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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Sun, 15 Mar 2020 23:58:27 +0100 (MET)

San Juan, March 15, 2020 (AFP) - The US territory of Puerto Rico on Sunday ordered a 9:00 pm to 5:00 am curfew to stem the spread of the novel coronavirus, the strongest measure yet taken on American soil.   It took effect immediately and lasts until March 30.   "Faced with the possibility of transmission and propagation of the virus, I have ordered the imposition of a curfew for all residents of Puerto Rico," Governor Wanda Vazquez announced in a video message.   "We must take every precaution to ensure that we do not become potential carriers," Vazquez said.

The Caribbean territory of 2.9 million, whose residents are US citizens, also will close many businesses from Sunday until the end of the month, she said.   That includes malls, movie theaters, concert venues, gyms, bars and other businesses that bring together large crowds on the island popular with tourists.   The exceptions will be businesses in the food supply chain, and in the medical care system, as well as drugstores, gas stations, banks and senior citizens' group homes.

At night, only those who are providing or receiving medical care, or carrying out essential duties, will be allowed to be on Puerto Rico's streets.   Anyone defying the curfew faces a six-month jail term and a fine of up to $5,000.   The island declared a state of emergency when its first cases were reported March 12. The island has reported five cases.   On Friday, Vazquez accepted the resignation of Health Secretary Rafael Rodriguez Mercado, who was under fire for his handling the coronavirus emergency.

Recently, island residents were irate when two warehouses were found to be filled with abandoned supplies, apparently never used after Hurricanes Irma and Maria in 2017.   The storms' one-two punch left Puerto Ricans without power for months and killed nearly 3,000 people, according to the local government's official numbers.   President Donald Trump has accused the Puerto Rican government of incompetence and siphoning off hurricane relief money.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
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.
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Benin

Benin - US Consular Information Sheet
April 28, 2008

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

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

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

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

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

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

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

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

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

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

See our information on Victims of Crime.

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

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s website at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

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

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

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

SPECIAL CIRCUMSTANCES:
U.S. citizens are advised to keep a notarized photocopy of the photo page of their passport with them at all times when traveling in Benin.
The Embassy has had a few reports of officials requesting a "gift" to facilitate official administrative matters (e.g., customs entry). Such requests should be politely but firmly declined.
It is prohibited to photograph government buildings and other official sites, such as military installations, without the formal consent of the Government of Benin. In general, it is always best to be courteous and ask permission before taking pictures of people. Beninese citizens may react angrily if photographed without their prior approval.
Obtaining customs clearance at the port of Cotonou for donated items shipped to Benin from the United States may be a lengthy process. In addition, to obtain a waiver of customs duties on donated items, the donating organization must secure prior written approval from the Government of Benin. Please contact the U.S. Embassy in Cotonou for more detailed information.Please see our Customs Information.

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

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Benin are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Benin. Americans withoutInternet access may register directly with the U.S. Embassy. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at Rue Caporal Anani Bernard in Cotonou. The Embassy's mailing address is B.P. 2012, Cotonou, Benin. The 24-hour telephone numbers are (229) 21-30-06-50, 21-30-05-13, and 21-30-17-92. The Embassy’s general fax number is (229) 21-30-06-70; the Consular Section’s fax number is (229) 21-30-66-82; http://cotonou.usembassy.gov/.
* * *
This replaces the Country Specific Information for Benin dated August 17th, 2007 to update sections on Safety and Security and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Netherlands Antilles

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

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

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

SAFETY AND SECURITY:
Drug-related organized crime exists within the Netherlands Antilles but has not directly affected tourists in the past.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings, including the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: In recent years, street crime has increased, especially in St. Maarten. Valuables, including passports, left unattended on beaches, in cars and hotel lobbies are easy targets for theft, and visitors should leave valuables and personal papers secured in their hotel. Burglary and break-ins are increasingly common at resorts, beach houses and hotels. Armed robbery occasionally occurs. The American boating community has reported a handful of incidents in the past, and visitors are urged to exercise reasonable caution in securing boats and belongings. Car theft, especially of rental vehicles for joy riding and stripping, can occur. Incidents of break-ins to rental cars to steal personal items have been reported by American tourists. Vehicle leases or rentals may not be fully covered by local insurance when a vehicle is stolen. Be sure you are sufficiently insured when renting vehicles and jet skis.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
Please see our information for American Victims of Crime Overseas.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is generally good in Curaçao and St. Maarten, but may be limited on the other three islands. Hospitals have three classes of services i.e.: First Class: one patient to a room, air conditioning etc.; Second Class: two to six patients to a room, no air conditioning; Third Class: 15 to 30 people in one hall. Patients are accommodated according to their level of insurance.
Bonaire: The San Francisco hospital is a medical center (35 beds) with decompression facilities. The hospital has an air ambulance service to Curaçao and Aruba.
Curaçao: St. Elizabeth hospital is a public hospital that may be compared to midrange facilities in the United States. St. Elizabeth's hospital has a decompression chamber and qualified staff to assist scuba divers suffering from decompression sickness. Several private clinics provide good to excellent medical service.
St. Maarten: St. Maarten Medical Center (79 beds) is a relatively small hospital where general surgery is performed. Complex cases are sent to Curaçao.
Statia: Queen Beatrix Medical Center (20 beds) is a medical facility well equipped for first aid. Surgery cases are sent to St. Maarten.
Saba: Saba Clinic (14 beds) is a well-equipped first aid facility. Surgery cases are sent to St. Maarten. The Saba Marine Park has a decompression chamber and qualified staff to assist scuba divers suffering from decompression sickness.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith.
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning the Netherlands Antilles is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving in the Netherlands Antilles is on the right hand side. Right turns on red are prohibited, and traffic conditions require somewhat defensive driving. Local laws require drivers and passengers to wear seat belts and motorcyclists to wear helmets. Children under 4 years of age should be in child safety seats; children under 12 should ride in the back seat.
Nonexistent or hidden and poorly maintained street signs are the major road hazard in the Netherlands Antilles. Therefore, drivers should proceed through intersections with caution. Roads in the Netherlands Antilles are extremely slippery during rainfall. Night driving is reasonably safe in the Netherlands Antilles as long as drivers are familiar with the route and road conditions. Most streets are poorly lit or not lit at all. In Curacao, drivers should be aware of herds of goats that may cross the street unexpectedly. In Bonaire, wild donkeys may also cross the road.
Taxis are the easiest, yet most expensive form of transportation on the islands. As there are no meters, passengers should verify the price before entering the taxi. Fares quoted in U.S. dollars may be significantly higher than those quoted in the local currency. Vans are inexpensive and run non-stop during daytime with no fixed schedule. Each van has a specific route displayed in the front of the windshield. Buses, which run on the hour, have limited routes. The road conditions on the main thoroughfares are good to fair.
See road safety information at the following sites; http://www.curacao.com, http://www.statiatourism.com, http://www.sabatourism.com, http://www.infobonaire.com, http://www.st-maarten.com/.
Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the Netherlands Antilles’ Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the Netherlands Antilles’ air carrier operations. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Dutch law in principle does not permit dual nationality. However, there are several exceptions. For example, American citizens who are married to Dutch citizens are exempt from the requirement to abandon their American nationality when they apply to become a Dutch citizen by naturalization. For detailed and specific information on this subject, contact the Embassy of the Netherlands in Washington or one of the Dutch consulates in the U.S. In addition to being subject to all Dutch laws affecting U.S. citizens, dual nationals may also be subject to other laws that impose special obligations on Dutch citizens.
Time-share buyers are cautioned about contracts that do not have a "non-disturbance or perpetuity protective clause" incorporated into the purchase agreement. Such a clause gives the time-share owner perpetuity of ownership should the facility be sold. Americans sometimes complain that the timeshare units are not adequately maintained, despite generally high annual maintenance fees. Because of the large number of complaints about misuse of maintenance fees, particularly in St. Maarten, prospective timeshare owners are advised to review the profit and loss statement for maintenance fees. Investors should note that a reputable accounting firm should audit profit and loss statements.
Potential investors should be aware that failed land development schemes involving time-share investments could result in financial losses. Interested investors may wish to seek professional advice regarding investments involving land development projects. Real estate investment problems that reach local courts are rarely settled in favor of foreign investors.
An unusually competitive fee to rent vehicles or equipment could indicate that the dealer is unlicensed or uninsured. The renter is often fully responsible for replacement costs and fees associated with any damages that occur during the rental period. Visitors may be required to pay these fees in full before leaving the Netherlands Antilles and may be subject to civil or criminal penalties if they cannot or will not make payment.
Netherlands Antilles customs authorities may enforce strict regulations concerning temporary importation into or export from the Netherlands Antilles. For example, it is strictly prohibited to export pieces of coral and/or seashells. Please see our information on customs regulations.
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offences. Persons violating the laws of the Netherlands Antilles, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the Netherlands Antilles are severe, and convicted offenders can expect long jail sentences and heavy fines. The Netherlands Antilles has strict gun control laws; even a stray bullet in a suitcase can trigger a fine or time in jail. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues web site.
REGISTRATION / EMBASSY LOCATION:
American citizens residing or traveling in the Netherlands Antilles are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within the Netherlands Antilles. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Consulate General is located at J.B. Gorsiraweg #1, Willemstad, Curaçao, telephone (599-9) 461-3066; fax (599-9) 461-6489; e-mail address: acscuracao@state.gov.
* * *
This replaces the Country Specific Information dated May 7, 2007, to update the Entry/Exit, Crime, Traffic Safety and Road Conditions, and Registry / Embassy Location sections.

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 ...

Estonia

Estonia US Consular Information Sheet
October 28, 2008
COUNTRY DESCRIPTION:
Estonia is a stable democracy with an economy that has developed rapidly in recent years.
Tourist facilities in Tallinn are comparable to other western Europe
n cities, but some amenities may be lacking in rural areas.
Some goods and services may not be available outside of major cities.
Please read the Department of State Background Notes on Estonia for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid passport is required.
Estonia is a party to the “Schengen” –Agreement. As such, U.S. citizens may enter Estonia for up to 90 days for tourist or business purposes without a visa. The passport should be valid for at least three months beyond the period of stay. For further details about travel into and within Schengen countries, please see our Schengen Fact Sheet.
For further information concerning entry requirements and residency permits, contact the Estonian Embassy, located at 2131 Massachusetts Ave., NW, Washington, DC 20008, telephone (202)588-0101, or the Consulate General of Estonia in New York City, telephone (212) 883-0636. Visit the Embassy of Estonia web site at http://www.estemb.org for the most current visa information. American citizens who wish to reside in Estonia (e.g. for work, studies, retirement, etc.) can also consult with the Estonian Citizenship and Migration Board at http://www.mig.ee
Information about dual nationality and the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information.

SAFETY AND SECURITY:
Civil unrest generally is not a problem in Estonia, and there have been no incidents of terrorism directed toward American interests. Large public gatherings and demonstrations may occur on occasion in response to political issues, but these have been, with few exceptions,
without incident in the past.

During periods of darkness, (roughly October through April), reflectors must be worn by pedestrians.
Violators of this law may be subject to a fine of up to 600 EEK (Estonian Kroon), or up to 6,000 EEK if the pedestrian is under the influence of alcohol. Reflectors are inexpensive and are available at most supermarkets and many smaller shops.
To meet legal requirements, the reflector’s packaging must include a reference to European safety standard EN13356.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s web site where the current Worldwide Caution, Travel Warnings and Travel Alerts can be found.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

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 others callers, 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:
Estonia is a relatively safe country, although crime in Tallinn’s “Old Town” is an ongoing concern, particularly during the summer tourist season.
Travelers should exercise the same precautions with regard to their personal safety and belongings they would take in major U.S. cities.
The most common crimes encountered by foreign tourists are purse snatching, pick-pocketing, and mugging.
Tourists are often targeted by individuals and small groups of thieves working together.
In public places such as the “Old Town,” in particular the Town Hall Square (“Raekoja Plats”), as well as the airport, train stations, bus stations and the Central Market, one must exercise special care in safeguarding valuables against purse-snatchers and pickpockets.
Valuables should never be left unattended in vehicles and car doors should be kept locked at all times.
Some violent crime does occur, mainly at night and often in proximity to nightlife areas.
Public drunkenness, car theft and break-ins also continue to be a problem in Tallinn.

The Estonian Police agencies are modern, well-equipped law enforcement entities on a standard comparable to most Western European police, with only isolated instances of corruption. However, large-scale reductions in the police force are scheduled for this year, which may decrease some of their capabilities. Many police officers speak only very limited English.

Credit card fraud is an ongoing concern, as is internet-based financial fraud and “internet dating” fraud.
Travelers should take precautions to safeguard their credit cards and report any suspected unauthorized transaction to the credit card company immediately.
Racially motivated verbal harassment and, on occasion, physical assault of Americans and other nationals of non-Caucasian ethnicity has occurred.
If an incident occurs, it should be reported to the police and to the Embassy.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft of a U.S. passport abroad 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.

The local equivalent to the “911” emergency line in Estonia is: 112. The level of English spoken by the operator answering may be minimal.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
The quality of medical care in Estonia continues to improve but still falls short of Western standards.
Estonia has many highly trained medical professionals, but hospitals and clinics still suffer from a lack of equipment and resources.
Elderly travelers and those with health problems may be at increased risk.
Visitors to forest areas in warm weather should also guard against tick-borne encephalitis.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Estonia.
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.
In recent years, a number of American citizens have been disembarked from cruise ships and hospitalized due to serious medical problems. Holding a policy providing for medical evacuation coverage can be critical to ensure access to timely emergency medical care. 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 is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Driving in Estonia can be more dangerous than in much of the United States.
Many roads, especially in rural areas, are poorly lit and are not up to Western standards.
Some drivers can be aggressive, recklessly overtaking vehicles and traveling at high speed, even in crowded urban areas.
Despite strict Estonian laws against driving under the influence of alcohol, accidents involving intoxicated drivers are very frequent. It is not uncommon for the police to set up checkpoints on major streets and highways; drivers should pull over when asked.
Drivers should always remain alert to the possibility of drunk drivers and drunken pedestrians.

Estonian traffic laws require drivers to stop for all pedestrians in marked crosswalks.
Nevertheless, Estonian motorists do not always comply with this regulation, and pedestrians should always be careful when crossing the streets.
In rural areas, wild animals, such as deer and moose, and icy road conditions can create unexpected hazards.
Dark-clothed or drunken pedestrians walking along unlit roads or darting across dimly-lit streets or highways pose a risk to unsuspecting drivers.
Winter roads are usually treated and cleared of snow, but drivers should remain vigilant for icy patches and large potholes.

Estonian laws against driving under the influence are strict and follow a policy of zero tolerance. Penalties are severe for motorists caught driving after consumption of even a small amount of alcohol. Local law requires that headlights be illuminated at all times while driving.
Use of a seatbelts by all passengers is required, and children too small to be secure in seatbelts must use child car seats.
The speed limit is 50 km/h in town and 90 km/h out of town unless otherwise indicated.
A right turn on a red light is prohibited unless otherwise indicated by a green arrow.
According to Estonian law vehicles involved in accidents should not be moved to the side of the road until the police reach the scene. Americans planning to drive in Estonia must obtain an international driving permit prior to arrival.

For information about international driving permits, contact AAA or the American Automobile Touring Alliance.
The Eesti Autoklubi (Estonian Auto Club – www.autoclub.ee), which is affiliated with AAA, provides emergency roadside assistance.
Drivers do not need to be a member to receive assistance; however, the fees charged are higher for non-members.
The number to call for roadside vehicle assistance and towing service is 1888.
For ambulance, fire or police assistance the number is 112.
Please note that for both numbers, the level of English spoken by the operator answering may be minimal.

Please refer to our Road Safety page for more information.
You may also visit the website of Estonia’s national tourist office at http://www.visitestonia.com.
For specific information concerning Estonian driving permits, vehicles inspections and road tax mandatory insurance, contact the Estonian Motor Vehicle Registration Center at http://www.ark.ee/atp.
Additional information may be obtained from the website of the Estonian Road Administration at http://www.mnt.ee/atp, or from Baltic Roads at http://www.balticroads.net
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Estonia, the U.S. Federal Aviation Administration (FAA) has not assessed the Estonian 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:
Commercial and financial transactions in Estonia are increasingly automated and on-line.
Cash is almost always acceptable. The national currency is the Estonian Kroon (EEK), the value of which is pegged to the Euro (15.65 EEK= 1 Euro). Most credit cards are widely recognized throughout the country.
ATM machines are common and many U.S.-issued bankcards are compatible with them. Bank checks are virtually unknown, and checks drawn on a U.S. bank are of little use in the country.

Estonia’s customs authorities encourage the use of an ATA (Admission Temporaire/Temporary Admission) Carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes.
ATA Carnet Headquarters, located at the U.S. Council for International Business, 1212 Avenue of the Americas, New York, NY 10036, issues and guarantees the ATA Carnet in the United States.
For additional information call (212) 354-4480, send and email to acarnet@uscib.org, or visit http://www.uscib.org for details.

Please see our information on Customs Regulations.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Estonian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Estonia 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 both in Estonia as well as in the United States.
Please see our information on Criminal Penalties.

DUAL NATIONALITY:
Estonian law requires that individual with dual nationality must choose between Estonian citizenship and his of her other citizenship at age 18. After that time, Estonian law does not permit the individual to carry passports of two (or more) different countries. However, the Estonian government reportedly has not regularly enforced this law in the past with respect to persons of Estonian background, and thus a number of individuals have continued to carry both Estonian and American passports. Any American citizen who also carries an Estonian passport should be aware that the Estonian government may not recognize the person as an American citizen in certain circumstances, thus limiting the consular services that can be provided by the U.S. Embassy (e.g. in case of arrest, etc.).

Please note that this discussion of dual nationality relates only to person who have a claim to Estonian citizenship, and not to persons who merely acquire an Estonian “residence” permit. For more information on citizenship and dual nationality, please see our web page.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Estonia are encouraged to register with the U.S Embassy in Tallinn through the State Department’s travel registration web site, and to obtain updated information on travel and security within Estonia.
Americans without Internet access may register directly with the U.S. Embassy in Tallinn by visiting in person.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The latest security information is available from the Embassy, including on its web site, http://estonia.usembassy.gov.

The U.S. Embassy is available 24 hours a day for emergency assistance for American citizens visiting or residing in Estonia. The Embassy is located approximately 1 km outside of Tallinn’s “Old Town.” The address is: Kentmanni 20, 15099 Tallinn, Estonia.
The Embassy’s main switchboard number is telephone (372) 668-8100.
The Consular Section can be reached directly at (372 668-8128, 8111, 8197 or 8129. The Consular Section’s fax number is (372) 668-8267. The Consular Sections’ email address for American Citizen Services is ACSTallin@state.gov. For after-hours emergencies, an Embassy Duty Officer may be contacted by mobile phone at (372) 509-2129, if dialing from the U.S., and 509-2129 if dialed from within Estonia.
The Embassy’s web site is http://estonia.usembassy.gov.
The American Citizen Services Unit email address is ACSTallinn@state.gov
* * *
This replaces the Consular Information Sheet dated March 26, 2008 to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Medical Insurance, Traffic Safety and Road Conditions, Special Circumstances, Criminal Penalties, Dual Nationality, and Registration/Embassy location.

Travel News Headlines WORLD NEWS

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: Sat 14 Apr 2018 09:35
Source: Err [edited]

A man who had returned from an overseas trip and a woman with whom he came in contact were diagnosed with measles in Saaremaa this week [week of Sun 8 Apr 2018].

This year [2018], 4 cases of measles have been diagnosed in Estonia, which in 2016 had been listed by the World Health Organization (WHO) as among the countries which had eliminated endemic measles. Last month [March 2018], an unvaccinated child contracted the disease on an overseas trip; their mother caught it in turn upon their return to Estonia.

It is not currently known whether the woman to contract measles this week [week of Sun 8 Apr 2018] was vaccinated or not; the man had been vaccinated with only 1 of 2 doses of the measles vaccine.

In the course of the Health Board's epidemiological study, persons who have been in contact with the 2 individuals as well as their vaccination status were determined. Those who have come in contact with them were also advised regarding the nature of the disease, prevention measures as well as vaccination.

Last week [week of Sun 1 Apr 2018], a case of rubella was diagnosed in Rapla County as well. The previous 2 instances of rubella in Eesti were recorded in 2013.

Measles and rubella are considered highly contagious diseases, but the modern measles, mumps and rubella (MMR) vaccine is over 95 percent effective in preventing measles and rubella.

According to the immunization schedule in Estonia, children are administered the 1st dose of the MMR vaccine at 1 year of age and the 2nd dose at age 13. The MMR vaccine is free for children in Estonia.

Measles symptoms
Some of the earliest symptoms in the onset of measles include fever, malaise, cough, runny nose, conjunctivitis and light sensitivity. A few days later, the signature rash appears, which begins behind the ears and spreads to the face and neck before covering the entire body. A measles patient is contagious beginning 4 -- 5 days before and for up to 5 days following the onset of the rash.

There is no treatment for the disease itself; only symptoms can be treated. Complications can include pneumonia, middle ear infections and inflammation of the brain.  [Byline editor: Aili Vahtla]
====================
[According to <https://news.err.ee/591626/number-of-unvaccinated-children-in-estonia-on-rise>, despite the fact that a number of serious infectious diseases have been beaten due to vaccination [in Estonia], there has been a steady increase in the number of parents refusing vaccination and number of children being left unprotected from various diseases.

"While the percentage of refusals in relative to the total number of vaccinations isn't high -- 3-3.9 percent in 2016 -- the steady increase of those refusing and the steady growth in the number of children being left unprotected from a number of infectious diseases is worrisome," said Director General of the Health Board Tiiu Aro.

For example, at the end of 2016, 95.4 percent of children ages 1-14 were vaccinated against measles, mumps and rubella (MMR).

"Considering the World Health Organization's (WHO) recommended level of vaccination for halting the spread of diseases, which is 95 percent, we should be satisfied, however the coverage level among children up to 2 years of age was 93.2 percent, which means that we did not achieve the recommended level of coverage," Aro noted.

As of the end of 2016, a total of 7481 children were unvaccinated against MMR, over 60 percent of whom live in Tallinn.

A Healthmap/ProMED of Estonia can be found at
Date: Wed, 13 Feb 2013 13:51:13 +0100 (MET)

TALLINN, Feb 13, 2013 (AFP) - Officials in Estonia raised the alarm Wednesday after a report into drug use in Europe found that the small Baltic nation had the highest incidence of deaths from drug overdoses in the EU. Last year, 160 people died from overdoses, data from the Europe Monitoring Centre for Drugs and Drug Addictions (EMCDDA) showed, an increase of 21 percent from last year. Most of the deaths were caused by taking a highly addictive form of synthetic heroin known as China White, which is often smuggled in from Russia.

"More people per million inhabitants perish in Estonia than in any other EU country due to drug overdoses, and most of these deaths are related to drugs called 'China White'," Ave Talu, head of Estonia's Drug Monitoring Centre, told AFP. While the average number of deaths from overdoses across the 27-member EU bloc stands at up to 20 people per million, in Estonia the figure is five times higher, at over 100 per million. In 2011, 132 people died from overdoses in the former Soviet nation of 1.3 million people.

Most of the people who died in 2012 were ethnic Russian men, the EMCDDA data showed. Using a new antidote to synthetic heroin, naloxone, could "cut the death rates from overdose nearly in half," Talu said. But the drug is not yet available on a community outreach basis, she said. "In Estonia, naloxone is used only by medical staff and unlike some other countries like the US, we do not yet have community-based naloxone distribution and training programmes, but they are urgently needed."
Date: Fri, 21 Dec 2012 16:42:17 +0100 (MET)

TALLINN, Dec 21, 2012 (AFP) - Pilots at the struggling Baltic carrier Estonian Air announced on Friday they would go on strike from January 7, demanding a return to a collective pay deal that was voided by the company.   The Estonian Airline Pilots Association, which represents all of the carrier's 75 pilots, warned that it could not accept plans to end a five-year-old agreement from February.   "We expect most of the pilots to be on strike," Rauno Menning, chairman of the association's board, told AFP.   In a statement, Estonian Air said the strike call was a surprise.

"Estonian Air has offered pilots a collective agreement that is line with the market and competitive situation and follows all EU flight safety requirements," the carrier's chief executive Jan Palmer was quoted as saying.   Menning faulted that stance.   "We are surprised that the company is surprised by the strike news, because we made the decision in November to go strike if needed, so Estonian Air knew this was a possibility," he told AFP.   Estonian Air had just warded off industrial action by other employees through a deal last week with the Estonian Air Cabin Crew Union, which is valid to the end of 2013.   State-controlled Estonian Air has made repeated efforts to cut its losses.   In November, the airline said it would slash staff numbers by half, from 318 to 146.   Estonian Air operates a small fleet of 10 planes.

Created in 1991, the year the Baltic republic of 1.3 million regained its independence from the Soviet Union, the airline has had mixed fortunes.   It was privatised in 1996, and from 2003 to 2010 was almost evenly split between the state, which owned 51 percent, and Scandinavian carrier SAS, with 49 percent.   Since then, the state has gradually raised its holding to the current 97 percent, but says its wants to find a new strategic investor.   Estonian Air's revenues in the first nine months of 2012 were 70.4 million euros ($93 million), compared with 58.7 million euros in the same period of 2011.   But nine-month losses reached 20.2 million euros, up from 11.2 million euros in the same period a year earlier.
Date: Mon, 8 Oct 2012 14:00:20 +0200 (METDST)

TALLINN, Oct 08, 2012 (AFP) - Striking Estonian doctors on Monday extended their week-long labour action to major hospitals in the Baltic state's capital and second city Tartu and curbed inpatient care in some other regions. The Estonian Doctors' Union said however that emergency care and treatment for children, pregnant women and patients with cancer would not be affected.

Terming the union's wage demands "unrealistic", the Estonian authorities last week repeated an offer to raise doctors' salaries by 6.6 percent as of January, but the union turned it down. It is demanding a 20 percent increase in the minimum wage to 1,400 euros ($1,800) next year and another 20 percent hike in 2014. The average monthly income of doctors in the EU state and eurozone member was 1,700 euros ($2,185) in 2011, compared to a national average of 839 euros ($1,078), according to Estonia's social affairs ministry.

After failed talks last week between the Estonian Health Insurance Fund, Hospital Union and the Doctors' Union, the delegations were to resume negotiations Monday. European Commission deputy chief Siim Kallas, a former Estonian prime minister, weighed into the dispute at the weekend saying the Estonian health care system created 20 years ago "has failed" and called for major reforms to give patients the option to choose from a number of health insurance providers. "Patients are not the priority in Estonia's current health care system," Kallas added.
More ...

Uganda

Uganda - US Consular Information Sheet
March 02, 2009
COUNTRY DESCRIPTION:
Uganda is a landlocked, developing country in central eastern Africa. Infrastructure is adequate in Kampala, the capital, but is limited in other areas.
Read t
e Department of State Background Notes on Uganda for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport valid for three months beyond the date of entry, visa and evidence of yellow fever vaccination are required.
Visas are available at Entebbe Airport upon arrival or may be obtained from the Embassy of the Republic of Uganda.
The current fee for a three month tourist visa obtained upon arrival at Entebbe Airport is $50.00.
Travelers should be aware that a visa does not determine how long a person may remain in Uganda.
The Ugandan immigration officer at the port of entry will determine the length of authorized stay, which is generally from one to three months as a tourist.
Extensions of duration of stay may be requested at Ugandan immigration headquarters on Jinja Road in Kampala.
Airline companies may also require travelers to have a visa before boarding.
Travelers should obtain the latest information and details from the Embassy of the Republic of Uganda at 5911 16th Street, NW, Washington, DC
20011; telephone (202) 726-7100.
The Ugandan Embassy may also be contacted by email.
Travelers may also contact the Ugandan Permanent Mission to the United Nations, telephone (212) 949-0110. Overseas, inquiries may be made at the nearest Ugandan embassy or consulate.

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

SAFETY AND SECURITY:
U.S. citizens residing in or planning to visit Uganda should be aware of threats to their safety posed by insurgent groups operating in the Democratic Republic of the Congo and southern Sudan, and the potential of cross border attacks carried out by these armed groups.
In addition, U.S. citizens traveling to the area commonly known as Karamoja in northeastern Uganda should also be aware of ongoing conflict and armed banditry in this region.

Northern Uganda:
After years of conflict, relative stability has returned to northern Uganda with the departure of the Lord’s Resistance Army (LRA) insurgent group in 2006.
Recent LRA activity has been restricted to the remote region of Garamba National Park in the Democratic Republic of the Congo (DRC), where LRA insurgents have continued to attack and terrorize civilian populations.
LRA attacks have also occurred in the neighboring Central African Republic and southern Sudan.
The Governments of Uganda, the DRC, and southern Sudan initiated joint military operations against LRA bases in Garamba National Park on December 14, 2008, after LRA leader Joseph Kony refused to sign a peace agreement following two years of negotiations.
These military operations continue and in order to deter an LRA return to Uganda, the Uganda Peoples Defense Force (UPDF) maintains a significant presence in the northern districts.
Given the continued threat to regional security posed by the LRA, American citizens should exercise caution when traveling in those districts of northwestern Uganda that border the DRC and southern Sudan and which could potentially be subject to LRA incursions.
The Ugandan Government also continues to expand and improve the capacity of the civilian police force in northern Uganda by deploying additional personnel and concentrating resources to further recovery and re-development activities throughout the north.

American citizens traveling to northern Uganda are advised to ensure that they have made appropriate travel, lodging, and communication arrangements with their sponsoring organization before visiting the region.
Local officials in northern Uganda have expressed concern for the safety and security of foreigners visiting the area to assist with relief efforts, but without any specific arrangements with a sponsoring organization.
Foreign citizens who travel to the region without a sponsoring organization may not find secure lodging or safe transport, and may become more susceptible to crime.
They may also find that local officials are unable to provide assistance in the event of an emergency.
There is a general lack of infrastructure throughout northern Uganda, and services such as emergency medical care are nonexistent.
Given crime and other security concerns in northern Uganda, American citizens are advised to restrict travel to primary roads and during daylight hours only.

Cattle rustling, armed banditry, and attacks on vehicles are very common in the Karamoja region of northeastern Uganda, and the UPDF continues to implement a program to disarm Karamojong warriors.
Past incidents have included ambushes of UPDF troops, and attacks on vehicles, residences, and towns that resulted in multiple deaths.
Most of the violence occurred in the districts of Kaabong, Kotido, and Abim, although some violent incidents also occurred in Moroto and Nakapiripirit Districts.
American citizens are advised to avoid travel to the Karamoja region given the frequent insecurity.
Any travel to Karamoja (excluding charter flights to Kidepo National Park) by U.S. Embassy personnel must first be authorized by the Chief of Mission.

Southwestern Uganda:
American citizens traveling in southwestern Uganda should also exercise caution given the ongoing conflict in the districts of North and South Kivu in the DRC, and the close proximity of fighting to the Ugandan border.
During spikes in the conflict, refugee flows across the border number in the thousands and there is also a risk of incursions by armed combatants.
American citizens should review the Travel Warning for the Democratic Republic of the Congo for the most up-to-date information regarding the conflict in the DRC.

On August 8, 2007, a group of armed assailants entered Uganda from the DRC and raided Butogota, a town in Kanungu District, southwestern Uganda.
Three Ugandans were killed and many others assaulted during the raid.
Ugandan officials believe that the perpetrators of the attack were members of one of the various militia groups operating in the southeastern region of the DRC or possibly remnants of the "Interahamwe," a group that participated in the 1994 genocide in Rwanda and was also responsible for the 1999 attack on Bwindi Impenetrable National Park.
The 1999 Bwindi attack killed four Ugandans and eight foreign tourists.
The 2007 raid on Butogota is in an area transited by tourists traveling to Bwindi, a popular gorilla-trekking destination.
Within Bwindi Impenetrable National Park, armed security personnel accompany tourists on the daily gorilla hikes and the UPDF maintains a military presence.
At Ishasha Camp, another popular tourist destination located in the southern sector of Queen Elizabeth National Park, the UPDF also maintains a small military base near the park headquarters for security purposes.

Eastern Uganda:
In February 2008, an isolated incident occurred in Mount Elgon National Park in eastern Uganda that resulted in the death of a foreign tourist.
A Belgian tourist climbing Mt. Elgon in the company of park rangers was shot and killed.
The attack occurred while the group was camped for the night and assailants fired into the campsite.
The tourist was reportedly struck by gunfire when exiting her tent in the darkness.
Ugandan security and park officials suspected that the attack was perpetrated by smugglers engaged in cattle rustling or other illicit activities that are common in the border area.

Demonstrations:
Demonstrations take place in Kampala and other Ugandan cities from time to time in response to world events or local developments.
In most cases, these demonstrations occur with no warning and demonstrations intended to be peaceful can turn confrontational and possibly violent.
American citizens are therefore urged to avoid the areas of demonstrations if possible, and to exercise caution if they find themselves in the vicinity of any demonstration.
American citizens should stay current with media coverage of local events and be aware of their surroundings at all times.
Because many demonstrations are spontaneous events, the U.S. Embassy may not always be able to alert American citizens that a demonstration is taking place and to avoid a specific area.
If employed with an institution or other large organization, American citizens may find it helpful to request that local employees notify expatriates when they learn of a demonstration from local radio reports or other sources.
Recent protests have occurred over land disputes involving Kampala market areas, university closures and strikes, opposition political party demonstrations, and protests by taxi drivers over the enforcement of traffic regulations.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State's, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. 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:
Crimes such as pick pocketing, purse snatching, and thefts from hotels and parked vehicles or vehicles stalled in traffic jams are common.
The Embassy receives frequent reports of theft of items from locked vehicles, even when the stolen items were secured out of sight and the vehicle was parked in an area patrolled by uniformed security personnel.
Pick pocketing and the theft of purses and bags is also very common on public transportation.
Armed robberies of pedestrians also occur, sometimes during daylight hours and in public places.
Although infrequent, the Embassy also receives reports of armed carjackings and highway robbery.
In May 2007, two American citizens reported an attempted robbery when they were traveling near the town of Bugiri in eastern Uganda.
The Americans reported that a second vehicle with at least one armed assailant tried to stop their vehicle by forcing it off the road.
This incident occurred during daylight hours.
On June 27, 2007, two American citizens were robbed and held at gunpoint when the vehicle transporting them to Entebbe Airport was stopped by a group of armed men.
This incident occurred during the early morning hours on Entebbe Road.
Although some of these attacks are violent, victims are generally injured only if they resist.
U.S. Embassy employees are advised against using roads at night, especially in areas outside the limits of cities and large towns. Home burglaries also do occur and sometimes turn violent.
In April 2008, the Ugandan police reported an increase in armed robberies in the Kampala neighborhoods of Bukoto, Kisaasi, Kiwatule, Naalya, Najera, and Ntinda.
Several of these robberies occurred as the victims were arriving at their residences after nightfall and the assailants struck as they were entering their residential compounds.

Women traveling alone are particularly susceptible to crime.
In early 2008, there was an increase in reports of sexual assaults against expatriate females.
In some instances, the victims were walking alone, or were single passengers on one of the common modes of public transport which include "boda boda" motorcycle taxis.
If the victim of a sexual assault, medical assistance should be sought immediately and counseling provided regarding prophylactic treatment to help prevent the transmission of HIV and other sexually transmitted diseases. The U.S. Embassy provides a list of local medical providers for those with medical needs.

American citizens visiting Uganda are advised not to accept food or drink offered from a stranger, even a child, because such food may contain narcotics used to incapacitate a victim and facilitate a robbery or sexual assault.
In addition, patrons of bars, casinos, nightclubs, and other entertainment centers should never leave their drink or food unattended.
When visiting such establishments, it is advisable to remain with a group of friends as single individuals are more likely to be targeted.
Victims have included female patrons who reported they were drugged, and taken to another location and sexually assaulted.
Robberies have been facilitated on public transportation under similar circumstances.
In 2006, an American citizen traveling by bus from Kenya to Uganda was incapacitated and robbed on the bus when the passenger accepted a sealed beverage from a fellow traveler.
Expatriates traveling by bus to the popular tourist destination of Bwindi Impenetrable National Forest in southwest Uganda were also incapacitated and robbed when they accepted snacks from fellow bus passengers.

There has been a recent, marked increase in financial crime, including fraud involving wire transfers, credit cards, checks, and advance fee fraud perpetrated via email.
The U.S. Embassy recommends using money orders for all fund transfers and protecting all bank account and personally identifiable information such as social security numbers and other types of information.

An increasing number of U.S. exporters (primarily vendors of expensive consumer goods such as computers, stereo equipment, and electronics) have been targeted by a sophisticated check fraud scheme.
A fictitious company in Uganda locates a vendor on the Internet, makes e-mail contact to order goods, and pays with a third-party check.
The checks, written on U.S. accounts and made out to entities in Uganda for small amounts, are intercepted, chemically "washed" and presented for payment of the goods with the U.S. vendor as payee and an altered amount.
If the goods are shipped before the check clears, the U.S. shipper will have little recourse, as the goods are picked up at the airport and the company cannot be traced.
American companies receiving orders from Uganda are encouraged to check with the Political - Economic Section of the Embassy to verify the legitimacy of the company.
The Embassy strongly cautions U.S. vendors against accepting third-party checks as payment for any goods to be shipped to Uganda.

Additional information about the most common types of financial fraud can also be found in the State Department Financial Scams brochure.

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.

The local equivalent to the "911" emergency line in Uganda is: 999.
Please see our information on Victims of Crime, including possible victim compensation programs in the United States.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those 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 Ugandan laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Uganda 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.

SPECIAL CIRCUMSTANCES:
Please note that U.S. currency notes in $20 and $50 denominations are exchanged at a lower rate than $100 currency notes.
In addition, travelers often find that they cannot exchange or use U.S. currency printed earlier than the year 2000.
Travelers who find they cannot pay for accommodation or expenses often must request that friends or family wire money to them in Uganda.
There are offices that facilitate Western Union, MoneyGram, and other types of money transfers in Kampala and other cities throughout the country.
ATMs are available in Uganda, particularly in downtown Kampala, but usually only customers who have an account with a specific Ugandan bank may use them.
A few machines function with overseas accounts.

The U.S. Embassy frequently receives requests from American citizens to verify the bona fides of nongovernmental (NGO) and charity organizations operating in Uganda.
The Embassy is unable to provide information regarding the bona fides of these organizations and American citizens traveling to Uganda to work for an organization are encouraged to request that the charity provide references of past volunteers whom they may contact.
American citizens have also reported intimidation and harassment by directors of organizations, when the Americans questioned the organization's activities or use of donated funds.
While the vast majority of NGOs operating in Uganda are legitimate organizations aiding development efforts, there have been reports from concerned Americans regarding the suspected diversion of charity funds for personal gain, etc.

Ugandan Customs authorities may enforce strict regulations concerning the importation of pets.
A Ugandan import permit is required, along with an up-to-date rabies vaccination certificate and a veterinary certificate of health issued by a USDA-approved veterinarian no more than thirty days before arrival.
Travelers are advised to contact the Ugandan Embassy in the United States for specific information regarding customs requirements.
Please see our Customs Information sheet.

Photography in tourist locations is permitted.
However, taking pictures of military/police installations or personnel is prohibited.
Military and police officers have detained tourists for taking photographs of Entebbe Airport and of the area around Owen Falls Dam, near Jinja, although the prohibition on taking photographs is not publicly displayed on signs.

The U.S. Embassy receives frequent inquiries from American citizens wishing to register a nongovernmental organization (NGO) in Uganda.
Information about registering an NGO can be obtained from the Ugandan NGO Board which has offices within the Ministry of Internal Affairs.
The NGO Board can be reached on phone number: 256 414 341 556.
One of the requirements for registering an NGO is that a foreign national employee or volunteer must provide a Certificate of Good Conduct/Criminal Background Check.
The U.S. Embassy Kampala cannot provide a Certificate of Good Conduct or Criminal Background Check, so American citizens intending to travel to Uganda as an employee an NGO or who plan to register an NGO should obtain a Certificate of Good Conduct from their local police or the Federal Bureau of Investigation (FBI) before departing the United States.
More information on how to obtain a Criminal Background Check can be found on the FBI web page about Identification Record Requests.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Uganda, including Kampala, are limited and not equipped to handle most emergencies, especially those requiring surgery. Outside Kampala, hospitals are scarce and offer only basic services.
Recently, American citizens involved in automobile accidents required immediate evacuation from Uganda as surgery could not be performed due to insufficient blood supplies at the hospital where they sought treatment.
Equipment and medicines are also often in short supply or unavailable.
Travelers should carry their own supplies of prescription drugs and preventive medicines.
A list of medical providers is available at the U.S. Embassy.

Tuberculosis is an increasingly serious health concern in Uganda.
For further information, please consult the CDC's Travel Notice on TB.

Malaria is prevalent in Uganda.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what antimalarials they have been taking.
For additional information on malaria, including protective measures, see the CDC’s information on malaria.

In January, 2009, the CDC’s Special Pathogens Branch retrospectively diagnosed a case of Marburg hemorrhagic fever in a U.S. traveler, who had returned from Uganda in January, 2008. The patient developed illness four days after returning to the United States.
The Amcit had visited the “python cave” in Queen Elizabeth Park, western Uganda, which is a popular destination among tourists to see the bat-infested cave.
For additional information on Marburg hemorrhagic fever, including protective measures, visit the CDC web site.

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.
For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site.
Further health information for travelers is available from the WHO. Uganda has experienced recent outbreaks of Marburg Hemorrhagic Fever, Ebola Hemorrhagic Fever, Pneumonic Plague, Meningitis, and other types of infectious diseases.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Uganda.
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.
American citizens who are seriously injured in vehicle or other types of accidents in Uganda generally seek medical evacuation to Kenya or other destinations for more advanced emergency medical treatment.
These medical evacuations can be very expensive, and in the event the American citizen does not have sufficient insurance coverage, the evacuation is carried out at their personal expense.
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 Uganda is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Most inter-city transportation in Uganda is by small van or large bus.
Many drivers of these vehicles have little training and some are reckless.
Small vans and large buses are often poorly maintained, travel at high speeds, and are the principal vehicles involved in the many deadly single and multi-vehicle accidents along Ugandan roads.
Accident victims have included American citizens traveling in small vans and personal cars, passengers on motorcycle taxis locally known as "boda bodas," and pedestrians.
Large trucks on the highways are often over-loaded, with inadequately secured cargo and poor braking systems.
Alcohol frequently is a contributing factor in road accidents, particularly at night.
Drivers are advised to take extra care when driving.
Nighttime driving and road transportation should be avoided whenever possible.
Pedestrians often walk in the roads and may not be visible to motorists.
Large branches or rocks in the road sometimes indicate an upcoming obstruction or other hazard.
Highway travel at night is particularly dangerous, including the road between Entebbe Airport and Kampala.
The Embassy recommends caution on this road and use of a reliable taxi service to and from the airport.

Traffic accidents draw crowds.
Ugandan law requires that the drivers stop and exchange information and assist any injured persons.
In some cases where serious injury has occurred, there is the possibility of mob anger.
In these instances, Ugandans often do not get out of their cars, but drive to the nearest police station to report the accident.

Please refer to our Road Safety page for more information.
For specific information concerning Ugandan driving permits, vehicle inspection, road tax and mandatory insurance, please contact Tourism Uganda, IPS building, 14, Parliament Avenue, Kampala, Uganda; telephone 256-414-342 196. You may also wish to consult the Tourism Uganda web site or, for information on government agencies, see the My Uganda web site.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Uganda, the U.S. Federal Aviation Administration (FAA) has not assessed Uganda's Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA web site.

International airlines offer several weekly flights to Europe and the United Arab Emirates, and Kenya Airways has daily flights between Entebbe Airport and Nairobi.
Other regional airlines operate weekly flights to other destinations in Africa, such as Dar es Salaam, Addis Ababa, Cairo, and Johannesburg.

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 Uganda are encouraged to register with the U.S. Embassy in Kampala through the State Department’s travel registration web site to obtain updated information on travel and security within Uganda.
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 1577 Ggaba Road, Kampala; telephone 256-414-259-791 or 256 414 306 001; fax 256-414-258-451.
You may contact the Embassy via e-mail.
* * *
This replaces the Country Specific Information dated May 6, 2008, to update sections on Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, Medical Insurance, Traffic Safety and Road Conditions, Special Circumstances, Aviation Safety Oversight, Special Circumstances, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon, 30 Mar 2020 21:41:43 +0200 (METDST)

Kampala, March 30, 2020 (AFP) - Ugandan President Yoweri Museveni on Monday ordered an immediate 14-day nationwide lockdown in a bid to halt the spread of the coronavirus which has so far infected 33 people in the country.   Uganda last week banned public transport and sealed its borders and urged the population to stay home, but stopped short of a full shutdown.

Museveni said that from 10:00pm Monday private vehicles would also be banned, seeking to avoid give a more advanced warning that would see people flee the city, as has happened across the continent where many poor residents see better chances of survival in the countryside.   "I would have given the public time to adjust but... a longer time would give people time to go to the villages and in so doing they would transfer the very sickness we're trying to prevent. This freezing of movement will last for 14 days," he said in a televised address.

Museveni also ordered a 14-day nationwide curfew from 7:00pm.   Shopping malls and businesses selling non-food items were ordered to close.   Food market vendors who continue to trade are forbidden to return to their homes for the duration of the 14-day lockdown, while factories could stay open if remain on the premises for the duration of the shutdown.

People are still allowed to move around on foot but not gather in groups of more than five at a time.    In recent days, opposition leaders Kizza Besigye and Bobi Wine had undertaken small-scale food deliveries to people who had ost their incomes due to earlier restrictions but Museveni criticised such actions as "cheap politics".   "I direct the police to arrest the opportunistic and irresponsible politicians who tried to distribute food," he said.   "Anybody arrested in that effort will be charged with attempted murder."   Museveni said the government would begin distributing food to those who needed it, without providing details.

A weary looking Museveni, 75, pleaded with the population to change their behaviour in the face of the threat from the virus.   "This virus would not do much damage if it was not for the carelessness of people. Don't go into a group of people if you have a cold. Stay at home," he pleaded.   Last week police and Local Defence Units (LDUs) -- a uniformed militia under the control of the military - violently cleared streets in central Kampala.   Following a public outcry, army chief General David Muhoozi on Monday apologised for those actions, describing them as "high-handed, unjustified and regrettable" and said the culprits would be "dealt with".
Date: Fri 6 Mar 2020
Source: MMWR Morb Mortal Wkly Rep 2020;69:241-244 [edited]

Intervention To Stop Transmission of Imported Pneumonic Plague -- Uganda, 2019
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Plague, an acute zoonosis caused by _Yersinia pestis_, is endemic in the West Nile region of northwestern Uganda and neighbouring north-eastern Democratic Republic of the Congo (DRC) (1-4). The illness manifests in multiple clinical forms, including bubonic and pneumonic plague. Pneumonic plague is rare, rapidly fatal, and transmissible from person to person via respiratory droplets. On 4 Mar 2019, a patient with suspected pneumonic plague was hospitalized in West Nile, Uganda, 4 days after caring for her sister, who had come to Uganda from DRC and died shortly thereafter, and 2 days after area officials received a message from a clinic in DRC warning of possible plague. The West Nile-based Uganda Virus Research Institute (UVRI) plague program, together with local health officials, commenced a multipronged response to suspected person-to-person transmission of pneumonic plague, including contact tracing, prophylaxis, and education. Plague was laboratory-confirmed, and no additional transmission occurred in Uganda. This event transpired in the context of heightened awareness of cross-border disease spread caused by ongoing Ebola virus disease transmission in DRC, approximately 400 km to the south. Building expertise in areas of plague endemicity can provide the rapid detection and effective response needed to mitigate epidemic spread and minimize mortality. Cross-border agreements can improve ability to respond effectively.

Investigation and Findings
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The index patient (patient A) was a Ugandan woman, aged 35 years, living in DRC, approximately 5 km from the Ugandan border. On 27 Feb 2019, Ugandan family members traveled to DRC for the funeral of patient A's child, aged 4 years, and found patient A severely ill. They transported her to her ancestral Ugandan village in Zombo District of West Nile. While there, she complained of chest pain, experienced at least one episode of hemoptysis, and was admitted to a nearby clinic around midday the following day, 28 Feb 2019. She died a few hours later; no clinical samples were collected. She was buried in her ancestral village, preparation for which began the day of her death and culminated 2 days later, on 2 Mar 2019 [Table, for table, see original URL. - ProMED Mod.LL].

Meanwhile, on 1 Mar 2019, a local government office in Uganda received an alert from a private health clinic in DRC warning of possible plague circulation in a village near the border, the village from which patient A had come. Consequently, a team from UVRI's plague program, along with local health officials, initiated plague education and risk communication at area health clinics and with village residents, in concert with the burial of patient A. Reportedly, her husband in DRC died of an acute illness at approximately the same time, and others in patient A's family in DRC were ill, some with "fever and swellings."

On 3 Mar 2019, in Uganda, patient B, aged 23 years (the sister of patient A), developed fever. In a health care facility on the following day, she tested positive for malaria and lacked signs of pneumonia. She received intravenous artesunate for malaria, but in light of the suspicion for plague in the area, she was admitted and empirically started on gentamicin. Approximately 8 hours later, she coughed up blood-tinged sputum. Other patients were removed from the room, and droplet precautions were instituted.

Blood from patient B tested negative for Ebola virus disease and other hemorrhagic fever viruses at UVRI using established methods (5). Sputum yielded the maximal positive reaction (4+) on a commercial rapid diagnostic test (RDT) (New Horizons Diagnostics) for detection of _Yersinia pestis_ fraction 1 (F1) antigen. Cultures of blood and sputum (obtained approximately 8 hours after initiation of antibiotic treatment) were negative. Subsequent testing of plasma and sputum by real-time polymerase chain reaction (PCR) yielded evidence of _Y. pestis_ DNA. The patient was treated with gentamicin for 7 days and doxycycline for 4 days and was discharged on 14 Mar 2019. _Y. pestis_ infection was confirmed by seroconversion on a total immunoglobulin F1 antigen passive hemagglutination assay (acute titer = 0 [collected 4 Mar 2019]; convalescent titer = 1:2,048 [collected 18 Mar 2019]).

Patient B did not travel to DRC for the burial of patient A's child and did not arrive in the ancestral village to care for her sister until the morning of 28 Feb 2019. Patient B cared for patient A that morning, including using her hand to clean around patient A's mouth, feeding her, transporting her to the clinic via motorbike, and attending to her at the clinic. She was not involved in transport of patient A's body back to the village or in burial preparations.

Public Health Response
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On 5 Mar 2019, UVRI and district representatives rapidly mobilized and executed contact tracing and prophylaxis administration. In total, 129 persons were identified as contacts of patient A or B, including 8 (6%) clinic staff members; 127 were placed on a 5-day prophylactic course of doxycycline, co-trimoxazole, or ciprofloxacin. Most persons identified as contacts (80; 62%) reported physical contact with or exposure within one meter or less of either patient. 98 (76%) persons reported contact with patient A, including those involved in handling her body after her death. 53 traced contacts (41%) had high-risk exposure, as determined by subjective assessment of their distance from either patient and presumed patient infectiousness [Figure, for figure, see original URL. - ProMED Mod.LL].

During a 10-day follow-up period, no identified contacts developed plague-like symptoms, and no indication of plague activity in Uganda was detected despite active clinic-, community-, and rodent-based surveillance for plague in the region. Comprehensive public health response was limited by jurisdiction; the UVRI team was unable to provide expertise and resources to support plague control just over the border in DRC. The fate of patient A's DRC-based family and community members, given the likely ongoing circulation of _Y. pestis_ among rodents and fleas in that village, is not known.

Discussion
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Plague persists in transmission cycles involving rodents and fleas on several continents, including Africa (1). Although plague generates fear because of its historical reputation, pneumonic plague transmission in modern times can be controlled by implementing droplet precautions, antimicrobial therapy, and prophylaxis of contacts (6,7). This report summarizes importation of plague from DRC into Uganda. Rapid and effective response curtailed epidemic spread of pneumonic plague beyond a single transmission event from patient A to patient B in Uganda.

Worldwide, most plague occurs following the bite of an infected flea and results in bubonic plague, characterized by acute fever and a painful swollen lymph node (1,4). Untreated, infection can spread to the lungs (2). Pneumonic plague transmission occurs via respiratory droplets and requires close contact with severely ill persons (7). The highest-risk exposures are those within 2 meters of persons coughing blood-tinged sputum; transmission might also occur during body preparation in traditional burials (8). The typical incubation period for primary pneumonic plague is less than one day to 4 days, and the condition is often fatal if effective antibiotics are not initiated within 24-36 hours of illness onset (2).

Patient B's exposure to patient A was limited to the morning hours of 28 Feb 2019 and was followed by patient B's illness onset approximately 72 hours later. Persons with high-risk exposures to patient A as identified upon contact tracing were 3-5 days postexposure when antibiotic prophylaxis was initiated on 5 Mar 2019. Because only patient B became ill, the secondary attack rate among all persons with high-risk exposures was 2%. Postexposure prophylaxis might have prevented illness among some of those who received it, particularly those exposed to patient B, who were all still within the incubation period. This outcome highlights that pneumonic plague is not as transmissible as is often believed; and spread typically occurs among persons with close and substantial, rather than incidental, contact with a patient with late-stage disease (7). Secondary transmission rates in outbreaks in Madagascar and Uganda have been estimated at approximately 8%; however, transmission also depends on cultural and behavioral factors that might place persons at increased risk above the inherent transmissibility of the organism (8,9). Engagement with community leaders, members, health workers, and traditional healers in areas where plague is endemic can improve early recognition and implementation of simple interventions to curtail epidemic spread (7,10).

Even in areas with endemic plague, clinical diagnosis is challenging because of the nonspecific nature of the febrile illness in the absence of painful lymphadenopathy or blood-tinged sputum (3). RDT, real-time PCR, and paired serology testing were all positive for plague in patient B, despite collection of clinical specimens after initiation of effective antibiotic treatment, which did, however, hinder recovery of the organism in culture. RDT use occurred as part of ongoing research jointly conducted by CDC and UVRI to evaluate the sensitivity and specificity of RDTs for plague on human clinical specimens. Validated RDTs used by trained personnel might have value in providing rapid information to guide public health response but should be supported by additional diagnostic tests. Even in the remote setting of northwestern Uganda, collection of multiple clinical samples and use of multiple tests allowed for confirmation of the etiology.

CDC has worked with Uganda's Ministry of Health and UVRI since 2003 to provide technical support for clinic- and animal-based plague surveillance, laboratory capacity, and community education and to conduct multifaceted research into improved diagnostics and effectiveness of environmental plague prevention approaches. Despite initial cross-border notification of suspected plague in DRC, lack of an established local cross-border collaboration prevented the resources and plague expertise in Uganda from supporting mitigation of ongoing risk just over the porous geopolitical boundary. Cross-border collaboration can improve capability to effectively respond to public health threats that affect border regions.

References
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1. Pollitzer R. Plague. Geneva, Switzerland: World Health Organization; 1954. <https://apps.who.int/iris/handle/10665/41628>
2. Mead PS. Plague (_Yersinia pestis_) [Chapter 229A]. In: Bennett JE, Dolin R and Blaser MJ, eds. Principles and practices of infectious diseases. 9th ed. Vol. 2. Philadelphia, PA: Elsevier; 2020:2779-87. <https://www.us.elsevierhealth.com/mandell-douglas-and-bennetts-principles-and-practice-of-infectious-diseases-9780323482554.html>
3. Forrester JD, Apangu T, Griffith K, et al. Patterns of human plague in Uganda, 2008-2016. Emerg Infect Dis 2017;23:1517-21.
4. Dennis DT, Gage KL, Gratz ND, Poland JD, Tikhomirov E. Plague manual: epidemiology, distribution, surveillance and control. Geneva, Switzerland: World Health Organization; 1999. <https://apps.who.int/iris/handle/10665/66010>
5. Shoemaker TR, Balinandi S, Tumusiime A, et al. Impact of enhanced viral haemorrhagic fever surveillance on outbreak detection and response in Uganda. Lancet Infect Dis 2018;18:373-5.
6. Mead PS. Plague in Madagascar--a tragic opportunity for improving public health. N Engl J Med 2018;378:106-8.
7. Kool JL. Risk of person-to-person transmission of pneumonic plague. Clin Infect Dis 2005;40:1166-72.
8. Ratsitorahina M, Chanteau S, Rahalison L, Ratsifasoamanana L, Boisier P. Epidemiological and diagnostic aspects of the outbreak of pneumonic plague in Madagascar. Lancet 2000;355:111-3.
9. Begier EM, Asiki G, Anywaine Z, et al. Pneumonic plague cluster, Uganda, 2004. Emerg Infect Dis 2006;12:460-7.
10. CDC. Bubonic and pneumonic plague--Uganda, 2006. MMWR Morb Mortal Wkly Rep 2009;58:778-81.  [Authors: Apangu T, Acayo S, Atiku LA, et al]
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[This reports poetically highlights how a rapid response to a single case of a highly transmissible infectious disease in a rapid manner can minimize secondary cases.  This is a followup to ProMED post: Plague - Uganda: Congo DR border, pneumonic, fatal http://promedmail.org/post/20190312.6363171  - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Zombo District, Uganda: <http://healthmap.org/promed/p/24924>]
Date: Fri 21 Feb 2020
Source: WHO Emergencies preparedness, response, Disease Outbreak News [edited]

From 4 Nov [2019] through 14 Feb 2020, 8 laboratory-confirmed cases of yellow fever in Buliisa (3), Maracha (1), and Moyo (4), including 4 deaths (CFR 50%), were detected through the national surveillance system.

On 10 Dec 2019, the Ministry of Health (MoH) was notified by the Uganda Virus Research Institute (UVRI) Regional Reference Laboratory of a case of yellow fever confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR). The case was a 37-year-old male with suspected viral haemorrhagic fever (VHF). His occupation was cattle farming with a history of travel to trade milk between Kizikya cell, Buliisa district in Uganda, and the Democratic Republic of Congo (DRC). On 30 Oct 2019, he presented to hospital with symptoms of fever and headache of a 5-day duration. His symptoms worsened with vomiting, abdominal pain, and epistaxis, and he died on 4 Nov 2019.

During an in-depth investigation in December [2019], 8 samples were collected from close contacts, including family members and neighbours, and tested for yellow fever. On 22 Jan 2020, UVRI notified the MoH of a 2nd case of yellow fever confirmed by serological testing (IgM and PRNT) in Buliisa with connection to the index case and with a similar occupation. The other samples collected during the investigation were negative for yellow fever.

Also, 2 other confirmed cases of yellow fever were identified in Moyo district in West Nile region, which shares a border with South Sudan. The cases were aged 18 and 21 years, traded timber between Uganda and South Sudan, and spent time in both countries. Onset of illness for both cases was 3 Jan 2020, and they were admitted at a health center in Moyo District. They were later referred to a General Hospital with symptoms of fever, vomiting, diarrhoea, fatigue, headache, abdominal and joint pains, confusion, and unexplained bleeding. The cases deteriorated and died in the hospital on 5 and 6 Jan 2020, respectively. Results from UVRI confirmed yellow fever infection by RT-PCR performed at UVRI.

Subsequently, Moyo district notified a 2nd cluster of suspected and confirmed yellow fever infection in a different village. The confirmed case in the suspected cluster was a 59-year-old patient who presented with symptoms including unexplained bleeding and fever on 22 Jan [2020] and died on 23 Jan 2020. A blood sample collected tested positive for yellow fever by RT-PCR at UVRI. His death was preceded by the death of 2 of his family members in early January [2020] with similar symptoms.

The Minister of Health of the Government of Uganda declared an outbreak of yellow fever on 23 Jan 2020.

Subsequent to the declaration of an outbreak, 3 additional cases were confirmed in Buliisa (1), Moyo (1), and Maracha (1). Detailed investigations of these cases are ongoing.

Public health response
National rapid response teams have been deployed to Moyo and Buliisa districts to conduct further investigations and initiate outbreak response. Other response activities include enhanced surveillance and active case finding in all districts in the northwest region and entomological surveys in the affected districts of Buliisa and Moyo. Cross-border notification with South Sudan in reference to the cases in Moyo district has been done. Investigations are ongoing in DRC and South Sudan, and WHO AFRO is supporting coordination.

The Ministry of Health is planning a reactive campaign, approved by the International Coordinating Group on Vaccine Provision for Yellow Fever Control. This reactive campaign will target approximately 1.7 million people to stop transmission and prevent imminent risk of the outbreak spreading in the northwest part of country particularly in Buliisa, Koboko, Maracha, Moyo, and Yumbe districts. To achieve sustained protection across the country, the MoH is preparing to apply for the introduction of yellow fever vaccination into the routine immunization programme in 2021 and implementation of preventive mass vaccination campaigns nationally.

WHO risk assessment
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes and has the potential to spread rapidly and cause serious public health impact. Uganda is classified as a high-risk country in the "Eliminate Yellow Fever Epidemics" (EYE) initiative, with history of recent outbreaks in 2019, 2018, 2016, and 2011. Epidemic spread of yellow fever is a risk in Uganda, as the estimated overall population immunity is low (4.2%) and attributable to past reactive vaccination activities in focal districts that are not affected by the current outbreak.

Due to the negligible population immunity in the affected districts, the detection of yellow fever cases is concerning. The affected districts share international borders with both DRC and South Sudan and are marked by frequent population movements and high interconnectivity. Population immunity for yellow fever in the cross-border areas is also low, and the forest biome between countries is continuous, indicating that there is a risk of international spread. Close monitoring of the situation with active cross-border coordination and information sharing is needed, as the possibility of cases in neighbouring countries and risk of onward spreading to DRC and South Sudan cannot be completely excluded.

WHO advice
Vaccination is the primary means for prevention and control of yellow fever and provides immunity for life. In urban centres, targeted vector control measures are also helpful to interrupt transmission. The country plans to introduce yellow fever vaccination into the routine immunization program and complete preventive mass vaccination activities to rapidly boost population immunity. Expedited planning and implementation of these activities to protect the population will help avert risk of future outbreaks.

WHO recommends vaccination against yellow fever for all international travellers aged 9 months and above going to Uganda as there is evidence of persistent or periodic yellow fever virus transmission. Yellow fever vaccination is safe and highly effective and provides lifelong protection. However, yellow fever vaccination is not recommended for infants aged 6-8 months, except during epidemics when the risk of yellow fever virus transmission may be very high. The risks and benefits of vaccination in this age group should be carefully considered before vaccination. The vaccine should be used with caution during pregnancy or breastfeeding. However, pregnant or breastfeeding women may be vaccinated during epidemics or if travel to a country or area with risk of transmission is unavoidable. Uganda also requires, as a condition of entry, a valid yellow fever vaccination certificate for travelers aged one year and above.

In accordance with the International Health Regulations (2005) 3rd edition, the international certificate of vaccination against yellow fever is valid from 10 days after vaccination and throughout the life of the person vaccinated. A single dose of WHO-approved yellow fever vaccine is sufficient to confer sustained immunity and lifelong protection against yellow fever disease. A booster dose of the vaccine is not needed and is not required of international travellers as a condition of entry.

WHO encourages its member states to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination. As a general precaution, WHO also recommends avoidance of mosquito bites. The highest risk for transmission of yellow fever virus is during the day and early evening. Travelers should be made aware of the signs and symptoms of yellow fever and instructed to rapidly seek medical advice if experiencing signs and symptoms suggestive of yellow fever infection. Viraemic returning travelers may pose a risk for the establishment of local cycles of yellow fever transmission in areas where a competent vector is present.

WHO does not recommend any restrictions on travel and trade to Uganda on the basis of the information available on this outbreak.
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[The earlier ProMED-mail post reported 2 small (2 infected individuals in each locality) yellow fever (YF) outbreaks that were not interconnected, having occurred at 2 sites at far distances from each other (see Yellow fever - Africa (03): Uganda (BL, MY) http://promedmail.org/post/20200124.6913409). The number of confirmed YF cases has now increased to 8 with new localities. The Ministry of Health is wise to increase YF surveillance and to mount a prompt vaccination campaign. The current vaccination coverage (4.2%) is extremely low and far short of the 80% that would provide adequate immunity for the population.

Yellow fever is no stranger in Uganda, and outbreaks occur sporadically. A recent previous outbreak reported by the Ugandan Ministry of Health was in May 2019 after laboratory-confirmed cases were reported from Koboko in the Northern region and Masaka in the Central region districts, 600 km (373 mi) apart. These cases are spillover from endemic sylvan (forest) maintenance of the virus. Maintaining adequate vaccination coverage in these areas is important to prevent initiation of urban transmission of the virus, which can quickly get out of hand. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Date: Wed, 19 Feb 2020 16:12:54 +0100 (MET)
By Michael O'HAGAN

Otuke, Uganda, Feb 19, 2020 (AFP) - Under a warm morning sun scores of weary soldiers stare as millions of yellow locusts rise into the northern Ugandan sky, despite hours spent spraying vegetation with chemicals in an attempt to kill them.   From the tops of shea trees, fields of pea plants and tall grass savanna, the insects rise in a hypnotic murmuration, disappearing quickly to wreak devastation elsewhere.   The soldiers and agricultural officers will now have to hunt the elusive fast-moving swarms -- a sign of the challenge facing nine east African countries now battling huge swarms of hungry desert locusts.

They arrived in conflict-torn South Sudan this week, with concerns already high of a humanitarian crisis in a region where 12 million are going hungry, according to the UN's Food and Agriculture Organization (FAO).    "One swarm of 40 to 80 million can consume food" for over 35,000 people in a day, Priya Gujadhur, a senior FAO official in Uganda, told AFP.

In Atira -- a remote village of grass-thatched huts in northern Uganda -- some 160 soldiers wearing protective plastic overalls, masks and goggles sprayed trees and plants with pesticide from before dawn in a bid to kill the resting insects.   But even after hours of work they were mostly able to reach only lower parts of the vegetation.   Major General Kavuma sits in the shade of a Neem Tree alongside civilian officials as locusts sprayed with pesticide earlier that morning fall around them, convulsing as they die.   An intense chemical smell hangs in the air.

- 'They surrounded me' -
Zakaria Sagal, a 73-year-old subsistence farmer was weeding his field in Lopei village some 120 kilometres (75 miles) away, preparing to plant maize and sorghum, when without warning a swarm of locusts descended around him.   "From this side and this side and this side, they surrounded me," Sagal said, waving his arms in every direction.    "We have not yet planted our crops but if they return at harvest time they will destroy everything. We are not at all prepared."

East Africa's regional expert group, the Climate Prediction and Applications Centre (ICPAC), warned Tuesday that eggs laid across the migratory path will hatch in the next two months, and will continue breeding as the rainy season arrives in the region.   This will coincide with the main cropping season and could cause "significant crop losses... and could potentially worsen the food security situation", ICPAC said in a statement.

- 'Panic mode' -
Since 2018 a long period of dry weather followed by a series of cyclones that dumped water on the region created "excessively ideal conditions" for locusts to breed, says Gujadhur.    Nevertheless, governments in East Africa have been caught off guard and are currently in "panic mode" Gujadhur said.   The locusts arrived in South Sudan this week after hitting Ethiopia, Somalia, Kenya, Djibouti, Eritrea, Tanzania, Sudan and Uganda.   Desert locusts take over on a dizzying scale.

One swarm in Kenya reached around 2,400 square kilometres (about 930 square miles) -- an area almost the size of Moscow -- meaning it could contain up to 200 billion locusts.   "A swarm that size can consume food for 85 million people per day," said Gujadhur.   Ugandan authorities are aware that subsequent waves of locusts may pose problems in the weeks to come, but in the meantime they are attempting to control the current generation.

Gujadhur is quick to praise the "quite strong and very quick" response from the Ugandan government but is concerned that while the army can provide valuable personnel, a military-led response may not be as effective as is necessary.    "It needs to be the scientists and (agriculture officials) who take the lead about where the control operations need to be and how and when and what time," she said.

- 'They eat anything green' -
The soldiers have been working non-stop for two days, criss-crossing the plains on the few navigable roads, trying to keep up with the unpredictable swarms.    Major General Kavuma recognises that the biggest threat is from the eggs which are yet to hatch but is confident the army will be able to control this enemy.   "We have the chemicals to spray them, all we need is to map the places they have been landing and sleeping," he said.   "In two weeks time we will come back and by that time they will have hatched and that will be the time to destroy them by praying."

Back in Lopei village, Elizabeth Namoe, 40, a shopkeeper in nearby Moroto had been visiting family when the swarm arrived.   "When the locusts settle they eat anything green, the animals will die because they have nothing to feed on, then even the people (will suffer)," she said.   "The children will be affected by hunger and famine since all life comes from all that is green. I fear so much."
Date: Sun, 9 Feb 2020 04:22:39 +0100 (MET)

Kampala, Feb 9, 2020 (AFP) - Four endangered mountain gorillas, including three adult females, have been killed by an apparent lightning strike in a Ugandan national park, a conservation group has said.   A post-mortem examination has been performed on the four, including a male infant, who died on February 3 in Mgahinga National Park in southwest Uganda.   "Based on the gross lesions from the post-mortem... the tentative cause of death for all four individuals is likely to be electrocution by lightning," the Greater Virunga Transboundary Collaboration (GVTC) said in a statement Saturday, although laboratory confirmation will take two to three weeks.

The four were members of a group of 17 known as the Hirwa family which had crossed into the Mgahinga National Park in August last year from Volcanoes National Park in neighbouring Rwanda.   "This was extremely sad," GVTC executive secretary Andrew Seguya told the BBC.   "The potential of the three females for their contribution to the population was immense."   The other 13 members of the group had been found.

In 2008, there were estimated to be only 680 of the great apes left but thanks to conservation efforts and anti-poaching patrols, their population has grown to more than 1,000.   Due to these efforts, in 2018 the mountain gorilla, a subspecies of the eastern gorilla, was moved from "critically endangered" to "endangered" on the IUCN's "Red List" of threatened species.   Covering the northern slopes of three volcanoes, Mgahinga National Park is part of the Virunga massif shared with Rwanda and the Democratic Republic of Congo.   The massif is one of the most important conservation sites in the world and one of only two places where mountain gorillas are found.
More ...

World Travel News Headlines

Date: Tue, 31 Mar 2020 10:27:16 +0200 (METDST)

Nairobi, March 31, 2020 (AFP) - Six of Africa's 54 nations are among the last in the world yet to report cases of the new coronavirus. The global pandemic has been confirmed in almost every country, but for a handful of far-flung tiny island states, war-torn Yemen and isolated North Korea.  In Africa authorities claim they are spared by god, or simply saved by low air traffic to their countries, however some fear it is lack of testing that is hiding the true impact.

- South Sudan -
The east African nation is barely emerging from six years of civil war and with high levels of hunger, illness and little infrastructure, observers fear the virus could wreak havoc.   Doctor Angok Gordon Kuol, one of those charged with overseeing the fight against the virus, said the country had only carried out 12 tests, none of which were positive.   He said the reason the virus has yet to reach South Sudan could be explained by the low volume of air traffic and travel to the country.   "Very few airlines come to South Sudan and most of the countries affected today they are affected by... people coming from abroad."   He said the main concern was foreigners working for the large NGO and humanitarian community, or people crossing land borders from neighbouring countries.   South Sudan has shut schools, banned gatherings such as weddings, funerals and sporting events and blocked flights from worst-affected countries. Non-essential businesses have been shuttered and movement restricted.   The country can currently test around 500 people and has one isolation centre with 24 beds.

- Burundi -
In Burundi, which is gearing up for general elections in May, authorities thank divine intervention for the lack of cases.   "The government thanks all-powerful God who has protected Burundi," government spokesman Prosper Ntahorwamiye said on national television last week.   At the same time he criticised those "spreading rumours" that Burundi is not capable of testing for the virus, or that it is spreading unnoticed.   Some measures have been taken, such as the suspension of international flights and placing handwashing stations at the entrances to banks and restaurants in Bujumbura.   However several doctors have expressed their concerns.   "There are zero cases in Burundi because there have been zero tests," a Burundian doctor said on condition of anonymity.

- Sao Tome and Principe -
Sao Tome and Principe -- a tiny nation of small islands covered in lush rainforest -- has reported zero cases because it is unable to test, according to World Health Organisation representative Anne Ancia.   However "we are continuing preparations," with around 100 people in quarantine after returning from highly-affected countries, and the WHO keeping an eye on cases of pneumonia.   With only four ICU beds for a population of 200,000 people, the country is desperate to not let the virus take hold and has already shut its borders despite the importance of tourism to the local economy.

- Malawi -
Malawi's health ministry spokesman Joshua Malango brushed aside fears that Malawi might not have registered any Covid-19 cases due to a lack of testing kits: "We have the testing kits in Malawi and we are testing."   Dr Bridget Malewezi from the Society of Medical Doctors told AFP that while "we may not be 100 percent ready", government was gearing up for the arrival of the virus.   She suggested it may only be a matter of time before the pandemic hits Malawi.    "It's only been in the past few weeks that it has been rampantly spreading across Africa so most people feel it will get here at some point...," she said.   Malawi has asked people coming from hard-hit countries to self-quarantine, which Malawezi said had helped "safeguard the country from any possible spread of the virus".

- Lesotho -
Tiny Lesotho, a kingdom encircled by South Africa with only two million inhabitants, went into national lockdown on Monday despite registering zero cases.   Until last week the country had no tests or testing centres, and received its first kits thanks to a donation by Chinese billionaire Jack Ma.   Authorities had reported eight suspected cases which they had not been able to test and the first results are expected soon.

- Comoros -
The Indian Ocean island nation of the Comoros, situated between Madagascar and Mozambique, has yet to detect a single case of the virus, according to the health ministry.   One doctor in the capital Moroni, Dr Abdou Ada, wonders if it may not be because of the wide use of the drug Artemisinin to treat malaria.   "I believe that the mass anti-malarial treatment explains the fact that the Comoros are, at least for now, spared from Covid-19. it is a personal belief that needs to be confirmed scientifically."
Date: Tue, 31 Mar 2020 09:50:04 +0200 (METDST)
By Sophie DEVILLER with Dene-Hern CHEN

Bangkok, March 31, 2020 (AFP) - Underfed and chained up for endless hours, many elephants working in Thailand's tourism sector may starve, be sold to zoos or be shifted into the illegal logging trade, campaigners warn, as the coronavirus decimates visitor numbers. Before the virus, life for the kingdom's estimated 2,000 elephants working in tourism was already stressful, with abusive methods often used to 'break them' into giving rides and performing tricks at money-spinning animal shows.   With global travel paralysed the animals are unable to pay their way, including the 300 kilograms (660 pounds) of food a day a captive elephant needs to survive.

Elephant camps and conservationists warn hunger and the threat of renewed exploitation lie ahead, without an urgent bailout. "My boss is doing what he can but we have no money," Kosin, a mahout -- or elephant handler -- says of the Chiang Mai camp where his elephant Ekkasit is living on a restricted diet.   Chiang Mai is Thailand's northern tourist hub, an area of rolling hills dotted by elephant camps and sanctuaries ranging from the exploitative to the humane.   Footage sent to AFP from another camp in the area shows lines of elephants tethered by a foot to wooden poles, some visibly distressed, rocking their heads back and forth.

Around 2,000 elephants are currently "unemployed" as the virus eviscerates Thailand's tourist industry, says Theerapat Trungprakan, president of the Thai Elephant Alliance Association. The lack of cash is limiting the fibrous food available to the elephants "which will have a physical effect", he added.  Wages for the mahouts who look after them have dropped by 70 percent.   Theerapat fears the creatures could soon be used in illegal logging activities along the Thai-Myanmar border -- in breach of a 30-year-old law banning the use of elephants to transport wood.  Others "could be forced (to beg) on the streets," he said. It is yet another twist in the saga of the exploitation of elephants, which animal rights campaigners have long been fighting to protect from the abusive tourism industry.

- 'Crisis point' -
For those hawking a once-in-a-lifetime experience with the giant creatures -- whether from afar or up close -- the slump began in late January.   Chinese visitors, who make up the majority of Thailand's 40 million tourists, plunged by more than 80 percent in February as China locked down cities hard-hit by the virus and banned external travel. By March, the travel restrictions into Thailand -- which has 1,388 confirmed cases of the virus -- had extended to Western countries.

With elephants increasingly malnourished due to the loss of income, the situation is "at a crisis point," says Saengduean Chailert, owner of Elephant Nature Park.   Her sanctuary for around 80 rescued pachyderms only allows visitors to observe the creatures, a philosophy at odds with venues that have them performing tricks and offering rides.   She has organised a fund to feed elephants and help mahouts in almost 50 camps nationwide, fearing the only options will soon be limited to zoos, starvation or logging work.  For those restrained by short chains all day, the stress could lead to fights breaking out, says Saengduean, of camps that can no longer afford medical treatment for the creatures.

Calls are mounting for the government to fund stricken camps to ensure the welfare of elephants. "We need 1,000 baht a day (about $30) for each elephant," says Apichet Duangdee, who runs the Elephant Rescue Park. Freeing his eight mammals rescued from circuses and loggers into the forests is out of the question as they would likely be killed in territorial fights with wild elephants. He is planning to take out a two million baht ($61,000) loan soon to keep his elephants fed.   "I will not abandon them," he added.
Date: Tue, 31 Mar 2020 07:10:34 +0200 (METDST)
By Bernadette Carreon

Koror, Palau, March 31, 2020 (AFP) - A coronavirus-free tropical island nestled in the northern Pacific may seem the perfect place to ride out a pandemic -- but residents on Palau say life right now is far from idyllic.   The microstate of 18,000 people is among a dwindling number of places on Earth that still report zero cases of COVID-19 as figures mount daily elsewhere.   The disparate group also includes Samoa, Turkmenistan, North Korea and bases on the frozen continent of Antarctica.

A dot in the ocean hundreds of kilometres from its nearest neighbours, Palau is surrounded by the vast Pacific, which has acted as a buffer against the virus.   Along with strict travel restrictions, this seems to have kept infections at bay for a number of nations including Tonga, the Solomons Islands, the Marshall Islands and Micronesia.   But remoteness is not certain to stop the relentless march of the new disease. The Northern Mariana Islands confirmed its first cases over the weekend, followed by a suspected death on Monday.

Klamiokl Tulop, a 28-year-old artist and single mum, is hopeful Palau can avoid the fate of Wuhan, New York or Madrid -- where better-resourced health services were overrun.   But she describes a growing sense of dread, a fear that the virus is coming or could already be on the island undetected.   "You can feel a rising tension and anxiety just shopping," she told AFP. "Stores are crowded even more during non-payday weeks."   There have been several scares on Palau, including a potential case that saw one person placed into quarantine this week as authorities await test results.

- Antarctic seclusion -
Inside Australia's four remote Antarctic research bases, around 90 people have found themselves ensconced on the only virus-free continent as they watch their old home transform beyond recognition.   There is no need for social distancing in the tundra.   "They're probably the only Australians at the moment that can have a large dinner together or have the bar still open or the gym still open," Antarctic Division Operations manager Robb Clifton told AFP.   The bases are now isolated until November, so the group is safe, but Clifton admits "the main thing that's on the mind of expeditioners is how their loved ones are going back home."

In some places, reporting no cases does not always mean there are no cases to report.   North Korea has portrayed emergency measures as an unqualified success in keeping COVID-19 out, despite sustained epidemics in neighbouring China and South Korea.   But state media also appears to have doctored images to give ordinary North Koreans face masks -- handing sceptics reason to believe the world's most secretive government may not be telling the whole truth.

- 'Waiting for the inevitable?' -
While Palau has no confirmed cases, it has still been gripped by the society-altering fears and economic paralysis that have affected the rest of the world.   Supermarket aisles in the country's largest town Koror have seen panic buying and there are shortages of hand sanitisers, masks and alcohol.   The islands depend heavily on goods being shipped or flown in, meaning supplies can quickly run low.

United Airlines used to fly six times a week from nearby Guam -- which has seen more than 50 cases -- but now there is just one flight a week.   "Look at how bad we coped when shipments were late before this pandemic happened," Tulop said. "Everyone was practically in uproar."   Residents have been practising social distancing. Doctors are waiting for test kits to arrive from Taiwan. The government is building five isolation rooms that will be able to hold up to 14 patients.   It all feels like waiting for the inevitable.   "I would like to be optimistic we won't get the virus," Tulop said. "But Palau would most definitely get it. We rely heavily on tourism and most of us even need to travel for work."

Rondy Ronny's job is to host big tourist events, but work has already dried up, and he admits to being "very anxious".   "I have loans and bills and payments due," he said. "This will definitely put me back, I hope the government will do something about our economy too, to help it recover."   Palau's biggest test may yet come with the first positive case.   But even in the most remote corners of the world, the impact of this truly global pandemic is already being felt.   Nowhere, it seems, is truly virus-free.
Date: Tue, 31 Mar 2020 04:46:26 +0200 (METDST)

Panama City, March 31, 2020 (AFP) - The government of Panama on Monday announced strict quarantine measures that separate citizens by gender in an effort to slow the spread of the novel coronavirus.   From Wednesday, men and women will only be able to leave their homes for two hours at a time, and on different days.   Until now, quarantine regulations were not based on gender.

Men will be able to go to the supermarket or the pharmacy on Tuesdays, Thursdays and Saturdays, and women will be allowed out on Mondays, Wednesdays and Fridays.   No one will be allowed to go out on Sundays.

The new measures will last for 15 days.   "This absolute quarantine is for nothing more than to save your life," security minister Juan Pino said at a press conference.   According to Pino, more than 2,000 people were detained last week for not abiding by the quarantine.   Since the first case was reported on March 10, Panama has confirmed 1,075 cases of the coronavirus, 43 of which are in intensive care, and 27 deaths.
Date: Tue, 31 Mar 2020 00:54:08 +0200 (METDST)
By Celia Lebur with AFP Africa Bureaux

Lagos, March 30, 2020 (AFP) - More than 20 million Nigerians on Monday went into lockdown in sub-Saharan Africa's biggest city Lagos and the capital Abuja, as the continent struggles to curb the spread of coronavirus.   President Muhammadu Buhari ordered a two-week "cessation of all movements" in key cities to ward off an explosion of cases in Africa's most populous country.

Businesses are being closed, non-food shops shut and people required to stay at home as officials look to track down possible carriers of the disease after reporting 131 confirmed cases and two deaths so far.   Enforcing the restrictions in sprawling Lagos will be a mammoth challenge as millions live crammed into slums and rely on daily earnings to survive.

In the ramshackle outdoor markets of Lagos Island, anxious locals complained they did not have the money to stock up, while at higher-end supermarkets better-off residents queued to buy supplies.    "Two weeks is too long. I don't know how we will cope," said student Abdul Rahim, 25, as he helped his sister sell foodstuffs from a stall in Jankarra market.    "People are hungry and they won't be able to stock food."

City officials have pledged to provide basic provisions to 200,000 households but the central government in Africa's largest oil producing nation is already facing financial strain as the price of crude  has collapsed.    The streets of Ghana's capital Accra were also empty as most people in two regions appeared to be following a presidential order to stay indoors after it went into force.

- Zimbabwe locks down -
Dozens of African nations have imposed restrictions ranging from night-time curfews to total shutdowns.    Zimbabwe, which is already suffering a recession, began enforcing a three-week lockdown after the disease left one person dead and infected six others.   Police mounted checkpoints on routes leading to Harare's central business district, stopping cars and turning away pedestrians who had no authorisation to be in the area.   "We don't want to see people here on the streets. We don't want to see people who have no business in town just loitering," a policewoman said through a loud hailer. "Everyone to their homes."

Some people were trying to head for villages.   "We would rather spend the 21 days at our rural home, where we don't have to buy everything. I can't afford to feed my family here when I am not working," said Most Jawure.   "We have been waiting here for more than two hours but there are no buses," Jawure told AFP while standing with his wife and daughter beside a bulging suitcase.

For many of Zimbabwe's 16 million people, the lockdown means serious hardship.   With the unemployment rate estimated at around 90 percent, most Zimbabweans have informal jobs to eke out a living and few have substantial savings.   As a similar scenario played out in other poor nations, the UN on Monday called for a $2.5-trillion aid package to help developing countries weather the pandemic, including debt cancellation and a health recovery "Marshall Plan".

- 'A matter of time' -
Experts warn that Africa is highly vulnerable to COVID-19 given the weak state of health systems across the continent.    The number of infections lags far behind Europe but testing has been limited and the figures are growing rapidly.    Angola and Ivory Coast on Sunday became the latest countries to record their first deaths, bringing the number of African fatalities to around 150 of nearly 4,800 recorded cases.

In Democratic Republic of Congo, two new cases were reported in the volatile South Kivu region and an adviser to the nation's president announced he had tested positive.

Ugandan President Yoweri Museveni ordered a 14-day lockdown in a bid to halt the spread of the disease after reporting 33 infections.    Police in South Sudan, one of a few nations in Africa yet to confirm a case, enforced strict new rules, shutting shops selling non-essential items and limiting passengers in public transport.   Mauritius, which has 128 cases -- the highest in East Africa -- has extended its lockdown to April 15.

South Africa's defence minister Nosiviwe Mapisa-Nqakula on Monday denounced alleged intimidation by security forces after videos emerged showing some forcing civilians to squat or roll on the ground for allegedly violating restrictions.   In an interview with local Newzroom Afrika television channel, she said she was aware of two videos "which have circulated where clearly there (is) some abuse".   "I'm saying I condemn that, we will not allow that to continue," she said.
Date: Mon, 30 Mar 2020 21:41:43 +0200 (METDST)

Kampala, March 30, 2020 (AFP) - Ugandan President Yoweri Museveni on Monday ordered an immediate 14-day nationwide lockdown in a bid to halt the spread of the coronavirus which has so far infected 33 people in the country.   Uganda last week banned public transport and sealed its borders and urged the population to stay home, but stopped short of a full shutdown.

Museveni said that from 10:00pm Monday private vehicles would also be banned, seeking to avoid give a more advanced warning that would see people flee the city, as has happened across the continent where many poor residents see better chances of survival in the countryside.   "I would have given the public time to adjust but... a longer time would give people time to go to the villages and in so doing they would transfer the very sickness we're trying to prevent. This freezing of movement will last for 14 days," he said in a televised address.

Museveni also ordered a 14-day nationwide curfew from 7:00pm.   Shopping malls and businesses selling non-food items were ordered to close.   Food market vendors who continue to trade are forbidden to return to their homes for the duration of the 14-day lockdown, while factories could stay open if remain on the premises for the duration of the shutdown.

People are still allowed to move around on foot but not gather in groups of more than five at a time.    In recent days, opposition leaders Kizza Besigye and Bobi Wine had undertaken small-scale food deliveries to people who had ost their incomes due to earlier restrictions but Museveni criticised such actions as "cheap politics".   "I direct the police to arrest the opportunistic and irresponsible politicians who tried to distribute food," he said.   "Anybody arrested in that effort will be charged with attempted murder."   Museveni said the government would begin distributing food to those who needed it, without providing details.

A weary looking Museveni, 75, pleaded with the population to change their behaviour in the face of the threat from the virus.   "This virus would not do much damage if it was not for the carelessness of people. Don't go into a group of people if you have a cold. Stay at home," he pleaded.   Last week police and Local Defence Units (LDUs) -- a uniformed militia under the control of the military - violently cleared streets in central Kampala.   Following a public outcry, army chief General David Muhoozi on Monday apologised for those actions, describing them as "high-handed, unjustified and regrettable" and said the culprits would be "dealt with".
Date: Sun 29 Mar 2020
Source: Spanish government COVID-19 update 58 [in Spanish, trans. ProMed Mod.MPP, edited]

COVID-19 update 59 [data as of 28 Mar 2020 21:00 CET]
-----------------------------------------------------
Situation in Spain
------------------
In Spain, to date [28 Mar 2020], 78 797 cases have been reported, of which 6528 have died and 14,709 recovered (table 1 and figure 1 -- at source URL above). The Autonomous Communities with the greater cumulative incidence in the last 14 days are La Rioja 419.5 per 100,000 population), Madrid 287.1 per 100,000 population), Navarre (279.4 per 100,000 population), and Castile-La Mancha (238.3 per 100,000 population) (figures 2, 3). The distribution by age groups of hospitalized patients, those admitted to the ICU, and deaths is found in table 2.

Autonomous Community:
Total / last 24 hours / Incidence per 100,000 population in past 14 days

  • Madrid: 22,677 / 1157 / 287.14
  • Catalonia: 15,026 / 763 / 186.46
  • Basque Country: 5740 / 604 / 231.45
  • Castile and Leon: 5414 / 623 / 213.46
  • Castile-La Mancha: 5246 / 734 / 238.33
  • Valencia: 4784 / 750 / 87.43
  • Andalusia: 4682 / 405 / 50.45
  • Galicia: 3139 / 367 / 109.06
  • Navarre: 2011 / 182 / 279.42
  • Aragon: 1858 / 266 / 129.69
  • La Rioja: 1629 / 193 / 419.51
  • Extremadura : 1456 / 62 / 127.47
  • Canary Islands: 1125 / 100 / 47.18
  • Asturias: 1088 / 84 / 92.98
  • Cantabria: 1023 / 86 / 167.28
  • Balearic Islands: 958 / 96 / 79.69
  • Murcia: 872 / 70 / 53.62
  • Melilla: 48 / 3 / 46.25
  • Ceuta: 21 / 4 / 23.59
********
Total: 78,797 / 6549 / 151.04
======================
[Spain has been rapidly accelerating in terms of transmission of the SARS-CoV-2. As of today (29 Mar 2020), there have been a total of 78 797 cases and 6528 deaths reported, an increase from 72 248 cases with and 5690 deaths confirmed in the preceding 24 hours. The countrywide 2-week incidence per 100 000 population is 151. It is now 2nd in Europe, behind Italy, and 4th globally behind the USA, Italy, and China, in terms of absolute numbers of cases.

Of the 78,797 cases, 43 397 (55.1%) were hospitalized, 4907 (6.2%) were admitted to the ICU. The crude reported death rate was 8.3% with more deaths occurring than reported ICU admissions.

A map of Spain showing provinces (autonomous communities) can be seen at
and a HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/43>.

La Rioja, Navarre, and Basque Country are located together in the north of the country. Madrid is in the northern part of central Spain and Castilla de la Mancha is just to the south of Madrid, with Toledo as its capital. - ProMed Mod.MPP]
Date: Sun 29 Mar 2020
Source: Worldometer [accessed 10:30 PM EDT]

USA cases by state
State: Total cases / New cases

  • New York: 59,648 / 6193
  • New Jersey: 13,386 / 2262
  • California: 6312 / 653
  • Michigan: 5486 / 836
  • Massachusetts: 4955 / 698
  • Florida: 4950 / 912
  • Washington: 4483 / 173
  • Illinois: 4596 / 1105
  • Louisiana: 3540 / 225
  • Pennsylvania: 3419 / 668
  • Texas: 2808 / 479
  • Georgia: 2683 / 237
  • Colorado / 2307 / 246
  • Connecticut: 1993 / 469
  • Tennessee: 1720 / 208
  • Ohio: 1653 / 247
  • Indiana: 1514 / 282
  • Maryland: 1239 / 247
  • North Carolina: 1167 / 145
  • Wisconsin: 1154 / 165
  • Nevada: 920 / 299
  • Arizona: 919 / 146
  • Missouri / 903 / 65
  • Virginia: 890 / 151
  • Alabama: 827 / 125
  • South Carolina: 774 / 114
  • Mississippi: 758 / 179
  • Utah: 719 / 117
  • Oregon: 548 / 69
  • Minnesota: 503 / 62
  • Arkansas: 449 / 40
  • Kentucky: 439 / 45
  • Oklahoma: 429 / 52
  • District of Columbia: 401 / 59
  • Iowa: 336 / 38
  • Kansas: 319 / 58
  • Idaho: 310 / 49
  • Rhode Island: 294 / 55
  • New Hampshire: 258 / 44
  • Maine: 253 / 42
  • New Mexico: 237 / 29
  • Vermont: 235 / 24
  • Delaware: 232 / 18
  • Hawaii: 175 / 24
  • Montana: 161 / 32
  • West Virginia: 124 / 11
  • Nebraska: 120 / 24
  • Alaska: 102 / 17
  • North Dakota: 98 / 15
  • South Dakota: 90 / 22
  • Wyoming: 87 / 3
  • Guam / 56 / 5
  • Northern Mariana Islands: 2
  • Puerto Rico: 127 / 27
  • US Virgin Islands: 21 / 0
  • Wuhan repatriated: 3 / 0
  • Diamond Princess Cruise: 46 / 0
**************
Total: 142 321 / 38 179
Total reported deaths: 2484
====================
[The above are the latest breakdowns of confirmed cases of SARS-CoV-2 infection in the USA, as per Worldometer data. The total number of confirmed cases in the USA and territories is now 142 321 including 2484 deaths. New York state, with 59 648 (41.9%) cumulative cases reports and 6193 (33.3%) newly confirmed cases over the past 24 hours, is clearly the epicenter of the outbreak in the USA, although case reporting elsewhere is showing increases. Daily reported case counts are accelerating in New Jersey, Michigan, Florida, Louisiana, Massachusetts, and Illinois.

The Centers for Disease Control and Prevention website (<https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html>) has 2 epidemic curves. One focuses on date of confirmation of disease, the other on date of onset of illness. The curve of interest, by date of onset of disease, is based on 14.6% of the number of cases plotted on the epidemic curve using date of confirmation of disease.

A map of the United States can be seen at
<http://www.mapsofworld.com/usa/> and a HealthMap/ProMED-mail map at
Date: Sun 29 Mar 2020 11:46 AM GST
Source: Reuters [abridged, edited]

Iran's coronavirus death toll has risen to 2640, a health ministry official said on Sunday [29 Mar 2020], as the Middle East's worst-hit country grapples with the fast-spreading outbreak. "In the past 24 hours we had 123 deaths and 2901 people have been infected, bringing the total number of infected people to 38 309," Alireza Vahabzadeh, an adviser to the health minister, said in a tweet. "12,391 people infected from the virus have recovered." Health ministry spokesman Kianush Jahanpur told state TV that 3467 of those infected were in "critical condition".  "I am happy to announce that also 12,391 people who had been infected across the country have recovered," Jahanpur said. "The average age of those who have died of the disease is 69."

President Hassan Rouhani urged Iranians to adapt to their new way of life, which was likely to continue for some time. "We must prepare to live with the virus until a treatment is discovered ... The new measures that have been imposed are for everyone's benefit ... Our main priority is the safety and the health of our people," Rouhani said during a televised meeting.

The government has banned inter-city travel after warning of a potential surge in coronavirus cases because many Iranians defied calls to cancel travel plans for the Persian New Year holidays that began on [20 Mar 2020]. The authorities told Iranians to stay at home, while schools, universities, cultural, religious, and sports centres have been temporarily closed.

To stem the spread of the virus in crowded jails, Iran's judiciary on Sunday [29 Mar 2020] extended furloughs for 100,000 prisoners. On [17 Mar 2020], Iran said it had freed about 85,000 people from jail temporarily, including political prisoners. "The 2nd wave of (the) temporary release of prisoners had already started and their (100,000 prisoners) furloughs have been extended until [19 Apr 2020]," judiciary spokesman Gholamhossein Esmaili was reported as saying by state television. Iran said it had 189,500 people in prison, according to a report submitted by the UN special rapporteur on human rights in Iran to the Human Rights Council in January [2020].  [byline: Parisa Hafezi]
===================
[In the 24 hours from 28 to 29 Mar 2020, the number of cases of COVID-19 confirmed in Iran grew from 35 408 to, 38 309, an increase of 2901 newly confirmed cases. The number of deaths has also increased from 2517 to 2640 an increase of 123 deaths in the 24-hour period. In terms of total numbers of confirmed cases, Iran ranks 7th globally behind USA, Italy, China, Spain, Germany and France. In early March 2020, Iran and Italy were on the same trajectory with respect to daily growth in cumulative newly confirmed cases, but starting 8 Mar 2020, Italy's daily reported newly confirmed cases accelerated at an alarming speed. By 14 Mar 2020, Italy was reporting almost twice as many cases as Iran on a daily basis.

A map of Iran showing provinces can be seen at
HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/128>. - ProMed Mod.MPP]
Date: Sun 29 Mar 2020
Source: Italian Government Health Ministry [in Italian, machine trans., edited]

Cases in Italy as of 6:00 pm 29 Mar 2020
----------------------------------------
Regarding health monitoring related to the spread of the new coronavirus [SARS-CoV-2] on the national territory, there are a total of 97,689 cases. At the moment 73,880 people are positive for the virus; 13,030 people have recovered. There are 27,386 patients hospitalized with symptoms, 3906 are in intensive care, and 42,588 are in home isolation.

There have been 10,779 reported deaths, however, this number can only be confirmed after the Istituto Superiore di Sanita has established the actual cause of the death.

Case distribution by province:
number of cases (number of new cases in past 24 hours)

  • Lombardy: 41 007 (1592)
  • Emilia-Romagna: 13 119 (736)
  • Veneto: 8358 (428)
  • Marche: 3558 (185)
  • Piedmont: 8206 (535)
  • Tuscany: 4122 (305)
  • Campania: 1759 (167)
  • Lazio: 2706 (201)
  • Liguria: 3076 (254)
  • Friuli Venezia Giulia: 1480 (44)
  • Sicily: 1460 (101)
  • Apulia: 1549 (91)
  • Umbria: 1023 (54)
  • Abruzzo: 1293 (160)
  • Molise: 127 (4)
  • Trento: 1594 (89)
  • Bolzano: 1214 (105)
  • Sardinia: 638 (14)
  • Basilicata: 202 (20)
  • Aosta Valley: 584 (73)
  • Calabria: 614 (59)
*********
Total: 97,689 (5217)
======================
[The tally of confirmed cases of COVID-19 in Italy is now 97,689 cases, including 10,779 deaths, up from 92,472 cases and 10,023 deaths reported on 28 Mar 2020. The 24-hour change between 28 and 29 Mar 2020 was 5217 newly confirmed cases, compared with 5974 newly confirmed cases between 27 and 28 Mar 2020. Cases continue to be concentrated in Lombardy (41 007), the epicenter of the outbreak, Emilia-Romagna (13 119), and Veneto (8358), all in the northern part of the country. Those 3 provinces combined account for 52.8% of newly confirmed cases in the past 24 hours, representing a drop from the previous 24 hours when they represented 56.% of nationally reported cases. Another active province is Piemonte with a total of 8206 cases and represents 10.3% of newly reported cases. In the past 24 hours Tuscany has reported 5.9% of newly reported cases, a slight drop from the preceding day when it was reporting 6.1% of newly confirmed cases. There is an excellent interactive map at <http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1> to visualize the caseloads per region in near real time.

On 9 Mar 2020, Italy announced a lockdown for the northern provinces where the outbreak was concentrated. On 10 Mar 2020, this was expanded to be countrywide. On 11 Mar 2020, Italy announced the closure of non-essential businesses. It is now 19 days since the start of the lockdown in the north and 18 days since the countrywide lockdown.

A map of Italy showing regions can be seen at
HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/75>. - ProMed Mod.MPP]