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Moldova

Moldova - US Consular Information Sheet
October 10, 2008
COUNTRY DESCRIPTION:
Moldova is a republic with a freely elected government. It has been an independent nation since 1991. Its capital, Chisinau, offers adequate hotels and restauran
s, but tourist facilities in other parts of the country are not highly developed, and many of the goods and services taken for granted in other countries are not yet available. Read the Department of State Background Notes on Moldova for additional information.
ENTRY/EXIT REQUIREMENTS: Since January 1, 2007, citizens of the United States, EU member states, Canada, Switzerland, and Japan do not require visas to enter Moldova. For more information on entry requirements, please contact the Moldovan Embassy, 2101 S Street N.W., Washington, D.C. 20008, telephone: (202) 667-1130, (202) 667-1131, or (202) 667-1137, fax: (202) 667-1204, e-mail: moldova@dgs.dgsys.com. Travelers may also wish to consult the Embassy of Moldova’s web site at http://embassyrm.org/en/cons-serv/visas.html for general information on Moldovan visas and for application forms.

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 U.S. Government has no information related to the targeting of U.S. citizens, interests or facilities by terrorist organizations in Moldova, and no Americans have been killed or injured as a result of terrorist activity in Moldova. However, the U.S. government remains deeply concerned about the heightened threat of terrorist attacks against U.S. citizens and interests abroad. Americans are reminded to remain vigilant with regard to their personal security and to exercise caution. Because Moldovan Government authorities often ask to see identification on the street, Americans should carry a copy of their passport with them at all times.
There is a separatist regime in control of the Transnistria region that is not recognized by the United States. Consular assistance to American citizens in that region cannot be ensured. Travelers should exercise caution when visiting or transiting Transnistria. Travelers should be aware that there are numerous road checkpoints along roads leading into and out from Transnistria. Taking photographs of military facilities, public buildings, and security forces, including checkpoints along roads leading into and out from Transnistria, is strictly prohibited.

Racially motivated incidents against foreigners and persons of color have occurred in Moldova. Persons of African, Asian, or Arab heritage may be subject to various types of harassment, such as verbal abuse, and denied entrance into some clubs and restaurants. These Americans are also at risk for harassment by police authorities.

In some instances, Americans have become victims of harassment, mistreatment and extortion by Moldovan law enforcement and other officials. Low-level bribery attempts are commonplace in Moldova. These encounters should always be reported to the U.S. Embassy. Moldovan authorities have cooperated in investigating such cases, but those investigations enjoy the greatest chance of success when the officer is identified by name, physical description, or other identifying characteristics. Please note this information if you ever have a problem with police or other officials. Americans who have refused to pay bribes in Moldova generally report no consequences beyond being delayed or inconvenienced.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: Moldova’s economic difficulties, as well as organized criminal activity and more frequent travel by foreigners to Moldova, contribute to the risk visitors face from street crime, some potentially violent. While this risk is no greater than in most cities in the United States, many Americans have reported theft of money and small valuables from hotel rooms and local apartments. Cases of breaking and entering into homes and offices have occurred. Sexual assault against foreigners is rare. Travelers are wise to exercise the same precautions with regard to personal safety and protection of valuables in Chisinau that they would in any major U.S. city.
Precautions should also be taken when using ATMs in Moldova. Some Americans have reported unauthorized withdrawals from their accounts after using ATMs. Instances have been reported of PIN theft from use of ATMs in Moldova, either by “skimming” devices, which record the ATM card information while in use, or by surreptitious observation.

Train and bus services are below Western European standards and some U.S. citizens have been victims of crimes involving thefts while traveling on international trains to and from Moldova.
Americans who use the Moldovan postal service report frequent losses from international letter and package mail.
Internet Fraud Warning: The Embassy is aware of various confidence schemes that have taken advantage of American citizens, frequently via the Internet. In some cases these involve the purchase or sale of items on the Internet in which the payment or shipment of goods was not completed by a Moldovan counterpart. In the spring of 2006, Moldovan police recovered over $250,000 in jewelry that was sent to “buyers” in Moldova from the United States via fake online escrow companies. Substantial criminal enterprises specializing in this type of crime (Internet auction fraud) have emerged in Moldova. In other cases, American citizens, particularly males, have met potential Moldovan fiancé(e)s on the Internet who have convinced them to send hundreds or even thousands of dollars, but have no intention of a serious relationship. Once the American citizen starts to question the reason for sending the money, the Moldovan fiancé(e)s suddenly ends his/her contact. On occasion, American citizens who come to Moldova to visit someone they have first met over the Internet have reported becoming subject to crimes such as extortion and involuntary detention. American citizens should be aware that any such activity committed by individuals in Moldova is subject to the Moldovan legal system and could prove difficult to prosecute. In the vast majority of cases, there is little that the U.S. Embassy can do to assist American citizens who are defrauded by Moldovans via the Internet.
Please see our information on International Financial Scams.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

The local equivalent to the “911” emergency line in Moldova is: 9-0-2 (Police Assistance) or 9-0-3 (Ambulance Assistance)
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in Moldova is substandard throughout the country, including Chisinau. In the event of serious medical conditions every effort should be made to go to Western Europe. In the event of emergency, travelers should attempt first to contact the local ambulance service, which is trained to determine which medical facility is most appropriate for treatment and will transport the injured or sick person to that location. Hospital accommodations are inadequate throughout the country and advanced technology is lacking. Shortages of routine medications and supplies may be encountered. Elderly travelers and those with existing health problems may be at particular risk due to inadequate medical facilities. The U.S. Embassy maintains lists of medical facilities and English-speaking doctors, but cannot guarantee or endorse competence. Visitors to Moldova are advised to bring their own supply of both prescription and common over-the-counter medications. Pharmacies are not stocked to Western standards and products are not labeled in English. Poor quality and/or fraudulent medications have been reported.
HIV/AIDS restrictions: Some HIV/AIDS entry restrictions exist for visitors to or foreign residents of Moldova. Short term visitors (periods of less than 90 days) do not require HIV testing. Applicants for residence permits, however, are required to submit to a HIV test and demonstrate that they are HIV negative. Please verify this information with the Embassy of Moldova at www.embassyrm.org before you travel.

Medical Information: Tuberculosis is an increasingly serious health concern in Moldova; the World Health Organization (WHO) has placed it in its “highest risk” category. Travelers planning to stay in Moldova for more than 3 months should have a pre-departure PPD skin test status documented. Given the way TB is transmitted, travelers should consider limiting their exposure to TB by avoiding crowded public places and public transportation whenever possible. Domestic help should be screened for TB. For further information, please consult the CDC's Travel Notice on TB at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.
Other major health concerns include Hepatitis A (food-borne), Hepatitis B, and Hepatitis C (blood- and body fluids-borne). The incidence of sexually transmitted diseases is as "high" as it is in most developing countries.

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 WHO’s 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 if 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 Moldova is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Moldova’s highway infrastructure consists mainly of two-lane roads that often lack markings or signage, are unevenly maintained, and seldom have lighting. Caution should be taken to prevent collisions with agricultural vehicles and/or livestock. Urban roads in Moldova are infrequently maintained and often lack clear signs or lane markings. Travel outside of urban areas before dawn and after dusk should be avoided if at all possible. Drivers and pedestrians should exercise extreme caution to avoid accidents, which are commonplace. Many Moldovan drivers would be considered aggressive or erratic by American standards. Many accidents involve drunk drivers. The quality and safety of public transportation vary widely. Trains, trolleybuses, and buses are often old and may frequently break down. Taxis are available in most urban areas, and vary from old Soviet-era vehicles to newer, Western European or American model vehicles. Emergency services are generally responsive. Police emergency assistance can be called at 902 and emergency ambulance at 903.
Please refer to our Road Safety page for more information. Visit the web site of the Moldova’s national tourist office at http://www.turism.md/
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Moldova, the U.S. Federal Aviation Administration (FAA) has not assessed Moldova’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: Travelers are advised to register any foreign currency brought into Moldova with customs authorities upon entering the country. It is advisable to contact the Embassy of Moldova in Washington for specific information regarding customs requirements. Please see our Customs Information.
Visas and residency: Current Moldovan Government (GOM) border registration procedures will remain unchanged under the new immigration law. As of January 1, 2007, U.S. and most other foreign nationals arriving in Moldova do not require a visa and are permitted stays of up to 90 days in any given six-month period. At the point of entry (i.e., airport or border), the Border Guard Service enters the traveler’s personal data into a computer program and transfers the data to the GOM’s Population Register. Visitors are not given a paper “registration receipt.” U.S. citizens are able to enter Moldova through Transnistria. However, because they will not have been registered at the border, they will still have to register with the nearest office of the Ministry of Information Development (MID) within three days of arrival in right-bank (western) Moldova.

For stays exceeding 90 days, foreign nationals are required to obtain “immigration certificates” and residence permits from the National Bureau for Migration. Foreign nationals planning to work in Moldova must also obtain a work permit. Immigration, residence and work permits usually need to be extended annually, but may be issued for up to five years.
For more information on registering with Moldovan authorities, U.S. citizens are encouraged to call the Consular section of the U.S. Embassy in Chisinau at (373) (22) 40-83-00.
Requirement to Carry Documentation: As noted above, Moldovan police have the right to request identity documents from any person. Individuals who fail to produce appropriate ID upon request may be subject to detention and fines. Therefore, Americans are advised to carry their U.S. passports (or a copy of their passport’s biographic information page) with registration card, if applicable, or a Moldovan-issued identification document when in public.
Consular Access: Moldovan law enforcement authorities, particularly in the Transnistria region, have an uneven record of reporting the arrest or detention of American citizens to the U.S. Embassy, as required under international agreements. American citizens are therefore advised that if they are detained or arrested by Moldovan authorities, they should immediately request that the U.S. Embassy be contacted. Moldovan authorities have generally respected such requests in a prompt manner.
Photography: Americans who choose to travel in Transnistria should be aware that foreigners have reported being detained or harassed by authorities for taking photographs of military facilities or public buildings. Photography of checkpoints along roads leading into and out from the Transnistria region, or the personnel working there, is prohibited.
Dual Nationality: Recent Moldovan legislation allows dual citizenship. There is no requirement that dual nationals enter Moldova on their Moldovan passports. For further questions, please contact the Moldovan Embassy in Washington, D.C.

Telephone and Postal Services: Outside of Chisinau, travelers may have difficulty finding public telephones and receiving or making international and local calls. Losses have been reported from international letter and package mail, both of which are subject to a customs inspection before delivery. “Express” mail services such as DHL and Federal Express are available in Chisinau, although in most instances prices are high, and shipments arrive from (or reach) the United States in no less than five (5) business days.
Disabled Access: Persons with disabilities should be aware that public facilities and transportation in Moldova are rarely designed or built in a way that allows for wheelchair access. Wheelchair entrances, ramps, lifts or similar accommodations are rare; those that do exist are often below Western standards and/or poorly maintained. Most streets, sidewalks and other public paths are not well maintained and can be hazardous, particularly in poor weather conditions.
Commercial Transactions: Although still generally a cash-only economy, traveler’s checks and credit cards may be accepted in Chisinau, although locations that will accept them outside the capital are still rare. Some vendors require the customer dial in a PIN to authorize a sale by credit card. Caution is advised, however, as some travelers have reported incidents of unauthorized expenditures made on credit cards during or following their use in Moldova, and there have also been reported incidents of fraud and account theft using bank machines (ATMs – see “CRIME” above).
Business in Transnistria: As noted in the Safety and Security section above, a separatist regime controls a narrow strip of land in eastern Moldova known as Transnistria ("Pridnestrovie" in Russian). Individuals considering doing business in Transnistria should exercise extreme caution. The Embassy may not be able to offer consular or commercial services to Americans in Transnistria. Moldovan law requires firms (including those located in Transnistria) to register with the Moldovan Government and to use Moldovan customs seals on their exports. Under a December 2005 agreement between Moldova and Ukraine, Ukrainian customs and border officials require Moldovan customs seals on goods exported from Moldova, including Transnistria, and are enforcing this requirement with EU assistance. Transnistrian firms not legally registered with Moldovan authorities operate in contravention of Moldovan law, which may complicate or prevent the import or export of goods. The Government of Moldova has indicated that it will not recognize the validity of contracts for the privatization of firms in Transnistria that are concluded without the approval of the appropriate Moldovan authorities. A number of Internet fraud schemes have originated in Transnistria.
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 Moldovan laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Moldova are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in illicit 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 Moldova are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, and to obtain updated information on travel and security within Moldova. Americans without Internet access may register directly with the U.S. Embassy. By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy is located in Chisinau, Moldova, Strada Alexei Mateevici 103; telephone: (373)(22) 23-37-72, after-hours telephone: (373)(22) 23-73-45; Consular Section Fax: (373)(22) 22-63-61. The Embassy’s web site is http://moldova.usembassy.gov
* * *
This replaces the Consular Information Sheet dated January 18, 2008, to update sections on Entry/Exit Requirements, Safety and Security, Medical Facilities and Health Information, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Wed 10 Sep 2014
Source: Jurnal.md [in Romanian, transl., edited]

Cahul: 3 [more] people hospitalized with anthrax
------------------------------------------------
The number of cases of anthrax in the South [of Moldova] increased from day to day. According to the National Center for Public Health, a further 3 people infected with anthrax, cutaneous form, were admitted to the infectious diseases ward in Cahul District Hospital.

Two patients, one woman and her son, were infected from slaughtering a sick sheep. The case was registered for the village of Vadul Isaac, where 6 other people were earlier infected with the same disease after killing [and butchering] a sick calf.

The 3rd patient is a native of the village of Crihana. He became ill after visiting a cattle farm where an animal was slaughtered and butchered in Vad Isaac, which is under quarantine. He was also admitted to the District Hospital in Cahul.

Initially, a man infected with cutaneous anthrax came to the Crihana village hospital. Health of all patients is satisfactory. They are to be discharged after 2 weeks.
-------------------------------------
Communicated by:
Sabine Zentis
Castleview English Longhorns
Gut Laach
D-52385 Nideggen
Germany
======================
[To find Cahul district in south west Moldova on the Romanian border, go to:

So to date we have 9 cases, with one dying. This is probably a sound conservative set of numbers when considering what one sick animal, apparently a "calf", can do. Where more care is taken handling dead animals, the number can be flipped to have one human case for every 10 sick animals butchered or rendered. When there is a bias to only report human cases, it can be a guessing game as to the numbers of animals involved. With thanks, as usual, to Sabine. - ProMed Mod.MHJ]

[A HealthMap/ProMED-mail map can be accessed at:
Date: 5 Sep 2014
Source: Itar-Tass [edited]

A total of 6 workers of a livestock farm in the Cahul district of Moldova have been hospitalized on the suspicion of contracting anthrax, the national Healthcare Ministry said on Friday [5 Sep 2014].

"The patients are in a satisfactory condition, and the illness makes itself manifest mostly in skin lesions, but they have a normal temperature," Viktor Dyatishin, the head doctor of the infectious diseases hospital in Chisinau told reporters. "They will stay at hospital for about 2 weeks until full recovery."

The previous case of anthrax in Moldova was reported last year [2013]. The experts point to the numerous livestock burial sites -- from where anthrax spores can be washed out on to fields and into rivers by rainwater -- as the main source of the incident.

Moldova's sanitary, veterinary and epidemiological services were taking urgent steps on Friday [5 Sep 2014] to localize the dangerous infection.
-----------------------------
communicated by:
Sabine Zentis
Castleview English Longhorns
Gut Laach
D-52385 Nideggen, Germany
******************************
Date: 5 Sep 2014
Source: Press.try.md [edited]

Five people were diagnosed with anthrax yesterday [4 Sep 2014] at the Chisinau infectious diseases hospital. All patients are residents of the Cahul district.

The 1st ill person with symptoms of an open form of anthrax was delivered on Wednesday [3 Sep 2014] to a hospital in the Cahul village of Vadul. He is known to the employee of a private farm in the village.

Under suspicion of doctors were another 4 people. Their relatives say that the 1st symptoms appeared a few days ago, but local doctors gave them the wrong diagnosis. "[He had a fever]; he was sick; his appetite disappeared. [They] gave him headache tablets, but he still complained of feeling unwell."

The woman and her son ate food prepared from contaminated meat. Now they are under the supervision of doctors. "[We bought] half of the cow's head; someone took the other. He has some kind of sore on his leg."

Accidentally or not, one of the men who participated in the slaughter of cattle died. "He died at the hospital. We were not allowed to visit him. The cause of death not reported. He had some sores on his feet."

The mayor of the village said that the owner of the farm knew that the cows were sick but had not reported it to the authorities. "The 1st cases in animals appeared on 9 Aug 2014. Cows died, but the incident was [not] reported to any veterinary service or to the National Centre of Public Health," said the mayor of the village of Vadul.

All 5 were hospitalized in the capital hospital. "The patients are satisfactory; [their] temperature is normal. They will stay with us for about 2 weeks for treatment until they are cured," said the director of the hospital.

Representatives of the agency's food safety say that animals that carry the dangerous disease have not been vaccinated. "The animals were vaccinated. Still, cows were not vaccinated, because they have entered a period of maturation" [whatever that might mean. - ProMed Mod.MHJ], said the head of the agency's food security, Gregory Porchesku.

Epidemiologists went from Chisinau to study the situation on the ground in the Cahul district. Everyone who has been in contact with patients is under the supervision of physicians. A vaccination [campaign] for all the cattle in the village has still to occur.
---------------------------------------------------
communicated by:
Sabine Zentis
Castleview English Longhorns
Gut Laach
D-52385 Nideggen, Germany
==========================
[These Moldovan accounts are confused. The simplest explanation would be that 5 patients are in hospital under treatment doing well and for some reason will be released in 2 weeks time, which is a fair period if they are without a raised temperature. At some point, a 6th person died who had skin lesions. As "suspected" is used in relation to their diseased conditions, it would seem that if any samples were taken for laboratory analysis, the results are not back yet -- that is, the diagnoses were symptomatic, thus the prescription for headache. - ProMed Mod.MHJ]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sun, 27 Apr 2014 14:12:01 +0200 (METDST)

BRUSSELS, April 27, 2014 (AFP) - Citizens of Ukraine's neighbour Moldova will be granted visa-free travel from Monday to most European Union nations as part of the country's bid to sign an association deal with the EU bloc.

The decision shows that "closer relations with the European Union do bring tangible benefits to all," said the EU's home affairs commissioner Cecilia Malmstroem.   Under the deal, Moldovans carrying a biometric passport will be authorised to travel without a visa for short stays to the Schengen zone, which currently comprises 26 countries, 22 of them members of the 28-nation EU.   Between 50,000 and 55,000 Moldova nationals apply for short-term visas into the EU each year.

Moldova is one of the six former Soviet satellites that the EU hoped to draw into a wide-ranging Eastern Partnership programme on its eastern flank until Armenia, Azerbaijan and Belarus decided to turn back towards Moscow, and Ukraine's ousted leader Viktor Yanukovych too backed out in November at Russia's behest.

Moldova and Georgia however stood firm, initialling the partnership programme in November. They are expected to sign a final association deal with the EU in June.   Wedged between Romania to the west and Ukraine to the east, Moldova's 3.5 million people are Europe's poorest.   In the capital Chisinau there was a mixed response to the new visa-free travel, with a poll showing 50 percent of respondents underwhelmed on the grounds they were either too poor to travel or already owned a Romanian passport opening the door to the EU.
Date: Sun 7 Jul 2013
Source: Liga Novosti [in Russian, trans. ProMed Mod.NP, edited]

The Ministry of Health of Moldova has reported an outbreak of anthrax in the village of Veden, in Soroca district, located in northeast Moldova close to the border with Ukraine. Results of an epidemiological survey of several inhabitants of the village revealed the 4 patients were infected after a meal in which the main dish was freshly cooked beef.

All patients were hospitalized to the Republican Infectious Diseases hospital: one of them is in critical condition and the other 3 are in the moderately severe condition.

Specialists of Ministry of Agriculture of Moldova are providing the measures for the localization of the infection to prevent the spread of infection. [Presumably livestock vaccination and destruction of any contaminated meat. - ProMed Mod.MHJ]
==================
[This outbreak is to the north of the previous report of human cases in Dubasari district (Transnistria) and probably reflects an ongoing problem which gathers few reports.

>From their reports to OIE, anthrax in Moldova is sporadic with few outbreaks. And yet it receives considerable government attention via vaccination. For example, in 2012 vaccination coverage for cattle was 226 871/221 113 (103 percent), sheep & goats 937 421/908 079 (103 percent), horses 40 722/49 319 (83 percent), and pigs 3636/496 634 (0.7 percent). Outbreaks occur among pigs almost as frequently as reported for cattle. The last reported outbreak in sheep and goats was in 2004. With this level of vaccination the disease is clearly of concern, and possibly the problem is of poor reporting and poor usage of the vaccines distributed.

A HealthMap/ProMED-mail interactive map of Moldova can be seen at <http://healthmap.org/r/7ytP>.

To find Soroca district in northeastern Moldova, go to

Our thanks to Natalia for the translation. - ProMed Mod.MHJ]
Date: Tue 18 Jun 2013
Source: EVZ.ro [in Romanian, trans., edited]

A suspected case of anthrax has been recorded in Dubasari in Transnistria, in a private household.  According to Tiraspol press, the results of laboratory tests are currently expected to determine if it really is about the disease "mad cow". [Why is "mad cow" not explained? - ProMed Mod.MHJ]

The Regional Veterinarians normally take preventive measures to avoid the possible spread of the disease. Local media did not specify what it is, and the Dubasari President, Gregory Policinschi, did not know any details.

The last case of anthrax disease of animals in Moldova was registered in March last year [2012, in Riscani], and in 2011, 2 [porcine] cases were reported. Anthrax is a potentially fatal disease caused by the bacterium _Bacillus anthracis_. It occurs in cattle, horses, sheep, and goats.  [Byline: Roxana Roseti]
-----------------------------------------------
Communicated by:
Sabine Zentis
Castleview Pedigree English Longhorns
Gut Laach
52385 Nideggen
Germany
cvlonghorns@aol.com
=========================
[As at least one of the 2 cases in Dubasari has died I think we can presume that this report refers to livestock cases, and as they quote "mad cow" probably bovine.  A HealthMap/ProMED-mail interactive map of Moldova can be seen at <http://healthmap.org/r/7pn0>. For the location of Dubasari and Transnistria in a map of Moldova, go to <http://www.lib.utexas.edu/maps/commonwealth/moldova_pol01.jpg>; Dubasari Province is currently under the administration of the breakaway government of the Moldovan Republic of Transnistria. - ProMed Mod.MHJ]
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Mauritania

Mauritania US Consular Information Sheet
September 23, 2008
COUNTRY DESCRIPTION:
Mauritania is a developing country in northwestern Africa.
Arabic is the official language, but French is widely used and several local languages are als
spoken.
Tourist facilities in the capital, Nouakchott, are adequate, but limited or non-existent elsewhere.
Read the Department of State Background Notes on Mauritania for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport and a visa are required, as is evidence of a yellow fever vaccination.
For the most current visa information, contact the Embassy of the Islamic Republic of Mauritania, 2129 Leroy Place NW, Washington, DC
20008, tel. (202) 232-5700, or the Mauritanian Permanent Mission to the UN, 211 East 43rd Street, Suite 2000, New York, NY 10017, telephone (212) 986-7963 or 8189, or e-mail Mauritania@un.int.
Overseas, inquiries should be made at the nearest Mauritanian embassy or consulate.

See our information on dual nationality, the prevention of international child abduction and Customs regulations.

SAFETY AND SECURITY:
There is increasing activity by the terrorist group Al Qaeda in the Islamic Maghreb (AQIM) in Mauritania.
On December 24, 2007, terrorists shot and killed four French tourists and wounded a fifth near the town of Aleg, in southeastern Mauritania.
On December 26, 2007, terrorists killed four soldiers near the town of El Ghallaouiya in northern Mauritania.
These two attacks were followed by an attack on the Israeli Embassy and an adjoining nightclub frequented by westerners early in the morning of February 1, 2008.
The perpetrators of these attacks are believed to be linked to AQIM.
These are the first attacks that have occurred in Mauritania since June 2005, when members of the terrorist group GSPC (now known as AQIM) attacked a military outpost based at Lemgheity, near the Algerian and Malian borders.
In the attack, they killed or wounded about 35 soldiers.
Travelers should avoid all non-essential travel to the Hodh El Charghi region of southeastern Mauritania due to increased AQIM activities in the border area.
Official Americans continue to travel to the town of Atar, although AQIM has also talked about targeting Westerners there.
Travelers should check http://mauritania.usembassy.gov for current Consular Warden messages concerning Mauritania.

Travelers should exercise prudence and caution when traveling in Mauritania.
They should not venture outside of urban areas unless in a convoy and accompanied by an experienced guide, and even then only if equipped with sturdy vehicles and ample provisions.
The U.S. Embassy in Nouakchott has received reports of banditry and smuggling in the more remote parts of Mauritania.
Landmines also remain a danger along the border with the Western Sahara and travelers should cross only at designated border posts.
The U.S. Embassy recommends that travelers avoid travel in regions north and east of Zouerate, Ouadane, and Tichit unless with a government escort.
Travelers planning overland trips from Mauritania to Morocco, Algeria, Senegal or Mali should check with the U.S. Embassy in Nouakchott before setting out.
For more information about travel in Mauritania, please see the section “Traffic Safety and Road Conditions” below.

The Mauritanian military led a bloodless coup on August 6, 2008.
There has been increased political unrest following the coup, but no violence.
There have also been increased political gatherings and street demonstrations.
The police have been using tear gas to break up some anti-coup demonstrations.
An increased police presence and additional vehicle controls may also be expected.
U.S. citizens should avoid large crowds and maintain security awareness at all times.

In Nouakchott and other major cities in Mauritania, there is an increased security presence and additional checkpoints.
Police routinely conduct road blocks at which they may ask for proof of identity and drivers’ licenses.
These checkpoints should be respected.
Americans visiting Mauritania should be prepared for such inquiries and carry their identification cards at all times.
It is best to drive cautiously and be prepared to stop at short notice.

American citizens should be aware of their surroundings at all times and maintain good personal security practices, including always locking their homes and cars.
They should avoid established patterns and take care not to draw attention to themselves.
When going out, they should avoid being part of large, highly visible groups of Westerners and when in restaurants or cafes, avoid sitting in areas that are easily visible from the street.

Although U.S. citizens are generally welcomed in Mauritania, there were reports of anti-American incidents such as threats and stoning of vehicles, following the 1998 U.S.- and British-led intervention in Iraq, and demonstrations outside the Embassy during the 2003 U.S. intervention in Iraq.
Some Muslim extremists have occasionally perceived Christian non-governmental organizations as a threat.
However, local authorities closely monitor political violence and religious extremist groups.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affair’s web site at http://travel.state.gov, 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 U.S. and Canada or, for other callers, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. eastern time, Monday through Friday (except U.S. federal holidays).

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

CRIME:
Crime in Mauritania is moderate but steadily increasing.
Most incidents occur in the cities and larger towns, and are petty crimes such as pick pocketing and the theft of improperly secured and openly visible valuables left in vehicles.
Most criminal activity occurs at night and walking alone at night is not advisable.
Residential burglaries and robberies, particularly at the beaches in Nouakchott, are not uncommon.
In Nouakchott, travelers should avoid the beach at night.
During the day, beach-goers should travel in large groups or stay in popular areas because of the increase in the number of thefts and robberies, some involving injury to victims, reported there in the past several years.
Violent crimes and crimes involving the use of weapons are rare, but increasing.
Rapes and assaults have occurred and, in some instances, involved the American community.
Foreign tourists, including Americans, might be targeted for kidnapping in Mauritania.

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 can be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Mauritania are limited.
There are few modern clinics or hospitals beyond the capital and a few major towns.
At local pharmacies, some medicines are difficult to obtain; travelers are advised to bring their own supplies.

Malaria is a serious and sometimes fatal disease.
Chloroquine-resistant P. falciparum malaria is a severe form of the disease that is found in many parts of western Africa, including Mauritania.
Because travelers to Mauritania are at high risk for contracting malaria, they should take one of the following anti-malarial drugs:
mefloquine (Lariam™), doxycycline, or atovaquone/proguanil (Malarone™).
The Centers for Disease Control and Prevention (CDC) have determined that a traveler who is on an appropriate anti-malarial drug has a greatly reduced chance of contracting the disease.
In addition, other personal protective measures, such as the use of insect repellents, may help to reduce malaria risk.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what anti-malarial drugs they have been taking.
For additional information on malaria, protection from insect bites, and anti-malarial drugs, please visit the CDC travelers’ health web site at http://www.cdc.gov/malaria/.

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.

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

Public transportation is not safe and road conditions in Mauritania are generally poor, particularly in the interior.
Overland travel is difficult and roadside assistance is almost nonexistent.
The country’s size and harsh climate make road maintenance and repair especially problematic.
Mauritania has only about 2,070 km (1,286 miles) of surfaced roads, 710 km (441 miles) of unsurfaced roads, and 5,140 km (3,194 miles) of unimproved tracks.
Drivers should not offer rides to hitchhikers, nor should visitors to Mauritania accept rides offered by strangers.


The traditional route to Nouadhibou, prior to the completion of a paved road, was along the beach during low tide.
Some travelers continue to use this route, as do visitors to coastal fishing villages and other points of interest, and smugglers and others who try to avoid the security checkpoints that are often established along the asphalt roads.
Pedestrian visitors to the beach should exercise caution because of the beach’s use as a route for motorized vehicles.

U.S. citizens traveling overland for long distances in Mauritania should travel in convoys and be sure to have suitable four-wheel drive vehicles, a local guide, an adequate supply of water and food, and a second fuel reservoir.
Multiple vehicles are recommended in case of breakdown.
A Global Position Satellite (GPS) receiver and satellite phone are essential when traveling in remote areas.
Visitors are urged not to travel alone into the desert.

Driving in Mauritania is treacherous, and we encourage travelers to hire a trained local driver.
Traffic patterns differ considerably from American-style “rules of the road,” and many Mauritanians drive without regard to traffic signs or rules.
Roadway obstructions and hazards caused by drifting sand, animals, and poor roads often plague motorists; when combined with the number of untrained drivers and poorly maintained vehicles, heightened caution is imperative at all times.
Drivers should be alert to conditions and always wear their seat belts.
Motorcycle and bicycle riders should wear helmets and protective clothing.
Nighttime driving is discouraged.

The telecommunications infrastructure is limited and cellular telephone coverage is not wide spread.
For those traveling outside the major urban areas, it is recommended to have a satellite telephone readily available.

Please refer to our Road Safety page for more information.

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

SPECIAL CIRCUMSTANCES:
Mauritanian customs authorities may enforce strict regulations concerning the temporary import or export of items such as firearms, narcotics, alcoholic drinks and pork products.
Contact the Embassy of Mauritania in Washington, DC for specific information regarding customs regulations.

The local currency is the ouguiya, and it may not be imported or exported.
Credit cards can be used only at a few hotels in the capital, Nouakchott, and the northwestern city of Nouadhibou.
ATM machines are available only in Nouakchott.
Major foreign currencies are changeable in banks and numerous currency exchanges; however, this service is not always available without advanced notice or prior arrangement.
There is a risk of getting fraudulent bank notes even from banks which often do not have the security means to detect fake bank notes.
Furthermore, credit card fraud is a problem, so it is strongly advisable to pay hotel bills in cash.

Islamic ideals and beliefs in the country encourage conservative dress.
Sleeved garments and below-the-knee skirts are recommended, and people should avoid wearing shorts.
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 Mauritania’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in Mauritania 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 Mauritania 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 Mauritania. 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 between the Presidency building and the Spanish Embassy on Rue Abdallaye.
The postal address is B.P. 222, Nouakchott, telephone (222) 525-2660/2663, 525-1141/45, or 525-3038 (ext. 5441), and fax (222) 525-1592.
The Consular Section may be contacted by e-mail at ConsularNKC@state.gov
* * *
This replaces the Consular Information Sheet dated April 29, 2008, to update the section on Safety and Security.

Travel News Headlines WORLD NEWS

Date: Mon 30 Apr 2018
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/crimean-congo-hemorrhagic-fever-case-reported-mauritania-28755/>

The Mauritania Ministry of Health has reported a confirmed case of Crimean-Congo haemorrhagic fever [CCHF] in Ould Yengé commune, Guidimaka region located in the southern-most part of the country. The case-patient is a 58-year-old male herder from Elghabra locality who became ill on [16 Apr 2018] (reportedly) after tending to a sick cow days earlier. He presented to a private clinic the same day [16 Apr 2018] with high fever, arthralgia and headache. He was admitted, managed for an unspecified medical condition and discharged on [18 Apr 2018].

The following day [19 Apr 2018], he developed bleeding from the gums and nose, and was admitted to the regional hospital where he was transfused and subsequently discharged on [20 Apr 2018], following an apparent clinical improvement. On [21 Apr 2018], the case-patient's health deteriorated and he was taken to Guerou health centre, from where he was immediately referred to Cheikh Zayed hospital in Nouakchott on [22 Apr 2018].

A blood specimen was obtained and shipped to the national public health laboratory. The test result released on [24 Apr 2018] was IgM positive for Crimean-Congo haemorrhagic fever. A total of 32 close contacts, including 10 health workers and 4 family members, have been listed and are being followed up. Efforts to identify other close contacts are ongoing.

The case-patient used public transportation and a taxi at various stages of his movement during the course of illness. Preliminary investigations also established that all the 4 healthcare facilities that managed the case-patient did not apply appropriate infection prevention and control measures, potentially indicating a higher number of contacts.

According to the WHO, Crimean-Congo haemorrhagic fever is a widespread disease caused by a tick-borne virus (_Nairovirus_) of the _Bunyaviridae_ family. The CCHF virus causes severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10-40 percent. CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north - the geographical limit of the principal tick vector.

The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats. Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites.

Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vector. The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible.
=======================
[There is need to emphasize inter-sectoral collaboration involving health, veterinary and entomology/environmental services to map the areas of vector distribution. Furthermore, awareness messages among the high exposure groups should be widespread as CCHF vector propagates from May onwards leading to higher transmission rates in summer. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map:
Guidimaka Region, Mauritania: <http://healthmap.org/promed/p/25044>]
Date: Mon 27 Nov 2017
Source: Outbreak News Today [edited]

Following cases of Crimean-Congo haemorrhagic fever (CCHF) reported this spring and summer [2017], the Mauritania Ministry of Health has reported an addition CCHF case last week [week ending Sun 26 Nov 2017] in a 48-year-old male farmer from Haye Sakin community in Dar Nairn, at the outskirt of the capital city, Nouakchott. He fell sick on the [11 Nov 2017] and was later treated and discharged last week.  The frequency of these events affirms the relative prevalence of the pathogen and the reservoir and vector for CCHF virus (Hyalomma ticks) in the country.

According to the WHO, Crimean-Congo hemorrhagic fever is a widespread disease caused by a tick-borne virus (Nairovirus) of the _Bunyaviridae_ family. The CCHF virus causes severe viral haemorrhagic fever outbreaks, with a case fatality rate of 10-40 percent.  CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north - the geographical limit of the principal tick vector. The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats.

Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vector.

The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible.
=========================
[Crimean-Congo hemorrhagic fever (CCHF), an acute viral disease in humans, is characterized by extensive ecchymoses, bleeding, and hepatic dysfunction and is associated with a 30 percent case-fatality ratio (World Health Organization Crimean-Congo haemorrhagic fever. Fact sheet no. 208. Geneva: the Organization; 1998). It is caused by CCHF virus (genus _Nairovirus_, family _Bunyaviridae_).

CCHF is a zoonosis transmitted to large and small mammals and birds by ticks. Although the virus has been isolated from several genera and species of ixodid ticks, the main group of vectors involved in CCHF virus transmission appears to be ticks of the genus _Hyalomma_ (Hoogstraal H. The epidemiology of tick-borne Crimean-Congo haemorrhagic fever in Asia, Europe, and Africa. J Med Entomol. 1979;15(4):307-417.). Immature ticks acquire the virus by feeding on infected small vertebrates. Once infected, they remain infected throughout their development and, when they are mature, transmit the infection to large animals, such as livestock. Transovarian transmission has also been demonstrated.

The circulation of CCHF virus and the high prevalence of infected animals and ticks have been well documented in Mauritanian farming areas since 1983 (Gonzalez JP, LeGuenno B, Guillaud M, Wilson ML. A fatal case of Crimean-Congo haemorrhagic fever in Mauritania: virological and serological evidence suggesting epidemic transmission. Trans R Soc Trop Med Hyg. 1990;84(4):573-6).

Mauritania experienced a fairly large CCHF outbreak in 2003, involving 38 cases with a case fatality rate of 28.6 percent. Over 90 percent of the cases (35/38) were resident in Nouakchott. In 2017, the WHO reported confirmation of a 3rd CCHF case in Boutilimit as well as in 2 patients referred from Mauritania to Dakar, Senegal who tested positive between May and June 2017. These cases had also originated from the capital city Nouakchott. This may be indicative of the relative prevalence of the reservoir and vector for the CCHF virus (Hyalomma ticks) in the country.

Even though the country has established adequate diagnostic capacity, which facilitated rapid confirmation of cases; the national authorities and partners need to carry out extensive outbreak investigations, including seroprevalence studies, to determine the potential risk for continued CCHF outbreaks in humans and institute effective prevention and control measures, with a strong animal health component  (<http://apps.who.int/iris/bitstream/10665/258794/1/OEW34-192582017.pdf>).

The case reported in this report is a farmer admitted in early
November [2017], however no exposure history is mentioned. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map Nouakchott, Nouakchott, Mauritania:
Date: 28 Aug 2017
Source: Outbreak News Today [edited]

On 24 Aug 2017, the Mauritania Ministry of Health notified WHO of a confirmed case of Crimean-Congo hemorrhagic fever (CCHF) in a 47-year-old shepherd, from Arafat Village in Mohammedia, Boutilimit Prefecture, located about 150 km southeast of the capital, Nouakchott.

In May 2017, health officials reported 2 imported cases of Crimean-Congo hemorrhagic fever (CCHF) in Senegal imported from Mauritania. A 3rd imported case was reported in June 2017.

He developed headache, muscle and joints pains and diarrhea on 20 Aug 2017 and sought medical attention. He was treated with anti-malarial medicines and analgesics.

After 2 days, he returned for medical care as his condition worsened. He was tested for CCHF because of bleeding manifestations and was IgM positive for Crimean-Congo haemorrhagic fever by enzyme-linked immunosorbent assay (ELISA). The patient is still hospitalized and in stable clinical condition.

Mauritania experienced a fairly large CCHF outbreak in 2003, involving 38 cases with a case fatality rate of 28.6 percent. According to the WHO, Crimean-Congo hemorrhagic fever is a widespread disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family. The CCHF virus causes severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10-40 percent.

CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north, the geographical limit of the principal tick vector. The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats.

Animals become infected by the bite of infected ticks, and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vectors.

The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible.  [Byline:  Robert Herriman]
==================
[An outbreak of Crimean-Congo hemorrhagic fever was documented in Nouakchott, the capital of Mauritania in 2003. The index case was detected on 18 Feb 2003. By 21 Mar 2003, the Ministry of Health of Mauritania had reported a total of 35 cases (18 laboratory confirmed) of Crimean-Congo haemorrhagic fever (CCHF), including 6 deaths [Crimean-Congo hemorrhagic fever - Mauritania (04) http://promedmail.org/post/20030324.0732].

In the period from February to August 2003, 38 persons were infected with Crimean-Congo hemorrhagic fever (CCHF) virus; 35 of these persons were residents of Nouakchott. The 1st patient was a young woman who became ill shortly after butchering a goat. She transmitted the infection to 15 persons in the hospital where she was admitted and 4 members of her family. In Nouakchott, 2 disease clusters and 11 isolated cases were identified. Of the patients not infected by the 1st case-patient, almost half were butchers, which suggests that the primary mode of animal-to-human transmission was direct contact with blood of infected animals.

Cattle heavily infested with ticks were more likely to be CCHFV seropositive, and vector control to reduce the tick burden can result in reduced seroprevalence. Cattle are noted as the most sensitive indicator of low-level CCHFV circulation because they tend to be highly infested with _Hyalomma_ spp. ticks, which are the most common vectors of CCHF  [<http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004210>].

The circulation of CCHF virus and the high prevalence of infected animals and ticks have been well documented in Mauritanian farming areas since 1983 [Crimean-Congo haemorrhagic fever and Rift Valley fever in south-eastern Mauritania. Saluzzo JF, Digoutte JP, Camicas JL, Chauvancy G Lancet. 1985 Jan 12; 1(8420):116].

Since then, this is the latest case reported from that country, with history of exposure to livestock. - ProMed Mod.UBA]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/13859>.]
Date: Sat 3 Jun 2017, 11:08 AM
Source: Alakhbar [in French, trans. Mod.AB, edited]

A suspected case of Rift Valley fever (RVF) was discovered at the Nouakchott Hospital Center according to a source for Alakhbar.

The patient is a 37-year-old Mauritanian. He was isolated upon his arrival at the hospital after the 1st medical tests revealed the existence of fever. Further in-depth analyzes are required for confirmation.

The Mauritanian health authorities have often denied the existence of the virus in its 1st appearances.

RVF is a disease that mainly affects animals but can contaminate humans either by mosquito bites or by contact with blood, physiological fluids, or organs of infected animals. The RVF virus was 1st identified in 1931 during an investigation of an epidemic affecting sheep in a Rift Valley farm in Kenya.
=====================
[If this case were to be definitively confirmed in the laboratory, it would have occurred almost 18 months after the series of cases, including 4 fatal cases, which Mauritania had experienced over various provinces in October 2015. At the same time, at least 4 foci of the disease occurred in sheep and goats in Brakna region (Aleg, Tidjikja, Magta-Lahjar, Kiffa).

The recent episode of RVF in Niger (September 2016 to February 2017) could be the cause of the re-emergence of the disease in Mauritania because, although these 2 countries do not share a common border, there is an incessant movement of livestock between the different areas of the Sahel where nomadism is a widespread lifestyle. It would appear that veterinary surveillance in these areas is sub-optimal, and this would explain why the detection of human cases precedes that of animal cases at the origin of these cases. - ProMED Mod.AB]

[RVF virus likely is endemic in parts of Mauritania, with cases of human and domestic animals occurring sporadically there. ProMED Mod AS provided an excellent comment on RVF previously; "Rift Valley fever (RVF) is a peracute or acute zoonotic disease of domestic ruminants. It is caused by a single serotype of a mosquito-borne virus of the _Bunyaviridae_ family (genus _Phlebovirus_). The disease occurs in climatic conditions favouring the breeding of mosquito vectors and is characterised by abortion, neonatal mortality, and liver damage. The disease is most severe in sheep, goats and cattle. Older, non-pregnant animals, although susceptible to infection, are more resistant to clinical disease. There is considerable variation in the susceptibility to RVF of animals of different species. Camels usually have an inapparent infection with RVF virus (RVFV), but sudden mortality, neonatal mortality, and abortion occur, and abortion rates can be as high as in cattle.

"Humans are susceptible to RVFV and are infected through contact with infected animal material (body fluids or tissues) or through bites from infected mosquitoes. RVFV has also caused serious infections in laboratory workers and must be handled with biosafety and biocontainment measures. It is recommended that laboratory workers be vaccinated if possible.

"RVFV is endemic in many African countries and may involve several countries in the region at the same time or progressively expand geographically over the course of a few years. In addition to Africa, large outbreaks have been observed in the Arabian Peninsula and some Indian Ocean Islands. These generally, but not exclusively, follow the periodic cycles of unusually heavy rainfall, which may occur at intervals of several years, or the flooding of wide areas favouring the proliferation of mosquitoes.

"Rainfall facilitates mosquito eggs to hatch. _Aedes_ mosquitoes acquire the virus from feeding on infected animals and may potentially vertically transmit the virus so that new generations of infected mosquitoes may hatch from their eggs. This provides a potential mechanism for maintaining the virus in nature, as the eggs of these mosquitoes may survive for periods of up to several years in dry conditions. Once livestock is infected, a wide variety of mosquito species may act as the vector for transmission of RVFV and can spread the disease.

"Low level RVF activity may take place during inter-epizootic periods. RVF should be suspected when exceptional flooding and subsequent abundant mosquito populations are followed by the occurrence of abortions, together with fatal disease marked by necrosis and haemorrhages in the liver that particularly affect newborn lambs, kids and calves, potentially concurrent with the occurrence of an influenza-like illness in farm workers and people handling raw meat.

"During an outbreak, preventive measures to protect workers from infection should be employed when there are suspicions that RVFV-infected animals or animal products are to be handled.

"The above and much more information is available at

ProMED would appreciate receiving additional information including laboratory results about this case and any new ones that might appear as they become available, in addition to information on presumed location of infection as the diagnosis was made in the capital city, but no mention of where the individual came from. - ProMED Mod.TY]

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

A HealthMap/ProMED-mail map can be accessed at:
Date: Tue 22 Mar 2016
Source: Points Chaud [in French, trans. Mod.MPP, edited]

A Mauritanian who came from Angola with yellow fever died on Monday [20 Mar 2016] at the Friendship Hospital. According to the Mauritanian community in Angola, the deceased had contracted the disease in Angola and decided to return to the country 2 days ago on a plane from a Moroccan company. His situation deteriorated after having been transferred to the Friendship Hospital where he died on Monday [20 Mar 2016].

It's not known whether the health authorities of the country had or did not have any concept of the severity of his disease. It's known that Angola presently has an epidemic of yellow fever ongoing that has already killed [more than] 158 people.

Yellow fever is a serious disease transmitted by insects that proliferate in standing water in dirty locations and places with waste.
=====================
[This is yet another case where a yellow fever virus infected individual travelled to a distant country in Africa. YF-infected individuals have travelled from Angola to the DR Congo and to Kenya. The risk of ongoing transmission in Mauritania is unknown, but health authorities there should be vigilant. - ProMED Mod.TY]

[HealthMap/ProMED-mail maps can be accessed at
More ...

World Travel News Headlines

Date: Fri, 13 Dec 2019 16:41:23 +0100 (MET)
By Mariëtte Le Roux and Joseph Schmid

Paris, Dec 13, 2019 (AFP) - French commuters gritted their teeth for a ninth day of public transport strikes Friday, with unions vowing to keep up their protest against a pension overhaul through the holidays unless the government backs down.   Officials have said they are ready to negotiate, with Education Minister Jean-Michel Blanquer meeting teachers' representatives on Friday to try and stave off another day of class shutdowns.   "It was an intense and frank meeting... but we still need details, and maintain our call to strike on Tuesday," Stephane Crochet of the SE-Unsa union said.

Unions are hoping for a repeat of 1995, when they forced a rightwing government to back down on pension reforms after three weeks of metro and rail strikes just before Christmas.   The prospect of a protracted standoff has businesses fearing big losses during the crucial year-end festivities, and travellers worried that their Christmas plans may be compromised.   "Right now it's a catastrophe here, but we're hoping there will be a solution before Christmas," Frederic Masse, a foie gras producer at the huge Rungis wholesale food market south of Paris, told AFP on Friday.

The capital city was again choked by huge traffic jams as most metro lines remained shut, only a handful of buses and trams were running, and one in four TGV trains were cancelled.   "I'm sick of this, and I won't be able to keep working if it goes on," Zigo Makango, a 57-year-old security agent, told AFP onboard a bus in the Bobigny suburb northeast of Paris.   To get home at night Makango said he has to use taxis, but "my boss doesn't reimburse me for that".

- 'Historic reform' -
President Emmanuel Macron on Friday expressed his "solidarity" with people impacted by the strike, "but I want the government to continue its work" in forging a single pension system, a key campaign promise.   "It's a historic reform for the country," he told journalists at an EU summit in Brussels. 

The overhaul unveiled by Prime Minister Edouard Philippe would do away with 42 separate regimes, some of which offer early retirement and other benefits to public-sector employees such as train drivers, dockers and even Paris Opera employees.   But Philippe angered unions further by proposing a reduced payout for people who retire at the legal age of 62 instead of a new, so-called "pivot age" of 64.

They have called for new mass demonstrations for next Tuesday, the third since the action started on December 5 in the biggest show of strength in years by France's notoriously militant unions.   Philippe insisted on Twitter that "My door is open and my hand outstretched".   But Laurent Brun of the hard-line CGT union, the largest among public-sector workers including those at rail operator SNCF, has already warned "There won't be any Christmas truce" unless the government drops the plan entirely.

- France divided -
A poll released Thursday by the Elabe institute found France evenly divided on Philippe's plan, with 50 percent for and 49 percent against.  But 54 percent rejected the mooted 64-year cutoff for a full pension, and 54 percent supported the protest.

Staff at four of France's eight oil refineries were on strike Friday, affecting output and raising fears of shortages down the line.   And both Paris operas, the Garnier and the Bastille, again cancelled Friday performances and others through the weekend.   Macron's government insists the changes will make for a fairer system and help erase pension system deficits forecast to reach as much as 17 billion euros ($19 billion) by 2025.   The average French person retires at just over 60, years earlier than most in Europe or other rich OECD countries.
Date: Fri, 13 Dec 2019 14:05:22 +0100 (MET)

Milan, Dec 13, 2019 (AFP) - More than 300 flights were cancelled Friday in Italy due to a planned one-day strike by workers from Alitalia and Air Italy.   Alitalia said in a statement that 315 flights were cancelled on Friday, with another 40 cancelled Thursday night and Saturday morning. It was not immediately clear how many flights were cancelled at Air Italy.   The 24-hours strike, which involves pilots, flight attendants and ground personnel, was called by three unions to draw attention to what they called "the ongoing crisis at Alitalia and Air Italy."

The strike was felt most in Sardinia, with about 30 flights cancelled.    Money-losing Alitalia has been under special administration since 2017 when employees rejected a restructuring plan that would have laid off 1,700 workers out of an approximately 11,000.   The government has so far looked for buyers without success.    Unions plan to meet on Tuesday with Economy Minister Stefano Patuanelli.    A potential consortium of buyers for the ailing carrier fell apart last month after Atlantia, which operates Rome's airports, pulled out.
Date: Fri, 13 Dec 2019 05:24:44 +0100 (MET)
By Neil SANDS

Wellington, Dec 13, 2019 (AFP) - Adventure tourism is a key part of New Zealand's international appeal but the White Island volcano eruption is a tragic reminder that such activities carry genuine risk that must be better explained to travellers, experts say.   The South Pacific nation offers a wealth of adrenaline-fuelled pursuits, from heli-skiiing on snow-capped mountains to ballooning and blackwater rafting through caves.

Some, such as bungee-jumping, jet-boating and zorbing -- where you hurl yourself down a hill inside an inflatable ball -- were invented or popularised in a country that prides itself on catering to intrepid visitors.   The tourism industry as a whole is among New Zealand's biggest earners, generating about NZ$16.2 billion ($10.7 billion) and attracting 3.8 million international visitors annually.     "Adventure tourism is a massive sector in New Zealand. We are promoting ourselves as the adventure capital of the world," professor Michael Lueck, a tourism expert at Auckland University of Technology, told AFP.

New Zealand is also renowned for its rugged landscapes, which feature prominently films such as Kiwi director Peter Jackson's "Lord of the Rings".   Day-trips to White Island combined both, taking tourists including cruise ship passengers to a desolately beautiful island off the North Island coast where they could experience the thrill of standing on an active volcano.   Instead, at least 16 people are believed to have died and dozens suffered horrific burns when 47 tourists and guides were caught on the island during Monday's eruption.

The disaster has raised questions about why tourists were allowed on a volcano where experts had recently raised threat levels, as well as broader issues about the regulation of risky activities in the tourism sector.   "There will be bigger questions in relation to this event," Prime Minister Jacinda Ardern told parliament after the eruption.   "These questions must be asked, and they must be answered."

- 'Slapdash' or world's best? -
The disaster on White Island -- also known as Whakaari -- is not the first mass-fatality accident to affect tourists in New Zealand.   In 2015, seven people were killed when a scenic helicopter flight crashed into Fox Glacier. Two years earlier, a hot-air balloon claimed 11 lives and in 2010 nine died when a plane carrying skydivers plunged into a paddock.

Briton Chris Coker's son Brad, 24, died in the skydive plane crash and since then he has campaigned from afar for tighter regulations in New Zealand's adventure tourism sector.   "In my opinion, the New Zealand authorities... are still slapdash about tourist safety," Coker told news website stuff.co.nz after the White Island eruption.   "To run tourists there is insane. I know they signed a waiver and so on, but it's not really taking care of people."

Trade body Tourism Industry Aotearoa disputes such assessments, saying operators are "working within a world's best regulatory framework", but could not eliminate risk completely.   "Operators put safety first, but adventure activity inherently carries some risk and it's critical that 'adventure' remains in adventure tourism," TIA chief executive Chris Roberts told AFP.   "Operators take all practical actions to minimise the risks and the safety culture of individual operators remains the key factor in preventing accidents."

Roberts said the issue was not tourism operators, but the alert system they relied on at volcanic destinations such as White Island, which attracts about 17,000 visitors a year.   The GeoNet monitoring agency raised White Island's threat level in the week before the eruption but also advised current activity "does not pose a direct hazard to visitors".   "The reviews need to look at the science and specifically the guidance provided about volcanic activity, and whether the operating practices followed for the past 30 years need to change," Roberts said.

- 'Understand the risks' -
Travel companies such as White Island Tours brief customers before setting off and require them to sign a waiver declaring they understand the risk, as well as supplying equipment such as hard-hats and gas masks.   However, some relatives of those affected by the eruption have expressed scepticism that their loved ones truly appreciated the potential danger they faced.   Options for legal redress are limited under New Zealand's Accident Compensation Commission scheme, which covers victims' medical bills and provides modest compensation but does not allow civil suits for damages.

Neither Roberts nor Lueck expected the White Island eruption to hit international arrivals in New Zealand, which have continued to climb despite major earthquakes in 2011 and 2016.   The nature of any review arising from White Island remains uncertain, but Lueck said at the very least tourists needed to be better informed about any risks.   "Operators and tourism boards should have tourists understand what these risks are, and not brush over quickly signing a waiver," he said.   "Only then can tourists make an informed decision and decide whether or not they want to take that particular risk."
Date: Thu, 12 Dec 2019 21:25:36 +0100 (MET)

Kinshasa, Dec 12, 2019 (AFP) - Twenty-three cases of Ebola have been recorded in four days in eastern Democratic Republic of Congo, where deadly violence is hampering efforts to end the 16-month-old epidemic, authorities said on Thursday.   Ten cases were recorded on Tuesday alone in Mabalako in North Kivu province, after six on Monday, according to the Multisectoral Committee for Epidemic Response (CMRE).   Three out of the six were practitioners of traditional medicine, it said.

On Wednesday, three cases were recorded in North Kivu, including one in the Biena neighbourhood -- which has had no new Ebola cases for the last 85 days.   More than 2,200 people have died since the epidemic was declared on August 1, 2018.   As of November 22, the rate of new cases had fallen to 10 per week.   CMRE said "security reasons" -- attacks on Ebola health workers and sites by armed groups and angry youths -- had "paralysed" work in the key zones of Beni, Biakato and Mangina.   The attacks led to a pullout of locally-employed Ebola workers in Biakato by the UN's World Health Organization (WHO) and Doctors Without Borders (MSF).
Date: Thu, 12 Dec 2019 15:59:23 +0100 (MET)

Juba, Dec 12, 2019 (AFP) - Devastating flooding in South Sudan following a fierce drought could tip parts of the country into famine in the next few months, the World Food Programme (WFP) warned on Thursday.   According to the UN refugee agency nearly one million people were affected by floodwaters that submerged entire towns, compounding an already dire humanitarian situation after six years of war.

The WFP said that 5.5 million people are expected to be going hungry in early 2020 -- the time at which the population is generally benefiting from their harvest in October and November of the previous year.   An earlier harvest failed due to drought. This time crops have been washed away.    "The number of people in need is likely to increase because of the catastrophic level of destruction caused by floods since October following a drought that hammered parts of the country earlier in the year," the agency said in a statement.

The floods wiped out 73,000 metric tons of potential harvests as well as tens of thousands of cattle and goats, said the WFP.   "We know the problems that we've been having in South Sudan, but the rains and the floods have led to a national disaster and are much worse than anyone could have anticipated," said WFP Executive Director David Beasley.    "In fact, if we don't get funding in the next few weeks and months, we are literally talking about famine. We need support, we need help and we need it now."   The agency estimated its needs at $270 million (242 million euros) for the first half of 2020.   South Sudan declared a "man-made" famine affecting around 100,000 people in 2017. 

The term "famine" is used according to a scientific system agreed upon by global agencies, when at least 20 percent of the population in a specific area has extremely limited access to basic food; acute malnutrition exceeds 30 percent; and the death rate exceeds two per 10,000 people per day for the entire population.   "Famine in South Sudan was defeated after four months in 2017 by a concerted large-scale humanitarian response," said the WFP.   "Experts now say the country's food security outlook has never been so dire."   Political instability is also high as President Salva Kiir and his rival Riek Machar have again delayed their formation of a power-sharing government, this time by 100 days until February 2020.
Date: Wed, 11 Dec 2019 09:33:13 +0100 (MET)
By Holly ROBERTSON

Sydney, Dec 11, 2019 (AFP) - Up to 20,000 protesters rallied in Sydney on Wednesday demanding urgent climate action from Australia's government, as bushfire smoke choking the city caused health problems to spike.   Sydney has endured weeks bathed in toxic smoke as hundreds of blazes have raged across the countryside, with hospitals recording a 25 percent increase in the number of people visiting emergency departments last week.   On Tuesday smoke alarms rang out across Australia's biggest city, with thick haze triggering smoke alarms and forcing buildings to be evacuated, school children to be kept indoors, and ferries to be cancelled.   The devastating fires have focused attention on climate change, with scientists saying the blazes have come earlier and with more intensity than usual due to global warming and a prolonged drought.   Police estimated the crowd size at 15,000, organisers put the figure at 20,000.

Many of the protestors voiced anger at the government's silence in the face of the crisis.   "The country is on fire" said 26-year-old Samuel Wilkie attending his first climate protest. He described politicians' response as "pathetic".    "Our government is not doing anything about it," said 29-year-old landscape gardener Zara Zoe. "No one is listening, no one is doing anything."   Prime Minister Scott Morrison -- a staunch backer of Australia's vast coal industry -- has said little about the smoke since the crisis began, preferring to focus on fire-hit rural communities.   Organiser Chloe Rafferty said that had created anger at the conservative government's inaction.   "I think the wider public can see that we are not expecting the climate crisis in the future but we are facing the climate crisis now," she told AFP.   "People are experiencing it in their day-to-day lives."   As well as a rise in people visiting hospitals with smoke-related health symptoms, the number of emergency calls for ambulances spiked 30 percent last week.    "For most people, smoke causes mild symptoms like sore eyes, nose and throat," top health department official Richard Broome said.   "However, people with conditions like asthma, emphysema and angina are at greater risk because the smoke can trigger their symptoms."

Smoke from bushfires is one of the biggest contributors to air pollution in Australia, releasing fine particles that can lodge deep within people's lungs and cause "severe" health impacts over time, according to scientist Mick Meyer from government-funded scientific research agency CSIRO.   "The impact of smoke on people remote from the fires may, on occasion, substantially exceed the direct injury to people within the fire zone," he wrote in The Conversation.   "But we currently lack the operational tools to understand the extent of these impacts or to manage them."   Six people have been killed and more than 700 houses destroyed in bushfires this fire season.   Though the human toll has been far lower than the deadliest fire season in 2009 -- when almost 200 people died -- the scale of this year's devastation has been widely described as unprecedented.   Three million hectares (7.4 million acres) of land has been burnt -- the size of some small countries -- and vast swathes of koala habitat scorched.   Official data shows 2019 is on track to be one of the hottest and driest years on record in Australia.
Date: Tue 3 Dec 2019
Source: Trinidad Express [abridged, edited]

The number of local deaths from the influenza virus has risen to 24. At the Health Ministry's update last week, 16 fatalities were reported from the flu, with Health Minister Terrence Deyalsingh appealing to citizens -- especially those considered at-risk -- to get vaccinated.
Date: Sat 30 Nov 2019
Source: The New Indian Express, Express News Service [edited]

According to official data, 14 swine flu [influenza A/H1N1] deaths across the state were recorded this year [2019] till [17 Nov 2019]. The figure is slightly less than the previous year's [2018] toll of 17. The total number of H1N1 swine flu-positive cases [has] also come down this year [2019] compared with 2018 from 402 to 325. Health officials are setting up isolation wards in hospitals as a preventive measure.

As the winter season has set in and the minimum temperatures are coming down, health officials are instructing the public to take precautions in order to stay away from being infected by swine flu. The health department has initiated steps to set up district-[wide] swine flu testing facilities and isolation wards in every district hospital, area hospital, and community health centre.

As per the requirement of treatment procedure, the government has to set up special isolation wards in all government hospitals and provide protection kits to the healthcare staff, especially to those who will attend to the patients suffering from the flu. Across the state, Visakhapatnam registered the highest number of positive swine flu cases and deaths. Out of 325 positive cases, 180 alone were reported from Visakhapatnam, of which 8 died. West Godavari district registered 3 deaths, and Anantapur, East Godavari, and Srikakulam registered one death case each.

All the district health officials have been instructed to intensify awareness camps and screening centres. As part of the action plan, isolation wards with 5-10 beds are to be set up in every teaching, district, and area hospital. A sufficient stock of drugs, masks, and PPE [personal protective equipment] kits are to be made available. Currently, there are 18 labs eligible for conducting confirmation test in the state. "We are creating awareness by distributing pamphlets and putting up screening centres at bus stops and railway stations," DMHO [district medical and health officer] Dr. TSR Murthy said.

Symptoms of swine flu are generally similar to that of seasonal flu. These include cough, fever, sore throat, stuffiness, runny nose, body aches, headache, chills, fatigue, diarrhoea, and vomiting. Later on, breathlessness, chest pain, drowsiness, low blood pressure, sputum mixed with blood, and bluish discoloration of nails also develops.
Date: Thu 28 Nov 2019
Source: GDN Online [edited]

Two expatriates living in Oman died after contracting the seasonal influenza (H1N1) or swine flu in the governorate of Dhofar -- the 1st in July and the 2nd in August [2019]. They were among 78 confirmed cases of swine flu registered at the Sultan Qaboos Hospital over the first 9 months of 2019 in the governorate.

The hospital authorities reported a total of 599 registered suspected cases of H1N1 between January and last September [2019]. Doctors working at Sultan Qaboos Hospital dealt overall with 1779 cases of respiratory infections during the same period.

Patients most vulnerable to the respiratory viruses are those over 18 years, particularly pregnant women; those suffering from chronic illnesses, kidney and heart diseases, liver problems, diabetes, asthma, blood disorders, and HIV/AIDS; and even health workers, according to Muscat Daily.
Date: Wed 11 Dec 2019
Source: UNICEF/WHO Situation report 11 Dec 2019 [edited]

Highlights
- 5 new human cases reported in the past week
- In response to 1st human vaccine-derived poliovirus type 1 (VDPV1) case from the island province of Basilan, in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), outbreak immunization was conducted
in Maluso, Basilan, with bivalent oral polio vaccine (bOPV) against polio type 1, vaccinating 13 547 children under 10 years old (102% of the target).
- Currently 9 human cases confirmed with circulating VDPV type 2 (cVDPV2), 1 case with VDPV1, 1 case with cVDPV1, and 1 case with immunodeficiency-related VDPV type 2 (iVDPV2).
- A case with VDPV1 from Sultan Kudarat is pending genetic analysis; 1 case of cVDPV1 from Malaysia was confirmed as genetically linked to the Basilan case.
- Synchronized polio vaccination campaign conducted on [25 Nov 2019 - 10 Dec 2019] (including 2 days of extension) vaccinated 4 309 566 children under 5, which is 98% of the target total of 4.4 million children under 5. A total of 1 395 365 children under 5 were vaccinated in National Capital Region (NCR), which is 109% of the target, and 2 914 201 (94%) in Mindanao.
- DOH planning to conduct outbreak immunization with bOPV targeting 710,296 children under 10 in the Sulu Archipelago, Zamboanga City, and Lambayong, Sultan Kudarat, on [6-12 Jan 2020].
- Current polio outbreak resulting from persistently low routine immunization coverage, and poor sanitation and hygiene.
- Philippines is affected by both cVDPV1 and cVDPV2. cVDPV is considered a public health emergency of international concern (PHEIC).

cVDPV1
---------
- In response to the 1st human case confirmed with VDPV1 from Maluso, Basilan (BARMM), outbreak immunization was conducted in the area with bOPV for children under 10 years old, vaccinating 13,547 children under 10 years of age (102% of the target).
- A cVDPV1 case in Sabah state, Malaysia, was confirmed to be genetically linked to the Basilan case by the Victorian Infectious Diseases Reference Laboratory (VIDRL) in Australia. Since the 2 viruses are genetically linked, they are both classified as circulating.
- A new VDPV1 case from Sultan Kudarat (Region XII) was confirmed on [6 Dec 2019] and is pending further genetic analysis.
- All 13 cVDPV1 environmental samples found in Manila are genetically linked.

cVDPV2
---------
- All 9 human cases and 17 environmental samples confirmed with cVDPV2 are genetically linked. All human cases were reported from Mindanao (BARMM and Region XII), whereas environmental samples were found in NCR and Davao.
- All samples were tested by the National Polio Laboratory at the Research Institute for Tropical Medicine (RITM), whereas sequencing and genetic analysis is done at the NIID in Japan, and additional genetic characterization is provided by the United States Centers for Disease Control and Prevention (CDC).
=======================
[Given the identification of the cVDPV1 case in Malaysia that is genetically related to the VDPV1 case in Basilan, it is now clear there are at least 2 separate cVDPV outbreaks in the Mindinao region of the Philippines: one of the outbreaks is associated with cVDPV2, and the other with cVDPV1 and one outbreak of cVDPV1 in the Manila Metropolitan area (although only environmental samples have been positive without AFP (acute flaccid paralysis) cases as yet.) What all these areas have in common is pockets of populations with suboptimal vaccination coverages. Clearly, we await further information on the genetic profiling of the newly identified VDPV1 case in Sultan Kudarat, also located in southern Philippines. Note that Basilan Island, Sultan Kudarat, and Sabah state in Malaysia, while all in the same general area, are not contiguous, each being on a different island. In. total, there are 11 cases of AFP in the Philippines that are attributable to infection with a VDPV.

A map showing the provinces in the Philippines can be found at

HealthMap/ProMED-mail map of the Philippines: