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Greenland

Located to the northeast of Canada, Greenland lies mostly within the Arctic Circle, extending to within less than 500 miles (800 km) of the North Pole. It is bordered on the north by the Lincoln Sea and the Arctic Ocean, and on the east and south by the G
eenland Sea, the Denmark Strait, and the Atlantic Ocean.

Its climate is bleak and Arctic, although rapid changes like bright sunshine and powerful blizzards are common. Average January and July temperatures in the south are 21°F (-6°C) and 45°F (7°C). In the north, average January and July temperatures are -31°F (-35°C) and 39°F (4°C). Average monthly precipitation decreases from 9 inches (24 cm) in the south to about half an inch (1.5 cm) in the north. Although summer rainfall is concentrated in the southwest, snow can fall in any month. Summers can be rather pleasant on the southwest coast, but the inland ice is uniformly cold, with a July average of 10°F (-12°C) and a February mean of -53°F (-47°C).

Health Precautions
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General Cautions
Recent medical and dental exams should ensure that the traveler is in good health. Carry appropriate health and accident insurance documents and copies of any important medical records. Bring an adequate supply of all prescription and other medications as well as any necessary personal hygiene items, including a spare pair of eyeglasses or contact lenses if necessary.

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: Thu, 17 Oct 2019 05:32:08 +0200 (METDST)
By Tom LITTLE

Kulusuk, Denmark, Oct 17, 2019 (AFP) - Kayaking past blue-white icebergs drifting along near a pristine harbour, wandering around colourful houses or trekking in the snow-capped wilderness: July and August are high season for tourists in eastern Greenland.   Many of the 85,000 tourists who visit each year head to the west coast, but eastern Greenland, with its glaciers, wilderness and wildlife starring whales and polar bears, is also drawing visitors.

Sarah Bovet, a 29-year-old Swiss artist, said it's hard to know what to expect.   "Thinking you're going to be surprised, you are even more so in reality," she said standing outside a hostel in the tiny village of Kulusuk.   Bovet was on an artistic residency in Greenland when she visited Kulusuk and its 250 souls.   Although she had imagined a small village before arriving, its stunning views and bright colours still came as a surprise.   With just one supermarket, an airport built in the 1950s by the US military to serve a Cold War radar base, and a harbour surrounded by brightly painted wooden houses, most of the villagers appreciate the extra revenue from tourism.

Justus Atuaq, a young hunter in Kulusuk, takes tourists out on sled tours in March and April -- the spring high season -- earning money that helps him feed and care for the dogs he uses for racing and hunting.   "Now I can take dogsleds for hunting, and sometimes tourists coming from other countries also want to dogsled," he said outside his wooden house.   Tourists also take boat trips during the summer high season from July to August.   Arrivals to the island grew 10 percent year-on-year from 2014 to 2017, and three percent in 2018, according to the tourist board, Visit Greenland.   Many adventure seekers and nature lovers arrive by plane, but cruise ships also bring admirers, hugging the picture perfect coastline.

- Growing strategic importance -
But they are not alone in taking an interest in the world's largest island.   The Danish territory's rich natural resources and growing strategic importance as the Arctic ice sheet melts have attracted the attention of US President Donald Trump.   The Arctic region has untapped reserves of oil, gas and minerals, as well as abundant stocks of fish and shrimp.   In August, Trump offered to buy Greenland, then called off a visit to Copenhagen over its refusal to sell.

Denmark colonised Greenland in the 1700s, granting it autonomy in 1979.    Today, many Greenlandic political parties advocate full independence.   The territory still receives an annual subsidy from Copenhagen, which was 4.3 billion Danish kroner (576 million euros) in 2017, and tourism could help it to become economically self-reliant.   Like many parts of Greenland, Kulusuk has no tarmac roads and visitors must travel by plane or boat.   The growth in tourism could put a strain on the village's infrastructure, and the sector faces unique challenges given Greenland's location, weather and the cost of travelling there.

Day tours of Kulusuk with flights from the Icelandic capital Reykjavik are 97,000 Icelandic kronur ($780, 700 euros).   Jakob Ipsen, a 48-year-old who grew up between Denmark and Greenland's west coast, runs Kulusuk's sole hotel.   The 32-room hotel stands beside a fjord, and from its dining room, guests can watch icebergs drift by during the summer.    But the region's isolation can be problematic, Ipsen admits.    "We have to get all our supplies in with the first ship for the whole summer season, and for the winter season when everything is frozen over, we have to get all our supplies in with the last ship for the whole winter," he said.

- 'They go back as different people' -
Greenland must tackle its infrastructure challenges if it wants to develop tourism, Visit Greenland says.   Government-funded work is under way to extend runways at the capital Nuuk and Ilulissat, both on the west coast, and a new airport is planned in the south.   The tourist body said it would weigh the environmental impact of boosting infrastructure, both on the environment and on local communities.    Ipsen worries about the effects of uncontrolled tourism to the region.   "We want to try to maintain it as it is, so it's not exploding," he said.

Already, said Johanna Bjork Sveinbjornsdottir, who runs tours in Kulusuk for an Iceland-based company, the rise in visitor numbers is making itself felt.   "In the campsites here out in nature where you used to be alone, there's two, three groups at a time," she said.   Like Ipsen, she is also concerned about the effect that rising visitor numbers could have on the wilderness around the village.    "If you want nature to survive that, you have to build up the infrastructure," she said, pointing to the lack of officially designated campsites around Kulusuk, with no rubbish bins or toilets for travellers outdoors and no one supervising the sites.   Despite the concerns, Sveinbjornsdottir hopes visitors will keep coming.   "They go back as different people," she said. "Everything is beyond what you ever imagined."
Date: Fri, 16 Nov 2018 14:19:01 +0100

Copenhagen, Nov 16, 2018 (AFP) - Greenland's parliament has adopted a plan to upgrade or build airports to serve the massive North Atlantic island, keen to attract more tourists to its pristine Arctic wilderness.   Two airports -- in the capital Nuuk and in the tourism centre Ilulissat -- will be substantially upgraded, making it possible to fly directly to Greenland from Europe and North America.

A new national airport will be built in Qaqortoq in the south.   Greenland is an autonomous Danish territory. The plans have been controversial because of Copenhagen's direct financial involvement.   The project is estimated to cost at least 3.6 billion kroner (482 millions euros, $546 million).   Almost 20 percent of the financing will be provided by Denmark, which contributes 3.6 billion kroner to the island's annual budget.   Parliament adopted the proposal late Thursday with 18 out of 29 votes.

In September, the project plunged Greenland into a three-week political crisis, with an independent supporting party quitting the government coalition in protest against Denmark's involvement.   The social democratic Siumut party, which has dominated Greenland politics for four decades, was ultimately able to cling to power with a new, narrower majority.   "We are creating lots of opportunities for Greenland's future. We are not selling out," Prime Minister Kim Kielsen insisted in parliament's debate, local television KNR reported.   The three airports will serve the main population centres of the island, which is home to 55,000 people spread out across an area more than four times the size of France.

Smaller communities have meanwhile complained they will remain isolated.   In addition, "other risks have also been raised, like the reaffirmed presence of the US military, which not everyone sees as a positive thing, and the environmental risks brought on by better international connections," Mikaa Mered, a professor of Arctic geopolitics at the ILERI School of International Relations in Paris, told AFP.

Since 2009, Greenland has been largely independent when it comes to its economic policy but foreign and defense issues remain under Copenhagen's control.   "The big winner in this affair is Copenhagen. Both on the political, economic and geopolitical levels, Copenhagen is strengthening its positions across the board, vis-a-vis China and the triangular alliance with Washington," Mered said, referring to Beijig's eagerness to invest in the Arctic which has raised concern in the US.   Construction of the airports is scheduled to be completed by 2023.
Date: Fri, 13 Jul 2018 14:25:42 +0200

Stockholm, July 13, 2018 (AFP) - A massive iceberg drifting near the coast of Greenland has triggered fears of flooding if it breaks up, leading the authorities to  evacuate a high-risk zone.    The authorities have urged residents of the Innarsuit island settlement with houses on a promontory to move away from the shore over fears that the iceberg, which was spotted on Thursday, could swamp the area.   "We fear the iceberg could calve and send a flood towards the village," Lina Davidsen, a security chief at the Greenland police, told Danish news agency Ritzau on Friday.

The settlement in northwestern Greenland has 169 inhabitants, but only those living closest to the iceberg have been evacuated, Ritzau reported.    "The iceberg is still near the village and the police are now discussing what do to next," Kunuk Frediksen, a police chief in the Danish autonomous territory, told AFP.   The incident comes weeks after scientists at New York University shot and released a video of a massive iceberg breaking free from a glacier in eastern Greenland in June.    Last year, four people died and 11 were injured after an earthquake sparked a tsunami off another island settlement called Nuugaatsiaq, sending several houses crashing into the sea.
Date: Mon, 14 Aug 2017 17:54:23 +0200

Stockholm, Aug 14, 2017 (AFP) - Police in Greenland warned people to stay away from western areas of the island as wildfires scorched swathes of scrubland.     In a statement, the police said it "still discourages all traffic -- including hiking and hunting -- in two areas around Nassuttooq and Amitsorsuaq."     "The fires are not expected to end within the next few days," the statement added.    Some of the blazes have been burning since July 31.

Denmark's meteorological service BMI said the island registered its hottest-ever temperature of 24.8 degrees (77 Fahrenheit) on August 10.   Last year was Greenland's hottest on record.    The Danish territory has lost about 4,000 gigatons of ice since 1995, British researchers said in June, making ice melt on the huge island the biggest single contributor to rising sea levels.
Date: Sun, 18 Jun 2017 16:10:26 +0200

Stockholm, June 18, 2017 (AFP) - Four people were listed as missing Sunday after an earthquake sparked a tsunami off Greenland and forced some residents to be evacuated.   "Four people are missing," local broadcaster KNR quoted local police chief Bjorn Tegner Bay as telling a news conference in the autonomous Danish territory.   There were no confirmed fatalities, but Bay said 11 houses had been swept away after a magnitude 4 overnight quake off Uummannaq, a small island well above the Arctic Circle.    "The huge waves risk breaking over Upernavik and its environs. The residents of Nuugaatsiaq are going to be evacuated," police said on Facebook, referring to nearby hamlets.

Some residents posted images to social media showing huge waves breaking over buildings in the town.   "A good explanation is that the quake created a fault at the origin of a tsunami," meteorologist Trine Dahl Jensen told Danish news agency Ritzau, warning of potential aftershocks.   "It's not normal, such a large quake in Greenland," she said.   KNR quoted Ole Dorph, mayor of Qaasuisup, a municipality in the area affected, as lamenting "a serious and tragic natural catastrophe which has affected the whole region."   Danish Prime Minister Lars Lokke Rasmussen tweeted news of what he termed a "terrible natural catastrophe at Nuugaatsiaq."   The world's largest island situated between the North Atlantic and Arctic oceans, Greenland, population 55,000, has an ice sheet particularly vulnerable to climate change.
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Zambia

Zambia US Consular Information Sheet
June 02, 2008
COUNTRY DESCRIPTION:
Zambia is a developing country in southern Africa. Tourist facilities outside of the capital, Lusaka, Livingstone (Victoria Falls), and well-known game parks are not f
lly developed. Read the Department of State Background Notes on Zambia for additional information.
ENTRY/EXIT REQUIREMENTS: A passport and visa are required. A visa may be obtained in advance at a Zambian Embassy or Consulate or at the port of entry. Zambia raised the visa fee for American passport holders to $135 as of January 26, 2008. American citizens should bring exact change, whenever practical. Visas are valid for 3 years, and for multiple entries. At the time of entry, the immigration officer will stamp your passport with the permitted length of stay. This is normally 30 days and can ordinarily be extended twice (for a total time of 90 days) by visiting the immigration home office in Lusaka. All Americans, except resident diplomats, must pay an airport departure tax which is collected in U.S. dollars. Airlines include this tax in the cost of the ticket. However, passengers will need to verify that this tax has been paid at the airport. The passenger will receive a “no-fee” receipt reflecting this payment.

Travelers transiting through South Africa should ensure that they have at least two blank (unstamped) visa pages in their passports. South African immigration authorities routinely turn away visitors who do not have enough blank visa pages in their passports. Zambian Immigration officials insist visitors carry the original or a certified copy of their passport and their immigration permit at all times. Certified copies must be obtained from the immigration office that issued the permit. American citizens should closely follow immigration guidelines, including visa requirements for travel to Zambia.
NOTE: Some tour operators were previously able to obtain visas at reduced rates using a special tourism waiver. Zambia announced that they were ending this waiver program as of January 26, 2008 and that all American tourists would be required to pay the new $135 fee. Travelers with outstanding reservations with tour operators should be prepared to pay the difference upon arrival in Zambia.
Additional information on entry requirements may be obtained from the Embassy of the Republic of Zambia, 2419 Massachusetts Avenue NW, Washington, DC 20008, telephone (202) 265-9717 or 19 or online at http://www.zambiaembassy.org. 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:
U.S. citizens are advised to exercise caution when traveling in northern Luapula Province and in areas of the Northern Province adjacent to the Democratic Republic of Congo (DRC). Although a cease-fire is currently in effect, the DRC is not yet stable and uncontrolled militias operate in the eastern DRC. In the past, armed gunmen have occasionally attacked vehicles near the DRC-Zambian border. Land mines and unexploded ordnance along the western, southern, and eastern borders make off-road travel to those areas potentially hazardous. For these reasons, the U.S. Embassy discourages travelers from driving off-road or on remote little-used tracks near the borders with DRC and Angola. American citizens who must drive in these areas are encouraged to drive in convoy and to carry satellite telephones.

U.S. citizens should avoid political rallies and street demonstrations and maintain security awareness at all times. For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

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

CRIME: Travel in many sections of Lusaka, Livingstone and most other major cities as well as in the major game parks, is generally safe during daylight hours. Travelers using public transportation or visiting high pedestrian traffic areas are advised to be vigilant against robbery and pick-pocketing.

Vehicle thefts, burglaries, and armed robbery occur throughout the country. Carjacking remains an ongoing problem, especially in Lusaka and other major cities. Carjackers generally employ a strategy of blocking the back of one’s car when the car is waiting to pass through a security gate into a residence or other facility. It is recommended to drive with doors locked and windows closed at all times and remain vigilant when entering or exiting one’s residence.
Foreign tourists have frequently been the target of small-scale financial scams involving bogus “fees” to be paid to various Zambian officials and groups. The embassy cautions travelers to make sure that they receive an official, Government of Zambia receipt for any fines and duties paid. Often, travelers will be told that the official does not have a receipt book or that this type of fine is not receipted. Polite, but firm insistence on a Zambian Government receipt will often result in these fines disappearing.
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: Government hospitals and clinics are often understaffed and lack supplies. Private medical clinics in major cities can provide reasonable care in many cases, but major medical emergencies usually require medical evacuation to South Africa, Europe, or the United States. Basic medical care outside of major cities is extremely limited. Doctors and hospitals often expect immediate cash payment for health services. Travelers should carry their prescription drugs and medications in original labeled containers, as well as the written prescription from their physician. (See “Criminal Penalties” section.)
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Zambia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Traffic circulates on the left side of the road, and there are many British-style roundabouts rather than intersections with traffic lights. There is no left turn on red. Seat belts are mandatory, as are helmets for motorcyclists. A child's seat is not mandatory by law, but is essential for safeguarding children. The speed limit is 50 km/30 mph in Lusaka and 100 km/60 mph outside of city limits. However, speed limits are rarely respected, and most cars drive 80 km/50 mph in the city and 120 km/75 mph outside town. Most vehicles operate at even faster speeds on the road from Lusaka to Livingstone. Drivers under the influence of alcohol who are involved in accidents are tested at Lusaka's University Teaching Hospital (UTH) and then taken to court.

Driving on Zambian roads can be hazardous. Most roads do not have shoulders or sidewalks; pedestrians and livestock use the roadways both day and night. While the main roads in Lusaka as well as the principal highways linking Lusaka with the major provincial capital are generally maintained, many secondary roads are in poor repair. During the rainy season (end of October to mid-March), travelers who do not have a four-wheel drive vehicle will encounter problems driving on rural roads. Even in daylight, passing another vehicle can be particularly dangerous given the general condition of roads. Driving at night can be hazardous and is discouraged. When breakdowns occur, local drivers place a few branches behind the car to indicate trouble, but this is hardly visible at night. As a result, many drivers use their high beams at night to detect stopped vehicles and pedestrians.
Since 2000, Americans have been involved in a number of series car accidents. There are no emergency services for injured or stranded drivers. Car accident victims are vulnerable to theft by those who pretend to be “helpful.” It is advisable to have a cell phone when undertaking a trip outside of town, although many parts of the country do not yet have cell phone service.

City traffic is comprised mostly of cars and minibuses; motorcycles are rare. Minibuses serve as the primary means of inter-city travel in Zambia. They are often overcrowded and seldom punctual. Drivers often use pass using road shoulders or opposing traffic lanes. Often they will stop with little or no warning, in order to pick up or drop off passengers. Some luxury buses do ply the routes between Lusaka and Livingstone and the Copperbelt. Please refer to our Road Safety page for more information. Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://www.zambiatourism.com/.
AVIATION SAFETY OVERSIGHT:As there is no direct commercial air service to the United States by carriers registered in Zambia, the U.S. Federal Aviation Administration (FAA) has not assessed Zambia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Perpetrators of business fraud often target foreigners, including Americans. While such fraud schemes in the past have been largely associated with Nigeria, they are now prevalent throughout Africa, including Zambia. For additional information, please consult The Department of State's publication "International Financial Scams." In addition, Americans are advised to exercise caution when approached with unsolicited offers to purchase gemstones or precious metals for export as the Embassy has received multiple recent complaints from Americans who have been victimized as a result of their involvement in these deals.
U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times, so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available. Zambian police do not provide the U.S. Embassy with timely notification of the arrest of American citizens. If you are detained, you should insist on your right to contact a U.S. consular officer.
MasterCard and Visa cards are accepted in major supermarkets, restaurants, stores, and hotels in Lusaka and Livingstone (Victoria Falls). Credit card fraud is increasing in Zambia and there have been several cases involving fraudulent charges, including some at major hotels catering primarily to foreign visitors. Many businesses use carbonized paper documents to process payment. These documents are not secure and can pose a threat to cardholders. The Embassy urges caution when using debit or credit cards at any point of purchase, especially if the transaction is not processed electronically. Normally, American travelers can withdraw money (in local currency) from ATMs in major cities in Zambia using their ATM cards or credit cards from the United States. However, from time to time, the banks lose their connections with the credit card exchanges, thus making withdrawals impossible. Zambian banks and bureaux de change will not accept dollar-denominated notes issued before 1990.
Travel to military areas and photographing military facilities, airports, bridges, and other facilities deemed to be of security relevance, are prohibited. Often these sites are not clearly marked and the first notification that a tourist would receive is a police officer demanding their film and/or camera. Authorities may also challenge photography of areas other than tourist attractions. Service providers in Zambia, including the tourism sector, are not subject to the same standards of safety oversight that exist in the United States; visitors should evaluate risks carefully.

Travelers are cautioned to observe local or park regulations and heed all instruction given by tour guides. Even in the most serene settings, wild animals can pose a threat to life and safety.

Large numbers of travelers visit tourist destinations, including South Luangwa National Park and Livingstone (Victoria Falls), without incident. However, American citizens are advised to avoid rafting and other whitewater boating activities on the Zambezi River below Victoria Falls during the high-water season, February through June. During periods of high water, the Batoka Gorge section of the river becomes unpredictable and several tourists have been involved in fatal accidents.
Please see our Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Zambian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Zambia 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.

It is against both Zambian and U.S. law to buy, possess or transport animals or animal products, such as tortoise shell, rhino horn, elephant ivory, tusks of any animal or any items made out of these materials. In Zambia, penalties range from large fines to mandatory 5-year prison sentences. The Zambian Wildlife Authority has screeners at international ports of entry/exit and WILL prosecute offenders to the fullest extent of the law.

While many of these items are sold in open markets particularly aimed at foreign tourists, it remains the responsibility of the customer to ensure that he/she is not purchasing a prohibited item.

Further instructions on the importation of items to the U.S. may be found on the U.S. Customs and Border Protection web site at
http://www.customs.gov/xp/cgov/travel/vacation/kbyg/prohibited_restricted.xml.

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 Zambia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Zambia. 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 the corner of Independence and United Nations Avenues. The mailing address is P.O. Box 31617, Lusaka, Zambia. Telephone exchanges have recently changed within Zambia. When calling from the United States, please contact the American Embassy during regular work hours, Monday through Thursday from 7:30 a.m. to 5:00 p.m., and on Friday from 7:30 a.m. to 12:30 p.m. by dialing 011-260-21-125-0955. For after-hours emergencies involving American citizens, please dial 011-260-21-125-0955 extension 1. The fax number is 260-21-125-2225. The web site is http://zambia.usembassy.gov.
* * *
This replaces the Country Specific Information for Zambia dated February 14, 2008, to update sections on Entry/Exit Requirements and Crime.

Travel News Headlines WORLD NEWS

Date: Tue, 29 Oct 2019 20:07:03 +0100 (MET)

Lusaka, Oct 29, 2019 (AFP) - More than two million Zambians are facing "severe" food insecurity after drought and flooding reduced harvests, the Red Cross said Tuesday.   Southern Africa is grappling with one of the worst droughts in decades after months of erratic rainfall and record-high temperatures.   Zambia Red Cross warned the drought had left an estimated 2.3 million people facing "severe food insecurity", up from 1.7 million a month ago.   "The successive mixture of drought and flooding has been catastrophic for many communities," said Zambia Red Cross head Kaitano Chungu in a statement.

While rainfall hit a record low in southern and western Zambia, flash floods and  waterlogging occurred in the north and east of the country.   The Red Cross said that combination resulted in "poor harvests", with families in the worst-affected areas surviving on wild fruit and roots -- posing a serious risk to their health.   "In most of the affected areas there isn't enough drinking water, which means that people and animals-both livestock and wildlife-are having to use the same water points," said Chungu.    "This is unacceptable as it exposes people to diseases and creates a heightened risk of animal attacks," he added.

Zambia's regional neighbours have also felt the impact.   More than five million rural Zimbabweans -- nearly a third of the population -- could face food shortages before the next harvest in 2020, according to the United Nations.   And wildlife has been affected as well.   At least 55 elephants died in Zimbabwe and 100 in Botswana over the past two months due to lack of food and water.
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, 23 Aug 2019 15:08:04 +0200 (METDST)
By Obert SIMWANZA

Lusaka, Aug 23, 2019 (AFP) - Children living in a central Zambian mining town are still exposed to high levels of toxic lead 25 years after the mine closed, Human Rights Watch said Friday, as lawyers announced plans to take legal action.   Decades of lead mining have left Kabwe, around 150 kilometres (95 miles) north of Lusaka, severely polluted, with serious health implications for residents.   The mine, which operated from the early 1900s until its closure in 1994, was at one time the world's largest lead mine. It was run by the Zambian government from the early 1970s when the mining industry was nationalised.     In a report published Friday, HRW said the town in the Copperbelt area still has extreme levels of contamination and children continue to be exposed to high levels of toxic lead in soil and dust around their homes, schools and play areas.

HRW's children's rights fellow and report author Joanna Naples-Mitchell described the situation in Kabwe as "a public health emergency" and said the government was "not responding with the sense of urgency that is warranted".    "The Zambian government is aware that Kabwe has been severely contaminated... since the 1990s and efforts to clean up have been inadequate," she told AFP.   A class action suit is being prepared to demand compensation for poisoning from Anglo American South Africa, a former investor in the mine, London-based law firm Leigh Day announced Friday. The law firm deals in human rights issues.   The case will be brought in courts in South Africa, where the mining firm is based, said the lawyers, who are acting on behalf of some 200 children who have been treated for lead poisoning.   Anglo American on Friday said in a statement it did not believe it was "in any way responsible for the current situation" in Kabwe.    "We were concerned to learn of the situation at Kabwe as reported by the press," it said, adding "the nationalisation more than 40 years ago effectively placed these issues under the control of the Zambian Government".

- 'Severely contaminated' -
The HRW report said that although lead and zinc mining have stopped in the town, various medical studies conducted over the past seven years show children there still had elevated levels of lead in their blood.   Between 2003 and 2011, the World Bank funded a government project to decontaminate Kabwe's affected townships, and to test and treat children. But some 76,000 people, or a third of the town's population, still live in contaminated areas.   One recent study published last year and cited by HRW estimated that more than 95 percent of children in the townships surrounding the lead mine have elevated blood lead levels and that about half of them require medical intervention.   "This is the worst environmental disaster I have seen in 30 years of practice," said lawyer Richard Meeran of Leigh Day.    Johannesburg-based collaborating lawyer Zanele Mbuyisa said they will argue that "the environmental damage created has potentially contaminated almost three generations of men, women and children".

- Insufficient resources -
Three years ago, the government launched another five-year World Bank-funded project to get rid of the lead and carry out new rounds of testing and treatment.   The project targets around 10,000 people including children, pregnant women and mothers.   "We think this a very important opportunity for the Zambian government to find a lasting solution to this problem," said Naples-Mitchell.   She urged Zambia to find new and effective methods to clean up the lead, adding that their 2018 study indicated that pollution levels were "as high they had been in the 1970s".    In a letter last month, the government indicated to HRW that it does not have enough resources to address the full scale of the contamination.   The government did not immediately comment on the report.   Children are more vulnerable to lead poisoning since they absorb four to five times as much as an adult and this can retard their growth and IQ, while in worst cases it can result in brain damage or even death.
Date: Sat 6 Jul 2019
From: Johannes Jochum <j.jochum@uke.de> [edited]

A 19-year-old German woman was diagnosed with East African trypanosomiasis (due to _Trypanosoma brucei rhodesiense_) during a stay in Zambia.

The patient had been working since August 2018 in a school project close to Kabwe. From 29 May to 4 Jun [2019] she visited South Luangwa National Park. On 31 May [2019], she received a mildly painful insect bite on her calf during an afternoon game-viewing drive from Kafunta River Lodge.

She recalled seeing numerous tsetse flies during this drive but was told there had not been any cases of trypanosomiasis for years in this area. The bite initially healed well and she returned to Kabwe.

On the evening of 11 Jun [2019], she developed high fever, rigors, and severe headache. The site of the insect bite on her calf was swollen and showed livid discoloration. Several point-of-care tests for malaria were negative.

Antibiotic treatment at a local hospital led to no improvement of her symptoms. On 16 Jun [2019] she was admitted to Lusaka Coptic Hospital where African trypanosomiasis was diagnosed by blood microscopy. Central nervous system involvement was ruled out by spinal tap, and treatment with suramin was started on 17 Jun [2019]. The patient returned in stable condition to Germany on 2 Jul [2019] where she sought further treatment and follow-up at our institution.

South Luangwa National Park is known to be endemic for East African trypanosomiasis with several cases in recent years; the most recent report in ProMED-mail is in March 2019:  <http://www.promedmail.org/post/http://promedmail.org/post/20190320.6377064>.

Game animals and livestock are the main reservoir of this zoonotic disease in south-eastern Africa. Tourists acquire the disease occasionally during game safaris in Zambia, Malawi, Zimbabwe, Uganda, and Tanzania. West African trypanosomiasis (_Trypanosoma brucei gambiense_) accounts for substantially more cases in total, affecting local populations mostly in remote rural areas of the Democratic Republic of Congo, Angola, and Central African Republic  (<https://www.who.int/trypanosomiasis_african/country/en/>).
---------------------------------------------
Communicated by:
Dr. Johannes Jochum
Department of Tropical Medicine
Bernhard Nocht Institute for Tropical Medicine
Department of Medicine
University Medical Center Hamburg-Eppendorf
Hamburg, Germany
==========================
[This is the website of the national park:

Trypanosomiasis is endemic in the national parks in southern Africa, where there are tsetse flies and a reservoir of the trypanosomes in the wildlife. It is important to consider trypanosomiasis in febrile travellers to these national parks with negative tests for malaria. - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Date: Tue 14 May 2019
Source: Lusaka Times [edited]

Government has revealed that about 17 people are admitted to Mpulungu urban clinic for suspected cholera. Mpulungu District Commissioner Dennis Sikazwe has confirmed the development to ZANIS [Zambia News and Information Services] in Mpulungu today [14 May 2019].

Mr. Sikazwe said the Ministry of Health has since recommended that schools be closed for the period of one week to ensure that the situation is contained. He added that all operations of ferrying people from Mpulungu to Nsumbu in Nsama district by boats has been suspended for the period of one week. Mr. Sikazwe has also revealed that the ministry has put up measures to sensitize people on the need to maintain high levels of hygiene during this period.

The District Commissioner has also urged people to work with the medical staff at the health facility in order to control a further spread of the disease. He has also urged people to report all suspected cholera cases to the nearest health centres.

In Mbala, 5 people have been admitted at Tulemane clinic for suspected cholera. Sources from Tulemane clinic, who sought anonymity, confirmed the development to ZANIS in Mbala yesterday [13 May 2019]. Mbala District Commissioner Kedrick Sikombe, who could not confirm the matter, has promised to give a detailed report once he gets details from the Ministry of Health in the area.
==================
[The mortality from cholera and most diarrheal illnesses is related to non-replacement of fluid and electrolytes from the diarrheal illness.

As stated by Lutwick and colleagues (Lutwick LI, Preis J, Choi P. Cholera. In Chronic illness and disability: the paediatric gastrointestinal tract. Greydanus DE, Atay O, Merrick J, editors. New York: Nova Bioscience; 2018:113-127), oral rehydration therapy can be life-saving in outbreaks of cholera and other forms of diarrhoea: "As reviewed by Richard Guerrant et al. (1), it was in 1831 that cholera treatment could be accomplished by intravenous replacement, and, although this therapy could produce dramatic improvements, not until 1960 was it 1st recognized that there was no true destruction of the intestinal mucosa, and gastrointestinal rehydration therapy could be effective, and the therapy could dramatically reduce the intravenous needs for rehydration. Indeed, that this rehydration could be just as effective given orally as through an orogastric tube (for example, refs 2 and 3) made it possible for oral rehydration therapy (ORT) to be used in rural remote areas and truly impact the morbidity and mortality of cholera. Indeed, Guerrant et al. (1) highlight the use of oral glucose-salt packets in war-torn Bangladeshi refugees, which reduced the mortality rate from 30% to 3.6% (4) and quotes sources referring to ORT as "potentially the most important medical advance" of the 20th century. A variety of formulations of ORT exist, generally glucose or rice powder-based, which contain a variety of micronutrients, especially zinc (5).

"The assessment of the degree of volume loss in those with diarrhoea to approximate volume and fluid losses can be found in ref 6 below. Those with severe hypovolemia should be initially rehydrated intravenously with a fluid bolus of normal saline or Ringer's lactate solution of 20-30 mL/kg followed by 100 mL/kg in the 1st 4 hours and 100 mL/kg over the next 18 hours with regular reassessment. Those with lesser degrees of hypovolemia can be rehydrated orally with a glucose or rice-derived formula with up to 4 L [4.2 qt] in the 1st 4 hours, and those with no hypovolemia can be given ORT after each liquid stool with frequent reevaluation."

References
1. Guerrant RL, Carneiro-Filho BA, Dillingham RA: Cholera, diarrhoea, and oral rehydration therapy: triumph and indictment. Clin Infect Dis 2003;37(3):398-405; available at <http://cid.oxfordjournals.org/content/37/3/398.long>.
2. Gregorio GV, Gonzales ML, Dans LF, Martinez EG: Polymer-based oral rehydration solution for treating acute watery diarrhoea. Cochrane Database Syst Rev 2009;(2):CD006519; available at <http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006519.pub3/full>.
3. Gore SM, Fontaine O, Pierce NF: Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials. BMJ 1992;304(6822):287-291; available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1881081/>.
4. Mahalanabis D, Choudhuri AB, Bagchi NG, et al: Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med 1973;132(4):197-205; available at <http://www.searo.who.int/publications/journals/seajph/media/2012/seajph_v1n1/whoseajphv1i1p105.pdf>.
5. Atia AN, Buchman AL: Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol 2009;104(10):2596-2604; abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/19550407>.
6. WHO. The treatment of diarrhea, a manual for physicians and other senior health workers. 4th ed. 2005; available at <http://whqlibdoc.who.int/publications/2005/9241593180.pdf>. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Zambia:
More ...

Anguilla

Anguilla US Consular Information Sheet
March 03, 2009
COUNTRY DESCRIPTION: Anguilla is a British overseas territory in the Caribbean, part of the British West Indies. It is a small but rapidly developing island with particularly well-developed
ourist facilities.

ENTRY/EXIT REQUIREMENTS:
The Intelligence Reform and Terrorism Prevention Act of 2004 requires all travelers to and from the Caribbean, Bermuda, Panama, Mexico and Canada to have a valid passport to enter or re-enter the United States. U.S. citizens must have a valid U.S. passport if traveling by air, including to and from Mexico.
If traveling by sea, U.S. citizens can use a passport or passport card. We strongly encourage all American citizen travelers to apply for a U.S. passport or passport card well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

In addition to a valid passport, U.S. citizens need onward or return tickets, and sufficient funds for their stay.
A departure tax is charged at the airport or ferry dock when leaving. For further information, travelers may contact the British Embassy, 19 Observatory Circle NW, Washington, DC
20008; telephone (202) 588-7800; or the nearest consulate of the United Kingdom in Atlanta, Boston, Chicago, Dallas, Los Angeles, New York, Denver, Houston, Miami, Orlando, Seattle, or San Francisco. Visit the British Embassy web site 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:
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

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

CRIME:
While Anguilla's crime rate is relatively low, both petty and violent crimes
do occur. Travelers should take common-sense precautions to ensure their personal security, such as avoiding carrying large amounts of cash or displaying expensive jewelry. Travelers should not leave valuables unattended in hotel rooms or on the beach. They should use hotel safety deposit facilities to safeguard valuables and travel documents. Similarly, they should keep their lodgings locked at all times, whether they are present or away, and should not leave valuables in their vehicles, even when locked.

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

The local emergency line in Anguilla is 911.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
There is only one hospital, Princess Alexandra Hospital (telephone: 264-497-2551), and a handful of clinics on Anguilla, so medical facilities are limited.
Serious problems requiring extensive care or major surgery may require evacuation to the United States, often at considerable expense.

There are no formal, documented HIV/AIDS entry restrictions for visitors to and foreign residents of Anguilla, but there have been anecdotal reports of exclusion.
Please verify this information with the British Embassy before you travel.

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

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 Anguilla is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Unlike the U.S., traffic in Anguilla moves on the left. The few roads on the island are generally poorly paved and narrow. While traffic generally moves at a slow pace, with the increasing number of young drivers in Anguilla, there are occasional severe accidents caused by excessive speed. Although emergency services, including tow truck service, are limited and inconsistent, local residents are often willing to provide roadside assistance. For police, fire, or ambulance service dial 911.

Please refer to our Road Safety page for more information.
Visit the Government of Anguilla web site for further road safety information.

AVIATION SAFETY OVERSIGHT:
Civil aviation operations in Anguilla fall under the jurisdiction of British authorities. The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Kingdom’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Anguilla’s air carrier operations.
For more information, travelers may visit the FAA web site.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Anguilla laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Anguilla 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 Anguilla are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration web site and to obtain updated information on travel and security within Anguilla. 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 with consular responsibility over Anguilla is located in Bridgetown, Barbados in the Wildey Business Park in suburban Wildey, southeast of downtown Bridgetown.
The main number for the Consular Section is (246) 431-0225; after hours, the Embassy duty officer can be reached by calling (246) 436-4950.
Visit the U.S. Embassy Bridgetown online for more information.
Hours of operation are 8:30 a.m. – 4:30 p.m. Monday through Friday, except Barbadian and U.S. holidays.
* * *
This replaces the Country Specific Information for Anguilla dated April 2, 2008, to update sections on Country Description, Entry/Exit Requirements, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Sat, 9 Sep 2017 19:31:32 +0200

Paris, Sept 9, 2017 (AFP) - France's meteorological agency on Saturday issued its highest warning for the Caribbean islands of St Martin and St Barts as Hurricane Jose bore down, three days after they were hit by Hurricane Irma.   The alert warned of a "dangerous event of exceptional intensity," with winds that could reach 120 kilometres (75 miles) per hour, and strong rains and high waves.

St Barts is a French overseas territory, as is the French part of St Martin, which is divided between France and the Netherlands.   Twelve people were killed on the two islands by Hurricane Irma, thousands of buildings were flattened and the authorities are struggling to control looting.   The French state-owned reinsurer CCR on Saturday estimated the damage at 1.2 billion euros ($1.4 billion).   Irma is now heading for Florida, where a total of 6.3 million people have been ordered to evacuate, according to state authorities.
Date: Tue 29 Apr 2014
Source: National Institute for Public Health and the Environment [edited]

1 Oct 2013-29 Apr 2014 (week 18) St Maarten - Since the last report (week 15 [17?]) 52 new cases have been confirmed among St Maarten residents. Up to 29 Apr 2014, now a total of 343 confirmed cases have been reported. One of these confirmed cases was hospitalized.

The median age of the confirmed patients was 44 years, range 4-92 years. Of those cases for which gender was available, 201 were female and 130 were male.

- On 6 Dec 2013, the 1st indigenous chikungunya [virus infection] case of St Maarten was reported. Retrospectively, the 1st patient with suspected complaints was reported in mid-October 2013 in St Martin.
------------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
=====================
[The report also has graphs showing case numbers over time.

Maps of St Martin/St Maarten can be accessed at
Date: 5-11 May 2014
Source: Institut de Veille Sanitaire (French Institute for Public Health Surveillance, InVS) [edited]

Cases since the beginning of the outbreak in December 2013:
- St Martin: (susp) 3240 cases; deaths 3; stable.
- St Barthelemy: (susp) 500 cases; stable.
- Martinique: (susp) 24 180; deaths 3; increasing.
- Guadeloupe: (susp) 13 600 cases; deaths 1; increasing.
- French Guiana: (susp) not available; (probable or confirmed) 122 cases with 83 locally acquired; increasing, with a new cluster in Kourou and 2 near Cayenne.
======================
[The 16 May 2014 report from Guyaweb (<http://www.guyaweb.com/actualites/news/sciences-et-environnement/le-chik-revient-kourou-setend-cayenne-desormais-saint-laurent/>) states that there are 2 new cases in Saint-Laurent-du-Maroni, overlooking the Suriname River, of which one is certainly autochthonous, and a new focal point occurred in Kourou with 4 cases.

Maps of the area can be seen at
and <http://healthmap.org/promed/p/35574>. - ProMed Mod.TY]
Date: 7-13 Apr 2014
Source: INVS Point Sanitaire No. 14 [in French, trans. ProMed Mod.TY, edited]

Cases since the beginning of the outbreak in December, 2013:
- St. Martin: (susp.) 2980 cases, (probable and conf.) 793 cases; Deaths 3; Decreasing.
- Saint Barthelemy: (susp.) 460 cases, (probable or confirmed) 135 cases; Decreasing.
- Martinique: (susp.) 16 000, (probable or confirmed) 1473 cases; Deaths 2; Increasing.
- Guadeloupe: (susp.) 4710 cases, (probable or confirmed) 1261 cases; Deaths 1; In epidemic status.
- French Guiana: (susp.) 7 cases with 4 locally acquired, (probable or confirmed) 39 cases with 26 locally acquired) 30 cases; (imported) 16 cases; Moderate to increasing; Half of probable and confirmed cases are located in Kourou; however indigenous cases have also been recorded from the Cayenne Matoury, Remire and Macouria communities.
=================
[Maps showing case distributions on each island can be accessed at the above URL. - ProMed Mod.TY]
Date: Thu 27 Mar 2014
Source: The Daily Herald [edited]

As St. Maarten continues to take measures to combat the spread of the chikungunya virus, the number of cases continues to climb.

Health Minister Cornelius de Weever announced on Wednesday [26 Mar 2014], that the total number of confirmed chikungunya cases thus far stood at 224.

De Weever also announced that government will be signing a Memorandum of Understanding (MOU) with French St. Martin as a means of collectively responding to the mosquito threat that puts the population at risk. He said both sides have been working closely together to address the dengue and chikungunya threats.

The MOU will cover, amongst other things, a regular exchange of epidemiological information on vector-borne diseases and collectively publishing and representing data collected under the agreement.

The need for collective information campaigns and enhancement of the mosquito vector-control programme will also be included in the MOU. The MOU also describes the need for planning execution and evaluation of collective responses to the chikungunya threat.
=========================
[The increase in the number of chikungunya virus infections over the past week in St. Maarten is of concern, rising from 123 cases to 224 cases. This number is confirmed in another report that also indicates that there are an additional 325 suspected cases (<http://www.rivm.nl/dsresource?type=pdf&disposition=inline&objectid=rivmp:239786>).  - ProMed Mod.TY]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/35574>.]
More ...

Czech Republic

Czech Republic US Consular Information Sheet
May 31, 2007
COUNTRY DESCRIPTION:
The Czech Republic is located in the heart of Europe. Tourist facilities in Prague are at the level of those found in most European capitals, while travelers ca
expect lower standards outside of Prague. Travelers are encouraged to be vigilant as pick-pocketing and petty theft occurs often in crowded tourist areas, restaurants and on public transportation. More information can be found in the section on crime. Please read the Department of State Background Notes on the Czech Republic for additional information.

ENTRY REQUIREMENTS: A passport is required and must be valid for 3 months beyond the intended stay. Visas are not required for U.S. citizens for tourist, short study or business visits of up to 90 days. Visas are required for longer stays and for any gainful activity. See our Foreign Entry Requirements brochure for more information on the Czech Republic and other countries.
Visit the Embassy of the Czech Republic’s website at http://www.mzv.cz/washington for the most current visa information.
The Czech Government requires that proof of finances to pay for your stay and for you to have travel/health insurance and is requiring proof of medical insurance for travelers to the Czech Republic. Minimum coverage of the insurance has to be at least $35,000.

According to the Czech Government, a health insurance card or an internationally recognized credit card with health insurance included will generally be accepted as proof of insurance to enter the Republic.

The health insurance requirement does not apply to those who have visas permitting them to work.
See Entry and Exit Requirements for more information pertaining to dual nationality and the prevention of international child abduction.
Please refer to our Customs Information
to learn more about customs regulations.

SAFETY AND SECURITY:
Civil disorder is rare in the Czech Republic, although strikes and demonstrations may occur. U.S. citizens should be vigilant in protecting their security, bearing in mind that even demonstrations meant to be peaceful may turn violent. Americans are advised to avoid street demonstrations.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site, where the current Worldwide Caution Public Announcement, Travel Warnings and Public Announcements can be found.

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

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

CRIME:
The Czech Republic generally has a low rate of crime. However, street crime-particularly pick-pocketing and occasional mugging-is a problem, especially in major tourist areas in Prague. Travelers are encouraged to be especially vigilant in Prague’s restaurants, train stations, and on public transportation around the city center.
Incidents of pick pocketing were reported in significant numbers during 2006. Incidents of violent crime, while still relatively infrequent, are becoming more common in Prague. Travelers should be aware of the reported use of rohypnol, and other “date rape” drugs in the Czech Republic. Caution should be used when accepting open drinks at bars or clubs. Travelers should be very careful while riding trains, trams or metro, where most crime occurs. Travelers should keep a copy of their passport in a safe place separate from the passport itself; this copy can help you to apply for a new passport if yours is lost or stolen. Visitors should be alert to the potential for substantial overcharging by taxis, particularly in areas frequented by tourists. Radio-dispatched taxis are often much more reliable. It is also advisable to set the price in advance.

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 or 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.

See our information for Victim’s of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Prague has good Western-style medical clinics with English-speaking doctors and dentists. However, staff members at the majority of Czech medical facilities do not speak English. Doctors and hospitals often expect cash payment for health services, though some facilities do accept credit cards. Hospitalization in the Czech Republic is much more liberal that in the United States; conditions that would be treated on an outpatient basis in the United States are often treated on an inpatient basis in the Czech Republic.
Ambulance services are not on a par with U.S. standards. Response time can sometimes be slow, and different ambulances are dispatched depending on the perceived severity of the patient’s condition.
Many ambulance companies expect payment at the time of delivery. Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars or more.
Please note that because euthanasia is not permitted under Czech law, U.S. living wills providing for no exceptional interventions to prolong life cannot be honored in the Czech Republic.

People traveling from April through October who plan to participate in camping or hiking in long grass or woodlands run the risk of both tick-borne encephalitis and Lyme disease. All travelers should take precautions to prevent tick bites. There is a vaccine for the former, but not for Lyme disease.

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-TRTP (1-877-394-8747) or via the CDC’s Internet site at http://www.cdc.gov/travel.
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.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.

Please see our information on medical insurance overseas
TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning the Czech Republic is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Travelers should note that road fatalities are occurring at an increasing rate in the Czech Republic, placing it amongst the most lethal places to drive in Europe. First-class roads in the Czech Republic generally meet European standards. However, on side roads, drivers should be prepared to encounter uneven surfaces, irregular lane markings and sign placements that are not clear. Streets in towns are not always in good condition. U.S. drivers should pay special attention to driving on cobblestone and among streetcars in historic city centers. Traffic lights are placed before the intersection and not after as in the United States. Speed limits are 50 km/h in towns, 90 km/h outside of towns and 130 km/h on highways. An International Driving Permit (IDP), available from AAA (in the United States only), must accompany a U.S. driver’s license; failure to have the IDP with a valid license may result in denial of an insurance claim after an accident.

Persons driving into the Czech Republic should be aware that a road usage tax sticker is required to drive legally on major highways. Signs stating this requirement are posted near the border, but they are easy to miss. The stickers are available at gasoline stations. The fine for failing to display a motorways toll sticker is assessed on the spot.

For specific information concerning Czech requirements for driver’s permits, vehicle inspection, road tax and mandatory insurance, please contact the Czech Tourist Authority offices in New York by telephone at (212)288-0830 or via email at infor@czechcenter.com.

Visit the websites of the Czech Republic’s national tourist office and national authority responsible for road safety at http://www.turistik.cz and http://www.mdcr.cz .

Please refer to our Road Safety page for information.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Czech Republic’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization international aviation safety standards for oversight of the Czech Republic’s air carrier operations.
For more information, travelers may visit the FAA’s Internet web site at www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Czech customs authorities enforce strict regulations concerning temporary importation into or export from the Czech Republic of items such as firearms, antiquities, medications, business equipment, etc. It is advisable to contact the Embassy of the Czech Republic in Washington, D.C, or the Consulates General of the Czech Republic in New York and Los Angeles for specific information regarding customs requirements.

Please see our information on Customs Regulations.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Czech Republic laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the Czech Republic are strict and convicted offenders can expect 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 AND CONSULATE LOCATIONS:
Americans living in the Czech Republic are encouraged to register with the U.S. Embassy through the State Department’s travel registration website, and to obtain updated information on travel and security within the Czech Republic.
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 Prague is located at Trziste 15, 118 01 Prague, Czech Republic; telephone (420)257 530 663; for after-hours emergencies only, telephone (420 257 532 716; Consular Section’s fax (420) 257 534 028; webpage: www.usembassy.cz.
*

*

*
This replaces the Consular Information Sheet dated October 31, 2006, to update information in the Crime section.

Travel News Headlines WORLD NEWS

Date: Fri 24 May 2019
Source: Radio Praha [edited]

The Czech Republic recorded the highest number of tick-borne encephalitis (TBE) cases in the EU last year [2018]. In the whole of Europe, only Russia recorded more cases of the potentially deadly disease.

There were 712 recorded TBE cases in the country last year [2018], the highest number since 2011, a Czech member of the International Scientific Working Group on TBE (ISW-TBE) said in a press release on Thursday [23 May 2019].

Only about one-quarter of inhabitants of the Czech Republic are vaccinated against TBE, a low percentage compared to other EU countries. Within the bloc, the 2nd-highest number of TBE cases was recorded in Germany, which has a population 8 times larger.

Encephalitis patients suffer from fever, headache, aching joints, and muscles. It can develop into meningitis.  [Byline: Brian Kenety]
========================
[Given the large number of tick-borne encephalitis (TBE) virus infection in the Czech Republic last year (2018), it seems curious that the above report makes no mention of preventive measures such as vaccination and avoidance to tick bites that could be taken currently to avoid infection. The TBE virus transmission season is beginning at this time. TBE virus is endemic in the Czech Republic, and cases occur there annually. A 2016 ProMED-mail post indicated that although Central and Eastern Europe countries are endemic for the European subtype of TBE virus and cases occur there yearly, cases have declined significantly in Austria and remain low in Germany, Poland, and Slovakia, while remaining high in recent years in the Czech Republic [see Tick-borne encephalitis - Czech Republic (02): background http://promedmail.org/post/20160210.4009410].

WHO has stated that "Approximately 10 000-12 000 clinical cases of tick-borne encephalitis are reported each year, but this figure is believed to be significantly lower than the actual total. Immunization offers the most effective protection. Currently, there are 4 widely used vaccines of assured quality: FSME-Immun and Encepur, manufactured in Austria and Germany, respectively, and based on European strains of the virus; and TBE-Moscow and EnceVir, manufactured in the Russian Federation and based on Far-Eastern strains. The 4 vaccines are considered to be safe and efficacious" (<https://www.who.int/immunization/diseases/tick_encephalitis/en/>).

TBE is a virus infection caused by one of 3 TBE virus subtypes belonging to the Flaviviridae family: Central European, Siberian, and Far Eastern (formerly known as Russian spring-summer encephalitis). It is transmitted to humans through the bite of infected _Ixodes_ ticks. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Date: Sat 27 Apr 2019
Source: Food Safety News [edited]

_Salmonella_ in chicken has been linked to over 70 cases in the Czech Republic. Health authorities in the city of Zlin reported the outbreak in the middle of March 2019 at Tomase Bati Regional Hospital. A total of 68 people, of whom 38 were patients and 30 staff, were found to be connected with the salmonellosis outbreak. In addition, 4 people -- 1 staff member and 3 other patients -- were hospitalized in the town of Uherske Hradiste.

A common vehicle of infection was a chicken and rice dish served for lunch on 14 Mar 2019. An epidemiological survey found that all patients consumed this lunch. The alarm was raised on 15 Mar 2019 by the hospital in a message to health authorities. The next day, _Salmonella_ Enteritidis was detected in faecal samples. Samples of raw materials and swabs from the kitchen and storage areas were taken. Sanitation and disinfection of all kitchen and storage areas were ordered. The chicken used in the meals was also destroyed.

Symptoms of _Salmonella_ infection usually appear 12 to 72 hours after infection and include fever, abdominal pain, diarrhoea, nausea and sometimes vomiting. The illness usually lasts 4 to 7 days, and most people recover without treatment. The laboratory analysis at the Institute of Public Health in Ostrava and in the State Veterinary Institute in Olomouc did not confirm _Salmonella_ in any sample of frozen chicken available during the investigation. Clinical material from patients was sent to the lab of the Veterinary Research Institute in Brno.

In an updated statement concluding the investigation, health authorities in Zlin reported that _ S._ Enteritidis, identical to the strain grown from clinical cases, was confirmed in a chicken and rice sample.

In a statement, officials from the hospital said they had introduced strict measures for food after the _Salmonella_ infection, including strengthening controls on the defrosting and cooking of meat so procedures are monitored consistently. Officials said while the hospital cannot influence the incidence of _Salmonella_ in raw materials supplied to the hospital, they want to focus consistently on the correct procedures for processing. The hospital is also considering buying cameras and putting them in areas where hospital food is being prepared so human error can be detected in time and eliminated in the future.
=======================
[Hospital food remains a particular problematic source for foodborne pathogens given the cohort of individuals who may consume it and their comorbidities. Minimizing salmonellosis spread from fowl requires adequate cooking and appropriate kitchen hygiene. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps:
Zlin District, Czech Republic: <http://healthmap.org/promed/p/62211>]
Date: Tue, 2 Apr 2019 14:58:37 +0200

Prague, April 2, 2019 (AFP) - Czech veterinary authorities said Tuesday they had detected another 510 kilos of chicken breast from Poland tainted with the dangerous salmonella bacteria, following a rift over meat imports.   "The meat has been distributed and... most probably consumed," the State Veterinary Administration (SVS) said in a statement.   Meat from Poland caused a stir in the Czech Republic after local vets slapped mandatory laboratory checks on Polish beef in February following the discovery of a salmonella-tainted batch.

That same month, vets said they had found 1,200 kilos (some 2,600 pounds) of Polish chicken containing salmonella, part of which had already been distributed.   They lifted the measure last week but insisted they would continue random sample checks on imports, especially of beef and poultry from Poland.   SVS spokesman Petr Vorlicek told AFP that vets were not contemplating mandatory lab checks on Polish poultry now.   He noted that salmonella is not uncommon in poultry.   "We are closely monitoring all imports, that's why we have also detected this batch," he added.

The scandal erupted when the TVN24 commercial news channel aired footage of apparently sick or lame cows being butchered at a small slaughterhouse in northeast Poland in secret late at night when veterinary authorities were unlikely to visit.   In January, Poland exported 2.7 tonnes of suspect beef to around a dozen fellow EU members, triggering a probe.   Poland is a leading producer and exporter of meat in Europe, turning out around 600,000 tonnes of beef per year and exporting most of it to the EU, according to meat producer associations.
Date: Thu 20 Dec 2018
Source: Radio Praha [edited]

More than 690 people in the Czech Republic were infected with tickborne encephalitis between January and November this year [2018], which is more or less the same as for the whole of 2017. The figure is also the highest since 2006, according to data published by the National Institute of Public Health on Thursday [20 Dec 2018].

The Czech Republic, along with the Baltic States, has the highest number of tickborne encephalitis cases in Europe. There is no cure for encephalitis, but an increasing number of Czechs get themselves vaccinated against the disease.  [byline: Ruth Frankova]
==========================
[Tickborne encephalitis (TBE) virus is endemic in the Czech Republic, and cases occur there annually. A 2016 ProMED-mail post indicated that although Central and Eastern Europe countries are endemic for the European subtype of TBE virus and cases occur there yearly, cases have declined significantly in Austria and remain low in Germany, Poland, and Slovakia, while remaining high in recent years in the Czech Republic [see Tick-borne encephalitis - Czech Republic (02):  background http://promedmail.org/post/20160210.4009410].

WHO has stated that "Approximately 10 000-12 000 clinical cases of tick-borne encephalitis are reported each year, but this figure is believed to be significantly lower than the actual total. Immunization offers the most effective protection. Currently, there are 4 widely used vaccines of assured quality: FSME-Immun and Encepur, manufactured in Austria and Germany, respectively, and based on European strains of the virus; and TBE-Moscow and EnceVir, manufactured in the Russian Federation and based on Far-Eastern strains. The 4 vaccines are considered to be safe and efficacious"  (<https://www.who.int/immunization/diseases/tick_encephalitis/en/>).

TBE is a virus infection caused by one of 3 TBE virus subtypes belonging to the _Flaviviridae_ family: Central European, Siberian, and Far Eastern (formerly known as Russian spring-summer encephalitis). It is transmitted to humans through the bite of infected ixodes ticks. - ProMED Mod.TY]

[HealthMap/ProMED-mail map: Czech Republic:
Date: Sun 16 Dec 2018
Source: Radio Praha [edited]

While last year [2017], 142 cases of measles were detected in the Czech Republic, 182 cases had been detected as of 4 Dec 2018, according to the State Health Institute. Doctors warn that although it is mandatory to vaccinate children against measles, many are not [vaccinated]. The disease is preventable through 2 doses of a safe and effective vaccine.

The highly contagious, airborne disease experienced an unprecedented resurgence in 2017 in the Americas, Eastern Mediterranean and Europe, according to the World Health Organization. It can cause debilitating or fatal complications, including encephalitis (an infection that leads to swelling of the brain), severe diarrhoea and dehydration, pneumonia, ear infections and permanent vision loss.  [byline: Brian Kenety]
More ...

World Travel News Headlines

Date: Tue, 10 Dec 2019 10:50:09 +0100 (MET)

Sydney, Dec 10, 2019 (AFP) - The death toll from New Zealand's White Island volcano eruption rose to six late Tuesday, after an injured person died in an Auckland hospital, police said.   "Police can confirm a further person has died following the eruption on Whakaari/White Island, bringing the official toll to six," a police statement said.   Eight more people who remain missing are presumed dead after the volcano erupted Monday.
Date: Tue, 10 Dec 2019 09:27:57 +0100 (MET)
By Andrew BEATTY, with Daniel de Carteret in Gosford

Sydney, Dec 10, 2019 (AFP) - Toxic haze blanketed Sydney Tuesday triggering a chorus of smoke alarms to ring across the city and forcing school children inside, as "severe" weather conditions fuelled deadly bush blazes along Australia's east coast.   Fire engines raced office-to-office in the city centre with sirens blaring, as inland bushfires poured smoke laden with toxic particles into commercial buildings.   Emergency services responded to an "unprecedented" 500 automatic call-outs inside a few hours according to New South Wales Fire and Rescue's Roger Mentha.

A regional fire headquarters miles from the nearest blazes was itself evacuated while throngs of mask-wearing commuters choked their way through thick acrid air and the organisers of a harbour yacht race declared it was unsafe to proceed.   "The smoke from all the fires is just so severe here on the harbour that you just can't see anything, so it's just too dangerous," said spokeswoman Di Pearson of an event that normally foreshadows the famed Sydney-Hobart yacht race. "The vision is just so poor."   Some of the city's commuter ferries were also cancelled "due to thick smoke" and school kids were kept inside at breaktime and sent home early as pollution levels soared far above "hazardous" levels.

For weeks the east of the country has been smothered in smoke as drought and climate-fuelled bushfires have burned. But the scale of the problem on Tuesday shocked even hardened residents.   Bruce Baker -- an 82-year-old who lives in Gosford, north of Sydney -- said he was skipping his daily morning walk because of the smoke.   "This is the worst it's been, for sure," he told AFP. "It dries your throat. Even if you're not asthmatic, you feel it."   Authorities recommended that the vulnerable cease outdoor activity altogether and that everyone stay inside as much as possible, although one couple braved the toxic air to get married on the waterfront in front of Sydney Harbour Bridge shrouded in smog.

A cricket match between New South Wales and Queensland also went ahead, despite a barely visible ball.   Tuesday had been expected to bring strong winds and high temperatures that made for "severe conditions where embers can be blown ahead of the fire into suburbs and threaten properties."   But New South Wales Rural Fire Service said "deteriorating fire conditions have been delayed by a thick blanket of smoke" over the east of the state.   As the day developed there were nearly 100 bushfire incidents in the state of New South Wales alone and dozens more in Queensland.   Total fire bans were put in place across much of the east of the country and in large parts of western Australia.   Temperatures in some inland areas eased past 44 degrees Celsius (111 Fahrenheit).

- The 'big dry' -
To the northwest of Sydney, several fires already burning for weeks have combined to create a "megafire" that has already destroyed 319,000 hectares (788,000 acres) of land, mostly inside national parks.   Prime Minister Scott Morrison  -- who for weeks has not commented on the smoke haze -- defended his government's handling of the fires and said there were no plans to professionalise the countryside's largely volunteer force.    "Our policy is sensible when it comes to addressing and taking action on climate change. Our actions on climate change are getting the results they're intended to get," he said.   Morrison's conservative coalition has been criticised by former fire chiefs for failing to heed warnings about climate change.   The crisis has been propelled by a prolonged drought that has made vegetation tinder dry.

The Bureau of Meteorology has reported that Australia experienced its driest November on record this year.   The "big dry" has left farmers desperate and small towns facing the prospect of running out of water completely.   A swathe of the east of the country has seen "rainfall deficiencies" since early 2017 -- almost three years.   Many dams in New South Wales are empty and almost all are well below capacity.   Firefighters south of Brisbane recently reported 1,000 litres of water were stolen from tanks at their station.   Amid the shortage, Tuesday also saw the toughest water restrictions in a decade being introduced for Sydney -- with curbs on everything from hosepipe use to washing cars.
Date: Tue, 10 Dec 2019 03:09:17 +0100 (MET)
By Allison JACKSON

Sao Paulo, Dec 10, 2019 (AFP) - Gripping the deadly snake behind its jaws, Fabiola de Souza massages its venom glands to squeeze out drops that will save lives around Brazil where thousands of people are bitten every year.   De Souza and her colleagues at the Butantan Institute in Sao Paulo harvest the toxin from hundreds of snakes kept in captivity to produce antivenom.    It is distributed by the health ministry to medical facilities across the country.

Dozens of poisonous snake species, including the jararaca, thrive in Brazil's hot and humid climate.    Nearly 29,000 people were bitten in 2018 and more than 100 died, official figures show.   States with the highest rates of snakebite were in the vast and remote Amazon basin where it can take hours to reach a hospital stocked with antivenom.   Venom is extracted from each snake once a month in a delicate and potentially dangerous process.

Using a hooked stick, de Souza carefully lifts one of the slithering creatures out of its plastic box and maneuvers it into a drum of carbon dioxide.    Within minutes the reptile is asleep.    "It's less stress for the animal," de Souza explains.    The snake is then placed on a stainless steel bench in the room where the temperature hovers around 27 degrees Celsius (80 degrees Fahrenheit).    De Souza has a few minutes to safely extract venom before the snake begins to stir.      "It's important to have fear because when people have fear they are careful," she says.

- Antivenom 'crisis' -
The snakes are fed a diet of rats and mice that are raised at the leafy institute and killed before being served up once a month.   After milking the snake, de Souza records its weight and length before placing it back in its container.    The antivenom is made by injecting small amounts of the poison into horses -- kept by Butantan on a farm -- to trigger an immune response that produces toxin-attacking antibodies.

Blood is later extracted from the hoofed animals and the antibodies harvested to create a serum that will be administered to snakebite victims who might otherwise die.   Butantan project manager Fan Hui Wen, a Brazilian, says the institute currently makes all of the country's antivenom -- around 250,000 10-15 millilitre vials per year.

Brazil also donates small quantities of antivenom to several countries in Latin America.    There are now plans to sell the life-saving serum abroad to help relieve a global shortage, particularly in Africa.    About 5.4 million people are estimated to be bitten by snakes every year, according to the World Health Organization (WHO). 

Between 81,000 and 138,000 die, while many more suffer amputations and other permanent disabilities as a result of the toxin.   To cut the number of deaths and injuries, WHO unveiled a plan earlier this year that includes boosting production of quality antivenoms.   Brazil is part of the strategy. It could begin to export antivenom as early as next year, Wen says.   "There is interest for Butantan to also supply other countries due to the global crisis of antivenom production," she says.
Date: Mon, 9 Dec 2019 14:14:15 +0100 (MET)

Dec 9, 2019 (AFP) - New Zealand, struck by a deadly volcanic eruption Monday, lies in a zone where Earth's tectonic plates collide, making it a hotspot for earthquakes and volcanic activity.   In one of its worst natural disasters, a huge mass of volcanic debris from the eruption of Mount Ruapehu triggered a mudslide in 1953 that washed away a bridge and caused a passenger train to plunge into a river with the loss of 151 lives.  After Monday's eruption on New Zealand's White Island, here is a recap of some of the deadliest volcanic eruptions around the world in the past 25 years.

- 2018: Indonesia -
In December the Anak Krakatoa volcano, a small island in the Sunda Strait between Java and Sumatra, erupts and a section of its crater collapses, sliding into the ocean and generating a tsunami. More than 420 people are killed and 7,200 wounded.

- 2018: Guatemala -
The June eruption of the Fuego volcano, about 35 kilometres (22 miles) from the capital, unleashes a torrent of mud and ash that wipes the village of San Miguel Los Lotes from the map. More than 200 people are killed.

- 2014: Japan -
The sudden eruption in September of Mount Ontake, in the central Nagano region, kills more than 60 people in Japan's worst volcanic disaster in nearly 90 years. The mountain is packed with hikers at the time. In 1991 an eruption of the southwestern Unzen volcano kills 43.

- 2014: Indonesia -
At least 16 people are killed on the island of Sumatra in February by a spectacular eruption of Mount Sinabung, which had lain dormant for 400 years before roaring back to life five months earlier. In 2016 villages are scorched and farmland devastated after another eruption kills seven.

- 2010: Indonesia -
Indonesia's most active volcano, Mount Merapi on Java island, starts a series of explosions in October, eventually killing more than 320 people. An 1930 eruption of the volcano killed 1,300 people and one in 1994 claimed more than 60 lives.

- 2002: DR Congo -
The eruption in July of Mount Nyiragongo in the eastern Democratic Republic of Congo destroys the centre of Goma town, along with several residential areas, and kills more than 100 people.

- 1997: Montserrat -
The capital of the small British colony, Plymouth, is wiped off the map and 20 are killed or left missing in avalanches of hot rock and ash clouds when its volcano erupts in June.

- 1995: The Philippines -
At least 70 are killed and another 30 missing after the crater of the Parker volcano in the south of the island of Mindanao collapses. Five years earlier the eruption of Mount Pinatubo, 80 kilometres north of the capital Manila, kills more than 800 people.

- Worst ever -
The explosion of Indonesia's Krakatoa volcano in 1883 is considered the worst ever seen. The eruption sent a jet of ash, stones and smoke shooting more than 20 kilometres (12 miles) into the sky, plunging the region into darkness, and sparking a huge tsunami that was felt around the world. The disaster killed more than 36,000 people.

The most famous eruption in history is that of Mount Vesuvius in modern-day Italy in 79 AD, which destroyed the towns of Herculaneum, Stabiae and Pompeii, wiping out an estimated 10 percent of the population of the three cities.
Date: Mon 9 Dec 2019
Source: Fox 29 Philadelphia [edited]

A total of 31 people have been sickened by salmonellosis at 4 health care facilities in south-eastern Pennsylvania. A majority of those cases occurred after individuals ate pre-cut fruit from New Jersey-based Tailor Cut Produce. The Food and Drug Administration (FDA) announced the salmonellosis outbreak in conjunction with the Pennsylvania Department of Health (DOH) on [Fri 6 Dec 2019]. The North Brunswick distributor has recalled its fruit mix with cantaloupe, honeydew, pineapple and grapes as a result.

Tailor Cut Produce reports that its products may be found in restaurants, banquet facilities, hotels, schools and institutional food service establishments in Pennsylvania, New Jersey and New York. "We recommend that any facility who use Tailor Cut Produce pre-cut fruit to immediately stop and throw it away," Pennsylvania Secretary of Health Dr. Rachel Levine said.

Salmonellosis is an infection caused by _Salmonella_ bacteria that generally affects the intestinal tract. People usually become infected by either eating or drinking contaminated food or water, by contact with infected people or animals, or through contact with contaminated environmental sources.
Date: Mon 9 Dec 2019
Source: Sixth Tone [edited]

Dozens of researchers in northwestern China's Gansu province have been infected with brucellosis, an animal-borne disease that causes flu-like symptoms and, potentially, lingering problems. In a statement [Fri 6 Dec 2019], the Lanzhou Veterinary Research Institute, an affiliated institute of the Chinese Academy of Agricultural Sciences, said that the 1st few grad students from the institute's foot-and-mouth disease prevention team tested positive for brucellosis antibodies on [28 Nov 2019]. The labs affected have been closed, the institute said, and national and local health authorities have assembled a team to investigate the outbreak.

Li Hui, an official at the health commission in Lanzhou, the provincial capital, told Sixth Tone on [Mon 9 Dec 2019] that the total number of brucellosis cases at the institute had climbed to 96. None have shown clinical symptoms, according to domestic media, and it remains unclear how they were exposed to the bacteria.

Brucellosis -- also known as Malta, Mediterranean, or undulant fever -- is a zoonotic disease that mainly affects animals, including livestock and dogs, which can in turn transmit the bacteria to humans through direct contact. Symptoms include fever, chills, sweating, lethargy, and aches and pains, according to the WHO. In the absence of early diagnosis and treatment, brucellosis can become a chronic condition that is difficult to cure.

In China, brucellosis is a Class B disease, ranking below a more serious category that includes cholera and plague. Human-to-human transmission has only been known to occur between lactating mothers and their babies. According to state broadcaster China National Radio, the brucellosis outbreak at the Gansu veterinary institute has prompted health checks among local students and staff who fear that they may have come into contact with infected animals.

One of the last brucellosis outbreaks in China occurred in 2011, when an agricultural university in the northeastern Heilongjiang province reported 28 cases stemming from infected goats being used in lab research. The school publicly apologized, fired 2 administrators, and offered each of the students' affected monetary compensation.

Scientific labs are subject to different experimental standards depending on their biosafety level, according to a researcher surnamed Yang at the Shanghai Institutes for Biological Sciences, an affiliate of the Chinese Academy of Sciences.

"If the protection levels don't keep pace (with biosafety levels), there will be a risk of infection," Yang, who studies viruses and works in a Biosafety Level 2+ lab, told Sixth Tone. As a result, labs generally require researchers to undergo safety training or even pass an exam to earn a certification, said Yang, who only used her surname because she was not authorized by her employer to speak to media.

The Lanzhou Veterinary Research Institute describes itself as "China's only authorized research center for working with the live virus that causes foot-and-mouth disease," a highly contagious disease affecting livestock. The institute is reportedly also one of the few in China with Biosafety Level 3 labs, which are required for _brucella_ pathogen studies, according to the National Health Commission.

As the local agriculture department tries to ascertain the source of the recent infections, Lanzhou's health commission said [Fri 6 Dec 2019], it is implementing precautionary measures so that brucellosis does not pose a threat to neighbouring communities. [Byline: Yuan Ye]
=================
[An earlier report suggested that 4 persons were clinically ill but this is not confirmed here.  Brucellosis (<http://www.medicinenet.com/brucellosis/article.htm>) is a disease that is thought to have existed since ancient times, as it was 1st described more than 2000 years ago by the Romans and Hippocrates. It was not until 1887 that a British physician, Dr. David Bruce, isolated the organism that causes brucellosis from several deceased patients from the island of Malta. This disease has had several names throughout its history, including Mediterranean fever, Malta fever, Crimean fever, Bang's disease, and undulant fever (because of the relapsing nature of the fever associated with the disease).

The symptoms and signs of brucellosis may develop from days to months after the initial exposure to the organism. While some individuals may develop mild symptoms, others may go on to develop long-term chronic symptoms. The signs and symptoms of brucellosis are extensive, and they can be similar to many other febrile illnesses, so recognition of potential exposure -- from ingestion of unpasteurized milk or cheese, employment as a veterinarian or veterinary student, in a slaughter house or meat processing plant, or working in a microbiology lab -- is vital. In this outbreak, it is not clear what symptoms the students had or whether they were just seropositive. ProMED would like more information about this episode. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Gansu Province, China: <http://healthmap.org/promed/p/333>]
Date: Tue 3 Dec 2019
Source: Outbreak News Today [edited]

In late November [2019], Uganda health authorities notified the World Health Organization of a fatal Rift Valley fever (RVF) case from Obongi district.  The case was a 35-year-old man from South Sudan who was living in the Palorinya Refugee camp in Obongi district, Uganda. The case had travel history to South Sudan between 12 and 19 Nov 2019 to harvest cassava. While in his home country, he developed fever and other symptoms and was treated for malaria; however, his condition got worse.  He later returned to the refugee camp in Uganda and his symptoms progressed and he was hospitalized. Viral hemorrhagic fever was suspected. Samples were collected and sent to the Uganda Virus Research Institute; however, the patient died. A safe and dignified burial was performed on 22 Nov 2019. As of 24 Nov 2019, a total of 19 contacts were recorded during the active case search including 10 healthcare workers.
===================
[The circumstances and specific location under which the man became infected with Rift Valley fever (RVF) virus in South Sudan is not mentioned. It is worth noting that there was an RVF outbreak in the Eastern Lakes region of South Sudan during the 1st 3 months of last year (2018). At the end of that outbreak, the OIE's follow-up report no. 3 reported: "The event cannot be considered resolved, but the situation is sufficiently stable. No more follow-up reports will be sent. Information about this disease will be included in the next 6-monthly reports."

There were more human cases than animal ones in that outbreak, prompting Mod.AS to comment: "Unfortunately, during the recent South Sudan RVF event, as in most -- if not all -- previous RVF events in other African countries, humans served as sentinels. Improved surveillance in animals is desperately needed in Africa, to allow timely measures applied, predominantly preventive vaccination, before the development of a full-blown epizootic involving secondary infection in humans." Intensified surveillance is needed in South Sudan in those localities where the affected man had been prior to his return to Uganda.

It is likely that RVF virus has persisted in this area in transovarially infected eggs of _Aedes_ mosquito vectors. These eggs can remain viable for long periods of time and hatch when flooded during future rain events, with the subsequent emergence of infected females ready to transmit the virus. This risk provides justification for maintaining livestock of the area well vaccinated into the future. This may have accounted for the reappearance of RVF in South Sudan in 2018, after nearly 2 years without additional reported cases in humans or livestock and again with this human case in 2019. - ProMED Mod.TY]

Obongi district, Uganda is located approximately 50 km (30 mi) from the South Sudan border.
HealthMap/ProMED-mail maps:

According to OIE's data, a total of 2 outbreaks of RVF affecting animals have been reported from Sudan during the event. The 1st outbreak started in the Arabaata dam area, Red Sea state, on 25 Sep 2019, affecting goats. The 2nd (and, so far, last) outbreak started 10 Oct 2019 in the River Nile state, affecting sheep and goats. Both outbreaks have been declared as 'resolved' on 14 Nov 2019.

Outbreak summary:
Total outbreaks = 2 (Submitted)
Species / Susceptible / Cases / Deaths / Killed and disposed of / Slaughtered
Goats / 1700 / 37 / 7 / 0 / 0
Sheep / 1550 / 37 / 5 / 0 / 0

According to the recent (5 Dec 2019) OCHA (UN Office for the Coordination of Humanitarian Affairs) update, the (human) RVF situation in Sudan, as of 26 Oct 2019, was the following: "a total of 345 suspected RVF cases -- including 11 related deaths -- reported in the states of Red Sea (128), River Nile (212), Khartoum (1), White Nile (1), Kassala (2), and Gedaref (1). The most affected age group is 15 to 45 years, which accounts for 83% of the total suspected cases. The male to female ratio is 2.6, with a high proportion of the cases being farmers (37.5 per cent). RVF is endemic in Sudan and 3 outbreaks affecting people have been documented in 1973, 1976, and 2008. During the outbreak in 2008, a total of 747 laboratory-confirmed cases were reported, including 230 deaths."

Egypt suffered its 1st RVF outbreak in 1977/78 with serious human disease and death as well as severe losses in livestock; several additional events have been recorded since. A recent historical review paper [1] concluded: "due to the availability and abundance of the potential vectors, the suitability of environmental conditions, continuous importation of livestock's from Sudan, and the close association of susceptible domestic animals with humans, the RVF virus could possibly occur and circulate in Egypt."   (https://tinyurl.com/whz3pz5)

Reference
---------
1. Kenawy MA, Abdel-Hamid YM, Beier JC. Rift Valley fever in Egypt and other African countries: Historical review, recent outbreaks, and possibility of disease occurrence in Egypt. Acta Trop. 2018; 181: 40-49; <https://doi.org/10.1016/j.actatropica.2018.01.015>  - ProMED Mods.AS/TY]
Date: Fri 6 Dec 2019 5:53 PM MST
Source: CTV News [edited]

A syphilis outbreak is worsening in Alberta [Canada], and the majority of new cases are in the Edmonton zone. Edmonton saw 1186 of the 1753 infectious syphilis [primary, secondary and early latent syphilis] cases reported in Alberta in 2019, a total of 68 per cent.

Alberta Health Services [AHS] declared an outbreak in July 2019, saying cases had 'increased dramatically' in the province since 2014. The number increased again in July [2019]  [<https://edmonton.ctvnews.ca/alberta-declares-province-wide-syphilis-outbreak-1.4510737>].

AHS sent a new public health alert to doctors on [27 Nov 2019], asking for their help to control the outbreak [<https://www.albertahealthservices.ca/assets/info/hp/phys/if-hp-phys-moh-ez-syphilis-outbreak.pdf>]. "It's very significant," said Dr Ameeta Singh, a clinical professor in infectious diseases. "That's an alarming rise in new syphilis cases in Alberta." She said it's the highest number of cases the province has seen since the 1940s.

According to Dr Singh, the increase in cases being reported is partially due to a greater number of people getting tested. "We know more people are coming in to get tested, but if we look a bit closer at the data we have, we do see there's, in fact, a [bigger] rise in the number of cases than we would expect to see," said Singh.

Another factor could be the rise in methamphetamine use in Edmonton. "I believe this is a major factor. Meth also stimulates risky sexual behaviour and increases the chance people will engage in multiple, usually casual or anonymous partners as well and not use precautions such as condoms to protect themselves during sex," she said.

What's also alarming, Singh said, is the spike in cases of congenital syphilis, where the disease is passed on to newborns. According to AHS, there have been 38 cases of congenital syphilis in 2019, 31 of which were in the Edmonton area. That accounts for more than half of the 61 cases of congenital syphilis reported since 2014.

"Those are not numbers we should be talking about in Canada ever...in a country that has universal access to health care, in a major city in Canada where syphilis testing is offered to all pregnant women who access prenatal care," she said. "What we're seeing with the congenital syphilis cases is many of the women are not accessing prenatal care until they come into the hospital to deliver and then the tests are being done."
===================
[A recent ProMED-mail post (Syphilis - Canada (04): (AB) RFI http://promedmail.org/post/20190718.6574300) reported a rise in "infectious syphilis" cases over a 4-year period: from 2014 to 2018 but made no mentioned of contributing factors. As illicit drug use has been cited as a contributing factor to recent increases in syphilis cases in the Canadian provinces of Ontario and Manitoba, I questioned in this prior ProMED-mail post if use of illicit drugs, in particular, methamphetamine, could similarly be contributing to the rise of syphilis cases in Alberta. The news article above reports that the rise in methamphetamine use in Edmonton, as well as increased testing for syphilis, are thought to be contributing factors in Alberta.

Methamphetamine can be swallowed, snorted, smoked or injected by needle and syringe

When methamphetamine is injected, transmission of syphilis may occur as a consequence of sharing a needle/syringe contaminated with infected blood from somebody who has primary or secondary syphilis (<https://ucsdnews.ucsd.edu/archive/newsrel/health/04-28TransmissionSyphilis.asp>); but syphilis can also be acquired by direct contact with an infected lesion during oral, vaginal, or anal sex when the drug is taken by any route of administration. Methamphetamine use is associated with sexual behaviors that increase the risk for acquiring syphilis and other sexually transmitted diseases, including having multiple sex partners, inconsistent condom use, and exchange of sex for drugs or money (<https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a4.htm>).

The linkage of methamphetamine use and syphilis transmission 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.

Bacteremia due to _Treponema pallidum_, the cause of syphilis, which occurs during primary, secondary, and latent syphilis, can result in transplacental transmission of this organism to the fetus during pregnancy and cause congenital syphilis. An increase in the incidence of syphilis in women in the population is commonly accompanied by increasing rates of congenital syphilis.

Edmonton, with a population of 932 546 residents in 2016, is the capital of the Canadian province of Alberta
(<https://en.wikipedia.org/wiki/Edmonton>).

A map showing the location of Edmonton can be found at
<https://goo.gl/maps/Rfq6XC2vvwi19ypb6>. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Alberta, Canada:
9 December 2019
https://www.who.int/bangladesh/news/detail/09-12-2019-cholera-vaccination-campaign-launched-to-protect-635-000-people-in-cox-s-bazar

Cox’s Bazar, Bangladesh

Over 635,000 Rohingya refugees and Bangladeshi host community will be vaccinated against cholera in a 3-week-long campaign beginning today at the refugee camps in Cox’s Bazar and nearby areas, to protect vulnerable population against the deadly disease amidst increasing number of cases of acute watery diarrhoea (AWD).


The Oral Cholera Vaccination (OCV) campaign will be implemented in the refugee camps from 8-14 December to reach 139,888 Rohingya aged 1 year and less than 5 years. In the host community, the campaign will take place from 8-31 December and aims to reach any person older than 1 year (495,197). In total, 635,085 people are expected to be reached.

Led by the Ministry of Health and Family Welfare, with support of the World Health Organization (WHO), UNICEF and other partners, the campaign aims to reach people who missed some or all previous cholera vaccination opportunities. The campaign, including operational costs, is funded by Gavi, the Vaccine Alliance.

“We want to equip these populations with more protection against diarrheal diseases. Despite the progresses made to ensure access to quality water and sanitation, such diseases remain an issue of concern: approximately 80% of host community living near the camps have not been targeted in previous OCV campaigns and are still vulnerable”, says Dr Bardan Jung Rana, WHO Representative in Bangladesh.

Earlier rounds of cholera vaccination, which have taken place since the beginning of the emergency response in 2017, have helped prevent outbreaks of the disease. To this date, over 1 million people were vaccinated against cholera.
6th December 2019
https://www.theguardian.com/world/2019/dec/06/flooding-hits-new-zealand-tourist-hubs-of-wanaka-and-queenstown

Heavy rain has led to rivers bursting their banks, forcing the closure of shops and restaurants

Streets in the South Island tourist towns of Wanaka and Queenstown were slowly going under water on Friday, after Lake Wanaka and Lake Wakatipu burst their banks earlier in the week, flooding businesses and sewerage systems.

Water and large debris closed the main street of Wanaka, a popular spot with Instagrammers thanks to its famous tree that appears to have grown out of the lake. On Friday businesses were sandbagging as heavy rain continued to fall.

Sewerage systems in the town were also at risk of contaminating the lake, with the Queenstown Lakes District council taking the precautionary measure of shutting down the sewer connection to a handful of premises.

Wanaka residents were told to be on “high alert” with heavy rain predicted all weekend.

The streets of the usually bustling tourist town were largely empty, and the popular cafes and restaurants on the lake shore were closed.