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Faroe Islands

http://en.wikipedia.org/wiki/Faroe_Islands
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The early history of the Faroe Islands is not very clear. According to Færeyinga Saga emigrants who left Norway to escape the tyranny of Harald I of Norway settled in the isla
ds about the beginning of the 9th century. There is also evidence that Irish monks settled the islands, introducing sheep in the process. Early in the 11th century Sigmund, whose family had flourished in the southern islands but had been almost exterminated by invaders from the northern islands, was sent from Norway, from which he had escaped, to take possession of the islands for Olaf Tryggvason, king of Norway. He introduced Christianity and, though he was subsequently murdered, Norwegian supremacy was upheld. Norwegian control of the islands continued until 1380, when Norway entered into a union with Denmark, which gradually evolved into the double monarchy Denmark/Norway. The reformation reached the Faroes in 1538. When Norway was taken away from Denmark at the Treaty of Kiel in 1814, Denmark retained possession of the Faroe Islands.
The monopoly trade over the Faroe Islands was abolished in 1856. Since then, the country developed towards a modern fishery nation with its own fleet. The national awakening since 1888 was first based on a struggle for the Faroese language, and thus more culturally oriented, but after 1906 was more and more politically oriented after the foundation of the political parties of the Faroe Islands.
On April 12, 1940, the Faroes were invaded and occupied by British troops. The move followed the invasion of Denmark by Nazi Germany and had the objective of strengthening British control of the North Atlantic (see Second Battle of the Atlantic). In 1942–43 the British Royal Engineers built the only airport in the Faroes, the Vágar Airport. Control of the islands reverted to Denmark following the war, but in 1948 a home rule regime was implemented granting a high degree of local autonomy. The Faroes declined to join Denmark in entering the European Community (now European Union) in 1973. The islands experienced considerable economic difficulties following the collapse of the fishing industry in the early 1990s, but have since made efforts to diversify the economy. Support for independence has grown and is the objective of the government.
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Denmark, Greenland and the Faeroe Islands US Consular Information Sheet
August 15, 2006
COUNTRY DESCRIPTION: Denmark is a highly developed stable democracy with a modern economy. Greenland is a self-governing dependency of Denmark. The Faroe Islands are a self-governing overseas administrative division of Denmark. Read the Department of State Background Notes on Denmark for additional information.

ENTRY REQUIREMENTS: Passport and visa regulations are similar for Denmark, Greenland, and the Faroes. A valid passport is required. U.S. citizen tourist and business travelers do not need visas for visits of up to 90 days. That period begins when entering any of the following countries which are parties to the Schengen agreement: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, The Netherlands, Norway, Portugal, Spain, and Sweden. See our Foreign Entry Requirements brochure for more information on Denmark and other countries. Contact the Royal Danish Embassy at 3200 Whitehaven Street, N.W. Washington, DC 20008, telephone (202) 234-4300 or visit its website at for the most current visa information.

Note: Although European Union regulations require that non-EU visitors obtain a stamp in their passports upon initial entry to a Schengen country, many borders are not staffed with officers carrying out this function. If an American citizen wishes to ensure that his or her entry is properly documented, it may be necessary to request a stamp at an official point of entry. Under local law, travelers without a stamp in their passports may be questioned and asked to document the length of their stay in Schengen countries at the time of departure or at any other point during their visit, and could face possible fines or other repercussions if unable to do so.

Find more information about Entry and Exit Requirements pertaining to dual nationality and the prevention of international child abduction .
SAFETY AND SECURITY: Denmark remains largely free of terrorist incidents, however the country shares, with the rest of Western Europe, an increased threat of Islamic terrorism. Like other countries in the Schengen area, Denmark's open borders with its Western European neighbors allow the possibility of terrorist groups entering and exiting the country with anonymity. Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

Public demonstrations occasionally occur in Copenhagen and other Danish cities and are generally peaceful events. Prior police approval is required for public demonstrations, and police oversight is routinely provided to ensure adequate security for participants and passers-by. Nonetheless, as with any large crowd comprised of diverse groups, situations may develop which could pose a threat to public safety. U.S. citizens are advised to avoid areas where public demonstrations are taking place.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State's web site , where the current Worldwide Caution Public Announcement , Travel Warnings, and Public Announcements 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 United States, or, for callers outside the United States 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: Denmark, Greenland, and the Faroes all have very low violent crime rates, however, non-violent crimes of opportunity have slightly increased over the last few years, especially in Copenhagen and other major Danish cities, where tourists can become targets for pickpockets and sophisticated thieves. Criminals frequent airports, train stations, and cruise ship quays to take advantage of weary, luggage-burdened travelers. Thieves also operate at popular tourist attractions, shopping streets, and restaurants. In hotel lobbies and breakfast areas, thieves take advantage of even a brief lapse in attention to snatch jackets, purses, and backpacks. Women's purses placed either on the backs of chairs or on the floor are typical targets for thieves. Car and home break-ins are also on the rise.

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, to contact family members or friends, and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

Denmark has a program to provide financial compensation to victims who suffer serious criminal injuries. According to existing regulations, the victim must report the incident to the police within 24 hours. Danish police routinely inform victims of serious crime of their rights to seek compensation. The relevant forms can be obtained from the police or the Danish Victims' Compensation Board: Civilstyrelsen, Erstatningsnaevnet, Gyldenløvesgade 11, 1600 Copenhagen V, TEL: (45) 33-92- 3334; FAX: (45) 39-20-45-05; www.erstatningsnaevnet.dk ; Email: erstatningsnaevnet@erstatningsnaevnet.dk . Claim processing time is a minimum of 4 weeks. There is no maximum award limit.

See our information for Victims of Crime .
MEDICAL FACILITIES AND HEALTH INFORMATION: Excellent medical facilities are widely available in Denmark. In Greenland and the Faroe Islands, medical facilities are limited and evacuation is required for serious illness or injury. Although emergency medical treatment is free of charge, the patient is charged for follow-up care.

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 (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC's website at . 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 .

MEDICAL INSURANCE: The Department 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 Denmark is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

A valid U.S. driver's license may be used while visiting Denmark, but the driver must be at least 18 years old. Driving in Denmark is on the right side of the road. Road signs use standard international symbols. Many urban streets have traffic lanes reserved for public transport only. Unless otherwise noted on traffic signs, the speed limit is 50 km/h in urban areas, 80 km/h on open roads, and 130 km/h on expressways.

Use of seat belts is mandatory for drivers and all passengers. Children under three years of age must be secured with approved safety equipment appropriate to the child's age, size, and weight. Children from three to six years of age may use approved child or booster seats instead of seat belts.

Driving under the influence of alcohol or drugs is considered a very serious offense. The rules are stringently enforced, and violations can result in stiff fines and possible jail sentences.

Copenhagen, the capital and largest city in Denmark, has an extensive and efficient public transportation system. Trains and buses connect Copenhagen with other major cities in Denmark and to Norway, Sweden, and Germany. Bicycles are also a common mode of transportation in Denmark. Passengers exiting public or tourist buses, as well as tourists driving rental cars, should watch for bicycles on their designated paths, which are usually located between the pedestrian sidewalks and the traffic lanes.

Danish expressways, highways, and secondary roads are of high quality and connect all areas of the country. It is possible to drive from the northern tip of Denmark to the German border in the south in just four hours. Greenland has no established road system, and domestic travel is performed by foot, boat, or by air. The majority of the Faroe Islands are connected by bridges or serviced by boat. Although the largest islands have roads, most domestic travel is done on foot, horseback, boat, or by air.

The emergency telephone number for police/fire/ambulance in Denmark and the Faroe Islands is 112. In Greenland contact the local police.

Please refer to our Road Safety page for more information. Visit the website of the country's national tourist office and national authority responsible for road safety at . See also additional information on driving in Denmark at .

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the government of Denmark's Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Denmark's air carrier operations. This rating applies to Greenland and the Faroe Islands as well. For more information, travelers may visit the FAA's Internet website at www.faa.gov/safety/programs_initiatives/oversight/iasa .

SPECIAL CIRCUMSTANCES: The official unit of currency in Denmark is the Danish krone. ATM machines are widely available throughout Denmark. Please see our information on customs regulations .

For information concerning the importation of pets into Denmark, please visit the following website:
.
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 protection 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 Denmark's laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Denmark are severe and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties .

CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website.

REGISTRATION/EMBASSY LOCATION: Americans living or traveling in Denmark are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website , and to obtain updated information on travel and security within Denmark. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at Dag Hammarskjolds Alle 24; 2100 Copenhagen, telephone: (45) 33-41-71-00; Embassy fax: (45) 35-43-02-23; Consular Section fax: (45) 35-38-96-16; After-hours emergency telephone: (45) 35-55-92-70. Information is also available via the U.S. Embassy's website at http://www.usembassy.dk. The United States has no consular presence in Greenland or the Faroe Islands.
* * *
This replaces the Consular Information Sheet dated February 10, 2006, to update the section on Entry Requirements and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Fri, 25 Nov 2011 12:19:28 +0100 (MET)

COPENHAGEN, Nov 25, 2011 (AFP) - A hurricane packing winds of almost 200 kilometres (125 miles) an hour tore through the Faroe Islands overnight, causing major damage and evacuations but no deaths, police said Friday.  "There was a hurricane... a lot of material damage has been reported but no deaths so far," said Rani Wardum, a police officer in Torshavn, the capital of the North Atlantic archipelago. "Winds reach up to 55 metres per second," or 198 kilometres per hour, in some places, meteorologist Mogens Roenebek of the Danish Meteorological Institute told AFP.

The Faroe Islands, an autonomous Danish province, are home to around 48,000 people. The extent of the damage was not immediately known. "Many roofs were blown off and we had to evacuate a retirement home. The seniors were moved into a hospital," Wardum said.

Some residents were also evacuated from their homes during the night and a number of boats came loose from their moorings and ended up on land, he added. "The winds are still raging, but it was particularly violent last night and overnight," Wardum said, noting that the southern coastal regions of the Faroes Islands were hardest hit. The storm was heading towards the west coast of Norway on Friday, with strong winds and heavy seas, according to Roenebek.
Date: Thu, 6 May 2010 16:55:58 +0200 (METDST)

REYKJAVIK, May 6, 2010 (AFP) - The quantity of ash spewed by Iceland's Eyjafjoell volcano increased overnight and the higher ash cloud could make it to the Faroe Islands Friday, Icelandic authorities said Thursday.   "Ash production did increase last night and the ash plume is going higher now than the last couple of days," Agust Gunnar Gylfason, who monitors the eruption's progress at Iceland's Civil Protection Department, told AFP.

The ash cloud "might reach the Faroe Islands around midnight (GMT Thursday) under 20,000 feet (6,000 meters)" and continue on south towards Ireland on Friday, he added.   "The plume went up to 30,000 feet (9,000 meters) for some time last night, and again this morning, due to an increase in explosive activity, but otherwise it's been around 18,000 and 20,000 feet" high, he said.

At the strongest period of the eruption, Eyjafjoell sent a plume around 30,000 feet into the air, but scientists have stressed that the height of the plume does not necessarily reflect a particular quantity of ash.   On Tuesday, the plume contained about only 10 percent of the ash it held at the beginning of the eruption.   European airspace and airports across the continent were open on Thursday, but intergovernmental air traffic controller Eurocontrol said the ash cloud could mean transatlantic flights might need to be re-routed.

Airspace above Ireland, Northern Ireland and Scotland was partly shut Wednesday for the second time in two days, causing the cancellation of hundreds of flights.   The fresh disruption came after Europe's skies were closed for up to a week last month by the eruption of the Eyjafjoell volcano. It was the biggest aerial shutdown in Europe since World War II, with more than 100,000 flights cancelled and eight million passengers affected.
More ...

Thailand



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Travel in Health in Thailand
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General Introduction:
Irish travellers are going to Thailand in great numbers. The relatively cheap cost and also the contrast in culture has captured many hearts. Some are travelli
g for a once off 2 week trip and for others the exploration of Thailand will take longer. It is truly a beautiful country and the people have a charm all of their own but nevertheless your journey can be so very easily ruined by taking health risks.
Water-Borne Disease:
In most of the major cities of Thailand the water supply is well chlorinated and so the risks associated with drinking mains tap water are limited. However many of the bedrooms will not be supplied with mains water so take care. Smell the water and if there is a distinct chlorine odour then it should be safe. Also remember that when you travel around the country, especially around the northern regions, the water supply may be grossly contaminated and so never drink the water or use it for brushing your teeth. Also no ice in your drinks under these circumstances.
Food-Borne Disease:
There is a good selection of food in Thailand and you should have no great difficulty in finding food to suit your taste. In the majority of the restaurants the food is well cooked and maintained in a healthy sterile fashion. These are the places to eat. As you walk around the cities you will see many street traders selling food stuffs from their carts. The level of hygiene is very low and frequently the food will be contaminated. Never indulge yourself by eating from street vendors.
Mosquito-Borne Disease:
Under this title most travellers will only consider the possibility of developing malaria. This is of course one of the most important illnesses transmitted via mosquitoes but by no means the only one in Thailand. For most travellers to Thailand there will be no need to take malarial prophylaxis as the cities are deemed to be free of malaria. This does not mean that you will not be bitten by mosquitoes and develop some of the other diseases such as Dengue Fever or perhaps Japanese Encephalitis. Many travellers also develop a very severe reaction to the mosquito bite and so for all these reasons it is prudent to avoid being bitten whenever possible.
Entertainment-Borne Disease:
It would be wrong not to emphasize the very high risk which travellers face if they are unwise enough to indulge in any form of sexual activity in Thailand. The percentage of street girls with the Aids virus is rising each year and is now thought to be over 80%. This figure may be an underestimate. Be especially careful if you have taken any alcohol. The cities of Bangkok and Pattaya are thought to be among the main centres of HIV transmission throughout the world and within the next few years the extent of the Aids problem in S.E. Asia will have exceeded Africa. There is limited availability of condoms.
Road-Borne Disease:
The traffic situation in Thailand is severe. The motorbikes have no insurance as they are too often involved in accidents. Use only regular taxi cabs and fix your price before you leave.
Vaccination Schedule:
There are no compulsory vaccines for entry into Thailand from Ireland. Nevertheless the usual recommended vaccines include Polio, Typhoid, Tetanus and Hepatitis A cover. For those trekking or staying for longer periods then cover against Hepatitis B and Rabies would be worth discussing.
Most travellers should start their vaccines about 4 to 5 weeks before they leave Ireland.
Note:
For the vast majority of Irish travellers a holiday in Thailand will be a time of great pleasure and, later, fond memories of the people, their customs and the countryside. Just remember that illness can occur so follow some good common sense rules and so you can enjoy yourself
and Travel in Health.

Thailand

Travel News Headlines WORLD NEWS

Date: Sat, 14 Sep 2019 11:16:53 +0200 (METDST)

Bangkok, Sept 14, 2019 (AFP) - Floods in northeastern Thailand have submerged homes, roads and bridges, leaving more than 23,000 people in evacuation shelters as anger grows over the government's "slow" emergency response.   Torrential rain has lashed the country for the last two weeks, causing flash floods and mudslides in almost half its provinces, with families evacuated from their homes in boats or makeshift rafts.   Since August 29, 32 people have been killed in the deluge, said a statement from the disaster department on Saturday that also gave the number of people staying in emergency shelters.   Two weather events are behind the widespread floods, the department said -- Storm Podul and a tropical depression that formed over the South China Sea called Kajiki.

Local media reports from the worst-hit province of Ubon Ratchathani showed people wading through chest-deep water and rescuers in boats trying to steer buffalo to higher ground.   Flooding in the province, which borders Laos and Cambodia, has been exacerbated by rising water levels in the Moon and Chi rivers.   "It will take three weeks to drain the floodwater" from up to 90 percent of inundated households, said provincial governor Sarit Witoon.   "The water has slightly receded about four centimetres today and I think it will keep going down," he added.

But the situation is already "unlivable" for families in one-storey homes, said Pongsak Saiwan, local director of opposition party Future Forward.   Access to an entire district is currently cut off due to flood waters, which are about two metres (6.5 foot) deep in the main town, while three major bridges are "impassable", he said.   "The government has been very slow in responding to the situation since the floods started in the beginning of September," Pongsak told AFP.   Ubon Ratchathani's plight started trending on Twitter this week with the hashtag #SaveUbon.   Aerial shots of the flood-hit plains blanketed with muddy river water were widely shared, as well as photos of stray dogs being rescued by passing boats.

One Twitter user compared the flood response to how quickly the government had mobilised and saved 12 young boys and their football coach from a waterlogged cave last year -- an incident that catapulted Thailand to international attention.   "Only 13 lives stuck in the cave and it was still very high-profile, but this is hundreds of thousands of lives," tweeted Yosita8051. "It's not okay."   Thailand's junta leader-turned-premier Prayut Chan O-Cha tweeted on Saturday that he has told agencies to "expedite assistance" to those in the affected areas.
15 Aug 2019

Thailand health officials reported an additional 4500 dengue fever cases during the past week, which has brought the total case tally to 49,174 cases with 64 deaths, according to a Chiang Rai Times report. This has prompted the health minister to order preventive measures against dengue fever to include requiring the healthcare sector to report the number of new infections to contain the outbreak. Local authorities and volunteers will spray chemicals to kill mosquitoes, and pubic members are advised to destroy mosquito breeding grounds around their houses.

HealthMap/ProMED-mail map of Thailand:
Date: Tue, 18 Jun 2019 06:14:38 +0200

Mae Sai, Thailand, June 18, 2019 (AFP) - Tourists snap selfies by a bronze statue of the diver who died trying to save the 'Wild Boars' football team from a flooded cave, while momentos from their rescue fly off the shelves -- scooped up by the 1.3 million people who have descended on a once serene mountainside in northern Thailand.   "It's amazing what happened here. I followed everything from Australia," tourist John McGowan told AFP after taking photos at the visitor centre around 100 metres from the Tham Luang cave entrance.   "I wanted to see it with my own eyes," the 60-year-old said, adding he was a little disappointed the cave is still off limits to visitors.

For a few dollars tourists can get framed photos at the site, pick up posters of the footballers and take home a souvenir t-shirt  -- some printed with the face of Saman Gunan the Thai diver who died in the bid to save the group.   There has been extraordinary global interest in the picturesque rural backwater of Mae Sai since 12 youngsters -- aged between 11 and 16 -- and their coach entered the Tham Luang cave on June 23, 2018.   They quickly became trapped by rising water levels and the daring, unprecedented mission to extract them through twisting flooded passageways captivated the world for 18 nail-biting days.   When they emerged -- after being heavily sedated and manoeuvered out by expert divers -- they did so into the centre of a global media frenzy.

The cave, which previously received around 5,000 visitors a year, has since been inundated by visitors both Thai and foreign.   "A miracle has happened here with these children," Singaporean tourist Cheong, giving one name, said but adding Tham Luang "must still have a spiritual side" despite the mass popularity.   - Tragedy and luck -   Mae Sai district, where the cave is located, was considered off the beaten track for foreign visitors.    But between October 2018 and April this year alone "1.3 million people visited," site manager Kawee Prasomphol told AFP.

The government now has big plans for the area around the storied cave, Kawee added, allocating a total of 50 million baht ($1.6 million) including a shopping complex, restaurants, hotels and several campsites outside the national park.   Vans disgorge streams of tourists who explore a visitor hub where the centrepiece is a mural entitled "The Heroes".   It depicts the young footballers, stars of the rescue, and junta chief Prayut Chan-O-Cha -- a reminder of the governmental fingerprints in aiding their cause.   At the heart of the mural is the beaming face of Saman Gunan, the Thai Navy SEAL diver who ran out off oxygen attempting to establish an air line to the children and their coach -- the only fatality across the near three-week rescue mission.

Laying white flowers at the foot of his bronze statue, Thai nurse Sumalee, who travelled four hours to the site, described him as "the hero of the whole country" in a sobering reminder of the risks involved in the rescue amid the blizzard of marketing opportunities now attached to the cave story.    Nearby lottery ticket vendors are capitalising on the perceived good fortune linked to the boys' survival and the folkloric appeal of a nearby shrine. The number of stalls has mushroomed from a few dozen to around 250.    Kraingkrai Kamsuwan, 60, who moved his stall to the site weeks after the rescue, sells 4,000 tickets a month ($2.5) but reckons more will visitors will arrive once the cave reopens.    He told AFP: "People want to gamble after wishing for luck from the shrine."
Date: Fri 24 May 2019
Source: CGTN [edited]

Syphilis has become a serious public health concern in Thailand. An alarming rise in syphilis cases in the country underscores the need for a public health education campaign. But it's a topic rarely discussed freely in Thailand, where sexual dialogue is received with embarrassment, mockery or laughter in sex education classes.

According to the Thai Health Ministry, the average age of the 1st sexual encounter of Thais has fallen to 13-15 years old. Fifty percent report to have not used a condom. Teens are becoming complacent about sexually transmitted infections. Syphilis in Thailand has now reached alarming rates, and about 37% of new infections recorded last year [2018] were found among those aged between 15 and 24 [years old].

We asked a group of 18-year-old students what they knew about syphilis and were met with shaking heads, faces of confusion and blank stares. They can be forgiven for not knowing much about syphilis. It is, after all, considered to be a practically ancient ailment. But its incidence has been rising almost every year for the past 10 years in Thailand from 2 to 3 cases to now 12 people out of 100,000 who have been infected. That's almost a 300% increase.

Unfortunately, this trend is also seen around the world. Cases in Japan have hit a 50-year high. Western Europe saw increases of over 50% in new cases, while the US saw a 73% increase of infection rates from 2013 to 2017.

Rossaphorn Kittiyaowamarn, a medical doctor at Bangrak STI [sexually transmitted infection] Clinic in Bangkok, believes that this is because "having sexual relationships now is a lot easier." In a conservative country like Thailand, she continues, "people used to go and pay for sexual services. Now, society has changed and encounters can happen everywhere and are becoming more casual."

The disease is curable with antibiotics, but it's a bit of a secret agent, transmissible through almost all sexual means and erupting as a tiny lesion about a month after exposure. At various stages of the infection, it might cause no symptoms or a puzzling array of them. If gone undiagnosed, it can cause everything from disfigurement to seizures.

Mond* happens to be one of the unlucky ones. He came to Bangrak STI Clinic in Bangkok as rashes started to appear. His tests came back positive for syphilis, a disease he knew nothing about. "I've never heard about this disease. I only just found out about this on the posters on the wall while I was waiting for the doctor."

But that is essentially the problem. Today, syphilis has somewhat been forgotten. And that is what makes it so dangerous. Because after all, it hasn't disappeared. London today, Tokyo or Bangkok tomorrow and a different bedmate at each stopover. And with that, the chance of getting infected with syphilis increases as containment becomes virtually impossible.

*Name has been changed to protect identity.  [Byline: Dusita Saokaew]
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[The rising incidence of syphilis and other sexually transmitted diseases (STDs) is an international issue. The reasons for the increase in incidence of STDs are varied and likely differ by locality and the patient population affected. Increased diagnostic testing for STDs could contribute to some extent to the increased incidence in some groups, such as men who have sex with men (MSM). Some of the factors that could promote unprotected sex include lack of sex education and access to condoms for teenagers; the opioid epidemic and sale of sex for drugs; the popularity of cell phone geolocating dating apps that facilitate sexual activity with multiple anonymous partners; use of Internet chat rooms to meet sex partners; use of psychoactive "party drugs"; and use among MSM of pre-exposure HIV prophylaxis, or PrEP, which is a way to prevent HIV infection for people who do not have HIV but who are at substantial risk of getting it by engaging in risky condomless sexual activity (<https://www.cdc.gov/hiv/pdf/PrEP_fact_sheet_final.pdf>).

The news report above says that about 37% of new infections recorded last year [2018] were found among those aged 15 to 24 years old. Syphilis and other sexually transmitted infections in this age-group in Thailand are being attributed to a lack of education about STDs and the necessity of safer sexual practices to prevent these diseases. STDs in teenagers and young adults has been similarly attributed to lack of education in the US (see ProMED-mail post Syphilis, gonococcal disease, chlamydia: USA, Argentina http://promedmail.org/post/20170507.5019549), where the CDC reports that in the years 2013 and 2017 -- the latest year for which data are available -- about 23% to 25% of new primary and secondary syphilis infections occurred in those aged 15 to 24 years old (Table 34, <https://www.cdc.gov/std/stats17/tables/34.htm>). - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Date: Sun 19 May 2019
Source: Nation Multimedia [edited]

As many as 249 babies were born with syphilis in Thailand this year [2019], according to the Public Health Ministry. "The babies were affected because their mothers were infected," the ministry's permanent secretary, Dr Sukhum Karnchanapimai, said yesterday [18 May 2019].

Sukhum said that between 1 Jan and 13 May 2019, 3080 people of all ages were diagnosed with syphilis. Of them, 40.42 per cent are between 15 and 24 years old. Some 24.48 per cent of others are between 25 and 34 years old. "The number of syphilis patients is rising. The increase reflects that many teenagers and people in the reproductive age group have engaged in unsafe sex," he said.

Sukhum said he has instructed provincial public-health chiefs to closely monitor the situation and to prevent the disease from spreading. He urged people to protect themselves by using condoms, refraining from having several sex partners, and regularly undergoing blood tests. "Pregnant women, along with their husbands, should take blood tests too," he said.
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[Thailand was said to have eliminated congenital syphilis by the WHO just a few years ago (2016) (See Sidibe M, Singh PK below.) Thailand thus joins the countries that now report a rise in incidence of congenital syphilis. In the U.S., for example, after syphilis reached historic lows in 2000, with less than 6000 reported cases and an incidence rate of only 2.1 cases per 100 000 people, the United States has since experienced a rising incidence of primary and secondary (P&S) syphilis (<https://www.cdc.gov/std/sam/2017syphilis.htm>). Initially, during 2000-2015, the rise in the rate of reported P&S syphilis in the US was primarily attributable to increased cases among men, specifically among gay, bisexual, and other men who have sex with men (MSM). More recently, syphilis also increased among women. For example, during 2014-2015, the rate increased 18.1 percent among men, but increased 27.3 percent among women  (<http://www.loopcayman.com/content/syphilis-cases-increase-1>).

These increases among women are of particular concern because congenital syphilis cases tend to increase as the rates of primary and secondary syphilis increase among women  (<https://www.cdc.gov/std/stats16/figures/44.htm>).

Transmission of _Treponema pallidum_, the organism that causes of syphilis, to the fetus occurs via the bloodstream when the foetus is exposed in utero to a mother with untreated early syphilis. Transmission may also occur during delivery if maternal genital lesions are present. Late abortion, stillbirth, and neonatal death may result from congenital infection in untreated pregnancies. Among survivors, manifestations that develop in the 1st 2 years of life are called "early" and are similar to adult secondary syphilis; manifestations that develop after age 2 years are called "late" and include tooth abnormalities (Hutchinson teeth), bone changes (saber shins), "Clutton's joints" (bilateral painless swelling of the knee joints), neurological involvement, blindness, and deafness.

We are not told in the news report above about the factors responsible for the changing epidemiology of syphilis in Thailand, which could account for their increasing incidence of congenital syphilis. In the U.S. and Canada, the recent increasing incidence of syphilis in heterosexual men and women has been linked to illicit drug use, which is reminiscent of the increase in syphilis among heterosexuals during the crack cocaine epidemic of the 1980s and 1990s, when the practice of trading sex with multiple partners for drugs, especially crack cocaine, played a major role in the transmission of syphilis. Under these circumstances, the identities of sex partners are often unknown, which weakens the traditional syphilis-control strategy of partner notification.

Control of congenital syphilis is achieved by antenatal screening and treatment of mothers who are infected. Routine serologic screening should be done at the 1st prenatal visit in all pregnant women and in communities and populations in which the risk for congenital syphilis is high; serologic testing and a sexual history also should be obtained at 28 weeks gestation and at delivery. Groups at high risk include uninsured women, women living in poverty, sex workers, illicit drug users, women diagnosed with sexually transmitted diseases, and those living in communities with high syphilis morbidity (<http://www.ahrq.gov/clinic/uspstf09/syphilis/syphpgsum.htm>). No mother or neonate should leave the hospital without maternal serologic status having been documented at least once during pregnancy and, if the mother is considered high risk, also at delivery.

Reference:
Sidibe M, Singh PK. Thailand eliminates mother-to-child transmission of HIV and syphilis. The Lancet 2016: 387(10037);2488-2489, June 9, 2016 DOI: <https://doi.org/10.1016/S0140-6736(16)30787-5>. - ProMED Mod.ML]

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Cameroon

Cameroon - US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
Cameroon is a developing country in central Africa.
Although there are many natural and cultural attractions in Cameroon, facilities catering to Western-styl
tourism are quite limited.
The capital is Yaoundé, though Douala, the country's largest city, is its main port and commercial center.
Official languages are French and English, though French predominates in most of the country.
English may be used in Cameroon's two Anglophone provinces of Southwest and Northwest, and the larger cities.
The staff of major hotels in Cameroon’s large cities is usually bilingual.
In February 2008, social and political unrest led to civil unrest, although the immediate threat of violence has now receded.
For general information on Cameroon, read the Department of State Background Notes on Cameroon.

ENTRY/EXIT REQUIREMENTS:
A valid passport, visa, evidence of yellow-fever vaccination, and current immunization records are required, and travelers may be denied entry if they lack the proper documentation.
Travelers should obtain the latest information and details from the Embassy of the Republic of Cameroon, 2349 Massachusetts Avenue, NW, Washington D.C. 20008, tel: (202) 265-8790, fax: (202) 387-3826.
Visit the Embassy of Cameroon’s web site at http://www.ambacam-usa.org/ 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:
During the week of February 25, 2008, Cameroon experienced significant civil unrest in half of its ten provinces, most notably in the port city of Douala.
Demonstrators clashed violently with police and then military personnel, resulting in the reported deaths of forty persons and arrest of over 1,600 individuals.
The unrest was marked by widespread road blockages, attacks on public and private vehicles, looting, burning of government and other buildings, and roaming crowds of malcontents.
This disturbance created shortages of fuel, food and other supplies throughout the country, and was ended through the deployment of military units and the use of significant force.

Following the restoration of order, some efforts have been made to address fuel and food prices that were among the key grievances of the demonstrators.
However, economic conditions, notably the high unemployment rate, remain difficult without the prospect for rapid improvement.
Political tensions also remain, particularly over a possible amendment to the Constitution that would allow President Biya to serve again.
Although a rapid resumption of violence is considered unlikely, Americans living in or visiting Cameroon are encouraged to stay abreast of local political and social developments that could signal additional difficulties for the country.

Embassy employees have been instructed to refrain from travel outside of city limits after dusk, and to monitor their movements in centrally located areas within cities and towns.
Private American citizens are urged to follow the same guidelines and are strongly advised against nighttime travel.
Armed highway bandits (most notably in border areas); poorly lit roads; hazardous, poorly maintained vehicles; and unskilled, aggressive and/or intoxicated drivers pose a threat to motorists.
Attacks and accidents are most common outside major towns, especially in the provinces bordering Chad and the Central African Republic but occur in all areas of the country.

The U.S. Department of State continues to warn U.S. citizens against travel to neighboring Central African Republic (CAR).
On occasion, conflict between insurgents and government security forces in CAR has spilled across the border into Cameroon, affecting outposts in both Adamawa and East Provinces.
Humanitarian and religious workers in eastern Cameroon are strongly encouraged to coordinate their efforts with the Embassy and the Office of the United Nations High Commission for Refugees (UNHCR) in Yaoundé.

In February 2008, an attack by rebel insurgents on Ndjamena, the capital of Chad, forced the evacuation of the Embassy in Chad and sent up to 50,000 refugees across the border into the town of Kousseri in Cameroon.
Although the attack was ultimately repelled, the possibility of further military action by the rebel forces remains.

In late 2006, inter-ethnic clashes were reported in the town of Kye-Ossi near the Cameroonian border with Gabon.
These confrontations were a result of a discord between moto-taxi drivers and the security forces, which resulted in demonstrations and roadblocks.
According to security authorities, tensions in the area are still high, despite the deployment of a large security force to the region.

Following a ruling from the International Court of Justice defining a section of the Cameroon-Nigeria border, Cameroon assumed administrative control of most of the Bakassi Peninsula, in August 2006, with Nigerian military forces withdrawing across the border.
Although the transition has generally gone smoothly, there was an attack on Cameroonian military forces in November 2007, reportedly by criminal elements from the Niger Delta not connected to the Nigerian government.
It is very difficult to reach Bakassi, but travelers thinking of going near there should exercise extreme caution as there is the potential for violence if tensions rise.

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 Worldwide Caution, Travel Warnings, and Travel Alerts 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:
Crime is a serious and growing problem throughout Cameroon and U.S. citizens should exercise caution when traveling in Cameroon.
Internet-based crime is escalating rapidly, and Americans should be extremely skeptical of financial
transactions --
e.g. adoptions, hiring a service worker, such as a nanny, to come to the U.S., or purchasing a pet -- that involve sending money for goods or services not yet delivered (see below).
In February 2008, two European nationals were kidnapped by criminals posing as businessmen seeking to establish a palm oil export business. Although several perpetrators were arrested and the individuals were not harmed, the incident highlights a dangerous new confluence of internet-based and violent crime.
If you have concerns about the legitimacy of a transaction, such as adoption, in Cameroon contact the U.S. Embassy in Cameroon – see Registration/Embassy Location section below.
All foreigners are potential targets for theft with possible attendant violence.
Petty crimes, crimes against persons, thefts from vehicles, and of vehicles are the most common criminal activities.
Armed banditry is a growing problem throughout all ten provinces in Cameroon.
Specifically, incidents of armed highway-robbery have been reported in the North West, West, South West and East provinces.
Armed bandits have erected road barricades on major routes that link rural towns to provincial headquarters, and have taken as many as 100 cars in a single attack.
To curb banditry, security personnel may request persons to show their passport, residence card, driver's license, and/or vehicle registration at random checkpoints.
Certified copies of these important documents should be kept in a secure location separate from the originals.
Security personnel have been known to ask for bribes and may hurt citizens who refuse to pay.
The U.S. Government does not condone bribery or corruption of any kind.

Due to the frequency of criminal incidents involving public transportation, American citizens are advised that use of public taxis can be dangerous.
In April 2007, two American women were assaulted and robbed in a taxi.
Public taxis in Cameroon function more like the U.S. bus system with drivers stopping to pick up additional passengers as long as there is space left in the vehicle.
There have been numerous reports of assaults and robberies committed by "passengers" in shared taxis since crimes – rape and robbery being among the most common – are often a collaborative effort between the driver and "passengers."
If a traveler must use a taxi, the use of a private taxi – or a taxi hired for exclusive use by the individual for that particular trip – where the driver is known to the passenger is a better alternative to the use of shared taxis.
Taxi passengers should be particularly vigilant at night.

The risk of street and residential crime is high, and incidents of violent crime are on the rise throughout the country.
During the last year, the number of carjacking and armed burglary incidents in residences and restaurants, particularly in Yaoundé and Douala, continued to increase.
Carjacking and robbery has also been reported on rural highways, especially in the Northern provinces and regions near Cameroon's border with the Central African Republic.

On March 27, 2006, 11 armed men attacked a group of four U.S. citizens in a private residence (adjacent to a hotel frequented by expatriates) in Kribi, located in the Southern province.
A group of five armed bandits held up and robbed staff and guests of a hotel in Ngaoundere (Adamawa Province) on December 20, 2006.
Similar incidents occurred in the middle of the night at hotels in Bertoua (East Province) on April 22, 2007, and in Yaoundé (Central Province) on May 15, 2007 when assailants broke into hotel rooms and robbed the residents.
Americans were among the victims.
Crimes against property, such as carjacking and burglaries, have often been accompanied by violent acts and have resulted in fatalities.
There were four incidents of armed robberies in the month of April 2007, involving American citizens in or near restaurants in Yaoundé and Bertoua.

In January 2007, a French expatriate was fatally shot in the upscale Bastos neighborhood of Yaoundé.
The woman was dropping off a friend to her residence and interrupted an attempted home invasion.
Upon realizing what was happening, the friend returned to the vehicle and both women attempted to flee the scene.
As they were leaving, an armed bandit shot and fatally wounded the driver of the vehicle.

In September 2007, several expatriates suffered armed attacks.
In one incident, an Israeli citizen giving a ride to a friend was attacked in Bastos by two men with knives.
In the ensuing scuffle, the Israeli was critically wounded.
A Moroccan diplomat was fatally injured while walking near his residence.
Found unconscious by security guards, he was taken to a local hospital where he died the following day.
A Chinese business woman was also robbed and killed outside her home in a neighborhood near Bastos.
All incidents occurred late at night.

In December 2007, a police officer was arrested and jailed in Yaoundé after he and his accomplices surprised a couple returning from Europe and stole a briefcase and jewelry.

In January 2008, three bandits posing as passengers on a bus to Douala – and carrying locally made guns - were intercepted at Bafoussam and apprehended.
In Douala, armed bandits robbed a soap company at gun point, surprising the employees.
They attempted to loot the company’s computers, but were intercepted by a SWAT team and ran off.
Also in January, an Embassy employee using public transportation in the Northwest Province was the victim of highway robbers, who robbed the passengers (including a local mayor) and roughed-up those who did not have enough money.
In February 2008, Cameroon experienced a brief period of civil unrest during a taxi strike that involved road blockages, attacks on public and private vehicles, looting, burning of government and other buildings, and roaming crowds of malcontents.
This period was attended by a sharp increase in reported crimes, including the stabbing death of a night watchman at a residence in Yaoundé, an attack at the Brussels Airline travel agency in the Bonapriso district of Douala, an attack by a group of armed bandits on a motorbike rider who suffered a gunshot wound to the head, and numerous reports of rape and armed attacks with firearms and machetes in Douala.

Recently, many American citizens have become victims of Cameroonian advance-fee fraud and other scams offering antiques, exotic and domesticated animals, and even adoption services through the Internet.
Americans should be very cautious about sending money or traveling to Cameroon to meet someone contacted via the Internet.
Commercial scams targeting foreigners, including many U.S. citizens, continue to be a problem.
The scams generally involve phony offers of lucrative sales and repeated requests for additional funds to pay for unforeseen airport and/or customs fees.
No one should provide personal financial or account information to unknown parties.
The ability of U.S. Embassy officers to extricate U.S. citizens from unlawful business deals and the consequences is limited.
For more information on international financial scams, including those involving Internet dating, a promise of an inheritance windfall, a promise of a work contract overseas, overpayment for goods purchased on-line, or money-laundering, see the Department of State's publication International Financial Scams.

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 facilities in Cameroon are extremely limited.
Even in large cities, emergency care and hospitalization for major illnesses and surgery are hampered by the lack of trained specialists, outdated diagnostic equipment, and poor sanitation.
Medical services in outlying areas may be completely nonexistent.
Doctors and hospitals often require immediate payment for health services in cash.
Pharmacies in larger towns are well stocked, but in other areas many medicines are unavailable.
Travelers are advised to carry their own supply of needed prescription and anticipated over-the-counter medicines.

Malaria is a serious and sometimes fatal disease.
Plasmodium falciparum malaria, the type that predominates in Cameroon, is resistant to the antimalarial drug chloroquine.
Because travelers to Cameroon are at high risk for contracting malaria, the Centers for Disease Control and Prevention (CDC) advises that travelers should take one of the following antimalarial drugs: mefloquine (Lariam™), doxycycline, or atovaquone/proguanil (Malarone™) as prophylaxis to reduce this risk.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area, and up to one year after returning home, should seek prompt medical attention and tell the physician their travel history and what antimalarials they have been taking.
For additional information on malaria, including protective measures, see the CDC Travelers’ Health web site at http://www.cdc.gov/malaria/.
There are periodic outbreaks of cholera in Cameroon.
Yellow fever can cause serious medical problems, but the vaccine, required for entry, is very effective in preventing the disease.

In March 2006, avian influenza (H5N1) was confirmed in wild ducks in northern Cameroon.
There have been no reports of avian influenza among humans in Cameroon.
Avian influenza has been reported in both birds and humans in neighboring Nigeria.
For additional information on avian influenza as it affects American citizens residing abroad, please visit the U.S. Department of State’s Avian Influenza Fact Sheet.

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 website at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) website 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 Cameroon is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Cameroon's road networks, both paved and unpaved, are poorly maintained and unsafe at all times of the year.
Vehicles are poorly maintained and there is no mechanism or requirement to inspect for roadworthiness.
During the rainy season, many roads are barely passable with four-wheel-drive vehicles.
Livestock and pedestrians create constant road hazards (especially at night) and road safety rules are frequently ignored.
There are few road and traffic signs; speed limits are neither posted nor enforced.
Buses and logging trucks travel at excessive speed and are a constant threat to other road traffic.

Travelers on roads near the borders with CAR and Chad should ensure that their vehicles are fully fueled, and that they have adequate cooking fuel, food, and water for several days as well as a reliable means of communication, such as a satellite or cell phone, or radio.

Visitors who are not in possession of a valid passport and a visa may experience difficulties at police roadblocks or other security checkpoints.
It is not uncommon for a uniformed member of the security forces to stop motorists on the pretext of a minor or non-existent violation of local motor vehicle regulations in order to extort small bribes.
Visitors are advised not to pay bribes and to request that the officer provide a citation to be paid at the local court.

Local law states that vehicles involved in an accident should not be moved until the police arrive and a police report can be made.
If an accident results in injury, drivers should be aware of the possibility that a "village justice" mentality may develop.
If an angry crowd forms, drive directly to the U.S. Embassy or another location where you can receive assistance.
Contact the local police once you are safely away from danger.
Cameroon has no real equivalent to 911-type service or roadside emergency telephone numbers, but you can dial 112 in major cities to contact ambulance services.
American citizens should contact the U.S. Embassy (237) 2220-1500 if emergency assistance is needed.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Cameroon, the U.S. Federal Aviation Administration (FAA) has not assessed Cameroon’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
While visiting game parks and reserves, tourists should bear in mind that they are ultimately responsible for maintaining their own safety.
Tourists should use common sense when approaching wildlife, maintain a safe distance from animals, and heed all instructions given by guides or trackers.
Even in the most serene settings, the animals in Cameroon's game parks are wild and can pose a threat to life and safety.

Cameroonian Customs authorities may enforce strict regulations concerning temporary importation into or export from Cameroon of items such as large quantities of medicine or wood products.
Customs regulations also restrict the importation of ivory.
Please see our information on customs regulations.

Cash in local currency, the Central African franc (CFA), is the only form of payment accepted throughout the country.
Larger hotels in Yaoundé and Douala will change U.S. dollars and cash traveler's checks, though at a disadvantageous rate.
Credit card cash advances are not available, and most banks do not cash personal or traveler's checks for non-clients.
While credit cards are accepted at some larger hotels and shops in Yaoundé and Douala, caution is urged, as identity theft is endemic in the region.
Some larger banks in Yaoundé and Douala have ATM facilities, and several banks in Cameroon have wire transfer services through Western Union.
The U.S. Embassy does not provide currency exchange, check cashing or other financial services.
Tourists and business travelers should also note that there is an increasing circulation of counterfeit U.S. and Cameroonian currency in the country.
In recent years, business travelers have experienced difficulty in obtaining adequate services from Cameroon's banking sector.
Business travelers are also advised that using the services of a local agent is strongly recommended in establishing a presence in the Cameroonian market.

While photography is not officially forbidden, security officials are sensitive about photographs taken of government buildings, military installations, and other public facilities, many of which are unmarked.
Photography of these subjects may result in seizure of photographic equipment by Cameroonian authorities.
Due to the threat of harassment and the lack of signs designating sites prohibited for photography, photography should be limited to private homes and among friends.
U.S. citizens are advised to seek proper permission before taking a photograph of a specific subject or location.

The government of Cameroon has recently started enforcing laws against homosexuality.
Charges of homosexuality and/or of corruption are also made and enforced indiscriminately in the course of business or personal disputes.

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.
Cameroonian law does not afford many of the protections to which Americans are accustomed, and legal proceedings tend to be complex, lengthy, and subject to inappropriate influence.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Additionally, the condition of detention centers, while improving, is poor.
Persons violating Cameroonian laws, even unknowingly, may be expelled, arrested or imprisoned.
During the February 2008 civil unrest, there were reports that people were arrested arbitrarily by law enforcement officials quelling the civil disorder that ensued.
Although no expatriates were known to have been arrested, the Department of State cautions Americans against venturing out during such periods of unrest.

Penalties for possession, use, or trafficking in illegal drugs in Cameroon are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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 Cameroon are encouraged to register with the U.S. Embassy through the State Department’s travel registration website so that they can obtain updated information on travel and security within Cameroon.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy in Yaoundé is located on Avenue Rosa Parks in the Mbankolo Quartier, adjacent to the Mount Febe Golf Club; mailing address P.O. Box 817; embassy tel. (237) 2220-1500, fax: (237) 2220-1572.
The Embassy Branch Office in Douala is located on the corner of Rue Ivy and Rue French in the Ecobank Building in Bonanjo, tel: (237) 3342-5331, fax: (237) 3342-7790.
Further information, including the U.S. Embassy's business hours, is available at the U.S. Embassy's web site: http://yaounde.usembassy.gov.
*

*

*
This replaces the Country Specific Information for Cameroon dated 7 June 2007, to update sections on Country Description, Entry and Exit Requirements, Safety and Security, Crime, Aviation Safety Oversight, Criminal Penalties, Children’s Issues, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Tue 9 Jul 2019
Source: Agence Cameroun Presse [in French, trans. Corr.SB, edited]

A highly contagious disease with faecal-oral transmission, cholera is transmitted by dirty hands or by food contamination and water (contaminated water). According to our colleague, [Journal du Cameroun], 48 deaths due to cholera have been recorded in the northern part of Cameroon.

According to figures compiled on Mon 8 Jul 2019 by the Ministry of Public Health (Minsante), the cholera epidemic, which is raging in the northern part of Cameroon, has already killed 48 people. The northern region, which has been particularly affected by this epidemic for almost a year, has a fatality rate of 6.2%.

Outside the North, the neighbouring Far North region is also affected by the disease, which raises fears of a spread of the disease with the onset of rains in this part of the country. Cholera had also been reported in the southern part of the country, particularly in the Central and Littoral regions, where one death had been registered.

According to the Journal du Cameroun, since the reappearance of the disease last February 2019, 775 reported cases have been counted and confirmed, revealing "an alarming epidemiological situation".

It should be noted that cholera 1st appeared in Cameroon in 1971. Since 1990, major epidemics have been recorded, particularly in 1991, 1996, 1998, 2004, 2010 and 2011. The general trend shows an annual increase in the number of cases. Between 2004 and 2016, epidemiological surveillance reported 50 007 cases with 2052 deaths, a high case fatality rate of 4.1%.

The main epidemics were recorded in the north, in the northern regions and the Far North and in the south of the country in the Littoral region, which is home to the economic capital Douala.  [Byline: Danielle Ngono Efondo]
Date: Thu, 30 May 2019 19:24:40 +0200

Yaoundé, May 30, 2019 (AFP) - Cameroon has declared a public emergency after reporting a polio case in its far north, four years after the virus disappeared from the country, the health ministry said on Thursday.   The confirmed case of polio type 2 was found in the Mada area in the remote north bordering Chad and Nigeria, the ministry said in a statement.   It declared a "new polio epidemic following the confirmation of a case of poliovirus type 2 detected in samples."

A source at the ministry said the outbreak may have been caused in part by a refusal of vaccinations and the cross-border movement of people in the area.   Polio is a highly infectious viral disease which mainly affects young children and can result in permanent paralysis. There is no cure and it can only be prevented through immunisation.   International polio vaccination efforts have run into problems in Pakistan and Afghanistan. Militants and religious leaders in rural areas often tell locals immunisation is part of a shadowy conspiracy to weaken their faith.
Date: Wed, 28 Nov 2018 11:40:16 +0100

Yaoundé, Nov 28, 2018 (AFP) - At least 29 people were wounded Wednesday when a women bomber blew herself up in a border town in Cameroon's Far North, a region frequently hit by Boko Haram jihadists, security sources said.    But a second bomber was shot dead by troops deployed in the town before she could detonate her explosives, the source said.    "A suicide bomber blew herself up this morning in Amchide" on the Nigerian border, a regional security source said, speaking on condition of anonymity and giving a toll of 29 wounded.

The attack occurred on market day when the town was filling up with early-morning shoppers, a local civil defence group official said.    "There were many people hurt, I saw about 20," he said. "After the attack, the market emptied."   A once-bustling trade hub, in 2014 Amchide was thrust into the forefront of a major battle between Cameroonian troops and Boko Haram militants who held the nearby Nigerian town of Banki for several months.    The violence forced most residents to flee the town, although some have now begun to return.    After pushing back Boko Haram, the Cameroonian army dug long trenches around Amchide and even inside the town to foil new incursions by the jihadists, with Wednesday's attack the first in many months.
Date: Fri 26 Oct 2018
Source: PLoS Negl Trop Dis 2018;12:e0006750 [edited]

Wanji S, Chounna Ndongmo WP, Fombad FF, et al. Impact of repeated annual community-directed treatment with ivermectin on loiasis parasitological indicators in Cameroon: implications for onchocerciasis and lymphatic filariasis elimination in areas co-endemic with _Loa loa_ in Africa. PLoS Negl Trop Dis 2018;12:e0006750.

Abstract
---------
Background
Loiasis is a filarial infection endemic in the rainforest zone of west and central Africa, particularly in Cameroon, Gabon, Republic of Congo, and Democratic Republic of the Congo. Repeated treatments with ivermectin have been delivered using the annual community-directed treatment with ivermectin (CDTI) approach for several years to control onchocerciasis in some _Loa loa_ and _Onchocerca volvulus_ co-endemic areas. The impact of CDTI on loiasis parasitological indicators is not known. Therefore, we designed this cross-sectional study to explore the effects of several rounds of CDTI on parasitological indicators of loiasis.

Methodology/principal findings
The study was conducted in the East, Northwest, and Southwest 2 CDTI projects of Cameroon. Individuals who consented to participate were interviewed for ivermectin treatment history and enrolled for parasitological screening using thick smears. Ivermectin treatment history was correlated with loiasis prevalence/intensity. A total of 3684 individuals were recruited from 36 communities of the 3 CDTI projects, and 900 individuals were from 9 villages in a non-CDTI district. In the East, loiasis prevalence was 29.3% (range, 24.2% to 34.6%) in the non-CDTI district but 16.0% (3.3% to 26.6%) in the CDTI district with 10 ivermectin rounds (there were no baseline data for the latter).

In the Northwest and Southwest 2 districts, reductions from 30.5% to 17.9% (after 9 ivermectin rounds) and from 8.1% to 7.8% (not significantly different after 14 rounds) were registered post-CDTI, respectively. Similar trends in infection intensity were observed in all sites. There was a negative relationship between adherence to ivermectin treatment and prevalence/intensity of infection in all sites. None of the children (ages 10 to 14 years) examined in the East CDTI project harboured high (8000 to 30,000 mf/mL) or very high (more than 30,000 mf/mL) microfilarial loads. Individuals who had taken more than 5 ivermectin treatments were 2.1 times more likely to present with no microfilaraemia than those with fewer treatments.

Conclusion
In areas where onchocerciasis and loiasis are co-endemic, CDTI reduces the number of and microfilaraemia in _L. loa_-infected individuals, and this, in turn, will help to prevent non-neurological and neurological complications post-ivermectin treatment among CDTI adherents.
====================
[Onchocerciasis (African River blindness) is a neglected tropical disease, but the invasive nematode _Loa loa_ is not on the list. The study clearly demonstrates that scheduled regular ivermectin against onchocerciasis also reduced the nematode burden of _L. loa_.

_L. loa_, the African eye worm, is a nematode transmitted by tabanid flies (Order: Diptera; Family: Tabanidae) of the genus _Chrysops_. _L. loa_ may cause skin oedema (Calabar swellings) and may occasionally invade the eye. As far as it is known, there is no animal reservoir. - ProMED Mod.EP]

[HealthMap/ProMED map:
Date: Sat, 6 Oct 2018 04:59:35 +0200
By Gregory WALTON

Buea, Cameroon, Oct 6, 2018 (AFP) - "For the peak season I would have about 280 persons climbing Mount Cameroon," said John Ngomba, a tour guide in the town of Buea, which has been at the forefront of Cameroon's anglophone separatist insurgency.   "But now there are no tourists coming. It's really crazy. The reason tourists are not coming is because of the crisis."

Since an independence declaration a year ago, Buea -- once a tourist hotspot -- has suffered near-daily clashes and visitors have all but disappeared.   The violence has claimed the lives of at least 420 civilians, 175 members of the security forces and an unknown number of separatists, according to the International Crisis Group think-tank.   "Sometimes I would receive 600 Germans a year. They would come through the cruise ships. I could have about 30 to 50 tourists a week who came to visit," said Ngomba in his hut in the town's Bismarck Fountain gardens.

Cameroon was once a German colony but was divided between Britain and France after World War I -- a separation that lies at the heart of the current conflict.   France's colony won independence in 1960, becoming Cameroon, and in 1961 the British-ruled Southern Cameroons was merged into it, giving the new state English-speaking majorities in the northwest and southwest.   "I am a father of five children. How am I living with them? It's impossible," said Ngomba, who has appealed for help from the German embassy, which assists with the upkeep of the garden containing a bust of Bismarck.

- Empty hotels -
"The fountain is not even working," he said, looking out over the restive town below and the former German governor's residence, which is now an army base.   But Ngomba insisted that the foothills above Buea remained safe.   "If the tourists arrive and get to this point, they are safe," he said.   "I tell people: after the election, things will be OK," he added of polls due on unday at which President Paul Biya will seek a seventh term.

But several countries including Germany, Britain, Canada and the United States have issued security advisories to their citizens about the anglophone regions.   "We used to have customers coming from many countries -- America, Europe, Nigeria," said Janet Nkowo, 30, a receptionist at the Eta Palace Hotel in downtown Buea.   "I think it's because of the crisis. The difference is really clear," she said.   "We have one-quarter of what we had, I don't know how the director does it. I think things will hopefully get better on Sunday."

Most of Buea's hotels are sitting empty, the majority of shops are shuttered and only a handful of students queued up at the town's university to register for the new academic term.   A total of 246,000 people have fled their homes in the southwest region that includes Buea -- and 25,000 have left the country altogether for Nigeria, according to UN figures.

At the town's weekly market, one of the few retail outlets still functioning, many stalls sat empty.   A man in a white vest shouted "French bastards" at passers-by, in French.   "Maybe if voting passes well, they will come back," said Fidelis Kum, a stallholder selling hair extensions, as customers haggled over live chickens nearby and women sat shelling snails.
More ...

World Travel News Headlines

Date: Tue, 22 Oct 2019 13:43:23 +0200 (METDST)

Capriata d'Orba, Italy, Oct 22, 2019 (AFP) - A taxi driver has drowned in Italy during violent storms in the north which flooded towns and destroyed a bridge, the fire service said Tuesday.   Farmers in the sweltering south meanwhile sounded the alarm over a draught expected to hit crops hard.   Over 100 people were evacuated Monday across the Alessandria province in the Liguria region, while firefighters carried out 900 operations across the north from Milan to Genoa, as rising waters surged across roads and railways.

The taxi was swept away in the town of Capriata d'Orba, where a bridge had also given way as the river burst its banks.   "There's water everywhere", driver Fabrizio Torre, 52, told his bosses before his phone line cut out, media reported.   His passenger managed to escape the vehicle and survived by clinging to a tree, the reports said.   Two men, aged 61 and 84, were found alive by firefighters after going missing in another part of the storm-hit region.   Rescue workers also pulled young children, their grandmother and the family's dog out of a house submerged by a landslide.   The Po river rose by more than 3.5 metres (11 feet) over a 24-hour period, according to Coldiretti, Italy's main agricultural association.   Lake Maggiore was also nearing a historic level.

Italy has seen "over three storms a day since the start of autumn, 18 percent more than the same period last year," it said.   "And while the north is under rain clouds... in the south, record heat and lack of rainfall has triggered a drought alarm."   Italy was seeing "the effects of climate change, with exceptional weather events becoming the norm".   It noted a "clear endency to tropicalisation" in the Mediterranean country, which was experiencing "a crazy autumn that ranks in the top ten of the hottest since 1800, with a temperature of 1.27 degrees above the average".   The high frequency of violent events was expected to continue, with the north pummelled by rains while farmers in the south risk losing crops.
Date: Tue, 22 Oct 2019 09:57:15 +0200 (METDST)
By Tupad POINTU

La Paz, Oct 22, 2019 (AFP) - Bolivia braced for a general strike on Tuesday hours after violence broke out in several cities when the main opposition candidate rejected presidential election results that seemed set to hand a controversial victory to long-time incumbent Evo Morales.   Opposition supporters reacted with fury, torching electoral offices in the southwestern cities of Sucre and Potosi, while rival supporters clashed in the capital La Paz.    Incidents were reported in cities across the South American country.   Carlos Mesa, who came a close second to Morales in Sunday's polls -- forcing a run-off, according to preliminary results -- denounced revised results released by election authorities as a "fraud."   "We are not going to recognize those results that are part of a shameful, consumated fraud, that is putting Bolivian society in a situation of unnecessary tension," said Mesa.

International monitors from the Organization of American States voiced "deep concern" at sudden changes to the election count to show Morales closing in on an outright victory in the first round.   Preliminary results released late Sunday showed neither Morales, 59, nor 66-year-old Mesa with a majority and "clearly indicated a second round," the OAS mission said.   The partial results put Morales in the lead with 45 percent of the votes, with Mesa on 38 percent, meaning Morales would have to contest a run-off for the first time.   But results released late Monday, after a long and unexplained delay, showed Morales edging towards an outright victory with 95 percent of the votes counted.   Mesa, a former president of the country between 2001-2005, accused Morales of colluding with the Supreme Electoral Tribunal (TSE) to tweak delayed results and avoid a run-off.

- Opposition call general strike -
The call for a general strike was issued by Fernando Camacho, head of an influential civil society organization in Bolivia's biggest city, Santa Cruz, where transport and businesses were expected to shut down from noon.   "Tomorrow we start at 12:00 to block this country," Camacho told opposition demonstrators late Monday, before holding talks with leaders from other regions.   Long lines formed at gas stations amid fears of shortages.   Riot-police dispersed a crowd who tried to storm the electoral offices in the Andean city of Oruro, south of La Paz.    Clashes were also reported in Tarija in the south, Cochabamba in the center and Cobija in the north.

- 'Subverting democracy' -
The United States' top diplomat for Latin America said the Electoral Tribunal was attempting "to subvert Bolivia's democracy by delaying the vote count and taking actions that undermine the credibility of Bolivia's elections."   "We call on the TSE to immediately act to restore credibility in the vote counting process," the official, Michael Kozak, said on Twitter.   The OAS observer mission in the country expressed "surprise at the drastic and hard-to-explain change in the trend of the preliminary results revealed after the closing of the polls," it said in a statement.   It urged the election authority to "firmly defend the will of the Bolivian people" and called for calm on the streets.   "It is extremely important that calm is maintained and any form of violence is avoided in this delicate situation."

- Longest serving president -
Morales, Latin America's longest-serving president, is controversially seeking a fourth term.   He obtained Constitutional Court permission in 2017 to run again for president even though the constitution allows only two consecutive terms.   The former coca farmer and leftist union leader has led the poor but resource-rich Latin American country for the past 13 years, though his popularity has waned amid allegations of corruption and authoritarianism.   He has led the country since taking office in 2006, when he became its first indigenous president.

A new mandate would keep him in power until 2025.   As leader of his Movement for Socialism Party (MAS), Morales points to a decade of economic stability and considerable industrialization as his achievements, while insisting he has brought "dignity" to Bolivia's indigenous population, the largest in Latin America.   He has come under severe criticism this year as wildfires in August and September ravaged Bolivia's forests and grasslands, with activists saying his policies encouraged the use of blazes to clear farmland.
Date: Tue, 22 Oct 2019 06:44:29 +0200 (METDST)

Papeete, Oct 22, 2019 (AFP) - A French tourist has been seriously injured in a rare shark attack in the palm-fringed Pacific islands of Polynesia, emergency services said Tuesday.   The 35-year-old woman was swimming during a whale-watching trip on Monday in the French overseas territory when the oceanic whitetip shark tore into her chest and arms.   "Luckily for her, there were two nurses on the scene who could deliver first aid," firefighter Jean-Jacques Riveta told AFP.   The woman lost both hands and a lot of blood in the attack and was airlifted to hospital, he said.
Date: Tue, 22 Oct 2019 05:13:16 +0200 (METDST)

Wellington, Oct 22, 2019 (AFP) - A huge fire at a construction site sent clouds of acrid black smoke billowing over Auckland on Tuesday, forcing large parts of the downtown area to be cordoned off as firefighters battled the blaze.   The fire broke out on the roof of the SkyCity convention centre site shortly after 1:10pm (0010 GMT) and quickly spread, Fire and Emergency NZ said.   Office workers were warned to stay inside and turn off air conditioning as a thick pall of smoke engulfed the centre of New Zealand's largest city, but there were no reports on injuries.   Unconfirmed reports said the fire was started by a construction worker using a blowtorch on the building, which is one of the venues for the 2021 APEC summit being held in Auckland.
Date: Mon, 21 Oct 2019 18:48:23 +0200 (METDST)

Harare, Oct 21, 2019 (AFP) - At least 55 elephants have died in a month in Zimbabwe  due to a lack of food and water, its wildlife agency said Monday, as the country faces one of the worst droughts in its history.   More than five million rural Zimbabweans -- nearly a third of the population -- are at risk of food shortages before the next harvest in 2020, the United Nations has warned.

The shortages have been caused by the combined effects of an economic downturn and a drought blamed on the El Nino weather cycle.   The impact is being felt at Hwange National Park, Zimbabwe's largest game reserve.   "Since September, we have lost at least 55 elephants in Hwange National Park due to starvation and lack of water," Zimbabwe National Parks spokesman Tinashe Farawo told AFP.   Farawo said the park was overpopulated and that food and water was scarce "due to drought".

Africa's elephant numbers have dropped from around 415,000 to 111,000 over the past decade, mainly due to poaching for ivory, according to the International Union for Conservation of Nature (IUCN).   But Zimbabwe, like other countries in the southern African region, is struggling with overpopulation.   "Hwange was meant for 15,000 elephants but at the moment we are talking of more than 50,000," Farawo said.   "The situation is dire. We are desperately waiting for the rains."   An adult elephant drinks 680 litres (180 gallons) of water per day on average and consumes 450 kilogrammes (990 pounds) of food.

Hungry elephants have been breaking out of Zimbabwe's game reserves and raiding human settlements in search for food, posing a threat to surrounding communities.   Farawo said 200 people have died in "human-and-animal conflict" in the past five years, and "at least 7,000 hectares (17,300 acres) of crop have been destroyed by elephants".   The authorities took action earlier this year by selling nearly 100 elephants to China and Dubai for $2.7 million.   Farawo said the money had been allocated to anti-poaching and conservation projects.   Botswana, Namibia, Zambia and Zimbabwe have called for a global ban on elephant ivory trade to be relaxed in order to cull numbers and ease pressure on their territories.
Date: Mon, 21 Oct 2019 13:34:35 +0200 (METDST)

Santiago, Oct 21, 2019 (AFP) - Chile, reeling from its worst social unrest in decades, has since the 1990s been considered a Latin American hub of political stability and economic growth after 17 years of dictatorship.   Here is some background.

- From dictatorship to democracy -
In 1973 General Augusto Pinochet toppled Socialist President Salvador Allende in a military coup. Allende committed suicide in the presidential palace as troops closed in.   Pinochet imposed a right-wing dictatorship that lasted for 17 years, during which at least 3,200 people were killed or disappeared as a result of political repression. Around 38,000 were tortured.   In 1988 he lost a plebiscite on remaining in power and handed over to democratically elected Patricio Aylwin in 1990, remaining head of the armed forces until 1998.    Pinochet died in 2006 without standing trial for atrocities under his regime.   In 2006 Socialist Michelle Bachelet became Chile's first female president. Re-elected in 2013, she was barred constitutionally from standing again immediately and appointed UN right commissioner in 2018.   The 2017 elections were won by conservative billionaire Sebastian Pinera, who had already been president in 2010-2014.

- Model economy -
Pinochet applied neo-liberal free-market methods, privatising healthcare, education and pensions.   Chile turned to exports and in the 1980s became the preferred Latin American host for foreign investors.   With this economic model still largely in place, growth reached a strong 4% in 2018. The country of 18 million people also has the highest per capita income of Latin America at $20,000.   GDP, however, fell to 1.8% in the first half of 2019 -- due to a challenging external context, adverse climatic conditions and a delay in reforms -- and is expected at 2.5 percent for the year.   Despite slashing poverty from 30% in 2000 to 8.6% in 2019, the country has high social inequalities including in healthcare, education and pensions.   It is the world's biggest producer of copper, with lithium, timber, fisheries, gold, silver, avocados and oil also driving exports.

- Paedophile priests scandal -
The staunchly Roman Catholic country has been rocked by allegations of sexual abuse within the church going back decades.   In May 2018 Pope Francis summoned all 34 Chilean bishops to Rome over the crisis and all tendered their resignations, although only a handful have been accepted.   Since 2000 about 80 priests have been reported to authorities in Chile for alleged sexual abuse, including of children and adolescents.   Prosecutors said in August 2018 they were investigating 158 members of the church, both priests and lay people.   Ultra-conservative Chile allowed divorce only from 2004 and legalised abortion in certain cases in 2017.

- World's most seismic -
Bordered by the Pacific Ocean to the west and the Andes mountain range to the east, long and narrow Chile is the world's most seismic country.   In 1960 it was struck by the most powerful earthquake ever registered which measured 9.5 and struck at Valdivia. More than 5,700 people were killed.   In 2010 a 8.8-magnitude quake in the south and centre unleashed a tsunami that swept away entire villages, leaving around 520 people dead.

- Astronomy heaven -
Benefitting from a totally clear sky for most of the year, northern Chile is home to some of the world's most powerful telescopes.   The construction of the planet's biggest telescope was launched in May 2017 in the Atacama desert by ESO, the European Organisation for Astronomical Research in the Southern Hemisphere.
Date: Sun 20 Oct 2019
Source: Pakistan today [edited]

The death toll from a mysterious throat virus has reached 9 children in Seerani and its surrounding localities in Badin district as one more child infected by the virus died, affected people said on [Sun 20 Oct 2019].

A child, R, son of RM, died after contracting the disease. The most affected areas are reported to be Seerani and its surrounding localities. Teams of the health department and other organizations reached Seerani and took blood samples of at least 30 children who were infected by the virus. The blood samples will be sent to Islamabad for the tests.

The people of the area are worried about this new throat viral disease and have demanded authorities to provide immediate health cover to them.
====================
[There is little information to go on other than the throats of children are affected and the case fatality rate is high (10 of at least 30). No other symptoms are provided, nor is the basis for concluding that a virus is involved or what the epidemiological data are (dates, ages, sex of children involved, and local conditions). ProMED-mail would welcome additional information. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: 21 Oct 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/polio-cases-reported-in-zambia-chad-and-togo-73820/>

Circulating vaccine-derived polio virus (cVDPV) type cases have been confirmed in 10 African countries through [16 Oct 2019] this year [2019]. Now, the World Health Organization (WHO) is reporting 3 additional countries from the continent that more recently reported circulating vaccine-derived polio virus type 2 (cVDPV2) cases: Zambia, Chad and Togo.

Zambia
The Ministry of Health of Zambia reported last week on a confirmed case of circulating vaccine-derived polio virus type 2 (cVDPV2) in a 2-year-old child in Chienge district, Luapula province on the border with Democratic Republic of the Congo. This is the 1st case of cVDPV2 reported from Zambia in 2019. [Date of onset of paralysis reported to be 16 Jul 2019 according to another media report <https://www.lusakatimes.com/2019/10/21/polio-case-has-been-recorded-in-zambias-luapula-province/>.

In addition to the initial case-patient, 34 stool samples were collected from healthy contacts, and 2 samples tested positive for VDPV2, which were genetically linked to the case-patient. No established links have so far been found with the ongoing outbreak of cVDPV2 in Democratic Republic of the Congo, where 37 cases have been reported in 2019. The last recorded case of indigenous polio in Zambia was in 1995, while between 2001 and 2002, 5 cases of wild polio virus were identified among Angolan refugees in the Western province of the country.

Chad
Last week, WHO was informed about cVDPV2 in Chad. A cVDPV2 was isolated from a 13-month-old case of acute flaccid paralysis (AFP), with onset of paralysis on [9 Sep 2019] in Chari Baguirmi province, bordering Cameroon. The isolated virus has 32 nucleotide changes from Sabin 2, and is genetically linked to a cVDPV2 detected in Borno, Nigeria and is part of the Jigawa emergence. The last indigenous wild poliovirus cases were reported in 2000 in Chad.

Togo
In addition, last week WHO was informed about cVDPV2 in Togo. A cVDPV2 was isolated from a 30-month-old case of AFP with onset of paralysis on [13 Sep 2019] in Plateaux province, bordering Benin and Ghana. The isolated virus has 32 nucleotide changes from Sabin 2 and is genetically linked to a cVDPV2 detected in Irewole state, Nigeria and is part of the Jigawa emergence as well. The last indigenous wild poliovirus case was reported in 1999 in Togo.
======================
[Three more countries are joining the list of cVDPV outbreak countries, all with cVDPV2 isolates. Two of the 3 countries (Togo and Chad) have viruses related to the Jigawa, Nigeria cVDPV2 outbreak. The case in Zambia is suspected to be associated with the ongoing cVDPV2 transmission in the Democratic Republic of the Congo (DR Congo), but genetic testing is presumably still pending or has been negative. See my comments below after the following section, as they are relevant to what is ongoing globally with respect to cVDPVs.

Below are the HealthMap/ProMED map links to countries where cVDPV cases/outbreaks have occurred in the past 12 months, a total of 20 countries.

Angola: <http://healthmap.org/promed/p/165>
Benin: <http://healthmap.org/promed/p/59>
Cameroon: <http://healthmap.org/promed/p/65>
Central African Republic: <http://healthmap.org/promed/p/66>
Chad: <http://healthmap.org/promed/p/57>
China: <http://healthmap.org/promed/p/155>
Democratic Republic of the Congo: <http://healthmap.org/promed/p/194>
Ethiopia: <http://healthmap.org/promed/p/95>
Ghana: <http://healthmap.org/promed/p/53>
Indonesia: <http://healthmap.org/promed/p/184>
Kenya: <http://healthmap.org/promed/p/174>
Mozambique: <http://healthmap.org/promed/p/177>
Myanmar: <http://healthmap.org/promed/p/148>
Niger: <http://healthmap.org/promed/p/58>
Nigeria: <http://healthmap.org/promed/p/62>
Papua New Guinea: <http://healthmap.org/promed/p/188>
Philippines: <http://healthmap.org/promed/p/158>
Somalia: <http://healthmap.org/promed/p/125>
Togo: <http://healthmap.org/promed/p/64>
Zambia: <http://healthmap.org/promed/p/170> - ProMED Mod.MPP]
Date: Fri 18 Oct 2019 07:32 PM EDT
Source: WSPA [edited]

North Carolina health officials say a 4th person has died from an outbreak of legionnaires' disease linked to a hot tub display at the North Carolina Mountain State Fair, which is held at the Western North Carolina Agricultural Center.

We've also learned another person, who did not attend the NC Mountain State Fair, was diagnosed with legionnaires' after attending a quilt show that was held inside the same building as the hot tub exhibit. That building is the Davis Event Center.

7 News spoke with folks who have been impacted by the outbreak. "We were like 'Oh no, I hope nobody gets sick,'" [LP] said. He attended the North Carolina Mountain State Fair-an event tied to at least 140 cases of legionnaires'. He said 2 people he knows, including his uncle, got sick after the fair. "They didn't actually have legionnaires', but they had respiratory problems that did come out of it," he said. [Perhaps Pontiac fever?] Even so, [LP] was back at the WNC Agricultural Center on [Fri 18 Oct 2019] to help host his club's annual Antique Tractor Show.

And while everything appeared to be business as usual, [LP] was concerned as another person was just diagnosed with the disease and didn't attend the fair. Instead, they were at a quilt show held at the WNC Agricultural Center 2 weeks later. "Anytime there's an outbreak of something, it's always going to have a thing in the back of your mind that says, 'I don't know if I want to do this or not,'" he said.

The Davis Event Center has since been closed; but health officials say it's possible the source for the newest case of legionnaires' may not have been at the WNC Agricultural Center. "There are other possible exposures that this person had, so it's hard. At this point, we can't pinpoint," Jennifer Mullendore with Buncombe County Health and Human Services said.

According to a statement by the WNC Agricultural Center, the hot water system in the Davis Event Center, and every other building on the grounds, went through a disinfecting process as a precautionary measure. "They did some cleaning and doing some real hot high-powered water through the water system here, and so we do have a clean bill of health," Phillips said.  It's unclear at this time when the Davis Event Center will re-open.  [Byline: Scottie Kay]
========================
[The latest status, as of 18 Oct 2019, of the legionellosis outbreak associated with the Mountain State Fair that was held in western North Carolina between 6 and 15 Sep 2019 at the Western North Carolina Agricultural Center (WNC Ag Center) in Fletcher, a town in Henderson County, can be found at <https://epi.dph.ncdhhs.gov/cd/legionellosis/outbreak.html>.

The source of the outbreak has still not as yet been confirmed. However, hot tub displays in one of the buildings (Davis Event Center) has been linked to the outbreak. A site map of the WNC Ag Center that shows the location of the Davis Event Center building can be found at <https://www.wncagcenter.org/p/mountainstatefair/competitions/map>.

One more case and an additional death have been reported since the last ProMED-mail post on this outbreak, but no cases linked to the outbreak had a symptom onset date more than 2 weeks after the end of the fair, that is, within the incubation period for legionnaires' disease (<https://www.cdc.gov/legionella/clinicians/clinical-features.html>). The latest case of legionnaires' disease didn't attend the fair, but instead attended a quilt show held 2 weeks later at the Davis Event Center, but the source for this case is thought possibly to have not been at the WNC Agricultural Center. The Davis Event Center has since been closed.

The number of confirmed cases of legionellosis by county are as follows: Buncombe, 49; Burke, 1; Caswell, 1; Cherokee, 1; Gaston, 1; Granville, 1; Haywood, 12; Henderson, 34; Jackson, 3; Madison, 6; McDowell, 5; Mecklenburg, 5; Mitchell, 2; Polk, 1; Rutherford, 3; Transylvania, 3; Union, 1; Watauga, 1; and Yancey, 1. 10 cases occurred out of state (in South Carolina). Total cases: 141. A map showing the location of the North Carolina counties can be found at <https://geology.com/county-map/north-carolina.shtml>.

Male, 82 (59%)*; female, 58 (41%)*. Median age in years (range): 61 (24-91). Hospitalizations: 94 (69%)*; deaths 4. *Some cases reported with unknown gender or hospitalization status.

A total of 133 (94%) have legionnaires' disease, the pneumonic form of the infection, and 8 (6%) have Pontiac fever, the non-pneumonic form of the infection.

The species of _Legionella_ detected in patients is not specified; however, the usual pathogen in the USA is _L. pneumophila_ serogroup 1 and one sample of water collected from the women's restroom in the Davis Event Center was previously reported to be positive for _L. pneumophila_. Genotyping clinical and environmental isolates will help identify clusters of cases with a common source and identify the source responsible for infection in these clusters. - ProMED Mod.ML]
 
[HealthMap/ProMED-mail map of North Carolina, United States:
Date: Sun 20 Oct 2019 12:52 AM IST
Source: Deccan Chronicle [edited]

The respite from cases of dengue, notwithstanding, the city [Hyderabad] is now caught in the grip of viral encephalitis, or brain fever. There is an alarming increase in the number of viral encephalitis cases being reported across city hospitals. This is ironic as October is medically termed as 'fair-weather' season. The rise in the number of cases has been worrisome and those getting inflicted include children and elders.

Many are complaining of fever of the brain with body temperature touching [106-107 deg F/41.1-41.6 deg C].

According to doctors, at least 3 cases are reported each week in the tertiary hospitals of which 7 major ones are in the city.

Dr Shyam Jaiswal, neurologist at Care Hospitals, explains, "Of late, we have been admitting viral encephalitis-affected children in the hospital. Most fall sick because of the body's low immunity. Immediate hospital care is a must as most complain of severe headache, delirium, and in some cases even loss of memory. The treatment takes between 2-3 days."

It is a medical nightmare that some elders are suffering from both chikungunya and viral encephalitis.

Dr Hari Kishan B, general physician with Apollo Hospitals, explains, "The combination of chikungunya and viral encephalitis has been noted earlier too. These are rare cases but do occur from time to time. The viral infections have been very high this year [2019] and those suffering from diabetes, hypertension, and other cardiovascular ailments, will suffer more when infected with these viruses."  [Byline: Kaniza Garari]
=====================
[This report does not provide total case numbers, nor indicate how long 2-3 cases per week have been occurring. The virus suspected or confirmed as the etiology of these cases is not mentioned, but the comment that October is termed "a fair weather season" suggests that Japanese encephalitis virus may be involved with the usual transmission season declining in October. No mention is made of acute encephalitis syndrome, a clinical designation with a variety of suggested Aetiologies in other cases in north-eastern India. - ProMED Mod.TY]

[Maps of India: