WORLD NEWS

Getting countries ...
Select countries and read reports below or

Andorra

General
************************************
This small country is situated between France and Spain. Because of its elevation and proximity to the Pyrenees the climate is generally pleasant throughout the year.
Climate
**************
*********************
During the summer months the temperatures can rise to 30c but there is usually a cooling breeze. Lightening storms can occur during the summer months associated with torrential rain.
Sun Exposure and Dehydration
***************************************
Those from Northern Europe can develop significant sun exposure and so remember to use a wide brimmed hat when necessary. The altitude can also lead to significant tiredness and dehydration so take sufficient initial rest and drink plenty of fluids.
Safety & Security
************************************
The level of crime throughout the country directed at tourists is very low. Nevertheless take care of your personal belongings at all times and use hotel safety boxes where possible.
Local Customs
************************************
There are strict laws regarding the use of illegal drugs. Make sure you have sufficient supplies of any medication you required for your trip and that it is clearly marked. The European E111 form is not accepted in Andorra and so it is essential that you have sufficient travel insurance for your trip.
Winter Sports
************************************
Andorra is one of the regions where many travel to partake of their winter sport facilities. Generally this is well controlled and one of the safer regions. Nevertheless, make certain your travel insurance is adequate for the activities you are planning to undertake.
Vaccination
************************************
The only standard vaccine to consider for Andorra would be tetanus in line with many other developed countries of the world.

Travel News Headlines WORLD NEWS

Date: Thu, 12 Jul 2018 15:24:06 +0200

Andorra la Vella, Andorra, July 12, 2018 (AFP) - The tax haven of Andorra has long been a favourite destination for smokers looking to stock up on cheap cigarettes, but the enclave said Thursday that it would soon stop advertising the fact.   The government said it had signed up to the World Health Organization's (WHO) anti-tobacco convention, which aims to encourage people to quit smoking and combat contraband sales.   "The goal is to contribute to public health and pursue the fight against trafficking," government spokesman Jordi Cinca said at a press conference.

The tiny principality of Andorra, perched in the Pyrenees on the border between France and Spain, attracts millions of shoppers each year to duty-free stores, where prices of alcohol, cigarettes, electronics and clothes can be up to 20 percent cheaper than elsewhere in the EU.   High taxes on tobacco imposed by many countries to help people kick smoking make Andorra's cigarettes a particularly good deal.   The average pack costs just three euros ($3.50) compared with eight euros in France, which has said it will gradually raise the price to 10 euros a pack by November 2020.

Tobacco sales bring in some 110 million euros a year for Andorra, whose economy is otherwise based almost entirely on tourism.   It is also an enticing destination for smugglers, with French and Spanish border agents regularly seizing cartons from people trying to sneak them out, either by car or by hiking down the mountain trails which criss-cross the Pyrenees.   No date has been set for the advertising ban, which will come into effect three months after the ratification of the WHO accord is voted by parliament.
Date: Fri, 16 Mar 2018 02:41:51 +0100

Andorra la Vella, Andorra, March 16, 2018 (AFP) - The tiny principality of Andorra is witnessing a once in a generation phenomenon -- a widespread strike.   Around a third of civil servants across the mountainous micro-state have walked out to protest proposed reforms to their sector in what has been described as Andorra's first large-scale strike since 1933.

With no negotiation breakthrough in sight, picket lines are expected to be manned again on Friday with customs officers, police, teachers and prison staff among those taking part.   The first major strike in 85 years was sparked by plans from the government of Antoni Marti to reform civil servant contracts.   He has assured officials "will not do an hour more" work under the reforms and that 49 million euros would be allocated for the next 25 years to supplement civil servant salaries.   But government workers are unconvinced with unions warning the reforms could risk their 35 hour working week and pay.

Customs officers involved in the strike interrupted traffic on the Andorran-Spanish border this week, according to unions, while some 80 percent of teachers have walked out of classes.   Strikers have occupied the government's main administrative building and held noisy protests outside parliament calling for Marti's resignation.    "We have started collecting signatures to demand the resignation of the head of government and now nobody will stop us," Gabriel Ubach, spokesman for the public service union, told reporters.
Date: Mon 27 Sep 2017
Source: Contagion Live [edited]

A recent Dispatch article published in the Centers for Disease Control and Prevention (CDC)'s Emerging Infectious Diseases journal, offers insight into a large norovirus outbreak that sprung up in Spain in 2016 that had been linked with bottled spring water. The Public Health Agency of Catalonia (ASPCAT) reported a staggering 4136 cases of gastroenteritis from 11-25 Apr 2016. Of the 4136 cases, 6 individuals required hospitalization. The CDC defines a "case-patient" as an "exposed person who had vomiting or diarrhoea (3 or more loose stools within 24 hours)," as well as 2 or more of the following symptoms: nausea, stomach pain, or fever.

ASPCAT investigators traced back the outbreak to contaminated bottled spring water in office water coolers. The water came from a source in Andorra, a small independent principality located between Spain and France. Norovirus is a "very contagious virus," according to the CDC, and it is common for individuals to become infected by eating contaminated food. Although it is possible to be infected by consuming contaminated drinking water, this mode of transmission is "rare in developed countries," according to the article.

The investigators collected water samples from a total of 4 19-L water coolers in 2 different offices located in Barcelona, "from which affected persons had drunk; samples 1 and 2 came from 2 water coolers in one office, while samples 3 and 4 came from 2 water coolers in another office. Using "positively charged glass wool and polyethylene glycol precipitation for virus concentration," the investigators tested the samples.

"We detected high RNA levels for norovirus genotype I and II, around 103 and 104 genome copies/L, in 2 of the 4 water cooler samples concentrated by glass wool filtration and polyethylene glycol precipitation," according to the article. The investigators noted that a drawback of using molecular methods is that they are not able to differentiate between particles that are infectious and those that are not. Therefore, they "predicted the infectivity of norovirus in the concentrated samples by treating the samples with the nucleic acid intercalating dye PMA propidium monoazide and Triton X surfactant before RT-qPCR," which allowed them to "distinguish between virions with intact and altered capsids."

In those 2 water samples, they found high genome copy values -- 49 and 327 genome copies/L for norovirus genotype I and 33 and 660 genomes copies/L for norovirus genotype II. This was not an unexpected finding, due to the large number of infected individuals associated with the outbreak. Through "PMA/Triton treatment before RT-qPCR assays," the investigators found that the proportion of infected virions accounted for 0.3% to 5.6% of the total number of physical particles in the water samples, "which was enough to cause gastrointestinal illness."

The investigators also analyzed faecal samples collected from infected individuals who worked at the office in which the 1st 2 water samples were collected. They detected the following genotypes in those faecal samples: GI.2 and GII.17. In the faecal samples collected from the other office, they isolated the following genotypes: GII.4/Sydney/2012, GI.2, GII.17, and GII.2.

"We hypothesize that the spring water was contaminated by all 4 strains (GI.2, GII.2, GII.4, and GII.17) but levels of viral contamination for each genotype were not homogeneous in all bottled coolers," the investigators wrote. "We may have detected only the GII.4 genotype in water samples 1 and 2 because of a higher concentration of this specific genotype or because of bias caused by the sampling, concentration, and molecular detection procedures."

The investigators admit one limitation to their study: the small number of water samples collected and analyzed. They attribute this to the fact that on 15 Apr 2016, 4 days after the onset of the outbreak, the company that produced the drinking water recalled over 6150 containers of water "of suspected quality" as a precautionary measure. The recall prevented the investigators from collecting more samples to assess, according to the article.

Although the exact cause of the contamination has not yet been identified, the investigators posit that "the high number of affected persons from 381 offices that received water coolers, and the many different genotypes found in some patients' faecal specimens" suggest that the spring aquifer had been contaminated by "sewage pollution," and the Andorra Ministry of Health and Welfare banned further use of the spring.

The investigators suggest that assessing commercially-produced mineral waters for different harmful pathogens, such as norovirus would be beneficial. They note, however, that creating, enhancing, and managing such "virus surveillance systems" would be costly. Thus, the investigators suggest taking a "balanced approach to keep both the cost and the time required for the analyses within feasibility limits."  [Byline: Kristi Rosa]
=====================
[The interesting article published in the September 2017 issue of Emerging Infectious Diseases is:
Blanco A, Guix S, Fuster N, et al: Norovirus in bottled water associated with gastroenteritis outbreak, Spain, 2016. Emerg Infect Dis. 2017; 23(9): 1531-34; https://wwwnc.cdc.gov/eid/article/23/9/16-1489_article. - ProMED Mod.LL]

[Catalonia and Andorra can be located on the HealthMap/ProMED-mail map at http://healthmap.org/promed/p/1341. - ProMED Sr.Tech.Ed.MJ]
Date: Thu, 26 Dec 2013 22:25:05 +0100 (MET)

ANDORRA LA VELLA, Andorra, Dec 26, 2013 (AFP) - A Spanish skier and a French snowboarder have died in avalanches in different mountain ranges in Europe, officials said Thursday.

The 27-year-old skier, a woman from Barcelona, died Wednesday while going off-piste alone in the Soldeu resort in Andorra, in the Pyrenees mountains between France and Spain, a resort manager told AFP.   Although she was rescued within 10 minutes, after her glove was spotted on the surface, she was unable to be revived despite a helicopter dash to hospital.

In the Italian Alps, close to the border with France, a 24-year-old Frenchman who was snowboarding with three friends on a closed run died Thursday when an avalanche swept over him in the resort town of Les Arnauds.   Local officials said he succumbed to multiple injuries, asphyxia and hypothermia.

Avalanches are common in Europe's ski resorts at this time of year, when early snows are heavy with moisture, and several deaths occur each winter.   Last Sunday, a 35-year-old Frenchman died in an avalanche in the Alps near the Italian border while on a three-day trek with a friend.
Date: Fri 7 Feb 2003 From: Jaime R. Torres Source: EFE Salud, Thu 6 Feb 2003 (translated by Maria Jacobs) [edited] -------------------------------------------------- Close to 300 students in one school and 173 tourists staying in 7 hotels in the Principality of Andorra have been affected by outbreaks of gastroenteritis that, according to local authorities, are not related to each other. Monica Codina, Minister of Health, stated that the outbreak that has affected almost 300 children and 8 adults in the San Ermengol school was detected last Monday [3 Feb 2003] but that it may have started Wednesday or Thursday of the previous week. The epidemiological surveys of a group of pre-school and grammar school students that may also be affected have not been performed yet. Also pending are the results of the microbiological tests of the food and water served in the school dining room, but the minister has indicated that the probable cause of the outbreak is the fact that water pitchers were filled with hoses directly from the faucet. The Minister stated that this outbreak of gastroenteritis is not related to the one that affected 173 tourists, most of them young people on holiday, who where staying in 7 hotels of the Principality. The government is also investigating the cause of this outbreak and has indicated that an anomaly in the system that supplies water to the hotels was detected, requiring a process of chlorination, which has not been carried out due to the heavy snowfall of the past few days. * * * * * * * * * * [The suspicion that defective water supplies may be responsible for all of these independent outbreaks suggests that the etiologic agent may be an enterovirus, hepatitis A virus, or non-viral, rather than one of the noroviruses associated with sudden-onset viral gastroenteritis. Information on the outcome of diagnostic tests in progress would be welcomed. - ProMed Mod.CP]
More ...

World Travel News Headlines

Date: Sun 3 Nov 2019
Source: Nigeria Centre for Disease Control (NCDC) [edited]

Highlights
- In the reporting week 44 (28 Oct - 3 Nov 2019), 11 new confirmed** cases were reported from Ondo (6) and Edo (5) states with one new death from Edo state.
- From 1 Jan - 3 Nov 2019, a total of 4396 suspected* cases have been reported from 23 states. Of these, 754 were confirmed positive, 19 were probable, and 3623 were negative (not a case).
- Since the onset of the 2019 outbreak, there have been 158 deaths in confirmed cases. Case-fatality ratio in confirmed cases is 21%.
- A total of 23 states (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Plateau, Taraba, Adamawa, Gombe, Kaduna, Kwara, Benue, Rivers, Kogi, Enugu, Imo, Delta, Oyo, Kebbi, Cross River, Zamfara, Lagos, and Abia) have recorded at least one confirmed case across 86 local government areas [LGAs] - Figure 1.
- 93% of all confirmed cases are from Edo (38%), Ondo (31%), Ebonyi (7%), Bauchi (7%), Taraba (5%), and Plateau (5%) states - Figure 1.
- Predominant age group affected is 21-40 years (range: greater than one month to 98 years; median age: 34 years) - Figure 6.
- The male-to-female ratio for confirmed cases is 1:1 - Figure 6.
- In the reporting week 44, no new healthcare worker was affected. A total of 19 healthcare workers have been infected since the onset of the outbreak in 10 states: Edo (6), Ondo (4), Ebonyi (2), Enugu (1), Rivers (1), Bauchi (1), Benue (1), Delta (1), Plateau (1) and Kebbi (1) with 2 deaths in Enugu and Edo states.
- Nine patients are currently being managed at various treatment centres across the country: Irrua Specialist Teaching Hospital (ISTH) treatment Centre (7) and Federal Medical Centre, Owo (2).
- A total of 8400 contacts have been identified from 21 states. Of these, 356 (4.2%) are currently being followed up, 7967 (94.8%) have completed 21 days follow-up, while 12 (0.1%) were lost to follow-up. A total of 132 symptomatic contacts have been identified, of which 65 (49.2%) have tested positive.
- National Lassa fever multi-partner, multi-sectoral Technical Working Group (TWG) continues to coordinate response activities at all levels.

Figures [available at the source URL above]
-------------------------------------------
Figure 1 [map]. Randomised distribution of confirmed Lassa fever cases in Nigeria as at 3 Nov 2019.
Figure 2 [map]. LGAs with confirmed Lassa fever cases in Nigeria as at 3 Nov 2019.
Figure 3 [graph]. Epicurve of Lassa fever confirmed cases (754) in Nigeria - week 01-44, 2019.
Figure 4 [graph]. November 2019. Weekly trends of Lassa fever confirmed cases in Nigeria, 2016/week 01-2019/week 44.
Figure 5 [graph]. Confirmed Lassa fever cases in Nigeria with state-specific case-fatality rates (CFR) as at 3 Nov 2019.
Figure 6 [graph]. Age-sex distribution of confirmed Lassa fever cases in Nigeria as at 3 Nov 2019.

*Suspected case describes any individual presenting with one or more of the following: malaise, fever, headache, sore throat, cough, nausea, vomiting, diarrhoea, myalgia, chest pain, hearing loss, and either (a) history of contact with excreta or urine of rodents or (b) history of contact with a probably or confirmed Lassa fever case within a period of 21 days of onset of symptoms, or any person with inexplicable bleeding/hemorrhagia.
**Any suspected case with laboratory confirmation (positive IgM antibody, PCR, or virus isolation)
==================
[The 11 new confirmed and 4396 suspected cases indicate that Lassa fever (LF) virus transmission is continuing. Nigeria should be in the period of the year when fewer cases usually occur, as illustrated in the graph in Figure 3 (at the source URL above), but more cases are still occurring. There has been a peak in case numbers between weeks 1 and 11 (January-March) over the past 3 years and probably will be the case again next year (2020).

The number of confirmed deaths has increased by 2 to 158. Fortunately, there are no new healthcare workers infected during this reporting period, and the total number of infected healthcare workers remains at 19, a likely indication that effective barrier nursing and the use of personal protective equipment are being employed. This outbreak remains widespread so far in 2019, with confirmed cases occurring in 23 states, and the number of affected LGAs remains at 86. ProMED-mail readers may wish to see the maps and graphs (Figures 1-6) that are available at the source URL above.

Transmission of LF virus occurs when individuals are in contact with rodent reservoir host excreta or are within healthcare facilities. It would be interesting to know whether the prevalence of Lassa fever virus has been increasing in populations of rodent hosts in areas where human cases are occurring.

Images of the rodent reservoirs of Lassa fever virus:
_Mastomys natalensis_:
_Mastomys erythroleucus_ and _Hylomyscus pamfi_:

There is no mention in the plans above of public education for avoidance of contact with these rodents and their excreta. - ProMED Mod.TY]

[Maps of Nigeria:
Date: Thu 14 Nov 2019
From: Larry Lutwick <lutwick.larry@mayo.edu> [edited]

Over the past 5 days, our health care facility in northwest Wisconsin, USA, has seen 3 women hospitalized with _E coli_ O157 infection. All presented with significant abdominal pain without fever and watery diarrhoea which in 2 progressed to bloody diarrhoea. None of the 3 have manifested any evidence of haemolytic-uremic syndrome. Both of the women seen by the Infectious Diseases service stated that their diet contains a lot of salads.

We would appreciate any reports of upswings in the number of cases of this process in the upper Midwest USA or elsewhere.
--------------------------------------------
Larry Lutwick MD
Eau Claire, Wisconsin
=========================
[Although the classical source of enterohemorrhagic _E. coli_ infections is ground beef, fresh produce as in salad ingredients are also well represented as vehicles of transmission. ProMED would appreciate any further reports as the country health departments work on this as yet small outbreak. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Wisconsin, United States: <http://healthmap.org/promed/p/250>]
Date: Tue 12 Nov 2019
Source: Daily Times [edited]

[_Naegleria fowleri_] has claimed another life in Karachi on [Mon 11 Nov 2019]. This was the 16th death reported in the ongoing year [2019] because of the disease. According to details, a 28-year-old resident of New Karachi area was brought to a private clinic 4 days ago where he died of the disease during treatment.

According to the researchers, _Naegleria_ has a fatality rate of more than 98%. Infections can happen when contaminated water enters the body through the nose. It cannot be passed person-to-person.

The amoeba travels from the nasal membranes to the brain. Symptoms are initially very mild, including a headache, stiff neck, fever, and stomach pain. Death usually occurs 5 to 7 days after infection.

_N. fowleri_ is a microscopic amoeba, which is a single-celled living organism. It can cause a rare and devastating infection of the brain called primary amoebic meningoencephalitis (PAM). The amoeba is commonly found in warm freshwater such as lakes, rivers, ponds, and canals.

Once the amoeba enters the nose, it travels to the brain where it causes PAM (which destroys brain tissue) and is usually fatal. Infections usually occur when it is hot for prolonged periods of time, which results in higher water temperatures and lower water levels.
====================
[Even though the weather has cooled considerably in northern parts of the country, Sindh province, which includes Karachi, continues to experience hot and humid climate which is conducive to the proliferation of the Naegleria parasite.

A public awareness message from the Government of Sindh Health Department can be seen at

Optimum chlorination is the key measure to prevent _Naegleria fowleri_ infection. In the absence of chlorination of the supply water in the city, residents need to clean water tanks and chlorinate water in the tanks. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Date: Tue 12 Nov 2019
Source: Outbreak News Today [edited]

Moncton is a city of some 85,000 people in south-eastern New Brunswick, Canada. In a CBC [Canadian Broadcasting Corporation) report today [12 Nov 2019], it is reported that a 3rd Creutzfeldt-Jakob disease (CJD) case this year [2019] -- all 3 cases had cataract surgery at the Moncton Hospital.  In April [2019], Moncton Hospital reported the identification 2 separate cases where a patient with probable Creutzfeldt-Jakob disease (CJD) had cataract surgery in the facility.

Dr Gordon Dow, division head of infectious diseases at the Moncton Hospital, said even he was shocked when another case of CJD was discovered.  "I think even though there's the overwhelming weight of evidence suggesting that we've had a cluster of sporadic cases, there is no need for public alarm," Dow said. "This is not an indication that there's been an outbreak of CJD."

Prion diseases are rare, fatal, degenerative brain disorders that are thought to occur worldwide in both humans and animals. They belong to the general category of brain diseases called proteinopathies, which also includes Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis (ALS). Although there are several forms of human prion disease, the most common is Creutzfeldt-Jakob disease (CJD).  Since January 1998, Canada has reported 1037 definitive and probable CJD cases and New Brunswick has seen 31 cases during this period.
Date: Mon 11 Nov 2019
Source: Pan American Health Organization (PAHO)

Mexico has become the 1st country in the world to receive validation from the World Health Organization (WHO) for eliminating dog-transmitted rabies as a public health problem. "Eliminating [dog-transmitted] rabies doesn't happen by accident," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "It takes political resolve, careful planning, and meticulous execution. I congratulate the Government of Mexico on this wonderful achievement and hope many other countries will follow its example."

Rabies causes 60,000 deaths each year, mainly in Asia and Africa. In Latin America and the Caribbean, new cases of rabies were reduced by more than 95 percent in humans and 98 percent in dogs since 1983.

"By eliminating human rabies transmitted by dogs, Mexico is showing the world that ending infectious diseases for the next generation is possible and is the right way forward," said PAHO Director, Carissa F Etienne.

Mexico's achievement
--------------------
In order to achieve elimination, the country has implemented a national strategy for the control and elimination of rabies. This includes free, mass vaccination campaigns for dogs, that have taken place since the 1990's with more than 80 percent coverage; continuous and effective surveillance; public awareness-raising campaigns; timely diagnosis; and the availability of post-exposure prophylaxis in the country's public health services.

As a result, the country went from registering 60 cases of human rabies transmitted by dogs in 1990, to 3 cases in 1999, and zero cases in 2006. The last 2 cases occurred in 2 people from the State of Mexico, who were attacked in 2005 and presented symptoms in 2006.

The validation process
----------------------
WHO considers a country to be free of rabies after registering 2 years of zero transmission of rabies to humans. However, there was previously no process to verify the achievement of this goal, until this was developed by PAHO/WHO. Mexico became the 1st country in the world to begin this in December 2016.

The validation process was extensive and included the creation of a group of independent international experts established by PAHO/WHO. It also included the preparation, by Mexico, of an almost 300-page file containing all historical information about the situation of rabies in the country. PAHO and its specialized center in veterinary public health, PANAFTOSA, accompanied and supervised the implementation of the validation process throughout.

The group of experts carried out a mission to Mexico in September 2018 to review the file and verify the country complied with all WHO requirements. In September 2019, the group recommended the Director General of WHO and PAHO validate the elimination.

Moving forward
--------------
In order to sustain elimination, PAHO/WHO recommends continuing all rabies prevention, surveillance and control actions, particularly as rabies virus continues to circulate among wild animals such as bats.

PAHO collaborated with the countries of the Americas to eliminate rabies through technical cooperation, staff training, periodic meetings between those responsible for the issue in-country, and through the provision of recommendations on international standards. As of September 2019, there have been zero cases of rabies transmitted by dogs in humans in the Americas.

In addition to rabies, Mexico eliminated onchocerciasis in 2015 and trachoma in 2017, 3 of the more than 30 infectious diseases and related conditions that PAHO's new Communicable Disease Elimination Initiative in the Region of the Americas has set as a goal for elimination from the continent by 2030.
===================
[This is certainly an outstanding achievement and should be celebrated by all. It is also an example to other countries.  Of course, someone acquiring rabies from a bat would be outside of this situation. This WHO/PAHO validation specifically refers to rabies acquired from dog bites. This is a great milestone. Congratulations Mexico! - ProMED Mod.TG]

[HealthMap/ProMED-mail map of Mexico:
Date: Mon, 18 Nov 2019 08:37:15 +0100 (MET)

Jakarta, Nov 18, 2019 (AFP) - An endangered Sumatran Tiger has mauled to death an Indonesian farmer and seriously injured a domestic tourist, a conservation official said Monday.   The fatal attack happened Sunday at the farmer's coffee plantation on Sumatra island where the 57-year-old wrestled with the big cat before it killed him, according to Genman Hasibuan, head of the South Sumatra conservation agency.   "The farmer was attacked while he was cutting a tree at his plantation," he told AFP on Monday.   The mauling came a day after the same tiger attacked a group of Indonesian tourists who were camping at a local tea plantation in South Sumatra's Mount Dempo region.

One of the tourists was rushed to hospital for wounds to his back after the cat stormed into his tent, Hasibuan said.   The animal, which remains loose in the protected-forest area, is believed to be one of just 15 critically endangered tigers in South Sumatra, which has seen five tiger attacks this year, including two fatal incidents, Hasibuan said.

Human-animal conflicts are common in the vast Southeast Asian archipelago, especially in areas where the clearing of rainforest to make way for palm oil plantations is destroying animals' habitats and bringing them into closer contact with people.   In March last year, a man was killed by a tiger in Sumatra's Riau province while several months earlier a tiger also killed a plantation worker in the area.   Sumatran tigers are considered critically endangered by protection group the International Union for Conservation of Nature, with 400 to 500 remaining in the wild.
Date: Fri, 15 Nov 2019 17:12:24 +0100 (MET)

Karachi, Nov 15, 2019 (AFP) - Pakistan has become the first country in the world to introduce a new typhoid vaccine, officials said Friday, as the country grapples with an ongoing outbreak of a drug-resistant strain of the potentially fatal disease.   The vaccine, approved by the World Health Organization (WHO), will be used during a two-week immunisation campaign in southern Sindh province.

Sindh is where most of Pakistan's 10,000 cases of typhoid have been documented since 2017.    "The two-week campaign beginning from today would target over 10 million children of nine months to 15 years of age," Azra Pechuho, the health minister in Sindh province, said in Karachi on Friday.   The new vaccines have been provided by Gavi, the Vaccine Alliance, to the Pakistani government free of cost.

After the two-week campaign, it will be introduced into routine immunisations in Sindh, and in other areas of Pakistan in the coming years.   Pakistan spends a meagre amount of its national resources on public health and a majority of its population remains vulnerable to contagious diseases such as typhoid.   In 2017, 63 percent of the typhoid cases documented and 70 percent of the fatalities were children, according to a joint press release from the Pakistani government, WHO and Gavi.
Date: Sat, 16 Nov 2019 05:50:25 +0100 (MET)
By Abhaya SRIVASTAVA

New Delhi, Nov 16, 2019 (AFP) - A thick grey smog choked New Delhi for the fifth day Saturday, adding to a mounting pollution health crisis, but retired naval commander Anil Charan is one of the vast majority of the city's 20 million inhabitants who do not wear a mask.   Indian media is packed with warnings about the risk of premature death, lung cancer and particular danger to children from PM2.5 -- tiny particles that get into the bloodstream and vital organs -- carried in the smog.   But the smartly-dressed Charan was among shoppers in Delhi's upmarket Khan Market district browsing the luxury clothes and jewellery stores without a mask, seemingly oblivious to the risk.   Many are too poor to afford protection but others simply do not like the way a pollution mask looks.

Charan, wearing aviator sunglasses, said it did not fit his "rough and tough" image.   "I have been brought up in this kind of atmosphere, the smog and all, so I am kind of used to it. And being a naval officer I think if I wear a mask I will think I am a sissy," he said.   Doctors say face masks must be worn and air purifiers used at home and in offices.   There are a variety of masks to choose from. A basic cloth version can cost as little as 50 rupees (70 US cents) but the protection they offer is debatable.    More reputable types start from 2,500 rupees ($34) while some Khan Market stores charge more than 5,500 rupees ($75) for top of the range imported models.

- Bare-faced bravado -
The mask-look worried a lot of the Khan Market shoppers and diners however. Some said the danger had been overblown.   "I know I am risking my health but I am not very comfortable wearing them (masks)," said Ritancia Cardoz, who works for a private company.   "I don't find it appealing," she told AFP.   Lopa Diwan, on a visit to the capital from the provinces, said the Delhi air was "not as bad as it is being made out to be."   "So many people advised me not to go to Delhi because of the pollution but I don't think it's that bad. I don't see people dying," she said.

Pollution -- blamed on industrial and car emissions mixed with stubble fires on thousands of farms surrounding the city -- has been building up each winter for the past decade. The past five years have been particularly bad.   The toxic air cuts short the lives of one million people in India every year, according to government research published earlier this year.    Concentrations of the most harmful airborne pollutants in Delhi are regularly about 20 times the World Health Organisation safe limit. That rams home the city's reputation as the world's most polluted capital.   Some foreign companies and embassies now do not let families move to Delhi, or at least give strong warnings about the pollution.

The Delhi government has given out hundreds of thousands of masks to children and closed schools for four of the past five days. Construction is banned and cars can only go on the roads on alternate days.   But still only a tiny number of inhabitants follow medical advice when outside. Rickshaw drivers who earn about $7 a day on an average say they cannot afford masks.   Chand Babu, a car park attendant at Khan Market, said he could buy one of the cheaper masks but it was too much of a hassle to wear.   "I have to blow the whistle all the time so it's inconvenient."   Babu does worry, however, about his three children who also do not have masks. "They go outside to play. The problem is real, but what do we do, tell me?"
Date: Sun, 17 Nov 2019 14:28:44 +0100 (MET)
By Filippo MONTEFORTE with Charles ONIANS in Rome

Venice, Nov 17, 2019 (AFP) - Venice's St Mark's Square was closed on Sunday as the historic city suffered its  third major flooding in less than a week, while rain lashing the rest of Italy prompted warnings in Florence and Pisa.   Venice's latest "acqua alta", or high water, hit 150 centimetres (just under five feet) on Sunday, lower than Tuesday's 187 centimetres -- the highest level in half a century -- but still dangerous.   "The water has stopped rising," tweeted mayor Luigi Brugnaro, who has estimated damage so far from the invading salt water at over one billion euros (dollars).   "High of 150 centimetres... Venice is working to restart," Brugnaro said after the sea water swamped the already devastated city where authorities have declared a state of emergency.   To the south, Tuscany president Enrico Rossi tweeted a warning of a "flood wave" on the Arno and said boards were being installed on the swollen river's banks in Pisa "as a precautionary measure".

The Italian army tweeted photos of paratroopers helping to bolster river defences in Pisa, with authorities monitoring the same river in Florence after heavy rain made it rise dramatically overnight.   Arno flooding devastated Renaissance jewel Florence in 1966, killing around 100 people and destroying thousands of priceless works of art. Civil protection units in Florence advised citizens "not to stand near the Arno's riverbanks".   Firefighters tweeted footage of a hovercraft being deployed to rescue stranded citizens in southern Tuscany's Grossetano province.

- Brief respite -
The renewed threat from exceptionally high tides in Venice came after a brief respite on Saturday.   Emergency workers removed temporary walkways from St Mark's Square as the water started to rise on Sunday, with only police and soldiers visible at around midday.   The top tourist site had already been shut for several hours on Friday as strong storms and winds battered the region, leaving it submerged by sea surges.

Churches, shops and homes have also been inundated in the Renaissance city, a UNESCO World Heritage site.   A massive infrastructure project called MOSE has been under way since 2003 to protect the city, but the multi-billion euro project has been plagued by cost overruns, corruption scandals and delays.   "We weren't expecting the high waters to be so exceptionally high," said Guido Fulgenzi, who had planned to open his cafe on St Mark's square this week.   "We're paying the price" for the MOSE project not being completed, he said, sloshing around in his flooded kitchen and pointing to Tuesday's high water mark on the wall.   The crisis has prompted the government to release 20 million euros ($22 million) in funds to tackle the devastation.   Culture Minister Dario Franceschini has warned that the task of repairing the city, where more than 50 churches have suffered damage, will be huge.

- Hotel reservations cancelled -
Residents whose houses have been hit are eligible for up to 5,000 euros in immediate government aid, while restaurant and shop owners can receive up to 20,000 euros and apply for more later.   Most of the city's cash machines were no longer working, making life even more difficult for tourists and Venetians.   "We didn't expect there to be so much water, now we're soaked," said French tourist Magali Mariolou, visiting Venice for her wedding anniversary.   "We'll come back another year when it's a bit drier. The boots are heavy, they're full of water!"

Older residents who remember the infamous "acqua alta" of 1966, when the water rose to 1.94 metres, say they have not seen such frequent flooding before.   Hotels reported cancelled reservations, some as far ahead as December, following the widespread diffusion of images of Venice underwater.   Tuesday's high waters submerged around 80 percent of the city, officials said.   Many, including Venice's mayor, have blamed the disaster on global warming and warned that the country prone to natural disasters must wake up to the risks posed by ever more volatile seasons.   The Serenissima, as the floating city is called, is home to 50,000 residents but receives 36 million visitors each year.
Date: Mon, 18 Nov 2019 06:41:11 +0100 (MET)

Wellington, Nov 18, 2019 (AFP) - Samoa finalised plans for a compulsory measles vaccination programme Monday, after declaring a state of emergency as a deadly epidemic sweeps the Pacific nation.   At least six fatalities, including five children, have been linked to the outbreak of the virus, which has also hit other island states such as Tonga and Fiji.   Samoa is the worst affected with more than 700 cases reported from across all areas of the country, prompting the government on Friday to invoke emergency powers.

Declaring a state of emergency, the government said plans for compulsory measles, mumps and rubella (MMR) immunisations would be published on Monday.   "MMR vaccinations for members of the public who have not yet received a vaccination injection is now a mandatory legal requirement for all of Samoa," it said.   A national emergency operations centre to coordinate the measles response in the nation of 200,000 people was opened on Monday, with children aged six months to 19 years and non-pregnant females aged 20-35 given priority.

However, no information was immediately available on how the vaccinations would be administered or whether those who were not immunised would face sanctions.   Children are the most vulnerable to measles, which typically causes a rash and fever but can also lead to brain damage and death.   Samoa has closed all schools, kindergartens and the country's only university in a bid to halt the spread of the virus.   New Zealand, which is experiencing its own measles outbreak in the Auckland region, will this week send 30 nurses, 10 doctors and 3,000 MMR doses to Samoa.

University of Auckland immunologist Helen Petousis-Harris said even though measles was already widespread, the mass rollout of vaccinations could help limit the number of cases and reduce the death count.   She said it was also important to boost Samoa's low levels of immunisation and help prevent future outbreaks.   "In Samoa, the proportion of people who are immune to measles is very, very low, one of the lowest in the world," she told AFP.   "So if they aren't able to improve that, this is going to happen again."   The country's vaccination programme was briefly suspended last year when two babies died shortly after being given the MMR vaccine.   Subsequent investigations found the problem was not the widely used vaccine but the fact that nurses had prepared it incorrectly.

Neighbouring Tonga last week announced government primary schools and kindergartens would be closed until later this month as the number of measles cases in the kingdom approaches 200.   Fiji has reported four cases but says they are contained to a township west of the capital Suva.