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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Mon, 12 Feb 2018 05:54:19 +0100

San Juan, Feb 12, 2018 (AFP) - Most of San Juan and a strip of northern Puerto Rico municipalities were plunged into darkness Sunday night after an explosion at a power station, five months after two hurricanes destroyed the island's electricity network.

The state electric power authority (AEE) said the blast was caused by a broken-down switch in Rio Piedras, resulting in a blackout in central San Juan and Palo Seco in the north.   "We have personnel working to restore the system as soon as possible," the AEE said.   San Juan's mayor, Carmen Yulin Cruz, said on Twitter that emergency services and local officials attended the scene in the neighbourhood of Monacillos, but no injuries were reported.

Meanwhile, the Puerto Rican capital's airport said it was maintaining its schedule using emergency generators.   The blackout comes as nearly 500,000 of AEE's 1.6 million customers remain without power since Hurricanes Irma and Maria struck the US territory in September 2017.   AEE engineer Jorge Bracero warned on Twitter that the outage was "serious," and advised those affected that power would not be restored until Monday.
Date: Wed, 13 Dec 2017 03:08:12 +0100
By Leila MACOR

Fajardo, Puerto Rico, Dec 13, 2017 (AFP) - Until Hurricane Maria hit Puerto Rico, Jose Figueroa did brisk business renting kayaks to tourists itching to see a lagoon that lights up by night thanks to millions of microorganisms.   Today, things are so dire he's considering selling water to motorists stopped at red lights.   "Now we are trying to survive," the 46-year-old tour guide said.

It used to be that visitors had to reserve a month in advance to get one of his kayaks and paddle around in the dark on the enchanting, bioluminescent body of water called Laguna Grande.   But tourists are scarce these days as the Caribbean island tries to recover from the ravages of the storm back in September.   "We do not know if we will have any work tonight," Figueroa said. "Last week, we worked only one day."    He and another employee of a company called Glass Bottom PR are cleaning kayaks on the seaside promenade of Fajardo, a tourist town in eastern Puerto Rico whose main attraction is the so-called Bio Bay.

The year started off well for Puerto Rico, with the global success of the song "Despacito" by local musicians Luis Fonsi and Daddy Yankee.   The catchy tune helped promote the US commonwealth island of 3.4 million people, which is saddled with huge debts and declared bankruptcy in May.    But the hurricane turned what should be an island bustling with tourists into one with deserted beaches, shuttered restaurants and hotels full of mainland US officials working on the rebuilding of the island.   "What few tourists we have are the federal officials themselves," said Figueroa.

- Locals only -
The grim outlook spreads up and down the seaside promenade of Fajardo, where many restaurants are closed because there is no electricity.   On this particular day around noon, the only restaurant open is one called Racar Seafood. It has its own emergency generator.   "We get by on local tourists," said its 61-year-old owner, Justino Cruz.   "Our clients are local -- those who have no electricity, no generator, cold food or no food."

Puerto Rico's once-devastated power grid is now back up to 70 percent capacity, but this is mainly concentrated in the capital San Juan.   So while inland towns that depend on tourism are struggling mightily, things are getting better in San Juan as cruise ships are once again docking.   On November 30, the first cruise ship since the storm arrived with thousands of vacationers on board. They were received with great fanfare -- quite literally, with trumpet blaring and cymbals crashing.

- Pitching in to help -
The World Travel & Tourism Council, based in London, says tourism accounted for about eight percent of Puerto Rico's GDP in 2016, or $8.1 billion.   Hurricane Maria's damage has been uneven. Although some tour guides now have no work and many eateries are shut down, hotels that have their own generators are doing just fine.   Thanks to the thousands of US government officials and reconstruction crew members that came in after the storm, the hotels that are open -- about 80 percent of the total -- are pretty much full.

These people are starting to leave the island this month but hotels may receive tourists around Christmas, at least in San Juan, where power has for the most part been restored.   The hurricane "undoubtedly cost billions in lost revenue," said Jose Izquierdo, executive director of the Puerto Rico Tourism Company.    But Izquierdo nevertheless says he is "optimistic" and suggests an alternative: put tourists to work as volunteers in the gargantuan reconstruction effort that the island needs.   "We want to look for travellers who want to travel with a purpose, who might have the commitment to help rebuild," said Izquierdo.

The program, called "Meaningful Travel" and launched in mid-November, organizes trips on which residents, Puerto Ricans living abroad and tourists are invited to help the island get back on its feet.   "The plan aims to create empathy with this tourist destination," said Izquierdo.    "We want to be like New Orleans after Katrina, where 10 years after the hurricane, tourism is the driving force of its economy. We want to build that narrative of recovery," he added.   "There are different ways in which the world wants to help Puerto Rico. The best way is to visit us."
Date: Thu, 9 Nov 2017 12:39:04 +0100
By Marcos PÉREZ RAMÍREZ

San Juan, Nov 9, 2017 (AFP) - Andrea Olivero, 11, consults her classmate Ada about an exercise during their daily English class at San Juan's Sotero Figueroa Elementary School. The task: list the positive and negative aspects of Hurricane Maria's passing almost two months ago.

The girls only have to look around. There is no electricity and they "roast" in the heat, Andrea says. At the back of the room, computers and televisions collect dust.   "We would like to move past the topic of the hurricane a bit. It is already getting repetitive," Andrea told AFP.   She is one of more than 300,000 pupils in the public education system, although only half of schools are functioning. Barely 42 per cent of Puerto Ricans have electricity seven weeks after Maria struck, killing at least 51 in the American territory.

The lack of power has prompted disorienting timetable changes on the tropical island, to avoid both the hottest hours of the day and the use of dining facilities.   "The children are very anxious. We manage to make progress in lessons and they change the hours again. Everything is messed up and we fall behind," English teacher Joan Rodriguez explained.   "We can't use the computers to illustrate classes," she said. "They are reading the novel "Charlotte's Web," and we wanted to do exercises comparing it to the film version. But we cannot use the television.

- Suspicions -
From October 23, some directors reopened their schools in the western region of Mayaguez and San Juan.   But last Thursday, the Department of Education ordered their closure, insisting they must be evaluated by engineering and architectural firms, then certified by the US Army Corps of Engineers.   One of those schools was Vila Mayo, also in San Juan. The community presumed it would open, as it had been used as a shelter, its electrical infrastructure had been inspected and it had not suffered structural damage.

But Luis Orengo, the education department's director in San Juan, told protesters outside the school it was closed as inspectors' findings had not reached the central government.   "This is unacceptable! The school is ready to give classes but they don't want to open it. Our children cannot lose a year," fumed Enid Guzman, who protested with her 11-year-old son, Reanny De la Cruz.   There are suspicions the stalled reopening of schools is, in part, related to the prior closure of 240 schools over the past year during Puerto Rico's long-running financial crisis.   The fiscal difficulties have seen the island's population drop over the past decade by 14 percent, leading in turn to a fall in school enrolment.

Before the storms, 300 schools were at risk of closure -- and for the president of Puerto Rico's federation of teachers, Mercedes Martinez, the government's aim is clear.   "Secretary (Julia) Keleher seems to have an orchestrated plan to close schools," she said, referring to the education secretary. "Why do you have to wait 30 days to get a certification so a school can open?"   Keleher has announced she expects most schools to be open by the middle of November.
Date: Tue 24 Oct 2017
Source: KFOR Oklahoma News4 [edited]

Puerto Rico has reported at least 76 cases of suspected and confirmed leptospirosis, including a handful of deaths, in the month after Hurricane Maria, said Dr. Carmen Deseda, the state epidemiologist for Puerto Rico.

Two deaths involved leptospirosis confirmed through laboratory testing, and "several other" deaths are pending test results, Deseda said. The 76 cases, up from 74 last week, also include one patient with confirmed leptospirosis who is currently hospitalized.

The island typically sees between 63 and 95 cases per year, she said. Health officials had expected that there would be a jump after the hurricane. "It's neither an epidemic nor a confirmed outbreak," Public Affairs Secretary Ramon Rosario Cortes said at a news conference Sunday [22 Oct 2017]. "But obviously, we are making all the announcements as though it were a health emergency."

Leptospirosis may be treated with antibiotics, but many people recover on their own. "The majority of leptospirosis cases is a mild, subclinical disease with no complications," Deseda said. "But one out of 10 people who have leptospirosis develop severe illness." In the 1st stage of leptospirosis, symptoms vary widely from fever and headache to red eyes and rashes. Some people may have no symptoms at all. But a small number will develop dire complications: meningitis, kidney and liver damage, bleeding in the lungs and even death.

Doctors are required to report any potential leptospirosis cases to health authorities, Deseda said. Those cases must then be tested to confirm the bacteria, since the symptoms can be difficult to tell apart from other illnesses. After that, health officials may look for patterns or clusters and determine whether there is an outbreak.

The lab tests on the suspected cases have been sent to the US Centers for Disease Control and Prevention, Deseda said. The turnaround time is about 5-6 days.

Doctors on the island have expressed concerns about burgeoning health crises amid hospitals that are overwhelmed, undersupplied and sometimes burning hot. Influenza is another concern on the horizon, Deseda said. Drinking water is also hard to come by on many parts of the island.

Dr. Raul Hernandez, an internist in San Juan, told CNN that people were drinking water from whatever sources they could find, such as rivers and creeks. If that water contains urine from a [leptospirosis-infected rat], those people will be at risk, he said.

Deseda said people should be discouraged from walking barefoot, drinking or swimming in potentially leptospirosis-contaminated waters.

"These diseases are everywhere, and there's a way to prevent them," she said.
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[Leptospirosis is a zoonotic, spirochetal infection that occurs worldwide and is transmitted to humans by exposure to soil or fresh water contaminated with the urine of wild and domestic animals (including dogs, cattle, swine, and especially rodents) that are chronically infected with pathogenic _Leptospira_. _Leptospira_ may survive in contaminated fresh water or moist soil for weeks to months. Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers.

Parts of Puerto Rico saw more than 30 inches of rain and consequent flooding with recent Hurricane Maria. A map showing the estimated rainfall across Puerto Rico with this hurricane is available at <https://twitter.com/NWSSanJuan/status/910983698597777409/photo/1?ref_src=twsrc%5Etfw&ref_url>.

With continued absence of potable water, inadequate sanitation, and flooding in the streets for a large proportion of the population in Puerto Rico, food- and water-borne diseases, like leptospirosis, will be a major problem. - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu, 19 Oct 2017 16:37:27 +0200
By Ricardo ARDUENGO, con Nelson DEL CASTILLO en San Juan y Leila MACOR en Miami

Utuado, Puerto Rico, Oct 19, 2017 (AFP) - It's been a month since Hurricane Maria ripped through Puerto Rico and Samuel de Jesus still can't drive out of his isolated, blacked-out town.   In fact, much of the US territory in the Caribbean is still a crippled mess four weeks after that fierce Category Four storm.

The bridge connecting Rio Abajo to the rest of the island was swept away when Maria slammed the island on September 20. For two weeks Rio Abajo, located in a mountainous region in central-western Puerto Rico, was cut off and forgotten, without power or phone service.   "We didn't know what to do. We were literally going crazy," said de Jesus, 35.   "Those were difficult, desperate days. We could not find a way out, and the hurricane caused extensive damage," he told AFP.

During the two long weeks following Maria, the 27 families living in Rio Abajo saw their supplies quickly deplete.   De Jesus, who has diabetes, needed to keep his insulin refrigerated. The storm blew away the island's already decrepit power grid, so people resorted to emergency generators.   "But I was running out of gasoline to run the generator," he said.   A helicopter now makes regular deliveries of food, water and medicine because with the bridge washed out, there is no other way in or out of town.

People can't wade across the river because it is contaminated with human waste after a pipe broke when the bridge went.   Some brave souls use a precarious ladder rigged to get across the water, but for most people it is too dangerous.   We need a bridge "to take out our vehicles and leave in case of emergency, or if there is a landslide," he said.   Where the bridge once stood, residents set up a system of ropes, pulleys and buckets to move supplies over the river, which has been contaminated with sewer water since the hurricane.   Over the remains of the bridge locals hung the single-star, red, white and blue flag of Puerto Rico and a sign that reads "the campsite of the forgotten."

- Desperate need for electricity -
Puerto Rico Governor Ricardo Rossello visited the surrounding municipality of Utuado on Wednesday to deliver supplies, but he did not stop in Rio Abajo.   "Utuado is certainly one of the most severely affected municipalities in all of Puerto Rico," Rossello said.   "Our commitment is to give it support and aid during the whole road to recovery."   Eighty-one percent of Puerto Rico remains blacked out one month after Maria struck. Clean water for drinking, cooking and bathing is scarce, too.

Puerto Ricans' main obstacle to getting back to some semblance of normality is the slowness of the Puerto Rico Electric Power Authority in getting the power grid back up and running.   The lack of power has paralyzed a key industry -- pharmaceutical production -- and most businesses including restaurants are closed or operating at great cost through the use of diesel powered generators.

This nightmare comes about a year after the US government established an external fiscal control board for the island after it declared bankruptcy because of 73 billion dollars in debt.   Economist Joaquin Villamil told AFP that damage from Hurricane Maria is estimated at 20 billion dollars -- four times that of Hurricane Georges in 1998, when measured in 2016 dollars.

Villamil said reconstruction money provided by the Federal Emergency Management Agency and from insurance companies will have a positive impact on the island's economy in the second half of fiscal 2018 and in fiscal 2019, but this boost will just be temporary.   "From an economic point of view there is not much net gain," said Villamil, who works for a consulting firm called Estudios Tecnicos.   He said the economy has been shrinking since 2006 and Maria will delay any prospect of recovery.   It will take at least until 2026 to get back to the GDP level of 2006, he added.

Making things worse, people are leaving the island for the mainland US. Forecasts are that the population now at 3.4 million will go down to 3.1 million or even less by 2026, said Villamil.   The government of Florida estimates that since October 3 -- the day a state of emergency to deal with an influx of Puerto Ricans was declared -- more than 36,000 people from the island have poured in.
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Benin

Benin - US Consular Information Sheet
April 28, 2008

COUNTRY DESCRIPTION:
Benin is a developing country in West Africa. Its political capital is Porto Novo. However, its administrative capital, Cotonou, is Benin's largest city and the
site of most government, commercial, and tourist activity. Read the Department of State Background Notes on Benin for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. Visas are not routinely available at the airport. Visitors to Benin should also carry the WHO Yellow Card (“Carte Jaune”) indicating that they have been vaccinated for yellow fever. Contact the Embassy of Benin for the most current visa information. The Embassy is located at: 2124 Kalorama Road NW, Washington, DC 20008; tel: 202-232-6656.

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:
U.S. citizens should avoid crowds, political rallies, and street demonstrations and maintain security awareness at all times.
U.S. citizens should not walk on the beach alone at any time of day. It is also highly recommended not to carry a passport or valuables when walking in any part of the city. Travelers should carry a notarized photocopy of the photo page of their passport (see Crime section). They should not walk around the city after dark, and should take particular care to avoid the beach and isolated areas near the beach after dark.
The ocean currents along the coast are extremely strong and treacherous with rough surf and a strong undertow, and several people drown each year.

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: Street robbery is a significant problem in Cotonou. Robbery and mugging occur along the Boulevard de France (the beach road by the Marina and Novotel Hotels) and on the beaches near hotels frequented by international visitors. Most of the reported incidents involve the use of force, often by armed persons, with occasional minor injury to the victim. Travelers should avoid isolated and poorly lit areas and should not walk around the city or the beaches between dusk and dawn. Even in daylight hours, foreigners on the beach near Cotonou are frequent victims of robberies. When visiting the beach, travelers should not bring valuables and should carry only a photocopy of their passport. If you are a victim of crime, you should contact the U.S. Embassy immediately. There has been a continued increase in the number of robberies and carjacking incidents after dark, both within metropolitan Cotonou and on highways and rural roads outside of major metropolitan areas. Motorists are urged to be wary of the risk of carjacking. Keep the windows of your vehicle rolled up and the doors locked. Stay alert for signs of suspicious behavior by other motorists or pedestrians that may lead to carjacking, such as attempts to stop a moving vehicle for no obvious reason. Travelers should avoid driving outside the city of Cotonou after dark and should exercise extreme caution when driving in Cotonou after dark (see Traffic Safety and Road Conditions below). Overland travel to Nigeria is dangerous near the Benin/Nigeria border due to unofficial checkpoints and highway banditry.
Travelers should avoid the use of credit cards and automated teller machines (ATMs) in Benin due to a high rate of fraud. Perpetrators of business and other kinds of fraud often target foreigners, including Americans. While such fraud schemes in the past have been largely associated with Nigeria, they are now prevalent throughout West Africa, including Benin, and are more frequently perpetrated by Beninese criminals. Business scams are not always easy to recognize, and any unsolicited business proposal should be carefully scrutinized. There are, nevertheless, some indicators that are warnings of a probable scam. Look out for:

Any offer of a substantial percentage of a very large sum of money to be transferred into your account, in return for your "discretion" or "confidentiality";

Any deal that seems too good to be true;
Requests for signed and stamped, blank letterhead or invoices, or for bank account or credit card information;
Requests for urgent air shipment, accompanied by an instrument of payment whose genuineness cannot immediately be established;
Solicitations claiming the soliciting party has personal ties to high government officials;
Requests for payment, in advance, of transfer taxes or incorporation fees;
Statements that your name was provided to the soliciting party either by someone you do not know or by "a reliable contact";
Promises of advance payment for services to the Beninese government; and
Any offer of a charitable donation.
These scams, which may appear to be legitimate business deals requiring advance payments on contracts, pose a danger of both financial loss and physical harm. Recently more American citizens have been targeted. The perpetrators of such scams sometimes pose as attorneys. One common ploy is to request fees for “registration” with fictitious government offices or regulatory authorities. The best way to avoid becoming a victim of advance-fee fraud is common sense – if it looks too good to be true, it probably is. Travelers should carefully check out any unsolicited business proposal originating in Benin before committing any funds, providing any goods or services, or undertaking any travel. For additional information, please see the Department of State’s Bureau of Consular Affairs brochure, International Financial Scams.

Scams may also involve persons posing as singles on Internet dating sites or as online acquaintances who then get into trouble and require money to be "rescued." If you are asked to send money by someone you meet online please contact the U.S. Embassy before doing so.

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.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities in Benin are limited and not all medicines are available. Travelers should bring their own supplies of prescription drugs and preventive medicines. Not all medicines and prescription drugs available in Benin are USFDA-approved. Malaria is a serious risk to travelers to Benin. For information on malaria, its prevention, protection from insect bites, and anti-malarial drugs, please visit the CDC Travelers' Health web site at http://www.cdc.gov/malaria/.

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

With the exception of the road linking Cotonou in the south to Malanville on the border with Niger in the north, and from Parakou in central Benin to Natitingou in the northwestern part of the country, roads in Benin are generally in poor condition and are often impassable during the rainy season. Benin's unpaved roads vary widely in quality; deep sand and potholes are common. During the rainy season from mid-June to mid-September, dirt roads often become impassable. Four-wheel drive vehicles with full spare tires and emergency equipment are recommended.
Most of the main streets in Cotonou are paved, but side streets are often dirt with deep potholes. Traffic moves on the right, as in the United States. Cotonou has no public transportation system; many Beninese people rely on bicycles, mopeds, motorbikes, and zemidjans (moped taxis). All official Americans are required to wear safety helmets when on a motorcycle and are strongly discouraged from using zemidjans. Travelers using zemidjans, particularly at night, are much more vulnerable to being mugged, assaulted or robbed. Buses and bush taxis offer service in the interior.
Gasoline smuggled from Nigeria is widely available in glass bottles and jugs at informal roadside stands throughout Cotonou and much of the country. This gasoline is of unreliable quality, often containing water or other contaminants that can damage or disable your vehicle. Drivers should purchase fuel only from official service stations. There are periodic gas shortages, which can be particularly acute in the north of the country where there are few service stations.
U.S. citizens traveling by road should exercise extreme caution. Poorly maintained and overloaded transport and cargo vehicles frequently break down and cause accidents. Drivers often place branches or leaves in the road to indicate a broken down vehicle is in the roadway. Undisciplined drivers move unpredictably through traffic. Construction work is often poorly indicated. Speed bumps, commonly used on paved roads in and near villages, are seldom indicated. Drivers must be on guard against people and livestock wandering into or across the roads. Nighttime driving is particularly hazardous as vehicles frequently lack headlights and/or taillights, and brake lights are often burned out.
With few exceptions, Cotonou and other cities lack any street lighting, and lighting on roads between population centers is non-existent. The U.S. Embassy in Cotonou prohibits non-essential travel outside of metropolitan areas after dusk by official Americans and strongly urges all U.S. citizens to avoid night driving as well. There have been numerous carjackings and robberies on roads in Benin after dark, several of which resulted in murder when the driver refused to comply with the assailants' demands. The National Police periodically conduct vehicle checks at provisional roadblocks in an effort to improve road safety and reduce the increasing number of carjackings. When stopped at such a roadblock, you must have all of the vehicle's documentation available to present to the authorities.
Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office at http://www.benintourisme.com.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Benin, the U.S. Federal Aviation Administration (FAA) has not assessed Benin’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:
U.S. citizens are advised to keep a notarized photocopy of the photo page of their passport with them at all times when traveling in Benin.
The Embassy has had a few reports of officials requesting a "gift" to facilitate official administrative matters (e.g., customs entry). Such requests should be politely but firmly declined.
It is prohibited to photograph government buildings and other official sites, such as military installations, without the formal consent of the Government of Benin. In general, it is always best to be courteous and ask permission before taking pictures of people. Beninese citizens may react angrily if photographed without their prior approval.
Obtaining customs clearance at the port of Cotonou for donated items shipped to Benin from the United States may be a lengthy process. In addition, to obtain a waiver of customs duties on donated items, the donating organization must secure prior written approval from the Government of Benin. Please contact the U.S. Embassy in Cotonou for more detailed information.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 Benin laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Benin 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 Benin are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Benin. Americans withoutInternet access may register directly with the U.S. Embassy. 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 Rue Caporal Anani Bernard in Cotonou. The Embassy's mailing address is B.P. 2012, Cotonou, Benin. The 24-hour telephone numbers are (229) 21-30-06-50, 21-30-05-13, and 21-30-17-92. The Embassy’s general fax number is (229) 21-30-06-70; the Consular Section’s fax number is (229) 21-30-66-82; http://cotonou.usembassy.gov/.
* * *
This replaces the Country Specific Information for Benin dated August 17th, 2007 to update sections on Safety and Security and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Fri, 10 May 2019 19:38:30 +0200
By Hazel WARD and Daphne BENOIT

Paris, May 10, 2019 (AFP) - French special forces have freed two French hostages, an American and a South Korean in northern Burkina Faso in an overnight raid in which two soldiers died, authorities announced Friday.   The operation was launched to free two French tourists who had disappeared while on holiday in the remote Pendjari National Park in neighbouring Benin on May 1.

But during the raid, the French troops were surprised to discover two women also in captivity, with top officials saying they had been held for 28 days.    The French tourists were identified as Patrick Picque, 51, and Laurent Lassimouillas, 46, but the women's identities were not immediately clear.     "No one was aware of (the women's) presence," French Defence Minister Florence Parly told reporters, while French armed forces chief Francois Lecointre said.   "We know little about these other two hostages," Parly told reporters, saying that even Seoul and Washington did not appear to be aware the pair were in increasingly unstable Burkina Faso.    The raid was approved by French President Emmanuel Macron in what was seen as the last opportunity to stop the hostages being transferred to lawless territory in Mali to the north.

Parly said it was "too early to say" who had snatched the two French nationals from Benin, which has long been an island of stability in a region where Islamist militants are increasingly active.   "The message to terrorists and criminal gangs is clear: those who attack France and its nationals know that we will not spare any effort to track them down, find them and neutralise them," she said.   Four of the six kidnappers were killed in the raid.    French forces, helped by intelligence provided by the United States, had been tracking the kidnappers for several days as they travelled across the semi-desert terrain of eastern Burkina Faso from Benin to Mali.   They seized the opportunity to prevent "the transfer of the hostages to another terrorist organisation in Mali," Lecointre said, referring to the Macina Liberation Front (FLM).   The FLM is a jihadist group formed in 2015 and headed by a radical Malian preacher, Amadou Koufa. It is aligned with Al-Qaeda in the region.

- US intelligence support -
In a statement, Macron congratulated the special forces on the operation, in which he also expressed sorrow over the death of the two soldiers "who gave their lives to save those of our citizens".   And Parly thanked authorities in Benin and Burkina Faso for their help with the "complex operation", as well as the United States which provided intelligence and support.

The operation was also made possible by the presence of France's Operation Barkhane, which counts some 4,500 troops deployed in Mali, Burkina Faso, Niger and Chad to help local forces battle jihadist groups.   American special forces and drones are also known to operate in the violence-wracked Sahel region, which France fears could become further destabilised as jihadist groups are pushed out of north Africa, Iraq and Syria.   Burkina Faso has suffered from increasingly frequent and deadly attacks attributed to a number of jihadist groups, including the Ansarul Islam group, the Group to Support Islam and Muslims (GSIM) and Islamic State in the Greater Sahara.

- Relief and sadness -
The French tourists -- Patrick Picque who works in a Paris jewellery shop, and Laurent Lassimouillas a piano teacher, -- went missing with their guide on the last leg of their holiday in usually peaceful Benin.   The Pendjari wildlife reserve, which is famed for its elephants and lions, lies close to the porous border with Burkina Faso.   The badly disfigured body of their guide was found shortly after they disappeared, as well as their abandoned four-wheel Toyota truck.   The two freed men will be flown back to France on Saturday, alongside the South Korean woman, where they will be met on arrival by Macron and other top French officials.   Washington thanked the French forces for freeing the American hostage, with France saying she would likely be "repatriated independently" from the other three. 

The two dead French soldiers were named as Cedric de Pierrepont and Alain Bertoncello, decorated naval special forces members born in 1986 and 1991 respectively.   They were part of the prestigious Hubert commando unit of the French naval special forces which was deployed to the Sahel at the end of March.   A total of 24 French soldiers have died in the region since 2013 when France intervened to drive back jihadist groups who had taken control of northern Mali. The last death was on April 2.
Date: Tue 15 Jan 2019
Source: Punch [edited]

The Kwara state government has confirmed 2 cases of Lassa fever infecting a husband and wife in the state.

Speaking with newsmen on Tuesday [15 Jan 2019] at a news briefing, the Kwara commissioner for health, Alhaji Usman Rifun-Kolo, said the outbreak of Lassa fever was identified in a farm settlement in Taberu, Baruten local government area.

He explained that the 2 cases of the disease affected a husband and wife, natives of Benin republic, which shares a border with the state. He added that the husband and wife are farming in Baruten. "These cases of Lassa fever originated from Benin republic, whose citizen have interrelations with people in the Baruten area," he said.

According to him, the husband and wife were diagnosed in a health facility, and the state government had already deployed a disease-surveillance team to identify those who have been in contact with the patients.

Rifun-Kolo further explained that the surveillance team identified 4 people with a history of fever in the area. He said that the 4 cases raised suspicion of Lassa fever, which prompted them to take samples from the individuals for further investigation. He noted that the 4 individuals have commenced treatment in Taberu, Baruten LGA.
=====================
[The above report states that the couple was infected in Benin, although the timeline when that may have occurred is not given. The report also mentions 4 individuals in the Kwara state who had a history of Lassa fever, implying that the virus is present in that state in Nigeria as well. In December [2018], there were Lassa fever cases in Benin that were imported from Nigeria as well as infections that were locally acquired in Benin, so the Lassa fever cases cross the border in both directions. The source of the infecting virus for any of these cases is not mentioned. - ProMED Mod.TY

[HealthMap/ProMED-mail maps:
Kwara state, Nigeria: <http://healthmap.org/promed/p/19690>]
Date: Wed 26 Dec 2018
Source: Quotidein Le Matinal [in French, trans. ProMED Corr.SB, edited]

Minister of health Benjamin Hounkpatin confirmed on Wednesday [26 Dec 2018] 4 new cases of Lassa haemorrhagic fever in Benin, including one in Cotonou. This occurred in the period from 15-26 Dec 2018.

In the case of Cotonou, a 28-year-old (has been infected). His case was detected on 24 Dec [2018], but his illness commenced the previous week. He had a fever, a cough, a cold, and fatigue. Due to the persistence of the cough and cold, and with the appearance of traces of blood in nasal discharge on 24 Dec 2018, the alert was given.

The patient was placed in isolation on [Tue 25 Dec 2018], and on the morning of Wed 26 Dec 2018, his result from the laboratory came back positive [for Lassa fever]. Subsequently, the patient was isolated and put on treatment.

According to the details provided by Hounkpatin, there is no indication of travel [by the patient] to an epidemic locality of Lassa fever. According to the patient's statements, there is no known contact with rodents.

Taking advantage of this opportunity, the minister reassured the public that public health measures are underway. He also reminded people of the behaviours that will help avoid becoming infected. This involves washing hands regularly with soap and water; avoiding contact with stool, sperm, urine, saliva, vomit, and contaminated objects from a person suspected to be ill or dead from Lassa; and protecting food and keeping it in a safe place, out of reach of rodents.

It should be recalled that 7 cases have been recorded since the beginning of the epidemic to date, including 5 positive cases.
=======================
[One case is located in Cotonou on the Benin coast and apparently was locally acquired, perhaps from contact with the rodent host or its excrement. The location of the other 3 cases is not mentioned, but a 13 Dec 2018 report indicated that there were 3 cases in the municipality of Parakou in Borgou Department, in the northern part of Benin. Perhaps these 3 cases, which came from the village Taberou (in Nigeria), located 5 km [3.1 mi] from Tandou in the commune of Tchaourou, are the ones mentioned in this report.

The previous Lassa fever cases in Benin this year [2018] occurred in January and also involved case importation from Nigeria. A previous WHO report stated that Lassa fever is endemic in bordering Nigeria, and, given the frequent population movements between Nigeria and Benin, the occurrence of additional cases is not unexpected. Strengthening of cross-border collaboration and information exchange between the 2 countries is, therefore, needed. - ProMED Mod.TY]

[Images of the rodent reservoirs of Lassa fever virus can be seen as follows:
For _Mastomys natalensis_, see
For _M. erythroleucus_ and _Hylomycus pamfi_, see

HealthMap/ProMED-mail maps:
Date: Fri, 29 Jun 2018 13:37:32 +0200

Cotonou, June 29, 2018 (AFP) - Benin's Constitutional Court has banned the right to strike by workers in the country's defence, security, justice and health sectors, sparking concern among union officials and legal observers.   The ruling, issued late on Thursday, came after months of wrangling between the government and the court, which had previously said the measure was unconstitutional.

"Civil servants, public security forces and equivalents should fulfil their duties in all circumstances and not exercise their right to strike," the court said in its new ruling.   "There should be no disruption to the duties of public sector defence, security, justice and health workers."   The decision was taken "in the public interest" and for "the protection of citizens", it said.

Speaking on Friday, one senior union leader, who asked to remain anonymous, described the ruling as shocking and a "hammer blow".   And Benin legal affairs expert Albert Medagbe told AFP the decision was a "worrying sudden legal U-turn".   Earlier this month, a close ally of President Patrice Talon, Joseph Djogbenou, was elected to lead the Constitutional Court during a vote held behind closed doors.   Djogbenou is Talon's former personal lawyer and was previously  Benin's attorney general.

Until his arrival, the court had strained relations with Talon, and had criticised the government for misunderstanding and failing to respect the constitution.   The small West African nation was last year hit by a wave of public sector strikes, which brought the education, health and justice system to a near halt.   The industrial action was sparked by Talon's attempts to introduce free-market reforms.
Date: Wed, 21 Feb 2018 17:31:52 +0100

Cotonou, Feb 21, 2018 (AFP) - Nine people appeared in a Benin court Wednesday on charges of selling fake drugs at the start of a landmark trial in a regional campaign against illicit medicines.   The suspects, who include executives from major pharmaceutical companies operating in the West African nation, were remanded in custody until March 6 on technical grounds.   They are accused of "the sale of falsified medicines, (and) display, possession with a view to selling, commercialisation or sale of falsified medical substances."   A tenth defendant, the head of the Directorate for Pharmacies, Medications and Diagnostic Evaluation (DPMED) under the control of the ministry of health, was not in court on the trial's opening day.   He is accused of failing to prevent the offences.

Benin launched the crackdown last year after mounting alarm about the scale of the trafficking of expired and counterfeit drugs in West Africa.   Fake medicines are drugs that are bogus or below regulatory standards but often are outwardly indistinguishable from the genuine product.   Taking them may do nothing to tackle an illness or -- in the case of antibiotics -- worsen the problem of microbial resistance.   According to an investigation by the Paris-based International Institute of Research Against Counterfeit Medicines (IRACM), West African markets are awash with fake drugs made in China and India.

In 2015, the American Society of Tropical Medicine and Hygiene estimated that 122,000 children under five died due to taking poor-quality antimalarial drugs in sub-Saharan Africa.   A 15-nation regional body, the Economic Community of West African States (ECOWAS), last April announced an investigation into the fake drugs business.   A lawyer for the civilian plaintiffs told AFP that the trial in Benin was adjourned until March 6 at their request "in order to incorporate another case, of illegal pharmaceutical practice".
More ...

Netherlands Antilles

Netherland Antilles US Consular Information Sheet
May 12, 2008
COUNTRY DESCRIPTION:
The five islands of Bonaire, Curaçao, Saba, St. Eustatius (or “Statia”) and St. Maarten (Dutch side) comprise the Netherlands Antilles, an autonomous
art of the Kingdom of the Netherlands. Tourist facilities are widely available. Read the Department of State Background Notes on the Netherlands Antilles for additional information.
ENTRY/EXIT REQUIREMENTS: All Americans traveling by air outside the United States are required to present a passport or other valid travel document to enter or re-enter the United States. This requirement will be extended to sea travel (except closed loop cruises), including ferry service, by the summer of 2009. Until then, U.S. citizens traveling by sea must have government-issued photo identification and a document showing their U.S. citizenship (for example, a birth certificate or certificate of nationalization), or other document compliant with the Western Hemisphere Travel Initiative, such as a passport card for entry or re-entry to the U.S. Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.

Applications for the new U.S. Passport Card are now being accepted. Based on current projections, we expect to begin production of the passport card in June 2008 and be in full production in July 2008. The card may not be used to travel by air and is available only to U.S. citizens. Further information on the Passport Card is available at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html. We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel. American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.
The U.S. Consulate recommends traveling in the Netherlands Antilles with a valid U.S. passport to avoid delays or misunderstandings. A lost or stolen passport is also easier to replace when outside the United States than other evidence of citizenship. Visitors to the Netherlands Antilles may be asked to show onward/return tickets or proof of sufficient funds for their stay. Length of stay is granted for two weeks and may be extended for 90 days by the head office of immigration. For further information, travelers may contact the Royal Netherlands Embassy, 4200 Linnean Avenue, N.W., Washington, D.C. 20008, telephone (202) 244-5300, or the Dutch Consulate in Los Angeles, Chicago, New York, Houston or Miami. Visit the web site for the Embassy of the Netherlands at http://www.netherlands-embassy.org/homepage.asp for the most current visa information.

We have more information pertaining to dual nationality and international child abduction. Please refer to our customs information to learn more about customs regulations.

SAFETY AND SECURITY:
Drug-related organized crime exists within the Netherlands Antilles but has not directly affected tourists in the past.
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, 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: In recent years, street crime has increased, especially in St. Maarten. Valuables, including passports, left unattended on beaches, in cars and hotel lobbies are easy targets for theft, and visitors should leave valuables and personal papers secured in their hotel. Burglary and break-ins are increasingly common at resorts, beach houses and hotels. Armed robbery occasionally occurs. The American boating community has reported a handful of incidents in the past, and visitors are urged to exercise reasonable caution in securing boats and belongings. Car theft, especially of rental vehicles for joy riding and stripping, can occur. Incidents of break-ins to rental cars to steal personal items have been reported by American tourists. Vehicle leases or rentals may not be fully covered by local insurance when a vehicle is stolen. Be sure you are sufficiently insured when renting vehicles and jet skis.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
Please see our information for American Victims of Crime Overseas.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is generally good in Curaçao and St. Maarten, but may be limited on the other three islands. Hospitals have three classes of services i.e.: First Class: one patient to a room, air conditioning etc.; Second Class: two to six patients to a room, no air conditioning; Third Class: 15 to 30 people in one hall. Patients are accommodated according to their level of insurance.
Bonaire: The San Francisco hospital is a medical center (35 beds) with decompression facilities. The hospital has an air ambulance service to Curaçao and Aruba.
Curaçao: St. Elizabeth hospital is a public hospital that may be compared to midrange facilities in the United States. St. Elizabeth's hospital has a decompression chamber and qualified staff to assist scuba divers suffering from decompression sickness. Several private clinics provide good to excellent medical service.
St. Maarten: St. Maarten Medical Center (79 beds) is a relatively small hospital where general surgery is performed. Complex cases are sent to Curaçao.
Statia: Queen Beatrix Medical Center (20 beds) is a medical facility well equipped for first aid. Surgery cases are sent to St. Maarten.
Saba: Saba Clinic (14 beds) is a well-equipped first aid facility. Surgery cases are sent to St. Maarten. The Saba Marine Park has a decompression chamber and qualified staff to assist scuba divers suffering from decompression sickness.
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 the Netherlands Antilles is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving in the Netherlands Antilles is on the right hand side. Right turns on red are prohibited, and traffic conditions require somewhat defensive driving. Local laws require drivers and passengers to wear seat belts and motorcyclists to wear helmets. Children under 4 years of age should be in child safety seats; children under 12 should ride in the back seat.
Nonexistent or hidden and poorly maintained street signs are the major road hazard in the Netherlands Antilles. Therefore, drivers should proceed through intersections with caution. Roads in the Netherlands Antilles are extremely slippery during rainfall. Night driving is reasonably safe in the Netherlands Antilles as long as drivers are familiar with the route and road conditions. Most streets are poorly lit or not lit at all. In Curacao, drivers should be aware of herds of goats that may cross the street unexpectedly. In Bonaire, wild donkeys may also cross the road.
Taxis are the easiest, yet most expensive form of transportation on the islands. As there are no meters, passengers should verify the price before entering the taxi. Fares quoted in U.S. dollars may be significantly higher than those quoted in the local currency. Vans are inexpensive and run non-stop during daytime with no fixed schedule. Each van has a specific route displayed in the front of the windshield. Buses, which run on the hour, have limited routes. The road conditions on the main thoroughfares are good to fair.
See road safety information at the following sites; http://www.curacao.com, http://www.statiatourism.com, http://www.sabatourism.com, http://www.infobonaire.com, http://www.st-maarten.com/.
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 the Netherlands Antilles’ Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the Netherlands Antilles’ 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:
Dutch law in principle does not permit dual nationality. However, there are several exceptions. For example, American citizens who are married to Dutch citizens are exempt from the requirement to abandon their American nationality when they apply to become a Dutch citizen by naturalization. For detailed and specific information on this subject, contact the Embassy of the Netherlands in Washington or one of the Dutch consulates in the U.S. In addition to being subject to all Dutch laws affecting U.S. citizens, dual nationals may also be subject to other laws that impose special obligations on Dutch citizens.
Time-share buyers are cautioned about contracts that do not have a "non-disturbance or perpetuity protective clause" incorporated into the purchase agreement. Such a clause gives the time-share owner perpetuity of ownership should the facility be sold. Americans sometimes complain that the timeshare units are not adequately maintained, despite generally high annual maintenance fees. Because of the large number of complaints about misuse of maintenance fees, particularly in St. Maarten, prospective timeshare owners are advised to review the profit and loss statement for maintenance fees. Investors should note that a reputable accounting firm should audit profit and loss statements.
Potential investors should be aware that failed land development schemes involving time-share investments could result in financial losses. Interested investors may wish to seek professional advice regarding investments involving land development projects. Real estate investment problems that reach local courts are rarely settled in favor of foreign investors.
An unusually competitive fee to rent vehicles or equipment could indicate that the dealer is unlicensed or uninsured. The renter is often fully responsible for replacement costs and fees associated with any damages that occur during the rental period. Visitors may be required to pay these fees in full before leaving the Netherlands Antilles and may be subject to civil or criminal penalties if they cannot or will not make payment.
Netherlands Antilles customs authorities may enforce strict regulations concerning temporary importation into or export from the Netherlands Antilles. For example, it is strictly prohibited to export pieces of coral and/or seashells. 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 offences. Persons violating the laws of the Netherlands Antilles, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the Netherlands Antilles are severe, and convicted offenders can expect long jail sentences and heavy fines. The Netherlands Antilles has strict gun control laws; even a stray bullet in a suitcase can trigger a fine or time in jail. 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 on international adoption of children and international parental child abduction, see the Office of Children’s Issues web site.
REGISTRATION / EMBASSY LOCATION:
American citizens residing or traveling in the Netherlands Antilles 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 Netherlands Antilles. 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. Consulate General is located at J.B. Gorsiraweg #1, Willemstad, Curaçao, telephone (599-9) 461-3066; fax (599-9) 461-6489; e-mail address: acscuracao@state.gov.
* * *
This replaces the Country Specific Information dated May 7, 2007, to update the Entry/Exit, Crime, Traffic Safety and Road Conditions, and Registry / Embassy Location sections.

Travel News Headlines WORLD NEWS

Date: Thu, 16 May 2019 23:41:35 +0200

Washington, May 16, 2019 (AFP) - The Church of Scientology said Thursday all the passengers from a cruise ship that was quarantined over a measles case had been cleared to leave.    "All passengers and crew (100%) of the Freewinds have been fully cleared of any possible risk of being infected by the measles or infecting others," the organization said in a statement.   "All passengers and crew are free to come and go as they wish," a spokesman added to AFP.

The infected individual was a member of the crew who, according to the Church, had fully recovered and was given a clean bill of health a week ago. She had been earlier confined on the ship.   The ship, which is based in Willemstad on the island of Curacao in the Dutch West Indies, was quarantined after its arrival in Saint Lucia on April 30.   It remained there for two days before returning to Willemstad on May 4 where local authorities ordered a fresh quarantine to give them time to confirm the passengers were either immunized or had no risk of contracting the virus.
Date: Sat, 4 May 2019 20:37:18 +0200
By Sara MAGNIETTE

The Hague, May 4, 2019 (AFP) - The Dutch territory of Curacao said Saturday it would do what is needed to prevent measles spreading from a Scientology cruise ship, after a crew member came down with the disease.   The Freewinds, which left the Caribbean island of St. Lucia on Friday, arrived back in its home port of Curacao at around 9:00 am (1300 GMT) Saturday, according to myshiptracking.com.

The Curacao government said in a statement that it would "take all necessary precautions to handle the case of measles on board of the Freewinds," including vaccinations.   "An investigation will also be done to determine who will be allowed to leave the ship without (posing) a threat to the population of Curacao," it said.   "It is imperative to make all efforts to prevent a spread of this disease internationally."   Dutch broadcaster NOS reported that three health officials had boarded the boat to examine those on board. Only people able to prove that they have been vaccinated against measles or had already had the disease would be able to leave the boat, its correspondent there reported.

- Anti-vaccine movement -
The Church of Scientology says the 440-foot (134-meter) vessel is used for religious retreats and is normally based in Curacao.   The vessel had arrived in St Lucia from Curacao on Tuesday, when it was placed under quarantine by health authorities there because of a measles patient, said to be a female crew member.   According to NOS, the crew member concerned is a Danish national, who arrived in Curacao from Amsterdam on April 17. It was only when the boat was at sea, on route to St Lucia, that a doctor discovered she had measles, their correspondent said.

The resurgence of the once-eradicated, highly contagious disease is linked to the growing anti-vaccine movement in richer nations, which the World Health Organization (WHO) has identified as a major global health threat.   The authorities in Curacao nevertheless urged local people not to panic, as the risk of the disease spreading in this case was fairly low.   Several people did however visit the cruise ship between April 22 and April 28 before it set sail for St Lucia and the authorities asked them to make themselves known to health officials.

Officials said the Freewinds had travelled between Curacao, St Lucia and another Dutch-held island, Aruba, several times towards the end of April.   There were about 300 people aboard the ship, according to Saint Lucia authorities, which placed the vessel in quarantine. They said they provided 100 doses of measles vaccine at no cost.   The Scientology church, founded by science fiction writer L Ron Hubbard in 1953, did not respond to requests for comment.   Its teachings do not directly oppose vaccination, but followers consider illness a sign of personal failing and generally avoid medical interventions.
Date: 4 Jul 2017
From: Harry Vennema <harry.vennema@rivm.nl> [edited]

On several of the Caribbean islands, epidemics of viral conjunctivitis are ongoing. Recently, general practitioners in the overseas territories of the Netherlands reported an increased incidence of this syndrome.

As of 26 May 2017, an outbreak of conjunctivitis occurred in a nursing home on Bonaire. In total, 14 patients and 13 healthcare workers presented with conjunctivitis. Patients were between 71 to 94 years of age. The number of new cases peaked in week 20 through 22. After week 22, a significant reduction was seen (1-3 new cases per week). Initially, conjunctival swabs from 5 patients were tested for the presence of adenovirus by PCR; all 5 were negative.

Subsequently, swabs from 4 patients were analyzed for the presence of enterovirus by RT-PCR, and all 4 were positive. The enterovirus from 3 samples was further characterized by partial VP1 sequence analysis. In all 3 samples, the enterovirus was characterized as Coxsackievirus A24, which belongs to Enterovirus C. Coxsackievirus A24 has been identified frequently as the causative agent of epidemic viral conjunctivitis. The strain from Bonaire is at least 5 percent different from any of the previously isolated and sequenced CV-A24 strains available in Genbank in a 330nt VP1 fragment. The strain involved in the most recent outbreak of CV-A24 conjunctivitis on La Reunion in 2015 is 6 percent different from the Bonaire 2017 strain.

[Andert Rosingh, Yingbin Celestijn-Wu, Fundashon Mariadal Hospital, Clinical Microbiology, Kralendijk, Bonaire, Caribbean Netherlands Annelies Riezebos, University Medical Centre Utrecht, Medical Microbiology, Utrecht, Netherlands Harry Vennema, Kim Benschop, Johan Reimerink, Hans van den Kerkhof, National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, Netherlands]
--------------------------------------------
Harry Vennema
National Institute for Public Health and the Environment
Centre for Infectious Disease Control
Bilthoven, Netherlands
=========================
[ProMED thanks Harry Vennema and colleagues for this report.  Acute hemorrhagic conjunctivitis (AHC) is characterized by sudden onset of painful, swollen, red eyes with subconjunctival haemorrhages and excessive tearing. Most cases are self-limited but highly contagious, with the potential for causing considerable illness. Adenoviruses and picornaviruses can cause AHC outbreaks (1). Among picornaviruses, enterovirus 70 and coxsackievirus A24 variant (CA24v) have caused large outbreaks of AHC[2].

Coxsackieviruses are transmitted primarily via the fecal-oral route and respiratory aerosols, although transmission via fomites is possible. The viruses initially replicate in the upper respiratory tract and the distal small bowel. They have been found in the respiratory tract up to 3 weeks after initial infection and in feces up to 8 weeks after initial infection[3]. The potential for exponential spread is, therefore, quite considerable.

It is important to understand that sequential outbreaks of AHC due to CA24v might occur in the same location after a considerable period, and public health precautions are necessary to control these outbreaks.

References:
1. Hierholzer JC, Hatch MH. Acute hemorrhagic conjunctivitis. In: Darrell RW, editor. Viral diseases of the eye. Philadelphia: Lea & Febiger; 1985. p. 165-96.
2. Kono R. Apollo 11 disease or acute hemorrhagic conjunctivitis: a pandemic of a new enterovirus infection of the eyes. Am J Epidemiol. 1975;101:383-90.

[A HealthMap/ProMED-mail map can be accessed at:
Date: Published ahead of print 7 Dec 2015
Source: American Journal of Tropical Medicine & Hygiene Published on line doi:10.4269/ajtmh.15-0308 [edited]

Noellie Gay, Dominique Rousset, Patricia Huc, Severine Matheus, Martine Ledrans, Jacques Rosine, Sylvie Cassadou, and Harold Noel. Seroprevalence of Asian Lineage Chikungunya Virus Infection on Saint Martin Island, 7 Months After the 2013 Emergence.

Abstract
--------
At the end of 2013, chikungunya virus (CHIKV) emerged in Saint Martin Island, Caribbean. The Asian lineage was identified. 7 months after this introduction, the seroprevalence was 16.9 percent in the population of Saint Martin and 39.0 percent of infections remained asymptomatic. This moderate attack rate and the apparent limited size of the outbreak in Saint Martin could be explained by control measures involved to lower the exposure of the inhabitants. Other drivers such as climatic factors and population genetic factors should be explored. The substantial rate of asymptomatic infections recorded points to a potential source of infection that can both spread in new geographic areas and maintain an inconspicuous endemic circulation in the Americas.
--------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
===================
[Asymptomatic or very mild infections may be an important source of infectious blood meals for vector mosquitoes. These infections should not be overlooked in epidemiological assessments of chikungunya virus outbreaks and implementation of control measures in the field. - ProMed Mod.TY]
Date: Wed, 26 Aug 2015 16:43:59 +0200 (METDST)

Miami, Aug 26, 2015 (AFP) - Tropical storm Erika took aim at the Lesser Antilles Wednesday as storm warnings went up there and in Puerto Rico in anticipation of heavy rains, US forecasters said.   With winds of 75 kilometres (45 miles) per hour, Erika was 540 kilometres (335 miles) east of Antigua at 1200 GMT, the Miami-based National Hurricane Center reported.

Advancing at a speed of 28 kilometres (17 miles) per hour, it was expected to sweep over the Lesser Antilles Wednesday night and then head toward Puerto Rico and the Virgin Islands.   Tropical storm warnings were up in Puerto Rico, the Virgin Islands, Antigua and Barbuda, Guadeloupe, Montserrat, St Kitts and Nevis, Anguilla, Saba, St Eustacia and St Maarten.

A US Air Force hurricane hunter aircraft that flew into the storm found it was slightly increasing in strength.   "Some slow strengthening is forecast during the next 48 hours," the hurricane centre said.   According to the NHC's projections, Erika could become a hurricane by the end of the week, or early next, as it nears Florida.   But "the intensity forecast remains very uncertain," it said.

Erika is arriving on the heels of Danny, the season's first hurricane which petered out before reaching the Caribbean.   Experts said earlier this month that there was a 90 percent chance the 2015 hurricane season in the Atlantic would be less active than usual.
More ...

American Samoa

Samoa US Consular Information Sheet
January 23, 2008
COUNTRY DESCRIPTION:
Samoa consists of the two large islands of Upolu and Savai’i and seven small islets. The country has a stable parliamentary democracy with a developing economy. To
rist facilities are accessible by bus, taxi and car and are within walking distance of access roads. Infrastructure is adequate in Apia, the capital, but it is limited in other areas. Nearly all Internet connections use a relatively slow dial-up method. Samoa has two digital telephone service providers, and visitors can easily purchase prepaid phones that cover virtually the entire country. The Samoa Tourism Authority, at http://www.visitsamoa.ws/, provides a wide range of information of interest to travelers. Read the Department of State Background Notes on Samoa for additional information.

ENTRY/EXIT REQUIREMENTS:
U.S. nationals who are not U.S. citizens, and who are resident in American Samoa, must obtain a visitor permit prior to all travel to Samoa. U.S. nationals have not been permitted to travel to Samoa on certificates of identity since May 2005 except on a case by case basis. (U.S. law distinguishes between individuals who are citizens and those who are nationals. The U.S. passport bio-page shows one’s status as either a citizen or a non-citizen national.) As of March 22, 2006, visitor permits to travel to Samoa can be applied for at the new Samoa Consulate General office in Pago Pago, American Samoa. A valid passport and an onward/return ticket are required for all Americans (both citizens and nationals) to travel to Samoa. Visitor permits are not required for U.S. citizens (only for U.S. nationals) seeking to stay in Samoa for up to 60 days. All visitors are required to pay a departure tax of 40 Tala (approximately 17.50 USD) upon leaving the country. Further information about entry requirements and the departure tax may be obtained from the Samoa Mission to the United Nations at 800-2nd Avenue, Suite 400J, New York, NY 10017, telephone (212) 599-6196, fax (212) 599-0797. Visit the Embassy ofSamoa web site at http://www2.un.int/public/Samoa/ 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:
In Apia and many villages, stray dogs wander the streets. Visitors should not approach or feed them; they can become aggressive in the presence of food or if they feel threatened.

Although there have been no major accidents involving the ferry service linking Upolu and Savai’i, vessels are sometimes overloaded. One of the ferries, a multi-deck automobile ferry, sometimes transports passengers on its automobile deck. Americans who choose to use this ferry are encouraged not to remain in the automobile deck during the crossing and to ride only in the passenger compartment in order to avoid injury from shifting vehicles.

Samoa has numerous “blowholes” (lava tubes open to the sea where wave action produces, often spectacular, geysers). These blowholes are popular tourist attractions. The footing around the mouths of most blowholes is very slippery. To avoid being swept in, visitors should not approach too closely and should never stand between the opening of the blowhole and the sea.

Snorkeling and diving in ocean lagoons is a popular activity for many visitors to Samoa. Tide changes can produce powerful currents in these lagoons. Visitors are encouraged to consult local residents and tour operators about hazards and conditions at a particular location before venturing into the water.

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:
Overall, Samoa is considered a low threat environment. Nevertheless, visitors should remain aware of their surroundings, lock their doors at night, and not leave their belongings unattended. Incidents of petty theft/robberies of personal effects are common. Some such incidents have involved residential break-ins. While rare, violent assaults, including sexual assaults have occurred in Samoa. No specific groups have been targeted, nor have there been any racially motivated or hate crimes against Americans. Police responsiveness in Apia is generally good. Because of the very limited police presence elsewhere in Samoa (where order is maintained primarily by local village authorities), police responsiveness elsewhere is problematic.

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.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Health care facilities in Samoa are adequate for routine medical treatment, but are limited in range and availability; complex illnesses and life-threatening emergencies generally need to be treated elsewhere. Dental facilities do not meet U.S. standards, but good dental treatment and some emergency care can be obtained nearby at the LBJ Tropical Medical Center in Pago Pago, American Samoa. The national hospital and a small private hospital are located in Apia, and there are several small district hospitals on Savai'i and in outlying areas of Upolu. There are no hyperbaric chambers on any of the islands for the treatment of scuba diving related injuries. Serious cases of decompression sickness are evacuated to the nearest treatment center in Suva, Fiji, or Auckland, New Zealand. Serious medical conditions and treatments that require hospitalization and/or medical evacuation to the United States can cost thousands of dollars. Travelers should carry emergency evacuation insurance. Doctors and hospitals often expect immediate cash payment for health services. There is no reported incidence of malaria or rabies in Samoa. Occasional outbreaks of typhoid and non-hemorrhagic dengue do occur.

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

Safety of public transportation and rural road conditions in Samoa, are considered fair, while urban road conditions/maintenance is considered good. Taxis in particular are widely available and used by Samoans and visitors alike; buses are slow, generally crowded and uncomfortable, and rarely utilized by visitors. Rental cars can also be obtained. No roadside assistance is available. Most major roads are tar-sealed, but secondary roads are predominantly dirt and gravel and may be overgrown with vegetation. A four-wheel drive vehicle is recommended for travel on these roads. Travelers should be aware that vehicle safety regulations are rarely enforced and traffic violations occur routinely. Roads outside Apia are often narrow, winding, relatively steep, with narrow or no shoulders, and poorly lighted. Pedestrians as well as vehicles and livestock regularly travel these roads. Due to poor and deteriorating road conditions, night driving on unlit rural roads can be dangerous and should be avoided if possible. Roads in Samoa often traverse small streams. Drivers are urged to exercise extreme caution when fording these streams, which can become swollen and dangerous with little warning. Vehicles should never enter a stream if the roadbed is not visible or if the water’s depth exceeds the vehicle’s clearance.

Speed limits in Samoa are 25 miles per hour in the Apia area and 35 miles per hour outside Apia, with certain exceptions. At unmarked intersections, traffic on the left has the right of way. As in the United States, vehicular traffic moves on the right side of the road; although right-hand-drive vehicles (mainly from New Zealand) do exist in Samoa. Importing right hand drive vehicles to Samoa is currently legally forbidden.

Please refer to our Road Safety page for more information. Visit the web site of the country’s national tourist office at Samoa Tourism Authority at http://www.visitsamoa.ws/.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government ofSamoa’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Samoa’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:
Some overseas treatment centers, known as Behavior Modification Facilities, operate in Samoa. Though these facilities may be operated and staffed by U.S. citizens, the Samoan government is solely responsible for compliance with local safety, health, sanitation and educational laws and regulations, including all licensing requirements of the staff in country. These standards, if any, may not be strictly enforced or meet the standards of similar facilities in the U.S. Parents should be aware that U.S. citizens and non-citizen nationals 14 years of age and older have a right to apply for a passport and to request repatriation assistance from the U.S. government, both without parental consent. Any U.S. citizen or non-citizen enrollee has the right to contact a representative from the U.S. Embassy. For further information, consult the Department of State's Fact Sheet on Behavior Modification Facilities, available via the Bureau of Consular Affairs home page. Parents may also contact the U.S. Embassy in Apia or the country officer in the Office of American Citizens Services, Bureau of Consular Affairs at 202-647-5226.

Financial Transactions:
Although some businesses (especially those in Apia or those frequented by tourists) do accept credit cards, many (including gas stations) do not. Major credit cards (Visa, Master Card, and American Express) are accepted at major hotels and some restaurants and stores. Samoan currency can be obtained from ATMs, which are located in Faleolo Airport and in many locations in Apia. For more information on ATM locations and banking services see ANZ web site at http://www.anz.com/samoa/overview.asp and WESTPAC web site at http://www.westpac.com.ws/pacific/publish.nsf/Content/PFSA+HomePage.

Disaster Preparedness: Samoa is located in an area of high seismic activity. Although the probability that a major earthquake would occur during an individual trip is remote, earthquakes can and will continue to happen. Major cyclones have occurred in the past and are always a concern. Strong winds and very heavy rains are common, especially during the rainy season from November to April. During this period, Samoa receives most of its annual average of over 130 inches of rain. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency’s (FEMA) web site at http://www.fema.gov/.

Customs: Samoa customs authorities may enforce strict regulations concerning temporary importation into or export from Samoa of items such as firearms, fruits, pets and other animals, and drugs. It is advisable to contact the Samoan Mission to the United Nations at 800 2nd Avenue, Suite 400J, New York, NY 10017, telephone (212) 599-6196 for specific information regarding customs requirements. 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 Samoa’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Samoa 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:
Samoa is not a member of the Hague Convention on the Civil Aspects of International Child Abduction. 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 Samoa 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 withinSamoa. 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 the Accident Compensation Board (ACB) Building, Fifth Floor, Apia. The Embassy is open to the public from 8:15 a.m. to 5:00 p.m. Monday - Friday. The Embassy's mailing address is U.S. Embassy, P.O. Box 3430, Apia, Samoa 0815. The telephone numbers are (685) 21436/21631/22696 and 21452. The fax number is (685) 22030. An Embassy officer can be reached after hours in an emergency involving the welfare of a U.S. citizen or non-citizen national at (685) 21514 or (685) 777-1776. Visit the U.S. Embassy’s web site at http://samoa.usembassy.gov/.
* * *
This replaces the Consular Information Sheet (now known as Country Specific Information) dated May 21, 2007, to update sections on Country Description and Crime.

Travel News Headlines WORLD NEWS

American Samoa. 8 Mar 2017.
(susp) as of mid-February 30 cases of Dengue.

A HealthMap/ProMED-mail map showing the location of American Samoa in the Pacific can be accessed at <http://healthmap.org/promed/p/380>
and a map of the island at <http://www.nationsonline.org/maps/tutuila-island-map.jpg>. - ProMED Mod.TY
Date: Sat 20 Sep 2014
Source: Radio New Zealand [edited]

Latest figures from Samoa's Ministry of Health show an increase of suspected and confirmed cases of chikungunya [virus infections] from 400 to 626 since the outbreak of the acute fever, rash and joint pain disease was reported in July [2014].

However, the ministry says so far presentation of the main signs and symptoms of those affected have largely been mild.

The highest number of people affected is recorded in the districts of Vaimauga west in the urban area with 151 cases; Faleata east, 139 cases; and 113 in Faleata west.  The majority of patients is young.

In American Samoa, the chikungunya outbreak is on the wane. Health officials say there are now 823 probable cases of the mosquito-borne illness, with 15 people requiring hospital care.
===========
[The chikungunya outbreak continues to grow in Samoa, from 269 cases reported on 25 Aug 2014 to 433 reported on 8 Sep 2014 and now to 626 cases. One hopes that a prompt and aggressive clean up of breeding sites will reduce the vector mosquito population enough to halt, or at least reduce, transmission.

On 26 Jul 2014, it was reported that American Samoa had about 100 cases, with 3 laboratory confirmed as chikungunya virus infections (see ProMED-mail archive no. 20140727.2638925). This is a sharp outbreak, with over 700 cases in a little over one month, apparently peaking at 823 probable cases reported above. Once introduced into American Samoa, spread of the virus is not surprising, because it has had dengue virus transmission in the past, and the same mosquitoes that transmit dengue viruses can transmit chikungunya virus as well.

A map showing the location of Samoa in the Pacific Ocean can be accessed at <http://www.worldatlas.com/webimage/countrys/oceania/wsnewz.gif>. A HealthMap/ProMED-mail map showing the location of both Samoa and American Samoa in the Pacific Ocean can be accessed at <http://healthmap.org/promed/p/380>. - ProMed Mod.TY]
Date: Mon 9 Sep 2014
Source: Radio New Zealand [edited]
<http://www.radionz.co.nz/international/pacific-news/253977/chikungunya-related-cases-reach-over-700-in-american-samoa

The latest reports from American Samoa reveal that chikungunya-related [febrile] cases have now reached over 700, and there is now one probable case in Ofu, Manua. The virus was discovered in the territory in July 2014, but there have been no reported cases in Manua until now.

Health officials are urging residents not to travel to Manua if they have chikungunya, and testing is being done to determine whether the case in Ofu is due to the virus. Since July 2014, there have been 11 hospitalisations with the virus but no deaths.

Health officials continue to urge those with symptoms to drink plenty of fluids, get a lot of rest, and visit the emergency department if symptoms become serious.
=======================
[On 26 Jul 2014, it was reported that American Samoa had about 100 cases, with 3 laboratory confirmed as chikungunya virus infections (see ProMED-mail archive no. 20140727.2638925). This is a sharp outbreak, with over 700 cases in a little over one month. Once introduced into American Samoa, spread of the virus is not surprising, because it has had dengue virus transmission in the past, and the same mosquitoes that transmit dengue viruses can transmit chikungunya virus as well.

A HealthMap/ProMED-mail map showing the location of American Samoa in the Pacific Ocean can be accessed at
Date: Tue 5 Aug 2014
Source: Radio New Zealand International [edited]

The American Samoan Department of Health says there are now more than 300 confirmed cases of chikungunya or 'chik' virus in the territory.

The Health Director Motusa Tuileama Nua says his department and LBJ hospital have confirmed the outbreak of fever, rashes, and joint pains among people on the main island of Tutuila is due to chikungunya.

He says there have been 343 recorded cases, with 6 patients hospitalised and no deaths, since the beginning of July [2014].

He recommends those who are ill with fever and body aches do not travel off island.
--------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
===============
[CHIKV has been circulating in Pacific islands this year (2014).

Maps showing the location of American Samoa in the Pacific Ocean can be accessed at
<http://healthmap.org/promed/p/380>. - ProMed Mod.TY]
****************************
American Samoa: confirmed
Date: Fri 8 Aug 2014
Source: Samoa News [edited]

The American Samoa Department of Health and the LBJ hospital have created a 24 hour a day hotline for the CHIK virus. The CHIK hotline number is 731-7511.

The Health Alert issued yesterday [7 Aug 2014] confirms chikungunya (CHIK) virus as the cause of fever, rash, and joint pains outbreak on Tutuila and there have been more than 390 recorded cases, with 7 patients hospitalized and no deaths since 1 Jul 2014.

According to the health alert, there is no cure for CHIK virus [infection, and] it can usually be treated at home by drinking lots of fluids, taking pain medicine like Tylenol, ibuprofen, or Aleve as needed but only as much and with cautions as recommended on the package.

The health alert urges not to work while your joints are painful, let them rest and apply ice or cold packs on the joints and this may protect against prolonged joint pain.

DOH notes you should go to the Emergency Room to see a doctor if symptoms persist more than 10 days, or if you have bleeding from any part of the body or bruised skin. Call the hotline "or come to the ER or clinic if you are worried about your condition getting worse."

The alert once again urges that people stay indoors in air-con, behind screens, or under bed nets while you are ill, because if you are bitten by mosquitoes while you are ill, you can spread the disease to your family and neighbors.

For travelers, the DOH urges those who are ill not to travel off island, including to Manu'a. "If you travel and become ill when you arrive, tell the doctor who sees you that you may have been exposed to the CHIK virus."  [Byline: B. Chen]
----------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
-----------------------------------
[Interestingly, the 5 Aug 2014 report above indicated that there were 343 reported cases, and in the subsequent report of 8 Aug 2014 above, that number has increased to 390 cases, indicating that transmission of CHIK virus is continuing. - ProMed Mod.TY]
******
Samoa: suspected cases
Date: Fri 8 Aug 2014
Source: Island Business [edited]

Samoa's Ministry of Health has reported 2 deaths from acute fever and rash, saying it is now an outbreak. A press statement from the Director General, Leausa Toleafoa Dr Take Naseri, says there have been 21 recorded cases as of earlier this week with 4 people hospitalised.

The cases are suspected to be chikungunya virus, similar to dengue fever, but results are yet to be confirmed and 3 children and one man have been admitted to the intensive care unit.

The ministry says collaboration with other government agencies, and media campaigns, aim to raise awareness of the outbreak and help its containment.

Samoa has also sought assistance from the Ministry of Health's development partners including the Secretariat of the Pacific Community and the World Health Organisation.

In neighbouring American Samoa, there have been more than 300 confirmed cases of chikungunya.
======================
[This is the 1st ever ProMED-mail report of a chikungunya outbreak in Samoa. Concerning the current outbreak, it would be unusual to have 2 deaths from chikungunya virus infections of a total of 21 recorded cases. One explanation for the high proportion of fatal cases could be significant underreporting of non-fatal cases. No mention is made indicating that there were contributory underlying medical conditions in these 2 fatal cases. ProMED-mail will be interested in receiving results of the laboratory tests when they become available.

Maps showing the location of Samoa in the Pacific Ocean can be accessed at
at <http://healthmap.org/promed/p/2>. - ProMed Mod.TY]
Date: Wed 14 May 2014
Source: Radio New Zealand International [edited]

Health officials in American Samoa are warning the public about an amoebic dysentery outbreak which has so far affected 26 people, half of which have been admitted to the LBJ hospital. A Pacific Island Health Officers' Association Epidemiologist, Mark Duran, says the department of health is leading an investigation into the source of the parasite.

Dr Duran says amoebic dysentery is spread through contamination of human waste. "It especially attacks the intestines and invades its way into the wall of the intestines; it causes abdominal pain, it causes bloody diarrhoea, fever." Dr Duran says in serious cases the parasite can travel through the body and cause abscesses especially in the liver.
===================
[Maps of American Samoa can be seen at
<http://healthmap.org/promed/p/380>. - ProMed Sr.Tech.Ed.MJ]
More ...

World Travel News Headlines

Date: Mon, 24 Jun 2019 16:11:10 +0200

Kinshasa, June 24, 2019 (AFP) - More than 1,500 people have died in a nearly 10-month-old outbreak of Ebola in the Democratic Republic of Congo, the health ministry said Monday.   As of Sunday, 1,506 people have died out of 2,239 recorded cases, it said.   Earlier this month, the virus claimed two lives in neighbouring Uganda among a family who had travelled to the DRC.   Nearly 141,000 people have been vaccinated in the affected eastern DRC provinces of Ituri and North Kivu, the epicentre of the outbreak.

Ebola spreads among humans through close contact with the blood, body fluids, secretions or organs of an infected person, or objects contaminated by such fluids.   The current outbreak in the DRC is the worst on record after an epidemic that struck mainly in Liberia, Guinea and Sierra Leone between 2014-2016, killing more than 11,300 people.   Chronic violence and militia activity in Ituri and North Kivu as well as hostility to medical teams among locals have hampered the response.

On Monday, a crowd of people opposed to the burial of two Ebola victims in the Beni area burnt the vehicle of a health team, local police chief Colonel Safari Kazingufu told AFP.   He said a member of the medical team had been injured in the attack and taken to hospital.    The United Nations in May nominated an emergency coordinator to deal with the crisis. However, the World Health Organization (WHO) said this month the outbreak currently did not represent a global threat.
Date: Mon, 24 Jun 2019 20:27:21 +0200

Ouagadougou, June 24, 2019 (AFP) - Hundreds of doctors and nurses demonstrated Monday in the Burkina Faso capital Ouagadougou to protest against declining health facilities and to demand better working conditions.   The main doctors' union also warned it would stage a general strike from June 30 to July 7 to demand "concrete responses" to their grievances.

Health professionals staged a series of strikes at the end of May, seriously disrupting work at health centres in the poor West African country.   "We are... asking health authorities not to underestimate the health crisis," said Alfred Ouedraogo, general secretary of the Union of Burkina Doctors.   "For several months, there have been recurring breakdowns in laboratories," he said. "In most health centres, there are no X-ray films."    The protesters marched to the health ministry and submitted their demands.

Health worker Idrissa Compaore said that ever since the introduction of free medical care for children under five and pregnant women, "basic goods were regularly lacking" at health facilities.   "The situation is the same in health centres," he said.   The doctors also want the implementation of an accord signed with the government in 2017 promising better working conditions which they say remains only on paper.   If their demands are not met, the health workers could launch an open-ended strike which would affect consultations and surgeries, Ouedraogo said.
Date: Wed 19 Jun 2019
Source: InSight crime [edited]

Disease outbreaks show desperate Venezuelans have migrated to illegal gold mining areas for work.

Outbreaks of malaria and diphtheria in a region of Venezuela where these diseases are rare has revealed how armed groups are organizing a vast migration to illegal mines.

The outbreaks show that criminals operating in the state of Miranda found a way to make money amid the country's worsening crisis by moving into the illegal gold mines of Bolivar state, in the south of Venezuela.

In the middle of 2017, doctors witnessed an unusual, sustained, and inexplicable malaria outbreak in Valles del Tuy, a region in the state of Miranda located between the coast and the center of Venezuela where the mosquito-borne disease is seldom seen, Efecto Cocuyo reported.

The startling epidemic offered the 1st clue to the changing criminal dynamics in the region.

"Malaria was not a disease native to states in the center of the country, so this caught our attention. We started to ask patients about it to find out how they contracted it. The surprise came when one of the patients told me that he had caught it in the mining region in the state of Bolivar, where they went to work in gold mining," explained a doctor whose practice is in Charallave, the municipal seat in Cristobal Rojas municipality in Miranda state. The doctor asked to remain anonymous for security reasons.

Pressured by the economic situation and massive inflation, residents of the Valles del Tuy region began working during their vacations in the illegal mines in Bolivar, more than 500 kilometers [about 311 mi] away. The doctor said that they were recruited by 'pranes', or prison gang bosses, who had previously been the leaders of local 'megabandas' in Valles del Tuy.

The megabandas' grip on Valles del Tuy began in 2013, when various sites were converted into so-called peace zones, areas where security forces could not enter.

Later, when kidnappings and extortion stopped being profitable in the poor areas where they operated, members of the same megabandas migrated to the mining region in search of other sources of income, and to escape police and military raids.

InSight crime analysis
----------------------
Criminals are not immune to the effects of Venezuela's current economic, political, and social crisis.

Many criminals, primarily pranes and leaders of megabandas, have been forced to abandon their former strongholds and change the pattern of their criminal activities, according to investigations conducted by InSight Crime.

Criminals are trading robbery, petty theft, and kidnappings for drug trafficking and illegal mining. Additionally, they are migrating to states where these illicit economies are strongest: Sucre, Zulia, Tachira, and Bolivar. In the south of Venezuela, Bolivar has become the principal destination for the pranes of Valles del Tuy.

Ramon Teran Rico, alias "Monchi," for example, was the leader of one of the largest criminal organizations in the state of Miranda. Community representatives told InSight Crime that he fled to Bolivar's mines 2 years ago.

Monchi was the 1st crime boss to try his luck at the Orinoco Mining Arc, a transnational mining project created in 2016. He gradually moved his henchmen there from the Valles del Tuy. Sources in his circle of friends say that he even purchased his own dredge to extract gold.

Leaders of other criminal structures operating in the Valles del Tuy have also had to reinvent themselves in order to survive, and have moved into southern Venezuelan states where they operate comfortably.

Hundreds of residents of the towns in Valles del Tuy have migrated to the mining region. "All of the families here have at least one person that has gone to work in the mines," said a resident of Ocumare del Tuy in Miranda state, who reports seeing his neighbors' children and relatives head for the mines.

In November 2016, a case of diphtheria, an acute infectious disease [that most commonly affects the throat and the tonsils], was detected in the Sucuta sector of Ocumare del Tuy, alerting health authorities to the re-emergence of a disease rarely seen in the center of the country.

Follow-up with the patient found that he had contracted the infection in the Bolivar mines.

Health authorities developed prevention plans targeted at the neighborhoods where criminal groups operate. Investigations conducted by health authorities demonstrated that the men that go to work in the mines, as well sex workers or women who work in the kitchens there, carried these diseases back to the Valles del Tuy.

The public health problem shed light on the fact that an illegal gold mining fever had emerged -- an economic lifeline that is now strengthening organized crime.  [Byline: Venezuela Investigative Unit]
=======================
[Malaria has surged in Venezuela over the past 9 years (see ProMED reports below). Control measures have ceased to exist and drugs for treatment have become difficult to find. The association with illegal haphazard mining was reported from Bolivar state in 2012, and the present report underlines that such activities constitute high risk for malaria and other diseases.

The diphtheria outbreak that began in July 2016 remains ongoing. Through February 2019, Venezuela has seen a total of 2726 suspected cases (1612 confirmed), including 164 in 2019 to date (<http://outbreaknewstoday.com/diphtheria-update-venezuela-60872/>). - ProMED Mod.EP]

[Maps of Venezuela:
Date: 23 Jun 2019
Source: Outbreak News [edited]

The Malaysia Ministry of Health is reporting a methanol poisoning cluster believed linked to counterfeit alcohol.

For the period of 11-21 Jun 2019, 3 methanol poisoning clusters were reported to the National Crisis Preparedness and Response Center (CPRC). The incidents involved 19 cases from the following states:
Penang (8), Johor (6) and Negeri Sembilan (5). The cause of the methanol poisoning was believed to be due to the counterfeit liquor branded by Myanmar Whiskey, Miludeer Beer, Whiskey 99 and Martens Extra Strong.

The cluster of methanol poisoning cases in Penang began on 11 Jun 2019 and involved 8 Myanmar citizens. Two of the cases have died. They had been drinking Myanmar branded whiskey. The drink was purchased from the same seller who sells directly at the premises where these poisoning victims work. On 21 Jun 2019, one methanol poisoning case was still being treated at a Penang hospital in critical condition, while 5 others were discharged.

In the state of Johor, reporting of methanol poisoning cases has been received since 18 Jun 2019. It involves 6 cases, 3 Malaysians and one Pakistani, Nepalese and Indian, respectively. Three of the cases involved were found to have consumed a drink believed to be counterfeit branded Miludeer Beer. Four of the cases of methanol poisoning have died. On 21 Jun 2019, one case was still being treated at the Sultanah Aminah Hospital (HSA) in critical condition, and one more reported case of blurred vision was being treated in a regular ward at Sultan Ismail Hospital, Johor Bahru, Johor.

The Negeri Sembilan Health Department (JKNNS) reported one methanol poisoning cluster on 20 Jun 2019 involving 5 cases from the Port Dickson district including 2 deaths. It involves 3 Malaysians, one Indian citizen and one Myanmar citizen. Investigations found cases involved drinking alcoholic beverages allegedly branded Miludeer Beer (2 cases), Whisky 99 (1 case) and Martens Extra Strong (1 case), while one case had no brand information. On 21 Jun 2019, 3 cases were being treated at Port Dickson Hospital, 2 critical cases, and one case in a regular ward.

Clinical samples were taken from all 19 cases for methanol test analysis. The results showed 5 positive cases of methanol and one negative case of methanol but showed symptoms and clinical signs of methanol poisoning. Laboratory results for the remaining 13 cases are still pending.

The Penang State Health Department, Negeri Sembilan and the State of Johor have collaborated with the Royal Malaysian Police and Royal Malaysian Customs in an investigation to identify the sources of the counterfeit alcoholic drink.

The MOH continues to monitor the situation and take preventative and control measures to address these methanol poisoning incidents. Consumers are advised to ensure each purchased alcohol product has a label containing complete manufacturer, importer, agent and listing information.

Consumers are also advised to avoid consuming home-brewed alcoholic beverages or alcohol being sold at low prices.

If individuals have symptoms of methanol intoxication such as stomach-ache, nausea, vomiting, headache, and vision loss within 5 days of consuming an alcoholic drink, MOH advises them to seek immediate treatment at any clinic or the closest hospital.
===========================
[Methanol toxicity initially lacks severe toxic manifestations. Its pathophysiology represents a classic example of lethal synthesis in which toxic metabolites cause fatality after a characteristic latent period. In other words, these people may not realize they are sick or ill until some time after consumption.

Methanol is sometimes used as an ethanol substitute for alcohol. Foods such as fresh fruits and vegetables, fruit juices, fermented beverages, and diet soft drinks containing aspartame are the primary sources of methanol in the human body, but [they contain] minute quantities.

Wood alcohol is also known as methanol. It is a commonly used toxic organic solvent causing metabolic acidosis, neurologic issues, and death when ingested. It is a part of many commercial industrial solvents and of adulterated alcoholic beverages or is mistaken as being the same as alcohol for ingestion. Methanol toxicity remains a common problem in many parts of the developing world, especially among members of lower socioeconomic classes.

Neurological complications are recognized more frequently due to advanced technologies and because of early recognition of the toxicity and advances in supportive care. Hemodialysis and better management of acid-base disturbances remain the most important therapeutic improvements.

Serum methanol levels of greater than 20 mg/dL correlate with ocular injury. Funduscopic changes are notable within only a few hours after methanol ingestion. The mechanism by which the methanol causes toxicity to the visual system is not well understood. Formic acid, the toxic metabolite of methanol, is regarded as being responsible for ocular toxicity, and blindness can occur in humans.

The prognosis in methanol poisoning correlates with the amount of methanol consumed and the subsequent degree of metabolic acidosis; more severe acidosis confers a poorer prognosis. Methanol has a relatively low toxicity. The adverse effects are thought to be from the accumulation of formic acid, a metabolite of methanol metabolism. The prognosis is further dependent on the amount of formic acid that has accumulated in the blood, with a direct correlation existing between the formic acid concentration and morbidity and mortality. Little long-term improvement can be expected in patients with neurologic complications.

The minimal lethal dose of methanol in adults is believed to be 1 mg/kg of body weight. The exact rates of morbidity and mortality from methanol intoxication are not available.

Rapid, early treatment is necessary for survival, but sequelae such as blindness may be permanent.

Metabolic acidosis in methanol poisoning may necessitate the administration of bicarbonate and assisted ventilation. Bicarbonate potentially may reverse visual deficits. In addition, bicarbonate may help to decrease the amount of active formic acid.

Antidote therapy, often using ethanol or fomepizole, is directed towards delaying methanol metabolism until the methanol is eliminated from the patient's system either naturally or via dialysis. Like methanol, ethanol is metabolized by ADH, but the enzyme's affinity for ethanol is 10-20 times higher than it is for methanol. Fomepizole is also metabolized by ADH; however, its use is limited because of high cost and lack of availability.

Hemodialysis can easily remove methanol and formic acid. Indications for this procedure include (1) greater than 30 mL [1 oz] of methanol ingested, (2) serum methanol level greater than 20 mg/dL, (3) observation of visual complications, and (4) no improvement in acidosis despite repeated sodium bicarbonate infusions.

Intravenous administration of ethanol in a 10 percent dextrose solution may be helpful. As ethanol prolongs the elimination half-life of methanol, the treatment may take several days, and the patient should be hospitalized. Dialysis may be necessary to prevent kidney failure as well. Hemodialysis remains an effective treatment.

Portions of this comment were extracted from:

[HealthMap/ProMED map available at:
Date: Fri 21 Jun 2019
Source: WHO/EMRO (Regional Office for the Eastern Mediterranean) [edited]

Situation reports on Al-Hol camp, Al-Hasakah
--------------------------------------------
- Over the past 2 weeks, a total of 633 people have left the camp. This number includes 107 people who returned to their homes in north-east Syria. There were no new arrivals during the reporting period.
- 9 medical points are reporting regularly to the disease Early Warning And Response System (EWARS). Leishmaniasis, acute diarrhoea, bloody diarrhoea, and severe acute malnutrition (SAM) remain the most commonly reported diseases.
- 38 new cases of leishmaniasis were detected. All patients are being treated by a WHO-supported mobile team in coordination with the Al-Hasakeh Directorate of Health.
- 7 suspected cases of measles were reported. No new cases of tuberculosis were detected during the reporting period.
- 30 children with severe acute malnutrition with medical complications were admitted to Al-Hikmah hospital during the reporting period, of whom 22 were discharged, one died, and the remainder are still under treatment. Mortality rates related to severe acute malnutrition remain below the emergency threshold.
- 2 new static health care points have been established, bringing the total number to 12. There is still an acute shortage of health care points in the Foreign Annex.
- 35 water sources were tested for microbial contamination in Al-Hasakeh water national laboratory during the reporting period. All 35 samples tested negative for contamination. WHO continues to test the quality of water from different sources in the camp.
- Stool samples from patients with diarrhoea were tested for
_Salmonella_, _E. coli_, and cholera, with all samples testing negative. Blood samples from patients with suspected measles were also sent for testing, and all samples tested negative.
- Following intensive negotiations by WHO, the local authorities have given their approval in principle to evacuate a patient requiring advanced mental health treatment
===================
[Leishmaniasis has surged throughout Syria during the civil war on all sides and continues to be a health problem in the refugee population. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Syria:
Date: Mon, 24 Jun 2019 05:38:33 +0200

Jakarta, June 24, 2019 (AFP) - A powerful magnitude 7.3 quake struck eastern Indonesia on Monday, US seismologists said, but no tsunami warning was issued and there were no immediate reports of major damage or casualties.   The quake hit at a depth of 208 kilometres (129 miles) south of Ambon island in the Banda Sea at 11:53 local time, the US Geological Survey said.

The Pacific Tsunami Warning Center said there was no threat of a tsunami as the quake was too deep.   The strong temblor came hours after a 6.1-magnitude earthquake hit Papua, also in the eastern part of the Southeast Asian archipelago.   That quake hit about 240 kilometres (150 miles) west of the town of Abepura in Papua province, at a relatively shallow depth of 21 kilometres, according to the USGS.

There were also no immediate reports of casualties after the earthquake.   A shallower 6.3-magnitude hit the area last week, but the damage was not extensive.   Indonesia experiences frequent seismic and volcanic activity due to its position on the Pacific "Ring of Fire", where tectonic plates collide.   Last year, a 7.5-magnitude quake and a subsequent tsunami in Palu on Sulawesi island killed more than 2,200 with a thousand more declared missing.   On December 26, 2004, a 9.1-magnitude earthquake struck Aceh province, causing a tsunami and killing more than 170,000.
Date: Sat, 22 Jun 2019 21:45:46 +0200
By Anna SMOLCHENKO with Irakli METREVELI in Tbilisi

Moscow, June 22, 2019 (AFP) - Russia's government on Saturday banned Georgian airlines from flying into its territory, extending restrictions imposed by President Vladimir Putin as part of growing tensions between Moscow and its ex-Soviet neighbour.   Putin had signed a decree late Friday banning Russian airlines from flying to pro-Western Georgia from July 8 in response to anti-Moscow rallies in the Georgian capital Tbilisi.

The protests broke out after a Russian lawmaker addressed parliament from the speaker's seat earlier this week, a hugely sensitive move for two countries whose relations remain tense after a brief war in 2008.   The rallies have morphed into a broader movement against the Georgian authorities while the Kremlin has branded them a "Russophobic provocation".   On Saturday, protesters took to the streets of the Georgian capital for a third day of rallies, with some 3,000 demanding snap elections and electoral reform.   The crowd sang a profanity-laced, anti-Putin chant and some of the demonstrators held up placards insulting the Russian president.   Demonstrators also shot paper airplanes into the sky in response to the Russian bans.

Russia's transportation ministry said that from July 8 two Georgian airlines would be banned from flying to Russia, citing the need to ensure "aviation safety" and debt owned by the Georgian companies.   The Kremlin has said the ban against travel to Georgia was to "ensure Russia's national security and protect Russian nationals from criminal and other unlawful activities."

Authorities recommended travel companies stop selling holiday packages to Georgia and advised Russian tourists to return home.   Russia's travel industry and ordinary Russians hit out at the decision by the Kremlin, saying it was a politically motivated move that has little to do with safety concerns.   "Tourism in Georgia is on the rise, and the decision has shocked the whole industry," Aleksan Mkrtchyan, head of Pink Elephant, a chain of travel agencies, said in a statement.

- 'This is politics' -
The ban during high season is expected to hit the travel industry in both countries hard and become a major nuisance for Russian holidaymakers.   Russia and Georgia fought a brief but bloody war in 2008 and tensions between the two governments remain high.   But Georgia -- known for its picturesque Black Sea resorts, rich national cuisine and generous hospitality -- has emerged as one of the most popular destinations for Russian tourists over the past few years, with more than 1.3 million visiting last year.

Irina Tyurina, a spokeswoman for the Russian Tourism Union, said that most in the industry believed that Georgia was not a dangerous destination.   "Georgians have traditionally treated Russians well," Tyurina told AFP.    It was too early to estimate potential industry losses from the ban, she said.   More than 7,000 people have signed a petition calling on Moscow to resume flights.

Russian tourists in Tbilisi expressed regret at the restrictions.   "We are against the ban," Nina Guseva told AFP in the Georgian capital. "We are not guilty and we do not have to suffer."   Fellow traveller Mikhail Strelkov added: "This is politics and has nothing to do with people on holidays."   In Russia, many struck a similar note.   Elena Chekalova, a prominent chef and culinary blogger, said the latest Kremlin move "shocked" her.   "Why are they deciding for us what we cannot eat, where we cannot fly, who we cannot be friends with?" she wrote on Facebook.

- Simmering discontent -
Moscow has suspended flights to Georgia before -- during a spike in tensions in October 2006 and in August 2008 following the outbreak of the five-day war over the breakaway regions of Abkhazia and South Ossetia.   "Putin decided to punish Georgia because there are street protests there," opposition leader Alexei Navalny said on Twitter.   A senior government official in Tbilisi said the Kremlin ban was politically motivated.   "Putin's decision is of course political and has nothing to do with safety concerns," the official told AFP on condition of anonymity.

Analysts say the latest restrictions may further fuel simmering discontent with Kremlin policies.   Since 2014, Russians have been chafing under numerous rounds of Western sanctions over Moscow's role in Ukraine and other crises, with real incomes falling for the fifth year in a row.    During an annual phone-in with Russians this week, Putin dismissed calls to "reconcile" with the West to alleviate economic hardship, saying Moscow needed to protect its interests and "nothing" would change anyway.
Date: Sat, 22 Jun 2019 04:35:24 +0200
By Alexandre MARCHAND

Chennai, India, June 22, 2019 (AFP) - Angry residents fight in queues at water taps, lakes have been turned into barren moonscapes and restaurants are cutting back on meals as the worst drought in living memory grips India's Chennai.   The hunt for water in south India's main city has become an increasingly desperate obsession for its 10 million residents after months with virtually no rain.   The bustling capital of Tamil Nadu state usually receives 825 million litres of water a day, but authorities are currently only able to supply 60 percent of that.   With temperatures regularly hitting 40 degrees Celsius (104 Fahrenheit), reservoirs have run dry and other water sources are dwindling each day.

A rainstorm on Thursday night, the first for about six months, brought people out onto the streets to celebrate, but provided only temporary relief.   "We don't sleep at night because we worry that this well will run out," said Srinivasan V., a 39-year-old electrician who starts queueing for water before dawn in his home district near Chennai airport.   The 70 families who use the well are allowed three 25-litre pots each day. Most pay high prices to private companies to get the extra water they need to survive.   Local officials organise a lottery to determine who gets to the front of the queue. The lucky first-comers get clear, fresh water. Those at the end get an earth-coloured liquid.

- Long, hot wait -
Srinivasan said he waits about five hours each day in water queues and spends around 2,000 rupees ($28) a month on bottled water or paying for a tanker truck to deliver water.   It is a big chunk of his 15,000-rupee monthly salary. "I have loans, including for the house, and I can't repay them now," he said.

The desperation has spilled over into clashes in Chennai. One woman who was involved in a water dispute with neighbours was stabbed in the neck.   In another suffering Tamil Nadu city, Thanjavur, an activist was beaten to death by a neighbouring family after he accused them of hoarding water.   Many in Chennai do not have the money to pay for extra supplies, and arguments in queues for free water often turn violent.   The hunt for H2O dominates daily life.   Some Chennai restaurants now serve meals in banana leaves so that they do not have to wash plates. Others have stopped serving lunch altogether to save water.

- Isolated showers -
Families have had to reorganise daily life, setting up schedules for showers and devoting up to six hours a day to line up for water -- three in the morning, three in the afternoon.   Most of those queuing are women, including housewife Nagammal Mani, who said looking for water was like "a full time job".   "You need one person at home just to find and fill up the water while the other person goes to work," she said.   Chennai gets most of its water from four lakes around the city. But it had a poor monsoon last year and levels have not recovered since.   The bones of dead fish now lie on the cracked bottoms of the lakes.   While weak rainfall is a key cause of Chennai's crisis, experts say India's poor record at collecting water does not help, particularly as the country of 1.3 billion people becomes increasingly urbanised.   The drought is seen as a symbol of the growing threat faced in many of India's highly vulnerable states, which have been hit by longer periods each year of sweltering heat that has devastated food production.

Hundreds of villages have already emptied in the summer heat this year because their wells have run dry.   Pradeep John, a local weather expert known online as "Tamil Nadu Weatherman", said if families in the area had spent their money on rain-collection equipment instead of truckloads of water they would be "self-sufficient" now.   "We've got almost 1,300-1,400 millimetres of rainfall every year. So that is a very significant amount of rainfall," he told AFP.   "So we have to find out where the problem lies, where the problem of urbanisation lies -- whether we are encroaching into the (rain) catchment areas -- improve these catchment areas, and then find a long-term solution."   John said there is no immediate hope for rains to end the crisis, with the monsoon not expected before October.   "If the water doesn't come, people will be shedding blood instead of tears," said housewife Parvathy Ramesh, 34, as she endured her daily queue in Chennai's stifling heat.
Date: Fri, 21 Jun 2019 22:49:46 +0200
By Laure FILLON

Paris, June 21, 2019 (AFP) - Forecasters say Europeans will feel sizzling heat next week with temperatures soaring as high as 40 degrees Celsius (104 degrees Fahrenheit) in an "unprecedented" June heatwave hitting much of Western Europe.   From Great Britain to Belgium to Greece, a wave of hot air coming from the Maghreb in North Africa and Spain will push up temperatures starting this weekend and hitting a peak around mid-week.    Spain's meteorological agency (Aemet) has issued a "yellow alert" for severely bad weather for Sunday and says it expects the country to see a "hotter than usual" summer, like last year.

In Germany, forecasters are predicting temperatures up to 37 degrees C on Tuesday and 38 C on Wednesday, with similar hot weather also expected in Belgium and Switzerland.   The British MetOffice said it was particularly concerned that the heatwave could trigger "violent storms" and warned Britons to expect "hot, humid and unstable" weather.   Greece will be one of the countries most affected by the heatwave with temperatures hitting 39 degrees C at the weekend.

In France, meteorologist Francois Gourand said the heatwave is "unprecedented for the month of June" and will no doubt beat previous heat records.    Back in the summer of 2003, France suffered an intense heatwave that led to the deaths of nearly 15,000 mostly elderly people.   Starting on Tuesday, France will see temperatures from 35 to 40 degrees C, which will remain high at night offering little respite from the heat, forecasters predicted.   "Since 1947, only the heatwave of 18 to 28 June, 2005, was as intense," said Meteo France, adding the scorching weather would probably last a minimum of six days.   This latest intense heatwave again shows the impact of global warming on the planet, and such weather conditions are likely to become more frequent, meteorologists said.
Date: Thu, 20 Jun 2019 13:08:42 +0200

Berlin, June 20, 2019 (AFP) - German cabin crew union UFO called Thursday for a strike against airline giant Lufthansa in July, threatening travel chaos during the busy summer holiday season over a wage dispute.   Employees of Lufthansa's subsidiaries Eurowings and Germanwings are expected to vote next week on whether to take action.   Depending on the ballot, dates for the walkout are to be announced for July.   In the coming weeks, UFO union members will also decide whether to go on strike at main company Lufthansa.   "Lufthansa has deliberately managed to escalate wage disputes with its employees," said UFO vice-president Daniel Flohr in a statement.

Lufthansa called off talks with UFO last week and Flohr warned that strike action could cause "flight attendants, passengers and shareholders an additional worry this summer".   With most German schools shut for summer holidays in July, the industrial action could seriously disrupt travel plans in the peak season.   However, a Lufthansa spokesman insisted "there can be no strike, as currently there are neither wage agreements still open nor concrete demands".  The German airline reacted angrily with spokesman Boris Ogursky telling AFP it wants a "reliable collective bargaining partner" to be able to "jointly  develop solutions in the interest of employees and the company.  "At present we cannot see when and how UFO can once again fulfil its role  as a predictable, constructive bargaining partner.    "Therefore, no talks are currently taking place."