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Kyrgyzstan

Kyrgyzstan Republic - US Consular Information Sheet
August 29, 2008
COUNTRY DESCRIPTION:
The Kyrgyz Republic, a mountainous country of five million people, is undergoing political and economic change. Tourist facilities are not highly deve
oped, and many of the goods and services taken for granted in other countries are not yet widely available. Read the Department of State Background Notes on the Kyrgyz Republic for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. American citizens can obtain a one-month single-entry, non-extendable tourist visa upon arrival at the “Manas” International Airport outside Bishkek for a $36 fee without invitation or sponsorship. Newly enacted legislation requires that all foreigners present in the Kyrgyz Republic for more than sixty days register with the Kyrgyz Department of Visa and Passport Control. Failure to do so may cause difficulties when exiting the country. Individuals traveling to Kyrgyzstan to perform religious work or work in affiliation with any religious organization in any capacity are required by Kyrgyz law to declare so on their visa applications. Failure to do so may lead to difficulties with local law enforcement as it is considered a violation of Kyrgyz law to engage in activities not matching the purpose of travel indicated on an individual’s visa. In general, travelers should apply for the correct category of visa for their purpose of travel. Travelers cannot obtain a tourist visa at land borders or other airports. American citizens visiting the Kyrgyz Republic are not required to register with the Office of Visas and Registration. The Embassy recommends that Americans traveling in the Kyrgyz Republic also obtain Kazakh visas, as commercial air travel out of the Kyrgyz Republic is limited and Americans may need to travel through Kazakhstan to return to the United States. For further information regarding entry/exit requirements, contact the Embassy of the Kyrgyz Republic at 2630 Massachusetts Avenue, NW, Washington, DC 20008, telephone: (202) 338-5141, fax: (202) 742 6501. Visit the Embassy of the Kyrgyz Republic web site at http://www.kgembassy.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:
The Department of State urges U.S. citizens to avoid all travel to rural areas along the Kyrgyz-Uzbek and Kyrgyz-Tajik borders, and all areas to the south and west of the provincial capital of Osh. Security conditions in these parts of the southern Kyrgyz Republic differ from security conditions in the north, and the threat of violence against foreigners in the southern Kyrgyz Republic continues. Hostage-taking incidents involving foreigners occurred during the summers of 1999 and 2000, including one incident in the summer of 2000 involving American citizens. In 2007, there were reports of attempted “bride-kidnappings” in rural areas. While foreigners are not believed to be intentional targets, an American female was held against her will for several days in one reported incident. In 2006, suspected militants attacked a border post on the Kyrgyz-Tajik border, and ensuing skirmishes took place between the militants and Kyrgyz military forces throughout the southern Batken region. Land mines in Batken Oblast and near the Kyrgyz-Tajik border continue to be a concern. There are currently restrictions for U.S. Government employees traveling to areas of the Kyrgyz Republic south and west of Osh and in rural areas along the Kyrgyz-Uzbek border because of the volatile security situation in these areas.
Supporters of extremist groups such as the Islamic Movement of Uzbekistan (IMU), the Islamic Jihad Union (IJU), al-Qaeda, and the Eastern Turkistan Islamic Movement remain active in Central Asia. These groups have expressed anti-U.S. sentiments and may attempt to target U.S. Government or private interests in the region, including in the Kyrgyz Republic. Terrorist attacks involving the use of suicide bombers have previously taken place in neighboring Uzbekistan. Terrorists do not distinguish between official and civilian targets. Because of increased security at official U.S. facilities, terrorists are seeking softer civilian targets such as residential areas, clubs and restaurants, places of worship, hotels, schools, outdoor recreation events, resorts, beaches, maritime facilities, airports and aircraft.
In 2005-2007, there were several large-scale demonstrations and protests. Demonstrations in Bishkek have occurred in front of the Presidential Administration building (White House) and on Alatoo Square in the city center. The Embassy does not always have advance information regarding new demonstrations. Therefore, all Americans are reminded to remain vigilant and are urged to avoid the vicinity of all protests, because even protests that are intended to be peaceful can turn confrontational and possibly escalate into violence.
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: The U.S. Embassy advises U.S. citizens to exercise caution in urban areas of the Kyrgyz Republic due to the high rate of violent crime against foreigners. Travelers arriving at Manas International Airport should arrange their transportation from the airport in advance. Foreign travelers have been the victims of extortion by airport taxi drivers, who appeared in some cases to be colluding with airport personnel to identify their victims. Travelers should not take public transportation or walk after dark, and should be extremely cautious in or near hotels, bars, parks and all places that attract an expatriate clientele. The Kyrgyz Republic has a high rate of violent crime due to unemployment and a large number of organized gangs. Muggings often occur after dark and can be quite violent, leaving the victim severely injured. Other common crimes include auto theft, mugging, and pick pocketing in crowded places such as markets, Internet cafes and on public transportation. U.S. citizens have been the victims of such crimes as rape, assault, kidnapping and robbery while in urban and rural parts of Kyrgyzstan, and there have been reports of U.S. citizens who were robbed by groups of young men who had followed them back to their residences from hotels and bars. Police officers rarely speak English and no victims’ assistance programs are available. Medical and psychiatric care for victims is limited.
Harassment and extortion by people who purport to be Kyrgyz police officers are common. According to Kyrgyz law, any person claiming to be a police officer must show identifying documents on demand. U.S. citizens should not act upon requests by people, whether in civilian dress or in police uniform, if they have no official identification. Also U.S. citizens should not get into cars with someone they do not know, even if the person claims to be a police officer.

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.

The local equivalent to the “911” emergency lines in Kyrgyzstan are: 101 for fire; 102 for police;
103 for first aid ambulance (state-funded); 151 (from landline), 0 312 684466 (from landline or cellphone); and 161 for rescue service (under the Ministry of emergency situations.)

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical services in the Kyrgyz Republic are extremely limited. Elderly travelers and those with existing health problems may be at risk due to inadequate medical facilities. The U.S. Embassy strongly recommends that travelers to the Kyrgyz Republic carry medical evacuation insurance in case of emergency. The Consular Section of the U.S. Embassy in Bishkek maintains a list of foreign-trained and local physicians who have agreed to give medical assistance to Americans. This list is available on the Embassy web site at http://bishkek.usembassy.gov.
Some HIV/AIDS entry restrictions exist for visitors to and foreign residents of Kyrgyzstan. There is no legal requirement for HIV/AIDS testing during the visa application or registration process. Kyrgyz law does state that if a foreign citizen refuses to submit to HIV/AIDS testing when requested while in Kyrgyzstan, that person could be deported. Please verify this information with the Embassy of Kyrgyzstan at http://www.kgembassy.org before you travel.

Tuberculosis is an increasingly serious health concern in Kyrgyzstan. For further information, please consult the CDC's Travel Notice on TB available at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.

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 the Kyrgyz Republic is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Most of the Kyrgyz Republic’s road infrastructure consists of two-lane roads, which are all in various states of disrepair, and are poorly marked and lit. Many local drivers tend to disobey fundamental traffic laws – such as stopping at red lights. As a result, driving can be very dangerous. Accidents involving severe injury and/or death are not uncommon.
Drivers must exercise particular caution to avoid uneven pavement, potholes and open drains and manholes. Night driving should be avoided, as roads are inadequately lit. In winter, roads are seldom plowed and ice and snow make the poor driving conditions even more hazardous. Pedestrians routinely walk in the road, often wearing dark clothes at night, necessitating even greater caution for drivers. Mountain roads in the Kyrgyz Republic are often narrow and treacherous, and may close without notice due to snow, ice or rockslides. Guardrails and barriers preventing falling rocks are often missing. The Kyrgyz Republic does not have a roadside assistance infrastructure. Towing companies do not exist. Although mechanics are available in cities there is little organized oversight or certification of their practices or abilities. Rest areas are infrequent and very primitive. Service stations are generally available in and near cities, but the fuel they provide may be adulterated or of poor quality.
The road between Almaty, Kazakhstan and Bishkek, Kyrgyz Republic, is especially treacherous at night or during poor weather. Americans and other travelers have been killed in traffic accidents on that road, and travel at night is not recommended.
Generally, speed limits are 60 km per hour in the cities and 90 km per hour in rural areas. Kyrgyz law mandates that all automobile passengers wear seat belts and that motorcycle riders wear helmets. International driving permits are recognized in the Kyrgyz Republic.

Drivers may face harassment by traffic police, who have been known to demand payment for arbitrary "fines" for purported infractions.

The Kyrgyz Republic has a "zero tolerance" policy for driving under the influence of alcohol.
Public transportation in the Kyrgyz Republic is limited to buses, taxis, and very few intercity trains. Travelers should be particularly careful when using public transportation. Buses tend to be very crowded and can be unsafe and unreliable. Taxis too can be dangerous. Due to the danger of theft or assault, travelers should avoid entering a cab that already contains passengers. Taxis are seldom metered, and travelers should negotiate a fare prior to entering a cab and be aware that cab drivers often try to charge foreigners a high fare. Drivers of vehicles that are not taxis are often willing to drive people for fares. However, U.S. citizens should avoid using any of these "private taxis" and unmarked taxis.

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 insert site here.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in the Kyrgyz Republic, the U.S. Federal Aviation Administration (FAA) has not assessed the Kyrgyz Republic’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:
Kyrgyz customs authorities may enforce strict regulations concerning temporary importation into or export from the Kyrgyz Republic of items such as antiquities or hunting trophies. It is advisable to contact the Embassy of the Kyrgyz Republic in Washington at 2630 Massachusetts Avenue, NW, Washington, DC 20008, telephone: (202) 338-5141, fax: (202) 742 6501 or at http://www.kgembassy.org/ for specific information regarding customs requirements.
The Kyrgyz Republic is a cash-only economy. The banking system is not well developed. ATMs are available, but the security of these machines remains untested. A hotel or bank may, on occasion, accept traveler’s checks or credit cards, but the fees can be as high as 20 percent for traveler’s checks.
U.S. citizens are encouraged to carry a copy of their U.S. passport with them at all times, so that, if questioned by local officials, proof of identity and citizenship are readily available.

In accordance with the Vienna Convention on Consular Relations and certain bilateral treaties, a consular officer from the U.S. Embassy must be given access to any U.S. citizen arrested in the Kyrgyz Republic. U.S. citizens who are arrested or detained should ask that the U.S. Embassy be contacted immediately. This is generally recognized, though there can be a sizeable delay in notification times depending on the local authorities’ interpretation of the case’s legal status.
The Kyrgyz Republic is an earthquake-prone country. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.
Hunting and trekking are popular sports for locals and tourists in the Kyrgyz Republic; however, American citizens traveling to the Kyrgyz Republic should know that hunting in the Kyrgyz Republic without proper licenses is illegal. It is illegal to import or own firearms in the Kyrgyz Republic without a permit issued by the Kyrgyz government. Foreign hunters who do not have official permission to hunt or take trophies out of the country may face criminal and civil charges. Both hunting and trekking infrastructures are underdeveloped with limited services, especially in the high mountainous regions popular with trekkers and hunters. Avalanches and landslides are common in these mountainous regions, often cutting off villages for weeks at a time. These villages and hunting areas are in isolated, rugged, mountainous areas inaccessible by the limited rescue services available in the Kyrgyz Republic. Americans traveling to the Kyrgyz Republic to hunt or trek need to be aware of the risks involved. The Embassy recommends that all Americans register with the Embassy in Bishkek for the duration of their stay in the country.
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 the Kyrgyz Republic’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in The Kyrgyz Republic 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 the Kyrgyz Republic 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 the Kyrgyz Republic. Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy in Bishkek is located at 171 Prospect Mira, 720016 Bishkek, Kyrgyz Republic. The phone number is 996-312-551-241, fax: 996-517-777-202, and web site: http://bishkek.usembassy.gov
* * *
This replaces the Country Specific Information for the Kyrgyz Republic Dated January 8, 2008, to update sections on Country Description, Entry/Exit Requirements, Crime, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed 9 Jan 2019
Source: AKIpress [abridged, edited]

A total of 722 cases of measles have been registered since the beginning of 2018 in Kyrgyzstan compared with one case in January through November 2017, the National Statistics Committee reports.

[Full story is available only by subscription.]
=====================
[HealthMap/ProMED-mail map:
Date: Wed 21 Nov 2018 14:26 KGT
Source: Kazakh Telegraph Agency (KazTAG] [edited]

KyrTAG [Kyrgyzstan Telegraph Agency] reports 2 people have been hospitalized in the Jalal-Abad region with anthrax assumption. "2 inhabitants of Suzak district have been hospitalized with anthrax assumption. The lab tests made in Jalal-Abad have shown a negative result, we sent the analysis to Osh for a repeated research," said Usen Zhorobayev, head of center of state sanitary-epidemiological surveillance of the Suzak district. In his words, the hospitalized men had been butchering a cow. The patients are in satisfactory condition
=============================
[To find Suzak in western Kyrgyzstan, go to:
<http://www.fallingrain.com/world/KG/03/Suzak.html>.

For a description of Jalal-Abad region, go to

Outbreaks in Jalal-Abad are an overflow of infection from the enzootic state of this disease in the adjoining Fergana Valley of Uzbekistan. Jalal-Abad is in western Kyrgyzstan at the head of the Fergana Valley. The Fergana Valley is rife with livestock anthrax. Without a coordinated vaccination-control program between the 2 countries in this region, we will continue to see outbreaks there. In spite of an initial negative test result, not uncommon with human cases, the authorities are assuming a greater probability of cutaneous anthrax based on the exposure history of these 2 farm workers. A pity they did not get their veterinary colleagues to test what was still available from this dead cow. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map of Kyrgyzstan:
Date: 27 Jun 2018
Source: Interax Kazakhstan [edited]

Nine people have been hospitalized with suspected anthrax infection in the Jalal-Abad region of southern Kyrgyzstan, Mamatzhan Miyanov, the coordinator of the healthcare ministry for the Jalal-Abad region, told Interfax on Wednesday [27 Jun 2018].
Date: Tue 13 Mar 2018
Source: XinHuaNet [edited]

A total of 14 people, including 4 children, were hospitalized after a mass botulism food poisoning outbreak in southern Kyrgyzstan, the Health Ministry said [Tue 13 Mar 2018]. It said 3 of them are in a serious condition. An epidemiological investigation has been conducted and all patients have received the botulinum antitoxin.

The first case of food poisoning in the city of Uzgen in the Osh region was reported on [Sun 11 Mar 2018]. According to preliminary data, the poisoning occurred due to eating homemade canned vegetable salad. A month earlier [February 2018], 17 people in southern Kyrgyzstan were hospitalized for the same reason; 2 of the 7 children affected died in that outbreak.
======================
[It is unclear if these clusters are related. Most clusters of botulism are associated with home prepared food. - ProMed Mod.LL]

[HealthMap/ProMED-mail map:
Date: Tue 5 Sep 2017 16:10
Source: Evening Bishjkek [in Russian, trans. ProMED Mod.NR, edited]

Currently in the at-Bashy district of Naryn region 3 recorded cases of anthrax infection are in the hospital, and 15 under the supervision of experts. Doctors say that the locals butchered the carcass of an animal, and 10 days later the 1st symptoms of this dangerous infection appeared on the skin of the wrist areas and forearms.

People have turned to professionals with complaints of ulcers. Then on [Wed 30 Aug 2017] 3 people were hospitalized in the Infectious Diseases Department. Tests confirmed the preliminary diagnosis. Doctors have checked all sick family members and friends, and currently they are under surveillance.

The incubation period of the infection is 10-14 days.[Actually it can be as short as 3 days and up to 60 days. - ProMED Mod.MHJ] At the end of this period, if there is no suspicion, patients are discharged from the hospital. "This disease is curable, it is treatable by conventional antibiotics. It's just included in the list of especially dangerous infections classifications of the World Health Organization. The main sources of infection are animals", - said the Director of the Republican center of Quarantine and Especially Dangerous Infections the Sabyrzhan of Abdykaimov.

It is likely that the meat of an infected animal got into the markets. According to some reports, some infectious contaminated products were located in the market town of Tokmak. Now multiple site checks are in hand by the Investigative Department. In addition, the market site and the territory around the cattle slaughter site have been quarantined, say doctors. And veterinary control has been initiated, along with the population being educated.

However, the situation is aggravated by the confused information from the sick individuals. They can't exactly tell where the infected meat was sent, said Abdykaimov. "One says that the meat is buried. Another says sold. Now this is in the hands of the investigating authorities and veterinary services. They don't say what happened: just stopped someone in a car; it was loaded, and they left. And where, on what car - they don't specify. The investigating authorities are handling this, but we in Public Health are doing our best to explain what should happen," - said Abdykaimov.  [Byline: Rodion Reshetov]
====================
[Comment by ProMED Mod.NP. In the territory of the Republic there are 1219 natural foci of anthrax. Concreted and enclosed only 1000 of them. Vaccination of cattle is held only periodically, delayed due to problems with funding and vaccine supplies, increasing the risk disease anthrax in both animals and humans. Annually in the territory of the Republic there are nearly 20 cases of anthrax in people. In this case, the situation is compounded by the fact that there is no accurate information on location of infected meat, which can lead to new cases of the disease. - ProMED Mod.NP]

[Public Health as it really is and not as shown on television. People get confused and, fearing legal action, may make up stories. My thanks to my colleague Natalia. It seems that circulation of the news in English is limited and widely available in Kyrgyz. - ProMED Mod.MHJ]

[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.
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[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.