WORLD NEWS

Getting countries ...
Select countries and read reports below or

Andorra

General
************************************
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
**************
*********************
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
***************************************
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
************************************
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
************************************
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
************************************
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
************************************
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]
=====================
[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]
More ...

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: Tue, 14 Jan 2020 03:06:55 +0100 (MET)

Sydney, Jan 14, 2020 (AFP) - An Australian man was found alive and well after being lost for three weeks in a crocodile-infested rain forest in the far north of the country, police said Tuesday.   Milan Lemic disappeared after his vehicle became bogged down on December 22 while travelling through the Daintree forest in the north-eastern state of Queensland.

Police initially feared Lemic, 29, had been eaten by a crocodile, which are numerous in the region, but after days of searching were unable to locate any of the reptiles big enough to have taken him.   He was finally found by police on Monday several kilometres (miles) from his abandoned vehicle.   "He was in good physical condition considering he had been in the rain forest for three weeks," police said in a statement.   Lemic survived on wild fruit and berries, they said.
Date: Mon, 13 Jan 2020 08:49:02 +0100 (MET)
By Andrew BEATTY

Sydney, Jan 13, 2020 (AFP) - Exhausted firefighters said they had finally brought Australia's largest "megablaze" under control Monday, as wet weather promised to deliver much-needed respite for countryside ravaged by bushfires.   New South Wales firefighters said they finally had the upper hand in the fight against the vast Gospers Mountain fire on Sydney's north-western outskirts, which has been burning for almost three months.   Visiting the area on Monday, New South Wales Rural Fire Service commissioner Shane Fitzsimmons said there was a "small area of burning still to complete" but the "containment prognosis looks promising".

The fire seared an area of national park three times the size of Greater London and lit several connected blazes totalling over 800,000 hectares.   As residents and authorities continued to come to grips with the sheer scale of the devastation, the Bureau of Meteorology forecast some fire grounds areas could get up to 50 millimetres (two inches) of rain in the next week, a relief after a prolonged drought.   If that forecast bears out, the New South Wales Rural Fire Service said it would be "all of our Christmas, birthday, engagement, anniversary, wedding and graduation presents rolled into one. Fingers crossed."   Dozens of other fires are yet to be controlled.

- Alice Cooper -
The climate-change-fuelled fires have prompted an international outpouring and donations from around the world to help communities and animal populations.   Australia's unique flora and fauna has taken a catastrophic hit, with an estimated one billion animals killed, and countless trees and shrubs burned away.   The country's environment minister Sussan Ley has warned that in some areas, koalas may have to be reclassified as endangered.

The government has earmarked an initial $50 million (US$35 million) to spend on helping with the wildlife recovery.   "This has been an ecological disaster, a disaster that is still unfolding," Treasurer Josh Frydenberg announcing the emergency fund.   This weekend, Sydney will host a charity gig to benefit fire services, the Red Cross and animal welfare organisations.    Headliners include Alice Cooper, Olivia Newton-John and Queen.

- Bushfire backlash -
The political impact of the bushfires is also coming into sharper relief.   A poll released Monday showed Prime Minister Scott Morrison's approval ratings have nosedived in the face of widespread anger over his handling of the deadly crisis.   The Newspoll survey showed 59 percent of Australian voters are dissatisfied with the conservative leader's performance overall, and only 37 percent were satisfied, an abrupt reversal since his shock election win last May.   Morrison has been criticised heavily for his response to the months-long crisis -- which included going on holiday to Hawaii, making a series of gaffes and misleading statements about his government's actions, and forcing angry victims to shake his hand.

Morrison began the crisis insisting local authorities had enough resources to handle the fires and exhausted volunteers firefighters "want to be there".    He also repeatedly stated that Australia was doing more than enough to meet its emission reduction targets, prompting a series of large-scale street protests.   Seeing a backlash, Morrison has since deployed the military, launched the largest peacetime call up of reserves, pledged billions of dollars in aid, increased payments to firefighters, and suggested more work may need to be done on emissions.
Date: Wed 8 Jan 2020
Source: Mirage News [abridged, edited]

NSW Health is advising people to be alert for symptoms of measles after a 2nd case was diagnosed in as many days. A local woman diagnosed with the infection visited a number of locations in Sydney's Eastern Suburbs and Inner West while infectious. The young woman had not travelled prior to her illness and has no known links to previously identified measles cases.

Dr Christine Selvey, NSW Health Acting Director of Communicable Diseases, said, "This is the 2nd case of measles in 2 days in a person who has not travelled overseas. This is a reminder for everyone to check that they are protected against measles, which is extremely infectious.

"As it's not clear where this woman acquired her infection, it is important that everyone is on the lookout for the early signs of measles, particularly people born during or after 1966 who have not had 2 doses of measles vaccine."
Date: Fri, 10 Jan 2020 10:55:46 +0100 (MET)
By Holly ROBERTSON

Eden, Australia, Jan 10, 2020 (AFP) - Gale-force winds in Australia merged two enormous fires into a megablaze across land almost four times the area of New York City on Friday, while thousands rallied to again demand action on climate change.   "The conditions are difficult today," said Shane Fitzsimmons, rural fire service commissioner for New South Wales state, after days of relative calm.   "It's the hot, dry winds that will prove once again to be the real challenge."

Temperatures soared above 40 degrees Celsius (104 degrees Fahrenheit) in parts of New South Wales and neighbouring Victoria, where attention was focused on the two fires that linked to form yet another monster blaze.   A "state of disaster" was extended 48 hours ahead of Friday's forecast of scorching temperatures, and evacuation orders were issued for areas around the New South Wales-Victoria border.   New South Wales Premier Gladys Berejiklian said there were more than 130 fires burning in the state, with just over 50 not yet under control.   On Kangaroo Island off south Australia, the largest town was cut off as firefighters battled dangerous infernos, forcing some residents to flee to the
local jetty.

The catastrophic bushfires have killed at least 26 people, destroyed more than 2,000 homes and scorched some eight million hectares (80,000 square kilometres) -- an area the size of Ireland.   University of Sydney scientists estimate one billion mammals, birds and reptiles have been killed in the fires.   The severe conditions have been fuelled by a prolonged drought and worsened by climate change, with experts warning that such massive blazes were becoming more frequent and intense.   Australia experienced its driest and hottest year on record in 2019, with its highest average maximum temperature of 41.9 degrees Celsius recorded in
mid-December.

- 'Scott, take it personally' -
In Sydney and Melbourne, thousands of people again took to the streets to demand Australia's conservative government do more to tackle global warming and reduce coal exports.   "Change the politics not the climate" read one sign, reflecting an increasingly charged argument over the cause of the fires.   Researchers say the bushfire emergency has sparked an online disinformation campaign "unprecedented" in the country's history, with bots deployed to shift blame for the blazes away from climate change.

One hashtag in particular, #arsonemergency, has gained traction rapidly and conservative-leaning newspapers, websites and politicians across the globe have promoted the theory that arson is largely to blame, rather than climate change, drought or record high temperatures.   Timothy Graham, a digital media expert at the Queensland University of Technology, told AFP his research showed half of the Twitter users deploying the hashtag displayed bot- and troll-like behaviour.   "Our findings show a concerted effort aimed to misinform the public about the cause of the bushfires," Graham said.   "The campaign is nothing on the scale of what we have been seeing in other countries, such as the 2016 US election, but this amount of disinformation in Australia is unprecedented."

Prime Minister Scott Morrison on Friday tried to parry journalists' questions about whether climate change would make horrific bushfire seasons the norm.   "Look, we have covered that on a number of occasions now," Morrison said testily, adding that reviews will take place once the bushfire season is over.   Towamba volunteer firefighter Tony Larkings, 65, said battling the fires in recent weeks had been a "hot, dirty and dangerous" task.   "It's been horrendous. It's never been like this before," he told AFP.   He was deeply critical of Morrison's response to the bushfires, calling it mere "lip service" and slamming the leader's response to public criticism.   "His great statement was 'I don't take this personally'. Scott, take it personally," Larkings said.
Date: Tue, 7 Jan 2020 10:48:26 +0100 (MET)
By Andrew BEATTY

Sydney, Jan 7, 2020 (AFP) - Firefighters raced to contain massive bushfires in southeastern Australia Tuesday, taking advantage of a brief drop in temperatures and some much-needed rainfall before another heatwave strikes later this week.   Exhausted volunteers cleared ground vegetation and carried out controlled burns before temperatures and winds were expected to pick up again by Friday.   "It really is about shoring up protection to limit the damage potential and the outbreak of the fires over the coming days," said New South Wales Rural Fire Service commissioner Shane Fitzsimmons.   He described current conditions as "much more favourable" but warned "we are expecting hotter weather to return later in the week".

Dozens of vast blazes continue to burn out of control across the east of the country and there are growing fears that two fires in New South Wales and Victoria could connect to form another uncontrollable megablaze.   Rainfall on Monday offered modest relief, but it was not heavy enough in most areas to extinguish the fires, and in some places it hampered firefighters' preparations by making back-burning more difficult.

Twenty-five people have died since the start of the disaster in September, more than 1,800 homes have been destroyed, and some eight million hectares (80,000 square kilometres) has burned, an area the size of Ireland or South Carolina.   Smoke from the fires has been spotted more than 12,000 kilometres (7,400 miles) away in Chile and Argentina, weather authorities in the South American countries said.

The cost of the disaster is still not clear, but the Insurance Council of Australia said claims worth Aus$700 million ($485 million) had already been filed and the figure was expected to climb significantly.   The government has earmarked an initial Aus$2 billion ($1.4 billion) for a national recovery fund to help devastated communities.   The human toll was again laid bare Tuesday, as firefighters held a memorial in Sydney for 36-year-old colleague Andrew O'Dwyer who died battling blazes in late December.   Volunteers in bright orange fire suits lined the road as his cortege passed -- with the coffin draped in a Rural Fire Service flag.

- Glimmers of hope -
Conditions in the next week are not expected to match the worst days of the crisis, but Fitzsimmons told public broadcaster ABC it was important not to "get lulled into a false sense of security".   Many of the blazes are too big to be put out, so only sustained rainfall would end the crisis.   There were some faint signs Tuesday that a reprieve may be on the way, as tropical cyclone Blake brought heavy rain to the northwestern coast.

Blake is not expected to have an impact on the bushfires raging in other parts of the massive country, but could signal a change in hot and dry conditions that have fuelled the fires.   "It was nice to see a cyclone forming. I shouldn't say that -- hopefully no damage -- but it was nice to see a cyclone forming up the top end of (Western Australia)," said Fitzsimmons.

"Hopefully (it is) a signal that we may see monsoon activity which will disrupt the dominant hot air mass continuing to influence so much of the weather."   In hard-hit communities residents took advantage of the respite to return home and utility firms said they were slowly reconnecting power.

But in the worst-hit areas, like the town of Cobargo, recovery will take much longer.   "There is extensive damage to the electricity network that supplies power from the zone substation to the residents of Cobargo," said Essential Energy.   "Helicopters are assisting local crews scope what repairs are needed. Extended outages are to be expected."

Meanwhile, police said they had arrested three people for alleged offences in bushfire areas as the authorities sought to crackdown on isolated incidents of looting.   "We are not living in South-Central LA, we are not living in Syria, we don't do this to each other. This is the south coast of NSW," emergency services commissioner David Elliott said.   Anyone, he said, who seeks to take "advantage of their fellow citizens' disadvantage they should expect the full force of the law."
More ...

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/
*

*

*
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 ...

San Marino

US Consular Information Sheet Italy, Holy See (Vatican City) and San Marino
January 21, 2009
COUNTRY DESCRIPTION:
Italy is a developed democracy with a modern economy.
The Holy See is a sovereign entity that serves as the ecclesiastic
l, governmental and administrative capital of the Roman Catholic Church, physically located within the State of the Vatican City inside Rome, with a unique, non-traditional economy.
San Marino is a developed, constitutional democratic republic, also independent of Italy, with a modern economy.
Tourist facilities are widely available.

Read the Department of State Background Notes on Italy, the Holy See, and San Marino for additional information.

ENTRY/EXIT REQUIREMENTS:
Italy is a party to the Schengen agreement.
As such, U.S. citizens may enter Italy 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 fact sheet.

For all other purposes, a visa is required and must be obtained from the Italian Embassy or Consulates before entering Italy.
For further information concerning visas and entry requirements for Italy, travelers may contact the Embassy of Italy at 3000 Whitehaven Street NW, Washington, DC 20008, via telephone at (202) 612-4400 or online at http://www.ambwashingtondc.esteri.it/ambasciata_washington, or Italian Consulates General in Boston, Chicago, Detroit, Houston, Los Angeles, Miami, Newark, New Orleans, New York, Philadelphia, or San Francisco, accessible through the Italian Embassy web site.

Americans staying or traveling within Italy for less than three (3) months are considered non-residents. This includes persons on vacation, those taking professional trips, students registered at an authorized school, or persons performing research or independent study.
As of May 2007, under Italian law (http://www.camera.it/parlam/leggi/07068l.htm), all non-residents are required to complete a dichiarazione di presenza (declaration of presence). Tourists arriving from a non-Schengen-country (e.g. the United States) should obtain a stamp in their passport at the airport on the day of arrival. This stamp is considered the equivalent of the declaration of presence. Tourists arriving from a Schengen-country (e.g. France) must request the declaration of presence form from a local police office (commissariato di zona), police headquarters (questura) or their place of stay (e.g hotel, hostel, campgrounds) and submit the form to the police or to their place of stay within eight business days of arrival. It is important that applicants keep a copy of the receipt issued by the Italian authorities. Failure to complete a declaration of presence is punishable by expulsion from Italy. Additional information may be obtained (in Italian only) from the Portale Immigrazione at http://www.portaleimmigrazione.it and the Polizia di Stato at http://www.poliziadistato.it/pds/ps/immigrazione/soggiorno.htm.
Americans staying in Italy for more than three (3) months are considered residents and must obtain a permesso di soggiorno (permit of stay). This includes Americans who will work or transact business and persons who want to simply live in Italy.
An application "kit" for the permesso di soggiorno may be requested from one of 14,000 national post offices (Poste Italiane). The kit must then be returned to one of 5,332 designated Post Office acceptance locations.
It is important that applicants keep a copy of the receipt issued by the post office.
Additional information may be obtained from an Italian immigration website online at http://www.portaleimmigrazione.it/.
Within 20 days of receiving the permit to stay in Italy, Americans must go to the local Vital Statistics Bureau (Anagrafe of the Comune) to apply for residency. It generally takes one to two months to receive the certificate of residence (Certificato di Residenza).

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:
There have been occasional episodes of politically motivated violence in Italy, most often connected to Italian internal developments or social issues.
Italian authorities have found bombs outside public buildings, received bomb threats, and were subjects of letter bombs.
Firebombs or Molotov cocktails have been thrown at buildings or offices in the middle of the night.
These incidents have all been attributed to organized crime or anarchist movements.
Americans were not targeted or injured in these instances.

Demonstrations may have an anti-American character.
Even demonstrations intended to be peaceful have the potential to turn into confrontational situations and possibly escalate into violence.
U.S. citizens traveling or residing in Italy should take common sense precautions and follow news reports carefully in order to avoid demonstrations and to be aware of heightened security and potential delays when they occur.
American citizens are encouraged to read the Warden Messages posted on the Embassy’s web site at http://italy.usembassy.gov/acs/demonstration/default.asp.

Italy remains largely free of terrorist incidents.
However, like other countries in the Schengen area, Italy’s open borders with its Western European neighbors allow the possibility of terrorist groups entering/exiting the country with anonymity.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State's, Bureau of Consular Affairs’ web site, 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., 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 A Safe Trip Abroad.

CRIME:
Italy has a moderate rate of violent crime, some of which is directed towards tourists, principally for motives of theft.
Some travelers are victims of rape and beatings.
There are incidents of drinks laced with drugs being used by criminals to rob, and in some cases, assault tourists.
Many of these incidents occur in the vicinity of Rome’s Termini train station and at major tourist centers such as Campo de Fiori and Piazza Navona, as well as in Florence and Naples.
Criminals using this tactic “befriend” a traveler at a train station, bus stop, restaurant, café or bar in tourist areas, then eventually offer a drink laced with a sleeping drug.
When the tourist falls asleep, criminals steal the traveler’s valuables.
There are also instances where the victim is assaulted, either physically or sexually.

Americans are urged to exercise caution at train stations and airports, and when frequenting nightclubs, bars and outdoor cafes, particularly at night, because criminals may make initial contact with potential victims in such settings.
Individuals under the effect of alcohol may become victims of crime, including robbery, physical and sexual assault, due to their impaired ability to judge situations and make decisions.
This is particularly a problem for younger Americans visiting Italy, where the age limit on the sale of alcoholic beverages is lower than in the United States.
If you are a victim of such a crime, please file a police report and contact the U.S. Embassy or nearest consulate.
There are also in-country organizations, which provide counseling, medical, and legal assistance to certain crime victims.

Petty crimes such as pick-pocketing, theft from parked cars, and purse snatching are serious problems, especially in large cities.
Pick-pockets sometimes dress like businessmen.
Tourists should not be lulled into a false sense of security by believing that well-dressed individuals are not potential pick-pockets or thieves.
Most reported thefts occur at crowded tourist sites, on public buses or trains, or at the major railway stations: Rome's Termini; Milan's Centrale; Florence's Santa Maria Novella; and Naples' Centrale and Piazza Garibaldi.
Travelers should also be alert to theft in Milan’s Malpensa Airport, particularly at car rental agencies.
Clients of Internet cafes in major cities are also targeted.
Tourists who have tried to resist petty thieves on motor scooters have suffered broken arms and collarbones.

Thieves in Italy often work in groups or pairs.
Pairs of accomplices or groups of street urchins are known to divert tourists' attention so that another can pick-pocket them.
In one particular routine, one thief throws trash, waste or ketchup at the victim; a second thief assists the victim in cleaning up the mess; and the third discreetly takes the victim's belongings.
Criminals on crowded public transportation slit the bottoms of purses or bags with a razor blade or sharp knife removing the contents.
Theft of small items such as radios, luggage, cameras, briefcases, and even cigarettes from parked cars is a major problem.

Carjackings and thefts are reported by occupants of vehicles waiting in traffic or stopped at traffic lights.
Vehicles parked near beaches during the summer are broken into and robbed of valuables.
Robbers take items from cars at gas stations often by smashing car windows.

In a scam practiced on the highways, one thief signals a flat tire to the driver of another car and encourages the driver to pull over.
Often, the tire has been punctured by an accomplice, while in other instances, there may, in fact, be nothing wrong with the vehicle.
When the driver stops, one thief helps change the tire, while the other takes the driver's belongings.
Use particular caution driving at night on highways, when there may be a greater incidence of robbery attempts.
There are occasional reports of break-ins of rental cars driven by Americans when the precautions mentioned above were not followed during stops at highway service areas.

On trains, a commonly reported crime involves one or more persons who pretend to befriend a traveler and offer drugged food or drink.
Also, thieves are known to impersonate police officers to gain the confidence of tourists.
The thief shows the prospective victim a circular plastic sign with the words "police" or “international police."
If this happens, the tourist should insist on seeing the officer's identification card (documento), as impersonators tend not to carry forged documents.
Tourists should immediately report thefts or other crimes to the local police.

The U.S. Secret Service in Rome is assisting Italian Law Enforcement authorities in investigating an increase in the appearance of ATM skimming devices.
These devices are attached to legitimate bank ATMs, usually located in tourist areas, and capture the account information stored electronically on the card’s magnetic strip.
The devices consist of a card reader installed over the legitimate reader and a pin-hole video camera mounted above the keypad that records the customer’s PIN.
ATMs with skimming devices installed may also allow normal transactions to occur.
The victim’s information is sold, traded on-line, or encoded on another card such as a hotel key card to access the compromised account.
Here are some helpful hints to protect yourself and to identify skimming devices:

1) Use ATMs located in well-lit public areas, or secured inside the bank/business
2) Cover the keypad with one hand as you enter your PIN
3) Look for gaps, tampered appearance, or other irregularities between the metal faceplate of the ATM and the card reader
4) Avoid card readers that are not flush with the face of the ATM
5) Closely monitor your account statements for unauthorized transactions

Organized criminal groups operate throughout Italy, but are more prevalent in the south.
They occasionally resort to violence to intimidate or to settle disputes.
Though the activities of such groups are not generally targeted at tourists, visitors should be aware that innocent by-standers could be injured.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm.

According to Italian Law (Law 80 of May 14, 2005), anyone caught buying counterfeit goods (for example, DVD’s, CD’s, watches, purses, bags, belts, sunglasses, etc.) is subject to a fine of no less than EUR 1,000.
Police in major Italian cities enforce this law to varying degrees.
Travelers are advised to purchase products only from stores and other licensed retailers to avoid unknowingly buying counterfeit and illegal merchandise.

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.
Lost or stolen credit cards present risk of identity theft and should be cancelled immediately.
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.

The local equivalent to the “911” emergency line in Italy is: 113.
Please see our information on 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 of 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 Italian law, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use or trafficking in illegal drugs in Italy are severe and convicted offenders can expect long 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:
Strikes and other work stoppages occur frequently in the transportation sector (national airlines, airports, trains, and bus lines).
Most are announced in advance and are of short duration.
Information on strikes may be found at http://www.infrastrutture.gov.it/page/NuovoSito/site.php.
Reconfirmation of domestic and international flight reservations is highly recommended.

U. S citizens using public transportation while in Italy are reminded they must adhere to local transportation laws and regulations. Travelers must purchase train tickets and validate them by punching them in validating machines usually located near the entrance of train tracks prior to boarding.
Failure to follow this procedure may result in an on-the-spot fine by an inspector on the train. Travelers must purchase bus tickets prior to boarding and validate them immediately after boarding. Tickets may be purchased at tobacco stores or kiosks. Failure to follow this procedure may result in an immediate fine imposed by an inspector on the bus. If the violator does not pay the fine on the spot, it will automatically double and will be forwarded to the violator’s home address.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are available, but may be limited outside urban areas.
Public hospitals, though generally free of charge for emergency services, sometimes do not maintain the same standards as hospitals in the United States, so travelers are encouraged to obtain insurance that would cover a stay in a private Italian hospital or clinic.
It is almost impossible to obtain an itemized hospital bill from public hospitals, as required by many U.S. insurance companies, because the Italian National Health Service charges one inclusive rate (care services, bed and board).

In parts of southern Italy, the lack of adequate trash disposal and incineration sites has led to periodic accumulations of garbage in urban and rural areas.
In some cases, residents have burned garbage, resulting in toxic emissions that can aggravate respiratory problems.
The U.S. Navy initiated a public health evaluation in the Naples area in 2008.
Updates on that evaluation can be found at http://www.nsa.naples.navy.mil/risk.
After finding levels of bacterial and chemical contamination of potential health concern, particularly in samples of area well water, the Navy recommended all personnel living off-base in the Naples area use only bottled water for drinking, cooking, ice-making, and brushing teeth.
For more information on safe food and water precautions, see the CDC’s web site below.

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

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 Italy is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Streets in historic city centers are often narrow, winding and congested.
Motor scooters are very popular and drivers often see themselves as exempt from conventions that apply to automobiles. Travelers who rent scooters should be particularly cautious.
Pedestrians and drivers should be constantly alert to the possibility of scooters’ sudden presence.
Most vehicle-related deaths and injuries involve pedestrians or cyclists who are involved in collisions with scooters or other vehicles.
U.S. citizens should remain vigilant and alert while walking or cycling near traffic.
Pedestrians should be careful, as sidewalks can be extremely congested and uneven.
Drivers of bicycles, motorcycles, and other vehicles routinely ignore traffic signals and traffic flows and park and drive on sidewalks.
For safety, pedestrians should look carefully in both directions before crossing streets, even when using a marked crosswalk with a green avanti ("walk") light illuminated.

Traffic lights are limited, often disobeyed, and a different convention of right-of-way is observed.
Italy has over 5,600 kilometers (3,480 mi.) of Autostrada, or superhighways.
Commercial and individual vehicles travel and pass on these well-maintained roads at very high speeds.
Accidents occur in which contributing factors include excessive speed, alcohol/drug use, and/or sleepiness of long-distance drivers.
Italy has one of the highest rates of car accident deaths in the European Union.

In rural areas, a wide range of speed on highways makes for hazardous driving.
Roads are generally narrow and often have no guardrails.
Travelers in northern Italy, especially in winter, should be aware of fog and poor visibility, responsible for multiple-car accidents each year.
Most Italian automobiles are equipped with special fog lights.
Roadside assistance in Italy is excellent on the well-maintained toll roads, but limited on secondary roads.
Use of safety belts and child restraining devices is mandatory and headlights should be on at all times outside of urban areas.

U.S. citizens driving in Italy are reminded that they must adhere to the local driving laws and regulations.
Vehicle traffic in some historic downtown areas of cities and towns throughout Italy is limited by a system of permits (called “ZTL” and functioning the same way as an EasyPass system in the United States might on the freeway).
Cameras record the license plates of cars driving in parts of the city that require a permit.
Although most of the automated verification stations are clearly marked, if a driver passes one it is impossible to know at the time that a violation occurred or has been recorded.
Violators are not pulled over or stopped, and there is no personal contact with a police officer.
Whenever possible, the fines imposed for these violations are forwarded to the driver’s home in the United States to request payment.
The fines are cumulative for each time a driver passes a control point.
A similar system of automated traffic control cameras is in place in many parts of the highway system and is used to ticket speeding violations.

U.S. citizens driving in Italy should also note that, according to Italian regulation, if a resident of a non-European Union country (e.g. the United States) violates a traffic law, the violator must pay the fine at the time the violation occurs to the police officer issuing the ticket.
If the citizen does not or cannot pay the fine at the time, Italian regulation allows the police officer to confiscate the offender’s vehicle (even if the vehicle is a rental vehicle).

For specific information concerning Italian driving permits, vehicle inspection, road tax and mandatory insurance, contact the Italian Government Tourist Board (ENIT) offices via the Internet at: http://www.enit.it, tel: 212-245-4822 or the A.C.I. (Automobile Club Italiano) at Via Magenta 5, 00185 Rome, tel: 39-06-4477.
For information on obtaining international drivers licenses, contact AAA or the American Automobile Touring Alliance.

Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office at http://www.italiantourism.com and national authority responsible for road safety at http://www.infrastrutturetrasporti.it.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) assessed the Government of Italy’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Italy'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.

DISASTER PREPAREDNESS:
Several major earthquake fault lines cross Italy.
Principal Italian cities, with the exception of Naples, do not lie near these faults, but smaller tourist towns, like Assisi, do and experience earthquakes.
General information about disaster preparedness is available online from the U.S. Federal Management Agency (FEMA) at http://www.fema.gov.
Detailed information on Italy's earthquake fault lines is available from the U.S. Geological Survey (USGS) at http://www.usgs.gov
Italy also has several active volcanoes generating geothermal events.
Mt. Etna, on the eastern tip of the island of Sicily, has been erupting intermittently since 2000.
Mt. Vesuvius, located near Naples, is currently capped and not active.
Activity at Mt. Vesuvius is monitored by an active seismic network and sensor system, and no recent seismic activity has been recorded.
Two of Italy's smaller islands, Stromboli and Vulcano in the Aeolian Island chain north of Sicily, also have active volcanoes with lava flows.
Detailed information on volcano activity in Italy is available from the U.S. Geological Survey (USGS) at http://www.usgs.gov.

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

REGISTRATION / EMBASSY AND CONSULATE LOCATIONS:
Americans living or traveling in Italy are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, so they can obtain updated information on travel and security within Italy.
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 Via V. Veneto 119/A, tel.: 39-06-46741 and fax: 39-06-4674-2217; web site: http://italy.usembassy.gov/english/.

The U.S. Consulates are located in:
Florence:
Lungarno Amerigo Vespucci 38, tel: 39-055-266-951, consular fax: 399-055-215-550;
Milan:
Via Principe Amedeo 2/10, tel: 39-02-290-351, and fax:
39-02-290-35-273;
Naples:
Piazza della Repubblica, tel:
39-081-583-8111, and consular fax:
39-081-583-8275.

There are U.S. Consular Agents located in:
Genoa:
Via Dante 2, tel:
39-010-584-492, and fax: 39-010-553-3033;
Palermo:
Via Vaccarini 1, tel:
39-091-305-857, and fax:
39-091-625-6026;
Venice:
Viale Galileo Galilei, 30, tel: 39-041-541-5944, and fax: 39-041-541-6654.
* * *
This replaces the Consular Information Sheet dated June 10, 2008, to update the sections onSafety and Security and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

More ...

Mozambique

Mozambique US Consular Information Sheet
July 15, 2008
COUNTRY DESCRIPTION:
Mozambique is a developing country in southern Africa which has steadily rebuilt its economy and civic institutions since ending a 16-year civil war in 1992.
he country stabilized following Mozambique's first multi-party elections in October 1994, and a new president was elected in December 2004.
Despite high economic growth rates in recent years, Mozambique remains among the world's poorest countries.
Facilities for tourism in Maputo, the capital city, are steadily improving but remain limited in other areas as many of the goods and services taken for granted in other countries are not yet available.
The official language is Portuguese, although English is spoken in many tourist areas, and in some rural areas only local languages are widely spoken.
Read the Department of State Background Notes on Mozambique for additional information.
ENTRY/EXIT REQUIREMENTS:
A visa is required for entry into Mozambique.
It is recommended that travelers acquire the appropriate visa prior to departing for Mozambique, although a one-entry visa can be obtained at country points of entry, including airports.
Foreigners in Mozambique without a valid visa can expect to pay a substantial fine for each day they are in Mozambique illegally.
The fine can be assessed upon departure or if caught while in Mozambique by authorities.
The passports of all travelers who wish to enter Mozambique must be valid for six months upon arrival and must contain at least three clean (unstamped) visa pages each time entry is sought.
The Mozambican Embassy and Consulates in South Africa charge up to five times the amount charged in the U.S. or at border crossing points for a tourist visa to Mozambique.
In September 2007 the Mozambican Interior and Health Ministries decreed that all travelers entering Mozambique, having previously visited a country where yellow fever is present, must present a valid certification of vaccination against yellow fever.
We recommend all travelers be vaccinated to avoid complications at the border.
Any passenger who cannot present such a certificate at the port of entry will be vaccinated at a cost of $50 US dollars or the equivalent in metical.
Additionally, all travelers entering Mozambique must carry their yellow vaccination book.
For further information on entry requirements, contact the Embassy of Mozambique located at 1525 New Hampshire Avenue NW, Washington, DC 20036, telephone: (202) 293-7146, email: embamoc@aol.com, fax: (202) 835 0245, or the nearest Mozambican embassy or consulate. Visit the Embassy of Mozambique web site at http://www.embamoc-usa.org/ for the most current visa information.

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:
Overland travel after dark is extremely dangerous due to poor road conditions, lack of emergency services, and the increased potential for vehicle hijacking.
Visitors should be particularly vigilant when driving on the main thoroughfares connecting Mozambique and South Africa as incidents of vehicle theft, including assault and robbery, have been reported.
Official Americans serving in Mozambique are prohibited from overland travel outside Maputo city limits after dark and are encouraged to travel in convoys of two or more vehicles when outside of the city during daylight hours.
Accidents involving pedestrians are increasingly common, and some reports suggest pedestrians purposely throw themselves in front of vehicles driven by foreigners in order to extort reparation payment.
Due to residual landmines, overland travelers are advised to remain on well-traveled roads or seek local information before going off-road outside of Maputo and other provincial capitals.
Drivers should obey police signals to stop at checkpoints, which are common throughout Mozambique.
Foreigners in Mozambique for more than 90 days are required to have an International Driver’s License or to obtain a Mozambican driver’s license. Although demonstrations do occur in Mozambique, they are infrequent and there have been no recent demonstrations against U.S. interests.
If any demonstrations do occur, they should be avoided.
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:
Although the vast majority of visitors complete their travels in Mozambique without incident, the most serious threat facing U.S. citizens visiting Mozambique is crime.
Street crimes, including mugging, purse snatching and pick-pocketing are common, both in Maputo and in secondary cities.
Carjacking is increasingly common in Maputo.
Visitors must be vigilant when out in public areas and should not display jewelry or other expensive items.
Isolated areas should be avoided.
Joggers and pedestrians have frequently been mugged, even during daylight hours.
Visitors should take caution when walking at night, even in well-known tourist areas.

Mozambican police are not at the standard U.S. citizens are accustomed to in the United States and visitors should not expect the same level of police service.

Many airline trips from Mozambique to the U.S., Europe, or African destinations transit Johannesburg, South Africa.
Baggage pilferage is an ongoing problem at Johannesburg's Oliver Tambo International Airport.
Travelers are encouraged to secure their luggage, use an airport plastic wrapping service, and avoid placing currency, electronics, jewelry, cameras, cosmetics, running shoes, or other valuables in checked luggage.
Having a complete inventory of items placed in checked baggage can aid in processing a claim if theft does 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, 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.
There is no local equivalent to the “911” emergency line in Mozambique.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are rudimentary, and most medical providers do not speak fluent English.
Medicines are not always consistently available.
There are both public and private medical facilities in the city of Maputo and most provincial capitals.
All health care institutions and providers require payment at the time of service, and may even require payment before service is given.
While some private clinics accept credit cards, many medical facilities do not.
Doctors and hospitals outside Maputo generally expect immediate cash payment for health services.
Outside of Maputo, available medical care ranges from very basic to non-existent.

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

Tuberculosis is an increasingly serious health concern in Mozambique.
For further information, please consult the CDC's Travel Notice on TB
http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.
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:
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 Mozambique is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
The main north-south thoroughfare is passable until the city of Caia (Sofala province), where vehicle passengers must disembark and cross the Zambezi River by ferryboat.
On the north side of the river, the road continues to the Northern provinces.
The road network connecting provincial capitals is in fair condition, but can be riddled with potholes and other obstacles.

The EN4 toll road between Maputo and South Africa is well-maintained.
Official Americans are prohibited from traveling outside cities after dark because of the increased risk of banditry, poor road conditions in some areas, poor maintenance of many vehicles in the country (e.g., no headlights or rear lights), as well as the threat imposed by livestock that graze on roadsides.
Travel outside Maputo often requires a four-wheel drive vehicle, which creates an additional security risk since these vehicles are high-theft items.
Public transportation is limited and often has poor safety standards.
Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office at http://www.turismomocambique.co.mz/.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Mozambique, the U.S. Federal Aviation Administration (FAA) has not assessed Mozambique’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Mozambican law requires that all persons carry an identity document, such as a passport, when out in public, and produce it if requested by police.
Notarized copies of both the biographic page of a passport and a valid Mozambican visa are acceptable forms of identification, although police will occasionally demand original documents.
There are certain areas in Mozambique where pedestrian traffic is prohibited and the ban is strictly enforced.
These areas include the front of the presidential offices located north of the Hotel Polana on the seaside of Avenida Julius Nyerere and the Praça dos Herois on Avenida Acordos de Lusaka near the airport, both in Maputo.

It is against the law to destroy Mozambican currency; offenders can expect a jail sentence or fine.
The limit for an undeclared amount of U.S. dollars one can take out of the country is $5,000.
The limit on local currency is 500 metical, which is approximately 20 U.S. dollars.
Some American travelers have reported having difficulties cashing traveler’s checks and have relied instead on ATMs and credit cards for money withdrawals in Mozambique.
Outside of the major hotels and restaurants, credit cards are not widely accepted in Mozambique.
The South African rand and U.S. dollar are sometimes accepted as legal tender, although this is more common in the southern part of the country or in tourist areas; all transactions must have a local currency (metical) payment option. 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 Mozambique’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Mozambique 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 living or traveling in Mozambique are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Mozambique.
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 in Maputo at 193 Avenida Kenneth Kaunda, telephone (258) 21 49 2797.
The after-hours telephone number for use in emergencies is (258) 21 49 0723.
The Consular Section's fax number is (258) 21 49 0448.
The Consular Section's e-mail address is consularmaputo@state.gov.
The Embassy's web site is http://maputo.usembassy.gov/
*

*

*
This replaces the Country Specific Information for Mozambique dated January 14, 2008, to update sections on Entry/Exit requirements, Information for Victims of Crime, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Sat, 3 Aug 2019 12:59:45 +0200 (METDST)

Maputo, Aug 3, 2019 (AFP) - Mozambique on Saturday set up disease checkpoints along its border with Malawi as a precaution against any spreading of a deadly Ebola outbreak, a senior health ministry official said.   More than 1,800 people have died in eastern Democratic Republic of Congo since Ebola broke out there in August last year.   Mozambique has yet to report an Ebola case, but DRC's regional neighbours have been on high alert while the World Health Organization (WHO) has elevated the crisis to a global health emergency.

Checkpoints began operating in the Milage and Morrumbala districts in the Zambezia province and controls are expected to widen to other provinces of Mozambique that share borders with Malawi, according to a ministry of health official.   "Setting up Ebola checkpoints is a guideline given by decision of the Ministry of Health and World Health Organization to prevent the spread of the disease to other countries" Zambezia province health director, Hidayate Kassim told reporters.   "The checkpoints aim to track all people entering Mozambique having fevers or if they have had contact with anyone who has been in Congo," he said.   "Depending on this control we will determine whether there is a risk or not in our province," Kassim added.   Authorities characterised the screening of people entering Mozambique as a preventive control measure to prepare, prevent, detect and treat any Ebola case that could develop in the country.

The deadliest epidemic of Ebola broke out in West Africa in December 2013 and lasted more than two years, killing more than 11,300 of the 29,000 infected people recorded.   The current one-year old epidemic has left 1,823 dead, according to the DR Congo health ministry, making it second only to the 2013-2016 crisis.   Rwanda on Thursday shuttered its border with DRC after a third case of the deadly virus was detected in the border city of Goma.
Date: Fri 3 May 2019
Source: France24, Agence France-Presse (AFP) [edited]

Provincial authorities said Fri 3 May 2019 that 14 cholera cases have been confirmed in northern Mozambique following floods caused by a powerful cyclone that battered the country last week. The city of Pemba registered 11 cases of the disease while the neighbouring district of Mecufi had 3. "We were already prepared for that -- the healthcare sector has been on the alert since Cyclone Kenneth started," the provincial health director, Anastacia Lidimo, told reporters.

Cyclone Kenneth made landfall in northern Cabo Delgado province on 25 Apr 2019, packing winds up to 220 kilometres (137 miles) per hour -- hitting a region that has not experienced a tropical cyclone in the modern era.

According to the UN humanitarian agency OCHA, Pemba, a city of 200,000 people and the capital of Cabo Delgado province, is in one of the most cholera-endemic regions in Mozambique. In Beira, the impoverished and aid-dependent country administered nearly 900 000 doses of oral cholera vaccines after Cyclone Idai [4-9 Mar 2019] to avert an epidemic.
====================
[Maps of Mozambique:
Date: Fri, 3 May 2019 12:08:16 +0200

Maputo, May 3, 2019 (AFP) - Fourteen  cholera cases have been confirmed in northern Mozambique following floods caused by a powerful cyclone that battered the country last week, provincial authorities said Friday.   The city of Pemba registered 11 cases of the disease while the neighbouring district of Mecufi had three.   "We were already prepared for that - the health care sector has been on the alert since Cyclone Kenneth started," the provincial health director, Anastacia Lidimo, told reporters.

Cyclone Kenneth made landfall in northern Cabo Delgado province on April 25, packing winds up to 220 kilometres (137 miles) per hour -- hitting a region that has not experienced a tropical cyclone in the modern era.   It killed at least 41 people, with some 226,000 affected, destroyed thousands of homes and wrecked water supply systems.   It was the second massive storm to hit Mozambique in six weeks after Cyclone Idai devastated the port city of Beira 1,000 kilometres (600 miles) to the south, causing huge floods and more than 600 deaths.    Cholera is transmitted through contaminated drinking water or food and causes acute diarrhoea.

According to the UN humanitarian agency OCHA, Pemba, a city of 200,000 people and the capital of Cabo Delgado province, is in one of the most cholera-endemic regions in Mozambique.   In Beira, the impoverished and aid-dependent country administered nearly 900,000 doses of oral cholera vaccines after Cyclone Idai to avert an epidemic.    At least four deaths from cholera were recorded in Beira and surrounding districts out of 4,979 cases.
Date: Wed, 24 Apr 2019 19:23:46 +0200

Moroni, Comoros, April 24, 2019 (AFP) - Violent winds caused landslides and flooding and cut off roads in Comoros in the vanguard of tropical storm Kenneth, set to hit Wednesday evening before heading to recently cyclone-ravaged Mozambique, officials said.   As the storm neared, schools were closed and inter-island hopper flight suspended.    Chief of the Comoros Centre for Relief and Civil Protection Centre (COSEP) Mouigni Daho said the arrival of the cyclone on the island was preceded by strong winds and floods.    There have been no reports of injuries.   Comoros Interior Minister Mohamed "Kiki" Daoudou urged citizens Wednesday to "stay calm and follow the instructions."

After Comoros, Kenneth is expected to reach the far north of Mozambique late Thursday or early Friday, if it stays on its current course.   This comes a month after cyclone Idai ravaged the country and neighbouring Zimbabwe, claiming some 1,000 lives and causing about $2 billion in damage, according to the World Bank.   The Mozambique National Meteorology Institute (INAM) warned in a statement that the storm system was intensifying.    "The severe tropical storm has intensified in the past few hours into a Category Three tropical cyclone, and forecasts project that the cyclone could intensify to a Category Four on April 25," it said.

Heavy rains and winds of up to 140 kilometres per hour (87 miles per hour) would follow, it added.   Mozambique's National Institute of Disaster Management (INGC) cautioned Wednesday that 692,000 people could be affected.    The INGC said it would relocate rescue equipment, including boats and helicopters previously reserved in Sofala province for victims of Idai, to Cabo Delgado where Kenneth is expected.   "We have water, we have a generator, we are prepared. We've done everything we were told to," said a hotel owner in the small town of Mucojo which is projected to be close to the eye of the cyclone.

- 'Concerned' -
"We've learned with Idai that it's a good strategy to allocate the rescue means before the cyclone..." Augusto Maita, general director of INGC told AFP.   The province of Cabo Delgado, bordering Tanzania, is also dealing since 2017 with a wave of deadly violence attributed to a jihadist group that advocates the application of Islamic law.   Volunteers of the Red Cross and Red Crescent, who had assisted in cyclone Idai rescue efforts, said teams were already "on alert".   "We are concerned about the impact that this storm could have across the three countries," regional director for Africa for the International Federation of Red Cross and Red Crescent Societies (IFC), Dr Fatoumata Nafo-Traore said.   "We are especially concerned about its possible impact in Mozambique where communities are still recovering from the devastation of Cyclone Idai," she said.   In Mozambique alone, Idai killed more than 600 people and affected 1.85 million, while over 340 died in Zimbabwe.   "Typically cyclones occur in the rainy season which is already over. This cyclone at the end of April is unusual," Comoros environment ministry expert Youssouf Hamadi told AFP.   "It confirms the increasing intensity and frequency of cyclones in the Indian Ocean" -- a phenomenon some blame on global warming.
Date: Tue, 23 Apr 2019 17:10:55 +0200

Maputo, April 23, 2019 (AFP) - A tropical system off Mozambique threatens to unleash a cyclone on the northern Cabo Delgado province just weeks after the country's central parts were ravaged by a powerful storm, meteorologists warned Tuesday.   The poor southern African country is still reeling from the impact of deadly cyclone Idai -- the most powerful storm to hit the region in recent decades -- which left about 1,000 dead in Mozambique and Zimbabwe.   The storm is forecast to make landfall late this week in Cabo Delgado province, reeling from violence at the hands of Islamists who have been terrorising villagers in remote communities for the past 18 months.   "The (weather) system we are talking about was a low pressure and today evolved into tropical depression," Aniceto Tembe, spokesman for the Mozambique Meteorology Institute told AFP in the capital Maputo.

The depression was north of Madagascar island Tuesday, approaching the Mozambique Channel where warm conditions are conducive for it to grow into a cyclone.    "We are projecting that a severe tropical cyclone may arrive and if the conditions allow it can even reach Category 3 tropical cyclone" strength -- with winds of between 140 and 160 kilometres (87 to 99 miles) per hour, he added.   "The projections indicate that the system will approach the coast of Mozambique... mainly the northern part of Cabo Delgado and the southern part of Tanzania," Tembe told AFP.   In a statement Monday, the public works ministry issued a warning of strong winds and heavy rains that could cause flooding and destruction of property in the province of Cabo Delgado and its southern neighbouring province of Nampula.   It said 80,000 people were at risk.

The centre for disaster management issued a warning Tuesday of a tropical storm with wind speeds of between 80 and 120 kilometres per hour, expected to make landfall Friday in the gas-rich district of Palma, the nerve centre of Mozambique's nascent gas industry.   Hardline Islamists have launched several deadly attacks in the Muslim-majority, oil and gas-rich Cabo Delgado province in the past year, killing about 200 people, beheading some of them, and forcing thousands from their homes.   Last month Cyclone Idai cut a path of destruction through Mozambique, Malawi and Zimbabwe on the night of March 14-15, causing damage worth about $2 billion, according to the World Bank.   In Mozambique alone, more than 600 people died among the 1.85 million affected, while over 340 died in Zimbabwe.
More ...

Congo, Republic of the

Republic of Congo US Consular Information Sheet
August 29, 2008
COUNTRY DESCRIPTION:
The Republic of the Congo (Congo-Brazzaville) is a developing nation in central Africa. The official language is French. The largest cities are the capita
, Brazzaville, on the Congo River, and Pointe Noire on the coast. Civil conflict in 1997 and again in 1998-99 damaged parts of the capital and large areas in the south of the country. The last rebel group still engaged in armed struggled signed a cease-fire accord with the government in March 2003. Facilities for tourism are very limited. Read the Department of State Background Notes on the Republic of the Congo (Brazzaville) for additional information.
ENTRY/EXIT REQUIREMENTS: A passport, visa and evidence of yellow fever vaccination are required for entry. Additional information on entry requirements may be obtained from the Embassy of the Republic of the Congo, 4891 Colorado Avenue NW, Washington, DC 20011, telephone (202) 726-5500, or from the Permanent Mission of the Republic of the Congo to the United Nations, 14 E. 65th St., New York, NY, 10021, telephone (212) 744-7840. Overseas, inquiries should be made at the nearest Congolese embassy or consulate.
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:
As a result of past conflicts, there is extensive damage to the infrastructure in Brazzaville and in the southern part of the country, and the government is working to reconstruct roads and buildings. Fighting broke out in March and June of 2002 when rebel groups launched attacks first in the Pool region, and later, at the Brazzaville airport. The fighting in Brazzaville was quickly contained and the rebels were repulsed. In March 2003, the rebels and the government signed a cease-fire accord, which remains in effect, although there was some violence in Brazzaville in December 2003.

Occasionally, political unrest in neighboring Kinshasa can affect Brazzaville on the other side of the Congo River. For example, in 2007, stray small arms fire originating in Kinshasa landed in Brazzaville.

Continued security awareness remains a key consideration for all visitors. Night travel outside of cities should be avoided. U.S. citizens should avoid political rallies and street demonstrations and maintain security awareness at all times.
In the event of a fire, call the fire brigade at 81-53-87.
The Department of State suspended operations at the U.S. Embassy in Brazzaville in 1997. The Brazzaville U.S. Embassy interim offices are located in the B.D.E.A.C (Central African Development Bank) building in Brazzaville. A new embassy compound is under construction and slated to open in 2009. While Brazzaville is still not fully open for normal operations, Embassy personnel are present in Brazzaville to provide information and guidance to American citizens. Staff can be contacted through the Embassy’s interim offices (see Registration/Embassy Location section below). The reduced staff in Brazzaville has limited ability to provide emergency services and non-emergency services generally take a few days to coordinate through Embassy Kinshasa.
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 pamphletA Safe Trip Abroad.

CRIME: In the Congo, petty street crime targeting foreigners is rare. Incidents of mugging and pick pocketing happen frequently near the ports in Pointe Noire and Brazzaville, and sometimes in the Congolese neighborhoods surrounding Brazzaville's city center.

Criminal elements are known to target middle-class and affluent residences without 24-hour guards for burglary. Roadblocks and robberies by armed groups targeting travelers occur in the Pool region south of Brazzaville. Travel to the Pool region is discouraged due to these elements.

Travelers should note that in the case of theft and robbery, legal recourse is limited and therefore, they may wish to leave all valuable items at home.

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 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.

While there is no local equivalent to the “911” emergency line in Republic of the Congo, the Rapid Response Police Team can be reached at 665-4804. However, police resources are limited and response to emergency calls is often slow (15 minutes or longer).

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities are extremely limited. Some medicines are in short supply, particularly outside the larger cities. Travelers should carry their own supply of properly labeled medications.
Malaria is a serious and sometimes fatal disease. Plasmodium falciparum malaria, the type that predominates in the Congo, is resistant to the antimalarial drug chloroquine. Because travelers to the Republic of the Congo are at high risk for contracting malaria, the Centers for Disease Control and Prevention (CDC) advises that travelers should take one of the following antimalarial drugs: mefloquine (Lariam™), doxycycline, or atovaquone/proguanil (Malarone™). Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what antimalarials they have been taking. For additional information on malaria, including protective measures, see the CDC Travelers’ Health web site at http://wwwn.cdc.gov/travel/yellowBookCh4-Malaria.aspx/.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of the DRC.

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: 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 Republic of the Congo is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Road conditions are generally poor and deteriorate significantly during the rainy season, November-May. Maintenance of the few paved roads is limited. Overland travel off the main roads requires a four-wheel drive vehicle. Poorly marked checkpoints, sometimes manned by undisciplined soldiers, exist in many areas of the countryside.

Taxis are considered an acceptable mode of transport due to availability and low cost. Registered public transportation vehicles are painted green with white roofs and striping. Security is not generally an issue with taxis but buses are often overcrowded and thus less secure. Mechanical reliability of both vehicle types remains in question.
Traffic safety in general is hazardous due to high speeds, aggressive driving, poorly maintained vehicles and general apathy for pedestrians and cyclists.

Roads are narrow, dangerously potholed, frequently wash out during rainy season and are often full of debris, and pedestrians.
Emergency services are limited. Please refer to the medical section above.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in the Republic of the Congo, the U.S. Federal Aviation Administration (FAA) has not assessed the Republic of the Congo’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Ferry service between Brazzaville and Kinshasa normally operates from 8 A.M. to 4 P.M. Monday through Saturday and 8 A.M. to 12 P.M. Sunday, but it may close completely with minimal notice. A special exit permit from the Republic of the Congo’s Immigration Service and a visa from the Democratic Republic of the Congo’s embassy/consulate are required to cross the Congo River from Brazzaville to Kinshasa. Passenger travel on the railroad is discouraged, as there are frequent reports of extortion by undisciplined security forces and robberies by criminal elements along the route.
The Congo is primarily a cash economy and uses the Central African Franc (CFA), a common currency with Gabon, Chad, Cameroon, the Central African Republic, and Equatorial Guinea. U.S. dollars may be exchanged for local currency. Traveler’s checks can be cashed for a fee at some hotels. Two hotels in Brazzaville, and several in Pointe Noire, accept major credit cards, but prefer payment in cash. Prices are usually quoted in CFA or Euros. Other businesses do not normally accept credit cards. Personal checks drawn on foreign accounts are not accepted. Western Union has offices in Brazzaville and Pointe Noire, and one bank in Brazzaville has an ATM.
Airport police and customs officials routinely inspect incoming and outgoing luggage, even for internal travel. For a complete list of prohibited items, please contact the nearest Congolese embassy or consulate. Please see our Customs Information.
Local security forces in areas outside Brazzaville and Pointe Noire may detain foreigners to solicit bribes. Detention of U.S. citizens, particularly in remote areas, may not always be promptly reported to the U.S. Government by Congolese authorities. U.S. citizens are encouraged to carry a copy of their passports with them at all times so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available. If detained or arrested, U.S. citizens should always ask to be allowed to contact the U.S. Embassy. Please see the Registration/Embassy Location section below.
In general there are no restrictions on photography; however photographs of government buildings or military installations, port facilities or the airport should not be taken. When photographing human beings in remote areas where populations adhere to traditional beliefs, it is best to request permission first. If permission is refused, the photo should not be taken.
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 Republic of the Congo’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Republic of the Congo 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 living or traveling in Republic of the Congo are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Republic of the Congo. Americans withoutInternet 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 in Brazzaville has interim offices located in the B.D.E.A.C Building, 4th Floor, Place du Gouvernement, Plateau de Centre Ville, Brazzaville. The web site is http://brazzaville.usembassy.gov. The telephone number during regular business hours (7:30 am until 4:30 pm, Monday through Friday) is 242-81-14-81; email is Consular.Brazzaville@state.gov. For after-hours emergencies, call the U.S. Embassy in Kinshasa (see below).

The U.S. Embassy in Kinshasa, Democratic Republic of the Congo (DRC) is located at 310 Avenue des Aviateurs, Gombe; tel. 243-(0)81-225-5872 (do not dial the zero when calling from abroad into the DRC). Entrance to the Consular Section of the U.S. Embassy in Kinshasa is on Avenue Dumi, opposite Ste. Anne residence. The Consular Section of the Embassy in Kinshasa may be reached at cellular tel. 243-(0)81-884-4609, 243-(0)81-884-6859 or 243-(0)81-225-5872; fax 243-(0)81-301-0560. For after-hours emergencies, use 243-81-225-5872. (Cellular phones are the norm, as other telephone service is often unreliable).
* * *
This replaces the Country Specific Information for Republic of the Congo dated August 20, 2008 to update the section on Safety and Security.

Travel News Headlines WORLD NEWS

Date: Tue, 17 Dec 2019 15:29:01 +0100 (MET)

Brazzaville, Dec 17, 2019 (AFP) - The Republic of Congo on Tuesday appealed for help after 150,000 people in the north of the country were hit by rains that flooded homes, destroyed fields and swept away cattle.   President Denis Sassou Nguesso said he was making an "urgent appeal to the international community" to help provide "a more effective response to the humanitarian situation which has arisen."

Sassou Nguesso, who made the call in his annual state-of-the-nation speech to parliament, blamed "climatic disruption" for the disaster.   The flooding has badly affected people living on the banks of the Congo and one of its tributaries, the Ubangi.   The European Union (EU) on Monday announced humanitarian aid of one million euros ($1.12 million), which will be shared with the neighbouring Democratic Republic of Congo (DRC), which has also been hit.
Date: Thu, 3 Oct 2019 16:35:31 +0200 (METDST)

Brazzaville, Oct 3, 2019 (AFP) - The Republic of Congo on Thursday launched a campaign to distribute anti-malaria bed nets to more than 90 percent of the nation's households.   More than three million insecticide-treated nets will be distributed over the five-day operation, initiated by Prime Minister Clement Mouamba in the capital Brazzaville.

The cost of the operation, put at 12 million euros ($13.39 million), is being met by the Global Fund to Fight AIDS, Tuberculosis and Malaria.   Health Minister Jacqueline Lydia Mikolo said malaria was the prime cause of death among children aged under five, and the disease was a major cause of absence from school.   Insecticide-treated nets are a time-honoured but highly effective way of preventing transmission of the mosquito-borne malarial parasite.   The last major net distribution in the Republic of Congo was 2012.
Date: Wed 26 Sep 2018
Source: WHO Relief Web [edited]

The Republic of Congo, in collaboration with the World Health Organization (WHO) and partners, started today [26 Sep 2018] a vaccination campaign to control the spread of yellow fever in the port city of Pointe Noire and surrounding areas. More than one million people from 9 months of age are expected to be vaccinated in this 6-day campaign.

The vaccination campaign uses doses from the global emergency yellow fever vaccine stockpile managed by the International Coordination Group on Vaccine Provision (ICG) and funded by Gavi, the Vaccine Alliance. The ICG coordinates the timely and equitable provision of vaccines during outbreaks and maintains an emergency stockpile of 6 million doses of yellow fever vaccine, which is continually replenished. Gavi will also cover operational costs for this campaign.

The immunization drive is a response to a laboratory-confirmed yellow fever case, which tested positive on 21 Aug 2018, after the person visited a rural area. Since then, no other case has been confirmed in the country, but more than 200 suspected cases have been reported since the beginning of the year [2018], with most of these notified by the health authority in Pointe Noire. It is possible that there are also undetected cases, as a large proportion of the Pointe Noire population seeks care in the private system; therefore, the national surveillance system may not be receiving notification.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes that can be deadly but is prevented by an extremely effective vaccine. Urban outbreaks are of particular concern, and Pointe Noire is the country's economic capital, with a population of more than one million people. After declining for many years, yellow fever outbreaks are on the rise globally. The ease and speed of population movements, rapid urbanization and a resurgence of mosquitoes because of global warming have significantly increased the risk of urban outbreaks with international spread.

"Yellow fever has re-emerged as a public health threat in recent years in the African region," said Dr. Ibrahima Soce Fall, WHO's Emergencies Director for Africa. "However, the vaccine is safe and provides life-long immunity. This reactive vaccination campaign is focusing on people who are most at risk and will set up a firewall which will prevent the virus from spreading further."

The neighbouring Democratic Republic of the Congo has shown solidarity with the Republic of Congo by lending more than 700 000 syringes for the vaccination campaign while Pointe Noire health authorities wait for syringes to arrive from the international stockpile next month [October 2018].

The response to this outbreak is part of a comprehensive strategy to eliminate yellow fever epidemics (EYE) globally by 2026. WHO, UNICEF, Gavi, and more than 50 partners are supporting the Government of Congo and 39 other high-risk countries to assess epidemic risk, roll out vaccination campaigns, engage with communities and deliver other response activities, including surveillance and laboratory diagnosis.

Nationwide preventive actions are also needed to ensure the protection of the entire population at risk. Rapid outbreak detection and response and long-term prevention are integral to a sustained control of yellow fever. As part of the EYE Strategy, more than 4 million additional people are expected to be vaccinated in preventive mass campaigns in the Republic of Congo over the few next years.
=====================
[It is encouraging to see that components of a large yellow fever (YF) vaccination campaign have come together to start the effort 2 days ago [26 Sep 2018]. Although there is only one confirmed YF case, considering the 200 suspected cases and the risk of rapid YF virus spread in Pointe Noir, a city with a dense and susceptible human population and abundant mosquito vectors, the vaccination campaign is prudent. A recent report indicated that entomological surveys in the affected area have revealed high densities of mosquito vectors (_Aedes aegypti_) responsible for urban YF transmission, signaling the potential for human-to-human transmission via _Aedes aegypti_ and rapid amplification. Larval sites have been found around the homes of suspected cases, and this situation could worsen with the arrival of the rainy season. WHO is supporting the Ministry of Health and Population in implementing targeted vector control activities for adult mosquitoes and larvae within a 200-metre [660-foot] perimeter of areas where the confirmed case-patient lives and works. YF outbreaks under conditions like these can spread rapidly and get out of control, as occurred in Angola with spillover into the Democratic Republic of the Congo. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Republic of Congo: <http://healthmap.org/promed/p/166>]
Date: Tue 25 Sep 2018
Source: Africa News [edited]
<http://www.africanews.com/2018/09/25/congo-to-launch-immunization-against-yellow-fever-outbreak-the-morning-call/>

On Thursday [27 Sep 2018], the government of the Republic of Congo will begin what it calls a robust and coordinated response against the yellow fever outbreak recorded in some parts of the country. The planned response follows the health ministry's warning last month [August 2018] of "an emerging event of epidemic proportions." According to the head of the government's epidemics unit, Lambert Kitembo, 186 suspected cases of yellow fever have been detected this year [2018], many of which were reported in the western commercial hub of Pointe Noire. [Byline: Jerry Bambi]
===================
[The numbers of reported yellow fever cases in the Republic of the Congo (RC) is growing, especially in the Pointe-Noire area. Pointe-Noire is a port city and oil industry hub with an international airport and links to other large cities. A previous report indicated that a retrospective search in 16 health centre registers in Pointe-Noire found 69 additional suspected cases during 2018 that meet the clinical case definition for yellow fever; 56 of the suspected cases were already recorded in the national surveillance system. Of these, 2 of the suspected cases reported staying in Angola.

The above report indicates that there are now 186 suspected cases. A recent WHO risk assessment reported that the overall public health risk at the national level is high due to the confirmation of a yellow fever case in the densely populated urban city of Pointe Noire (‎1.2 million inhabitants), with suboptimal immunization coverage in the affected community and the potential risk of spread within the Congo, especially to the capital city of Brazzaville.

The Ministry of Health and Population (MoHP) declared a yellow fever outbreak in Pointe Noire on 22 Aug 2018, and the national committee for outbreak management was promptly activated. WHO was notified on 23 Aug 2018, in line with the International Health Regulations (IHR 2005). A recent report indicated that entomological surveys in the affected area have revealed high densities of mosquito vectors (_Aedes aegypti_) responsible for urban yellow fever transmission, signalling the potential for human-to-human transmission and rapid amplification. Larval sites have been found around the homes of suspected cases, and this situation could worsen with the arrival of the rainy season.

WHO is supporting the MoHP in implementing targeted vector control activities for adult mosquitoes and larvae within a 200-metre [660 foot] perimeter of areas where the confirmed case-patient lives and works. It is difficult to assess the risk of an ongoing outbreak without knowing the proportion of the unvaccinated population in the areas where the cases occurred. One hopes that the planned vigorous vaccination campaign will be initiated as planned this week. Yellow fever outbreaks can quickly get out of hand, as occurred in Angola and the DRC in 2016-2017.

Frequent movement of individuals across borders of neighbouring countries and beyond underscores the need for prompt action to prevent spread. - ProMED Mod.TY]

[HealthMap/ProMED map available at: Republic of Congo: <http://healthmap.org/promed/p/166>]
Disease outbreak news
7 September 2018

Event Description
On 5 July 2018, a 20-year-old male living in Bissongo, Republic of the Congo, visited Bissongo health centre in the Loandjili District of Pointe-Noire City, with a fever he had developed the previous day. On 9 July, due to the onset of jaundice and persistent fever, he returned to the same health facility. The patient did not have a history of yellow fever vaccination or haemorrhagic symptoms. The patient had previously travelled to Ngoyo and Tchiamba Nzassi districts two weeks prior to symptom onset; Tchiamba Nzassi is a rural district in Pointe-Noire located along the border with Angola.

He was admitted to the health facility and received antimalarial and antibiotic treatments. As yellow fever was also suspected as a differential diagnosis, a blood sample was collected on 10 July and sent to Institut National de Recherche Biomédicale (INRB) in Kinshasa, Democratic Republic of the Congo, for testing; on 26 July, the sample tested positive for yellow fever by serology. On 30 July, INRB sent a sample to Institut Pasteur de Dakar for confirmation; on 21 August, the sample tested positive for yellow fever by seroneutralization with a high titre.

Following the confirmation of yellow fever, an investigation was conducted in the affected area. A retrospective search in 16 health centre registers in Pointe-Noire found 69 additional suspected cases during 2018 which meet the clinical case definition for yellow fever; 56 of the suspected cases were already recorded in the national surveillance system. Two of the suspected cases reported staying in Angola. Samples were collected from 43 of these cases and sent to INRB; all samples tested negative for yellow fever. Entomological surveys in the affected area have revealed high densities of mosquito vectors (Aedes aegypti) responsible for urban yellow fever transmission, signalling the potential for human-to-human transmission and rapid amplification. Larval sites have been found around the homes of suspected cases, and this situation could worsen with the arrival of the rainy season.

Public health response

The Ministry of Health and Population (MoHP) declared a yellow fever outbreak in Pointe-Noire on 22 August 2018 and the national committee for outbreak management was promptly activated. WHO was notified on 23 August 2018 in line with the International Health Regulations (IHR 2005).

WHO is supporting the country in the preparation of an emergency response plan and an International Coordinating Group (ICG) request for supplies for a reactive mass vaccination campaign targeting the Pointe-Noire area, which has a population of approximately one million people. WHO is also supporting resource mobilization activities, as the country is not eligible for Gavi support.

WHO is supporting the MoHP in implementing targeted vector control activities for adult mosquitoes and larvae within a 200-metre perimeter of areas where the confirmed case-patient lives and works. WHO is also providing technical support to strengthen surveillance at points of entry, case management, and public awareness, as well as recommending the use of mosquito nets during the day time.

WHO risk assessment

The overall public health risk at the national level is high due to the confirmation of a yellow fever case in a densely populated urban city of Pointe-Noire (‎1.2 million inhabitants), with suboptimal immunization coverage in the affected community and the potential risk of spread within the Congo, especially to the capital city of Brazzaville. Entomological surveys in the affected area revealed high densities of Aedes aegypti, responsible for urban transmission of yellow fever, signalling the potential for rapid amplification. The approaching rainy season may potentially increase this risk. Thus, the risk of an urban epidemic needs to be mitigated urgently, although there is no indication of active urban transmission according to the information available.

The risk at the regional level is considered to be moderate due to the lack of information to describe the scope and the dynamics of the outbreak, as well as because of cross-border movements, particularly between to and from Gabon and Cabinda in Angola. Pointe-Noire is a port city and oil industry hub with an international airport and links to other large cities. Angola and the Democratic Republic of the Congo have recently conducted mass preventive and reactive yellow fever vaccination campaigns, respectively. However, population immunity levels in the Democratic Republic of the Congo are low in the zones not targeted by the 2016 reactive campaigns, such as the areas neighbouring Pointe-Noire. No other yellow fever cases related to the outbreak in Pointe-Noire have been reported outside the country at this stage.

The risk at the global level is considered low. Risks need to be closely monitored and regularly reassessed.

WHO Recommendations

Vaccination is the primary means for prevention and control of yellow fever. In urban centres, targeted vector control measures are also helpful to interrupt transmission. WHO and partners will continue to support local authorities to implement these interventions to control the current outbreak.

WHO recommends vaccination against yellow fever for all international travellers above nine months of age going to the Republic of the Congo, as there is evidence of yellow fever virus transmission. The Republic of the Congo also requires a yellow fever vaccination certificate for all travellers aged 9 months or older . Yellow fever vaccination is safe, highly effective and provides life-long protection. In accordance with the IHR (2005), the validity of the international certificate of vaccination against yellow fever extends to the life of the person vaccinated. A booster dose of yellow fever vaccine cannot be required of international travellers as a condition of entry.

WHO encourages its Member States to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination. Travellers should also be made aware of yellow fever symptoms and signs and instructed to rapidly seek medical advice when presenting with these. Viraemic returning travellers may pose a risk for the establishment of local cycles of yellow fever transmission in areas where the competent vector is present.

WHO advises against the application of any restrictions on travel or trade to the Republic of the Congo in relation to this outbreak, based on the information currently available.
More ...

Ukraine

Ukraine - US Consular Information Sheet
March 28, 2008
COUNTRY DESCRIPTION:
Ukraine is undergoing profound political and economic change as it moves from its Soviet past toward a market economy, multi-party democracy, and integration into
uro-Atlantic and other international institutions.
In recent years, the availability of goods and services has increased along with increased rates of growth in Ukraine's economy, and facilities for travelers have improved somewhat.
Nonetheless, the availability of travel and tourist services remains uneven throughout the country, and Ukraine still lacks the abundance of many of the goods and services taken for granted in other countries.
Read the Department of State Background Notes on Ukraine for additional information.

ENTRY/EXIT REQUIREMENTS: Depending on the length and purpose of travel, U.S. citizens may or may not be required to get a Ukrainian visa prior to coming to Ukraine.
A passport valid for six months beyond the planned date of travel is required.
According to Ukrainian Presidential Decree #1008, dated June 30, 2005, U.S. citizens are exempt from the requirement to have a Ukrainian visa as long as the duration of their stay in Ukraine does not exceed 90 days and the purpose of their travel is tourism, private travel, or business. U.S. citizens whose planned stay in Ukraine exceeds 90 days, and so consequently bears the characteristics of a long-term stay, must have visas authorizing their entry into Ukraine. If the purpose of their visit is other than tourism, private travel, or business, an appropriate visa must be obtained. U.S. citizens may apply for all types of visas through Ukrainian Embassies and Consulates overseas. A list of required documents for the visa application will be determined based on the purpose and length of travel on a case-by-case basis. Contact details for Ukrainian Embassies and Consulates are available on the Ministry of Foreign Affairs of Ukraine web site at http://www.mfa.gov.ua/mfa/en/305.htm.

Visas may be obtained from the Consular Office of the Embassy of Ukraine in Washington, DC, or from Ukrainian Consulates General in New York, Chicago, or San Francisco.
For additional information about Ukrainian visas and related policy, please contact the Ukrainian Embassy or Consulate nearest you.

Embassy of Ukraine
3350 M Street, NW
Washington, D.C. 20007
Tel: (202) 333-0606
Fax: (202) 333-0817
Web site: http://www.mfa.gov.ua/usa/en/
Consulate General of Ukraine in New York
240 East 49th Street
New York, NY 10017
Tel: (212) 371-5690
Fax: (212) 371-5547
Web site: http://www.ukrconsul.org/
Consulate General of Ukraine in San Francisco
530 Bush Street, Suite 402
San Francisco, CA 94108
Tel: (415) 398-0240
Fax: (415) 398-5039
Web site: http://www.ukrainesf.com/
Consulate General of Ukraine in Chicago
10 East Huron St.
Chicago, IL 60611
Tel: (312) 642 4388
Fax: (312) 642 4385
Web site: http://www.ukrchicago.com/
The Government of Ukraine does not issue visas at the point of entry into Ukraine.
Travelers whose purpose of travel puts them in a category that requires a visa must obtain the correct Ukrainian visa prior to arrival; otherwise they will be turned back to the United States or will have to travel to another country to obtain a visa.

Please check your visa carefully upon receipt and pay careful attention to validity dates.
Each traveler is responsible for understanding the type of visa issued and the provisions of the visa.
Frequently, American citizens are refused entry to Ukraine because they thought they possessed a multiple entry visa, but in fact their visa was valid for only a single entry; Americans occasionally try to reenter Ukraine after using their single-entry visa, believing they have unlimited travel for six months.
In some cases, Americans attempt to enter Ukraine before their visa becomes valid.
This is a common mistake, since in Ukraine the date is written day-month-year, not month-day-year.
Thus, a visa issued on 01/05/07 is valid from May 1, 2007 and NOT from January 5, 2007.
Such travelers can be detained at the port of entry, refused admission and sent back to the country from which they traveled.
The U.S. Embassy in Kyiv is unable to assist travelers in these situations.

All foreigners entering or staying in Ukraine must be registered with Ukrainian authorities. American Citizens traveling to or staying in Ukraine are reminded that recent changes to Ukrainian immigration law change the registration procedures for short-term stays. The registration for short-term visits of up to 90 days is completed at the border by the customs offices.
Such registration is valid for 90 days out of each period of 180 days; the calculation of the 90-day period begins from the date of first entry into Ukrainian territory.

The initial registration for both short- and long-term visits to Ukraine, with or without a visa, is accomplished at the border when entering Ukraine.
Future extensions for stays exceeding 90 days are completed through the Ukrainian Ministry of Internal Affairs’ Office of Citizenship, Immigration and Registration (OVIR).
Most cities will have several OVIR offices.
Extensions are not automatic, however, and are valid only for continued presence in the country.
It is not possible to depart Ukraine and return on the extension, nor can an adjustment to visa status be made from within Ukraine. Applications for extension of registration should be submitted at least three days before the current registration expires.

Travelers who intend to visit Russia from Ukraine must also have a Russian visa.
The Consular Section of the Russian Embassy in Ukraine is located at Prospekt Kutuzova 8, tel.: (380-44) 284-6816, fax 284-7936, e-mail: general@rucons.kiev.ua, http://www.embrus.org.ua.

Visitors to Ukraine should also note that Ukrainian law requires them to obtain mandatory health insurance.
For more information see the section on Medical Insurance below.

Visit the Embassy of Ukraine’s web site at http://www.mfa.gov.ua/usa/en/1609.htm for the most current visa information.
Also, see the Ukrainian Ministry of Foreign Affairs’ web site at http://www.mfa.gov.ua/usa/en or http://www.ukraineinfo.org/.

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 Regulations sheet and visit the Ukrainian State Customs Service web site at http://www.customs.gov.ua/dmsu/control/en/index.

SAFETY AND SECURITY:
Ukraine is largely free of significant civil unrest or any organized anti-American domestic political movements.
However, occasionally, mass demonstrations occur in larger cities, such as Kyiv, and are usually sponsored by individual political forces.
In 2008, there has been an upsurge in the number of pro-Russian anti-NATO protests.
These protests are likely to increase in size and frequency as Ukraine pursues closer ties to the alliance.
While the majority of these protests are small and peaceful, they can still result in violence and it is best to avoid such gatherings.

There also have been increasing incidents of racially-motivated violence; groups of “skinheads” and neo-Nazis target people of Asian, African, or other non-European descent, as well as religious minorities, in Kyiv and throughout Ukraine (see the section on Crime below).

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, including 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., 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:
Ukraine is undergoing a significant economic, political, and social transformation, and income disparities have grown sharply.
As a result, foreign visitors may be perceived as wealthy targets for criminals.
Americans often stand out in Ukraine, and are therefore more likely to be targeted than in Western European countries, where incomes are higher and Americans may blend in better.

Most street crime ranges from various scams, simple pocket picking, purse snatching, and theft of personal items from parked cars, to mugging, armed robbery, or the drugging of unsuspecting victims at nightspots and bars (where they are then robbed).
Cases of assaults in apartment building corridors, elevators, and stairwells, as well as armed break-ins and crimes involving small caliber firearms have also been reported.
Please see the Embassy’s web site for additional security information for Americans at http://kyiv.usembassy.gov/amcit_security_eng.html.

A commonly reported scam in Kyiv is”The Wallet Scam”, which involves a person dropping a wallet or a packet of money near a potential victim. After the victim picks up the wallet and attempts to return it to the individual who “dropped” it, the perpetrator then claims that the wallet is missing money which the victim stole.
The perpetrator either threatens to call the police if the victim does not pay, or asks the victim to show his or her wallet to the perpetrator to ensure that the victim did not take any money.
When the victim produces his or her wallet, the perpetrator grabs the money and flees.
Another variant involves a second person who claims to be a police officer – who is of course involved in the crime – who approaches the victim after the wallet has been picked-up.
This second person also asks to see the wallet, grabbing the money and fleeing or, through sleight-of-hand, stealing the victim’s money.

While most travelers do not encounter problems with crime in Ukraine, there has been an increase in the number of hate crimes directed at ethnic and religious minorities over the past few years. Many of these incidents are conducted by “skinheads” or neo-Nazis in Kyiv, but similar crimes have also been reported throughout the country. In Kyiv, these incidents have occurred without provocation in prominent downtown areas commonly frequented by tourists.
While the majority of people targeted have been of Asian, African, or other non-European descent, all travelers should exercise caution.
In addition to incidents of assault, racial minorities may be subject to various types of harassment, such as being stopped on the street by both civilians and law enforcement officials. Individuals belonging to religious minorities have also been harassed and assaulted in Kyiv and throughout Ukraine.

The police and government’s slow response to hate crimes is a continuing concern.
Although senior Government of Ukraine officials (including the President and Prime Minister) have publicly deplored these hate crimes and groups, Ukrainian street level law enforcement activities are unable to effectively deter hate crimes or adequately protect racial minorities.
The Embassy has received numerous reports from victims of violent hate crimes, as well as from bystanders, stating that uniformed police officers observed the assaults and did nothing to prevent the attacks, to assist the victims afterward, or to investigate and apprehend the attackers.
The Government of Ukraine took initial steps to address the problem in the final months of 2007 with the establishment of special law enforcement units to prevent and investigate hate crimes in Ukraine.
It remains to be seen if these units will be effective.

Credit card and ATM fraud is widespread.
Ukraine operates as a cash economy, and money scams are widespread.
Although credit card and ATM use among Ukrainians is increasingly common, it is nevertheless strongly recommended that visitors and permanent residents of Ukraine refrain from using credit cards or ATM cards except at major international establishments.

Burglaries of apartments and vehicles represent a significant threat to long-term residents.
Although few cars are actually stolen, primarily because of increased use of alarm systems and security wheel locks, vehicular break-ins and vehicular vandalism are common.

Ukraine lacks reliable tourist and travel services for foreign victims of crime.
Transferring funds from the United States, replacing stolen traveler’s checks or airline tickets, or canceling credit cards can be difficult and time consuming.
There are few safe low-cost lodgings, such as youth hostels.
Public facilities in Ukraine are generally not equipped to accommodate persons with physical disabilities.

Over the past several years, the Embassy has received a number of reports of harassment and intimidation directed against foreign businesspersons and interests.
While these reports have become much less frequent in recent years, they have not ended entirely.
Reported incidents range from physical threats (possibly motivated by rival commercial interests tied to organized crime), to local government entities engaging in such practices as arbitrary termination or amendment of business licenses, dilution of corporate stock to diminish U.S. investor interest, delays of payment or delivery of goods, and arbitrary “inspections” by tax, safety or other officials that appear designed to harm the business rather than a genuine attempt at good governance. American business entities are encouraged to read the Corruption, Money Laundering and Organized Crime section of the 2007 Crime Report for Ukraine at http://kyiv.usembassy.gov/amcit_crimereport_eng.html.
American businesses and other private sector organizations are also encouraged to read the most recent Overseas Security Advisory Council (OSAC) Annual Crime and Safety Report for Ukraine at https://www.osac.gov/Regions/country.cfm?country=42.

Computer fraud is also becoming more common in Ukraine.
Internet scams appear to be on the rise.
The Embassy suggests refraining from wiring money unless the recipient is well-known and the purpose of business is clear.
American citizens have reported transferring money to Ukraine to pay for goods purchased from residents of Ukraine via online auction sites, but never receiving the goods in return.
The Embassy regularly receives complaints from Americans regarding scams involving marriage and dating services.
Numerous Americans have lost money to agencies and individuals that claimed they could arrange for student or fiancée visas to the U.S.
Additional information is available on our web site in a document titled “Marriage Brokers” at http://kyiv.usembassy.gov/amcit_marriage_eng.html and on the Department of State’s web site under Ukraine: Internet and Other Fraud Schemes.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm.

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 is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to provide a list of local attorneys who have informed the Embassy that they are willing to take foreign clients.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
In December 2005, Ukraine reported the first cases of H5N1 (“avian influenza,” "avian flu," "bird flu," "chicken flu") among birds in Crimea.
Further outbreaks followed in 2006.
On January 18, 2008, another outbreak of the H5N1 avian influenza virus was detected at a poultry farm in the Krasnogvardiyskyi Rayon in Crimea. There are no registered human cases of H5N1 in Ukraine.
For detailed information on H5N1, please review the Avian Influenza Fact Sheet.

The U.S. Embassy maintains a list of hospitals and clinics with some English-speaking staff.
Many facilities have only limited English speakers.
There are no hospitals in Ukraine that provide a level of medical care equal to that found in American hospitals, or which accept American health insurance plans for payment (see the section on Medical Insurance below).
Some facilities are adequate for basic services.
Basic medical supplies are available; however, travelers requiring prescription medicine should bring their own.
Elderly travelers and those with existing health problems may be at risk due to inadequate medical facilities.
When a patient is hospitalized, the patient, relative, or acquaintance must supply bandages, medication, and food.
The Embassy recommends that ill or infirm persons not travel to Ukraine.
The Embassy also recommends that travelers obtain private medical evacuation insurance prior to traveling to Ukraine.

Medical evacuation remains the best way to secure western medical care.
This option, however, is very expensive and could take at least several hours to arrange.
Travelers may wish to purchase medical evacuation insurance prior to travel, or have access to substantial lines of credit to cover the cost of medical evacuation.
The Consular Section of the U.S. Embassy has information on various air ambulance companies that perform medical evacuations to Europe or to the U.S.
Serious medical problems requiring hospitalization and/or medical evacuation to other European countries can cost from $25,000 to $50,000, and to the U.S. as much as $70,000 or more.
More information can be found on the U.S. Embassy's web site in the document “Medical Services in Kyiv” at http://usembassy.kiev.ua/amcit_medical_serv_eng.html.

Please note that while the Embassy can help American travelers and their families make contact with a medical evacuation service, the U.S. Government cannot pay for medical evacuation.
Travelers should make sure they have medical evacuation insurance, which is available from many private companies, or have funds available for evacuation, should the need arise.

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, http://wwwn.cdc.gov/travel/default.aspx.
Tuberculosis is an increasingly serious health concern in Ukraine.
For further information, please consult the CDC’s Travel Notice on TB at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.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.

RADIATION AND NUCLEAR SAFETY:
In 1986, the Chornobyl incident resulted in the largest short-term, unintentional, accidental release of radioactive materials to the atmosphere ever recorded.
The highest areas of radioactive ground contamination occurred within thirty kilometers of the Chornobyl nuclear power station.
The city of Kyiv was not badly affected because of the wind direction, but it was not completely spared.
The last operating reactor at the Chornobyl Nuclear Power Plant site closed officially on December 15, 2000. All identified stabilization measures on the existing sarcophagus are complete, and preparatory work to start construction of the new shelter is almost nearing completion. The contract for the new Chornobyl shelter was awarded in September 2007 and its construction is projected to be completed in 2012.

The Ukrainian government has an effective program of monitoring fresh foods and meats sold in local markets.
Street purchase of produce should be avoided.
Wild berries, mushrooms, and wild fowl and game should be avoided, as these have been found to retain higher than average levels of radiation.
Background levels of radiation are monitored regularly by the Embassy and, to date, have not exceeded the level found on the Eastern seaboard of the United States. If external radiation levels are high enough to require evacuation, the U.S. Embassy will notify the American community through the Embassy warden e-mail and text messaging system.

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.

The Ukrainian parliament passed a law in 1997 whereby all visitors to Ukraine are required to obtain mandatory health insurance. According to information from the Ukrainian authorities, the cost of this medical insurance depends on the anticipated length of a foreigner's stay in Ukraine.
The cost for the insurance is approximately 25 cents per day (more for short stays).
This required insurance can be purchased after arrival and covers only the costs of basic medical care inside Ukraine; it does not cover medical evacuation.
Failure to purchase mandatory health insurance often results in refusal of treatment at Ukrainian public hospitals and clinics.
Private clinics do not require Ukrainian public health insurance, but can be as expensive as similar clinics in the United States and may require payment in advance
More information can be found online in Ukrainian at http://www.pro100.com.ua, or by calling +38 (044) 206 2885 from abroad or 8-800-500-1080 from within Ukraine.

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 Ukraine is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Generally, roads in Ukraine outside major urban areas are in poor condition and are poorly lit.
Visitors should drive defensively at all times, since local drivers often disregard traffic rules.
Drivers are often poorly trained or drive without a valid driver's license.
Drivers can also be very aggressive, and they normally do not respect the rights of pedestrians, even at clearly marked pedestrian crossings.
Pedestrians should also be aware of cars driving or attempting to park on sidewalks.
Many cars do not meet the safety standards common in America.

Due to heavy traffic and congested roads, vehicle accidents are a common occurrence in larger Ukrainian cities, especially in Kyiv. In Ukraine, it is mandatory for motorists involved in vehicle accidents not to remove the vehicle from the site of the accident, unless it presents a clear safety concern. Local police must be notified and will report to the scene to conduct an investigation. Persons should be prepared to wait until the police arrive and complete their report. Due to traffic and slow response, it may take up to several hours for police to arrive. When police arrive, they will ascertain responsibility, take the drivers’ personal information, and file a report of the accident.

Cross-country travel at night and in winter can be particularly dangerous.
The Embassy strongly recommends that visitors and permanent residents of Ukraine refrain from driving their private vehicles after dark outside of major cities.
However, major roads are drivable during daylight hours.
Roadside services such as gas stations and repair facilities are becoming more common, particularly on the main national and regional overland highways and in large and mid-size cities.

Nonetheless, such services are far from American standards, and travelers should plan accordingly.
There have been isolated reports of carjackings of western-made or foreign-registered cars.
There has also been an increase in the number of documented reports of criminal acts (primarily theft) occurring on trains and other modes of public transport.

Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Ukraine’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Ukraine’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:
Ukraine does not recognize dual nationality.
American citizens entering Ukraine with a Ukrainian passport will be treated as Ukrainian citizens by the local authorities.
This may include being required to perform mandatory military service.
Also, Ukrainians who have immigrated to the U.S. without obtaining the proper exit visa from Ukrainian authorities may be subject to civil or criminal penalties, and will be required to obtain an exit visa before returning to the U.S.
For additional information, see the Consular Affairs web site at http://travel.state.gov/index.html for our Dual Nationality flyer.

Ukraine is a cash economy.
Traveler’s checks and credit cards are gaining wider acceptance in larger cities.
Even in Kyiv, however, acceptance of credit cards is not nearly as widespread as in the U.S. or in Western European countries.
Expect credit card use to be limited to major hotels, upscale restaurants, international airlines, and the rapidly growing, but still select number of up-market stores.

Exchanging U.S. dollars into the national Ukrainian currency, hryvnya, is simple and unproblematic, as licensed exchange booths are widespread, and exchange rates are normally clearly advertised.
Currency exchange is only legal at such licensed exchange booths, banks, and currency exchange desks at hotels; anyone caught dealing on the black market can expect to be detained by the local militia.

There are many banks and licensed currency exchange booths located in major cities.
ATMs (a.k.a. bankomats) are becoming more common throughout Ukraine, particularly in Kyiv and in other larger cities.
In smaller cities and towns, ATMs are still virtually non-existent.
Most ATMs disperse cash only in the local currency, hryvnya. The difficulties of a currency shortage can be avoided by coming to Ukraine with a sufficient supply of hard currency to cover necessary obligations during travel.
Funds may be transferred by wire, advances may be drawn on credit cards, and traveler’s checks may be cashed at many locations.
Again, the Embassy emphasizes that the incidence of credit card and ATM bankcard fraud is high, and strongly recommends that visitors and permanent residents of Ukraine refrain from using local ATMs.

Customs regulations prohibit sending cash, traveler’s checks, personal checks, credit cards, passports, or other forms of identification through the international mail system, as well as via courier mail (FedEx, DHL, etc.).
Customs authorities regularly confiscate these items as contraband.
Ukrainian customs authorities may also enforce strict regulations concerning temporary importation into or export from Ukraine of items such as firearms, antiquities, currency, etc.
It is advisable to contact the Embassy of Ukraine in Washington, or one of Ukraine's consulates in the United States for specific information regarding customs requirements.
As in many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines.

Ukrainian law requires that travelers declare all cash and jewelry, regardless of value, upon entering Ukraine.
Travelers should fill out a customs declaration and ask customs officials to stamp it.
According to Ukrainian law, foreign citizens may bring up to $15,000 in cash, or up to $30,000 in traveler’s checks, into Ukraine without a special license.
A traveler must declare the imported currency.
If customs officials determine that a traveler entering or exiting the country is carrying undeclared currency, they can and often do confiscate the undeclared funds.
When leaving the country, foreign travelers are only allowed to take out a maximum of $3,000 in cash, or as much cash as they declared upon their entry into Ukraine.
If a traveler wants to take out more than $3,000, the traveler must have a customs declaration proving that he or she in fact brought the corresponding sum of money into the country.

Travelers desiring to bring more than $15,000 into Ukraine must obtain a special license AFTER entering the country.
Details for obtaining this license are available on the Embassy's web site in the document “Ukrainian Customs: Procedures for Transporting Currencies, Monetary Instruments, or Precious Metals” at http://kyiv.usembassy.gov/amcit_travel_ukrcustoms_eng.html.
Ukraine has strict limitations for the export of antiques and other goods and artifacts deemed to be of particularly important historical or cultural value.
This includes any items produced before 1950.

Ukraine is a developing democratic nation undergoing significant political, economic, and governmental reform.
This includes reform of police and emergency services.
Visitors should be aware that although Ukrainian police and emergency services have made much progress, they still generally remain below Western European and U.S. standards in terms of training, responsiveness, and effectiveness.
American citizens have reported waiting sometimes hours for Ukrainian police and ambulance services to respond to calls for emergency assistance.
Although this may generally be atypical, it does nevertheless occur.

It is advisable to contact the Embassy of Ukraine in Washington, or one of Ukraine's consulates in the United States, for specific information regarding customs requirements.
Please see our information on Customs Regulations.

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 Ukraine’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Ukraine 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 living or traveling in Ukraine 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 Ukraine.
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 Consular Section of the U.S. Embassy is located at #6 Mykoly Pymonenka St., 01901 Kyiv, Ukraine. Telephone: (38-044) 490-4422, fax 486-3393. The American Citizen Services unit is located at the same address and can be reached at (38-044) 490-4445
The Embassy is located at #10 Yuriy Kotsyubynsky St. 01901 Kyiv, Ukraine. Tel.: (38-044) 490-4000.
* * *
This replaces the Country Specific Information Sheet dated February 15, 2008 to update the sections on Safety and Security and Crime.

Travel News Headlines WORLD NEWS

Date: Mon 18 Nov 2019
Source: 112.UA [edited]

Eight school classes in Odesa [Odessa] have been closed for quarantine. More than 30% of school students in these classes are sick with Coxsackie virus, a highly contagious respiratory disease, said Olena Buynevych, the director of the city hall's department for science and education, as quoted by UNN news agency.

"More than 30% of students in these classes are sick wi h acute
respiratory diseases, which include cases of cases and Coxsackievirus," the official said. She urged the parents to keep the children away from schools in case they have any symptoms of acute respiratory diseases.

The symptoms are basically the same as flu; the key difference is the rash on the palms, in case of the Coxsackievirus.

Coxsackievirus is a member of a family of viruses called enteroviruses. Enteroviruses are made up of a single strand of ribonucleic acid (RNA). The enteroviruses are also referred to as picornaviruses ("pico" means "small," so, "small RNA viruses"). They are present all over the world and spread by fecal-oral route. About 90% of infections don't cause symptoms or present with a fever only. Infants and young kids are particularly susceptible to symptomatic coxsackie.
======================
[Coxsackievirus belongs to a family of nonenveloped, linear, positive-sense, single-stranded RNA viruses, Picornaviridae and the genus _Enterovirus_, which also includes poliovirus and echovirus. Enteroviruses are among the most common and important human pathogens, and ordinarily its members are transmitted by the fecal-oral route. Coxsackieviruses share many characteristics with poliovirus. With control of poliovirus infections in much of the world, more attention has been focused on understanding the nonpolio enteroviruses such as coxsackievirus.

Coxsackieviruses are divided into group A and group B viruses based on early observations of their pathogenicity in neonatal mice. In general, group A coxsackieviruses tend to infect the skin and mucous membranes, causing herpangina, acute hemorrhagic conjunctivitis, and hand, foot, and mouth (HFM) disease. Both group A and group B coxsackieviruses can cause nonspecific febrile illnesses, rashes, upper respiratory tract disease, and aseptic meningitis.

Group B coxsackieviruses tend to infect the heart, pleura, pancreas, and liver, causing pleurodynia, myocarditis, pericarditis, and hepatitis (inflammation of the liver not related to the hepatotropic viruses). Coxsackie B infection of the heart can lead to pericardial effusion.

The development of insulin-dependent diabetes (IDDM) has recently been associated with recent enteroviral infection, particularly coxsackievirus B pancreatitis.

It is common for the coxsackievirus to cause a febrile upper respiratory tract infection with sore throat and/or a runny nose. Some patients have a cough resembling bronchitis. Less commonly, coxsackievirus may cause pneumonia. Some people with coxsackievirus have a rash. In many, this is a nonspecific generalized red rash or clusters of fine red spots. The rash may not appear until the infection has started to get better.

Coxsackievirus is spread from person to person. The virus is present in the secretions and bodily fluids of infected people. The virus may be spread by coming into contact with respiratory secretions from infected patients. If infected people rub their runny noses and then touch a surface, that surface can harbor the virus and become a source of infection. People who have infected eyes (conjunctivitis) can spread the virus by touching their eyes and touching other people or surfaces. Conjunctivitis may spread rapidly and appear within one day of exposure to the virus. Coxsackieviruses are also shed in stool, which may be a source of transmission among young children. The virus can be spread if unwashed hands get contaminated with fecal matter and then touch the face. This is particularly important for spread within  day-care centers or nurseries where diapers are handled. Diarrhoea is the most common sign of coxsackievirus intestinal infection.

Most infections are self-limiting, and no specific treatment is required or available. Some options include intravenous immune globulin (IVIG), which contains antibodies and may be somewhat effective.

HealthMap/ProMED-mail map:
Odesa oblast, Ukraine: <http://healthmap.org/promed/p/51897>]
Date: Mon 28 Oct 2019, 12:41 PM
Source: 112 International [edited]

"A total of 15 students of the secondary school No. 7 in Chernihiv were hospitalized with suspicion of hepatitis A on [28 Oct 2019]," the press service of Ukraine's State Emergency Service reports. It is noted that at the moment a complex of epidemic prevention measures are being carried out.

Besides, a 2018 hepatitis outbreak was spotted in Mykolaiv -- 47 people were hospitalized with a confirmed diagnosis.
========================
[With this number of cases admitted with the suspicion of acute hepatitis A on the same day, it is likely that a point-source outbreak related to a food or water source occurred. The definitive test for the disease is the finding of IgM anti-HAV in the blood.

Chernihiv, also known as Chernigov, is a historic city in northern Ukraine, which serves as the administrative centre of the Chernihiv Oblast (province), as well as of the surrounding Chernihiv Raion (district) within the oblast. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Thu 24 Oct 2019 (accessed Mon 28 Oct 2019)
Source: Ministry of Health, Ukraine, press release [in Ukrainian, machine trans., edited]

In Ukraine, the 1st confirmed case of vaccine-associated paralytic polio has occurred in a 2 year old child from Volyn Oblast. The parents deliberately refused the vaccinations provided by medical standards. Recent cases of illness in Ukraine were recorded in 2015 and 2017.

Pathogenesis of the disease
---------------------------
Sources of the disease: a person who is ill or a carrier that carries the virus asymptomatically. Fecal-oral routes (dirty hands, water, contaminated food, excrement) and airborne droplets are considered as transmission routes.

Symptoms: In most cases, the disease first goes unnoticed, which worsens the patient's chances of recovery; then there are signs that are different in nature, depending on the form of the virus. You can learn more about the symptoms on the website of the Public Health Center at <https://old.phc.org.ua/pages/diseases/other_social_diseases/poliomyelitis>  [in Ukrainian]

The incubation period of the disease is 2-35 days, more often 7-14 days. The following types of disease are classified: with and without lesions of the central nervous system (CNS). It should be noted that even atypical poliomyelitis (without lesion of the CNS) is capable of seriously harming the patient. They all pose a significant threat to the unvaccinated person and cause irreversible processes that can lead to death.

Myths and refutations
---------------------
On World Polio Day [24 October], the Ministry of Health of Ukraine dispels myths that provoke refusal of immunization. Common among parents is talk about the dangers of vaccination and the side effects of vaccination. You can read more about refuting these stereotypes at <https://moz.gov.ua/article/health/9-mifiv-pro-vakcinaciju> [in Ukrainian].

Why are vaccines safe?
----------------------
The Global Polio Eradication Initiative is using several vaccines to combat the disease. In Ukraine, there are 2 types -- the inactivated polio vaccine (IPV) and the oral polio vaccine (OPV). Both vaccines are purchased through the United Nations Children's Fund (UNICEF) and have a World Health Organization  ualification that guarantees quality and ongoing monitoring of manufacturers. For more information on vaccine production standards, go to: <https://moz.gov.ua/article/news/nichogo-krim-pravdi-5-faktiv-pro-vakcini>  [in Ukrainian]

The WHO website explains:
- OPV is one of the safest vaccines invented by humanity and used to immunize newborns;
- it is so safe that it can be used even when the baby is sick;
- OPV is used several times to achieve the maximum immunity of the vaccine, but the increase in the number of vaccinations does not increase the risk of side effects.

Where, when, and who should be vaccinated?
------------------------------------------
Polio vaccination is required from the birth of a baby. Vaccination must be carried out in a comprehensive manner, without missing any dose, to increase the body's resistance to the disease.
1st dose - at 2 months of baby's life;
2nd dose - at 4 months;
3rd dose - at 6 months;
4th dose - at 18 months;
5th dose - at 6 years;
6th dose - at 14 years.

Free polio vaccination is available from your family doctor or pediatrician at public health facilities, as well as from private contractors with the National Health Service of Ukraine. More information is available at <https://moz.gov.ua/article/immunization/chomu-v-aptekah-i-privatnih-klinikah-mozhe-ne-buti-vakcin-ta-de-zrobiti-scheplennja-bezoplatno> [in Ukrainian].

The only way to protect yourself and your children from the effects of this disease is vaccination, as there is no specific treatment. The Ministry of Health of Ukraine recommends that you consult the calendar of preventive vaccinations at <https://moz.gov.ua/article/immunization/kalendar-profilaktichnih-scheplen>  [in Ukrainian]
--------------------------------------
communicated by:
Viki Hansen-Landis, RN, MPH
Medical Information and Analysis team, International SOS
======================
[According to information from the Global Polio Eradication Initiative, Ukraine had 2 cases of cVDPV1 confirmed in 2015 (see <http://polioeradication.org/polio-today/polio-now/this-week/circulating-vaccine-derived-poliovirus/> for table of cVDPVs by type and year, and see Poliomyelitis update (05): Ukraine, vaccine-derived, WHO http://promedmail.org/post/20150901.3616558 and Poliomyelitis update (04): Ukraine, 2 cases, RFI http://promedmail.org/post/20150901.3616015 for details on these cases). No additional cases of cVDPV were reported by the Ukraine to WHO in 2017. If there is additional information on case(s) reported in 2017, ProMED-mail would greatly appreciate receiving it, as well as information on the serotype of cVDPV associated with this current case.

The addition of this case will bring the total number of cVDPV associated cases confirmed with date of onset in 2019 to 103, and the number of countries reporting cVDPV associated paralytic cases to 20.

Maps of Ukraine can be seen at
and <http://healthmap.org/promed/p/123>.
Volyn oblast is located in the north west of Ukraine, sharing a border with Poland to the west and Belarus to the north. - ProMED Mod.MPP]
Date: Thu, 22 Aug 2019 19:34:04 +0200 (METDST)

Kiev, Aug 22, 2019 (AFP) - Around 200 anti-vaccine protesters rallied in central Kiev Thursday after authorities threatened to ban unvaccinated children from schools in Ukraine, which has been hit by a deadly measles outbreak.   Ukraine has one of the lowest vaccination rates in Europe and has recorded more than 57,000 measles cases since the start of the year, including 18 deaths.

This is a record number of cases since the country gained independence from the Soviet Union in 1991.    "I came here with my child to protect her right for education without vaccination, without injecting poison into her blood," said 29-year-old Iryna Lazutkina, who was at the protest with her young daughter.   "Vaccination is a ticking time bomb," she said, suggesting that it could lead to allergies, autoimmune diseases and even cancer -- claims which are not backed up by medical research.    Authorities blame distrust of vaccines among a section of the population, as well as an earlier shortage of medical supplies, for the current outbreak.   In mid-August, the government threatened to ban unvaccinated children from schools.    This year the health ministry organised mass vaccinations in schools in areas most affected by the crisis.

Acting health minister Ulyana Suprun last week warned of the likelihood of diphtheria and tetanus outbreaks because of low vaccination rates.   But the protesters, many of them young parents with children, insisted they had the right to refuse vaccinations.    "I am for free choice and against discrimination," said Alla Fedorchuk, a 25-year-old who travelled to the capital from the western city of Lutsk.    Her three-year-old son has not been vaccinated. Fedorchuk said a relative suffered side effects after vaccination.

Some protesters carried banners that read "Forced medical intervention is a crime."    Kateryna Bulavinova, a consultant with the UN children's agency UNICEF, said local doctors' lack of knowledge about vaccines was a reason why many missed out on them.   Bulavinova said that doctors and nurses must explain to patients in detail how the vaccine works and what kind of reactions are normal.    "When there is this understanding, the fear goes away," she said.   According to the UNICEF survey, Ukrainians were most likely to be put off vaccines because of fears of side effects or a distrust of the manufacturers.   There is growing concern over global public resistance to vaccinations.

Measles cases nearly tripled globally during the first seven months of the year compared to the same period in 2018, the World Health Organization (WHO) said this month.    Measles, which is highly contagious, can be entirely prevented through a two-dose vaccine, but the WHO has in recent months sounded the alarm over vaccination rates.    The airborne infection causing fever, coughing and rashes can be deadly in rare cases and had been officially eliminated in many countries with advanced healthcare systems.
Date: Wed 14 Aug 2019
Source: Unian [abridged, edited]

Director of the Department of Health of Kyiv Valentyna Hinzburh has said that an outbreak of measles in Kyiv has become the largest since the independence of Ukraine.

According to her, over 5000 people fell ill with measles in Kyiv in 6 months of 2019, of which almost 3000 were adults. This is 3 times the figure recorded in the same period of 2018. About 50% of patients required hospitalization due to the severe course of the disease. This year [2019], 2 adults died from measles, as they were not vaccinated and reported to the doctor too late.

Ukraine is among the countries that have reported the highest numbers of measles cases in 2019.

"Today, nothing but vaccines will protect Kyiv from outbreaks and epidemics of vaccine-preventable infectious diseases," Hinzburh said. She said the current situation in the capital and Ukraine as a whole was a result of reduced collective immunity. "Here are just a few figures that are staggering. In 2015, 5 people got measles in Kyiv, 3 in 2016, 87 in 2017, 3045 in 2018, and over 5000 for 6 months in 2019!" she said.
More ...

World Travel News Headlines

Date: Mon, 27 Jan 2020 01:07:04 +0100 (MET)

Wuhan, China, Jan 27, 2020 (AFP) - China's central government said on Monday that the nationwide total of confirmed infections from a deadly respiratory virus had risen to 2,744, with 769 new cases coming to light.   However, it said no new deaths were confirmed outside of Hubei province, which had earlier reported 24 new fatalities to bring the national total to 80 dead.
Date: Sun, 26 Jan 2020 22:16:28 +0100 (MET)

Beijing, Jan 26, 2020 (AFP) - Chinese authorities have ordered the extension of a public holiday in an effort to contain an epidemic that has killed 56 people and infected nearly 2,000 worldwide, state-run media reported.   A working group chaired by Premier Li Keqiang to tackle the outbreak decided on Sunday "to reduce population flows" by extending the Spring Festival holiday which had been scheduled to end on January 30, state news agency Xinhua said.   It was not immediately clear how long the extension is.

The group also ordered changes to "the starting dates of schools" and "people to work from home by working online."   "The meeting stressed that the country is at a crucial time in the prevention and control of the novel coronavirus outbreak, urging Party committees and governments at all levels to take more 'decisive, powerful and orderly, scientific and well-planned' measures to effective curb the spread," Xinhua reported.   In a bid to slow the spread of the respiratory virus, the government had previously locked down hard-hit Hubei, a province in central China that is at the outbreak's epicentre, in an unprecedented operation affecting tens of millions of people.

The previously unknown virus has caused global concern because of its similarity to the Severe Acute Respiratory Syndrome (SARS) pathogen, which killed hundreds across mainland China and Hong Kong in 2002-2003.   Originating in Hubei's capital of Wuhan, the virus has spread throughout China and across the world -- with cases confirmed in around a dozen countries including as far away as the United States.   Several countries were making arrangements to evacuate their citizens from Wuhan, where an eery calm pervades as new restrictions prohibit most road traffic in the metropolis of 11 million.
Date: Sun, 26 Jan 2020 21:47:53 +0100 (MET)

Washington, Jan 26, 2020 (AFP) - US health authorities said Sunday there are now five confirmed cases of the coronavirus in the United States and more are expected.   Nancy Messonnier, head of the respiratory disease section at the Centers for Disease Control and Prevention, said around 100 people in 26 states are being investigated for the virus, which originated in the Chinese city of Wuhan.

Of the confirmed cases, all five people had travelled to Wuhan, Messonier said during a conference call with reporters.   "Every case we have had in the United States is someone who has had direct contact in Wuhan," she said.   Messonier said there are two cases in California and one each in Arizona, Illinois and Washington state. Until now the toll was three.   While Chinese officials have launched an extraordinary emergency response, Messonier insisted that the health risk for Americans in general remains low "at this time."
Date: Sun, 26 Jan 2020 13:44:57 +0100 (MET)

Lagos, Jan 26, 2020 (AFP) - Nigerian health authorities have announced stepped-up emergency measures to tackle a rise in Lassa fever cases after 29 people died this month.   "As at 24th of January 2020, 195 confirmed cases and 29 deaths had been reported in 11 states," the Nigeria Centre for Disease Control (NCDC) said in a statement Saturday.   A national emergency operations centre had been activated to coordinate the response "to the increasing number of Lassa fever cases" across the country.

Endemic to Nigeria, Lassa fever belongs to the same family as the Ebola and Marburg viruses, but is much less deadly.   The virus is spread by contact with rat faeces or urine. It starts with fever and can, in worst case scenarios, lead to severe bleeding and organ failure.   Nigeria declared an outbreak of Lassa fever a year ago and around 170 people died from the virus in 2019.

The number of cases usually climbs in January due to weather conditions during the dry season.    Almost 90 percent of the recent confirmed cases have been in Edo, Ondo and Ebonyi states in southern Nigeria, but their have also been deaths in the north.

The NCDC said that compared to the same period last year the fatality rate had dropped from 23.4 percent to 14.8 percent.    It encouraged Nigerians to "practise good hygiene and take measures to protect themselves and their families".   Nigeria, Africa's most populous nation with a population of some 200 million, has five laboratories with the capability to diagnose Lassa fever.
Date: Sun, 26 Jan 2020 12:18:19 +0100 (MET)

Beijing, Jan 26, 2020 (AFP) - Two Chinese provinces and three cities have ordered citizens to wear face masks in public, to help control the spread of a deadly virus.   The measure is required in the provinces of Guangdong in the south and Jiangxi in the centre, plus the eastern city of Nanjing, Ma'anshan city in Anhui province, and Xinyang city in Henan, according to local authorities.   China's industry and information technology ministry has said it would "spare no effort in increasing supply" after demand for masks skyrocketed.
Date: Sun, 26 Jan 2020 04:03:51 +0100 (MET)

Hong Kong, Jan 26, 2020 (AFP) - Hong Kong's Disneyland announced it was shutting its doors on Sunday until further notice over the deadly virus outbreak in central China, a day after city authorities classified the crisis as an emergency.   "As a precautionary measure in line with prevention efforts taking place across Hong Kong, we are temporarily closing Hong Kong Disneyland park out of consideration for the health and safety of our guests and cast members," the park said in a statement.
Date: 26 Jan 2020
Source: MENAFN [edited]

Two more polio cases have surfaced from Landikotal tehsil in Khyber tribal district, after which the number of reported cases in Khyber Pakhtunkhwa has reached 4 this year [2020].

According to the Emergency Operations Centre (EOC), a 2-year-old [male child] from Nekikhel and another child from Torwela have been diagnosed with polio. The samples of these 2 children were sent for laboratory tests in 2019, so these cases will be counted in the tally of 2019, which stands at 141 now.

The 2 cases in Landiktoal were reported 2 days after the emergence of 3 new polio cases in Qambar, Dadu and Sajawal districts of Sindh. Among them, 2 children contracted the crippling disease in 2019, but the cases were confirmed on Friday [24 Jan 2020].

On [21 Jan 2020], the 1st case of polio in Pakistan in 2020 surfaced in Lakki Marwat, the district with the highest number of cases in 2019.

The year 2019 was worse for Pakistan in polio eradication efforts, as 141 cases surfaced in Pakistan, including 96 cases in KP. Most cases in KP surfaced in Lakki Marwat, where 32 children were diagnosed with the crippling disease. In 2018, only 12 cases were reported, while in 2017, 8 cases were reported.

Currently, Pakistan and Afghanistan are the only 2 countries in the world which have not fully eradicated polio. The main cause behind the emergence of so many polio cases is refusal of parents to cooperate with the vaccination teams. According to media reports citing Health Ministry data, over a million parents refused to cooperate with vaccination teams in 2019. Most of the refusal cases were reported in April last year [2019] when rumours spread in Peshawar that many children had fainted after consuming vaccination drops. A total of 1 089 087 parents refused to give vaccination drops to their children in 2019.

The emergence of so many polio cases in Pakistan, particularly in KP, has brought the federal and provincial governments under pressure over their performance and strategy to control the spread of disease.

Experts believe that polio vaccination efforts cannot succeed completely until the refusing parents are convinced to cooperate with vaccination teams.
==================
[The End Polio Pakistan website has not added all of the media reported cases as yet, so it's a bit difficult to follow at times and know which cases were 2019 onset and which were 2020 onset. The above media report clearly states 2019 onset and puts the tally for 2019 as 141 cases, but the media reports from Friday's [24 Jan 2020] report is less clear (see Poliomyelitis update (10): global, Pakistan (BA, SD) http://promedmail.org/post/20200124.6911971).

A good map of Pakistan showing districts and provinces can be found at:
Date: Fri 24 Jan 2020
Source: SciTechDaily [abridged, edited]

Citation: Amman BR, Bird BH, Bakarr IA, et al. Isolation of Angola-like Marburg virus from Egyptian rousette bats from West Africa. Nat Commun. 2020; 11:510.  <https://doi.org/10.1038/s41467-020-14327-8>

Scientists have detected Marburg virus in fruit bats in Sierra Leone, marking the 1st time the deadly virus has been found in West Africa. A total of 11 Egyptian rousette fruit bats tested positive for active Marburg virus infection. Research teams caught the bats separately in 3 health districts.

The presence of Marburg virus, a close relative to Ebola virus that also causes hemorrhagic disease in people, was detected in advance of any reported cases of human illness in Sierra Leone. However, the virus's presence in bats means people who live nearby could be at risk for becoming infected. No outbreaks have been reported to date.

The findings, based on PCR, antibody, and virus isolation data, were officially published today [24 Jan 2020] in the journal Nature Communications. Preliminary findings were announced earlier in December 2018 to ensure rapid notification to the citizens of Sierra Leone and the international health community.

The paper highlights the value of collaborating with government and key stakeholders across human, animal, and environmental sectors to engage at-risk communities about the discovery, address health concerns, and communicate risk-reduction strategies before recognized spillovers occur.

Marburg virus was detected by projects led by the Centers for Disease Control and Prevention, the USAID-funded PREDICT project led by the One Health Institute at the UC Davis School of Veterinary Medicine; Njala University, Sierra Leone; and the University of Makeni, Sierra Leone.

"Finding Marburg virus in bats in Sierra Leone before any known cases in people is a huge success, as public health officials and doctors can now include Marburg virus among the possible causes when diagnosing hemorrhagic fever cases in the region," said Tracey Goldstein, co-principal investigator and pathogen detection lead for the PREDICT project from the UC Davis One Health Institute.

To date, there have been 12 known outbreaks of Marburg virus, with the most recent in Uganda in 2017. The largest and deadliest outbreak occurred in Angola in 2005 when 227 people died. Five of the new strains identified among the Marburg-positive bats in Sierra Leone were genetically similar to the strain that caused the outbreak in Angola. This is the 1st time scientists have detected these Angolan-like strains in bats.

The virus-positive bats were all Egyptian rousette bats, the known reservoir for Marburg virus, which primarily feed on fruit. Infected bats shed the virus in their saliva, urine, and feces. Egyptian rousette bats are known to test-bite fruits, urinate, and defecate where they eat, potentially contaminating fruit or other food sources consumed by other animals or people, particularly children. These bats sometimes serve as a food source for local populations as well. People may be exposed to Marburg virus through bat bites as they catch the bats.

Following the announcement of the preliminary findings by the government of Sierra Leone, the PREDICT team worked with government partners, universities, and other key stakeholders to develop and implement evidence-based public health messaging across national, district, and local community levels in Sierra Leone.  "Over a year ago, we worked with our Sierra Leone government colleagues to inform people across the country as fast as possible of this new health risk and remind people not to harm or come in contact with bats," said Brian Bird from the UC Davis One Health Institute and global lead for Sierra Leone and Multi-Country Ebola operations for PREDICT-USAID. "I'm very proud of that work and our teams now that this full report is available."
----------------------------------------------
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
and
Mary Marshall
===========================
[The initial report of this finding, prior to this publication, was posted by ProMED-mail (Marburg virus disease - Sierra Leone (02): bats, additional information http://promedmail.org/post/20181223.6221436) when the virus was detected for the 1st time in fruit bats in Sierra Leone.

According to the CDC (<https://www.cdc.gov/vhf/marburg/index.html>), Marburg virus was 1st recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, Germany, and in Belgrade, Yugoslavia (now Serbia). A total of 31 people became ill, initially laboratory workers followed by several medical personnel and family members who had cared for them; 7 deaths were reported. The 1st people infected had been exposed to imported African green monkeys or their tissues while conducting research. One additional case was diagnosed retrospectively.

The reservoir host of Marburg virus is the African fruit bat, _Rousettus aegyptiacus_. Fruit bats infected with Marburg virus do not show obvious signs of illness. Primates (including humans) can become infected with Marburg virus, and may develop serious disease with high mortality.

Ebola virus is closely related to Marburg virus. "Ebola viral RNA fragments were found in an oral swab from a greater long-fingered bat (_Miniopterus inflatus_), captured in 2016 in Liberia's Sanniquellie-Mahn district, which borders Guinea. The bat, which lives in many parts of Africa, roosts in caves and feeds on insects. Scientists had previously found 2 other Ebola species in a related insect-eating bat, _M. schreibersii_. However, most other evidence has pointed to fruit bats as the carriers of Ebola Zaire, Epstein says [J Epstein, veterinary epidemiologist at EcoHealth Alliance in New York City and a member of the PREDICT consortium]. "What it really says to me is that this is a virus that has multiple hosts, and it might be regionally dependent as to which species carries it."

Supporting the variety of bat hosts for Ebola, the bat implicated in the initiation of the West African Ebola virus outbreak in December 2013 was _Mops condylurus_, long-tailed insect-eating bats, that were previously suspected in an outbreak of the Sudan strain of Ebola virus, which is related to the Zaire strain. - ProMED Mod.LK]

[HealthMap/ProMED-mail map:
Date: Sat, 25 Jan 2020 11:49:16 +0100 (MET)
By Su Xinqi, Jerome TAYLOR

Hong Kong, Jan 25, 2020 (AFP) - Hong Kong on Saturday declared a new coronavirus outbreak as an "emergency" -- the city's highest warning tier -- as authorities ramped up measures to reduce the risk of further infections.   The announcement came as city leader Carrie Lam faced criticism in some quarters over her administration's response to the crisis.

Of the five people who have tested positive for the virus in Hong Kong so far, four arrived via a newly built high-speed train terminal which connects with the mainland.   That led to calls from some medical experts and politicians to limit, or even halt, arrivals from China, the epicentre of the outbreak with 41 people dead.

Lam held emergency meetings with health officials on Saturday morning after returning from Davos.   "Today I declare the lifting of the response level to emergency," she told reporters.   Schools and universities, which are currently on a Lunar New Year break, would remain closed until 17 February, Lam said.   All mainland arrivals to Hong Kong will now need to sign health declaration forms, she added, while public events including a new year gala and next month's marathon, would also be called off.    "We haven't seen serious and widespread infections (in Hong Kong), but we are taking this seriously and we hope to be ahead of the epidemic," Lam said.

- Tragic past -
Hong Kong has a recent experience of deadly viral outbreaks.    Nearly 300 people were killed by SARS in 2003, a tragedy that left a profound psychological impact on one of the most densely populated places on earth.   The city's ability to combat the crisis was hampered by moves in mainland China to cover up and play down the outbreak, leaving a lasting legacy of distrust among many Hong Kongers.   Animosity towards the mainland has intensified in recent years as Beijing tightens political control over the semi-autonomous territory.

The outbreak also comes at a sensitive time for Lam, who currently boasts record low approval ratings after seven months of pro-democracy protests.   "We must stand united so that we can prevent and control the disease," she said, in a nod to the political unrest.   The often violent protests have battered Hong Kong's reputation for stability and helped tip it into recession, with the recent virus outbreak compounding the city's economic woes.

Hospitals are already struggling with the winter flu season, but officials are isolating anyone with a history of travel to central China and those exhibiting respiratory tract infections that look similar to the virus.   So far some 300 people have been tested and monitored for the virus. Quarantine centres have been set up in remote holiday parks for anyone found to have come into close contact with people who tested positive.   On Saturday, officials announced a newly built but still-empty public housing block would be used for medical staff on the frontline who did not want to risk returning to their families.
Date: Sat, 25 Jan 2020 06:46:59 +0100 (MET)
By Mahmut Bozarslan and Fulya Ozerkan in Istanbu

Elazig, Turkey, Jan 25, 2020 (AFP) - A powerful earthquake has killed at least 20 people and injured more than 1,000 in eastern Turkey, as rescue teams searched through the rubble of collapsed buildings for survivors on Saturday.    At least 30 people were missing following the magnitude 6.8 quake on Friday night, which had its epicentre in the small lakeside town of Sivrice in the eastern province of Elazig.   "It was very scary, furniture fell on top of us. We rushed outside," 47-year-old Melahat Can, who lives in the provincial capital of Elazig, told AFP.   President Recep Tayyip Erdogan said all steps were being taken to aid people affected by the quake, which caused widespread fear.   "We stand by our people," Erdogan said on Twitter.

The Turkish government's disaster and emergency management agency (AFAD) said the quake hit Sivrice at around 8.55 pm (1755 GMT). Turkey lies on major faultlines and is prone to frequent earthquakes.    Turkish television showed images of people rushing outside in panic, as well as a fire on the roof of a building.   Interior, environment and health ministers, who were in the quake zone, said the casulties were in Elazig province and in the neighbouring province of Malatya, which lies to the southwest.

At least 20 people died and 1,015 others were wounded, according to AFAD.   "There is nobody trapped under the rubble in Malatya but in Elazig search and rescue efforts are currently under way to find 30 citizens," Interior Minister Suleyman Soylu said on Friday.   Rescue teams were searching for survivors trapped in a five-storey collapsed building in a village some 30 kilometres from Elazig, according to AFP journalists at the scene. One person was pulled alive from the rubble.   Emergency staff and people waiting at the scene lit fires in the streets to stay warm in freezing temperatures.   Sports centres, schools and guest houses had been opened to accommodate quake victims in Malatya.

- 'Everybody is in the street' -
Sivrice -- a town with a population of about 4,000 people -- is situated south of Elazig city on the shores of Hazar lake -- one of the most popular tourist spots in the region and the source of the Tigris river.   The lake is home to a "Sunken City", with archaeological traces dating back 4,000 years in its waters.

The tremor was felt in several parts of eastern Turkey near the Iraqi and Syrian borders, the Turkish broadcaster NTV reported, adding that neighbouring cities had mobilised rescue teams for the quake area.   "Everybody is in the street, it was very powerful, very scary," said Zekeriya Gunes, 68, from Elazig city, after the quakes caused a building to collapse on her street.   "It lasted quite long, maybe 30 seconds," added Ferda, 39. "I panicked and was undecided whether to go out in this cold or remain inside."

The US Geological Survey assessed the magnitude as 6.7, slightly lower than AFAD, adding that it struck near the East Anatolian Fault in an area that has suffered no documented large ruptures since an earthquake in 1875.   "My wholehearted sympathy to President @RTErdogan and the Turkish people following the devastating earthquake that has hit Turkey. Our search and rescue teams stand ready to assist," Greek Prime Minister Kyriakos Mitsotakis wrote on Twitter.   In Athens, the Greek premier's office said later that Mitsotakis had spoken by phone to Erdogan.   "The Turkish president... said Turkish teams had the situation under control for now and that it would be re-evaluated in the morning," his office added.

In 1999, a devastating 7.4 magnitude earthquake hit Izmit in western Turkey, leaving more than 17,000 people dead including about 1,000 in the country's largest city Istanbul.    In September last year, a 5.7-magnitude earthquake shook Istanbul, causing residents to flee buildings in the economic capital.   Experts have long warned a large quake could devastate the city of 15 million people, which has allowed widespread building without safety precautions.