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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Saint Kitts and Nevis

St. Kitts and Nevis - US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
St. Kitts and Nevis is a developing Caribbean nation consisting of two islands.
Tourist facilities are widely available.
Read the Department
f State Background Notes on St. Kitts and Nevis for additional information.

ENTRY/EXIT REQUIREMENTS:
All Americans traveling by air outside the United States are required to present a passport or other valid travel document to enter or re-enter the United States.
This requirement will be extended to sea travel (except closed loop cruises), including ferry service, by the summer of 2009.
Until then, U.S. citizens traveling by sea must have government-issued photo identification and a document showing their U.S. citizenship (for example, a birth certificate or certificate of nationalization), or other WHTI compliant document such as a passport card for entry or re-entry to the U.S.
Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.

Applications for the new U.S. Passport Card are now being accepted.
We expect cards will be available and mailed to applicants in spring 2008.
The card may not be used to travel by air and is available only to U.S. citizens. Further information on the Passport Card is available at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html.

We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

Visitors may be asked to present an onward/return ticket and proof of sufficient funds to cover the cost of their visit.
Stays of up to three months are granted at immigration.
Anyone requiring an extension must apply to the Ministry of National Security.
There is an airport departure tax and environmental levy charged when leaving the country.

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:
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 Worldwide Caution, Travel Warnings, and Travel Alerts 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:
Petty street crime occurs in St. Kitts and Nevis, as well as the occasional burglary; visitors and residents should take common-sense precautions.
Avoid carrying large amounts of cash and use hotel safety deposit facilities to safeguard valuables and travel documents.
Do not leave valuables unattended on the beach or in cars.
Exercise caution when walking alone at night.

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 care is limited.
The main hospitals are Joseph N. France General Hospital (telephone (869) 465-2551) on St. Kitts and Alexandria Hospital (telephone (869) 469-5473) on Nevis.
St. Kitts has two additional hospitals and both islands have several health clinics.
Neither island has a hyperbaric chamber.
Divers suffering from decompression illness are transported to the island of Saba, in the Netherlands Antilles.
Serious medical problems requiring hospitalization and/or medical evacuation to the U.S. can cost thousands of dollars.
Doctors and hospitals expect immediate cash payment for health services.

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

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

Traffic in St. Kitts and Nevis moves on the left-hand side of the road.
Roads are reasonably well paved but narrow and sometimes poorly marked.
Drivers often stop on the side of or in the middle of the road to visit with other drivers, blocking one lane of traffic.
Honking one's horn is a common form of greeting, not a warning.
Travelers are required to obtain a visitor's drivers license, which may be obtained from the Traffic Department or the Fire Station for a small fee on presentation of a valid home or international license.
Public Transportation consists of mini-buses and taxis.
Established fares are available from airport dispatchers and local hotels.
Complaints regarding taxi or minibus services may be lodged with The Department of Tourism or with your hotel.

More detailed information on roads and traffic safety can be obtained from the Ministry of Tourism, Culture and the Environment, Bay Road, Pelican Mall, P.O. Box 132, Basseterre, St. Kitts, telephone (869) 465-4040.
For specific information concerning St. Kitts and Nevis driving permits, vehicle inspection, road tax and mandatory insurance, contact the St. Kitts and Nevis national tourist organization via the Internet at http://www.stkitts-tourism.com/index.asp.
Please refer to our Road Safety page for more information

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of St. Kitts and Nevis’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of St. Kitts and Nevis’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
There is no U.S. Embassy or Consulate in St. Kitts and Nevis.
The U.S. Embassy in Bridgetown, Barbados, is responsible for American citizen services in these islands.
U.S. citizens are encouraged to carry a copy of their U.S. passports or other proof of citizenship with them at all times so that, if questioned by local officials, proof of identity and U.S. citizenship are readily available.

All Caribbean countries can be affected by hurricanes.
The hurricane season normally runs from June to the end of November, but there have been hurricanes in December in recent years.
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/.

Please see Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating St. Kitts and Nevis laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in St. Kitts and Nevis 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 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 St. Kitts and Nevis are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within St. Kitts and Nevis.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located in Barbados in the Wildey Business Park, Wildey, St. Michael, telephone 1-246-436-4950, web site http://barbados.usembassy.gov/.
The Consular Section telephone number is 1-246-431-0225. The Consular Section fax number is 1-246-431-0179. Hours of operation are 8:30 a.m. to 4:00 p.m. Monday-Friday, except Barbados and U.S. holidays.
In certain circumstances, the U.S. Consular Agency in Antigua can be of assistance.
Persons seeking assistance should call the Consular Agent, Rebecca Simon, at 1-268-463-6531 to schedule an appointment.
*

*

*
This replaces the Country Specific Information for St. Kitts and Nevis dated June 6, 2006, to update sections on Entry/Exit Requirements, Safety and Security, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed 21 May 2014
Source: West Indies News Network (WINN) FM [edited]

There are now 20 confirmed cases of chikungunya disease in St Kitts, according to Acting Chief Environmental health Officer Alexander Riley. Mr Riley made this confirmation Tuesday [20 May 2014] during an edition of WINN FM's Talking Trash programme.

Chikungunya is a mosquito-borne disease that causes fever and joint pain in humans. Other symptoms of the disease include rash, muscle pain, and fatigue.

As the hurricane season approaches Mr Riley lists measures that the environmental health department will be taking to prevent the spread of chikungunya [virus] include fogging beginning this Wednesday [20 May 2014].

Meanwhile, Mr Riley sought to allay fears and concerns about the health and environmental health department risks of fogging, noting that the chemicals used are environmentally friendly.  [Byline: Andre Huie]
===================
[Fogging will provide only temporary vector mosquito control. Elimination or treatment of breeding sites is necessary for significant vector mosquito population reduction. This same report was also sent in by Roland Hubner.

Maps of St Kitts and Nevis can be accessed at
and <http://healthmap.org/promed/p/31>. - ProMed Mod.TY]
Date: Thu 20 Feb 2014
Source: Winn FM [edited]

The Federation [St. Kitts and Nevis] has recorded its 1st confirmed case of the chikungunya virus [infection]. A statement from the Ministry of Health Thursday morning [20 Feb 2014] indicated that the 30-year-old male resident of St. Kitts was hospitalized and discharged without complications 2 weeks ago. Confirmation testing was done by the Trinidad-based Caribbean Public Health Agency (CARPHA).

Speaking to WINN FM Thursday morning, Chief Medical Officer Dr. Patrick Martin assured that there was no need to panic. "There is no need for travel or trade restrictions, no need for alarm, no need to panic. If you have the fever and pain, Paracetamol, lots of fluids... don't tire out yourself," Dr. Martin said Thursday.

Like dengue, chikungunya is characterized by fever and pain which appear up 3-7 days after being bitten by an infected mosquito. Other symptoms include headache, nausea, vomiting, fatigue and rash.

Acute chikungunya fever typically lasts a few days to a few weeks, but as with dengue, some patients have prolonged fatigue lasting several weeks. There is no risk of bleeding complications with chikungunya which distinguishes it from dengue.

Dr. Martin advised that persons exhibiting symptoms can be treated at, and use over the counter medications except for aspirin and ibuprofen.

Dr. Martin said Thursday [20 Feb 2014] that in all likelihood the virus has been in the Federation [St. Kitts and Nevis] for several weeks and that there have been other cases.   [Byline: Toni Frederick]
-----------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
===================
[This report does not indicate whether the chikungunya virus infection was acquired locally on St. Kitts or in another locality where transmission is going on. No mention was made of the individual's travel history off of St. Kitts island, and the Chief Medical Officer mentioned that it is likely that the virus has been present in the Federation for several weeks with occurrence of other cases; these factors suggest that the infection was, in fact, acquired locally.

A HealthMap/ProMED-mail map showing the location of St. Kitts can be accessed at
<http://healthmap.org/r/1E3K>. - ProMed Mod.TY]
Wednesday 15th February 2012

WASHINGTON, Feb 14, 2012 (AFP) - US Supreme Court Justice Stephen Breyer was robbed at his Caribbean island vacation home last week by a masked, machete-wielding bandit, a court spokeswoman said Tuesday.  The incident took place February 9 at the justice's home in Nevis, with about $1,000 cash taken, the spokeswoman said.  "No one was hurt," said the official, noting that the 73-year-old Breyer was "robbed by an armed intruder" and that "the individual was armed with a machete."  Breyer was on vacation during a break from the schedule of the top US court, which resumes hearings Friday.

St Kitts and Nevis

Flag of St Kitts and Nevis
Still current at: 30 November 2011
Updated: 29 November 2011

This advice has been reviewed and reissued, with an amendment to the Entry Requirements - Passport Validity section (updated). The overall level of the advice has not changed; there are no travel restrictions in place in this travel advice for St Kitts and Nevis.

(see travel advice legal disclaimer)


  • There is no British High Commission in St Kitts and Nevis. British nationals requiring emergency consular assistance may contact the British Honorary Consul, Sarah Percival, on +1 (869) 764 4677 begin_of_the_skype_highlighting +1 (869) 764 4677 end_of_the_skype_highlighting. If the Honorary Consul is not available and for all other non-consular related matters please contact the British HighCommission in Bridgetown, Barbados.
  • Around 4,700 British nationals visited St Kitts and Nevis in 2008 (Source: Ministry of Tourism). Most visits to St Kitts and Nevis are trouble-free. The main type of incidents for which British nationals required consular assistance in St Kitts and Nevis in 2008 were replacing lost and stolen passports and dealing with hospitalisations. Over the past year, there has been an overall increase in crime in St Kitts, including gun crimes although these tend to occur within the local community.
  • There is a low threat from terrorism. But you should be aware of the global risk of indiscriminate terrorist attacks which could be in public areas, including those frequented by expatriates and foreign travellers.
  • The hurricane season in St Kitts and Nevis normally runs from June to November. See the Natural Disasters section of this Travel Advice.
  • You should take out comprehensive travel and medical insurance before travelling. See General - Insurance.

Safety and Security - Terrorism
There is a low threat from terrorism. But you should be aware of the global risk of indiscriminate terrorist attacks which could be in public areas, including those frequented by expatriates and foreign travellers. For more general information see our Terrorism Abroad page.

Safety and Security - Crime
Around 5,000 British nationals visit St Kitts and Nevis each year (Source: Ministry of Tourism) and the vast majority of visits are trouble-free. St Kitts and Nevis is a friendly and welcoming country but incidents of violent crime including murder do occur. Gun crime is increasingly problematic; there have been more than 25 murders in 2011, the majority as a result of shootings. Although these tend to occur within the local community, there have been a number of recent incidents involving British nationals in the Half Moon Court area, including a double murder and violent attack.

You should maintain vigilance at all times even when staying with family or friends. Avoid walking alone in isolated areas, including beaches, after dark. Do not carry large amounts of cash or jewellery. Valuables and travel documents should be left, where possible, in safety deposit boxes and hotel safes.

For more general information see our Victims of Crime Abroad page.

Safety and Security - Local Travel

Safety and Security - Local Travel - Road Travel
In order to be able to drive a car in St Kitts and Nevis you must purchase a local driving licence, usually from the car hire company, at a cost of EC$ 100. You must show your current driving licence to obtain this. Motorists drive on the left in St Kitts and Nevis. Main roads are generally well maintained but many follow winding routes so careful driving is necessary. Roads are not well lit at night. You must be alert for stray livestock and speed bumps in some areas that are not well marked. Hiring of scooters is popular amongst visitors but safety equipment is not included in the hire price; despite the additional cost this is highly recommended for your own protection. You should be cautious when driving a scooter, as other road users do not always give them due consideration.

For more general information see our Driving Abroad page.

Safety and Security - Local Travel - Air Travel
You will have to pay a departure tax when leaving St Kitts and Nevis. Departure tax is EC$58 (per adult) and EC$25 (child under 12).

Safety and Security - Political Situation
St Kitts and Nevis Country Profile

You should note that there are severe penalties for all drug offences. Pack all luggage yourself and do not carry anything through customs for anyone else. You should be aware that it is an offence for anyone, including children, to dress in camouflage clothing. Certain homosexual acts are illegal under the laws of St Kitts and Nevis. For more general information for different types of travellers see our Your Trip page.

Entry requirements - Visas
British Passport holders do not require visas to visit St Kitts and Nevis. On entry you are granted a one month stay. If you wish to stay longer you must apply and pay for an extension of stay through the St Kitts and Nevis Immigration Department. It is an offence to overstay the entry period granted or to work without a work permit.

Entry requirements may change from time to time and should be checked with the High Commission of St Kitts and Nevis in London.

Entry requirements - Passport validity
You must hold a valid passport to enter St Kitts & Nevis. Your passport must be valid for a minimum period of six months from the date of entry into St Kitts & Nevis.

The medical facilities on the islands are limited to one hospital, which can deal only with routine medical cases. More serious cases will need to be dealt with in Puerto Rico, USA once the patient is in a stable condition.

Dengue fever is common across the Caribbean and can occur throughout the year. Dengue is a mosquito-borne infection that can cause a feverish illness associated with headache, muscle aches and pains, and rash. Some cases of dengue are severe. Dengue can be prevented by avoiding being bitten by the disease-carrying mosquitoes that feed predominately during daylight hours. For more information on prevention, see the National Travel Health Network and Centre website.

You should exercise normal precautions to avoid exposure to HIV/AIDS. For more general information on how to do this see our HIV and AIDS page.

You should seek medical advice before travelling to St Kitts & Nevis and ensure that all appropriate vaccinations are up-to-date. For further information on vaccination requirements, health outbreaks and general disease protection and prevention you should visit the websites of the National Travel Heath Network and Centre (NaTHNaC) and NHS Scotland's Fit For Travel or call NHS Direct on 0845 46 47.

For more general health information see our Travel Health and Swine Flu page.


The hurricane season in St Kitts and Nevis normally runs from June to November. You can also access the World Meteorological Organisation for updates and the US National Hurricane Centre. For more general information see our Tropical cyclones page.

General - Insurance

You should take out comprehensive travel and medical insurance, which includes medical evacuation, before travelling. Check for any exclusions and that your policy covers you for all the activities you want to undertake. Be especially careful about cover for recurring illnesses as they may not be include in all insurance policies. For more general information see our Travel Insurance page.

If things do go wrong when you are oversees see our When Things Go Wrong page.

General - Registration

Register with our LOCATE service to tell us when and where you are travelling abroad or where you live abroad so our consular and crisis staff can provide better assistance to you in an emergency. More information about registering with LOCATE can be found here.

General - Package Holidays

If you are on a package holiday, you must travel on the specified return date. If you fail to do so it is likely that you will have to pay for a return ticket yourself.

General - Passports


Keep a copy of the photo page of your passport and relevant entry stamp in case your documents are stolen.

The passport service for British nationals in St Kitts and Nevis has now moved from Barbados to the UK Passport Service Centre for the Americas and Caribbean in Washington D.C. (http://ukinusa.fco.gov.uk/passports).

If you are applying for a renewal of your UK passport and you are in St Kitts and Nevis your application, with the appropriate passport fee plus a return courier fee of US $21, should be sent direct to:

The UK Passport Service for the Americas and Caribbean
British Embassy
19 Observatory Circle, NW
Washington, DC 20008

The British High Commission in Bridgetown will continue to issue Emergency Passports for people who have lost their passports and who have an urgent need to travel to the UK.

Date: Fri 15 Jan 2010
Source: Institut de Veille Sanitaire: Le point epidemiologique - N2 [in French, trans. & summ. ProMed Mod.TY, edited]
<http://www.invs.sante.fr/surveillance/dengue/points_sbsm/2009/pe_sb_2009_14_dengue.pdf>

Surveillance of cases clinically suggestive of dengue
-----------------------------------------------------
After reaching very high values between mid-Nov and mid-Dec [2009], the number of cases clinically suggestive of dengue fever has abruptly decreased in week 2009-52 without, however, running below the epidemic threshold. Since then, there has been a gradual increase in new cases, with an estimated 40 cases in the 1st week of Jan [2010]. The number of suggestive [dengue] cases has been well above the epidemic threshold for the past 2 months. It is estimated that during this period, 340 cases suggestive of dengue were seen by general practitioners on the island, averaging over 40 per week. The number of cases clinically suggestive of dengue fever is an estimate for the entire population of the island, based on the number of people who consulted a general practitioner for a clinical syndrome suggestive of dengue. This estimation is performed using data collected from the network of sentinel physicians.

Monitoring of laboratory confirmed cases
----------------------------------------
The number of laboratory confirmed cases of dengue fever follows a dynamic similar to that of suggestive cases. After a sharp decline in week 2009-52, there was a further increase in the number of confirmed cases during the last week of Dec (2009-53), then an equally high number of laboratory confirmations during the past week (2010-01). Since the 3rd week of Nov (2009-47), 239 laboratory confirmed cases were recorded, and the number of weekly cases has far exceeded the epidemic threshold.

Positivity rate of requests for laboratory confirmation and circulating [dengue virus, DENV] serotypes
-------------------------------------------------------
As in the previous week, the positivity rate has been very high in the week 2010-01, since 26 of the 41 samples analyzed have been positive (66 per cent). This is the 2nd consecutive week for this rate, so it is increasing during the upswing of the epidemic. Since mid-Nov 2009 (week 2009-47), DENV-1 has constituted the vast majority [of isolates], accounting for 95 per cent of viruses isolated (73 of 77 samples analyzed). DENV-2 has also been identified but only 4 times.

Hospitalized cases
------------------
Since early Dec [2009], no new confirmed cases of dengue have been hospitalized for more than 24 hours. The number of laboratory confirmed hospitalized cases has been constant since October 2009, with 2 hospitalizations occurring each month.

Spatial distribution
--------------------
The geographical distribution of laboratory confirmed cases indicates their presence on all sectors of the island, indicating that there still is widespread circulation of the virus.

Situation analysis
------------------
At Saint Barthelemy, the epidemic continues. Virus circulation is still important and widespread on the island. The number of hospitalized cases remains very low. The epidemiological situation is still in Phase 3 of PSAG of the Northern Islands as an epidemic phase.
======================
[A map of Saint Barthelemy (St. Barts) in the Caribbean can be accessed at
<http://www.worldatlas.com/webimage/countrys/namerica/caribb/stbarts.htm>. - ProMed Mod.TY]
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Reunion

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Thu 2 May 2019
Source: France TV Info [trans. ProMED SB, edited]

Ti Baba nursery in Saint-Paul has been affected by cases of salmonellosis. Five babies were infected with the bacterium. They were examined by the nursery doctor following symptoms of acute gastroenteritis. For several days, symptoms of acute gastroenteritis have been occurring in the toddlers.

The analyses were carried out on the foodstuffs, the menus served to the children, and, according to the director of the SPL Ti Baba, the service providers in charge of the meals The LRA and the various health authorities are continuing the investigations to find the source of the infection.  [Byline: Rahabia Issa]
=======================
[The source of salmonellosis here is not yet known. Although a foodborne outbreak in the centre is possible, introduction of this enteric pathogen into the day care centre by a child is also possible.

Reunion, one of the overseas departments of France, is an island with a population of about 800 000 located in the Indian Ocean, about 943 km (586 mi) east of Madagascar and about 200 km (120 mi) southwest of Mauritius, the nearest island. A map showing the location of Reunion Island in the Indian Ocean and its main cities can be accessed at <http://www.nationsonline.org/oneworld/map/reunion-map.htm>.

A HealthMap/ProMED-mail interactive map of Reunion Island can be accessed at
<http://healthmap.org/promed/p/45149>. - ProMED Mod.LL]
- La Reunion. 10 Apr 2019

From 800 confirmed cases the previous week, the dengue epidemic increased to 904 cases in the week.
<https://la1ere.francetvinfo.fr/reunion/dengue-barre-900-cas-confirmes-semaine-est-depassee-698934.html> [in French, trans. ProMED Corr.SB]

- La Reunion. 12 Apr 2019. Dengue La Reunion (French overseas territory): dengue cases near 5000 in Q1 2019. New transmission zones have been identified in Saint-Andre, Saint-Denis, Sainte-Marie, and Sainte-Suzanne. In addition, the number of hospitalizations is increasing with 25-30 recorded weekly.

- La Reunion. 27 Mar 2019. The circulation of the dengue virus continues at a sustained level, say the prefecture and the ARS. From 11-17 Mar 2019, 682 cases of dengue fever were confirmed. Since the beginning of the year [2019], 153 emergency room visits have been recorded and 80 patients have been hospitalized. In addition, 5 deaths have been reported since the beginning of 2019, of which 2 have been considered, after investigation, as directly related to dengue fever. The most active households are located at: the Saint-Louis River, Saint Louis, Saint Pierre, the Etang-Sale Cabris Ravine.
- Reunion Island. Fri 24 Aug 2018

6476 dengue cases gave been confirmed since January 2018; 138 hospitalized, 20 cases of severe dengue, including 3 deaths.

[HealthMap/ProMED-mail map of Reunion Island:
Reunion Island. 23 May 2018

In the Indian Ocean, it is also serotype 2 that predominates during the dengue epidemic affecting western and southern Reunion. According to the last assessment of [22 May 2018], 3416 biologically confirmed or probable cases have been reported since [1 Jan 2018, including 387 in a single week. Among them, 75 cases were hospitalized, including 9 severe cases.

[HealthMap/ProMED-mail map of Reunion Island:
Date: Fri 25 May 2018, 5:29 PM
Source: Linfo [in French, trans. ProMED Corr.SB, edited]
<http://www.linfo.re/la-reunion/societe/leptospirose-89-cas-confirmes-depuis-le-debut-de-l-annee-a-la-reunion>

Since the beginning of the year, 89 cases of leptospirosis have been reported in Reunion (against 50 in 2017). This disease can be contracted through contact with contaminated wetland (stagnant water, mud, etc). The West and South are the most affected regions with 21 confirmed cases in Saint-Paul.

Once again, the cleaning of courtyards and gardens or bathing in fresh water [flood water that is contaminated with urine from infected animals, e.g., rats, dogs?] after heavy rains is particularly at risk. The ARS Indian Ocean [the French Regional Health Agency in charge of health administration for Mayotte and La Reunion islands] wants to sensitize the population: it is essential to apply protective measures and fight against rats.

In addition, in the context of a proven epidemic of dengue fever, it is recommended to consult your doctor in case of high fever, in order to be tested and treated appropriately if necessary. [Byline: Lucie Touza]
===================
[Leptospirosis is a zoonotic bacterial infection that is distributed widely throughout the world in warm climates and is transmitted to humans by direct contact of abraded skin or mucous membranes with the urine of infected animals or by contact with wet soil, vegetation, or water that has been contaminated with infected animal urine. _Leptospira_ bacteria shed in urine may survive in fresh water or moist soil for weeks to months.

Many species of wild and domestic animals (including dogs, cattle, swine, and especially rats) are susceptible to chronic kidney infection with pathogenic _Leptospira_. Different leptospiral serovars are prevalent in particular geographical regions. Inadequate disposal of trash and debris provides a suitable habitat for rat infestation in urban settings.

Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers. Reunion experiences seasonal outbreaks of leptospirosis probably related to the rainfall. Reunion, one of the overseas departments of France, is an island with a population of about 800,000 located in the Indian Ocean, about 943 km (586 mi) east of Madagascar and about 200 km (120 mi) south west of Mauritius, the nearest island.

A map showing the location of Reunion Island in the Indian Ocean and its main cities can be accessed at
<http://www.nationsonline.org/oneworld/map/reunion-map.htm>.

A HealthMap/ProMED-mail interactive map of Reunion Island can be accessed at
<http://healthmap.org/promed/p/45149>. - ProMED Mod.ML]
More ...

El Salvador

El Salvador - US Consular Information Sheet
May 01, 2008
COUNTRY DESCRIPTION: El Salvador is a democratic country with a developing economy. Tourism facilities are not fully developed. The capital is San Salvador, accessible by El Salvador's In
ernational Airport at Comalapa. Both the U.S. Dollar and the Salvadoran Colon are legal tender in El Salvador. While Colones are still accepted, the primary currency of El Salvador is the U.S. Dollar. Americans traveling with U.S. Dollars should not exchange them for Colones. Read the Department of State Background Notes on El Salvador for additional information.

ENTRY/EXIT REQUIREMENTS:
To enter the country, U.S. citizens must present a current U.S. passport and either a Salvadoran visa or a one-entry tourist card.
The tourist card may be obtained from immigration officials for a ten-dollar fee upon arrival in country.
U.S. travelers who plan to remain in El Salvador for more than thirty days can apply in advance for a multiple-entry visa, issued free of charge, from the Embassy of El Salvador in Washington, DC or from a Salvadoran consulate in Boston, Chicago, Dallas, Houston, Las Vegas, Long Island, Los Angeles, Miami, New York City, or San Francisco.
Travelers may contact the Embassy of El Salvador at 1400 16th Street NW, Washington, DC
20036, tel. (202) 265-9671, 265-9672; fax (202) 232-3763; e-mail: correo@elsalvador.org or visit the Embassy's web site at http://www.elsalvador.org.
When applying for a visa, travelers may be asked to present evidence of U.S. employment and adequate finances for their visit at the time of visa application or upon arrival in El Salvador.
For passengers departing by air, El Salvador has an exit tax of $32.00 which is usually included in the price of the airline ticket.

Travelers should be aware that El Salvador's entry requirements vary in accordance with agreements the country has with foreign governments.
Citizens of several countries in addition to the United States may enter El Salvador with a current passport and either a visa or tourist card.
Citizens of many other countries, including many Latin American and western European nations, may enter with only a current passport.
However, citizens of most nations are required to present both a current passport and a visa to enter El Salvador.
Non-U.S. citizen travelers are advised to contact a Salvadoran embassy or consulate to determine the entry requirements applicable to them.

In June 2006, El Salvador entered into the “Central America-4 (CA-4) Border Control Agreement” with Guatemala, 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 must request a one-time extension of stay from local immigration authorities in the country where the traveler is physically present, or they must leave 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.

Airlines operating out of El Salvador International Airport require all U.S. citizen passengers boarding flights for the United States (including U.S.-Salvadoran dual nationals) to have a current U.S. passport.
U.S. citizens applying for passports at the U.S. Embassy in San Salvador are reminded that proof of citizenship and identity are required before a passport can be issued.
Photographic proof of identity is especially important for young children because of the high incidence of fraud involving children.
Since non-emergency passports are printed in the United States, and not at the U.S. Embassy in El Salvador, citizens submitting applications in El Salvador should be prepared to wait approximately one week for receipt of their new passports.

The U.S. Embassy in El Salvador reminds U.S. citizen travelers that their activities in El Salvador are governed by Salvadoran law and the type of visa they are issued.
Under Salvadoran law, all foreigners who participate directly or indirectly in the internal political affairs of the country (i.e. political rallies, protests) lose the right to remain in El Salvador, regardless of visa status or residency in El Salvador.

Visit the Embassy of El Salvador’s web site at http://www.elsalvador.org
for the most current visa information.

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

In an effort to prevent international child abduction, many governments have initiated procedures at entry/exit points.
These often include requiring documentary evidence of relationship and permission for the child's travel from the parent(s) or legal guardian if not present.
Having such documentation on hand, even if not required, may facilitate entry/departure.
Minors traveling on Salvadoran passports and who are traveling alone, with one parent or with a third party must have the written permission of the absent parent(s) or legal guardian to depart El Salvador.
A Salvadoran notary must notarize this document.
If the absent parent(s) or legal guardian is (are) outside of El Salvador, the document must be notarized by a Salvadoran consul.
If a court decree gives custody of the child traveling on a Salvadoran passport to one parent, the decree and a passport will allow the custodial parent to depart El Salvador with the child.
Although Salvadoran officials generally do not require written permission for non-Salvadoran minors traveling on U.S. or other non-Salvadoran passports, it would be prudent for the parents of minor children traveling on U.S. passports to provide similar documentation if both parents are not traveling with their children.

SAFETY AND SECURITY: Most travelers to El Salvador experience no safety or security problems, but the criminal threat in El Salvador is critical.
Random and organized violent crime is endemic throughout El Salvador.
U.S. citizens have not been singled out by reason of their nationality, but are subject to the same threat as all other persons in El Salvador.
See the section below on Crime for additional related information.
Political or economic issues in the country may give rise to demonstrations, sit-ins or protests at any time or place, but these activities occur most frequently in the capital or on its main access roads.
U.S. citizens are cautioned to avoid areas where demonstrations are being held and to follow local news media reports or call the U.S. Embassy for up-to-date information.
Information about demonstrations also is available as “Security Alerts” on the U.S. Embassy home page at http://elsalvador.usembassy.gov.
Many Salvadorans are armed, and shootouts are not uncommon.
Foreigners, however, may not carry guns even for their own protection without first obtaining a firearms license from the Salvadoran government.
Failure to do so will result in the detention of the bearer and confiscation of the firearm, even if it is licensed in the United States.
Armed holdups of vehicles traveling on El Salvador's roads are increasing, and U.S. citizens have been victims in various incidents.
In one robbery, an American family was stopped by gunmen while driving during the day on the Pan American highway in the Santa Ana Department.
In another incident, an American citizen passenger was robbed after the van in which she was riding was carjacked by armed men.
The van was stopped at a traffic light on the busy road between Comalapa International Airport and San Salvador shortly after dark.
Strong undertows and currents can make swimming at El Salvador's Pacific Coastal beaches extremely dangerous for even strong and experienced swimmers.
As an example of this hazard, during a single seven-day holiday period, nine Salvadoran citizens drowned while swimming at Pacific beaches.
In one month alone, three U.S. citizens drowned while swimming at Pacific beaches in La Libertad and La Paz Departments.

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, including the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: The U.S. Embassy considers El Salvador a critical crime-threat country.
The homicide rate in the country increased 25 percent from 2004 to 2007, and El Salvador has one of the highest homicide rates in the world.
Violent crimes, as well as petty crimes are prevalent throughout El Salvador, and U.S. citizens have been among the victims. The Embassy is also aware that there has been at least one rape of an American minor and one attempted rape of an American adult in the past year.
Travelers should avoid displaying or carrying valuables in public places.
Passports and other important documents should not be left in private vehicles.
Armed assaults and carjacking take place both in San Salvador and in the interior of the country, but are especially frequent on roads outside the capital where police patrols are scarce.
Criminals have been known to follow travelers from the international airport to private residences or secluded stretches of road where they carry out assaults and robberies.
Armed robbers are known to shoot if the vehicle does not come to a stop.
Criminals often become violent quickly, especially when victims fail to cooperate immediately in surrendering valuables.
Frequently, victims who argue with assailants or refuse to give up their valuables are shot.
Kidnapping for ransom continues to occur, but has decreased in frequency since 2001.
U.S. citizens in El Salvador should exercise caution at all times and practice good personal security procedures throughout their stay.
The U.S. Embassy warns its personnel to drive with their doors locked and windows raised, to avoid travel outside of major metropolitan areas after dark, and to avoid travel on unpaved roads at all times because of criminal assaults and lack of police and road service facilities.
Travelers with conspicuous amounts of luggage, late-model cars or foreign license plates are particularly vulnerable to crime, even in the capital.
Travel on public transportation, especially buses, both within and outside the capital, is risky and not recommended.
The Embassy advises official visitors to use radio-dispatched taxis or those stationed in front of major hotels.
U.S. citizens using banking services should be vigilant while conducting their financial exchanges either inside local banks or at automated teller machines.
There have been several reports of armed robberies in which victims appear to have been followed from the bank after completing their transactions.
Visitors to El Salvador should use caution when climbing volcanoes or hiking in other remote locations.
Armed robberies of climbers and hikers are common.
Mine-removal efforts ceased several years ago, but land mines and unexploded ordnance in backcountry regions still pose a threat to off-road tourists, backpackers, and campers.
The Embassy strongly recommends engaging the services of a local guide certified by the national or local tourist authority when hiking in backcountry areas, even when within the national parks.
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 U.S. Embassy.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the U.S. Embassy for assistance.
The Embassy 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 crime is solely the responsibility of local authorities, consular officers can help you understand the local criminal justice process and find an attorney if needed.

Victims of crime should bear in mind that law enforcement resources are limited and judicial processes are uneven in El Salvador.
Many crimes in the country go unsolved and the likelihood for redress through the judicial system is limited.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: There are few private hospitals with an environment that would be acceptable to visiting Americans.
The Embassy recommends that these hospitals be used only for emergency care, to stabilize a condition prior to returning to the U.S. for definitive evaluation and treatment.
Private hospitals and physicians expect upfront payment (cash or, for hospitals, credit card) for all bills.
Priority Ambulance (503-2264-7911) is the only ambulance service in San Salvador that has trained personnel and medical equipment to manage most emergencies.
Not all medicines found in the U.S. are available in El Salvador.
Medicines often have a different brand name and are frequently more expensive than in the U.S.
No specific vaccinations are required for entry into El Salvador from the United States. Travelers coming from countries where yellow fever is endemic must have had a yellow fever vaccination in order to enter the country.
For more information visit El Salvador’s Immigration web site at http://www.seguridad.gob.sv/Web-Seguridad/Migracion/migracion.htm.

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

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
It may be possible to purchase supplemental coverage for travel.
U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States.
Separate insurance should be obtained for medical evacuation, as it may cost in excess of $50,000.
Many travel agents and private companies offer insurance plans that will cover health care expenses incurred overseas, including emergency medical services and even transportation of remains, in the event of death.
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 El Salvador is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Road conditions throughout El Salvador are not up to U.S. standards.
However, the rebuilding of major roads following the earthquakes in 2001 is nearly completed.
Mini-buses, buses, and taxis are often poorly maintained.
Drivers are often not trained, and generally do not adhere to traffic rules and regulations.
The U.S. Embassy recommends that its personnel avoid using mini-buses and buses, and use only taxis that are radio-dispatched or those stationed in front of major hotels.
Robberies and assaults on buses are commonplace.
Because of inconsistent enforcement of traffic laws in El Salvador, drivers must make an extraordinary effort to drive defensively.
Passing on blind corners is commonplace.
Salvadoran law requires that the driver of a vehicle that injures or kills another person must be arrested and detained until a judge can determine responsibility for the accident.
This law is uniformly enforced.
Visitors to El Salvador may drive on their U.S. license for up to thirty days.
After that time, a visitor is required to obtain a Salvadoran license.
Please refer to our Road Safety page for more information.
Visit the web site of El Salvador’s national tourist office and national authority responsible for road safety at http://www.elsalvadorturismo.gob.sv/.
Further information on traffic and road conditions is available in Spanish from Automovil Club de El Salvador, at telephone number 011-503-2221-0557.
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of El Salvador’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of El Salvador’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Travelers intending to carry cell phones from the United States should check with their service provider to determine if the service will be available in El Salvador.
Credit cards are acceptable for payment in many-but not all-retail stores and restaurants in major cities.
Automatic teller machines with access to major U.S. bank networks are widely available in San Salvador, but less prevalent elsewhere in the country.
Please see our information on Customs Information.
DISASTER PREPAREDNESS:
El Salvador is an earthquake-prone country.
Flooding and landslides during the rainy season (June to November) also pose a risk.
On October 4, 2005, the Government of El Salvador declared a nation-wide state of emergency following major flooding caused by a series of storms.
More than 50 deaths were confirmed as attributed to landslides and flooding at that time and over 34,000 residents were evacuated to temporary shelter.
The Llamatepec Volcano, located approximately 50 kilometers west of San Salvador, erupted briefly on October 1, 2005, casting rocks and volcanic ash onto neighboring regions and producing two confirmed deaths.
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/.
An earthquake measuring 7.6 on the Richter scale devastated much of El Salvador on January 13, 2001.
A second earthquake on February 13, 2001, measured 6.6 on the Richter scale, and caused significant additional damage and loss of life.
Reconstruction efforts are largely complete and the country has returned to normal.
Additional information in Spanish about earthquakes (sismos) in El Salvador can be found on the Government of El Salvador’s web page at http://www.snet.gob.sv/.
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 El Salvador’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in El Salvador 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.

Guns:
El Salvador has strict laws requiring a locally obtained license to possess or carry a firearm in the country.
The Embassy strongly advises persons without a Salvadoran firearms license not to bring guns into the country or use a firearm while in El Salvador.
During a three-month period in 2006, three U.S. citizens were arrested in separate incidents for firearms violations.
In each instance, the individuals complied with airline procedures, declared the firearm on a Customs form upon arrival at El Salvador's Comalapa International Airport, and were allowed to depart the airport without hindrance.
However, when the individuals returned to the airport and declared the weapons to airline employees, they were arrested by Salvadoran police, not for violating aviation regulations but for having carried an unlicensed firearm while in El Salvador.
The Embassy cannot intervene in the judicial process when a U.S. citizen is charged with a firearms violation.
Conviction for possessing an unlicensed firearm can carry a prison sentence of three to five years.

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 El Salvador are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, and to obtain updated information on travel and security within El Salvador.
Americans without Internet access may register directly with the Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The Consular Section of the U.S. Embassy in San Salvador is located at Final Boulevard Santa Elena Sur, Urbanizacion Santa Elena, Antiguo Cuscatlan, La Libertad, telephone 011-503-2501-2999, fax 011-503-2278-5522, e-mail: CongenSansal@state.gov.
The Embassy's web site can be accessed at http://sansalvador.usembassy.gov/.
The Consular Section is open for U.S. citizens’ services from 8:15 a.m. to 11:30 a.m. weekdays, excluding U.S. and Salvadoran holidays.
After business hours, the Embassy can be contacted by telephone at 011-503-2501-2316 or 011-503-2501-2253.
For any questions concerning U.S. visas for either temporary travel to or permanent residence in the U.S., please contact our regional U.S. Visa Information Center.
From El Salvador, the Visa Information Center may be reached by calling 900-6011 from any landline operated by Telecomm, or by purchasing a VISAS-USA calling card from any location that sells Telefonica phone cards.
Calling instructions are on the back of the card.
Calls using the 900 number cost approximately $2.15 per minute and will be charged to the caller's telephone bill.
The Telefonica phone card costs $15.00 and permits a seven-minute call.
From the U.S., the Visa Information Center can be contacted by dialing 866-730-2089 and charging the call to a Visa or MasterCard credit card.
*

*

*
This replaces the Country Specific Information for El Salvador dated October 2007, to update the format and sections on Entry/Exit Requirements, Crime, Information for Victims of Crime, Medical Facilities and Health Information, Disaster Preparedness, and Registration and Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu, 30 May 2019 14:19:59 +0200

San Salvador, May 30, 2019 (AFP) - A 6.6 magnitude earthquake struck off the coast of El Salvador on Thursday near the capital but authorities said there were no initial reports of casualties or damage.   The quake was so strong it was likely felt throughout Central America, officials said.   The quake struck in the Pacific Ocean around 25 miles (40 kilometres) south of San Salvador at a depth of 40 miles (65 km), according to the US Geological Survey.

The Salvadoran environment ministry said the quake was even stronger, with a magnitude of 6.8.   The Pacific Tsunami Warning Center did not issue an alert for the quake. But the Environment Ministry issued one of its own, predicting sea level variations of up to 12 inches (30 centimetres).   However, Environment Minister Lina Pohl said the alert was sent "as a protocol."   Coastal residents should avoid entering the water for four hours after the quake, the ministry said on Twitter.

President-elect Nayib Bukele, who takes office on Saturday, said on Twitter that the earthquake was felt "throughout 100 percent of the country."   Police and firemen fanned out across the country to evaluate the situation and reported "no serious or generalized damage," the Civil Protection department said on Twitter.   The Education Ministry cancelled classes in coastal areas.   In the coastal town of Puerto de la Libertad, authorities evacuated families who live near the water.   Rattled residents stood outside their homes Thursday morning digesting the quake.   "The quake was very strong. Thank God, nothing happened to me. But we are taking precautions," one of them, Maria Valencia, told Canal 21 television.

The Environment Ministry reported as many as 12 aftershocks ranging from 3.3 to 4.9 in magnitude.   In San Salvador, police and soldiers patrolled streets but people largely stayed indoors despite the scare from the quake.   The government gave slightly different figures for its location.   It placed it more shallow than the USGS at 48 kilometres, and said the epicentre was a bit further out to sea, some 66 kilometres from Puerto de La Libertad.
Date: Mon 1 Apr 2019
Source: La Prensa Grafica, El Salvador [in Spanish, trans., edited]

According to MINSAL [El Salvador's Ministry of Public Health] figures for week 12 (updated till 23 Mar) 2019, the number of cases of typhoid fever remains high. They have reported 517 cases in 2019, compared to 313 cases in 2018, which is equivalent to an increase of 65%.

The head of health surveillance of the ISSS [El Salvador's Social Security Institute], Jose Adan Martinez, said that the figures themselves reflect an increase of 44%. It is worth mentioning that the MINSAL presents the data at the national level, which include those of the ISSS, FOSALUD [El Salvador Solidarity Fund for Health], and other institutions.

"We have been experiencing this upward trend in the disease since the beginning of 2019, and it has increased in the last week," Martinez said.

He also recalled that this is a disease transmitted by water or food contamination. "Given the scarcity of water that has been in some sectors of San Salvador, which is the most affected department, [the increase] could be due to the lack of hygiene measures that the population is taking, both for the preparation of food and for water consumption," he added.  [Byline: Edwin Teos]
========================
[Vaccine intervention is an important step, as increasing antimicrobial resistance in the typhoid bacillus in Asia has made treatment more difficult.

Typhoid fever, so-called enteric fever caused by _Salmonella enterica_ serotype Typhi, has a totally different presentation from that of the more common kinds of salmonellosis. Epidemiologically, usually spread by contaminated food or water, typhoid is not a zoonosis like the more commonly seen types of salmonellosis. Clinically, vomiting and diarrhoea are typically absent; indeed, constipation is frequently reported. As it is a systemic illness, blood cultures are at least as likely to be positive as stool in enteric fever, particularly early in the course of the infection, and bone marrow cultures may be the most sensitive.

The symptoms of classical typhoid fever typically include fever; anorexia; lethargy; malaise; dull, continuous headache; non-productive cough; vague abdominal pain; and constipation. Despite the (often high) fever, the pulse is often only slightly elevated. During the 2nd week of the illness, there is protracted fever and mental dullness, classically called coma vigil. Diarrhoea may develop but usually does not. Many patients develop hepatosplenomegaly (both liver and spleen enlarged). After the 1st week or so, many cases develop a maculopapular rash on the upper abdomen. These lesions ("rose spots") are about 2 cm (0.78 inch) in diameter and blanch on pressure. They persist for 2-4 days and may come and go. Mild and atypical infections are common. The word typhoid (as in typhus-like) reflects the similarity of the louse-borne rickettsial disease epidemic typhus and that of typhoid fever; in fact, in some areas, typhoid fever is still referred to as abdominal typhus. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Sun 29 Jul 2018
Source: La Prensa Grafica, El Salvador [in Spanish, machine trans. edited]
<https://www.laprensagrafica.com/elsalvador/Casos-de-tifoidea-se-duplicaron-y-triplicaron-20180728-0055.html>

All the departments of the country experienced significant rises in typhoid fever in the 1st 6 months of 2018, with the exception of Cabanas, in comparison with the figures for the 1st 6 months of 2017. The statistics were provided by the Information and Response Office of the Ministry of Health (MINSAL), at the request of The Graphic Press. According to the data, the departments that registered the highest increases were San Miguel, San Salvador, La Paz and Sonsonate. Throughout 2017, San Miguel, for example, reported 9 cases of typhoid fever; while only between January and June 2018, cases rose to 17.

In San Salvador, cases for 2017 totalled 427, but during the 1st months of 2018 only, they totalled 653. Although the increase was noticed by the Salvadoran Social Security Institute (ISSS), through a press release issued on 8 Feb 2018, the Ministry of Health (MINSAL) spent several weeks without issuing any report with official data and did not speak of the outbreak until several months later, a few days after the end of June 2018. After the ISSS report, some physicians and infectious disease experts also reported an increase in cases of infection caused by the _Salmonella_ Typhi bacterium in private clinics and hospitals.

By mid-February 2018, MINSAL confirmed that there was a 30% increase in cases, compared to the same period in 2017: from 56 to 73. However, it did not include the statistics in its weekly epidemiological surveillance bulletins, for which the medical association denounced the lack of transparency with respect to the preventive management of the disease, which if not treated in time can be fatal. The Minister of Health, Violeta Menja­var, even admitted at that time that there was no vaccine against typhoid fever in the public health network. "In the vaccination scheme, there is not one; so that we can produce a vaccine against typhoid, we have to wait for the one being prepared by the Pan American Health Organization (PAHO), since there is not one that meets the conditions; we have incorporated it into the vaccination scheme," he explained.

The abysmal difference between 622 confirmed cases in the ISSS network, which serves only 17% of the population, and zero confirmed cases in the national public network, which serves more than 80% of the population, generated even more doubts than certainties about the management of the disease by the MINSAL. Finally, in the 2nd half of June 2018, Minister Menja­var acknowledged that there was an outbreak of typhoid fever that affected mainly 28 municipalities in the country, although she suggested that the effect was moderate and not high. "This year [2018], we have almost double that of 2017; it has happened that in 28 municipalities we have an epidemic outbreak; it is not epidemic because that would have to be in the entire country," she said.

The total numbers of cases of 2017 were 675, while the total between January and June of 2018 rose to 937. The authorities have reiterated on several occasions that this disease is directly related to the hygiene habits of people, so they have emphasized, to the point of exhaustion, that the population should take necessary precautions to avoid contagion, especially with surveillance of water quality in water used to cook food or for consumption. Drinking water, however, is the product that has been most scarce in recent months. At the end of March 2018, there was chaos due to lack of drinking water at the start of Holy Week, as the Water and Sewerage Administration (ANDA) reported one of its 48-inch main pipes damaged, which affected the San Pedro Metropolitan Area, Salvador (AMSS).

Less than a month ago, ANDA again left a million inhabitants of the AMSS without water, also due to another fault in the same 48-inch pipeline. The municipalities with the highest figures of typhoid fever between January and June 2018 were San Salvador, (205), Mejicanos (70), Soyapango (59) and Apopa (54), in the capital of the country. After San Salvador, which totaled 653 cases in that period, is La Libertad, with 85 cases. [Byline: Evelyn Machuca]
===========================
[Typhoid fever, so-called enteric fever caused by _Salmonella enterica_ serotype Typhi, has a totally different presentation from that of the commoner kinds of salmonellosis. Epidemiologically, usually spread by contaminated food or water, typhoid is not a zoonosis like the more commonly seen types of salmonellosis. Clinically, vomiting and diarrhoea are typically absent; indeed, constipation is frequently reported.

As it is a systemic illness, blood cultures are at least as likely to be positive as stool in enteric fever, particularly early in the course of the infection, and bone marrow cultures may be the most sensitive. The symptoms of classical typhoid fever typically include fever, anorexia, lethargy, malaise, dull continuous headache, non-productive cough, vague abdominal pain, and constipation. Despite the (often high) fever, the pulse is often only slightly elevated.

During the 2nd week of the illness, there is protracted fever and mental dullness, classically called coma vigil. Diarrhoea may develop but usually does not. Many patients develop hepatosplenomegaly (both liver and spleen enlarged). After the 1st week or so, many cases develop a maculopapular rash on the upper abdomen. These lesions ("rose spots") are about 2 cm (0.78 in) in diameter and blanch on pressure. They persist for 2-4 days and may come and go.

Mild and atypical infections are common. The word typhoid (as in typhus-like) reflects the similarity of the louse-borne rickettsial disease epidemic typhus and that of typhoid fever; in fact, in some areas, typhoid fever is still referred to as abdominal typhus. -  ProMED Mod.LL]

[HealthMap/ProMED map available at: El Salvador:
<http://healthmap.org/promed/p/21>]
Date: Fri 15 Jun 2018 12:02 AM CST
El Mundo, El Salvador [in Spanish, trans., edited]
<http://elmundo.sv/ministerio-de-salud-dice-hay-un-brote-epidemico-de-fiebre-tifoidea/>

The Minister of Public Health, Violeta Menja­var, said that there is an epidemic outbreak of typhoid fever in some 26 municipalities, not in the entire country. "We have salmonellosis and within it some typhoid cases, an increase of cases in 26 municipalities, which have a mild to moderate affectation ... What does that mean? We are talking about an epidemic outbreak because it is localized; it is not a national epidemic, "Menja­var said on [14 Jun 2018].

The head of the health surveillance unit, Hector Ramos, said that they had 644 cases suspected of typhoid but that it is too early to speak of a decrease. "We have to wait but it seems that it is starting to level off and we hope that it will continue to decrease," said Minister Menja­var. The minister explained that the increase was a surprise because the winter was early as a result of the La Nina phenomenon.

The municipalities moderately affected are:
San Antonio Pajonal in the department of Santa Ana;
Santa Tecla in La Libertad;
and Apopa, Cuscatancingo, San Salvador, Mejicanos, Panchimalco, Ilopango,
and Soyapango in the department of San Salvador.
**************************************
Date: Tue 12 Jun 2018 12:00 AM CST
Source:  El Mundo, El Salvador [in Spanish, trans. ProMED Sr.Tech.Ed.MJ, summ., edited]
<http://elmundo.sv/tifoidea-ha-afectado-nueve-municipios-moderadamente/>

The epidemiological bulletin of the Salvador Ministry of Public Health and Social Assistance (MINSAL) reported moderate activity of typhoid fever in 9 of the country's 262 municipalities. From January 2018 to date, 469 suspected cases of typhoid fever have been hospitalized, of which 346 have been confirmed by blood culture.

In addition to the 9 municipalities moderately affected, there are 19 municipalities mildly affected and none severely affected. During the week of 4 Jun 2018, the epidemiological bulletin reported 644 suspected cases between January and May 2018. 376 cases were reported during the same period in 2017. One person has died in 2018 and one person died in 2017.
========================= 
[Typhoid fever, so-called enteric fever caused by _Salmonella enterica_ serotype Typhi, has a totally different presentation from that of the commoner kinds of salmonellosis. Epidemiologically, usually spread by contaminated food or water, typhoid is not a zoonosis like the more commonly seen types of salmonellosis. Clinically, vomiting and diarrhoea are typically absent; indeed, constipation is frequently reported.

As it is a systemic illness, blood cultures are at least as likely to be positive as stool in enteric fever, particularly early in the course of the infection, and bone marrow cultures may be the most sensitive. The symptoms of classical typhoid fever typically include fever, anorexia, lethargy, malaise, dull continuous headache, non-productive cough, vague abdominal pain, and constipation.

Despite the often high fever, the pulse is often only slightly elevated. During the 2nd week of the illness, there is protracted fever and mental dullness, classically called coma vigil. Diarrhoea may develop but usually does not. Many patients develop hepatosplenomegaly (both liver and spleen enlarged). After the 1st week or so, many cases develop a maculopapular rash on the upper abdomen.

These lesions ("rose spots") are about 2 cm (0.78 in) in diameter and blanch on pressure. They persist for 2-4 days and may come and go. Mild and atypical infections are common. The word typhoid (as in typhus-like) reflects the similarity of the louse-borne rickettsial disease epidemic typhus and that of typhoid fever; in fact, in some areas, typhoid fever is still referred to as abdominal typhus. - ProMED Mod.LL]

[Maps of El Salvador: <http://www.lib.utexas.edu/maps/americas/elsalvador.jpg>
and <http://healthmap.org/promed/p/21>.]
Date: Sat 12 May 2918
Source: The New England Journal of Medicine (NEJM) [edited]

ref: Gomez CA, Banaei N. _Trypanosoma cruzi_ reactivation in the brain. N Engl J Med. 2018; 378(19):1824. doi: 10.1056/NEJMicm1703763.
----------------------------------------------------------------------
A 31-year-old man who had recently received a diagnosis of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome [AIDS] presented to the emergency department with headache, confusion, and gait instability.

He had immigrated to the United States from El Salvador 6 years earlier. Fever (temperature, 38.9 deg C [102 deg F]) and an ataxic gait were noted on physical examination.

Laboratory test results were notable for a CD4 positive cell count of 60 per cubic millimeter, an HIV viral load of 409 000 copies per milliliter, a positive result for IgG antibodies to _Toxoplasma gondii_, and a negative result for IgM antibodies to _T. gondii_.

Magnetic resonance images of the brain showed a mass measuring 8 by 7 by 6 cm in the corpus callosum and the white matter of the right parietal and occipital subcortical lobes.

Cytologic examination of a brain aspirate revealed intracellular organisms, with prominent kinetoplasts (masses of mitochondrial DNA) visible within macrophages and astrocytes.

The organisms were identified as _Trypanosoma cruzi_ on the basis of partial protozoal 28S ribosomal RNA sequencing. After vector-borne transmission, which occurs mainly in Central America, South America, and some rural areas in Mexico, _T. cruzi_ infection can persist asymptomatically. Immunosuppression predisposes patients to _T. cruzi_ reactivation in the brain, which can manifest as a brain abscess or meningoencephalitis.

The patient received benznidazole, followed by the initiation of antiretroviral therapy. After 2 weeks of treatment, clinical improvement was noted in his mentation and gait.
======================
[The case underlines that one has to expect the unusual in immunocompromised patients and underlines that biopsy is needed also from the brain in order to reach the correct diagnosis. The guide to the suspicion of a _T. cruzi_ infection is the history of immigration from an endemic area. We do not know if the patient was seropositive for _T. cruzi_ antibodies. - ProMED Mod.EP]

[HealthMap/ProMED-mail map
More ...

Spain

Spain and Andorra US Consular Information Sheet
January 13, 2009
Spain and Andorra are both advanced stable democracies and modern economies. Spain is a member of North Atlantic Treaty Organization (NATO) and the European Union.
Read the D
partment of State Background Notes on Spain and Andorra for additional information.

ENTRY/EXIT REQUIREMENTS:
Spain is a party to the Schengen agreement.
As such, U.S. citizens may enter Spain for up to 90 days for tourist or business purposes without a visa.
The passport should be valid for at least three months beyond the period of stay.
For further details about travel into and within Schengen countries, please see our Schengen Fact Sheet.

In an effort to prevent international child abduction, many governments have initiated procedures at entry/exit points.
These often include requiring documentary evidence of relationship and permission for the child's travel from the parent(s) or legal guardian not present.
Having such documentation on hand, even if not required, may facilitate entry/departure.
For further information concerning entry requirements for Spain, travelers should contact the Embassy of Spain at 2375 Pennsylvania Avenue NW, Washington, DC 20037, telephone (202) 452-0100, or the nearest Spanish Consulate in Boston, Chicago, Houston, Los Angeles, Miami, New Orleans, New York, San Francisco, or San Juan.
Spanish government web sites with information about entry requirements (in Spanish) can be found at http://www.mae.es and http://www.mir.es.
Additional information may be obtained from the Tourist Office of Spain in New York, telephone (212) 265-8822, or online at http://www.spain.info/.
For further information on entry requirements to Andorra, travelers should contact the Andorran Mission to the UN, 2 U.N. Plaza, 25th floor, New York, NY 10018, telephone (212) 750-8064 or online at http://www.andorra.ad.
Visit the Embassy of Spain and Andorra web sites for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
Spain and Andorra share with the rest of the world an increased threat of international terrorist incidents.
Like other countries in the Schengen area, Spain's open borders with its Western European neighbors allow the possibility of terrorist groups entering and exiting the country with anonymity.
Spain’s proximity to North Africa makes it vulnerable to attack from Al Qaeda terrorists in the Maghreb region.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

In the deadliest terrorist attack in recent European history, in March 2004, Islamist extremists bombed four commuter trains entering Madrid, causing 191 deaths and over 1,400 injuries.
Spanish authorities tried the suspected terrorists and their co-conspirators in February 2007 and convicted in October 2007.
The Basque Fatherland and Liberty (ETA) terrorist organization remains active in Spain.
ETA has historically avoided targeting foreigners, directing their attacks against the police, military, local politicians, and Spanish government targets as well as attempts to disrupt transportation and daily life. However, foreigners have been killed or injured collaterally in ETA attacks.
Two examples of this are the Barajas Airport bombing in December 2006, in which two Ecuadorian nationals were killed and the bombing at the University of Navarre in October 2008, in which 17 students were injured including one American student.
In addition, bombs have been used as part of criminal extortion of businesses, particularly in the Basque region. The risk of “being in the wrong place at the wrong time” in event of an ETA action is a concern for foreign visitors and tourists.
U.S. tourists traveling to Spain should remain vigilant, exercise caution, monitor local developments, and avoid demonstrations and other potentially violent situations.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State’s 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 A Safe Trip Abroad.
CRIME:
Andorra has a low rate of crime.
While most of Spain has a moderate rate of crime and most of the estimated one million American tourists have trouble free visits to Spain each year, street crimes against tourists occur in the principal tourist areas.
Madrid and Barcelona, in particular, report incidents of pick-pocketing, mugging and occasional violent attacks, some of which require the victim to seek medical attention.
Although crimes occur at all times of day and night and to people of all ages, older tourists and Asian Americans seem to be particularly at risk.
Criminals frequent tourist areas and major attractions such as museums, monuments, restaurants, outdoor cafes, Internet cafes, hotel lobbies, beach resorts, city buses, subways, trains, train stations, airports, and ATMs.

In Madrid, incidents have been reported in all major tourist areas, including the area near the Prado Museum, near Atocha train station, in Retiro Park, in areas of old Madrid including near the Royal Palace and in Plaza Mayor.
There have been a number of passport and bag thefts reported at Madrid’s Barajas Airport, local hotels, as well as in El Rastro (Madrid’s flea market) and in the Metro.

In Barcelona, the largest number of incidents reported also occurred in major tourist areas, on Las Ramblas, Barcelona’s El Prat airport, Sants train station, Metro stations, in the Sagrada Familia Area, in the Gothic Quarter, in Parc Güell, in Plaza Real, and along Barcelona’s beaches.
There has been a rise in the number of thefts reported at the Port Olimpic Area and nearby beaches.

Travelers should remain alert to their personal security and exercise caution. Travelers are encouraged to carry limited cash, only one credit card, and a copy of their passport; leaving extra cash, extra credit cards, passports and personal documents in a safe location.
When carrying documents, credit cards or cash, you are encouraged to secure them in a hard-to-reach place and not to carry all valuables together in a purse or backpack.
Thieves often work in teams of two or more people.
In many cases, one person distracts a victim while the accomplices perform the robbery.
For example, someone might wave a map in your face and ask for directions, “inadvertently” spill something on you, or help you clean-up bird droppings thrown on you by a third unseen accomplice.
While your attention is diverted, an accomplice makes off with the valuables.
Thieves may drop coins or keys at your feet to distract you and try to take your belongings while you are trying to help.
Attacks are sometimes initiated from behind, with the victim being grabbed around the neck and choked by one assailant while others rifle through or grab the belongings.
A group of assailants may surround the victim in a crowded popular tourist area or on public transportation, and only after the group has departed does the person discover he/she has been robbed.
Purse-snatchers may grab purses or wallets and run away, or immediately pass the stolen item to an accomplice.
A passenger on a passing motorcycle sometimes robs pedestrians.
There have been reports of thieves posing as plainclothes police officers, beckoning to pedestrians from cars and sometimes confronting them on the street asking for documents, or to inspect their cash for counterfeit bills, which they ultimately “confiscate” as evidence.
The U.S. Embassy in Madrid has received reports of cars on limited access motorways being pulled over by supposed unmarked police cars.
The Spanish police do not operate in this fashion.
American citizens are encouraged to ask for a uniformed law enforcement officer if approached.
Theft from vehicles is also common.
“Good Samaritan" scams are unfortunately common, where a passing car or helpful stranger will attempt to divert the driver’s attention by indicating there is a flat tire or mechanical problem.
When the driver stops to check the vehicle, the “good Samaritan” will appear to help the driver and passengers while the accomplice steals from the unlocked car. Drivers should be cautious about accepting help from anyone other than a uniformed Spanish police officer or Civil Guard.
Items high in value like luggage, cameras, laptop computers, or briefcases are often stolen from cars. Travelers are advised not to leave valuables in parked cars, and to keep doors locked, windows rolled up, and valuables out of sight when driving.
While the incidence of sexual assault is statistically very low, attacks do occur.
Spanish authorities warn of the availability of so-called "date-rape" drugs and other drugs, including "GBH" and liquid ecstasy.
Americans should not lower their personal security awareness because they are on vacation.
A number of American citizens have been victims of lottery or advance fee scams in which a person is lured to Spain to finalize a financial transaction. Often the victims are initially contacted via Internet or fax and informed they have won the Spanish Lottery (El Gordo), inherited money from a distant relative, or are needed to assist in a major financial transaction from one country to another.
For more information, please see the Bureau of Consular Affairs web site on International Financial Scams.

In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm.
The Embassy’s U.S. Commercial Service receives reports of a type of scam targeting U.S. businesses, utilizing the name of a legitimate Spanish concern and legitimate-appearing Spanish bank references.
The scam usually involves a temptingly large order or business proposal.
The U.S. Commercial Service in Spain at http://www.buyusa.gov/spain/en/ stands ready to counsel any U.S. firm which would like to verify the legitimacy of an unsolicited business proposal purporting to come from a Spanish firm.

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, help you 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.
Spain does have a Crime Victim’s Assistance program.
More information can be obtained at http://www.mjusticia.es/Directorio/Victimas?menu_activo=1057821035144&lang=es_es.

The local equivalent to the “911” emergency line in Spain is 112.
Please see our information on Victims of Crime, including possible victim compensation programs.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Good medical care is available in both Spain and Andorra.
Regulations regarding medications may vary from those in the United States; Americans with need for specific medications are encouraged to bring a supply sufficient for their anticipated period of stay, as the medication may not be available and customs regulations may prohibit certain medications to be mailed from the United States to Spain or Andorra.
The Department of State strongly urges Americans to consult with their medical insurance companies prior to traveling abroad to confirm whether their policy applies overseas and if it will cover emergency expenses such as a medical evacuation.
U.S. medical insurance plans may not cover health costs incurred outside the United States unless supplemental coverage is purchased.
Further, U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States. You should contact your insurance provider before departure so appropriate arrangements can be made.
Many travel agents and private companies offer insurance plans that will cover health care expenses incurred overseas, including emergency services such as medical evacuations.

When making a decision regarding health insurance, Americans should consider that many foreign doctors and hospitals require payment in cash prior to providing service and that a medical evacuation to the United States may cost well in excess of $50,000.
Uninsured travelers who require medical care overseas often face extreme difficulties, whereas travelers who have purchased overseas medical insurance have found it to be life saving when a medical emergency has occurred.
When consulting with your insurer prior to your trip, please ascertain whether payment will be made to the overseas healthcare provider or if you will be reimbursed later for expenses that you incur.
Some insurance policies also include coverage for psychiatric treatment and for disposition of remains in the event of death.

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

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

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning name of country is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Traffic in Madrid and Barcelona is faster-paced than in U.S. cities and can be unnerving due to unfamiliar signs or motorbikes weaving between traffic lanes.
Drivers should always obey the closest traffic light, as there are separate pedestrian lights in the city.
Drivers should be alert when driving at night in urban areas, due to the possibility of encountering drivers or pedestrians under the influence of alcohol.
Night driving in isolated rural areas can be dangerous because of farm animals and poorly marked roads.
Rural traffic is generally heavier in July and August as well as during the Christmas and Easter seasons.
Traffic regulations in effect in Spain include the prohibition on the use of a mobile phone without a hands-free device while driving a car.
There is a fine of 300 euros for violation of this regulation and loss of driving privileges.
In addition, all drivers and passengers are required to carry a reflective vest and put it on if they need to stop on the roadside.
A reflective triangle warning sign for a vehicle stopped on the side of the road is also mandatory.
Those renting vehicles are encouraged to check with the rental company about traffic regulations and safety equipment.
U.S. citizens using U.S. issued drivers licenses must obtain International Driving Permits prior to their arrival if they plan to drive in Spain.
Pedestrians should use designated crossing areas when crossing streets and obey traffic lights.
Public transportation in large Spanish cities is generally excellent.
All major cities have metered taxis, in which extra charges must be posted in the vehicle.
Travelers are advised to use only clearly identified cabs and to ensure that taxi drivers always switch on the meter.
A green light on the roof indicates that the taxi is available.
Rail service is comfortable and reliable, but varies in quality and speed. Intercity buses are usually comfortable and inexpensive.
Please refer to our Road Safety page for more information.
For specific information concerning Spanish driving permits, vehicle inspection, road tax and mandatory insurance, please contact the Spanish National Tourist Organization offices in New York at http://www.spain.info/us/TourSpain.
For information about driving in Andorra, refer to http://www.andorra.ad/en-US/Pages/default.aspx.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Spain’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Spain’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offences.
Persons violating the laws of Spain or Andorra, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Spain and Andorra are severe, and convicted offenders can expect long jail sentences and heavy fines. The cities of Madrid and Barcelona and The Balearics Regional Government have banned the consumption of alcohol in the street, other than in registered street cafes and bars.
Visitors to Madrid, Barcelona, Mallorca, Ibiza, and Menorca should be aware that failure to respect this law might result in the imposition of 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 Spain or Andorra are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site to obtain updated information on travel and security within Spain or Andorra.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Embassy is located at Serrano 75; telephone (34) (91) 587-2200, and fax (34) (91) 587-2303. U.S. citizens who register in the Consular Section at the U.S. Embassy, Consulate General, or one of the Consular Agencies listed below can obtain updated information on travel and security within Spain or Andorra.
Additional information and appointments for routine services are available through the U.S. Embassy’s home page at http://madrid.usembassy.gov.
Appointments are required for routine Consular Services.
To make an appointment, go to https://evisaforms.state.gov/acs/default.asp?postcode=MDD&appcode=1.
The U.S. Consulate in Barcelona is located at Paseo Reina Elisenda 23-25; telephone (34) (93) 280-2227 and fax (34) (93) 205-5206.
Visitors to Barcelona can access additional information from the Consulate General’s web page at http://madrid.usembassy.gov/barcelonaen.html.
There are six consular agencies in Spain, which provide limited services to American citizens, but are not authorized to issue passports.
Anyone requesting service at one of the consular agencies should call ahead to verify that the service requested will be available on the day you expect to visit the agency.
Fuengirola (in Malaga Province), at Avenida Juan Gomez Juanito #8, Edificio Lucia 1C, Fuengirola 29640 Spain. Telephone (34) (952) 474-891 and fax (34) (952) 465-189.
Hours 10:00 a.m. to 2:00 p.m.
La Coruna, Calle Juana de Vega 8, 5º Piso, Oficina I, La Coruna 15003 Spain.
Telephone (34) (981) 213-233 and fax (34) (981 22 28 08).
Hours 10:00 a.m. to 1:00 p.m.

Las Palmas, at Edificio Arca, Calle Los Martinez de Escobar 3, Oficina 7, Las Palmas, Gran Canaria 35007 Spain.
Telephone (34)(928) 222-552 and fax (34)(928) 225-863.
Hours 10:00 a.m. to 1:00 p.m.
Palma de Mallorca, Edificio Reina Constanza, Porto Pi, 8, 9-D, 07015 Palma de Mallorca 07015 Spain.
Telephone (34) (971) 40-3707 or 40-3905 and fax (34) (971) 40-3971.
Hours 10:30 a.m. to 1:30 p.m.
Seville, at Plaza Nueva 8-8 duplicado, 2nd Floor, Office E-2 No.4, Sevilla, 41101 Spain. Telephone: (34) (65) 422-8751 and fax (34) (91) 422-0791.
Hours: 10:00 a.m. to 1:00 p.m.
Valencia, at Doctor Romagosa #1, 2-J, 46002, Valencia 46002 Spain.
Telephone (34) (96)-351-6973 and fax (34) (96) 352-9565.
Hours 10:00 a.m. to 2:00 p.m.
For Andorra, please contact the U.S. Consulate in Barcelona.
*

*

*
This replaces the Country Specific Information for Spain and Andorra dated July 15, 2008, to update sections on Safety and Security and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Thu, 23 Jan 2020 14:43:33 +0100 (MET)

Barcelona, Jan 23, 2020 (AFP) - The death toll from a violent storm which has wrought havoc on huge swathes of Spain's eastern and southern coastline rose to nine on Thursday as rescuers pressed the hunt for at least five missing people.    The latest death was that of a man whose body was found in a flooded river near Jorba, some 70 kilometres (45 miles) northwest of Barcelona, the emergency services said.    Rescuers in Catalonia had been searching for a missing person in the same area but said it was too early to confirm if it was him.

Catalan rescuers had late on Wednesday found another body of a man who died after falling into the water in Palamos, a port town about 100 kilometres up the coast from Barcelona.    They are also searching for a man who went missing from a merchant ship in the same area, as well as a person in Cadaques near the French border.   Earlier on Thursday, regional officials confirmed the death of a 75-year-old woman whose house collapsed because of heavy rain in Alcoi, a town in the eastern Alicante region.

Storm Gloria hit the region on Sunday, bringing strong winds, torrential rains and heavy snow, battering Spain's southern and eastern flanks before moving north.   Gale-force winds and huge waves smashed into seafront towns, with dramatic images showing massive flooding that has damaged shops, houses and restaurants.   National weather agency Aemet had on Wednesday said the storm was starting to abate although it kept Catalonia and the Balearic Islands on alert.   As the storm eased, Prime Minister Pedro Sanchez was on Thursday visiting some of the worst-hit areas, overflying parts of Catalonia before heading to the Balearic Islands which on Tuesday were hit by record waves, the port authority said.

Rescuers on the islands are still searching for three people, including a 25-year-old Briton who went missing on a beach in northern Ibiza, and a 27-year-old Spaniard who disappeared in Mallorca while practising canyoning -- a mix of rappelling, climbing and watersliding through deep gorges.   Rescuers had found three other bodies on Wednesday, including that of a 67-year-old man who went missing in his car near the southeastern resort town of Benidom.    They also found two bodies in the southern Andalusia region, one of a 77-year-old man who died when a greenhouse collapsed on him in a hailstorm in Nijar as well as that of a homeless man who died of hypothermia.
Date: Fri, 17 Jan 2020 17:48:09 +0100 (MET)

Barcelona, Jan 17, 2020 (AFP) - Spain's Balearic Islands passed a bill Friday aimed at clamping down on alcohol-fuelled holidays in the Mediterranean archipelago which bans happy hours when drinks are offered a discount and open bars.   "This is the first law adopted in Europe which restricts the sale and promotion of alcohol in certain touristic areas," the regional government of the Balearic Islands which have long been a magnet for young German and British tourists, who often drink heavily and enjoy rowdy late-night clubbing.

The restrictions will apply to three areas with a reputation for excess: San Antoni on the island of Ibiza and El Arenal and Magaluf -- which has been nicknamed "Shagaluf" because of its reputation for drunken casual sex -- on Mallorca, the largest of the Balearic's four islands.   The law, which was drawn up in consultation with the tourism industry also bans pub crawls and two-for-one drink offers, prohibits the sale of alcohol in shops between 9:30 pm and 8 am and forbids advertising party boats in the designated areas.   Establishments that break the new rules risk fines of up to 600,000 euros ($669,000) and the threat of being closed down for three years.

The new law also takes aim at the so-called "balconing" craze, the term given to holidaymakers who decide to jump into a swimming pool from a hotel or apartment balcony, a stunt which claims several lives every year.   It bans "balconing" across the entire archipelago and requires hotels to evict anyone who does it. Those caught jumping from balconies face fines of up to 60,000 euros ($67,000).   Up until now only some resorts on the Balearics imposed fines for "balconing".

The regional government of the Balearics said the law, which stiffens measures already introduced in 2015, will "fight excesses in certain tourist zones" and "force a real change in the tourism model of those destinations".   Magaluf made global headlines in 2014 after a video showing a young woman performing oral sex on several men on the dance floor of a nightclub went viral.   Local shops sell souvenir T-shirts with the catchphrase "On it 'till we vomit".

The four islands which make up the Balearics -- Palma de Mallorca, Ibiza, Menorca and Formentera, received nearly fourteen million tourists in 2018, drawn by their crystal clear waters, and in many cases by all-inconclusive package holidays.   The archipelago is Spain's second most visited region. Spain is the world's second most visited country after France.
Date: Wed, 15 Jan 2020 20:53:05 +0100 (MET)

Alicante, Spain, Jan 15, 2020 (AFP) - A fire broke out Wednesday on the roof of the airport in Alicante, a city on the eastern Mediterranean coast which is a tourism hotspot, forcing its closure to air traffic.   "The fire is under control but it has not been extinguished. Firefighters are continuing to work," a spokesman for Spanish airport operator Aena told AFP, adding the airport will remain closed to air traffic until noon on Thursday.

Ten flights which were due to land at Alicante were cancelled, as were 12 which were supposed to depart from the airport, he said.    Another four flights which were due to land at Alicante were diverted to other Spanish airports.   The flames were visible from inside the terminal, according to an AFP photographer at the scene.   Passengers and workers stood outside as dense smoke rose from the terminal building.   No one was injured and the authorities are still not sure what caused the fire.

The airport serves the eastern region of Valencia, which is home to several popular resorts such as Benidorm. It handled just under 14 million passengers last year, making it Spain's fifth busiest airport.   Aena recommended in a tweet that passengers contact their airline before heading to Alicante airport to see what the status of their flight was.   "We are coordinating with airlines. Consult your company to know if your flight is cancelled or will operate from an alternative airport," it said.
Date: Tue 17 Dec 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/ciguatera-outbreak-reported-in-the-canary-islands-56254/>

Health officials with the Government of the Canary Islands have reported a possible outbreak of ciguatera after finding 6 cases of food poisoning [that occurred] after consuming black medregal (amberjack) in La Victoria de Acentejo, according to an El Dia report (computer translated). Ciguatera is not unknown in the Canary Island[s], [which report] several cases annually [including] some 20 outbreaks in the past decade.

More than 400 species of fish, including barracuda, black grouper, blackfin snapper, cubera snapper, dog snapper, greater amberjack, hogfish, horse-eye jack, king mackerel, and yellowfin grouper, have been implicated in this food-borne illness that is relatively common in several areas of the world.

The toxin causing the illness is produced by marine algae and passed up through the food chain. These marine algae hang on to dead coral and seaweed. They are then eaten by herbivore fish that are subsequently eaten by predatory reef fish, which concentrates the toxin in its tissue.

People get this food-borne toxin from eating these contaminated larger fish. The reef fish are more likely to get contaminated during storms and other turbulence. After eating the affected fish (the fish does not get sick from the toxin and actually tastes good), [cases will find] in as little as a couple of hours symptoms may appear.

Gastrointestinal symptoms like diarrhOea, nausea and vomiting tend to appear early. Then a feeling of weakness and hypertension may occur, in addition to complaints of intense itching. Some mild to severe neurological symptoms are common with ciguatera; dizziness, impaired coordination, blurred vision and even coma may be seen in severe cases.

An unusual characteristic that is common in ciguatera is temperature reversal. This may be seen from 2 to 5 days after eating the fish. Hot objects seem cold and cold objects can give a shock-like sensation. There have been serious injuries because a person was unable to recognize extremely hot sensations.

Other odd symptoms are food may taste metallic and teeth may seem painful or loose. The gastrointestinal symptoms usually resolve in a couple days; however, neurological symptoms may last for months or years. Symptoms may come back after ingesting certain foods and drinks: alcohol, caffeine, nuts and fish.

There are no laboratory tests to diagnose this disease, and [diagnosis] is based on clinical symptoms and a history of eating an offending fish. Some studies have shown that IV mannitol is effective in providing relief and recovery if taken within the first 72 hours of intoxication. Other than that, most treatment is for the various symptoms the person may have.

So how can you prevent getting this potentially serious toxin?
Prevention can be difficult since the toxin in the fish cannot be killed by cooking and there is no offensive odour or appearance to the fish. So the only way to truly try to prevent this intoxication is to avoid eating large reef fish or getting your fish through a reputable supplier.
=============================
[A recent open access review of ciguatera fish poisoning (CFP) has been published in Marine Drugs (Friedman MA , Fernandez M, Backer LC, et al: An updated review of ciguatera fish poisoning: clinical, epidemiological, environmental, and public health management. Mar Drugs 2017;15:pii:E72. <http://www.mdpi.com/1660-3397/15/3/72/htm>). The description of the acute illness with the citations intact (the citations can be found at the URL above) has been extracted below: "CFP is characterized by gastrointestinal, neurological, and cardiovascular symptoms. In addition, after the initial or acute illness, neuropsychological symptoms may be reported. Clinical features can vary depending on elapsed time since eating the toxic meal, and whether the geographic source of the implicated fish was the Caribbean Sea, Pacific, or Indian Ocean [17,36,52-58]. Gastrointestinal symptoms and signs usually begin within 6-12 hours of fish consumption and resolve spontaneously within 1-4 days. Gastrointestinal symptoms may include nausea, vomiting, abdominal pain, and diarrhea. The neurologic symptoms usually present within the first 2 days of illness. They often become prominent after the gastrointestinal symptoms (particularly in CFP events from Caribbean fish), although they may present concurrently with gastrointestinal symptoms (K Schrank, written communication, April 2016) [59]. The neurologic symptoms vary among patients and include paresthesias (that is, numbness or tingling) in the hands and feet or oral region, metallic taste, sensation of loose teeth, generalized pruritus (itching), myalgia (muscle pain), arthralgia (joint pain), headache, and dizziness. A distinctive neurologic symptom is cold allodynia, sometimes referred to as 'hot-cold reversal,' an alteration of temperature perception in which touching cold surfaces produces a burning sensation or a dysesthesia (that is, unpleasant, abnormal sensation) [60]. One study revealed that intra-cutaneous injection of CTX in humans elicited this sensation [61]. Cold allodynia is considered pathognomonic of CFP, although not all patients report experiencing it and it can be seen with other human seafood poisoning syndromes (such as neurotoxic shellfish poisoning). Less commonly, severe central nervous system symptoms, such as coma or hallucinations, have been reported [54,62,63]. Neuropsychological symptoms, which often become apparent in the days or weeks after the initial or acute illness, include subjectively reported cognitive complaints such as confusion, reduced memory, and difficulty concentrating [64-67], depression or irritability [64,65,68], and anxiety [65]. Fatigue or malaise have been reported and may be debilitating [6,62,69,70]. Cardiac symptoms and signs may manifest, generally in the early stage of the illness. When present, they usually occur in combination with gastrointestinal and/or neurologic signs and symptoms [71,72]. Cardiac signs often include hypotension and bradycardia which may necessitate emergency medical care." - ProMED Mod.LL]

[HealthMap/ProMED-mail map: Canary Islands, Spain:
<http://healthmap.org/promed/p/203>]
Date: Tue 3 Dec 2019
Source: Animals Health, Espana [in Spanish, machine trans. edited]

A total of 9 people have been treated in Health Centers of La Rioja for an outbreak of Q fever, and 3 of them have been admitted, according to various local media. This disease is a zoonosis that is transmitted by inhalation of the bacteria present in infected animals.

In addition, 3 citizens of the Basque Country, specifically from Biscay, are also admitted with Q fever, and a 4th person is waiting for bacteriological results. The patients would have acquired the disease after a visit to La Rioja, where they would have been infected by having contact with infected animals. They spent a weekend in La Rioja, and all of them, during a rural stay, maintained direct contact with newborn goats.

The spread of Q fever does not occur from person to person but only occurs through direct contact with sick animals. Therefore, the disease, caused by the bacterium _Coxiella burnetii_, has implications for animal health, especially for livestock, and infections can also be caused by the inhalation of bacterial spores that can be transported long distances by dust and wind.

Acute cases of Q fever are often mild, with symptoms similar to those of the flu, and can be treated with antimicrobials. However, chronic cases can cause dangerous infections in the heart and blood vessels and have a poor prognosis.

Recently, the Valencian Ministry of Health reported the existence of another outbreak of Q fever in Villajoyosa (Alicante), with 6 cases declared, all of them now in good health.
=====================
[Q fever is due to _Coxiella burnetii_, an obligate intracellular rickettsia-like bacterial pathogen. It is highly resistant to drying and heat, which enables the bacteria to survive for long periods in the environment. Its survival is attributed to a small cell variant of the organism that is part of its biphasic developmental cycle.

Q fever is a zoonosis. Although it has a wide and diverse host range, in animals this organism is primarily known as a cause of reproductive losses in domesticated ruminants. Clinical cases seem to be most significant in sheep and goats, with sporadic losses and occasional outbreaks that may affect up to 50-90% of the herd. Infected animals can be difficult to recognize: nonpregnant animals do not seem to have any obvious clinical signs, and seropositivity is not always correlated with shedding of the bacteria. The organism is shed in urine, feces, milk, and especially birthing products; intermittent high-level shedding occurs at the time of parturition, with millions of bacteria being released per gram of placenta.

Humans usually become infected by inhaling aerosolized organisms,often when they are exposed to an animal that had aborted but also if birth was at term and seemed normal. Acute symptoms of a flu-like illness usually develop within 2-3 weeks of exposure, although as many as half of humans infected with _C. burnetii_ do not show symptoms (<http://www.cdc.gov/qfever/symptoms/index.html>). Although most persons with acute Q fever infection recover, others may experience serious illness with complications that may include pneumonia, granulomatous hepatitis, endocarditis (especially in patients with previous cardiac valvulopathy), myocarditis, and central nervous system involvement. Pregnant women who are infected may be at risk for pre-term delivery or miscarriage.

Q fever is frequently an occupationally acquired illness; people most at risk include workers from the meat and livestock industries, shearers, veterinarians, laboratory personnel performing _C. burnetii_ cultures, as well as the general population in close proximity to infected animals in stockyards, feedlots, processing plants, or farms. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
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World Travel News Headlines

Date: Thu, 20 Feb 2020 16:20:39 +0100 (MET)

Damascus, Feb 20, 2020 (AFP) - A bomb explosion wounded two people in Damascus Thursday, the state news agency reported, the latest of several such attacks in the Syrian capital.   "An explosive device planted on a pickup truck went off in the Marjeh area" in central Damascus, SANA said, adding that two civilians were wounded by the blast.

The Syrian Observatory for Human Rights war monitor said the device was a "sticky bomb" planted on a military vehicle, although it was not immediately clear what the target was.   There was no immediate claim of responsibility for the blast, nor for a similar explosion that wounded five people in another neighbourhood of Damascus on Tuesday. The Syrian capital was routinely targeted by major car bomb attacks in the course of the nine-year-old conflict but blasts have been less frequent since regime forces reclaimed full control of the Damascus region in 2018.
Date: Thu, 20 Feb 2020 15:40:35 +0100 (MET)
By Laurent Thomet, with Miwa Suzuki in Tokyo

Beijing, Feb 20, 2020 (AFP) - China on Thursday touted a big drop in new virus infections as proof its epidemic control efforts are working, but the toll grew abroad with deaths in Japan and South Korea.   Fatalities in China hit 2,118 as 114 more people died, but health officials reported the lowest number of new cases in nearly a month, including in hardest-hit Hubei province.

More than 74,000 people have been infected by the new coronavirus in China, and hundreds more in over 25 countries.   The number of deaths outside mainland China climbed to 11.   Japan's toll rose to three as a man and a woman in their 80s who had been aboard a quarantined cruise ship died, while fears there mounted about other passengers who disembarked the Diamond Princess after testing negative.

South Korea reported its first death, and the number of infections in the country nearly doubled Thursday to 104 -- including 15 at a hospital in Cheongdo county.   The mayor of Daegu -- South Korea's fourth-largest, with 2.5 million people -- advised residents to stay indoors, while commanders at a major US military base in the area restricted access.   Iran reported two deaths on Wednesday, the first in the Middle East. Deaths have previously been confirmed in France, the Philippines, Taiwan and Hong Kong.

Chinese officials say their drastic containment efforts, including quarantining tens of millions of people in Hubei and restricting movements in cities nationwide, have started to pay off.   "Results show that our control efforts are working," Foreign Minister Wang Yi said at a special meeting on the virus with Southeast Asian counterparts in Laos, citing the latest data.   Wang said the situation was "significantly improving" in Hubei and Wuhan, but an official in a central government team dealing with the epidemic said it was still "very severe".

- 'Not turning point' -
Although more than 600 new infections were reported in Hubei's capital Wuhan, it was the lowest daily tally since late January and well down from the 1,749 new cases the day before.   The national figure has now fallen for three straight days.   Chinese authorities placed the city of 11 million under quarantine on January 23 and quickly locked down the rest of the province in the days that followed.

Wuhan authorities this week carried out a three-day, door-to-door check on residents, with the local Communist Party chief warning that officials would be "held accountable" if any infections were missed.   Cities far from the epicentre have limited the number of people who can leave their homes for groceries, while rural villages have sealed off access to outsiders.   Richard Brennan, a World Health Organization official, said in Cairo that China was making "tremendous progress" and "trends are very encouraging, but we are not at a turning point yet".

- 'Chaotic' cruise quarantine -
While China has boasted progress in its fight against the COVID-19 epidemic, Japan's government has been criticised for the quarantine measures it placed on the Diamond Princess.   The huge vessel moored in Yokohama is easily the biggest coronavirus cluster outside the Chinese epicentre, with 634 cases confirmed among passengers and crew.   Another 13 people on board the ship were diagnosed with the virus Thursday, Japan's health ministry said.   Still, passengers were disembarking after negative tests and having completed a 14-day quarantine period -- packing into yellow buses and leaving for stations and airports.

Questions were asked over the wisdom of allowing them to mingle in Japan's crowded cities.   "Is it really safe to get off?" screamed a headline in the Nikkan Sports tabloid.   The paper quoted one passenger who said he was tested on February 15, but only left four days later.   "I thought I could be infected during the four days. I thought 'Is it really OK'?"

A specialist in infectious diseases at Kobe University slammed as "completely chaotic" the quarantine procedures on board in rare criticism from a Japanese academic.   "The cruise ship was completely inadequate in terms of infection control," said Kentaro Iwata in videos he has since deleted.

South Korea, meanwhile, announced 51 new cases, with more than 40 in a cluster centred on the Shincheonji Church of Jesus, an entity often accused of being a cult.  The infections apparently came from a 61-year-old woman who first developed a fever on February 10 and attended at least four services before being diagnosed.   Local media said she had twice refused to be tested for the coronavirus on the grounds she had not recently travelled abroad.   Authorities were investigating whether she might have visited the hospital where a long-term patient contracted the virus and later died.

Some 15 other patients have now been found to have the virus.   Shincheonji claims its founder, Lee Man-hee, has donned the mantle of Jesus Christ and will take 144,000 people with him to heaven on the day of judgement.   A man in his 60s tested positive for the coronavirus after dying Wednesday following symptoms of pneumonia, South Korean authorities said.
Date: Thu, 20 Feb 2020 10:28:16 +0100 (MET)

Lagos, Feb 20, 2020 (AFP) - An outbreak of Lassa in Nigeria has killed 103 people this year, health authorities said, as the first confirmed case was reported in the economic hub Lagos.    "Cumulatively from week 1 to week 07, 2020, 103 deaths have been reported with a case fatality rate of 17.6%," said the Nigeria Centre for Disease Control (NCDC) in its latest statistics on the virus released on Wednesday.    The overall number of confirmed cases rose by 115 last week to a total of 586 across the country.

Separately, health authorities in Lagos, Nigeria's most populous city with 20 million inhabitants, said an infected person was diagnosed there on February 17 and being treated in isolation in hospital.    "Sixty-three people that may have been in contact with the patient and who may have been infected in the process have been identified and are being monitored," the state government wrote on Twitter on Thursday.

Endemic to Nigeria, Lassa fever belongs to the same family as the Ebola and Marburg viruses, but is much less deadly.   The disease is spread by contact with rat faeces or urine or the bodily fluids of an infected person.    The majority of those infected do not show symptoms but the disease can go on to cause severe bleeding and organ failure in about 20 percent of cases.

An outbreak of Lassa fever killed some 170 people around Nigeria last year.     The number of cases usually climbs around the start of the year linked to the dry season.   While the overall number of confirmed cases and deaths is up this year on the same period in 2019, the mortality rate is lower.    Twenty health workers across the country have been confirmed as contracting the disease so far in 2020.    The virus takes its name from the town of Lassa in northern Nigeria, where it was first identified in 1969.
Date: Thu, 20 Feb 2020 09:58:17 +0100 (MET)
By Nicolas DELAUNAY

Les Mamelles, Seychelles, Feb 20, 2020 (AFP) - On a plain suburban street in Seychelles, far from the idyllic coastline and luxury resorts pampering honeymooners and paradise-seekers, heroin addicts queue anxiously for their daily dose of methadone.   It is a scene few outsiders would associate with the tropical nirvana adrift in the Indian Ocean, and one rarely, if ever, glimpsed by tourists as they shuttle from the airport to five-star luxury on white-sand beaches.

But life for many Seychellois is far from picture perfect: the tiny archipelago nation is battling what officials say are the world's highest rates of heroin addiction.   Nearly 5,000 people are hooked, government figures show, equivalent to nearly 0 percent of the national workforce -- a statistic that has startled the government into action.

In comparison, 0.4 percent of the global population consumed opioids in 2016, half of them in Asia, according to a United Nations report that puts Seychelles among the top consumers alongside producing countries such as Afghanistan.   The Seychelles' heroin boom, which took off over the past decade, gripped young and old alike and cut across class lines.   Among those queueing in the town of Les Mamelles for methadone -- a substitute narcotic used to wean users off heroin -- are parents with young children, an old man leaning on a cane and a taxi driver between shifts.

Graham Moustache, a 29-year-old father of two, described how the arrival of affordable and high-quality heroin in Seychelles swept up his entire family.   "I have four brothers and two sisters, and we have all been heroin addicts at one point," he told AFP, tracing his fingers over the needle scars on his arms.   "I've been to prison twice," he said, adding his mother had turned him in as "she didn't know what to do any more".   "Sometimes, I didn't have enough to eat and I had to choose between eating and buying heroin. I chose heroin."

- Soaring addiction -
The rise of new trafficking routes through East Africa in the late 2000s, coupled with porous borders and relatively high purchasing power among Seychellois, flooded the paradisal islands with heroin.   The average salary in the archipelago is $420 (390) -- high compared to other African nations.   The World Bank considers the Seychelles the only high-income country on the continent, thanks to the growing tourism industry.    But around 40 percent of the population still lives in poverty.

By 2011, around 1,200 people were addicted, prompting a punitive crackdown.   "We did not make a difference between the victim and the trafficker," said Patrick Herminie, director of the state-run Agency for Drug Abuse Prevention and Rehabilitation (APDAR).   By 2017, addiction had risen four-fold, placing Seychelles among the world's most drug-dependent nations.   The government, realising its war on drugs had failed, changed tack and declared a public health emergency.   "The magnitude of the problem is simply because we reacted a bit late," Herminie said.

Money has poured into combating the scourge, with state funds for drug prevention and rehabilitation programmes soaring to 75 million Seychelles rupees ($5.5 million) in 2020 -- almost 10 times the 2016 budget.    APDAR, a specialist drug agency created in 2017 to tackle the problem, employs four times as many staff as the body that preceded it.   A state-run methadone programme has reached 2,500 people, with medical follow-ups helping to track their progress.    But the free availability of methadone has also prompted drug dealers to lower their prices.

Mobile clinics drive around offering methadone to addicts and providing free health checks and advice.    "I've been clean for more than a year. I found a job as a fisherman, and I can see my two kids," said Moustache proudly, as he queued at the white methadone van staffed with healthcare workers.   Others have struggled to stay the course.   "Methadone helps me a lot, but it's difficult not to take heroin at all," said Gisele Moumou, an emaciated 32-year-old addict, drawing ragged breaths and sweating as she waits for her small cup of methadone.

- Stopping the scourge  -
Schoolchildren are being taught about the damage done by drugs through awareness campaigns and billboards in classrooms.    But there is much work to be done, especially among children from families affected by drug use, says Noellie Gonthier from CARE, a local harm-reduction charity.   "Sometimes, four- or five-year-olds at school mimic injecting heroin," she said.   "Our challenge is to make them understand that what they consider normal -- because of their family context -- actually isn't at all."   On Mahe, a small, mountainous island with lush vegetation, most of the population lives near the water. Life is quiet here, without traffic, and the streets are mostly clean.

Poverty is largely hidden, concentrated in a few neighbourhoods behind faded walls or in the hills.   So why do so many Seychellois take drugs? The authorities admit they haven't quite figured it out, but say it appears that while poverty does not quite allow people to live well, it allows them enough money to buy drugs to forget their woes.   "The root of the cause, we're still working on it," said Herminie.   Early studies show that health and social problems associated with heroin use have declined since the government switched its response from punishment to prevention, officials say.

Crime has nearly halved and annual cases of new hepatitis C infections have fallen 60 percent.    Youth unemployment, meanwhile, has shrunk from 6.5 percent to 2.1 percent in recent years.   One recovering addict, a taxi driver who did not want to be named, offered a bleak assessment as he waited for his daily methadone in an empty car park in Les Mamelles.    "We're a small island in the middle of the ocean. What else is there to do here?" he said.
Date: Wed, 19 Feb 2020 16:12:54 +0100 (MET)
By Michael O'HAGAN

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

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

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

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

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

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

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

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

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

Back in Lopei village, Elizabeth Namoe, 40, a shopkeeper in nearby Moroto had been visiting family when the swarm arrived.   "When the locusts settle they eat anything green, the animals will die because they have nothing to feed on, then even the people (will suffer)," she said.   "The children will be affected by hunger and famine since all life comes from all that is green. I fear so much."
Date: Wed, 19 Feb 2020 12:55:06 +0100 (MET)

Beijing, Feb 19, 2020 (AFP) - China's President Xi Jinping called Wednesday for greater protection of medical staff fighting the new coronavirus after the deaths of prominent doctors sparked national anger at the government's handling of the outbreak.   At least seven medical workers have died from the virus, while 1,716 have been confirmed as infected, most at the epicentre of the epidemic in central Hubei province where hospitals have dealt with a huge influx of patients.

Staff have faced shortages of masks and protective bodysuits, with some even wearing makeshift suits and continuing to work despite showing respiratory symptoms, health workers have told AFP.   Xi said China must "strengthen efforts to relieve the stress of medical workers, provide them with daily necessities, arrange time for their rest and give them encouragement", the official Xinhua news agency reported.   Liu Zhiming, the director of Wuchang Hospital in Hubei's capital Wuhan, died Tuesday, more than a week after the death of whistleblowing ophthalmologist Li Wenliang in the same city prompted nationwide mourning and calls for political reforms.

- 'Majestic spirit' -
A paper published by China's Center for Disease Control and Prevention said an additional 1,300 health workers may have been infected but have yet to receive a diagnosis.   Xi said China must ensure medical teams in Hubei and Wuhan "carry out work in a safe, orderly, coordinated, effective and swift manner", Xinhua reported.   The deaths of frontline medical workers "reflected doctors' humane and majestic spirit", Xi said.   The death toll from the virus jumped past 2,000 on Wednesday, while 74,185 cases of infection have been confirmed in mainland China.
Date: Wed, 19 Feb 2020 12:19:59 +0100 (MET)

Tehran, Feb 19, 2020 (AFP) - Two people in Iran tested positive Wednesday for the deadly new coronavirus, the health ministry said, in the Islamic republic's first cases of the disease.   Kianoush Jahanpour, a ministry spokesman, said the cases were detected in the holy city of Qom, south of the Iranian capital.   "In the past two days, some suspect cases of the new coronavirus were observed in Qom city," he said, quoted by state news agency IRNA.

"Teams were dispatched after receiving the reports, and based on the existing protocols the suspect cases were isolated and tested," said Jahanpour.   "Out of the samples sent, a laboratory tested two of them as positive for coronavirus just minutes ago and some of the other samples were type B influenza."

The health ministry spokesman said additional tests were being done on the two cases and final results would be announced "as soon as possible".   The new coronavirus epidemic has killed more than 2,000 people in China and infected more than 74,000. It has spread to at least two dozen countries.   The United Arab Emirates was the first country in the Middle East to report cases of coronavirus last month.
Date: Tue 18 Feb 2020
Source: CIDRAP (Center for Infectious Disease Research & Policy) News [edited]

The WHO's African regional office said that both Chad and the Central African Republic (CAR) are in the midst of measles outbreaks, with both countries reporting increasing case counts since [1 Jan 2020].

In Chad, 1276 cases, including 14 deaths have been reported since 1 Jan 2020, with 352 suspected measles cases and 4 deaths reported in the week ending on 9 Feb 2020.  "Most, 78%, of the investigated cases never received any vaccination against measles," the WHO said. "60% of the investigated cases were under 5 years of age while 19% were between 5 and 14 years and 14% were 15 years and above."

In CAR, a total of 1498 suspected measles cases, including 15 deaths, have been recorded since [1 Jan 2020]. The outbreak has been ongoing since early 2019. From 1 Jan 2019, through 9 Feb 2020, a total of 5724 suspected measles cases, including 83 deaths (case fatality rate, 1.45%) have been reported in 13 health districts.  Almost 3/4 of the cases (72%) are in children under the age of 5.
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[HealthMap/ProMED-mail maps
Central African Republic: <http://healthmap.org/promed/p/6>]
Date: Wed 19 Feb 2020
Source: Circular/News, Veterinary Services, Israel's Ministry of Agriculture [in Hebrew, trans. Mod.AS, edited]

Rabies, Case No. 6 for 2020, dog, Ramot Naftali, Upper Galilee. Reference: Kimron Vet Institute [KVI] Laboratory Test No. A00373420, dated 19 Feb 2020
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On 17 Feb 2020, a dead dog was brought for examination to the KVI [at Beit-Dagan]. The dog died while being transported to a rabies observation kennel since, as reported, it had attacked grazing cattle and attempted to attack people.  It was also reported that the dog had bitten itself. The tested animal has been diagnosed rabies positive.  [Byline: Dr. Avi Wasserman Head, Field Veterinary Services (acting)]
====================
[The above and 5 earlier rabies cases in Israel since 1 Jan 2020 are located within a small region along the Lebanese border, facing Lebanon's governorate A-Nabatieh. See the rabies map (2020) at <https://moag.maps.arcgis.com/apps/webappviewer/index.html?id=a6d8aae5cbc04c958d5efefd2724318f>.

The 2019 map, presenting a total of 17 cases, is available at

The 6 cases during 2020 are: 3 jackals, 2 dogs, 1 cow. Most likely, rabies is currently circulating within the Lebanese side of the border.

It would be interesting to note whether the rabid dog was owned and, in case affirmative, whether and when this dog was last vaccinated against rabies, as prescribed by law. Israel's owned dogs are included in the national dog registry, currently counting more than 400,000 dogs. - ProMED Mod.AS]
Date: Tue 18 Feb 2020
Source: Qatari Ministry of Public Health [edited]

The Ministry of Public Health (MOPH) declared that a case of Middle East respiratory syndrome (MERS) has been confirmed. The case is a male citizen aged 65 years who has been suffering from several chronic diseases. The patient has been admitted to the hospital to receive the necessary medical care in accordance with the national protocol to deal with confirmed or suspected cases of the disease.

The Ministry of Public Health, in cooperation with the Ministry of Municipality and Environment, is taking all necessary preventive and precautionary measures to control the disease and prevent it from spreading.

MERS is a viral respiratory disease that is caused by one of the coronaviruses (MERS-CoV), but it differs from the novel coronavirus, known as COVID-19, which has recently spread in several countries. Both viruses differ in terms of the source of infection, mode of transmission, and the disease severity. The Ministry of Public Health confirms that no cases of the novel coronavirus (COVID-19) have been diagnosed in Qatar so far.

Only 3 cases of MERS-CoV were registered in Qatar during the past 2 years. The Ministry of Public Health calls on all members of public, and especially people with chronic diseases or those with immunodeficiency disorders, to adhere to public hygiene measures. This includes washing the hands regularly with water and soap, using hand sanitizers, as well as avoiding close contact with camels and seeking medical advice when experiencing symptoms of fever, cough, sore throat, or shortness of breath.

The Rapid Response Team of the Health Protection and Communicable Disease Control is available round-the-clock to receive notifications or inquiries related to communicable diseases on its hotline numbers 66740948 or 66740951.
======================
[In early December 2019, Qatar reported 3 cases of MERS-CoV infection, a fatal case and 2 asymptomatic contacts of the fatal case. The fatal case denied a history of contact with camels or recent travel. She did have a history of underlying medical conditions (which may have led to contact with the health sector in the 2 weeks prior to onset of illness). Prior to these cases, the most recent report of a case of MERS-CoV infection in Qatar was in 2017 when there were 3 cases reported (see prior ProMED-mail posts listed below.)

The location of residence of this patient was not available, nor were other epidemiological variables, including possible high risk exposures.

The HealthMap/ProMED-mail map of Qatar is available at