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Suriname

Suriname - US Consular Information Sheet
December 19, 2008
COUNTRY DESCRIPTION:
The Republic of Suriname is a developing nation located on the northern coast of South America. Tourist facilities are widely available in the capital city of
aramaribo; they are less developed and in some cases non-existent in the country's rugged jungle interior. English is widely used, and most tourist arrangements can be made in English. Please read the Department of State Background Notes on Suriname for additional information.

ENTRY/EXIT REQUIREMENTS: A passport, valid visa, and, if traveling by air, return ticket are required for travel to Suriname. There is a processing fee for business and tourist visas, and visas must be obtained before arrival in Suriname. A business visa requires a letter from the sponsoring company detailing the reason for the visit. There is an airport departure charge and a terminal fee, normally included in the price of airfare. Travelers arriving from Guyana, French Guiana, and Brazil are required to show proof of a yellow fever vaccination. For further information, travelers can contact the Embassy of the Republic of Suriname, 4301 Connecticut Avenue, NW, Suite 460, Washington, DC 20008, telephone (202) 244-7488, email: embsur@erols.com, or the Consulate of Suriname in Miami, 7235 NW 19th Street, Suite A, Miami, Fl 33126, telephone (305) 593-2697.
Visit the Embassy of Suriname web site at www.surinameembassy.org for the most current visa information.

Important information for foreigners who have the intention of staying longer than three months:
s of October 1, 2008, persons who intend to stay longer than three months in Suriname must apply for an Authorization for Temporary Stay (MVK) before travel to Suriname. The above implies that foreigners who need a visa (with the exception of foreigners of Surinamese origin) who have traveled to Suriname on a tourist or business visa will not be able to apply for residence during their stay in Suriname.

Information about dual nationality or the prevention of international child abduction can be found on our website.
For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
Demonstrations do occur, primarily in the capital or second cities, and are usually peaceful, but American citizens traveling to or residing in Suriname should take common-sense precautions and avoid large gatherings or other events where crowds have congregated to demonstrate or protest. Travelers proceeding to the interior may encounter difficulties due to limited government authority. Limited transportation and communications may hamper the ability of the U.S. Embassy to assist in an emergency situation.

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 United States and Canada, or for callers outside the United States and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

CRIME:
Criminal activity throughout the country is on the rise and foreigners, including Americans, may be viewed as targets of opportunity. Burglary, armed robbery, and violent crime occur with some frequency in Paramaribo and in outlying areas. Pick-pocketing and robbery are increasingly common in the major business and shopping districts of the capital. Visitors should avoid wearing expensive or flashy jewelry or displaying large amounts of money in public.
There have been several reports of criminal incidents in the vicinity of the major tourist hotels and night walks outside the immediate vicinity of the hotels are therefore to be avoided.
Visitors should avoid the Palm Garden area (“Palmentuin” in Dutch) after dark, as there is no police presence and it is commonly the site of criminal activity.

Theft from vehicles is infrequent, but it does occur, especially in areas near the business district. Drivers are cautioned not to leave packages and other belongings in plain view in their vehicles. There have been reports of carjackings within Paramaribo, particularly in residential areas. When driving, car windows should be closed and doors locked. The use of public minibuses is discouraged, due to widespread unsafe driving and poor maintenance.
Travel to the interior is usually trouble-free, but there have been reports of tourists being robbed. Police presence outside Paramaribo is minimal, and banditry and lawlessness are occasionally of concern in the cities of Albina and Moengo and the district of Brokopondo, as well as along the East-West Highway between Paramaribo and Albina and the Afobakka Highway in the district of Para. There have been reports of attempted and actual carjackings committed by gangs of men along the East-West Highway. Travelers proceeding to the interior are advised to make use of well-established tour companies for a safer experience.

The emergency number 115 is used for police, fire, and rescue and normally does not provide English-language services.
Fire and rescue services provide a relatively timely response, but police response, especially during nighttime hours, is a rarity for all but the most serious of crimes.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm
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 are solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care, including emergency medical care, is limited and does not meet U.S. standards. There is one public emergency room in Paramaribo with only a small ambulance fleet providing emergency transport with limited first response capabilities. The emergency room has no neurosurgeon, and other medical specialists may not always be available. As a rule, hospital facilities are not air-conditioned, although private rooms with individual air-conditioning are available at extra cost and on a space-available basis. Emergency medical care outside Paramaribo is limited and is virtually non-existent in the interior of the country.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Suriname is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Traffic moves on the left in Suriname; left-hand-drive cars are allowed on the road. Excessive speed, unpredictable movements by vehicles, and motorcyclists/bicycles, unusual right of way patterns, poorly maintained roads, and a lack of basic safety equipment on many vehicles are daily hazards on Surinamese roads. As of January 2007, seatbelts are required for all passengers of automobiles, and drivers must use a hands-free device if using a mobile phone while driving. Visitors are encouraged to use automobiles equipped with seat belts and to avoid the use of motorcycles or scooters. An international driver's license is necessary to rent a car.
The major roads in Paramaribo are usually paved, but not always well maintained. Large potholes are common on city streets, especially during the rainy seasons, which last from approximately mid-November to January, and from April to July (rainy seasons can differ from year to year by as much as six weeks). Roads are often not marked with traffic lines. Many main thoroughfares do not have sidewalks, forcing pedestrians, motorcycles, and bicycle traffic to share the same space.
The East-West Highway, a paved road that stretches from Nieuw Nickerie in the west to Albina in the east, runs through extensive agriculture areas; it is not uncommon to encounter slow-moving farm traffic or animals on the road. Travelers should exercise caution when driving to and from Nieuw Nickerie at night due to poor lighting and sharp road turns without adequate warning signs.
There are few service stations along the road, and western style rest stops are non-existent.
The road is not always well maintained, and during the rainy season, large, sometimes impassable, sink holes develop along the road.
Police recommend that travelers check with the police station in Albina for the latest safety information regarding travel between Paramaribo and Albina.
Roads in the interior are sporadically maintained dirt roads that pass through rugged, sparsely populated rain forest. Some roads are passable for sedans in the dry season, but they deteriorate rapidly during the rainy season. Interior roads are not lit, nor are there service stations or emergency call boxes. Bridges in the interior are in various states of repair. Travelers are advised to consult with local sources, including The Foundation for Nature Conservation in Suriname, or STINASU, at telephone (597) 421-683 or 476-579, or with their hotels regarding interior road conditions before proceeding.

For specific information concerning Suriname driving permits, vehicle inspection, road tax, and mandatory insurance, please contact the Embassy of Suriname in Washington, D.C., or the Consulate of Suriname in Miami.
Please refer to our Road Safety page for more information.
Visit the website of the country’s national tourist office and national authority responsible for road safety at http://www.suriname-tourism.org/cms/
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Suriname’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Suriname’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa
SPECIAL CIRCUMSTANCES:
Credit cards are not widely accepted outside the major hotels and upscale restaurants. Travelers should contact their intended hotel or tour company to confirm that credit cards are accepted. Currently, only one bank, Royal Bank of Trinidad and Tobago (RBTT), has Automatic Teller Machines (ATMs) accepting foreign ATM cards. In order to withdraw money from the ATM machines of other banks, you must have a local Surinamese bank account and ATM card. Visitors can exchange currency at banks, hotels, and official exchange houses, which are called “cambios.” Exchanging money outside these locations is illegal and can be dangerous. Telephone service within Suriname can be problematic, especially during periods of heavy rains. 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 Surinamese laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Suriname 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 residing or traveling in Suriname 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 Suriname.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at Dr. Sophie Redmondstraat 129, telephone (011) (597) 472-900, web site http://suriname.usembassy.gov. The Consular Section hours of operation for routine American citizen services are Mondays and Wednesdays from 8:00 to 10:00 AM, or by appointment, except on American and Surinamese holidays. U.S. citizens requiring emergency assistance on evenings, weekends, and holidays may contact an Embassy duty officer by cell phone at (011) (597) 088-08302. The U.S. Embassy in Paramaribo also provides consular services for French Guiana.
* * *
This replaces the Country Specific Information for Suriname dated April 11, 2008, to update the sections on Entry/Exit Requirements, Crime, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Tue 28 Mar 2017
Source: WHO Disease Outbreak News [edited]

On Thu 9 March 2017, the National Institute for Public Health and the Environment (RIVM) in the Netherlands reported a case of yellow fever to WHO. The patient is a Dutch adult female traveller who visited Suriname from the middle of February until early March 2017. She was not vaccinated against yellow fever.

The case was confirmed for yellow fever in the Netherlands by RT-PCR in 2 serum samples taken with an interval of 3 days at the Erasmus University Medical Center (Erasmus MC), Rotterdam. The presence of yellow fever virus was confirmed on Thu 9 Mar 2017 by PCR and sequencing at Erasmus MC, and by PCR on a different target at the Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.

While in Suriname, the patient spent nights in Paramaribo and visited places around Paramaribo, including the districts of Commewijne (Frederiksdorp and Peperpot) and Brokopondo (Brownsberg), the latter is considered to be the most probable place of infection. She experienced onset of symptoms (headache and high fever) on Tue 28 Feb 2017 and was admitted to an intensive care unit (University Medical Center) in the Netherlands on Fri 3 Mar 2017 with liver failure. The patient is currently in critical condition.

Suriname is considered an area at risk for yellow fever and requires a yellow fever vaccination certificate at entry for travellers over one year of age arriving from countries with risk of yellow fever, according to the WHO list of countries with risk of yellow fever transmission; WHO also recommends yellow fever vaccination to all travellers aged 9 months and older. This is the 1st reported case of yellow fever in Suriname since 1972.

Public health response

This report of a yellow fever case in the Netherlands with travel history to Suriname has triggered further investigations. Following this event, health authorities in Suriname have implemented several measures to investigate and respond to a potential outbreak in their country, including:
 - Enhancing vaccination activity to increase vaccination coverage among residents. Suriname will continue with its national vaccination programme and will focus on the district of Brokopondo. A catch-up vaccination campaign is also being conducted to increase coverage in Brownsweg.
 - Enhancing epidemiologic and entomologic surveillance including strengthening laboratory capacity.
 - Implementing vector control activities in the district Brokopondo.
 - Carrying out a survey of dead monkeys in the suspected areas.
 - Conducting social mobilization to eliminate _Aedes aegypti_ breeding sites (e.g. by covering water containers/ barrels).
 - Issuing a press release to alert the public.
 - Mapping of the suspect area of Brownsweg, as well as the Peperpot Resort.
================
[This case would suggest local transmission of yellow fever in Suriname which isn't surprising given the on-going outbreak in Brazil. This case would also suggest travelers to the area consider getting vaccinated for yellow fever prior to entering the country. One wonders if perhaps the local wildlife may be acting as a reservoir as well based on the outbreaks seen in monkeys in Brazil. - ProMED Mod.JH]

[A HealthMap/ProMED-mail map can be accessed at:
Eurosurveillance, Volume 22, Issue 11, 16 March 2017
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22744

A Dutch traveller returning from Suriname in early March 2017, presented with fever and severe acute liver injury. Yellow fever was diagnosed by (q)RT-PCR and sequencing. During hospital stay, the patient’s condition deteriorated and she developed hepatic encephalopathy requiring transfer to the intensive care. Although yellow fever has not been reported in the last four decades in Suriname, vaccination is recommended by the World Health Organization for visitors to this country.

Yellow fever virus (YFV) is known to be enzootic in South America, causing periodic outbreaks of disease in monkeys and humans in some countries. In Brazil, there has been an outbreak of yellow fever ongoing since December 2016 with 1,500 cases as at 9 March [1,2]. Here we report an imported case of human infection with YFV in a traveller returning from Suriname, on the north-eastern coast of South America, from where the last case of yellow fever was reported 45 years ago.

Case description

In March 2017, a Dutch Caucasian female in her late 20s from the Netherlands was referred to the University Medical Center Groningen in the Netherlands because of high fever and signs of severe acute liver injury after returning from a two-week stay in Suriname. She had no co-morbidities apart from obesity (body mass index around 40 kg/m2, norm: 18.5–25 kg/m2). During her visit she stayed in the capital of Suriname, Paramaribo, and she made several daytrips by boat and car, of which two in the tropical rainforest (Figure).

Figure

Timeline of events and diagnostic results, case of yellow fever in a traveller returning from Suriname to the Netherlands, March 2017

/images/dynamic/articles/22744/17-00187-f1

P: Paramaribo; RNA: ribonucleic acid; UMCG: University Medical Center Groningen; YFV: yellow fever virus.

She recalled having been bitten by mosquitoes during her hike at Brownsberg, a nature resort in the rainforest with wildlife. Before her travel, she did not visit a travel clinic and did not receive yellow fever vaccination. On day 12 of her visit in Suriname, she experienced mild muscle pain, headache and nausea and she developed a high-grade fever. She returned to the Netherlands on day 15 and visited the emergency department of a secondary care centre, from where she was referred to our University hospital. At physical examination she was not icteric. Except for a temperature of 39.9 °C, vital parameters were normal. The results of the remaining physical examination were unremarkable. Laboratory testing revealed leukopenia (leukocytes 0.9x109/L, norm: 4.0–10.0x109/L) and massive liver injury (aspartate aminotransferase 5,787 U/L, norm: <31 U/L; alanine aminotransferase 4,910 U/L, norm: <34 U/L), with mildly elevated bilirubin levels (total bilirubin 20 µmol/L, norm: <17 µmol/L). Liver synthesis was impaired as revealed by increased clotting times (activated partial thromboplastin time (APTT): 49s, norm: 23–33s; prothrombin time (PT): 26.6s, norm: 9.0–12.0s) and reduced antithrombin (49%, norm: 80–120%). Fibrinogen was diminished suggestive of diffuse intravascular coagulation. Renal function was normal apart from severe albuminuria (up to 22.6 g/24h, norm: 0g/24h). Malaria, viral hepatitis (A, B, C, E, Epstein Barr virus, cytomegalovirus, herpes simplex virus), dengue, chikungunya and Zika were ruled out (Table). Diagnostic tests to exclude leptospirosis performed on day 6 post onset of symptoms (dps 6) were inconclusive (Table) and a convalescent serum was going to be tested at the time of publication. Because of the combination of fever, leukopenia, thrombocytopenia, liver injury and travel history, yellow fever was included in the differential diagnosis. Real-time reverse transcriptase PCR (qRT-PCR) was positive for YFV in serum taken on dps 3. On dps 7 the patient’s condition deteriorated due to hepatic encephalopathy (ammonia 149 µmol/L, norm: 15–45 µmol/L). Cerebral oedema and bleeding was ruled out by computed tomography (CT)-scan. The patient was transferred to the intensive care unit for close observation of vital parameters. Vitamin K was administered. Hepatic encephalopathy was treated with rifaximin and lactulose. Ceftriaxone (2g per day intravenously) was given for 7 days as antibiotic prophylaxis. Consequently, possible leptospirosis was also treated. Her neurological condition stabilised on dps 10 together with the coagulation parameters. On dps 13 the patient was transferred back to the ward.

Table

Pathogens for which laboratory tests were performed, yellow fever case, the Netherlands, March 2017


Pathogen Blood (day 3 post onset of symptoms)
Plasmodium spp. Thick smear negative, antigen test negative
Hepatitis A virus IgM and IgG negative
Hepatitis B virus Serological screening negative
Hepatitis C virus Serological screening negative
Hepatitis E virus PCR negative
Epstein Barr virus IgM and IgG negative
Cytomegalovirus IgM and IgG negative
Herpes simplex virus type 1 and 2 PCR negative
Dengue virus PCR negative, IgM and IgG negative
Chikungunya virus PCR negative, IgM and IgG negative
Zika virus PCR negative, IgM and IgG negativea
Leptospira spp. PCR negative, microscopic agglutination test negative, IgM 1:80b

a Performed on day 5 post onset of symptoms (dps 5).

b ELISA (in-house ELISA Dutch Leptospirosis Reference Center) performed on dps 6 showed IgM 1:80 (cut-off positive IgM ≥1:160). IgM results were negative on dps 3 and dps 7 using Leptocheck-WB (Zephyr Biomedicals, Goa, India).

Virology findings

qRT-PCR and/or pan-flavivirus RT-PCR on blood samples on dps 3 did not detect chikungunya virus (CHIKV), dengue virus (DENV), or Zika virus (ZIKV) (Table) [3,4]. In four consecutive samples of dps 3–6, YFV-RNA was detected (Figure) [4-6], with increasing Ct values (from 23 to 31 from dps 3 to dps 5 [5] and 39 on dps 6 [6]). Sequencing of a 176 bp pan-flavivirus hemi-nested RT-PCR product, targeting part of the NS5 genomic region confirmed YFV infection [4]. The sequence was deposited in the GenBank database under the following accession number: KY774973.

On dps 3, indirect immunofluorescence assays (IFA) was negative for IgM and IgG against YFV (Flavivirus Mosaic, Euroimmun AG, Luebeck, Germany). A convalescent sample of dps 6 was clearly positive for YFV IgM (titre 1:10, Figure), with non-reactive IgG. This anti-YFV IgM response on dps 6 is in line with literature stating that IgM antibodies usually appear during the first week of illness. Neutralising IgG antibodies are likely to appear towards the end of the first week after onset of illness and will be tested for in convalescent serum [7].

Background

YFV is a mosquito-borne virus in the genus Flavivirus, family Flaviviridae, related to DENV, ZIKV, tick-borne encephalitis virus and West Nile virus. YFV is maintained in a sylvatic cycle between non-human primates and so-called ‘jungle’-mosquitoes (Hemagogus and Sabethes spp. in South America) [8]. Sporadic infection of humans with sylvatic YFV can occur when unprotected humans are exposed while entering the habitats where the viruses circulate. Subsequent introduction of a viraemic human case to urban areas with high population densities and Aedes aegypti mosquitoes can initiate an urban transmission cycle [9]. YFV is endemic in (sub)tropical areas of South America and Africa. The risk for YFV infection in South America is the highest in tropical regions and during the rainy season (January–May) when mosquito population densities peak [10]. In 2011, Suriname was identified by the World Health Organization (WHO) as one of 14 South American countries at risk for YFV transmission based on current or historic reports of yellow fever, plus the presence of competent mosquito vectors and animal reservoirs [11].

Since December 2016, an outbreak of sylvatic YFV is ongoing in Brazil; as at 9 March 2017, there were 371 confirmed and 966 suspected human cases, while a total of 968 epizootics in non-human primates have been reported, of which 386 were confirmed [2]. So far, there has been no evidence for a change from sylvatic to an urban transmission cycle [1]. In addition, Bolivia, Colombia and Peru have reported suspected and confirmed yellow fever cases in 2017 [2].

A subclinical infection with YFV is believed to occur in most infected people. In symptomatic cases, symptoms of general malaise occur after an incubation period of 3–6 days (range 2–9 days), followed by remission of the disease in the majority of patients. However, 15-25% of symptomatic persons develop a complicated course of illness, in which symptoms recur after 24–48 hours, with a reported mortality of 20-60% [7,12]. This phase is characterised by fever, abdominal symptoms, severe hepatic dysfunction and jaundice, multi-organ failure and haemorrhagic diathesis. As no specific antiviral treatment is currently available, treatment consists of supportive care [7,12].

Discussion

Although Suriname is considered to be endemic for YFV, no human cases have been officially reported since 1971 [13]. With a population of ca 570,000 people, Suriname has a YFV vaccination coverage of 80–85% in infants [14]. Although WHO recommends vaccination for travellers to countries with risk of YFV transmission like Suriname, sporadic cases of imported yellow fever in returning travellers have been reported for example in Europe, the United States and Asia [15-17], with three reported cases related to the ongoing YFV outbreaks in South America in European travellers since 2016 [18,19]. The establishment of ongoing YFV circulation in Suriname extends the current YFV activity in South America to five countries [2]. However, despite the presence of competent Ae. albopictus mosquitoes in France [20] and Ae. aegypti in Madeira, the risk for YFV transmission in Europe is currently considered to be very low due to the lack of vector activity [18]. An effective, safe live-attenuated YFV vaccine is available for people aged ≥ 9 months and offers lifelong immunity [7]. Vaccination is advised by the WHO for all travellers to Suriname, for the coastal area as well as the inlands [21]. With regard to yellow fever, pre-travel health advice should take into account destination, duration of travel, season and the likelihood of exposure to mosquitoes (in rural areas, forests versus urban areas), and potential contraindications for vaccination with a live-attenuated vaccine.

The multi-country YFV activity might reflect current, wide-spread ecological conditions that favour elevated YFV transmissibility among wildlife and spill-over to humans. Thorough sequence analysis of currently circulating strains in Brazil, Bolivia, Colombia, Peru and Suriname should provide insight whether the human cases in these countries are epidemiologically linked or represent multiple, independent spill-over events without extensive ongoing community transmission. Because of its potential public health impact, our case of yellow fever was notified to the WHO and the European Union Early Warning and Response System on 9 March 2017, according to the international health regulations [22].

Conclusion

Clinicians in non-endemic countries should be aware of yellow fever in travellers presenting with fever, jaundice and/or haemorrhage returning from South America including Suriname. This case report illustrates the importance of maintaining awareness of the need for YFV vaccination, even for countries with risk of YFV transmission that have not reported cases for decades.

Date: Fri 11 Dec 2015
From: Abraham Goorhuis, MD <a.goorhuis@amc.nl> [edited]

We report a confirmed case of Zika virus infection in a 60-year-old and otherwise healthy female patient, who had returned from Suriname on 29 Nov 2015, following a 3-week holiday. She had visited Paramaribo, Carolina Kreek, Klaaskreek and the Commewijne province. On the day of return to the Netherlands, she developed fever, itching in the hands and a red skin rash on the face, neck, trunk and extremities. The skin was painful upon touch and the joints of her fingers and ankles felt stiff. She also reported swelling of both lower legs. She reported multiple insect bites. She presented at our outpatient clinic at the AMC in Amsterdam, the Netherlands, on 2 Dec 2015, the 3rd day of her illness.

Physical examination showed an afebrile patient who was not acutely ill. She had a pronounced macular skin rash of her trunk, extremities, neck and face, as well as a marked conjunctival injection. In addition, she had pitting oedema on both lower legs.

Laboratory investigation showed a normal red and white blood cell count, with atypical lymphocytes in the differential. Renal function and liver enzymes were normal, except for a slightly elevated LDH of 297 IU/l.

One day after her initial presentation, the skin rash had improved markedly. She recovered quickly. Upon follow-up on 11 Dec 2015, her only complaints were arthralgias that seemed to further improve.

The clinical diagnosis of Zika virus infection was confirmed by PCR (Erasmus MC, Rotterdam), on a sample taken on 2 Dec 2015 (the 3rd day of illness).

To date, Zika virus infection has been rarely reported as cause of febrile illness among returned travellers and this is the 1st confirmed case in the Netherlands. Because symptomatology and clinical course are often mild, it is likely that the diagnosis is easily missed. Given the expanding base of information regarding complications possibly associated with this disease (such as neurologic manifestations and the reported increase of infants born with microcephaly in endemic areas), it is important to facilitate diagnostic capacities. This case underscores the fact that changing epidemiology of infectious disease also affects the spectrum of disease in returned travelers. Among other arboviral infections, such as dengue and chikungunya, Zika virus infection should be included in the differential diagnosis of any febrile traveler who has returned from an endemic area, such as Suriname.
------------------------------------
Abraham Goorhuis, MD, on behalf of the medical team
Center of Tropical and Travel Medicine
Academic Medical Center
Amsterdam
The Netherlands
=====================
[Although ProMED does not normally post case reports of arboviruses imported into countries with no possibility of ongoing mosquito transmission unless there is something unusual about them, this case is important for the very reasons noted above. With Zika virus expanding its geographic range in the Americas, we are likely to see more cases imported into a variety of localities where it has not occurred before. The sound advice of Dr. Goorhuis and colleagues to include Zika virus, along with dengue and chikungunya viruses in differential diagnoses when patients with histories of travel to Zika-endemic countries seek medical attention for febrile disease with rash is prudent. This case also illustrates the need to obtain patient travel histories. And clinicians should not forget that there was good evidence of sexual transmission when an infected man infected in Africa returned to his home in a country where Zika virus was not present ((see ProMED-mail archive no.  http://promedmail.org/post/20150516.3367156).

ProMED thanks Dr. Goorhuis and colleagues for submitting this case report.

It was not surprising that Zika virus arrived in Suriname, since 2 other countries in northern South America -- adjacent Brazil and somewhat more distant Colombia -- have reported ongoing cases. Transmission of the virus is continuing there.

A map showing the location of Suriname in northeastern South America can be accessed at
<http://healthmap.org/promed/p/37>. - ProMed Mod.TY]
Date: Tue 3 Nov 2015
Source: Loop [edited]

There are 2 confirmed cases of the Zika virus, also known as Zik-V.

These cases were confirmed by the AZP [Academisch Ziekenhuis Paramaribo, a scientific research center in Paramaribo, Suriname]. The Bureau of Public Health (BOG) has made it known that it requires external confirmation of these results. This stance has dismayed AZP Lab director John Codrington, who stated that it shows a lack of confidence in local authority.

The BOG has made it clear why they have come to this decision. They will conduct further tests through the CARPHA [Caribbean Public Health Agency] because this is the 1st possible instance of the virus locally; the virus is similar in presentation to other ailments such as dengue fever and chikungunya, also known as Chik-V; and the positive test cases may have brought it back from foreign travels.

The call for further study will not disrupt any preventative measures as doctors have been armed with the necessary information that the public requires regarding the nature and procedures surrounding the virus. Its similarity to dengue and Chik-V means that a similar approach to prevention is required.

People need to ensure that their homes and communities are free of mosquito-friendly breeding grounds. As with the chikungunya virus, there is no vaccine or preventive drug for Zik-V, and only treatment of symptoms is possible. Usually non-steroid anti-inflammatories and/or non-salicylic analgesics are used.

While there is no cure or vaccine for the virus, health officials urge people to reduce the risk of contracting Zika virus infection by using the following measures:

Use anti-mosquito devices (insecticide-treated bed nets, coils, smudge pots, spray, repellents) and wearing long sleeves and clothes with long legs, especially during the hours of highest mosquito activity (morning and late afternoon).

Mosquito repellent based on a 30 per cent DEET concentration is recommended -- for new-born children under 3 months, repellents are not recommended; instead, insecticide-treated bed nets should be used.

Before using repellents, pregnant women and children under the age of 12 years should consult a physician or pharmacist.

Unlike Chik-V, Zik-V can also be transmitted through sexual contact.

[byline: Jonathan Stuart]
=================
[It would not be surprising if Zika virus has arrived in Suriname, since 2 other countries in northern South America -- adjacent Brazil and somewhat more distant Colombia -- have reported ongoing cases. The report does not indicate if these 2 cases are locally acquired or are imported cases of Zika virus infection. Sending samples to an outside international reference laboratory is prudent in situations when a new pathogen appears. The AZP laboratory should welcome confirmation of their test results.

A map showing the location of Suriname in north eastern South America can be accessed at
<http://healthmap.org/promed/p/37>. - ProMED Mod.TY]
Monday 30th January 2012
A ProMED-mail post
<http://www.promedmail.org>

- Suriname. 25 Jan 2012. "Up to now more than 300 dengue cases have been registered at the Academic hospital lab, while other labs also confirm cases," the health ministry said in a press release. With the dengue outbreak now a month old, health authorities said they believe cases of the mosquito-borne disease are peaking. Due to overcrowding in hospitals, patients were being treated in the army's health facilities.
======================
[A HealthMap/ProMED-mail interactive map of Suriname can be accessed at <http://healthmap.org/r/1GZ2>. - ProMed Mod.TY]
More ...

World Travel News Headlines

Date: Tue, 31 Mar 2020 10:27:16 +0200 (METDST)

Nairobi, March 31, 2020 (AFP) - Six of Africa's 54 nations are among the last in the world yet to report cases of the new coronavirus. The global pandemic has been confirmed in almost every country, but for a handful of far-flung tiny island states, war-torn Yemen and isolated North Korea.  In Africa authorities claim they are spared by god, or simply saved by low air traffic to their countries, however some fear it is lack of testing that is hiding the true impact.

- South Sudan -
The east African nation is barely emerging from six years of civil war and with high levels of hunger, illness and little infrastructure, observers fear the virus could wreak havoc.   Doctor Angok Gordon Kuol, one of those charged with overseeing the fight against the virus, said the country had only carried out 12 tests, none of which were positive.   He said the reason the virus has yet to reach South Sudan could be explained by the low volume of air traffic and travel to the country.   "Very few airlines come to South Sudan and most of the countries affected today they are affected by... people coming from abroad."   He said the main concern was foreigners working for the large NGO and humanitarian community, or people crossing land borders from neighbouring countries.   South Sudan has shut schools, banned gatherings such as weddings, funerals and sporting events and blocked flights from worst-affected countries. Non-essential businesses have been shuttered and movement restricted.   The country can currently test around 500 people and has one isolation centre with 24 beds.

- Burundi -
In Burundi, which is gearing up for general elections in May, authorities thank divine intervention for the lack of cases.   "The government thanks all-powerful God who has protected Burundi," government spokesman Prosper Ntahorwamiye said on national television last week.   At the same time he criticised those "spreading rumours" that Burundi is not capable of testing for the virus, or that it is spreading unnoticed.   Some measures have been taken, such as the suspension of international flights and placing handwashing stations at the entrances to banks and restaurants in Bujumbura.   However several doctors have expressed their concerns.   "There are zero cases in Burundi because there have been zero tests," a Burundian doctor said on condition of anonymity.

- Sao Tome and Principe -
Sao Tome and Principe -- a tiny nation of small islands covered in lush rainforest -- has reported zero cases because it is unable to test, according to World Health Organisation representative Anne Ancia.   However "we are continuing preparations," with around 100 people in quarantine after returning from highly-affected countries, and the WHO keeping an eye on cases of pneumonia.   With only four ICU beds for a population of 200,000 people, the country is desperate to not let the virus take hold and has already shut its borders despite the importance of tourism to the local economy.

- Malawi -
Malawi's health ministry spokesman Joshua Malango brushed aside fears that Malawi might not have registered any Covid-19 cases due to a lack of testing kits: "We have the testing kits in Malawi and we are testing."   Dr Bridget Malewezi from the Society of Medical Doctors told AFP that while "we may not be 100 percent ready", government was gearing up for the arrival of the virus.   She suggested it may only be a matter of time before the pandemic hits Malawi.    "It's only been in the past few weeks that it has been rampantly spreading across Africa so most people feel it will get here at some point...," she said.   Malawi has asked people coming from hard-hit countries to self-quarantine, which Malawezi said had helped "safeguard the country from any possible spread of the virus".

- Lesotho -
Tiny Lesotho, a kingdom encircled by South Africa with only two million inhabitants, went into national lockdown on Monday despite registering zero cases.   Until last week the country had no tests or testing centres, and received its first kits thanks to a donation by Chinese billionaire Jack Ma.   Authorities had reported eight suspected cases which they had not been able to test and the first results are expected soon.

- Comoros -
The Indian Ocean island nation of the Comoros, situated between Madagascar and Mozambique, has yet to detect a single case of the virus, according to the health ministry.   One doctor in the capital Moroni, Dr Abdou Ada, wonders if it may not be because of the wide use of the drug Artemisinin to treat malaria.   "I believe that the mass anti-malarial treatment explains the fact that the Comoros are, at least for now, spared from Covid-19. it is a personal belief that needs to be confirmed scientifically."
Date: Tue, 31 Mar 2020 09:50:04 +0200 (METDST)
By Sophie DEVILLER with Dene-Hern CHEN

Bangkok, March 31, 2020 (AFP) - Underfed and chained up for endless hours, many elephants working in Thailand's tourism sector may starve, be sold to zoos or be shifted into the illegal logging trade, campaigners warn, as the coronavirus decimates visitor numbers. Before the virus, life for the kingdom's estimated 2,000 elephants working in tourism was already stressful, with abusive methods often used to 'break them' into giving rides and performing tricks at money-spinning animal shows.   With global travel paralysed the animals are unable to pay their way, including the 300 kilograms (660 pounds) of food a day a captive elephant needs to survive.

Elephant camps and conservationists warn hunger and the threat of renewed exploitation lie ahead, without an urgent bailout. "My boss is doing what he can but we have no money," Kosin, a mahout -- or elephant handler -- says of the Chiang Mai camp where his elephant Ekkasit is living on a restricted diet.   Chiang Mai is Thailand's northern tourist hub, an area of rolling hills dotted by elephant camps and sanctuaries ranging from the exploitative to the humane.   Footage sent to AFP from another camp in the area shows lines of elephants tethered by a foot to wooden poles, some visibly distressed, rocking their heads back and forth.

Around 2,000 elephants are currently "unemployed" as the virus eviscerates Thailand's tourist industry, says Theerapat Trungprakan, president of the Thai Elephant Alliance Association. The lack of cash is limiting the fibrous food available to the elephants "which will have a physical effect", he added.  Wages for the mahouts who look after them have dropped by 70 percent.   Theerapat fears the creatures could soon be used in illegal logging activities along the Thai-Myanmar border -- in breach of a 30-year-old law banning the use of elephants to transport wood.  Others "could be forced (to beg) on the streets," he said. It is yet another twist in the saga of the exploitation of elephants, which animal rights campaigners have long been fighting to protect from the abusive tourism industry.

- 'Crisis point' -
For those hawking a once-in-a-lifetime experience with the giant creatures -- whether from afar or up close -- the slump began in late January.   Chinese visitors, who make up the majority of Thailand's 40 million tourists, plunged by more than 80 percent in February as China locked down cities hard-hit by the virus and banned external travel. By March, the travel restrictions into Thailand -- which has 1,388 confirmed cases of the virus -- had extended to Western countries.

With elephants increasingly malnourished due to the loss of income, the situation is "at a crisis point," says Saengduean Chailert, owner of Elephant Nature Park.   Her sanctuary for around 80 rescued pachyderms only allows visitors to observe the creatures, a philosophy at odds with venues that have them performing tricks and offering rides.   She has organised a fund to feed elephants and help mahouts in almost 50 camps nationwide, fearing the only options will soon be limited to zoos, starvation or logging work.  For those restrained by short chains all day, the stress could lead to fights breaking out, says Saengduean, of camps that can no longer afford medical treatment for the creatures.

Calls are mounting for the government to fund stricken camps to ensure the welfare of elephants. "We need 1,000 baht a day (about $30) for each elephant," says Apichet Duangdee, who runs the Elephant Rescue Park. Freeing his eight mammals rescued from circuses and loggers into the forests is out of the question as they would likely be killed in territorial fights with wild elephants. He is planning to take out a two million baht ($61,000) loan soon to keep his elephants fed.   "I will not abandon them," he added.
Date: Tue, 31 Mar 2020 07:10:34 +0200 (METDST)
By Bernadette Carreon

Koror, Palau, March 31, 2020 (AFP) - A coronavirus-free tropical island nestled in the northern Pacific may seem the perfect place to ride out a pandemic -- but residents on Palau say life right now is far from idyllic.   The microstate of 18,000 people is among a dwindling number of places on Earth that still report zero cases of COVID-19 as figures mount daily elsewhere.   The disparate group also includes Samoa, Turkmenistan, North Korea and bases on the frozen continent of Antarctica.

A dot in the ocean hundreds of kilometres from its nearest neighbours, Palau is surrounded by the vast Pacific, which has acted as a buffer against the virus.   Along with strict travel restrictions, this seems to have kept infections at bay for a number of nations including Tonga, the Solomons Islands, the Marshall Islands and Micronesia.   But remoteness is not certain to stop the relentless march of the new disease. The Northern Mariana Islands confirmed its first cases over the weekend, followed by a suspected death on Monday.

Klamiokl Tulop, a 28-year-old artist and single mum, is hopeful Palau can avoid the fate of Wuhan, New York or Madrid -- where better-resourced health services were overrun.   But she describes a growing sense of dread, a fear that the virus is coming or could already be on the island undetected.   "You can feel a rising tension and anxiety just shopping," she told AFP. "Stores are crowded even more during non-payday weeks."   There have been several scares on Palau, including a potential case that saw one person placed into quarantine this week as authorities await test results.

- Antarctic seclusion -
Inside Australia's four remote Antarctic research bases, around 90 people have found themselves ensconced on the only virus-free continent as they watch their old home transform beyond recognition.   There is no need for social distancing in the tundra.   "They're probably the only Australians at the moment that can have a large dinner together or have the bar still open or the gym still open," Antarctic Division Operations manager Robb Clifton told AFP.   The bases are now isolated until November, so the group is safe, but Clifton admits "the main thing that's on the mind of expeditioners is how their loved ones are going back home."

In some places, reporting no cases does not always mean there are no cases to report.   North Korea has portrayed emergency measures as an unqualified success in keeping COVID-19 out, despite sustained epidemics in neighbouring China and South Korea.   But state media also appears to have doctored images to give ordinary North Koreans face masks -- handing sceptics reason to believe the world's most secretive government may not be telling the whole truth.

- 'Waiting for the inevitable?' -
While Palau has no confirmed cases, it has still been gripped by the society-altering fears and economic paralysis that have affected the rest of the world.   Supermarket aisles in the country's largest town Koror have seen panic buying and there are shortages of hand sanitisers, masks and alcohol.   The islands depend heavily on goods being shipped or flown in, meaning supplies can quickly run low.

United Airlines used to fly six times a week from nearby Guam -- which has seen more than 50 cases -- but now there is just one flight a week.   "Look at how bad we coped when shipments were late before this pandemic happened," Tulop said. "Everyone was practically in uproar."   Residents have been practising social distancing. Doctors are waiting for test kits to arrive from Taiwan. The government is building five isolation rooms that will be able to hold up to 14 patients.   It all feels like waiting for the inevitable.   "I would like to be optimistic we won't get the virus," Tulop said. "But Palau would most definitely get it. We rely heavily on tourism and most of us even need to travel for work."

Rondy Ronny's job is to host big tourist events, but work has already dried up, and he admits to being "very anxious".   "I have loans and bills and payments due," he said. "This will definitely put me back, I hope the government will do something about our economy too, to help it recover."   Palau's biggest test may yet come with the first positive case.   But even in the most remote corners of the world, the impact of this truly global pandemic is already being felt.   Nowhere, it seems, is truly virus-free.
Date: Tue, 31 Mar 2020 04:46:26 +0200 (METDST)

Panama City, March 31, 2020 (AFP) - The government of Panama on Monday announced strict quarantine measures that separate citizens by gender in an effort to slow the spread of the novel coronavirus.   From Wednesday, men and women will only be able to leave their homes for two hours at a time, and on different days.   Until now, quarantine regulations were not based on gender.

Men will be able to go to the supermarket or the pharmacy on Tuesdays, Thursdays and Saturdays, and women will be allowed out on Mondays, Wednesdays and Fridays.   No one will be allowed to go out on Sundays.

The new measures will last for 15 days.   "This absolute quarantine is for nothing more than to save your life," security minister Juan Pino said at a press conference.   According to Pino, more than 2,000 people were detained last week for not abiding by the quarantine.   Since the first case was reported on March 10, Panama has confirmed 1,075 cases of the coronavirus, 43 of which are in intensive care, and 27 deaths.
Date: Tue, 31 Mar 2020 00:54:08 +0200 (METDST)
By Celia Lebur with AFP Africa Bureaux

Lagos, March 30, 2020 (AFP) - More than 20 million Nigerians on Monday went into lockdown in sub-Saharan Africa's biggest city Lagos and the capital Abuja, as the continent struggles to curb the spread of coronavirus.   President Muhammadu Buhari ordered a two-week "cessation of all movements" in key cities to ward off an explosion of cases in Africa's most populous country.

Businesses are being closed, non-food shops shut and people required to stay at home as officials look to track down possible carriers of the disease after reporting 131 confirmed cases and two deaths so far.   Enforcing the restrictions in sprawling Lagos will be a mammoth challenge as millions live crammed into slums and rely on daily earnings to survive.

In the ramshackle outdoor markets of Lagos Island, anxious locals complained they did not have the money to stock up, while at higher-end supermarkets better-off residents queued to buy supplies.    "Two weeks is too long. I don't know how we will cope," said student Abdul Rahim, 25, as he helped his sister sell foodstuffs from a stall in Jankarra market.    "People are hungry and they won't be able to stock food."

City officials have pledged to provide basic provisions to 200,000 households but the central government in Africa's largest oil producing nation is already facing financial strain as the price of crude  has collapsed.    The streets of Ghana's capital Accra were also empty as most people in two regions appeared to be following a presidential order to stay indoors after it went into force.

- Zimbabwe locks down -
Dozens of African nations have imposed restrictions ranging from night-time curfews to total shutdowns.    Zimbabwe, which is already suffering a recession, began enforcing a three-week lockdown after the disease left one person dead and infected six others.   Police mounted checkpoints on routes leading to Harare's central business district, stopping cars and turning away pedestrians who had no authorisation to be in the area.   "We don't want to see people here on the streets. We don't want to see people who have no business in town just loitering," a policewoman said through a loud hailer. "Everyone to their homes."

Some people were trying to head for villages.   "We would rather spend the 21 days at our rural home, where we don't have to buy everything. I can't afford to feed my family here when I am not working," said Most Jawure.   "We have been waiting here for more than two hours but there are no buses," Jawure told AFP while standing with his wife and daughter beside a bulging suitcase.

For many of Zimbabwe's 16 million people, the lockdown means serious hardship.   With the unemployment rate estimated at around 90 percent, most Zimbabweans have informal jobs to eke out a living and few have substantial savings.   As a similar scenario played out in other poor nations, the UN on Monday called for a $2.5-trillion aid package to help developing countries weather the pandemic, including debt cancellation and a health recovery "Marshall Plan".

- 'A matter of time' -
Experts warn that Africa is highly vulnerable to COVID-19 given the weak state of health systems across the continent.    The number of infections lags far behind Europe but testing has been limited and the figures are growing rapidly.    Angola and Ivory Coast on Sunday became the latest countries to record their first deaths, bringing the number of African fatalities to around 150 of nearly 4,800 recorded cases.

In Democratic Republic of Congo, two new cases were reported in the volatile South Kivu region and an adviser to the nation's president announced he had tested positive.

Ugandan President Yoweri Museveni ordered a 14-day lockdown in a bid to halt the spread of the disease after reporting 33 infections.    Police in South Sudan, one of a few nations in Africa yet to confirm a case, enforced strict new rules, shutting shops selling non-essential items and limiting passengers in public transport.   Mauritius, which has 128 cases -- the highest in East Africa -- has extended its lockdown to April 15.

South Africa's defence minister Nosiviwe Mapisa-Nqakula on Monday denounced alleged intimidation by security forces after videos emerged showing some forcing civilians to squat or roll on the ground for allegedly violating restrictions.   In an interview with local Newzroom Afrika television channel, she said she was aware of two videos "which have circulated where clearly there (is) some abuse".   "I'm saying I condemn that, we will not allow that to continue," she said.
Date: Mon, 30 Mar 2020 21:41:43 +0200 (METDST)

Kampala, March 30, 2020 (AFP) - Ugandan President Yoweri Museveni on Monday ordered an immediate 14-day nationwide lockdown in a bid to halt the spread of the coronavirus which has so far infected 33 people in the country.   Uganda last week banned public transport and sealed its borders and urged the population to stay home, but stopped short of a full shutdown.

Museveni said that from 10:00pm Monday private vehicles would also be banned, seeking to avoid give a more advanced warning that would see people flee the city, as has happened across the continent where many poor residents see better chances of survival in the countryside.   "I would have given the public time to adjust but... a longer time would give people time to go to the villages and in so doing they would transfer the very sickness we're trying to prevent. This freezing of movement will last for 14 days," he said in a televised address.

Museveni also ordered a 14-day nationwide curfew from 7:00pm.   Shopping malls and businesses selling non-food items were ordered to close.   Food market vendors who continue to trade are forbidden to return to their homes for the duration of the 14-day lockdown, while factories could stay open if remain on the premises for the duration of the shutdown.

People are still allowed to move around on foot but not gather in groups of more than five at a time.    In recent days, opposition leaders Kizza Besigye and Bobi Wine had undertaken small-scale food deliveries to people who had ost their incomes due to earlier restrictions but Museveni criticised such actions as "cheap politics".   "I direct the police to arrest the opportunistic and irresponsible politicians who tried to distribute food," he said.   "Anybody arrested in that effort will be charged with attempted murder."   Museveni said the government would begin distributing food to those who needed it, without providing details.

A weary looking Museveni, 75, pleaded with the population to change their behaviour in the face of the threat from the virus.   "This virus would not do much damage if it was not for the carelessness of people. Don't go into a group of people if you have a cold. Stay at home," he pleaded.   Last week police and Local Defence Units (LDUs) -- a uniformed militia under the control of the military - violently cleared streets in central Kampala.   Following a public outcry, army chief General David Muhoozi on Monday apologised for those actions, describing them as "high-handed, unjustified and regrettable" and said the culprits would be "dealt with".
Date: Sun 29 Mar 2020
Source: Spanish government COVID-19 update 58 [in Spanish, trans. ProMed Mod.MPP, edited]

COVID-19 update 59 [data as of 28 Mar 2020 21:00 CET]
-----------------------------------------------------
Situation in Spain
------------------
In Spain, to date [28 Mar 2020], 78 797 cases have been reported, of which 6528 have died and 14,709 recovered (table 1 and figure 1 -- at source URL above). The Autonomous Communities with the greater cumulative incidence in the last 14 days are La Rioja 419.5 per 100,000 population), Madrid 287.1 per 100,000 population), Navarre (279.4 per 100,000 population), and Castile-La Mancha (238.3 per 100,000 population) (figures 2, 3). The distribution by age groups of hospitalized patients, those admitted to the ICU, and deaths is found in table 2.

Autonomous Community:
Total / last 24 hours / Incidence per 100,000 population in past 14 days

  • Madrid: 22,677 / 1157 / 287.14
  • Catalonia: 15,026 / 763 / 186.46
  • Basque Country: 5740 / 604 / 231.45
  • Castile and Leon: 5414 / 623 / 213.46
  • Castile-La Mancha: 5246 / 734 / 238.33
  • Valencia: 4784 / 750 / 87.43
  • Andalusia: 4682 / 405 / 50.45
  • Galicia: 3139 / 367 / 109.06
  • Navarre: 2011 / 182 / 279.42
  • Aragon: 1858 / 266 / 129.69
  • La Rioja: 1629 / 193 / 419.51
  • Extremadura : 1456 / 62 / 127.47
  • Canary Islands: 1125 / 100 / 47.18
  • Asturias: 1088 / 84 / 92.98
  • Cantabria: 1023 / 86 / 167.28
  • Balearic Islands: 958 / 96 / 79.69
  • Murcia: 872 / 70 / 53.62
  • Melilla: 48 / 3 / 46.25
  • Ceuta: 21 / 4 / 23.59
********
Total: 78,797 / 6549 / 151.04
======================
[Spain has been rapidly accelerating in terms of transmission of the SARS-CoV-2. As of today (29 Mar 2020), there have been a total of 78 797 cases and 6528 deaths reported, an increase from 72 248 cases with and 5690 deaths confirmed in the preceding 24 hours. The countrywide 2-week incidence per 100 000 population is 151. It is now 2nd in Europe, behind Italy, and 4th globally behind the USA, Italy, and China, in terms of absolute numbers of cases.

Of the 78,797 cases, 43 397 (55.1%) were hospitalized, 4907 (6.2%) were admitted to the ICU. The crude reported death rate was 8.3% with more deaths occurring than reported ICU admissions.

A map of Spain showing provinces (autonomous communities) can be seen at
and a HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/43>.

La Rioja, Navarre, and Basque Country are located together in the north of the country. Madrid is in the northern part of central Spain and Castilla de la Mancha is just to the south of Madrid, with Toledo as its capital. - ProMed Mod.MPP]
Date: Sun 29 Mar 2020
Source: Worldometer [accessed 10:30 PM EDT]

USA cases by state
State: Total cases / New cases

  • New York: 59,648 / 6193
  • New Jersey: 13,386 / 2262
  • California: 6312 / 653
  • Michigan: 5486 / 836
  • Massachusetts: 4955 / 698
  • Florida: 4950 / 912
  • Washington: 4483 / 173
  • Illinois: 4596 / 1105
  • Louisiana: 3540 / 225
  • Pennsylvania: 3419 / 668
  • Texas: 2808 / 479
  • Georgia: 2683 / 237
  • Colorado / 2307 / 246
  • Connecticut: 1993 / 469
  • Tennessee: 1720 / 208
  • Ohio: 1653 / 247
  • Indiana: 1514 / 282
  • Maryland: 1239 / 247
  • North Carolina: 1167 / 145
  • Wisconsin: 1154 / 165
  • Nevada: 920 / 299
  • Arizona: 919 / 146
  • Missouri / 903 / 65
  • Virginia: 890 / 151
  • Alabama: 827 / 125
  • South Carolina: 774 / 114
  • Mississippi: 758 / 179
  • Utah: 719 / 117
  • Oregon: 548 / 69
  • Minnesota: 503 / 62
  • Arkansas: 449 / 40
  • Kentucky: 439 / 45
  • Oklahoma: 429 / 52
  • District of Columbia: 401 / 59
  • Iowa: 336 / 38
  • Kansas: 319 / 58
  • Idaho: 310 / 49
  • Rhode Island: 294 / 55
  • New Hampshire: 258 / 44
  • Maine: 253 / 42
  • New Mexico: 237 / 29
  • Vermont: 235 / 24
  • Delaware: 232 / 18
  • Hawaii: 175 / 24
  • Montana: 161 / 32
  • West Virginia: 124 / 11
  • Nebraska: 120 / 24
  • Alaska: 102 / 17
  • North Dakota: 98 / 15
  • South Dakota: 90 / 22
  • Wyoming: 87 / 3
  • Guam / 56 / 5
  • Northern Mariana Islands: 2
  • Puerto Rico: 127 / 27
  • US Virgin Islands: 21 / 0
  • Wuhan repatriated: 3 / 0
  • Diamond Princess Cruise: 46 / 0
**************
Total: 142 321 / 38 179
Total reported deaths: 2484
====================
[The above are the latest breakdowns of confirmed cases of SARS-CoV-2 infection in the USA, as per Worldometer data. The total number of confirmed cases in the USA and territories is now 142 321 including 2484 deaths. New York state, with 59 648 (41.9%) cumulative cases reports and 6193 (33.3%) newly confirmed cases over the past 24 hours, is clearly the epicenter of the outbreak in the USA, although case reporting elsewhere is showing increases. Daily reported case counts are accelerating in New Jersey, Michigan, Florida, Louisiana, Massachusetts, and Illinois.

The Centers for Disease Control and Prevention website (<https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html>) has 2 epidemic curves. One focuses on date of confirmation of disease, the other on date of onset of illness. The curve of interest, by date of onset of disease, is based on 14.6% of the number of cases plotted on the epidemic curve using date of confirmation of disease.

A map of the United States can be seen at
<http://www.mapsofworld.com/usa/> and a HealthMap/ProMED-mail map at
Date: Sun 29 Mar 2020 11:46 AM GST
Source: Reuters [abridged, edited]

Iran's coronavirus death toll has risen to 2640, a health ministry official said on Sunday [29 Mar 2020], as the Middle East's worst-hit country grapples with the fast-spreading outbreak. "In the past 24 hours we had 123 deaths and 2901 people have been infected, bringing the total number of infected people to 38 309," Alireza Vahabzadeh, an adviser to the health minister, said in a tweet. "12,391 people infected from the virus have recovered." Health ministry spokesman Kianush Jahanpur told state TV that 3467 of those infected were in "critical condition".  "I am happy to announce that also 12,391 people who had been infected across the country have recovered," Jahanpur said. "The average age of those who have died of the disease is 69."

President Hassan Rouhani urged Iranians to adapt to their new way of life, which was likely to continue for some time. "We must prepare to live with the virus until a treatment is discovered ... The new measures that have been imposed are for everyone's benefit ... Our main priority is the safety and the health of our people," Rouhani said during a televised meeting.

The government has banned inter-city travel after warning of a potential surge in coronavirus cases because many Iranians defied calls to cancel travel plans for the Persian New Year holidays that began on [20 Mar 2020]. The authorities told Iranians to stay at home, while schools, universities, cultural, religious, and sports centres have been temporarily closed.

To stem the spread of the virus in crowded jails, Iran's judiciary on Sunday [29 Mar 2020] extended furloughs for 100,000 prisoners. On [17 Mar 2020], Iran said it had freed about 85,000 people from jail temporarily, including political prisoners. "The 2nd wave of (the) temporary release of prisoners had already started and their (100,000 prisoners) furloughs have been extended until [19 Apr 2020]," judiciary spokesman Gholamhossein Esmaili was reported as saying by state television. Iran said it had 189,500 people in prison, according to a report submitted by the UN special rapporteur on human rights in Iran to the Human Rights Council in January [2020].  [byline: Parisa Hafezi]
===================
[In the 24 hours from 28 to 29 Mar 2020, the number of cases of COVID-19 confirmed in Iran grew from 35 408 to, 38 309, an increase of 2901 newly confirmed cases. The number of deaths has also increased from 2517 to 2640 an increase of 123 deaths in the 24-hour period. In terms of total numbers of confirmed cases, Iran ranks 7th globally behind USA, Italy, China, Spain, Germany and France. In early March 2020, Iran and Italy were on the same trajectory with respect to daily growth in cumulative newly confirmed cases, but starting 8 Mar 2020, Italy's daily reported newly confirmed cases accelerated at an alarming speed. By 14 Mar 2020, Italy was reporting almost twice as many cases as Iran on a daily basis.

A map of Iran showing provinces can be seen at
HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/128>. - ProMed Mod.MPP]
Date: Sun 29 Mar 2020
Source: Italian Government Health Ministry [in Italian, machine trans., edited]

Cases in Italy as of 6:00 pm 29 Mar 2020
----------------------------------------
Regarding health monitoring related to the spread of the new coronavirus [SARS-CoV-2] on the national territory, there are a total of 97,689 cases. At the moment 73,880 people are positive for the virus; 13,030 people have recovered. There are 27,386 patients hospitalized with symptoms, 3906 are in intensive care, and 42,588 are in home isolation.

There have been 10,779 reported deaths, however, this number can only be confirmed after the Istituto Superiore di Sanita has established the actual cause of the death.

Case distribution by province:
number of cases (number of new cases in past 24 hours)

  • Lombardy: 41 007 (1592)
  • Emilia-Romagna: 13 119 (736)
  • Veneto: 8358 (428)
  • Marche: 3558 (185)
  • Piedmont: 8206 (535)
  • Tuscany: 4122 (305)
  • Campania: 1759 (167)
  • Lazio: 2706 (201)
  • Liguria: 3076 (254)
  • Friuli Venezia Giulia: 1480 (44)
  • Sicily: 1460 (101)
  • Apulia: 1549 (91)
  • Umbria: 1023 (54)
  • Abruzzo: 1293 (160)
  • Molise: 127 (4)
  • Trento: 1594 (89)
  • Bolzano: 1214 (105)
  • Sardinia: 638 (14)
  • Basilicata: 202 (20)
  • Aosta Valley: 584 (73)
  • Calabria: 614 (59)
*********
Total: 97,689 (5217)
======================
[The tally of confirmed cases of COVID-19 in Italy is now 97,689 cases, including 10,779 deaths, up from 92,472 cases and 10,023 deaths reported on 28 Mar 2020. The 24-hour change between 28 and 29 Mar 2020 was 5217 newly confirmed cases, compared with 5974 newly confirmed cases between 27 and 28 Mar 2020. Cases continue to be concentrated in Lombardy (41 007), the epicenter of the outbreak, Emilia-Romagna (13 119), and Veneto (8358), all in the northern part of the country. Those 3 provinces combined account for 52.8% of newly confirmed cases in the past 24 hours, representing a drop from the previous 24 hours when they represented 56.% of nationally reported cases. Another active province is Piemonte with a total of 8206 cases and represents 10.3% of newly reported cases. In the past 24 hours Tuscany has reported 5.9% of newly reported cases, a slight drop from the preceding day when it was reporting 6.1% of newly confirmed cases. There is an excellent interactive map at <http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1> to visualize the caseloads per region in near real time.

On 9 Mar 2020, Italy announced a lockdown for the northern provinces where the outbreak was concentrated. On 10 Mar 2020, this was expanded to be countrywide. On 11 Mar 2020, Italy announced the closure of non-essential businesses. It is now 19 days since the start of the lockdown in the north and 18 days since the countrywide lockdown.

A map of Italy showing regions can be seen at
HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/75>. - ProMed Mod.MPP]