WORLD NEWS

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

Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Puerto Rico

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Thu, 16 Jan 2020 02:45:27 +0100 (MET)
By Ivelisse RIVERA, con Leila MACOR en Miami

Yauco, Puerto Rico, Jan 16, 2020 (AFP) - Living out in the open, their nerves on edge after a series of earthquakes that have shaken Puerto Rico, some 5,000 people are hoping that their president, Donald Trump, will heed the island's plea to be designated a disaster zone and free up much-needed aid.   Since December 28, more than 1,000 tremors have rattled the US island territory in the Caribbean, which just two years ago was devastated by two powerful hurricanes in quick succession.

In Yauco, one of the areas worst hit by the earthquakes, dozens of people were sitting on cot beds Wednesday in the parking lot of a municipal stadium, sheltered from the sun by white tents and blue tarps handed out by the federal disaster management agency, known as FEMA.  "The most difficult thing is the psychological aspect," said Wilfredo Rodriguez, 31. His house had been fractured by the seismic movement and he has spent a week living with his kids, aged six and 10, under an awning.    "We are living in constant fear of another powerful tremor," he said.

He only returns to his house to wash, then hurries back to the shelter. "We worry that there'll be a more powerful tremor while we are inside the house," he said.   Throughout the day, volunteers arrive to hand out food and toys for the children who fill the shelters: schools have been suspended because the buildings are not sturdy enough to withstand another quake.    The island's earthquake detection system has registered 1,104 tremors in the past two weeks alone, of which 186 could be felt by the population. By comparison, during the whole of 2019 there were 6,442 tremors, of which just 62 could be felt by people on the island.

Further south, in Guanico, Juan Santiago decided to move into a shelter on Saturday after a tremor of 5.9 on the Richter scale hit the island. "The mountain shook and rocks and earth started to come down," said the 30-year-old.  "My house has a crack in it and is about to fall down," he added. His home had weathered the Category Five winds of Hurricane Maria in September 2017 and of Hurricane Irma which followed it just two weeks later.   "It's different to a hurricane. What is happening now is much nastier," he said.

As he was talking the earth shook again, a tremor of 5.2 magnitude. Vehicles rocked like hammocks in the wind, but the quake-hardened victims barely reacted.   The houses in this part of the island are mostly rudimentary constructions built by the people who live in them with scant resources available in the mountains, where no regulations stipulate that buildings should be earthquake resistant.    The government of Puerto Rico said that as of Monday, there were 4,924 people living in 28 shelters in 14 municipalities. There were no figures on how many buildings had been damaged or destroyed.

- Seeking disaster designation -
Puerto Rico's governor Wanda Vazquez Garced called on Trump to declare the earthquake a disaster and clear the way for desperately needed aid. Trump had declared an emergency days before, but the governor wanted more.   The declaration of an emergency frees up to $5 million dollars in aid for the island, although Congress can bump that figure up. But if the situation is designated a disaster, there is no ceiling on funding, a FEMA spokesman said.   On Wednesday, the government said it would release $8.2 billion in delayed hurricane relief that had been stalled after the president threatened to divert Puerto Rico's emergency funds to help pay for his wall on the US-Mexico border.

In the past few days there have been growing calls among Democratic lawmakers for Trump to declare the situation in Puerto Rico a disaster.   It is a delicate subject, as Trump has accused the government of Puerto Rico of incompetence and of siphoning off hurricane relief money, triggering a public spat between the president and the mayor of San Juan, Carmen Yulin Cruz, as well as the former governor Ricardo Rossello, who was forced to step down last summer amid massive protests.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
Date: Sat, 11 Jan 2020 15:43:12 +0100 (MET)

Washington, Jan 11, 2020 (AFP) - A 5.9 magnitude earthquake rocked Puerto Rico Saturday, the latest in a series of powerful tremors that have shaken the US territory in recent days, the US Geological Survey reported.

The latest quake occurred at 8:54 am local time (1254 GMT) around 13 kilometres (eight miles) southeast of Guanica, a town on the island's southern Caribbean coastline that was hard hit by earlier quakes.   The USGS revised its initial report of a 6.0 magnitude quake to 5.9.   It follows a 6.4 magnitude quake Tuesday that killed one person, knocked
out electric power and caused widespread damage.

Puerto Rico Governor Wanda Vazquez declared a state of emergency after Tuesday's quake, which forced an automatic shutdown of the power grid.    Puerto Rico's electric power authority reported outages in the towns of Ponce, Lares, Adjuntas and San German after the latest quake.   The Pacific Tsunami Information Center in Hawaii issued a statement saying there was "no significant tsunami threat" but a small possibility of tsunami waves along coasts nearest the epicentre.

The island is still recovering from Hurricane Maria, which came ashore more than two years ago as a devastating Category 4 storm.   Starting December 28, a wave of tremors have swept the island, putting residents on edge.   The 6.4 quake on January 7 came a day after a 5.8 magnitude quake; it was followed by major aftershocks.   Saturday's quakes were also preceded by a string of smaller tremors.
Date: Tue, 7 Jan 2020 23:44:45 +0100 (MET)
By Ricardo Arduengo

Guayanilla, Puerto Rico, Jan 7, 2020 (AFP) - Puerto Rico's governor declared a state of emergency on Tuesday after a powerful 6.4 magnitude earthquake killed at least one person in the south of the island and caused widespread damage.   Governor Wanda Vazquez said the declaration would allow for the activation of National Guard troops in the US territory still recovering from a devastating 2017 hurricane.   The US Geological Survey said the quake struck at 4:24 am (0824 GMT) with the epicenter off the coast of the southern city of Ponce, and was followed by more than a dozen aftershocks.

Tuesday's quake was the most powerful in a series of tremors that have shaken the island since December 28.   Scientists initially sent out an alert about a potential tsunami but it was later canceled.   The island's electricity authority said the quake had forced an automatic shutdown of the power grid, already severely damaged by Hurricane Maria more than two years ago.   The worst damage appeared to be in towns on the southwest coast, including Ponce, Guayanilla and Guanica.   El Nuevo Dia newspaper said a 73-year-old man died after a wall fell in his home in Ponce. Eight others there were reported injured.

Two power plants in Guayanilla sustained major damage, the Puerto Rico Electric Power Authority said. The city could be without power for two weeks, its mayor Nelson Torres Yordan said.   Celebrity chef Jose Andres announced that a charity he runs, World Central Kitchen, had started serving meals and distributing solar-powered lamps in quake-hit areas.   Vazquez announced that $130 million in emergency aid funding will be disbursed.   On social media, people wrote of being shaken awake by the force of the quake.   One woman on Twitter said she had been "wrenched from sleep."   "Everybody is awake & scared all over," she posted.   In Guayanilla, the Inmaculada Concepcion church, built in 1841, was heavily damaged.   Volunteers salvaged statues and other valuable items from the ruins as a priest consoled distraught parishioners.

- 'Be safe' -
A 5.8 magnitude quake on Monday toppled some structures, caused power outages and small landslides, but did not result in any casualties.   It also destroyed a popular tourist landmark, Punta Ventana, a natural stone arch that crumbled on the island's southern coast.   Vazquez, the governor, said government employees were being given the day off on Tuesday to take care of their families.   "We want everyone to be safe," she said.   She said ports were undamaged and there are several weeks' supply of gasoline, diesel and natural gas stored so people need not worry about shortages.

The White House said President Donald Trump had been briefed and Pete Gaynor, head of the Federal Emergency Management Agency (FEMA), had been in touch with the governor.   Trump's administration came under severe criticism for its response to Hurricane Maria.   The Category 4 storm destroyed the island's already shaky power grid, overwhelmed public services, left many residents homeless and claimed several thousand lives, according to government estimates.
Date: Tue, 7 Jan 2020 12:52:34 +0100 (MET)

Washington, Jan 7, 2020 (AFP) - A strong earthquake struck south of Puerto Rico early Tuesday, the US Geological Survey said, the latest in a series of tremors that have shaken the island since December 28.   The shallow 6.5 magnitude quake struck 13.6 kilometres (8.5 miles) south of the city of Ponce, the USGS said, revising down its initial reading of 6.6.   The quake struck just off the US territory's southern Caribbean coastline at 4:24 am local time (0824 GMT).   "The whole island is without power," the director of Puerto Rico Electric Power Authority, Jose Ortiz, told local media.

Puerto Rico's governor Wanda Vazquez Garced posted on Twitter that the government's security protocols had been activated.   She said government employees were not expected at work, adding: "We want everyone to be safe."   On social media, people wrote of being shaken awake by the force of the quake.   One woman on Twitter said she had been "wrenched from sleep", adding "Everybody is awake & scared all over."

Dramatic images also shared on social media appeared to show widespread damage in the town of Guayanilla, home to around 20,000 people, as well as nearby Guanica.   The mayor of Guayanilla told local news channel NotiUno that the town's church had collapsed in the incident.

An alert issued by the Tsunami Warning Center immediately following the earthquake was later cancelled.   Tuesday's quake was the strongest of a series of tremors that have shaken the island since December 28, topping Monday's 5.8 quake.   That earthquake toppled houses and caused power outages, but there were no reports of casualties.
Date: Mon, 6 Jan 2020 18:04:21 +0100 (MET)

Miami, Jan 6, 2020 (AFP) - A 5.8-magnitude earthquake shook Puerto Rico Monday, toppling houses and causing power outages and small landslides but there were no reports of casualties, the US Geological Survey said.   The quake, just off the US territory's southern Caribbean coastline, was felt throughout much of the island, including the capital San Juan.

Some 250,000 customers were hit by electric power outages after the quake, which struck at 6:32 am local time (1032GMT).   Images posted on social media showed houses tumbled from their supporting pillars, cracks in walls, cars crushed under collapsed houses and small scale landslides.   The quake was the strongest of a series that have rippled through the island since December 28, and it was followed by at least eight aftershocks, officials said.   No tsunami alerts were issued.
More ...

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 ...

Nicaragua

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 ...

Ecuador

Ecuador US Consular Information Sheet
November 05, 2008
COUNTRY DESCRIPTION:
Ecuador is a Spanish-speaking country about the size of Colorado.
It has a developing economy and a democratically elected government.
Ecuador is geogra
hically and ethnically diverse.
In general, tourist facilities are adequate but vary in quality.
Ecuador adopted the U.S. dollar in 2000.
Both U.S. coins and Ecuadorian coins, which are equivalent to the value of the U.S. coins, are used.
Read the Department of State Background Notes on Ecuador for additional information.

ENTRY/EXIT REQUIREMENTS:
A U.S. passport with remaining validity of at least six months is required to enter Ecuador. A valid U.S. passport is required to depart Ecuador.
Tourists must also provide evidence of return or onward travel.
U.S. citizens traveling on regular passports for tourism or business do not need a visa for a stay of 90 days or less.
Those planning a longer visit must obtain a visa in advance of arrival.
Travelers who stay in Ecuador beyond the allowed entry time are charged a substantial fee and are barred from re-entering Ecuador for six months from the date of departure.
An airport exit tax is required when departing Ecuador.

U.S. citizens whose passports are lost or stolen in Ecuador must obtain a new passport at the U.S. Embassy in Quito or the U.S. Consulate General in Guayaquil and present it, together with a police report of the loss or theft, to the main immigration offices in those cities prior to arriving at the airport in order to obtain permission to depart.

Ecuador’s exit procedures mandate that minors (under the age of 18) who are citizens or residents of Ecuador and who are traveling alone, with one parent, or with a third party, must present a copy of their birth certificate and written authorization from the absent parent(s) or legal guardian.
When a parent is deceased, a notarized copy of the death certificate is required in lieu of the written authorization.
If documents are prepared in the United States, the authorization and the birth certificate must be translated into Spanish, notarized and authenticated by the Ecuadorian Embassy or an Ecuadorian consulate within the United States.
It is not uncommon for some local authorities to insist these documents be apostilled (authenticated).
Documents must be apostilled by the same State that issued the document.
For a list of State Authentication Authorities go to http://travel.state.gov/about/info/customer/customer_312.html; if documents are prepared in Ecuador, only notarization by an Ecuadorian notary is required.
This paragraph does not apply to children who enter Ecuador with U.S. passports as tourists, unless they hold dual U.S./Ecuadorian citizenship.

For further information regarding entry, exit, and customs requirements, travelers should contact the Ecuadorian Embassy at 2535 15th Street NW, Washington, DC 20009; telephone (202) 234-7166; web page http://www.ecuador.org/; or the Ecuadorian Consulate in Chicago (312) 338-1002/03; fax (312) 338-1004, Houston (713) 572-8731, Jersey City (201) 985-1700, Los Angeles (323) 658-5146; (323) 658-1068; fax (323) 658-1198, Miami (305) 539-8214, New Orleans (504) 523-3229, New York (212) 808-0211, or San Francisco (415) 982-1819.
Visit the Embassy of Ecuador’s web site at http://www.ecuador.org
for the most current visa information.

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

SAFETY AND SECURITY: The U.S. Embassy in Quito advises caution when traveling to the northern border region of Ecuador, to include areas in the provinces of Sucumbios, Orellana and Carchi, northern Esmeraldas, and southern Esmeraldas, south of Atacames.
U.S. government personnel are under limitations with respect to traveling alone and over-nighting in these areas due to the spread of organized crime, drug trafficking, small arms trafficking, and incursions by various Colombian terrorist organizations.
Since 1998, at least ten U.S. citizens have been kidnapped near Ecuador's border with Colombia.
One U.S. citizen was murdered in January 2001 by kidnappers holding him for ransom. Violent crime has significantly increased in 2007 and 2008 with American citizens being victims of crimes, to include but not limited to, homicides, armed assaults, robberies, sexual assaults, and home invasions.
American citizens have also been the victims of violent crime on beaches regardless of whether the beach is a popular tourist destination or remote.

Political demonstrations occur frequently throughout Ecuador for various reasons. Protesters often block city streets and rural highways, including major arteries such as the Pan American Highway. Public transportation is often disrupted during these events. Protesters may burn tires, throw rocks and Molotov cocktails, engage in destruction of property and detonate small improvised explosive devices during demonstrations. Police response may include water cannons and tear gas. U.S. citizens and U.S. affiliated interests are not usually targeted, but U.S. citizens are advised to avoid areas where demonstrations are in progress and to be prepared with backup transportation plans. Although political demonstrations have not been directed at foreigners in the past, visitors are reminded that peaceful demonstrations can turn violent with little or no warning.
Additionally, foreigners are prohibited from protesting in Ecuador and may be subject to arrest for participating in demonstrations of any kind.
Please see the following links for the local information in Quito and Guayaquil's Consular Districts, respectively at http://ecuador.usembassy.gov/security-and-safety/warden-messages.html and http://guayaquil.usconsulate.gov/warden_messages.html . U.S. citizens may also keep informed of daily happenings by following the local news and police reports.

Ecuadorian authorities may declare states of emergency in provinces and regions affected by civil unrest, natural disaster, or other disruptions. During states of emergency, authorities have expanded powers to restore order, including suspension of some constitutional rights, expanded detention powers, and imposition of curfews.

Radicals in various locations in Ecuador, including Quito, Guayaquil, and Cuenca, have occasionally placed small explosive devices that release political literature, known locally as pamphlet bombs. Targets have included local and international businesses and various Government of Ecuador buildings. Although no foreign tourists have been injured in these explosions, American citizens visiting or residing in Ecuador are urged to take common-sense precautions and avoid suspicious looking packages.

U.S. citizens should carry identification at all times, including proof of U.S. citizenship.
Travelers to Ecuador’s beach areas should be aware that strong currents, undertow, and underwater hazards may exist and are not always posted.
Most beaches lack staffed lifeguard stations.

For information on the Galapagos Islands, please see the “Special Circumstances” section of this Country Specific Information.
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:
Crime is a serious problem in Ecuador, and visitors should be alert and cautious.
Non-violent crime is common: hundreds of Americans are robbed every year in Ecuador.
Violent crime has increased in recent years.
Thieves and small gangs armed with guns or knives are now sometimes active even in smaller cities such as Otavalo, Manta, and Cuenca.
Tourists have been robbed at gunpoint on beaches and along hiking trails, including on the well-populated trail to the summit of Pichincha Volcano in Quito.
Incidents of rape have increased, even in well-traveled tourists areas and when the victims traveled in groups for safety. Shootings, kidnappings, and carjackings are still relatively rare, but American citizens have been victimized by those crimes.
The Ecuadorian government has increased police patrols in tourist areas, but travelers should remain alert to their surroundings and maintain constant control of personal belongings.

Travelers should avoid wearing expensive-looking jewelry and watches.
Avoid deserted beaches, hiking trails, and infrequently traveled roads, as well as the interior regions of large city parks, particularly at night. Robberies on public buses are a continuing problem.
The Embassy recommends that visitors use legitimate taxicabs (yellow, with meters) to travel around the larger cities.
Public buses can be dangerous – from both a traffic safety and a personal security point of view.

Pickpockets and other petty thieves are particularly active in public markets, airports, bus terminals, restaurants, and crowded streets.
Backpackers are frequently targeted for robbery and “snatch and grabs”; business travelers carrying laptop computer bags are similarly targeted.
Many travelers who travel by bus store their luggage below the bus, where it is sometimes stolen.
Therefore, we recommend that you do not store your passport in your luggage. Always be aware of your surroundings, and try to not travel alone.
Thefts from vehicles are common.
Do not leave anything of value in plain view in a car, including sunglasses or sports equipment.
Carjackings have occurred in both rural and urban areas.
Visitors are advised to drive with doors locked and windows rolled up.

In Quito, travelers should be particularly alert on the crowded streets of south Quito, at the Panecillo, in Old Quito, and in the areas of El Tejar, Parroquia San Sebastian, Avenida Cristobal Colon, and Gonzalez Suarez.
The U.S. Embassy strongly discourages hiking to the summit of Pichincha as violent crime is sharply rising.
Groups as large as eight have been robbed at gunpoint by masked men; female hikers have been sexually assaulted.
The Mariscal Sucre District is a popular tourist area in Quito with numerous restaurants, bars, hotels, and shopping sites.
Since 1999, U.S. government employees and private U.S. citizens have been victimized there, prompting the U.S. Embassy to put certain bars off-limits and to declare a nighttime curfew in the area for its employees.
Increased police presence and better lighting in prime tourist squares of Old Quito have improved safety, but similar measures in the Mariscal district have not been as effective.

In Guayaquil, take extra caution in the downtown area at night, in the street market area of La Bahia, at the Christ Statue (Sagrado Corazon de Jesus) on Cerro del Carmen, in the airport area, and in the southern part of the city.
The riverfront park area called the Malecon 2000 and the passage up to the lighthouse in the Las Penas area are generally safe and well patrolled although at night caution should be observed.
There have been repeated instances of travelers followed from the airport and intercepted by robbers using two vehicles to cut off the traveler.
There is some evidence that those most at risk are people who appear to be returning from family visits laden with gifts and large amounts of cash.
There have been armed robberies of restaurants and their patrons, including in the fashionable areas of Guayaquil.
Guayaquil has also experienced an increase in kidnappings for ransom, often in connection with hijackings, although tourists have not been targeted.

Criminals sometimes use incapacitating drugs such as scopolamine on unsuspecting tourists in order to rob them.
These so-called date rape drugs are put into drinks in order to drug the unsuspecting victim.
This drug can render the victim disoriented and can cause prolonged unconsciousness and serious medical problems.
Never allow a stranger to “buy” you a drink and never leave your drink unattended.
Several American citizens have reported thefts of property following ingestion of such substances.

Every year, 15 to 20 American citizens are arrested for attempting to traffic drugs between Ecuador and the United States, or between mainland Ecuador and the Galapagos.
Suitcases with false bottoms and other packages are common methods of transporting illegal substances. Many of these citizens claim to have been unaware that they were transporting drugs.
As in any other country, do not accept gifts, packages, or suitcases from other persons; even trusted travel companions have been known to take advantage of their friends and family to traffic drugs through Ecuador’s airports. See the Criminal Penalties section below for more details about Ecuador strict laws and sentences regarding illegal drug trafficking.

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

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
Female victims of crime may receive assistance from the Comisaria de la Mujer at Ave. 24 de Mayo y Calle Loja, telephone 593 2 228 4016 or the Oficina de Derechos de la Mujer, Guayanas E-331 y Inglaterra, Quito 593 2 252 9909.
The local equivalent to the emergency line in Ecuador is the same as the U.S., dial “911”. The operators typically speak Spanish only. Victims should also call the Embassy or Consulate to report the crime and for assistance.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Adequate medical and dental care can be readily obtained in the major cities of Ecuador.
In smaller communities and in the Galapagos Islands services are limited, and the quality is variable and generally below U.S. standards.
Ambulances, with or without trained emergency staff, are in critically short supply.
Acute surgical and cardiac services are not available on the Galapagos Islands.
Serious cases must be evacuated to the Ecuadorian mainland or the United States for treatment.
Pharmacies are readily available in any city.
However, the availability of some medications is sporadic, and formulations and brand names will differ from products available in the U.S.
Narcotics and tranquilizers are extremely limited in availability.
“Pharmacists” sometimes prescribe and dispense medications.
These individuals often have little training and prescribe broad-spectrum antibiotics and other inappropriate medications.
Travelers should not seek their advice.
Folk healers and traditional markets offer herbal and folk remedies which should be avoided as formulations are questionable and some components may interact with other prescription medications.

Travelers to Quito (close to 10,000 feet) and other highland areas may require some time to adjust to the altitude, which can adversely affect blood pressure, digestion, and energy level.
Travelers are encouraged to consult with their personal health care providers before undertaking high-altitude travel.
In particular, travelers with heart or lung problems and persons with sickle cell trait may develop serious health complications at high altitudes.

Scuba divers in the Galapagos Islands should be aware of limited facilities for decompression.
A privately owned decompression chamber is available on Santa Cruz Island in the Galapagos Islands.
The Ecuadorian Navy operates a second decompression chamber at the San Eduardo Naval Base in Guayaquil.
Due to the high costs for these services and associated emergency transportation, divers are advised to obtain adequate medical evacuation and divers insurance.

Travelers should be aware of the presence of malaria, dengue fever, and yellow fever in areas of Ecuador below 4,500’ elevation.
Historically there has not been dengue or malaria in the Galapagos archipelago, and yellow fever has only occurred in the Amazon Basin.
Travelers who are on an appropriate anti-malarial drug have a greatly reduced chance of contracting malaria, while vaccine can provide protection against yellow fever.
Avoiding mosquito bites is the only effective prevention for dengue and personal protective measures, such as the use of insect repellents, help to reduce the risk of contracting all of these illnesses.
Travelers who become ill with a fever or flu-like illness while traveling in a high-risk area, and for up to one year thereafter, should seek prompt medical attention.
For additional information on malaria or dengue, protection from insect bites, and anti-malarials, consult the Center for Disease Control and World Health Organization web sites listed below.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Ecuador.
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 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 Ecuador is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Road travel throughout Ecuador can be dangerous, especially at night.
Many roads are poorly maintained or unmarked.
Heavy rains and mudslides often close or wash out roads.
Heavy fog is common in mountainous areas.
Driving practices differ from U.S. standards.
Inter-urban and inter-provincial bus passengers are often targets of crime, including robbery and sexual assault.

Highways are often unmarked and do not have signs indicating destinations.
Road safety features such as crash barriers and guardrails along steep mountainsides are rare.
In the countryside livestock are often herded along roads or graze on roadsides.
Many roads are used for pedestrian and animal traffic as well as vehicular traffic.
Driving habits vary from region to region.
In general, drivers in Quito and the mountain areas and the Oriente (eastern jungle) drive more slowly, observe traffic signals, and slow down for speed bumps.
Vehicles are reasonably well maintained.
On the coast, drivers have a more liberal approach to vehicle maintenance and traffic regulations.
In all areas buses, both intra-city and intercity, will stop at any point on their route to pick up or drop off passengers.
Speed bumps abound, even on major highways such as the Pan American Highway, to slow traffic.
Drivers turn right and left from any lane and do not yield for pedestrians and cyclists.

Intoxicated drivers can be encountered at any time, but they are especially prevalent on weekends and holidays.
Ecuador’s frontier regions are largely rural, poor, and lack police presence.
Because drug traffickers, criminal organizations, and smugglers of all types use clandestine border crossings to move their goods, the U.S. Embassy advises against driving on all but the most traveled highways.

If you are the driver of a vehicle involved in an automobile accident, you will likely be taken into police custody, especially if injuries are involved.
You are almost certain to spend some time in jail until all parties are satisfied that responsibility has been assigned and adequate financial satisfaction received.
Drivers may face criminal charges if injuries or damages are serious.
When driving your own vehicle or a rented vehicle, be sure to have proper vehicle registration papers with you.
Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office at http://www.turismo.gov.ec/ and the Ministerio de Transporte y Obras Publicas, the national authority responsible for road safety, at http://www.mtop.gov.ec/ .

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Ecuador's Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Ecuador'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
GALAPAGOS ISLANDS: A significant number of Ecuadorian tour vessels operating in the Galapagos Islands are neither inspected nor operated in accordance with U.S. regulations, and do not meet U.S. safety standards.
The Government of Ecuador requires that vessels carrying more than sixteen passengers comply with the International Safety Management (ISM) code established by the International Maritime Organization.
However, the quality of inspections, oversight, crewmember proficiency evaluation, and other requisites for safe vessel operation may vary substantially.
Tour boat accidents are more frequent among small vessels (those carrying fewer than sixteen passengers), but travelers should inquire about safety features of any vessel, regardless of size. When boarding vessels be sure to look for the life boats, floatation devices and if possible take a moment to inspect the life vest you would be using if there were an accident.

There have been at least three cases in 2004-2006 in which small quantities of drugs have been placed by unknown persons in unsecured pockets of tourists' checked bags, including backpacks, en route to the Galapagos.
Upon arrival, these drugs have been detected by police canine units, and the owners of the bags have been arrested and detained for months while the cases are resolved.
Travelers are advised to secure all parts of their bags thoroughly before checking them on flights to the Galapagos.

Strikes and disturbances by local fisherman in the Galapagos Islands have become violent on occasion.
While tourists have not been targeted, the incidents affected their movement and access to some sites.
Such disturbances have been minimal since April 2004, but the issue remains unsettled and could resurface at any time.

The islands are over 600 miles from the mainland and help may be slow in arriving in case of emergency.
The Government of Ecuador has very limited search and rescue capabilities.
Travelers to the Galapagos are encouraged to contact tour operators and visit the Bureau of Consular Affairs' web site for the most recent information when planning their trips to the Galapagos.

OTHER LEGAL ISSUES: Under Ecuadorian law, business disputes that normally would be handled by civil litigation in the United States may be converted into criminal proceedings.
This provision of the law has been used to impose travel prohibitions against resident U.S. citizens, and it also has led to the arrest and incarceration of U.S. business people while they were awaiting a hearing on the civil matter.

When considering purchasing property in Ecuador, Americans should be aware that competing claims to property might only surface after an apparently legal sale has been made.
Deficiencies in the Ecuadorian system for surveying and registering property and weaknesses in the judicial system mean that these disputes can last years.
The Mission is aware of several cases of American citizen land owners in Ecuador being threatened with physical harm and/or confiscation of their property by individuals claiming rights to the land, and, in at least one case, buildings have been razed.
American citizens considering buying property in Ecuador should engage a competent attorney and carefully research land title issues before making a purchase.

DISASTER PREPAREDNESS: Ecuador has 19 potentially active volcanoes, including nine that have shown recent activity.
Earthquakes occur frequently.
Three active volcanoes within 50 kilometers of Quito pose a significant threat to the city: Guagua Pichincha, Cotopaxi, and Reventador.
The primary threat is from failures of transportation, water, communications, and power systems due to heavy ash fall and damage to infrastructure outside the city.
Air transportation is especially vulnerable.
Potentially serious respiratory problems are caused by inhalation of ash.

The town of Banos, a popular tourist destination approximately 120 kilometers south of Quito, is at the base of the Tungurahua Volcano.
Tungurahua has erupted explosively several times since 1999, most recently in February of 2008, causing deaths and forcing thousands to evacuate their homes.
Explosive eruptions can occur with little warning.
The resulting flows of mud and lava could pose a significant and immediate threat to Banos and other population centers in the vicinity.
Travelers should to be aware of these conditions when choosing to stay overnight in Banos, especially on the western side of the town, and should be ready to evacuate on short notice.

Other volcanoes active in Ecuador include Reventador, 100 kilometers east of Quito, and Cotopaxi, 50 kilometers south of Quito.
In 2002, lava and mudflows caused by Reventador volcano closed a major Quito/northern-border highway and volcanic ash blanketed Quito, shutting down the Quito airport for several days.

The Quito City Government and the Ecuadorian Geophysical Institute monitor these volcanoes and issue regular reports on their activity.
In the event of eruptions, travelers should pay close attention to the news media for updates on the situation.
Other volcanoes in Ecuador may also exhibit increased activity at any time.
Further information is available via the Internet from the Ecuadorian Geophysical Institute at http://www.igepn.edu.ec/ and the National Oceanic and Atmospheric Administration at http://www.ssd.noaa.gov/VAAC/guag.html .

CUSTOMS REGULATIONS:
Ecuadorian customs authorities may enforce strict regulations concerning temporary importation into or export from Ecuador of items such as firearms, religious materials, antiquities, medications, electronic equipment, and currency.
Contact the Embassy of Ecuador in Washington, D.C., or one of Ecuador’s consulates in the United States 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 Ecuadorian laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Ecuador 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.

The Ecuadorian government is required by international law to notify the U.S. Embassy or the nearest U.S. Consulate promptly when an American citizen is arrested and requests such notification.
Delays in notification can limit the assistance the U.S. Government can provide an arrested American citizen.
Therefore, Americans should promptly identify themselves as such to arresting officers and request that the U.S. Embassy in Quito or the U.S. Consulate in Guayaquil be notified immediately.

Prison conditions in Ecuador are extremely poor.
In many facilities food is insufficient in both quantity and quality, and prisoners must pay for adequate nutrition from their own funds.
Most Ecuadorian prisons provide poor medical care, and urgent medical conditions may receive only minimal attention.
The Guayaquil penitentiary medical clinic does not have medicine but is staffed with medical personnel. Prisoners must personally pay to have someone outside of the prison obtain medicine and prescriptions. Those accused of crimes in Ecuador can expect lengthy delays before trial and sentencing.
The accused are usually incarcerated while awaiting trial and sentencing, and in the case of serious crimes, bail is generally not an option.

CHILDREN'S ISSUES:
For information on 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 Ecuador 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 Ecuador.
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 in Quito is located at Avigiras E12-170 y Eloy Alfaro.
The telephone during business hours (8:00a.m. to 5:00 p.m.) is (011) 593 2 398 5000.
For after-hours emergencies use (011) 593 2 398 5000. Within the same city use the last seven digits.
Add the city code for intercity telephone calls.
The Embassy's web site is http://ecuador.usembassy.gov/
The U.S. Consulate General in Guayaquil is located at the corner of 9 de Octubre and Garcia Moreno (near the Hotel Oro Verde); telephone (011-593-4) 232-3570 during business hours (8:00 a.m. to 5:00 p.m.) or 232-1152 for after-hours emergencies; fax (011-593-4) 232-0904.
The Consulate General's web site is http://guayaquil.usconsulate.gov/.

Consular services for U.S. citizens in the Galapagos Islands are provided by the Consulate General in Guayaquil with assistance from a U.S. Consular Agent in Puerto Ayora, Galapagos, at (05) 2526-330 or (05) 2526-296.

The Consular Section in Quito is open for American Citizen Services, including registration, from 1:30 to 4:00 p.m., Monday through Thursday, excluding U.S. and Ecuadorian holidays.
In order to provide better customer service and reduce waiting times, the American Citizen Services section in Guayaquil uses an online appointment system. Appointments are available from 12:00 noon to 4:00 p.m., Monday through Thursday. Notary appointments are Friday, 8:00 a.m. to 12:00 p.m., excluding U.S. and Ecuadorian holidays. Walk-in service remains available, but customers with appointments take precedence.
To make an appointment, go to http://guayaquil.usconsulate.gov/online_appointments.html
*

*

*
This replaces the Country Specific Information for Ecuador dated March 28, 2008, to update the sections on Entry/Exit Requirements, Information for Victims of Crime, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Tue, 14 Jan 2020 09:19:55 +0100 (MET)

Quito, Jan 14, 2020 (AFP) - A volcano erupted on an uninhabited island in the Galapagos, Ecuadorian authorities said, spewing lava on the ecologically sensitive environment.   La Cumbre volcano on Fernandina island, one of the youngest in the archipelago, began erupting Sunday evening, Galapagos National Park (PNG) officials said in a statement.   The 1,467 metre high (4,813 feet) volcano has a crack along its south-eastern flank and "a lava flow descends to the coast", PNG added.

The island is home to a number of species including iguanas, penguins, flightless cormorants, snakes and an endemic rat, and has "very important" ecological value, PNG said.   Before the eruption, an earthquake with a magnitude of 4.7 was felt, according to the local Ecuadorian Geophysical Institute, followed by 29 aftershocks.

The volcano also erupted in June 2018.  The unique fauna of the UNESCO-listed Galapagos Islands -- located 1,000 kilometres (620 miles) east of mainland Ecuador -- helped English naturalist Charles Darwin develop his theory of evolution by natural selection.
Date: Sun, 31 Mar 2019 11:14:25 +0200

Washington, March 31, 2019 (AFP) - A strong 6.2 magnitude earthquake struck just off the coast of Ecuador early Sunday, the US Geological Survey said, but there were no immediate reports of damage and there was no tsunami warning.   The quake occurred at a shallow depth of 18.5 kilometres (11.5 miles), in the Pacific Ocean west of Guayaquil and 27 kilometres north of Santa Elena, the agency reported.
Date: Fri, 7 Sep 2018 12:17:58 +0200

Quito, Sept 7, 2018 (AFP) - A deep 6.2 magnitude earthquake struck Ecuador on Thursday night, causing damage to buildings and injuring two people.   The quake hit at 9:12 pm local time (0212 GMT on Friday) at a depth of 93.5 kilometres, near the center of the South American country.   It was felt across several provinces, according to Twitter users. Two people were injured in the town of Cumanda.

The walls of homes cracked and ceilings caved in, mayor Marco Marquiasca said.   Local authorities recorded its magnitude as 6.5.   Ecuador suffered a 7.8 magnitude earthquake on April 16, 2016, which devastated villages in the coastal provinces of Manabi and Esmeraldas and killed 673 people.   The losses amounted to more than $3 billion, according to authorities.    Located on the boundary of the Nazca and South America tectonic plates, Ecuador is very prone to seismic activity.
Date: Thu, 16 Aug 2018 03:58:11 +0200

Quito, Aug 16, 2018 (AFP) - Colombia's government said Wednesday that 19 of the victims of a deadly bus crush in Ecuador were its citizens, as Quito lowered the overall death toll from the accident.   Ecuador's foreign ministry said in a statement that 23 people were killed in the Tuesday crash, instead of 24 as previously announced.   Twelve Colombians, four Venezuelans and two Ecuadorans who died in the accident have been identified, the statement said.

The bus, which had foreign license plates, overturned and crashed into three houses after a collision with an all-terrain vehicle near Quito.   Ecuador transport colonel Julio Barba said the driver "probably overused the brakes... which produced an overheating of the brake system leading to a loss of control of the vehicle."   Colombia's Transport Ministry had said on Tuesday that the bus was not authorized to carry tourists.  One of the two drivers, who was injured in the crash, has been arrested.

Traffic accidents are among the leading causes of death in Ecuador. According to the watchdog group Justicia Vial, on average seven people are killed and some 80 people injured each day in traffic accidents.   And 96 percent of those accidents are due to human error, according to the group's figures.   On Sunday, 12 people were killed and 30 injured when a bus carrying fans of Barcelona SC, Ecuador's most popular football club based in Guayaquil, ran off the highway and flipped.
Date: Mon, 11 Jun 2018 22:10:52 +0200

Quito, June 11, 2018 (AFP) - A Lebanese man has been stuck in immigration purgatory at an airport in Ecuador for 42 days after losing his passport and being returned there from Spain.   Nizam Hussein Shalak, 56, who does not speak Spanish, has been residing in the international terminal of the Jose Joaquin de Olmedo airport in Guayaquil, El Universo newspaper reported.   "It is a case of inadmissibility because he has no documents," a foreign ministry source said.   "The only legal body to issue a travel document is the Lebanese consulate in Bogota," which has not responded to requests that it do so, the source said.   "We are closely following the case and are working with the interior (ministry) to get Lebanon to issue him a travel document so he can return to his country."   The situation resembles that of an Iranian refugee who lived in a Paris airport from 1988 to 2006 and was portrayed in the film "The Terminal" starring Tom Hanks.

Shalak visited Guayaquil two months ago and stopped on the way back to Lebanon in Lima, Peru, and Barcelona, Spain, where he was detained after losing his passport as well as his credit cards, El Universo newspaper reported.   He stayed in Barcelona for 10 days and Lima for another 11 before being returned to Guayaquil, where he had to make a makeshift a bed on the seats of the terminal.   "He eats with the coupons that the airline... gives him from time to time" and showers "every three or four days, when they take him to a bathroom in another part of the terminal," the newspaper said.   The foreign ministry source said that while Shalak left with a passport, he did not have one upon his return and could not pass immigration.   Therefore, "he is not legally in the country."
More ...

Bosnia and Herzegovina

Bosnia & Herzegovina US Consular Information Sheet
December 01, 2008
COUNTRY DESCRIPTION:
Since the December 1995 signing of the Dayton Peace Accords, there has been significant progress in restoring peace and stability in Bosnia and Herze
ovina.
Significant progress has been made in reconstructing the physical infrastructure that was devastated by the war. Nonetheless, political tensions among the ethnic groups persist. Hotels and travel amenities are available in the capital, Sarajevo, and other major towns, but they are relatively expensive. In the more remote areas of the country, public facilities vary in quality.
For more details, read the Department of State Background Notes on Bosnia and Herzegovina.

ENTRY/EXIT REQUIREMENTS:
A passport is required for travel to Bosnia and Herzegovina. American citizens do not require a visa for tourist stays up to three months.
Travelers who are not staying at a hotel (i.e. a private residence) must register with the local police within 24 hours of arrival. U.S. citizens planning to remain in Bosnia and Herzegovina for more than three months must obtain a visa prior to travel, or apply for a temporary residence permit from the local police station having jurisdiction over their place of residence. Applications for temporary residence permits should be submitted 15 days prior to the expiration of the initial three month tourist visa. A police certificate indicating that the applicant has no criminal record is required for this permit and should be obtained from the applicant’s state of residence in the U.S.
For additional information please contact the Embassy of Bosnia and Herzegovina, at 2109 E. Street, NW, Washington, DC 20037, telephone 202-337-6473.
Visit the Embassy of Bosnia and Herzegovina web site at http://www.bhembassy.org for the most current visa information.

Beginning in May 2008, the immigration authorities of Bosnia and Herzegovina began to strictly enforce a provision of a Bosnian law that requires any unaccompanied minor (under 18) to have written permission from both parents in order to enter and leave the country.
If traveling with one parent only, the minor is required to have written permission for the trip from the non-traveling parent. 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:
Landmines remain a problem in Bosnia and Herzegovina. As of 2008, there are still an estimated 13,000 minefields and an estimated 222,000 active land mines.
The area of suspected landmine contamination is estimated at over 2000 square kilometers more than 4% of the country’s territory.
These devices have killed more than 400 people since 1996.
While most urban areas have been largely cleared, special care should be taken when near the former lines of conflict, including the suburbs of Sarajevo.
The de-mining community recommends staying on hard surfaced areas and out of abandoned buildings.
Families traveling with children in Bosnia and Herzegovina should be especially aware of the danger posed by mines and unexploded ordnances.
For more information about landmines please visit http://www.bhmac.org/en/stream.daenet?kat=19
Localized political difficulties continue and random violence may occur with little or no warning.

Bosnian criminals use firearms and explosives to settle personal, business, and political disputes.
In October 2008, an explosive device detonated in a public shopping mall in Vitez, killing a store security guard.
The foreign community is rarely the target of such violence, but there is always the danger of being in the wrong place at the wrong time.
While most Bosnian citizens appreciate the assistance of the international community, occasional anti-foreign sentiment is sometimes encountered.
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 A Safe Trip Abroad.
CRIME:
The overall crime rate throughout the country remains relatively low­the most common being confrontational crimes and residential break-ins.
Pick-pocketing and vehicle break-ins are also a problem. Most pickpockets operate in pairs and employ distraction methods to execute their craft.
There are also documented cases of pick-pocketing and other scams to get money from foreign passengers aboard public transportation.
Travelers should take normal precautions to protect their property from theft and exercise common sense personal security measures, traveling in groups, and staying in well-lighted areas after dark.
Confrontations with local citizens resulting from traffic incidents or public disagreements should be avoided.

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 Victims of Crime, including possible sources of U.S. assistance..
The local equivalent to the “911” emergency line in Bosnia and Herzegovina is: Police­122; Ambulance--124 and Fire­123.
MEDICAL FACILITIES AND HEALTH INFORMATION:
The lack of adequate medical facilities, especially outside Sarajevo, may cause problems for visitors.
Because many medicines are not obtainable, travelers should bring their own supply of prescription drugs and preventive medicines.
Private practitioners and dentists are becoming more common; however, quality of care varies and rarely meets U.S. or western European standards.
All major surgery is performed in public hospitals.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Bosnia and Herzegovina

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 Bosnia and Herzegovina is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Road travel is possible throughout most of the country.
However, some roads are still damaged from the war, and poorly maintained.
Roads are sometimes blocked due to landslides, de-mining activity, and traffic accidents.
Bosnia and Herzegovina is among the rare countries in Europe that has fewer than ten kilometers of four-lane highway.
The existing, two-lane roads between major cities are quite narrow at places, lack guardrails, and are full of curves.
Travel by road can be risky due to poorly maintained roads, and morning and evening fog in the mountains.
Driving in winter is hazardous due to fog, snow, and ice.
Local driving habits are poor, and many vehicles are in bad condition.
Many accidents occur when drivers exceed safe speeds along winding mountain roads.
Accidents involving drunk driving are an increasing problem.
Driving after dark is especially dangerous, and street lighting is not common outside the major towns.
Road construction may be poorly marked, and automobiles share the road with heavy vehicles and agricultural equipment.
Travelers are encouraged to convoy with other vehicles, if possible, and to plan their trip to ensure they travel only during daylight hours.

Although the number of service stations outside major cities has increased in recent years, many do not offer mechanical or other services.
The emergency number for vehicle assistance and towing service is 1282; Speed limit traffic signs are not always obvious or clear.
The speed limit on the majority of roads is 60 km/h, and on straight stretches of road it is generally 80 km/h.
The use of seat belts is mandatory.
Talking on a cell phone while driving is prohibited.
The tolerated percentage of alcohol in the blood is .03%.

In order to drive legally in Bosnia and Herzegovina, you must have an international driving permit in addition to your U.S. license.

Please refer to our Road Safety page for more information.
Visit the web site of the Bosnia and Herzegovina’s national tourist office and national authority responsible for road safety at http://www.bihamk.ba
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Bosnia and Herzegovina, the U.S. Federal Aviation Administration (FAA) has not assessed Bosnia and Herzegovina’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://faa.gov/safety/programs_initiatives/oversight/iasa .
During the winter months, flights into and out of Sarajevo are frequently delayed or canceled due to heavy fog.
Travelers should be prepared for last-minute schedule changes, lengthy delays, alternate routings, or time-consuming overland transportation.

SPECIAL CIRCUMSTANCES:
Bosnia and Herzegovina is still predominantly a cash economy.
Although the use of credit cards has become more widespread in recent years, travelers still should not expect to use them to cover all expenses. Automated Teller Machines (ATMs) are available in sufficient numbers at international banks in Sarajevo and other major cities and towns.
Traveler's checks can be cashed in banks in major cities, but often with delays of a few weeks or strict monthly limits.
Cash transfers from abroad may also involve delays.
The convertible mark, the national currency, is pegged to the euro under a currency-board regime, which guarantees its stability.
All official payments must be made in convertible marks, though many private stores and service providers also accept euros.
Any bank in Bosnia and Herzegovina should be able to exchange U.S. dollars into convertible marks with the usual bank commission (between 1% and 2%).

Photographing military installations, including airports, equipment, bridges, government checkpoints, troops and the U.S. Embassy, is forbidden.
If in doubt, please ask permission before taking photographs. 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 Bosnia and Herzegovina laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Bosnia and Herzegovina 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 Bosnia and Herzegovina 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 Bosnia and Herzegovina.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at Alipasina 43, telephone (387) (33) 445-700, fax: (387) (33) 221-837; http://sarajevo.usembassy.gov/.
On weekends, holidays, and after hours, an Embassy duty officer can be reached at telephone (387) (33) 445-700.
If after dialing you receive a recorded message, press “0”, and then ask for the duty officer.
* * *
This replaces the Consular Information Sheet dated March 11, 2008, to update sections on Country Description, Entry and Exit Requirements, Safety and Security; and Crime.

Travel News Headlines WORLD NEWS

Date: Tue, 14 May 2019 17:36:11 +0200

Sarajevo, May 14, 2019 (AFP) - Torrential downpour has flooded hundreds of homes and swamped roads in northern Bosnia, officials said Tuesday, as rescuers searched for a six-year-old boy swept away by a swollen stream.   The child went missing in the northern Zepce region, national television BHRT reported on Tuesday. 

The heavy rain, which started Sunday, has sparked fears of a repeat of the 2014 floods that devastated the Balkan region, killing 77 people.   Weather services have predicted the rain will taper off.   Several Bosnian towns in the hardest-hit north have declared a state of emergency and begun protective evacuations.

More than 200 people have been evacuated in villages around north-eastern Doboj, where two rivers have overflowed.   "About 100 houses were flooded, as well as the offices of five companies and 50 hectares of land," said civil defence official Senad Begic.    Floods have also hit around 200 households in northwest Prijedor and 100 east in the town of Celinac.    "The danger has not passed and I invite inhabitants to follow the instructions of the authorities, without panic," urged Radovan Viskovic, Prime Minister of Republika Srpska, Bosnian's Serb-run region.

Dozens of homes were also flooded in neighbouring Croatia, where eight tourists, including two children, were rescued by firemen at a campsite on the banks of the Korana river, national TV reported.   After rising rapidly overnight, water levels in major rivers are falling slightly or stagnating, according to weather services.   In the spring of 2014, the Balkans region was hit by its worst floods in more than a century, which affected 1.6 million people and caused an estimated two billion euros in damage, mostly to houses and farmland.
Date: Thu, 24 Dec 2015 20:40:42 +0100

Sarajevo, Dec 24, 2015 (AFP) - Air pollution forced Bosnian authorities to shut schools in the capital Sarajevo on Thursday, while smog levels also spiked in other parts of the Balkan country due to a lack of rainfall, local officials said.   The air quality index, whose "normal" levels range from 0 to 50, reached 94 in Sarajevo on Thursday, official data showed.   Registered levels had been even higher in recent days, with the index soaring above the dangerous 300 mark and the city literally shrouded in a smog.

Regional authorities in Sarajevo decided to close primary and secondary schools Thursday, they said in a statement, while the city council demanded an early start to the winter holiday, so that children would be spared from being exposed to the smog.   Winter holidays traditionally start later in Bosnia than in western Europe, just ahead of the New Year.

Health authorities urged citizens meanwhile, particularly those with health problems, pregnant women and children, to refrain from going out at all.   Red Cross and non-governmental activists distributed protective masks to people across the city, which is surrounded by mountains that lock in the air especially during dry spells.   Pollution levels were also exacerbated by fumes from heating tens of thousands of homes.

Weather forecasts indicate that smog levels are not expected to improve before January.   Several other Bosnian towns were also hit by smog, especially those with large industrial areas such as Lukavac and Tuzla, where the air pollution index reached 293 and 193 respectively on Thursday.
Date: Tue, 24 Nov 2015 11:23:17 +0100

Sarajevo, Nov 24, 2015 (AFP) - Bosnian prosecutors were investigating an explosion at a police station Tuesday which authorities said could be an act of "terrorism", days after two members of the country's military were shot dead.   Unknown perpetrators threw an explosive device on the roof of the station in the central town of Zavidovici in the early hours, causing minor damage but no injuries, police spokeswoman Aldina Ahmic said.   "There are indications that this case has elements of the criminal act of terrorism," said Ahmic.

The national prosecutor's office has taken over the case and formed a special team tasked with investigating.   The incident comes less than a week after two military men were killed on November 18 by a man who attacked them with automatic weapons near a barracks in Sarajevo before blowing himself up.   Authorities have said that the perpetrator had links to Islamist circles and that the attack was almost certainly a "terrorist act".

Muslims make up about 40 percent of Bosnia's 3.8 million people while the rest of the Balkan country is mostly Serb Orthodox or Catholic.   The vast majority of Bosnian Muslims are moderates but a tiny minority openly support radical Wahhabism.   After the deadly Islamic State attacks in Paris earlier this month, Bosnia's Islamic spiritual leader Husein Kavazovic urged Europe's Muslims to keep the peace, saying the killings were a "sin towards God".
Date: Mon 27 Apr 2015
Source: WBNS-TV, Associated Press (AP) report [edited]

Authorities in Bosnia's capital have declared a foodborne outbreak after nearly 200 preschool children became sick at public day care centers in Sarajevo. Local health minister Emira Tanovic-Mikulec declared the outbreak on Mon 27 Apr 2015. Lab tests show that the food the children ate last week [week of 20 Apr 2015] was infected with salmonella enteridis [see comment below]. Out of the 193 children with fever, diarrhea, and abdominal cramping, 51 had to be hospitalized but none are in a life-threatening condition, hospital officials say.

About 2900 kids eat food prepared in a central kitchen that supplies the 29 centers in Sarajevo. The symptoms started last Wed 22 Apr 2015, when macaroni with cheese and eggs was on the menu.
================
[Both cheese (especially if unpasteurized) and eggs (if undercooked or recontaminated from poor kitchen hygiene) are common reservoirs for salmonellosis. The serotype is not specially stated as, in the original post, the statement is "was infected with salmonella enteridis" which could mean salmonella enteritis (as the name of the condition) or _Salmonella_ Enteritidis (as the name of the organism). - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu 2 Apr 2015
Source: Outbreak News Today [edited]
-------------------------------------------------------------------------
The US Centers for Disease Control and Prevention (CDC) issued 3 travel notices Wednesday due to on-going measles outbreaks in Angola, Bosnia-Herzegovina and Ethiopia. In Angola, the US federal health agency says the country is experiencing an on-going measles outbreak. The number of confirmed measles cases increased from 6558 in 2013 to 12 036 in 2014; and cases continue to occur in 2015.

In Europe, as of February 2015, the Federal Institute of Public Health in the Federation of Bosnia and Herzegovina has reported more than 3800 cases since January 2014. Most of the cases have been in 3 Central Bosnia Canton municipalities: Bugojno, Fojnica, and Travnik.

Finally, on the Horn of Africa, Ethiopia is experiencing an on-going measles outbreak. The number of confirmed measles cases increased from 6100 in 2013 to more than 14,000 confirmed cases in 2014; cases continue to occur in 2015.

The CDC recommends that travellers to all 3 destinations protect themselves by making sure they are vaccinated against measles, particularly infants 6-11 months of age (1 dose of measles vaccine) and children 12 months of age or older (2 doses of measles vaccine). Clinicians should keep measles in mind when treating patients with fever and rash, especially if the patient has recently travelled internationally.  [Byline: Robert Herriman]
More ...

World Travel News Headlines

Date: Sun 23 Feb 2020
Source: Q Costa Rica News [edited]
<https://qcostarica.com/costa-rica-is-the-first-country-in-america-where-very-resistant-antibiotic-bacteria-for-meningitis-is-isolated/>

A 50-year-old man and a senior became the 1st 2 people in Costa Rica -- and in the Americas -- found to be infected with the bacteria most resistant to antibiotics used in the treatment of meningitis and meningococcal septicaemia that cause serious brain damage and even death. The Centro Nacional de Referencia en Bacteriolog­a (CNRB) -- National Center of Reference in Bacteriology, of the Instituto Costarricense de Investigacian y Enseaanza en Nutricin y Salud (Inciensa) -- Costa Rican Institute for Research and Education in Nutrition and Health (Incense), issued an alert, in early February [2020], after documenting the circulation of _Neisseria meningitidis_ (_N. meningitidis_) serogroup Y, resistant to penicillin and not sensitive to cefotaxime [and ceftriaxone?], two 3rd generation antibiotics, reports La Nation.
====================
[Invasive meningococcal disease (meningococcaemia and meningitis) is a life-threatening infection caused by _Neisseria meningitidis_ that evolves rapidly, often even when appropriate treatment has been started promptly. Because antimicrobial treatment for invasive meningococcal disease with a 3rd-generation cephalosporin (cefotaxime and ceftriaxone) is the widely accepted standard recommendation (<https://academic.oup.com/cid/article/39/9/1267/402080>), resistance of _N. meningitidis_ to cefotaxime and ceftriaxone is very worrisome.

The news report above says that 2 patients in Costa Rica were infected with _N. meningitidis_ serogroup Y resistant to penicillin and 2 3rd generation cephalosporins, one of which was cefotaxime. The other 3rd generation cephalosporin is not specified, but is perhaps ceftriaxone, the other 3rd generation cephalosporin usually used to treat this disease. We are also not told in the news report above if the 2 patients were epidemiologically linked, nor are we told the extent (that is, MICs [minimum inhibitory concentration] of penicillin or cefotaxime), the mechanisms of resistance, or resistance to any of the other antimicrobial drugs used to prevent or treat this disease.

More information would be appreciated from knowledgeable sources. Reduced susceptibility of _N. meningitidis_ to penicillin has been reported in the past in many countries, including the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>), usually due to decreased affinity of target penicillin-binding proteins for penicillin and less commonly to beta-lactamase production (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC89938/>, <https://pubmed.ncbi.nlm.nih.gov/3134848-relative-penicillin-g-resistance-in-neisseria-meningitidis-and-reduced-affinity-of-penicillin-binding-protein-3/>, and <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC162989/pdf/392577.pdf>).

Meningococcal isolates with reduced susceptibility to penicillin G usually were reported susceptible to 3rd-generation cephalosporins (cefotaxime and ceftriaxone). For example, despite the decrease in susceptibility to penicillin G in 33% of 2888 isolates of _N. meningitidis_, all isolates were susceptible to ceftriaxone in Brazil from 2009 to 2016 (<https://pubmed.ncbi.nlm.nih.gov/29717974-surveillance-of-antimicrobial-resistance-in-neisseria-meningitidis-strains-isolated-from-invasive-cases-in-brazil-from-2009-to-2016/>). Similar data have been reported for the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>).

However, one previous study reported 8 clinical isolates _N. meningitidis_ in Delhi, India in 2006 that were resistant to ceftriaxone and cefotaxime, with most also resistant to penicillin, ciprofloxacin, and chloramphenicol (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698303/>). All of the isolates were identified as serogroup A _N. meningitidis_, but no further details concerning these isolates were given in this report (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1865813/>).

Resistance to other antimicrobial agents that may be used for therapy of meningococcal infections or for prophylaxis of case contacts has been reported in several countries. This includes resistance to chloramphenicol, fluoroquinolones, and rifampin. Horizontal exchange of genes that encode resistance for penicillin, rifampin, and the fluoroquinolones from other _Neisseria_ species that share a common ecological niche with _N. meningitidis_ in the nasopharynx has been proposed as one possible mechanism of acquisition of meningococcal antibiotic resistance (<http://jac.oxfordjournals.org/cgi/content/full/49/3/545>). - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Costa Rica: <http://healthmap.org/promed/p/17>]
Date: Tue 25 Feb 2020
From: Anne Laudisoit, PhD [edited]
<laudisoit@ecohealthalliance.org>

A suspect plague outbreak cluster has been noted in the the Godjoka health area as of 19 Feb 2020. The chief medical officer of the Rethy Health zone, the head nurse and the laboratory team from the Rethy General reference hospital investigated the outbreak site. The Godjoka village is located in the Linga health zone, Djugu territory, Ituri province, in the Congo DR (N 02.01'47.9'' and E030.44'56.6'', 1940m) in the plague endemic area.
 
There have been 6 suspected cases of plague, including 5 deaths and 1 recovering patient. The index case is a young boy who died on 19 Feb 2020. His mother, the neighbour and her child all died on 21 Feb 2020 and were buried the night of 24 Feb 2020, under pressure from the villagers. Finally the traditional healer ["tradipraticien"] who took care of the mother (who was the 2nd case) died in turn on 25 Feb 2020, and samples were taken that same day. The rapid diagnostic test was positive for plague.  Because of their rapidly fatal course, pneumonic plague is suspected for one or more of the 5 fatal cases. 

The only survivor has been under treatment at the Godjoka Health center since 22 Feb; he is the 20 year-old brother of the index case. The test on the sputum of this patient was negative.
-------------------------------------
Francoise Ngave Nyisi, Rethy General Reference Hospital, DR Congo
Mandro Michel, Provincial Division of Health, Bunia, DR Congo
Adroba Pascal, Provincial Division of Health, Bunia, DR Congo
Laudisoit Anne, Ecohealth Alliance, New York, USA
=====================
[ProMED thanks Dr Laudisoit and her hardworking Congolese colleagues for this important report.  Thus far the diagnosis of plague rests on the single positive diagnostic test obtained from the traditional healer, as it appears that the first 4 fatal cases were buried before diagnostic tests could be obtained. Following this logic, It is possible that the sole survivor thus far has the bubonic form of the disease, and thus a negative sputum result.  We seek and hope to obtain further information on all of these cases, including age, nature and duration of symptoms, presence or absence of buboes, etc.

This putative plague cluster is in a known historic plague-endemic region, where there were 31 cases and 8 deaths between Jan - Oct 2019, as previously reported by ProMED (Plague - Congo DR (02): (IT) fatal http://promedmail.org/post/20191016.6731137).  The Ituri district, of course, has also been affected by the still smouldering North Kivu-Ituri Ebola outbreak that began in July 2018.  This district has also been, and continues to be, a region of great civil unrest, with multiple armed insurgency groups operating near and across the Ugandan border.

The following background information on plague by Mod.LL is copied from our most recent ProMED post on plague [see below under See Also]:

"The bacterium that causes plague is _Yersinia pestis_. Most cases of plague are due to bubonic plague following the bite of an infected rodent flea causing a swollen and very tender lymph gland. The swollen gland is called a "bubo." Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2-6 days after being bitten. At this point in the illness, there is no risk of person-to-person spread, so if this was indeed a case of bubonic plague, no isolation or quarantine is necessary.

When bubonic plague is left untreated, plague bacteria invade the bloodstream. As the plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition. Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The infected person may experience high fever, chills, cough, and breathing difficulty and may expel bloody sputum. If plague patients are not given specific antimicrobial therapy, the disease can progress rapidly to death. At this stage, as appears to have happened in this case, person-to-person spread can occur, causing other cases of "primary" plague pneumonia. - ProMED Mod.LL]

[A ProMED/HealthMap of DR Congo is available at: DR Congo:
Date: Thu, 27 Feb 2020 09:14:05 +0100 (MET)
By Anuj Chopra and Haitham El-Tabei

Riyadh, Feb 27, 2020 (AFP) - Saudi Arabia on Thursday suspended visas for visits to Islam's holiest sites for the "umrah" pilgrimage, an unprecedented move triggered by coronavirus fears that raises questions over the annual hajj.   The kingdom, which hosts millions of pilgrims every year in the cities of Mecca and Medina, also suspended visas for tourists from countries with reported infections as fears of a pandemic deepen.

Saudi Arabia, which so far has reported no cases of the virus but has expressed alarm over its spread in neighbouring countries, said the suspensions were temporary. It provided no timeframe for when they will be lifted.   "The kingdom's government has decided to take the following precautions: suspending entry to the kingdom for the purpose of umrah and visit to the Prophet's mosque temporarily," the foreign ministry said in a statement.   "Suspending entry into the kingdom with tourist visas for those coming from countries, in which the spread of the new coronavirus (COVID-19) is a danger."

The move comes as Gulf countries implement a raft of measures, including flight suspensions and school closures, to curb the spread of the disease from people returning from pilgrimages to Iran.  Even as the number of fresh coronavirus cases declines at the epicentre of the disease in China, there has been a sudden increase across the Middle East.

Since its outbreak, the United Arab Emirates has reported 13 coronavirus cases, Kuwait has recorded 43, Bahrain has 33 and Oman is at four cases.   Iran has emerged as a major hotspot in the region, with 19 fatalities from 139 infections -- the highest death toll outside China, where COVID-19 originated.   While no cases have been reported in Saudi Arabia, one citizen is reported to be infected in Kuwait along with four Saudi women in Bahrain -- all of whom had returned from Iran.

- 'Unprecedented' move -
The umrah, which refers to the Islamic pilgrimage to Mecca that can be undertaken at any time of year, attracts millions of devout Muslims from all over the globe each year.    There was no clarity over how the move would affect the annual hajj pilgrimage due to start in late July.   Some 2.5 million faithful travelled to Saudi Arabia from across the world to take part in last year's hajj -- one of the five pillars of Islam.

The event is a key rite of passage for Muslims and a massive logistical challenge for Saudi authorities, with colossal crowds cramming into relatively small holy sites.   "This move by Saudi Arabia is unprecedented," Ghanem Nuseibeh, founder of London-based risk consultancy Cornerstone Global Associates, told AFP.   "The concern for Saudi authorities would be Ramadan, which starts at the end of April, and hajj afterwards, should the coronavirus become a pandemic."

The holy fasting month of Ramadan is considered a favourable period by Muslim pilgrims to perform the Umrah.   Saudi Arabia's custodianship of Mecca and Medina -- Islam's two holiest sites -- is seen as the kingdom's most powerful source of political legitimacy.     But a series of deadly disasters over the years has prompted criticism of the Sunni kingdom's management of the pilgrimage.

In September 2015, a stampede killed up to 2,300 worshippers -- including hundreds of Iranians -- in the worst disaster ever to strike the pilgrimage.   The pilgrimage forms a crucial source of revenue for the government, which hopes to welcome 30 million pilgrims annually to the kingdom by 2030.   De facto ruler Crown Prince Mohammed bin Salman's Vision 2030 reform plan seeks to shift the economy of Saudi Arabia -- the world's top crude exporter -- away from oil dependency towards other sources of revenue, including religious tourism.
Date: Thu, 27 Feb 2020 05:04:04 +0100 (MET)

Kuala Lumpur, Feb 27, 2020 (AFP) - Badminton's German Open will not go ahead next week and the Polish Open has been postponed, officials said as two more Olympic qualifying events fell victim to the coronavirus.   It hasn't yet been decided whether the German Open, originally scheduled for March 3-8, will be postponed or cancelled entirely, the Badminton World Federation said late Wednesday.   New dates are being sought for the Polish Open, which was meant to take place on March 26-29, but it will not now fall in the qualifying period for the Tokyo Olympics.

Both events were in the same month as the All England Open, one of the biggest events in the badminton calendar, although that tournament is currently still set to go ahead.   "The BWF is continuing to monitor all official updates on COVID-19 with no change to the intention to stage other HSBC BWF World Tour or BWF-sanctioned tournaments," said a statement.   This week the Vietnam International Challenge, which also carried rankings points for the Olympics, was shifted from late March to early June.

The loss of qualifying tournaments will pose a problem for many players including two-time Olympic champion Lin Dan, who needs a rapid rise up the rankings to win a place on the Chinese team.   Many of China's players are currently in Britain and have been cleared to play during what is a "critical period" of Olympic qualifying, the Chinese Badminton Association said last weekend.   China have been the dominant force in badminton at recent Olympics, sweeping all five titles at London 2012 and winning the men's singles and doubles gold medals four years ago in Rio.
Date: Thu, 27 Feb 2020 09:58:42 +0100 (MET)

Tallinn, Feb 27, 2020 (AFP) - Estonia reported its first coronavirus case on Thursday, a day after the man returned to the Baltic nation of just 1.3 million people from his homeland Iran.    "The person, a permanent resident of Estonia who is not a citizen, arrived in Estonia on Wednesday evening," Social Affairs Minister Tanel Kiik told public broadcaster ERR.   He said the Iranian citizen is currently hospitalised.

Local media said the man arrived in Tallinn by bus from the Latvian capital Riga.   "For now, there are no plans of putting cities in quarantine following this one case," Kiik said.    "The patient is isolated, there is no risk of the disease spreading, now we have to identify all the people the patient was in contact with."   Iran has announced a total of 19 deaths and more than 130 infections, including the country's deputy health minister.   Iran's coronavirus death toll is the highest after that of China, where more than 2,700 people have died from the disease.
Date: Wed, 26 Feb 2020 19:27:33 +0100 (MET)

Vynnyky, Ukraine, Feb 26, 2020 (AFP) - Ukrainian authorities began the task of destroying 37,000 bottles of illicit adulterated vodka on Wednesday, a national "record" in a country where consumption of illegal alcohol regularly poisons and even kills.    Minister of Justice Denys Malyuska launched the operation in the city of Vynnyky in the central Lviv region where the bottles, holding 14 tonnes of alcohol, have been stored since their seizure in 2014.   "It is difficult to say what is in there but consumption is strictly not recommended," said the minister.    "This adulterated alcohol poses a huge threat to people's health and their lives."    In front of the media, the contents of several bottles were poured into plastic tanks or blue dye was added, to rule out any illegal re-sale of the beverage.

The procedure should last about a week, after which the liquid will be poured into the sewers at a secret location, according to the minister.   "This is the first time this procedure has been used so that everyone can see that the alcohol that has been seized is really destroyed," said Maliouska.   The minister said that in the past there had been "complaints" from the business community that because of corruption within the police, the illicit alcohol had often turned up in shops after being seized.   Cases of poisoning from adulterated drinks are a regular occurence in Ukraine, where the consumption of alcohol, especially spirits, remains high. And they are often fatal.

In 2016, 73 people died from a total of 150 people who were poisoned by adulterated alcohol.    The following year, six poisoning cases killed three people and, according to Ukrainian media, ten poisonings recorded by the authorities in 2018 led to nine deaths.   The tax department of the Lviv region told AFP on Wednesday that the most adulterated alcohol was vodka, which is then sold in shops in small towns or cafes located along the roads.
Date: Thu, 27 Feb 2020 07:21:09 +0100 (MET)

Copenhagen, Feb 27, 2020 (AFP) - Denmark reported its first coronavirus case Thursday, a man who had returned from a skiing holiday in northern Italy which has become a hotspot for the disease.   "The man who came back from a skiing trip with his wife and son on February 24 has been suffering since then from a cough and a temperature," Denmark's public health agency said in a statement.   "The man tested positive, but the results of his wife and son are negative," it said.   The man is relatively well and has returned to his home, where he remains in isolation with his family, it added.   According to public TV station TV2, the man is one of its employees.   Italy has reported 400 coronavirus cases, mostly in the north, and 12 deaths.
Date: Wed, 26 Feb 2020 23:18:10 +0100 (MET)

Bucharest, Feb 26, 2020 (AFP) - Romania reported its first confirmed case of the novel coronavirus on Wednesday -- a man who was in contact with an Italian who visited the country last week.    "The patient, who is in good health and is showing no symptoms, will be transferred to Bucharest's hospital of infectious diseases," Health Minister Victor Costache told a press conference.

Seven other people who live at the same address as the man in the south-eastern Gorj county have all tested negative but will be quarantined for 14 days as a precaution, emergency department official Raed Arafat said.   The Italian believed to be the source of Romania's first diagnosis tested positive for the deadly virus upon returning to Italy after a four-day visit to Gorj.

New cases have been emerging across Europe, many linked to the continent's coronavirus hotspot in northern Italy.    Several governments have advised against travel to Italy, which has now recorded 400 cases and 12 deaths.   The COVID-19 outbreak has killed over 2,700 people and infected more than 80,000 in 34 countries, although the vast majority of cases remain in China, according to the World Health Organization.
Date: Wed, 26 Feb 2020 21:33:56 +0100 (MET)

Oslo, Feb 26, 2020 (AFP) - Norwegian health authorities on Wednesday announced the first case of coronavirus in the Nordic nation in someone who returned from China last week, but said the patient was not "in danger".   "The person is not ill, they are in good health and do not present any symptoms," Line Vold, an official at the Norwegian Institute of Public Health, told reporters. "We think it is very unlikely that they have infected" others.   Routine tests had given a "weekly positive result" and detected traces of the new coronavirus, the institute said.
Date: Wed, 26 Feb 2020 20:03:47 +0100 (MET)

Tbilisi, Feb 26, 2020 (AFP) - Georgia on Wednesday announced its first confirmed case of the novel coronavirus in the South Caucasus region.   "A Georgian national has tested positive for the novel coronavirus," Health Minister Ekaterine Tikaradze told a news conference, adding that the infected man has been placed in isolation in a Tbilisi hospital.   "Three different tests of the 50-year-old man's nasopharyngeal smear gave positive results, but he is doing well, he is clinically healthy," head of Georgia's national centre for disease control, Amiran Gamkrelidze told journalists.

The man had arrived in Georgia from Iran via Azerbaijan, Gamkrelidze said.   Tikaradze said Georgia would introduce a two-week ban on Iranian nationals entering Georgia, but flatly dismissed fears of a coronavirus epidemic in the ex-Soviet country "at this point".   On Sunday, Georgia's neighbour Armenia closed its border with Iran and suspended flights as fears over an outbreak of coronavirus in Iran sent neighbouring countries scrambling to contain the outbreak.