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Belize

Belize US Consular Information Sheet
November 05, 2008
COUNTRY DESCRIPTION:
Belize is a developing country.
Tourism facilities vary in quality, from a limited number of business class hotels in Belize City and resorts on the cayes to
range of ecotourism lodges and very basic accommodations in the countryside.
Crime is a growing concern. Read the Department of State Background Notes on Belize for additional information.

ENTRY/EXIT REQUIREMENTS :
All U.S. citizens must have a U.S. passport valid for the duration of their visit to Belize.
U.S. citizens do not need visas for tourist visits of up to thirty days, but they must have onward or return air tickets and proof of sufficient funds to maintain themselves while in Belize.
Visitors for purposes other than tourism, or who wish to stay longer than 30 days, must obtain visas from the government of Belize.
All tourists and non-Belizean nationalities are required to pay an exit fee of U.S. $35 (payable in U.S. dollars only) when leaving Belize. Additional information on entry and customs requirements may be obtained from the Embassy of Belize at 2535 Massachusetts Avenue NW, Washington, DC
20008, Tel. (202) 332-9636 or at their web site:
http://www.embassyofbelize.org.

Information is also available at the Belizean Consular offices in Miami, and Los Angeles, or at the Belizean Mission to the UN in New York.
Visit the Embassy of Belize web site at http://belize.usembassy.gov for the most current visa information.

Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
Visitors should exercise caution and good judgment when visiting Belize.
Crime can be a serious problem (see Crime), particularly in Belize City and remote areas.
Road accidents are common (see Traffic Safety and Road Conditions) and traffic fatalities have included Americans.
Public buses and taxis are frequently in poor condition and lack safety equipment.
Medical care is limited and emergency response services such as ambulances or paramedics may be either unavailable or limited in capability or equipment (See Medical Facilities and Health Information).

Boats serving the public, especially water taxis, often do not carry sufficient safety equipment, may carry an excess number of passengers and may sail in inclement weather.
Rental diving equipment may not always be properly maintained or inspected, and some local dive masters fail to consider the skill levels of individual tourists when organizing dives to some of Belize’s more challenging sites. Deaths and serious mishaps have occurred as a result of negligent diving tour operators and the lack of strict enforcement of tour regulations. The Embassy strongly recommends that anyone interested in scuba diving and snorkeling while in Belize check the references, licenses and equipment of tour operators before agreeing to or paying for a tour.
Both tour guides and boat captains are now required to be licensed by the Government of Belize. Safety precautions and emergency response capabilities may not be up to U.S. standards.

Following a fatal accident at the Cave Branch Archeological Park in September 2008, the Belize Tourism Board (BTB) is implementing new regulations, effective and legally enforced beginning October 15, 2008, to improve safety at cave tubing attractions.
Those policies will include an enhanced, mandatory guest-to-guide ratio of eight-to-one for all operating cave tubing tour companies in Belize.
Additional signage will be posted in each cave tubing excursion site, informing participants of park rules and current water conditions and/or warnings.
Mandatory specialty training for each cave tubing guide will continue and include education on new regulations.

Helmets will also be required for each cave tubing participant starting January 1, 2009.
Furthermore, the National Institute of Culture and History (NICH), which manages the Cave Branch Archeological Park, will be installing additional monitoring equipment for cave tubing excursions which measure currents and other factors needing to be taken into considerations to ensure participant safety,

Cave tubing participants are urged to exercise due caution and their own best judgment regarding safety and river conditions at the time of their tour, particularly during the rainy/hurricane season from June 1 through November 30.
Rainfall upstream from tour sites, sometimes miles away, can cause rapid changes in current strength and water level conditions without notice.

The border between Belize and Guatemala is in dispute, but the dispute thus far has not affected travel between the two countries.
There have not been any terrorist activities in Belize.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for 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:
The incidence of crime, including violent crimes such as armed robbery, shooting, stabbing, murder, and rape, is on the rise.
The Embassy has noted an increase in recent years in reports of crimes against tourists at resorts and on the roadways and river ways.
The incidence of crimes such as theft, burglary, purse snatching and pick pocketing rises around the winter holidays and spring break.
Several victims who resisted when confronted by criminals have received serious personal injuries, including gunshot wounds.
Although the majority of reported incidents are in Belize City, crime occurs in all districts including tourist spots such as San Pedro, Caye Caulker, and Placencia.

Sexual harassment and/or assault of females traveling alone or in small groups have occurred this past year.
Several American travelers have been the victims of sexual assaults in recent years. One of these occurred after the victim accepted a lift from an acquaintance, while others have occurred during armed robberies in resort areas.
One of these assaults has resulted in the death of the victim.

The Embassy recommends that visitors travel in groups and only in daylight hours, stay off the streets after dark, in urban and rural areas, and avoid wearing jewelry, or carrying valuable or expensive items.
As a general rule, valuables should not be left unattended, including in hotel rooms and on the beach.
Care should be taken when carrying high value items such as cameras, or when wearing expensive jewelry on the street.
Women’s handbags should be zipped and held close to the body.
Men should carry wallets in their front pants pocket.
Large amounts of cash should always be handled discreetly.

If traveling by taxi, use only vehicles with green license plates, do not get in a taxi that is occupied by more than the driver, and do not let the driver pick up additional fares.

Armed robberies of American tourist groups occurred during the summer of 2006 in the Mountain Pine Ridge and Caracol regions of the western district of Belize.
Due to increased police patrols, coordinated tours among resort security managers, and the arrest of two of the "highway bandits," there have not been any additional robberies since June, 2006. In the past, criminals have targeted popular Mayan archeological sites in that region.
Visitors should travel in groups and should stick to the main plazas and tourist sites.
Although there are armed guards posted at some of the archeological sites, armed criminals have been known to prey on persons walking from one site to another.
Victims who resist when confronted by these armed assailants frequently suffer personal injury.

Travel on rural roads, especially at night, increases the risk of encountering criminal activities.
Widespread narcotics and alien smuggling activities can make remote areas especially dangerous.
Though there is no evidence that Americans in particular are targeted, criminals look for every opportunity to attack, so all travelers should be vigilant.

Rather than traveling alone, use a reputable tour organization.
It is best to stay in groups, travel in a caravan consisting of two or more vehicles, and stay on the main roads.
Ensure that someone not traveling with you is aware of your itinerary.
Travelers should resist the temptation to stay in budget hotels, which are generally more susceptible to crime, and stay in the main tourist destinations.
Do not explore back roads or isolated paths near tourist sites.
And remember always to pay close attention to your surroundings.

Americans visiting the Belize-Guatemala border area should consider carefully their security situation and should travel only during daylight hours. Vehicles should be in good operating condition, adequately fueled, and carry communications equipment.
Persons traveling into Guatemala from Belize should check the Country Specific Information for Guatemala and the U.S. Embassy web site at http://guatemala.usembassy.gov for the latest information about crime and security in Guatemala.

A lack of resources and training impedes the ability of the police to investigate crimes effectively and to apprehend serious offenders. As a result, a number of crimes against Americans in Belize remain unresolved.
Nonetheless, victims of crime should report immediately to the police all incidents of assault, robbery, theft or other crimes as well as notifying the U.S. Embassy in Belmopan, telephone 822-4011(after hours and weekends 610-5030).
Tourists may contact the Belizean tourist police unit in addition to the main police office for assistance.

In addition to reporting crimes to local police, American citizens should report all criminal incidents to the U.S. Embassy in Belmopan, telephone 822-4011 (after hours and weekends 610-5030).
The embassy staff can assist an American with finding appropriate medical care, contacting family members or friends, and having funds transferred, as well as in determining whether any assistance is available from the victim’s home state.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help explain the local criminal justice process and assist in finding an attorney if needed.

Drug use is common in some tourist areas.
American citizens should avoid buying, selling, holding, or taking illegal drugs under any circumstances.
Penalties for possession of drugs or drug paraphernalia are generally more severe than in the U.S.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov.

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 for minor conditions is generally available in urban areas.
Trauma or advanced medical care is limited even in Belize City; it is extremely limited or unavailable in rural areas.
Serious injuries or illnesses often necessitate evacuation to another country.
The Government of Belize reported an outbreak of dengue fever in April, May and June of 2005.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas .
TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Belize is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Valid U.S. driver's licenses and international driving permits are accepted in Belize for a period of three months after entry.
Driving is on the right-hand side of the road.
Buses and private vehicles are the main mode of transportation in Belize; no trains operate in the country.
Roadside assistance can be difficult to summon, as there are very few public telephones along the road and emergency telephone numbers do not always function properly.
The Belizean Department of Transportation is responsible for road safety.

Roads in Belize vary from two-lane paved roads to dirt tracks.
The few paved roads are high-crowned roads, which can contribute to cars overturning, and have few markings or reflectors.
Even in urban areas, few streets have lane markings, leading many motorists to create as many lanes as possible in any given stretch of street or road.
Bridges on the major highways are often only single lanes.
The Manatee Road, leading from the Western Highway to Dangriga, is unpaved, easily flooded after storms and without services.
The Southern Highway from Dangriga to Punta Gorda is mostly completed and in good condition, except for a short portion that is under construction.
Service stations are plentiful along the major roads, although there are some significant gaps in the rural areas.

During Tropical Storm Alma/Arthur in May-June 2008, the Southern Highway bridge over the Sittee River, north of Kendall, Stann Creek District, was destroyed.
In the interim, a temporary causeway has been constructed pending permanent replacement of the Kendall bridge but at times the causeway may not be passable due to conditions on the Sittee River.
The causeway itself has had to be replaced several times following major rainfall and flooding.

Poor road and/or vehicle maintenance causes many fatal accidents on Belizean roads.
Speed limits are 55 miles per hour on most highways and 25 miles per hour on most other roads, but they are seldom obeyed or even posted.
Many vehicles on the road do not have functioning safety equipment such as turn signals, flashers, or brake lights.
Seatbelts for drivers and front-seat passengers are mandatory, but child car seats are not required.
Driving while intoxicated is punishable by a fine; if an alcohol-related accident results in a fatality, the driver may face manslaughter charges. Moreover, Americans can and have been imprisoned in Belize for accidents, even where alcohol is not involved.

Unusual local traffic customs include: pulling to the right before making a left turn; passing on the right of someone who is signaling a right-hand turn; stopping in the middle of the road to talk to someone while blocking traffic; carrying passengers, including small children, in the open beds of trucks; and tailgating at high speeds.

Bicycles are numerous and constitute a traffic hazard at all times.
Bicyclists often ride against traffic and do not obey even basic traffic laws such as red lights or stop signs.
Few bicycles have lights at night. It is common to see bicyclists carrying heavy loads or passengers, including balancing small children on their laps or across the handlebars.
The driver of a vehicle that strikes a bicyclist or pedestrian is almost always considered to be at fault, regardless of circumstances.
Americans who have struck cyclists in Belize have faced significant financial penalty or even prison time.

Driving at night is not recommended, due to poor signage and road markings, a tendency not to dim the lights when approaching other vehicles, and drunk driving.
Pedestrians, motorcyclists and bicyclists without lights, reflectors, or reflective clothing also constitute a very serious after-dark hazard.
Local wildlife and cattle also are road hazards in rural areas.
For safety reasons, travelers should not stop to offer assistance to others whose vehicles apparently have broken down.

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Belize’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Belize’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Belize is vulnerable to tropical storms, especially from June 1 until November 30 of each year. General information on weather conditions may be obtained from the National Hurricane Center at http://www.nhc.noaa.gov.

It is not possible to access most U.S. bank accounts through automated teller machines (ATMs) in Belize.
However, travelers can usually obtain cash advances from local banks, Monday through Friday, using major international credit cards.

Special Notice for Dual Nationals:
A person who is a citizen of both the U.S. and Belize is able to enter Belize with only a Belizean passport; such a dual national should be aware, however, that he/she must have a U.S. passport in order to board a flight to the U.S. from Belize, and that average processing time for a passport at the U.S. Embassy in Belize is approximately 10 working days.

Belize customs authorities may enforce strict regulations concerning temporary importation into or export from Belize of firearms.
It is advisable to contact the Embassy of Belize in Washington or one of Belize’s Consulates in the U.S. for specific information regarding customs requirements.
Please see our Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Belize laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Belize 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.
Belize has strict laws making possession of a firearm or ammunition illegal unless a valid permit is obtained.
Penalties for firearms violations are severe.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Belize are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site in order to obtain updated information on travel and security within Belize.
Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located in the capital city of Belmopan, approximately 50 miles west of Belize City.
The U.S. Embassy is on Floral Park Road, Belmopan, Cayo District, and the telephone number is 822-4011.
The American Citizen Services section fax number is 822-4050.
In the event of an after hours emergency, the embassy duty officer may be reached at 610-5030. The Embassy is open from 8:00 a.m. to 5:00 p.m., Monday through Friday, except for the 12:00 noon to 1:00 p.m. lunch hour, and on U.S. and Belizean holidays.
The Embassy web site is http://belize.usembassy.gov/; the e-mail address is embbelize@state.gov

Travel News Headlines WORLD NEWS

Date: Wed 2 May 2018, 3:30 PM CST.
Source: Breaking Belize News [edited]

Ministry of Health staff from the Western Health Region are currently in Benque Viejo and surrounding areas monitoring a developing situation due to confirmed cases of hepatitis A in Arenal and Benque. According to a statement from the Ministry, there have been 3 confirmed cases in Benque Viejo and 11 suspected cases in Arenal.

Part of the plan includes sensitization of school staff and students about hepatitis A, its transmission and risk factors. Food handlers in Benque and Arenal will also be visited and informed of the risks of hepatitis A and the importance of following established protocols.

The relevant departments in health have been made aware and are working closely with the region to minimize ongoing cases including a sensitization session on the local radio station in Benque.
===================
[No information is given about the age of those affected. In much of the developing world where hepatitis A is quite endemic, the population is almost all seropositive for HAV by the age of 10. I would wonder if the infection was confirmed by a specific IgM anti-HAV antibody. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Cayo District, Belize: <http://healthmap.org/promed/p/6149>]
Date: Mon 8 Oct 2017
Source: Outbreak News Today [edited]

The summer of 2017 appears to be "pink eye", or conjunctivitis season in the Americas with a number of countries in Central and South America and the Caribbean reporting increases of the eye infection.

Now joining the Bahamas, Brazil, Costa Rica, Dominica, the Dominican Republic, Guadeloupe, Martinique, Mexico, Panama, Saint Lucia, Saint Martin, Suriname, and the Turks and Caicos Islands is Belize where health officials report an increase in the number of reported conjunctivitis cases, particularly in the northern and central health regions.

The Belize Health Ministry says the symptoms of pink eye include:
- redness in the white of the eye or inner eyelid;
- watery eyes;
- thick yellow discharge that crusts over the eyelashes, especially after sleep; and
- itchy eyes, blurred vision and increased sensitivity to light

They offer the following measures to prevent the spread of this contagious infection:
- wash your hands often with soap and warm water. Wash them especially before and after cleaning, or applying eye drops or ointment to your infected eye;
- avoid touching or rubbing your eyes. This can worsen the condition or spread the infection;
- with clean hands, wash any discharge from around your eye(s) several times a day using a clean wet washcloth. Wash the used washcloth with hot water and soap, and then wash your hands again with soap and warm water;
- wash pillowcases, sheets, washcloths, and towels often with hot water and soap; wash your hands after handling such items;
- do not wear contact lenses until your eye doctor says it's okay to start wearing them again;
- do not share personal items such as pillows, washcloths, towels, eye drops, eye and face makeup, makeup brushes, contact lenses and contact lens containers, or eyeglasses;
- avoid shaking hands with others;
- persons suffering pink eye should stay away from work, school and public places until the infection clears.  [Byline: Robert Herriman]
==================
[Viral conjunctivitis, also called pinkeye, is a common, self-limiting condition that is typically caused by adenovirus. Other viruses that can be responsible for conjunctival infection include herpes simplex virus (HSV), varicella-zoster virus (VZV), picornavirus (enterovirus 70, Coxsackie A24), poxvirus (molluscum contagiosum, vaccinia), and human immunodeficiency virus (HIV) (<http://emedicine.medscape.com/article/1191370-overview>). But bacteria and allergens also can cause conjunctivitis.

There is no known specific treatment for this disease, and containment includes increased attention to hygiene.

According to <https://www.garda.com/crisis24/news-alerts/73151/belize-conjunctivitis-outbreak>, in the [3 weeks leading up to 26 Sep 2017], 1108 cases have been reported [in Belize] in what government officials are calling the worst such outbreak since 2005. Cases have been reported in Belize City, Corozal, Cayo, Chetumal, and Orange Walk, among other places.

See ProMED Conjunctivitis - Americas (10): Panama, Grenada, Mexico http://promedmail.org/post/20170929.5348507 for further discussion regarding the conjunctivitis outbreak in the Americas.

A HealthMap/ProMED-mail map of Belize can be found at
Date: Sat 26 Aug 2017
Source: Amandala [edited]
<http://amandala.com.bz/news/ciguatera-poisoning-linked-turneffe-barracudas/>

Each year, between 10,000 and 50,000 people who live in or visit tropical and subtropical areas suffer from Ciguatera Fish Poisoning (CFP), which is said to be one of the most frequently reported seafood-toxin illness in the world. Ciguatera poisoning, which causes symptoms such as tingling and numbness in fingers and toes, around lips, tongue, mouth and throat; nausea, vomiting, diarrhoea and/or abdominal cramps; joint pains and headache; and breathing difficulty, has also been reported in Belize, and over the past 4 days, 2 alerts have been issued by the Ministry of Health in Belize, following reports of cases cropping up, which have been linked to the consumption of barracuda fish. In the 1st alert, issued on [Fri 18 Aug 2017], the Ministry of Health reported that "suspected fish poisoning (Ciguatera poisoning) was detected in people that had eaten fish bought from a fish vendor in Ladyville, Belize District."

In the 2nd alert, issued on [Tue 23 Aug 2017], the Ministry said that 2 further cases of suspected Ciguatera poisoning, linked to the consumption of the large predatory fish, had been identified. "Investigations conducted so far reveal that the barracuda fish from the Turneffe Islands area has been the sole carrier of the ciguaxtoin or poison," the alert said. It warned that toxic fish does not have any odor or taste and cooking and freezing does not eliminate the toxin. According to the US Center for Disease Control and Prevention (CDC), ciguatera fish poisoning (or ciguatera) is an illness caused by eating fish that contain toxins produced by a marine microalgae called _Gambierdiscus toxicus_, associated with corals.

Whereas the barracuda is believed to be the culprit for the most recent bouts of illness caused by the toxin, other fish may also carry the toxin, including coral trout, red snapper, donu, parrot fish, grouper, Spanish mackerel, red emperor, wrasse, reef cod, sturgeon fish, trevally and moray eel. The CDC also lists blackfin snapper, cubera snapper, dog snapper, greater amberjack, hogfish, horse-eye jack, and king mackerel among the fish which have been known to carry ciguatoxins. "Anyone who consumes fish contaminated with the ciguatera toxin will become ill," the Ministry's alert said, adding that, "The gastrointestinal or stomach symptoms normally appear within 24 hours of exposure and those of the nervous system can appear 1 to 2 days later."

Although some symptoms may last only a few days, in some cases, the toxin can continue to affect those who ingest it for months. The CDC says people who have ciguatera may find that cold things feel hot and hot things feel cold. The Belize Ministry of Health has shared some guidelines for reducing the risk of CFP.

It advises the following:
- Avoid eating larger reef fish that have a greater likelihood of carrying ciguatoxins, especially the barracuda.
- Limit the weight of a fish to less than 11 pounds, as ciguatera fish poisoning occurs more frequently in larger fish.
- Eat other types of fish not listed above.
- Avoid eating the head, roe or fish egg, liver, or other organs of the fish, as it is where the highest level of toxin is present. [Byline: Adele Ramos]
=========================
[A recent open access review of ciguatera fish poisoning (CFP) has been published in Marine Drugs: Friedman MA , Fernandez M, Backer LC, et al: An updated review of Ciguatera Fish Poisoning: Clinical, epidemiological, environmental, and public health management. Mar Drugs 2017, 15(3): pii: E72; doi:10.3390/md15030072; available at: <http://www.mdpi.com/1660-3397/15/3/72/htm.

The publication does not say that the intoxication occurs related to fish from European waters. The description of the acute illness with the citations intact (the citations can be found at the original URL) has been extracted below: "CFP is characterized by gastrointestinal, neurological, and cardiovascular symptoms. In addition, after the initial or acute illness, neuropsychological symptoms may be reported.

Clinical features can vary depending on elapsed time since eating the toxic meal, and whether the geographic source of the implicated fish was the Caribbean Sea, Pacific, or Indian Ocean [17,36,52-58]. Gastrointestinal symptoms and signs usually begin within 6-12 hours of fish consumption and resolve spontaneously within 1-4 days.

Gastrointestinal symptoms may include nausea, vomiting, abdominal pain, and diarrhoea. The neurologic symptoms usually present within the 1st 2 days of illness. They often become prominent after the gastrointestinal symptoms (particularly in CFP events from Caribbean fish), although they may present concurrently with gastrointestinal symptoms (K Schrank, written communication, April 2016) [59].

The neurologic symptoms vary among patients and include paresthesias (that is, numbness or tingling) in the hands and feet or oral region, metallic taste, sensation of loose teeth, generalized pruritus (itching), myalgia (muscle pain), arthralgia (joint pain), headache, and dizziness. A distinctive neurologic symptom is cold allodynia, sometimes referred to as "hot-cold reversal," an alteration of temperature perception in which touching cold surfaces produces a burning sensation or a dysesthesia (that is, unpleasant, abnormal sensation) [60]. One study revealed that intra-cutaneous injection of CTX in humans elicited this sensation [61].

Cold allodynia is considered pathognomonic of CFP, although not all patients report experiencing it and it can be seen with other human seafood poisoning syndromes (such as neurotoxic shellfish poisoning). Less commonly, severe central nervous system symptoms, such as coma or hallucinations, have been reported [54,62,63].

Neuropsychological symptoms, which often become apparent in the days or weeks after the initial or acute illness, include subjectively reported cognitive complaints such as confusion, reduced memory, and difficulty concentrating [64-67], depression or irritability [64,65,68], and anxiety [65]. Fatigue or malaise have been reported and may be debilitating [6,62,69,70].

Cardiac symptoms and signs may manifest, generally in the early stage of the illness. When present, they usually occur in combination with gastrointestinal and/or neurologic signs and symptoms [71,72]. Cardiac signs often include hypotension and bradycardia which may necessitate emergency medical care." - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at: <http://healthmap.org/promed/p/19>.]
Date: Thu 2 Feb 2017 10:41 AM CST
Source: Breaking Belize News [edited]

Yesterday [1 Feb 2017] the Belize Agricultural Health Authority (BAHA) announced that bovine rabies has been confirmed in 3 districts in Belize: Orange Walk, Cayo, and Toledo.

Bovine rabies is a specific type of rabies that affects cattle; however, it can be transmitted to humans and as a result, farmers are advised by BAHA to vaccinate their livestock as well as sheep, cattle and horses.

Bovine rabies is a fatal disease that can be prevented through vaccination of animals.

Affected animals will show aggressive behavior and may salivate more than normal.

If [bovine] rabies is suspected in your district, please contact BAHA immediately at phone number 822-0818.
===================
[Rabies is a viral infection caused by viruses belonging to the Lyssavirus genus. It is a zoonosis -- an animal disease that can spread to humans -- transmitted through saliva from bites, and even scratches of infected animals.

In Belize, as urban rabies is well controlled, most cases of rabies occur as bovine paralytic rabies transmitted by the vampire bat. Rabies in cattle has been reported in all 6 districts. According to the OIE vaccinating 70 percent of dogs allows rabies to be eradicated from a given endemic area.

Generally in Belize the rabies is of vampire bat origin. Cases of human rabies, including deaths, have been reported in Belize. There, several strains of the rabid virus circulate in the vampire bat, _Desmodus rotundus_.

The hairy-legged vampire bat, _Diphylla ecaudata_, is naturally infected by rabies virus (same variant as one infecting _D. rotundus_), so this vampire species is definitely a source for rabies cases in humans.

This vampire species ranges from Southern Tamaulipas (Mexico) to Colombia, Venezuela, Ecuador, Peru, Bolivia, Belize, and Brazil (except the central Amazon basin); a single vagrant individual has also been reported from Southern Texas, USA. (For a picture go to  <https://naturalhistory.si.edu/mna/images/images/831032911523015.jpg>).

Predators and parasites can be plastic when it comes to selecting their preys/hosts, and this confers to them the ability to adapt to environmental changes, and a phenomenon of special interest for public health, as it is associated with the link between human-driven change and emerging diseases.

Notifications of suspect rabies cases are investigated by BAHA, the MoH and the Ministry of Agriculture (MNRA) at no cost to the animal owner. A history of the animal determines the steps to be taken, I.e., whether it is isolated and kept for observation or euthanatized and the brain sent to the veterinary services laboratory in Panama. The MoH will determine human exposure to the virus. If warranted (bite, scratch, saliva) a post exposure regimen will be initiated which consists of 5 vaccines. Laboratory-confirmed cases in cattle trigger control response which includes vaccination of herd, vaccination of susceptible animals in protection zone and vampire bat control at farm and roosts (caves).

If you believe your animal, regardless of whether it is bovine, dog or other animal has rabies or is acting differently than normal, please call your veterinarian. Remember that thinking a bovine is choking and putting your hand in the mouth to remove the blockage may expose you to rabies.

Portions of this comment were extracted from

[Maps of Belize can be seen at
<http://healthmap.org/promed/p/19>. - ProMED Sr.Tech.Ed.MJ]
Date: Thu, 4 Aug 2016 08:41:33 +0200
By Henry MORALES

Puerto Barrios, Guatemala, Aug 4, 2016 (AFP) - A hurricane packing 130 kilometre (80 mile) per hour winds and heavy rain made landfall in Central America near Belize's capital, where officials warned of likely flooding and damage to homes Thursday.   Hurricane Earl swept in from the Caribbean to strike just south of Belize City, population 60,000, around midnight Wednesday (0600 GMT Thursday), according to the US National Hurricane Center (NHC).

Along the way, it had gathered strength and dumped rain on northern Honduras as it brushed past at sea.     The hurricane's heavy rains "could cause flash floods and mudslides especially over higher terrain," Belize's National Emergency Management Organization said in a bulletin just before it arrived.   "For coastal areas, there is also a risk for flooding, especially in low-lying areas."   Nearby Guatemala, Honduras and southern Mexico also issued alerts. Airports in the area were closed.

- Evacuations -
Earl was expected to weaken as it continued west from Belize City, farther inland, toward northern Guatemala and southeastern Mexico.   The Mexican authorities took no chances, evacuating 300 families living close to a river along the border with Belize in the southeastern state of Quinta Roo for fear of flooding.   More than 750 shelters were readied in the state in preparation for expected high winds and fierce gusts.

Other southern Mexican states likely to be affected were Campeche, Tabasco and Yucatan.   In the northern Guatemala town of Puerto Barrios, a military commander, Colonel Nelson Tun, told AFP that "patrols in vulnerable areas" were being carried out.   "We have identified high areas to where the population can evacuate before possible flooding," he said.

Guatemala in particular is prone to rainy season flooding and mudslides that often prove fatal.   Guatemala's population, at 16 million, is much bigger than the 330,000 in Belize, Central America's only English speaking country.   Guatemala's president, Jimmy Morales, late Wednesday offered Belize humanitarian aid and shelters along the border if needed.   That gesture was significant after months of tensions between the two countries following a shooting death of a Guatemalan boy by a Belizean border patrol in April.

- Category 1 hurricane -
The fifth named tropical storm of the 2016 season, Earl strengthened to a Category 1 hurricane on Wednesday, according to the NHC. Winds initially measured at 120 kilometers per hour picked up just before landfall.   Category 1, the lowest of five grades on the hurricane scale, is described as having dangerous winds of between 119 and 153 kilometers per hour that can rip off roofs, bring down trees and cause extensive damage to power lines.   Belizean public and private sector workers were permitted to go to their homes Wednesday to secure property.   Officials warned that people living on the ground floor "will experience flooding" and some older wooden buildings would likely be destroyed.   The authorities have opened 29 shelters.
More ...

World Travel News Headlines

Date: Wed, 20 Nov 2019 22:35:51 +0100 (MET)

Manila, Nov 20, 2019 (AFP) - Philippine police were ordered Wednesday to arrest anyone caught vaping in public, just hours after Philippine President Rodrigo Duterte announced he would ban e-cigarettes.   The abrupt prohibition, revealed by Duterte late Tuesday adds to a growing global backlash against a product once promoted as less harmful than tobacco smoking.

Duterte, a former smoker, called the devices "toxic" and said vaping introduced "chemicals" into the user's body.   He ordered the arrest of anyone vaping publicly in a country that already has some of Asia's toughest anti-smoking rules.    No formal, written order has been made public that spells out the scope of the ban or penalties for violations.   Duterte is notorious internationally for his deadly anti-narcotics crackdown, but he has also targeted tobacco with a wide-ranging ban on smoking in public.   Citing "the order of the president", on Wednesday a statement from the head of the Philippine police ordered "effective today, all police units nationwide to enforce the ban on use of vapes; ensure that all violators will be arrested".

The ban came days after Philippine health authorities reported the nation's first vaping-related lung injury, which resulted in a 16-year-old girl being hospitalised.   Vaping has taken off in the Philippines, with speciality shops and vapers puffing away in public a common sight.     E-cigarette users were caught off guard by the ban and questioned the utility of arresting people who, at worst, were hurting themselves.   "It's inappropriate. In any case, we don't hurt people, the environment or animals," said 22-year-old student Alexis Martin.   "Why are vapers being targeted?"

E-cigarettes warm flavoured liquid to produce vapour that is free of the estimated 7,000 chemicals in tobacco smoke, but does contain a number of substances that could potentially be harmful.  Critics say that apart from being harmful in themselves, the multiple exotic flavours of e-cigarette liquids appeal particularly to youngsters and risk getting them addicted to nicotine.

The devices have become hugely popular in the past decade but a rash of vaping-linked deaths and illnesses in the United States is feeding caution about the product, already banned in some places.   In September 2019 India became the latest country to ban the import, sale, production and advertising of e-cigarettes, citing in particular concerns for its youth.   The devices are already banned in several places such as Brazil, Singapore, Thailand and the US state of Massachusetts.
Date: Wed, 20 Nov 2019 17:17:39 +0100 (MET)

Lagos, Nov 20, 2019 (AFP) - Nigerian President Muhammadu Buhari on Wednesday announced a campaign to end defecation in public, in a country where tens of millions of people going to the toilet outside poses a major health risk.    "Nigeria has committed to end open defecation throughout the country by 2025," a statement by the presidency said a day after the United Nations marked World Toilet Day.     The decree set up a new body called the Clean Nigeria Campaign Secretariat to ensure "that all public places including schools, hotels, fuel stations, places of worship, market places, hospitals and offices have accessible toilets and latrines within their premises". 

According to the United Nations children agency, UNICEF, Nigeria has amongst the highest number of people practising open defecation in the world, estimated at over 46 million people -- almost a quarter of the population.   Around Nigeria each year 87,000 children die from diarrhoea, with more than 90 per cent of deaths caused by a lack of water, sanitation and hygiene, according to the World Bank.   The new agency will be disbanded when the goal of ending open defecation has been met, the presidency said.
Date: Wed, 20 Nov 2019 12:59:15 +0100 (MET)

Kampala, Nov 20, 2019 (AFP) - Global health charity Marie Stopes said Wednesday it had recalled hundreds of thousands of faulty condoms on sale in Uganda, where HIV rates are among the highest in the world.   The recall followed a warning from Uganda's National Drug Authority (NDA) that the Life Guard brand condoms had failed manufacturing "quality tests" because they contained holes and may burst.   The affected condoms were manufactured by India-based MHL Healthcare in April 2019 and have an expiry date of April 2024, the government regulator said.   Marie Stopes Uganda spokesman David Kamu told AFP on Wednesday that the two affected batches each contained "around 400,000" condoms.

Earlier reports had suggested millions of condoms could have been involved but NDA spokesman Fred Ssekyana told AFP the figure was below one million.   Marie Stopes Uganda said more than half of the condoms of concern had been recalled.   "While the LifeGuard brand follows strict quality controls, unfortunately two recent batches have fallen short of the quality we demand," the charity's country director, Carole Sekimpi, said in a statement Tuesday.   Marie Stopes is the largest and most specialised sexual reproductive health organisation in Uganda, the charity says on its website.   According to UNAIDS, 1.4 million Ugandans are living with HIV.   Last year 53,000 people were newly infected with the disease in the East African country, the UN agency said.
Date: Wed, 20 Nov 2019 15:08:18 +0100 (MET)

Luanda, Nov 20, 2019 (AFP) - Angola recorded an outbreak of polio this week after almost a decade without cases of the paralysing viral disease, the government said.   The highly infectious condition mainly affects children under the age of five. It attacks the nervous system and can lead to total paralysis, or in some cases death.   "After seven years without polio we are unfortunately confronted with a difficult situation," Angola's health minister Sante Silvia Lutucuta said on Monday, at the launch of a new vaccination campaign in the capital Luanda.   "We have recorded 44 new cases in ten of the country's 18 provinces," she added.

The vaccination campaign is expected to reach 2.5 million children aged five and under.   "All children must be protected by three doses of the oral anti-poliomyelitis vaccine," said Lutucuta, adding that the campaign would span over two weeks to "control the epidemic".   Two out of three strains of the wild polio virus have been eradicated so far, according to the World Health Organization (WHO).           While only 33 wild polio cases were reported globally last year, vaccine-derived polio still breaks out sporadically in some parts of Africa and Asia.    The Centers for Disease Control and Prevention has recommended that all travellers to Angola be fully vaccinated against the virus.
Date: Thu, 21 Nov 2019 01:34:32 +0100 (MET)

Bangkok, Nov 21, 2019 (AFP) - A 6.1-magnitude earthquake hit north-western Laos near the Thai border early Thursday, the United States Geological Survey reported.    The shallow quake hit at 6:50 am local time (2350 Wednesday GMT), USGS said. 
Date: Thu, 21 Nov 2019 01:25:15 +0100 (MET)

Sydney, Nov 21, 2019 (AFP) - The fire danger was elevated across wider swathes of southern Australia on Thursday, with residents warned to avoid at-risk areas as smoke from bushfires choked Sydney and other major cities.   Devastating fires along the country's east coast have claimed six lives and destroyed more than 500 homes since mid-October, with climate change and unseasonably hot, dry conditions fuelling the unprecedented blazes.   Now the fire danger has moved into states further south, with a so-called "Code Red" -- the highest possible fire risk in Victoria -- being declared in the state's northwest for the first time in a decade.   "What that means is that if we see fires in those areas they will be fast moving, they will be unpredictable, they will be uncontrollable," emergency management commissioner Andrew Crisp told reporters.

Country Fire Authority chief Steve Warrington told people living in rural areas to leave for the safety of cities.   "We are saying, 'do not be there, do not be there when a fire occurs, because you will not survive if you are there'," he said.   "There is a good chance if a fire occurs that your home will be destroyed."   The fire danger was also elevated to "severe" in the island state of Tasmania off mainland Australia's southeastern coast,  where a total fire ban was declared.   Two bushfires in the state's northeast did not pose an immediate threat to residents, the Tasmania Fire Service said.

For the second time in two days, smoke from bushfires blanketed Sydney, Australia's biggest city and home to more than five million people, sending air quality plummeting to hazardous levels.   More than 110 fires are still burning in worst-hit New South Wales and neighbouring Queensland, while in South Australia more than 40 fires broke out during catastrophic fire conditions Wednesday.    A South Australia Country Fire Service spokeswoman said all of those blazes had been brought under control or extinguished by Thursday, with the exception of a major fire on the Yorke Peninsula that had come perilously close to a small town.

Conditions were expected to ease in the coming days in South Australia, where the state capital Adelaide was also shrouded in bushfire smoke and residents were being told to stay indoors for health reasons.   Bushfire-prone Australia has experienced a horror start to its fire season, which scientists say is beginning earlier and becoming more extreme as climate change pushes temperatures higher and saps moisture from the environment after months of severe drought.   Growing calls to curb fossil fuels and drastically cut greenhouse gas emissions are being ignored by the country's conservative government, which is eager to protect its lucrative mining industry.   The country is bracing for challenging fire conditions to continue throughout the Southern Hemisphere summer.
Date: Mon 18 Nov 2019
Source: 112.UA [edited]

Eight school classes in Odesa [Odessa] have been closed for quarantine. More than 30% of school students in these classes are sick with Coxsackie virus, a highly contagious respiratory disease, said Olena Buynevych, the director of the city hall's department for science and education, as quoted by UNN news agency.

"More than 30% of students in these classes are sick wi h acute
respiratory diseases, which include cases of cases and Coxsackievirus," the official said. She urged the parents to keep the children away from schools in case they have any symptoms of acute respiratory diseases.

The symptoms are basically the same as flu; the key difference is the rash on the palms, in case of the Coxsackievirus.

Coxsackievirus is a member of a family of viruses called enteroviruses. Enteroviruses are made up of a single strand of ribonucleic acid (RNA). The enteroviruses are also referred to as picornaviruses ("pico" means "small," so, "small RNA viruses"). They are present all over the world and spread by fecal-oral route. About 90% of infections don't cause symptoms or present with a fever only. Infants and young kids are particularly susceptible to symptomatic coxsackie.
======================
[Coxsackievirus belongs to a family of nonenveloped, linear, positive-sense, single-stranded RNA viruses, Picornaviridae and the genus _Enterovirus_, which also includes poliovirus and echovirus. Enteroviruses are among the most common and important human pathogens, and ordinarily its members are transmitted by the fecal-oral route. Coxsackieviruses share many characteristics with poliovirus. With control of poliovirus infections in much of the world, more attention has been focused on understanding the nonpolio enteroviruses such as coxsackievirus.

Coxsackieviruses are divided into group A and group B viruses based on early observations of their pathogenicity in neonatal mice. In general, group A coxsackieviruses tend to infect the skin and mucous membranes, causing herpangina, acute hemorrhagic conjunctivitis, and hand, foot, and mouth (HFM) disease. Both group A and group B coxsackieviruses can cause nonspecific febrile illnesses, rashes, upper respiratory tract disease, and aseptic meningitis.

Group B coxsackieviruses tend to infect the heart, pleura, pancreas, and liver, causing pleurodynia, myocarditis, pericarditis, and hepatitis (inflammation of the liver not related to the hepatotropic viruses). Coxsackie B infection of the heart can lead to pericardial effusion.

The development of insulin-dependent diabetes (IDDM) has recently been associated with recent enteroviral infection, particularly coxsackievirus B pancreatitis.

It is common for the coxsackievirus to cause a febrile upper respiratory tract infection with sore throat and/or a runny nose. Some patients have a cough resembling bronchitis. Less commonly, coxsackievirus may cause pneumonia. Some people with coxsackievirus have a rash. In many, this is a nonspecific generalized red rash or clusters of fine red spots. The rash may not appear until the infection has started to get better.

Coxsackievirus is spread from person to person. The virus is present in the secretions and bodily fluids of infected people. The virus may be spread by coming into contact with respiratory secretions from infected patients. If infected people rub their runny noses and then touch a surface, that surface can harbor the virus and become a source of infection. People who have infected eyes (conjunctivitis) can spread the virus by touching their eyes and touching other people or surfaces. Conjunctivitis may spread rapidly and appear within one day of exposure to the virus. Coxsackieviruses are also shed in stool, which may be a source of transmission among young children. The virus can be spread if unwashed hands get contaminated with fecal matter and then touch the face. This is particularly important for spread within  day-care centers or nurseries where diapers are handled. Diarrhoea is the most common sign of coxsackievirus intestinal infection.

Most infections are self-limiting, and no specific treatment is required or available. Some options include intravenous immune globulin (IVIG), which contains antibodies and may be somewhat effective.

HealthMap/ProMED-mail map:
Odesa oblast, Ukraine: <http://healthmap.org/promed/p/51897>]
Date: Tue 19 Nov 2019 6:07 AM GMT
Source: 3 FM [edited]

There's been an outbreak of a highly contagious disease among wood pigeons on [Isle of Man]. That's according to Manx Wild Bird Aid (MWBA) which says its already taken in a number of the animals from Douglas, Groudle, and Crosby which are suffering with 'canker'.

The infection isn't harmful to humans or mammals but the organisation says it can cause growths in the birds' mouths which can lead them to starve to death.

MWBA is offering advice to people about how to help stop it spreading, including strict hygiene on bird-feeding tables and if you come across a sick pigeon to take it to the nearest vet as soon as possible.  [Byline: Rob Pitchard]
========================
[_Trichomonas gallinae_ is a common protozoan parasite of pigeons (Columbiformes) which principally infects the upper alimentary tract where it can cause necrotic ingluvitis. Epidemic mortalities in columbiform species are sporadically reported, and the parasite may infect other avian taxa such as birds of prey and songbirds. (<http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0012215>). - ProMED Mod.PMB]

[HealthMap/ProMED-mail map of the Isle of Man:

HealthMap/ProMED map available at:
Date: Tue 19 Nov 2019
Source: Caracas Chronicles [edited]

The Venezuelan Public Health Society and the Let's Defend The National Epidemiology Network issued an alert after a case of yellow fever was confirmed in the state of Bolivar, after 14 years without the disease. The Health Ministry hasn't published information about the case or issued an alert, but Venezuela must formally report it to international institutions, due to the risk to a population that isn't vaccinated, having the vector (mosquitoes) in all of the territory (increasing the odds of an epidemic), and the poor access to an epidemiologic report [about the case]. Doctor Julio Castro wrote about the case for Prodavinci.  [Byline: Naky Soto]
======================
[There is little information about this case: where and when it occurred in Bolivar state, tests used to diagnose the case, condition of the patient, and any follow-up measures taken by public health authorities. Yellow fever (YF) virus is endemic in Venezuela as it is in many South American countries.

The most recent ProMED-mail report of YF in Venezuela was in 2010, in Anzoategui state, where there were 3 probable YF cases in monkeys. This outbreak was enzootic, as determined by the Ministry of Health (see Yellow fever - South America: Venezuela (AN) monkey, susp http://promedmail.org/post/20101112.4114).

Presumably, this current case is one of spill-over from the sylvan (forest) transmission cycle. Maintenance of a high level (80-90%) of coverage is essential to prevent cases and avoid outbreaks involving the urban cycle with _Aedes aegypti_ transmission. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Venezuela:
Date: Thu 14 Nov 2019
Source: WHO Emergencies preparedness, response, Disease Outbreak News (DONs) [edited]

On 10 Oct 2019, the National IHR Focal Point for Sudan notified WHO of 47 suspected [human] cases of Rift Valley fever (RVF), including 2 deaths in Arb'aat Area, Towashan Village, in El Qaneb locality, Red Sea State. The suspected cases presented with high-grade fever, headaches, joint pain, vomiting. There were no hemorrhagic signs or symptoms observed. The 1st case presented to the health facility on 19 Sep 2019.

On 28 Sep 2019, a total of 14 samples were sent to the National Public Health Laboratory in Khartoum, and 5 tested positive for RVF by immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) and reverse-transcriptase polymerase chain reaction (RT-PCR). These samples were also tested for malaria and were found negative.

On 13 Oct 2019, a total of 10 suspected RVF cases were recorded in Barbar and Abu Hamed localities, of River Nile State. Of the 10 suspected RVF cases, 5 samples were tested and 4 were found positive for RVF. From 19 Sep 2019 until 11 Nov 2019, a total of 293 suspected human RVF cases, including 11 associated deaths have been reported from 6 states; including the Red Sea (120), River Nile (168), Kassala (2), White Nile (1), Khartoum (1), and Al Qadarif (1) States. The most affected age group is 15-45 years old, which accounts for 83% of the total suspected cases. The male to female ratio is 2.6, with a high proportion of the cases being farmers (37.5%).

These human RVF cases are concomitant with abortions and deaths among goats in the areas where the human suspected and confirmed cases have been reported. From 25 Sep through 3 Nov 2019, 21 goats in Red Sea State were reported as positive for RVF, including 4 deaths; and in River Nile State 16 goats, with 3 deaths, and 37 sheep, with 5 deaths, were confirmed positive for RVF by ELISA test at the Central Veterinary Research Laboratory in Khartoum.

Public health response
----------------------
Red Sea State
-------------
- Activation of RVF task force committee;
- printing and distribution of RVF guidelines;
- deployment of surveillance teams for daily reporting and active case finding in the affected areas;
- establishment of 2 health centers and one dispensary with a capacity of 11 beds, laboratory items, drugs, and supplies to provide health services in the affected villages;
- conducting household inspections and fogging: In Arb'aat area, a total of 452 households were inspected, out of which 30 were found positive for the presence of a competent vector; in Port Sudan, out of 1225 households inspected, 29 were found positive for the competent vector, and fogging was provided to 1949 households;
- the Veterinary Epidemiology Department of the Ministry of Animal Resources conducted vector control in 4 animal enclosures in the affected villages.

River Nile State
- A joint investigation conducted by the State Ministry of Health (SMoH) and WHO on 12 Oct 2019;
- initiation of an RVF Action plan by the SMoH and WHO;
- initiation of Integrated Vector Management (IVM), surveillance, case management, and Rapid Response Team (RRT) activities.

WHO risk assessment
-------------------
RVF is endemic in Sudan. There have been 3 outbreaks affecting humans previously documented in 1973, 1976, and 2008. During the outbreak in 2008, a total of 747 laboratory-confirmed cases were reported, including 230 deaths.

The recent floods, following heavy rains on 13 Aug 2019, caused flash floods in 17 of the 18 states, including Abyei area in West Kordofan State. These floods have favored vector abundance, distribution, and longevity. The current RVF outbreak started on 19 Sep 2019 and has affected states impacted by the floods.

The uncontrolled movements of animal populations within and outside the country borders may increase the spread of the disease to new areas.

RVF can cause significant economic losses due to livestock travel and trade restrictions, as well as high mortality and abortion rates among infected animals.

In a country where the export of livestock is one of the major sources of the national income, the current RVF outbreak, in the context of political unrest and a debilitated health system requires an urgent need for external assistance.

WHO advice
----------
Rift Valley fever (RVF) is a mosquito-borne viral zoonosis that primarily affects animals but also has the capacity to infect humans. The majority of human infections result from direct or indirect contact with the blood or organs of infected animals. Herders, farmers, slaughterhouse workers, and veterinarians have an increased risk of infection.

Awareness of the risk factors of RVF infection and measures to prevent mosquito bites is the only way to reduce human infection and deaths. Public health messages for risk reduction should focus on:
- reducing the risk of animal-to-human transmission resulting from unsafe animal husbandry and slaughtering practices;
- practicing hand hygiene as well as wearing gloves or other personal protective equipment when handling sick animals or their tissues and when slaughtering animals;
- reducing the risk of animal-to-human transmission arising from the unsafe consumption of raw or unpasteurized milk or animal tissue. in endemic regions, all animal products should be thoroughly cooked before eating;
- reducing the risk of mosquito bites through the implementation of vector control activities (e.g. insecticide spraying and use of larvicidal to reduce mosquito breeding sites), use of insecticide-impregnated mosquito nets and repellents, light-coloured clothing (long-sleeved shirts and trousers);
- restricting or banning the movement of livestock to reduce the spread of the virus from infected to uninfected areas;
- routine animal vaccination is recommended to prevent RVF outbreaks. Vaccination campaigns are not recommended during an outbreak as they may intensify transmission among the herd through needle propagation of the virus;
- outbreaks of RVF in animals precede human cases, thus the establishment of an active animal health surveillance system is essential in providing early warning for veterinary and public health authorities.

WHO advises against the application of any travel or trade restrictions with the affected country based on the current information available on this event.
=====================
[The report above provides a good overview of the development of the current Rift Valley fever outbreak. Surveillance and responses require a One Health approach since both humans and animals are affected and environmental change, in this situation extensive flooding, has promoted vector abundance. Effective vector control over extensive geographical areas is difficult to achieve and is expensive. Maintenance of herd immunity through vaccination of animals can be a successful preventive measure prior to the occurrence of cases. - ProMED Mod.TY]

[Neighbouring Egypt, which suffered introductions of RVF from Sudan in the past, has undertaken preventive measures. This relates initially to the 2 governorates bordering Sudan, namely the Red Sea and the New Valley governorates. In the Red Sea governorate, vaccination has already started. Reportedly, as of 18 Nov 2019, a total of 12 801 animals have been vaccinated, including 11 568 sheep and goats, 712 camels, and 421 cows and buffalo. The vaccination, which is free of charge, is being continued. In the New Valley governorate, 62 guidance seminars about RVF for animal breeders in the 5 provincial centers have been undertaken; the implementation of a "magnified immunization campaign for a month" is said to commence "next Saturday" (23 Nov 2019), "aimed at immunizing 120 000 cattle, goats, and sheep." Intensified surveillance in animals has, reportedly, been applied in both governorates; no suspected cases detected. - ProMED Mod.AS]