases of measles, the highest number and percentage -- 278 (56.4%) -- are laboratory confirmed; 117 (23.7%) are epidemiologically related, while 98 cases (19.9%) are measles [presumably this means clinically diagnosed but not laboratory confirmed. - ProMED Mod.SH].

Since the onset of the epidemic, in Skopje, total of 9958 children under 14 years of age have been vaccinated as part of the response to the outbreak with a 1st or 2nd dose. In the rest of the republic, since the epidemic began, a total of 5193 children up to 14 years have been vaccinated with a 1st or 2nd dose. The total number of those aged 14 years [and under] who have received MRP vaccine since the start of the epidemic in the Republic of Macedonia is 15 151.
Date: Sat 9 Feb 2019
Source: China.org.cn, a Xinhua report [edited]

The Macedonian Health Minister Venko Filipce confirmed on [Fri 8 Feb 2019] the death of a 6-month-old baby related to measles. According to Filipce, the baby was under treatment for lung complications and was not vaccinated.

The minister said vaccination in Macedonia should continue in order to strengthen the immunity of the population after the significant drop on vaccination coverage in 2014.  Filipce also confirmed that 2 children are treated for lung complications but are not in life-threatening conditions. The minister made the remarks after his visit at the Neurology Clinic in Skopje. On [2 Jan 2019], the Health Ministry in Macedonia declared the outbreak of measles in the capital of Skopje.
Date: Wed 2 Jan 2019
Source: Outbreak News Today [abridged, edited]

Health officials in Macedonia are reporting a measles outbreak in the capital city of Skopje. Minister of Health Assoc. Dr. Venko Filipce announced the outbreak declaration today [2 Jan 2019].

In addition to the 7 cases that appeared in the Skopje settlement Radishani 10 days ago, there are now 12 new cases from almost all municipalities in Skopje, of which 6 are officially laboratory confirmed and 6 have a clear clinical picture and are awaiting official laboratory confirmation. The outbreak has affected both children and adults, all of whom were unvaccinated.

"Of the 15 000 unvaccinated children with vaccine calls, only 310 were vaccinated, which is a small figure. It is a good circumstance that schools [were closed] because of the holidays.

"But, of course, we have the situation under control. This is an extremely serious disease that, unfortunately, is sometimes fatal to the lives of children. Any disregard for the recommendations is an additional risk for the health of the whole population," said Minister Filipche (computer translated).  [Byline: Robert Herriman]
=========================
[A total of 310 children vaccinated of 15 000 is only 2% of the children immunized. This is an unacceptably high risk for the children. - ProMED Mod.LK]

[HealthMap/ProMED-mail map:
Skopje, Macedonia (FYROM): <http://healthmap.org/promed/p/1999>]
More ...

World Travel News Headlines

Date: Fri, 16 Aug 2019 03:38:45 +0200 (METDST)
By Paulina ABRAMOVICH

Santiago, Aug 16, 2019 (AFP) - Once deep in powder this time of year, Chile's ski stations are fighting the ravages of climate change and pollution that have brought less and less snow to the central Andes.   Just a few decades ago, the Andes mountain range could be buried under four meters of snow, forcing the closure of access roads and requiring the use of tractors to get around.

But this year, it's snowed only three times in the Chilean Andes, and never more than 30 centimetres.   It's not just Chile affected, but the whole of the Andes where the area of snow cover in the central zone has diminished by five to 10 percent each decade, according to Raul Cordero, an academic at the University of Santiago.   "But it's not just snow cover that's decreasing, the thickness of the snow cover is also reducing," he said.   "So when we talk about a decrease of the cover of five to 10 percent, this probably signifies a much greater reduction in the volume of available snow over the Andes."

Rising temperatures mean the snow line -- above which snow never melts all year round -- keeps creeping upwards.   The snow melt is even more pronounced in the central zone due to pollution from the Chilean capital, one of the most contaminated urban areas in the region.   A recent study led by Cordero found that soot, or black carbon, from Santiago was settling in the Andes and accelerating the snow melt.   As it's black, it absorbs more solar radiation and heats up quicker.   "When this pollution is over the cities it poisons people and when the wind blows, this pollution goes and is deposited on the mountains and contributes to the snow melt," said Cordero.

- Essential snow cannons -
The upshot is that Chile's ski stations have had a difficult season.    But thanks to the snow cannons, the erection of fences and a tailored piste management policy, the resorts have managed to stay open throughout a winter in which there has been almost no snow.   "All the ski centers in the central zone are without natural snow. However, thanks to the fabrication of snow we've been able to keep open pistes that without this fabrication would not have been able to stay open," Fernando Montenegro, the operations director at Andacor, which operates the El Colorado and Parque Farellones ski stations, told AFP.

El Colorado is 50 kilometers from Santiago and sits at 2,800-meters. It pumps out snow whenever the conditions allow it.   Low temperatures and high humidity is what's needed for the snow cannons to chug into gear and churn out snowflakes from water.   This technology has been around since 1994, but it's never before been in use as much as it is now -- and even then the ski station is only operating at 70 percent capacity.   But even if the situation gets worse, the ski stations will manage, according to Montenegro.   "There's no risk. However, we need to manage the snow and manage the water in the mountain range in a good way."   El Colorado has already invested almost $4 million in buying snow cannons and hopes to increase that to $10 million over the coming years.

- 'Variety so important' -
Last weekend, some 7,000 people descended on El Colorado where ski and snowboard national teams come to train -- although, they're not necessarily happy.   "If there's not enough snow, there's not as many hills. We don't get the variety, we don't get steepness, (or) different slopes: it's so important for us to have that variety," Megan Farrell, a member of the Canadian snowboard team, told AFP.   Amateur skiers also noticed the difference from previous years.   "You can see that the snow is harder. It's not very deep, there are a lot of stones and snow made by the cannons, which makes it feel like you're skiing on a different type of snow," said Chilean Rado Milosevic, 24.
Date: Thu, 15 Aug 2019 20:21:28 +0200 (METDST)

Tokyo, Aug 15, 2019 (AFP) - A powerful tropical storm lashed Japan on Thursday, bringing strong winds and torrential rain that claimed at least one life, prompted warnings of landslides and flooding, and sparked evacuation advisories and travel chaos at a peak holiday period.   Severe Tropical Storm Krosa -- one notch below a typhoon -- slammed into the southern Hiroshima region, packing wind gusts of up to 126 kilometres (78 miles) per hour.   Dramatic television footage showed violent winds uprooting trees, snapping lampposts and spinning pods on a Ferris wheel.

Meanwhile, high waves smashed into a breakwater, engulfing a 10-metre lighthouse, while swollen rivers broke their banks and swamped nearby roads.  Authorities issued a voluntary evacuation advisory to around 430,000 people in the storm's path, although few appeared to have heeded the warning.

A 82-year-old man was confirmed dead after he fell in the sea in Hiroshima while trying to moor his boat, a local government spokesman said.    Japanese news agency Kyodo reported that a total of 49 people were injured from Wednesday to Thursday.   "We still have intermittent downpours," said Takayoshi Sugimoto, a disaster management official in the southwestern province of Tokushima.   "We will remain vigilant," he told AFP.

The national disaster management agency said a party of 18 people, including children, were stranded during a barbeque in a valley when a river rose rapidly on Wednesday. They were rescued Thursday morning.   Krosa also sparked travel chaos as people battled to return to major cities following the Obon holiday.   More than 800 domestic flights were cancelled to and from cities in western Japan, and bullet train services were either scrapped or sharply reduced.   Ferries connecting the southern Shikoku island and other parts of Japan were also cancelled as high waves lashed the coast.

The storm brought strong winds and downpours to the capital Tokyo.   Several ceremonies commemorating the end of World War II were cancelled in western Japan due to bad weather.    Krosa weakened significantly from earlier in the week as it stalled in the Pacific Ocean but it boasts an unusually large eye, meaning it is likely to dump rain over a wide area.   It was moving north at 35 kilometres (22 miles) per hour and the rain was expected to last for an extended period.   The storm crossed Japan's mainland and hit the Sea of Japan late Thursday.
Date: Thu, 15 Aug 2019 15:36:40 +0200 (METDST)

Tripoli, Aug 15, 2019 (AFP) - Flights at the Libyan capital's sole functioning airport were suspended Thursday after deadly overnight rocket fire, a spokesman for the country's unity government said.   Wednesday night's rocket fire "killed a guard and wounded several security agents tasked with protecting the airport," said Moustafa al-Mejii, spokesman for the Tripoli-based Government of National Accord (GNA).   He blamed the attack on "the militias of (Khalifa) Haftar" whose forces launched an offensive on the Libyan capital in April.   Arrivals and departures at Mitiga airport were suspended as a result, Mejii said.   Located east of Tripoli, Mitiga is a former military airbase that has been used by civilian traffic since Tripoli international airport suffered severe damage during fighting in 2014.

Mitiga is in a zone under the control of forces loyal to the GNA and has often been targeted, leading to repeated suspensions of flights.   United Nations envoy Ghassan Salame, in a report to the UN Security Council last month, urged "authorities in Tripoli to cease using the (Mitiga) airport for military purposes and for the attacking forces to halt immediately their targeting of it."   The GNA protested at what it said were "untruths" in the envoy's report.   Haftar's self-styled Libyan National Army (LNA) has encountered fierce resistance from pro-government forces in the battle for Tripoli.   A stalemate on the ground in the capital's southern outskirts has led to a greater reliance on air strikes by both sides.

The fighting since April has killed 1,093 people and wounded 5,752 others, according to the World Health Organization.   More than 120,000 people have been displaced.   The LNA said Thursday its air force carried out a strike against an airfield in Zuwara, a town west of Tripoli, and destroyed two hangars allegedly used to house Turkish drones.   "The runway and terminals were spared" at the airfield, which is not open to commercial flights, LNA spokesman General Ahmed al-Mesmari wrote on Facebook.   The GNA, however, posted pictures of a huge crater and debris on the tarmac.   Libya has been mired in chaos since a NATO-backed uprising that toppled and killed dictator Moamer Kadhafi in 2011.
Date: Thu, 15 Aug 2019 14:11:31 +0200 (METDST)

Hong Kong, Aug 15, 2019 (AFP) - Hong Kong's government unveiled HK$19.1 billion (US$2.44 billion) worth of economic relief measures and downgraded its growth forecasts on Thursday as the international hub reels from simmering pro-democracy protests and the US-China trade war.   Last week city leader Carrie Lam warned that 10-weeks of anti-government protests were hitting businesses like a "tsunami".    On Thursday, financial chief Paul Chan predicted the city's economy would grow by a miserly zero to one percent this year, the worst rate since 2009 after the global crash hit.

But as he announced a raft of sweeteners in a surprise "mini-budget", he denied the move was linked to the roiling unrest.   "The measures that we have just announced... trying to tackle the current economic difficulties and the coming economic headwinds, is not related to the political difficulties that we are facing," Chan told reporters.   Instead, he said, the primary headwinds remained ongoing trade tensions between Washington and Beijing -- two major markets for Hong Kong -- and the possible impact of Brexit.    "Based on the latest developments and assessments on the outlook, the Hong Kong economy will continue to face an austere environment for the rest of the year," he said.

Nonetheless, the sweeteners seemed to be aimed at winning over support from moderate Hong Kongers as the city reels from the protests.    The measures included financial breaks for small businesses, more generous student subsidies and goodies for low-income households.  Ten weeks of unprecedented rallies, demonstrations and occupations in Hong Kong have seen millions of people take to the streets in the biggest challenge to China's rule of the semi-autonomous city since its 1997 handover from Britain.   The social and political unrest was triggered by a controversial bill which would have allowed extraditions to mainland China, but has evolved into a call for wider democratic reforms and a halt to sliding freedoms.

The retail and tourism sectors have been especially hit by the drop in arriving visitors to the city, but the property market remains strong.   At a "citizens press conference" on Thursday, one protest group blamed the city's economic woes on the local leaders who they accused of undermining the city's business appeal by kowtowing to Beijing.
Date: Thu, 15 Aug 2019 11:07:44 +0200 (METDST)

Johannesburg, Aug 15, 2019 (AFP) - South Africa on Thursday announced visa waivers for four countries in a bid to boost tourism amid an economic crisis and falling visitor numbers.   Visitors from Qatar, Saudi Arabia, United Arab Emirates and New Zealand will no longer require a visa to visit for holiday, conferencing and business purposes, Home Affairs Minister Dr Aaron Motsoaledi said.

The unilateral decision comes as official tourism figures released in May reflected a dip in the overall number of visitors to South Africa from Europe and the Middle East in the first financial quarter of the year, normally one of the most popular times to visit.   Foreign traveller arrivals decreased by more than 10 percent between April and May 2019 alone.   Motsoaledi said the South African government was engaging with Qatar, Saudi Arabia, United Arab Emirates and New Zealand about a similar relaxation of entry requirements for SA citizens.   He argued the move by his department would boost tourism "and by extension growing the economy and creating jobs".

South Africa's economy has hit trouble, with gross domestic product (GDP) contracting by 3.2 percent in the first three months of 2019 and unemployment at a record high of 29 percent.   The government estimates there is potential to create 2.1 million jobs in the tourism sector by 2028.   South Africa is in talks to extend the visa waiver to Ghana, Cuba and Principe and Sao Tome.    The country has already waived the visa requirement for 82 of the 193 countries who are UN members.
Date: Tue 13 Aug 2019, 18:22 PM
Source: The News Minute (TNM) [edited]

In early July [2019], 2 children from Sathyamangalam in Tamil Nadu's Erode district succumbed to diphtheria. Around this time, several other cases of diphtheria were being reported from the state. The latest information shows that at least 50 people have been admitted to the Coimbatore Medical College and Hospital with diphtheria.

Health officials in the state have begun stepping up measures to ensure that the spread of the disease is contained and that more people are vaccinated. The Directorate of Public Health (DPH) even issued an alert to doctors in Chennai to treat all children presenting with sore throat with an antibiotic used to treat the disease, without waiting for the confirmation of a diagnosis.

Despite several campaigns to raise awareness about the importance of vaccination and ensuring that children are vaccinated according to the immunisation schedule, officials note that discrepancies in immunisation have played a large role in the current outbreak of diphtheria.

Tamil Nadu's Deputy Director of Public Health, Dr. K Kolandaswamy, had earlier told TNM that the current spike in the number of cases had to do with lack of immunisation. While several parents had skipped vaccinating their children at a young age, many others had not ensured that the booster dose was taken at a later age. However, in light of the recent outbreak in which both young people and adults have been affected, preventive measures have been stepped up. Not only are children being given the vaccine and booster doses (as deemed necessary), but so are adults.

Diphtheria is a disease caused by the organism _Corynebacterium diphtheriae_ and is highly contagious. Symptoms of diphtheria are often very similar to that of a common cold or any mild respiratory infection, which makes it difficult to differentiate between diphtheria and a more generic infection.

An infected individual may begin to present with symptoms anywhere from 2 to 10 days after exposure to the bacteria. The infected person usually develops a sore throat, which aggravates and will generally develop other respiratory issues as well, if left untreated. While the treatment for diphtheria consists of antibiotics and supportive measures as necessary (painkillers, fluids, etc), it has been determined that the best course of action is to take preventive measures.

The vaccine against diphtheria is given as a pentavalent vaccine (offers immunisation against 5 diseases: diphtheria, pertussis, tetanus, hepatitis B and Hib-Haemophilus influenza type b). It is given at 1.5, 2.5 and 3.5 months of age. The DPT vaccine (trivalent, covers 3 diseases: diphtheria, pertussis and tetanus) is given between 16 to 24 months of age. When the child is around 6 years old, another booster dose is required. In addition, the Centre has also advised that children be given the Td vaccine (covers tetanus and diphtheria) at age 10 and age 15.  [Byline: Dr Nimeshika Jayachandran]
========================
[Erode, with a population of about 2.25 million residents in 2011, is the largest district in the Indian state of Tamil Nadu, located in the state's westernmost region; its headquarters is the city of Erode (<https://en.wikipedia.org/wiki/Erode_district>).

A map showing the location of Erode District in south-central India can be found at
<https://www.google.com/maps/place/Erode,+Tamil+Nadu,+India>.

Diphtheria is caused by toxin-producing strains of _Corynebacterium diphtheriae_, an aerobic Gram positive bacillus. _C. diphtheriae_ causes respiratory tract or cutaneous diphtheria. Toxin production occurs only when the bacillus is infected (lysogenized) by a specific bacteriophage that carries the gene encoding the toxin. The most common sites of diphtheria infection are the pharynx and the tonsils, where an adherent pseudomembrane forms, which may result in respiratory obstruction. The toxin is responsible for the major complications, myocarditis (such as cardiac arrhythmias and heart failure) and neuritis (such as paralysis of the soft palate, eye muscles, limbs, and diaphragm). The overall case fatality rate for diphtheria is 5-10% but is higher (up to 20%) among persons younger than 5 and older than 40 years of age.

Close contacts, especially household contacts, should receive a diphtheria booster, appropriate for age, and antibiotics, such as benzathine penicillin G or a 7-10-day course of oral erythromycin. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of India:
Date: Tue 13 Aug 2019 2:21 AM CDT
Source: MPR [Minnesota Public Radio] News [edited]

[Minnesota] state health officials said [Tue 13 Aug 2019], 3 children are sick from _E. coli_ bacteria after swimming in a Minneapolis lake. The children have tested positive for the same strain of _E. coli_ after swimming at Lake Nokomis beaches between [26 Jul and 2 Aug 2019]. 2 beaches of the lake are closed until further notice, the Minnesota Department of Health said. The children, all under the age of 10, were not hospitalized.

Minneapolis Park Board Superintendent Al Bangoura said it's the 1st time someone has fallen ill after swimming in a Minneapolis lake in more than 20 years. "We take this very seriously and are working closely with the Minnesota Department of Health as they conduct their investigation," Bangoura said in a news release.

Symptoms of illness caused by _E. coli_ bacteria include stomach cramps and diarrhea, with mild or no fever. People typically become ill 1 to 8 days after exposure. It's rare, but the infections sometimes lead to a serious complication involving kidney failure. Health officials say children younger than 10 years old, the elderly, and those with weakened immune systems have a higher chance of developing complications from _E. coli_ infections.

"This is also an important reminder that anyone who is experiencing diarrhoea should not go swimming while they are sick," said Trisha Robinson, waterborne disease supervisor at the Health Department.

Officials also want to hear from anyone else who may have become ill after swimming in Lake Nokomis.

"If there are other people who have gone swimming and are concerned about their symptoms of illness, we very much encourage them to contact their health care providers," Robinson said.
===================
[It is important to understand that there are many different kinds of _E coli_. The organism is an important component of the human intestinal tract and can perform important functions helpful to its host. These strains can cause human infections if they "escape" from the usual location into the urinary tract, gall bladder, or abdominal cavity. They are also what are mentioned when a beach is closed for _E. coli_ contamination. In this circumstance, officials are measuring the organism or "coliforms" in the water to reflect human sewage contamination.

Additionally, there are some strains of _E. coli_ that can produce toxins that can produce diarrhea, and much of so-called travellers' diarrhoea is caused by these strains. All of these strains are human bacteria, not zoonotic organisms, that is, not spread from animal hosts. One _E. coli_ group called Shiga toxin producing or enterohemorrhagic _E. coli_ (EHEC) is the organism likely to be involved here, are zoonotic. Spread in a number of ways, including via undercooked ground beef, contaminated vegetables, and direct or direct contact with farm animals including contaminated water, EHEC can cause significant disease and even death.

In the spring of 2000, in Walkerton, a town of 5000 in southern Ontario, an outbreak of _E. coli_ O157:H7 infection claimed 7 lives -- 6 adults and a child -- and over 200 were seen at local area hospitals.

Swimming-associated transmission is illustrated in the following references:

1. Keene WE, McAnulty JM, Hoesly FC, et al. A swimming-associated outbreak of hemorrhagic colitis caused by _Escherichia coli_ O157:H7 and _Shigella sonnei_. N Engl J Med. 1994; 331(9): 579-84; available at <http://www.nejm.org/doi/full/10.1056/NEJM199409013310904>.
2. CDC. Lake-associated outbreak of _E. coli_ O157:H7 - Illinois. MMWR 1996; 45(21): 437-9; available at <https://www.cdc.gov/mmwr/preview/mmwrhtml/00042070.htm>.
3. Ackman D, Marks S, Mack P, et al. Swimming-associated hemorrhagic colitis due to _Escherichia coli_ O157:H7 infection: evidence of prolonged contamination of a fresh water lake. Epidemiol Infect. 1997;119:1-8; available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808815/>. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Minnesota, United States:
Date: 13 Aug 2019
Source: RFI France [edited]

38 children in France, including babies, living near what was once Europe's largest gold mine have tested positive for arsenic poisoning.

Children in the Orbiel Valley, in the southern department of Aude, were examined when families became concerned that flooding in October last year [2018] had carried arsenic and heavy metals from the nearby Salsigne mine.

After testing 103 children aged under 11 years, the Occitanie Regional Health Agency confirmed on Tue [13 Aug 2019] that 38 of them had returned positive test results for above-average levels of arsenic.

Salsigne, the world's largest arsenic mine, had been operating for almost a century when it closed in 2004. Millions of tons of toxic waste, which local NGOs say have not been properly sealed, are in storage at 5 nearby sites.

In October 2018, 14 people were killed when the Aude was hit by violent floods. Media reports say the Orbiel river and its tributaries have spread pollutants from the old mine.  [Byline: Eric Cabanis]
=========================
[There are a number of ways products can enter the body: inhalation, absorption, ingestion, and injection. Absorption is often thought of as products being absorbed through the GI tract, but it is also most significantly through the skin (such as a bath if arsenic is in the water). The integument (skin) is one of the largest organs of the body.

There are different forms of arsenic. There are 2 forms of inorganic arsenic: the reduced or trivalent arsenic (+3) or arsenite, and the oxidized or pentavalent (+5) form known as arsenate. Both of these forms can be absorbed and accumulated in tissues and body fluids.

There are also organic arsenics, but these are generally regarded as less harmful, by orders of magnitude.

Arsenic is a known carcinogen. The article does not tell us whether the exposure was to organic or inorganic arsenic. The form of arsenic is important with regard to toxicity. We are not told the specific ages of the children or babies. However, children, babies, and even pregnant women metabolize arsenic differently than non-pregnant adults.

Exposure to higher than average levels of arsenic occur mostly in the workplace, near hazardous waste sites, or in areas with high natural levels. At high levels, inorganic arsenic can cause death. Exposure to lower levels for a long time can cause a discoloration of the skin and the appearance of small corns or warts. In the United States, arsenic has been found in at least 1149 of the 1684 National Priority List sites identified by the Environmental Protection Agency (EPA).

Arsenic is a naturally occurring element widely distributed in the earth's crust. In the environment, arsenic is combined with oxygen, chlorine, and sulfur to form inorganic arsenic compounds. Arsenic in animals and plants combines with carbon and hydrogen to form organic arsenic compounds.

Inorganic arsenic compounds are mainly used to preserve wood. Copper chromated arsenate (CCA) is used to make "pressure-treated" lumber. CCA is no longer used in the U.S. for residential uses; it is still used in industrial applications. Organic arsenic compounds are used as pesticides, primarily on cotton fields and orchards.

What happens to arsenic when it enters the environment?
- Arsenic occurs naturally in soil and minerals and may enter the air, water, and land from wind-blown dust and may get into water from runoff and leaching.
- Arsenic cannot be destroyed in the environment. It can only change its form.
- Rain and snow remove arsenic dust particles from the air.
- Many common arsenic compounds can dissolve in water. Most of the arsenic in water will ultimately end up in soil or sediment.
- Fish and shellfish can accumulate arsenic; most of this arsenic is in an organic form called arsenobetaine that is much less harmful.

How might I be exposed to arsenic?
- Ingesting small amounts present in your food and water or breathing air containing arsenic.
- Breathing sawdust or burning smoke from wood treated with arsenic.
- Living in areas with unusually high natural levels of arsenic in rock.
- Working in a job that involves arsenic production or use, such as copper or lead smelting, wood treating, or pesticide application.

How can arsenic affect my health?
Breathing high levels of inorganic arsenic can give you a sore throat or irritated lungs.

Ingesting very high levels of arsenic can result in death. Exposure to lower levels can cause nausea and vomiting, decreased production of red and white blood cells, abnormal heart rhythm, damage to blood vessels, and a sensation of "pins and needles" in hands and feet.

Ingesting or breathing low levels of inorganic arsenic for a long time can cause a darkening of the skin and the appearance of small "corns" or "warts" on the palms, soles, and torso. Skin contact with inorganic arsenic may cause redness and swelling.

Almost nothing is known regarding health effects of organic arsenic compounds in humans. Studies in animals show that some simple organic arsenic compounds are less toxic than inorganic forms. Ingestion of methyl and dimethyl compounds can cause diarrhea and damage to the kidneys.

Several studies have shown that ingestion of inorganic arsenic can increase the risk of skin cancer and cancer in the liver, bladder, and lungs. Inhalation of inorganic arsenic can cause increased risk of lung cancer. The Department of Health and Human Services (DHHS) and the EPA have determined that inorganic arsenic is a known human carcinogen. The International Agency for Research on Cancer (IARC) has determined that inorganic arsenic is carcinogenic to humans.

There is some evidence that long-term exposure to arsenic in children may result in lower IQ scores. There is also some evidence that exposure to arsenic in the womb and early childhood may increase mortality in young adults.

There is some evidence that inhaled or ingested arsenic can injure pregnant women or their unborn babies, although the studies are not definitive. Studies in animals show that large doses of arsenic that cause illness in pregnant females, can also cause low birth weight, fetal malformations, and even fetal death. Arsenic can cross the placenta and has been found in fetal tissues. Arsenic is found at low levels in breast milk.

How can families reduce their risk for exposure to arsenic?
- If you use arsenic-treated wood in home projects, you should wear dust masks, gloves, and protective clothing to decrease exposure to sawdust.
- If you live in an area with high levels of arsenic in water or soil, you should use cleaner sources of water and limit contact with soil. - If you work in a job that may expose you to arsenic, be aware that you may carry arsenic home on your clothing, skin, hair, or tools. Be sure to shower and change clothes before going home.

There are tests available to measure arsenic in your blood, urine, hair, and fingernails. The urine test is the most reliable test for arsenic exposure within the last few days. Tests on hair and fingernails can measure exposure to high levels of arsenic over the past 6-12 months. These tests can determine if you have been exposed to above-average levels of arsenic. They cannot predict whether the arsenic levels in your body will affect your health.

The EPA has set limits on the amount of arsenic that industrial sources can release to the environment and has restricted or cancelled many of the uses of arsenic in pesticides. EPA has set a limit of 0.01 parts per million (ppm) for arsenic in drinking water.

The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit (PEL) of 10 micrograms of arsenic per cubic meter of workplace air (10 ug/m3) for 8 hour shifts and 40 hour work weeks.

Reference:
Agency for Toxic Substances and Disease Registry (ATSDR). 2007. Toxicological Profile for Arsenic (Update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Portions extracted from Agency for Toxic Substance and Disease Registry;
<https://www.atsdr.cdc.gov/toxfaqs/tf.asp?id=19&tid=3>. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Date: Sat 10 Aug 2019
Source: Nigeria CDC [edited]

The Nigeria Centre for Disease Control (NCDC) is aware of a suspected outbreak of yellow fever in Ebonyi state and has had a rapid response team supporting Ebonyi state's response since [Tue 30 Jul 2019], in partnership with the World Health Organization (WHO).

Following a report of cases and deaths from fever of unknown origin in Izzi local government area (LGA) in Ebonyi state, the state public health team commenced an investigation. As at [Wed 31 Jul 2019], 3 cases had tested positive for yellow fever at NCDC's national reference laboratory, which triggered an immediate response.

The Ebonyi State Epidemiology Team is leading the response with support from the Nigeria Centre for Disease Control (NCDC), the National Primary Health Care Development Agency (NPHCDA), and the World Health Organisation (WHO). In the course of investigation, it was discovered that between 1 May-7 Aug 2019, there had been cases that fit into the case definition for yellow fever and 20 deaths in Izzi LGA, Ebonyi state, indicating that the outbreak may have been going on for a few months, undetected by local health authorities. It was too late to collect samples for confirmation from these cases.

Immediately [after] it was notified, NCDC deployed a rapid response team to support Ebonyi state with contact tracing, case finding, risk communications, and the management of cases. Detailed analysis and plans are in advanced stages to apply to the international vaccine stockpile to enable a reactive vaccination campaign in Ebonyi state, in response to the cluster of cases.

Yellow fever virus is spread through bites of an infected mosquito. There is no human-to-human transmission of the virus. Yellow fever is a completely vaccine-preventable disease, and a single shot provides immunity for a lifetime. The yellow fever vaccine is available for free in primary health care centres in Nigeria as part of the routine immunisation schedule. Every child is protected for life if vaccinated. We encourage every family to ensure that children receive all their childhood vaccines.

In addition to the vaccine, the public is advised to keep their environments clean and free of stagnant water to discourage the breeding of mosquitoes and to use insecticide-treated mosquito nets as well as screens on windows and doors to prevent mosquito bites. It is important to avoid self-medication. Visit a health facility immediately if you feel ill.

Since September 2017, Nigeria has recorded suspected cases of yellow fever in all states in the country. As at [Wed 31 Jul 2019], 78 cases have been laboratory confirmed in Nigeria in 2019 alone. A multi-agency yellow fever technical working group coordinated by NCDC has been leading the investigation and response to yellow fever cases. The National Primary Health Care [Development] Agency is leading efforts to provide an additional opportunity of vaccination through preventive vaccination campaigns across the country.

Healthcare workers are reminded that the symptoms of yellow fever include yellowness of the eyes, sudden fever, headache, and body pain. If you have these symptoms or notice someone in your community displaying them, please contact your nearest health centre.
=====================
[The yellow fever [YF] virus is endemic in Nigeria, and cases occur there sporadically. This has been an active year (2019) for YF in Nigeria. The previous ProMED-mail post indicated that 930 suspected cases have been reported this year from 1 Jan-30 Apr 2019. There are 332 suspected cases during the April 2019 reporting period, up from 254 suspected cases on 19 Feb 2019. There are 3 new presumptive and 3 new confirmed yellow fever cases during the April 2019 reporting period.

The current focus of transmission is in Ebonyi state. The above report indicates that YF vaccine is available without cost in primary healthcare centers but does not mention if an organized vaccination campaign is underway or being planned, nor the proportion of the Ebonyi state population that is unvaccinated and, hence, at risk for YF. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Ebonyi state, Nigeria: <http://healthmap.org/promed/p/1306>]
Source: Arutz Sheva 7 [edited]
Date: Tue 13 Aug 2019

A stewardess of Israel's El Al airline died Tuesday [13 Aug 2019], following a months-long battle with measles. The 43-year-old stewardess was infected with the measles virus during a flight from New York to Israel 5 months ago.

After she was infected, the stewardess was hospitalized in serious condition at Meir Medical Center in Kfar Saba in central Israel after she was found unconscious and struggling to breathe. During her hospitalization, the stewardess' condition deteriorated, and she was transferred to the quarantine section of the hospital's intensive care wing.

On Tuesday [13 Aug 2019], doctors at Meir hospital declared her death, following the 5-month struggle.  [Byline: Orly Harari]
===========================
[This is a very sad outcome, and our condolences go out to the family of the flight attendant, who worked for El Al, the Israeli national airline. It is not clear whether she contracted the virus in New York, in Israel, or on a flight between the two locations. The flight attendant received only one dose of the measles vaccine when she was a child. It wasn't discovered until later that one dose is only about 93% effective. More recently -- in the USA, starting in 1989 -- children have been given 2 doses, which is about 97% effective, according to the CDC. See Measles update (27) http://promedmail.org/post/20190418.6429834 for an earlier report on the flight attendant. - ProMED Mod.LK]