Date: Thu, 22 Jan 2015 17:59:17 +0100 (MET)

Valletta, Jan 22, 2015 (AFP) - Nearly 90 migrants rescued at sea by the Maltese navy were on Thursday being held in quarantine as a precaution against Ebola, after 20 others reportedly died during the journey and were thrown overboard.   Charles Mallia Azzopardi, who heads the national Ebola Response Unit, told a press briefing that the 87 migrants were being held in isolation "as a precaution" after one of the passengers said he was from Guinea.   Rescuers donned special protective gear and an isolation tent was set up after three of the survivors were discovered in need of urgent medical assistance, although Azzopardi said they were most likely to be suffering from severe dehydration.

The three were hospitalised immediately, but police later said one of them had died, and an autopsy would be carried out in the next few days.   The surviving migrants, who hail from Burkina Faso, Guinea, Ivory Coast and Mali, are being tested for the virus and will be held in a detention centre in isolation for 21 days.   They told rescuers around 20 others had died during the crossing from North Africa and their bodies had been tipped into the sea.   "@Armed_Forces_MT rescuing 80 immigrants on a distressed dinghy off #Malta coast. Another 20 reported dead and thrown at sea during crossing," Maltese Prime Minister Joseph Muscat said on Twitter.    The deadly Ebola epidemic has killed 8,626 people according to the World Health Organisation, but is now slowing throughout west Africa.
Date: Wed, 8 May 2013 11:37:53 +0200 (METDST)

VALLETTA, May 08, 2013 (AFP) - Five French tourists were feared dead Wednesday after their boat apparently capsized in stormy seas in Malta, where rescuers have recovered three unidentified bodies. US Navy and Italian coast guard aircraft joined in the increasingly desperate search off Gozo, one of three islands that make up the Maltese archipelago. The five had been on their way back by boat on Sunday to their yacht, El Pirata, after dinner on shore during a Mediterranean cruise, witnesses said.

Rescuers said they had recovered the bodies of two women wearing life jackets on Tuesday and the body of a man on Wednesday and that they believe they are three of the five people missing. The man's body was plucked from the water by a Maltese army helicopter in the area, where strong winds made the search more difficult. The capsized boat has also been found. "We are still in the process of identifying but we have no other reports of missing people," said a spokesman for Maltese military, which is in charge of coast guard operations in the island nation.

Maltese officials named the five as Marie Grimaud, 38, Philippe Grimaud, 41, Sandrine Gaudet, 36, Elias Chonouni, 49 and his 14-year-old son Eli. The news website Malta Today reported that Malta is in contact with French authorities. The yacht was moored off the picturesque village of Dwejra in Gozo. The alarm was raised on Monday by the yacht's skipper, a Spaniard, who had remained on board the vessel.
Date: Tue, 7 May 2013 20:59:29 +0200 (METDST)

VALLETTA, May 07, 2013 (AFP) - Maltese rescuers recovered the bodies of two women wearing life jackets on Tuesday as they searched together with the US Navy and Italian coast guards for a boat carrying five French tourists. The group, including two men, two women and a 14-year-old boy, have been missing since Sunday when they set off for the shore on a four-metre (13-foot) tender from their yacht, El Pirata, during a Mediterranean cruise.

The yacht was moored off the picturesque village of Dwejra in Gozo, one of three islands that make up the Maltese archipelago. The alarm was raised by the yacht's skipper, a Spaniard, who had remained on board the vessel. Maltese authorities have requested assistance in their search from US Navy and Italian coast guard patrols.

On Tuesday, a spokesman for the Maltese military said two bodies which have still not been identified had been found. "We suspect that they might be two of the missing but now there will be a process of verification," said the spokesman for the military, which is in charge of coast guard patrols in the tiny Mediterranean island state.
Date: Thu 5 Jul 2012
Source: Eurosurveillance 2012; 17(27) [abbrev., edited]

1st report of sandfly fever virus infection imported from Malta into Switzerland, Oct 2011
D Schultze, W Korte [Center of Laboratory Medicine, St. Gallen, Switzerland] P Rafeiner [Department of Internal Medicine, Division of Infectious
Diseases, Cantonal Hospital, St Gallen, Switzerland] M Niedrig [Center for Biological Security (ZBS-1), Robert Koch Institute, Berlin, Germany]

We report the 1st documented cases of sandfly fever virus [family _Bunyaviridae_, genus _Phlebovirus_, species _Sandfly Fever Naples virus_] infection in travellers returning from Malta to Switzerland in autumn 2011. These cases illustrate the importance of considering sandfly-borne viral infection in the differential diagnosis of febrile patients from the Mediterranean island Malta. Raising awareness among physicians is relevant especially now at the beginning of the summer tourist season.

On 17 Oct 2011, a Swiss citizen was hospitalised with fever, nausea, vomiting, and intensifying headache 2 days after his return from the Mediterranean island of Malta, where he had spent 2 weeks on Gozo Island. 9 days before his admission, the patient had suffered back pain, tiredness, and subfebrile temperatures, but had recovered after medication with the non-steroidal anti-inflammatory drug ibuprofen. The patient's wife had suffered from similar, less intense symptoms. Both had multiple insect bites and were diagnosed with laboratory-confirmed sandfly fever. The couple's 2 accompanying children and 2 further travel companions had been frequently bitten by small flying insects, but suffered no symptoms.

Phleboviruses [viruses classified in the family _Bunyaviridae_], transmitted to humans by arthropods, are found in Europe, Africa, central Asia, and the Americas. In Mediterranean Europe, the phleboviruses Toscana virus (TOSV), sandfly fever Naples virus (SFNV), sandfly fever Sicilian virus (SFSV), and sandfly fever Cyprus virus (SFCV) are transmitted by phlebotomine sandflies. Among these, TOSV circulates in countries around the Mediterranean Sea (Algeria, Cyprus, France, Greece, Italy, Portugal, Spain, and Turkey) [1,2].

TOSV may cause an acute, nonfatal, influenza-like symptomatology or even aseptic meningitis and meningoencephalitis [2-4]. SFNV, SFSV and other related viruses can cause the so-called '3-day fever' or 'pappataci fever'. Patients present with influenza-like symptoms including fever, retro-orbital pain, myalgia, and malaise and usually recover fully within a week. However, infections with these viruses, even when mild, have been shown to be highly incapacitating during the time the patients are affected [2].

Case History
Case 1, a man in his late 40s, was admitted to hospital in Switzerland 2 days after his return from Malta and presented in a reduced general condition. He had fever (38.4 degC/101.12 degF), a generalised rash and complained of severe headache, without meningism. Multiple skin lesions due to insect bites were visible on the extremities. Laboratory tests for this patient, including C-reactive protein, electrolytes, and transaminases revealed no abnormalities, and a complete blood cell count showed relative lymphopenia (17.9 per cent, normal range: 20-52 per cent).

Because of the recent stay in a Mediterranean country and the multiple skin lesions, a sandfly fever virus (SFV) infection (pappataci fever) was assumed. Serology for SFV was positive on a serum sample taken on the day after admission -- that is, 10 days after onset of 1st symptoms on Malta. An immunoblot (IB) for bunyaviruses (Mikrogen, Munich, Germany) showed reactivity with the TOSV bands, with stronger intensity than the cut-off reference, indicating the presence of IgM and IgG antibodies against TOSV. An indirect immunofluorescence test (IIFT) (Sandfly fever virus Mosaic 1, Sandfly fever virus serotypes Sicilian, Naples, Toscana, Cyprus; Euroimmun, Lubeck, Germany) revealed high serum antibody titres against Toscana and Naples SFV, indicating an infection with a phlebovirus belonging to the SFNV serological complex. In a convalescent serum, taken 52 days after onset of illness, an 8-fold increase of anti-TOSV IgM was demonstrated, accompanied by a 5-fold increase for anti-TOSV IgG.

The patient gradually improved under analgesic and anti-emetic therapy. On day 15 after onset of illness he could be transferred to a rehabilitation centre and fully recovered 21 days after onset of symptoms. The patient suffered no relapse in the following 8 months.

[Interest readers can find corresponding case histories of the patient's unaffected companions in the original text at the source URL. - ProMed Mod.CP]

Viruses in the genus _Phlebovirus_ can cause a variety of clinical syndromes ranging from a brief, self-limiting febrile illness to encephalitis, meningoencephalitis, and fatal haemorrhagic fever. Of our cases, the male patient suffered from symptoms of a SFV infection that incapacitated him for 2 weeks, while his wife had less severe symptoms. The other 4 travellers accompanying the couple were not infected, despite multiple insect bites.

The genus _Phlebovirus_ genus consists of more than 60 distinct virus serotypes. While antigenically unrelated to members of other genera in the family _Bunyaviridae_, various degrees of cross-reactivity in serological tests can occur within the genus, as reported for the SFNV and SFSV antigenic complexes [6,7]. Our patients showed cross-reactions in the IIFT using SFNV and TOSV antigens, both members of the SFNV antigenic complex. Although IIFT using SFSV and SFCV as antigens yielded negative results, reactions with other serotypes in the genus _Phlebovirus_ cannot be ruled out.

Viral neutralisation tests (VNT) using early convalescent sera remain the serological reference method to identify these viruses or to assess the specificity of the antibody response [8]. Although generally regarded as the gold standard assay for specificity, the VNT is relatively labour-intensive and only established in few laboratories. SFV-specific commercial assays such as IIFT, enzyme-linked immunoassay and IB are much more commonly used. For the diagnosis of the cases described here, we used IIFT for screening purposes and the IB as confirmatory assay [8].

Direct viral diagnosis by isolation and RT-PCR from blood or cerebrospinal fluid is only possible in the early stages of infection, i.e., the 1st 2 days after onset of symptoms and before seroconversion [2]. Case 1 presented on day 9 after symptom onset, at a time when SFV-specific serology was already positive. Diagnosis was therefore attempted by serological investigation, using 2 commercial kits. That the increase in anti-TOSV IgM and IgG in the convalescent serum of Case 1 was higher than the increase in antibodies against SFNV, was suggestive of an infection with TOSV rather than with SFNV. Similarly in Case 2, anti-TOSV IgM increased more than anti-SFNV IgM and was accompanied by higher seroconversion for anti-TOSV IgG than for SFNV-IgG.

Most cases of TOSV infection have been reported in residents of or travellers to central Italy and Spain, and sporadically in other Mediterranean regions such as Portugal, Cyprus, southern France, and Greece [9]. Asymptomatic infections have also been described [9]. Unlike the other SFV serotypes, TOSV shows a peculiar neurotropism. It can cause meningitis or meningoencephalitis from which patients generally recover within 2 to 10 days [9]. TOSV infections occur particularly during the summer and correlate with the life cycle of the insect vectors _Phlebotomus perniciosus_ and P. perfiliewi [9].

TOSV has been isolated from _P. perfiliewi_ and _P. perniciosus_. The latter vector is distributed throughout the Mediterranean region as 2 races. SFNV has been isolated in Italy from _P. perniciosus_, in Serbia from _P. perfiliewi_ and in Egypt from _P. papatasi_ [10]. The typical_P. perniciosus_ race occurs in Italy as well as in Tunisia, Morocco, and Malta [10]. However, to the best of our knowledge, neither TOSV nor SFNV infections have been reported from Malta so far. Thus, in connection with the beginning of the summer season, it is now of particular relevance to consider sandfly-borne phleboviruses in the differential diagnosis of patients returning from Malta and presenting with febrile illness.

[Interested readers should consult the original text via the source URL for the list of references cited. - ProMed Mod.CP]
[This report establishes the importance of considering specific sandfly-borne viral infections in the differential diagnosis of febrile patients coming from the Mediterranean island of Malta, although previously neither SFNV nor TOSV had been recorded there although present in the Mediterranean region. Raising awareness among physicians is relevant especially now that the summer tourist season has begun. It is likely also with enforced human populations movements in the region that these sandfly fever virus infections will be encountered with increasing frequency.

The HealthMap interactive map of the island of Malta can be accessed at
<>. - ProMed Mod.CP]
Date: Sat, 10 Mar 2012 17:03:44 +0100 (MET)

VALLETTA, March 10, 2012 (AFP) - A 69-year-old British tourist cried in vain for help as he was swept away by a huge wave Saturday in force 10 winds lashing Malta, police and witnesses on the Mediterranean island said.  The incident took place in Qawra, on the island's northern coast as the man, who was not named, was walking on the promenade and stopped to take photos of the rough sea.

Eyewitness Lynda Matthews, also a British national, said she tried to help but the waves prevented her. "He was shouting for help. I tried to reach him but the waves were too strong, by the time I got close enough to grab him he was dead so I stepped back.  "I don't know who he was but I will never forget his face and how frightened he looked taking his last breath," she wrote in a message on local news portal

Police sources told AFP the man must have died when he hit his head on the ground as he was being swept away.  Soldiers brought the man out of the water in a risky operation involving a helicopter.  The winds also caused damage to trees and infrastructure on Malta and its sister island Gozo.
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