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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Tue, 24 Sep 2019 07:27:34 +0200 (METDST)

Miami, Sept 24, 2019 (AFP) - A strong 6.0 magnitude struck off the northwest coast of Puerto Rico late Monday, the United States Geological Survey said, although no casualties or damage were reported.   The quake struck 62km northwest of San Antonio at 11:23 pm local time (03:20 GMT) at a depth of 10km, the agency said.  San Antonio is home to Rafael Hernandez Airport, a key air link to the mainland US.    In 2010 nearby Haiti was struck by a devastating 7.0 magnitude earthquake that killed more than 250,000 people and crippled the nation's infrastructure.
Date: Mon, 12 Feb 2018 05:54:19 +0100

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Algeria

Algeria US Consular Information Sheet
May 08, 2008
COUNTRY DESCRIPTION:
Algeria is the second-largest country in Africa, with over four-fifths of its territory covered by the Sahara desert.
The country has a population of 35 million p
ople mainly located near the northern coast.
Algeria is a multi-party, constitutional republic.
Facilities for travelers are available in populated areas, but sometimes limited in quality and quantity.
Read the Department of State Background Notes on Algeria for additional information.

ENTRY/EXIT REQUIREMENTS:
Passports and visas are required for U.S. citizens traveling to Algeria.
The Algerian visa application must be typed.
The Algerian Embassy no longer accepts handwritten visa applications.
For further information on entry/exit requirements, travelers may contact the Embassy of the People's Democratic Republic of Algeria at 2137 Wyoming Avenue NW, Washington, DC 20008, telephone (202) 265-2800.
Visit the Embassy of the People's Democratic Republic of Algeria web site at http://www.algeria-us.org for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY: Although no Americans are known to have been killed by terrorists in Algeria, more than 120 foreigners were murdered at the height of the terrorism threat in Algeria in the 1990s.
In response to the terrorist threat, the U.S. government substantially reduced the number of U.S. Government personnel in Algeria during the 1990s.
Small-scale terrorist activities, including bombings, false roadblocks, kidnappings, ambushes, and assassinations, occur regularly.
Since early 2007, vehicle-borne suicide bomb attacks have emerged as a terrorist tactic in Algeria, including in the capital.
Suicide car bomb attacks in December 2007 targeted the UN Headquarters and the Algerian Constitutional Council in Algiers.
The attacks occurred in areas where many diplomatic missions and residences are located.
The group that claimed credit for the December attacks has pledged more attacks against foreign targets, and specifically American targets.

The Travel Warning for Algeria contains the most current information concerning the threat from terrorism.
Currently, Embassy staffing is at full capacity and the Embassy is able to provide full services. U.S. Government employees traveling between cities must be accompanied by a security escort.
U.S. citizens should also carefully consider the security risks involved when using public transportation such as buses and taxis.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affair’s 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:
The crime rate in Algeria is moderately high and increasing.
Serious crimes have been reported in which armed men posing as police officers have entered homes and robbed the occupants at gunpoint.
False roadblocks/checkpoints have been employed to rob motorists (see Traffic Safety and Road Conditions section below).
Some of these incidents resulted in the murder of the vehicles' occupants; there has been an increase in the kidnapping of vehicle occupants who appear to be wealthy.
Petty theft and home burglary occur frequently, and muggings are on the rise, especially after dark in the cities.
Theft of contents and parts from parked cars, pick-pocketing, theft on trains and buses, theft of items left in hotel rooms and purse snatching are common.
Alarms, grills, and/or guards help to protect most foreigners' residences.

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

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, 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.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Hospitals and clinics in Algeria are available and improving in the large urban centers, but are still not up to Western standards. Doctors and hospitals often expect immediate cash payment for services.
Most medical practitioners speak French; English is not widely used.
Prescription medicines are not always readily available.
Some pharmacies may at times be out-of-stock.
In addition, the medicine may be sold under a different brand name and may contain a different dosage than in the U.S.
Please be aware that some newer medications may not yet be available in Algeria.
It is usually easy to obtain over-the-counter products.
Emergency services are satisfactory, but response time is often unpredictable.
In all cases, response time is not as fast as in the U.S.

Cases of tuberculosis are regularly reported, but do not reach endemic levels.
Every summer, public health authorities report limited occurrences of water-borne diseases, such as typhoid.
In addition, HIV/AIDS is a concern in the remote southern part of the country, especially in border towns.

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 (CDC) and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en .

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

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

Algerian roads are overcrowded and traffic-related accidents kill a large number of people every year.
Drivers will encounter police and military checkpoints on major roads within and on the periphery of Algiers and other major cities.
Security personnel at these checkpoints expect full cooperation.
Motorists should be aware that terrorists employ false roadblocks as a tactic for ambushes and kidnappings, primarily in the central regions of Boumerdes and Tizi Ouzou and some parts of eastern Algeria (see Crime section above).

Travel overland, particularly in the southern regions, may require a permit issued by the Algerian government.
For specific information concerning Algerian driver's permits, vehicle inspection, road tax, and mandatory insurance, contact the Algerian Embassy.

Please refer to our Road Safety page for more information.
Visit the website of the national authority responsible for road safety at http://www.ministere-transports.gov.dz/ .

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Algeria, the U.S. Federal Aviation Administration (FAA) has not assessed Algeria’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:
Algeria maintains restrictions on the import and export of local currency.
Foreign currency must be exchanged only at banks or authorized currency exchange locations, such as major hotels.
Photography of military and government installations is prohibited.
It is also illegal to import weapons, body armor, handcuffs or binoculars.
Please see our Customs Information.

PROSELYTIZING:
Islam is the state religion of Algeria.
The Algerian government allows non-Muslim religious worship only in structures exclusively intended and approved for that purpose. Activities such as proselytizing, engaging in activities which the Algerian authorities could view as encouraging conversion to another faith, and convening religious ceremonies in private residences are prohibited under a March 2006 law.

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 Algerian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Algeria 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 on intercountry adoption and international parental child abduction, please see our Office of Children’s Issues web pages.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Algeria 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 Algeria.
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 5 Chemin Cheikh Bachir El-Ibrahimi, B.P. 408 (Alger-gare) 16000, in the capital city of Algiers.
The telephone number is [213] 770-08-20-00 which can also be reached after hours.
The fax number is [213] 21-9822-99.
The U.S. Embassy work week is Saturday through Wednesday.
* * * * * *
This replaces the Country Specific Information dated March 26, 2008, to update the section on Crime.

Travel News Headlines WORLD NEWS

Date: Mon, 9 Sep 2019 11:25:29 +0200 (METDST)

Paris, Sept 9, 2019 (AFP) - Some 13,000 passengers, mainly booked on flights to and from Algeria, are still stranded after France's second-largest airline Aigle Azur went into receivership, a senior French official said Monday, adding that several potential buyers had been identified.   The airline, which employs almost 1,200 staff, filed for bankruptcy and suspended flights last week after losses which prompted a shareholder coup that ousted the chief executive.   "Out of 19,000 passengers who found themselves in difficulty at the peak of the crisis, there are still 13,000" who have yet to be repatriated, the secretary of state for transport, Jean-Baptiste Djebbari, told the Le Parisien daily.

He said these included 11,000 passengers booked on flights into and out of Algeria, 600 on Mali flights as well as other destinations ranging from Russia to Lebanon.   Air France chartered two special flights on Saturday and then again on Sunday to help passengers booked on Algeria flights, which flew out one quarter full but were full on the return.   "The hardest moment of the crisis will be over before the end of the week. At least half the passengers (affected) will have been repatriated," Djebbari said.

The airline transported last year some 1.9 million passengers, with destinations in Algeria making up half of its operations that brought in 300 million euros ($329 million) of revenue.   "There needs to be a serious buyer who is capable of offering guarantees for a maximum number of employees. The good news is that many (potential buyers) have expressed interest," said Djebbari.

He said the former chief executive of Air France's subsidiary Hop!, Lionel Guerin, was among interested parties, backed by a team of aviation professionals with financial support.   He added that Air France itself also appeared interested in making an offer.    "This shows there is still an interest in Aigle Azur," he added. Neither party has so far publicly confirmed an interest, with Air France declining to comment on an "evolving" situation.

According to union officials, Air France could be interested in the medium-haul routes to Algeria and the Dubreuil group, the majority shareholder in Air Caraibes, the long haul routes to destinations like Brazil and Mali.   The largest shareholder in Aigle Azur is the Chinese conglomerate HNA Group, which owns Hainan Airlines, with a 49-percent stake.    David Neeleman, an American airline entrepreneur whose companies include JetBlue and TAP Air Portugal, owns 32 percent, and French businessman Gerard Houa owns 19 percent.
Date: Fri 30 Aug 2019
Source: Depeche de Kabylie [in French, translated, edited]

The current human brucellosis epidemic in Ath Mansour has again claimed new victims. These are 2 citizens of Ath Vouali, hospitalized Wednesday [28 Aug 2019] at the EPH Kaci Yahia M'Chedallah. The affected subjects are a 40-year-old father and his 15-month-old son. Met in the halls of the hospital, the father indicated that he and his family have consumed raw milk from the farmer whose goats were infected almost 2 months ago.

After these 2 new victims, 6 cases of human brucellosis have been detected since last week [18-24 Aug 2019] in this commune and hospitalized at M'Chedallah hospital. In this context, we learned that a Daira commission, composed of a member of the APC executive of Ath Mansour, the subdivisionary of agriculture of Ahnif, a member of the prevention of the Ahnif EPSP and the M'Chedallah Civil Protection Unit, was set up on the instructions of the Daira Chief.

This commission has already visited the premises where the goat farmer in question resides, in Rodha, south of the capital of the commune, to make the necessary arrangements, such as the census of the animals and their quarantine (isolation) with slaughter orientation on those carrying this disease. It should be remembered that caprine brucellosis was detected by an animal health practitioner at the farm level in June 2019 and that part of the herd was already slaughtered at the municipal slaughterhouse.

A total of 75 goats were slaughtered out of 300 heads, with carcass burial as stipulated by the regulations in force. "The transmission of this epidemic was made from the consumption of milk that the farmer of the contaminated livestock sold to a merchant of this commune. This product, raw or curd, was then sold retail to customers. It should be noted that the brucellosis virus has an incubation period that can last several months before the 1st symptoms, which are fever and nausea followed by a general weakness, begin to appear. The treatment is also spread over a long period of time," says a medical source who expects more cases to be detected in the coming days.

Distraught, the citizens of Ath Mansour storm the health institutions of the region where samples are taken for the purposes of screening. A source close to the agricultural services says that none of the citizens hitherto infected by this bacterium has goats.  [Byline: Oulaid Soualah]
==========================
[This infection, a bacterial zoonosis, is classified among the category B biowarfare agents. Natural transmission to humans occurs after occupational exposure or through ingestion of contaminated food products. Although brucellosis has become a rare entity in the USA and many industrialized nations because of animal vaccination programs, this condition remains a significant health problem in many developing countries.

Each species of _Brucella_ has a specific animal reservoir in which chronic disease is present. The bacilli tend to localize in the reproductive organs of the animals, causing sterility and abortions, and are shed in large numbers in the animal's urine, milk, and placental fluid. This localization allows for efficient spread to farmers, veterinarians, slaughterhouse workers, and consumers.

Among the 4 species known to cause disease in humans, _Brucella melitensis_ (from goats, sheep, or camels) may be the most virulent, producing the most severe and acute cases of brucellosis with disabling complications. A prolonged course of illness, which may be associated with suppurative destructive lesions, is associated with _B. suis_ (from feral or commercially raised pigs) infection. _B. abortus_ (from cattle, buffalo, and camels) is associated with mild-to-moderate sporadic disease that is rarely associated with complications. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Mon 10 Jun 2019
Source: Algerie 360, a Lequotidien-oran.com report [in French, trans. ProMED Corr.SB, edited]

A total of 3 cases of brucellosis, known as "Malta fever", a disease that affects farm animals, were recorded at Ksar-Chellala, in the far east of the Tiaret wilaya (province). These are 3 women who consumed curd in the last days of Ramadan, according to doctors at the local hospital. In all, more than 150 cases of brucellosis in humans have been recorded since the beginning of 2019.

According to the Department of Health and Population (DSP), the wilaya of Tiaret has recorded 154 cases of brucellosis in humans in 25 municipalities since the beginning of 2019. Due mainly to the consumption of dairy products and unpasteurized derivatives, cases of brucellosis have been recurrent in the wilaya of Tiaret for several years. Blood samples from cattle and goats were collected as part of an epidemiological survey, in collaboration with the Mostaganem Regional Veterinary Laboratory, which has already confirmed cases of brucellosis in localities in the eastern part of the country in wilayat such as Zmalet Emir Aek and Ksar Chellala.

However, the services concerned, starting with the veterinary inspection of wilaya, have always warned against the consumption of natural raw milk without boiling or direct contact with the infected animal.  [Byline: El-Houari Dilmi]
=========================
[This infection, a bacterial zoonosis, is classified among the category B biowarfare agents. Natural transmission to humans occurs after occupational exposure or through ingestion of contaminated food products. Although brucellosis has become a rare entity in the United States and many industrialized nations because of animal vaccination programs, this condition remains a significant health problem in many developing countries.

Each species of _Brucella_ has a specific animal reservoir in which chronic disease is present. The bacilli tend to localize in the reproductive organs of the animals, causing sterility and abortions, and are shed in large numbers in the animal's urine, milk, and placental fluid. This localization allows for efficient spread to farmers, veterinarians, slaughterhouse workers, and consumers.

Among the 4 species known to cause disease in humans, _Brucella melitensis_ (from goats, sheep, or camels) may be the most virulent, producing the most severe and acute cases of brucellosis with disabling complications. A prolonged course of illness, which may be associated with suppurative destructive lesions, is associated with _B. suis_ (from feral or commercially raised pigs) infection. _B. abortus_ (from cattle, buffalo, and camels) is associated with mild-to-moderate sporadic disease that is rarely associated with complications.

In the Maghreb and the Middle East, human brucellosis is usually contracted through consumption of raw goat/ewe's milk or local artisanal cheese made from raw milk, and _Brucella melitensis_ is responsible for the great majority of the reported cases, with a marked predominance of its biovar 3, as in other Mediterranean countries. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
12th May 2019

Algeria - National.
8 May 2019. 358 confirmed cases [of Dengue] and 1100 records of patients with fever
Date: Thu 28 Feb 2019
Source: Algeria Press Service [In French, trans. by ProMED Corr.SB, abridged, edited]

An upsurge of cases of cutaneous leishmaniasis was observed in 2018 in the wilaya [administrative district] of Ghardaia, compared with previous years, reveals a report from the local direction of public health. Cases of cutaneous leishmaniasis, a parasitic zoonosis transmitted by the sandfly, numbered 444 in 2018 compared with 323 cases in 2017 and 383 cases in 2016.

The distribution of cases of cutaneous leishmaniasis corresponds broadly to the epidemiological situation of the past 5 years in the wilaya, always placing the region of Guerrara with 281 cases, followed by Ghardaia (55), Metlili (36) and Berriane (32), among the affected localities, the authorities say. This cutaneous-type pathology has been increasing in the wilaya, particularly in Guerrara, despite the establishment of a system for the control of epidemiological disease vectors and the construction of sanitation networks and other treatment plants in these areas.

The campaign against the infection has experienced several difficulties, including disturbances in the spraying of [insecticides] against the sandflies and disinfection of homes in several municipalities of the wilaya, the lack of environmental hygiene, and habitats for the animal reservoir in urban neighbourhoods. Many health facility officials, who have indicated that this zoonotic disease is a "heavy financial burden", also have indicated that leishmaniasis is likely to increase because of the deterioration of environmental health, living conditions and the environment, plus the anarchic urbanization that constitutes a "risk factor" in the wilaya.
=================
[Both Libya and Tunisia are endemic for leishmaniasis, most frequently cutaneous leishmaniasis. In Libya, the main species are _Leishmania major_ and _Leishmania infantum_. In Tunisia, _L. infantum_, _L. major_ and _Leishmania tropica_ are found with a high endemicity in the northern part of the country. For more details and maps with the distribution of leishmania in the 2 countries, please refer to Alvar J et al. Leishmaniasis worldwide and global estimates of its incidence. PLoS One 2012;7(5):e35671 <https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035671> -- S54 Libya and S91 Tunisia. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps:
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Ireland

Ireland US Consular Information Sheet
December 2, 2008
COUNTRY DESCRIPTION:
Ireland is a highly developed democracy with a modern economy. Tourist facilities are widely available.
Read the Department of State Background Notes on Irela
d for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport is necessary, but a visa is not required for tourist or business stays of up to three months.
Visit the Embassy of Ireland web site (www.irelandemb.org/) for the most current visa information, or contact the Embassy at 2234 Massachusetts Avenue, NW, Washington, DC
20008, tel: 1-202-462-3939, or the nearest Irish consulate in Boston, Chicago, New York or San Francisco.

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:
Ireland remains largely free of terrorist incidents.
While the 1998 ceasefire in Northern Ireland is holding, there have been incidents of violence in Northern Ireland associated with paramilitary organizations.
These have the potential for some spillover into Ireland.
Travelers to Northern Ireland should consult the Country Specific Information sheet for the United Kingdom and Gibraltar.

Several Americans have reported incidents of verbal abuse, apparently in reaction to U.S. policy on the war on terrorism.
As elsewhere in Europe, there have been public protests, which for the most part were small, peaceful and well policed.
Americans are advised, nonetheless, to avoid public demonstrations in general and to monitor local media when protests occur.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the United States and Canada, or for callers outside the United States and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.
CRIME:
Ireland has a low rate of violent crime.
There have been a limited number of incidents in which foreigners and tourists have been victims of assault, including instances of violence toward those who appear to be members of racial minority groups.
In addition, there have been several reported assaults in Dublin by small, unorganized gangs roaming the streets in the early morning hours after the pubs close.
There is a high incidence of petty crime – mostly theft, burglary and purse snatching – in major tourist areas.
Thieves target rental cars and tourists, particularly in the vicinity of tourist attractions, and some purse and bag snatching incidents in these areas have turned violent, especially in Dublin.
Travelers should take extra caution to safeguard passports and wallets from pickpockets and bag snatchers.

Crimes involving credit and debit cards and automated teller machines (ATMs) are also a concern.
Travelers should protect their PIN numbers at all times and avoid using ATM machines that appear to have been tampered with.
There has been an increase in Ireland of the use of “skimmers” on ATM machines, especially in tourist areas.
Skimmers are usually small electronic devices that are attached to the outside of an ATM machine in order to “skim” the ATM or credit card data for later criminal use.
Most ATMs in Ireland now have electronic warnings about their use and advise customers to look closely at the ATM before using it.


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 in Ireland, in addition to reporting to local police (Gardai), please contact the U.S. Embassy in Dublin for assistance.
The Embassy staff can, for example, assist you in finding appropriate medical care, contacting family members or friends, and learning how funds can 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.
The Irish Tourist Assistance Service (ITAS) is a free nationwide service offering support and assistance to tourists who are victimized while visiting Ireland. If you are a tourist victim of crime, report the incident to the nearest Garda Station (police station), which will contact ITAS.
All tourist victims of crime are referred to ITAS by the Gardai. To learn about possible compensation in the United States if you are a victim of a violent crime while overseas, see our information on Victims of Crime
The local equivalent to the “911” emergency line in Ireland is 999 or 122.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Modern medical facilities and highly skilled medical practitioners are available in Ireland.
Because of high demand, however, access to medical specialists can be difficult and admissions to hospitals for certain non-life-threatening medical conditions may require spending significant periods of time on waiting lists.
Those traveling to or intending to reside in Ireland who may require medical treatment while in the country should consult with their personal physicians prior to traveling.
Over-the-counter medication is widely available.
Irish pharmacists may not be able to dispense medication prescribed by your U.S. physician and may direct you to obtain a prescription from an Irish doctor before providing you with your required medication.
A list of Irish general practitioners in each area of Ireland may be obtained from the web site of the Irish College of General Practitioners at http://www.icgp.ie/go/find_a_gp. Emergency services usually respond quickly.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Ireland.

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’s) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.
FOOT AND MOUTH DISEASE: The Irish Department of Agriculture and Food advises all incoming passengers to Ireland that the current foot and mouth situation in Great Britain represents a high risk of the spread of disease to Ireland.
If you are traveling from Great Britain to Ireland and have visited a farm with cattle, sheep, goats or pigs on your travels, you must report to the Irish Department of Agriculture and Food office at the port of entry.
Fresh meat or unpasteurized milk products purchased in Great Britain may not be brought into Ireland.
If you are carrying any of these products, they must be disposed of in the bins provided at the port of entry.
For further information, please visit the Irish Department of Agriculture, Fisheries and Food at www.agriculture.gov.ie.
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 following information concerning Ireland is provided for general reference only and may not be totally accurate in a particular location or circumstance.
As driving is on the left side of the road in Ireland, motorists without experience in left-drive countries should be especially cautious.
Tourists driving on the wrong side of the road are the cause of several serious accidents each year.
Turning on red is not legal in Ireland.
The vast majority of rental cars are manual transmission; it can be difficult to find automatic transmission rental cars.
Road conditions are generally good, but once travelers are off main highways, country roads quickly become narrow, uneven and winding.
Roads are more dangerous during the summer and on holiday weekends due to an increase in traffic. As in the United States, police periodically set up road blocks to check for drunk drivers.
Penalties for driving under the influence can be severe.
More information on driving in Ireland can be found on the U.S. Embassy in Dublin‘s web site at http://dublin.usembassy.gov/service/other-citizen-services/other-citizen-services/driving.html.

For specific information concerning Irish driving permits, vehicle inspection, road tax and mandatory insurance, please visit the official tourism guide for Ireland at http://www.tourismireland.com.

Taxis are reasonably priced but availability varies with time of day and where you are in the country.
Bus service in the cities is generally adequate, although many buses are overcrowded and frequently late.
Intercity bus and train services are reasonably good.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Ireland’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Ireland’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:
Most Irish banks will not accept U.S. $100 bills.
ATMs are widely available, but some, particularly in rural areas, may not accept cards from U.S. banks.
Credit cards are widely accepted throughout Ireland.
A number of travelers have been told by their airline that their passport must remain valid for six months after their entry into Ireland.
The Government of Ireland has advised that this is a recommendation of the airline industry and is not an Irish legal requirement. Travelers must be in possession of a valid passport to travel.
Please see 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 Ireland’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use or trafficking in illegal drugs in Ireland 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 Ireland are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Ireland.
Americans without Internet access may register directly with the Embassy in Dublin.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located at 42 Elgin Road, Ballsbridge, Dublin 4.
The Embassy can be reached via phone at 353-1-668-8777, after hours number 353-1-668-9612, fax 353-1-668-8056, and online at http://dublin.usembassy.gov
*

*

*
This replaces the Country Specific Information for Ireland dated May 12, 2008, and updates sections on Information for Victims of Crime, Medical Facilities and Health Information, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Thu 10 Oct 2019
Source: Vax-Before-Travel [edited]

The Health Protection Surveillance Centre in Ireland reported an increase in typhoid fever notifications in travellers returning from Pakistan [<http://ndsc.newsweaver.ie/epiinsight/1npbbpsg5wm>]. According to the Irish authorities on [9 Oct 2019], there have been 23 cases of _Salmonella enterica_ serovar Typhi (_S._ Typhi) in 2019. This is the 1st time that cases of XDR typhoid fever have been identified by the national reference laboratory in Ireland.

The European Centre for Disease Prevention and Control (ECDC) reported 12 of these cases had a recent travel history to Pakistan [see item [2] below]. Unfortunately, 3 of these 12 cases of typhoid fever with travel history in Pakistan were infected with extensively drug-resistant (XDR) strains.

According to the WHO/EMRO bulletin, Pakistan is experiencing a continuous surge of XDR _S._ Typhi since 2016. As of August 2019, 10 365 cases of XDR typhoid fever were reported from 23 districts in Sindh province, with the Karachi district being the most affected, having 67 percent of the cases. Pakistan is the world's 6th-most populous country with a population exceeding 210 million people, located in South Asia.

The XDR _S._ Typhi strain acquired a plasmid that confers resistance to multiple antibiotics, including the 1st-line antibiotics chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole, as well as fluoroquinolones and 3rd-generation cephalosporins, says the ECDC. The strain remained susceptible to azithromycin and carbapenems. The increased resistance in typhoid fever limits treatment options and poses a threat to international spread.

In response, the US Centers for Disease Control and Prevention (CDC) issued a Level 1 Travel Alert regarding traveling to Pakistan in 2019 [<https://wwwnc.cdc.gov/travel/notices/watch/xdr-typhoid-fever-pakistan>]. This 'Practice Usual Precautions' Travel Alert published on [30 Sep 2019], is very important since, in rare cases, typhoid fever can be fatal.

According to the Pakistan Tourism Development Corporation, about 1.75 million tourists visited Pakistan in 2017 alone.

The CDC says 'if you are going to South Asia, including Pakistan, protect yourself against typhoid infection by getting a typhoid fever vaccination.' The CDC's Advisory Committee on Immunization Practices (ACIP) recommends 2 typhoid fever vaccines, an oral vaccine, Vivotif, and an injectable vaccine, Typhim VI. The oral vaccine Vivotif is approved for people 6 years of age or older and should be taken as directed, at least one week before departure. The injectable vaccine is approved for people 2 years of age or older. Travelers should receive the injectable vaccine Typhim VI at least 2 weeks before departure. Neither vaccine is 100 percent effective, so travellers should also practice safe eating and drinking while traveling abroad, says the ACIP.

Typhoid fever is a serious disease caused by the bacterium _Salmonella_ Typhi, spread by contaminated food and water. Humans are the only source of these bacteria. The incubation period of typhoid and paratyphoid infections is 6-30 days, says the CDC. Symptoms of typhoid fever often include high fever, weakness, stomach pain, headache, cough, and loss of appetite. People may have diarrhoea or constipation.

If you travel abroad and get sick while traveling, seek medical care ASAP. If you get sick after returning to the United States, seek medical care and tell your health care provider where and when you traveled. Do not prepare food for other people, says the CDC.

An estimated 26 million cases of typhoid fever and 5 million cases of paratyphoid fever occur worldwide each year, causing 215,000 deaths.

Also, the CDC says to ensure you are up-to-date on several vaccinations before visiting Pakistan. These vaccines and related medications can be found at most travel pharmacies in the USA.

Travel Alert news is published by Vax-Before-Travel
Date: Sun 8 Sep 2019
Source: Irish Mirror [abridged, edited]

A TD [member of the Irish Parliament] has warned of "serious repercussions" after it was revealed the child vaccination uptake has dropped into the World Health Organisation (WHO) red zone. Statistics from the Health Protection Surveillance Centre show up to 25% of infants and toddlers are not receiving shots in parts of Ireland.

Sinn Fein spokeswoman Louise O'Reilly said: "We need to get past all the misinformation on social media and the anti-vaxxers and talk to parents face to face."

Fears are growing that highly contagious diseases such as measles could run rampant again, with experts warning of a possible epidemic.

Officials from the European Centre for Disease Prevention and Control have recorded 10,958 cases of the illness -- which can prove fatal -- across the continent from January to [14 Jul] this year [2019]. It is the worst performance in over a decade and the 1st time the country has been in the range since the anti-vax movement began.

EU countries worst affected are France, Bulgaria, Italy, Poland and Lithuania -- but the slump in Ireland means we could soon be facing an epidemic of our own. The number of measles cases reported tripled last year [2018] with 77 cases -- up from just 25 in 2017.  [Byline: Ailbhe Daly]
Date: Fri 17 May 2019 16:33 IST
Source: Breaking News Irish Examiner Reporter [abridged, edited]

There have been 58 reports of measles recorded so far this year [2019], according to the HSE's [Health Service Executive] Health Protection Surveillance Centre [HPSC].

Another 2 cases were reported to the HPSC in the past week -- one from the Eastern Regional Health Authority and the other from the Southern Health Board. The 2 people affected were both female and aged between 15 and 34 years.

The HSE's assistant national director of health protection, Dr Keven Kelleher, has warned that cases of measles are set to rise over the summer [2019].

There has been an increase in measles, an acute viral disease, throughout the world and cases are spreading because people are travelling more.

Dr Kelleher said measles is very active throughout southern Europe.

Current vaccination rates are not good enough currently, with take-up rates up to 8% below what they should in some parts of the country.  [Byline: Evelyn Ring]
========================
[HealthMap/ProMED-mail map of Ireland:
Date: Wed 17 Apr 2019
Source: Leitrim Observer [abridged, edited]

The HSE [Ireland's national health service] says it "had not seen diseases like measles in Donegal, Sligo or Leitrim for a number of years, because 95% of children were vaccinated against them. Last year [2018], the uptake of childhood vaccinations dropped slightly in Donegal, and this resulted in an outbreak of measles in January this year [2019]."

The HSE says "There is also an ongoing mumps outbreak across Donegal, Sligo and Leitrim. The HSE has been notified of 116 cases so far.

"As soon as vaccination rates fall, diseases like measles and mumps return. Fortunately, the majority of people in Donegal, Sligo and Leitrim are protecting their children with vaccination. The most recent figures for 2018 show that 90% of children in Donegal received the MMR and 93% of children in Sligo and Leitrim received it.

"However, over 95% of children need to be vaccinated with the MMR in order to prevent the spread of measles in our community. This is the goal for 2019, as it is really important for 'herd immunity'. In this way, we can protect new-borns and vulnerable children, including those with cancer or immune problems who can't get vaccinated, from coming in contact with measles and other diseases like meningitis."

This year [2019] European Immunisation Week runs 24-30 Apr. The goal is to raise awareness of the benefits of vaccination and to celebrate the vaccine heroes who contribute to protecting lives through vaccination. Vaccine heroes include health workers who administer vaccines, parents who choose vaccination for their children, and everyone who promotes vaccination.

"Every parent wants to protect their child and do what's right for them. Sometimes it can be difficult to know what to do, now that there is so much false and misleading information on the internet and social media when it comes to vaccination," says Dr. Laura Heavey, Specialist Registrar in Public Health Medicine in HSE North West, "I would really encourage parents to look for information in the right places. Two good sources of reliable, evidence-based information are <www.immunisation.ie> and the Vaccine Knowledge Project at <http://vk.ovg.ox.ac.uk/>. Essentially all of the vaccines on the infant, child and adolescent schedule in Ireland are backed up with years of data on their safety."

Another goal for the HSE in 2019 is to continue to increase the uptake of the HPV vaccine in teenagers. In 2018, 70% of teenage girls in Ireland got the vaccine. In Scotland, where HPV vaccination started over 10 years ago and 90% of teenage girls get the HPV vaccine, researchers have found that the vaccine has nearly wiped out cases of cervical pre-cancer in young women. We want to see as many Irish teenagers as possible getting vaccinated in 2019, so that we can see those same results here. This year [2019], the vaccine will also be offered to teenage boys. If all our young people receive the vaccine, cervical cancer could be eliminated in Ireland in the future.
========================
[HealthMap/ProMED-mail map of Ireland:
Date: Wed 27 Feb 2019
Source: The Times [abridged, edited]

A total of 384 cases mumps have been reported this year [2019] from Irish Universities, HSE figures have shown.

There were 64 new cases reported last week, bringing the total to 384 since the start of the year [2019]. The number of cases has been rising steadily in recent weeks, with 278 in the 1st 6 weeks of the year. Last year [2018] there had been 52 cases by the end of February. There were 576 cases in total last year [2018].  [Byline : Catherine Sanz]
===================
[Also see ProMED-mail Mumps update (02): USA (CO, TX), Europe (Ireland) http://promedmail.org/post/20190221.6329434 for more on the outbreak in Ireland. - ProMED Mod.LK]

["Before the U.S. mumps vaccination program started in 1967, about 186,000 cases were reported each year, but the actual number of cases was likely much higher due to underreporting. Since the pre-vaccine era, there has been a more than 99% decrease in mumps cases in the United States. Since the 2-dose vaccination program was introduced in 1989, mumps cases have ranged year to year from a couple of hundred to several thousand.

However, in recent years, there has been an increase in the number of reported cases, from 229 cases in 2012 to 6366 cases in 2016. The recent increase has been mainly due to multiple mumps outbreaks reported across the country in settings where people often have close contact with one another, like college campuses." CDC (<https://www.cdc.gov/mumps/outbreaks.html>). - ProMED Mod.LK]
More ...

Bolivia

Bolivia US Consular Information Sheet
July 19, 2006

COUNTRY DESCRIPTION: Bolivia is a constitutional democracy and one of the least-developed countries in South America. Tourist facilities are generally adequate, but vary greatly in qualit
. The capital is La Paz, accessible by Bolivia's international airport in El Alto. Read the Department of State Background Notes on Bolivia for additional information.

ENTRY/EXIT REQUIREMENTS: A U.S. passport valid for at least six months from the date of proposed entry into Bolivia is required to enter and depart Bolivia. U.S. citizen tourists do not need a visa for a stay of one month or less (that period can be extended up to 90 days upon application to the Bolivian immigration authorities). Visitors for other purposes must obtain a visa in advance. U.S. citizens whose passports are lost or stolen in Bolivia must obtain a replacement passport and present it, together with a police report of the loss or theft, to a Bolivian government immigration office in order to obtain permission to depart. For more information on replacement passport procedures, please consult the U.S. Embassy's Web site at . An exit tax is charged when departing Bolivia by air. Travelers with Bolivian citizenship or residency pay an additional fee upon departure. While the Bolivian Government does not require travelers to purchase round-trip air tickets in order to enter the country, some airlines have required travelers to purchase round-trip tickets prior to boarding aircraft bound for Bolivia. Some tourists arriving by land report that immigration officials did not place entry stamps in their passports, causing problems at checkpoints and upon departure. See our Foreign Entry Requirements brochure for more information on Bolivia and other countries. Visit the Embassy of Bolivia web site at for the most current visa information (please note that the web site is primarily in Spanish).

Bolivian consulates are located in Houston, Los Angeles, Miami, Oklahoma City, New York, San Francisco, and Seattle. For information on in-country visa procedures and requirements, please consult the Bolivian Immigration Service at (please note that the web site is in Spanish), fax/telephone (591-2) 211-0960, street address Avenida Camacho entre Loayza y Bueno, La Paz, Bolivia. See Entry and Exit Requirements for more information pertaining to dual nationality and the international child abduction . Please refer to our Customs Information to learn more about customs regulations.

ADDITIONAL REQUIREMENTS FOR MINORS: In an effort to prevent international child abduction, the Bolivian Government has initiated procedures at entry/exit points. Minors (under 18) who are citizens or residents of Bolivia and who are traveling alone, with one parent or with a third party, must present a copy of their birth certificate and written authorization from the absent parent(s) or legal guardian, specifically granting permission to travel alone, with one parent or with a third party. When a parent is deceased, a notarized copy of the death certificate is required in lieu of the written authorization. If documents are prepared in the United States, the authorization and the birth certificate must be translated into Spanish, notarized, and authenticated by the Bolivian Embassy or a Bolivian consulate within the United States. If documents are prepared in Bolivia, only notarization by a Bolivian notary is required. Using these documents, a t ravel permit may be obtained from the Juzgado del Menor. This requirement does not apply to children who enter the country with a U.S. passport as tourists, unless they hold dual U.S./Bolivian citizenship or have been in Bolivia for more than 90 consecutive days.

SAFETY AND SECURITY: The countrywide emergency number for the police, including highway patrol, is 110. The corresponding number for the fire department is 119. The National Tourism Police has an office in La Paz, with plans to expand to Cochabamba and Santa Cruz, providing free assistance to tourists 24 hours a day. These services include English-speaking officials who may assist tourists in filing police reports of lost/stolen documents or other valuables. The La Paz office is located at Plaza del Stadium, Edificio Olympia, planta baja, Miraflores, telephone number 222-0516.

Protests, strikes, and other civic actions can occur at any time and disrupt transportation on a local and national level. This is particularly true before, during and after elections or other changes in government. While protest actions generally begin peacefully, they have the potential to become violent. The police have used tear gas to break up protests. In addition to rallies and street demonstrations, protesters sometimes block roads; they sometimes react with force when travelers attempt to pass through or go around roadblocks and occasionally have used the threat of explosives to press their point.

U.S. citizens should avoid roadblocks and demonstrations. Demonstrations protesting government or private company policies occur frequently, even in otherwise peaceful times. Roadblocks and demonstrations in June 2005 led to the closure of the El Alto airport in La Paz, resulting in cancellation and diversion of flights and other inconveniences to travelers. U.S. citizens planning travel to or from Bolivia should take into consideration the possibility of disruptions to air service in and out of La Paz and other airports. Americans should monitor Bolivian media reports for updates. The Embassy strongly recommends that U.S. citizens avoid areas where roadblocks or public demonstrations are occurring or planned. Political rallies should similarly be avoided in light of press reports of violence at some rallies in various parts of Bolivia.

U.S. citizens who find themselves in a roadblock should not attempt to "run" a roadblock, as this may aggravate the situation and lead to physical harm. Taking alternative, safe routes, or returning to where the travel started may be the safest courses of action under these circumstances. U.S. citizens embarking on road trips should monitor news reports and may contact the American Citizen Services Unit of the U.S. Embassy in La Paz at (591)(2)(216-8297 or the U.S. consular agencies in Cochabamba at (591)(4)425-6714 and/or Santa Cruz at (591) (3) 351-3477 for updates. Given that roadblocks may occur without warning and have stranded travelers for several days, travelers should take extra food and water. The U.S. Embassy also advises its employees to maintain at least one week's supply of drinking water and canned food in case roadblocks affect supplies, as occurred in June 2005. For more information on emergency preparedness, please consult the Federal Emergency Management Authority (FEMA) Web site at . That Web site includes a Spanish language version.

Americans living or traveling in Bolivia are encouraged to register and update their contact information at the U.S. Embassy in La Paz and/or the U.S. consular agencies in Cochabamba and Santa Cruz, Bolivia. Registration may be done online and in advance of travel. Information on registering may be found at the Department of State's Consular Affairs website .

In February and October 2003, approximately one hundred people died during violent demonstrations and protests in downtown La Paz and the nearby city of El Alto. These demonstrations also affected Cochabamba and other towns and villages in the Altiplano. While the protests and demonstrations subsided, many of the underlying social, political, and economic causes remain, and in March 2005, several intercity roads, including Bolivia's major east-west highway, were closed by blockades for several weeks.

Since 2000 the resort town of Sorata, located seventy miles north of La Paz, has been cut off by blockades on three occasions, ranging from one week to one month. Visitors contemplating travel to Sorata should contact the Consular Section in La Paz prior to travel.

In the Chapare region between Santa Cruz and Cochabamba and the Yungas region northeast of La Paz violence and civil unrest, primarily associated with anti-narcotics activities, periodically create a risk for travelers to those regions.

Confrontations between area residents and government authorities over coca eradication have resulted in the use of tear gas and stronger force by government authorities to quell disturbances. Pro-coca groups have expressed anti-U.S. sentiments and may attempt to target U.S. Government or private interests. U.S. citizen visitors to the Chapare or Yungas regions are encouraged to check with the Consular Section of the U.S. Embassy prior to travel. Violence has also erupted recently between squatters unlawfully invading private land and security forces attempting to remove them.

For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site , where the current Worldwide Caution Public Announcement , Travel Warnings and Public Announcements 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: The U.S. Department of State currently classifies Bolivia as a medium to high crime threat country. Street crime, such as pick pocketing and theft from parked vehicles, occurs with some frequency in Bolivia. Theft of cars and car parts, particularly late-model four-wheel-drive vehicles, is common. Hijacking of vehicles has occurred, and travelers should take appropriate precautions to avoid being victimized. In November 2003, an American citizen was murdered during an attempted carjacking in Santa Cruz.

Bolivian police state that there are currently eight organized criminal groups operating in the La Paz area. The techniques employed by these groups vary, but there are a few major patterns that can be identified.

There have been reports of "false police" -- persons using police uniforms, identification, and even buildings modified to resemble police stations -- intercepting and robbing foreign tourists. Under Bolivian law, police need a warrant from the "fiscal" or prosecutor to detain a suspect. Any searches or seizures must occur at a bona fide police station in the presence of the fiscal. The warrant requirement also applies to suspected drug trafficking cases, although such searches and seizures may occur without a fiscal present. If detained, U.S. citizens should request to see the warrant and demand immediate contact with the nearest U.S. Consular Office (in La Paz, Cochabamba or Santa Cruz).

According to press reports, criminals using the "false police" method focus on foreigners in areas frequented by tourists including bus terminals and tourist markets such as Sagarnaga Street in La Paz. The perpetrators will identify a potential victim and have an accomplice typically driving a white taxi offer taxi services to the potential victim. They focus on European/American tourists who are not wearing a traditional "trekker" backpack and are traveling without a large number of bags. A few blocks after the potential victim boards the taxi another accomplice, pretending to be a recently arrived tourist, boards the taxi with the potential victim. With all the accomplices then in place, the "false police" stop the taxi, "search" the passengers, and rob the victim. As part of this scam, the false police may take the victim to a "false police" station.

A similar variation also introduces a "tourist" to the victims. This introduction can take place on a bus, taxi, train, or just walking down the street. The "tourist" will befriend the victims and might seek assistance in some manner. After a period of time, the "police" intercept the victims and the "tourist." At this point, the "police" discover some sort of contraband (usually drugs) on the "tourist." The entire group is then taken to the "police station." At this point, the "police" seize the documents, credit cards, and ATM cards of the victims. The perpetrators obtain pin numbers, sometimes by threat of violence, and the scam is complete.

Another technique again introduces a "tourist" to the victims. This "tourist" can be any race or gender and will probably be able to speak the language of the victims. This meeting can happen anywhere and the goal of the "tourist" is to build the trust of the victims. Once a certain level of trust is obtained, the "tourist" suggests a particular mode of transportation to a location (usually a taxi). The "taxi" picks up the victims and the "tourist" and delivers the group to a safe house in the area. At this point the victims are informed that they are now kidnapped and are forced to give up their credit cards and ATM cards with pin numbers.

Bolivian police sources state that two Austrian citizens fell victim to this scam and had their bank accounts emptied through use of their ATM card. The perpetrators then suffocated the victims and buried them in clandestine graves, where police found their bodies on April 3, 2006. During that timeframe, a Spanish citizen also purportedly fell prey to this scam, and his body was found nearby.

In most instances, the victims are released, but the murder of the victims is still a possibility. The techniques and the perpetrators are convincing. Authentic uniforms, badges, and props help persuade the victims that the situation is real and valid. All tourists visiting Bolivia should exercise extreme caution. Visitors should be suspicious of all "coincidences" that can happen on a trip. If the tourist has doubts about a situation, the tourist should immediately remove him/herself from the scene.

Thefts of bags, wallets, and backpacks are a problem throughout Bolivia, but especially in the tourist areas of downtown La Paz and the Altiplano. Most thefts involve two or three people who spot a potential victim and wait until the bag or backpack is placed on the ground, often at a restaurant, bus terminal, Internet café, etc. In other cases, the thief places a disagreeable substance on the clothes or backpack of the intended victim, and then offers to assist the victim with the removal of the substance. While the person is distracted, the thief or an accomplice grabs the bag or backpack and flees. In such a situation, the visitor should decline assistance, secure the bag/backpack, and walk briskly from the area. To steal wallets and bags, thieves may spray water on the victim's neck, and while the person is distracted, an accomplice takes the wallet or bag. At times the thief poses as a policeman, and requests that the person accompany him to the police station, using a nearby taxi. The visitor should indicate a desire to contact the U.S. Embassy and not enter the taxi. Under no circumstances should you surrender ATM or credit cards, or release a PIN number. While most thefts do not involve violence, in some instances the victim has been physically harmed and forcibly searched for hidden valuables. Visitors should avoid being alone on the streets, especially at night and in isolated areas.

Five years ago female tourists reported being drugged and raped by a tourist guide in the city of Rurrenabaque in the Beni region. Visitors should be careful when choosing a tour operator and should not accept any type of medication or drugs from unreliable sources. The Embassy has received reports of sexual assaults against female hikers in the Yungas Valley, near the town of Coroico. Visitors to Coroico are advised to avoid hiking alone or in small groups.

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 may 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 care in large cities is adequate for most purposes but of varying quality. Ambulance services are limited-to-non-existent. Medical facilities are generally not adequate to handle serious medical conditions. Pharmacies are located throughout Bolivia, and prescription and over the counter medications are widely available. Western Bolivia, dominated by the Andes and high plains (Altiplano), is largely insect-free. However, altitude sickness (see below) is a major problem. Eastern Bolivia is tropical, and visitors to that area are subject to related illnesses. In March 2005, several cases of yellow fever were reported in the Chapare region. News media periodically report outbreaks of rabies, particularly in the larger cities.

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 Internet site at . For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at . Further health information for travelers is available at .

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. Most medical evacuation flights cannot land at the airport serving La Paz due to the altitude; instead flights may need to use the international airport in Santa Cruz, Bolivia. Please see our information on medical insurance overseas .

HIGH-ALTITUDE HEALTH RISKS: Official U.S. Government travelers to La Paz are provided with the following information: The altitude of La Paz ranges from 10,600 feet to over 13,000 feet (3,400 to 4,000 meters) above sea level. Much of Western Bolivia is at the same altitude or higher, including Lake Titicaca, the Salar de Uyuni, and the cities of Oruro and Potosi. The altitude alone poses a serious risk of illness, hospitalization, and even death, if you have a medical condition that affects blood circulation or breathing.

Prior to departing the U.S. for high-altitude locations (over 10,000 feet above sea level), travelers should discuss the trip with their personal physician and request information on specific recommendations concerning medication and lifestyle tips at high altitudes. Coca-leaf tea is a popular beverage and folk remedy for altitude sickness in Bolivia. Possession of this tea, which is sold in bags in most Bolivian grocery stores, is illegal in the United States.

The State Department's Office of Medical Services does not allow official U.S. Government travelers to visit La Paz if they have any of the following:

Sickle cell anemia or sickle cell trait: 30 percent of persons with sickle cell trait are likely to have a crisis at elevations of more than 8,000 feet.
Heart disease: A man 45 years or older, or a woman 55 years or older, who has two of the following risk factors (hypertension, angina, diabetes, cigarette smoking, or elevated cholesterol) should have a stress EKG and a cardiological evaluation before the trip.
Lung disease: Anyone with asthma and on maximum dosage of medication for daily maintenance, or anyone who has been hospitalized for asthma within the last year should not come to La Paz and surrounding areas.
Given potential complications from altitude sickness, pregnant women should consult their doctor before travel to La Paz and other high-altitude areas of Bolivia.
All people, even healthy and fit persons, will feel symptoms of hypoxia (lack of oxygen) upon arrival at high altitude. Most people will have increased respiration and increased heart rate. Many people will have headaches, difficulty sleeping, lack of appetite, minor gastric and intestinal upsets, and mood changes. Many travelers limit physical activity for the first 36 to 48 hours after arrival and avoid alcohol and smoking for at least one week after arrival.

For additional information, travelers should visit the World Health Organization's website at as well as the CDC's travel warning on high altitude sickness at .

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 Bolivia is provided for general reference only, and may not be totally accurate in a particular location or circumstance. U.S. citizens planning on driving in Bolivia, despite the hazards described below, should obtain an international driver's license through their local automobile club before coming to Bolivia.

Road conditions in Bolivia are hazardous. Although La Paz, Santa Cruz, and Cochabamba are connected by improved highways, the vast majority of roads in Bolivia are unpaved. Few highways have shoulders, fencing or barriers, and highway markings are minimal. Yielding for pedestrians in the cities is not the norm. For trips outside the major cities, especially in mountainous areas, a four-wheel-drive vehicle is highly recommended. Travel during the rainy season (November through March) is difficult, as most routes are potholed, and some roads and bridges are washed out. Added dangers are the absence of formal training for most drivers, poor maintenance and overloaded vehicles, lack of lights on some vehicles at night, and intoxicated or overly tired drivers, including commercial bus and truck drivers.

The majority of intercity travel in Bolivia is by bus, with varying levels of safety and service. In recent years there have been major bus crashes on the highway between La Paz and Oruro, and on the Yungas road. The old Yungas road is considered one of the most dangerous routes in the world. Taxis, vans, and buses dominate intracity transportation. From a crime perspective, public transportation is relatively safe and violent assaults are rare. However, petty theft of unattended backpacks and other personal items does occur. For reasons of safety, visitors are advised to use radio taxis whenever possible.

Drivers of vehicles involved in traffic accidents are expected to remain at the scene until the arrival of local police authorities. Any attempt to leave the scene is in violation of Bolivian law. The Embassy believes any attempt to flee the scene of an accident would place the driver and passengers at greater risk of harm than remaining at the scene until the arrival of local police. 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 Bolivia as being in compliance with ICAO international aviation safety standards for oversight of Bolivia's air carrier operations. For more information, travelers may visit the FAA's Internet web site at www.faa.gov/avr/iasa/index.cfm . There are limited flights within Bolivia and to neighboring countries. Flight delays and cancellations are common. In February and March 2006, strikes at national carrier Lloyd Aereo Boliviano led to the cancellation of both national and international flights with resultant delays and other inconveniences for travelers.

SPECIAL CIRCUMSTANCES: In the run-up to the July 2006 Constituent Assembly elections, President Morales accused the United States military of infiltrating Bolivia with operatives disguised as "students and tourists." As an apparent result of these comments, some U.S. citizens have reported harassment by Bolivian officials and been subjected to unwanted media attention. In one case, a local Bolivian newspaper wrongly identified an American citizen as an operative for the Central Intelligence Agency. Americans planning on traveling to Bolivia should be aware of the political atmosphere and the possibility of unwanted attention from pro-governmental groups and other Bolivian officials.

For information on in-country visa procedures and requirements, please consult the Bolivian Immigration Service at (please note that the Web site is in Spanish), fax/telephone (591-2) 211-0960, street address Avenida Camacho entre Loayza y Bueno, La Paz, Bolivia. In emergency cases, the Immigration Service may permit temporary residency applicants to retrieve their passports from those applications. However, under current regulations in such cases the applicant would need to commence the application anew, including paying the corresponding fees. Any U.S. documents, such as birth, marriage, divorce or death certificates, to be presented in Bolivia must first be authenticated in the U.S. at the nearest Bolivian Embassy or consulate. For information on those procedures, please consult the Department of State Office of Authentications web site, www.state.gov/m/a/auth , and the nearest Bolivian Embassy or consulate.

Please see our information on customs regulations .
MARRIAGE: Please see our information on marriage in Bolivia , available on the Embassy's Web site at
MOUNTAIN TREKKING AND CLIMBING SAFETY: U.S. citizens are advised to exercise extreme care when trekking or climbing in Bolivia. Since June 2002, four American citizens have died in falls while mountain climbing in Bolivia. Three of the deaths occurred on Illimani, a 6,402-meter peak located southeast of La Paz. Many popular trekking routes in the Bolivian Andes cross passes as high as 16,000 feet. Trekkers must have adequate clothing and equipment, not always available locally, and should be experienced mountain travelers. It is not prudent to trek alone. Solo trekking is the most significant factor contributing to injuries and robberies. The safest option is to join an organized group and/or use a reputable firm to provide an experienced guide and porter who can communicate in both Spanish and English. If you develop any of the following symptoms while climbing at altitude - severe headache, weakness, vomiting, shortness of breath at rest, cough, chest tightness, unsteadiness - descend to a lower altitude immediately. Trekkers and climbers are strongly encouraged to purchase adequate insurance to cover expenses in case of injury or death.

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 Bolivian laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Bolivia 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 .

It often takes years to reach a decision in Bolivian legal cases, whether involving property disputes, civil, or criminal matters. Depending on the circumstances of the case, the court can order a defendant held in jail for the duration of the case. Prison conditions are primitive, and prisoners are expected to pay for food and lodging. For further information, please see the Annual Human Rights Report for Bolivia at . Lists of local Bolivian attorneys and their specialties are available from the Consular Section of the U.S. Embassy in La Paz and the Consular Agencies in Santa Cruz and Cochabamba, and may also be found on our Web site at .

CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website . Pending U.S. implementation of the Hague Convention on International Adoptions, under Bolivian law U.S. citizens who are not resident in Bolivia are not permitted to adopt Bolivian children./p>

REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Bolivia are encouraged to register with the nearest U.S. Embassy or Consular Agency through the State Department's travel registration website, and to obtain updated information on travel and security within Bolivia. Americans without Internet access may register directly with the nearest U.S. Embassy or Consular Agencies in Cochabamba and Santa Cruz. By registering, American citizens make it easier for the Embassy or Consular Agency to contact them in case of emergency.

The U.S. Embassy is located at 2780 Avenida Arce in La Paz, between calles Cordero and Campos; telephone (591-2) 216-8297 during business hours 8:30 a.m.-5:30 p.m., or (591-2) 216-8000 for after-hours emergencies; fax (591-2) 216-8808; Internet . The U.S. Embassy in La Paz is open for American Citizen Services Monday through Thursday from 1:30PM to 5:00PM and Fridays from 08:30 to12:30 and from 2:00PM to 4:00PM, except U.S. and Bolivian holidays. Questions should be directed to the email address USCit.Services.Bolivia@gmail.com or consularlapaz@state.gov .

There are two consular agencies in Bolivia, which provide limited services to American citizens, but are not authorized to issue passports. Anyone requesting service at one of the consular agencies should call ahead to verify that the service requested would be available on the day you expect to visit the agency.

Santa Cruz: The Consular Agency in Santa Cruz is located at 146 Avenida Roque Aguilera (Tercer Anillo); telephone (591-3) 351-3477, 351-3479, or 351-3480; fax (591-3) 351-3478. The U.S. Consular Agency in Santa Cruz is open to the public Mondays from 09:00 to 12:30 and from 2:00PM to 5:00PM and on Tuesday through Friday from 09:00 to 12:30, except U.S. and Bolivian holidays.

Cochabamba: The Consular Agency in Cochabamba is located at Avenida Oquendo 654, Torres Sofer, room 601; telephone (591-4) 411-6313; fax (591-4) 425 -6714. The U.S. Consular Agency in Cochabamba is open Monday through Friday from 9:00 a.m. - 12:00 noon, excluding U.S. and Bolivian holidays.
* * *
This replaces the Consular Information Sheet dated April 4, 2006 to update Entry/Exit Requirements, Safety and Security, Crime, Marriage, Special Circumstances and web links.

Travel News Headlines WORLD NEWS

Date: Tue, 22 Oct 2019 09:57:15 +0200 (METDST)
By Tupad POINTU

La Paz, Oct 22, 2019 (AFP) - Bolivia braced for a general strike on Tuesday hours after violence broke out in several cities when the main opposition candidate rejected presidential election results that seemed set to hand a controversial victory to long-time incumbent Evo Morales.   Opposition supporters reacted with fury, torching electoral offices in the southwestern cities of Sucre and Potosi, while rival supporters clashed in the capital La Paz.    Incidents were reported in cities across the South American country.   Carlos Mesa, who came a close second to Morales in Sunday's polls -- forcing a run-off, according to preliminary results -- denounced revised results released by election authorities as a "fraud."   "We are not going to recognize those results that are part of a shameful, consumated fraud, that is putting Bolivian society in a situation of unnecessary tension," said Mesa.

International monitors from the Organization of American States voiced "deep concern" at sudden changes to the election count to show Morales closing in on an outright victory in the first round.   Preliminary results released late Sunday showed neither Morales, 59, nor 66-year-old Mesa with a majority and "clearly indicated a second round," the OAS mission said.   The partial results put Morales in the lead with 45 percent of the votes, with Mesa on 38 percent, meaning Morales would have to contest a run-off for the first time.   But results released late Monday, after a long and unexplained delay, showed Morales edging towards an outright victory with 95 percent of the votes counted.   Mesa, a former president of the country between 2001-2005, accused Morales of colluding with the Supreme Electoral Tribunal (TSE) to tweak delayed results and avoid a run-off.

- Opposition call general strike -
The call for a general strike was issued by Fernando Camacho, head of an influential civil society organization in Bolivia's biggest city, Santa Cruz, where transport and businesses were expected to shut down from noon.   "Tomorrow we start at 12:00 to block this country," Camacho told opposition demonstrators late Monday, before holding talks with leaders from other regions.   Long lines formed at gas stations amid fears of shortages.   Riot-police dispersed a crowd who tried to storm the electoral offices in the Andean city of Oruro, south of La Paz.    Clashes were also reported in Tarija in the south, Cochabamba in the center and Cobija in the north.

- 'Subverting democracy' -
The United States' top diplomat for Latin America said the Electoral Tribunal was attempting "to subvert Bolivia's democracy by delaying the vote count and taking actions that undermine the credibility of Bolivia's elections."   "We call on the TSE to immediately act to restore credibility in the vote counting process," the official, Michael Kozak, said on Twitter.   The OAS observer mission in the country expressed "surprise at the drastic and hard-to-explain change in the trend of the preliminary results revealed after the closing of the polls," it said in a statement.   It urged the election authority to "firmly defend the will of the Bolivian people" and called for calm on the streets.   "It is extremely important that calm is maintained and any form of violence is avoided in this delicate situation."

- Longest serving president -
Morales, Latin America's longest-serving president, is controversially seeking a fourth term.   He obtained Constitutional Court permission in 2017 to run again for president even though the constitution allows only two consecutive terms.   The former coca farmer and leftist union leader has led the poor but resource-rich Latin American country for the past 13 years, though his popularity has waned amid allegations of corruption and authoritarianism.   He has led the country since taking office in 2006, when he became its first indigenous president.

A new mandate would keep him in power until 2025.   As leader of his Movement for Socialism Party (MAS), Morales points to a decade of economic stability and considerable industrialization as his achievements, while insisting he has brought "dignity" to Bolivia's indigenous population, the largest in Latin America.   He has come under severe criticism this year as wildfires in August and September ravaged Bolivia's forests and grasslands, with activists saying his policies encouraged the use of blazes to clear farmland.
Date: Wed 7 Aug 2019
Source: El Deber [in Spanish trans. ProMED Mod.TY, edited]

Soldier LC, who completed his military service in the Bolivian Condors School (ESCONBOL) in Sanadita, died of [a] hantavirus [infection], according to laboratory results issued this [Wed 31 Jul 2019] by the National Center for Tropical Diseases (CENETROP) of the Tarija Department of Health Service (SEDES).

The Chief of Epidemiology, Claudia Montenegro, confirmed that the conscript died from this disease that is transmitted by the long-tailed rat and that he had been infected in a forest locality near to the Campo Largo community, where he was from.

According to Montenegro, this is the 15th hantavirus [infection] case reported in Tarija department in 2019; 5 of them died.

The hantavirus cases correspond to patients from Bermejo and the Chaco region where the rat that carries [the] hantavirus lurks.  [Byline: David Maygua]
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[The case count is now up to 15 in Tarija department; 5 of them, including the case above, died. As noted in earlier posts, cases of hantavirus infections in Tarija department are not new. The department is endemic for hantaviruses, and cases occur there sporadically. Last year (2018), there were 11 cases. The previously reported 2015 cases of hantavirus pulmonary syndrome (HPS) that occurred in Tarija department were confirmed. As noted in the previous comments, earlier cases of hantavirus pulmonary syndrome have been reported from tropical, lowland areas of Bolivia, including 7 cases in Tarija during 2014. The specific hantaviruses involved in these or previous cases in Bolivia were not given.

In the lowland Amazon Basin of Bolivia, the rodent hosts of the hantavirus that might be involved in these hantavirus pulmonary syndrome (HPS) cases, with their images, include the following:
- Laguna Negra virus (small vesper mouse, _Calomys laucha_ <http://www.faunaparaguay.com/calomyslaucha.html> and large vesper mouse, _C. callosus_
- Bermejo (Chaco rice rat, _Oligoryzomys chacoensis_
- Oran (long- tailed pygmy rice rat, _O. longicaudatus_

Since previous cases in Tarija department have occurred in Bermejo, perhaps Bermejo hantavirus was involved.

Dr Jan Clement commented earlier that there is a need to be able to differentiate Seoul orthohantavirus (SEOV) as a causative agent, but that is hampered by the fact that most current commercial ELISA or WB (Western Blot) formats no longer contain a SEOV antigen, so that a preliminary presumption of a hantavirus infection can even be missed in non-research laboratories (Clement J, LeDuc JW, Lloyd G, et al. Wild rats, laboratory rats, pet rats: global Seoul hantavirus disease revisited. Viruses. 2019; 11(7): 652; pii: E652; <https://www.mdpi.com/1999-4915/11/7/652/htm>; and Reynes JM, Carli D, Bour JB et al. Seoul virus infection in humans, France, 2014-2016. Emerg Infect Dis. 2017; 23(6): 973-7; <https://wwwnc.cdc.gov/eid/article/23/6/16-0927_article>.

SEOV is widely distributed around the world in the brown rat and is likely found in Tarija department. - ProMED Mod.TY]

[Maps of Bolivia:
Date: Wed 17 Jul 2019
Source: El Deber [in Spanish trans. ProMED Mod.TY, edited]

The 1st 3 cases of Chapare arenavirus haemorrhagic fever were detected between December 2003 and January 2004, but the vector [reservoir] was not identified. The affected individuals had febrile and cardiac symptoms.

The New World Chapare arenavirus haemorrhagic fever, which has recently affected 5 people in La Paz [department], 3 of whom died, had its 1st outbreak in 16 years in a rural locality in the Cochabamba tropics; however, since then, until now, the vector [reservoir] has not been identified.

It is known that arenaviruses are transmitted by rodents, and because of this the latest investigations in northern La Paz, where the 1st case was reported (that now is known as the Chapare genotype), was focused on searching for _Calomys callous_ [the large vesper mouse. - ProMED Mod.SH], which transmits Machupo virus, but it may also be transmitted by other rodent families, say knowledgeable people.

The chief of epidemiology of the Departmental Health Services (SEDES), Roberto Torrez, recalled that Chapare virus was identified more than a decade ago, after 3 people presented with haemorrhagic fever symptoms in the rural community of Samusaveti (Cochabamba tropics) between December 2002 and January 2004. The ill individuals presented with febrile and haemorrhagic symptoms and, mainly, cardiac problems. The investigation results indicated that they were dealing with a virus that was "very related" to Machupo, but was genetically distinct. In 2006, it was given the name Chapare, for the locality of its origin.

Torrez explained that the focus [of infection] was controlled, but the vector [reservoir] was not identified. Until now, it is still unknown how the virus has reappeared in northern La Paz, although the possibilities are that the vector [reservoir] has migrated from the Cochabamba tropics or has been inhabiting northern La Paz and that recently infected people have presented [with the disease]. "We know that it is transmitted by rodents, but we do not know the vector [reservoir] of the original Chapare virus, neither of the Cochabamba one, nor of the La Paz one," he said.

The chief of epidemiology discarded the idea that Santa Cruz department is at risk of an outbreak, since that "cases of the disease have never been registered nor have rodents of the _Calomys callous_ family [sic; genus and species] infected with Machupo virus been encountered." Torrez said that many years ago, in San Ignacio de Velasco, in the [municipal] limits of Piso Firme, _Calomys callous_ rodents were taken with Latino virus, which is not a human pathogen.

Technicians of the Ministry of Health have captured rodents in the areas of Caranavi and Guanay, where the 1st fatal case (a farmer) lived and worked. Since calomys rodents were not encountered, the investigation was expanded to other types of rodents.

[A hospitalized medical student who died 4 Jun 2019 was first diagnosed with dengue and later with a fatal arenavirus infection. The legal dispute between the patient's family and the hospital physicians is not translated here, since it adds nothing to the understanding of treatment or of epidemiology of the infection. - ProMED Mod.TY]  [byline: Deisy Ortiz, Miguel A Melendres]
====================
[New World arenavirus haemorrhagic fever virus Chapare, that has recently infected 5 patients in La Paz [department], 3 of whom died, brought to mind the 1st outbreak 16 years ago in a rural area of Cochabamba; however, since then it has not been possible to identify the animal reservoir. At that time, 3 people presented with symptoms of haemorrhagic fever in the rural community of Samusaveti (Cochabamba tropics) between December 2003 and January 2004. - ProMED Mod.JT]

This report definitely identifies the virus involved in these cases as Chapare arenavirus. Symptoms of Chapare and Machupo virus infections include: early clinical manifestations consist of nonspecific signs and symptoms, including fever, headache, fatigue, myalgia, and arthralgia. Within 7 days, patients may develop haemorrhagic signs, including bleeding from the oral and nasal mucosa and from the bronchopulmonary, gastrointestinal, and genitourinary tracts. Case fatality rates range from 5% to 30% (see ProMED-mail post Bolivian haemorrhagic fever - Bolivia: background http://promedmail.org/post/20190705.6553672).

The original cases were investigated by a team of Bolivian health authorities, US Navy health experts based in Lima, Peru, and the US Centers for Disease Control and Prevention. The virus was characterized as Chapare arenavirus, a previously unrecognized arenavirus, discovered in serum samples from a patient in rural Bolivia who eventually died of the infection. A full report of the study was published 18 Apr 2008 in the open-access journal PLoS Pathogens cited below.

Reference
---------
Delgado S, Erickson BR, Agudo R, et al. Chapare virus, a newly discovered arenavirus isolated from a fatal hemorrhagic fever case in Bolivia. PLoS Pathog. 2008; 4(4): e1000047; <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2277458/>

It is unfortunate that the rodent reservoir of Chapare virus is still unknown. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Bolivia:
Date: Thu 18 Jul 2019
Source: Centers for Disease Control and Prevention (CDC), Haemorrhagic Fever in Bolivia [edited]

Watch-level 1. Practice usual precautions
-----------------------------------------
Key Points:
- An outbreak of haemorrhagic fever was recently reported in Bolivia.
- The outbreak is caused by an arenavirus that appears similar to Chapare virus, which causes Chapare haemorrhagic fever.
- Travellers to Bolivia should avoid contact with rodents, with rodent urine or faeces (droppings), and with people who are sick.

What is the current situation?
Health officials in Bolivia have reported an outbreak of haemorrhagic fever associated with an arenavirus similar to Chapare arenavirus. The 1st case was in a man from Caranavi Province. A health care provider who treated him became ill and was transferred to La Paz. Currently, several additional cases have been reported; all have been in health care providers or family members of the 1st patient.

Testing suggests that the virus is genetically similar to Chapare virus, a New World arenavirus that was 1st documented in Bolivia in 2003. During that outbreak, a small number of people became ill, and one died. Since then, no additional cases have been reported. Additional testing is ongoing to determine the exact cause of this outbreak.

What can travelers do to protect themselves?
- Although the animal source for this virus has not been confirmed, travellers should avoid contact with rodents and rodent urine or faeces.
- Avoid contact with people who are sick.
- Travellers going to Bolivia to provide health care to local populations may be at risk and should wear full personal protective equipment when treating suspect hemorrhagic fever cases.
===========================
[The above CDC precaution is in response the recent occurrence of Chapare arenavirus hemorrhagic fever in the La Paz department of Bolivia (see Chapare virus - Bolivia: (LP) http://promedmail.org/post/20190719.6573996). The initial 3 cases of Chapare arenavirus hemorrhagic fever were detected between December 2003 and January 2004, but the vector [reservoir] was not identified. The virus recently affected 5 people in La Paz [department], 3 of whom died, had its 1st outbreak in 16 years in a rural locality in the Cochabamba tropics; however, since then, until now, the vector [reservoir] has not been identified.

As noted earlier, the original cases were investigated by a team of Bolivian health authorities, US Navy health experts based in Lima, Peru, and the US Centers for Disease Control and Prevention. The virus was characterized as Chapare arenavirus, a previously unrecognized arenavirus, discovered in serum samples from a patient in rural Bolivia who eventually died of the infection. A full report of the study was published 18 Apr 2008 in the open-access journal PLoS Pathogens cited below.

Citation
--------
Delgado S, Erickson BR, Agudo R, et al. Chapare virus, a newly discovered arenavirus isolated from a fatal hemorrhagic fever case in Bolivia. PLoS Pathog. 2008; 4(4): e1000047;

The rodent reservoir of Chapare virus is still unknown. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Fri 5 Jul 2019
Source: GIDEON (Global Infectious Disease Epidemiology Network) [edited]

Re: ProMED-mail Undiagnosed illness - Bolivia (02): (LP) Bolivian haemorrhagic fever conf. http://promedmail.org/post/20190704.6551379

In 2019, a small outbreak of Bolivian haemorrhagic fever was reported at a hospital in La Paz [department], Bolivia. The following background data on Bolivian haemorrhagic fever are abstracted from Gideon www.GideonOnline.com and the Gideon e-book series.[1,2] Primary references are available from the author.

Bolivian haemorrhagic fever (BHF) is caused by Machupo virus (Arenaviridae, Tacaribe complex, _Mammarenavirus_). The disease was initially described in 1959 as a sporadic hemorrhagic illness in rural areas of Beni department, eastern Bolivia, and the virus itself was 1st identified in 1963. BHF is most common during April to July in the upper savanna region of Beni. Principal exposure occurs through rodents ([the large vesper mouse] _Calomys callosus_), which enter homes in endemic areas.

BHF is one of several human _Arenavirus_ diseases reported in the Americas: Argentine haemorrhagic fever (Junin virus), Brazilian haemorrhagic fever (Sabia virus), lymphocytic choriomeningitis, Venezuelan haemorrhagic fever (Guanarito virus) and Whitewater Arroyo virus infection. (At least 2 related diseases are reported in Africa: Lassa fever and Lujo virus infection.)

Infection of _C. callosus_ results in asymptomatic viral shedding in saliva, urine, and feces; 50% of experimentally infected _C. callosus_ are chronically viremic and shed virus in their bodily excretions or secretions. _C. callosus_ acquires the virus after birth, and start shedding it through their urine and saliva while suckling. When mice acquire the virus as adults, they may develop immunity and no longer shed the virus.

Although the infectious dose of Machupo virus in humans is unknown, exposed persons may become infected by inhaling virus in aerosolized secretions or excretions of infected rodents, ingestion of food contaminated with rodent excreta, or by direct contact of excreta with abraded skin or oropharyngeal mucous membranes. Nosocomial and human-to-human spread have been documented. Hospital contact with a patient has resulted in person-to-person spread of Machupo virus to nursing and pathology laboratory staff.

In 1994, fatal secondary infection of 6 family members in Magdalena, Bolivia from a single naturally acquired infection further suggested the potential for person-to-person transmission.

During December 2003 to January 2004, a small focus of haemorrhagic fever was reported in the area of Cochabamba. A 2nd _Arenavirus_, Chapare virus, was recovered from one patient with fatal infection.

Early clinical manifestations consist of nonspecific signs and symptoms, including fever, headache, fatigue, myalgia, and arthralgia. Within 7 days, patients may develop hemorrhagic signs, including bleeding from the oral and nasal mucosa and from the bronchopulmonary, gastrointestinal, and genitourinary tracts. Case fatality rates range from 5% to 30%.

Ribavirin has been used successfully in several cases of BHF. The recommended adult regimen is 2.0 g intravenously (IV), followed by 1.0 g IV every 6 hours for 4 days, and then 0.5 g every 8 hours for 6 days.

Note that the etiologic agent and clinical features of BHF are similar to those of Argentine hemorrhagic fever (AHF). Neurological signs are more common in AHF, while hemorrhagic diatheses are more common in BHF. A vaccine available for AHF could theoretically be effective against BHF as well.

References
1. Berger S. American hemorrhagic fevers: global status, 2019. Gideon e-books.
2. Berger S. Infectious diseases of Bolivia, 2019. 342 pages, 87 graphs, 495 references.
Communicated by:
Steve Berger
Geographic Medicine
Tel Aviv Medical Center, Israel
=======================
[ProMED-mail thanks Dr. Berger for the overview of Bolivian haemorrhagic fever presented above. As noted in the previous comment, and above, Bolivian haemorrhagic fever, caused by Machupo virus, occurs sporadically in lowland Bolivia, especially in Beni department. There was a case there in 2013, and in 2012 ProMED-mail reported that 13 people had been infected with Machupo virus and 7 had died as a consequence of the disease. In Beni department at that time, 5 municipalities, including Magdalena, were reported to have had large populations of _Calomys callosus_ mice, the reservoir host of Machupo virus, which can persistently infect the mice. It is not surprising to find cases in lowland areas of La Paz department again, where the current cases are occurring. The drylands vesper mouse, _C. musculinus_ mentioned in the previous post, although present in southern Bolivia, is unlikely to be the reservoir rodent involved in the current cases. _C. callosus_ mice are the recognized reservoir hosts of Machupo virus. Health officials can provide information about rodent control and assist in implementing it to reduce the risk of exposure to Machupo virus, but effective long-term implementation of rodent control ultimately rests with local residents.

An image of _C. callosus_, the large vesper mouse and reservoir host of Machupo virus, can be seen at

[HealthMap/ProMED-mail map:
More ...

World Travel News Headlines

Date: Tue, 22 Oct 2019 13:43:23 +0200 (METDST)

Capriata d'Orba, Italy, Oct 22, 2019 (AFP) - A taxi driver has drowned in Italy during violent storms in the north which flooded towns and destroyed a bridge, the fire service said Tuesday.   Farmers in the sweltering south meanwhile sounded the alarm over a draught expected to hit crops hard.   Over 100 people were evacuated Monday across the Alessandria province in the Liguria region, while firefighters carried out 900 operations across the north from Milan to Genoa, as rising waters surged across roads and railways.

The taxi was swept away in the town of Capriata d'Orba, where a bridge had also given way as the river burst its banks.   "There's water everywhere", driver Fabrizio Torre, 52, told his bosses before his phone line cut out, media reported.   His passenger managed to escape the vehicle and survived by clinging to a tree, the reports said.   Two men, aged 61 and 84, were found alive by firefighters after going missing in another part of the storm-hit region.   Rescue workers also pulled young children, their grandmother and the family's dog out of a house submerged by a landslide.   The Po river rose by more than 3.5 metres (11 feet) over a 24-hour period, according to Coldiretti, Italy's main agricultural association.   Lake Maggiore was also nearing a historic level.

Italy has seen "over three storms a day since the start of autumn, 18 percent more than the same period last year," it said.   "And while the north is under rain clouds... in the south, record heat and lack of rainfall has triggered a drought alarm."   Italy was seeing "the effects of climate change, with exceptional weather events becoming the norm".   It noted a "clear endency to tropicalisation" in the Mediterranean country, which was experiencing "a crazy autumn that ranks in the top ten of the hottest since 1800, with a temperature of 1.27 degrees above the average".   The high frequency of violent events was expected to continue, with the north pummelled by rains while farmers in the south risk losing crops.
Date: Tue, 22 Oct 2019 09:57:15 +0200 (METDST)
By Tupad POINTU

La Paz, Oct 22, 2019 (AFP) - Bolivia braced for a general strike on Tuesday hours after violence broke out in several cities when the main opposition candidate rejected presidential election results that seemed set to hand a controversial victory to long-time incumbent Evo Morales.   Opposition supporters reacted with fury, torching electoral offices in the southwestern cities of Sucre and Potosi, while rival supporters clashed in the capital La Paz.    Incidents were reported in cities across the South American country.   Carlos Mesa, who came a close second to Morales in Sunday's polls -- forcing a run-off, according to preliminary results -- denounced revised results released by election authorities as a "fraud."   "We are not going to recognize those results that are part of a shameful, consumated fraud, that is putting Bolivian society in a situation of unnecessary tension," said Mesa.

International monitors from the Organization of American States voiced "deep concern" at sudden changes to the election count to show Morales closing in on an outright victory in the first round.   Preliminary results released late Sunday showed neither Morales, 59, nor 66-year-old Mesa with a majority and "clearly indicated a second round," the OAS mission said.   The partial results put Morales in the lead with 45 percent of the votes, with Mesa on 38 percent, meaning Morales would have to contest a run-off for the first time.   But results released late Monday, after a long and unexplained delay, showed Morales edging towards an outright victory with 95 percent of the votes counted.   Mesa, a former president of the country between 2001-2005, accused Morales of colluding with the Supreme Electoral Tribunal (TSE) to tweak delayed results and avoid a run-off.

- Opposition call general strike -
The call for a general strike was issued by Fernando Camacho, head of an influential civil society organization in Bolivia's biggest city, Santa Cruz, where transport and businesses were expected to shut down from noon.   "Tomorrow we start at 12:00 to block this country," Camacho told opposition demonstrators late Monday, before holding talks with leaders from other regions.   Long lines formed at gas stations amid fears of shortages.   Riot-police dispersed a crowd who tried to storm the electoral offices in the Andean city of Oruro, south of La Paz.    Clashes were also reported in Tarija in the south, Cochabamba in the center and Cobija in the north.

- 'Subverting democracy' -
The United States' top diplomat for Latin America said the Electoral Tribunal was attempting "to subvert Bolivia's democracy by delaying the vote count and taking actions that undermine the credibility of Bolivia's elections."   "We call on the TSE to immediately act to restore credibility in the vote counting process," the official, Michael Kozak, said on Twitter.   The OAS observer mission in the country expressed "surprise at the drastic and hard-to-explain change in the trend of the preliminary results revealed after the closing of the polls," it said in a statement.   It urged the election authority to "firmly defend the will of the Bolivian people" and called for calm on the streets.   "It is extremely important that calm is maintained and any form of violence is avoided in this delicate situation."

- Longest serving president -
Morales, Latin America's longest-serving president, is controversially seeking a fourth term.   He obtained Constitutional Court permission in 2017 to run again for president even though the constitution allows only two consecutive terms.   The former coca farmer and leftist union leader has led the poor but resource-rich Latin American country for the past 13 years, though his popularity has waned amid allegations of corruption and authoritarianism.   He has led the country since taking office in 2006, when he became its first indigenous president.

A new mandate would keep him in power until 2025.   As leader of his Movement for Socialism Party (MAS), Morales points to a decade of economic stability and considerable industrialization as his achievements, while insisting he has brought "dignity" to Bolivia's indigenous population, the largest in Latin America.   He has come under severe criticism this year as wildfires in August and September ravaged Bolivia's forests and grasslands, with activists saying his policies encouraged the use of blazes to clear farmland.
Date: Tue, 22 Oct 2019 06:44:29 +0200 (METDST)

Papeete, Oct 22, 2019 (AFP) - A French tourist has been seriously injured in a rare shark attack in the palm-fringed Pacific islands of Polynesia, emergency services said Tuesday.   The 35-year-old woman was swimming during a whale-watching trip on Monday in the French overseas territory when the oceanic whitetip shark tore into her chest and arms.   "Luckily for her, there were two nurses on the scene who could deliver first aid," firefighter Jean-Jacques Riveta told AFP.   The woman lost both hands and a lot of blood in the attack and was airlifted to hospital, he said.
Date: Tue, 22 Oct 2019 05:13:16 +0200 (METDST)

Wellington, Oct 22, 2019 (AFP) - A huge fire at a construction site sent clouds of acrid black smoke billowing over Auckland on Tuesday, forcing large parts of the downtown area to be cordoned off as firefighters battled the blaze.   The fire broke out on the roof of the SkyCity convention centre site shortly after 1:10pm (0010 GMT) and quickly spread, Fire and Emergency NZ said.   Office workers were warned to stay inside and turn off air conditioning as a thick pall of smoke engulfed the centre of New Zealand's largest city, but there were no reports on injuries.   Unconfirmed reports said the fire was started by a construction worker using a blowtorch on the building, which is one of the venues for the 2021 APEC summit being held in Auckland.
Date: Mon, 21 Oct 2019 18:48:23 +0200 (METDST)

Harare, Oct 21, 2019 (AFP) - At least 55 elephants have died in a month in Zimbabwe  due to a lack of food and water, its wildlife agency said Monday, as the country faces one of the worst droughts in its history.   More than five million rural Zimbabweans -- nearly a third of the population -- are at risk of food shortages before the next harvest in 2020, the United Nations has warned.

The shortages have been caused by the combined effects of an economic downturn and a drought blamed on the El Nino weather cycle.   The impact is being felt at Hwange National Park, Zimbabwe's largest game reserve.   "Since September, we have lost at least 55 elephants in Hwange National Park due to starvation and lack of water," Zimbabwe National Parks spokesman Tinashe Farawo told AFP.   Farawo said the park was overpopulated and that food and water was scarce "due to drought".

Africa's elephant numbers have dropped from around 415,000 to 111,000 over the past decade, mainly due to poaching for ivory, according to the International Union for Conservation of Nature (IUCN).   But Zimbabwe, like other countries in the southern African region, is struggling with overpopulation.   "Hwange was meant for 15,000 elephants but at the moment we are talking of more than 50,000," Farawo said.   "The situation is dire. We are desperately waiting for the rains."   An adult elephant drinks 680 litres (180 gallons) of water per day on average and consumes 450 kilogrammes (990 pounds) of food.

Hungry elephants have been breaking out of Zimbabwe's game reserves and raiding human settlements in search for food, posing a threat to surrounding communities.   Farawo said 200 people have died in "human-and-animal conflict" in the past five years, and "at least 7,000 hectares (17,300 acres) of crop have been destroyed by elephants".   The authorities took action earlier this year by selling nearly 100 elephants to China and Dubai for $2.7 million.   Farawo said the money had been allocated to anti-poaching and conservation projects.   Botswana, Namibia, Zambia and Zimbabwe have called for a global ban on elephant ivory trade to be relaxed in order to cull numbers and ease pressure on their territories.
Date: Mon, 21 Oct 2019 13:34:35 +0200 (METDST)

Santiago, Oct 21, 2019 (AFP) - Chile, reeling from its worst social unrest in decades, has since the 1990s been considered a Latin American hub of political stability and economic growth after 17 years of dictatorship.   Here is some background.

- From dictatorship to democracy -
In 1973 General Augusto Pinochet toppled Socialist President Salvador Allende in a military coup. Allende committed suicide in the presidential palace as troops closed in.   Pinochet imposed a right-wing dictatorship that lasted for 17 years, during which at least 3,200 people were killed or disappeared as a result of political repression. Around 38,000 were tortured.   In 1988 he lost a plebiscite on remaining in power and handed over to democratically elected Patricio Aylwin in 1990, remaining head of the armed forces until 1998.    Pinochet died in 2006 without standing trial for atrocities under his regime.   In 2006 Socialist Michelle Bachelet became Chile's first female president. Re-elected in 2013, she was barred constitutionally from standing again immediately and appointed UN right commissioner in 2018.   The 2017 elections were won by conservative billionaire Sebastian Pinera, who had already been president in 2010-2014.

- Model economy -
Pinochet applied neo-liberal free-market methods, privatising healthcare, education and pensions.   Chile turned to exports and in the 1980s became the preferred Latin American host for foreign investors.   With this economic model still largely in place, growth reached a strong 4% in 2018. The country of 18 million people also has the highest per capita income of Latin America at $20,000.   GDP, however, fell to 1.8% in the first half of 2019 -- due to a challenging external context, adverse climatic conditions and a delay in reforms -- and is expected at 2.5 percent for the year.   Despite slashing poverty from 30% in 2000 to 8.6% in 2019, the country has high social inequalities including in healthcare, education and pensions.   It is the world's biggest producer of copper, with lithium, timber, fisheries, gold, silver, avocados and oil also driving exports.

- Paedophile priests scandal -
The staunchly Roman Catholic country has been rocked by allegations of sexual abuse within the church going back decades.   In May 2018 Pope Francis summoned all 34 Chilean bishops to Rome over the crisis and all tendered their resignations, although only a handful have been accepted.   Since 2000 about 80 priests have been reported to authorities in Chile for alleged sexual abuse, including of children and adolescents.   Prosecutors said in August 2018 they were investigating 158 members of the church, both priests and lay people.   Ultra-conservative Chile allowed divorce only from 2004 and legalised abortion in certain cases in 2017.

- World's most seismic -
Bordered by the Pacific Ocean to the west and the Andes mountain range to the east, long and narrow Chile is the world's most seismic country.   In 1960 it was struck by the most powerful earthquake ever registered which measured 9.5 and struck at Valdivia. More than 5,700 people were killed.   In 2010 a 8.8-magnitude quake in the south and centre unleashed a tsunami that swept away entire villages, leaving around 520 people dead.

- Astronomy heaven -
Benefitting from a totally clear sky for most of the year, northern Chile is home to some of the world's most powerful telescopes.   The construction of the planet's biggest telescope was launched in May 2017 in the Atacama desert by ESO, the European Organisation for Astronomical Research in the Southern Hemisphere.
Date: Sun 20 Oct 2019
Source: Pakistan today [edited]

The death toll from a mysterious throat virus has reached 9 children in Seerani and its surrounding localities in Badin district as one more child infected by the virus died, affected people said on [Sun 20 Oct 2019].

A child, R, son of RM, died after contracting the disease. The most affected areas are reported to be Seerani and its surrounding localities. Teams of the health department and other organizations reached Seerani and took blood samples of at least 30 children who were infected by the virus. The blood samples will be sent to Islamabad for the tests.

The people of the area are worried about this new throat viral disease and have demanded authorities to provide immediate health cover to them.
====================
[There is little information to go on other than the throats of children are affected and the case fatality rate is high (10 of at least 30). No other symptoms are provided, nor is the basis for concluding that a virus is involved or what the epidemiological data are (dates, ages, sex of children involved, and local conditions). ProMED-mail would welcome additional information. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: 21 Oct 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/polio-cases-reported-in-zambia-chad-and-togo-73820/>

Circulating vaccine-derived polio virus (cVDPV) type cases have been confirmed in 10 African countries through [16 Oct 2019] this year [2019]. Now, the World Health Organization (WHO) is reporting 3 additional countries from the continent that more recently reported circulating vaccine-derived polio virus type 2 (cVDPV2) cases: Zambia, Chad and Togo.

Zambia
The Ministry of Health of Zambia reported last week on a confirmed case of circulating vaccine-derived polio virus type 2 (cVDPV2) in a 2-year-old child in Chienge district, Luapula province on the border with Democratic Republic of the Congo. This is the 1st case of cVDPV2 reported from Zambia in 2019. [Date of onset of paralysis reported to be 16 Jul 2019 according to another media report <https://www.lusakatimes.com/2019/10/21/polio-case-has-been-recorded-in-zambias-luapula-province/>.

In addition to the initial case-patient, 34 stool samples were collected from healthy contacts, and 2 samples tested positive for VDPV2, which were genetically linked to the case-patient. No established links have so far been found with the ongoing outbreak of cVDPV2 in Democratic Republic of the Congo, where 37 cases have been reported in 2019. The last recorded case of indigenous polio in Zambia was in 1995, while between 2001 and 2002, 5 cases of wild polio virus were identified among Angolan refugees in the Western province of the country.

Chad
Last week, WHO was informed about cVDPV2 in Chad. A cVDPV2 was isolated from a 13-month-old case of acute flaccid paralysis (AFP), with onset of paralysis on [9 Sep 2019] in Chari Baguirmi province, bordering Cameroon. The isolated virus has 32 nucleotide changes from Sabin 2, and is genetically linked to a cVDPV2 detected in Borno, Nigeria and is part of the Jigawa emergence. The last indigenous wild poliovirus cases were reported in 2000 in Chad.

Togo
In addition, last week WHO was informed about cVDPV2 in Togo. A cVDPV2 was isolated from a 30-month-old case of AFP with onset of paralysis on [13 Sep 2019] in Plateaux province, bordering Benin and Ghana. The isolated virus has 32 nucleotide changes from Sabin 2 and is genetically linked to a cVDPV2 detected in Irewole state, Nigeria and is part of the Jigawa emergence as well. The last indigenous wild poliovirus case was reported in 1999 in Togo.
======================
[Three more countries are joining the list of cVDPV outbreak countries, all with cVDPV2 isolates. Two of the 3 countries (Togo and Chad) have viruses related to the Jigawa, Nigeria cVDPV2 outbreak. The case in Zambia is suspected to be associated with the ongoing cVDPV2 transmission in the Democratic Republic of the Congo (DR Congo), but genetic testing is presumably still pending or has been negative. See my comments below after the following section, as they are relevant to what is ongoing globally with respect to cVDPVs.

Below are the HealthMap/ProMED map links to countries where cVDPV cases/outbreaks have occurred in the past 12 months, a total of 20 countries.

Angola: <http://healthmap.org/promed/p/165>
Benin: <http://healthmap.org/promed/p/59>
Cameroon: <http://healthmap.org/promed/p/65>
Central African Republic: <http://healthmap.org/promed/p/66>
Chad: <http://healthmap.org/promed/p/57>
China: <http://healthmap.org/promed/p/155>
Democratic Republic of the Congo: <http://healthmap.org/promed/p/194>
Ethiopia: <http://healthmap.org/promed/p/95>
Ghana: <http://healthmap.org/promed/p/53>
Indonesia: <http://healthmap.org/promed/p/184>
Kenya: <http://healthmap.org/promed/p/174>
Mozambique: <http://healthmap.org/promed/p/177>
Myanmar: <http://healthmap.org/promed/p/148>
Niger: <http://healthmap.org/promed/p/58>
Nigeria: <http://healthmap.org/promed/p/62>
Papua New Guinea: <http://healthmap.org/promed/p/188>
Philippines: <http://healthmap.org/promed/p/158>
Somalia: <http://healthmap.org/promed/p/125>
Togo: <http://healthmap.org/promed/p/64>
Zambia: <http://healthmap.org/promed/p/170> - ProMED Mod.MPP]
Date: Fri 18 Oct 2019 07:32 PM EDT
Source: WSPA [edited]

North Carolina health officials say a 4th person has died from an outbreak of legionnaires' disease linked to a hot tub display at the North Carolina Mountain State Fair, which is held at the Western North Carolina Agricultural Center.

We've also learned another person, who did not attend the NC Mountain State Fair, was diagnosed with legionnaires' after attending a quilt show that was held inside the same building as the hot tub exhibit. That building is the Davis Event Center.

7 News spoke with folks who have been impacted by the outbreak. "We were like 'Oh no, I hope nobody gets sick,'" [LP] said. He attended the North Carolina Mountain State Fair-an event tied to at least 140 cases of legionnaires'. He said 2 people he knows, including his uncle, got sick after the fair. "They didn't actually have legionnaires', but they had respiratory problems that did come out of it," he said. [Perhaps Pontiac fever?] Even so, [LP] was back at the WNC Agricultural Center on [Fri 18 Oct 2019] to help host his club's annual Antique Tractor Show.

And while everything appeared to be business as usual, [LP] was concerned as another person was just diagnosed with the disease and didn't attend the fair. Instead, they were at a quilt show held at the WNC Agricultural Center 2 weeks later. "Anytime there's an outbreak of something, it's always going to have a thing in the back of your mind that says, 'I don't know if I want to do this or not,'" he said.

The Davis Event Center has since been closed; but health officials say it's possible the source for the newest case of legionnaires' may not have been at the WNC Agricultural Center. "There are other possible exposures that this person had, so it's hard. At this point, we can't pinpoint," Jennifer Mullendore with Buncombe County Health and Human Services said.

According to a statement by the WNC Agricultural Center, the hot water system in the Davis Event Center, and every other building on the grounds, went through a disinfecting process as a precautionary measure. "They did some cleaning and doing some real hot high-powered water through the water system here, and so we do have a clean bill of health," Phillips said.  It's unclear at this time when the Davis Event Center will re-open.  [Byline: Scottie Kay]
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[The latest status, as of 18 Oct 2019, of the legionellosis outbreak associated with the Mountain State Fair that was held in western North Carolina between 6 and 15 Sep 2019 at the Western North Carolina Agricultural Center (WNC Ag Center) in Fletcher, a town in Henderson County, can be found at <https://epi.dph.ncdhhs.gov/cd/legionellosis/outbreak.html>.

The source of the outbreak has still not as yet been confirmed. However, hot tub displays in one of the buildings (Davis Event Center) has been linked to the outbreak. A site map of the WNC Ag Center that shows the location of the Davis Event Center building can be found at <https://www.wncagcenter.org/p/mountainstatefair/competitions/map>.

One more case and an additional death have been reported since the last ProMED-mail post on this outbreak, but no cases linked to the outbreak had a symptom onset date more than 2 weeks after the end of the fair, that is, within the incubation period for legionnaires' disease (<https://www.cdc.gov/legionella/clinicians/clinical-features.html>). The latest case of legionnaires' disease didn't attend the fair, but instead attended a quilt show held 2 weeks later at the Davis Event Center, but the source for this case is thought possibly to have not been at the WNC Agricultural Center. The Davis Event Center has since been closed.

The number of confirmed cases of legionellosis by county are as follows: Buncombe, 49; Burke, 1; Caswell, 1; Cherokee, 1; Gaston, 1; Granville, 1; Haywood, 12; Henderson, 34; Jackson, 3; Madison, 6; McDowell, 5; Mecklenburg, 5; Mitchell, 2; Polk, 1; Rutherford, 3; Transylvania, 3; Union, 1; Watauga, 1; and Yancey, 1. 10 cases occurred out of state (in South Carolina). Total cases: 141. A map showing the location of the North Carolina counties can be found at <https://geology.com/county-map/north-carolina.shtml>.

Male, 82 (59%)*; female, 58 (41%)*. Median age in years (range): 61 (24-91). Hospitalizations: 94 (69%)*; deaths 4. *Some cases reported with unknown gender or hospitalization status.

A total of 133 (94%) have legionnaires' disease, the pneumonic form of the infection, and 8 (6%) have Pontiac fever, the non-pneumonic form of the infection.

The species of _Legionella_ detected in patients is not specified; however, the usual pathogen in the USA is _L. pneumophila_ serogroup 1 and one sample of water collected from the women's restroom in the Davis Event Center was previously reported to be positive for _L. pneumophila_. Genotyping clinical and environmental isolates will help identify clusters of cases with a common source and identify the source responsible for infection in these clusters. - ProMED Mod.ML]
 
[HealthMap/ProMED-mail map of North Carolina, United States:
Date: Sun 20 Oct 2019 12:52 AM IST
Source: Deccan Chronicle [edited]

The respite from cases of dengue, notwithstanding, the city [Hyderabad] is now caught in the grip of viral encephalitis, or brain fever. There is an alarming increase in the number of viral encephalitis cases being reported across city hospitals. This is ironic as October is medically termed as 'fair-weather' season. The rise in the number of cases has been worrisome and those getting inflicted include children and elders.

Many are complaining of fever of the brain with body temperature touching [106-107 deg F/41.1-41.6 deg C].

According to doctors, at least 3 cases are reported each week in the tertiary hospitals of which 7 major ones are in the city.

Dr Shyam Jaiswal, neurologist at Care Hospitals, explains, "Of late, we have been admitting viral encephalitis-affected children in the hospital. Most fall sick because of the body's low immunity. Immediate hospital care is a must as most complain of severe headache, delirium, and in some cases even loss of memory. The treatment takes between 2-3 days."

It is a medical nightmare that some elders are suffering from both chikungunya and viral encephalitis.

Dr Hari Kishan B, general physician with Apollo Hospitals, explains, "The combination of chikungunya and viral encephalitis has been noted earlier too. These are rare cases but do occur from time to time. The viral infections have been very high this year [2019] and those suffering from diabetes, hypertension, and other cardiovascular ailments, will suffer more when infected with these viruses."  [Byline: Kaniza Garari]
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[This report does not provide total case numbers, nor indicate how long 2-3 cases per week have been occurring. The virus suspected or confirmed as the etiology of these cases is not mentioned, but the comment that October is termed "a fair weather season" suggests that Japanese encephalitis virus may be involved with the usual transmission season declining in October. No mention is made of acute encephalitis syndrome, a clinical designation with a variety of suggested Aetiologies in other cases in north-eastern India. - ProMED Mod.TY]

[Maps of India: