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Guyana

Guyana US Consular Information Sheet
June 09, 2008
COUNTRY DESCRIPTION:
Guyana is a developing nation on the north coast of South America. Tourist facilities are not developed, except for hotels in the capital city of Georgetown and a limi
ed number of eco-resorts. The vast majority of Guyanese nationals live along the coast, leaving the interior largely unpopulated and undeveloped. Travel in the interior of Guyana can be difficult; many interior regions can only be reached by plane or boat and the limited roads are often impassable in the rainy seasons. Read the Department of State Background Notes on Guyana for additional information.

ENTRY/EXIT REQUIREMENTS: A valid U.S. passport is required for U.S. citizens to enter and depart Guyana. On arrival, Guyanese Immigration normally grants U.S. visitors a stay of up to 3 months. U.S.-Guyanese dual nationals may be granted an indefinite stay. Extensions of stay may be obtained from the Ministry of Home Affairs at 60 Brickdam Street, Georgetown. The Central Office of Immigration located on Camp Street, Georgetown, must note the extension in the visitor's passport. Travelers for purposes other than tourism should check with the Ministry of Home Affairs for information about requirements for work permits and extended stays. U.S.-Guyanese dual nationals departing Guyana for the United States using a Guyanese passport must present to Guyanese authorities a U.S. Certificate of Naturalization or other document establishing that they may legally enter the United States. For further information about entry, exit and customs requirements, travelers may consult the Embassy of Guyana at 2490 Tracy Place NW, Washington, DC 20008, telephone (202) 265-6900, the Consulate General in New York, or honorary consuls in California, Florida, Ohio, and Texas. Visit the Embassy of Guyana web site at www.guyana.org for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY: Driving in Guyana can be particularly dangerous, with a significant number of accidents and road fatalities occurring. See the section below on “Traffic Safety and Road Conditions” for additional information. In the past, demonstrations and protests occasionally occurred in Georgetown; however, these are increasingly rare. Past demonstrations have not been directed at U.S. citizens and violence against Americans in general is not common. Visitors should nevertheless remain alert and take prudent personal security measures to deal with the unexpected while in Guyana. It is advisable to avoid areas where crowds have congregated and to maintain a low profile when moving about Georgetown and other Guyanese cities. Most major eco-tourist resorts and hotels in Guyana do not have written emergency plans in place, and many of them have safety deficiencies, including a lack of easily identifiable lifeguards or no lifeguards at all. Many of these resorts also do not have adequately stocked first aid supplies. 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 Public Announcements, including 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 United States and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME: Serious crime, including murder and home invasion, continues to be a major problem; the murder rate in Guyana is three times higher than the murder rate in the United States. In early 2008, an attack in the Georgetown suburb of Lusignan and in the Essequibo River town of Bartica by heavily armed gangs resulted in the deaths of more than 20 persons, mostly innocent Guyanese civilians. An investigation into these attacks is continuing, but most of the perpetrators are still at large. In addition, there have been several instances of random shootings at night at police headquarters or police stations in Georgetown. U.S. citizens are encouraged to maintain a high level of vigilance, consider security issues when planning activities throughout Guyana, minimize movement when possible, and avoid traveling at night, when possible.

Armed robberies continue to rise, especially in major business and shopping districts. Hotel room strong-arm break-ins are also increasing, so travelers should use caution when opening their hotel room doors and should safeguard valuables left in hotel rooms. Criminals may act brazenly, and police officers themselves have been the victims of assaults and shootings. Vehicle occupants should keep their doors locked and be aware of their surroundings at all times. Robbery and theft occur with some frequency in Georgetown and New Amsterdam. U.S. citizens should avoid stopping in or traveling through the village of Buxton, which lies along the road between Georgetown and New Amsterdam, and Agricola, which is located on the East Bank highway. The Department of State recommends that Embassy staff using the public golf course at Lusignan, next to Buxton, do so in groups and only during daylight hours. Pickpocketing, purse snatching by thieves on bicycles, assault, and theft can occur in all areas of Georgetown. The areas adjacent to the sea wall and the National Park in Georgetown, although frequented by joggers, dogwalkers, and families are generally considered safe during daylight hours, have been the scenes of crimes in the past. Travelers should exercise extra care when visiting these areas after dusk. Pickpockets and thieves also frequent Stabroek and Bourda, the two major markets, and great care should be taken to safeguard personal property when shopping in these markets. U.S. passports and permanent residency cards are prized by thieves as they may be used for smuggling and identity theft. There have been numerous incidents of piracy in recent months in and around the waters of Guyana. Mariners are advised to be vigilant and take appropriate precautions. Travelers should avoid walking alone around Georgetown, even in the main areas and especially at night. Although bandits have been known to attack taxis, they are generally safe and remain the safest means of getting about town and to and from the airport for visitors. Only taxis from reputable companies should be used. Exercise constant vigilance. Do not dress ostentatiously, as there have also been reports of gold chains or other jewelry being snatched off of pedestrians. The response of local law-enforcement authorities to the increase in violent crime has been largely ineffectual; the police are cooperative but lack the resources to respond effectively to serious criminal incidents. Nevertheless, Americans who are victims of crime are encouraged to contact the police as well as the American Citizens Services Unit of the U.S. Embassy's Consular Section.

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 in finding appropriate medical care, contact family members or friends and explain how funds may be transferred. Although the investigation and prosecution of the crime are solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is available for minor medical conditions. Emergency care and hospitalization for major medical illnesses or surgery are limited, due to a lack of appropriately trained specialists, below standard in-hospital care, and poor sanitation. Ambulance service is limited to transportation without any medical care and is frequently not available for emergencies. An MRI (linked to the United States for interpretation) has been installed and is operational, but results may take up to 4 days. Visitors are advised to bring prescription medicine sufficient for their length of stay and should be aware that Guyana's humid climate may affect some medicines. Some prescription medicines (mainly generic rather than name-brand) are available. Special attention should be paid to HIV/AIDS in Guyana. In addition to infection rates as high as 45% in high-risk populations such as commercial sex workers and mobile populations such as miners or loggers, data from the World Health Organization estimate that 1.6% of the general population is infected with HIV; this is among the highest prevalence rates in Latin America and the Caribbean. 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 Guyana is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
In 2007, road fatalities increased more than 40% from the previous year. The rate of traffic accident fatalities in Guyana is 70% higher than in the United States. The Traffic Division of Guyana's National Police Force is responsible for road safety but is ill-trained and ill-equipped. Driving in Guyana is hazardous because of very poor road surfaces; farm animals sleeping or wandering on the roads; pedestrians walking on the road; and poor driving habits, including speeding, reckless driving, tailgating, cell phone use, quick stops without signaling, failure to dim headlights, and weaving in and out of traffic. Traffic lights installed in Georgetown are often ignored or simply flash, posing a risk to drivers and pedestrians. Visitors should exercise caution at all times while driving and avoid driving at night, when possible. The Department of State recommends that Embassy staff travel in groups of two or more vehicles when traveling outside Georgetown at night.
Travelers are advised to use caution traveling to and from Cheddi Jagan International Airport, especially at night. The Embassy requires its staff to use official vehicles when traveling this route between dusk and dawn due to a combination of most of the aforementioned characteristics of driving in Guyana.
Penalties for drivers involved in an accident resulting in injury or death are severe, including life imprisonment. If involved in an accident, call 911 for police and 913 for an ambulance. Please note that police may be slow to respond and an ambulance may not be available.
Drivers use the left side of the road in Guyana. Seatbelt use is required by law and is enforced; failure to use a seatbelt can result in a fine. There presently are no laws in Guyana concerning use of child car seats, but the use of age-appropriate seats is strongly recommended for child passengers. Both drivers and passengers on motorcycles must wear protective helmets that meet certain specifications.
Mini-buses (small 12- to 15-passenger vans) ply various routes both within and between cities. Mini-bus drivers have come under severe criticism from the government, press, and private citizens for speeding, aggressive and reckless driving, overloading of vehicles, poor vehicle maintenance and repair, and offensive remarks directed at passengers, but little change in their driving behavior has been noted. Mini-buses have been involved in the majority of fatal vehicular accidents in recent years.
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.

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

SPECIAL CIRCUMSTANCES:
Air Travel: Flights on all airlines can be delayed, rerouted, or canceled without notice. Air travel within Guyana generally depends on demand. Flights that are not full may be canceled or passengers may be expected to pay for the empty seats. Travelers to the United States from Guyana have found narcotics planted in their luggage, both in bags registered under their names and in items they were carrying for others. Travelers should not carry any items they did not purchase and pack themselves and should take care that no additional bags are registered in their names. Travelers should hand carry medications, valuables, and perishable items.
Flooding: The coastal plain, which occupies about 5% of the country's area, is home to more than 90% of its inhabitants. The plain extends from the Corentyne River in the east to the Venezuelan border in the northwest. This coastal plain was created through the polder system, a technique that dams and then drains a water-covered area. The polder system consists of a front dam (the sea wall along the east coast) and a back dam (the freshwater conservancy) that is approximately 5 to 6 kilometers inland from the sea wall. The system is in a fragile state due to a chronic lack of maintenance. In addition, a dozen major drainage canals run from the base of the dam to the Atlantic Ocean across the polder itself. These main canals are, in turn, fed by literally thousands of lateral canals that run along both sides of almost every street and road. Seasonal rains (December-January and May-July), combined with the lack of maintenance and improper new construction, led to significant flooding in Greater Georgetown and along the East Coast in January 2005 and in the Mahaica-Mahaicony Abrary area, Canals 1 and 2, on the West Coast Demerara and the Pomeroon River catchment area in January 2006.
Drinking Water: An inadequate garbage removal system has resulted in illegal residential and commercial dumping on the roadside and into the drainage system. Decaying animal carcasses are periodically discovered in the intake canals for the Georgetown water supply. The water supply system throughout the country should be considered contaminated and travelers should treat or boil water before consumption, or purchase bottled water.
Changing Currency and Credit Card Use: Travelers should have enough cash or travelers checks to meet their expenses. With few exceptions, credit cards and ATM cards should not be used to withdraw cash from an overseas account, due to a high risk of stolen PIN data. Although credit cards are accepted at certain institutions in Georgetown, travelers should be careful when using them and check their receipts and statements to ensure that additional unauthorized purchases have not been made to their card. American citizens are advised to exchange currency only with banks, hotels, and licensed money exchange houses (“cambios”). Many foreigners who opt to exchange money on the streets, lured by promises of higher exchange rates, become victims of fraud or receive counterfeit currency. Foreigners have been mugged after completing bank transactions. There is no legal recourse unless the police are successful in apprehending the perpetrator; even then there is no guarantee that the money will be recovered.
Firearms: Guyanese customs authorities may enforce strict regulations concerning temporary importation into or export from Guyana of items such as firearms. If you plan to take your firearms or ammunition to or through Guyana, you should contact officials at the Embassy of Guyana to learn about its regulations and fully comply with those regulations before traveling. You may consult http://www.customs.gov for information on importing firearms into the United States.
Wildlife: Many plants and animals common in Guyana are globally threatened or endangered species protected by the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES at www.cites.org). The Guyanese Ministry of Agriculture will grant an export permit for taking an exotic bird out of the country only to those persons who have been legally residing in Guyana for more than one year. There have been several U.S. citizens arrested for attempting to leave Guyana carrying birds without having obtained an export permit. Americans who have legally resided in Guyana for more than a year and who would like to take back to the United States any birds or animals, including pets, that are listed in CITES Appendices I, II, and III, must also have an appropriate U.S. import permit from the U.S. Fish and Wildlife Service (USFWS). This is a U.S. regulation that applies regardless of distinctions among the three CITES Appendices. Individuals can obtain fact sheets and permit applications from the USFWS Office of Management Authority, Branch of Permits, 4401 N. Fairfax Drive, Arlington, VA 22203, telephone (703) 358-2104, fax (703) 358-2281, http://www.fws.gov/permits/.

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 Guyanese laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Guyana are severe, and convicted offenders can expect long jail sentences and heavy fines. Possession of unlicensed guns can result in fines and imprisonment. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime in Guyana and also prosecutable in the United States.

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 Guyana 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 Guyana. 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 100 Young and Duke Streets, telephone 011-592-225-4900 through 225-4909, fax 011-592-225-8497, web site http://georgetown.usembassy.gov/. Hours of operation are Monday-Friday, 7:30 am to 4:00 pm, except local and U.S. holidays. For emergencies after hours, on weekends and on holidays, U.S. citizens are requested to call the U.S. Embassy duty officer at 011-592-623-1992.
* * *
This replaces the Country Specific Information dated November 21, 2007, to reflect changes to Safety and Security, Crime, and Wildlife.

Travel News Headlines WORLD NEWS

Date: Tue 16 Apr 2019
Source: Kaieteur News Online [edited]

The mystery illness, which was erroneously assumed to be H1N1 (swine flu) and as leptospirosis in 2 cases, affecting employees working in the Guyana Manganese Inc. tunnel in Matthew's Ridge, Region One, Barima-Waini has finally been determined to be histoplasmosis, an infection by a fungus found in the droppings of birds, bats and rats in humid areas. [Histoplasmosis is caused by a fungus _Histoplasma capsulatum_ that lives in soil enriched by bird or bat, not rat, droppings. - ProMED Mod.ML]

This was confirmed when the Ministry of Public Health held a press conference yesterday [15 Apr 2019] in its Mental Health Unit Boardroom to provide an update on the recent outbreak and related issues.

Samples were collected from all patients, and initially some testing was done at the National Public Health Reference Laboratory (NPHRL). Further samples were sent to the Caribbean Public Health Agency Laboratory (CARPHA) in Trinidad for confirmation.

The results initially were negative for influenza A and B inclusive of H1N1, chikungunya, Zika and dengue. All patients underwent malaria tests in Matthews Ridge, and they were also negative.

Chief Medical Officer (CMO) Dr. Shamdeo Persaud provided a detailed update.

Relating the developments sequentially, the CMO said that the 1st 4 cases were reported on 28 Mar [2019]; one died while receiving care at Pakera District Hospital in Region One. The following day, 4 more were brought in to Pakera District Hospital complaining of similar symptoms (fever, headaches, joint pains, mild shortness of breath). Subsequently, the 7 Chinese workers were transferred to the Georgetown Public Hospital Corporation (GPHC).

An additional 6 employees, including one Guyanese, were attended to at the Port Kaituma Hospital but later transferred to the GPHC. One of the 6 persons visited the hospital on his own. He was evaluated but not admitted.

Once the cases were reported, several teams visited the site from the regional level. The teams included the Regional Health Officer and the Regional Environmental Health Officer, along with some supporting medical staff.

"In the initial stage, we weren't sure what we were dealing with, but since it was a febrile illness with respiratory symptoms, we took all the necessary precautions to restrict access to both the site and the hospital where the patients were being kept. The additional staffers that were sent to the region set up a temporary facility at the community centre in Matthews Ridge where they were seeing the regular patients," the CMO recounted. "Following the transfer of the patients on 3 Apr [2019], they cleaned up the Pakera District Hospital and closed down the temporary sites. Work resumed as normal at the hospital for Maternal Child Health and other services."

"Two persons are dead; one died at Pakera District Hospital and one at GPHC. Of those admitted at the GPHC, 2 were discharged. An additional person was discharged from Pakera District Hospital. Ten workers were transferred to China on Mon 9 Apr [2019]. 16 Chinese workers were under care and treatment. Following the transfer, 2 more were admitted to Pakera Hospital bringing it to a total of 18."

Blood, sputum and urine samples were collected from those that were under care, while tissue samples were collected during the post mortem from the 2 deceased. Testing for these samples was done locally at the National Public Health Reference Laboratory (NPHRL), and confirmation was done at Caribbean Public Health Agency (CARPHA) in Trinidad.

"All tests were negative for influenza A & B, dengue, chikungunya and Zika. Even though [it was] reported we had 2 positive for leptospirosis, according to the NPHRL, those were later found negative through confirmation from CARPHA. On the weekend of 7 Apr [2019], a team was flown in to Matthews Ridge. The team included officers from the Environmental Protection Agency and Occupational Safety and Health, and they did an evaluation of the work site and looked at some of the risk factors relating to the environment. A community meeting was also held with residents," Dr. Persaud said.

It was disclosed that from 8-10 Apr [2019], 2 consultants from the Pan American Health Organization/World Health Organization (PAHO/WHO) along with the Chief Medical Officer and a team from the Ministry of Public Health visited the area. A team of 9 officers from the Centre for Disease Control (CDC), China was also part of the visiting team. "During the visit, the team met with the hospital staff. We reviewed their procedures for infectious disease control and prevention, and we met with company officials. Interviews were conducted with the persons who were working in the mine." A total of 23 Chinese workers were interviewed. They were working in the 4 different tunnels.

The CMO continued: "On 10 Apr [2019], we received word from CARPHA that 5 samples were tested for histoplasmosis; 4 were positive. The Chinese CDC tested an additional 6 persons, and 5 were positive for histoplasmosis.  One person tested showed weak positive hantavirus, but this may have been because of a past exposure to that germ. "Currently, we are monitoring persons at Matthews Ridge. During the last 2 days, 2 persons developed fever, and they were admitted to Pakera District Hospital and are under close observation and treatment for hantavirus, which is a fungal infection. [Hantavirus infection is a viral, not fungal infection. - Mod.ML] We also took samples from them, and they are presently being processed for shipment to CARPHA."

Meanwhile, the absence of safety gear for workers was highlighted. Interviews were done with employees who had not developed any illness. And this revealed the shortcomings. Officials were told that the safety gear was in the country but was not on site. They had not cleared customs at the wharf at that time. However, that claim was never confirmed. Occupational Safety and Health (OSH) Consultant Gwyneth King said, "Our information to date is that the workers were not wearing [any] personal safety gear. That is to say that they were not wearing respirators, so they were exposed to breathing in the fungus. If you have to do a job like that, you need to wear personal safety gear; otherwise, you could expose yourself."

King said that officials will be working within the confines of the Occupational Safety and Health Act to see what action, if any, can be taken against the company for this major inadequacy. However, they are only now going through their findings and preparing the report.
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[As I assumed in my ProMED moderator comments in the last ProMED-mail post on this outbreak, the cause of the acute respiratory illness in workers in manganese mine tunnels in Guyana is apparently histoplasmosis.

We were initially told (ProMED-mail post (Undiagnosed resp. illness - Guyana: (Barima-Waini) manganese mine, fatal, RFI http://promedmail.org/post/20190401.6396933) that workers at a manganese mining company in Guyana, owned by a subsidiary of Chinese company Bosai Minerals Group Guyana Company Limited, developed what was said to be an influenza-like illness with "respiratory discomfort, rash, and high-grade fever." More than a dozen miners were affected, and 2 of the workers died. Post-mortem examinations on the 2 dead miners initially were said to have "revealed that they died from haemorrhagic pneumonia as a result of leptospirosis;" we now learn the diagnosis of leptospirosis was erroneous.

Initially, we were told that all infected persons were exposed to one common area, without evidence of person-to-person transmission (that is, presumably there were no secondary cases), but we were not told what that common area was. We were subsequently told the common area is the "Matthews Ridge tunnel site."

Manganese mines are usually open pits, which are subject to flooding that could lead to exposure to leptospirosis if there is also rat infestation. However, tunnels could be infested with bats and their guano, which would place mine workers at risk for histoplasmosis, a fungal pulmonary infection that follows unprotected inhalation of large inocula of _Histoplasma capsulatum_ spores. The fungus lives in soil fertilized by bird or bat droppings. Contaminated soil can remain potentially infectious for years. Microconidia spores become airborne when the contaminated soil is disturbed, for example, by digging in contaminated soil. Most infected individuals remain asymptomatic. Symptomatic illness is primarily caused by an intense exposure, and the severity of disease is related to the number of spores inhaled.

ProMED-mail previously reported on a histoplasmosis outbreak in tunnel workers in the Dominican Republic (see "See Also's" below).

Symptoms of histoplasmosis usually include non-specific flu-like symptoms (fever, chills, muscle aches, dry cough, and chest discomfort); potentially fatal adult respiratory distress syndrome (ARDS) may occur when larger inocula are inhaled (<http://journal.publications.chestnet.org/article.aspx?articleid=1047573> and <http://www.ncbi.nlm.nih.gov/pubmed/7244706?dopt=Abstract>). The pulmonary infection can disseminate throughout the body, and immunocompromised individuals may develop a severe form of histoplasmosis called progressive disseminated disease.

Histoplasmosis cannot be transmitted from person to person or from animals to people. The diagnosis can be made by culture of the organism from sputum or tissues, by serology, or by tests for antigen in urine and serum specimens. For treatment guidelines, see Clinical Practice Guidelines for the Management of Patients with Histoplasmosis: 2007 Update by the Infectious Diseases Society of America. Clin Infect Dis 2007; 45(7): 807-25. Available at <http://cid.oxfordjournals.org/content/45/7/807.full>. - ProMED Mod.ML]

[HealthMap/ProMED map available at:
Date: Sat 6 Apr 2019
Source: Outbreak News Today [edited]

Health officials in Guyana have reported a leptospirosis outbreak among Guyana Manganese Inc. (GMI) workers on [Fri 5 Apr 2019].  According to authorities, 2 Chinese nationals have been treated and released, while another mining employee, who was also tested positive for leptospirosis, is in "critical but stable condition".

One individual died from complications associated with leptospirosis on [Wed 3 Apr 2019] night while undergoing treatment at the Georgetown Public Hospital Corporation (GPHC). Chief Medical Officer (CMO) Dr. Shamdeo Persaud said that "all precautionary measures are still in place at the Matthews Ridge tunnel site and immediate surroundings and essential medical supplies are in stock to treat employees of the mining firm and residents of the area.

Since last week's outbreak, the area has been deemed a 'Red Zone' by Ministry of Public Health (MOPH) authorities and "no one is allowed to enter the site," Dr. Persaud reminded on [Thu 4 Apr 2019].
Date: Mon 1 Apr 2019
Source: DPI Guyana [edited]

Public health officials have ruled out swine flu (H1N1), Zika, Chikungunya, dengue, and influenza A and B as possible causes of the recent spate of illnesses and death in Matthew's Ridge. Thus far, there has been no evidence of person-to-person transmission of infection. It is noted that only persons who were directly exposed to one common area became ill.

As of Sunday, 31 Mar [2019], a response team comprising the Environmental Protection Agency (EPA), Surveillance, EH, doctors, and nurses were dispatched to region 1 to support the efforts taken in theregion to address the illnesses. The fortified health response focuses on providing uninterrupted health services to the residents of Matthew's Ridge, as well as on conducting health assessments of all persons working in the mining area.

The decision was taken to transfer all the patients with the acute respiratory illness, rash, and fever to our tertiary institution, the Georgetown Public Hospital (GPHC), where critical care can be provided should the need arise. While the specialists continue to work on the 7 patients admitted on Saturday [30 Mar 2019], results have shown that 2 patients tested positive for leptospirosis, which is known to be spread by direct contact with rat urine or faeces. Further tests are being conducted locally, and samples will be sent overseas with support from PAHO and CARPHA to get further tests done to rule out other possible infections.

The Public Health Ministry is taking all necessary precautions to ensure staff and members of the community at Matthew's Ridge are kept safe.

The mining company has been instructed to halt further exploration until the ministry and a team from the Occupational Health and Safety department of the Ministry of Social Protection can advise further. The Ministry of Public Health, along with partners, will continue to monitor the situation closely until resolution.
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[Leptospirosis is a bacterial disease that affects humans and animals. It is caused by bacteria of the genus _Leptospira_. In humans, it can cause a wide range of symptoms, some of which may be mistaken for other diseases. Some infected persons, however, may have no symptoms at all.

Without treatment, leptospirosis can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, respiratory distress, and even death  (<https://www.cdc.gov/leptospirosis/index.html>).

Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, such as farmers, mine workers, sewer workers, slaughterhouse workers, veterinarians and animal caretakers, fish workers, dairy farmers, and military personnel. The disease has also been associated with swimming, wading, kayaking, and rafting in contaminated lakes and rivers. As such, it is a recreational hazard for campers or those who participate in outdoor sports. The risk is likely greater for those who participate in these activities in tropical or temperate climates.

According to the above report, appropriate public health measures are being taken to contain the above "outbreak" and confirm any new cases as early as possible. - ProMED Mod.UBA]

[We were told in the initial ProMED-mail post (Undiagnosed resp. illness - Guyana: (Barima-Waini) manganese mine, fatal, RFI http://promedmail.org/post/20190401.6396933) that 8 individuals working at a manganese mining company in Guyana, owned by a subsidiary of Chinese company Bosai Minerals Group Guyana Company Limited, developed what was said to be an influenza-like illness with "respiratory discomfort, rash, and high-grade fever." One of the individuals died.

A subsequent update from Guyana Department of Public Information (above) says that swine flu (H1N1), Zika, chikungunya, dengue, and influenza A and B have been ruled out as possible causes of this outbreak, although 2 patients tested positive for leptospirosis, without specifying what tests were done to make that determination. All infected persons are said to have been exposed to one common area, without evidence of person-to-person transmission (that is, presumably there are no secondary cases), but we are not told what that common area is.

Leptospirosis is an infection transmitted to humans by exposure to soil or fresh water contaminated with the urine of wild and domestic animals (including dogs, cattle, swine, and especially rodents) that are chronically infected with pathogenic _Leptospira_. The Bosai mine is an open pit mine, the usual way manganese is mined (<https://demerarawaves.com/2017/01/27/manganese-mining-in-north-west-district-to-create-hundreds-of-jobs-improved-infrastructure/>). Open pit mines are subject to flooding, which could lead to exposure to leptospirosis if there is also rat infestation.

The clinical presentation of leptospirosis is frequently nonspecific, with fever, headache, and myalgias. Patients often have a dry cough, which is usually mild and without any sequelae, that accompanies the other symptoms. Severe leptospirosis, known as Weil's disease, is characterized by liver damage (causing jaundice), renal failure, and bleeding. Meningoencephalitis and myocarditis may also be present. However, pulmonary involvement, which manifests itself as pulmonary hemorrhage, can be severe, with massive hemoptysis, respiratory insufficiency, and death (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519021/>). The diagnosis of leptospirosis can be made by PCR assays during the acute illness and ELISA (enzyme-linked immunosorbent assay) for the detection of _Leptospira_-specific IgM antibodies. The microscopic agglutination test (MAT), which detects antibodies to specific serovars using several reference strains, confirms the diagnosis.

Another disease transmitted by rodents is hantavirus infection. Infected rodents shed the virus in feces, urine, and saliva. Dr. Jan Clement in previous ProMED-mail posts (e.g., Leptospirosis - South Africa (02): (WC) fatal, prisoners, rat infestation, comment http://promedmail.org/post/20151004.3690652) has pointed out the need to consider hantavirus infection in the differential diagnosis of rodent-borne diseases such as leptospirosis. ProMED-mail moderator TY [ProMED Mod.TY] has indicated the presence of hantaviruses in this region of northeastern South America. See ProMED-mail post Hantavirus update 2010 - Americas (40): Chile, French Guiana http://promedmail.org/post/20101224.4542. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Barima-Waini region, Guyana: <http://healthmap.org/promed/p/3849>]
Date: Sun 31 Mar 2019
Source: Kaieteur News [edited]

One of several afflicted manganese workers is now dead, after exhibiting symptoms of a viral influenza, yesterday [30 Mar 2019]. The other 7, who are also Chinese nationals, are currently being treated at the Georgetown Public Hospital Corporation (GPHC).

A team of medical personnel was deployed to Matthews Ridge [Barima-Waini region] yesterday, from the Mabaruma Hospital after the members received these reports.

The 7 men were airlifted to Eugene F Correia International Airport, Ogle, and transported to GPHC for treatment.

A medical practitioner on the team informed this publication that the team has been extremely cautious, both, in its transport of the patients and with the level of care they're currently receiving.

This publication was informed that 2 floors of the Male Medical Ward of GPHC were cleared and restricted yesterday, to quarantine the victims of the undetermined illness.

The 7 workers had initially been taken to Pakera Hospital, Matthews Ridge, for treatment.

The medical personnel at the hospital have been running a battery of tests. Further testing is expected to be done to ascertain the exact nature of the illness. One doctor involved has dismissed speculation that swine flu [influenza A(H1N1)] is the cause of the symptoms.

The workers were reportedly stationed at a manganese mine owned by Guyana Manganese Inc. (GMI), a subsidiary of Chinese company, Bosai Minerals Group Guyana Company Limited, when they began showing signs of respiratory discomfort, rash, and [high grade fever].

Just [Fri 29 Mar 2019], Ministers of Natural Resources and Public Affairs, Raphael Trotman, and Dawn Hastings-Williams, visited the mine to inspect it, since operations there are expected to restart soon.

To date, 113 Guyanese and 23 expatriates have already been employed with GMI.

According to health officials, they are up on the alert for measles and immunisable diseases.
===================
[According to the report above, the clinical presentation of the cases includes high grade fever with a rash and respiratory symptoms. The report mentions 8 workers who developed symptoms but does not provide information on epidemiological factors such as whether the workers lived in close proximity prior to developing symptoms, any travel history or new arrivals to the mine, or any co-morbid conditions. Detection of the responsible pathogen or toxin is necessary to provide appropriate treatment and to protect the other workers. Any further information in this regard will be highly appreciated. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map of Guyana:
Date: Wed 13 Sep 2017
Source: Stabroek News [edited]

Residents of Wakapoa, in Region Two (Pomeroon-Supenaam), suspect that there is a typhoid outbreak in the community, where the absence of medical professionals and drugs at the community health centre has become the norm. At least 8 people from the village have been reported as having typhoid.

A resident sought to highlight the plight of those in her village in a recent Facebook post by calling on those in authority to look into the matter. "Hello my friends, with a feeling of anxiety and frustration I reach out to you this evening to ask if anyone can refer me to the relevant authorities for help for the folks of Wakapoa. Presently, there seems to be an outbreak of typhoid in my community! With 6 people from my family already sick and in need of treatment!! There's no doctor or medex at our health centre and it is apparent we do not have any treatment here right now... 4 members in my family [are] presently at Suddie Hospital talking treatment... But it is very expensive to travel to that hospital and the required tests are also expensive," she wrote, while asking for assistance to notify the Public Health Minister and other organizations that could help the community.
======================
[Typhoid fever, so-called enteric fever caused by _Salmonella enterica_ serotype Typhi, often has a totally different presentation from that of the commoner kinds of salmonellosis. Epidemiologically, usually spread by contaminated food or water, typhoid is not a zoonosis like the more common types of salmonellosis. Clinically, vomiting and diarrhoea are typically absent; indeed, constipation is frequently reported. As it is a systemic illness, blood cultures are at least as likely to be positive as stool in enteric fever, particularly early in the course of the infection, and bone marrow cultures may be the most sensitive.

The symptoms of classical typhoid fever typically include fever, anorexia, lethargy, malaise, dull continuous headache, non-productive cough, vague abdominal pain, and constipation. Despite the frequently high fever, the pulse is often only slightly elevated. During the 2nd week of the illness, there is protracted fever and mental dullness, classically called coma vigil. Diarrhoea may develop but usually does not. Many patients develop hepatosplenomegaly [both liver and spleen enlarged]. After the 1st week or so, many cases develop a maculopapular rash on the upper abdomen. These lesions ("rose spots") are about 2 cm [0.78 in] in diameter and blanch on pressure. They persist for 2-4 days and may come and go. Mild and atypical infections are common.

The word typhoid (as in typhus-like) reflects the similarity of the louse-borne rickettsial disease epidemic typhus and that of typhoid fever; in fact, in some areas, typhoid fever is still referred to as abdominal typhus.

Pomeroon-Supenaam (Region 2) is a region in Guyana, bordering the Atlantic Ocean to the north, the region of Essequibo Islands-West Demerara to the east, the region of Cuyuni-Mazaruni to the south and the region of Barima-Waini to the west. Pomeroon-Supenaam contains the towns of Anna Regina, Charity, Pickersgill, Spring Garden and Suddie. It can be seen on a map of the country at <https://en.wikipedia.org/wiki/Pomeroon-Supenaam>. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
More ...

World Travel News Headlines

Date: Wed, 1 Apr 2020 14:43:58 +0200 (METDST)

Paris, April 1, 2020 (AFP) - A man has been jailed in France for repeatedly violating strict anti-coronavirus lockdown rules, which have seen 359,000 fines issued countrywide as the outbreak death toll continues to mount, authorities said Wednesday.    Police Minister Christophe Castaner warned residents to write off any travel plans for school holidays starting this weekend, promising to punish any unwarranted movement as the country continues to evacuate dozens of critically ill patients from hospitals in overstretched areas of the country.

The Ile-de-France region, with Paris at its core, saw its first evacuations Wednesday as the outbreak which started in the east of France takes an ever-heavier toll on the capital.   Twenty-four patients were sent from Paris to Brittany in northern France in the morning on a high-speed train, fully equipped as a hospital on tracks, with 12 others to follow on a second train later.

A third of the 499 deaths registered in France in the previous 24 hours had been from Ile-de-France, the government said, with the countrywide death toll now at 3,523.   Only deaths in hospital are counted towards the official tally, which excludes people who passed away in old age facilities or at home.   To date, the government has evacuated nearly 300 patients from hospitals in hard-hit areas of the country to lesser burdened ones, and some to Germany, Switzerland and Luxembourg. Austria said Wednesday it would take three patients from eastern France.

- 'We must stand strong' -
As the medical crisis escalates, a court in Calais in the country's north sentenced a 20-year-old man to two months in prison after he was caught eight times without the self-certified document all residents are required to show if they leave the house for critical business.   This can include essential shopping, going to the doctor, walking the dog, a quick jog, and going to work for those in critical fields.     In Paris on Tuesday, a court sentenced a 22-year-old man to 105 hours of community service, also for repeatedly violating the lockdown.

Castaner said some 5.8 million checks have been carried out and 359,000 fines issued since the lockdown started on March 17, and stressed that leaving on holiday was not allowed under the lockdown rules that have confined millions of children at home with schools closed.   Even with train and plane traffic slashed to a minimum, authorities fear a holiday exodus and the minister said controls will be stepped up on the roads and at train stations and airports.   "Confinement is a strain for families, I know, but we must stand strong," he said.   More than 22,700 people are hospitalised for COVID-19 in France, with 5,565 in intensive care.
Date: Wed, 1 Apr 2020 12:33:43 +0200 (METDST)

Tehran, April 1, 2020 (AFP) - Flooding in Iran caused by heavy rainfall has left 21 people dead and one missing, an emergency services spokesman said Wednesday, even as the country battles the coronavirus pandemic.   Mojtaba Khaledi told Iran's ISNA news agency that 22 people had also been injured, with most of the casualties in southern or central provinces.   He said 11 people had died in Fars province, three each in Hormozgan and Qom, two in Sistan and Baluchistan province, and one each in Bushehr and Khuzestan.   Khaledi said one person was still missing in Hormozgan on the Gulf coast.

Flooding last week killed 12 people, and Khaledi warned of more heavy rain to come.   Iran is battling one of the world's deadliest coronavirus outbreaks with 3,036 deaths and 47,593 infections.   In March and April last year, heavy rainfall and flooding killed at least 76 people in Iran.   At the time, the International Federation of Red Cross and Red Crescent Societies estimated 10 million people were affected, describing the floods as "the largest disaster to hit Iran in more than 15 years".
Date: Wed, 1 Apr 2020 10:00:47 +0200 (METDST)

Sydney, April 1, 2020 (AFP) - Australian health officials set up a coronavirus testing clinic on Sydney's Bondi Beach Wednesday, as concern grew that COVID-19 was spreading among backpackers in the popular tourist destination.   More than 100 cases of coronavirus have reportedly been identified in the area -- many linked to two massive club parties held in mid-March before the country shut down bars, pubs and other non-essential services.   Photos shared online last week also showed mostly young beachgoers packed together on the sand after outdoor gatherings were curtailed, drawing howls of protest.

That led to sunbathers, surfers and tourists being banned from the beach, with police enforcing the prohibition.   New South Wales Health said the Waverley Council area, which encompasses Bondi, had the highest number of confirmed cases in Sydney.   "A plausible explanation is they have come in contact with an infected backpacker before that backpacker was aware they had COVID-19," said chief health officer Kerry Chant.   Australia has recorded almost 5,000 coronavirus infections and 20 deaths, with almost half of those in New South Wales.
Date: Wed, 1 Apr 2020 00:15:13 +0200 (METDST)

London, March 31, 2020 (AFP) - A 13-year-old British boy has died days after testing positive for COVID-19, hospital officials and his family said on Tuesday, with relatives saying he had no underlying illnesses.   The boy, who died Monday at King's College Hospital in London, is believed to be Britain's youngest confirmed death in the coronavirus pandemic.

A 12-year-old girl, whose death was confirmed earlier on Tuesday in Belgium, is thought to be Europe's youngest victim.    The boy's family said Ismail Mohamed Abdulwahab "started showing symptoms and had difficulties breathing" before he was admitted to hospital.   "He was put on a ventilator and then put into an induced coma but sadly died yesterday morning," the family said through a family friend, Mark Stephenson, adding: "We are beyond devastated."

Nathalie MacDermott, a lecturer at King's College, said: "While we know it is much less likely for children to suffer severe COVID-19 infection than older adults, this case highlights the importance of us all taking the precautions we can to reduce the spread of infection in the UK and worldwide."   She urged research into deaths outside the groups expected to succumb to infection as it "may indicate an underlying genetic susceptibility."

On Tuesday, Britain announced 381 deaths from COVID-19 in the past 24 hours, the highest figure in the country since the start of the pandemic, bringing the death toll to 1,789.
Date: Tue 31 Mar 2020 4:36 PM PDT
Source: San Francisco Chronicle [abridged, edited]

The captain of a nuclear aircraft carrier with more than 100 sailors infected with the coronavirus pleaded Monday [30 Mar 2020] with US Navy officials for resources to allow isolation of his entire crew and avoid possible deaths in a situation he described as quickly deteriorating.

The unusual plea from Captain Brett Crozier, a Santa Rosa native, came in a letter obtained exclusively by The Chronicle and confirmed by a senior officer on board the aircraft carrier Theodore Roosevelt, which has been docked in Guam following a COVID-19 outbreak among the crew of more than 4000 less than a week ago. "This will require a political solution but it is the right thing to do," Crozier wrote. "We are not at war. Sailors do not need to die. If we do not act now, we are failing to properly take care of our most trusted asset -- our sailors." In the 4-page letter to senior military officials, Crozier said only a small contingent of infected sailors have been off-boarded. Most of the crew remain aboard the ship, where following official guidelines for 14-day quarantines and social distancing is impossible. "Due to a warship's inherent limitations of space, we are not doing this," Crozier wrote. "The spread of the disease is ongoing and accelerating." He asked for "compliant quarantine rooms" on shore in Guam for his entire crew "as soon as possible."

"Removing the majority of personnel from a deployed US nuclear aircraft carrier and isolating them for 2 weeks may seem like an extraordinary measure. ... This is a necessary risk," Crozier wrote. "Keeping over 4000 young men and women on board the TR is an unnecessary risk and breaks faith with those Sailors entrusted to our care."

Acting Navy Secretary Thomas Modly spoke to CNN. "I heard about the letter from Capt Crozier (Tuesday) morning [31 Mar 2020], I know that our command organization has been aware of this for about 24 hours and we have been working actually the last 7 days to move those sailors off the ship and get them into accommodations in Guam. The problem is that Guam doesn't have enough beds right now and we're having to talk to the government there to see if we can get some hotel space, create tent-type facilities," Modly said.

"We don't disagree with the (captain) on that ship and we're doing it in a very methodical way because it's not the same as a cruise ship, that ship has armaments on it, it has aircraft on it, we have to be able to fight fires if there are fires on board the ship, we have to run a nuclear power plant, so there's a lot of things that we have to do on that ship that make it a little bit different and unique but we're managing it and we're working through it," he said.

So far, none of the infected sailors has shown serious symptoms, but the number of those who have tested positive has jumped exponentially since the Navy reported infections in 3 crew members on [24 Mar 2020], the 1st time COVID-19 infections had been detected on a naval vessel at sea.

Retired Admiral James Stavridis, former NATO Supreme Allied Commander Europe, told The Chronicle Tuesday [31 Mar 2020] in an email that "we should expect more such incidents because warships are a perfect breeding ground for coronavirus." "Unfortunately, naval vessels are ideal breeding grounds for the spread of viruses because it is impossible to do social distancing on one" because of the tight quarters on board, Stavridis said. The ship's problems will "compound", Stavridis said, because you can't tie the vessel up "and send everyone ashore. It is full of weapons, billions of dollars of equipment, fire hazards, and nuclear reactors".

Scrubbing the Theodore Roosevelt of the virus will not be complicated, but "time-consuming", he said. He estimated cleaning would take 5 to 10 days with a crew of 350 people. Senior military officials said last week that the entire crew of more than 4000 will be tested. The carrier's home port is San Diego.

At the time, Modly expressed confidence that they identified all the sailors who had been in contact with the trio of infected sailors and they had been quarantined. "This is an example of how we are able to keep our ships deployed at seas and underway, even with active COVID-19 cases," Modly said. But by the time the ship reached port in Guam on Friday [27 Mar 2020], the number of cases had grown to 25, and soon after to 36, according to reports.

But by Monday [30 Mar 2020], a senior officer on board the massive aircraft carrier, who wished to remain anonymous because they are not authorized to speak to the media, said between 150 and 200 sailors had tested positive. None had been hospitalized -- yet, the source said. The Chronicle agreed to withhold the officer's name based on its anonymous sources policy.

Gilday told reporters last week [week of 23 Mar 2020] it was unclear if sailors became infected following the ship's previous port of call in early March [2020] to Da Nang, Vietnam. Gilday said they debated whether to go on with the Viet Nam visit, but at the time there were only 16 coronavirus cases in northern Viet Nam and the port was in the central part of the country. Sailors were screened prior to returning on board. The 1st 3 sailors tested positive 15 days after leaving Vietnam, officials said.

The virus has been hard to contain on board ever since. Federal and military guidelines recommend individual quarantine, including no use of common areas. "Due to the close quarters required on a warship and the current number of positive cases, every single sailor, regardless of rank, on board the TR [Theodore Roosevelt] must be considered 'close contact,'" Crozier wrote. The tight quarters on the carrier are "most conducive to spread", he wrote, including large amounts of sailors in a confined space, shared sleeping quarters, restrooms, workspaces and computers, a common mess hall, meals cooked by exposed personnel, and movement constraints requiring communal contact with ladders and hatches.

The captain compared the situation to the Diamond Princess cruise ship, citing a study that focused on what could have happened to that cruise ship had no isolation been done. A total of 712 passengers eventually tested positive for COVID-19 from that cruise departing from Japan; however, the study found if there had been no early isolation close to 80% of passengers and crew would have been infected. And had the cruise line immediately evacuated the ship after the 1st positive tests, the study found only 76 people would have tested positive.

Of the 1st 33 Roosevelt sailors testing positive, 7, or 21%, originally tested negative. After testing negative, those 7 sailors presented symptoms within 1 to 3 days after their initial negative test, Crozier said. The testing should be utilized, the captain wrote, after a proper 14-day quarantine to ensure no infected sailors return on board a clean ship. As part of his plan, 10% of the crew would stay on board to run the reactor plant, sanitize the ship, ensure security and provide contingency response for emergencies.  [byline: Matthias Gafni Joe Garofoli]
==================
[It does seem as though ships in general are ideal incubators for this virus (the SARS-CoV-2). Cruise ships with cabins for 2-4 passengers have proven to be excellent captive audiences for the virus to spread (see prior post: COVID-19 update (60): global, cruise ships, lessons learned, WHO http://promedmail.org/post/20200329.7156949 for a recent summary of cruise ship related outbreaks as well as a series of posts from mid-February 2020 through the present
http://promedmail.org/post/20200215.6993525,
http://promedmail.org/post/20200328.7153651).

In addition to having people in close quarters even in "luxury liners" where maintaining a minimum of 6 feet (2 m) separation is virtually impossible, meals are often buffet style, with serving instruments shared by all. Imagine naval ships with more dormitory style quarters, perfect locations for rapid viral transmission. One can't help but wonder how many other naval vessels from multiple countries around the world are also experiencing similar outbreaks on their ships. - ProMed Mod.MPP]
Date: Thu 26 Mar 2020
Source: The News [edited]

At a time when health authorities are dealing with the threat of coronavirus in the country, cases of Crimean-Congo haemorrhagic fever (CCHF), which is a lethal viral disease, have started surfacing in Sindh, and 2 people have been diagnosed with the tickborne viral ailment within a week.

"Today, we had a 37 year old female patient from Tharparkar, who was bleeding from her nose and mouth. We sent her sample to the lab and the lab test confirmed that she is infected with Crimean-Congo haemorrhagic fever (CCHF)," said Dr Seemin Jamali, the executive director of the JPMC [Jinnah Postgraduate Medical Centre], while talking to The News on Wednesday [25 Mar 2020].

It is the 2nd case of the Congo fever in the current year [2020], she said, adding that earlier a 40 year old person from the Pak Colony of the city had been referred to the JPMC from the Civil Hospital Karachi, who tested positive for the CCHF. Dr Jamali maintained that the previous patient, who was a butcher by trade, had recovered and been discharged from the hospital, but the new patient, a woman from the Tharparkar district of Sindh, was under treatment and in a precarious condition.

Experts say Crimean-Congo haemorrhagic fever is a tickborne viral disease whose mortality rate is over 40 per cent, and it is mostly people who deal with livestock, including butchers and shepherds, who contract the disease after coming into contact with infected animals.
======================
[This is the 2nd case of CCHF from Karachi in 2020. The 1st case has already been reported in an earlier post. The CCHF cases in Pakistan show biannual peaks, between the months of March-May and August-October. Many factors, including poor sanitation, unhygienic transportation, and numerous animal slaughter sites, inefficient tick-control programs, post-slaughter piles of animal remains, nomadic lifestyle, and lack of general awareness contribute to the spread of CCHF.

Pakistan has confirmed cases of CCHF in almost every province: Sindh (Karachi), Punjab (Faisalabad, Multan, and Rawalpindi), Balochistan (Quetta) and Khyber Pakhtunkhwa (Peshawar). There is a need to educate the general public, farmers, and healthcare workers about the causes, transmission, and risks of CCHF and advise on practical preventive measures. - ProMed Mod.UBA]

[Maps of Pakistan:
Date: Mon 30 Mar 2020

There were 3 newly confirmed cases reported by Botswana with travel histories to the UK and Thailand. - ProMed Mod.MPP

HealthMap/ProMED-mail of Botswana:
Date: Mon 30 Mar 2020
Source: Zee News [edited]

A child died due to acute encephalitis syndrome (AES) in Bihar on Sunday (29 Mar 2020). "A child has lost his life due to acute encephalitis syndrome at Sri Krishna Medical College & Hospital (SKMCH) in Muzaffarpur," Dr SK Shahi, SKMCH superintendent said.

This is the 1st AES related death in the district this year [2020]. Last year [2019], over 140 children died due to AES in the district. As per official data, 121 deaths were reported at the government-run SKMCH, which handled the largest number of patients in the district, while 21 deaths were confirmed at the Kejriwal Hospital.

AES is a viral disease that causes flu-like symptoms such as high fever, vomiting, and, in extreme cases, brain dysfunction, seizure, and inflammation of the heart and kidney.
====================
[AES is a common ailment in children in north-eastern India, especially in Bihar state.

The issue of the aetiology of AES has been under discussion for a long time. AES has continued to be attributed to various aetiologies, including Reye syndrome-like disease, possible Japanese encephalitis, enterovirus infection from polluted water, heatstroke, intoxication from lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_).

A recent publication states that dengue virus is one of the 3 commonest agents identified in AES, but existing surveillance for AES does not include routine testing for dengue.

The above report does not indicate whether any of the above aetiologies have been ruled out or confirmed. Until the aetiology (or aetiologies) of these AES cases is determined, effective and efficient prevention of these cases will not be possible. The season in which AES cases occur is just beginning, and additional cases can be expected over the coming 6-7 months. - ProMed Mod.TY]

[HealthMap/ProMED map available at:
Bihar State, India: <http://healthmap.org/promed/p/364>]
Date: Sat 28 Mar 2020
Source: CGTN Africa [edited]

The number of reported hepatitis E cases in Namibia are on the decrease, statistics released by the Ministry of Health on Saturday [28 Mar 2020] show. A total of 74 hepatitis E (HEV) cases were reported countrywide between 24 Feb and 8 Mar 2020, compared with 102 cases reported during the previous 2 weeks.

The Ministry of Health declared an outbreak of hepatitis E on 14 Dec 2017 in the capital, Windhoek. The outbreak then spread to other regions around April 2018, eventually involving a total of 10 regions. Cases have been reported mainly from informal settlements such as Havana and Goreangab in Windhoek, DRC [Democratic Resettlement Community] in Swakopmund and similar settings in other regions where access to potable water, sanitation, and hygiene is limited.

A total of 7457 hepatitis E cases have been reported since the outbreak began with 65 deaths reported nationally, representing a case fatality rate of 0.9 per cent.

"There is a decrease in the number of HEV cases during the reporting period. (However) the outbreak continues to be protracted and cases are still being detected in areas where water and toilet facilities are limited, particularly in Khomas and in Erongo regions," a report from the health ministry said.
=====================
[Hepatitis E is found worldwide, and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, whereas genotype 3 is usually seen in developed countries and does not cause outbreaks. Acute epidemic hepatitis E is attributable to infection with hepatitis E virus genotypes 1 and 2. Many of the deaths are in pregnant women, characteristic of genotype 1.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus. - ProMed Mod.LL]

[Maps of Namibia:
Date: Tue, 31 Mar 2020 22:17:01 +0200 (METDST)

Beirut, March 31, 2020 (AFP) - Lebanese authorities said Tuesday they would allow expatriates to return despite a lockdown in response to the coronavirus pandemic, a move that could affect up to 20,000 people.   The cabinet gave its initial approval for the proposal, which could be put in motion "in principle" from Sunday, a government statement said, without giving details of how it would be implemented.

An estimated 20,000 people "want to return to Lebanon", Foreign Minister Nassif Hitti told local television.  Beirut's international airport has been closed for nearly two weeks, along with schools, universities, restaurants and bars, and Lebanese have been urged to stay at home to stem the spread of COVID-19.   Lebanon has reported 463 official cases of the virus and 12 deaths.