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Nepal

General:
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Nepal is regarded as a developing nation which has a great variability of facilities for the tourist depending on the location throughout the country. It is a mountainous country and many travellers to th
s region undertake long arduous treks. It is wise to ensure that your general health will be sufficient for the trip you plan under normal circumstances. Talking your itinerary through with other experienced travellers to this region will be important before you finally book your holiday. The climate varies throughout the year with their monsoon season typically stretching from May to October. During this time significant flooding can occur and the high humidity leads to increased numbers of mosquitoes. Travel to the Terai plains during this period leads to the greatest risk of mosquito borne disease.
Safety & Security:
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The security situation throughout Nepal has caused quite a degree of concern throughout the past few years. There has been a general increased level of robberies and this has involved tourists on a number of occasions. Those trekking in Nepal are strongly advised to travel with reputable organised groups who will have checked the local situation out carefully before departure. It is very inadvisable to trek alone in Nepal. This is particularly true in the Rasuwa District of the Langtang Area. Airport security in Katmandu has been improved since the hijacking of Indian Airlines flight IC814 in December 1999 but take care of your belongings at all times and never carry anything for strangers no matter how plausible their reason may be.
Health Facilities:
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The level of Western health facilities in Katmandu and Pokhara are excellent but expensive. Outside of the main city the level of healthcare can be very limited. It is essential that all tourists ensure that they have adequate travel insurance which will cover accidents and evacuation by helicopter. Cover for cancelled flights and loss of belongings is also extremely important. The CIWEC Medical Clinic in Katmandu provides an excellent medical service for travellers and their web page gives extensive advice on travelling throughout Nepal.Telephone numbers Katmandu 228531, or 241732. Web site: www.ciwec-clinic.com
Food & Water Facilities:
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Katmandu is a large city with a large population and much squalor. The main tourist hotels provide a good degree of hygiene for travellers but those undertaking trekking holidays will leave this relative health security and head to regions of the country where food and water hygiene are very poor. It is essential that all food consumed is freshly prepared and well cooked. Cold vegetables or salads should be avoided as the risk of diseases like amoebiasis and giardiasis is very high. All water should be checked for a smell of chlorine and if this is not present then it should not be used for either drinking or brushing your teeth. Even bottled water from any source outside of the main hotels should be treated with suspicion as in many cases it will be plain untreated tap water.
Rabies risks in Nepal:
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This viral disease is usually transmitted by the bite (lick or scratch) from any infected warm blooded animal. Usually humans are infected by dogs but cats and monkeys are also frequently implicated. In many of the temples of Nepal there will be a multitude of monkeys and it may be difficult to avoid contact. If you are exposed then urgent medical attention will be required and this will often mean a rapid return to Katmandu. Never treat this disease lightly and always ensure that any contact is followed up as soon as possible.
Altitude Problems:
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Arriving into Katmandu at 4,500ft usually presents no major difficulty for travellers. However, depending on the actual trek which is proposed you may put yourself at risk of exhaustion, dehydration and altitude sickness. The better tour companies will tailor the actual trek to the abilities of those taking part but try not to allow yourself become attached to a group which will push your health to extremes. Many treks will take travellers to heights reaching 18,000ft.
Malaria risk in Nepal:
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The main risk of malaria in Nepal will be for those visiting the Terai region. Even here, the significant risk occurs during the monsoon season and for a period afterwards. However, malaria transmission is reported from other regions of the country and this will need to be talked through in depth before you leave home.
Mosquito Borne diseases:
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Apart from malaria there are two other significant mosquito borne diseases which occur in regions of Nepal. Dengue Fever and Japanese B Encephalitis are both frequently implicated in outbreaks and both diseases can cause severe illness even death. Avoiding mosquito and sandfly bites at all times is essential.
Road & Climbing Safety:
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The road conditions throughout rural Nepal are poor and care will be required at all times. Many mountainous passes are impassible during the monsoon season and can even be very hazardous at other times throughout the year. In Katmandu the roads are congested, pollution is a significant problem and walkways may be non existent in many places. If undertaking a trek it is important to make sure your general health is sufficient and that you have adequate clothing and shoes to suit both the expected and unexpected.
Local Laws & Customs:
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The Nepalese customs are very strict regarding importation and exportation of many goods including valuable metals, articles of archeological or religious importance, drugs, arms and communication equipment. Imprisonment can quickly follow any infringement of their rules. Women are advised to dress modestly and generally it is wiser to avoid inappropriate clothing in public such as shorts, sleeveless tops etc.
Vaccination for Nepal:
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Unless you are entering Katmandu from tropical Africa there are no essential vaccines for entry or exit. We used to receive reports of buses being stopped coming overland from India and for all on board to have evidence of Cholera vaccination. However, this does not appear to be a current problem. Nevertheless, for your own personal health it is recommended that travellers are covered against the following diseases;
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Poliomyelitis (childhood booster)
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Tetanus (childhood booster)
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Typhoid (food and water borne disease)
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Hepatitis A (food and water borne disease)
For those undertaking a longer more rural trip other vaccines may need to be considered including Hepatitis B, Rabies, Japanese B and Meningitis.
Summary:
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Tourists will need to ensure the highest level of personal care while visiting Nepal at all times. Many of the conditions and situations mentioned above occur frequently in those who forget the basic commonsense rules about travelling healthy.

Travel News Headlines WORLD NEWS

Kathmandu. 6 Sep 2019

If laboratory tests carried out at Sukraraj Tropical and Infectious Disease Hospital today [6 Sep 2019] are anything to go by, roughly 50% of those who visit the hospital with fever and muscle pain are dengue-infected. According to the hospital, of the 372 blood tests done today [6 Sep 2019], 175 tested positive for dengue. "There has been a significant rise in the number of dengue-infected patients at the hospital. Unless people are aware and start working on their own, it is difficult to prevent the infection," said Anup Bastola, spokesperson and consultant tropical medicine physician at Sukraraj Tropical and Infectious Disease Hospital.

- Kathmandu. 19 Sep 2019.The cases of dengue fever are on the rise in Bhaktapur, indicating that it is gradually taking an epidemic turn. In the past 2 weeks, 197 people have been diagnosed with dengue in the district.
12th September 2019
Communication from a medical colleague based in Kathmandu
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Dear friends,  I would like to alert you to a dengue outbreak in Nepal including in Kathmandu. It started in May 2019 in eastern Nepal but has come to Kathmandu in a big way in the past 2 weeks or so. Government figures (http://www.edcd.com.np/) indicates total of 5095 cases in Nepal including 1170 cases from Kathmandu. The government figures underestimate the problem due to underreporting issues. Kathmandu hospitals seem stretched to capacity due to dengue visits and admissions.

This problem is new to Kathmandu as we have had only sporadic cases of dengue in previous years. The public in Kathmandu has never taken mosquito bites seriously since we have not had major vector borne diseases in the past. We hope that the current dengue outbreak has peaked and will slow down once we get cooler nights from end September - early October.

If you have travellers coming this way, please alert them to this and send them with insect repellents and information on mosquito protection measures. DEET is not readily available and other repellent supplies have been depleted. 

Thank you. 
Prativa
======================
Dr. Prativa Pandey
Medical Director
CIWEC Hospital I Travel Medicine Center
prativapandey@ciwec-clinic.com
+977
98510-36742 I
http://www.ciwec-clinic.com/
Date: Sat, 13 Jul 2019 09:52:36 +0200

Kathmandu, July 13, 2019 (AFP) - Floods and landslides triggered by torrential monsoon rains have killed at least 40 people across South Asia in the last two days, officials said Saturday.   The monsoon, which lasts from June to September, causes widespread death and destruction across South Asia each year.   In Nepal, 27 people have died in floods and landslides after heavy rains hit the country's eastern region and the southern plains.

Bishwaraj Pokharel, spokesperson for Nepal Police, added that another 11 people were injured and 15 others reported missing.    Three of the victims were killed when a wall collapsed in the capital Kathmandu.   "Our first priority is life saving rescue and all our resources have been deployed," Home Ministry official Umakanta Adhikari told AFP.

Police used boats to bring people to safety as rivers swelled, inundating their settlements, while parents were seen wading across chest-high waters carrying children on their shoulders.    Nepal's weather department issued a high alert for the southern Sapta Koshi river on Saturday and sent SMS warnings to people in the area.

In neighbouring India 11 deaths have been recorded in the north-eastern states of Assam and Arunachal Pradesh, officials said Friday.  Monsoon floods have inundated 21 districts in Assam, affecting thousands, officials said Friday.

In Bangladesh aid groups were providing rations to Rohingya refugees in the southeast of the country with the UN World Food Programme saying Friday that two people including a child had died.   Last year, more than 1,200 people were been killed across South Asia in monsoon storms with India's Kerala suffering its worst floods in nearly 100 years.
Date: Mon, 27 May 2019 13:48:42 +0200

Kathmandu, May 27, 2019 (AFP) - Nepalese police arrested suspected Maoist activists after three deadly bomb blasts in Kathmandu as a general strike disrupted daily life in much of the South Asian nation on Monday, police said.   Amid a high alert after Sunday's attacks, which were blamed on an outlawed Maoist group, police blew up several suspicious packages.   The group broke away from the country's main communist party, which is now in power, and called the general strike to protest against the death of one of its leaders in police custody.

Police said at least 13 officials from the Maoist group had been arrested on Sunday night and early Monday in different parts of the country.   "Security agencies dealt with suspicious objects found in different areas, mostly outside the capital," said police spokesman Bishwa Raj Pokharel.   While some schools and offices remained closed in Kathmandu, "the effect of the general strike is nominal in the Kathmandu valley but very few vehicles are working outside the capital," the spokesman added.    Four men were killed and seven people injured in three explosions in Kathmandu on Sunday.

A blast inside a shop killed three people, one died in an explosion at a nearby house, whilst two men carrying explosives on a motorbike were among those injured.   There was no immediate claim of responsibility but police said they suspected the Maoist group whose pamphlets were found in a house where one of the explosions took place.

Nepal has enjoyed relative calm since the end of a decade-long civil war in 2006. But some former guerrillas have formed a new group accusing their former leaders of betraying their revolutionary cause.   The group was banned after it was implicated in an explosion that killed one person outside a telecom company office in February.
Date: Sun, 26 May 2019 19:09:29 +0200

Kathmandu, May 26, 2019 (AFP) - Four men died and seven were injured Sunday in three separate explosions in Kathmandu, Nepali police said.   There was no immediate claim of responsibility but police said they suspect involvement of a Maoist splinter group whose pamphlets were found in a house where one of the explosions took place.   A powerful blast inside a shop killed three people and injured four, while the explosion at a home about four kilometres away left one dead and another injured.

Two more were injured when an explosive they were carrying on a motorcycle in the outskirts of Kathmandu exploded.   Security personnel also defused explosives in other areas.    "We are investigating all incidents and have stepped up the security," police spokesman Bishwa Raj Pokharel told AFP.   Pokharel said that seven people have been arrested so far.    The incidents come on the eve of a nationwide strike called the same Maoist splinter group, protesting death of their cadre in a police encounter over a week ago.

Nepal has enjoyed a relatively peaceful environment since the end of a decade-long civil war which concluded with a peace deal struck in 2006.   But some former guerrillas, have broken away, accusing its leaders of betraying their original revolutionary ideals.   In February, the group was implicated in an explosion that killed one person outside the office of a telecom company Ncell, part of Malaysia-based Axiata Group Berhad.    The government outlawed the group following the incident, banning their activities.
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World Travel News Headlines

Date: Thu, 16 Jan 2020 02:59:31 +0100 (MET)
By Nicolas DELAUNAY

Cousin Island, Seychelles, Jan 16, 2020 (AFP) - Giant tortoises amble across Cousin Island as rare birds flit above.   The scene attests to a stunning success for BirdLife International, a conservation group that bought the tiny Seychelles isle in 1968 to save a songbird from extinction.   Thick vegetation smothers ruins that are the only reminder of the coconut and cinnamon plantations that covered the island when the group stepped in to protect the Seychelles Warbler.

Now teeming with flora and fauna and boasting white beaches, Cousin Island is firmly on the tourist map, with managers scrambling to contain visitor numbers and soften their negative environmental impact.    More than 16,000 people visited the island in 2018, compared with 12,000 a decade earlier.   "Tourism is important for Cousin. That's what allows us to finance the conservation projects we run here.    "But 16,000 tourists... that was too much," said Nirmal Shah, director of Nature Seychelles, which is charged with running the special reserve.

Before the island was in private hands, the population of Seychelles Warblers was thought to have shrunk to just 26, barely hanging on in a mangrove swamp after much of their native habitat had been destroyed.    Now, they number more than 3,000 and the greenish-brown bird has been reintroduced to four other islands in the archipelago.   The former plantations have transformed into native forests, teeming with lizards, hermit crabs and seabirds, and the island is the most important nesting site for hawksbill turtles in the western Indian Ocean.   The International Union for Conservation of Nature (IUCN) waxes lyrical about the "unique biodiversity and conservation achievements" of Cousin, "the first island purchased for species conservation", a model since replicated around the world.

- Nature first -
Tourists have been allowed onto the island since 1972, but the message is clear: nature comes first.   In a well-oiled routine, every morning a handful of luxury sailboats and small motorboats anchor off the island, where their occupants wait for Nature Seychelles to skipper them ashore on their boats.   "Tourist boats cannot land directly on the island, the biohazard risk is too big," Shah said.   "Non-indigenous animals who may accidently be on board could come to the island and threaten its (ecological) balance."   Too many tourists can also upset this balance.

Nature Seychelles in July increased the price of visits from 33 to 40 euros ($36 to $44) and removed a free pass for children under 15, resulting in a welcome 10-percent reduction in visitor numbers.   "Something had to be done, there was too much pressure on the environment," said Dailus Laurence, the chief warden of the island.   "When there are too many tourists it can bother nesting birds and turtles who want to come and lay their eggs on the island."

One guide said that some tourists, bothered by the island's ubiquitous mosquitos, would "leave the paths, move away from the group and walk where they are not supposed to", putting fragile habitats at risk.   Shah said that if they wanted to increase the number of tourists, it would require hiring more wardens and guides who live on the island, which would also have a negative impact on nature.   "Our absolute priority is nature, and it comes before tourists. If we have to take more steps to protect it and reduce the number of tourists, we will," he said.
Date: Thu, 16 Jan 2020 02:45:27 +0100 (MET)
By Ivelisse RIVERA, con Leila MACOR en Miami

Yauco, Puerto Rico, Jan 16, 2020 (AFP) - Living out in the open, their nerves on edge after a series of earthquakes that have shaken Puerto Rico, some 5,000 people are hoping that their president, Donald Trump, will heed the island's plea to be designated a disaster zone and free up much-needed aid.   Since December 28, more than 1,000 tremors have rattled the US island territory in the Caribbean, which just two years ago was devastated by two powerful hurricanes in quick succession.

In Yauco, one of the areas worst hit by the earthquakes, dozens of people were sitting on cot beds Wednesday in the parking lot of a municipal stadium, sheltered from the sun by white tents and blue tarps handed out by the federal disaster management agency, known as FEMA.  "The most difficult thing is the psychological aspect," said Wilfredo Rodriguez, 31. His house had been fractured by the seismic movement and he has spent a week living with his kids, aged six and 10, under an awning.    "We are living in constant fear of another powerful tremor," he said.

He only returns to his house to wash, then hurries back to the shelter. "We worry that there'll be a more powerful tremor while we are inside the house," he said.   Throughout the day, volunteers arrive to hand out food and toys for the children who fill the shelters: schools have been suspended because the buildings are not sturdy enough to withstand another quake.    The island's earthquake detection system has registered 1,104 tremors in the past two weeks alone, of which 186 could be felt by the population. By comparison, during the whole of 2019 there were 6,442 tremors, of which just 62 could be felt by people on the island.

Further south, in Guanico, Juan Santiago decided to move into a shelter on Saturday after a tremor of 5.9 on the Richter scale hit the island. "The mountain shook and rocks and earth started to come down," said the 30-year-old.  "My house has a crack in it and is about to fall down," he added. His home had weathered the Category Five winds of Hurricane Maria in September 2017 and of Hurricane Irma which followed it just two weeks later.   "It's different to a hurricane. What is happening now is much nastier," he said.

As he was talking the earth shook again, a tremor of 5.2 magnitude. Vehicles rocked like hammocks in the wind, but the quake-hardened victims barely reacted.   The houses in this part of the island are mostly rudimentary constructions built by the people who live in them with scant resources available in the mountains, where no regulations stipulate that buildings should be earthquake resistant.    The government of Puerto Rico said that as of Monday, there were 4,924 people living in 28 shelters in 14 municipalities. There were no figures on how many buildings had been damaged or destroyed.

- Seeking disaster designation -
Puerto Rico's governor Wanda Vazquez Garced called on Trump to declare the earthquake a disaster and clear the way for desperately needed aid. Trump had declared an emergency days before, but the governor wanted more.   The declaration of an emergency frees up to $5 million dollars in aid for the island, although Congress can bump that figure up. But if the situation is designated a disaster, there is no ceiling on funding, a FEMA spokesman said.   On Wednesday, the government said it would release $8.2 billion in delayed hurricane relief that had been stalled after the president threatened to divert Puerto Rico's emergency funds to help pay for his wall on the US-Mexico border.

In the past few days there have been growing calls among Democratic lawmakers for Trump to declare the situation in Puerto Rico a disaster.   It is a delicate subject, as Trump has accused the government of Puerto Rico of incompetence and of siphoning off hurricane relief money, triggering a public spat between the president and the mayor of San Juan, Carmen Yulin Cruz, as well as the former governor Ricardo Rossello, who was forced to step down last summer amid massive protests.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
Date: Wed, 15 Jan 2020 23:16:11 +0100 (MET)

Malabo, Equatorial Guinea, Jan 15, 2020 (AFP) - Firefighters battled to bring a blaze at Malabo's cathedral under control on Wednesday, as flames engulfed parts of the historic building, considered the most important Christian church in Equatorial Guinea.     Dozens of people gathered in silence near the cathedral in the early evening as the fire service sprayed water jets onto the century-old structure.

It was not immediately known whether anyone was hurt in the fire, in which huge flames consumed part of the facade of the building.       "We have just extinguished the fire, it's finished. The roof is gone, it is a catastrophe," firefighter Alfredo Abeso told AFP.   Another firefighter at the scene said: "The whole roof is gone, the interior is burned."   The cause of the fire is not known but the cathedral has been closed to the public since January 7 for restoration work.    Built in a neo-gothic style between 1897 and 1916, the cathedral is one of the central African country's main tourist attractions.

The blaze brought comparisons to the devastating fire that ravaged the 13th century Notre-Dame cathedral in Paris in April 2019.     The French Embassy in Malabo said the fire was a "cruel reminder" of the fire at Notre Dame.    "We share the emotion of our friends in Malabo and Equatorial Guinea and hope that the fire can be brought under control quickly," it said on Twitter.      Paris engineers are still working to stabilise the 13th century cathedral in the French capital after fire tore through its roof and dramatically toppled its spire last year.
Date: Wed, 15 Jan 2020 21:55:41 +0100 (MET)

Rio de Janeiro, Jan 15, 2020 (AFP) - Widespread complaints over foul-smelling drinking water in Rio de Janeiro have triggered a run on supermarket bottled water, though the public utility denied any health risk Wednesday.   Rio governor Wilson Witzel set alarm bells ringing in a Twitter post on Tuesday, saying the situation -- fuelled by social media rumours -- was "unacceptable" and calling for a "rigorous investigation."

Moving to calm growing fears, public water utility Cedae attributed the problems to the presence of geosmin, a harmless organic compound, insisting the resulting earthy-tasting tap water was safe to drink.   "The results of the analyses show the presence of geosmin, at a rate sufficient to change the taste. But there is no risk to health," Sergio Marques, the official in charge of water quality, told a press conference.   Cedae later said it had fired the head of the Guandu treatment plant, which supplies nearly 80 percent of Rio's drinking water.   It said the supply from Guandu would be treated with carbon in the coming days to get rid of the geosmin.

According to O Globo newspaper, nearly 70 districts of the capital have been affected.   It reported that more than 1,300 cases of gastroenteritis were recorded over the last 15 days in Santa Cruz in the west of Rio, where water quality complaints were rife.   Cedae's president Helio Cabral apologized "to the whole population for the problems in the water supply," which began earlier this month.

The problem has been exacerbated by false rumours circulating on social media that the water was toxic.   Despite assurances, many Rio citizens were taking no chances. In supermarkets, mineral water stocks have been selling out and long queues are formed as soon as they are replenished.   Geosmin is also responsible for the earthy taste in some vegetables.
Date: Wed, 15 Jan 2020 21:25:04 +0100 (MET)

Lima, Jan 15, 2020 (AFP) - Five tourists arrested for damaging Peru's iconic Machu Picchu site will be deported to Bolivia later on Wednesday, police said.   A sixth was released from custody and ordered to remain in Machu Picchu pending trial after paying bail of $910.   The six tourists -- four men and two women -- were arrested for damaging Peru's "cultural heritage" after being found in a restricted area of the Temple of the Sun on Sunday.   They were also suspected of defecating inside the 600-year-old temple, an important edifice in the Inca sanctuary.   "We've got the order. Today the five foreign tourists will be expelled," Cusco police official Edward Delgado told AFP.   "We're going to take them by road to the city of Desaguadero, on the border with Bolivia."   The border town, a nine-hour drive away, is the nearest frontier point to the southern Cusco region where Machu Picchu is located.

The sixth tourist, 28-year-old Nahuel Gomez, must sign at a local court every 10 days while awaiting trial.   He admitted to removing a stone slab from a temple wall that was chipped when it fell to the ground, causing a crack in the floor.   He could face four years in prison if found guilty of damaging Peru's cultural heritage.   Several parts of the semicircular Temple of the Sun are off limits to tourists for preservation reasons.   Worshipers at the temple would make offerings to the sun, which was considered the most important deity in the Inca empire as well as other pre-Inca civilizations in the Andean region.   The group -- made up of a Chilean, two Argentines, two Brazilians, including one of the women, and a French woman -- allegedly entered the Inca sanctuary on Saturday and hid on site so they could spend the night there -- which is prohibited.

A source with the public prosecutor's office told AFP that Nahuel admitted to the damage but said "it wasn't intentional, he only leant against the wall."   The Machu Picchu complex -- which includes three distinct areas for agriculture, housing and religious ceremonies -- is the most iconic site from the Inca empire, which ruled over a large swath of western South America for 100 years before the Spanish conquest in the 16th century.   Machu Picchu, which means "old mountain" in the Quechua language indigenous to the area, is at the top of a lush mountain and was built during the reign of the Inca emperor Pachacuti (1438-1471).
Date: Wed, 15 Jan 2020 20:53:05 +0100 (MET)

Alicante, Spain, Jan 15, 2020 (AFP) - A fire broke out Wednesday on the roof of the airport in Alicante, a city on the eastern Mediterranean coast which is a tourism hotspot, forcing its closure to air traffic.   "The fire is under control but it has not been extinguished. Firefighters are continuing to work," a spokesman for Spanish airport operator Aena told AFP, adding the airport will remain closed to air traffic until noon on Thursday.

Ten flights which were due to land at Alicante were cancelled, as were 12 which were supposed to depart from the airport, he said.    Another four flights which were due to land at Alicante were diverted to other Spanish airports.   The flames were visible from inside the terminal, according to an AFP photographer at the scene.   Passengers and workers stood outside as dense smoke rose from the terminal building.   No one was injured and the authorities are still not sure what caused the fire.

The airport serves the eastern region of Valencia, which is home to several popular resorts such as Benidorm. It handled just under 14 million passengers last year, making it Spain's fifth busiest airport.   Aena recommended in a tweet that passengers contact their airline before heading to Alicante airport to see what the status of their flight was.   "We are coordinating with airlines. Consult your company to know if your flight is cancelled or will operate from an alternative airport," it said.
Date: Wed, 15 Jan 2020 11:12:40 +0100 (MET)

Beijing, Jan 15, 2020 (AFP) - A new virus from the same family as the deadly SARS pathogen could have been spread between family members in the Chinese city of Wuhan, local authorities said Wednesday.   The outbreak, which has killed one person, has caused alarm because of the link with SARS (Sudden Acute Respiratory Syndrome), which killed 349 people in mainland China and another 299 in Hong Kong in 2002-2003.   One of the 41 patients reported in the city could have been infected by her husband, Wuhan's health commission said in a statement on Wednesday.   The announcement follows news that a Chinese woman had been diagnosed with the novel coronavirus in Thailand after travelling there from Wuhan.

No human-to-human transmission of the virus behind the Wuhan outbreak has been confirmed so far, but the health commission said the possibility "cannot be excluded".   The commission said that one man who had been diagnosed worked at Huanan Seafood Wholesale Market, which has been identified as the centre of the outbreak, but his wife had been diagnosed with the illness despite reporting "no history of exposure" at the market.   At a press conference on Wednesday following a fact-finding trip to Wuhan, Hong Kong health officials also said that the possibility of human-to-human transmission could not be ruled out despite no "definitive evidence".

Dr Chuang Shuk-kwan, from Hong Kong's Centre for Health Protection, said there were two family group cases among the recorded cases in Wuhan, including the husband and wife and a separate case of a father, son and nephew living together.   However, he said mainland doctors believed the three men were most likely to have been exposed to the same virus in the market.   The market has been closed since January 1.   The woman diagnosed in Thailand, who is currently in a stable condition, had not reported visiting the seafood market, the World Health Organization (WHO) said on Tuesday.

WHO doctor Maria Van Kerkhove said Tuesday that they "wouldn't be surprised if there was some limited human-to-human transmission, especially among families who have close contact with one another".   The US Centers for Disease Control and Prevention issued a Level 1 "Watch" alert for travellers to Wuhan after the patient was diagnosed in Thailand, saying they should practice normal precautions and avoid contact with animals and sick people.

Wuhan's health commission said on Wednesday that most of the patients diagnosed with the virus were male, and many were middle-aged or elderly.   In Hong Kong, hospitals have raised their alert level to "serious" and stepped up detection measures including temperature checkpoints for inbound travellers.   Hong Kong authorities said on Tuesday that the number of people hospitalised with fever or respiratory symptoms in recent days after travelling to Wuhan had grown to 71, including seven new cases since Friday.   Sixty of that total, however, have already been discharged. None have yet been diagnosed with the new coronavirus.
Date: Wed, 15 Jan 2020 03:48:17 +0100 (MET)
By Emile Kouton with Celia Lebur in Lagos

Lome, Jan 15, 2020 (AFP) - After he was struck down by malaria and typhoid, Togolese tailor Ayawo Hievi thought he was set to recover when he started taking drugs prescribed by his doctor.   But far from curing him, the medication he was given at the neighbourhood clinic made him far worse -- eventually costing him one of his kidneys.    The drugs were fake.   "After four days of care, there was no improvement, but I started to feel pain in my belly," Hievi, 52, told AFP.

After two weeks of suffering he became unable to walk and was rushed into the university hospital in the West African nation's capital Lome.    "The doctors told me that my kidneys had been damaged... the quinine and the antibiotics used to treat me in the medical office were fake drugs."   Now, over four years later, he remains crippled by chronic kidney failure and has to go to hospital for dialysis regularly.    Hievi's horror story is far from unique in a continent awash with counterfeit medicines.    The World Health Organization (WHO) estimates that every year some 100,000 people across Africa die from taking "falsified or substandard" medication.

The American Society of Tropical Medicine and Hygiene estimated in 2015 that 122,000 children under five died due to taking poor quality anti-malaria drugs in sub-Saharan Africa.   Weak legislation, poor healthcare systems and widespread poverty have encouraged the growth of this parallel -- and deadly -- market. Since 2013, Africa has made up 42 percent of the fake medicine seized worldwide.    The two drugs most likely to be out-of-date or poor, ineffective copies are antibiotics and anti-malarials, say experts.    And bogus drugs not only pose a risk to the patient -- they also play a worrying part in building resistance to vital frontline medications.

- 'Difficult to trace' -
In a bid to tackle the scourge, presidents from seven countries -- the Republic of Congo, Gambia, Ghana, Niger, Senegal, Togo and Uganda -- meet Friday in Lome to sign an agreement for criminalising trafficking in fake drugs.    The goal is to bolster cooperation between governments and encourage other African nations to join the initiative.   But even if leaders put pen to paper, the task of stamping out the flows of counterfeit medication is huge.    Medicines spread out on plastic sheets or offered at ramshackle stalls are for sale at markets across West Africa.

Those hawked on the streets are often a fraction of the price of what's available in more reputable pharmacies where controls are stricter and supplies often have to come through official channels.    "It is very difficult to trace where the fake medicines come from," said Dr Innocent Kounde Kpeto, the president of Togo's pharmacist association.    "The countries which are mentioned on the boxes are often not the countries of origin or manufacture of these drugs. The manufacturers cover their tracks so as not to be identified".

It is estimated that between 30 and 60 percent of medicine sold in Africa is fake and Kpeto said most of it comes from China or India.    Efforts to staunch the deadly torrents of counterfeits have made some headway.    Some trafficking hubs have been dismantled, such as Adjegounle market in Cotonou that served as a key gateway for fakes heading to giant neighbour Nigeria.   In mid-November, the police in Ivory Coast made a record seizure of 200 tonnes in Abidjan and arrested four suspects including a Chinese national.

Togo is one of the pioneer countries trying to stop the flow.    It changed the law in 2015 and now traffickers can face 20 years in jail and a fine of some $85,000 (75,000 euros).   In a show of force in July the authorities burnt over 67 tonnes of counterfeit pharmaceuticals discovered between     But even given these recent successes, those in the industry like Dr Kpeto insist that the threat is still grave and involves "highly organised criminal networks".    "The phenomenon remains major," he said.    Traffickers can turn an investment of just $1,000 (900 euros) into a profit of $500,000, he claimed.   The fake medicines are smuggled in the same way as guns or narcotics and often bring higher returns.

- 'Die for nothing' -
Nigeria, Africa's most populous country with a market of 200 million people, is the number one destination on the continent for fake drugs and a showcase of difficulties being faced.    In September 2016 the World Customs Organization seized tens of millions of fake pills and medicines at 16 ports around Africa: 35 percent were intended for Nigeria.    Across the vast nation there are tens of thousands of vendors selling the counterfeits.   Competition between traffickers is fierce and the official agency meant to combat the problem is overwhelmed.

In a bid to improve the situation, Vivian Nwakah founded in 2017 start-up Medsaf and raised $1.4 million to help Nigerians track their medication from producer to user.    "The country doesn't have a reliable and centralised distribution network," she said.    "A hospital sometimes has to deal with 30 or 40 distributors for all the medications it needs. How can you have quality control with so many suppliers?"   As a result, fake or faulty medicine has not just flooded markets but also pharmacies and hospitals -- both state and private.    Sometimes, without hospital administrators even being aware, that means the drugs that reach the patients can be expired, poorly stored or the wrong doses. 

Medsaf works to ensure the quality control of thousands of products at over 130 hospitals and pharmacies in Nigeria. It looks forward to expanding deeper into Nigeria as well as Ivory Coast and Senegal.   The company uses technology, database management and analytics to monitor the movement of medications and verifies their official registration number, the expiry dates and storage conditions.   "Technology we use can help to solve most of the issues related to fake drugs," Nwakah said. "People die for nothing. We can change that."
Date: Mon 13 Jan 2020, 00.45 IST
Source: The Hindu [edited]

A 58-year-old woman from Seegemakki village in Tumari Gram Panchayat limits in Sagar taluk died due to Kyasanur Forest Disease (KFD), also known as monkey fever, at a private hospital in Manipal in Udupi district on [Sat 11 Jan 2020].

The deceased, H, who had complained of high fever and aches in joints was admitted to government sub-divisional hospital in Sagar city for treatment on [Tue 7 Jan 2020]. Her blood tested positive for KFD.

Rajesh Suragihalli, District Health Officer, told The Hindu that as her health condition had worsened, she was shifted to a private hospital in Manipal on [Thu 9 Jan 2020] for advanced treatment. She failed to respond to the treatment and breathed her last on [Sat 11 Jan 2020], he said.

Following the death, the Department of Health and Family Welfare has sounded an alert in Sagar and Tirthahalli taluks from where 7 positive cases have been reported since [1 Jan 2020]. The vaccination drive has been stepped up in the villages from where positive cases are reported. Three advanced life support ambulances have been stationed in government sub-divisional hospital in Sagar to shift KFD patients with health complications to private hospitals in Shivamogga city or Manipal for additional treatment, he said.
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[Kyasanur Forest disease (KFD) is an acute febrile illness caused by Kyasanur Forest disease virus (KFDV), a member of the family _Flaviviridae_, characterized by severe muscle pain, gastrointestinal symptoms, and bleeding manifestations. The virus was 1st identified in 1957 after it was isolated from a sick monkey from the Kyasanur Forest in Karnataka state of India. The disease is transmitted to humans following a tick bite or contact with an infected animal, especially a sick or recently dead monkey. There is no evidence of person-to-person transmission (<https://www.cdc.gov/vhf/kyasanur/index.html>).

The case fatality of Kyasanur Forest disease (KFD) is 2-10% and mortality is higher in the elderly and in individuals with comorbid conditions. There is no specific treatment for KFD. Prompt symptomatic and supportive treatment can reduce morbidity and mortality. Surveillance (human, monkey, and tick), personal protection against tick bites, and vaccination are the key measures for prevention and control of KFD (<https://idsp.nic.in/WriteReadData/l892s/60398414361527247979.pdf>).

As per the media report above, 7 confirmed KFD cases have been reported from Sagar and Tirthahalli taluks in Karnataka state so far in 2020. KFD typically occurs during the dry season from November through May, which correlates with the increased activity of the nymphs of ticks. Exposure to adult ticks and nymphs in rural or outdoor settings increases the risk of infection; herders, forest workers, farmers, and hunters are particularly at increased risk of contracting the disease. Vaccination and personal protective measures against tick bites are keys to prevent KFD.

The recommended preventive measures include using tick repellents, walking along clear trails, avoiding contact with weeds, and wearing full sleeved clothes and long pants to reduce exposed skin to reduce contact with ticks and subsequent tick bites. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Karnataka State, India: <http://healthmap.org/promed/p/307>]
Date: Mon 13 Jan 2020
Source: Food Safety News [edited]

An emergency committee to control the sale of food has been created in a city in northwest Argentina after a spike in _Salmonella_ cases in early 2020. There have been 51 confirmed cases of salmonellosis in Salta so far in 2020. At least 5 people have been hospitalized but recovered after treatment.

The committee will be responsible for controlling food sold on public roads at street stalls and at commercial premises. It includes experts from the National University of Salta (UNSA) and Catholic University of Salta (Ucasal). Officials hope by increasing controls they can bring the rise in infections under control and minimize the risk to the public. The group, created by the Mayor of Salta Bettina Romero and Undersecretary of Health and Human Environment Monica Torfe, held a meeting with Juan Jose Esteban, manager of the Hospital Senor del Milagro, and teams from the department of epidemiology of the province on preventive measures to tackle the salmonellosis rise this past week.

Norma Sponton, head of the microbiology sector; Teresita Cruz, of the epidemiological surveillance program of the province; Paula Herrera, from the Ministry of Health, and Jose Herrera, from the hospital also participated. Experts from the 2 universities are involved in training the inspectors who will be in charge of carrying out the control tasks.

Food contaminated with _Salmonella_ bacteria does not usually look, smell, or taste spoiled. Symptoms of salmonellosis infection can include diarrhoea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for 4 to 7 days. In some cases, however, diarrhoea may be so severe that patients require hospitalization.
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[The serotype of _S. enterica_ is not stated and it is not clear what the food reservoir for this ongoing outbreak is. A food diary of affected persons may be helpful.

The city of Salta is located in north-western Argentina in the province of the same name which can be found on a map at

[HealthMap/ProMED-mail map of Argentina: