Date: Thu, 20 Dec 2018 13:44:40 +0100

Paris, Dec 20, 2018 (AFP) - Here is a recap of previous attacks targeting foreign tourists holidaying in North Africa, after Moroccan authorities arrested three suspects in the murder this week of two Scandinavian hikers.

- Morocco -
On April 28, 2011, a bomb attack on a popular tourist cafe in the city of Marrakesh kills 17 people, 11 of them European citizens, and wounding dozens of others.   The two men responsible for the attack are sentenced to death and seven others handed jail sentences ranging from two to 10 years.  The bombing is the deadliest in Morocco since attacks in the coastal city of Casablanca in 2003 that killed 33 people and 12 bombers.

- Tunisia -
On March 18, 2015, two men gun down 20 foreign tourists and a policeman at the Bardo National Museum in Tunisia. Among the dead are French, Italian and Japanese nationals.   The two attackers are shot dead by security forces.    The carnage, claimed by the Islamic State (IS) group, is the deadliest assault on foreigners in Tunisia since 2002.   Twenty-five people are being tried for the attack and could face the death sentence.   On June 26, 2015, a Tunisian student goes on a shooting spree at the Riu Imperial Marhaba Hotel in the beach resort of Sousse, killing 38 foreign tourists including 30 from Britain. The attack is claimed by IS.   The trial begins in May 2017 with 26 Tunisian nationals prosecuted including six members of the security forces accused of not assisting people in danger.

- Algeria -
On September 21, 2014 French national Herve Gourdel, 55, is kidnapped while hiking in a national park in the northeastern Kabyle region of Algeria.   Three days later the IS-linked Jund al-Khilifa, or "Soldiers of the Caliphate", claims to have beheaded Gourdel in a video posted online after Paris rejected their demand to halt air strikes in Iraq.  Gourdel's body is found three months later.
Date: Tue, 18 Dec 2018 11:59:06 +0100

Rabat, Dec 18, 2018 (AFP) - Moroccan authorities on Tuesday arrested a suspect following the murder of two Scandinavian women in the High Atlas mountains, a popular trekking destination for tourists.   Other suspects are being sought over the killings of the Danish and Norwegian hikers who were found dead on Monday with cuts to their necks, the interior ministry said.   The bodies were discovered in an isolated mountainous area 10 kilometres (six miles) from the tourist village of Imlil in the High Atlas range.   Imlil is a starting point for trekking and climbing tours of Mount Toubkal, which at 4,167 metres is the highest summit in North Africa.

The suspect was arrested in the former imperial city of Marrakesh, a tourist hub located at the foot of the mountains about 60 kilometres north of Imlil, and held in custody for questioning, the ministry said.   The Moroccan authorities described it as a "criminal act" but did not give further details about the circumstances of the murders.   The Danish victim, Louisa Vesterager Jespersen, 24, "had her throat cut," her mother Helle Petersen was quoted by the Danish newspaper B.T. as saying.   Her family had warned her against going to Morocco "because of the chaotic situation," she added.   According to her Facebook page, Jespersen had studied in Norway to be a guide.

- 'Every precaution' -
Norwegian media named the other victim as 28-year-old Maren Ueland.   "Her priority was safety. The girls took every precaution before going on this trip," her mother Irene Ueland told Norwegian broadcaster NRK.   The two women studied at a university in southern Norway and had planned to travel together for a month, she said, adding that her last contact with her daughter was on December 9.

A Norwegian policeman from the embassy in Rabat is travelling to Marrakesh to act as a liaison between the authorities.   Security was stepped up in the region and hiking suspended following the discovery of the bodies, Moroccan media said.   "It's very bad for the region. There will undoubtedly be cancellations," a local guide, Hossein, told AFP from Imlil.   Tourism is a cornerstone of Morocco's economy and the kingdom's second-largest employer, after agriculture.   The sector accounts for 10 percent of national income and is one of the country's main sources of foreign currency.   After several years of near-stagnation, Morocco welcomed a record 11.35 million visitors in 2017, exceeding the 11-million mark for the first time.
Date: Mon 12 Nov 2018, 9.54 AM EST
Source: The Guardian [edited]
<https://www.theguardian.com/science/2018/nov/12/briton-dies-from-rabies-after-trip-to-morocco>

A Briton has died after contracting rabies while visiting Morocco, public health officials have said. The UK resident was infected with the disease after being bitten by a cat, Public Health England (PHE) said on [Mon 12 Nov 2018]. PHE did not release any further details but reassured the public there was no wider risk. It said health workers and close contacts of the deceased were being assessed and offered vaccination where necessary.

Jimmy Whitworth, the professor of international public health at the London School of Hygiene and Tropical Medicine, told the Press Association: "My understanding is that this is somebody who had contact with a cat that was behaving abnormally and sought care, I believe in Morocco and in the UK, but unfortunately didn't receive vaccination until it was too late. I believe that the cat bit this person a few weeks ago."

He said that symptoms typically took 2 to 3 months to appear but could materialise in as little as a week. "That's why seeking prompt care and getting vaccination is so important," he said. "In this tragic case the person didn't get the vaccine in time." Given the lack of information, Whitworth said it was impossible to know whether the delay was in the UK or Morocco but it illustrated the importance of health workers being aware of the possibility of the disease.

There are no documented instances of direct human to human transmission of rabies. The disease does not circulate in either wild or domestic animals in the UK, although some species of bats can carry a rabies-like virus.

[Rabies] is common elsewhere, including in parts of Asia and Africa. PHE said the case was a reminder to travellers to rabies-affected countries to avoid contact with dogs, cats and other animals wherever possible, and seek advice about the need for a rabies vaccine prior to travel.

Dr Mary Ramsay, the head of immunisations at PHE, said: "This is an important reminder of the precautions people should take when travelling to countries where rabies is present. If you are bitten, scratched or licked by an animal you must wash the wound or site of exposure with plenty of soap and water and seek medical advice without delay."

It is only the 6th case of human rabies in the UK since 2000, all but one caused by animal exposure overseas. The last was in 2012, when a woman in her 50s died in London after being bitten by a dog in South Asia. She was reportedly turned away twice by doctors at a hospital in Kent before she was finally diagnosed.  [byline: Haroon Siddique]
======================
[According to another media source, the victim, a 58 year old man from Aylesbury Bucks, was staying 30 miles away from the Moroccan capital Rabat, visiting family, when he was infected with the disease. He did receive treatment but allegedly was not given anti-rabies serum in time;  <https://www.dailymail.co.uk/news/article-6382379/PICTURED-British-father-two-died-rabies-UK.html>.

The following statistics on rabies in animals were submitted by
Morocco for 2016 (last available annual report):
Official vaccinations in dogs: 71 759
Rabies outbreaks: 76

species / cases / deaths / killed
dogs / 41 / 28 / 13
cats / 12 / 11 / 1
bovine / 71/ 62 / 9
equine / 44/ 38/ 6
ovine / 6 / 5 / 1

The numbers of human cases, as reported to the OIE for the years 2010-2015, were 19, 18, 19, 24, 20, and 19, respectively. The number of human cases during 2016 (the most recent available data) was 17.

The tourism industry is well developed in Morocco; in 2017, Morocco was Africa's top tourist destination, with 10.3 million tourist arrivals, most of them from Europe, predominantly France and Spain. In the past, cases of rabies in animals illegally introduced from Morocco with returning visitors were recorded in France
(http://promedmail.org/post/20131104.2037811,
http://promedmail.org/post/20110812.2455,
http://promedmail.org/post/20040726.2047,
http://promedmail.org/post/20040222.0564).

The event is being investigated. - ProMED Mod.AS]

[HealthMap/ProMED maps available at:
England, United Kingdom: <http://healthmap.org/promed/p/279>
Morocco: <http://healthmap.org/promed/p/41>]
Date: Mon, 12 Nov 2018 15:54:12 +0100

London, United Kingdom, Nov 12, 2018 (AFP) - A Briton has died after being bitten by a cat with rabies in Morocco, officials said Monday, only the seventh known case in the United Kingdom since 2000.   England's health service issued a reminder Monday for travellers to avoid coming into contact with animals when travelling to rabies affected countries, particularly those in Asia and Africa.

Rabies has been effectively eradicated in Britain, although they do still spread among some bats.   "There is no risk to the wider public in relation to this case but, as a precautionary measure, health workers and close contacts are being assessed and offered vaccination when necessary," said Mary Ramsay, the health service's chief of immunisation.   The Press Association news agency said the person was bitten a few weeks ago and not given potentially life-saving treatment early enough.

Rabies is a viral disease that causes an inflammation of the brain. It is usually fatal by the time the first symptoms emerge.   England's health service said that no cases of humans acquiring the disease from any animal other than a bat have been recorded within the country since 1902.   One person acquired it from a bat in Scotland in 2002, and five people contacted while travelling between 2002 and 2017, the health service said.
Date: Thu 25 Oct 2018
Source: Medias24.com [In French, trans. ProMED Corr.SB, edited]
<https://www.medias24.com/MAROC/Quoi-de-neuf/186998-Des-cas-de-Leishmaniose-cutanee-confirmes-a-Tata.html>

Cases of cutaneous leishmaniasis have been confirmed in Tata. The treatment of all cases of cutaneous leishmaniasis recently recorded in the province of Tata have been paid for, free of charge, by the health services under the Ministry of Health, said the regional department of this department at Massa.

"Following the information relayed about the appearance of cases of leishmaniasis in the commune of Kasbat Sidi Abdellah Ben M'bark, in the province of Tata, the Directorate undertook on [19 and 21 Oct 2018] in-depth research thanks to a team of senior staff from the regional directorate of the Ministry of Health at the provincial level; samples were taken from patients suspected of having cutaneous leishmaniasis, and the necessary laboratory tests confirmed that a certain number of students were suffering from this disease," said the same source in a statement.

All the registered cases were taken care of, says the same source, at the health centre level 1 of the commune of Akka, and the rural health centre level 1 of the commune Kasbat Sidi Abdellah Ben M'bark, under the responsibility of province of Tata.

The same source confirmed that "the urban health centre and the rural health centre have all the medicines needed to treat such cases." The provincial health services of Tata remain mobilized, along with other stakeholders, to overcome the causes and effects of this disease, the statement added.
=====================
[The _Leishmania_ situation in Morocco according to the WHO
(<http://www.emro.who.int/neglected-tropical-diseases/countries/cl-morocco.html>):

This environmental complexity is reflected in the diversity of leishmaniasis. _Leishmania infantum_, _Leishmania major_ and _Leishmania tropica_ all occur, each in a specific range of vegetation types (bioclimatic stages).

Zoonotic cutaneous leishmaniasis due to _L. major_ occurs in unpredictable outbreaks in the south and south-east; _Phlebotomus papatasi_ is the vector, and the reservoir host has been identified as _Meriones shawi_. The transmission of _L. major_ from rodents to humans occurs at the end of the sandfly season (September and October). After a short incubation period of one week to 2 months, the lesions start to be seen in humans in late autumn and usually heal in less than 6 months. Sporadic zoonotic cutaneous leishmaniasis cases due to variants of _L. infantum_ occur in the north of the country.

Anthroponotic cutaneous leishmaniasis due to _L. tropica_ occurs in towns and villages in the centre of the country. The epidemiology of cutaneous leishmaniasis due to _L. tropica_ in Morocco is much more complex and less well understood than that of either visceral leishmaniasis or zoonotic cutaneous leishmaniasis.

The disease occurs at hypo-endemic intensity in separate foci between Tadla and Agadir, in the "subhumid" climate zone north and west of the High Atlas. Studies have shown discrepancy between the parasites in humans and vectors, this being an anomaly that requires further investigation, and strongly indicates the possibility of an unknown reservoir host.

Recent studies have found new focus on anthroponotic cutaneous leishmaniasis, and the emergence of cutaneous leishmaniasis is a current public health problem in Morocco. - ProMED Mod.EP]

[Tata District, Morocco: <https://en.wikipedia.org/wiki/Tata,_Morocco>

HealthMap/ProMED map:
Morocco: <http://healthmap.org/promed/p/41>]
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