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Virgin Islands

British Virgin Islands US Consular Information Sheet
April 03, 2006
COUNTRY DESCRIPTION: The British Virgin Islands (BVI) are a British overseas territory, part of the British West Indies, lying about 60 miles east of Puerto Rico. There are abo
t 50 islands in the BVI, many of them uninhabited. Tortola is the main island; other islands include Virgin Gorda, Jost Van Dyke, and Anegada. Tourist facilities are widely available.
ENTRY/EXIT REQUIREMENTS: For tourist stays of up to six months, U.S. citizens need a valid U.S. passport or other proof of U.S. citizenship (original or certified birth certificate, Certificate of Naturalization or Certificate of Citizenship as well as photo identification), onward or return tickets, and sufficient funds for their stay. Upon initial entry, no more than 60 days will be granted. At the end of 60 days, visitors must report to the Immigration Department's main office in Road Town for an extension. Extensions of up to 90 days are issued at the discretion of the Immigration Officer subsequent to an interview. For further information on travel to the British Virgin Islands, travelers should contact the BVI Department of Immigration at 1-284-494-3471. Visit the Embassy of the British Government web site at for the most current visa information.
See Entry and Exit Requirements for more information pertaining to dual nationality and the international child abduction . Please refer to our Customs Information to learn more about customs regulations.

SAFETY AND SECURITY For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site, where the current Travel Warnings and Public Announcements , including the Worldwide Caution Public Announcement , 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., 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 pamphlet A Safe Trip Abroad .
CRIME: Thefts and armed robberies do occur in the BVI. Visitors should take common-sense precautions against petty crime. Avoid carrying large amounts of cash and use hotel safety deposit facilities to safeguard valuables and travel documents. Do not leave valuables unattended on the beach or in cars. Always lock up boats when going ashore.
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.
See our information on Victims of Crime .
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in the British Virgin Islands consists of a small general hospital with an emergency room staffed 24-hrs/day by physicians, several clinics on Tortola, and one clinic in Virgin Gorda. Ambulances staffed with paramedics serve both islands. There are no medical facilities on the other islands. A volunteer organization, Virgin Islands Search and Rescue (VISAR), responds 24-hrs/day to medical emergencies at sea or on outer islands. VISAR transports casualties to the nearest point for transfer to ambulance. To reach VISAR, dial SOS (767) or call on Marine Channel 16.
There is no hyperbaric chamber in the BVI. Patients requiring treatment for decompression illness are transferred to St. John, U.S. Virgin Islands. Most sensitive medical cases are transferred to San Juan, Puerto Rico.
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 internet site at . For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at . Further health information for travelers is available at .
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 the British Virgin Islands is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Vehicles drive on the left (the British side) with most steering wheels on the left (the "American" side). Road signs are limited and seatbelts are required by law. Drivers often fail to yield the right-of-way to pedestrians, even at painted crosswalks. Speeding and reckless driving are fairly common in the BVI. Drivers can encounter nighttime drag racing on main thoroughfares and livestock on roads. Roads in Tortola's interior can be steep and extremely slippery when wet. Travelers planning to drive across the island should consider requesting four-wheel drive vehicles and should ensure that tires and brakes are in good operating condition on any rental vehicle. Please refer to our Road Safety page for more information, as well as the website of the BVI's national tourist office and national authority responsible for road safety at
.
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the British Virgin Islands as being in compliance with ICAO international aviation safety standards for oversight of BVI's air carrier operations. For more information, travelers may visit the FAA's Internet web site at .
CUSTOMS REGULATIONS: BVI customs authorities may enforce strict regulations concerning temporary importation into or export from the British Virgin Islands of items such as drugs and firearms. Visitors to BVI carrying firearms must declare them upon entry into any port in the territory. Firearms must be bonded and are held by the proper authorities until time of departure. Contact BVI Customs & Immigration at 1-284-494-3475, the Embassy of the United Kingdom in Washington, D.C. or one of the UK's consulates in the United States for specific information regarding customs requirements. Please see our information on 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 British Virgin Island laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the BVI are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties .
DISASTER PREPAREDNESS: All Caribbean countries can be affected by hurricanes. The hurricane season normally runs from June to the end of November, but there have been hurricanes in December in recent years. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA).
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website.
REGISTRATION/EMBASSY AND CONSULATE LOCATIONS: Americans living or traveling in the British Virgin Islands are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website , and to obtain updated information on travel and security within the BVI. 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 nearest U.S. Embassy to the BVI is located in Bridgetown, Barbados. The Consular Section is located in the American Life Insurance Company (ALICO) Building, Cheapside, telephone 1-246-431-0225 or fax 1-246-431-0179, email ConsularBridge2@state.gov , or . The U.S. Consular Agent in Antigua, located at Jasmine court, St. John's, tel. 1-268-463-6531, is closer to the BVI and can also assist in some limited non-emergency cases, by previous appointment only.
****
This replaces the British Virgin Islands Consular Information Sheet dated April 26, 2005 to update all sections.

Travel News Headlines WORLD NEWS

Date: Fri 31 Jan 2014
Source NBC News [edited]

The Explorer of the Seas outbreak was caused by norovirus, one of the worst outbreaks in 20 years, the Centers for Disease Control and Prevention (CDC) said. The Explorer of the Seas cruise ship returned to port after hundreds of passengers became ill. Federal health officials confirmed on Friday [31 Jan 2014] that norovirus was the culprit that sickened nearly 700 people on a cruise ship this week, and said it was one of the biggest norovirus outbreaks in 20 years. But the source of the outbreak on the Royal Caribbean ship Explorer of the Seas, which returned early to New Jersey on Wednesday [29 Jan 2014], may never be known, CDC said: "CDC has been investigating the outbreak since last Sunday [26 Jan 2014] but no particular source has been identified and it's quite possible a source won't be identified."

The report comes after passengers streamed off the Caribbean Princess on Friday morning [31 Jan 2014], the 2nd cruise cut short this week amid reports of illness on board. The ship, operated by Princess Cruises, returned to Houston [Texas] a day early with a confirmed outbreak of norovirus. "The ship was forced to return to Houston one day early because we were informed that dense fog was expected to close the port for much of the weekend," the company said in a statement. "The ship did not return early because of the increased incidence of norovirus on board, despite some media reports."

At least 178 people on board became ill during the cruise, according to the cruise line and CDC. Sick patients were quarantined to their rooms, and other passengers said they no longer had access to buffet tongs as crew members handed out hand sanitiser. CDC health officials met the Caribbean Princess at the Bayport Cruise Terminal in Pasadena, Texas. The vessel launched on a 7-day cruise to the western Caribbean on [25 Jan 2014] and had been scheduled to return on Saturday [1 Feb 2014]. Princess Cruises said the outbreak was over by the time the ship returned to Houston. "As a result of our actions, case numbers declined significantly and by the end of the cruise there were no passengers with active symptoms," the company said. "Over the course of the cruise 178 passengers (5.7 per cent) and 11 crew (1 per cent) reported ill to the Medical Center."

CDC officials also helped Royal Caribbean clean up the Explorer of the Seas, and said it had been approved to go back out again with a new batch of passengers Friday afternoon [31 Jan 2014]. Royal Caribbean officials say they cleaned the ship, which carried more than 3000 passengers, 3 times. It's the 3rd cruise ship outbreak to occur this year [2014]. A Norwegian Cruise Line ship, the Norwegian Star, reported that 130 passengers and 12 crew members became ill on 2-week cruise that launched [5 Jan 2014] from Miami.

About 20 million passengers take cruises in the US each year, fuelling a USD 37.8 billion annual industry, according to the American Association of Port Authorities. There were 9 vessel outbreaks in 2013 and 16 in 2012, according to the CDC. Norovirus is a common culprit in outbreaks on cruise ships, in nursing homes, and other confined places. It is a fast-moving gut bug typically spread by infected people or contaminated food or water. Norovirus is the most common cause of acute gastroenteritis in the US, resulting in about 21 million illnesses, between 56 000 and 71 000 hospitalizations and as many as 800 deaths, CDC says.

The virus lingers on surfaces and spreads very easily. Thorough hand washing with hot water and soap and meticulous environmental cleaning can help stop the spread. CDC says it's the season for norovirus. "Norovirus outbreaks wit high attack rates are common during this time of year," the agency said. "Most outbreaks occur between January and April."   [byline: Maggie Fox]
*****
Date: Wed 29 Jan 2014
Source: NBC News [edited]

Beleaguered passengers finally fled a Royal Caribbean cruise ship on Wednesday [29 Jan 2014] after a 10-day vacation cut short by a nasty gut bug that sickened nearly 700 people. One woman aboard the Explorer of the Seas yelled, "We made it!" as the ship docked in Bayonne [New Jersey], 2 days ahead of schedule. Other passengers stood on deck wrapped in blankets to watch the ship pull in. One person was removed from the Explorer of the Seas on a stretcher and taken away by ambulance. Others walked under their own power after the vessel arrived. Several passengers recounted a week full of tension and drama, but also professionalism and care from the cruise line crew.

Still, the ordeal on the 1020-foot ship -- whose relaxing voyage to the US Virgin Islands was thwarted by suspected norovirus -- may linger a little longer for people still showing signs of the fast-moving infection, health officials said. "We have passengers who are still exhibiting active disease," said Burnadette Burden, a spokeswoman for the Centers for Disease Control and Prevention. People who are still sick may be too ill to travel home -- and too contagious to use public transportation like trains and buses, health experts say. Royal Caribbean officials said Wednesday [29 Jan 2014] that they'd pay for hotels or make sure that ill passengers get additional medical care. "Should a guest feel sick enough that they want to go to the hospital, we will arrange for transportation," Royal Caribbean spokeswoman Cynthia Martinez said in an email. "We will work with the small number of guests that still feel ill to make them as comfortable as possible."

At least 630 of the ship's 3071 passengers and at least 54 of the 1166 crew members came down with diarrhea and vomiting -- classic signs of norovirus. Most of the cases occurred early in the cruise, which left New Jersey on [21 Jan 2014], and many passengers had already recovered. It's hard to say that the outbreak was the worst on record because of inconsistencies in record-keeping. But it's a bad one, Burden said. "It would be fair to say this is one of the largest numbers in the last 20 years or so," she said. One of the closest outbreaks to compare occurred in 2006, when a Carnival Cruise ship, the Carnival Liberty, was hit with an outbreak of norovirus that sickened 679 passengers and crew on a November trip to the US Virgin Islands.

CDC officials have not confirmed that norovirus is the culprit on the Explorer of the Seas, though it's a common cause of illness on cruise ships. Officials said testing was delayed by a treacherous winter snowstorm that closed the agency's Atlanta headquarters and results aren't expected until Friday [31 Jan 2014]. But if it is the germ, it's highly contagious for the one to 2 days when people are actively sick -- and for a few days afterward. The virus actually lingers in people's stool for 2 weeks or more, according to the CDC. That means that anyone who fell ill -- and those who were around them -- should pay extra attention to washing their hands and other kinds of cleanliness, said Dr Ruth Lynfield, outgoing head of the public health committee of the Infectious Diseases Society of America.

Cleanliness will be the key for the cruise line, too. Officials said they plan another scrub, a so-called "barrier sanitation" program to ensure that any remaining traces of illness are removed from the ship. Norovirus is a notoriously difficult bug to eradicate, health experts say. "It will be the 3rd aggressive sanitizing procedure the ship has undertaken since we became aware of the issue, and will additionally provide a window of more than 24 hours where there are no persons aboard the ship," officials said in a statement.   [byline: JoNel Aleccia]
******
Date: Fri 31 Jan 2014
Source: CDC, National Center for Environmental Health, Division of
Emergency and Environmental Health Services, Vessel Sanitation Program (VSP) [edited]

Cruise ship: Explorer of the Seas -- voyage dates: 21-31 Jan 2014
-----------------------------------------------------------------
- number of passengers who reported being ill during the voyage out of total number of passengers onboard: 634 of 3071 (20.6 per cent)
- number of crew who reported being ill during the voyage out of total number of crew onboard: 55 of 1166 (4.7 per cent)
- predominant symptoms: vomiting, diarrhea
- Causative agent: Norovirus

Actions: in response to the outbreak, Royal Caribbean Cruise Line and the crew aboard the ship took the following actions:
- increasing cleaning and disinfection procedures according to their outbreak prevention and response plan;
- making announcements to both notify onboard passengers of the outbreak and encourage case reporting;
- collecting stool specimens from ill passengers and crew for submission to the CDC lab;
- making multiple daily reports of gastrointestinal illness cases to the VSP [Vessel Sanitation Program];
- preparing additional crew members to join the ship mid-voyage to assist with case management and intensified sanitation procedures;
- consulting with CDC on plans for: passenger notification procedures and the planned delayed embarkation schedule in Bayonne, NJ on [31 Jan 2014], and disembarkation plans for active cases, terminal, and transport infection control procedures.

One CDC Vessel Sanitation Program epidemiologist, one contract epidemiologist, and one VSP environmental health officer boarded the ship in St Thomas, [US Virgin Islands] and are sailing on the ship as it travels back to port in New Jersey. This team is conducting an epidemiologic investigation, environmental health assessment, and evaluating the outbreak and response activities on board. One additional CDC Vessel Sanitation Program environmental health officer will board the ship upon arrival on [29 Jan 2014] to assist with the evaluation of the disinfection process. The team will continue the investigation and evaluation on the ship thru the boarding of new passengers for the next voyage. 5 clinical specimens were shipped to the CDC lab for testing on [26 Jan 2014].
**************************
Date: Fri 31 Jan 2014
Source: CDC, National Center for Environmental Health, Division of
Emergency and Environmental Health Services, Vessel Sanitation Program (VSP) [edited]

Cruise ship: Caribbean Princess -- voyage dates: 25 Jan-1 Feb 2014
------------------------------------------------------------------
- number of passengers who reported being ill during the voyage out of total number of passengers onboard: 181 of 3102 (5.8 per cent)
- number of crew who reported being ill during the voyage out of total number of crew onboard: 11 of 1148 (0.96 per cent)
- predominant symptoms: vomiting, diarrhea
- causative agent: Norovirus

Actions: in response to the outbreak, Princess Cruise Lines and the crew aboard the ship took the following actions:
- increasing cleaning and disinfection procedures according to their outbreak prevention and response plan;
- making announcements to both notify onboard passengers of the outbreak and encourage case reporting;
- collecting stool specimens from ill passengers and crew for submission to the CDC lab. Samples tested with the vessel's onboard rapid norovirus test were positive for norovirus. The specimens will be sent to the CDC lab for confirmatory analysis;
- making multiple daily reports of gastrointestinal illness cases to the VSP;
- consulting with CDC on plans for: passenger notification procedures and the planned delayed embarkation schedule in Houston, TX on [1 Feb 2014], and disembarkation plans for active cases, and terminal and transport infection control procedures.

Two CDC Vessel Sanitation Program environmental health officers will board the ship in Houston, TX on [31 Jan and 1 Feb 2014] to conduct an epidemiologic investigation, environmental health assessment, and evaluate the outbreak and response activities. Specimens are being collected and will be sent to the CDC lab for testing.
=====================
[ProMED-mail does not normally report outbreaks of norovirus-related gastroenteritis because of their ubiquity during the winter months. (Hence the alternate designation 'winter vomiting bug'). Norovirus infection is very contagious and can be contracted from an infected person, contaminated food or water, or by touching contaminated surfaces. The virus causes acute gastroenteritis with stomach pain, nausea, and diarrhea and vomiting. Anyone can be infected with norovirus and acquire norovirus illness repeatedly throughout life. Norovirus is the commonest cause of acute gastroenteritis in the United States. Each year, it causes 19-21 million cases and contributes to 56 000-71 000 hospitalizations and 570-800 deaths. Norovirus is also the commonest cause of foodborne disease outbreaks in the United States. There's no vaccine to prevent norovirus infection and no drug to treat it.

Norovirus illness is usually not serious. Most people get better in 1 to 3 days. But norovirus illness can be serious in young children, the elderly, and people with other health conditions. It can lead to severe dehydration, hospitalisation but rarely death. Most outbreaks of norovirus illness happen when infected people spread the virus to others. But, norovirus can also spread by consumption of contaminated food or water and by touching contaminated surfaces.

Health care facilities, including nursing homes and hospitals, are the most commonly reported places for norovirus outbreaks in the United States. Over half of all norovirus outbreaks reported in the United States occur in long-term care facilities. Outbreaks of norovirus illness appear to be occurring more frequently in cruise ships and similar environments. - ProMed Mod.CP]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/8vcv>.]
Date: Tue 13 Dec 2011
Source: Virgin Islands Daily News [edited]

The Centers for Disease Control and Prevention [CDC] has linked 5 past cases of Legionnaires' disease -- reported between March 2010 and August 2011 -- with stays at Marriott's Frenchman's Reef and Morning Star Beach Resort and Marriott's Frenchman's Cove [in Saint Thomas], prompting remediation work to the resorts' water systems. The VI [Virgin Islands] Health Department has been "working closely" with a team of CDC specialists to monitor the remediation efforts at the resorts, after an investigation into the 5 past cases, according to a statement the Health Department released Monday [12 Dec 2012].

The illness was found in stateside residents who had been guests at the resorts, said Health Department spokeswoman Eunice Bedminster. They required hospitalization but have since recovered, she said. There have been no reports of employees affected at either site, according to the Health Department statement.

The statement indicates that Frenchman's Reef and Morningstar Beach Resort has hired a consultant who led a cleaning project of the affected areas and treated the water system. Test results show no existence of _Legionella_ bacteria, although the Health Department statement said the test results have not yet been evaluated independently by the CDC.

The Health [Department] had asked the resorts to notify those who could potentially be affected by the bacteria: guests and employees, Bedminster said. The properties asked for an extension on a deadline that had been set, and it was granted, but the deadlines passed last week [week of 5 Dec 2011] without the notification to guests and employees going out, Bedminster said. She did not know if, after the deadline, the properties had made the requested notifications, she said.

The hotel provided The Daily News with a written statement that did not address guest notification: "Marriott takes hotel hygiene and cleanliness very seriously. As soon as we were notified of the possibility of the presence of _Legionella_ bacteria we immediately began to work with the USVI Department of Health (DOH) to address the situation. The Frenchman's Reef and Morning Star Beach Resorts hired a consultant who led a cleaning project of affected areas and the treatment of the water system. The latest test results taken after the implementation of these measures show no existence of _Legionella_ bacteria in the samples tested. We have complied with the recommendations provided by the DOH, and we have successfully addressed the issue at the resort. The DOH has allowed the hotel to remain fully open for business and welcome our guests."

The Daily News spoke with Marriott Frenchman's Reef and Morning Star Beach Resort General Manager Jose Gonzalez Espinosa by phone and asked for comment on the Health Department's assertion that the resort did not make the notifications it was supposed to make by the deadline. Gonzalez would not answer the questions unless they were in writing. The Daily News has a policy against submitting questions in writing because written Q and A stifles and slows follow-up and response. The resort underwent a major renovation during the summer, closing 3 May 2011 and reopening on 6 Oct 2011.

Legionnaires' disease is a pneumonia caused by the _Legionella_ bacteria, which live in warm water supplies, said Dr Lauri Hicks, a medical epidemiologist with the CDC. The bacteria that cause the disease do not pass from person to person. "It really requires exposure to water aerosol that contains _Legionella_," she said, Exposure may occur from showering or with time spent in a whirlpool or hot tub where the bacteria that lead to Legionnaires' disease are present, Hicks said.

Only a fraction of people -- typically those with certain risk factors, such as compromised immune systems -- exposed to the bacteria become ill, she said.

According to the Health Department statement, from 2000 through 2009, a total of 22 418 cases of legionellosis were reported to CDC from the 50 states and the District of Columbia. The CDC informed the Health Department in October [2011] of the 5 Legionnaires' disease cases among past guests at the resorts, and the Health Department asked for the agency's help in investigating. From 18 to 22 Oct 2011, CDC specialists conducted testing, and the properties were alerted about the possible _Legionella_ contamination, Bedminster said. On 3 Nov 2011, the Health Department notified each property of the CDC's conclusive findings and ordered them to immediately work on their water systems, including cleansing, superheating, chlorinating, and hiring a private consultant experienced in eliminating _Legionella_ from building water systems, according to the release. More than 6 weeks later, the Health Department notified the public with the statement it released Monday [12 Dec 2011].

Bedminster said that there had been no delay -- and that remediation work began immediately. "We have worked in good faith with both the resorts during what I have said was a monitoring process. We had some agreed-upon deadlines that had not been met, so we had to let the public know," she said.

Bedminster said that Health Department officials had discussed the possibility of enforcement actions with the Department of Labor and the Department of Planning and Natural Resources to get those deadlines met, but she did not know the outcome of the discussions. "Safeguarding the public's health, including that of employees and guests, from exposure and threats are of the utmost importance to the Department of Health," acting Health Commissioner Mercedes Dullum said in the prepared statement. "DOH will continue to monitor this situation with assistance from the CDC. People should not be discouraged from traveling to or within the US Virgin Islands."  [Byline: Joy Blackburn]
---------------------------------------------
Communicated by:
Denis Green
denis@gatesit.com.au
=======================
[The following has been extracted from the US CDC document Travel-Associated Legionnaires' Disease (<http://www.cdc.gov/legionella/faq.htm>):

"About 20-25 percent of all Legionnaires' disease reported to CDC is travel-associated. Legionnaires' disease is important to diagnose and to report because its identification implies the presence of an environmental source to which other susceptible individuals are likely to be exposed. Clusters of Legionnaires' disease associated with travel to hotels or aboard cruise ships are rarely detected by individual clinicians or health departments; travelers typically disperse from the source of infection before developing symptoms. Therefore, a travel history should be actively sought from patients with community-acquired pneumonia and _Legionella_ testing should be performed for those who have traveled in the 2 weeks before onset of symptoms.

"_Because of the multi-state nature of travel in the US, national-level surveillance is necessary to detect outbreaks of travel-associated Legionnaires' disease. CDC relies upon state and local health departments to conduct this surveillance. Surveillance through the National Notifiable Diseases Surveillance System (NNDSS) is still important for monitoring national trends; all cases should be reported through NNDSS."

"Because of the public health importance of timely reporting, inform CDC of travel-associated cases by emailing about the patient's movements in the 2-10 days before onset."

"Environmental sampling/testing should only be conducted after careful consideration of the epidemiologic evidence linking a case(s) to a particular location."

The following article is linked to the CDC document: Barbaree JM, et al: Protocol for Sampling Environmental Sites for Legionellae. Applied Environmental Microbiol 1987; 53(7): 1454-8 (<http://www.cdc.gov/legionella/files/sampling_protocol1987.pdf>): "Since legionellae not related to disease may be found in many of the sites sampled, an epidemiologic association with the probable source should be established before intervention methods, such as disinfection, are undertaken."

"Random sampling without an epidemiologic evaluation and comparing isolates from the environment and from patients could lead to false conclusions about sources of epidemic strains."

Potential environmental sampling sites for _Legionella_ spp that the CDC document suggests include: internal surfaces of faucets, aerators, and shower heads; and water from incoming water main, holding tanks and cisterns, water heater tanks, decorative fountains, irrigation equipment, fire sprinkler system (if recently used), whirlpools, and spas. Because _Legionella_ may be found in water supplies without linkage to any cases, the actual causative source should be demonstrated by matching the genotype of the environmental isolates with that of any clinical isolates to assure frequently costly corrective measures are carried out on the actual source (<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC86783/>; and <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730281/>).

The Virgin Islands are located in the Leeward Islands of the Lesser Antilles, which form the border between the Caribbean Sea and the Atlantic Ocean. Politically, the eastern islands form the British Virgin Islands and the western ones form the United States Virgin Islands. The US Virgin Islands consist of the main islands of Saint Croix, Saint John, and Saint Thomas (<http://en.wikipedia.org/wiki/United_States_Virgin_Islands >). They can be seen on the HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/1xng>. - ProMed Mod.ML]
Date: Sat 18 Sep 2010
Source: Virgin Islands Daily News [edited]
<http://virginislandsdailynews.com/dengue-outbreak-confirmed-in-1.1018284>

After 19 cases of suspected dengue fever -- and at least one death -- reported in the St Thomas-St John District, the VI Health Department issued a statement Friday [17 Sep 2010] saying that the district is experiencing a dengue fever outbreak. According to the Health Department statement released [Fri 17 Sep 2010], 9 of the 19 suspected cases have been laboratory-confirmed as dengue fever in the St Thomas-St John District since June [2010]. On St Croix, there have been 4 suspected cases with no confirmed cases. There is no requirement in the territory that people with suspected dengue fever undergo testing to confirm whether or not they have the mosquito-borne virus, said Health Department epidemiologist Eugene Tull.

His experience with a 2005 outbreak on St Croix leads him to believe that the number of dengue cases this year [2010] is higher than reported, Tull said, adding that he is now receiving anecdotal information about more cases in the community. According to the release, the strain causing the current outbreak is [dengue virus] type 2, which was responsible for the 2005 outbreak on St Croix.
================
[An interactive HealthMap/ProMED-mail map showing the location of the Virgin Islands in the Caribbean can be accessed at
<http://healthmap.org/r/01tp>. - ProMed Mod.TY]
Date: Fri 27 Aug 2010
Source: Virgin Islands Daily News [edited]
<http://virginislandsdailynews.com/news/dengue-fever-possible-cause-of-death-of-st-john-woman-1.977556>

A St John woman who was transferred last week [week of 16 Aug 2010] to a Miami hospital with possible dengue fever symptoms died there 20 Aug [2010] from complications, her husband said. VI [Virgin Islands] Health Department epidemiologist Eugene Tull said earlier this week [week of 23 Aug 2010] that he had no information about a possible death from dengue fever.

Health Department spokeswoman Eunice Bedminster said Thursday [26 Aug 2010] that the department was not aware of any deaths from the territory's dengue fever cases but had been investigating since receiving inquiries from reporters Monday [23 Aug 2010].

Tull said earlier this week that so far this year [2010], there have been 8 confirmed, laboratory positive cases of dengue fever in the territory, 3 probable cases with lab results pending, and 15 suspected cases. All of those were in the St Thomas/St John District, except for 2 of the suspected cases, which were on St Croix, he said. [Byline: Joy Blackburn]
=====================
[The attribution of the woman's death to dengue virus infection is speculative. ProMED-mail awaits confirmation (or not) as further information becomes available. It is clear, however, that locally acquired dengue virus infections are occurring there.

Maps showing the location of the US Virgin Islands can be accessed at <http://www.worldatlas.com/webimage/countrys/carib.htm>. and the HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/01tp> - ProMed Mod.TY]
Date: Thu 3 Jun 2010
Source: Caribbean Net News [summ. & edited]
<http://www.caribbeannetnews.com/news-23418--19-19--.html>

Health commissioner Julia Sheen on Wednesday [2 Jun 2010] said the Department of Health has confirmed the U.S. Virgin Islands' 1st case of dengue fever. The case was reported in the St Thomas-St John district and follow-up testing confirmed positive for the disease caused [by the virus transmitted] by the _Aedes aegypti_ mosquito, which is mostly found in the home, Sheen said.

"Increased rains can make certain areas near the home a haven for mosquito breeding and place individuals at risk for dengue fever," Sheen said. "We went through both the hurricane and rainy seasons last year [2009] without a positive case of dengue being reported and with this confirmed case, we urge residents to be vigilant and help their communities and the Department of Health stop the spread of dengue fever by doing basic things."

Residents should:
- Keep tires in a dry place
- Put plants that are currently in water, into soil and empty flowerpot vases weekly
- Keep water barrels tightly sealed
- Cover or turn pet dishes and buckets that hold water upside down
- Place a screen or mesh over the overflow pipe of cisterns
- Repair or replace damaged screens and keep windows and doors without screens closed
- Cover infant cribs with mosquito netting
- Spray dark closets often
- Use mosquito repellents containing DEET. Follow instructions carefully and use on arms, legs, ankles, and nape of neck. Avoid applying repellant to eyes, lips, or bruised skin, and to children under 2 years old and to the hands of older children

DOH epidemiologist Dr Eugene Tull said that the Department will issue a fogging schedule as part of its mosquito abatement program later this week [week of 3 Jun 2010] in light of recent rains, but reminds residents that the mosquito that causes [transmits] dengue [virus] is usually in the house. "They hide in dark closets and sleep when we sleep and are awake when we are awake," Dr Tull said.
================
[A HealthMap/ProMED-mail interactive map of the U.S. Virgin Islands southeast of Puerto Rico can be accessed at
<http://healthmap.org/r/01tp>. - ProMed Mod. TY]
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.