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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Benin - US Consular Information Sheet
April 28, 2008

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Guatemala

Guatemala - US Consular Information Sheet
October 13, 2006
COUNTRY DESCRIPTION:
Guatemala has a developing economy, characterized by wide income disparities.
Hotels and other tourist facilities in the principal tourist sites most freq
ented by visitors from the United States are generally good to excellent.
A peace accord, signed in 1996, ended a 36-year armed conflict.
Violent crime, however, is a serious concern due to endemic poverty, an abundance of weapons, a legacy of societal violence, and dysfunctional law enforcement and judicial systems.
Read the Department of State Background Notes on Guatemala for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid U.S. passport is required for all U.S. citizens, regardless of age, to enter Guatemala and to depart Guatemala for return to the U.S.
Even if dual nationals are permitted to enter Guatemala on a second nationality passport, U.S. citizens returning to the United States from Guatemala are not allowed to board their flights without a valid U.S. passport.
Guatemalan authorities do not accept Certificates of Naturalization, birth certificates, driver's licenses, and photocopies as alternative travel documents.
While in Guatemala, U.S. citizens should carry their passports, or a photocopy of their passports, with them at all times.

An exit tax must be paid when departing Guatemala by air.
The exit tax (currently $30) is generally included in an airline ticket price, but may be charged separately.
There is an additional airport security fee (20 Quetzales, approximately $2.50) that all travelers must pay at the airport.

Minors under 18 traveling with a valid U.S. passport need no special permission from their parents to enter or leave Guatemala.
U.S. citizens do not need a visa for a stay of 90 days or less (that period can be extended for an additional 180 days upon application to Guatemalan immigration).

A U.S. citizen whose passport is lost or stolen in Guatemala must obtain a new passport at the U.S. Embassy as soon as possible and present it, together with a police report of the loss or theft, to the Dirección de Migración (Guatemalan immigration agency), Sub-director de Control Migratorio (Sub-director for Migratory Control), to obtain permission to depart Guatemala.
The agency is located in Guatemala City at 6 Avenida 3-11, Zone 4, Guatemala City.
Office hours are weekdays from 8:00 a.m. to 4:00 p.m.; telephone 2411-2411.
No fee is charged by Guatemalan immigration for this service.

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

See our Foreign Entry Requirements brochure for more information on Guatemala and other countries.

For further information regarding entry, exit and customs requirements, travelers should contact the Guatemalan Embassy at 2220 R Street, NW, Washington, DC 20008; telephone (202) 745-4952, extension 102; fax (202) 745-1908; e-mail at info@guatemala-embassy.org; Internet web site - http://www.guatemala-embassy.org or contact the nearest Guatemalan consulate (Chicago, Denver, Houston, Los Angeles, Miami, New York, or San Francisco).

See Entry and Exit Requirements for more information pertaining to dual nationality and the prevention of international child abduction.
Please refer to our Customs Information to learn more about customs regulations.

SAFETY AND SECURITY:
Violent criminal activity has been a problem in all parts of Guatemala for years, including murder, rape, and armed assaults against foreigners.
The police force is inexperienced and under-funded, and the judicial system is weak, overworked, and inefficient.
Well-armed criminals know that there is little chance they will be caught and punished.
Traditionally, Guatemala experiences increases in crime before and during the Christmas and Easter holiday seasons.
Large demonstrations occur throughout Guatemala, often with little or no notice, and they can cause serious traffic disruptions.
Although most demonstrations are peaceful, they can turn violent, and travelers should avoid areas where demonstrations are taking place.
The use of roadblocks and/or blocking of public facilities, including the international airport, has increased and demonstrators may prevent tourists caught behind the blockades from leaving.

Due to uncontrolled drug and alien smuggling, the Guatemalan border with Mexico is a relatively high-risk area, in particular in the northern most Peten Department.
The most dangerous area in that region is on the northwestern border of the Peten, in the area including the Sierra de Lacandon and Laguna del Tigre National Parks.
Extra precautions are required when travel by U.S. Government personnel to the region is required.

In October 2005 Hurricane Stan caused widespread flooding and landslides on Guatemala's Pacific coast and in many parts of the Highlands, affecting a number of tourist destinations frequented by foreign travelers.
All major highways and tourist destinations reopened by the end of the month, and most secondary routes are also fully open.
Temporary repairs are still in place; some have already been washed out and others will likely fail during the current rainy season (May through October).
The following recommendations will help residents and visitors alike to increase their safety:

Avoid gatherings of agitated people.
Guatemalan citizen frustration with crime and a lack of appropriate judicial remedies has led to violent incidents of vigilantism, including lynching, especially in more isolated, rural areas.
Attempting to intervene may put you at risk of attacks from mobs.

Avoid close contact with children, including taking photographs, especially in rural areas.
Such contact can be viewed with deep alarm and may provoke panic and violence.
Rumors of foreigners stealing children surface periodically and can provoke a violent response towards strangers.
Foreign tourists have been attacked by mobs and some years ago one was killed while photographing children.

Keep informed of possible demonstrations by following the local news and consulting hotel personnel and tour guides.
Avoid areas where demonstrations are occurring.

Strong currents, riptides, and undertow along Guatemala's Pacific Coast beaches pose a serious threat to even the strongest swimmers.
Signs warning of treacherous surf are rare and confined mostly to private beaches owned by hotels.
Lifeguards are rarely present on beaches.

Tourists planning to climb Pacaya and Agua volcanoes during Guatemala's rainy season (May through October) should plan their climb for the morning hours, when it is less likely that thunderstorms will occur.
Climbers should monitor the weather situation and return to the base of the volcano as quickly as safely possible if thunderstorms gather.
In 2003, a Canadian tourist was killed by lightning while climbing Pacaya.
INGUAT, the Guatemalan Tourist Institute, has organized an active community-based tourism program in San Vicente Pacaya to minimize the risk of armed robbery on Pacaya.
Climbing in groups is still highly advisable for any volcano climb to reduce the risk of assault.

Security escorts for tourist groups and security information are available from the Tourist Assistance Office of INGUAT (the Guatemalan Tourist Institute) at 7a Avenida 1-17, Zona 4 Centro Cívico, Ciudad de Guatemala.
INGUAT's 24 hour/seven days per week direct telephone numbers for tourist assistance and emergencies are (502) 2421-2810 and (502) 5578-9836 and the fax is (502) 2421-2891.
INGUAT may be reached by its toll free number within the United States at 1-888- 464-8281.
You may also simply dial 1500 in Guatemala to reach INGUAT Tourist Assistance.
The e-mail address is asistur@inguat.gob.gt.
Travelers may also wish to visit INGUAT's website, http://visitguatemala.com.
Tourist groups are advised to request security escorts from INGUAT, Attention: Coordinator of the National Tourist Assistance Program.
There have been no incidents of armed robbery of groups escorted through the Tourist Protection Program.
The request should be submitted by mail, fax or e-mail and should arrive at INGUAT at least three business days in advance of the proposed travel, giving the itinerary, names of travelers, and model and color of vehicle in which they will be traveling.
Travelers should be aware that INGUAT might not be able to accommodate all requests.

For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site at http://travel.state.gov where the current Travel Warnings and Public Announcements, including the Worldwide Caution Public Announcement, 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 number of violent crimes reported by U.S. citizens and other foreigners has remained high in recent years.
Incidents include, but are not limited to, assault, theft, armed robbery, carjacking, rape, kidnapping, and murder.
Criminals often operate in groups of four or more and are confrontational and violent.
Gangs are a growing concern in Guatemala City and rural Guatemala.
Gang members are often well armed with sophisticated weaponry and they sometimes use massive amounts of force.
Emboldened armed robbers have attacked vehicles on main roads in broad daylight.
Travel on rural roads always increases the risk of a criminal roadblock or ambush.
Widespread narcotics and alien smuggling activities can make remote areas especially dangerous.
Though there is no evidence that Americans are particularly targeted, criminals look for every opportunity to attack, so all travelers should remain constantly vigilant.

Most tourists and visitors travel throughout Guatemala without mishap.
However, violent criminal activity on the highways continues, and tourists, among others, have been targeted.
Many of the robbery attempts have occurred in daylight hours on main highways.
Carjacking incidents and highway robberies are often violent.
Four Americans were killed in highway robbery attempts in 2002 and three killed and one wounded in 2003.
In 2004 one American tourist was murdered, and women and children were raped in highway assaults.
Several highway assaults of American citizens also took place in 2005, but without serious injury to the victims.
In some cases, assailants have been wearing full or partial police uniforms and have used vehicles that resemble police vehicles, indicating that some elements of the police might be involved.
Armed robberies have occurred within minutes of the tourist's vehicle being stopped by the police.
U.S. Embassy personnel continue to observe heightened security precautions in Guatemala City and on the roads outside the capital city.
U.S. tourists are urged to be especially aware of safety and security concerns when traveling on the roads in Guatemala.
Rather than traveling alone, use a reputable tour organization.
Stay in groups; travel in a caravan consisting of two or more vehicles; and, stay on the main roads.
Ensure that someone not traveling with you is aware of your itinerary.
Resist the temptation to stay in hotels that do not have adequate security.
Travel after dark anywhere in Guatemala is extremely dangerous.
It is preferable to stay in the main tourist destinations.
Do not explore back roads or isolated paths near tourist sites.
Pay close attention to your surroundings, especially when walking or when driving in Guatemala City.
Refrain from displaying expensive-looking jewelry, large amounts of money, or other valuable items.
Finally, if confronted by criminals, be aware that resistance may provoke a more violent response.

Additional information:
In recent months there has been an increasing number of carjacking incidents and armed robberies near the airport, most frequently between 6:00 and 10:00 am (see list of Recent Crime Incidents Involving Foreigners on the Embassy website for more specifics).
In the most common scenario tourists or business travelers who land at the airport around 7:00 am are held up by armed men as their vehicle departs the airport.
Private vehicles, taxis and shuttle buses have been attacked.
Typically, the assailants steal money, passports, and luggage, and in some but not all cases, the assailants steal the vehicle as well.
Victims who did not resist the attackers were not physically injured.
The Embassy advises its own employees to seek alternative routes for exiting the airport.

Pickpockets and purse-snatchers are active in all major cities and tourist sites, especially the central market and other parts of Zone 1 in Guatemala City and the city of Antigua.
In a common scenario, an accomplice distracts the victim, while an assailant slashes or simply steals a bag or backpack while the victim's attention is diverted.

As in other countries, criminals also use a number of scams to steal money and possessions from tourists in Guatemala.
In one popular scam, robbers place a nail in a parked vehicle's tire.
The vehicle is then followed by the robbers who pose as "good Samaritans" when the tire becomes flat and the victims pull to the side of the road.
While "help" is being rendered, the contents of the car are stolen, often without the knowledge of the victims.
However, in some cases, the robbers have threatened the tourists with weapons.
Parking areas in and around the Guatemala City International Airport are particularly prone to this crime.
In another scam, victims are approached in a hotel, restaurant or other public place by an individual claiming there is some sort of problem with his or the would-be victim's automobile in the parking lot.
On the way to investigate the "problem," usually in a remote or concealed area near the parking lot, the robber pulls a gun on the victim demanding cash, credit cards and other valuables.
A third popular scam involves various attempts to acquire a victim's ATM card and PIN number.
Some sophisticated criminals have even placed boxes outside ATM kiosks that record PIN numbers when unsuspecting victims believe they must enter their PIN number to gain entry to the ATM foyer.
After recording PIN numbers, robbers then steal the owner's ATM card to complete their crime.
There are dozens of techniques scammers can use to rob victims of money and possessions.
While most people mean no harm, always be cautious when strangers approach you for any reason or make unusual requests.

Parents adopting children in Guatemala have also been victimized in public places and at their hotels by police (or individuals dressed as police) who have threatened to arrest foster mothers and turn adoptive children over to orphanages, but released them in exchange for significant payments, often approaching $1000.
Such threats have no basis in Guatemalan law, and should be immediately reported to the Embassy.

For security reasons, the Embassy does not allow U.S. government employees to stay in hotels in Zone 1 in Guatemala City and urges private travelers to avoid staying in this area.

Avoid low-priced intra- and inter-city buses (recycled U.S. school buses); they are often attacked by armed robbers and are poorly maintained and dangerously driven.
The use of modern inter-city buses somewhat improves security and safety.
There have been, however, several attacks on travelers on first-class buses on highway CA-2 near the border areas with both Mexico and El Salvador and on highways CA-1 and CA-9 near the El Salvador border and in the highlands between Quetzaltenango and Solola.
Be cautious with personal items such as backpacks and fanny packs while riding buses, because tourists' possessions are a favorite target of thieves.

Do not hail taxis on the street in Guatemala City.
Use radio-dispatched taxis or taxis from major hotels instead.
The main road to Lake Atitlan via the Inter-American Highway (CA-1) and Solola is safer than the alternatives, though attacks in recent years have made traveling in a caravan highly recommended, even on the Inter-American Highway.
Robbery and assault have been frequently reported on secondary roads near the lake with the highest number of incidents occurring on the RN-11 (Las Trampas road) parallel to the east side of the lake.
Robbers have used mountain roads advantageously to stop buses, vans and cars in a variety of ways.

Armed attacks have occurred on roads from Guatemala City to the Peten.
Visitors to the Mayan ruins at Tikal are urged to fly to nearby Flores and then travel by bus or tour van to the site.

Violent attacks have occurred in the Mayan ruins in the Peten, including in the Cerro Cahui Conservation Park, Yaxha, the road to and inside Tikal Park, and in the Tikal ruins.
Tourist police (POLITUR) patrols inside the park have significantly reduced the violent crime incidents inside the park, but travelers should nevertheless remain in groups and on the principal trails leading to the Central Plaza and the Temple IV complex, and avoid remote areas of the park.

POLITUR (a joint police/Guatemalan Tourism Institute initiative) is present in all major tourist destinations.
They should be contacted in case of any criminal incident in such areas, even if minor.

Foreign residents of Guatemala have special concerns.
Twenty American citizen residents and five American citizen tourists have been murdered since December 1999, and suspects have been convicted in only two cases.
There have been "express" kidnappings in recent years, primarily in Guatemala City, in which a relatively small ransom that can be quickly gathered is demanded.
U.S. citizens have been kidnapped in recent years.
At least one incident of a random kidnapping, in which the victim was grabbed off the street in an affluent neighborhood of the city, occurred in December 2003 and resulted in a physical and sexual assault.

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: A full range of medical care is available in Guatemala City, but medical care outside the city is limited.
Guatemala's public hospitals frequently experience serious shortages of basic medicines and equipment.
Care in private hospitals is generally adequate for most common illnesses and injuries, and many of the medical specialists working in them are U.S. trained and certified.

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 http://www.cdc.gov/travel.
For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith.

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

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

Driving in Guatemala requires one's full attention, and safe drivers must take extraordinary efforts to drive defensively to avoid dangerous situations.

Traffic rules are only casually observed.
Many drivers do not use their turn signals to alert other drivers.
Instead, a common custom is for a driver or passenger to stick a hand out the window and wave it to indicate that they will be taking an unspecified action.
Speed limits, lane markings and stop signs are frequently ignored.
Passing blindly on winding and/or steep mountain roads, poorly designed surfaces, and unmarked hazards, including frequent landslides and precarious temporary highway repairs, present additional risks to motorists.

Common public transportation is by local recycled school busses, which serve every town in the country.
Criminal activity and frequent fatal accidents, however, make the low-priced inter-city buses particularly dangerous.
Modern inter-city buses offer some security from highway violence, but armed attacks are increasing, showing that all buses are vulnerable.
(See additional information in the CRIME section.)

Although city streets are lit, secondary and rural roads have little to no illumination.
Driving outside of urban areas at night is dangerous and not recommended.
The Inter-American Highway (CA-1) and the road from Guatemala City to the Caribbean coast (CA-9) are especially dangerous due to heavy traffic, including large trucks and trailers.
There are no roadside assistance clubs, however a roadside assistance force (PROVIAL) patrols most of the major highways in the country.
PROVIAL can be contacted by calling 2422-7878.
Their vehicles are equipped with basic tools and first aid supplies, and their services are free.
Police patrol the major roadways and may assist travelers, but the patrols are sporadic and may be suspended due to budget restraints.
For roadside assistance, travelers may call the police by dialing 120 or the fire department by dialing 122 or 123.
Cellular telephone service covers most areas frequented by tourists.

Valid U.S. driver's licenses are accepted for the first 30 days of a visit, and international driving permits are accepted in Guatemala for extended stays.
Guatemala's road safety authorities are the Department of Transit and the Joint Operations Center of the National Police.
Drivers use the right-hand side of the road in Guatemala, and speed limits are posted (in kilometers) depending on the condition of the road.
Speed limits are different in rural and urban areas, but are rarely enforced.
Drivers often drive at the absolute maximum speed possible for the particular vehicle at the time.
These drivers share the road with slow vehicles, some barely able to manage 20 miles per hour, creating a hazardous mix of velocities.
Turning right on red is not permitted unless otherwise posted, and drivers must yield when entering a traffic circle.
Seat belts must be worn in Guatemala, but there are no laws regarding the use of child safety seats.
It is against the law for drivers to operate cellular phones while driving.

People found driving under the influence of alcohol or other drugs are arrested and may serve jail time.
In an accident resulting in injury or death, every driver involved is taken into custody and the vehicle(s) impounded until a judge determines responsibility in a re-enactment of the accident.

Please refer to our Road Safety page for more information.
Visit the website of Guatemala's national tourist office and national authority responsible for road safety at http://www.inguat.gob.gt or via e-mail at asistur@inguat.gob.gt or info@inguat.gob.gt.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Guatemala's Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Guatemala's air carrier operations.
For more information, travelers may visit the FAA's Internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
A major renovation of the international terminal at La Aurora International Airport in Guatemala City is currently under way.
Until completion in late 2006 or early 2007, there is a temporary reconfiguration of arrival and departure vehicle traffic and major construction works inside the terminal.

Guatemalan customs authorities may enforce strict regulations concerning temporary importation into or export from Guatemala of items such as antiquities and other cultural property.
It is advisable to contact the Embassy of Guatemala in Washington or one of Guatemala's consulates in the United States for specific information regarding customs requirements.
In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines.

Please see our Customs Information.

Non-Guatemalan citizens who wish to marry in Guatemala are required to provide proof of identity and civil status (indicating whether they are single or divorced).
Prior notice of the marriage must be given in the Diario de Centro America (Guatemala's Official Record) and any large circulation daily newspaper for fifteen days.
The marriage must take place within six months of the publication of the notice.

DISASTER PREPAREDNESS:
Guatemala is a geologically active country.
Visitors should be aware of the possibility of earthquakes at any time and the need for contingency plans.
There are also four active volcanoes.
Volcanic activity, such as that of Fuego Volcano near Antigua in January 2003, and again in January 2006, has on occasion forced evacuations of nearby villages; the January-February 2000 activity of Pacaya Volcano near Guatemala City also briefly closed Guatemala City's international airport.
Both the Caribbean and Pacific coasts of Guatemala are also vulnerable to hurricanes and tropical storms from June through November.
Mudslides and flooding during the May to November rainy season often kill dozens of people and close roads.
In October 2005 Hurricane Stan caused widespread flooding and landslides on Guatemala's Pacific coast and in many parts of the Highlands.
Over 1000 Guatemalans died, and many highways across the affected regions were closed for days.
All highways have now reopened.
Temporary repairs are still in place; some have already been washed out and others will likely fail during the current rainy season.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offences.
Persons violating Guatemalan laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Guatemala 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 international adoption of children and international parental child abduction, see the Office of Children's Issues website.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Guatemala are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website and to obtain updated information on travel and security within Guatemala.
Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The latest security information is available from the Embassy, including its website, http://guatemala.usembassy.gov
The Consular Section is open for citizen services, including registration, from 7:30 a.m. to 12:00 noon and 1:00 p.m. to 3:30 p.m. Monday through Thursdays and 7:30 a.m. to 11:30 a.m. Fridays, excluding U.S. and Guatemalan holidays.
The second and last Friday of each month are reserved for administrative matters; therefore, routine citizen services are not provided.
Emergency services are available at all times.
The U.S. Embassy is located in Guatemala City at Avenida La Reforma 7-01, Zone 10; telephone (502) 2-326-4000 during Embassy business hours (8:00 a.m. to 5:00 p.m.), or (502) 2-331-2354 for emergencies during non-business hours; fax (502) 2-332-4353; Internet web site - http://guatemala.usembassy.gov.
* * *
This replaces the Consular Information Sheet dated June 13, 2006 to update the Entry and Exit requirements section.

Travel News Headlines WORLD NEWS

Date: Sat, 9 Mar 2019 23:07:09 +0100

Guatemala City, March 9, 2019 (AFP) - The parents of a British tourist who has been missing in Guatemala for the past five days launched an emotional appeal for her return Saturday as authorities continued their investigation.   Catherine Shaw, 23, was last seen Monday at a hotel in San Juan La Laguna near the country's fabled Lake Atitlan, about 75 kilometres (45 miles) west of the capital Guatemala City.   The area is famous for its lakes beneath towering volcanoes. Lake Atitlan is one of Guatemala's main tourist attractions.

Her parents put up a video appeal on the Twitter account of the Lucie Blackman Trust, a British charity that provides support to the families who have relatives missing, murdered or in a crisis abroad.   "Hello Catherine, we've been out of touch for five days and we, your family and your friends, need to know you're happy and that you're well. So please get in touch, get in touch with us, and we really you home," said her mother, who did not provide her name on the video.   "We need you, please come home, sweetheart," added her father.

Shaw was described as being five feet seven inches tall (170 centimetres) and of slim build, with blonde hair, blue eyes and piercings in her nose, lip and ears.   She had been traveling in Guatemala for two weeks having previously been in Mexico and California, leaving home in England in September 2018, according to the charity.   Eduardo Smith, the British embassy spokesman, told Prensa Libre that embassy staff were working with Guatemalan police on the case.
Date: Tue, 20 Nov 2018 02:54:29 +0100

Guatemala City, Nov 20, 2018 (AFP) - Guatemalan authorities declared a red alert and evacuated around 4,000 people Monday after the Fuego volcano erupted for the fifth time this year, sending bursts of ash and lava down the mountain before its activity decreased and then stopped.   Memories are still painfully fresh of the volcano's eruption in June, which swept away villages and left nearly 200 people dead and 235 missing.   The Institute of Volcanology's director Pablo Oliva said the volcano's activity level had dropped significantly by late Monday.

A spokesman for Guatemala's disaster management agency CONRED had earlier said it decided to evacuate the municipality of Escuintla and two other districts. Some 4,000 people were taken to temporary shelters as a precaution.   The spokesman, David de Leon, said the eruption became increasingly violent after it began Sunday morning, leading to fears for the safety of the thousands of people who live on the slopes of the 3,763 meter-high (12,246 feet) mountain.

A column of ash rose about 1,000 meters above the crater and areas west of the volcano -- 35 kilometers (22 miles) from Guatemala City -- were under a barrage of gas ash and fiery rocks, CONRED said.   As the volcano's activity fell back to normal parameters, evacuees were asked for the sake of cautiousness to return home on Tuesday by bus.

A previous eruption on October 12-13 was characterized by increasingly loud booms and lava flow. On that occasion, 62 people were evacuated from their homes as a precaution and a highway around the mountain was closed.   Many of those evacuated on Monday said they had feared a repeat of the deadly June eruption.   "We were scared and that's why we evacuated," said Miriam Garcia, from the village of El Rodeo which was largely spared the deadly eruption.

Oscar Juarez from El Rodeo said: "You have to get out as soon as possible because when that (volcanic material) comes close, you no longer have time to leave, even if you run, because it comes very fast."   Activity inside Guatemala's two other volcanoes, Pacaya and Santiaguito, has increased in recent months but they have not entered the eruptive phase.
Date: Mon, 19 Nov 2018 11:28:44 +0100

Guatemala City, Nov 19, 2018 (AFP) - Guatemalan authorities on Monday declared a red alert after the Fuego volcano erupted again, forcing about 200 residents to flee.   A fiery glow rose from the crater of Fuego which is erupting for the fifth time this year, one month after the last one and following a June 3 rain of rocks, ash and toxic gases that left almost 200 people dead and 235 missing.   A spokesman for Guatemala's disaster management agency CONRED, David de Leon, said 214 residents who live on the slopes of Fuego, mostly in the southern municipality of Escuintla, were moved to safe zones and more will follow.

He said about 2,000 people in total have been asked to leave the area of the 3,763-meter (12,246-foot) volcano, 35 kilometres (22 miles) from Guatemala City.   Since the eruption began Sunday morning, lava rises 500 meters above Fuego's crater, while the ash column exceeds one kilometre above the volcanic cone and is causing a rain of particles, the Institute of Volcanology said.   The previous eruption lasted from October 12-13 with loud booms and lava flow. It caused the evacuation of 62 people and closed a highway.
Date: Fri, 12 Oct 2018 18:54:16 +0200

Guatemala City, Oct 12, 2018 (AFP) - Guatemala's deadly Fuego volcano erupted anew early Friday, unleashing a 600-meter flow of lava and sending clouds of ash spiralling into the sky.   Increased volcanic activity over the last 24 hours could release tons of fiery volcanic material and force evacuations of mountain villages, warned Guatemala's disaster management agency CONRED.

A powerful June 3 eruption of the Fuego volcano -- located 35 kilometres (22 miles) southwest of the capital -- rained rocks, ash and toxic gases on several villages and left 190 people dead and 235 missing.   CONRED had yet to issue evacuation orders for mountain communities early Friday, but spokesman David de Leon said: "Considering how the volcano is behaving some communities could make decisions to evacuate to safe areas."

Authorities shut down a nearby highway as a precaution and vulcanologists warned the civil aviation agency of an ash cloud to the west and southwest of the volcano.   Scientists monitoring the 3,763-meter (12,346-foot) volcano reported increased activity from late Thursday. However, activity intensified on Friday with loud booms and lava flows, the Institute of Vulcanology said.   Some 2,900 displaced victims of the earlier disaster remain in temporary shelters as government promises to build a 1,000 permanent homes on a state farm have been held up by irregularities.
Date: Tue 6 Feb 2018
Source: Cooperativa.cl [in Spanish, machine trans., edited]

The Ministry of Public Health and Social Welfare of Guatemala reported [Tue 6 Feb 2018], that the number of people intoxicated by an outbreak of salmonellosis detected in a bakery in the country's capital has risen to 115. A source from the portfolio confirmed that, although initially reported of 54 affected, the number has risen to 115 and added that no further details of this case can be given as it is under investigation.

Health Minister Carlos Soto had previously indicated that the 1st 54 people infected after eating at this establishment, located in zone one of the capital, had already received medical discharge. In addition to _Salmonella_, the authorities detected in the establishment the bacterium _E. coli_ and during the investigations they verified that the workers did not have sanitary cards.

The bakery had until last [Fri 2 Feb 2018], to present the proof of release in this case, but asked for an extension at which time theHealth portfolio will make the decision to close or sanction the establishment.
====================
[The source of the salmonellosis outbreak linked to the bakery is not clear.

A map of (Guatemala): <http://healthmap.org/promed/p/13>. - ProMED Mod.LL]
More ...

Maldives

General:
***************************************
The Republic of Maldives is a series of over 1190 islands which are situated southwest of Sri Lanka. Frequently Irish tourists will combine these two destinations in a single holiday and enjoy the
pleasures of both destinations. The islands of the Maldives are spread over one million square kilometers and there are 26 atoll formations. The facilities for tourism is well developed throughout the resort islands and
straying away from these more built up regions will require advance approval. The climate is tropical with fairly consistent rainfall and temperatures throughout the year. The more northern islands are most commonly affected by cyclones and the rainfall in the southern regions tends to be between November to March. Temperatures are usually fairly consistently above 20C.

MALDIVES TOURIST BOARD WEB PAGE
***************************************
The web site http://www.visitmaldives.com/intro.html gives a potential visitor an excellent insight into the Islands and the range of facilities which they have to offer.
Safety and Security:
***************************************
Crime rate on the Maldives is low although tourists should be aware that they should take care of personal belongings at all times. It is wise to use the hotel safe deposit boxes on the island resorts.
Health Facilities:
***************************************
The medical facilities within the Maldives is limited to the main resorts. There are two hospitals on the main island (Male) and the cost of treatment can be high. Having personal health insurance is a wise precaution.
Transport within the Islands:
***************************************
The main means of transport between the islands tends to be by boat or seaplane. Only very few of the islands have cars but this is not generally a problem for tourists. In the main capital of Male the traffic moves on the left side of the road and there are taxis if required. Water taxis called ‘Dhonis’ are available between the airport and the capital and also to some of the outlying islands. The Air Taxi service stops one hour before sunset.
Food & Water Facilities:
***************************************
The tourist resorts have a high level of hygiene and the risk of significant illness among those who follow sensible food and water hygiene is small. Avoiding all bivalve shellfish is usually a wise precaution and this includes oysters, mussels and clams. The water in the main resorts will be chlorinated but check this on arrival. If unsure it will always be wiser to use sealed bottled water for drinking and brushing your teeth.
Malaria & Rabies Risk:
***************************************
There is no malaria or rabies transmission on the Maldives though avoidance of both mosquitoes and animals is always a wise precaution.
Water Sport Facilities:
***************************************
Those undertaking water sport activities and scuba diving should be aware that rescue facilities are not always easily available in all regions. There are decompression facilities available but these may be located at some distance from where the incident occurs. Make sure that you always choose to use one of the better maintained providers. If you are unhappy about their apparent level of expertise and care for their clients, change to a different provider but don’t take risks.
Sun Exposure:
***************************************
The level of direct sunlight throughout the islands is high and visitors should take special care with regard to the possibility of sun exposure and dehydration. Sea swimming should be in the company of others and take care to listen to local advice.
Local Laws & Customs:
***************************************
Throughout the Maldives their practice Islam and the overt public observance of any other religion is not permitted. In the past few years a number of non-Maldivian families have been expelled for religious activities. Tourists are permitted to carry personal religious texts (Bible etc) without difficulty. There are no cash dispensing machines and travellers cheques are used infrequently. The island resorts tend to be expensive and visitors should carry sufficient funds. Dress is usually informal but topless bathing is prohibited.
Vaccinations for the Maldives:
***************************************
Unless you are flying from tropical Africa there are no essential vaccines for entry or exit. However for your own personal health it is recommended that travellers are covered against the following diseases;
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food & water borne disease)
*
Hepatitis A (food & water borne disease)
For those considering a longer or more rural trip over vaccines may be considered including Hepatitis B.
Summary:
***************************************
Most Irish travellers to the Maldives will enjoy a splendid relaxing holiday in this beautiful series of islands. Nevertheless, commonsense and care are essential with some predeparture planning to ensure that all your travel plans run smoothly.

Travel News Headlines WORLD NEWS

12th May 2019

Maldives
- National. 25 Apr 2019. 1700 cases of dengue reported thus far this year [2019]. <https://raajje.mv/en/news/53605>

- National. 8 May 2019. The number of dengue cases reported across the Maldives has increased more than 200 percent compared to the previous year [2018]. Some 1912 cases of dengue were reported by the end of last month [April 2019] with 506 cases reported in April 2019 alone. The figure represents a sharp uptick from the 539 cases reported during the same period in 2018. There were 441 cases during the 1st 4 months of 2017. <https://maldivesindependent.com/society/maldives-records-sharp-rise-in-dengue-cases-145175>
Maldives - National. 2 Apr 2019

1303 cases of dengue and chikungunya reported, and viruses definitely on the rise now.
17th February 2019

- National. 12 Feb 2019. 107 cases of dengue reported so far in February [2019]: 16 cases in capital Male' and 91 in the outlying atolls. 237 cases of dengue were reported in the Male' region alone in December [2018], and the total number of cases in atolls has reached 321.
Date: Thu 7 Feb 2019
From: Taiichiro Kobayashi <tkobayashi@cick.jp> [edited]

[re: Dengue/DHF update (03): Asia (Japan ex United Arab Emirates) http://promedmail.org/post/20190201.6290139, Dr. Kobayashi shared the following information for correction to his earlier contribution on Promed-mail.]

"After publication of this information on ProMED-mail, the patients described to us a true story. They travelled not only UAE but also Maldives from [31 Dec 2018 to 4 Jan 2019]. The reason why they didn't share the information about their Maldives stay was a private issue. But we don't want to confuse the society. Finally, we diagnosed that these patients were infected with dengue fever in Maldives, not in UAE.

"We deeply apologize for our misinformation. We learned that clinicians could make a mistake about the origin of imported infectious diseases because clinicians have to get information on itinerary only by patients' testimony."
----------------------------------------
Communicated by:
Taiichiro Kobayashi MD, DTM&H, MCTM, PhD
Department of Infectious Diseases
Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome
Hospital
3-18-22 Honkomagome, Bunkyo-ku,
Tokyo 113-8677, Japan
=======================
[ProMED appreciates Dr. Kobayashi's update on the previously submitted report.   This highlights the fact that a lot of information related to travel is based on patient's or their family accounts, which may be incomplete or even misleading. That being said, key epidemiological information on the location of early cases of a novel disease or an impending outbreak is often closely linked to travel history and the endemic diseases in the visited areas. - ProMED Mod.UBA]

[HealthMap/ProMED maps available at:
Date: Tue, 22 Jan 2019 13:10:25 +0100

Colombo, Jan 22, 2019 (AFP) - Five tourists including a honeymooning couple have drowned in a single week in the Maldives, officials said, prompting a nationwide safety warning to holiday resorts in the pristine islands.   Tourism officials said all resort operators in the paradise archipelago were urged Monday to keep a close eye on their clients after the spate of deaths.

Strong currents caused by a north-east monsoon were blamed for the slew of drownings in the idyllic atoll nation, where such accidents are usually few and far between.   Around 1.4 million tourists visit the Maldives every year but the latest government data shows just 31 people drowned in 2017.

On January 13, two Filipino newlyweds were swept to their deaths by a powerful undertow.   The man got into trouble and his wife went to his aid, but both perished. Their bodies were recovered and repatriated to the Philippines, officials said.    An 84-year-old Czech tourist and a 66-year-old South Korean woman died within two days of each other at a resort near the capital Male while snorkelling.   A Russian woman on a dive trip was the latest casualty on Sunday.

A Pakistani holidaymaker came close to death but was plucked to safety and taken to hospital.   The tourism ministry was in the process of identifying safe zones for ocean swimming and diving after the spike in drownings, officials said.   The Maldives relies on tourism and visitors come for the turquoise waters and white sand beaches of the islands scattered some 800 kilometres (500 miles) across the equator.
More ...

World Travel News Headlines

Date: Mon, 16 Sep 2019 08:19:07 +0200 (METDST)

Tokyo, Sept 16, 2019 (AFP) - Almost 80,000 homes are still without power a week after a powerful typhoon battered eastern Japan, authorities said Monday, with sustained heavy rain prompting evacuation orders and hampering recovery efforts.    Typhoon Faxai powered into the Tokyo region in the early hours of Monday last week, packing record winds that brought down power lines, disrupted Rugby World Cup preparations and prompted the government to order tens of thousands of people to leave their homes.

The storm killed two people, with at least three elderly later confirmed dead due to heatstroke as temperatures soared to above 35 degrees Celsius (95 degrees Fahrenheit) in areas affected by a post-typhoon blackout.   Some 78,700 households were still without power in Chiba, southeast of the capital, Tokyo Electric Co. (TEPCO) spokesman Naoya Kondo told AFP.   "A complete recovery is still unlikely until September 27 as we have difficulties in mountain areas," he added.   Some 16,700 households were also without water because several water purification plants had no power, a local official said.   With help from the military, officials were dispatching water tanker trucks to the affected areas.

The national weather agency Monday issued new warnings for heavy rain in Chiba, while local authorities issued non-compulsory evacuation orders to 46,300 people due to the risk of landslides.   "A delay in recovery work is expected due to heavy rain," said Kenta Hirano, a disaster management official in Futtsu in Chiba, where more than 1,000 houses were damaged by the typhoon.   Local media showed residents in Chiba hurriedly covering broken roofs with blue tarps.   "We are at a loss as we can't live there again," a 66-year-old man told public broadcaster NHK after the typhoon ripped off the roof of his house.
Date: Sun, 15 Sep 2019 15:38:29 +0200 (METDST)

Athens, Sept 15, 2019 (AFP) - More than 160 firefighters on Sunday battled to contain a large fire near Athens blazing for a second day amid gale force winds, officials said.   And in another emergency, authorities evacuated dozens of people from two villages and a hotel on the island of Zakynthos after a new fire broke out on Sunday.

The fire department said the blaze near Athens burned in the mountains above Loutraki, a coastal resort some 60 kilometres (35 miles) west of Athens.   "The fire is burning near the top of the mountain," Stefanos Kolokouris, the fire department's deputy chief of operations, told state TV ERT.   "We are trying to create a perimeter but the terrain is very difficult, with ravines," he said.   Four water bombers and six helicopters were participating in operations. Given a lack of roads in the area, two squads of firefighters had to be carried to the mountaintop by Super Puma helicopter, state agency ANA said.   Officials had already evacuated 50 people from a local monastery when the fire broke out on Saturday, but stressed that other inhabited areas were not in danger.

On Zakynthos, officials ordered the evacuation of the villages of Agalas and Keri in the south of the island. Some 120 tourists were also relocated to a safe area.   The Greek fire department on Sunday said it had been called to nearly 80 fires over the past 24 hours.   It has already faced more than 9,600 rural and urban fires this year.
Date: Sat, 14 Sep 2019 16:08:47 +0200 (METDST)

Singapore, Sept 14, 2019 (AFP) - Pollution from forest fires in Indonesia pushed Singapore's air quality to unhealthy levels for the first time in three years on Saturday, the government said, a week ahead of the Formula One night race in the city.   The toxic smoke caused by burning to clear land for plantations is an annual problem for Indonesia's neighbours, but has been worsened this year by particularly dry weather.   "There has been a deterioration in the haze conditions in Singapore this afternoon," the National Environment Agency (NEA) said in a statement.   "This was due to a confluence of winds over the nearby region that led to more smoke haze from Sumatra being blown toward Singapore," it said, referring to one of the Indonesian islands where fires are raging.

The NEA said the pollutant standards index (PSI) worsened to 112 in parts of the island Saturday night.   An index reading between 101-200 is considered unhealthy, with residents advised against doing prolonged strenuous exercises outdoors.   Singapore may continue to experience hazy conditions over the next few days, the agency warned.   The city-state of 5.6 million people was shrouded in a thin white haze, with a few residents seen wearing face masks, but there was no major disruption to daily activities.   The F1 race is scheduled from Friday to Sunday on a street circuit in the Marina Bay financial district.

Singapore GP, the Formula One organisers, said the possibility of haze is one of the potential issues covered in their contingency plan for this year's grand prix.   "The plan was formulated and refined with stake holders, government bodies and the Formula One community," Singapore GP said in an emailed statement.   "In the event that the haze causes visibility, public health or operational issues, Singapore GP would work closely with the relevant agencies before making any collective decisions regarding the event."

Neighbouring Malaysia has also been affected by the smoke, with air quality in parts of the country including the capital Kuala Lumpur reaching unhealthy levels over the past few days and triggering a diplomatic row with Jakarta.   In 2015, the index reached "hazardous" levels of more than 300 in Singapore, forcing the closure of schools. Indonesian forest fires were the worst in two decades that year, firing up smog that blanketed large parts of Southeast Asia for weeks.
Date: Sat, 14 Sep 2019 11:16:53 +0200 (METDST)

Bangkok, Sept 14, 2019 (AFP) - Floods in northeastern Thailand have submerged homes, roads and bridges, leaving more than 23,000 people in evacuation shelters as anger grows over the government's "slow" emergency response.   Torrential rain has lashed the country for the last two weeks, causing flash floods and mudslides in almost half its provinces, with families evacuated from their homes in boats or makeshift rafts.   Since August 29, 32 people have been killed in the deluge, said a statement from the disaster department on Saturday that also gave the number of people staying in emergency shelters.   Two weather events are behind the widespread floods, the department said -- Storm Podul and a tropical depression that formed over the South China Sea called Kajiki.

Local media reports from the worst-hit province of Ubon Ratchathani showed people wading through chest-deep water and rescuers in boats trying to steer buffalo to higher ground.   Flooding in the province, which borders Laos and Cambodia, has been exacerbated by rising water levels in the Moon and Chi rivers.   "It will take three weeks to drain the floodwater" from up to 90 percent of inundated households, said provincial governor Sarit Witoon.   "The water has slightly receded about four centimetres today and I think it will keep going down," he added.

But the situation is already "unlivable" for families in one-storey homes, said Pongsak Saiwan, local director of opposition party Future Forward.   Access to an entire district is currently cut off due to flood waters, which are about two metres (6.5 foot) deep in the main town, while three major bridges are "impassable", he said.   "The government has been very slow in responding to the situation since the floods started in the beginning of September," Pongsak told AFP.   Ubon Ratchathani's plight started trending on Twitter this week with the hashtag #SaveUbon.   Aerial shots of the flood-hit plains blanketed with muddy river water were widely shared, as well as photos of stray dogs being rescued by passing boats.

One Twitter user compared the flood response to how quickly the government had mobilised and saved 12 young boys and their football coach from a waterlogged cave last year -- an incident that catapulted Thailand to international attention.   "Only 13 lives stuck in the cave and it was still very high-profile, but this is hundreds of thousands of lives," tweeted Yosita8051. "It's not okay."   Thailand's junta leader-turned-premier Prayut Chan O-Cha tweeted on Saturday that he has told agencies to "expedite assistance" to those in the affected areas.
Date: Fri, 13 Sep 2019 16:44:33 +0200 (METDST)

Niamey, Sept 13, 2019 (AFP) - Niger launched a campaign on Friday to vaccinate more than four million children against measles, one of the biggest causes of child mortality in the country, the health ministry said.

The one-week nationwide vaccination programme aims to "eliminate measles by the end of 2020", Health Minister Illiassou Mainassara said, adding, it "will reach 4.254 million children" aged from 9 months up to the age of five.   "Despite all the efforts made in the fight against communicable diseases, we still note the persistence of localised measles epidemics (in Niger)," Mainassara said on his way to the capital Niamey to launch the campaign.    But some experts say the vaccination programme should have kicked in sooner    "The delay of this campaign which should have happened in 2018 has resulted in ...the emergence of epidemics in several health districts," said Niger's UNICEF representative, Felicite Tchibindat.

Since January this year, 9,741 suspected cases have been documented in Niger resulting in 53 deaths, she said.   "Measles is a serious and extremely contagious viral disease and remains one of the leading causes of early childhood death, while it can be prevented by vaccination," TchibiNdat said.    She believes the children of migrants, refugees and displaced people will especially benefit from the campaign.    Niger's vaccination programme is supported by the World Health Organization (WHO), UNICEF (United Nations Children's Fund) and the Gavi vaccine Alliance.
Date: Fri, 13 Sep 2019 16:08:16 +0200 (METDST)

Nairobi, Sept 13, 2019 (AFP) - Kenya on Friday became the third country to start routinely innoculating infants against malaria, using the world's first vaccine to combat a disease that kills 800 children globally every day.   The vaccine -- lab name RTS,S -- targets the deadliest and most common form of malaria parasite in Africa, where children under five account for two-thirds of all global deaths from the mosquito-born illness.

Kenya joins Malawi and Ghana, which commenced their own pilot programs for the vaccine supported by the World Health Organization (WHO) earlier this year.   The vaccine will be introduced in phases across malaria-endemic parts of western Kenya near Lake Victoria, starting with Homa Bay, the country's health ministry said.   "It's an exciting time for Kenya as we roll out this vaccine in parts of the country where the burden of malaria is the highest," Health Minister Sicily Kariuki said in a statement.   RTS,S will be added to the national immunisation schedule in these areas, given alongside other routine shots for children under two.

The health ministry said 120,000 Kenyan children were expected to be vaccinated under the pilot programme.   The country has distributed insecticide-treated mosquito nets, fumigated homes and improved diagnostics in its fight against malaria.   But the disease remains stubborn. The health ministry says malaria claimed more than 10,000 lives in 2016, and infected millions more.   As in the rest of the world, children in Kenya bear the brunt of the disease.    Up to 27 percent of Kenyan children under five have been infected with the disease, the health ministry said.   "This vaccine represents an additional tool that will boost Kenya's efforts in reducing malaria infections and deaths among children," Kariuki said.   WHO says a child dies roughly every two minutes from malaria somewhere in the world.

- 30 years in making -
Known under its commercial name as Mosquirix, the vaccine was developed over 30 years by British pharmaceutical giant GlaxoSmithKline in partnership with nonprofit PATH and African research institutes.   It is the only vaccine to date to show a protective effect against malaria in young children, WHO says.   It acts against Plasmodium falciparum, the deadliest malarial parasite and the most prevalent in Africa, where illness and death from the disease remain high despite some gains.   The shots, administered over four doses, have been shown in clinical trials to significantly reduce cases of malaria, and malaria-related complications, in young children.   The vaccine prevented about four in 10 cases of malaria and three in 10 cases of the most severe, life-threatening form of the disease, within the trial group, WHO says.

Evidence gained from the vaccine pilot schemes could guide decisions about whether RTS,S is rolled out more widely in future, WHO says.   "This is the most advanced malaria vaccine that we have today. It has been in the making for the last almost three decades," Dr Richard Mihigo, WHO's co-ordinator of immunisation and vaccine development programme, told AFP before the Kenyan launch.   "Children are the most vulnerable group to this severe disease that is malaria, so protecting children can make a big impact in preventing malaria."   The disease kills more than 400,000 people around the world every year. Of these about 290,000 are under five.    Most are in Africa, where more than 90 percent of the world's malaria cases -- and fatalities -- occur.
Date: Fri, 13 Sep 2019 11:40:02 +0200 (METDST)

London, Sept 13, 2019 (AFP) - British Airways has cancelled all its scheduled UK flights for September 27, when company pilots will again strike in a long-running row over pay.   It comes after the carrier cancelled all flights departing and arriving in the UK on Monday and Tuesday owing to BA's first strike by pilots in the company's 100-year history.

In a statement released late Thursday, BA called on the British Airline Pilots Association (BALPA) union "to call off their strike and return to negotiations".    The airline added: "We are very sorry that BALPA's actions will affect thousands more travel plans."   This week's strike sparked travel chaos for about 200,000 passengers, mostly using London's Gatwick and Heathrow airports.   BALPA estimates that the 48-hour strike cost the airline £80 million ($99 million, 89 million euros), but BA has yet to provide a figure.
Date: Tue, 10 Sep 2019 13:02:19 +0200 (METDST)

Khartoum, Sept 10, 2019 (AFP) - Sudan reported four confirmed cases of cholera in Blue Nile Tuesday and said three people had also died of acute diarrhoea in the war-torn state.   Health Minister Akram al-Toum has asked the World Health Organization to send supplies of cholera vaccine immediately, the ministry said.

Ministry and WHO officials have been sent to the affected area.   "There are 37 cases of acute diarrhoea in Blue Nile... There have been three deaths," the ministry said in a statement.   Dozens of people died from acute diarrhoea in Sudan in 2016 after thousands of cases were reported nationwide.   Blue Nile state, which has a large ethnic minority population, has been the focus of a rebellion by the Sudan People's Liberation Army-North since 2011.   The army declared a ceasefire after the  overthrow of veteran president Omar al-Bashir earlier this year.
Date: Sat 14 Sep 2019
Source: Vax Before Travel [edited]

A new report from Japan's National Institute of Infectious Disease (NIID) indicates the Rubella virus outbreak continues to spread. As of [4 Sep 2019], there have been 2156 Rubella cases reported by the NIID during 2019.

This is an increase of about 260 rubella cases in Japan since July 2019. On a local basis, the city of Tokyo has reported 37% of Japan's 2019 Rubella cases.

Since Rubella is very dangerous for a pregnant woman and her developing baby, the US Centers for Disease Control and Prevention (CDC) said on [7 Aug 2019], "pregnant women who are not protected against rubella through either vaccination or previous rubella infection, should not travel to Japan during this outbreak."

But, pregnant women should not get a Rubella vaccination with the measles-mumps-rubella (MMR) says the CDC. This is because the MMR vaccine is an attenuated "live virus" vaccine.

The CDC says "pregnant women who are not vaccinated should wait to get [the] MMR vaccine until after they have given birth. And, women of childbearing age should avoid getting pregnant for at least 4 weeks after receiving the MMR vaccine."

Additionally, the CDC says "if a pregnant woman contracts the rubella virus, her baby could have birth defects such as deafness, cataracts, heart defects, mental disabilities, and organ damage."

And, when a rubella infection occurs during early pregnancy, serious consequences, such as miscarriages, stillbirths, and severe birth defects in infants, which are known as Congenital Rubella Syndrome (CRS), [may result].

This new NIID report indicates there have been 3 CRS cases in Japan during 2019. As a comparison, during 2005-2015 in the USA, only 8 babies with CRS were reported.

Moreover, [fewer] than 10 people in the USA are reported as having rubella each year. Since 2012, all rubella cases had evidence that they were infected when they were living or traveling outside the USA.

To alert international travellers, the CDC issued a Level 2 Travel Alert regarding Japan's ongoing Rubella virus outbreak in August 2019. This "Practice Enhanced Precautions" Travel Alert says "travellers to Japan should make sure they are vaccinated against rubella with the MMR vaccine before visiting Japan." This CDC Travel Alert is important since approximately 4.5 million US citizens visit Japan annually.

Additionally, the Public Health Agency of Canada and the UK Foreign Travel Advice recommend "pregnant women who are not protected against rubella avoid traveling to Japan."

In the USA, there are 2 approved rubella vaccines: MMR II-Rubella and ProQuad. Both rubella vaccines are available at most pharmacies. Travelers to Japan can request a rubella vaccine counselling appointment with a local pharmacist.

Rubella vaccines, like any medicine, can produce side effects. [People] are encouraged to report vaccine side effects to a healthcare provider or the CDC.  [Byline: Dani Reiter]
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[See discussion of rubella in ProMED-mail Rubella - Japan (02)

[HealthMap/ProMED-mail map:
Date: Tue 10 Sept 2019
Source: Focus Taiwan [edited]

Taiwan's enterovirus cases continued to increase last week, bringing the total number to nearly 20 000 between [1 and 7 Sep 2019], the Centers for Disease Control (CDC) said Tuesday [10 Sep 2019].

A total of 19 254 patients sought outpatient or emergency treatment at hospitals for enterovirus infection around the country, up 4% from the figure recorded the previous week [25-31 Aug 2019] and the highest over the same period in nearly 5 years, according to CDC data.

CDC physician Lin Yung-ching said there were 2 severe cases recorded last week, one of which involved an 8-month-old girl and the other a 4-year-old boy, both in central Taiwan. The 2 children were reported in stable condition after treatment.

Some of the 2 patients' family members or classmates with whom they had had contact have also been confirmed as enterovirus cases, and the CDC judged that the infection might have been spread through contact, Lin said.

A total of 303 cases of enterovirus-71 (EV-71), the most severe enterovirus strain, have been reported so far this year [2019], the highest in the same period from 2016 to 2018.

Meanwhile, a total of 36 cases with severe complications have been recorded nationwide, including 27 EV-71 cases, according to CDC statistics.

EV-71 is a neurological disease that attacks the nervous system, and infants under the age of 5 are at highest risk of developing severe complications from this type of infection.

In extreme cases, EV-71 can cause polio-like permanent paralysis, according to the CDC. As Taiwan is still in the peak season for enterovirus infection, CDC Deputy Director-General Philip Lo urged the public to take precautions against the spread of the illness, especially among children.

Children infected with enterovirus should be kept away from school so as to prevent the spread of the disease, as enterovirus is highly contagious, Lo advised.  [Byline: Chen Wei-ting and Evelyn Kao]
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[The enteroviruses are spread from person to person by coughs, sneezes, or touching objects or surfaces that have the virus on them. Therefore, practicing good personal hygiene -- washing hands regularly and thoroughly with soap and water -- is the best way to prevent from getting and spreading the infectious disease.

However, most people infected with non-polio enteroviruses do not get sick, or present with mild illness, like the common cold. Infants, children, and teenagers are more likely than adults to get infected and become sick because they do not yet have immunity (protection) from previous exposures to the viruses. Adults can get infected too, but they are less likely to have symptoms, or their symptoms may be milder. Symptoms of mild illness may include fever; runny nose, sneezing, and cough; skin rash; mouth blisters; and body and muscle aches.

Some non-polio enterovirus infections can lead to:
- Viral conjunctivitis;
- Hand-foot-mouth disease;
- Viral meningitis (infection of the covering of the spinal cord and/or brain);
- Viral encephalitis (infection of the brain);
- Myocarditis (infection of the heart);
- Pericarditis (infection of the sac around the heart);
- Acute flaccid paralysis (a sudden onset of weakness in one or more arms or legs);
- Inflammatory muscle disease (slow, progressive muscle weakness).

Infants and people with weakened immune systems have a greater chance of having these complications. People who develop myocarditis may have heart failure and require long-term care. Some people who develop encephalitis or paralysis may not fully recover.

Enterovirus cases were reported from Taipei, Taiwan in 2017 (Human enterovirus - Taiwan: alert http://promedmail.org/post/20170418.4978387), and health alerts like the one mentioned in report above were issued to the general public to observe proper hygiene to reduce disease transmission. Also the case number for EV-71 associated severe disease has also increased, which is a cause for public health concern. - ProMED Mod.UBA]

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