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Malta

Malta US Consular Information Sheet
November 26, 2008

COUNTRY DESCRIPTION:
Malta is a small, developed, democratic Mediterranean island nation, positioned as a cultural stepping-stone between Europe and North Africa.
Malta became
a member of the European Union with nine other new member states on May 1, 2004, and became a full member of the Schengen area in March 2008.
Tourist facilities of all categories are widely available.
Read the Department of State Background Notes on Malta for additional information.

ENTRY/EXIT REQUIREMENTS:
Malta is a party to the Schengen agreement.
As such, U.S. citizens may enter Malta for up to 90 days for tourist or business purposes without a visa.
The passport should be valid for at least three months beyond the period of stay.
For further details about travel into and within Schengen countries, please see our fact sheet.
For further information concerning entry requirements for Malta, travelers should contact the Embassy of Malta at 2017 Connecticut Avenue, NW, Washington DC
20008, tel.: (202) 462-3611, web site: http://www.foreign.gov.mt/default.aspx?MLEV=47&MDIS=505, or the Maltese Consulate in New York City, tel.: (212) 725-2345.

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:
Malta remains largely free of terrorist incidents. No indigenous terrorist or extremist groups are known to be active in Malta, and no foreign terrorist organization has carried out an attack against U.S. interests in Malta in recent years.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s web site at http://travel.state.gov where the current Travel Warnings and Travel Alerts, including the Worldwide Caution, can be found

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.

CRIME:
Malta has a low rate of violent crime.
Theft of unattended personal property and car stereos from vehicles is a common problem.
Visitors are strongly encouraged to secure their valuables, and be aware of pickpockets and purse snatchers.
Such criminals focus on areas and establishments frequented by tourists.
Caution is particularly urged in the Paceville nightclub area, where excessive drinking and poor crowd control have led to instances of violent behavior.
Poverty, homelessness, and panhandling are almost non-existent in Malta.
All visitors to Malta should practice the same good, common sense personal security precautions that are part of everyday life in urban areas within the U.S., particularly when spending time in areas frequented by tourists.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. The crime victim’s assistance agency is ‘APPOGG’- Support Line, tel: 179;
web site: www.appogg.gov.mt.
To learn about resources in the U.S. if you are the victim of a violent crime overseas, please also see our information on Victims of Crime.

The local equivalents to the “911” emergency line in Malta are: Police 191; Ambulance 196; Fire 199.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is available through public and private hospitals.
The quality of medical care in Malta is excellent.
Private hospitals generally offer a higher standard of service than the public hospitals, and the majority of the best doctors practice in private medical facilities.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Malta.
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 Malta is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Traffic in Malta flows on the left, requiring attentiveness and caution from visitors from right-hand drive countries such as the United States.
In addition, drivers may be erratic or undisciplined. Roads flood easily, and are often narrow, winding, and congested, with poor visibility around curves.
Traffic arteries are prone to bottlenecks and accidents.
Buses are the primary means of public transportation.
Though the bus fleet is being modernized, most buses are old, cramped, and not air-conditioned.
Taxis are safe but expensive and are not metered; it is a good practice to agree with the driver in advance on the charge.

Please refer to our Road Safety page for more information.
There is a Malta Tourist Information Office located at Freedom Square Valletta, tel. 21-237-747, web site: http://www.visitmalta.com/getting-around
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Malta’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Malta’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa
SPECIAL CIRCUMSTANCES:
Malta customs authorities may enforce strict regulations concerning currency restrictions and temporary importation into or export from Malta of items such as firearms, antiquities, and any item that might be deemed to have resalable value.
It is advisable to contact the Embassy of Malta in Washington or the Consulate of Malta in New York City for specific information regarding customs requirements.
Malta’s customs authorities encourage the use of an ATA (Admission Temporaire/Temporary Admission) Carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes.
ATA Carnet Headquarters located at U.S. Council for International Business, 1212 Avenue of the Americas, New York, N.Y. 10036, issues and guarantees the ATA Carnet in the United States.
For additional information call (212) 354-4480, send an e-mail to atacarnet@uscib.org or visit http://uscib.org for details.

For more information, please see our Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Malta’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Malta are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime prosecutable in the United States. Please see our information on Criminal Penalties.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Malta 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 Malta.
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 is on the third floor of the Development House, St. Anne Street, Floriana, Valletta, telephone (356) 2561-4000.
The Consular Section’s telephone number is (356) 2156-4115, fax: (356) 2124-3229, web site: http://malta.usembassy.gov/uscit_intro.html.
The Consular Section is open to the public Monday, Wednesday, and Friday from 8:00 a.m. to 11:00 a.m.
* * *
This replaces the Country Specific Information for Malta dated April 29, 2008, to update sections on Safety and Security and Exit and Entry Requirements.

Travel News Headlines WORLD NEWS

Date: Sun 29 Jul 2018 17:28 CEST
Source: Times of Malta [summ., edited]

The number of salmonellosis cases reported to the health authorities so far in July 2018 has surpassed that in previous years, peaking at 20 cases in July alone.

Figures supplied to The Sunday Times of Malta by the health authorities showed that so far this month [July 2018], 20 cases of the food poisoning infection have been reported, up from 11 in 2017. Since the beginning of 2018, 67 cases have been brought to the authorities' attention.

Salmonellosis is a type of foodborne illness caused by bacteria and is often more common in summer. The infection is contracted when food contaminated with the bacteria is consumed, with young children, older adults, and those with impaired immune systems being more susceptible to severe infection. Symptoms include diarrhoea, fever, and abdominal cramps and usually develop 12 to 72 hours after the infection is contracted. It usually lasts 4 to 7 days.

Just this week, the health authorities confirmed _Salmonella_ had been found in eggs from St Joseph Farm [Southern region] during sampling by the veterinary authorities as part of the Veterinary National Control programme for _Salmonella_. Eggs packed by this farm have since been recalled, with the public being advised not to consume them. The Superintendent of Public Health warned that food that has been listed as recalled should not be consumed, while the general handling of eggs should also be done with caution.

Eggs, she said, should always be cooked until both the yolk and the white are firm, while egg dishes should be cooked to an internal temperature of 71 deg C [160 deg F] or hotter. The eggs used in sauces or any other items that contain raw or lightly-cooked eggs should be pasteurized, Dr Gauci said. Hands, and any implements that come in direct contact with raw eggs, should always be thoroughly washed.  [Byline: Claire Caruana]
============================
[While undercooked eggs are a common source for human salmonellosis, it is not unclear if the finding of contaminated eggs on Malta is related to the upswing of human cases. No information is given regarding the human and egg isolates to assess if they are related. - ProMED Mod. LL]

[HealthMap/ProMED-mail map of Il-Hamrun, Malta:
Date: Mon 13 Mar 2018
From: Christian Lenart <christian@lenart.at> [edited]

We report a case of _Leishmania donovani_/_L. infantum_ in a 56-year-old man from Austria. He travelled to Malta in June 2017 and complained about itchy, partly exulcerated papules in November 2017. His wife too was suffering from the same lesions but did not consult a dermatologist, since the lesions regressed spontaneously.

The patient first contacted a dermatologist, who performed an excision showing _Leishmania_ negative granulomatous inflammation as a histological result. He was then referred to the dermatological ward of the municipal hospital. The lesions were up to 2 cm [0.8 in] in size, disseminated on all extremities.

Another excision was performed, showing plenty of amastigotes affected macrophages. He then was checked for signs of visceral manifestation, but showed no hepatosplenomegaly. The blood sample showed no conspicuity with normal haematological results and normal CRP [C-reactive protein]. The PCR test for _Leishmania_ sp. DNA was positive.

The Western blot (IgG) was positive as well, whilst immunoaffinity chromatography was negative. Skin biopsy genotyping proved a diagnosis of _Leishmania infantum_/_L.donovani_. Since the patient had multiple lesions treatment with miltefosine was initiated.

Leishmania in Malta
-----------------------------------------
While especially leishmaniasis was quite common in the early 20th century in Malta, there were hardly any cases of cutaneous leishmaniasis at the end of the century. For the last years the incidence has been stable with about 3 to 4 cases of visceral leishmaniasis, VL, per year (1).  In 2012, 3 VL and no CL cases were reported (2). All cases of leishmaniasis are caused by _L. infantum_ in Malta, transmitted from dogs to humans by _Phlebotomus perniciosus_. The 2 identified zymodemes in Malta are MON 1, causing visceral and MON 78, causing cutaneous leishmaniasis (3).

References
---------------------------------------
1. Alvar J, Vélez ID, Bern C, et al and the WHO Leishmaniasis Control Team. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012; 7(5): e35671. doi: 10.1371/journal.pone.0035671; available at <http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035671>.
2. Government of Malta, Ministry for Health, the Elderly and Community Care: Annual report 2012; p. 46; available at <https://www.gov.mt/en/Government/Publications/Documents/Annual%20Reports/MHEC.pdf>.
3. Pace D, Williams TN, Grochowska A, et al. Manifestations of paediatric _Leishmania infantum_ infections in Malta. Travel Med Infect Dis. 2011; 9(1):37-46. doi: 10.1016/j.tmaid.2010.11.005; available at <http://www.travelmedicinejournal.com/article/S1477-8939(10)00196-1/fulltext>.
--------------------------------------
Dr Christian Lenart
Department of Emergency Medicine
Krankenhaus Hietzing (Municipal Hospital Vienna-Hietzing)
Austria
christian@lenart.at
===============================
[Leishmaniasis is endemic in Malta and cases imported from Malta to other countries are not unusual. _Leishmania infantum_ usually results in visceral leishmaniasis and the genotyping in this case could not distinguish between _L. donovani_/_L. infantum_. Miltefosine is the drug of choice for cutaneous leishmaniasis. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps: Austria: <http://healthmap.org/promed/p/63886> Malta: <http://healthmap.org/promed/p/77>]
Date: Tue, 20 Feb 2018 18:18:07 +0100

Valletta, Feb 20, 2018 (AFP) - Malta International Airport was brought to a standstill on Tuesday by a fire that left flights suspended and hundreds of passengers stranded.   Passengers were evacuated from the airport as smoke billowed through the arrivals and departure lounges, an AFP reporter at the scene said.   Firefighters worked for two hours to put out the small blaze, which began at around 1:15 pm and caused no injuries.

Airport operators said 10 outbound international flights were delayed. They added later in an online statement that operations at the terminal were resuming.   The airport said the blaze broke out in the pump room for the airport's small aquarium, located in the arrivals concourse.   "Terminal operations are now resuming, and Malta International Airport's recovery plan has been activated," it said in a statement in the late afternoon.

Hundreds of passengers were left standing outside the airport and some even on the apron.   One flight to nearby Catania in Sicily was expected to take off 11 hours later than scheduled, according to the departures timetable.   Flights to Stockholm, Cyprus, Krakow, London Gatwick and Dublin were also delayed.   Flights from British airports Heathrow and Gatwick were diverted to Catania.
Date: Fri 24 Feb 2017
Source: Times of Malta [edited]

The meningitis B vaccine shortage [is] likely to persist. Malta will have to wait its turn, manufacturers say. Global demand for the vaccine outstrips supply, manufacturers say.

A one-year-old baby died of [meningococcal] meningitis [serogroup] B, a disease against which vaccines are currently unavailable, this newspaper is informed. Sources said the baby died last month [January 2017] after contracting the disease that affects the lining around the brain and spinal cord. The Central Procurement and Supplies Unit (CPSU) was informed that the local agent for the meningitis B vaccine had a stock of vaccines available in a number of local pharmacies, a Health Ministry spokeswoman said.

The representatives of international pharmaceutical company GlaxoSmithKline (GSK) in Malta were in liaison with their suppliers to hasten further delivery, and the CPSU was in liaison with both companies to monitor the situation, the spokeswoman added.

The ministry was also asked about the baby's death, but no reference was made to it in its reply late yesterday [23 Feb 2017] evening.

The government does not supply the vaccine against the specific strain that affected the infant, which can, however, be purchased from private hospitals and pharmacies. Paediatricians said private hospitals had purchased the vaccine from pharmacies abroad, but these too had since run out.

According to one paediatrician, the unavailability of such a vaccine in light of the baby's death was very worrying, particularly to parents. Another paediatrician, however, warned against the matter getting out of hand, saying the issue was not as worrying as parents were making it out to be. Babies who were not vaccinated were not in any immediate danger, he said.

A spokeswoman for the local representative of GSK confirmed that the vaccine was not available and it would not be for some time. She said no fixed date had yet been given as to when a supply would be made available to the local market. According to the spokeswoman, the vaccine was in high demand all over the world, and as GSK [GlaxoSmithKline] had agreements with a number of governments abroad, supplies would be shipped to these countries 1st. At present, demand exceeded the quantity manufactured.

"It's important to understand that, in these cases, we need to stock enough for boosters, so before sufficient doses are available, this will not be made available," the GSK spokeswoman said.

According to the Maltese Paediatric Association, about 10 cases of meningitis have been reported among children. The signs of meningitis are fever, severe headache, neck stiffness, vomiting, dislike of bright light and drowsiness. Infants and younger children may not always show such symptoms but, instead, feed poorly or become very lethargic.  [Byline: Claire Caruana]
===================
[Although there are at least 13 _ Neisseria meningitidis_ serogroups, based on the antigenic specificity of their capsular polysaccharides, disease due to serogroups A, B, C, Y, and W is most common. Meningococcal vaccines contain capsular polysaccharide for _Neisseria meningitidis_ serogroups A, C, Y, and W, either alone or conjugated to protein. The conjugate capsular polysaccharide vaccines are preferable, because, unlike the polysaccharide vaccines, conjugate vaccines immunize infants, reduce the carriage of meningococci in the throat and thus its transmission, as well as confer a more sustained immune response, and, therefore, longer-term protection than the polysaccharide vaccines.

Serogroup B vaccines are based upon meningococcal B outer membrane vesicle protein antigens, because group B polysaccharide is poorly immunogenic in humans and is a potential auto-antigen. At least 2 serogroup B meningococcal vaccines -- Bexsero (GlaxoSmithKline, GSK) and Trumenba (Pfizer) -- are available.

Meningococcal disease often occurs without warning and frequently progresses rapidly to death, even when it is treated appropriately. In addition, about 10-20 percent of survivors of meningococcal disease will suffer disabilities such as hearing loss, brain damage, and amputations. Vaccines are used to prevent meningococcal disease, not treat someone already ill from the disease. Immunity following use of a meningococcal vaccine is specific for the type of capsular polysaccharide the vaccine contains regarding the A, C, Y, and W polysaccharide or conjugate vaccines or the surface proteins regarding serogroup B vaccines, with no cross-protection against infection due to other meningococcal groups.

Vaccines are frequently used to prevent spread of meningococcal disease in the face of an institutional or community outbreak (<https://www.cdc.gov/meningococcal/downloads/interim-guidance.pdf>). Antibiotics are also used to prevent spread of meningococcal disease in persons who are at high risk because they have been in close contact (coughing or kissing) or lengthy contact, especially among people living in the same household.

According to the 2017 Malta National Immunization Schedule, meningococcal vaccines are not included in the series of vaccines for infants and children (<https://health.gov.mt/en/phc/pchyhi/Pages/National-Immunisation-Schedule.aspx>). In the U.S., vaccination against meningococcal disease due to serogroups A, C, Y, and W is only recommended for children aged 2 months through 10 years who are at increased risk for meningococcal disease, i.e., have complement component deficiencies, have functional or anatomic asplenia (including sickle cell disease), are in the risk group for an outbreak for which vaccination is recommended, or are traveling to or residing in regions where meningitis is epidemic or hyper-endemic (for specifics, see Table at <https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6324a2.htm#Tab>). The serogroup B vaccines Bexsero and Trumenba have been licensed by the U.S. Food and Drug Administration (FDA) only for individuals aged 10 through 25 years. However, the European Medicines Agency has approved Bexsero for use in individuals of 2 months of age and older, and Bexsero has been added to the routine childhood immunization schedule in the UK and Ireland (<http://www.meningitis.org/menb-vaccine>).

Malta, a member of the EU, is a southern European island country consisting of an archipelago in the Mediterranean Sea, 80 km (50 miles) south of Italy, with a population of just under 450,000 residents (<https://en.wikipedia.org/wiki/Malta>). - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu, 22 Jan 2015 17:59:17 +0100 (MET)

Valletta, Jan 22, 2015 (AFP) - Nearly 90 migrants rescued at sea by the Maltese navy were on Thursday being held in quarantine as a precaution against Ebola, after 20 others reportedly died during the journey and were thrown overboard.   Charles Mallia Azzopardi, who heads the national Ebola Response Unit, told a press briefing that the 87 migrants were being held in isolation "as a precaution" after one of the passengers said he was from Guinea.   Rescuers donned special protective gear and an isolation tent was set up after three of the survivors were discovered in need of urgent medical assistance, although Azzopardi said they were most likely to be suffering from severe dehydration.

The three were hospitalised immediately, but police later said one of them had died, and an autopsy would be carried out in the next few days.   The surviving migrants, who hail from Burkina Faso, Guinea, Ivory Coast and Mali, are being tested for the virus and will be held in a detention centre in isolation for 21 days.   They told rescuers around 20 others had died during the crossing from North Africa and their bodies had been tipped into the sea.   "@Armed_Forces_MT rescuing 80 immigrants on a distressed dinghy off #Malta coast. Another 20 reported dead and thrown at sea during crossing," Maltese Prime Minister Joseph Muscat said on Twitter.    The deadly Ebola epidemic has killed 8,626 people according to the World Health Organisation, but is now slowing throughout west Africa.
More ...

World Travel News Headlines

Date: Thu, 15 Nov 2018 04:25:14 +0100
By Javier TOVAR

Paradise, United States, Nov 15, 2018 (AFP) - The toll in the deadliest wildfires in recent California history climbed to 59 on Wednesday as authorities released a list of 130 people still missing.   Most of those unaccounted for are from the Butte County town of Paradise, in northern California, which was virtually erased from the map by the so-called "Camp Fire" blaze that erupted last week.   Butte County Sheriff Kory Honea told journalists Wednesday evening that 461 search and rescue personnel and 22 cadaver dogs were involved in the effort to locate those missing and DNA testing was being expedited to identify the victims.

"Beginning Thursday, anyone who believes a family member perished can provide a DNA sample" to the sheriff's office, Honea said.    Paradise, a town of around 26,000 in the foothills of the Sierra Nevada mountains, was popular with retirees and many of those reported missing by the sheriff's office are elderly -- in their 70s, 80s and 90s.

Virtually every home in Paradise, located 80 miles (130 kilometers) north of the state capital Sacramento, was destroyed by the fast-moving fire fueled by high winds.   At least 59 deaths have been reported so far from the devastating wildfires and body recovery teams were going house-to-house with cadaver dogs in Paradise on Wednesday.   "We are in the midst of a catastrophe," Governor Jerry Brown told a press conference. "The fire was unprecedented, overwhelming, so a lot of people got caught."

Brock Long, head of the Federal Emergency Management Agency (FEMA), said Paradise was looking at a "total rebuild" with many homes, businesses and infrastructure destroyed.   "This is going to be a very long and frustrating event for the citizens of Paradise," Long said. "We're going to have to find a new normal."   "You're not going to be able to rebuild Paradise the way it was."   An AFP reporter in Paradise on Wednesday saw crews removing trees, repairing fences along roads and towing away cars.    Authorities said livestock owners were being allowed in to restricted areas for brief periods to feed the animals but it was unclear when residents would be allowed back in.

- Tales of courage, survival -
Fifty-six deaths have been reported from the "Camp Fire," mostly in Paradise, while three people have died in the "Woolsey Fire."   Honea said that of the 56 human remains found in his county, 47 had been identified.   While the cause of the "Camp Fire" is still under investigation, a lawsuit has been filed against the local power company, PG&E, by fire victims claiming negligence by the utility.

The complaint alleged that the fire began on November 8 when a high voltage transmission line failed, igniting a vegetation fire.   As thousands of firefighters fought the fires, incredible tales have emerged of courage and survival.   A man who asked to be identified by only his first name, Scott, told the San Francisco Chronicle that when the "Camp Fire" surrounded his home in Concow in Butte County he and his family plunged into a reservoir along with a 90-year-old neighbor, Bruno.   "Bruno was saying, 'Just leave me. I can't do this,'" Scott, 51, told the newspaper. "I said, 'Bruno, we're not going to leave you. And I'm not going to burn, so you better hurry.'"   They remained in the cold water as flames licked the shore and made their way to a small island in the reservoir after finding a pair of rowboats.

- 'I was terrified' -
Allyn Pierce, a nurse in Paradise, told The New York Times and CNN how his life was saved by a bulldozer driver as he fled the town in his pickup truck along with other residents on Thursday.   Pierce said cars were catching fire around him and he dictated a goodbye message to his family, expecting his vehicle to catch fire next.   "I stayed calm but I was terrified," Pierce said.   "Then all of a sudden this bulldozer comes out of nowhere and knocks this burning truck out of the way," he said.   Instead of fleeing to safety, however, Pierce turned around and went back to the Adventist Health Feather River Hospital, where he works as an intensive care nurse, and helped evacuate patients to the hospital's helipad.   Pierce displayed pictures of his Toyota pickup truck which he said was still working despite lights which had melted and a rear passenger door which had been welded shut by the heat from the fire.

The "Camp Fire" has ravaged 135,000 acres (54,632 hectares) of land and is 35 percent contained, according to Cal Fire.   It has destroyed some 7,600 homes and 260 commercial properties. Battling the blaze are more than 5,600 fire personnel, some from as far away as Washington state and Texas.   The "Woolsey Fire" has razed 97,620 acres (39,505 hectares) and has been 47 percent contained.    Cal Fire said more than 3,500 fire personnel were battling the "Woolsey Fire," which has destroyed the Malibu homes of several celebrities including Miley Cyrus, Neil Young, Robin Thicke, Shannen Doherty and Gerard Butler.
Date: Wed, 14 Nov 2018 18:14:50 +0100

Kinshasa, Nov 14, 2018 (AFP) - A cholera epidemic in the Democratic Republic of Congo has claimed 857 lives since the start of the year, the World Health Organization (WHO) said Wednesday.   Health authorities have so far recorded 25,170 cases, occurring in 21 out of the country's 26 provinces, the WHO's office in the DRC said.

The provinces of East Kasai and Lomami, in the centre of the country, and South Kivu, Tanganyika and Upper Katanga in the east, are those most affected.   Last year, the country had 55,000 cases of cholera, resulting in 1,190 fatalities.   Cholera is a highly contagious bacterial infection, which can kill within hours if left untreated. It thrives in conditions of poor sanitation and contaminated water or food.    The DRC is also battling an outbreak of Ebola in two eastern provinces, North Kivu and Ituri, that has killed 212 people since August.
Date: Wed, 14 Nov 2018 18:00:49 +0100

Madrid, Nov 14, 2018 (AFP) - The Spanish government declared war on alternative medicine like acupuncture or homeopathy Wednesday, announcing it plans to eliminate from health centres what it considers a health risk.   The plan, unveiled by the science and health ministers, aims to avoid the "potential harmful effects" of these practices "when they are used as an alternative or a complement to treatment" which itself is based on "proof and scientific rigour," the government said in a statement.   It did not detail what it included as alternative medicine, but gave the examples of acupuncture and homeopathy.   "Many people still believe that some treatments work despite there being no scientific proof available," it read.   According to a 2016 poll, "59.8 percent believe that acupuncture is of therapeutic use and 52.7 percent think that homeopathic products work," the plan read.

The government said it wants to "eliminate" alternative medicine from health centres where all treatment must be given by "recognised" professionals.   The plan also wants to avoid alternative medicine being taught in Spanish universities by developing alliances with deans, chancellors or Spanish regional authorities to not give out diplomas linked to these practices.   Madrid also wants to modify legislation to fight "false advertising" with regard to alternative medicine online.   The issue has taken centre stage in Spain recently, with health and science professionals pressuring the health ministry to take action after several high-profile deaths.

One such case, as reported by Spain's Association to Protect Patients against Pseudo-scientific Therapies, involved 21-year-old Mario Rodriguez who died after dropping his hospital treatment for leukemia in favour of a supposed naturopath who said he could cure cancer with vitamins.   "Dad, I made a mistake," his father Julian Rodriguez quoted him as saying on his deathbed.   The association has a long list of treatment it considers alternative medicine, which includes aromatherapy, acupuncture -- in use in China for centuries -- and even psychoanalysis as created by Sigmund Freud.
Date: Mon 12 Nov 2018, 9.54 AM EST
Source: The Guardian [edited]

A Briton has died after contracting rabies while visiting Morocco, public health officials have said. The UK resident was infected with the disease after being bitten by a cat, Public Health England (PHE) said on [Mon 12 Nov 2018]. PHE did not release any further details but reassured the public there was no wider risk. It said health workers and close contacts of the deceased were being assessed and offered vaccination where necessary.

Jimmy Whitworth, the professor of international public health at the London School of Hygiene and Tropical Medicine, told the Press Association: "My understanding is that this is somebody who had contact with a cat that was behaving abnormally and sought care, I believe in Morocco and in the UK, but unfortunately didn't receive vaccination until it was too late. I believe that the cat bit this person a few weeks ago."

He said that symptoms typically took 2 to 3 months to appear but could materialise in as little as a week. "That's why seeking prompt care and getting vaccination is so important," he said. "In this tragic case the person didn't get the vaccine in time." Given the lack of information, Whitworth said it was impossible to know whether the delay was in the UK or Morocco but it illustrated the importance of health workers being aware of the possibility of the disease.

There are no documented instances of direct human to human transmission of rabies. The disease does not circulate in either wild or domestic animals in the UK, although some species of bats can carry a rabies-like virus.

[Rabies] is common elsewhere, including in parts of Asia and Africa. PHE said the case was a reminder to travellers to rabies-affected countries to avoid contact with dogs, cats and other animals wherever possible, and seek advice about the need for a rabies vaccine prior to travel.

Dr Mary Ramsay, the head of immunisations at PHE, said: "This is an important reminder of the precautions people should take when travelling to countries where rabies is present. If you are bitten, scratched or licked by an animal you must wash the wound or site of exposure with plenty of soap and water and seek medical advice without delay."

It is only the 6th case of human rabies in the UK since 2000, all but one caused by animal exposure overseas. The last was in 2012, when a woman in her 50s died in London after being bitten by a dog in South Asia. She was reportedly turned away twice by doctors at a hospital in Kent before she was finally diagnosed.  [byline: Haroon Siddique]
======================
[According to another media source, the victim, a 58 year old man from Aylesbury Bucks, was staying 30 miles away from the Moroccan capital Rabat, visiting family, when he was infected with the disease. He did receive treatment but allegedly was not given anti-rabies serum in time;  <https://www.dailymail.co.uk/news/article-6382379/PICTURED-British-father-two-died-rabies-UK.html>.

The following statistics on rabies in animals were submitted by
Morocco for 2016 (last available annual report):
Official vaccinations in dogs: 71 759
Rabies outbreaks: 76

species / cases / deaths / killed
dogs / 41 / 28 / 13
cats / 12 / 11 / 1
bovine / 71/ 62 / 9
equine / 44/ 38/ 6
ovine / 6 / 5 / 1

The numbers of human cases, as reported to the OIE for the years 2010-2015, were 19, 18, 19, 24, 20, and 19, respectively. The number of human cases during 2016 (the most recent available data) was 17.

The tourism industry is well developed in Morocco; in 2017, Morocco was Africa's top tourist destination, with 10.3 million tourist arrivals, most of them from Europe, predominantly France and Spain. In the past, cases of rabies in animals illegally introduced from Morocco with returning visitors were recorded in France

The event is being investigated. - ProMED Mod.AS]

[HealthMap/ProMED maps available at:
England, United Kingdom: <http://healthmap.org/promed/p/279>
Date: Tue 13 Nov 2018
Source: BC Centre for Disease Control [edited]

The BC [British Columbia] Centre for Disease Control (BCCDC) is alerting British Columbians to discard or return to the place of purchase any Little Qualicum Cheeseworks' Qualicum Spice cheese that they currently have at home. Products in the marketplace have a best before date up to and including 24 Apr 2019.

A total of 5 people in BC have been affected by an _Escherichia coli_ outbreak between August and October 2018. Qualicum Spice cheese samples were tested and found to be contaminated with _E. coli_. The investigation is ongoing to determine the source and extent of contamination.

Qualicum Spice is an unpasteurized cheese. It is distributed throughout BC and sold in grocery stores, farmers' markets, wineries, restaurants, and at the Little Qualicum Cheeseworks farmgate store. Little Qualicum Cheeseworks has voluntarily recalled the affected product. Little Qualicum Cheeseworks produces several other types of dairy products. No other products are being recalled at this time and consumers do not need to discard them.

People who become ill from _E. coli_ can have a wide range of symptoms. Some may have no symptoms and some may become seriously ill and be hospitalized. The following symptoms can appear within 1 to 10 days after infection:
- severe stomach cramps;
- diarrhea or bloody diarrhoea;
- vomiting;
- headache; and
- little or no fever

If you have eaten this product but have no symptoms, there is no need to do anything. If you become ill after consuming this cheese:
- practice good hand washing with warm water and soap to prevent the spread of illness;
- drink lots of clear fluids to stay hydrated;
- anyone who has bloody diarrhea or is concerned about their symptoms should see a health care provider or call HealthLinkBC at 811;
- antibiotics and anti-diarrhoea medications should not be used to treat this infection unless prescribed by your health care provider.
====================
[Although not specifically stated, the link to unpasteurized cheese and the description of the symptoms make it clear that the pathogen here is a member of the enterohemorrhagic _E coli_ pathotype.

Unpasteurized dairy products remain a potential risk for a variety of pathogens including enterohemorrhagic _E. coli_, either the prototypic serotype or one of the other serotypes. In analyzing the genetic and phenotypic profiles of non-O157 groups of EHEC [enterohemorrhagic _E. coli_], it has been found that they belong to their own lineages and have unique profiles of virulence traits different from the prototypic O157 strain (1). The serogroups appearing to be most prominent are O26, O111, O128, and O103 (2). As noted in the post, suspected cases of EHEC should not be treated with antimicrobials.

The following was extracted from Lutwick LI. Enterohemorrhagic _E. coli_ infections. In: Confronting emerging zoonoses: the One Health paradigm. Yamada A, Kahn LH, Kaplan B, Monath TP, Woodall J, Conti LA (editors). Tokyo, Japan: Springer, 2014, 77-112:

Risk factors for the subsequent development of HUS after EHEC include children less than 10 years of age, elevated white blood cell counts, persistent low platelet counts without reversal and the use of either antimicrobial agents or antimotility agents during the diarrhea stage before or after bloody diarrhea develops. Since fever is generally not part of the presentation but significant abdominal pain is, patients with diarrhea, significant abdominal pain and no fever should be considered to have EHEC infection, and antimicrobial or antimotility agents should be avoided. Additionally, certain strains -- for example, the so-called clade 8 and the chimeric organism _E. coli_ O104:H4 -- can be associated with a higher risk of HUS.

HUS itself is a thrombotic illness primarily caused by the effects of the EHEC produced Shiga toxin acting on the vascular endometrium of organs where the toxin's receptors are expressed, particularly the kidney and brain. The syndrome consists of the combination of prominent low platelet counts (thrombocytopenia), intravascular red blood cell destruction (hemolysis) and diminished kidney function that can require hemodialysis. Neurological involvement occurs mostly in those who develop renal failure and the central nervous system involvement portends much higher mortality. Indeed, most of the acute mortality relates to neurological disease. Most patients will recover, but some, perhaps 10 percent, remain with renal failure and require chronic hemodialysis.

References
----------
1. Schmidt H, Geitz C, Tarr PI, et al. Non-O157:H7 pathogenic Shiga-toxin producing _Escherichia coli_: phenotypic and genetic profiling of virulence traits and evidence for clonality. J Infect Dis. 1999; 179(1): 115-23; available at <https://academic.oup.com/jid/article/179/1/115/877122>.
2. Bettelheim KA. Role of non-O157 VTEC. Symp Ser Soc Appl Microbiol. 2000; (29): 38S-50S; abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/10880178>. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
British Columbia Province, Canada:
Date: Sun 4 Nov 2018
Source: Nigeria Center for Disease Control (NCDC) [edited]

Highlights
===========================
- In the reporting week 44 (29 Oct-4 Nov 2018) 5 new confirmed cases were reported from Edo (3), Ondo (1) and Ebonyi (1) state with 2 new deaths in Edo (1) and Ebonyi (1).
- From 1 Jan-4 Nov 2018, a total of 2950 suspected cases have been reported from 22 states. Of these, 553 were confirmed positive, 17 probable, 2380 negative (not a case).
- Since the onset of the 2018 outbreak, there have been 143 deaths in confirmed cases and 17 in probable cases. Case fatality rate (CFR) in confirmed cases is 25.9%.
- 22 states have recorded at least one confirmed case across 90 Local Government Areas (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo, Plateau, Lagos, Taraba, Delta, Osun, Rivers, FCT, Gombe, Ekiti, Kaduna, Abia, Adamawa and Enugu); 18 states have exited the active phase of the outbreak while 4; Edo, Ondo, Ebonyi and Delta states, remain active - figure 1 [see source URL above].
- In the reporting week 44 (29 Oct-4 Nov 2018), one new health care worker was affected; 42 health care workers have been affected since the onset of the outbreak in 7 states - Ebonyi (16), Edo (15), Ondo (6), Kogi (2), Nasarawa (1), Taraba (1) and Abia (1) with 10 deaths in Ebonyi (5), Kogi (1), Abia (1), Ondo (2) and Edo (1).
- 82% of all confirmed cases are from Edo (46%), Ondo (23%) and Ebonyi (13%) states.
- 10 patients are currently being managed at Irrua Specialist Teaching Hospital (ISTH) treatment Centre (4), Federal Medical Centre (FMC) Owo (4), and Federal Teaching Hospital Abakiliki (2).
- A total of 8587 contacts have been identified from 22 states. Of these 512 (6%) are currently being followed up, 7946 (92.5%) have completed 21 days follow up while 15 (0.2%) were lost to follow up. 114 (1.3%) symptomatic contacts have been identified, of which 36 (0.4%) have tested positive from 5 states (Edo - 20, Ondo - 8, Ebonyi - 3, Kogi - 3, Bauchi - 1 and Adamawa - 1).
- National RRT team (NCDC staff and NFELTP [Nigeria Field Epidemiology and Laboratory Training Program] residents) deployed Ondo state to support response.
- Lassa fever international Conference registration, abstract submission and travel scholarship now open to the public on the conference website <www.lic.ncdc.gov.ng> with the date for abstract submission extended to the 14 Nov 2018.
- Lassa fever national multi-partner, multi-agency Technical Working Group (TWG) continues to coordinate response activities at all levels

Figure 1 [map]: Distribution of confirmed Lassa fever cases in Nigeria as at 4 Nov 2018.
Figure 2 [map]: Distribution of suspected and confirmed Lassa fever cases in Nigeria by LGA.
Figure 3 [graph]: Epicurve of Lassa fever confirmed (548) and probable (17) cases in Nigeria week 1-44, 2018.
Figure 4 [graph]: Weekly trends of Lassa fever confirmed cases in Nigeria, 2016-2018, week 44.
Figure 5 [graph]: Confirmed Lassa fever cases in Nigeria with state-specific case fatality rates (CFR) as at 4 Oct 2018.
=======================
[Although the graphs in the above report clearly show that the Lassa fever virus transmission peak has passed, the 5 new confirmed cases and 2 new deaths indicate that Lassa fever virus transmission continues, and a few more cases might occur. Unfortunately, one health care worker was infected during this reporting period. This outbreak has been widespread, occurring in 22 states and 90 local government areas. It would be interesting to know whether the prevalence of Lassa fever virus has been increasing in populations of rodent hosts in this area.

Images of the rodent reservoirs of Lassa fever virus can be seen as follows:
For _Mastomys natalensis_, see
For _M. erythroleucus_ and _Hylomycus pamfi_, see

The maps and graphs in the report above are interesting and provide a good picture of how the outbreak has progressed over time. They can be accessed at the source URL above.

Maps of Nigeria:
Date: Mon 12 Nov 2018
Source: OIE, WAHIS (World Animal Health Information System), weekly
disease information 2018; 31(46) [edited]

Anthrax, Namibia
----------------
Information received on [and dated] 12 Nov 2018 from Dr Adrianatus Florentius Maseke, chief veterinary officer, Veterinary Services, Ministry of Agriculture, Water and Forestry, Windhoek, Namibia

Summary
Report type: immediate notification
Date of start of the event: 25 Oct 2018
Date of confirmation of the event: 1 Nov 2018
Reason for notification: recurrence of a listed disease
Date of previous occurrence: 13 Feb 2018
Manifestation of disease: clinical disease
Causal agent: _Bacillus anthracis_
Nature of diagnosis: clinical, laboratory (basic)
This event pertains to a defined zone within the country

New outbreaks (3)
Outbreak 1: Omiriu, Opuwo, Sesfontein, Kunene
Date of start of the outbreak: 25 Oct 2018
Outbreak status: continuing (or date resolved not provided)
Epidemiological unit: village
Affected animals
Species / Susceptible / Cases / Deaths / Killed and disposed of / Slaughtered
Goats / 537 / 25 / 23 / 2 / -
===================
[The location of the outbreaks can be seen on the interactive map included in the OIE report at the source URL above. Kunene is in north west Namibia, and Kavango East is between Angola & Botswana in the north east.
========================
[Remember it is summer in the southern hemisphere, which means that it is now their anthrax season. Livestock anthrax is sporadic in Namibia but a constant concern in their national parks. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map of Namibia:
Date: Tue, 13 Nov 2018 20:01:56 +0100

Tampa, Nov 13, 2018 (AFP) - Puzzled by a rise in US children with sudden paralysis in their arms or legs, health officials said Tuesday they are probing whether a virus or auto-immune disorder may be to blame.   A total of 252 cases of the disorder known as acute flaccid myelitis (AFM) are currently under investigation nationwide, an increase of 33 since last week, said Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the US Centers for Disease Control and Prevention (CDC).

With 80 confirmed cases so far this year, 2018 looks to be on pace with prior peak years like 2014 (120 cases) and 2016 (149 cases), Messonnier said.    More than 400 cases have been confirmed through lab tests since 2014, the first year the syndrome emerged.   A couple dozen cases were confirmed in 2015 and 2017.   Messonnier said she understands parents' alarm but stressed that the disorder remains "rare."   Most cases involve children aged two to eight. Almost all complained of fever and respiratory illness three to 10 days before suddenly experiencing paralysis in their arms or legs.   For some, the paralysis went away, but at least half have not recovered, said Messonnier.

The CDC has tested 125 spinal cord fluid samples, and half were positive for rhinovirus or enterovirus, which commonly cause symptoms like fever, runny nose, vomiting, diarrhea and body aches.    Yet scientists are still stumped about the precise cause of the sudden paralysis, since these viruses are common but AFM is not.   "We are trying to figure out what the triggers are that would cause someone to develop AFM," Messonnier told reporters.   "It may be one of the viruses we have already detected. It may be a virus that we haven't yet detected. Or it could be that the virus is kicking off another process that is actually triggering -- through an auto immune process -- AFM," she said.    "CDC is a science-driven agency. Right now, the science doesn't give us an answer."

Perhaps most frustrating for parents, there is no way to prevent it, and no targeted therapies or interventions.   "Parents and caregivers are urged to seek immediate medical care for a child who develops sudden weakness of the arms or legs," said the CDC latest report on AFM, released Tuesday.    Messonnier said the CDC has not been tracking every case of AFM since 2014, leading to gaps in the federal agency's knowledge of the illness, which experts are now trying to fill.   One child with AFM is reported to have died in 2017.
Date: Mon, 12 Nov 2018 15:54:12 +0100

London, United Kingdom, Nov 12, 2018 (AFP) - A Briton has died after being bitten by a cat with rabies in Morocco, officials said Monday, only the seventh known case in the United Kingdom since 2000.   England's health service issued a reminder Monday for travellers to avoid coming into contact with animals when travelling to rabies affected countries, particularly those in Asia and Africa.

Rabies has been effectively eradicated in Britain, although they do still spread among some bats.   "There is no risk to the wider public in relation to this case but, as a precautionary measure, health workers and close contacts are being assessed and offered vaccination when necessary," said Mary Ramsay, the health service's chief of immunisation.   The Press Association news agency said the person was bitten a few weeks ago and not given potentially life-saving treatment early enough.

Rabies is a viral disease that causes an inflammation of the brain. It is usually fatal by the time the first symptoms emerge.   England's health service said that no cases of humans acquiring the disease from any animal other than a bat have been recorded within the country since 1902.   One person acquired it from a bat in Scotland in 2002, and five people contacted while travelling between 2002 and 2017, the health service said.
Date: Tue, 13 Nov 2018 07:02:37 +0100

Hanoi, Nov 13, 2018 (AFP) - Vietnam's newest carrier Bamboo Airways has been granted a licence to fly, officials and the airline said, paving the way for its inaugural flight in a region crowded with competitors.    Run by one of the country's richest men, Bamboo will compete with well-established heavy hitters such as national carrier Vietnam Airlines and budget carrier Vietjet to serve a mushrooming middle class with growing appetites, and budgets, for travel.    Vietnam's Transport Ministry said Bamboo's official aviation license had been approved and that it would aim to operate 100 routes, including to lesser-travelled destinations in Vietnam and elsewhere in Asia, with plans to eventually fly to North America.   "The first domestic flights... are aimed at reducing pressure on aviation infrastructure in major cities, strengthening regional links (and) promoting tourism to Vietnam," the Transport Ministry said in a statement Tuesday.

The airline is owned by Trinh Van Quyet, who heads the FLC property empire that includes lush beachside resorts, golf clubs and luxury condos across Vietnam, a country still under one-party communist rule.   Bamboo has already signed up to buy 20 of Boeing's 787 Dreamliners worth $5.6 billion and committed a further $3.2 billion to buy 24 Airbus A321neo planes.    The airline said its inaugural flight, originally scheduled for last month, should take place before the end of the year.    "We have conducted a flight test, the results show that the aircraft fully meets technical specifications (and is) ready to go into operation," CEO Dang Tat Thang said in a statement.

Bamboo is hoping to steal customers from competitors by luring them to off-the-beaten-path destinations in Vietnam such as Quy Nhon and Thanh Hoa and by offering bundled travel packages to FLC resorts.   But analysts say the outdated model may not work in an era where most travellers can easily tailor holidays online, and wonder whether Bamboo's big bet will pay off in Southeast Asia's busy aviation market.    Quyet told AFP in an interview earlier this year that he is certain the airline "will be huge" and expects to make a profit soon after launch.   Born to a poor rural family near Hanoi where life among bamboo trees inspired the airline's name, he now runs FLC Group with a market capitalisation of around $200 million.

Vietnam's aviation sector has soared in recent years, with passenger numbers jumping to 62 million last year from 25 million in 2012.   There are already six commercial aviation licenses granted in Vietnam, including for a chartered helicopter service and a seaplane carrier.   Faced with increasingly squeezed airport capacity and tough competition across the region, in particular from budget airlines like AirAsia and TigerAir, the market has shown signs of cooling.    In 2009, Vietnam's first operational private airline Indochina Airlines ceased operation after just one year in the market due to financial troubles.