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Andorra

General
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This small country is situated between France and Spain. Because of its elevation and proximity to the Pyrenees the climate is generally pleasant throughout the year.
Climate
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During the summer months the temperatures can rise to 30c but there is usually a cooling breeze. Lightening storms can occur during the summer months associated with torrential rain.
Sun Exposure and Dehydration
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Those from Northern Europe can develop significant sun exposure and so remember to use a wide brimmed hat when necessary. The altitude can also lead to significant tiredness and dehydration so take sufficient initial rest and drink plenty of fluids.
Safety & Security
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The level of crime throughout the country directed at tourists is very low. Nevertheless take care of your personal belongings at all times and use hotel safety boxes where possible.
Local Customs
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There are strict laws regarding the use of illegal drugs. Make sure you have sufficient supplies of any medication you required for your trip and that it is clearly marked. The European E111 form is not accepted in Andorra and so it is essential that you have sufficient travel insurance for your trip.
Winter Sports
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Andorra is one of the regions where many travel to partake of their winter sport facilities. Generally this is well controlled and one of the safer regions. Nevertheless, make certain your travel insurance is adequate for the activities you are planning to undertake.
Vaccination
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The only standard vaccine to consider for Andorra would be tetanus in line with many other developed countries of the world.

Travel News Headlines WORLD NEWS

Date: Thu, 12 Jul 2018 15:24:06 +0200

Andorra la Vella, Andorra, July 12, 2018 (AFP) - The tax haven of Andorra has long been a favourite destination for smokers looking to stock up on cheap cigarettes, but the enclave said Thursday that it would soon stop advertising the fact.   The government said it had signed up to the World Health Organization's (WHO) anti-tobacco convention, which aims to encourage people to quit smoking and combat contraband sales.   "The goal is to contribute to public health and pursue the fight against trafficking," government spokesman Jordi Cinca said at a press conference.

The tiny principality of Andorra, perched in the Pyrenees on the border between France and Spain, attracts millions of shoppers each year to duty-free stores, where prices of alcohol, cigarettes, electronics and clothes can be up to 20 percent cheaper than elsewhere in the EU.   High taxes on tobacco imposed by many countries to help people kick smoking make Andorra's cigarettes a particularly good deal.   The average pack costs just three euros ($3.50) compared with eight euros in France, which has said it will gradually raise the price to 10 euros a pack by November 2020.

Tobacco sales bring in some 110 million euros a year for Andorra, whose economy is otherwise based almost entirely on tourism.   It is also an enticing destination for smugglers, with French and Spanish border agents regularly seizing cartons from people trying to sneak them out, either by car or by hiking down the mountain trails which criss-cross the Pyrenees.   No date has been set for the advertising ban, which will come into effect three months after the ratification of the WHO accord is voted by parliament.
Date: Fri, 16 Mar 2018 02:41:51 +0100

Andorra la Vella, Andorra, March 16, 2018 (AFP) - The tiny principality of Andorra is witnessing a once in a generation phenomenon -- a widespread strike.   Around a third of civil servants across the mountainous micro-state have walked out to protest proposed reforms to their sector in what has been described as Andorra's first large-scale strike since 1933.

With no negotiation breakthrough in sight, picket lines are expected to be manned again on Friday with customs officers, police, teachers and prison staff among those taking part.   The first major strike in 85 years was sparked by plans from the government of Antoni Marti to reform civil servant contracts.   He has assured officials "will not do an hour more" work under the reforms and that 49 million euros would be allocated for the next 25 years to supplement civil servant salaries.   But government workers are unconvinced with unions warning the reforms could risk their 35 hour working week and pay.

Customs officers involved in the strike interrupted traffic on the Andorran-Spanish border this week, according to unions, while some 80 percent of teachers have walked out of classes.   Strikers have occupied the government's main administrative building and held noisy protests outside parliament calling for Marti's resignation.    "We have started collecting signatures to demand the resignation of the head of government and now nobody will stop us," Gabriel Ubach, spokesman for the public service union, told reporters.
Date: Mon 27 Sep 2017
Source: Contagion Live [edited]

A recent Dispatch article published in the Centers for Disease Control and Prevention (CDC)'s Emerging Infectious Diseases journal, offers insight into a large norovirus outbreak that sprung up in Spain in 2016 that had been linked with bottled spring water. The Public Health Agency of Catalonia (ASPCAT) reported a staggering 4136 cases of gastroenteritis from 11-25 Apr 2016. Of the 4136 cases, 6 individuals required hospitalization. The CDC defines a "case-patient" as an "exposed person who had vomiting or diarrhoea (3 or more loose stools within 24 hours)," as well as 2 or more of the following symptoms: nausea, stomach pain, or fever.

ASPCAT investigators traced back the outbreak to contaminated bottled spring water in office water coolers. The water came from a source in Andorra, a small independent principality located between Spain and France. Norovirus is a "very contagious virus," according to the CDC, and it is common for individuals to become infected by eating contaminated food. Although it is possible to be infected by consuming contaminated drinking water, this mode of transmission is "rare in developed countries," according to the article.

The investigators collected water samples from a total of 4 19-L water coolers in 2 different offices located in Barcelona, "from which affected persons had drunk; samples 1 and 2 came from 2 water coolers in one office, while samples 3 and 4 came from 2 water coolers in another office. Using "positively charged glass wool and polyethylene glycol precipitation for virus concentration," the investigators tested the samples.

"We detected high RNA levels for norovirus genotype I and II, around 103 and 104 genome copies/L, in 2 of the 4 water cooler samples concentrated by glass wool filtration and polyethylene glycol precipitation," according to the article. The investigators noted that a drawback of using molecular methods is that they are not able to differentiate between particles that are infectious and those that are not. Therefore, they "predicted the infectivity of norovirus in the concentrated samples by treating the samples with the nucleic acid intercalating dye PMA propidium monoazide and Triton X surfactant before RT-qPCR," which allowed them to "distinguish between virions with intact and altered capsids."

In those 2 water samples, they found high genome copy values -- 49 and 327 genome copies/L for norovirus genotype I and 33 and 660 genomes copies/L for norovirus genotype II. This was not an unexpected finding, due to the large number of infected individuals associated with the outbreak. Through "PMA/Triton treatment before RT-qPCR assays," the investigators found that the proportion of infected virions accounted for 0.3% to 5.6% of the total number of physical particles in the water samples, "which was enough to cause gastrointestinal illness."

The investigators also analyzed faecal samples collected from infected individuals who worked at the office in which the 1st 2 water samples were collected. They detected the following genotypes in those faecal samples: GI.2 and GII.17. In the faecal samples collected from the other office, they isolated the following genotypes: GII.4/Sydney/2012, GI.2, GII.17, and GII.2.

"We hypothesize that the spring water was contaminated by all 4 strains (GI.2, GII.2, GII.4, and GII.17) but levels of viral contamination for each genotype were not homogeneous in all bottled coolers," the investigators wrote. "We may have detected only the GII.4 genotype in water samples 1 and 2 because of a higher concentration of this specific genotype or because of bias caused by the sampling, concentration, and molecular detection procedures."

The investigators admit one limitation to their study: the small number of water samples collected and analyzed. They attribute this to the fact that on 15 Apr 2016, 4 days after the onset of the outbreak, the company that produced the drinking water recalled over 6150 containers of water "of suspected quality" as a precautionary measure. The recall prevented the investigators from collecting more samples to assess, according to the article.

Although the exact cause of the contamination has not yet been identified, the investigators posit that "the high number of affected persons from 381 offices that received water coolers, and the many different genotypes found in some patients' faecal specimens" suggest that the spring aquifer had been contaminated by "sewage pollution," and the Andorra Ministry of Health and Welfare banned further use of the spring.

The investigators suggest that assessing commercially-produced mineral waters for different harmful pathogens, such as norovirus would be beneficial. They note, however, that creating, enhancing, and managing such "virus surveillance systems" would be costly. Thus, the investigators suggest taking a "balanced approach to keep both the cost and the time required for the analyses within feasibility limits."  [Byline: Kristi Rosa]
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[The interesting article published in the September 2017 issue of Emerging Infectious Diseases is:
Blanco A, Guix S, Fuster N, et al: Norovirus in bottled water associated with gastroenteritis outbreak, Spain, 2016. Emerg Infect Dis. 2017; 23(9): 1531-34; https://wwwnc.cdc.gov/eid/article/23/9/16-1489_article. - ProMED Mod.LL]

[Catalonia and Andorra can be located on the HealthMap/ProMED-mail map at http://healthmap.org/promed/p/1341. - ProMED Sr.Tech.Ed.MJ]
Date: Thu, 26 Dec 2013 22:25:05 +0100 (MET)

ANDORRA LA VELLA, Andorra, Dec 26, 2013 (AFP) - A Spanish skier and a French snowboarder have died in avalanches in different mountain ranges in Europe, officials said Thursday.

The 27-year-old skier, a woman from Barcelona, died Wednesday while going off-piste alone in the Soldeu resort in Andorra, in the Pyrenees mountains between France and Spain, a resort manager told AFP.   Although she was rescued within 10 minutes, after her glove was spotted on the surface, she was unable to be revived despite a helicopter dash to hospital.

In the Italian Alps, close to the border with France, a 24-year-old Frenchman who was snowboarding with three friends on a closed run died Thursday when an avalanche swept over him in the resort town of Les Arnauds.   Local officials said he succumbed to multiple injuries, asphyxia and hypothermia.

Avalanches are common in Europe's ski resorts at this time of year, when early snows are heavy with moisture, and several deaths occur each winter.   Last Sunday, a 35-year-old Frenchman died in an avalanche in the Alps near the Italian border while on a three-day trek with a friend.
Date: Fri 7 Feb 2003 From: Jaime R. Torres Source: EFE Salud, Thu 6 Feb 2003 (translated by Maria Jacobs) [edited] -------------------------------------------------- Close to 300 students in one school and 173 tourists staying in 7 hotels in the Principality of Andorra have been affected by outbreaks of gastroenteritis that, according to local authorities, are not related to each other. Monica Codina, Minister of Health, stated that the outbreak that has affected almost 300 children and 8 adults in the San Ermengol school was detected last Monday [3 Feb 2003] but that it may have started Wednesday or Thursday of the previous week. The epidemiological surveys of a group of pre-school and grammar school students that may also be affected have not been performed yet. Also pending are the results of the microbiological tests of the food and water served in the school dining room, but the minister has indicated that the probable cause of the outbreak is the fact that water pitchers were filled with hoses directly from the faucet. The Minister stated that this outbreak of gastroenteritis is not related to the one that affected 173 tourists, most of them young people on holiday, who where staying in 7 hotels of the Principality. The government is also investigating the cause of this outbreak and has indicated that an anomaly in the system that supplies water to the hotels was detected, requiring a process of chlorination, which has not been carried out due to the heavy snowfall of the past few days. * * * * * * * * * * [The suspicion that defective water supplies may be responsible for all of these independent outbreaks suggests that the etiologic agent may be an enterovirus, hepatitis A virus, or non-viral, rather than one of the noroviruses associated with sudden-onset viral gastroenteritis. Information on the outcome of diagnostic tests in progress would be welcomed. - ProMed Mod.CP]
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Gibraltar

United Kingdom and Gibraltar (England, Wales, Scotland, Northern Ireland) US Consular Information Sheet
June 03, 2008
COUNTRY DESCRIPTION:
The United Kingdom of Great Britain and Northern Ireland is a highly developed constitutional monarc
y comprised of Great Britain (England, Scotland and Wales) and Northern Ireland.
Read the Department of State Background Notes on the United Kingdom for additional information.
Gibraltar is a United Kingdom Overseas Territory bordering Spain and located at the southernmost tip of Europe at the entrance to the Mediterranean Sea.
It is one of thirteen former British colonies that have elected to continue their political links with London.
Tourist facilities are widely available.

ENTRY/EXIT REQUIREMENTS:
A visa is not required for tourist or business visits to the UK of less than six months in duration.
Visitors wishing to remain longer than one month in Gibraltar should regularize their stay with Gibraltar immigration authorities.
Those planning to visit the UK for any purpose other than tourism or business, or who intend to stay longer than six months, should consult the website of the British Embassy in the United States at http://britainusa.com for information about current visa requirements.
Those who are required to obtain a visa and fail to do so may be denied entry and returned to their port of origin.
The British government is currently considering reducing the visa-free period from six months to 90 days.
Travelers should be alert to any changes in legislation.
The U.S. Embassy cannot intervene in UK visa matters.
In addition to the British Embassy web site at http://britainusa.com, those seeking current UK visa information may also contact UK consular offices via their premium rate telephone service at 1-900-656-5000 (cost $3/minute) or 1-212-796-5773 ($12 flat fee).
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
The United Kingdom is politically stable, with a modern infrastructure, but shares with the rest of the world an increased threat of terrorist incidents of international origin, as well as the potential, though significantly diminished in recent years, for isolated violence related to the political situation in Northern Ireland (a part of the United Kingdom).
On July 7, 2005, a major terrorist attack occurred in London, as Islamic extremists detonated explosives on three underground trains and a bus in Central London, resulting in over 50 deaths and hundreds of injuries.
Following the attacks, the public transportation system was temporarily disrupted, but quickly returned to normal.
A similar but unsuccessful attack against London’s public transport system took place on July 21, 2005.
UK authorities have identified and arrested people involved in these attacks.
Similarly, those involved in terrorist incidents in London and Glasgow during the summer of 2007 were identified and arrested.
Like the US, the UK shares its national threat levels with the general public to keep everyone informed and explain the context for the various increased security measures that may be encountered. UK threat levels are determined by the UK Home Office and are posted on its web site at http://www.homeoffice.gov.uk/security/current-threat-level/.
Information from the UK Security Service, commonly known as MI5, about the reasons for the increased threat level and actions the public can take is available on the MI5 web site at http://www.mi5.gov.uk/.
On August 10, 2006, the Government of the United Kingdom heightened security at all UK airports following a major counterterrorism operation in which individuals were arrested for plotting attacks against US-bound airlines.
As a result of this, increased restrictions concerning carry-on luggage were put in place and are strictly enforced.
American citizens are advised to check with the UK Department for Transport at http://www.dft.gov.uk/transportforyou/airtravel/airportsecurity/ regarding the latest security updates and carry-on luggage restrictions.
The British Home Secretary has urged UK citizens to be alert and vigilant by, for example, keeping an eye out for suspect packages or people acting suspiciously at subway (called the “Tube” or Underground) and train stations and airports and reporting anything suspicious to the appropriate authorities.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.
For more information about UK public safety initiatives, consult the UK Civil Contingencies Secretariat web site at http://www.ukresilience.gov.uk.
The political situation in Northern Ireland has dramatically improved since the signing of the Good Friday Agreement in 1998, the announcement by the Irish Republican Army (IRA) on July 28, 2005, that it would end its armed campaign, and the agreement to set up a power-sharing government on May 8, 2007.
The potential remains, however, for sporadic incidents of street violence and/or sectarian confrontation. American citizens traveling to Northern Ireland should therefore remain alert to their surroundings and should be aware that if they choose to visit potential flashpoints or attend parades sporadic violence remains a possibility. Tensions may be heightened during the summer marching season (April to August), particularly during the month of July around the July 12th public holiday.

The phone number for police/fire/ambulance emergency services - the equivalent of "911" in the U.S. - is “999” in the United Kingdom and “112” in Gibraltar.
This number should also be used for warnings about possible bombs or other immediate threats.
The UK Anti-Terrorist Hotline, at 0800 789 321, is for tip-offs and confidential information about possible terrorist activity.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings, Travel Alerts, as well as the Worldwide Caution can be found.
Recent communications from U.S. Embassy London to the local American citizen community, called Warden Messages, can be found on the U.S. Embassy's American Citizens' Services web site at http://london.usembassy.gov/cons_new/acs/index.html.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet, A Safe Trip Abroad.
CRIME:
The United Kingdom and Gibraltar benefit from generally low crime rates and rates decreased slightly in 2007 in significant categories, including violent crime.
The crime situation in the UK is similar to the United States, with typical incidents including pick-pocketing; mugging; “snatch and grab” thefts of mobile phones, watches and jewelry; and theft of unattended bags, especially at airports and from cars parked at restaurants, hotels and resorts.
Pickpockets target tourists, especially at historic sites, restaurants, on buses, trains and the London Underground (the “Tube,” or subway).
Thieves often target unattended cars parked at tourist sites and roadside restaurants, looking for laptop computers and hand-held electronic equipment, especially global positioning satellite equipment.
Walking in isolated areas, including public parks, especially after dark, should also be avoided, as these provide advantageous venues for muggers and thieves.
At night or when there is little foot traffic, travelers should be especially careful using the underground pedestrian tunnels.
As a general rule, either walk the extra distance to use a surface crossing or wait until there are other adult pedestrians entering the tunnel.

In London, travelers should use only licensed “black taxi cabs,” or car services recommended by their hotel or tour operator.
Unlicensed taxis or private cars posing as taxis may offer low fares, but are often uninsured and may have unlicensed drivers.
In some instances, travelers have been robbed and raped while using these cars.
You can access 7,000 licensed “Black Cabs” using just one telephone number – 0871 871 8710. This taxi booking service combines all six of London’s radio taxi circuits, allowing you to telephone 24 hours a day if you need to “hail a cab.” Alternatively, to find a licensed minicab, text “HOME” to 60835 on your mobile phone to get the telephone number to two licensed minicab companies in the area. If you know in advance what time you will be leaving for home, you can pre-book your return journey.
The “Safe Travel at Night” partnership among the Metropolitan Police, Transport for London, and the Mayor of London maintains a website with additional information at http://www.cabwise.com/.
Travelers should not leave drinks unattended in bars and nightclubs.
There have been some instances of drinks being spiked with illegal substances, leading to incidents of robbery and rape.
Due to the circumstances described above, visitors should take steps to ensure the safety of their U.S. passports.
Visitors in England, Scotland, Wales, Northern Ireland, and Gibraltar are not expected to produce identity documents for police authorities and thus may secure their passports in hotel safes or residences.
Abundant ATMs that link to U.S. banking networks offer an optimal rate of exchange and they preclude the need to carry a passport to cash travelers’ checks.
Travelers should be aware that U.S. banks might charge a higher processing fee for withdrawals made overseas.
Common sense personal security measures utilized in the U.S. when using ATMs should also be followed in the UK.
ATM fraud in the UK is becoming more sophisticated, incorporating technologies to surreptitiously record customer ATM card and PIN information.
Travelers should avoid using ATMs that look in any way “temporary” in structure or location, or that are located in isolated areas.
Travelers should be aware that in busy public areas, thieves use distraction techniques, such as waiting until the PIN number has been entered and then pointing to money on the ground, or attempting to hand out a free newspaper.
When the ATM user is distracted, a colleague will quickly withdraw cash and leave.
If distracted in any way, travelers should press the cancel transaction button immediately and collect their card before speaking to the person who has distracted them.
If the person’s motives appear suspicious, travelers should not challenge them but remember the details and report the matter to Police as soon as possible.
In addition, travelers should not use the ATM if there is anything stuck to the machine or if it looks unusual in any way.
If the machine does not return the card, report the incident to the issuing bank immediately.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate at the opening of the next business day.
The U.S. Embassy or Consulate only issues replacement passports during regular business hours.
If you are the victim of a crime while overseas, report it to local police.
The nearest U.S. Embassy or Consulate will also be able to assist by helping you to find appropriate medical care, contacting family members or friends, and explaining how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

Visit the “Victim Support” web site, maintained by an independent UK charity to helps people cope with the effects of crime: http://www.victimsupport.org.uk/
See our information for Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
While medical services are widely available, free care under the National Health System is allowed only to UK residents and certain EU nationals.
Tourists and short-term visitors will be charged for medical treatment in the UK.
Charges may be significantly higher than those assessed in the United States.
Hiking in higher elevations can be treacherous.
Several people die each year while hiking, particularly in Scotland, often due to sudden changes in weather.
Visitors, including experienced hikers, are encouraged to discuss intended routes with local residents familiar with the area, and to adhere closely to recommendations.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
If your medical insurance policy does not provide overseas coverage, you may want to purchase a short-term policy for your trip.
The Department of State provides a list of travel insurance companies that can provide the additional insurance needed for the duration of one’s trip abroad in its online at medical insurance overseas.
Remember also that most medical care facilities and medical care providers in the UK do not accept insurance subscription as a primary source of payment.
Rather, the beneficiary is expected to pay for the service and then seek reimbursement from the insurance company.
This may require an upfront payment in the $10,000 to $20,000 range

Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning the United Kingdom is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

UK penalties for driving under the influence of even minimal amounts of alcohol or drugs are stiff and often result in prison sentences.
In contrast to the United States and continental Europe, where traffic drives on the right side of the road, in the UK, it moves on the left.
The maximum speed limit on highways/motorways in the UK is 70MPH.
Motorways generally have a hard shoulder (breakdown lane) on the far left, defined by a solid white line.
It is illegal to stop or park on a hard shoulder unless it is an emergency.
In such cases, you should activate your hazard lights, get out of your vehicle and go onto an embankment for safety.
Emergency call boxes (orange telephone booths with “SOS” printed on them) may be found at half-mile intervals along the motorway.
White and blue poles placed every 100 yards along the motorway point in the direction of the nearest call box.
Emergency call boxes dial directly to a motorway center.
It is best to use these phones rather than a personal cell phone, because motorway center personnel will immediately know the location of a call received from an emergency call box.
Roadside towing services may cost approximately £125.
However, membership fees of automotive associations such as the RAC or AA (Automobile Association) often include free roadside towing service.
Visitors uncomfortable with, or intimidated by, the prospect of driving on the left-hand side of the road may wish to avail themselves of extensive bus, rail and air transport networks that are comparatively inexpensive.
Roads in the UK are generally excellent, but are narrow and often congested in urban areas.
If you plan to drive while in the UK, you may wish to obtain a copy of the Highway Code, available at http://www.highwaycode.gov.uk.
Travelers intending to rent cars in the UK should make sure that they are adequately insured.
U.S. auto insurance is not always valid outside the U.S., and travelers may wish to purchase supplemental insurance, which is generally available from most major rental agents.
The city of London imposes a congestion charge of £8 (eight pounds sterling, or approximately U.S. $16.00) on all cars entering much of central London Monday through Friday from 7:00 a.m. to 6:30 p.m.
Information on the congestion charge can be found at http://www.cclondon.com.
Public transport in the United Kingdom is excellent and extensive.
However, poor track conditions may have contributed to train derailments resulting in some fatalities.
Repairs are underway and the overall safety record is excellent.
Information on disruptions to London transportation services can be found at http://www.tfl.gov.uk and information about the status of National Rail Services can be found at http://www.nationalrail.co.uk.
Many U.S. pedestrians are injured, some fatally, every year in the United Kingdom, because they forget that oncoming traffic approaches from the opposite direction than in the United States.
Extra care and alertness should be taken when crossing streets; remember to look both ways before stepping into the street.
Driving in Gibraltar is on the right-hand side of the road, as in the U.S. and Continental Europe.
Persons traveling overland between Gibraltar and Spain may experience long delays in clearing Spanish border controls.
Please refer to our Road Safety Overseas page for more information.
For specific information concerning United Kingdom driving permits, vehicle inspection, road tax and mandatory insurance, refer to the United Kingdom’s Department of Environment and Transport web site at http://www.dft.gov.uk, the Driving Standards Agency web site at http://www.dsa.gov.uk or consult the U.S. Embassy in London’s web site at http://london.usembassy.gov/.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Kingdom’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the UK’s air carrier operations.
For further information, travelers may visit the FAA's web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
The legal drinking age in the UK is generally lower than in the U.S. and social drinking in pubs is often seen as a routine aspect of life in Britain. Parents, organizers of school trips, and young travelers should be aware of the impact that this environment may have when combined with the sense of adventure that comes with being abroad.
Please see our Students Abroad web site as well Studying Abroad to help students plan a safe and enjoyable adventure.
The UK has strict gun-control laws, and importing firearms is extremely complicated. Travelers should consider leaving all firearms in the United States.
Restrictions exist on the type and number of weapons that may be possessed by an individual.
All handguns, i.e. pistols and revolvers, are prohibited with very few exceptions.
Licensing of firearms in the UK is controlled by the Police.
Applicants for a license must be prepared to show 'good reason' why they require each weapon.
Applicants must also provide a copy of their U.S. gun license, a letter of good conduct from their local U.S. police station and a letter detailing any previous training, hunting or shooting experience. Background checks will also be carried out.
Additional information on applying for a firearm certificate and/or shotgun certificate can be found on the Metropolitan Police Firearms Enquiry Teams web site at http://www.met.police.uk/firearms-enquiries/index.htm.
A number of Americans are lured to the UK each year in the belief that they have won a lottery or have inherited from the estate from a long-lost relative.
Americans may also be contacted by persons they have “met” over the Internet who now need funds urgently to pay for hospital treatment, hotel bills, taxes or airline security fees.
Invariably, the person contacted is the victim of fraud.
Any unsolicited invitations to travel to the UK to collect winnings or an inheritance should be viewed with skepticism.
Also, there are no licenses or fees required when transiting a UK airport, nor is emergency medical treatment withheld pending payment of fees.
Please see our information on International Financial Scams. Please read our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating British law, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the UK are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.
Many pocketknives and other blades, and mace or pepper spray canisters, although legal in the U.S., are illegal in the UK and will result in arrest and confiscation if detected.
A UK Metropolitan Police guide to items that are prohibited as offensive weapons is available at http://www.met.police.uk/youngpeople/guns.htm.
A UK Customs Guide, detailing what items visitors are prohibited from bringing into the UK, is available at http://customs.hmrc.gov.uk/channelsPortalWebApp/downloadFile?contentID=HMCE_CL_001734.
Air travelers to and from the United Kingdom should be aware that penalties against alcohol-related and other in-flight crimes (“air rage”) are stiff and are being enforced with prison sentences.
Please also see our information on customs regulations that pertain when returning to the US.

CHILDREN'S ISSUES:
For information on intercountry adoption and international parental child abduction, see the Office of Children’s Issues.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the United Kingdom are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within the United Kingdom.
By registering, Americans make it easier for the Embassy or Consulate to contact them in case of emergency, and to relay updated information on travel and security within the United Kingdom.
The Embassy and Consulates regularly send security and other information via email to Americans who have registered.
As noted above, recent communications from U.S. Embassy London to the local American citizen community, called Warden Messages, can be found on the embassy’s web site.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
The Consular Section also disseminates a newsletter every month.
Those wishing to subscribe to the monthly consular newsletter in London should send a request by email to SCSLondon@state.gov.
The U.S. Embassy is located at 24 Grosvenor Square, London W1A 1AE; telephone: in country 020-7499-9000; from the U.S. 011-44-20-7499-9000 (24 hours); Consular Section fax: in country 020-7495-5012; from the U.S. 011-44-20-7495-5012, and on the Internet at http://london.usembassy.gov.
The U.S. Consulate General in Edinburgh, Scotland, is located at 3 Regent Terrace, Edinburgh EH7 5BW; Telephone: in country 0131-556-8315, from the U.S. 011-44-131-556-8315.
After hours: in country 01224-857097, from the U.S. 011-44-1224-857097.
Fax: in country 0131-557-6023; from the U.S. 011-44-131-557-6023.
Information on the Consulate General is included on the Embassy’s web site at http://london.usembassy.gov/scotland.
The U.S. Consulate General in Belfast, Northern Ireland, is located at Danesfort House, 228 Stranmillis Road, Belfast BT9 5GR; Telephone: in country 028-9038-6100; from the U.S. 011-44-28-9038-6100.
Fax:
in country 028-9068-1301; from the U.S. 011-44-28-9068-1301.
Information on the Consulate General is included on the Embassy’s web site at: http://london.usembassy.gov/nireland.
There is no U.S. consular representation in Gibraltar.
Passport questions should be directed to the U.S. Embassy in Madrid, located at Serrano 75, Madrid, Spain, tel (34)(91) 587-2200, and fax (34)(91) 587-2303.
The web site is http://madrid.usembassy.gov.
All other inquiries should be directed to the U.S. Embassy in London.
* * *
This replaces the Consular Information Sheet dated December 12, 2007, to update the sections on Entry Requirements, Safety and Security, Crime, Victims of Crime, Medical Facilities, Medical Insurance, Traffic Safety and Road Conditions, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Thu 24 Aug 2017
Source: Gibraltar Chronicle [edited]
<http://chronicle.gi/2017/08/tiger-mosquito-found-in-gibraltar-but-no-cause-for-concern-officials-say/>

An aggressive species of mosquito known to transmit viral diseases has been detected in Gibraltar, but public health officials insist there is no cause for alarm. Public Health Gibraltar and the Environmental Agency confirmed that the mosquito of the species _Aedes albopictus_, also known as the tiger mosquito, has been found in Gibraltar.

Last June [2017] after 9 months of intensive surveillance, officials said no tiger mosquito had been found in Gibraltar. But this has now changed after the 1st tiger mosquito was found in the urban dome   stic environment within Gibraltar. "This finding alone does not however materially alter any health risks in Gibraltar and there is no immediate cause for public concern," the government said in a statement. Public Health Gibraltar was first alerted in January 2016 to the discovery of the mosquito in Malaga and Algeciras [in Andalusia, Spain]. Since then, together with the Environmental Agency, it began working with international experts to mount surveillance in Gibraltar.

World Health Organization experts visited Gibraltar and gave advice on setting traps and monitoring locations, but no tiger mosquito had been detected until now. The tiger mosquito is not native to Gibraltar and has not been previously found here. It is common in other countries where it transmits viral diseases like Zika, dengue, and chikungunya. It is a domestic species, breeds in water in urban areas -- water butts, blocked drains, rainwater gullies -- and is able to reach high abundance around residential areas.

It is also a day-time mosquito, that aggressively bites humans. "Health risks to the public only arise if the virus causing these diseases is also present, which is not the case in Gibraltar," the government said.  "The virus can, however, be imported by travellers returning from an overseas country and if this happens, there is a risk of spread, but only if the mosquito bites within a small window period of about a week after the fever starts."

Public Health Gibraltar has been raising awareness of travel risk amongst travellers through its publication A Factsheet for Travellers and recommends the following precautions:
- before travelling to affected areas, consult your doctor or seek advice from a travel clinic, especially if you have an immune disorder or severe chronic illness;
- if you are pregnant or are considering pregnancy, consider postponing non-essential travel;
- when staying in a mosquito-prone area, wear mosquito repellents and take mosquito bite prevention measures;
- if you have symptoms within 3 weeks of return from an affected country, contact your doctor;
- if you have been diagnosed with any of the diseases Zika, dengue, or chikungunya, take strict mosquito bite prevention measures for 10 days after the fever starts.
========================== 
[The appearance of _Aedes albopictus_ in Gibraltar is not surprising. A map of the distribution of this species as of April this year (2017) shows it present around the Mediterranean Basin and up to Gibraltar on the west (<https://ecdc.europa.eu/en/publications-data/aedes-albopictus-current-known-distribution-europe-april-2017>).

Now it has been found in Gibraltar. The concerns are real about transmission of dengue, chikungunya, and Zika viruses should populations of _Ae. albopictus_ become established. In 2015 there were a few locally acquired cases of dengue in the south of France. This also happened on a larger scale in Emilia Romagna, Italy, when a viraemic man introduced chikungunya virus into Italy and sparked an outbreak.

One hopes that mosquito surveillance will continue in Gibraltar, perhaps be intensified, and help guide vector control efforts. - ProMED Mod.TY]

[A HealthMap/ProMED-mail map can be accessed at: <http://healthmap.org/promed/p/517>.]
Date: Wed, 1 Jun 2011 01:46:48 +0200 (METDST)

GIBRALTAR, June 1, 2011 (AFP) - A fuel tank exploded and caught fire near a cruise ship in the British territory of Gibraltar Tuesday, injuring at least 15 people, most of them on the vessel, local officials and the ship's owners said. The blast was probably caused by a spark from welding operations, Chief Minister Peter Caruana told Radio Gibraltar. But police were not ruling out any possibility including that of an attack, he added. Flames several metres high could be seen coming out of the tank with dense black smoke billowing across the port as firefighters directed jets of water at the blaze from tugboats. The fire continued late into the night, with Radio Gibraltar reporting more explosions were heard. The tank was close to the giant cruise ship, Independence of the Seas, which had arrived in Gibraltar Tuesday morning. The ship made an emergency departure immediately after the blast Tuesday afternoon.

The Gibraltar government and the ship's owners, Royal Caribbean International, both said 12 people on the ship had been hurt. Gibraltar officials said one of the passengers had suffered a fractured arm. Two Spanish welders working on the tank were injured, including one who was in critical condition in a burns unit at a hospital in the southern Spanish city of Seville, Radio Gibraltar said. A police officer was also slightly injured in the rescue attempt, police said. "The lid of the tank was blown off by the blast," a police spokesman said. The statement from Royal Caribbean International said: "Immediately after the explosion, the ship retracted the gangway and moved a safe distance from the dock. "Twelve guests sustained minor injuries and have received medical treatment onboard." The boat was on a two-week cruise, having left the southern English port of Southampton on Saturday, the company added.

Air services to Gibraltar were suspended and offices in the port area evacuated. The police spokesman said the possibility of adjacent tanks overheating and exploding could not be ruled out. Caruana described it as a serious incident but said there was "no cause for concern". "Once it was established that there were welding operations going on, on top of the very tank at the time it exploded, (that) makes that a frontrunner for a likely explanation, but all possibilities are being kept open," he told Radio Gibraltar. "The police are obviously keeping their minds open to the possibility of maybe a security incident. It's looking unlikely but all possibilities are being looked into if only to be excluded."

"The plan is to allow it to carry on burning itself off," he said later Tuesday, but warned that the wind was due to change during the night, which could bring the smoke over land. Spanish tugs from a private company were helping the local fire services, he added. One witness said he was in his office nearby when he heard three loud explosions. "We started running out and saw one of the main tanks set alight. My concern was the poor people who were working there," he told Radio Gibraltar. The public was being advised to keep away from the area and keep windows closed due to the smoke. Gibraltar is a 6.5-square-kilometre (2.6-square-mile) British territory of around 30,000 people off the tip of southern Spain. Madrid ceded it to London in 1713 under the Treaty of Utrecht, but it has long fuelled tensions between the two countries.
Date: Tue, 10 Aug 2010 20:08:15 +0200 (METDST)

GIBRALTAR, Aug 10, 2010 (AFP) - Gibraltar on Tuesday condemned as "illegal" a proposal by the neighbouring Spanish town of La Linea to impose a tax on cars entering or leaving the tiny British territory by road.   The decision comes amid thorny relations between Madrid and London over the disputed British possession off the tip of southern Spain.

La Linea mayor Alejandro Sanchez on Monday announced the "congestion charge" of no more than five euros (6.5 dollars) on cars crossing into and out of Gibraltar, saying the measure will be imposed in October once it is passed by the town council.   He said lorries carrying debris and other materials used in Gibraltar to reclaim land from the sea will pay more, but the exact amount has not yet been determined.   Sanchez, a member of Spain's conservative opposition Popular Party, said the tax is needed partly to compensate the municipality for austerity measures imposed by the socialist government in Madrid.   La Linea residents would be exempt, but it was not clear if Gibraltarians would also have to pay.

The Gibraltar government reacted angrily and said it has contacted the Spanish authorities over the decision.   "The confused statements by the mayor of La Linea in respect of the proposed toll describe a litany of illegalities under EU Law and probably also under Spanish law," it said in a statement.   "The mayor of La Linea is clearly engaged in a political manoeuvre with his central government, which is unlikely to allow the proposal.

"The mayor's proposals are wholly unacceptable both legally and politically and in the unlikely event that these measures should be introduced, the (Gibraltar) government will take appropriate steps."   Spain ceded Gibraltar to Britain in 1713 under the Treaty of Utrecht but has retained first claim on the tiny peninsula should Britain renounce sovereignty.

"The Rock" has long fuelled tensions between Spain and Britain, with Madrid arguing the 6.5-square-kilometre (2.6-square-mile) territory that is home to roughly 30,000 people should be returned to Spanish sovereignty.   But its people overwhelmingly rejected an Anglo-Spanish proposal for co-sovereignty in a referendum in 2002.   In recent months British and Spanish naval and police boats have engaged in a series of cat and mouse games in the waters off Gibraltar, which lies at the strategic western entrance to the Mediterranean.
Date: Thu 23 Oct 2008
Source: Panorama.gi [edited]
---------------------------------
During the last 10 weeks, Gibraltar has experienced an outbreak of measles. "We have so far been notified of over 250 cases and notifications are still coming in at around 4-6 cases per day," said the Gibraltar Health Authority [GHA], who believe that the actual numbers are greater as many people with mild attacks have chosen not to report them. While the majority of infections in the outbreak have been mild, some have been severe and a few patients including babies have needed intensive care.  Measles is an unpleasant disease with fever, sore throat, streaming eyes, diarrhoea, and rash. Most people recover within a week or so, but complications like fits, bacterial infection, or pneumonia can develop. Long-term complications can also arise in very young children.

Says the GHA: It is important that all persons with symptoms suggestive of measles should report the illness to their doctor to enable complications to be detected at an early stage. In addition to medical advice, persons with the illness should follow general hygiene practices such as limiting contact with other people, carefully discarding soiled tissues, and washing their hands. Anyone who has had measles infection is immune for life and cannot get measles again. There is no basis for the rumour that some people have had measles twice. It is possible that infection with rubella (German measles, a different disease) may have caused the confusion. Vaccination with the MMR [measles, mumps, and rubella] vaccine is the only way to prevent measles infection.

[So far], the 250 cases have been in persons who are unvaccinated or partly vaccinated (one dose only). Not a single case has occurred in a person who has had a full course of MMR vaccine. MMR vaccine has been available free to children [from] Gibraltar's health service since 1989, although the boosters were only introduced in 2002. It is also a very safe and effective vaccine, with an impressive track record," they say. Gibraltar Health Authority adds that it is continuing to advise all parents of children who have not had the MMR vaccine to immunise their children. There had been some difficulties in obtaining vaccine recently due to an international shortage, but fresh supplies have now been received. The course consists of 2 injections, approximately 3 months apart. Please note that BOTH the doses are needed for adequate immunity. They add: If your child has received only one dose, either now or in the past, he or she could still be at risk. Arrangements have been made to offer additional  vaccination to all unimmunised children as follows: During October and November [2008], the Child Welfare Clinics (primary care centre) will be open on Mondays (2:00 pm to 4:00 pm), Wednesdays (9:00 am to 11:00 am) and Fridays (9:00 am to 11:00 am) for immunisations. Appointments are not necessary.
-------------------------------
[The Rock of Gibraltar is located at the entrance of the Mediterranean. Gibraltar is connected to Spain by a sandy isthmus, by a ferry to Morocco, and by flights to London. By virtue of its geographical position and political status Gibraltar is vulnerable to introduction of infectious disease from diverse sources. No information has been provided regarding the source of the measles virus responsible for this outbreak. In this respect it will be relevant to determine the genotype of the measles virus involved (see comment in ProMED-mail "Measles - Gibraltar 20080814.2529"). The outbreak has escalated from the 17 cases reported on 14 Aug 2008 to the current 250 cases. Despite the availability of free MMR vaccination it is clear that there is an appreciable number of unimmunised individuals in the community who remain susceptible to measles virus infection. It is encouraging that efforts are underway to expand vaccine coverage.


and the HealthMap/ProMED-mail interactive map at <http://healthmap.org/promed?g=2411586&amp;v=36.133,-5.35,7>. - ProMed Mod.CP]
Date: Wed, 16 Apr 2008 14:56:40 +0200 (METDST) GIBRALTAR, April 16, 2008 (AFP) - Animal rights groups have expressed outrage over a plan by Gibraltar's government to cull its famous Barbary Apes, which are posing a hazard as they roam the town in search of food. The government of the tiny British territory off Spain's southern coast plans to cull 25 of the simians, whose population has exploded to around 200. The mischievous primates climb over cars and pull out antennas, open rubbish bags and rifle through handbags left unattended in the popular tourist destination. Officially, the management of the apes is the responsibility of the Gibraltar Ornithological and Natural History Society (GONHS), on contract from the government. But the society said it has not approved the cull. "Our policy is that culling can be a population management solution but only in extreme cases when there is no other more suitable option," GONHS general secretary Dr. John Cortes said on Tuesday. "We would only ever recommend a cull after very careful assessment of the situation from a veterinary and a genetic point of view." However, Environment Minister Ernest Britto said a licence has been issued for the cull and two of the apes have already been given lethal injections. Helen Thirlway, the head of Britain's International Primate Protection League, said the government was failing to manage the apes "in a responsible manner." "There have been many advances and pilot studies in recent years on different methods of controlling free-roaming monkeys," she was quoted as saying in the local media Wednesday. "We are more than happy to work with the government of Gibraltar and with GONHS to help them develop more efficient, alternative solutions, but this needless slaughter has to stop." According to legend, if the apes disappear, Britain will lose control of Gibraltar. When wartime British prime minister Winston Churchill heard their population was low, British consuls in North Africa -- from where the apes originally came -- were tasked with sending new young simians to the Rock. At one time, the apes were looked after by the British army stationed in Gibraltar, which selected a place up the Rock where they were fed daily to keep them from loitering downtown. Spain ceded Gibraltar to Britain in 1713, but has retained a constitutional claim should Britain renounce sovereignty. The vast majority of the 30,000 people want to retain their links with Britain.
More ...

Australia

Travelling to Australia
===========================
Introduction
********************************************
Travelling to Australia for business or pleasure can be a most memorable experience and each year many Europeans travel this
route to experience something of life ‘down-under’. Staying healthy and well is essential if you want to enjoy your trip to its fullest extent. Australia is a huge continent and the climatic conditions vary considerably throughout. The main southern cities have a temperate climate similar to North West Europe, Perth enjoys a Mediterranean climate while Queensland and the Northern Territories have a sub-tropical weather pattern.
Preparation
********************************************
It is important that all travellers are in good general health before undertaking any long-haul trip. Patients who tire easily on light exercise or who have a significant underlying medical condition will need to take extra care. If you are concerned about this aspect of your proposed trip arrange for a meeting with a doctor at an early stage in your preparations.
Long Haul Flights
********************************************
On these long flights you will be travelling across many time zones. You will lose or gain hours depending on the direction of your flight. Your body will take time to adjust to the new time zone and so it is important to allow this to occur naturally. If you arrive during the daylight hours try to stay out in the sun for a period of time as this will help your body release a hormone which counteracts jet lag. (Watch you don’t get sun burnt!) Don’t plan to be too energetic during the first day or two after you arrive. Be sensible. If this is a business trip try not to make any major decisions over the first 24 hours. Even the relatively short flight from South East Asia down to Australia crosses time zones and again it will be important to allow your body to settle.
Stop-Overs in SE Asia
********************************************
Frequently travellers will stop-over in Singapore, Bali, Hong Kong or Bangkok on their way to or from Australia. During these short stops it is essential that travellers take all possible precautions to ensure that they rest and are careful about what they eat or drink as contaminated food or water is more common in some of these regions.

Mosquito protection in SE Asia
********************************************
Mosquito borne diseases are present depending on the location (Malaria, Dengue Fever, Japanese B Encephalitis etc) One of particular concern is Dengue Fever, which is a viral disease transmitted by the bite of an infected mosquito. These mosquitoes tend to bite during the day time. This is in contrast to the mosquitoes which transmit malaria which mainly bite at night. Many of the main tourist destinations throughout SE Asia are malaria free and so tablets to protect against the disease are not usually required. Those going off the usual routes will need to talk this through in depth before leaving.
Road Traffic Accidents
********************************************
Frequently, cars are purchased by tourists to Australia for the duration of their stay. Often the cost is low and the maintenance and safety of the vehicle may be somewhat questionable! Long monotonous driving associated with a lack of concentration can cause serious accidents. Car breakdown in the middle of ‘nowhere’ may lead to the risk of dehydration and potential animal attack (kangaroo, dingos, snakes etc). Make sure you always have sufficient food and water and some means of communication (fully charged mobile phone) before leaving to travel across the continent. Make sure other responsible friends or relations back home know of your intended route and inform them of any changes. Get contact numbers for essential services for your journey.

Health Concerns in Australia
********************************************
Many travellers feel that Australia is the same as at home in Europe and so little care with personal health needs be taken. This is not always the case as there are many local health variations throughout the country which should be considered.
Sun Exposure
********************************************
The northern European skin is usually unaccustomed to intensity of the sun exposure experienced in many parts of Australia. Unfortunately this regularly leads to sun burn among tourists but, more seriously, it also significantly increases the risk of potentially fatal skin cancers. Always use plenty of adequate sun block, cover exposed areas of your body where possible (especially by wearing a wide brimmed hat) and drink plenty of water. (You may also need to replace salt lost through increased perspiration ~ assuming no underlying blood pressure problem)
Northern Australia
********************************************
As mentioned previously, the northern parts of Australia are sub-tropical and mosquito borne diseases are more common. Malaria transmission does not occur and many of the diseases transmitted by mosquitoes or other insects cause mild discomfort. Unfortunately some are which are much more severe and can cause long term difficulties.
Ross River Fever
This viral disease is transmitted by mosquitoes and causes a severe arthritic type condition. The disease is often short lived but in some patients the disease may continue to cause arthritis for months and even years. There is no specific treatment and travellers need to be careful about avoiding bites.
Typhus
This disease occurs in isolated parts of Northern Australia through the bite of infected ticks. The disease can cause a skin rash, fever and general unwellness. Antibiotics can help to ease the symptoms but avoiding bites is essential at all times.
Dengue
This mosquito borne disease also occurs in parts of Northern Australia usually by day-biting mosquitoes. (See Dengue leaflet - TMB)
Other Risks
********************************************
The sea waters in parts of Australia are infested by sharks and jelly fish. Always take competent local advice before undertaking any sea activities. Drowning occurs regularly each year among tourists who disregard some of the basic rules of water safety. If in desert regions, take care with disturbing rocks in case you awaken a peaceful snake or scorpion.
Medical Care for Travellers
********************************************
If travellers have stopped in South East Asia and then become ill on arrival in Australia, they should make contact with a medical centre dealing with Tropical Medicine. Details of the centres in the major cities throughout Australia are available from the Tropical Medical Bureau.
Vaccinations for Stop-Overs
********************************************
Usually travellers will have vaccination cover for Typhoid, Poliomyelitis, Tetanus and Hepatitis A. Malaria prophylaxis may not be required depending on your actual itinerary. There is a higher risk of Hepatitis B in central Australia and so this may need to be considered if the risk of contact (mainly blood following accidents) is thought to be higher than usual. Rabies risk in Australia is almost non existent though obviously contact with all warm blooded animals should be avoided at all times.

Travel News Headlines WORLD NEWS

Date: Fri 30 Aug 2019
Source: Esperance Express (abridged, edited)

Esperance residents need to be alert to the risk of measles following confirmation of measles in a person who visited the region. [See URL for time and locations of possible exposure. - ProMED Mod.LK]

"With high vaccination coverage, naturally occurring measles has been eliminated from WA [Western Australia] for around 20 years, but occasional cases and small outbreaks occur, sparked by residents or visitors who were infected overseas," WA County Health Service's Dr Charles Douglas said.  [Byline: Jake Dietsch]
Date: Sun 18 Aug 2019 12:23 AM AEST
Source: ABC [edited]

The national death toll officially stands at 430, although the real figure could be much higher with experts saying some deaths are attributed to other causes despite flu-related complications.

In Queensland this year [2019], at least 84 people have died. Jianyun Lu, has travelled from China to study the unusual flu season under the tutelage of the University of Queensland's, Kirsty Short.

They have discovered a slight association with climatic factors, but not enough to account for the large spike. "We can't explain 100 per cent why, when it's over 25 degrees Celsius [77 deg F], we have a very sharp increase," Dr Lu said.

So they have turned their attention to the virus itself.  There was an unusual number of children hospitalised with flu over summer [2018-19] and it's the strains isolated from those patients that the researchers have under the microscope.

Dr Short said they are investigating whether certain mutations were enabling the virus to "survive longer in the environment", or allowing it to "transmit better".  "By the end of the year [2019], I think we'll have a good understanding of potential factors that could have contributed to our unusual summer flu," Dr Short said.

Professor Barr identified a large outbreak in the Northern Territory at the end of last year [2018], and a mild-2018 influenza season as contributing factors and said there needed to be year-round surveillance.  "In Australia we rely on a number of different reporting mechanisms, so we can track influenza seasons. Some of these are run all year round, but a number of them, such as the surveillance in hospitals, only run from April to November," he said.  "We need to be better prepared. Maybe we can tweak the vaccination timings if we see these early outbreaks."  A record 12.5 million vaccines have been distributed so far this year [2019].  [Byline: Dea Clark]
========================
[HealthMap/ProMED-mail map of Australia:
Date: Fri 23 Aug 2019
Source: The Sydney Morning Herald [abridged, edited]

New South Wales (NSW) residents have been advised to vaccinate themselves against measles after 2 returning travellers were diagnosed with the disease. Both people diagnosed with the infection are aged in their 40s. They bring the total number of measles notifications for NSW to 37 this year (2019), compared with 13 notifications for the same period last year (2018), data from NSW Health show.

Both NSW residents, returning from South America and New Zealand, respectively, remain isolated in hospital for management of complications from their infections. Dr Vicky Sheppeard, director of communicable diseases NSW Health, said that after their return to Australia both cases visited locations in Sydney while infectious on [15 and 16 Aug 2019] [see source URL for locations]. "Anyone who was in the same locations as the cases [on these dates] should be alert for signs and symptoms of measles until [8 Sep 2019]," Dr Sheppeard said. "None of the locations visited by these 2 people pose an ongoing risk."  [byline: Laura Chung]
Date: Wed 21 Aug 2019
Source: The Canberra Times [edited]

Australian Capital Territory (ACT) health officials are investigating a cluster of hepatitis A cases in Canberra's South Korean community. There have been 8 cases of the virus in the ACT and Sydney since June 2019. The cluster of cases comes as South Korea experiences a large outbreak of the virus, with more than 11,000 cases reported in the country in 2019.

ACT Health said it was working with its counterparts in New South Wales to investigate the cause of the outbreak. An ACT Health spokesman said most of the people affected by hepatitis A in recent weeks in Canberra had not reported travelling overseas recently. "Australia has a low incidence of hepatitis A, and when outbreaks occur, they are linked to consumption of contaminated food products or person-to-person spread," the spokesperson said. "However, at this stage of the investigation, no specific food has been connected to the outbreak."

Symptoms of the virus may include nausea, vomiting, fever and yellowing of the skin, dark urine and pale stools.

"The ACT Health directorate is reminding the South Korean community in Canberra and anyone travelling to South Korea, of the importance of vaccination prior to travel and practicing good hand hygiene to reduce the risk of spread," the spokesman said. Health officials have recommended at least one dose of a hepatitis A vaccination before travel. Two doses prevent an infection.

Handwashing in soap and water for at least 15 seconds has also been recommended by health officials to help prevent the spread of the virus.
===================
[Since no travel was involved, it is not clear if the cases were from imported food, food contaminated by an infected food handler or from transmission from an asymptomatic person. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Australia:
Date: Thu 25 Jul 2019 4:14 PM AEST
Source: Mirage News [edited]

The Department of Health today [25 Jul 2019] reported that an adult is currently recovering after being diagnosed with meningococcal disease serogroup W, bringing the number of reported cases of invasive meningococcal disease in 2019 to 13. Of the 13 cases, 3 have been serogroup B, 5 serogroup W, and 5 serogroup C meningococcal infections.

Meningococcal disease is an uncommon, life-threatening illness caused by a bacterial infection of the blood and/or the membranes that line the spinal cord and brain, and occasionally of other sites, such as the throat, lungs or large joints.

A total of 41 cases were notified in WA [Western Australia] in 2018. This was less than the 46 cases notified in 2017, but well above the long-term average for annual cases. The number of serogroup W cases in 2018 (30) was also the highest reported in any year.

A vaccine to protect against 4 serogroups of the meningococcal disease (serogroups A, C, W and Y) is offered free to all children in WA at 12 months of age, with a catch-up program for children who have not yet received the vaccine and who are aged 1-4 years. Due to a higher rate of meningococcal disease in Aboriginal people in WA, Aboriginal children are offered vaccination from age 6 weeks to 4 years of age. In addition, the vaccine is offered to all teenagers in Year 10, with a catch up program for 15-19 years.
======================
[_Neisseria meningitidis_, the cause of meningococcal disease, only infects humans; there is no animal reservoir, and the organism dies quickly outside the human host. _N. meningitidis_ colonizes the mucosal membranes of the nose and throat; up to 5-10 percent of a population may be asymptomatic nasopharyngeal carriers, but the carrier rate may be higher in epidemic situations. Droplets of nasopharyngeal secretions from these carriers are responsible for the spread of the disease. Close and prolonged contact with an infected person or a carrier facilitates the spread of the disease. The average incubation period is 4 days but can range between 2 and 10 days.

Immunity following use of a meningococcal capsular polysaccharide vaccine is specific for the type of capsular polysaccharide that the vaccine contains, with no cross-protection against infection due to other meningococcal polysaccharide groups. Although there are at least 13 _N. meningitidis_ serogroups, based on the antigenic specificity of their capsular polysaccharides, disease due to serogroups A, B, C, Y, and W are most common.

There are vaccines that contain capsular polysaccharide (A, C, Y, W), either alone or conjugated to protein. Conjugate vaccines are preferable, because, unlike the polysaccharide vaccines, conjugate vaccines immunize infants, reduce the carriage of meningococci in the throat and thus its transmission, as well as confer a more sustained immune response, and, therefore, longer-term protection than the polysaccharide vaccines. Serogroup B vaccines are based upon meningococcal B protein antigens, because group B capsular polysaccharide is poorly immunogenic in humans and is a potential auto-antigen.

Following the mass introduction into the population of a vaccine specific for one particular serogroup, the incidence of disease due to that serogroup has been found to fall dramatically, e.g., serogroup C disease in the UK following the introduction of C vaccine and serogroup A in the African Meningitis Belt following A vaccine, only to be replaced by emergence of disease due to other meningococcal serogroups.

In Australia, following the introduction of the conjugate meningococcal C vaccine in 2003, there has been a significant and sustained reduction in serogroup C meningococcal cases from 34 per cent of cases in 2003 to 5.7 per cent in 2012, accompanied by an increase in serogroup B from 60 per cent in 2003 to 83 per cent in 2012 (<http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3703-pdf-cnt.htm/$FILE/cdi3703e.pdf>). ProMED-mail reported in 2016 that serogroup W, rather than B, had become predominant in Western Australia (ProMED-mail post Meningitis, meningococcal - Australia (03): (WA) sg. W http://promedmail.org/post/20160925.4513543).

Because of the replacement of serogroup C by serogroup W, quadrivalent conjugate (MenACWY) vaccine was funded in 2017 by Western Australia for grade 10-12 students and persons aged 15-19 years who no longer attend school and then in 2018 funded for all children in Australia at 12 months of age, replacing meningococcal C vaccine, and in 2019 for adolescents aged 14-19 years; MenACWY vaccine is strongly recommended, but not funded, for adolescents and young adults aged 20-24 years who live in close quarters or who are current smokers (<http://ncirs.org.au/sites/default/files/2019-04/Meningococcal-history-April-2019.pdf> and <http://ncirs.org.au/sites/default/files/2019-05/Childhood-schedule-table_May_2019_Final.pdf>).

MenACWY vaccine is also strongly recommended, but not funded, for: infants younger than 12 months of age; adolescents and young adults aged 20-24 years who live in close quarters or who are current smokers; Aboriginal and Torres Strait Islander people aged 2 months to 19 years; infants and children aged 2 months and older with medical conditions associated with an increased risk of meningococcal disease (additional doses and boosters required); and travellers to areas where meningococcal disease is more common (<http://ncirs.org.au/sites/default/files/2019-05/Childhood-schedule-table_May_2019_Final.pdf>).

The B vaccine is strongly recommended, but not funded, for: infants and children younger than 2 years of age; adolescents aged 15-19 years; adolescents and young adults aged 15-24 years who live in close quarters or who are current smokers; Aboriginal and Torres Strait Islander people aged 2 months to 19 years; and infants and children aged 2 months and older with medical conditions associated with an increased risk of meningococcal disease  (<http://ncirs.org.au/sites/default/files/2019-05/Childhood-schedule-table_May_2019_Final.pdf>).

Western Australia, covering the entire western 1/3 of Australia, is mostly arid, its population being concentrated in the fertile southwest corner and its capital, Perth (<https://en.wikipedia.org/wiki/Western_Australia>). - ProMED Mod.ML]

[HealthMap/ProMED-mail map: <http://healthmap.org/promed/p/289>]
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Cape Verde

General
The Cape Verde islands are situated off the west coast of Africa (adjacent to Senegal) and are becoming a more popular destination for European travellers aiming to avoid the major busy tourist destinations of the world. There are nine inhabi
ed islands within the group and also some uninhabited volcanic ones. The capital is Praia (on Santiago) and Portugese is the official language. The major port is Mindelo on the island of Sao Vicente.

Travelling to Cape Verde
There is a recently opened international airport in Praia and a second international airport (Amilcar Cabral) located on Sal Island which is about 150 kms northeast of the capital. Generally the facilities for tourists are still quite limited though improving and most developed on Sal.
Arriving in Cape Verde
The climate is oceanic tropical with temperatures varying from 20oC to 30oC throughout the year. The light rainfall tends to occur in Aug to November. During this time humidity can be higher but this is not usually a significant factor.
Food & Water
In line with many hotter regions of the world the level of food and water hygiene varies greatly from area to area and depending on the establishment. Travellers are advised to eat freshly cooked hot food, to avoid cold meals (salads etc) and particularly to avoid any undercooked bivalve shellfish meals (clams, mussels, oysters etc). Fresh milk may be unpasteurised and should be avoided.
Travelling around the islands
As with many archipelago destinations there is a way of moving from island to island if you wish to explore. This can be by boat or plane in many but not all cases. However if travelling by plane be aware that the limited baggage handling capacity of the small planes may lead to some delay in eventually receiving your luggage. During the dry dusty season (December to April) flights may be cancelled due to poor visibility. The road traffic moves on the right and seatbelts are compulsory for all in the front seat. Motorcyclists must wear helmets and have their lights on at all times.

Accidents
The majority of accidents occur because of unlit narrow winding roads, aggressive driving and alcohol impairing the senses. There are a large number of festivals and around these times alcohol intake increases considerably with the resultant increase in danger for all road users.
Emergency numbers
The emergency numbers are 130 for medical assistance, 131 for fire assistance and 132 for the police. There is no organised roadside assistance and travellers are strongly advised to avoid hiring cars or motorbikes. Taxis and buses provide a reasonable service and are a much safer option.
Sun Exposure & Dehydration
Many travellers from Europe will enjoy the beautiful climate to excess and run the risk of severe sunburn and dehydration. This is particularly true for the first 24 to 48 hours after arrival (when the traveller may fall asleep under the glaring sun) and also for young children. Sensible covering, avoiding the midday sun and replacing lost fluids and salt are essential to maintain your health.
Swimming and Water Sports
Island life in the tropics tends to increase the amount of water exposure for many tourists. It is important to check out the facilities (both the professionalism of their personnel and the equipment) before undertaking any water sports. Talk to others who have already taken part or your holiday representative and listen to their experiences. This will help you make the right choices. Remember the tides and currents around the various islands can be very strong so always follow local advice and never swim alone. Watch children carefully.
Mosquitoes and Malaria
This island chain has only a few species of mosquitoes and the risk of malaria is thought to be negligible. WHO (2006) does not recommend prophylaxis for travellers but comments that there is a mild risk on Santiago mainly between August and November during the rainy season. Good repellents should be used by all travellers - especially at dusk and dawn.
Safety & Security
Unfortunately there is no idyllic destination throughout the world and petty crime occurs in Cape Verde as elsewhere. Take special care at festivals and in market places. Don't flaunt your personal wealth while out and about. Gangs of children have been involved in attacks against tourists so avoid any potential confrontation.
Contacts
U.S. Embassy: Rua Abilio m. Macedo 81, Praia Tel.: 238-61-56-16/17; Fax: 238-61-13-55; Web: usembassy.state.gov/praia
U.K. Embassy: Shell Cabo Verde, Sarl, Av Amilcar Cabral CP4, Sao Vincente
Tel.: 238-32-66-25/26/27; Fax: 238-32-66-29; E-mail: antonio.a.canuto@scv.sims.com
Vaccines
Travelling directly from Europe there are no essential vaccines for entering Cape Verde. It is a Yellow fever risk region but there have been no cases for many years. Other vaccines need to be considered against food and water borne diseases such as Hepatitis A & Typhoid.
Healthcare
This is a beautiful destination and direct flight will increase the numbers travelling. However all travellers to Cape Verde will need to be seen for a detailed medical consultation to ensure that they have appropriate advice and protection for their individual trip. Further information on health issues and all the latest world travel news reports are available at www.tmb.ie

Travel News Headlines WORLD NEWS

Date: Fri, 3 May 2019 12:24:17 +0200
By Anne-Sophie FAIVRE LE CADRE

Cha das Caldeiras, Cape Verde, May 3, 2019 (AFP) - Four years after the volcano erupted -- razing everything in its path in Cape Verde's Cha das Caldeiras valley -- the floor tiles of the small, rebuilt inn are warm to the touch.    "We constructed too quickly on lava that had not yet cooled down," says hotel owner Marisa Lopes, in her early 30s.   "For the first months, the floors in the rooms were so hot that you couldn't walk on them with bare feet."

Lopes is one of dozens of entrepreneurs locked in a perpetual tug of war with the Pico do Fogo volcano towering over Cha das Caldeiras, whose population numbers 500.    The name means Peak of Fire in Portuguese.   The volcano generates the bulk of the crater community's gross domestic product, attracting some 5,000 tourists every year who need hotel beds, food and tour guides -- about 30 make a living as guides in this remote part of West Africa.   But on the downside, the festering giant erupts once a generation -- six times in the last 200 years -- destroying everything in its path; crops, homes, roads.   On November 23, 2014, Lopes watched helplessly as the Pico -- almost 2,900 metres (9,500 feet) high -- erupted after a 19-year slumber.

Lava engulfed her brand new tourist hostel, eponymously named Casa Marisa.   Three months later, she built a new one, again in the flow zone of the crater.   "The volcano took a house from me, but it gave me another. Without it, there would be no tourism," she told AFP, undeterred.   Despite the constant danger and government efforts to dissuade them, the inhabitants of Cha das Caldeiras keep coming back.     After the last eruption, the military evacuated those in the path of the lava and the state provided food aid for six months afterwards.   But it was the people themselves who reconstructed roads and found the materials for rebuilding homes and hotels. Again.

- 'It's home' -
Cicilio Montrond, 42, was also there in 2014, looking on as a river of molten rock spewing from the Pico do Fogo burnt his fruit trees and buried everything he owned in a thick, grey coat.   The eruption killed no one, but left 1,500 people homeless.   After a few weeks in Sao Filipe, a nearby town to where the valley inhabitants were relocated, Montrond returned to Cha das Caldeiras with his wife.   Not a bird stirred in the air still polluted with ash, not a creature moved on the still warm lava ocean that now covered the valley floor.

For weeks, Montrond and his wife lived in a tent on the roof of their destroyed house with no water, no electricity and no food apart from a few canned goods.   "We lived in makeshift shelters, it was precarious, dangerous. But we were home."   For Montrond, it is unimaginable to live anywhere else than the fertile, lava-fed valley that, between outbursts, boasts an abundance of vines, fig trees and cassava.   "It is the volcano that allows us to live," said Montrond, tourist guide-turned-hotelkeeper and restaurateur.   The Pico's eruptions are rarely deadly in terms of human life.   But what about the next time?   "The volcano is my life," Montrond shrugged, as he gazed upon the house he built with his own hands.    "I was born here, I will die here."

- Rocks were falling -
The volcano gives. The volcano takes.   First it destroys the vines, then it provides fruitful soil for the planting of new ones. These produce wines -- some of it for the export market.   Far from fearing or despising the peak's constant threatening presence, the inhabitants appear to embrace it and have made it part of their identity.   They evoke past eruptions with a smile, sometimes even a touch of nostalgia.   Margarita Lopes Dos Santos, 99, has been forced out of her home by the three last eruptions of the Pico do Fogo.

The first was in June 1951, shortly after she gave birth to her first child.   "I remember the first time like it was yesterday," she said, through a beaming, toothless smile.   "It was a lot more violent. Rocks were falling from the sky. There were tornadoes of ash and of smoke," she recounted, while husking beans.   Outside her house, Lopes Dos Santos has planted flowers -- flashes of red begonias that provide the only colour in the grey and black landscape.   "The resilience of the people of Cha is extraordinary," said Jorge Nogueira, president of the municipal council of Sao Filipe, capital of the island of Fogo, Cape Verde.   "As soon as they could, they came back -- to poor living conditions, but no matter: the only thing that counted for them was to be home."
Date: Tue 3 Oct 2017
Source: Outbreak News Today [edited]

In a follow-up on the locally transmitted malaria increases reported on Cabo Verde [Cape Verde] this year [2017], 254 indigenous cases were reported through [24 Sep 2017].

Most cases (75 percent) have not sought treatment until 48-96 hours after illness onset. Despite this, case fatality rates have remained low (0.4 percent), with one death reported in an indigenous case to date. 7 severe malaria cases and 2 cases of malaria in pregnancy have been reported. There are also anecdotal reports of recrudescence.

To date, the disease has been localized to the city of Praia on Santiago Island without any further spread.

A handful of cases have also been detected on neighbouring islands (Sao Vicente, Sal, and Porto Novo); however, their infections were likely all acquired during travel to Praia or overseas, with no evidence of onward local transmission.

The malaria epidemic in Cabo Verde has begun to show early signs of improvement but the situation remains tenuous, with heavy rainfall continuing between August and October, health officials said.
===================
[The last news from ProMED from 4 Sep 2017 (archive no. http://promedmail.org/post/20170904.5293108) reported 116 cases of malaria in Praia. Thus, over the last month 136 new cases have been diagnosed. It is good news that the outbreak has not spread, showing that the control measures are working. Due to the present outbreak, the CDC is now recommending malaria chemoprophylaxis for travellers visiting the city of Praia on Santiago Island (<https://www.cdc.gov/malaria/new_info/2017/Cape_Verde_2017.html>). - ProMED Mod.EP]

[Maps of Cape Verde can be seen at
<http://healthmap.org/promed/p/6553>. - ProMED Sr.Tech.Ed.MJ]

08 Sep 2017


Following an increase in malaria cases, additional malaria prevention advice for some UK travellers to the capital city of Praia in Cape Verde is recommended.

Since June 2017, the Ministry of Heath for Cape Verde has reported an increase in locally acquired malaria cases in the capital city of Praia on the island of Santiago. As of 5 September 2017, a total of 164 locally acquired falciparum malaria cases have been reported in the local population [2][3]. Currently, there are no reports of malaria in tourists who have visited Cape Verde in 2017.  

Those travelling to Praia who are at increased risk of malaria e.g. long term travellers, or those at risk of severe complications from malaria: pregnant women, infants and young children, the elderly and travellers who do not have a functioning spleen, should consider taking anti-malarials and seek advice about which antimalarial is suitable for them from their travel health advisor.

Date: Sun 3 Sep 2017 08:58:00 WEST
Source: The Portugal News (TPN) Online [edited]
<http://theportugalnews.com/news/portugal-health-department-issues-malaria-warning-for-cape-verde-capital/43059

The Portuguese health department has advised pregnant women not to travel to the Cape Verde island of Santiago [where the capital, Praia, is located], and if travellers cannot put their journey off, they should take anti-malaria drugs.

The health department warning comes after the World Health Organisation (WHO) said in August [2017] that there was an outbreak of malaria in Praia, the archipelago's capital. Travellers are also advised that adults and children should use insect repellent throughout the day and reapply it as often as necessary. If travellers also use sun cream, they should apply the insect repellent on top of the sun cream, not under it, the warning said. So far, there have been 116 cases of malaria in Praia, numbers never before seen in the city, where the highest number was 95 cases in the whole of 2001.
============
[The Cape Verde authorities reported 45 cases of malaria up to 30 Jul 2017 (see archive no. http://promedmail.org/post/20170808.5236283).

The outbreak continues and it is important to introduce identification and spraying of breeding sites. Also using a single dose of primaquine after treatment, which kills gametocytes, to ensure that the cases cannot transmit the infection, as recommended by the WHO (http://www.who.int/malaria/publications/atoz/who_pq_policy_recommendation/en/). - ProMED Mod.EP

Maps of Cape Verde can be seen at
<http://www.nationsonline.org/maps/Cape-Verde-Map.jpg>
and <http://healthmap.org/promed/p/15>. - ProMED Sr.Tech.Ed.MJ]
Date: Tue 8 Aug 2017
Source: Outbreak News Today [edited]

During the past 5 years, an average of one locally acquired case annually of malaria has been reported in Cabo Verde, or Cape Verde. In 2017, between [30 Jun and 30 Jul 2017], 45 indigenous cases and one imported case were reported, all in the capital city of Praia, Santiago Island.

More than half the cases are reported in adult males. The causative agent has been confirmed as _Plasmodium falciparum_ using both microscopy and rapid diagnostic tests (RDTs).

Preliminary investigations have attributed the recent increase in local transmission to several factors, including suboptimal vector control strategies, possibly coupled with inappropriate use (incorrect dilution) of a new insecticide introduced into the country in November 2016; the unauthorized installation of a rice paddy field in the affected area; and an increase in mosquito breeding sites within construction zones of a shopping centre and houses. The local authorities are in the process of removing the paddy field as further investigations are ongoing.

Cape Verde is a low malaria transmission country, eligible for elimination of the disease. With limited underlying immunity, all people (irrespective of their age group) are at risk of infection and of developing severe disease.
======================
[In 2015, Cabo Verde reported 7 _P. falciparum_ infected cases <http://www.who.int/malaria/publications/country-profiles/profile_cpv_en.pdf>. Cabo Verde is close to the African continent, and visitors may be asymptomatic gametocyte carriers and can start a local transmission if the vector control is not optimal, as suggested here. - ProMED Mod.EP]

[A HealthMap/ProMED-mail map can be accessed at:
More ...

Nicaragua

Nicaragua - US Consular Information Sheet
December 22, 2008
COUNTRY DESCRIPTION:
Nicaragua’s fragile democracy remains under stress.
Following municipal elections in November 2008, in which opposition leaders have charged massive fr
ud took place, political tensions have increased significantly.
The economy remains among the poorest in the hemisphere.
Crime has increased significantly in recent months.

The national language is Spanish, although many residents of the Caribbean coastal areas also speak English and indigenous languages.
The climate is hot and humid, with the “summer” dry season running mid-November through mid-May and the “winter” rainy season running from mid-May through mid-November.
Terrain ranges from the hilly and volcanic to coastal beaches and tropical jungles.
Geological faults run throughout the country, along which active volcanoes are situated.
Earthquakes are common, but the last major earthquake, which destroyed the city of Managua, occurred in 1972.

Nicaragua lacks tourist infrastructure.
Except in the cities and major thoroughfares, most roads are unpaved.
Public transportation is unsafe and there are no sidewalks.
Most essential services are sporadic.
Most hospitals are substandard.
Hotels in Managua are adequate, but primarily are oriented to serve a business or government clientele.
Potential tourists may want to obtain information from the National Tourism Institute (INTUR), the governmental agency responsible for developing, regulating, and promoting tourism in Nicaragua at http://www.intur.gob.ni/.
Read the Department of State Background Notes on Nicaragua for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid U.S. passport is required to enter Nicaragua.
Although there is a bilateral agreement that waives the six-month validity passport requirement, U.S. citizens are urged to ensure that their passports are valid for the length of their projected stay in the country before traveling.
U.S. citizens must have an onward or return ticket and evidence of sufficient funds to support themselves during their stay.
A visa is not required for U.S. citizens; however, a tourist card must be purchased for $5 upon arrival.
Tourist cards are typically issued for 30 to 90 days.

A valid entry stamp is required to exit Nicaragua.
Pay attention to the authorized stay that will be written into your entry stamp by the immigration inspector.
Visitors remaining more than the authorized time must obtain an extension from Nicaraguan Immigration at http://www.migracion.gob.ni/.
Failure to do so will prevent departure until a fine is paid.

There is also a $32 departure tax.
Many airlines include this tax in the price of the ticket.
If the tax is not included in the ticket, payment can be made at the airline counter upon departure.

Per Nicaraguan law, individuals should exit Nicaragua with the same passport with which they entered the country.
Dual national minors who entered Nicaragua on their Nicaraguan passports will be subject to departure requirements specific to Nicaraguan children under the age of 18, even though they may also be citizens of other countries.
More information on these requirements can be found on the U.S. Embassy web site at http://nicaragua.usembassy.gov/dual_nationality.html.

According to Nicaragua’s Laws for Foreigners, foreigners must be in possession of a valid identity document at all times while in Nicaragua and may be required to show it to Nicaraguan authorities upon request.
Acceptable identity documents are: (1) a permanent residency card, (2) temporary residency card, or (3) valid passport or travel document accompanied by an entry stamp.

In June 2006, Nicaragua entered a “Central America-4 (CA-4) Border Control Agreement” with Guatemala, Honduras, and El Salvador.
Under the terms of the agreement, citizens of the four countries may travel freely across land borders from one of the countries to any of the others without completing entry and exit formalities at Immigration checkpoints.
U.S. citizens and other eligible foreign nationals, who legally enter any of the four countries, may similarly travel among the four without obtaining additional visas or tourist entry permits for the other three countries.
Immigration officials at the first port of entry determine the length of stay, up to a maximum period of 90 days.
Foreign tourists who wish to remain in the four-country region beyond the period initially granted for their visit are required to request a one-time extension of stay from local Immigration authorities in the country where the traveler is physically present, or travel outside the CA-4 countries and reapply for admission to the region.
Foreigners “expelled” from any of the four countries are excluded from the entire “CA-4” region.
In isolated cases, the lack of clarity in the implementing details of the CA-4 Border Control Agreement has caused temporary inconvenience to some travelers and has resulted in others being fined more than one hundred dollars or detained in custody for 72 hours or longer.

For the most current information about visas to visit Nicaragua, visit the Embassy of Nicaragua web site at http://www.cancilleria.gob.ni.

Information about dual nationality or the prevention of international child abduction can be found on our website.
For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
Municipal elections took place across Nicaragua on November 9, 2008.
Violent demonstrations followed as opposition groups questioned the authenticity of the results.
Activities observed during protests included but were not limited to tear gas, rubber bullets, setting off fireworks, rock-throwing, tire burning, road blocks, bus and vehicle burning, and physical violence between law enforcement and protestors and between political rivals.
Political demonstrations and strikes continue to occur sporadically, are usually limited to urban areas, and occasionally become violent.
U.S. citizens are advised to monitor local media reports, to avoid crowds and blockades during such occurrences and to exercise caution when in the vicinity of any large gathering.

U.S. citizens are cautioned that strong currents and undertows off sections of Nicaragua's Pacific coast have resulted in a number of incidents of drowning.
Powerful waves have also resulted in broken bones, and injuries caused by sting rays are not uncommon in popular resort bathing areas.
Warning signs are not posted, and lifeguards and rescue equipment are not readily available.
U.S. citizens contemplating beach activities in Nicaragua's Pacific waters should exercise appropriate caution.

Hiking in volcanic or other remote areas can be dangerous and travelers should take appropriate precautions.
Hikers should have appropriate dress, footwear, and sufficient consumables for any trek undertaken.
Individuals who travel to remote tourist or other areas for hiking activities are encouraged to hire a local guide familiar with the terrain and area.
In particular, there have been instances of hikers perishing or losing their way on the volcanoes at Ometepe Island.
While they may look like easy climbs, the terrain is treacherous and heavily overgrown.

Although extensive de-mining operations have been conducted to clear rural areas of northern Nicaragua of landmines left from the civil war in the 1980s, visitors venturing off the main roads in these areas are cautioned that the possibility of encountering landmines still exists.
Domestic travel within Nicaragua by land and air, particularly to the Atlantic side can be dangerous.
Domestic airlines use small airstrips with minimal safety equipment and little boarding security.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME:
Violent crime in Managua is increasing and petty street crimes are very common.
Gang activity also is increasing, though not at levels found in neighboring Central American countries.
Pick-pocketing and occasional armed robberies occur on crowded buses, at bus stops and in open markets like the Oriental and Huembes Markets.
Gang violence, drive-by shootings, robbery, assault and stabbings are most frequently encountered in poorer neighborhoods, including the Ticabus area, a major arrival and departure point for tourist buses.
However, in recent months it spread to more upscale neighborhoods and near major hotels, including the Zona Hippos.
In 2008, a U.S. citizen was critically injured in a gang-motivated drive-by shooting that occurred in the San Judas area.
Another U.S. citizen was kidnapped and left for dead in the Villa Fontana area of Managua.

U.S. citizens are increasingly targeted shortly after arriving in the country by criminals posing as Nicaraguan police officers who pull their vehicles – including those operated by reputable hotels -- over for inspection.
In each case, the incidents happened after dark and involved gun-wielding assailants who robbed passengers of all valuables and drove them to remote locations where they were left to fend for themselves.
Some assailants employed threats of physical violence.
While the traditional scene of these attacks has been the Tipitapa-Masaya Highway, this activity has recently spread to the Managua-Leon Highway.
The U.S. Embassy warns U.S. citizens to exercise extreme caution when driving at night from Managua’s International Airport and to avoid traveling the Tipitapa-Masaya Highway at night.
U.S. citizens should exercise caution when approached by strangers offering assistance.
Several U.S. citizens traveling by bus from San Juan del Sur to Managua have reported being victimized by fellow women travelers who offered to assist them in locating and/or sharing a taxi upon arrival in Managua.
In all cases, upon entering the taxi, the U.S. citizens have been held at knife-point, robbed of their valuables, and driven around to ATM machines to withdraw funds from their accounts.

Violent criminal activities and petty crime are also increasing in the tourist destination of San Juan del Sur.
In 2008, a U.S. citizen family was violently assaulted and kidnapped by several armed men.
Other American citizens have been the victims of armed robberies by assailants wielding machetes, knives, and/or guns along the beaches in and around San Juan del Sur.
U.S. citizens should exercise particular caution when visiting the following beaches: Maderas, Marsella, Yankee, Coco, and Remanso.

Police coverage is extremely sparse outside major urban areas, particularly in Nicaragua’s Atlantic coast autonomous regions.
Lack of adequate police coverage has resulted in these areas being used by drug traffickers and other criminal elements.
Street crime and petty theft are a common problem in Puerto Cabezas, Bluefields, and the Corn Islands along the Atlantic coast.
For security reasons, the Embassy has limited travel by its staff to the North and South Atlantic Autonomous Regions (RAAN and RAAS), including the Corn Islands.
Given the area’s geographical isolation, the Embassy’s ability to provide emergency services to U.S. citizens who choose to travel in the Caribbean costal area is constrained.
Police presence on Little Corn Island is made up of volunteers with little to no formal training, and is minimal on Corn Island and other remote areas.
In late 2007, a U.S. citizen was assaulted and violently raped while on vacation in Little Corn Island.
U.S. citizens have previously been the victims of sexual assault on this island and other beaches in the country.
The Embassy recommends traveling in groups when in isolated areas.
Single travelers should exercise special caution while traveling in the Corn Islands and other remote areas of the country.
Throughout the country, U.S. travelers should utilize hotels and guest houses that have strong security elements in place, including but not limited to rooms equipped with safes for securing valuables and travel documents and adequate access control precautions.

Visitors should avoid walking and instead use officially registered taxicabs.
Radio-dispatched taxis are recommended and can be found at the International Airport and at the larger hotels.
Robbery, kidnapping, and assault on passengers in taxis in Managua are increasing in frequency and violence, with passengers subjected to beating, sexual assault, stabbings, and even murder.
Several U.S. citizens reported brutal attacks in taxis during 2008, particularly around the International Airport area.

Before taking a taxi, make sure that it has a red license plate and that the number is legible.
Select taxis carefully and note the driver's name and license number.
Instruct the driver not to pick up other passengers, agree on the fare before departing, and have small bills available for payment, as taxi drivers often do not make change.
Also, check that the taxi is properly labeled with the cooperativa (company) name and logo.
Purse and jewelry snatchings sometimes occur at stoplights.
While riding in a vehicle, windows should be closed, car doors locked, and valuables placed out of sight.

Do not resist a robbery attempt.
Many criminals have weapons, and most injuries and deaths have resulted when victims have resisted.
Do not hitchhike or go home with strangers, particularly from nightspots.
Travel in groups of two or more persons whenever possible.
Use the same common sense while traveling in Nicaragua that you would in any high-crime area of a major U.S. city.
Do not wear excessive jewelry in downtown or rural areas.
Do not carry large sums of money, ATM, or credit cards that are not needed, or other valuables.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members, or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime are solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care is very limited, particularly outside Managua.
Basic medical services are available in Managua and in many of the smaller towns and villages.
However, treatment for many serious medical problems is either unavailable or available only in Managua.
Emergency ambulance services, as well as certain types of medical equipment, medications and treatments, are not available in Nicaragua.
Physicians and hospital personnel frequently do not speak English, and medical reports are written in Spanish.
Patients must have good understand and an ability to speak Spanish in order to navigate the local medical resources.

In an emergency, individuals are taken to the nearest hospital that will accept a patient.
This is usually a public hospital unless the individual or someone acting on their behalf indicates that they can pay for a private hospital.
Payment for medical services is typically done on a cash basis, although the few private hospitals will accept major credit cards for payment.
U.S. health insurance plans are not accepted in Nicaragua.

Dengue fever is endemic in Nicaragua.
Currently, no vaccine or specific medication is available to prevent or treat Dengue fever.
Malaria is endemic in the Atlantic coast region and anti-malarial medication should be taken before and after travel to this region.
Travelers are advised to take a prophylactic regimen best suited to their health profile.
No prophylaxis anti-malarial medication is required for Managua and the western, Pacific coast region.
For both Dengue fever and malaria, the best prevention is the use of DEET insect repellant, as well as the wearing of protective clothing and bed-nets to prevent mosquito bites.

Tap water is not considered safe in Nicaragua.
All persons should drink only bottled water.
Individuals traveling to Nicaragua should ensure that all their routine vaccinations are up to date.
Vaccination against Hepatitis A, Hepatitis B, rabies and typhoid is strongly recommended.
A yellow fever vaccination is not required to enter Nicaragua unless the traveler has recently visited a country where yellow fever is endemic.
Travelers taking prescription medications should bring an adequate supply with them when coming to Nicaragua.
Many newer combination medications are not available in local pharmacies.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Nicaragua.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
Driving in Nicaragua poses many difficulties and risks, including mandatory arrest for drivers involved in accidents that result in death or serious injury until police are able to determine who is at fault.

Driving is on the right side of the road in Nicaragua.
Motorists driving to Nicaragua should use the principal highways and official border crossings at Guasaule, El Espino, and Las Manos between Nicaragua and Honduras and Penas Blancas between Nicaragua and Costa Rica.
Although some of the principal highways connecting the major cities are in generally good condition, drivers should be aware that seasonal, torrential rains take a heavy toll on road beds.
With few exceptions, secondary roads are in poor repair, potholed, poorly lit, frequently narrow, and lack shoulders.
Road travel after dark is especially hazardous in all areas of the country.
Motorists are encouraged to prepare accordingly and may want to carry a cellular phone in case of an emergency.

Some of the major highways and roads are undergoing major repair, repaving, and upgrading.
Be on the lookout for detours and slow traffic on these roads.
In general, road signs are poor to non-existent.
Bicycles, oxcarts, dogs, horses, and vehicles without lights are at times encountered even on main thoroughfares in Nicaragua.
Motorcycles, often carrying passengers, dart in and out of traffic with little or no warning.
Many vehicles are in poor condition, travel very slowly, and break down without warning.
Drivers should be especially careful on curves and hills, as many drivers will pass on blind spots.
Speed limits vary depending on the type of road, but because the government lacks the resources, traffic rules are rarely enforced.
Due to the age and disrepair of many vehicles, many drivers will not signal their intentions using turn indicators.
Rather, it is common for a vehicle operator to stick his hand out the window to signal a turn.
If you do drive in Nicaragua, you need to exercise the utmost caution, drive defensively, and make sure you have insurance.

Nicaraguan law requires that a driver be taken into custody for driving under the influence or being involved in an accident that caused serious injury or death, even if the driver is insured and appears not to have been at fault.
The minimum detention period is 48 hours; however, detentions frequently last until a judicial decision is reached (often weeks or months), or until a waiver is signed by the injured party (usually as the result of a cash settlement).
Visitors to Nicaragua might want to consider hiring a professional driver during their stay.
Licensed drivers who are familiar with local roads can be hired through local car rental agencies.
In case of accident, only the driver will be taken into custody.

The Embassy has received an increasing number of complaints from U.S. citizens who have been stopped by transit police authorities demanding bribes in order to avoid paying fines.
Motorists in rental cars and those whose cars have foreign license plates are more likely to be stopped by transit police.
Transit police have seized driver licenses and car registration documents from motorists who refuse to or are unable to pay.
Subsequently, these drivers have reported difficulties in recovering the seized documents.
U.S. citizens are urged to ensure that their vehicles comply fully with Nicaraguan transit regulations, including being in possession of an emergency triangle and fire extinguisher, and that the vehicle is properly registered.
If transit police authorities demand an on-the-spot payment, drivers should ask for the officer's name and badge number, as well as a receipt, and inform the Embassy of when/where the event took place.
(Reports should be sent via email to ACS.Managua@state.gov.)
Rental car agencies should also be advised if their vehicles have been deemed negligent in meeting Nicaraguan transit regulations.

As noted in the “Crime” section above, several groups of U.S. citizens driving from Managua’s International Airport at night have been robbed and kidnapped by men dressed as Nicaraguan police officers.
While the majority of these crimes have occurred on the Tipitapa-Masaya Highway, recent reports indicate similar activity along the Managua-Leon Highway.
The U.S. Embassy warns U.S. citizens to exercise extreme caution when driving at night from Managua’s International Airport and to avoid traveling the Tipitapa-Masaya Highway at night.

Avoid taking public transportation buses.
They are overcrowded, unsafe, and often are used by pickpockets.
Because of the conditions discussed above, traffic accidents often result in serious injury or death.
This is most often true when heavy vehicles, such as buses or trucks, are involved.
Traditionally, vehicles involved in accidents in Nicaragua are not moved (even to clear traffic), until authorized by a police officer.
Drivers who violate this norm may be held legally liable for the accident.

Regulations governing transit are administered by the National Police.
For specific information concerning Nicaraguan driver’s permits, vehicle inspection, road tax, and mandatory insurance, you may wish to refer to the National Police web site at http://www.policia.gob.ni.
You may also contact the Embassy of Nicaragua or a Consulate for further information.
Please refer to our Road Safety page for more information.
Visit the website of the country’s national tourist office and national authority responsible for road safety at http://www.mti.gob.ni
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Nicaragua’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Nicaragua’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa
SPECIAL CIRCUMSTANCES:
Purchasing Property: U.S. citizens should be aware of the risks of purchasing real estate in Nicaragua and should exercise caution before committing to invest in property.
The U.S. Embassy has seen an increase in property disputes over the last several years.
The 1979-90 Sandinista government expropriated approximately 28,000 real properties, many of which are still involved in disputes or claims.
Land title remains unclear in many cases.
Although the government has resolved several thousand claims by U.S. citizens for compensation or return of properties, there remain hundreds of unresolved claims registered with the Embassy.
Potential investors should engage competent local legal representation and investigate their purchases thoroughly in order to reduce the possibility of property disputes.

The Nicaraguan judicial system offers little relief when the purchase of a property winds up in court.
The Embassy is aware of numerous cases in which buyers purchase property supported by what appear to be legal titles only to see themselves subsequently embroiled in legal battles when the titles are contested by an affected or otherwise interested third party.
Once a property dispute enters the judicial arena, the outcome may be subject to corruption, political pressure, and influence peddling.
Many coastal properties have been tied up in courts recently, leaving the ”buyer” unable to proceed with the intended development pending lengthy and uncertain litigation.
In other cases squatters have simply invaded the land while the police or judicial authorities are unable (or unwilling) to remove the trespassers.
Again, the Embassy advises that those interested in purchasing Nicaraguan property exercise extreme caution.
Please note that Nicaraguan law currently prohibits any individual from buying beach-front property (including islands) unless the original land title was registered before the 1917 Nicaraguan Agrarian Reform Law.
Coastal properties with titles pre-dating 1917 are not risk-free, however.
In 1987 the Nicaraguan Constitution established the property rights of indigenous communities over territory they have traditionally occupied.
The Embassy advises extreme caution when considering the purchase of coastal property in Nicaragua.

Currency and Credit Cards: U.S. dollars are widely accepted throughout the country, and major credit cards are also typically accepted in hotels, restaurants, stores, and other businesses in urban and tourist areas.
Visitors who need to change dollars are encouraged to do this at their hotel since this is typically the safest place.
ATM machines are available at banks in addition to some shopping centers and gas stations in urban and tourist areas.
However, individuals should exercise caution when using an automaticteller machine since they are typically in or near uncontrolled areas and criminal elements can easily see them withdrawing cash.
Traveler’s checks are accepted at a few major hotels and may also be exchanged for local currency at authorized exchange facilities ("casas de cambio").
Visitors will also find enterprising individuals - ”Cambistas” - waving wads of cash in the street.
Changing money in this fashion can be dangerous and is not recommended.

The U.S. Embassy has noted an increase in credit card fraud.
Although local police authorities have made several arrests in conjunction with credit card scam operations, the danger for abuse continues.
Illegal use can include “skimming” or making a copy of the magnetic strip on the credit card or simply copying the number for later use.
U.S. citizens who do continue to use credit cards in Nicaragua are advised to check statements frequently to monitor for abuse and/or to ask banks to email them when transactions exceed a certain number or size.

Disaster Preparedness: Nicaragua is prone to a wide variety of natural disasters, including earthquakes, hurricanes, and volcanic eruptions.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov
Boundary Disputes:
On the Atlantic side, nautical travelers should be aware that there is an ongoing boundary dispute with Colombia over the San Andres Island archipelago and the surrounding waters, specifically the area east of the 82nd and up to the 79th meridian.
Furthermore, the Government of Nicaragua has also begun to exercise sovereignty over territorial waters that were formerly controlled by Honduras but recently awarded to Nicaragua by the International Court of Justice.
Since October 2007, the Nicaraguan Navy has impounded about a dozen vessels, including two U.S.-owned vessels, for allegedly fishing without a Nicaraguan permit in theses zones.
Maritime boundary disputes also exist on the Pacific side.
In late-2007, the governments of Nicaragua, Honduras, and El Salvador reached an accord regarding shared fishing rights in the Gulf of Fonseca; however, questions remain regarding boundary demarcations in the Gulf of Fonseca.
Commercial fishing vessels should always ensure that they are properly licensed as problems have been reported in the areas off Cabo Gracias a Dios.
As a result of these disputes, in June 2008, the U.S. Coast Guard published a Special Warning on Nicaragua in the U.S. Notice to Mariners, which can be found at http://www.navcen.uscg.gov/Lnm/d1/lnm01242008.pdf (p. 6).

Travelers should also be aware that narcotics traffickers often use both the Caribbean and the Pacific coastal waters.
Customs Regulations: Before excavating archaeological materials, or agreeing to buy artifacts of historical value, all persons are strongly urged to consult with the National Patrimony Directorate of the Nicaraguan Institute of Culture.
Nicaraguan law and a bilateral accord limit the acquisition, importation into the United States and commercialization of said goods.
Severe criminal penalties may apply.
U.S. citizens planning to stay in Nicaragua for an extended period of time with the intention of bringing vehicles or household goods into the country should consult Nicaraguan customs officials prior to shipment.
Please see our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Nicaraguan laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Nicaragua are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans residing or traveling in Nicaragua are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Nicaragua.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at Kilometer 5 1/2 (5.5) Carretera Sur, Managua; telephone (505) 252-7100 or 252-7888; after hours telephone (505) 252-7634; Consular Section fax (505) 252-7304; Email: consularmanagua@state.gov or ACS.Managua@state.gov; web page: http://nicaragua.usembassy.gov/
*

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This replaces the Country Specific Information for Nicaragua dated June 3, 2008, to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Medical Facilities and Health Information, Traffic Safety and Road Conditions, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Thu, 25 Oct 2018 22:17:34 +0200

Montreal, Oct 25, 2018 (AFP) - Canadian tour operator Transat has cancelled all flights to Nicaragua this coming winter over the crisis that has left more than 320 dead in the Central American country, the company said Thursday.   This decision was made "because of the ongoing civil unrest and (the) weak demand that arises," Air Transat spokeswoman Debbie Cabana told AFP.   Air Transat would have offered three direct flights weekly form Toronto or Montreal to Managua from December 20 until the end of March.   "Customers who have reservations at the destination can change their booking or get a full refund," Cabana said.

Protests that began in April against a pension reform in Nicaragua grew into a movement demanding the departure of President Daniel Ortega and his wife, Vice President Rosario Murillo, who are accused of authoritarianism.    The protests have been severely repressed by police and paramilitaries, and the government proclaimed the situation normalized.   Canada continues to advise its nationals "to avoid any non-essential travel to Nicaragua."
Date: Fri, 7 Sep 2018 19:57:24 +0200

Managua, Sept 7, 2018 (AFP) - Many shops, banks and gas stations were closed Friday in a 24-hour strike in Nicaragua called by the opposition in protest at "political prisoners" and the rule of President Daniel Ortega's government.   In Mercado Oriental, one of the capital Managua's main trade districts, most of the 20,000 shops and businesses were shut, while few people were out on the streets.   "It's an excellent strike, this is how we are supporting those who were taken, who are being tortured, who have no business being in jail just for protesting," shopkeeper Geidy Areas, 38, told AFP.   The normally busy road south from Managua to Masaya, where many shops operate, appeared more desolate than normal.   Friday's strike, the first since July, was called by the opposition Civil Alliance for Justice and Democracy.   More than 300 Nicaraguans have been charged with crimes for taking part in protests, including 85 who are accused of terrorism.   The Alliance is demanding dialogue with Ortega's government after months of turmoil that left more than 300 people dead, according to rights groups.

In Managua, most banks, gas stations, shopping malls and book shops were closed but there were more buses and public transport vehicles running than during previous strikes in June and July.   In an important economic zone north of Managua, many hardware stores, shops and cafes remained open.   "People have to keep struggling because they've got bank debts and need to feed their children," food vendor Johana Blandon, who works in a busy free trade zone to the east of Managua, told AFP.   Government offices were operating as normal.   Nicaragua's descent into chaos was triggered on April 18 when relatively small protests against now-scrapped social security reforms were met with a government crackdown, backed by armed paramilitaries.

Catholic church-brokered peace talks broke down in June after Ortega rejected a key opposition demand to step down and bring forward presidential elections.   Last week, Ortega expelled the United Nations human rights mission after it published a report criticizing the "climate of fear" in the Central American country, one of the poorest in the region.   The UN denounced a wide range of serious violations, including disproportionate use of force by police, which in some cases resulted in extrajudicial killings, enforced disappearances, arbitrary detention and torture.   Ortega, a former guerrilla leader who has been in power for the last 11 years, denied the claims and described the UN as "an instrument of the policies of terror, lies and infamy."
Date: Thu, 6 Sep 2018 18:06:28 +0200

Managua, Sept 6, 2018 (AFP) - Nicaragua's opposition called a 24-hour strike on Thursday, due to start the next day, in protest against President Daniel Ortega and to demand the release of "political prisoners."   The strike is due to begin at midnight on Thursday, the Civil Alliance for Justice and Democracy, made up of students, businesses and civil service groups, said in a statement.

The opposition is demanding dialogue with Ortega's government after months of turmoil that left more than 300 people dead, according to rights groups.   It called on supporters to "join this national effort from your homes."   "Nicaragua needs an urgent and peaceful solution through dialogue," said the opposition.   "We need to live in security, without kidnappings, without political prisoners, without persecution and without the stigmatization of those who think differently."   Last week, Ortega expelled the United Nations human rights mission after it published a report criticizing the "climate of fear" in the Central American country, one of the poorest in the region.   The UN denounced a wide range of serious violations, including disproportionate use of force by police, which in some cases resulted in extrajudicial killings, enforced disappearances, arbitrary detention and torture.

Ortega, a former guerrilla leader who has been in power for the last 11 years, refuted the claims and described the UN as "an instrument of the policies of terror, lies and infamy."   In addition to the dead and 2,000 people injured in clashes between anti-government protesters and regime forces back by paramilitaries, more than 300 Nicaraguans have been charged with crimes for taking part in the protests, of which 85 are accused of terrorism.   Two Alliance leaders, Medardo Mairena and Edwin Carcache, are amongst those to have been charged.   The opposition says "dialogue is the only path" to overcome the current political crisis.

Nicaragua's descent into chaos was triggered on April 18 when relatively small protests against now-scrapped social security reforms were met with a government crackdown, backed by armed paramilitaries.   Catholic church-brokered peace talks broke down in June after Ortega rejected a key opposition demand to step down and bring forward presidential elections.   Opposition supporters claimed the last strike in mid-July was 90 percent respected, although government media said businesses had remained open in several trade zones.
Date: Fri, 27 Jul 2018 23:17:00 +0200

Managua, July 27, 2018 (AFP) - More than a dozen doctors, nurses and technical staff in a public hospital in Nicaragua have been sacked because they treated wounded anti-government protesters and were seen backing their cause, medical sources said Friday.

Those fired "without any legal justification" worked at the Oscar Danilo Rosales Hospital in the northwestern city of Leon, surgery and endoscopy department chief Javier Pastora told AFP.   The hospital is run by the health ministry.   The allegation bolstered reports that those perceived to back protest claims calling for the ouster of President Daniel Ortega were being persecuted by his government and sympathizers.

Nicaragua has seen more than three months of unrest as those protests were brutally countered by police and armed pro-government paramilitaries.   More than 300 people have been killed and thousands have fled to neighboring Costa Rica for safety, according to rights groups.   Pastora, who has worked in Nicaragua's public health system for 33 years, said the staff members were fired because they were deemed to support the protesters by treating them.   "They said we were people showing solidarity and support for the people's fight," he said.   Pastora said at least nine medical specialists were among those fired.

- Dismissed in surgery -
"I was in surgery when they came from human resources to tell me I could no longer stay because I was fired," said one of the dismissed medics, cancer surgeon Aaron Delgado.   A dismissed pediatrician, Edgar Zuniga, called the axings "arbitrary."   They were fired "for thinking differently, for saying Nicaragua needs democracy, freedom, that the repression and killings must stop and there has to be dialogue," he said.

The staff and residents in Leon held a protest in front of the hospital demanding the sackings be reversed.   Leon used to be a bastion of support for the Sandinista movement Ortega leads, but as the unrest took hold, there too paramilitaries and anti-riot police have stormed the city several times to crush protests.   Rights groups say more than 2,000 people have been hurt across the country since the clashes erupted mid-April.   Many of them sought medical attention for their wounds from volunteers outside the state health system, which was said to have received orders to turn them away.
Date: Wed, 11 Jul 2018 22:06:35 +0200

Washington, July 11, 2018 (AFP) - The known death toll from a four-month crackdown on anti-government protests in Nicaragua has risen to 264, the Inter-American Commission on Human Rights said Wednesday.

"As recorded by the IACHR since the start of the repression against social protests, to date, 264 people have lost their lives and more than 1,800 have been injured," the commission's chief Paulo Abrao told reporters.   He was speaking at a meeting of the Organization of American States -- of which the IACHR is part -- about the situation in the violence-wracked Central American country, where protesters are seeking the ouster of President Daniel Ortega.   The rights body had previously given a toll of 212 dead, although local estimates recently put the toll at about 250.

The influential Roman Catholic church has been mediating between Ortega's government and the opposition to end the unrest, but the process has become bogged down amid continuing violence.   In the latest outburst, at least 14 people died in a weekend raid by a pro-government mob near the opposition bastion of Masaya, in the country's southwest.   The opposition is planning to crank up the pressure on Ortega starting on Thursday with an anti-government protest and general strike.

A former leftist guerrilla, Ortega will next week commemorate the 1979 popular uprising that brought him to power with an annual July 19 march due to start in Masaya.   Once the hero of left-wing revolutionaries, Ortega is now widely viewed as an oppressor.   Having lost a presidential vote in 1990, he was re-elected in 2007 but opponents have accused him -- together with his wife Vice President Rosario Murillo -- of establishing a dictatorship characterized by nepotism and brutal repression.
More ...

Finland

Finland - US Consular Information Sheet
January 13, 2009
COUNTRY DESCRIPTION:
Finland is a highly developed democracy with a modern economy.
It is a member of the European Union.
Tourist facilities are widely available.
Read
the Department of State Background Notes on Finland for additional information.
ENTRY REQUIREMENTS:
Finland is a party to the Schengen agreement.
As such, U.S. citizens may enter Finland for up to 90 days for tourist or business purposes without a visa.
The passport should be valid for at least three months beyond the period of stay.
For further details about travel into and within Schengen countries, please see our Schengen fact sheet.

Travelers can contact the Embassy of Finland at 3301 Massachusetts Avenue, N.W., Washington, DC 20008, tel: (202) 298-5800, or the Finnish Consulates General in Los Angeles or New York.
Additional information is available via the Internet at http://www.finland.org.
The U.S. Embassy in Helsinki is not able to assist private U.S. citizens in obtaining any necessary visas for neighboring countries, including Russia and other countries of the former Soviet Union.

Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
Finland remains largely free of terrorist incidents.
However, like other countries in the Schengen area, Finland’s open borders with its Western European neighbors allow the possibility of terrorist groups entering/exiting the country with anonymity.
Elements of organized crime groups operating in the former Soviet Union and Eastern Europe are present in Finland, but these do not represent a specific danger to U.S. citizen residents or tourists.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up to date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the United States and Canada, or for callers outside the United States and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.

CRIME:
Although the crime rate in Finland is low compared to the U.S. and most European countries, it has increased in recent years; however, Finland remains a relatively safe environment.
Americans visiting Finland are seldom victims of crime, but visitors should not be complacent regarding personal safety or the protection of valuables.
The same precautions employed in the U.S. should be followed in Finland.
Finnish police services are excellent. Travelers should be aware that some police officers speak little English.
Due to the low crime rate, Finland has one of the lowest numbers of police officers of any European nation.
Outside of key sites in major urban centers, they rarely project a visible presence; consequently, response times to crisis situations may be unpredictable.
All forms of public transportation are considered safe.
Street crimes, such as muggings and pick-pocketing, remain uncommon, but do occur.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

Finland has a program to provide financial compensation to victims who suffer serious criminal injuries.
According to existing regulations, the victim must report the incident to the police and file an application for compensation within 10 years of the date of the crime.
Finnish police routinely inform victims of serious crime of their right to seek compensation.
The relevant forms and further information can be obtained from http://www.treasuryfinland.fi.
The local equivalent to the “911” emergency line in Finland is 112.
Please see our additional information for Victims of Crime, including possible victim compensation programs in the United States.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country’s laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Finland’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Finland are strict and convicted offenders can expect jail sentences and heavy fines.
Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties
SPECIAL CIRCUMSTANCES:
Commercial and financial transactions in Finland are increasingly automated and on-line.
Cash is almost always acceptable (the currency is the euro), but most major credit cards are widely recognized.
Automatic Teller Machines are very common and many U.S.-issued bankcards are compatible with them.

MEDICAL FACILITIES and Health information:
In Finland, medical facilities and their staff are generally excellent and are widely available for emergency services.
English is commonly spoken by Finnish medical personnel.
Helsinki is a frequent medical evacuation point for emergency cases from the countries of the former Soviet Union.
The public hospital system and many private hospitals honor foreign credit cards.
Most pharmacies (“apteekki” in Finnish) are open during normal shopping hours and major cities have at least one 24-hour service pharmacy.
If you are a tourist or temporary visitor to Finland and you require immediate emergency medical assistance, you may visit a local medical center or clinic, called “ensiapuasema” (first-aid station) in Finnish.
Usually these stations are located at hospitals and provide a full range of services.
The emergency telephone number, 112, can be used throughout Finland to contact emergency medical services.
For more detailed information on medicines and medical issues, please visit the website of the Finnish Embassy in Washington, DC at http://www.finland.org.
Travelers with special medical needs should consult with their personal physicians and take appropriate precautions, including bringing adequate supplies of necessary medication.
Medicines may be brought into the country as long as they are intended for the traveler’s personal use, however, there are special requirements concerning the quantity.
Medications categorized as narcotics may only be brought into the country to cover the traveler’s personal use for a maximum of 14 days and must be accompanied by a medical certificate stating why the traveler needs them.
For more detailed information, please contact the Finnish Embassy in Washington, DC at http://www.finland.org
In addition, stringent Finnish customs regulations prohibit travelers from receiving drugs from abroad after having arrived in the country.
Travelers may also find local physicians reluctant to prescribe equivalent quantities of dosages.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Finland.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith.
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Finland is provided for general reference only and may not be totally accurate in a particular location or circumstance.
Finnish roads are comparable to those in the U.S., though secondary roads may be less heavily traveled due to Finland’s sparse population outside the major urban areas.
These secondary routes often narrow to two lanes with a wider shoulder.
Slower vehicles are expected to move onto the shoulder to allow faster moving vehicles to pass.
Finland has an extensive network of highways throughout the country, as well as excellent public transportation services.
A valid U.S. driver’s license may be used while visiting Finland, but drivers must be at least 18 years of age.
Driving in Finland is on the right.
Traffic approaching from the right usually has priority, even if entering a primary roadway from a secondary one.
Road signs use standard international symbols and Finnish text.
Many urban streets have traffic lanes reserved for public transportation only.
Unless otherwise noted on traffic signs, the speed limit is 50 km/h in urban areas, 80 km/h on open roads, and 120 km/h on expressways during summer (reduced to 100 km/h during winter).
Vehicles must use headlights at all times.
Use of seatbelts is mandatory for drivers and all passengers.
Minor children must be seated in approved child or booster seats.

Public transport in Finland is of good quality and is the recommended method of travel.
Passenger trains, intercity buses, and air flights provide regular service over longer distances.
Public transportation in urban centers includes buses, subways, trams, suburban trains, and taxis.
Taxis are more expensive than in major U.S. cities.
Most local residents use public transport in Helsinki as parking can be hard to find and expensive.
The bus, train, and subway systems are relatively safe.
Travelers should be aware that drunk-driving laws are strict and acceptable blood alcohol levels are much lower in Finland than in the U.S.
Police strictly enforce all traffic laws and institute random roadside breath analyzer tests.
Drivers who register .05 or above alcohol content are subject to immediate arrest.
Drivers should be aware that regulations and traffic signs differ significantly from those in the U.S.
Visitors should be familiar with both prior to operating a vehicle in Finland.
Driving in Finland during the winter months can be hazardous.
Daylight hours are very short and one should be comfortable with driving in darkness.
Icy road conditions are common.
If driving in Finland, the vehicle must be winterized with studded snow tires and engine heaters are strongly recommended.
When driving at night, drivers must be alert to moose wandering onto major roadways.
There have been incidents of moose being struck by vehicles, causing severe damage to the vehicle and injury, sometimes fatal, to the occupants.
For real-time updates on road conditions throughout Finland, see the Finnish Road Administration’s travel and traffic information web site at http://www.finnra.fi
Please refer to our Road Safety page for more information.
Visit the website of the country’s national tourist office and national authority responsible for road safety at http://www.mek.fi
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Finland’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Finland’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa
Please see our information on customs regulations.

CHILDREN’S ISSUES:
For information, see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION AND EMBASSY LOCATION:
Americans living or traveling in Finland are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website, https://travelregistration.state.gov, so that they can obtain updated information on travel and security within Finland.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at Itainen Puistotie 14B.
The telephone number for the American Citizens Services unit is 358-9-616-25-701, 0830 to 1700 Monday to Friday (after hours, 358-9-616-25-0); the fax number is 358-9-616-25-800; e-mail:
HelsinkiACS@state.gov.
The address of the Embassy’s Internet home page is http://www.usembassy.fi
*

*

*
This replaces the Consular Information Sheet dated May 23, 2008 to update the sections on Information for Victims of Crime and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Fri 14 Dec 2018
Source: UUTISET [edited]

An unvaccinated individual, who caught the contagious disease in Poland, attended a large church service in Tampere and infected at least 2 other people. Three adults have been diagnosed with measles in Tampere after attending a Catholic parish church event in late November along with more than 100 people, according to the Pirkanmaa Hospital District.

Two of the adults diagnosed have been vaccinated, so they are not contagious. The source of the outbreak is an unvaccinated person, who caught the measles in Poland. But according to the Pirkanmaa Hospital District, further cases may still arise.

In 1975 Finland began to administer a single dose of the measles vaccine to all one-year-olds and by 1982 Finland began administering the vaccine in 2 doses between the ages of 1 and 6. However some people born in the 1970s are among those who received only one jab. MMR is a triple-dose vaccine that provides protection against measles, mumps and rubella.

Measles spread at religious event
---------------------------------
The event in question was Tampere's Pyhan Ristin (Sacred Cross) Catholic Parish church mass on 25 Nov 2018. It was attended by more than 100 people, including children. Pirkanmaa Hospital District doctor Kirsi Valve, a specialist in infectious diseases, confirmed that the infected individual who caught the measles in Poland was at the church event. The cases came to light when 2 vaccinated individuals contracted high fevers and came down with skin rashes. The unvaccinated person, who infected the others, has had more severe symptoms than the vaccinated individuals.

"The individuals quickly got in touch with healthcare services owing to high fevers, and skin rashes that rapidly spread all over their bodies," says Valve. "It was confirmed that on 25 Nov 2018 the unvaccinated individual who caught the measles in Poland and brought it back to Finland was at the parish event and is the source of the outbreak."

As the source of the outbreak is known, healthcare officials are also looking into whether the person could have possibly exposed others.

Measles in the news
-------------------
Measles has been on the agenda this winter after an unvaccinated child in Ostrobothnia took ill with measles. Meanwhile, it also came to light that many adults in Finland may not have been vaccinated against measles during the early 1970s.

Measles is a rare disease. The previous outbreak was 2 summers ago when 4 vaccinated children caught measles in Italy and started showing symptoms after returning to Finland. The Pirkanmaa Hospital District recommends that anyone who attended the Catholic parish event in late November 2018 and exhibits symptoms that suggest measles or anyone who hasn't been vaccinated with the MMR vaccine contact their healthcare centre.

If those who attended the parish event are healthy, but have not been vaccinated, the Pirkanmaa Hospital District recommends that they contact their healthcare centre to be vaccinated. The measles vaccine is free and administered as part of the MMR shot, which also provides protection against rubella and the mumps.
Date: Fri 2 Nov 2018
Source: UUTISET [edited]

Around 1/3 of the ticks in Finland -- mostly found in the south -- carry at least one pathogen, and 2 percent of the persistent arachnids carry several disease-causing agents, researchers at Turku University said.

About 30 percent of common ticks and 24 percent of taiga tick populations have been found to carry one disease pathogen. Common ticks more commonly carry several disease-causing pathogens than taiga ticks, according to the researchers.

The most common pathogen found in the ticks was _Borrelia burgdorferi_, the bacterial species that causes Lyme disease in humans, an illness referred to locally as borreliosis. The pathogen was found in 17 percent of the ticks at the university's growing tick database bank.

Lyme disease cases are treated with aggressive antibiotics without necessarily determining which specific bacterium is responsible for the infection.

Thanks to a growing tick database at the University of Turku, researchers have new insights into the disease pathogens that the tiny, blood-sucking arachnids carry.

New research has revealed that ticks on the south coast carry the most pathogens, but the region is almost exclusively home to the most common ticks: _Ixodes ricinus_, or castor bean ticks).

Both castor bean ticks and taiga ticks [_Ixodes persulcatus_] are now commonly found in areas across central Finland, the researchers said. Even further north, the tick populations are quite similar to ones in central areas, but the taiga has become more common in the north.

About 3 years ago, researchers at the university asked members of the public to send in ticks they had found, and now the institution has received more than 20 000 ticks. The researchers say that they want to take advantage of the significant amount of information they can learn from the specimens.

Examination of those thousands of tiny arachnids have uncovered many types of disease-causing bacteria, and researchers have new insights into the arachnids themselves and the potential illnesses they carry.

The researchers said they hope to learn more about ticks, saying that their research has only begun, and that their study of the ticks will continue for several years. Ultimately, their goal is to find how tick-borne illnesses are transmitted, they said.
======================
[This is an interesting example of how a large group of people, many undoubtedly non-scientists, can contribute to an effort that requires many hours of collection effort. Although _Borrelia burgdorferi_ is endemic in Finland, finding it and possibly other bacterial pathogens in about 1/3 of the 20 000 ticks collected is of public health significance. _Ixodes ricinus_ is also the tick vector of European tick-borne encephalitis virus, but no mention is made of it in the above report. Perhaps it was not tested for. Images of both ticks can be found in the above report. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Date: Thu, 1 Nov 2018 16:46:12 +0100
From: topic@afp.com

Helsinki, Nov 1, 2018 (AFP) - Santa Claus has already begun his preparations in Lapland -- by protecting himself from winter viruses and making sure he hires enough elves.   On Thursday nurse Tiia Kahkonen administered an anti-influenza vaccine to Santa, at his village in the Arctic Circle town of Rovaniemi, northern Finland. 

The jab is likely to be a sensible precaution, as the flu season coincides with the busiest time of the year by far in Lapland.    In December last year 390,000 foreign visitors spent a night in Finnish Lapland, an increase of almost ten percent on the previous Christmas.    By far the largest group of Christmas holidaymakers were Brits, followed by Russian, French and German tourists, according to official statistics.

Meanwhile a recruitment agency in Finnish Lapland, inside the Arctic circle, has put out a call for Christmas elves to look after the hordes of tourists who come to visit Santa in his natural habitat during the winter months.   Prior experience is not essential as the advert, posted by the firm Lapland Staff, promises that training will be provided in "the required elfing and communication skills."   Successful applicants will also be given tips on how to deal with the cold in northern Finland where temeratures rarely rise above zero degrees Celsius, and can drop as low as minus 40.

Although handling Santa's reindeer is not listed among the job's duties, elves will need to herd groups of visitors on and off buses, as well as keep tourists entertained. "Looking after the fireplace and pouring hot juice" are also required, as is supervising the toboggan hill.   Tourism to Lapland has reached an all-time high in recent years, with visitors spending 3.5 million nights in Lapland across the whole year, up from 2.6 million a decade earlier, according to Statistics Finland.    Much of the recent growth has been driven by tourism from Asia.
Date: Sun, 17 Dec 2017 04:43:36 +0100
By Camille BAS-WOHLERT

Rovaniemi, Finland, Dec 17, 2017 (AFP) - In the run up to Christmas tourists from around the world flock to the Santa Claus Village, an amusement park in Finnish Lapland, where temperatures can hit nearly -15 degrees Celsius (5 Fahrenheit).    They buy soft toys and souvenirs from pricey gift shops while a bearded Santa receives hundreds of admirers a day throughout December before embarking on his world tour from the valleys of Finland to the skyscrapers of New York and beyond to deliver gifts.

Holding their winter beanie hats in their hands, visitors wait patiently in line for a brief encounter with "Joulupukki" -- the Finnish word for Santa Claus -- and a photo opportunity in exchange for hard currency.    "We've seen other Santas but that wasn't the real one. But we're told that is the real one," said Mary Gleadall, an eight-year-old tourist from Southampton in the UK, visiting the amusement park with her parents, brother and sister.    According to Christmas lore, Santa lives in a secret place in the middle of the snowy pines of the North Pole. But the question is where?     Since 2010, Rovaniemi, the capital of Finnish Lapland, has marketed itself as Santa's "official home".    Situated a few miles from the city, the Santa Claus Village is located in front of a huge gas station. 

Tourists rush to cross the Arctic Circle, marked by a white line, to meet Santa Claus in his wooden home with a pointed roof.    But entering his private cottage is out of the question as Mother Claus is reportedly protective of their privacy.    In a large room, the white-bearded old man sits in an armchair next to a chest full of letters.    Each year, he receives more than 300,000 visitors, a deluge he embraces with humility.    "I'm very happy. I'm not exhausted but, of course, I get tired once in a while" he says.    And how does Santa Claus regain his energy?    "I love to take nap every once and then. Fifteen minutes sleeping and then all is very good." he says.

- Exalted tourists -
Shizuka Kawahara and Saki Itoi, Japanese tourists in their thirties, flew for more than 24 hours to hug Santa for a few seconds in a precious moment immortalised with a photograph taken by an elf.    The price for one shot starts at 30 euros ($35). Photographing with one's own camera is forbidden as it would ruin the magic of the moment, says the staff of the house.     Four-year-old Harry Gleadall, Mary's brother, approaches Santa without fear.    He quickly states his list of what he wants for Christmas: Transformers and some more Transformers before he skeptically shakes Santa's hand.    "But what if it wasn't the real Santa Claus?" Harry asks with concern.    Eager to set the record straight -- and justify the long trip -- his mother quickly assures him that the chubby red-clothed man is indeed the real deal.    After a tour around the shop which sells hand-made "Lapland" emblems and tons of souvenirs, the family is back in the village square, surrounded by wooden homes, Christmas carols piped out of nearby speakers.

- Polar safari -
In this winter wonderland, tourists have the opportunity to go on a reindeer sleigh ride.    A snow "safari" of 400 metres costs 14 euros per child and 18 euros per adult, an exotic experience for many foreigners who seek to discover the arctic landscapes steeped in pink light.    The -13 degrees Celsius does not discourage the plucky visitors bundled up in their ski suits.    "Everything that have been told to me during childhood, it's come true," said Perpetua, a tourist from Dubai, describing the break from the year round desert climate as "heaven".   "We expected magic and this is what we found," added Max, an Italian tourist. "Everything seems to be magic, the lights, the place, everything here".   But Miriana, a 24-year-old Italian on a university exchange programme in southern Finland, was less convinced.   "The place is really nice. But I think nevertheless that it's a bit commercial," she said.
Date: Tue 18 Oct 2016
From: Tiina Nokireki <tiina.nokireki@evira.fi> [edited]

The Finnish Food Safety Authority (Evira) received a bat (Daubenton's bat, _Myotis daubentonii_) for laboratory analyses. The bat was found by a private person. The bat had neurological signs and then died.

Laboratory analyses conducted during the 13 and 14 Oct 2016, confirmed the presence of rabies by FAT. The virus was then identified as European Bat Lyssavirus type 2 (EBLV-2) by RT-PCR and partial sequencing of the gene for the nucleoprotein. Also cell culture is positive.

The bat originated from Inkoo in the province of Southern Finland and is part of the Uusimaa region. This is the 2nd case of EBLV-2 in a bat in Finland.
-----------------------------------------
Tiina Nokireki
Head of Section, DVM, Specialist in Veterinary Medicine, Infectious
Diseases
Finnish Food Safety Authority Evira
Research Department, Veterinary Virology
Mustialankatu 3,
FI-00790 Helsinki,
Finland
=========================
[Special thanks to Dr. Nokireki for this important contribution. Infections by European Bat Lyssavirus type 2 (EBLV-2) have been previously reported in Northern Europe, not only in bats, but also in humans. EBLV-1 appears to be more prevalent, accounting for the vast majority of all EBLV-infected bats. Reports of EBLV-2 correspond to Daubenton's bats (_Myotis daubentonii_), indicating that this bat species is the reservoir of this _Lyssavirus_ strain.

For a picture of a Daubenton's bat go to

[A HealthMap/ProMED-mail map can be accessed at:
More ...

World Travel News Headlines

Date: Wed, 18 Sep 2019 16:44:19 +0200 (METDST)

London, Sept 18, 2019 (AFP) - British Airways pilots on Wednesday cancelled a strike that had been due September 27, the British Airline Pilots Association union said after two walkouts last week that cost the company dear.   "Someone has to take the initiative to sort out this (pay) dispute and with no sign of that from BA the pilots have decided to take the responsible course," BALPA General Secretary Brian Strutton said in a statement.    The union chief added that the airline's "passengers rightly expect BA and its pilots to resolve their issues without disruption and now is the time for cool heads and pragmatism to be brought to bear.    "I hope BA and its owner IAG show as much responsibility as the pilots," he added.   It was now "time for a period of reflection before the dispute escalates further and irreparable damage is done to the (BA) brand."

However the union added that should the airline "refuse meaningful new negotiations, BALPA retains the right to announce further strike dates".   British Airways, which likes to call itself "the world's favourite airline", flew into turbulence last week as pilots staged a costly and historic two-day strike, tarnishing its global reputation according to aviation analysts.   Pilots walked out for the first time in the company's 100-year history, sparked by a bitter and long-running feud over pay.   BA faced the embarrassment of grounding its entire UK fleet on September 9 and 10, causing the cancellation of about 1,600 flights.   The move sparked travel chaos for about 200,000 passengers who had been due to fly in and out of London's Gatwick and Heathrow airports.

The disruption continued into September 11 because half of BA's 300 aircraft and more than 700 pilots were mostly in the wrong place.   As a result, BA was forced to cancel approximately ten percent of its daily 850 flights in and out of Britain that day.    BALPA and its members are demanding a bigger share of British Airways profits.   The airline has offered a salary increase of 11.5 percent over three years, which it argues would boost the annual pay of some captains to £200,000 ($250,000 or 226,000 euros).   However, the union has rejected the proposal made in July.   BALPA meanwhile estimates that last week's 48-hour strike cost the airline £80 million.   BA is owned by IAG, which was formed in 2011 with the merger of British Airways and Spain's Iberia. IAG has since added other carriers, including Austria's Vueling and Ireland's Aer Lingus.
Date: Wed, 18 Sep 2019 12:26:37 +0200 (METDST)
By Sam Reeves

Kuala Lumpur, Sept 18, 2019 (AFP) - Toxic haze from Indonesian forest fires closed schools and airports across the country and in neighbouring Malaysia Wednesday, while air quality worsened in Singapore just days before the city's Formula One motor race.   Illegal fires to clear land for agriculture are blazing out of control on Sumatra and Borneo islands, with Jakarta deploying thousands of security forces and water-bombing aircraft to tackle them.

Indonesian blazes belch smog across Southeast Asia annually, but this year's are the worst since 2015 and have added to concerns about wildfire outbreaks worldwide exacerbating global warming.   On Wednesday, air quality deteriorated to "very unhealthy" levels on an official index in many parts of peninsular Malaysia, to the east of Sumatra, with the Kuala Lumpur skyline shrouded by dense smog.    Nearly 1,500 schools were closed across Malaysia due to the air pollution, with over one million pupils affected, according to the education ministry.

A growing number of Malaysians were suffering health problems due to the haze, with authorities saying there had been a sharp increase in outpatients at government hospitals -- many suffering dry and itchy eyes.   Indonesian authorities said hundreds of schools in hard-hit Riau province on Sumatra were shut, without providing a precise number, while about 1,300 were closed in Central Kalimantan province on Borneo.    Borneo is shared between Indonesia, Malaysia and Brunei.   Poor visibility closed seven airports in the Indonesian part of Borneo, the transport ministry in Jakarta said. Scores of flights have already been diverted and cancelled in the region in recent days due to the smog.

- Singapore smog race? -
Air quality in Singapore worsened to unhealthy levels and a white smog obscured the striking waterfront skyline, featuring the Marina Bay Sands casino resort with its three towers and boat-shaped top level.    The worsening pollution increased fears that this weekend's Formula One race may be affected. Organisers say the possibility of haze is one of the issues in their contingency plan for Sunday's showpiece night race, but have not given further details.

The city-state's tourism board said spectators would be able to buy masks as protection from the haze if conditions did not improve and assistance would be provided for those who feel unwell, the Today news portal reported.   The fires have sparked tensions between Indonesia and Malaysia.    Indonesia's environment minister initially suggested the haze was from Malaysian fires despite satellite data showing hundreds of blazes in Indonesia and only a handful in its neighbour, prompting anger from her Malaysian counterpart.

Indonesia later sealed off dozens of plantations where it said fires were blazing, including some owned by Malaysia-based firms, deepening the row.   But Prime Minister Mahathir Mohamad, who has struck a diplomatic tone throughout the crisis, said Malaysia may pass legislation forcing its companies to tackle fires on plantations abroad.   Malaysia wants its firms with sites overseas to put out blazes contributing to the haze, he said, adding: "Of course, if we find they are unwilling to take action, we may have to pass a law to make them responsible."

The Indonesian government has insisted it is doing all it can to fight the blazes. But this year's fires have been worsened by dry weather and experts believe there is little chance of them being extinguished until the onset of the rainy season in October.   Indonesia's meteorology, climate and geophysics agency said Wednesday that over 1,000 hotspots -- areas of intense heat detected by satellite that indicate a likely fire -- had been sighted, most of them on Sumatra.
Date: Wed, 18 Sep 2019 12:14:44 +0200 (METDST)
By Aishwarya KUMAR

New Delhi, Sept 18, 2019 (AFP) - India announced on Wednesday a ban on the sale of electronic cigarettes, as a backlash gathers pace worldwide due to health concerns about a product promoted as less harmful than smoking tobacco.   The Indian announcement, also outlawing production, import and distribution, came a day after New York became the second US state to ban flavoured e-cigarettes following a string of vaping-linked deaths.   "The decision was made keeping in mind the impact that e-cigarettes have on the youth of today," Finance Minister Nirmala Sitharaman told reporters in New Delhi.

E-cigarettes do not "burn" but instead heat up a liquid -- tasting of everything from bourbon to bubble gum and which usually contains nicotine -- that turns into vapour and is inhaled.   The vapour is missing the estimated 7,000 chemicals in tobacco smoke but does contain a number of substances that could potentially be harmful.   They have been pushed by producers, and also by some governments including in Britain, as a safer alternative to traditional smoking -- and as a way to kick the habit.

However critics say that apart from being harmful in themselves, the flavours of e-cigarette liquids appeal particularly to children and risk getting them addicted to nicotine.   Some 3.6 million middle and high school students in the United States used vaping products in 2018, an increase of 1.5 million on the year before.   The New York emergency legislation followed an outbreak of severe pulmonary disease that has killed seven people and sickened hundreds.   President Donald Trump's administration announced last week that it would soon ban flavoured e-cigarette products to stem a rising tide of youth users.

- Big E-Tobacco -
Although few Indians vape at present, the Indian ban also cuts off a vast potential market of 1.3 billion consumers for makers of e-cigarettes.   Tobacco firms have been investing heavily in the technology to compensate for falling demand for cigarettes due to high taxes and public smoking bans, particularly in the West.

In 2018 Altria, the US maker of brands such as Marlboro and Chesterfield, splashed out almost $13 billion on a stake in one of the biggest e-cigarette makers, Juul.   A few Indian states have already banned e-cigarettes although the restrictions have been ineffective since online sale of vaping products continue.   The new ban does not cover traditional tobacco products in India.   According to the World Health Organization, India is the world's second-largest consumer of tobacco products, killing nearly 900,000 people every year.

Nearly 275 million people over 15, or 35 percent of adults, are users, although chewing tobacco -- which also causes cancer -- is more prevalent than smoking.   India is also the world's third--largest producer of tobacco, the WHO says, and tobacco farmers are an important vote bank for political parties.   According to the Associated Chambers of Commerce and Industry, an estimated 45.7 million people depend on the tobacco sector in India for their livelihood.   Tobacco is also a major Indian export, and the government holds substantial stakes, directly or indirectly, in tobacco firms including in ITC, one of India's biggest companies.
Date: Wed, 18 Sep 2019 03:56:31 +0200 (METDST)

Washington, Sept 18, 2019 (AFP) - Hurricane Humberto strengthened to a major Category 3 storm on Tuesday and was expected to pass near Bermuda, threatening it with dangerous waves and heavy rain, the US National Hurricane Center said.   "Hurricane conditions are expected to reach Bermuda by Wednesday night and continue into early Thursday morning," the Miami-based NHC said.   "Some fluctuations in intensity are likely during the next day or so, but Humberto should remain a powerful hurricane through Thursday," it said.   As of 8:00 pm (0000 GMT), the storm had maximum sustained winds of 115 miles per hour (185 kilometers per hour) and was moving east-northeast at 12 miles per hour.
Date: Wed, 18 Sep 2019 01:36:21 +0200 (METDST)

Dakar, Sept 17, 2019 (AFP) - Four people died after a boat carrying dozens of tourists capsized during heavy storms in Senegal, authorities and emergency services said Tuesday.   The death toll could rise as three passengers were said to be missing after the accident.  The boat was carrying several Senegalese nationals, six French people, two Germans, two Swedes and one person from Guinea-Bissau, when it turned over Monday in driving rain and a heavy swell, fire department chief Papa Angel Michel Diatta said.   All the dead were Senegalese, officials and emergency services said.

Two worked in a national park, one was a woman and the other victim was a child, Diatta said.   The boat was heading for the Madeleine islands, site of an offshore national park popular with tourists who travel from Dakar, coastal capital of the West African country.   Senegalese President Macky Sall appealed for "greater caution and respect for existing security norms duing the rainy season" in a tweet.

Emergency services continued to look for those missing on Tuesday. AFP journalists saw a dozen divers at the scene. Distressed families were waiting on the shore to get news of their loved ones.    "The gendarmerie called us at 5:00 am (GMT and local time). My brother was on the boat. The worst thing is not knowing," said Aminata Diop, who was among the relatives on the beach.   There are "four dead bodies and between three and four people are missing. Thirty-five people were on the boat. Search and rescue operations are continuing this morning," Interior Minister Aly Ngouille Ndiaye told AFP by telephone.

The causes of the accident were unclear. The interior minister told Senegalese media overnight that several tourists were worried about the heavy rains and wanted to return to the pier but others wanted to stay on the boat.   The survivors spent the night on the island, Ndiaye told local radio on Tuesday. Blankets and food were sent to them and they were to be ferried back to the mainland in the morning, he added.   The rainy season arrived late this year and heavy storms have resulted in several casualties this month.    Two fishermen were killed on their canoe in the same area nearly two weeks ago.
Date: Tue, 17 Sep 2019 15:38:37 +0200 (METDST)

Jakarta, Sept 17, 2019 (AFP) - Massive forest fires in Indonesia that have caused a toxic haze to spread as far as Singapore and peninsular Malaysia are also seriously affecting endangered orangutans and their habitat, a rescue foundation said Tuesday.   Jakarta has deployed thousands of troops as temporary fireman and deployed dozens of water-bombing aircraft to battle blazes that are turning pristine forest into charred landscape in Sumatra and Borneo islands.   The fires -- usually started by illegal burning to clear land for farming -- have unleashed a choking haze across parts of southeast Asia.

The Borneo Orangutan Survival Foundation said Tuesday that the haze was affecting hundreds of great apes in its care at rescue centres and wildlife re-introduction shelters.   "The thick smoke does not only endanger the health of our staff... but also it affects the 355 orangutans we currently care for", the foundation said in a statement, referring to just once cetre in Kalimantan   "As many as 37 young orangutans are suspected to have contracted a mild respiratory infection," it added.   Conditions were so bad at their Samboja Lestari facility in East Kalimantan that outdoor activities for the animals had been restricted to a few hours a day.

Orangutans have been particularly vulnerable to commercial land clearances and have seen their natural habitat shrink dramatically in the last few decades.   The population of orangutan in Borneo has plummeted from about 288,500 in 1973 to about 100,000 today, according to the International Union for Conservation of Nature.   The toxic smoke caused by the forest fires is an annual problem for Indonesia and its neighbours, but has been worsened this year by particularly dry weather.   On Borneo island, which Indonesia shares with Malaysia and Brunei, pollution levels were "hazardous", according to environment ministry data.   Hundreds of schools across Indonesia and Malaysia were shut.
Date: Mon, 16 Sep 2019 16:24:55 +0200 (METDST)
By Boureima HAMA

Niamey, Sept 16, 2019 (AFP) - "At last, we're here!" Amina and Halima, who live in Niger's capital Niamey, exulted after reaching high ground following the worst floods to hit the city in 50 years.   Two weeks ago, authorities in Niamey declared a red alert when the waters of the Niger river -- the third biggest in Africa -- rose to a level "not seen in more than 50 years".

The floods have affected more than 6,300 people in the traditionally dusty city.   Nearly 60 have been killed and 130,000 displaced across the nation this rainy season, officials say.    Amina and Halima are among those who have been evacuated to tent shelters at Saguia in the highlands overlooking Niamey.   The women travelled in a van, but officials have been chartering all kinds of transport to move people in trouble, while others hire taxis, ride motorbikes and even walk.

Saguia is a patch of land owned by the army and usually off limits to the public.    In 2012, it was used to house about 400 soldiers from neighbouring Mali who had fled an offensive by Tuareg rebels.   For access to the site, people need "tickets" that are distributed in schools serving as transit centres for flood victims, according to the armed paramilitary police checking new arrivals.   The heights give a panoramic view of the homes and rice paddies largely submerged by the water.

- 'Surprised in our sleep' -
Inside the camp, the fire brigade and municipal employees have put up dozens of white tents supplied by the Red Cross and the United Nations.   "When people arrive here, they are installed in tents (...) and we have enough food for them all," Niamey governor Issaka Assane Karanta told AFP.   A generator and a fresh-water well have both been repaired, lamp posts will soon be installed and a medical centre is open "for the treatment of emergency cases", the governor said.

Some 122 households, comprising 854 people, have been allocated tents and the site can take in a total of 1,200 flood victims, he added.   "They gave us rice, millet, mosquito nets, blankets and drinking water," said Aissa Salifou, putting on makeup in her tent, her head and shoulders covered in a broad veil.   "The water surprised us in our sleep," added the woman from one of Niamey's hardest-hit districts, Kirkissoye. "We had to demolish the walls in neighbouring houses to scramble out."   "We live on the low ground where we were trapped by the water, but this place is spacious, well-aired and above all safe," said Fatouma Boubacar, another Kirkissoye resident, watching her cooking pot on the fire.

- 'I was lucky' -
Though Boubacar arrived only two days earlier, she has resumed her customary job, selling vegetables.   "I was lucky," said Ramatou Abdou, reclining in an armchair with a toothpick stuck between her teeth.   "I barely got out of the house before the roof fell in. I'm expecting my first baby in a month and I shall call it Saguia."    In the shade of a huge tree, a dozen new arrivals awaited the completion of their shelters before moving in.    Barefoot children meanwhile made up football teams and chased a rag ball on a makeshift pitch in the baking heat.

On the far side of the camp, a policeman with a gun slung over his shoulder watched over a bunch of children carrying plates and queuing for a hot meal provided by an NGO.   "We're trying to live here and waiting to see what Allah has in store for us," Boubacar said.    The level of the Niger has fallen slightly after bursting its banks, but governor Karanta is urging people from affected areas to be watchful and "to keep well away from the bed of the river".   Upstream in Mali, technicians have opened floodgates on a major dam and the extra water is "slowly but surely" flowing down to Niger, Karanta said.
Date: Thu, 12 Sep 2019 15:46:31 +0200 (METDST)

Rome, Sept 12, 2019 (AFP) - Authorities in Tuscany, home to some of Italy's most visited tourist attractions, have stepped up hospital controls after a deadly outbreak of the New Delhi superbug.

The antibiotic-resistant killer has shown "significant diffusion in the north-western area of Tuscany" since November 2018, infecting at least 75 people, local health authority ARS said.   The bacterial disease is believed to have killed at least 31 people in 17 different hospitals since then, Italian media reported Thursday.   More than 31 cases were reported in Pisa, home to the famous leaning tower.   Superbug NDM-1 (New Delhi metallo-beta-lactamase 1) sparked a global panic when it was found in the Indian capital in 2010 and showed resistance even to carbapenems, a group of antibiotics often reserved as a last line of defence.

The European Centre for Disease Prevention and Control in June issued a rapid risk assessment after a "large outbreak" of the New Delhi superbug in Tuscany.   It warned of possible cross-border infections, "especially since the affected area is a major tourist destination."   Tuscany's health authority said "the ability to resist antibiotics makes these bacteria dangerous, especially in vulnerable patients, already affected by serious pathologies or immunosuppressed."   As a result, hospitals in the region have "stepped up procedures for the prevention and control of infections in health facilities," it said.
Date: Thu 12 Sep 2019
Source: Korea Biomedical Review [abridged, edited]

The Korea Centers for Disease Control and Prevention (KCDC) said that it has confirmed that contaminated fermented shellfish was the main culprit behind the hepatitis A outbreak this summer of 2019.

The KCDC came to the conclusions after conducting an in-depth epidemiological investigation. The agency randomly sampled 270 of the 2178 hepatitis A patients, diagnosed between [28 Jul 2019] and [24 Aug 2019], and surveyed whether they consumed fermented shellfish this summer. It found that 42% of the patients had eaten fermented shellfish during the incubation period.

KCDC also found that 80.7% of the 26 patients diagnosed with hepatitis A in August 2019 also ate fermented shellfish, while discovering hepatitis A virus genes in 11 batches of the 18 batches collected after the outbreak. Notably, 5 of these genes found in the research showed close relations with the virus detected in hepatitis A patients.

The agency recommended that the public should stop consuming salted clams until it can confirm that they are safe to eat. The Ministry of Food and Drug Safety also plans to conduct a full survey of fermented shellfish distribution products this month [September 2019].

As of now, the disease control agency has confirmed 10 products that have tested positive to the hepatitis A virus. Nine of them were imported from China, and one was made in Korea. The KFDC asked the producers of sauced clams to halt the distribution and sale of their products for the time being and to conduct the hepatitis A virus test for each product when importing fermented shellfish.  [Byline: Lee Han-soo]
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[This outbreak in South Korea seems to be related to contaminated shellfish. In most developed countries, hepatitis A virus outbreaks are related to a definable food vehicle. This is not what has occurred in the USA in the past several years, where the huge increase in cases is related to poor hygiene and inadequate sanitation in marginalized populations. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Tue 17 Sep 2019, 10:07 AM
Source: AKIpress [edited]

A total of 4 shepherds were hospitalized with anthrax in Zhambyl region, Informbureau reports. The diagnosis was confirmed by laboratory examination. Patients came to the hospital with eruptions on their bodies.

"The patients work on one of the farms and have direct contact with animals. All of them were took part in the slaughtering of a cow, and 7-10 days after that they started complaining of these signs," said Gulfaira Mirzabekova, an employee of the Zhambyl regional infectious hospital. According to doctors, those infected sought medical aid in time. Anthrax just started damaging the organs. They will be treated for at least 10 days, they said.

Local authorities are not going to quarantine in the village of Shakpak, where the patients were infected. No anthrax cases were registered among cattle, they claim.