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South Africa

General Introduction: The Republic of South Africa lies at the Southern tip of the African continent, flanked between the Indian and Atlantic oceans. Although it lies close to the tropic of Capricorn, the inland areas are tempered by the relatively high a
titudes. Summers and winters are opposite to that found in Ireland. In South Africa the summer extents from October to March. Although South Africa is basically a developed country, much of its population, particularly in rural parts, live in poverty. However facilities for tourists in urban areas and game parks are generally excellent. Despite all the well documented reports overall violence against tourists is usually low but obviously care should always be taken. Travelling late at night is usually unwise and take particular care if visiting nightclubs etc.
Climate: There is generally a moderate climate with sunny days and cool nights. The Cape Town region has a mean yearly temperature of 170C while Johannesburg has an annual mean temperature of 160C. This is mainly because Johannesburg is at 5,700 feet altitude. Throughout South Africa, summer extends between October and March and winter is between June and September. In Johannesburg the winter months tend to be dry and cool while the rainy season tends to occur during the warmer summer months.
Health Facilities: In the larger cities of Johannesburg, Cape Town, Durban & Pretoria and many others there will be no difficulty in receiving excellent medical attention. However when travelling throughout the more isolated rural regions the same situation does not occur. Travellers should always ensure that they are up-to-date in their routine travel vaccinations. World Travel Medicine Consultants (WTMC) in South Africa offer excellent medical facilities in many of the main centres. Contact by email their head office at for further information.
Jet Lag: Even though the hour changes from Ireland are not great after flying for approximately 13 hours you will arrive tired. On the plane journey take some exercise by walking around and occasionally stretching your calf muscles to lessen any risk of blood clots. If you are on the contraceptive pill (women only!) this will increase your risk on a long haul flight and you should talk this through with the doctor looking after your health care advice and vaccines. On arrival, try and rest for the first 24 hours to allow your body to catch up with itself. If lying by the pool remember not to fall asleep and wake some hours later with significant sunburn!
Mosquito-Borne Disease: Mosquitoes are most often associated with Malaria, however it is not the only disease which the insect may carry. Insect repellents which contain more than 30% DEET are effective for keeping mosquitoes away but remember to cover your arms and legs when they are biting. This is mainly in the hours between dusk and dawn. The risk of malaria can be reduced by taking malarial prophylaxis on a regular basis if you are planning to visit the risk areas. Anti malaria tablets are advised for those visiting low altitude areas especially areas around the Kruger National Park, north, east and western Transvaal, and the costal lowlands of Natal. Large towns and cities and high altitudes are more likely to be free of mosquitoes.
Effects of Heat: Extreme climate conditions can also lead to gastrointestinal difficulties but don't forget that when you perspire you will loose both water and salt. Replacing the lost water is easy but many travellers forget to replace the salt in their diet. This can lead to muscular cramps, tiredness and lethargy, a dull headache and generally feeling cross and out of sorts. Replacing depleted salt is most easily achieved by sprinkling it on your meals. Salt tablets can be dangerous and are best avoided except in expert hands. If you have any blood pressure difficulties then it will be important to talk this whole issue through with your doctor before leaving Ireland.
Waterborne diseases: Water sources in well developed urban areas of South Africa are generally safe. Outside the main cities caution must always be exercised with regard to drinking water. Safe water should be well chlorinated and so will have a distinct chlorine odour. Sealed bottled water is more preferable especially in less developed areas. Avoid ice in your drinks as its source may be unknown and don't brush your teeth in water you wouldn't want to drink. If unsure be careful and use sealed bottled water from one of the hotels.
Food-Borne Disease: Again, in the larger cities and tourist resorts, the food and its preparation is generally of an excellent standard and you should experience no problems. It is advised however to avoid eating shellfish and cold/rare meats. In particular, Capetown is famous for its various shellfish meals. Personally I would strongly encourage travellers to avoid them even in the best hotels and restaurants. It is just not worth the risk. As in any hot climate it is also wise to choose only the type of fruit you can peel yourself. Above all avoid buying or consuming food from roadside stalls or street vendors.
Rabies in South Africa: Travellers need to be aware that this potentially fatal viral condition occurs throughout Africa. The risk to any tourist or business traveller is very small but common sense needs to be maintained at all times. The disease is mainly transmitted through the bite of an infected warm blooded animal. Usually dogs and cats are involved but also be very careful of monkeys. If bitten by any potentially at risk animal wash out the wound immediately, apply a strong antiseptic and seek medical attention urgently
Yellow Fever: A yellow fever vaccination certificate is only required for travellers coming from endemic zones in Africa and the Americas. Travellers on scheduled airlines whose flights have originated outside the areas regarded as infected (or who are only in transit through these areas) are NOT required to possess a certificate.
If the flight originated from within a Yellow fever endemic area a certificate is then required.

Vaccination Schedule: Apart from Yellow Fever vaccine in certain circumstances, as mentioned above, there are no other vaccinations required for entry into South Africa from Ireland. Nevertheless there are a number of recommended vaccines for most travellers which need to be discussed. For trekking holidays or extended visits Rabies and Hepatitis B may need to be considered. Most travellers should start their vaccines at least 4 to 6 weeks before departure.
Further Information: South Africa is a beautiful destination with much to offer. Further general health information on staying healthy while travelling abroad may be obtained from the Tropical Medical Bureau. www.tmb.ie

Travel News Headlines WORLD NEWS

Date: Thu, 15 Aug 2019 11:07:44 +0200 (METDST)

Johannesburg, Aug 15, 2019 (AFP) - South Africa on Thursday announced visa waivers for four countries in a bid to boost tourism amid an economic crisis and falling visitor numbers.   Visitors from Qatar, Saudi Arabia, United Arab Emirates and New Zealand will no longer require a visa to visit for holiday, conferencing and business purposes, Home Affairs Minister Dr Aaron Motsoaledi said.

The unilateral decision comes as official tourism figures released in May reflected a dip in the overall number of visitors to South Africa from Europe and the Middle East in the first financial quarter of the year, normally one of the most popular times to visit.   Foreign traveller arrivals decreased by more than 10 percent between April and May 2019 alone.   Motsoaledi said the South African government was engaging with Qatar, Saudi Arabia, United Arab Emirates and New Zealand about a similar relaxation of entry requirements for SA citizens.   He argued the move by his department would boost tourism "and by extension growing the economy and creating jobs".

South Africa's economy has hit trouble, with gross domestic product (GDP) contracting by 3.2 percent in the first three months of 2019 and unemployment at a record high of 29 percent.   The government estimates there is potential to create 2.1 million jobs in the tourism sector by 2028.   South Africa is in talks to extend the visa waiver to Ghana, Cuba and Principe and Sao Tome.    The country has already waived the visa requirement for 82 of the 193 countries who are UN members.
Date: Thu, 15 Aug 2019 00:22:55 +0200 (METDST)
By Susan NJANJI

Johannesburg, Aug 14, 2019 (AFP) - Four years ago, South African fashion designer Innocent Molefe, 38, was diagnosed with tuberculosis. A year ago, it developed into multi-drug resistant strain requiring painful injections and heaps of pills.   Three months after the first round of treatment, he relapsed and started a second round. At the end of it he still wasn't cured.

Thanks to a new treatment - approved Wednesday by the US Food and Drug Administration - he is now cleared of the disease, has bounced back to work and has even resumed night-clubbing, something he has stopped four years ago.   "I was willing to beat TB and I'm living proof. I can move around... I can still go clubbing till the early hours," said the dreadlocked designer at his home in Soweto township.   The announcement was especially welcomed in South Africa, one of the countries with the highest number of TB cases. Of the more than 1.6 million TB deaths recorded every year, more than 75,000 are in South Africa alone. In 2017, South Africa recorded more than 322,000 active TB cases.   The new treatment which cures highly drug-resistant strains of tuberculosis will drastically shorten the treatment period.

The three-drug regimen consists of bedaquiline, pretomanid and linezolid - collectively known as the BPaL regimen.    Pretomanid is the novel compound developed by the New York-based non-profit organisation TB Alliance and which received the FDA greenlight Wednesday.    The treatment regimen was trialed at three sites in South Africa involving 109 patients and achieved a 90 percent success rate after six months of treatment and six months of post-treatment follow-ups.

- 'Groundbreaking treatment'-
With the treatment involving five pills of the three drugs daily taken over just six months - it makes easier to administer.   This compares to between 30 and 40 drugs that multiple-drug resistant TB patients take each day for up to two years.   "Usually and in many places in the world the treatment for (multiple) ... drug resistant TB would take anything between 18 to 24 months," said Pauline Howell, principal investigator of the clinical trial at Sizwe Tropical Disease Hospital in Johannesburg.   "This still includes daily injections for six months, which are extremely painful," Howell said, adding that taking only five pills would make a huge difference.

The FDA approval represents a victory for those suffering from highly drug-resistant forms of the world's deadliest infectious disease, said Mel Spigelman, president and CEO of TB Alliance.    Last year there were more than half a million drug resistant TB cases in the world.    A chronic lung disease which is preventable and largely treatable if caught in time, tuberculosis is the top infectious killer, causing over 1.6 million deaths each year.   More than 10 million are cases recorded every year. The disease has worsened as it has become increasingly resistant to available medicines.

TB Alliance started designing the trial in 2014.   "This is really groundbreaking result we have here," said Folu Olugbosi, clinical director and head of the South African office of TB Alliance.   Patients are moving from a "truckload of pills" to cure the resistant strain with just three drugs and in just six months, Olugbosi said.   At the Sizwe hospital northeast of Johannesburg, a patient named Nxumalo arrived from Katlehong township for his regular post-treatment check-up to make sure he is still in the clear.   "With the old regimen, I would vomit," said the 23-year-old unemployed man. "But with the one for research, it's easier to take than 24 tablets."
Date: Sun 14 Jul 2019
Source: cape{town}etc [edited]

There has been a noticeable increase in cases of flu and pneumonia in South Africa compared to last year [2018], along with the time it takes for affected individuals to recover.

The Centre for Respiratory Diseases and Meningitis (CRDM) has announced its concerns regarding the rise in cases in a report, saying, "The 2019 South African influenza season, which started towards the end of April, is ongoing. Transmission of influenza measured using the Viral Watch programme and impact measured using the pneumonia surveillance programme have both reached high levels." As more people struggle to kick the nasty bug so do more find themselves contracting the flu from friends, family members, or colleagues. The CRDM has declared that the risk of contracting these respiratory illnesses will extend until October this year [2019].

Influenza A(H3N2) has been identified as the most prevalent strain this year. According to the CRDM, "To date, the majority 711/783 (91%) of influenza positive samples for this season, detected by 3 surveillance programmes, have been identified as influenza A(H3N2). Influenza A(H3N2) is one of the three seasonal influenza viruses prevalent in human populations."

Along with being longer than is the norm, the 2019 flu season also started earlier in the year. The 1st week of June is usually when it begins, but this year reports of cases of flu began being recorded in April.

CRDM warned that some groups may be especially vulnerable to this spike in flu cases, particularly pregnant people, the elderly and those already suffering with a disease that weakens their immune system. Locals are encouraged to be cautious and even take immunity-boosting supplements for prevention. Additionally, individuals who contract the flu should take at least 2 days off work to reduce the spread of the virus and shorten their recovery time.  [byline: Aimee Pace]
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[HealthMap/ProMED-mail map of South Africa:
Date: Fri, 28 Jun 2019 01:56:34 +0200
By Béatrice DEBUT

eMalahleni, South Africa, June 27, 2019 (AFP) - Tumelo has again lost several days at school because of sickness.   "My eyes are burning. Sometimes I can't breathe," she coughs.   "The doc said there is nothing we can do," says her mother Nono Ledwaba. "We need to take her out of eMalahleni. When she goes to her grandma in Mafikeng, the symptoms disappear."   The 14-year-old lives in house number 3094 of eMpumelelweni township in eMalahleni, part of the Highveld region turned over to mines and power plants that, according to activists, are killing local people.

Her neighbour in 3095, Lifa Pelican, has similar symptoms, which badly set back his schooling. At 25, he never moves without his inhaler, even inside his chilly home with rough-hewn walls.   "If I don't have it with me, sometimes I can't breathe. Sometimes I feel I am going to die," he says.   "These mines get a lot of money and we suffer. There's solar power. We don't need to use these coal plants."   Green energy such as solar and wind power account for less than two percent of electricity production in South Africa, while coal still provides 86 percent.   Lifa's breathing troubles began after he moved to eMalahleni, at the mercy of gritty coal dust and thick whitish smoke of electricity power stations burning fuel day and night.

Relief comes when he visits his father in Nelspruit, about 200 kilometres (125 miles) away, trips that feel like a new lease on life. "I don't use the inhaler."   Tumelo's own troubles began when the family moved to eMalahleni in 2007, when she was a toddler.   The trips to Mafikeng are literally a breath of fresh air -- her grandmother's home is 400 kms from the mines.   "The only solution is to close down the plants, but will this happen?" Ledwaba asks.   eMalahleni, which means "the place of coal", is among the worst places in the world for pollution by nitrogen dioxide and sulphur dioxide, according to Greenpeace.

- 'Deadly pollution levels' -
South Africa, like many developing countries, has placed a heavy bet on coal for its development -- a fuel that is plentiful, cheap and locally-sourced.   But campaign groups say health and climate costs are high.   Two environmental non-governmental organisations, groundWork and Vukani, say they have identified the top culprits.   They include 12 coal-burning power stations run by state-owned Eskom along with a plant for liquefying coal and an oil refinery.

Pollution from these sites was responsible for between 305 and 650 premature deaths in 2016, say the two NGOs.   They have initiated a suit against the government for "violation of the constitutional right to clean air" -- a legal first in South Africa, the leading industrial power on the continent.   The NGOs contend that the government has failed to reduce deadly pollution levels in the area, just an hour and a half's drive from Johannesburg.   "It has evolved into a public health crisis," says Tim Lloyd, lawyer for groundWork and Vukani.   "The cost of the air pollution to our economy each year is around 35 billion rand (1.8 billion euros, $2 billion)."

In response to the accusations, an environment ministry spokesman told AFP that SO2 (sulphur dioxide) emissions have "shown improvements across all the five monitoring stations" in the worst-affected region of the Highveld.   Criticism by environmental groups "fails to recognise these improvements', the ministry stated, declining to give further details about the data.   "The reality is that the desired improvements will not happen over a short period of time," it said.   Eskom admitted the area's pollution problem "requires urgent attention", adding that domestic coal burning, traffic and mining dust were also to blame.

- 'The life of my kids' -
"When people from other provinces come, they start getting sick with respiratory issues," says Alexis Mashifane, a doctor with a busy practice in Middelberg, 30 kms from eMalahleni.   "When they leave this area, some of them get better."   But many have no choice, saying they are stuck in the toxic region for economic reasons.   "I wish to move away because this place is not right," says Mbali Mathebula, a single mother who is raising a small daughter and a baby girl, both suffering from asthma. "I don't have money to buy a house".

In Mathebula's home at the foot of the Schonland coal mine, five-year-old Princess plays with the useless mask given to her mother at hospital.   Mathebula, a supermarket employee, could not afford a 70-euro ($80) oxygen machine to attach to the mask.   If a child has an asthma attack in the night, Mathebula says she has to wait until the morning and then go to hospital. "Sometimes I don't have money to go there. I must borrow."   Her neighbour Cebile Faith Mkhwanazi has to cope with her three-year-old daughter's asthma attacks.   "I'm thinking of taking them to my mother," she adds, broken-hearted. "So that they stay there forever for their health."
22nd June 2019
https://www.timeslive.co.za/news/south-africa/2019-06-22-cape-town-hit-by-flooding-and-evacuations-as-storms-strike/

Heavy rains and driving winds forced the evacuation of a Cape Town building and left several suburbs without power. City council disaster officials and firefighters evacuated as many as 1,000 people from a building in Kruskal Avenue in Bellville after it was damaged by the storm. City of Cape Town traffic chief Richard Coleman said while no injuries had been reported, the road was closed and emergency service personnel were attending to the incident. Mandy Thomas, of the city’s disaster risk management, said officials were dealing with the incident.

A massive cold front pounded the Western Cape with up to 50mm of rainfall expected over the weekend. The SA Weather Service issued a weather warning on Thursday, informing residents to take proactive measures as the cold front approached. Localised flooding was expected in some areas, and vulnerable residents were advised to dig trenches around their properties.

A tree fell over onto a train at Thornton station.
A tree fell over onto a train at Thornton station.

According to an update issued by disaster risk management earlier on Saturday, there had been numerous reports of flooded roadways and fallen trees. As a result, the electricity supply in parts of Milnerton, Plumstead and Sybrand Park was interrupted. “Roofs were blown off in Belhar, Strand, Khayelitsha, Woodstock and Claremont. No rockfalls or mudslides have been reported. The City's Electricity Department is busy restoring the power and other city departments are busy with mopping up operations,” the update read. A tree is also reported to have fallen over onto a train at Thornton station. Officials said the tree was being removed but that major train delays could be expected. 

More ...

World Travel News Headlines

Date: Fri, 23 Aug 2019 18:13:17 +0200 (METDST)

London, Aug 23, 2019 (AFP) - British Airways pilots on Friday said they will strike for three days in September in a dispute over pay, in a move that could affect tens of thousands of travellers.   The strikes on September 9, 10 and 27 were announced by the British Airline Pilots Association (Balpa), which said there had been a 93-percent vote in favour of industrial action.   "It is completely unacceptable that Balpa is destroying the travel plans of tens of thousands of our customers with this unjustifiable strike action," said the airline.   "We are extremely sorry that after many months of negotiations, based on a very fair offer, Balpa has decided on this reckless course of action," it said.

British Airways said it would change schedules to try and ensure as many people as possible can take their flights but warned that "many" customers will not be able to travel.   "We will be offering refunds and re-bookings for passengers booked on cancelled flights," it said.   Balpa said the strikes were "a last resort" but added that pilots had made "sacrifice after sacrifice" in recent years.   Balpa estimated each day of strike action would cost the company around £40 million (44 million euros, $49 million).
Date: Fri, 23 Aug 2019 15:08:04 +0200 (METDST)
By Obert SIMWANZA

Lusaka, Aug 23, 2019 (AFP) - Children living in a central Zambian mining town are still exposed to high levels of toxic lead 25 years after the mine closed, Human Rights Watch said Friday, as lawyers announced plans to take legal action.   Decades of lead mining have left Kabwe, around 150 kilometres (95 miles) north of Lusaka, severely polluted, with serious health implications for residents.   The mine, which operated from the early 1900s until its closure in 1994, was at one time the world's largest lead mine. It was run by the Zambian government from the early 1970s when the mining industry was nationalised.     In a report published Friday, HRW said the town in the Copperbelt area still has extreme levels of contamination and children continue to be exposed to high levels of toxic lead in soil and dust around their homes, schools and play areas.

HRW's children's rights fellow and report author Joanna Naples-Mitchell described the situation in Kabwe as "a public health emergency" and said the government was "not responding with the sense of urgency that is warranted".    "The Zambian government is aware that Kabwe has been severely contaminated... since the 1990s and efforts to clean up have been inadequate," she told AFP.   A class action suit is being prepared to demand compensation for poisoning from Anglo American South Africa, a former investor in the mine, London-based law firm Leigh Day announced Friday. The law firm deals in human rights issues.   The case will be brought in courts in South Africa, where the mining firm is based, said the lawyers, who are acting on behalf of some 200 children who have been treated for lead poisoning.   Anglo American on Friday said in a statement it did not believe it was "in any way responsible for the current situation" in Kabwe.    "We were concerned to learn of the situation at Kabwe as reported by the press," it said, adding "the nationalisation more than 40 years ago effectively placed these issues under the control of the Zambian Government".

- 'Severely contaminated' -
The HRW report said that although lead and zinc mining have stopped in the town, various medical studies conducted over the past seven years show children there still had elevated levels of lead in their blood.   Between 2003 and 2011, the World Bank funded a government project to decontaminate Kabwe's affected townships, and to test and treat children. But some 76,000 people, or a third of the town's population, still live in contaminated areas.   One recent study published last year and cited by HRW estimated that more than 95 percent of children in the townships surrounding the lead mine have elevated blood lead levels and that about half of them require medical intervention.   "This is the worst environmental disaster I have seen in 30 years of practice," said lawyer Richard Meeran of Leigh Day.    Johannesburg-based collaborating lawyer Zanele Mbuyisa said they will argue that "the environmental damage created has potentially contaminated almost three generations of men, women and children".

- Insufficient resources -
Three years ago, the government launched another five-year World Bank-funded project to get rid of the lead and carry out new rounds of testing and treatment.   The project targets around 10,000 people including children, pregnant women and mothers.   "We think this a very important opportunity for the Zambian government to find a lasting solution to this problem," said Naples-Mitchell.   She urged Zambia to find new and effective methods to clean up the lead, adding that their 2018 study indicated that pollution levels were "as high they had been in the 1970s".    In a letter last month, the government indicated to HRW that it does not have enough resources to address the full scale of the contamination.   The government did not immediately comment on the report.   Children are more vulnerable to lead poisoning since they absorb four to five times as much as an adult and this can retard their growth and IQ, while in worst cases it can result in brain damage or even death.
Date: Fri, 23 Aug 2019 14:02:01 +0200 (METDST)

Khartoum, Aug 23, 2019 (AFP) - Rain and flash floods have killed 54 people in Sudan since the start of July and affected nearly 200,000, the United Nations said Friday.   The worst affected area is While Nile state in the south but Khartoum and other regions have also been affected.   "More than 37,000 homes have been destroyed or damaged," the UN said, quoting figures from the government body it partners with in the crisis response.   "Humanitarians are concerned by the high likelihood of more flash floods," it said, adding that most of the 54 recorded deaths were due to collapsed roofs and electrocution.

The floods are having a lasting humanitarian impact on communities, with cut roads, damaged water points, lost livestock and the spread of water-borne diseases by insects.   The UN Office for the Coordination of Humanitarian Affairs said an extra $150 million were needed from donors to respond to the floods, in addition to the $1.1 billion required for the overall humanitarian situation in Sudan.
Date: Thu, 22 Aug 2019 21:40:50 +0200 (METDST)

Warsaw, Aug 22, 2019 (AFP) - At least five people, including two children, were killed and more than 100 others were injured Thursday during a sudden thunderstorm in Poland and Slovakia's Tatra mountains, according to rescuers and officials.   Most of the victims were on the Polish side, where lightning struck a large metal cross on top of Mount Giewont and a metal chain near the summit, rescuers said. One person died in Slovakia.   "There were a lot of incidents involving lightning strikes today in the Tatras," Polish mountain rescue service chief Jan Krzysztof told Poland's PAP news agency.    "More than 100 people are injured," Poland's Prime Minister Mateusz Morawiecki said after arriving in the nearby mountain resort town of Zakopane.

Rescuers believe many hikers were nearby when lightning struck the cross on Giewont's summit.   They had set out to climb Poland's highest mountains when the skies were clear earlier in the day.    "We heard that after (the) lightning struck, people fell... the current then continued along the chains securing the ascent, striking everyone along the way. It looked bad," Krzysztof said.    Lightning also struck on the nearby Czerwone Wierchy mountain massif, injuring a Portuguese citizen.
Date: Wed 21 Aug 2019
Source: Forbes [edited]

A Missouri county has imposed mandatory hepatitis A vaccinations for food handlers. Franklin County, Missouri, joins a handful of jurisdictions across the country with mandatory hepatitis A vaccine programs aimed at preventing further cases. This development is part of a larger trend aimed at expanding vaccinations for hepatitis A and addressing future outbreaks of the disease.

Hepatitis A is a contagious liver disease that can cause symptoms ranging from fever to jaundice and, in extreme cases, liver failure and death. According to the Centers for Disease Control and Prevention, the virus is most commonly spread in the USA via the fecal-oral route, meaning that a person unknowingly ingests something contaminated with the faeces of an infected person.

Hepatitis A is a particularly insidious virus, as an infected person is most contagious 2 weeks before symptoms develop, and those symptoms can take as long as 50 days after exposure to develop. Fortunately, hepatitis A is preventable by vaccine.

CDC is investigating outbreaks of hepatitis A across 29 states. According to CDC, 233 individuals have died from hepatitis A between 2016 and 2019 out of over 24 000 reported cases. Several states, including Kentucky, Florida, Ohio, and West Virginia, have seen thousands of cases.

In an effort to curb the increase in reported cases of hepatitis A, many local jurisdictions are considering mandatory hepatitis A vaccines for food service workers. For example, Missouri has reported 387 cases of hepatitis A in the past 2 years. Over 50 of these cases are from Franklin County, which has a population of about 100,000 residents. Franklin County officials have imposed mandatory vaccinations for individuals who handle food. Food establishments, including restaurants, have 90 days to ensure their employees are vaccinated. Nearby St Louis County, Missouri enacted a mandatory vaccine requirement nearly 20 years ago. Similar ordinances requiring vaccines for food service workers were enacted in Kentucky's Ashland and Boyd Counties in 2018.  [byline: Tommy Tobin]
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[A campaign to protect the patrons of restaurants from acquiring hepatitis A from the food as being done now in this county in Missouri is more than reasonable, as has been stated here previously. In addition to the recent outbreak of 23 cases of HAV linked to a New Jersey golf club (see alsos below), the following is an only partial list of recent reports of restaurant employees acquiring HAV:

Washington 16 Aug 2019
Hepatitis A forces Lynnwood restaurant to temporarily close

New York 16 August 2019
Confirmed case of hepatitis A in Platinum Pizza employee, vaccines to be made available to patrons

Florida 6 Aug 2019
Ocala restaurant employee infected with hepatitis A, officials say

Tennessee, Ohio 1 Aug 2019
National epidemic of hepatitis A outbreaks puts restaurant customers at risk

Mississippi 24 Jul 2019
Health officials investigating possible hepatitis A exposure at Mississippi restaurant

HealthMap/ProMED map available at:
Missouri, United States: <http://healthmap.org/promed/p/227>]
Date: Sun 18 Aug 2019
Source: Associated Press [edited]

Health officials in Las Vegas are using the word "outbreak" to describe a sharp spike in hepatitis A cases reported mostly among homeless people and drug users. The Southern Nevada Health District reported on Wednesday [14 Aug 2019] that from November [2018] to June [2019] it tallied 83 cases of the virus that causes liver damage and can lead to death.

That's far more than the 58 cases reported in 2016, 2017, and 2018, combined. The district says more than 80% of reported patients were people without a permanent place to live, and 92% use drugs, whether intravenous or not.

Clinical services chief Dr Fermin Leguen told the Las Vegas Review-Journal recently that the numbers are alarming. He noted that cases are being reported nationwide. Public health emergencies have been declared in cities including Miami and Philadelphia, and the Centers for Disease Control and Prevention is tracking outbreaks in 27 states. An outbreak of hepatitis A among homeless people in San Diego killed 20 in 2017.

Clark County officials announced in July 2019 that during a 2-day count in January 2019, almost 5300 people were tallied living on sidewalks, vacant lots, parks, and drainage tunnels in and around Las Vegas. That was down from about 6100 in 2017. The Southern Nevada Health District said the trend in hepatitis A cases has been upward: 6 reported cases in 2016; 13 cases in 2017; and 39 in 2018.

The Review-Journal accompanied a crisis intervention team visiting hepatitis A "hot spots" in Las Vegas to offer vaccine shots. The vaccine for the hepatitis A virus is effective soon after inoculation, although a 2nd dose is required after 6 months for full coverage.

Fuilala Riley, president of Help of Southern Nevada, told the newspaper that access to running water for people to wash their hands is important in preventing spread of the virus. Hepatitis A is most often transmitted through consumption of water or food contaminated with faeces.
=======================
[Nevada has yet to be listed in the CDC site following this unnecessary outbreak.  As the number of cases continues to rise in a number of states, and news of smaller (so far) outbreaks occur in others, the question at the end of ProMED-mail post http://promedmail.org/post/20190104.6241686 by a Kentucky official -- "This is a disease of developing countries. One has to ask: Why are we seeing it in the USA?" -- is more and more relevant. We are seeing these outbreaks because of the inability to deal with marginalized populations in our midst. The dramatic cutbacks in public health infrastructure in some of these states clearly feed the fire of these outbreaks. They must be addressed by bolstering public health resources and education and directly addressing the needs of these marginalized populations. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Las Vegas, Nevada, United States:
Date: Wed 21 Aug 2019
Source: Bring Me the News [edited]

There have now been 69 people to have fallen sick from the _Escherichia coli_ outbreak at Lake Nokomis. Health officials put out an alert earlier this month [August 2019] after 3 children became sick with the bug after swimming at the lake, prompting the closure of both its beaches.

The Minnesota Department of Health said on Friday [16 Aug 2019] it had received 49 confirmed cases of _E. coli_-related illness since the outbreak, and on Tuesday [20 Aug 2019] revealed that this number had grown to 69. Those affected went swimming at the south Minneapolis lake between 16 Jul and 11 Aug 2019, with the Shiga-toxin producing _E. coli_ taking up to 16 days to show symptoms. [We generally consider 10 days to be the long end of the incubation period. - ProMED Mod.LL]

Both beaches at the lake have been closed and will remain that way for the rest of the season, as part of MDH's response to contain the outbreak. Of the total cases, 20% affected children aged 10 and younger. Fortunately, nobody has required hospitalization.

The Star Tribune reports that with other beach closures at Bde Maka Ska and Lake Hiawatha, among others, this summer, it is the most beach closures seen in the city since it started testing for bacteria in 2003. The MDH advises anyone showing symptoms of a Shiga-toxin _E. coli_ infection -- diarrhea (often bloody), stomach cramps, no or low-grade fever -- should see a healthcare provider.  [byline: Adam Uren]
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[This has become a substantial outbreak.  It is important to understand that there are many different kinds of _E. coli_. The organism is an important component of the human intestinal tract and can perform important functions helpful to its host. These strains can cause human infections if they "escape" from the usual location into the urinary tract, gall bladder, or abdominal cavity. They are also what are mentioned when a beach is closed for _E. coli_ contamination. In this circumstance, officials are measuring the organism or "coliforms" in the water to reflect human sewage contamination.

In addition, some strains of _E. coli_ can produce toxins that can induce diarrhea, and much of so-called travelers' diarrhea is caused by these strains. All of these strains are human bacteria, not zoonotic organisms, that is, not spread from animal hosts. One _E. coli_ group called Shiga toxin producing or enterohemorrhagic _E. coli_ (EHEC), the organism likely to be involved here, is zoonotic. Spread in a number of ways, including via undercooked ground beef, contaminated vegetables, and direct or direct contact with farm animals including contaminated water, EHEC can cause significant disease and even death.

In the spring of 2000, in Walkerton, a town of 5000 in southern Ontario, an outbreak of _E. coli_ O157:H7 infection claimed 7 lives -- 6 adults and a child -- and over 200 were seen at local area hospitals.

Swimming-associated transmission is illustrated in the following references:

1. Keene WE, McAnulty JM, Hoesly FC, et al. A swimming-associated outbreak of hemorrhagic colitis caused by _Escherichia coli_ O157:H7 and _Shigella sonnei_. N Engl J Med. 1994; 331(9): 579-84; available
2. CDC. Lake-associated outbreak of _E. coli_ O157:H7 - Illinois. MMWR 1996; 45(21): 437-9; available at
3. Ackman D, Marks S, Mack P, et al. Swimming-associated hemorrhagic colitis due to _Escherichia coli_ O157:H7 infection: evidence of prolonged contamination of a fresh water lake. Epidemiol Infect. 1997; 119:1-8; available at

[HealthMap/ProMED-mail map of Lake Nokomis, Minnesota, United States:
28 Jul 2019

As many as 13 have died while 6677 have been infected across Tanzania. In Dar es Salaam region alone, 6631 cases and 11 deaths have occurred.

HealthMap/ProMED-mail map of Tanzania:
8 Aug 2019

Dengue-type1 outbreak was declared on the 27 Feb 2019 following a laboratory (NZLabPlus) confirmation of 7 dengue type 1 cases. From 28 Jan-4 Aug 2019, a cumulative number of 78 dengue cases have been reported (22 confirmed, and 56 probable-NS1Ag positives). Rarotonga and Aitutaki are the only islands affected and most of the cases have been from the main island of Rarotonga. Aitutaki has managed to contain its number of cases to 3. The last case was reported on 18 Apr 2019. A total of 42 cases have been hospitalised and given free mosquito nets to take and use at home. Apart from some severe cases, the hospitalisation was also an effort to contain and minimise the spread of the infection into the community. Unfortunately, some cases refused to be admitted but were given some health advice and mosquito precautionary measures. No deaths reported.

- Cook Islands. 17 Aug 2019. 78 dengue cases have been reported in Cook Islands since the outbreak began early in the year [2019]. The Cook Islands News reports the Ministry of Health saying 22 were confirmed cases while 56 have been deemed probable positives.

HealthMap/ProMED-mail map of Cook Islands:
19 Aug 2019

358 indigenous cases and 2 imported cases of dengue 2 have been confirmed since the beginning of 2019, according to the latest Health Watch bulletin. Tahiti is still in an epidemic phase: all communes are affected except Mahaena, Pueu, and Teahupoo. In the islands, Bora-Bora is in epidemic phase (at least 3 cases without epidemiological link): Vaitape and Faanui are affected. Moorea is in an epidemic phase: The communes of Afareaitu, Haapiti, and Paopao are affected. Six islands are in the alert phase: Nuku-Hiva (Taiohae), Fakarava, Raiatea, Rangiroa, Huahine, and Hiva Oa (Atuona). Since dengue type 2 has not circulated in the country since the year 2000, the population is poorly immunized, and the epidemic may be large. People under 20 or arriving in French Polynesia after 2000 are most at risk of becoming infected.

HealthMap/ProMED-mail map of French Polynesia: