BEIJING (Reuters) - The U.S. State Department on Friday issued an expanded health alert for all of China amid reports some U.S. diplomats based in the country had experienced a mysterious malady that resembles a brain injury and has already affected U.S. personnel in Cuba.

The entrance of the U.S. Consulate in Guangzhou, China June 7, 2018. REUTERS/Sue-Lin Wong

A previous statement in May only mentioned the southern Chinese city of Guangzhou as the location for the health alert, though it was sent to U.S. citizens throughout the country.

The State Department had confirmed earlier that one U.S. employee assigned to the consulate in Guangzhou had “suffered a medical incident”, and that it had deployed a team to screen employees and family members there.

On Wednesday the U.S. government said that it had brought a group of people from that consulate back to the United States for further evaluation of their symptoms, and that it was offering screening to anyone at the U.S. embassy in Beijing or other consulates in China who requested it.

The United States also operates consulates in the mainland Chinese cities of Chengdu, Shanghai, Shenyang and Wuhan.

The location of the health alert was changed to “countrywide” from Guangzhou in the updated statement sent by email.

“The State Department received medical confirmation that a U.S. government employee in China suffered a medical incident consistent with what other U.S. government personnel experienced in Havana, Cuba,” the statement said, reiterating comments made last month by Secretary of State Mike Pompeo.

It warned of “unexplained physical symptoms or events, auditory or sensory phenomena”, and said symptoms of the ailment included dizziness, headaches, tinnitus, fatigue, cognitive issues, visual problems, ear complaints and hearing loss, as well as difficulty sleeping.

China has said that it thoroughly investigated the initial case reported by the United States and found no reasons or clues to explain it.

Chinese Foreign Ministry spokeswoman Hua Chunying said on Thursday that as far as she was aware the Chinese government had not had any formal communication with U.S. officials on any new cases.

China’s state-run Global Times tabloid called the situation at the consulate “very strange”.

“Practically all Chinese people do not believe that this country’s official organizations would carry out such sonic attacks against U.S. diplomats. This does not fit with China’s basic concept and principles of diplomacy, and is inconceivable,” the Global Times said in an editorial.

It also said people found it hard to believe that another foreign country could carry out such an attack in China, escape China’s monitoring, and leave no trace.

Last year, 24 U.S. government employees and family members in Cuba displayed the symptoms, which were similar to those related to concussion and mild traumatic brain injury, according to the State Department.

The illnesses among the American diplomats stationed in Havana heightened tension between the old Cold War foes.

Pompeo released a statement on Tuesday saying the department established a task force last month “to direct a multi-agency response to the unexplained health incidents”.</s>US issues new China health alert over mystery illness

BEIJING: The US embassy in China issued a new health alert for its citizens on Friday after more US government employees were evacuated from the country over fears they may have been hit by a mysterious illness.

American officials sent a medical team to the southern city of Guangzhou last month after an employee attached to the consulate there was diagnosed with brain trauma after experiencing strange sounds.

The case revived fears that a US rival has developed some kind of acoustic or microwave device after similar symptoms were reported among American diplomats and their families in Cuba in 2016.

The US embassy’s latest health alert, the second in two weeks, said that following voluntary medical screenings, the State Department "has sent other individuals to the United States for further evaluation".

The message urges staff and family members to contact their health care provider if they experience "any unusual, unexplained physical symptoms or events, auditory or sensory phenomena, or other health concerns". "Symptoms to be attentive for include dizziness, headaches, tinnitus, fatigue, cognitive issues, visual problems, ear complaints and hearing loss, and difficulty sleeping," the alert says.</s>More US diplomats, employees, and their families in China are being medically evaluated and evacuated amid growing accounts of mysterious episodes involving sound and pressure that appear linked to the development of mild traumatic brain injuries, according to reports by The New York Times.

US gov’t employee in China left with brain injury after strange sounds, pressure Last month, the State Department revealed that one US employee at the US consulate in the city of Guangzhou, just northwest of Hong Kong, reported experiencing “subtle and vague, but abnormal, sensations of sound and pressure” and sustained a mild traumatic brain injury despite no evidence of a blow to the head. The episode drew eerie parallels to the mysterious “health attacks” experienced by diplomats at the US embassy in Cuba, which left 24 Americans with similar brain injuries.

That unidentified employee in Guangzhou was evacuated and sent for more medical testing in the US. The State Department, meanwhile, issued a health alert on May 23 for those remaining in China. Though the department suggested vigilance, it added that it was “not aware of any similar situations in China, either inside or outside of the diplomatic community,” suggesting that the episode may have been an isolated event so far.

But in an interview with the Times, Mark Lenzi, an American security engineering officer at the Guangzhou consulate, disputed that suggestion. “They knew full well it wasn’t [an isolated case],” he said.

Diplomats in Cuba have been under attack—but the weaponry is a mystery He, his wife, and two children were evacuated on Wednesday, June 6. He said that he and his wife had suffered unexplained headaches and sleeping problems since the end of last year—about the same time the first, unidentified evacuated employee reported experiencing problems. The couple also reported unexplained sounds, similar to marbles rolling around a metal funnel.

Since the health alert, more employees have come forward reporting such noise episodes and symptoms, including, “dizziness, headaches, tinnitus, fatigue, cognitive issues, visual problems, ear complaints and hearing loss, and difficulty sleeping,” according to the State Department. Those symptoms are generally consistent with those of a mild traumatic brain injury.

On May 31, a medical team and specialists from the Centers for Disease Control and Prevention arrived in Guangzhou and began screening some of the more than 100 employees at the consulate.

In a statement released to the press late Wednesday, State Department spokesperson Heather Nauert said:

The department would not reveal the counts of those screened and evacuated so far, but one official told the Times that a “sizable number” of people working in Guangzhou had requested screening.

For a “town-hall”-style meeting that took place Tuesday, June 5, acting Director General of the Foreign Service William E. Todd flew in to Guangzhou to discuss medical evacuations with employees, among other things.

“Injury to widespread brain networks” in victims of mystery attacks in Cuba Those evacuated are being sent for further evaluation at the University of Pennsylvania Center for Brain Injury and Repair, where a team of doctors conducted in-depth clinical exams on 21 Americans affected by similar episodes in Cuba. In those cases, the team determined that the victims had sustained “injury to widespread brain networks without an associated history of head trauma.” Their results were published in March in JAMA.

So far, there are no leading hypotheses for what is causing the sounds and brain injuries, despite rampant discussion of “sonic attacks,” as well as malfunctioning surveillance equipment. As Ars has noted before, it’s unlikely that audible sounds or even infrasound alone could cause such brain injuries—particularly without large, hard-to-conceal sonic equipment, like massive speakers, being noticed by victims. A team of researchers proposed that ultrasonic interference from devices such as room-occupancy sensors could explain the noises people report. But again, there’s no evidence or clear hypothesis for this causing the constellation of symptoms and brain injuries seen in victims.

High-intensity, focused ultrasounds (>20,000Hz) can cause brain tissue heating and damage. But, as Joseph Pompei, a former MIT researcher and psychoacoustics expert told the AP earlier, "somebody would have to submerge their head into a pool lined with very powerful ultrasound transducers” to sustain a brain injury.

As the team of doctors speculated in their JAMA report, the sounds may be merely associated with the harmful phenomena, not the cause of injuries. Other guesses as to the cause include collective delusions, toxins, and infectious agents.

On Thursday, June 7, the Chinese Foreign Ministry said it was prepared to aid the US in investigating the mysterious episodes.</s>The US embassy in China issued a new health alert for its citizens on Friday after more US government employees were evacuated from the country over fears they may have been hit by a mysterious illness.

American officials sent a medical team to the southern city of Guangzhou last month after an employee attached to the consulate there was diagnosed with brain trauma after experiencing strange sounds.

The case revived fears that a US rival has developed some kind of acoustic or microwave device after similar symptoms were reported among American diplomats and their families in Cuba in 2016.

The US embassy’s latest health alert, the second in two weeks, said that following voluntary medical screenings, the State Department “has sent other individuals to the United States for further evaluation”.

The message urges staff and family members to contact their health care provider if they experience “any unusual, unexplained physical symptoms or events, auditory or sensory phenomena, or other health concerns”.

“Symptoms to be attentive for include dizziness, headaches, tinnitus, fatigue, cognitive issues, visual problems, ear complaints and hearing loss, and difficulty sleeping,” the alert says.

The message urges people to “not attempt to locate the source of any unidentified auditory sensation” and instead move to a different location.

The cases come at a sensitive time in relations between the United States and China, with the two nations locked in negotiations aimed at preventing a trade war and tensions over Beijing’s claims to the South China Sea.

The State Department, which reported the latest medical evacuations on Wednesday, has not accused any particular country or organisation of being behind the latest incidents.

The Chinese foreign ministry said Thursday that its investigation into the first case has not yielded any clues as to the cause of the incident.

“As for the latest incident, my understanding is that the US side hasn’t had any formal communication with the Chinese side about it,” foreign ministry spokeswoman Hua Chunying said Thursday at a regular press briefing.

The State Department has previously said brain injuries suffered by 24 US officials and family members posted in Havana could have been the result of a “health attack”, perhaps from an unidentified secret weapon.

Washington has said in the past that Cuban authorities must take responsibility for the safety of US diplomats on their soil, but the Havana government denies any knowledge of an attack.

The US has set up a task force to oversee the response to the mystery ailments among diplomats in China and Cuba.</s>BEIJING (Reuters) - The U.S. State Department on Friday issued an expanded health alert for all of China amid reports some U.S. diplomats based in the country had experienced a mysterious malady that resembles a brain injury and has already affected U.S. personnel in Cuba.

“The State Department received medical confirmation that a U.S. government employee in China suffered a medical incident consistent with what other U.S. government personnel experienced in Havana, Cuba,” it said in an emailed statement.

“As a result of additional voluntary medical screenings, the department has sent other individuals to the United States for further evaluation.”

A previous statement in May only mentioned the southern Chinese city of Guangzhou as the location for the health alert, though it was sent to U.S. citizens throughout the country.</s>A U.S. medical team was screening more Americans who work in a southern Chinese city as the State Department confirmed evacuating a number of government workers who experienced unexplained health issues like those that have hurt U.S. personnel in Cuba and China.

The evacuations of the workers in Guangzhou followed medical testing that revealed they might have been affected. State Department spokeswoman Heather Nauert said "a number of individuals" have been brought to the U.S. but didn't say how many were affected or evacuated. One case in Guangzhou had been disclosed last month.

She said tests are being offered to "any personnel who have noted concerning symptoms or wanted baseline screening."
• U.S. pulls embassy staff from Cuba after mysterious 'attacks'

Security guards outside the consulate checked reporter's IDs on Thursday and told them to leave the area and not attempt to talk to consulate staff.

Asked about the latest incidents, Chinese Foreign Ministry spokeswoman Hua Chunying said the U.S. had not formally raised the matter with Beijing.

"If the U.S. makes formal contact with us, China will continue necessary investigations in an earnest and responsible manner and maintain close communication and cooperation with the U.S.," Hua said at a regularly scheduled news conference.

China had earlier said it had no information about the cause of the symptoms.

The New York Times identified the latest American employee evacuated as Mark A. Lenzi, a security engineering officer who left Wednesday night with his wife and two children.

Lenzi told the Times he resided in the same apartment tower as the officer evacuated in April and suffered in recent months from what he called "neurological symptoms."

Lenzi's apartment was in one of several high-rise buildings in The Canton Place featuring restaurants and galleries spaced around a central plaza. Another diplomat who reported symptoms was at a different upscale building near the consulate.

A U.S. official, who wasn't authorized to discuss the situation publicly and requested anonymity, said the evacuated Americans are being brought for testing to the University of Pennsylvania. That's where doctors have been treating and studying patients evacuated from the U.S. Embassy in Havana.

The China incidents have raised fears the unexplained issues that started in Cuba in 2016 have expanded. The U.S. government has deemed those incidents "specific attacks" on American workers but hasn't publicly identified a cause or culprit. Most of the incidents were accompanied by bizarre, unexplained sounds that initially led U.S. investigators to suspect a sonic attack.

The preliminary findings of the medical reports on the 24 U.S. Embassy personnel affected in Cuba showed they had sensory and memory problems similar to the brain dysfunction seen with concussions.

The Penn team said the patients experienced persistent disability though rehabilitation therapy customized for them seemed to help.

Canada in April also ordered families of diplomatic staff in Cuba to return home after mysterious health symptoms were detected in 10 Canadians stationed on the island.

Canada said the 10 continued to show unexplained brain symptoms and that "medical information raised concerns for a new type of a possible acquired brain injury."

Symptoms included dizziness, headaches and an inability to concentrate.

The American government worker who was removed from China earlier reported "subtle and vague, but abnormal, sensations of sound and pressure."

In testimony before the Senate Foreign Relations Committee last month, U.S. Secretary of State Mike Pompeo said China had "said all the right things and have demonstrated their willingness to help us identify the vector which led to this medical incident."

The China incidents affect one of the most important of the seven U.S. diplomatic outposts in the country. The Guangzhou consulate opened months after the establishment of diplomatic relations between Beijing and Washington in 1979 and moved to its new purpose-built facility in 2013.

It serves four southern provinces with a combined population of more than 204 million and processes more than 1 million visa applications of all types annually. It is also the only U.S. diplomatic installation in China authorized to process immigrant visas and handle adoptions.</s>A number of U.S. personnel in China have been sent back to the U.S. for further tests after health screenings found symptoms similar to the mysterious "acoustic" illness experienced by some U..S. staffers in Cuba, according to the U.S. State Department.

The medical teams were sent to the southern Chinese city of Guangzhou after an employee had complained of “subtle and vague, but abnormal sensations of sound and pressure” over several months from late 2017 until April.

"As a result of the screening process so far, the Department has sent a number of individuals for further evaluation and a comprehensive assessment of their symptoms and findings in the United States," State Department spokeswoman Heather Nauert said Wednesday.

She said the tests were offered to “any personnel who have noted concerning symptoms or wanted baseline screening.”

Last month, Secretary of State Mike Pompeo said a U.S. government employee stationed in Guangzhou had reported "abnormal sensations of sound and pressure" suggesting a mild brain injury. Pompeo said the medical indications are "very similar" and "entirely consistent" to those reported by American diplomats posted in Havana.

In 2016, some U.S. government personnel in Cuba reported hearing weird, loud sounds along with feelings of changes in air pressure in their homes owned and maintained by the Cuban government as well as hotel rooms. Although there had been no history of head trauma, the symptoms reported were consistent with brain injury.

The diplomats described the sounds as “buzzing, grinding metal, piercing squeals and humming.”

In response, the State Department initially reduced the number of workers in Havana, but in March made the sharp reductions permanent, citing health concerns. Some 15 Cuban embassy employees were ordered to leave the United States, although Washington has not formally charged Cuba with any deliberate attacks over the health issues.

Cuba has said there were no attacks and strongly denied any allegations of wrongdoing.

Asked about the latest incidents in Guangzhou, Chinese Foreign Ministry spokeswoman Hua Chunying said the U.S. had not formally raised the matter with Beijing.

“If the U.S. makes formal contact with us, China will continue necessary investigations in an earnest and responsible manner and maintain close communication and cooperation with the U.S.,” Hua said at a news conference.

The diplomats in Cuba described the sounds as “buzzing, grinding metal, piercing squeals and humming.”

An expert panel set up by the State Department last year said the initial findings were most likely related to "neurotrauma from a non-natural source" and recommended further investigation.

The New York Timesidentified the latest American employee evacuated from China as Mark A. Lenzi, a security engineering officer who left Wednesday night with his wife and two children.

Lenzi told the Times he lived in the same apartment tower as the officer evacuated in April and suffered in recent months from what he called “neurological symptoms.”

A U.S. official, who wasn’t authorized to discuss the situation publicly and requested anonymity, told the Associated Press that the evacuees from China were being tested at the University of Pennsylvania, where patients from Cuba were also treated and evaluated.

The Penn team has said the patients experienced persistent disability though rehabilitation therapy customized for them seemed to help.

In April, Canada also ordered families of diplomatic staff in Cuba to return home after mysterious health symptoms were detected in 10 Canadians stationed on the island.

Canada said the 10 continued to show unexplained brain symptoms and that “medical information raised concerns for a new type of a possible acquired brain injury.” Symptoms included dizziness, headaches and an inability to concentrate.</s>US Embassy in China sends new alert for mystery health issue

GUANGZHOU, China (AP) — The U.S. Embassy in China sent its second alert in two weeks Friday to its citizens over unexplained health issues that have prompted the evacuation of a number of U.S. government employees working at a consulate in a southern city.

The alert urged Americans to seek medical help in the event they suffered any "unusual, unexplained physical symptoms or events, auditory or sensory phenomena, or other health concerns."

The alert comes as a U.S. medical team is screening more Americans who work at the Guangzhou consulate. A previous case in Guangzhou, disclosed last month, prompted the tests.

The incidents have raised fears the unexplained issues that started in Cuba in 2016 have expanded to other countries. China says it has uncovered no information that could point to a cause.

The most recent evacuations followed medical testing that revealed they might have been affected. State Department spokeswoman Heather Nauert said "a number of individuals" had been brought to the U.S. but didn't say how many were affected or evacuated.

Friday's alert called for people to be attentive of symptoms including "dizziness, headaches, tinnitus, fatigue, cognitive issues, visual problems, ear complaints and hearing loss, and difficulty sleeping." It urged them "not to attempt to locate the source of any unidentified auditory sensation. Instead, move to a different location."

The U.S. government has deemed the Cuba incidents "specific attacks" on American workers but hasn't publicly identified a cause or culprit. Most of the incidents were accompanied by bizarre, unexplained sounds that initially led U.S. investigators to suspect a sonic attack.

Asked about the latest incidents, Chinese Foreign Ministry spokeswoman Hua Chunying said Thursday that the U.S. had not formally raised the matter with Beijing.

"If the U.S. makes formal contact with us, China will continue necessary investigations in an earnest and responsible manner and maintain close communication and cooperation with the U.S.," Hua said at a regularly scheduled news conference.

China earlier said it had looked into the case announced last month but came up with no clues about the cause of the symptoms.

A U.S. official, who wasn't authorized to discuss the situation publicly and requested anonymity, said the evacuated American government workers were being brought from China for testing to the University of Pennsylvania. That's where doctors have been treating and studying patients previously evacuated from the U.S. Embassy in Havana.

The preliminary findings of the medical reports on the 24 personnel affected in Cuba showed they had sensory and memory problems similar to the brain dysfunction seen with concussions.

The Penn team said the patients from Cuba experienced persistent disability though rehabilitation therapy customized for them seemed to help.

Canada in April also ordered families of diplomatic staff in Cuba to return home after mysterious health symptoms were detected in 10 Canadians stationed on the island. Canada said the 10 continued to show unexplained brain symptoms and that "medical information raised concerns for a new type of a possible acquired brain injury."

In testimony before the Senate Foreign Relations Committee last month about the first case in China, U.S. Secretary of State Mike Pompeo said China had "said all the right things and have demonstrated their willingness to help us identify the vector which led to this medical incident."

The China incidents affect one of the most important of the seven U.S. diplomatic outposts in the country. The Guangzhou consulate opened months after the establishment of diplomatic relations between Beijing and Washington in 1979 and moved to its new purpose-built facility in 2013.

It serves four southern provinces with a combined population of more than 204 million and processes more than 1 million visa applications of all types annually. It is also the only U.S. diplomatic installation in China authorized to process immigrant visas and handle adoptions.

People working in The Canton Place complex, a few kilometers (miles) from the consulate, said Thursday they were just hearing about the incidents, reflecting a lack of coverage in China's entirely state-controlled media.

Aled Williams, a British teacher at a kindergarten said Thursday that the reports sounded "sci-fi-ish."

"Hard to get my head around how it works," he said. "Better watch myself."

Linda Chen, who runs a coffee shop in the area, said she was mystified as to why only certain people seemed to have been affected in an area known for its comfort and safety.

"For me I feel it's very strange. But I don't feel that there's something to be very afraid of because it's probably a very special case," Chen said.

Associated Press writer Josh Lederman in Washington, D.C. contributed to this report.</s>Something mysterious and disturbing has happened to State Department personnel, first in Cuba and now in China. Strange high-pitched sounds — “buzzing,” “piercing squeals,” “grinding metal,” as the Cuba staffers later told doctors — preceded an eruption of health problems, including headaches, dizziness, confusion, ear pain, hearing loss, insomnia and fatigue.

Last year, then-Secretary of State Rex Tillerson referred to what happened in Havana as “attacks.” Numerous news stories and opinion columns speculated about “sonic attacks” using some kind of unknown acoustic weapon. The mystery spread this spring to China: A staffer in Guangzhou experienced “subtle and vague, but abnormal sensations of sound and pressure,” in the words of the State Department.

Days ago the department issued a health alert to staff in that country, telling anyone who experiences “any unusual acute auditory or sensory phenomena accompanied by unusual sounds or piercing noises, do not attempt to locate their source.” The embassy issued a second alert Friday, telling personnel with symptoms to seek medical advice.

What the phenomenon lacks so far is any solid information about cause and effect. It's not even clear that the ailments suffered have an external origin. Officials have produced no evidence that anyone has intentionally attacked the Americans, nor is there any obvious environmental cause. There is no sign of a rogue virus or other pathogen.

No one disputes that American staffers have been suffering from a long list of symptoms. But a much-publicized research report about the Cuba staffers, published Feb. 15 as “Preliminary Communication” in the eminent Journal of the American Medical Association, has triggered skepticism among outside researchers.

The report came from the University of Pennsylvania Medical School's Center for Brain Injury and Repair, where 21 State Department personnel from Cuba have been examined and treated. Most had persistent symptoms, such as cognitive problems, sleep impairment and hearing dysfunction. All but three had reported hearing unusual sounds in their homes or hotel rooms before the onset of their symptoms.

In Philadelphia, doctors concluded that the patients “appeared to have sustained injury to widespread brain networks without an associated history of head trauma.”

Their report offered no explanation for the injuries, however. The doctors detected no clear physical origin in the brain: Eighteen of the 21 patients showed nothing unusual on a brain scan, and the other three had “mild” or “moderate” damage to white matter that the investigators acknowledged could be due to preexisting disease processes.

Under the heading of “Meaning,” the paper notes, “The unique circumstances of these patients and the consistency of the clinical manifestations raised concern for a novel mechanism of a possible acquired brain injury from a directional exposure of undetermined etiology.”

The statement's many caveats, as well as a separate editorial, made clear that these cases are rife with unknowns, according to Howard Bauchner, JAMA's editor in chief. “I think the public can understand that there’s just uncertainty, that it was important for there to be documentation of what is known and what isn’t known,” he said.

But the paper left many outside experts perplexed. Two neuroscientists at the University of Edinburgh, Robert McIntosh and Sergio Della Sala, published a criticism in May, writing that the evidence of pathological mental impairment in the patients was “almost unbelievably flimsy.”

In emails to The Washington Post this week, Della Sala wrote: “Whatever the cause of the symptoms, the JAMA paper presented evidence far too thin to support the existence of brain damage.” He also said the Penn doctors defined impairment too liberally.

“The Penn researchers used a threshold of 40 percent to define pathological performance,” he noted. “This means that any four out of 10 normal people would be classed pathological. They used 37 measures with this incredibly lax criterion. Hence, the chances that anyone would be 'normal' with their measures is zero.”

Another University of Edinburgh neurologist, Jon Stone, said via email that the data published by JAMA “is compatible with individuals who have a genuine functional disorder consisting of dizziness, headache and cognitive symptoms, which we see routinely in neurological practice. These disorders ... are so common that it would not be hard to find a cluster of cases in a larger group of at-risk individuals.”

He added, “Another possibly more important phenomenon is the way that doctors, sensing an 'outbreak,' can suggest or over-diagnose symptoms in patients in order to fit an a priori hypothesis.”

A spokeswoman for Penn Medicine said the paper's authors would not be available for interviews. “We are continuing to work with the Department of State to evaluate and treat personnel who have reported audible phenomena experiences,” she added. “We are not able to provide specifics about different patient groups at this time.”

The cases in Cuba began in November 2016 and were first reported to embassy officials there at the end of that year. They continued until last August, then reportedly stopped. Those 10 months were a period of political turmoil and a chilling of U.S.-Cuban diplomatic relations after the election of President Trump.

Cuban scientists looked into the cases after conferring with U.S. officials. The Cuban conclusion: The issue was a “collective psychogenic disorder.”

According to a story in the journal Science, the U.S. government gave Cuban investigators recordings of irritating sounds around the residences of embassy personnel — which turned out to most closely match the buzzing of Jamaican field crickets.

Cuban scientists' skepticism has now been echoed in the United States and the United Kingdom.

“We're baffled by this [JAMA] report,” said Alberto Espay, a professor of neurology at the University of Cincinnati. “The symptoms are certainly very real and in no way fabricated. This is not a case of a bunch of people colluding to try to come up with some symptoms all together.” But medical literature, he noted, has long documented cases in which clusters of people in stressful situations will exhibit similar symptoms of health problems.

Last year, Trump told reporters that “some very bad things happened in Cuba. They did some bad things.” But although Tillerson described whatever happened there as “attacks,” the department has not used that term in recent weeks.

Secretary of State Mike Pompeo, testifying on Capitol Hill in late May, mentioned the health problem of the employee in China and said, “The medical indications are very similar and entirely consistent with the medical indications that have taken place to Americans working in Cuba.”</s>GUANGZHOU, China (AP) — The U.S. Embassy in China has sent its second alert in two weeks to its citizens over unexplained health issues that have prompted the evacuation of a number of U.S. government employees working at a consulate in a southern city.

Friday's alert urged Americans to seek medical help in the event they suffered any "unusual, unexplained physical symptoms or events, auditory or sensory phenomena, or other health concerns."

The alert comes as a U.S. medical team is screening more Americans who work at the Guangzhou consulate. A previous case in Guangzhou, disclosed last month, prompted the tests.

The incidents have raised fears the unexplained issues that started in Cuba in 2016 have expanded to other countries. China says it has uncovered no information that could point to a cause.
The United States expand their health alert from Guangzhou to all of China, after it repatriated multiple employees with symptoms resembling a brain injury.