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Vietnam

General:
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Viet Nam is becoming a more popular tourist destination with Irish travellers each year. In many cases these will be those who have no defined itinerary and so their travel plans may change at short
otice. Facilities for tourists vary greatly throughout the country and this needs to be borne in mind when considering some of the serious health issues which can occur throughout the country. The climate is cooler in the north and more tropical further south. There is a monsoon season from May to November each year and the Mekong Delta is prone to significant flooding. Transport during this time can be very difficult and there will be a higher incidence of various diseases during and soon after times of flooding.
Further local information on health issues in Viet Nam is available at http://www.doctorkot.com/index.htm
Safety & Security:
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The majority of those visiting Viet Nam will have no particular difficulty though street crime can be a problem in the main cities of Hanoi and Ho Chi Ming. Generally this is in the form of pick-pocketing, or snatch and grab incidents. Take care of your personal belongings at all times and tourists should not flaunt their relative wealth. Be careful while walking along the footpaths as occasionally a motorcyclist may grab at your bag or camera. Use the hotel safe to store belongings. Attacks against ships in the South China Sea are reported and it is sensible to be vigilant at all times.
Local Laws & Customs:
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Drug smuggling offences carry the death penalty. Don’t take photographs of any military or police installation and avoid any large gathering as the mood can suddenly change. Travel to some of the border areas of the country can be very restricted and so should be avoided. Religious freedom in Viet Nam is quite restricted and those attending gatherings may be detained and fined. Police may occasionally raid hotel rooms without notice. Seizure of documents, pornographic material, compact disks and other goods have lead to high fines and detention.
Road Transport:
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Traffic accidents are becoming more common throughout the country and tourists are occasionally involved with serious consequences. Hiring your own means of transport (car, motorbike etc) is generally unwise. International driving licences are not valid and those wishing to drive will need to obtain a Vietnamese licence. The streets are crowded and many road users will stop suddenly to make purchases from roadside vendors. Traffic laws are often unobserved and horns and gesticulations are used to indicate right of way! Outside the cities, buses and trucks often travel at high speed and accidents are a regular occurrence.
Food & Water:
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The level of food and water hygiene varies greatly throughout the country. Many tourists become ill following consumption of food from both street vendors and also from good quality hotels. Care should be taken at all times. Undercooked or reheated food should be avoided and tap water must be checked for the smell of chlorine. Make sure that a sealed bottle of water is brought to your table during meals. Carbonated water is safer. Bivalve shellfish meals are high risk and previously peeled fruit should not be eaten. Typhoid is reported as a particular problem in the Mekong Delta.
Malaria Risks:
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Viet Nam is endemic for malaria and the risk of transmission occurs in many regions of the country. However, the risk is highest during the monsoon season (May to November) and in the southernmost provinces of Ca Mau and Bac Lieu. The urban areas of Hanoi, Ho Chi Minh City, the Red River Delta and the coastal plain north of Nha Trang are regarded as low risk regions throughout the year.
Mosquito Borne Diseases:
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The other two main mosquito borne diseases are Dengue Fever and Japanese B Encephalitis. Both of these viral conditions can cause serious disease and it is essential that all travellers continually take special care to avoid mosquitoes. The mosquitoes which transmit Dengue tend to bite in the main urban areas while the ones that transmit Japanese B (and malaria) are more common out of the large cities.
Sun Exposure:
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The direct sunlight in Viet Nam can be very intense and both burn and dehydration can easily occur. After a long-haul flight this is a particular concern as many travellers will sleep beside the hotel pool to recover from their journey. After just a short while they may have become significantly burnt. Those trekking should increase their fluids and also take more salt in their diet if possible.
Entertainment Problems:
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Viet Nam has a reputation of a location where it is too easy to obtain sexual exposure for those unaware of the risks. This is particularly true following the consumption of alcohol. The risk of AIDS and other serious STD’s is very high and so contact should be avoided at all costs. A number of otherwise healthy male travellers have suddenly died during the past few years following what is thought to have been laced alcoholic drinks.
Rabies Risk:
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Rabies occurs throughout Viet Nam and any contact with warm-blooded animals should be avoided at all times. Dogs, Cats and Monkeys are most commonly involved in transmitting the disease to humans. Treat any exposure very seriously and wash out the wound, apply an antiseptic and seek urgent medical attention immediately.
Vaccinations for Viet Nam:
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There are no essential vaccines for entry to Viet Nam from Western Europe. However, for personal health, it is advised that all travellers consider cover against;
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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 & water borne disease)
For those trekking within the country there are a number of other vaccines which should be considered including Hepatitis B, Rabies, Japanese B and Meningitis.
Summary:
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The biggest risks within Viet Nam tend to be associated with food and water borne diseases, mosquito bites and the traffic. Commonsense and care is needed at all times to ensure a good safe holiday.

Travel News Headlines WORLD NEWS

Date: Thu, 10 Oct 2019 13:13:57 +0200 (METDST)

Hanoi, Oct 10, 2019 (AFP) - Selfie-snapping tourists railed against the closure of Hanoi's 'train street' on Thursday after police blocked off the Instragram-famous tracks for safety reasons.   The narrow railway corridor in central Hanoi has become a hotspot among visitors seeking the perfect holiday snap on the tracks -- often dodging trains that rumble through daily.    But Hanoi authorities said this week they would block people from the tracks to avoid accidents, and police on Thursday erected barricades to keep out disappointed visitors.    "I'm very frustrated because today I can't go in and take a picture," Malaysian tourist Mustaza bin Mustapha told AFP, vowing to come back later.

Dozens of other tourists were turned away, though some managed to get onto still-open sections of the railway, moving out of the way as an afternoon train chugged past.    Built by former colonial rulers, the railway once shipped goods and people across France's former Indochina colony and remains in use today by communist Vietnam's state-run railway company.    The stretch of the tracks was once known as a rough part of town, occupied by drug users and squatters until their recent discovery by camera-wielding holidaymakers who have splashed images of the area across social media.

Cafe owners complained that business would be hurt thanks to the new regulations, and that tourists always moved out of the way for oncoming trains.   "There has never been any regretful accidents here," said Le Tuan Anh, who runs a cafe from his home along the tracks.   "Compared to traffic density elsewhere in the city, this is much safer," he said, referring to Hanoi's chaotic, motorbike-clogged streets.   New signs were installed in the area Thursday, warning passersby not to take photos or videos in the "dangerous area", much to the chagrin of British tourist Harriet Hayes.   "People come from all over the world to Hanoi just to see the train go past," she told AFP.   "It's such a shame that we come and have been told that we have to leave."
Date: Wed 11 Sep 2019
Source: Saigon Giai Phong [edited]

The Hanoi-based Bach Mai Hospital yesterday [Tue 10 Sep 2019] warned of a high possibility of death from rare Whitmore's disease [melioidosis], as the disease re-occurred and killed 4 people in August [2019].

Moreover, the fatal disease infected 12 patients including a woman suffering from a severe abscess on her nose. The case was very rare, and the hospital treated such cases for the 1st time, said Director of the hospitals' Tropical Disease Center Dr. Do Duy Cuong. The patient was misdiagnosed as having sepsis caused by a staphylococcal infection at a local hospital. However, tests from her wound carried out at the center were positive for the Whitmore bacterium, _Burkholderia pseudomallei_.

The doctors had to change the treatment regimen; otherwise the patient could have died, as Dr. Cuong said. After 2 weeks of treatment, her wound had improved. However, she will still be undergoing treatment for at least 3 months under the close watch of doctors to avoid disease recurrence.

Dr. Cuong added that there have been around 20 cases of melioidosis in the past 5 to 10 years, but since the beginning of the year [2019], the center has admitted 20 cases, mostly from the northern and central provinces.

Melioidosis is an infectious disease caused by the bacterium _Burkholderia pseudomallei_. that can affect humans or animals. It is predominately a disease of tropical climates, especially in Southeast Asia and northern Australia where it is widespread.

The bacteria causing melioidosis are found in contaminated water and soil. It is spread to humans and animals through direct contact with the contaminated source. Patients developing the disease may die without proper treatment.  [Byline: Minh Khang - Translated by Uyen Phuong]
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[Melioidosis is a disease of the rainy season in its endemic areas. It mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (most common risk factor), renal disease, cirrhosis, thalassemia, alcohol dependence, immunosuppressive therapy, chronic obstructive lung disease, cystic fibrosis, and excess kava consumption (kava is an herbal member of the pepper family that can be associated with chronic liver disease).

Melioidosis may present at any age but peaks in the 4th and 5th decades of life, affecting men more than women. In addition, although severe fulminating infection can and does occur in healthy individuals, severe disease and fatalities are much less common in those without risk factors.

The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, and chest pain, and -- although the cough can be nonproductive -- respiratory secretions can be purulent, significant in quantity, and associated with on-and-off bright red blood. The lung infection can be rapidly fatal -- with bacteremia and shock -- or somewhat more indolent.

Acute melioidosis septicemia is the most severe complication of the infection. It presents as a typical sepsis syndrome with hypotension, high cardiac output, and low systemic vascular resistance. In many cases, a primary focus in the soft tissues or lung can be found. The syndrome, usually in patients with risk factor comorbidities, is characteristically associated with multiple abscesses involving the cutaneous tissues, lung, liver, and spleen, and a very high mortality rate of 80-95%. With prompt optimal therapy, the case fatality rate can be decreased to 40-50%.

The melioidosis bacillus is intrinsically insensitive to many antimicrobials, and in fact bioterrorism strains may be engineered to be even more resistant. _Burkholderia pseudomallei_ is usually inhibited by tetracyclines, chloramphenicol, trimethoprim-sulfamethoxazole (SXT), antipseudomonal penicillins, carbapenems, ceftazidime, and amoxicillin/clavulanate or ampicillin/sulbactam. Ceftriaxone and cefotaxime have good in vitro activity but poor efficacy; and cefepime did not appear, as well, to be equivalent to ceftazidime in a mouse model. The unusual antimicrobial profile of resistance to colistin and polymyxin B and the aminoglycosides but sensitivity to amoxicillin/clavulanate is a useful tool to consider in treatment of infection with the organism.

The randomized and quasi-randomized trials comparing melioidosis treatment have been reviewed, and it was found that the formerly standard therapy of chloramphenicol, doxycycline, and SXT combination had a higher mortality rate than therapy with ceftazidime, imipenem/cilastatin, or amoxicillin/clavulanate (or ampicillin/sulbactam). The betalactam-betalactamase inhibitor therapy, however, seemed to have a higher failure rate.

Source: Tolaney P, Lutwick LI: Melioidosis. In: Lutwick LI, Lutwick SM (eds). Bioterror: the Weaponization of Infectious Diseases. Totowa NJ: Humana Press, 2008 pp 145-58. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Fri, 10 May 2019 11:12:19 +0200

Ha Long Bay, Vietnam, May 10, 2019 (AFP) - Most visitors to Vietnam's famed Ha Long Bay opt for cruise views of the UNESCO heritage site but from Friday tourists can hop on a helicopter to see the area's famous karst rock formations from the skies.    Nervous flyers beware.   A pair of five-seater helicopters soared up to 300 metres (1,000 feet) to offer passengers aerial views of the limestone towers, cruise ships and the odd houseboat dotting Ha Long's green waters for the maiden flights on Friday.

Helicopter manufacturer Bell said the trips, which start at $125 for 12 minutes, were aimed at tapping into a growing number of tourists to Vietnam -- many from the world's second biggest economy.    "With the Chinese economy growing, you're seeing more tourists come here," said David Sale, Bell's managing director for Asia-Pacific.

The number of visitors to Vietnam grew nearly 20 percent last year, with one-third of the total coming from its powerful communist neighbour to the north.    Domestic tourism is also booming among Vietnam's fast-growing middle class with expanding appetites -- and budgets -- for travel.   Ha Long Bay is one of the country's top draws, with as many as 500 cruise ships in the bay every day and a newly-opened airport helping to funnel visitors into the area.

But the tourist boom has also prompted environmental concerns in the once-pristine bay in Quang Ninh province, also home to home to rapid industrialisation.    "We're under pressure from the coal industry, the urbanisation process, the arrival of more tourists and the population increase," said Le Minh Tan, deputy director of Quang Ninh's tourism department.    He added that a waste-water management system is set to be rolled out soon to deal with sewage spewed out by cruise ships daily.   "We're launching many programs in the area to ensure the environment of Ha Long is green and clean."
Date: Tue, 9 Apr 2019 13:43:38 +0200

Hanoi, April 9, 2019 (AFP) - Three divers who helped rescue a Thai football team last year have made a fresh discovery in Vietnam where they explored a tunnel that could expand the footprint of the world's largest cave.   The team was invited to descend into a waterlogged pit in the Son Doong cave in central Vietnam that has never been explored and is believed to connect to nearby chambers.    They were forced back at 77 meters (252 feet) because they did not have enough oxygen to push further, but they think the tunnels could be 120 meters deep.   If the tunnel connects to another cave, it would make Son Doong "easily the largest cave in the world and it would never be overtaken," British cave expert Howard Limbert, who helped organise the dive, said Tuesday at a press conference announcing the find.

The three divers -- Rick Stanton, Jason Mallinson and Chris Jewell -- were part of the daring rescue to save 12 Thai footballers and their coach who were trapped in a cave for eighteen days last year.    Stanton -- who found the boys on a ledge -- said the painstaking task of safely leading the group out of the tunnel alive helped to prepare for the mission in Vietnam.    "Our planning and preparation is without parallel," he said.   The team plans to return to Vietnam next year to try to link the tunnel to another cave near Son Doong, which is so big that it has its own ecosystem and weather patterns.

The cave in central Quang Binh province was first found by a local forager in 1991, but was not re-discovered for another 19 years because its entrance was hidden by thick surrounding jungle.   Only 30 percent of Vietnam's Phong Nha national park -- where Son Doong and a network of adjacent caves are located -- has so far been explored.     Son Doong is the world's largest cave by volume, big enough to house a New York city block -- including 40-storey skyscrapers -- according to Oxalis, which runs tours into the caves. 

Proposed plans to build a cable car in the area have sparked anger among the Vietnamese public who fear it will harm the area's wildlife and pristine views.      An official said Tuesday there were no plans to move ahead with the project despite offers from several companies.   "That is only in theory, in truth, to build a cable car there is no such project yet," the vice chairman of Quang Binh province Tran Thien Dung said Tuesday.       Vietnam's tourism industry is booming among domestic and foreign travellers alike, but the communist country has come under fire for failing to preserve landscapes as it rapidly expands the sector.
Date: Fri, 25 Jan 2019 12:21:09 +0100
By Jenny VAUGHAN

Vu Thu, Vietnam, Jan 25, 2019 (AFP) - Tran Huu Hoa was scared, desperate and on the verge of suicide after his leprosy diagnosis in 1958, fearing he'd never work or marry in an age when lepers were completely shunned from Vietnamese society.   He could not imagine he would find new life at the leprosy hospice where he has been living for 61 years, a walled off compound in northern Thai Binh province where he met his wife, worked as a union boss and took in needy children.    "There were about 2,000 people here then, mostly young people. It was fun because we started a teen union," the 80-year-old told AFP, sitting on his bed with his wife Teo of 54 years. 

Today there are only 190 patients at the hospital, all cured but living with disabilities caused by leprosy.    Many walk with prosthetic legs. Others like Hoa have lost fingers. Some are so severely disabled they spend the day bent over in bed, covered with thick blankets to keep the cold at bay.    Founded in 1900, Van Mon is the oldest leprosy hospital in northern Vietnam.    At its peak it treated 4,000 patients a year -- a number that has dwindled as leprosy cases have dropped across Vietnam thanks to improved healthcare, hygiene and greater awareness of the disease.   World Leprosy Day is January 27.

There were 248 people being treated for leprosy in 2017 in Vietnam, down by more than half from a decade earlier, according to data from the World Health Organization.    But as numbers have decreased so have the live-in patients at the Van Mon centre.   Meandering days are punctuated with a morning and midday meal. Some pass the time worshipping at the on-site chapel or pagoda, while most watch TV or listen to the radio during the day when they are not sleeping.    "I have no one to count on, I'm so lonely, so I just follow God. When I die I will follow God then too," said Pham Van Bac, 83, who has been at the centre since 1960. 

His daughter no longer visits and his grandchildren come only once a year, so he has little to look forward to most days, he says.    But many like Bac chose to stay, fearing they will be a burden on their families, or lose the care and small stipend provided at the government-run hospital.   Some, like Hoa, have found companions in the centre.   "It's a source of encouragement and motivation and they can have a happier and better life," said Nguyen Thi Thai, deputy director of the hospital where both her parents were once treated for leprosy.    And even though stigma against leprosy sufferers has largely faded outside the walls of the hospice, many prefer to remain at Van Mon.    Hoa said: "This is my second home, I will live here until my death."
More ...

World Travel News Headlines

Date: Wed, 20 Nov 2019 22:35:51 +0100 (MET)

Manila, Nov 20, 2019 (AFP) - Philippine police were ordered Wednesday to arrest anyone caught vaping in public, just hours after Philippine President Rodrigo Duterte announced he would ban e-cigarettes.   The abrupt prohibition, revealed by Duterte late Tuesday adds to a growing global backlash against a product once promoted as less harmful than tobacco smoking.

Duterte, a former smoker, called the devices "toxic" and said vaping introduced "chemicals" into the user's body.   He ordered the arrest of anyone vaping publicly in a country that already has some of Asia's toughest anti-smoking rules.    No formal, written order has been made public that spells out the scope of the ban or penalties for violations.   Duterte is notorious internationally for his deadly anti-narcotics crackdown, but he has also targeted tobacco with a wide-ranging ban on smoking in public.   Citing "the order of the president", on Wednesday a statement from the head of the Philippine police ordered "effective today, all police units nationwide to enforce the ban on use of vapes; ensure that all violators will be arrested".

The ban came days after Philippine health authorities reported the nation's first vaping-related lung injury, which resulted in a 16-year-old girl being hospitalised.   Vaping has taken off in the Philippines, with speciality shops and vapers puffing away in public a common sight.     E-cigarette users were caught off guard by the ban and questioned the utility of arresting people who, at worst, were hurting themselves.   "It's inappropriate. In any case, we don't hurt people, the environment or animals," said 22-year-old student Alexis Martin.   "Why are vapers being targeted?"

E-cigarettes warm flavoured liquid to produce vapour that is free of the estimated 7,000 chemicals in tobacco smoke, but does contain a number of substances that could potentially be harmful.  Critics say that apart from being harmful in themselves, the multiple exotic flavours of e-cigarette liquids appeal particularly to youngsters and risk getting them addicted to nicotine.

The devices have become hugely popular in the past decade but a rash of vaping-linked deaths and illnesses in the United States is feeding caution about the product, already banned in some places.   In September 2019 India became the latest country to ban the import, sale, production and advertising of e-cigarettes, citing in particular concerns for its youth.   The devices are already banned in several places such as Brazil, Singapore, Thailand and the US state of Massachusetts.
Date: Wed, 20 Nov 2019 17:17:39 +0100 (MET)

Lagos, Nov 20, 2019 (AFP) - Nigerian President Muhammadu Buhari on Wednesday announced a campaign to end defecation in public, in a country where tens of millions of people going to the toilet outside poses a major health risk.    "Nigeria has committed to end open defecation throughout the country by 2025," a statement by the presidency said a day after the United Nations marked World Toilet Day.     The decree set up a new body called the Clean Nigeria Campaign Secretariat to ensure "that all public places including schools, hotels, fuel stations, places of worship, market places, hospitals and offices have accessible toilets and latrines within their premises". 

According to the United Nations children agency, UNICEF, Nigeria has amongst the highest number of people practising open defecation in the world, estimated at over 46 million people -- almost a quarter of the population.   Around Nigeria each year 87,000 children die from diarrhoea, with more than 90 per cent of deaths caused by a lack of water, sanitation and hygiene, according to the World Bank.   The new agency will be disbanded when the goal of ending open defecation has been met, the presidency said.
Date: Wed, 20 Nov 2019 12:59:15 +0100 (MET)

Kampala, Nov 20, 2019 (AFP) - Global health charity Marie Stopes said Wednesday it had recalled hundreds of thousands of faulty condoms on sale in Uganda, where HIV rates are among the highest in the world.   The recall followed a warning from Uganda's National Drug Authority (NDA) that the Life Guard brand condoms had failed manufacturing "quality tests" because they contained holes and may burst.   The affected condoms were manufactured by India-based MHL Healthcare in April 2019 and have an expiry date of April 2024, the government regulator said.   Marie Stopes Uganda spokesman David Kamu told AFP on Wednesday that the two affected batches each contained "around 400,000" condoms.

Earlier reports had suggested millions of condoms could have been involved but NDA spokesman Fred Ssekyana told AFP the figure was below one million.   Marie Stopes Uganda said more than half of the condoms of concern had been recalled.   "While the LifeGuard brand follows strict quality controls, unfortunately two recent batches have fallen short of the quality we demand," the charity's country director, Carole Sekimpi, said in a statement Tuesday.   Marie Stopes is the largest and most specialised sexual reproductive health organisation in Uganda, the charity says on its website.   According to UNAIDS, 1.4 million Ugandans are living with HIV.   Last year 53,000 people were newly infected with the disease in the East African country, the UN agency said.
Date: Wed, 20 Nov 2019 15:08:18 +0100 (MET)

Luanda, Nov 20, 2019 (AFP) - Angola recorded an outbreak of polio this week after almost a decade without cases of the paralysing viral disease, the government said.   The highly infectious condition mainly affects children under the age of five. It attacks the nervous system and can lead to total paralysis, or in some cases death.   "After seven years without polio we are unfortunately confronted with a difficult situation," Angola's health minister Sante Silvia Lutucuta said on Monday, at the launch of a new vaccination campaign in the capital Luanda.   "We have recorded 44 new cases in ten of the country's 18 provinces," she added.

The vaccination campaign is expected to reach 2.5 million children aged five and under.   "All children must be protected by three doses of the oral anti-poliomyelitis vaccine," said Lutucuta, adding that the campaign would span over two weeks to "control the epidemic".   Two out of three strains of the wild polio virus have been eradicated so far, according to the World Health Organization (WHO).           While only 33 wild polio cases were reported globally last year, vaccine-derived polio still breaks out sporadically in some parts of Africa and Asia.    The Centers for Disease Control and Prevention has recommended that all travellers to Angola be fully vaccinated against the virus.
Date: Thu, 21 Nov 2019 01:34:32 +0100 (MET)

Bangkok, Nov 21, 2019 (AFP) - A 6.1-magnitude earthquake hit north-western Laos near the Thai border early Thursday, the United States Geological Survey reported.    The shallow quake hit at 6:50 am local time (2350 Wednesday GMT), USGS said. 
Date: Thu, 21 Nov 2019 01:25:15 +0100 (MET)

Sydney, Nov 21, 2019 (AFP) - The fire danger was elevated across wider swathes of southern Australia on Thursday, with residents warned to avoid at-risk areas as smoke from bushfires choked Sydney and other major cities.   Devastating fires along the country's east coast have claimed six lives and destroyed more than 500 homes since mid-October, with climate change and unseasonably hot, dry conditions fuelling the unprecedented blazes.   Now the fire danger has moved into states further south, with a so-called "Code Red" -- the highest possible fire risk in Victoria -- being declared in the state's northwest for the first time in a decade.   "What that means is that if we see fires in those areas they will be fast moving, they will be unpredictable, they will be uncontrollable," emergency management commissioner Andrew Crisp told reporters.

Country Fire Authority chief Steve Warrington told people living in rural areas to leave for the safety of cities.   "We are saying, 'do not be there, do not be there when a fire occurs, because you will not survive if you are there'," he said.   "There is a good chance if a fire occurs that your home will be destroyed."   The fire danger was also elevated to "severe" in the island state of Tasmania off mainland Australia's southeastern coast,  where a total fire ban was declared.   Two bushfires in the state's northeast did not pose an immediate threat to residents, the Tasmania Fire Service said.

For the second time in two days, smoke from bushfires blanketed Sydney, Australia's biggest city and home to more than five million people, sending air quality plummeting to hazardous levels.   More than 110 fires are still burning in worst-hit New South Wales and neighbouring Queensland, while in South Australia more than 40 fires broke out during catastrophic fire conditions Wednesday.    A South Australia Country Fire Service spokeswoman said all of those blazes had been brought under control or extinguished by Thursday, with the exception of a major fire on the Yorke Peninsula that had come perilously close to a small town.

Conditions were expected to ease in the coming days in South Australia, where the state capital Adelaide was also shrouded in bushfire smoke and residents were being told to stay indoors for health reasons.   Bushfire-prone Australia has experienced a horror start to its fire season, which scientists say is beginning earlier and becoming more extreme as climate change pushes temperatures higher and saps moisture from the environment after months of severe drought.   Growing calls to curb fossil fuels and drastically cut greenhouse gas emissions are being ignored by the country's conservative government, which is eager to protect its lucrative mining industry.   The country is bracing for challenging fire conditions to continue throughout the Southern Hemisphere summer.
Date: Mon 18 Nov 2019
Source: 112.UA [edited]

Eight school classes in Odesa [Odessa] have been closed for quarantine. More than 30% of school students in these classes are sick with Coxsackie virus, a highly contagious respiratory disease, said Olena Buynevych, the director of the city hall's department for science and education, as quoted by UNN news agency.

"More than 30% of students in these classes are sick wi h acute
respiratory diseases, which include cases of cases and Coxsackievirus," the official said. She urged the parents to keep the children away from schools in case they have any symptoms of acute respiratory diseases.

The symptoms are basically the same as flu; the key difference is the rash on the palms, in case of the Coxsackievirus.

Coxsackievirus is a member of a family of viruses called enteroviruses. Enteroviruses are made up of a single strand of ribonucleic acid (RNA). The enteroviruses are also referred to as picornaviruses ("pico" means "small," so, "small RNA viruses"). They are present all over the world and spread by fecal-oral route. About 90% of infections don't cause symptoms or present with a fever only. Infants and young kids are particularly susceptible to symptomatic coxsackie.
======================
[Coxsackievirus belongs to a family of nonenveloped, linear, positive-sense, single-stranded RNA viruses, Picornaviridae and the genus _Enterovirus_, which also includes poliovirus and echovirus. Enteroviruses are among the most common and important human pathogens, and ordinarily its members are transmitted by the fecal-oral route. Coxsackieviruses share many characteristics with poliovirus. With control of poliovirus infections in much of the world, more attention has been focused on understanding the nonpolio enteroviruses such as coxsackievirus.

Coxsackieviruses are divided into group A and group B viruses based on early observations of their pathogenicity in neonatal mice. In general, group A coxsackieviruses tend to infect the skin and mucous membranes, causing herpangina, acute hemorrhagic conjunctivitis, and hand, foot, and mouth (HFM) disease. Both group A and group B coxsackieviruses can cause nonspecific febrile illnesses, rashes, upper respiratory tract disease, and aseptic meningitis.

Group B coxsackieviruses tend to infect the heart, pleura, pancreas, and liver, causing pleurodynia, myocarditis, pericarditis, and hepatitis (inflammation of the liver not related to the hepatotropic viruses). Coxsackie B infection of the heart can lead to pericardial effusion.

The development of insulin-dependent diabetes (IDDM) has recently been associated with recent enteroviral infection, particularly coxsackievirus B pancreatitis.

It is common for the coxsackievirus to cause a febrile upper respiratory tract infection with sore throat and/or a runny nose. Some patients have a cough resembling bronchitis. Less commonly, coxsackievirus may cause pneumonia. Some people with coxsackievirus have a rash. In many, this is a nonspecific generalized red rash or clusters of fine red spots. The rash may not appear until the infection has started to get better.

Coxsackievirus is spread from person to person. The virus is present in the secretions and bodily fluids of infected people. The virus may be spread by coming into contact with respiratory secretions from infected patients. If infected people rub their runny noses and then touch a surface, that surface can harbor the virus and become a source of infection. People who have infected eyes (conjunctivitis) can spread the virus by touching their eyes and touching other people or surfaces. Conjunctivitis may spread rapidly and appear within one day of exposure to the virus. Coxsackieviruses are also shed in stool, which may be a source of transmission among young children. The virus can be spread if unwashed hands get contaminated with fecal matter and then touch the face. This is particularly important for spread within  day-care centers or nurseries where diapers are handled. Diarrhoea is the most common sign of coxsackievirus intestinal infection.

Most infections are self-limiting, and no specific treatment is required or available. Some options include intravenous immune globulin (IVIG), which contains antibodies and may be somewhat effective.

HealthMap/ProMED-mail map:
Odesa oblast, Ukraine: <http://healthmap.org/promed/p/51897>]
Date: Tue 19 Nov 2019 6:07 AM GMT
Source: 3 FM [edited]

There's been an outbreak of a highly contagious disease among wood pigeons on [Isle of Man]. That's according to Manx Wild Bird Aid (MWBA) which says its already taken in a number of the animals from Douglas, Groudle, and Crosby which are suffering with 'canker'.

The infection isn't harmful to humans or mammals but the organisation says it can cause growths in the birds' mouths which can lead them to starve to death.

MWBA is offering advice to people about how to help stop it spreading, including strict hygiene on bird-feeding tables and if you come across a sick pigeon to take it to the nearest vet as soon as possible.  [Byline: Rob Pitchard]
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[_Trichomonas gallinae_ is a common protozoan parasite of pigeons (Columbiformes) which principally infects the upper alimentary tract where it can cause necrotic ingluvitis. Epidemic mortalities in columbiform species are sporadically reported, and the parasite may infect other avian taxa such as birds of prey and songbirds. (<http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0012215>). - ProMED Mod.PMB]

[HealthMap/ProMED-mail map of the Isle of Man:

HealthMap/ProMED map available at:
Date: Tue 19 Nov 2019
Source: Caracas Chronicles [edited]

The Venezuelan Public Health Society and the Let's Defend The National Epidemiology Network issued an alert after a case of yellow fever was confirmed in the state of Bolivar, after 14 years without the disease. The Health Ministry hasn't published information about the case or issued an alert, but Venezuela must formally report it to international institutions, due to the risk to a population that isn't vaccinated, having the vector (mosquitoes) in all of the territory (increasing the odds of an epidemic), and the poor access to an epidemiologic report [about the case]. Doctor Julio Castro wrote about the case for Prodavinci.  [Byline: Naky Soto]
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[There is little information about this case: where and when it occurred in Bolivar state, tests used to diagnose the case, condition of the patient, and any follow-up measures taken by public health authorities. Yellow fever (YF) virus is endemic in Venezuela as it is in many South American countries.

The most recent ProMED-mail report of YF in Venezuela was in 2010, in Anzoategui state, where there were 3 probable YF cases in monkeys. This outbreak was enzootic, as determined by the Ministry of Health (see Yellow fever - South America: Venezuela (AN) monkey, susp http://promedmail.org/post/20101112.4114).

Presumably, this current case is one of spill-over from the sylvan (forest) transmission cycle. Maintenance of a high level (80-90%) of coverage is essential to prevent cases and avoid outbreaks involving the urban cycle with _Aedes aegypti_ transmission. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Venezuela:
Date: Thu 14 Nov 2019
Source: WHO Emergencies preparedness, response, Disease Outbreak News (DONs) [edited]

On 10 Oct 2019, the National IHR Focal Point for Sudan notified WHO of 47 suspected [human] cases of Rift Valley fever (RVF), including 2 deaths in Arb'aat Area, Towashan Village, in El Qaneb locality, Red Sea State. The suspected cases presented with high-grade fever, headaches, joint pain, vomiting. There were no hemorrhagic signs or symptoms observed. The 1st case presented to the health facility on 19 Sep 2019.

On 28 Sep 2019, a total of 14 samples were sent to the National Public Health Laboratory in Khartoum, and 5 tested positive for RVF by immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) and reverse-transcriptase polymerase chain reaction (RT-PCR). These samples were also tested for malaria and were found negative.

On 13 Oct 2019, a total of 10 suspected RVF cases were recorded in Barbar and Abu Hamed localities, of River Nile State. Of the 10 suspected RVF cases, 5 samples were tested and 4 were found positive for RVF. From 19 Sep 2019 until 11 Nov 2019, a total of 293 suspected human RVF cases, including 11 associated deaths have been reported from 6 states; including the Red Sea (120), River Nile (168), Kassala (2), White Nile (1), Khartoum (1), and Al Qadarif (1) States. The most affected age group is 15-45 years old, which accounts for 83% of the total suspected cases. The male to female ratio is 2.6, with a high proportion of the cases being farmers (37.5%).

These human RVF cases are concomitant with abortions and deaths among goats in the areas where the human suspected and confirmed cases have been reported. From 25 Sep through 3 Nov 2019, 21 goats in Red Sea State were reported as positive for RVF, including 4 deaths; and in River Nile State 16 goats, with 3 deaths, and 37 sheep, with 5 deaths, were confirmed positive for RVF by ELISA test at the Central Veterinary Research Laboratory in Khartoum.

Public health response
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Red Sea State
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- Activation of RVF task force committee;
- printing and distribution of RVF guidelines;
- deployment of surveillance teams for daily reporting and active case finding in the affected areas;
- establishment of 2 health centers and one dispensary with a capacity of 11 beds, laboratory items, drugs, and supplies to provide health services in the affected villages;
- conducting household inspections and fogging: In Arb'aat area, a total of 452 households were inspected, out of which 30 were found positive for the presence of a competent vector; in Port Sudan, out of 1225 households inspected, 29 were found positive for the competent vector, and fogging was provided to 1949 households;
- the Veterinary Epidemiology Department of the Ministry of Animal Resources conducted vector control in 4 animal enclosures in the affected villages.

River Nile State
- A joint investigation conducted by the State Ministry of Health (SMoH) and WHO on 12 Oct 2019;
- initiation of an RVF Action plan by the SMoH and WHO;
- initiation of Integrated Vector Management (IVM), surveillance, case management, and Rapid Response Team (RRT) activities.

WHO risk assessment
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RVF is endemic in Sudan. There have been 3 outbreaks affecting humans previously documented in 1973, 1976, and 2008. During the outbreak in 2008, a total of 747 laboratory-confirmed cases were reported, including 230 deaths.

The recent floods, following heavy rains on 13 Aug 2019, caused flash floods in 17 of the 18 states, including Abyei area in West Kordofan State. These floods have favored vector abundance, distribution, and longevity. The current RVF outbreak started on 19 Sep 2019 and has affected states impacted by the floods.

The uncontrolled movements of animal populations within and outside the country borders may increase the spread of the disease to new areas.

RVF can cause significant economic losses due to livestock travel and trade restrictions, as well as high mortality and abortion rates among infected animals.

In a country where the export of livestock is one of the major sources of the national income, the current RVF outbreak, in the context of political unrest and a debilitated health system requires an urgent need for external assistance.

WHO advice
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Rift Valley fever (RVF) is a mosquito-borne viral zoonosis that primarily affects animals but also has the capacity to infect humans. The majority of human infections result from direct or indirect contact with the blood or organs of infected animals. Herders, farmers, slaughterhouse workers, and veterinarians have an increased risk of infection.

Awareness of the risk factors of RVF infection and measures to prevent mosquito bites is the only way to reduce human infection and deaths. Public health messages for risk reduction should focus on:
- reducing the risk of animal-to-human transmission resulting from unsafe animal husbandry and slaughtering practices;
- practicing hand hygiene as well as wearing gloves or other personal protective equipment when handling sick animals or their tissues and when slaughtering animals;
- reducing the risk of animal-to-human transmission arising from the unsafe consumption of raw or unpasteurized milk or animal tissue. in endemic regions, all animal products should be thoroughly cooked before eating;
- reducing the risk of mosquito bites through the implementation of vector control activities (e.g. insecticide spraying and use of larvicidal to reduce mosquito breeding sites), use of insecticide-impregnated mosquito nets and repellents, light-coloured clothing (long-sleeved shirts and trousers);
- restricting or banning the movement of livestock to reduce the spread of the virus from infected to uninfected areas;
- routine animal vaccination is recommended to prevent RVF outbreaks. Vaccination campaigns are not recommended during an outbreak as they may intensify transmission among the herd through needle propagation of the virus;
- outbreaks of RVF in animals precede human cases, thus the establishment of an active animal health surveillance system is essential in providing early warning for veterinary and public health authorities.

WHO advises against the application of any travel or trade restrictions with the affected country based on the current information available on this event.
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[The report above provides a good overview of the development of the current Rift Valley fever outbreak. Surveillance and responses require a One Health approach since both humans and animals are affected and environmental change, in this situation extensive flooding, has promoted vector abundance. Effective vector control over extensive geographical areas is difficult to achieve and is expensive. Maintenance of herd immunity through vaccination of animals can be a successful preventive measure prior to the occurrence of cases. - ProMED Mod.TY]

[Neighbouring Egypt, which suffered introductions of RVF from Sudan in the past, has undertaken preventive measures. This relates initially to the 2 governorates bordering Sudan, namely the Red Sea and the New Valley governorates. In the Red Sea governorate, vaccination has already started. Reportedly, as of 18 Nov 2019, a total of 12 801 animals have been vaccinated, including 11 568 sheep and goats, 712 camels, and 421 cows and buffalo. The vaccination, which is free of charge, is being continued. In the New Valley governorate, 62 guidance seminars about RVF for animal breeders in the 5 provincial centers have been undertaken; the implementation of a "magnified immunization campaign for a month" is said to commence "next Saturday" (23 Nov 2019), "aimed at immunizing 120 000 cattle, goats, and sheep." Intensified surveillance in animals has, reportedly, been applied in both governorates; no suspected cases detected. - ProMED Mod.AS]