Date: Tue, 1 May 2018 11:13:05 +0200

Yerevan, May 1, 2018 (AFP) - Armenia's hugely popular protest leader Nikol Pashinyan warned lawmakers of the prospect of major unrest if they did not elect him prime minister during a parliamentary vote on Tuesday.   "There is information that (former presidents) Serzh Sarkisian and Robert Kocharyan -- the famous tandem -- are planning to take back power," Pashinyan said during a nail-biting session of parliament in the capital Yerevan.   "I want to warn them -- gentlemen, the mistaken interpretation of people's leniency as weakness can lead to a genuine political tsunami."

"I call on everyone to take to the streets because once again they want to steal the people's victory," he added.   Pashinyan, the leader of mass protests that forced former president turned prime minister Sarkisian from power in the impoverished South Caucasus nation, is the only candidate for the post of prime minister.   He however is a handful of votes short of a majority and lacks the crucial support of the ruling party to get elected.

Speaking to his supporters in the early hours of Tuesday, Pashinyan said that the ruling party planned to derail the vote and urged hundreds of thousands to take to the streets.   A source familiar with the negotiations told AFP on Tuesday that the situation was febrile, saying Pashinyan could still be elected prime minister if several lawmakers from the Republican Party defected and voted for him.

Pashinyan is six votes short of the 53 he needs from the 105-seat legislature, where the Republican Party has a majority.   Ex-Soviet Armenia has been in the grip of a severe political crisis for the past few weeks, with leader Sarkisian stepping down last week after a decade in power in the face of peaceful protests.
Date: Fri 23 Feb 2018 17:34
Source: News.am [edited]
<https://med.news.am/eng/news/17236/2-month-old-armenia-boy-dies-of-pertussis.html>

A 2 month old boy died of pertussis in Armenia's Nork infectious clinical hospital. The child, just as 2 other children in the family, was not vaccinated because of parents' refusal, the Armenian health ministry said in a statement.

The illness started 2 months ago, but parents rejected hospitalization despite doctor's instructions. The laboratory tests revealed that twins -- boys 2 months old -- were infected by their 2 year old sister.

More cases of pertussis, commonly known as whooping cough, have been recorded in Armenia over the recent 2 months. There are already 12 laboratory confirmed cases this year [2018] compared with 3 in the same period last year [2017]. Eight of 12 affected children were not vaccinated or were partially vaccinated. The disease mainly affects children under one [year of age].

The Armenian health ministry recalled that vaccination is the only efficient and safe prevention for pertussis.
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[Nork Republican Infectious Clinical Hospital is one of more than 40 hospitals in Yerevan, the capital of Armenia, with a population of about 1 million residents in 2017
(<https://en.wikipedia.org/wiki/List_of_hospitals_in_Yerevan>).

A map of Armenia can be found at
<https://www.google.com/maps/place/Armenia>. - ProMED Mod.ML]
Date: Sun 1 Oct 2017
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/tularemia-outbreak-reported-artsvaberd-armenia-95080/>

An outbreak of the zoonotic bacterial infection, tularemia, has been reported in Armenia according to a Haqqin.az report (computer translated). According to the report, at least 20 people in the village of Artsvaberd in Tavush province were affected by the outbreak. The report does not state how the villagers were infected.

Tularemia can be transmitted to people, such as hunters, who have handled infected animals. Infection can also arise from the bite of infected insects (most commonly ticks and deer flies); by exposure to contaminated food, water, or soil; by eating, drinking, putting hands to eyes, nose, or mouth before washing after outdoor activities; by direct contact with breaks in the skin; or by inhaling particles carrying the bacteria (through mowing or blowing vegetation and excavating soil).

Typical signs of infection in humans may include fever, chills, headache, swollen and painful lymph glands, and fatigue. If tularemia is caused by the bite of an infected insect or from bacteria entering a cut or scratch, it usually causes a skin ulcer or pustule and swollen glands. Eating or drinking food or water containing the bacteria may produce a throat infection, mouth ulcers, stomach pain, diarrhoea and vomiting. Inhaling the bacterium may cause an infection of the lungs with chest pain and coughing.

Tularemia can be effectively treated with antimicrobials. Untreated tularemia can lead to hospitalization and may be fatal if not diagnosed and treated appropriately.  [Byline: Robert Herriman]
=================
[Tularemia is typically found in animals, especially small mammals such as voles, mice, rodents, rabbits, and hares. _Francisella tularensis_ is found in a wide range of animal hosts and is capable of surviving for weeks at low temperatures in water, moist soil, or decaying plant and animal matter. Although hundreds of differing vertebrates and invertebrates can be infected with the tularemia bacillus, no more than a dozen or so are important in its ecology. Humans become infected through a variety of mechanisms including bites of infected arthropods (mosquitoes, ticks, deerflies), handling infected or dead animals, ingesting contaminated food or water, and inhaling aerosols of bacteria. The type of exposure will dictate the form of the disease manifestation, with cutaneous exposures usually resulting in the glandular or ulceroglandular forms.

The report does not give information about the clinical manifestations of tularemia in these cases, the mode of transmission or the method of diagnosis (clinical, serology or culture). Additionally, the time span of the development of the cases is not given, which would help decide whether the cases may be related (occurring over a short time) as opposed to 20 cases in 2017. A cluster of 20 cases would suggest a common source exposure such as contaminated water or food. ProMED would appreciate more information in this regard.

Tavush is a province of Armenia. It is located at the northeast of Armenia and bordered by Georgia from the north and Azerbaijan from the east and its location may be seen on a map at <https://en.wikipedia.org/wiki/Tavush_Province>. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/133>.]
Date: Sat 21 Jan 2017
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/botulism-outbreak-armenia-78880/>

A botulism outbreak that has struck 2 villages in Armenia has sickened 2 people, according to the Armenian press. The source of the infections has been linked to homemade canned marinade.

Less than a day after consuming the marinade, the victims presented with symptoms of botulism. They were taken to the hospital, where they are being treated. One is in serious condition, according to the report.

Food borne botulism is a severe intoxication caused by eating the pre-formed toxin present in contaminated food. It occurs when the bacterium _Clostridium botulinum_ is allowed to grow and produce toxin in food that is later eaten without sufficient heating or cooking to inactivate the toxin. Botulinum toxin is one of the most potent neurotoxins known.

Typically, in a few hours to several days after you eat the contaminated food, you will start to show the classic symptoms; blurred vision, dry mouth, and difficulty in swallowing. Gastrointestinal symptoms may or may not occur. If untreated, the paralysis always descends through the body starting at the shoulders and working its way down. The most serious complication of botulism is respiratory failure, where it is fatal in up to 10% of people. It may take months before recovery is complete.

If the disease is caught early enough, it can be treated with antitoxin. If paralysis and respiratory failure happen, the person may be on a ventilator for several weeks.
=====================
[When botulism does occur related to food, it is most likely to be home-prepared, as in this case. It should be noted that in typical foodborne botulism, the toxin is pre-formed in the food when ingested. Infant botulism (and its very rare adult equivalent, adult intestinal toxaemia botulism) is caused by ingestion of spores, which germinate, and toxin is formed _in situ_. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/133>.]
Date: Mon 1 Feb 2016
Source: ARKA [edited]
<http://arka.am/en/news/society/two_cases_of_botulism_reported_in_armenian_gyumri/>

Two cases of botulism reported in Gyumri, Armenia
-------------------------------------------------
Two residents in Armenia's 2nd-largest city of Gyumri in the north-western province of Shirak were hospitalized with botulism, a disease that usually occurs after eating improperly cooked or preserved foods. The ministry of health said an epidemiological examination found that a possible cause of poisoning is either preserved peppers or a home-made eggplant product.

According to the ministry, the day after eating these foods the patients developed symptoms of botulism -- nausea, vomiting, asthma and blurred vision and were hospitalized at a hospital in Gyumri, where they were given appropriate medical care. "At this moment, their condition is regarded as moderate. The treatment continues," the ministry said.

The ministry of health issued a statement saying in order to avoid botulism, home-made preserves must be boiled for 20-25 minutes before eating. It also said citizens must not buy preserved foods in the market or from random people.

Botulism cases in Armenia occur usually in winter when many families start eating home-made preserved food, despite the health ministry's warning against using such food or its instructions to at least thoroughly cook such food by boiling it for 20-25 minutes to destroy the botulism toxin.
====================
[When botulism does occur related to food, it is most likely to be home-prepared as in this case. It should be noted that in typical foodborne botulism, the toxin is preformed in the food when ingested. Infant botulism (and its very rare adult equivalent, adult intestinal toxemia botulism) is caused by ingestion of spores, which germinate, and toxin is formed _in situ_. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/30973>.]
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