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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

Recently, island residents were irate when two warehouses were found to be filled with abandoned supplies, apparently never used after Hurricanes Irma and Maria in 2017.   The storms' one-two punch left Puerto Ricans without power for months and killed nearly 3,000 people, according to the local government's official numbers.   President Donald Trump has accused the Puerto Rican government of incompetence and siphoning off hurricane relief money.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
Date: Thu, 16 Jan 2020 02:45:27 +0100 (MET)
By Ivelisse RIVERA, con Leila MACOR en Miami

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

An alert issued by the Tsunami Warning Center immediately following the earthquake was later cancelled.   Tuesday's quake was the strongest of a series of tremors that have shaken the island since December 28, topping Monday's 5.8 quake.   That earthquake toppled houses and caused power outages, but there were no reports of casualties.
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Benin

Benin - US Consular Information Sheet
April 28, 2008

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Saint Lucia

St. Lucia US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
St. Lucia is an English-speaking, developing Caribbean island nation.
Tourist facilities are widely available.
Read the Department of State Background No
es on St. Lucia 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.
It is expected that the 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.

Information about dual nationality or the prevention of international child abduction can be found on the State Department 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:
In 2006, there were five reported incidents of U.S. citizen visitors to St. Lucia staying in boutique hotels in rural areas being robbed at gunpoint in their rooms; some of the victims were assaulted and one was raped.
In September 2007, a U.S. citizen was robbed in her room at a resort hotel near Castries by armed men.
While authorities detained suspects in some of the cases, no one has been prosecuted.
Efforts by the Saint Lucian authorities to improve public safety on the island are ongoing.
Visitors should inquire about their hotel’s security arrangements before making reservations.
Valuables left unattended on beaches and in rental cars are vulnerable to theft.
Visitors should use caution, especially at night and in lightly frequented areas.

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.
There are two public hospitals and one private hospital in St. Lucia, neither of which provide the same level of care found in an American hospital.
The main hospital is Victoria Hospital (Telephone (758) 452-2421).
There is no hyperbaric chamber; divers requiring treatment for decompression illness must be evacuated from the island.
Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars.
Doctors and hospitals often 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. Lucia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Vehicles travel on the left side of the road in St. Lucia.
Roads are reasonably well paved but poorly marked, narrow and winding, with steep inclines/declines throughout the island.
There are few guardrails in areas that have precipitous drop-offs from the road.
In spite of these conditions, drivers often travel at excessive speed, and accidents are common.
St. Lucia is served by privately owned and operated mini-buses, plying licensed designated routes.
While most of these services operate only on weekdays during daylight hours, some may operate at night and on weekends and holidays.
Taxis are available at generally reasonable rates, but tourists are vulnerable to being overcharged.
When using minibus or taxi services, travelers should agree to a fare ahead of time. When hiring a service at night, travelers should take precautions such as having their hotel call a reputable company for service.

Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://www.stlucia.org/
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of St. Lucia’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of St. Lucia’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 on St. Lucia.
The U.S. Embassy in Bridgetown, Barbados is responsible for consular issues on St. Lucia, including American citizen services.
U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times, so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available.
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. Lucia laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in St. Lucia 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. Lucia 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. Lucia.
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 telephone number for the Consular Section 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.
*

*

*
This replaces the Country Specific Information for St. Lucia dated June 6, 2007, to update sections on Entry/Exit Requirements, Safety and Security, Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Sat 10 Aug 2019
Source: Coherent Magazine [abridged, edited]

Off the Caribbean islands, the measles-stricken cruise ship, reportedly owned by the Church of Scientology, has been quarantined. A female crew member has been confirmed as a measles case, causing the ship to quarantine since 29 Apr 2019. According to reports, over 300 passengers are on board. According to Church of Scientology's website, the vessel is 440 ft [134 m] long and named Freewinds; [the vessel] hosts religious retreats ministering the most advanced level of spiritual counselling in the Scientology religion. The ship has been quarantined in a port in the Caribbean Island's capital since the officials discovered infected patients.

St. Lucia's chief medical officer Dr. Merlene Fredicks-James said, "Because of the risk of potential infection, not just from the confirmed measles case but from other persons who may be on the boat at the time, we thought it prudent to make a decision not to allow anyone to disembark." St. Lucia was declared measles free since 2016, which means it has been free from local measles transmission as it was last reported in 1991. However, health officials, there is extremely [caution] over travellers importing highly infectious reporters.

"Due to the high intensity of international travel related to the large tourism sector, the Caribbean region remains at high risk for the importation of measles and rubella cases," said Dr. C. James Hospedales, executive director of the Caribbean Public Health Agency.

The measles outbreak is not restricted to St. Lucia; the World Health Organization, [in] April 2019, reported a 300% increase in global measles cases. Moreover, the US has currently 700 confirmed cases of measles in 2019, the highest number of cases since 1994. A lot of health officials around the world are blaming the hesitance toward the vaccination for this outbreak.

The major cause behind the measles outbreak is hesitance toward vaccination and misinformation spread about its efficacy.  [Byline: Sagar Jagtap]
Date: Fri, 3 May 2019 17:56:40 +0200

Castries, Saint Lucia, May 3, 2019 (AFP) - A cruise ship owned by the Church of Scientology that was quarantined in St Lucia for two days because of a measles case has left the Caribbean island and was headed toward Curacao on Friday, maritime tracking services said.   The Freewinds left the port capital Castries on Thursday at 11:15pm (0315 GMT Friday) and was cruising toward Willemstad in Curacao, a distance it previously covered in two days, according to myshiptracking.com and cruisin.me.

A spokeswoman for St Lucia's health ministry confirmed that the ship had left the island. The Church of Scientology says the 440-foot (134-meter) vessel is used for religious retreats and is normally based in Curacao.   The vessel had arrived in St Lucia from Curacao on Tuesday, when it was placed under quarantine by health authorities because of a measles patient -- a female crew member, according to Merlene Fredericks-James, St Lucia's chief medical officer.

Resurgence of the once-eradicated, highly-contagious disease is linked to the growing anti-vaccine movement in richer nations, which the World Health Organization (WHO) has identified as a major global health threat.   There were about 300 people aboard the ship, according to Saint Lucia authorities, which said they provided 100 doses of measles vaccine at no cost.   The church, founded by science fiction writer L Ron Hubbard in 1953, did not respond to requests for comment.   Its teachings do not directly oppose vaccination, but followers consider illness a sign of personal failing and generally eschew medical interventions.
Date: Thu 2 May 2019
Source: Reuters [abridged, edited]

A cruise ship quarantined for a reported case of measles left the Caribbean island of St. Lucia late on Thu [2 May 2019] after health officials provided 100 doses of vaccine to the ship, media reports said.

The Church of Scientology cruise ship was confined in port this week by island health officials after the highly contagious disease was detected on board.

CNN reported the ship had left St. Lucia, and online ship traffic data showed that the vessel was underway and headed for the island of Curacao.

One case of measles had been confirmed on the ship docked in port near the capital of Castries since Tuesday [30 Apr 2019], Dr. Merlene Frederick-James, St. Lucia's chief medical officer, said in a video statement.

"The confirmed case as well as other crew members are presently stable, but remain under surveillance by the ship's doctor," she said, noting that the incubation period of measles is 10-12 days before symptoms appear.

NBC News reported that nearly 300 passengers and crew were aboard the vessel, with one female crew member diagnosed with measles.
========================
[Also see
- Rapp. Mary Marshall.

According to the church's website, Scientologists use prescription drugs and are treated by medical doctors, but the church has not expressed a specific position on vaccinations. In a statement to The Hollywood Reporter in 2016, the church said it "takes no position one way or the other on this issue," despite several high-profile celebrities in the church speaking out against vaccines. - Mod.LK]

Update on cruise ship:
Date: 4 May 2019
Source: USA Today [2019]

Authorities worry that people aboard the ship might have been exposed after a female crew member was diagnosed with measles after coming back from Europe.

Authorities in Curacao boarded a ship that arrived in the Dutch Caribbean island under quarantine, to start vaccinating people to prevent a measles outbreak.

Health officials said only those who already have been vaccinated or have previously had measles will be free to leave the 440-foot (134-meter) ship, Freewinds, which reportedly belongs to the Church of Scientology.

Curacao epidemiologist Dr. Izzy Gerstenbluth told The Associated Press that a small team is assessing more than 300 people aboard the ship, and that the process might take more than a day.
Date: Wed 1 Nov 2017
Source: St Lucia Times [edited]

The Ministry of Health and Wellness has noted a reported increase in the cases of leptospirosis. Though increases in the number cases of leptospirosis is not unusual after periods of heavy rains or flooding it, remains an issue of concern to health authorities.  Leptospirosis is a disease caused by a bacterium, which can be found in some animals, which include rats, cattle, pigs, horses, and dogs. Persons can become ill if they are in contact with urine, water, food, or soil through breaks in the skin, mouth, eyes, or nose.

Symptoms can range from a mild flu-like illness with high fever, chills, headache, muscle pains, red eye, sore throat, and occasionally rash, which may worsen with time. In the more severe phase the disease can affect the liver causing jaundice (which is dark urine and the yellowing of the white part of the eye and the skin), and anaemia. If left untreated the disease can affect organs such as the brain, kidneys, lungs, and other internal organs. In some instances this may result in death.

This condition can be treated effectively with antibiotics if diagnosed on time. Seeking medical care early when these symptoms are noticed can prevent the disease from worsening.

Persons at greatest risk of getting leptospirosis are farmers and agricultural workers, sanitation workers, and sewer workers. However, anyone exposed to rat contaminated water and soil is also at risk of contracting the disease. The Ministry of Health has an established Rodent Reduction Programme, which will be further enhanced to respond to the current increase in leptospirosis. The ministry will also be working with a number of agencies including Ministry of Agriculture, farmer organizations and local government in order to heighten awareness of the disease to persons most at risk of contracting the disease.

The Ministry of Health advises all to take the following measures to reduce the risk of becoming ill with leptospirosis: wear protective clothing, shoes, gloves to avoid coming into contact with contaminated surfaces, soil, water source, or food; avoid contact with surfaces and water sources that may be contaminated with rat urine; keep your home and surroundings free of garbage; avoid leaving food where rats can get to it; keep food in covered containers; cover opened wounds properly; and visit your nearest health facility if there is any suspicion you might have been exposed to leptospirosis.

For further information, please contact the acting National Epidemiologist, Dr Gemma Chery, at telephone numbers 468-5325 and 285-4773.
==================
[Saint Lucia, with a population of 165,595 residents in the 2010 census, is a sovereign island country in the Windward Island chain (Dominica, Martinique, Saint Lucia, Saint Vincent and the Grenadines, and Grenada) that forms the eastern Caribbean Sea boundary with the Atlantic Ocean; the capital of St Lucia is Castries (<https://en.wikipedia.org/wiki/Saint_Lucia>).

A map of the island can be seen at
<http://www.geographicguide.com/america-maps/images/political-saint-lucia.jpg>.

The Windward Islands are the southern islands of the Lesser Antilles, within the West Indies, between the Leeward Islands to the north and Trinidad & Tobago to the south and west of Barbados.

A map of the Caribbean Islands can be found at
<https://en.wikipedia.org/wiki/Windward_Islands#/media/File:Caribbean_general_map.png>.

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

Hurricane Maria reached Category 5 strength on 18 Sep 2017 upon making landfall on Dominica, 172 km (107 mi) to the north of St Lucia, compounding recovery efforts in the areas of the Leeward Islands already struck by Hurricane Irma just 2 weeks prior (<https://en.wikipedia.org/wiki/Hurricane_Maria>). - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
1 Sep 2014: (SNO )
A ProMED-mail post
<http://www.promedmail.org>

The Ministry of Health has activated an EVD medical team at the Hewanorra International Airport. ...
Reports are that the officials at the airport were planning a protest on Sat [30 Aug 2014] since there was no medical team in place to deal with an international flight that had African nationals who could be possible EVD victims. ...
<http://www.stlucianewsonline.com/ebola-medical-team-activated-at-hewanorra-international/#sthash.DvfoxQER.dpuf>
More ...

Christmas Island

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Tue, 19 Sep 2006 17:41:31 +0200 (METDST) SYDNEY, Sept 19, 2006 (AFP) - A large earthquake with an estimated magnitude of 6.1 struck Tuesday near the Australian territory of Christmas Island, the US Geological Survey said. The quake struck at 20:58 local time (1358 GMT) and its epicentre was located 191 kilometres (119 miles) east-northeast of Christmas Island, the USGS report said. The reading was based on the open-ended Moment Magnitude scale, now used by US seismologists, which measures the area of the fault that ruptured and the total energy released.
27 Aug 2001 A NORWEGIAN ship carrying 438 sick and starving refugees was moored in limbo off Christmas Island last night, with John Howard refusing to allow them to disembark and Indonesia reluctant to let them berth anywhere in its territory. http://email.ni.com.au/Click?q=96-pjPWQtdfI9qzkLcbUQgkSoeR
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Tajikistan

Tajikistan - US Consular Information Sheet
December 9, 2008
COUNTRY DESCRIPTION: Tajikistan remains the poorest of the former Soviet republics in Central Asia.
It is a nominally constitutional, democratic, and secular republic, dominated b
President Emomali Rahmon who has been in power since 1992.
Tourist facilities are undeveloped and many goods and services usually available in other countries are unavailable.
Read the Department of State Background Notes on Tajikistan for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid passport and visa are required to enter and exit Tajikistan, as well as for registration at hotels.
The visa should be valid for the entire period of stay in country, through departure, and travelers should ideally request visas which allow for changing travel dates.
Failure to produce a valid visa will require the traveler to leave the country immediately.
Travelers planning to arrive in Tajikistan from countries that have Tajik embassies or consulates must obtain Tajik visas abroad prior to their travel.
Tajikistan is represented by embassies and consulates in the following countries:
United States of America, United Kingdom, Austria, Germany, Belgium, Turkey, China, Afghanistan (Kabul, Mazori Sharif), Iran, Pakistan, India, Russian Federation, Belarus, Kazakhstan, Kyrgyzstan, Uzbekistan, Turkmenistan, Egypt, and United Arab Emirates (Dubai).
Travelers arriving in Tajikistan from countries in which there are no Tajik embassies or consulates must have Tajik visa support, in the form of a letter from the Tajik Ministry of Foreign Affairs (MFA) confirming that a visa may be issued, in order to receive a Tajik visa at the Dushanbe International Airport upon arrival.
Travelers need to have two passport-size photos and a passport valid for at least six months longer than the duration of the planned stay in Tajikistan.
Visas issued at the Dushanbe airport are normally valid for only 45 days.
This “upon arrival” visa service does not apply to any other Tajik airports or land borders.

Travelers staying in Tajikistan three days or longer must, within three days of arrival in Tajikistan, obtain registration stamps at the MFA or the Department of Visas and Registration of the Ministry of Internal Affairs (OVIR), depending on whether the purpose of the visit to Tajikistan is for official or personal travel.
Immigration authorities may deny the departure of travelers who failed to register their visas until after they have paid a fine and obtained the registration stamps at the MFA or OVIR.

In order to receive visa support, an organization inviting a traveler to Tajikistan must submit a request to the MFA at least two weeks in advance of the planned travel date to Tajikistan.
Persons planning to arrive in Tajikistan at the invitation of a private Tajik resident (e.g., a friend or relative in Tajikistan) need to obtain a notification letter from OVIR.
According to OVIR, it may take up to 45 days to obtain the notification letter.
The MFA will issue Tajik visa support on the basis of the OVIR notification letter.
The inviting party will send a copy of visa support to the traveler.
The original MFA visa support will be sent to the Consular bureau at Dushanbe airport.
According to the Ministry of Foreign Affairs, persons traveling at the invitation of Tajik organizations or travel agencies, who are applying for visas at Tajik embassies or consulates abroad, will be able to obtain single-entry Tajik visas valid for 45 days upon direct submission of their visa request to the Tajik embassy or consulate (without a visa support letter).
With the issuance of visa support, travelers applying for visas at Tajik embassies or consulates abroad will be able to obtain multiple-entry visas valid for a maximum of three months.
Travelers who would like their visas extended need to apply for extension in advance through the MFA (official travelers) or OVIR (tourist or commercial travelers).
Entry into the Gorno-Badakhshan region, both from inside and outside of Tajikistan, requires special authorization in advance in addition to a valid Tajik visa.
Travelers can obtain this authorization at Tajik embassies and consulates abroad, or by applying to the MFA or OVIR once in Tajikistan.
Tajik authorities advise that sponsoring organizations in Tajikistan submit requests for travel authorization for the Gorno-Badakhshan Autonomous Region at least two weeks in advance of the planned travel.
The Tajik MFA or OVIR will list the names of the settlements and cities in Gorno-Badakhshan which the traveler plans on visiting in the travel authorization stamp.
The Gorno-Badakhshan travel authorization is not written on a Tajik visa sticker; it is a separate note put in a passport.

The government of Tajikistan requires visitors who remain in country for more than 90 days to present a medical certificate showing that they are HIV-free, or to submit to an HIV test in Tajikistan.
HIV is a growing health threat in Tajikistan.

Visit the Embassy of Tajikistan web site at http://www.tjus.org for the most current visa information.

Note: Departure options from Tajikistan may be limited in an emergency.
U.S. citizens, their family members, and their dependents can maximize departure options by obtaining extended visas for travel to countries with reliable connections to Tajikistan, including Kazakhstan, Kyrgyzstan, Uzbekistan and Russia.
Other destinations, notably Turkey, offer several flights a week and do not require American citizens to obtain visas in advance.
Please note, however, that in emergency situations, flights may be suspended.

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

SAFETY AND SECURITY:
Supporters of terrorist groups such as the Islamic Movement of Uzbekistan (IMU), the Islamic Jihad Union (IJU), al-Qaida, and the Eastern Turkistan Islamic Movement remain active in Central Asia, as do anti-Western, anti-Semitic extremist organizations such as Hizb’ut-Tahrir.
These groups have expressed anti-U.S. sentiments and may attempt to target U.S. Government or private interests in the region, including in Tajikistan.
Terrorist attacks involving the use of suicide bombers have previously taken place in neighboring Uzbekistan.
Taliban resurgence and successful operations in Afghanistan, including attacks in the north, could also affect the security situation in southern Tajikistan.

Minor explosions have occasionally occurred in Dushanbe in the last two years.
These explosions usually happen at night.
In June 2007, an individual threw a grenade at the Supreme Court building.
Witnesses and unofficial reports indicate that three guards were killed, although no official reports confirmed this.
In November 2007, a small explosive killed an individual outside the Kokhi Vahhdat conference center in the center of Dushanbe.
In both cases, no individual or organization claimed responsibility and authorities continue to investigate.
Also in November 2007, a small improvised explosive device destroyed the official car belonging to the Commander of the President’s National Guard.
Incursions along the Afghan border have resulted in shootings and kidnappings; however, most are believed to be related to narcotics trafficking.
None of these incidents have indicated the targeting of Americans or Westerners.

Criminal groups and terrorists do not distinguish between official and civilian targets.
Because of increased security at official U.S. facilities, terrorists are seeking softer civilian targets such as residential areas, clubs and restaurants, places of worship, hotels, outdoor recreation events, and other venues.
The limited number of facilities catering to Westerners presents a heightened risk.
American travelers should also avoid demonstrations and large crowds.
Demonstrations and mobs are rare in Tajikistan following the 1992-1997 civil war, and police reaction to such behavior is unpredictable.

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

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

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

CRIME:
The current crime rating for Dushanbe is high.
The primary concern is the inability of Tajikistan’s law enforcement entities to provide adequate and immediate assistance.
Lack of manpower, low salaries, and inadequate training all contribute to a lack of professionalism.
Tajikistan’s struggling economy and high unemployment have resulted in incidents of street crime, including pick pocketings, muggings and armed robberies.
Alcohol-related incidents such as bar fights and drunk driving are common.
Criminals are not deterred by the risk of confrontation and tend to operate in groups of two or more to decrease their chances of arrest.
When crimes do occur, they can be violent in nature.
Additionally, the lack of a free media, and the infrequent public outreach between the government and the public through the media, does not provide the average citizen current and accurate information to make informed decisions about safety.

Government statistics are typically inaccurate because many crimes are not reported to law enforcement organizations.
Often police refuse to open minor or routine cases that seem too difficult to resolve.
In 2007, the Ministry of Interior reported a number of arrests related to organized crime, although overall reported crimes saw a slight decrease.
The Ministry also reported a slight increase in firearm and drug-related offenses compared to previous years.

Crimes of opportunity can occur against anyone, and the Embassy reminds visitors to be careful and cautious in their own personal security, whether within the city limits of Dushanbe or in the more remote areas of the country.
Americans should be aware that danger increases after dark, and they are advised to use caution when traveling alone or on foot after dark.
The U.S. Embassy encourages visitors to travel in pairs and to notify colleagues of their whereabouts when not working, especially during evening hours.
Travelers are also encouraged to carry a copy of their passport (separate from their wallets) to speed up issuance of a new passport in case of theft.

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

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

The local equivalent to the “911” emergency line in Tajikistan is: 01 - Fire, 02 - Police, 03 - Ambulance
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
The quality of Tajikistan’s medical infrastructure is significantly below Western standards, with severe shortages of basic medical supplies, including disposable needles, anesthetics, and antibiotics.
Many trained medical personnel left the country during and following the civil war.
Elderly travelers and those with pre-existing health problems may be at particular risk due to inadequate medical facilities.

Significant disease outbreaks are possible due to population shifts and a decline in some immunization coverage among the general population.
There have been outbreaks of typhoid in the Dushanbe area and in the south, and the risk of contracting malaria, cholera, and water-borne illnesses is high.
Throughout Central Asia, rates of infection of various forms of hepatitis and tuberculosis (including drug-resistant strains) are on the rise.
Tuberculosis is an increasingly serious health concern in Tajikistan.
For further information, please consult the CDC’s Travel Notice on tuberculosis at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.
It is advised to drink only bottled or thoroughly boiled water while in Tajikistan.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Tajikistan.
However, the government of Tajikistan does require visitors who remain in country for more than 90 days to present a medical certificate showing that they are HIV-free, or to submit to an HIV test in Tajikistan.
HIV is a growing health threat in Tajikistan.

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 Tajikistan is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Travel to, from, and within Tajikistan is difficult and unreliable.
Neighboring countries may unilaterally close borders and some borders are poorly delineated.
Armed police or military checkpoints can make road travel outside of Dushanbe more difficult.
Crossing the Tajik-Uzbek border, in particular, has been known to present difficulties for drivers operating vehicles with non-Tajik government-issued plates.
Road travel should be undertaken only in daylight hours and on routes known to the traveler or a reliable escort.
Those traveling to Gorno-Badakhshan by car should do so only during daylight hours.
The roads traverse mountainous terrain along the Afghan border that is difficult to navigate, even in daylight hours.
Public transportation vehicles in the city are often overcrowded and not always safe.
If you are driving, be vigilant because pedestrians often tend to cross the street at inappropriate places or walk along the highway without paying attention to vehicular traffic.
Bus services between major cities have been severely disrupted by border closures and should not be relied upon.
The State Traffic Inspectorate (GAI, or in Tajiki, BDA), which has checkpoints in many cities and at regular intervals along all highways outside the city, frequently stops vehicles for inspection of the vehicle and the driver’s documents.

During the winter months, the potential dangers when traveling outside of Dushanbe in the mountainous areas of the country are heightened.
Every year, accidents and casualties occur on Tajikistan’s mountain roads and passes, often when drivers ignore warnings not to travel over a closed mountain pass.
Avalanches are a common occurrence in Tajikistan’s mountains during the winter months.
The tunnel bypassing the Anzob Pass is still not complete and travel via this construction project is not advised in any season.
Please exercise caution and limit winter travel to Tajikistan’s mountain regions.

In certain parts of the country, including in the Vakhsh and Rasht valleys and along the Afghan-Tajik border, land mines and cluster munitions form an additional hazard.
If an area has land mine warning signs, or is marked off with red and white plastic tape, heed the warning and do not venture off the road.
In all cases, do not pick up or handle anything that looks like unexploded munitions.

Emergency phone numbers in Tajikistan:
police – 02, ambulance – 03, state traffic control (GAI) duty officer – 235-45-45.
Please refer to our Road Safety page for more information.

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

SPECIAL CIRCUMSTANCES: Tajikistan has a cash-only economy.
International banking services are limited, but ATM machines have been installed in several locations.
Cash is dispensed in both U.S. and local currency.
Few establishments in the country accept credit cards and none accepts traveler's checks.
Tajikistan's national currency is the Somoni, which is convertible.

Tajik customs authorities may subject all items that are imported into or exported from Tajikistan to a high level of scrutiny.
The Government of Tajikistan may enforce strict customs regulations against those who import and export goods.
The export of antiques and cultural valuables requires special permission.
There are also currency restrictions.
Travelers must fill out a Customs Declaration Form upon arrival in Tajikistan, have it stamped by Tajik customs officials at the port of entry and retain the form until departure to demonstrate that the travelers are not leaving Tajikistan with more money than they brought into the country.
Please contact the Embassy of the Republic of Tajikistan in the United States, 1005 New Hampshire Avenue NW, Washington, DC, 20037; telephone (202) 223-6090, fax:
(202) 223-6091, e-mail: tajikistan@verizon.net, web site: http://www.tjus.org for specific information about customs requirements.

The Republic of Tajikistan does not recognize dual citizenship with most countries, including the United States (one exception is with Russia, where dual citizenship is regulated by a special interstate agreement).
Dual nationals who attempt to leave Tajikistan on U.S. passports without valid Tajik visas in them are likely to have problems with immigration authorities upon departing Tajikistan.

Travelers to Tajikistan are subject to frequent document inspections by local police.
U.S. citizens are strongly encouraged to carry copies of their U.S. passports, Tajik visas, and visa registration at all times (including while traveling within Tajikistan) so that, if questioned by local officials, proof of identity,
U.S. citizenship, and valid visa status in Tajikistan are readily available.
Always check your visa and registration validity dates so that these documents can be renewed if necessary before they expire.
Taking photographs of anything that could be perceived as being of military or security interest, including many government buildings, may result in problems with the authorities.
In accordance with the Vienna Convention on Consular Relations and certain bilateral agreements, local authorities must grant a U.S. consular officer access to any U.S. citizen who is arrested.
U.S. citizens who are arrested or detained should ask to contact the U.S. Embassy immediately.

Tajikistan is an earthquake-prone country.
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 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 Tajik laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Tajikistan 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 Tajikistan are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Tajikistan.
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 109A Ismoili Somoni Avenue, Dushanbe, Tajikistan, Main Phone: 992-37-229-2000, Consular Direct Line: 992-37-229-23-00, consular e-mail dushanbeconsular@state.gov, embassy fax:
992-37-229-20-50, Duty Officer: 992-90-770-10-32, web site: http://dushanbe.usembassy.gov
* * *
This replaces the Country Specific Information for Tajikistan dated February 14, 2008, to update the sections on Entry/Exit Requirements, Crime, Aviation Safety Oversight and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon, 6 Aug 2018 06:19:37 +0200
By Akbar Borisov, with Christopher Rickleton in Almaty

Dushanbe, Tajikistan, Aug 6, 2018 (AFP) - En route to mountainous Tajikistan's "roof of the world" lies a hastily-erected memorial to four bike tourists killed in an attack claimed by the Islamic State group late last month.     Roses and tulips lie scattered at the tribute -- featuring a plaque inscribed in English -- in the foreground of a scrubby mountain landscape.    "We express sincere condolences on behalf of all Tajik people and Tajikistan to the families and relatives of the died tourists in our country tragically and cruelly," the plaque reads.

It was here, approximately 100 kilometres south of Tajikistan's capital Dushanbe, that American tourists Lauren Geoghegan and Jay Austin, Dutch citizen Rene Wokke and Swiss citizen Markus Hummel were fatally wounded in an attack initially reported as a hit-and-run road accident.    The attack comes as a deep blow to Tajikistan, which has been trying to promote the authoritarian country as a tourism hotspot, simplifying visa bureaucracy and even declaring 2018 "the year of tourism."

Police said the gang that attacked the group of seven tourists, injuring two others, had also stabbed their victims, while a video released via IS' official media channel indicated the attackers were inspired by the Islamist group.   "It was a tragedy," 32-year-old account manager and biking enthusiast Pau Ros told AFP ahead of a seven-day cycle over Tajikistan's legendary Pamir Highway with girlfriend Mariona Miranda.   "This happens around the world now. But we are not going to change our lives because that is what these bad people would want," said Ros, who is a native of Barcelona.

- IS-linked? -
Authorities have played down video evidence that appears to show five men -- four of whom they say were killed resisting arrest -- swearing an oath of allegiance to IS leader Abu Bakr al-Baghdadi.   On Friday Tajikistan's state prosecutor said the clip had been released "with the aim of deflecting suspicions from another terrorist organisation -- the Islamic Renaissance Party", a former opposition party banned by the government in 2015. 

The IRPT has refuted links to the attack, as has Iran, a country that Tajikistan has poor ties with and says provided training to a 33-year-old man called Hussein Abdusamadov, who was detained for allegedly leading the attack on the cyclists.   In a brief interview with AFP, the mother of Abdusamadov, who was shown sporting a black eye in his police photo, could not say if he had traveled to Iran but said he spoke Arabic and had worked in Russia, a migration destination for hundreds of thousands of Tajiks.   "We do not know when he came back to (Tajikistan). The police just came to our door and told us he had committed a crime," Gulchekhra Shodmonova told AFP.

Analysts have pointed to a number of reasons to doubt the official narrative linking IRPT and Iran to the attack -- chiefly a downturn in Tajikistan's relations with Iran, an intensified crackdown on the opposition since 2015 and the IS video evidence.     Mahmudjon Faizrahmon, a spokesman-in-exile for the party that has always described itself as peaceful opposition force said on Thursday that police brought his 62-year-old mother for questioning after he denied links between the party and the attack on Twitter.     In addition to Abdusamadov, Tajikistan's prosecutor says 10 people have been detained under suspicion of financing the crime and failing to supply information to police before the attack took place.

- 'Simply Cycling' -
At the US embassy in Dushanbe, Tajikistan, a simple bicycle donated by a local student provides a fitting flourish to a display honouring 29-year-old Geoghegan and Austin, whose blog Simplycycling.org was popular among other bike-the-world cyclists.   The pair whose photo stood on a table at the heart of the display described themselves as enthusiasts who fell in love with cycling in adulthood but were not above "hitching a ride when a stretch of road is dangerous or just awful."   It is uncertain how the attack from which only one tourist, a Frenchman, emerged unscathed, will affect one of the few sources of economic optimism in the poorest country to gain independence from the Soviet Union.    Tajikistan announced plans to create a "tourist police" earlier this week, but provided few details.    One representative of a Bed and Breakfast in Dushanbe told AFP that a Polish tourist who had planned on cycling the highway had flown home. 
Date: Mon, 30 Jul 2018 10:24:00 +0200

Dushanbe, Tajikistan, July 30, 2018 (AFP) - Four foreign tourists were killed in Tajikistan on Sunday by armed attackers in what was originally reported as a hit-and-run road accident, the interior minister said Monday.   "(The suspects) had knives and firearms," minister Ramazon Hamro Rahimzoda said of the attack that left tourists from the United States, Switzerland and the Netherlands dead and two others injured.
Date: Sun, 29 Jul 2018 20:22:04 +0200

Dushanbe, Tajikistan, July 29, 2018 (AFP) - Four tourists were killed and another three injured on a bike tour in southern Tajikistan on Sunday when a car hit them before fleeing the scene, authorities said.   The seven cyclists included two Americans, two Dutch nationals and three other foreigners, the interior ministry told AFP without specifying the nationalities of those who died.   However, the US embassy in Tajikistan said two of the fatalities were US citizens.

The hit-and-run accident took place in the district of Danghara, 150 kilometres (90 miles) south of the capital Dushanbe.    "Three foreigners were killed at the scene and another died in hospital," the interior ministry said, adding that three other tourists had also received medical treatment.

Authorities in the Central Asian nation announced later Sunday one arrest and the deaths of two other suspects during a special operation launched to find those responsible for the deadly hit-and-run incident.   "One person has been arrested, two others resisted arrest and have been killed," the interior ministry said, without giving further details about the suspects.   Tajikistan is the poorest of the ex-Soviet republics and has been ruled by the iron hand of President Emomali Rakhmon since 1992.
Date: Tue 7 Nov 2017
Source: UN OCHA, ReliefWeb, Int Fed of Red Cross and Red Crescent Societies (IFRC) report [edited]

Measles outbreak DREF [Disaster Relief Emergency Fund] Operation MDRTJ025 Final Report
----------------------------------------------------------------------
A. Situation analysis
Description of the disaster
The measles epidemic in Tajikistan started in April 2017 in Rudaki district, and gradually spread to the capital city of Dushanbe and the surrounding districts, as well as Khatlon oblast. In mid-April 2017, 263 registered cases of measles were reported, out of which 157 were laboratory confirmed. By 1 May 2017, the number of notified and investigated cases rose from 263 to 345, with 246 patients (71 per cent) hospitalised. There were 2 child deaths registered over the course of the epidemic -- one in Khatlon oblast and one in the Districts of Republican Subordination).

The group most affected by the epidemic were children between 1 and 9 years of age. This also corresponded to the cohort born after the last national measles and rubella (MR) immunisation campaign conducted in 2009. Normally, the immunisation centre of the Ministry of Health and Social Protection (MoHSP) carries out immunisation on an annual basis for approx. 97 per cent of this cohort. The remaining 3 per cent -- including migrants, Roma and displaced people -- however, tends to remain non-immunised.

In response to the outbreak, the MoHSP decided to conduct a nationwide MR vaccination campaign targeting children aged 1-9 years, 15-26 May 2017, with the support of the Measles and Rubella Outbreak Response Initiative (MRI) Fund. The government of Tajikistan issued a decree on National Additional Immunisation Days in the country on 28 Apr 2017. The MoHSP issued an internal order on immunisation accordingly.
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[The complete IFRC report is available at

Maps of Tajikistan can be seen at
Date: Mon, 30 Jan 2017 09:06:48 +0100

Dushanbe, Tajikistan, Jan 30, 2017 (AFP) - Authorities in Tajikistan said Monday that at least seven people were killed in a series of avalanches that hit the mountainous Central Asian country over the weekend.   Avalanches killed at least five people on a highway linking the capital Dushanbe with Khujand, Tajikistan's second largest city, the emergency services committee said.

Two more died in avalanches in the remote Pamir region in the country's east, the committee said.   Authorities said a rescue operation was ongoing and the casualty toll could continue to rise.    A spokesperson for the committee told AFP around 800 people had been evacuated Sunday following the avalanches.   Mountainous and poverty-struck Tajikistan is prone to natural disasters including avalanches, landslides and earthquakes.   In February 2015, a single avalanche claimed six lives in the east of the country.
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Marshall Islands

Introduction
 
After almost four decades under US administration as the easternmost part of the UN Trust Territory of the Pacific Islands, the Mar
hall Islands attained independence in 1986 under a Compact of Free Association. Compensation claims continue as a result of US nuclear testing on some of the atolls between 1947 and 1962. The Marshall Islands hosts the US Army Kwajalein Atoll (USAKA) Reagan Missile Test Site, a key installation in the US missile defense network.
 
Geography
 
Located in the Oceania region its consists of two archipelagic island chains of 29 atolls, each made up of many small islets, and five single islands in the North Pacific Ocean, about half way between Hawaii and Australia
 
Climate
 
tropical; hot and humid; wet season May to November; islands border typhoon belt

Travel News Headlines WORLD NEWS

Date: Mon, 9 Mar 2020 00:51:21 +0100 (MET)

Majuro, Marshall Islands, March 8, 2020 (AFP) - The Marshall Islands has taken the radical step of banning all inbound air travellers for a two-week period in a bid to prevent the novel coronavirus reaching the Pacific island nation.   The emergency measure came into effect late Sunday and imposes "total suspension of air travellers coming into the Marshall Islands immediately" until March 22,  the country's health department said.    In addition, both air and sea arrivals from 10 countries -- including China, Japan, South Korea, Germany, France and Spain -- were barred with some exceptions to allow delivery of food and supplies.   The Marshalls, a group of islands and atolls about halfway between Australia and Hawaii, has also ordered cruise ships and yachts not to dock at its ports.

Health Secretary Jack Niedenthal said the air travel ban was designed to give the Marshalls time to establish isolation facilities and gear up healthcare staff for a possible local outbreak.   "We need more time to prepare," he told reporters Sunday.   The Marshalls, with a population of almost 80,000, welcomed about 6,800 international travellers in 2018, according to the most recent data from the UN World Tourism Organisation.   Small Pacific islands nations have so far had no confirmed cases of the virus, although there have been scares in the Marshalls, Fiji and Palau.

Samples from a possible case in Tonga are currently being examined by a New Zealand laboratory.   Niedenthal said last week that a lack of lab testing facilities in the islands was hampering the health response.   "If we know in a timely manner what we are dealing with here that would help us manage this situation much more effectively," he said.   The Marshalls last month barred international travel by government officials and elected leaders, with the only exception for patients referred for off-island medical treatment.   It has also "strongly advised" citizens and residents to postpone international travel until further notice.
Date: Fri, 29 Nov 2019 03:01:21 +0100 (MET)

Majuro, Marshall Islands, Nov 29, 2019 (AFP) - More than 200 people have been forced to flee their homes, after they were inundated by freak waves in the Marshall Islands capital Majuro.   Swells averaging five metres (16 feet) washed rocks and debris onto roads, temporarily cutting access to the international airport at the peak of the flooding on Wednesday.   The Red Cross set up evacuation centres at two schools, with local churches and Majuro's mosque also offering help to fleeing residents.

The Marshall Islands are one of the Pacific nations on the front line of climate change, causing increasingly intense weather phenomena and storm surges linked to rising seas.   Climate researcher Murray Ford said such factors may have played a role in this week's flooding but were not the main cause.   "The key driver of this current inundation appears to be a large swell which has arrived from a more northerly direction than the typical trade wind swell," he said.   "This particular event would be best described as a large swell, meeting a high, but not unusually high tide."   Disaster response officials were expected to complete a damage assessment on Friday.
8 Aug 2019

The Republic of the Marshall Islands declares dengue emergency, restricts travel. 1st case of DEN-3 confirmed on Ebeye Island; 21 cases probable.

HealthMap/ProMED-mail map of Marshall Islands:
Date: Mon, 28 May 2018 01:20:00 +0200

Majuro, Marshall Islands, May 27, 2018 (AFP) - Haze from the Kilauea volcano eruption in Hawaii blanketed the Marshall Islands 3,700 kilometres (2,300 miles) away on Sunday, as officials warned it would continue moving west.   The haze, a phenomenon known as "vog" or volcanic smog, "is spreading across Micronesia," the US National Weather Service based in Guam said.

The volcano on Hawaii's Big Island is now in its fourth week of eruptions.   Meteorologists advised residents on the Marshall Islands with respiratory problems to stay indoors while airlines and shipping companies were warned to be aware of "lower visibilities".

The Guam weather office said haze produced by Kilauea would spread farther westward and reach Kosrae, Pohnpei and possibly Chuuk in the Federated States of Micronesia over the next few days.   Kilauea is the world's most active volcano and one of five on Hawaii's Big Island.   It started erupting on May 3, prompting about 2,000 people to flee from their mountainside homes.   Scientists believe the volcanic activity may be a precursor to a major eruption similar to the one that shook the island in the mid-1920s.
Date: Fri 4 May 2018
Source: CDC. MMWR Morb Mortal Wkly Rep 2018; 67(17):504-5 [edited]

ref: Hofmeister MG, McCready JA, Link-Gelles R, et al. Notes from the field: Increase in hepatitis A virus infections -- Marshall Islands, 2016-2017. MMWR Morb Mortal Wkly Rep 2018; 67:504-5. doi: 10.15585/mmwr.mm6717a5
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In mid-September 2016, a case of hepatitis A virus (HAV) infection was reported to the Marshall Islands Ministry of Health and Human Services (MOHHS). On 4 Nov 2016, MOHHS received laboratory confirmation of 4 additional cases, prompting activation of an outbreak investigation by the MOHHS Exposure Prevention Information Network (EPINet) team and solicitation of technical assistance from the Pacific Island Health Officers' Association, the WHO, and CDC. CDC began participating in the investigation by providing technical assistance remotely at that time. CDC provided remote assistance throughout the course of the investigation. In April 2017, the CDC-affiliated coauthors traveled to the Marshall Islands to provide in-person technical assistance.

To characterize the outbreak, the MOHHS EPINet Team, with assistance from CDC, conducted an investigation through in-person interviews and medical chart abstractions. A probable HAV outbreak case was defined as an acute illness with onset of any signs or symptoms consistent with acute viral hepatitis (such as fever, anorexia, nausea, vomiting, diarrhoea, fatigue, dark urine, clay-colored stool, or abdominal pain) on or after 1 Sep 2016, and either jaundice or elevated serum aminotransferase levels; a confirmed case met the probable case definition and also had either a positive immunoglobulin M (IgM) antibody to HAV on laboratory testing or an epidemiologic link to a confirmed case.

>From September 2016 (epidemiologic week 37) through July 2017 (epidemiologic week 28), 194 outbreak-associated hepatitis A cases (168 confirmed and 26 probable) were reported by MOHHS (Figure [available at the source URL above. - ProMED Mod.LL]). Illness onset dates ranged from 12 Sep 2016 through 11 Jul 2017. The median age of infected persons was 8 years (range equal to 2-76 years), 57 percent of patients were male, 91 percent were Marshallese, and 11 percent were hospitalized. No deaths were reported. Persons younger than 25 years accounted for 90 percent of cases, and 92 percent of patients were residents of the capital, Majuro. The most commonly reported signs and symptoms were jaundice (92 percent), nausea (76 percent), anorexia (75 percent), and dark urine (68 percent). Clay-colored stool (10 percent) was less commonly reported.

Complete contact information was available for 102 (53 percent) patients. A total of 1143 contacts were identified, with a mean of 11 contacts identified per patient (range equal to 2-60). Among the identified contacts, 902 (79 percent) received post-exposure prophylaxis (PEP) with hepatitis A vaccine. Some contacts were identified outside the recommended PEP window of 14 days after exposure, and 14 contacts were infants who were too young to be vaccinated (1). 7 contacts refused vaccination.

The EPINet team disseminated public information about the outbreak and recommendations on hygiene and vaccination through radio shows, mass text messages, posters, and school presentations; developed standardized case reporting and interview tools; and expanded case finding through investigation of contacts. Hepatitis A vaccine is not currently included in the Marshall Islands routine childhood immunization schedule. Marshall Islands began immunization of contacts of patients with hepatitis A in January 2017 and then launched a comprehensive immunization campaign targeting school-aged children on Majuro in February 2017, which ultimately covered approximately 70 percent of the total kindergarten through 8th grade student population. Once the vaccine supply was replenished in April 2017, a 2nd immunization campaign was directed at high school students aged 14-19 years on Majuro. In total, approximately 12,500 doses of hepatitis A vaccine were administered to school-aged children and adult contacts of patients in response to the outbreak. No additional cases were reported as of 30 Aug 2017.

Before this outbreak, the last HAV outbreak in the Marshall Islands occurred approximately 25 years ago. Since then, approximately 5 hepatitis A cases per year have been reported (MOHHS, unpublished data, 2017). HAV infection is typically acquired through faecal-oral transmission, either from direct person-to-person contact or consumption of contaminated food or water. In this outbreak, transmission occurred primarily through direct person-to-person contact, and despite extensive measures, the initial source of HAV infection was not identified.

HAV infection occurs in 3 distinct epidemiologic patterns (high, intermediate, and low endemicity) associated with hygiene and sanitation, access to clean drinking water, household crowding, and socioeconomic conditions (2). As socioeconomic conditions and sanitation improve, areas transition from high to intermediate endemicity, which is associated with an increased incidence of symptomatic clinical disease and potential for outbreaks. Hepatitis A-related hospitalizations and mortality also increase as the age of infection shifts from early childhood, when disease is typically asymptomatic or mild, to adolescence and adulthood, when illness is more likely to be severe (2).

Before this outbreak, HAV was thought to be endemic in the Marshall Islands; however, this outbreak demonstrates that the country might be undergoing an epidemiologic transition toward intermediate endemicity (3). Health officials are evaluating the potential costs and benefits of incorporating routine hepatitis A vaccination in Marshall Islands as a means of reducing ongoing transmission and preventing outbreaks.

References
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1. Advisory Committee on Immunization Practices, CDC: Update: prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR Morb Mortal Wkly Rep 2007; 56(41): 1080-84; available at
2. Wasley A, Fiore A, Bell BP: Hepatitis A in the era of vaccination. Epidemiol Rev 2006; 28: 101-11; available at
3. Jacobsen KH: The global prevalence of hepatitis A virus infection and susceptibility: a systematic review. Geneva, Switzerland: World Health Organization; 2009; available at
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[This posting underscores the importance of the kind of epidemiologic pattern of HAV in an area and certainly suggests that this island nation has improved hygiene and sanitation to transition to intermediate endemicity where routine childhood HAV vaccination bears consideration. The current outbreaks in a variety of areas in the USA (including parts of Michigan, Utah, and Kentucky) affecting certain cohorts of adults (who were old enough not to be immunized as children) underscore immunization.

The Marshall Islands (<https://en.wikipedia.org/wiki/Marshall_Islands>), officially the Republic of the Marshall Islands, is an island country located near the equator in the Pacific Ocean, slightly west of the International Date Line. Geographically, the country is part of the larger island group of Micronesia. The country is spread out over 29 coral atolls, comprising 1156 individual islands and islets. Politically, the Marshall Islands is a presidential republic in free association with the United States, with the USA providing defense, subsidies, and access to USA-based agencies such as the Federal Communications Commission and the United States Postal Service. - ProMED Mod.LL]

[HealthMap/ProMED-mail map
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World Travel News Headlines

Date: Mon, 1 Jun 2020 10:23:53 +0200 (METDST)

Yerevan, June 1, 2020 (AFP) - Armenian Prime Minister Nikol Pashinyan and his family have tested positive for the coronavirus, he said Monday, as the rate of new infections soared in the Caucasus nation.   "My coronavirus test was positive yesterday," Pashinyan said in a self-recorded video message on Facebook, adding that his family were also infected.   He said he had no "viable symptoms" of the virus and would be working from home.   The prime minister and his wife Anna Hakobyan, who is a journalist, have four children.   The ex-Soviet republic of some three million has so far reported 9,492 cases of the coronavirus and 139 deaths.

Coronavirus patients have overwhelmed Armenia's hospitals and last week health officials said that intensive care treatment could be soon restricted to patients with the best chance of survival.   Pashinyan's announcement came nearly one month after Armenia on May 4 lifted a state of emergency imposed in March to slow the spread of the coronavirus.

The prime minister acknowledged his government had failed to enforce anti-virus measures and there had been widespread quarantine violations.   Pashinyan was elected prime minister in the wake of mass popular protests he led two years ago against veteran leader Serzh Sarkisian and his Republican Party.   He has since led a relentless crusade against graft and initiated sweeping judicial reforms.
Date: Mon, 1 Jun 2020 09:17:15 +0200 (METDST)

San Salvador, June 1, 2020 (AFP) - Tropical Storm Amanda triggered flash floods, landslides and power outages as it barrelled through El Salvador and Guatemala Sunday, killing 14 people, authorities said, warning of further heavy rain to come.   El Salvador President Nayib Bukele declared a 15-day state of emergency to cope with the effects of the storm, which he estimated to have caused $200 million in damage, but which weakened later in the day as it moved into Guatemala.

Amanda, the first named storm of the season in the Pacific, unleashed torrents of floodwater that tossed vehicles around like toys and damaged about 200 homes, the head of the Civil Protection Service William Hernandez said.   The fatalities were all recorded in El Salvador, Interior Minister Mario Duran said, warning that the death toll could rise.   One person is still missing, senior government official Carolina Recinos added.   "We are experiencing an unprecedented situation: one top-level emergency on top of another serious one," San Salvador mayor Ernesto Muyshondt said, referring to the coronavirus pandemic.

He added that half of those killed died in the capital, and that 4,200 people had sought refuge in government-run shelters after losing their homes or being forced to leave because they were in high-risk areas.   In some flooded areas, soldiers worked alongside emergency personnel to rescue people.   "We lost everything, we've been left with nowhere to live," said Isidro Gomez, a resident of hard-hit southeastern San Salvador, after a nearby river overflowed and destroyed his home.

Another victim, Mariano Ramos, said that at dawn residents of his San Salvador neighborhood were slammed by an avalanche of mud and water. An elderly man died in the area, officials said.   El Salvador's environment ministry warned residents of the "high probability" of multiple landslides that could damage buildings and injure or kill people.

Nearly 90 percent of El Salvador's 6.6 million people are considered vulnerable to flooding and landslides due to its geography.   In neighboring Guatemala, officials said roads had been blocked by at least five landslides and some flooding was reported, but no evacuations were underway.   Even though Amanda weakened to tropical depression status, Guatemalan officials warned that heavy rain would continue, with swollen rivers and possible "landslides affecting highways ... and flooding in coastal areas."
Date: Mon, 1 Jun 2020 06:55:18 +0200 (METDST)

Lima, June 1, 2020 (AFP) - Peru on Sunday reported 8,800 new COVID-19 infections, setting a new daily record for a country that already has the second highest number of novel coronavirus cases in Latin America after Brazil.   The death toll is now at 4,506, the third highest in the region -- itself the new hotspot of the deadly disease -- after Brazil and Mexico, with President Martin Vizcarra warning the country is only halfway through the crisis.

Infections have jumped in Peru despite a months-long mandatory lockdown and a nigh time curfew and the government ordering international borders to be closed.   The spike is concentrated around the capital Lima, where one third of the population lives, and put tremendous strain on Peru's economy and healthcare system.   Four out of every ten Peruvians lost their source of income when the lockdown began, according to one study, and last week Peru secured a two-year, $11 billion credit line from the International Monetary Fund.

- 'Tremendous challenge' in Chile -
Neighbouring Chile on Sunday reported 57 more fatalities in the past 24 hours, a new record that brings the country's COVID-19 death toll to 1,054.   "We are facing the largest pandemic of the past 100 years," said Deputy Health Minister Paula Daza, as she announced the latest figures.    "It is a tremendous challenge; we are living very difficult times in our country."

In Santiago, where the 80 percent of the virus cases were reported, 96 percent of the emergency room beds were taken, officials said.   Officials reported a sharp increase in cases over the past two weeks.   In early May the government of President Sebastian Pinera said that the number of virus cases had hit a plateau, and lockdown restrictions would be loosened.
Date: Mon, 1 Jun 2020 03:38:38 +0200 (METDST)
By Anna SMOLCHENKO

Moscow, June 1, 2020 (AFP) - Shopping malls and parks are set to reopen in Moscow on Monday as the Russian capital eases coronavirus restrictions despite having the world's third-largest caseload.   The relaxation of the confinement orders in Moscow, the epicentre of Russia's outbreak with a population of more than 12 million, comes after President Vladimir Putin announced the epidemic had passed its peak in the country.

Under lockdown since March 30, residents of Europe's most populous city were until now only allowed to leave their homes for brief trips to shop, walk dogs or travel to essential jobs with a permit.   While Muscovites welcomed the opportunity to return to parks and malls after weeks of being cooped up at home, many ridiculed the Moscow mayor's "experiment" aimed at regulating people's walks and exercise.

As a two-week test measure, Sergei Sobyanin said residents of Moscow will be allowed to take walks according to a staggered schedule based on their home address.   "Regular walks are allowed between 9am and 9pm but no more than three times a week -- twice on weekdays and once on a weekend," said Sobyanin on his blog, adding that a detailed schedule would be released separately.   People can jog or exercise between 5am and 9am but must wear masks, according to the new rules.   Sobyanin said he feared that without limits on walking, people would throng the streets in scenes reminiscent of May Day outpourings in Soviet times.

- 'Sheer lunacy' -
The new regulations unleashed a flood of mockery on social media, with political commentator Alexander Golts calling them "sheer lunacy".   Critics quipped that life in Moscow was beginning to imitate dystopian fiction such as the novels of Aldous Huxley and Yevgeny Zamyatin.

Popular comedian Maxim Galkin, who has nearly eight million followers on Instagram, released a sketch in which Putin and Sobyanin discuss a "breathing schedule" for Moscow residents.   The five-minute parody has been viewed nearly six million times over the past few days.   When the restrictions are relaxed, dry-cleaners, laundry services and repair workshops will be allowed to reopen, while restaurants, cafes and cinemas will remain closed for now.

Moscow authorities also said that no mass gatherings would be allowed during the city-wide quarantine that will remain in place until at least June 14.   On Thursday authorities sentenced prominent reporter and activist Ilya Azar to 15 days in jail for staging a lone protest in central Moscow.   Dozens of his supporters have also been briefly detained over the past few days.   Rights organisations including Amnesty International and the Council of Europe have warned Moscow against using the coronavirus lockdown as a pretext to muzzle activists.

Many critics have also questioned the move to lift the restrictions as Russia reported more than 9,000 new infections on Sunday.   With more than 405,000 confirmed infections and over 4,600 deaths, the country has the world's third-largest caseload after the United States and Brazil.   Analysts say Putin is keen to open up the Russian economy and has recently ordered a World War II victory parade postponed by the contagion to be held on June 24.   The 67-year-old leader is also widely expected to announce a new date for a vote on constitutional reforms that could pave the way for him to potentially stay in power until 2036.
Date: Sun, 31 May 2020 11:16:20 +0200 (METDST)

Mogadishu, May 31, 2020 (AFP) - At least 10 people died and 12 were wounded when an explosive device ripped through a minibus outside the Somali capital Mogadishu on Sunday, the government said.   The deadly explosion occurred near Lafole village along the Afgoye-Mogadishu where the passenger bus was travelling early in the day.   "At least 10 civilians were killed in an explosion at Lafole area this morning, those who died were all civilians," the information ministry said in a statement, adding that the victims were on their way to a funeral.

Witnesses said the minibus was completely destroyed, and described an horrific scene with everyone on board either dead or wounded and many bodies ripped apart or burned beyond recognition.   "This was a horrible incident this morning, the explosive device went off as the bus was passing by the area and destroyed it completely," said Daud Doyow, a witness.   "Bodies of civilians were strewn in pieces and most of the people died," he added.   "There were more than 20 people on board and 10 of them were confirmed dead while the rest are seriously wounded and taken to hospital, this is a horrible scene here," said another witness, Abdirisak Adan.   No group immediately claimed responsibility for the bombing, but Somalia's al Qaeda-aligned Shabaab group carries out regular attacks in and around the capital, often killing civilians.
Date: Wed, 27 May 2020 17:58:12 +0200 (METDST)

Nairobi, May 27, 2020 (AFP) - Kenya said Wednesday it had documented a record 123 cases of coronavirus in the past 24 hours, a "staggering" figure although one also explained in part by wider testing.   "Today, I come to you with sombre news," Health Minister Mutahi Kagwe said.   "Our figures today are staggering. Out of the 3,077 samples tested, we have 123 positive cases. For the first time we have hit a triple digit.    "This is the highest number of positive cases we have ever recorded in a single day since we recorded the first case on March 13."

A total of 1,471 cases of COVID-19 have been recorded in Kenya since the start of the epidemic. Of these, 55 have been fatal.   The tally of infections has doubled since mid-May but the country has also tripled its number of daily tests, from less than 1,000 to nearly 3,000, which has helped unearth more cases.

Kagwe sounded a warning about the vulnerability of crowded slums in the capital Nairobi, which leads the list of new cases followed by the port city of Mombasa.   "There is a raging number of infections in these areas," he said, adding: "No-one should have a false sense of security about their immunity to COVID-19."   Among its anti-coronavirus measures, Kenya has a national 7pm-5am curfew, which is currently in force until June 6, and has a ban on entering or exiting the cities of Nairobi, Mombasa, Kilifi, Kwale and Mandera.
Date: Wed, 27 May 2020 16:38:21 +0200 (METDST)

Nicosia, May 27, 2020 (AFP) - Cyprus hopes to attract tourists after its coronavirus lockdown by paying the medical costs of anyone who tests positive for COVID-19 while holidaying on the island, officials said Wednesday.   The plan was outlined in a letter to tour operators and airlines detailing the measures Cyprus is taking to ensure the safety of its tourism sector.   The letter was made public Wednesday and signed by the ministers of foreign affairs, transport, and tourism.

The Mediterranean island is marketing itself as a safe holiday destination during the global pandemic.   The Republic of Cyprus has reported 939 novel coronavirus cases and only 17 deaths.   The government said it is "committed to taking care of all travellers who test positive during their stay, as well as their families and close contacts".   It pledged to cover accommodation, dining and medical care if a tourist falls ill with the virus.   The "traveller will only need to bear the cost of their airport transfer and repatriation flight," it said.

- 'Quarantine hotels' -
A 100-bed hospital will be available exclusively for tourists who test positive, with more beds available "at very short notice if required".   An additional 112 beds in intensive care units with 200 respirators will be reserved for critically ill patients.   Designated "quarantine hotels" will have 500 rooms available for family members and close contacts of patients.

Other hotels on the island will be allowed to remain open if a guest tests positive, but their room will "undergo a deep clean".   Authorities have forecast a 70 percent decline in tourist arrivals in 2020.    Tourism earned Cyprus EUR2.68 billion ($2.94 bn) in 2019 -- about 15 percent of gross domestic product -- down one percent from the previous year, which was bolstered by a record 3.97 million arrivals.   Cyprus plans to reopen its airports on June 9 to arrivals from 13 countries considered low risk.   These include Israel, Greece, Germany, Austria and Malta but the island's two biggest markets Britain and Russia are not on the approved list.

hose arriving between June 9-19 will need to provide a health certificate proving they do not have the virus.   That requirement will be dropped from June 20, when another six countries will be added to the approved list, including Switzerland and Poland.   Cyprus says it will update the list of approved countries on a weekly basis based on scientific advice.

Officials will administer temperature checks and free random testing of arrivals.   Having tested over 10 percent of its population, Cyprus says it has one of the lowest coronavirus infection rates in Europe.   "Very few countries worldwide, especially in the Mediterranean, can boast about such statistics," the letter said.
Date: Wed, 27 May 2020 14:45:11 +0200 (METDST)

Stockholm, May 27, 2020 (AFP) - Airline SAS said Wednesday it would resume flights on several domestic and international routes in June, over two months after the operator grounded most of its fleet over the new coronavirus' impact on travel.   "This primarily includes domestic flights within and between the Scandinavian countries, but flights to New York, Chicago and Amsterdam from Copenhagen are also set to resume," SAS said in a statement.

The Scandinavian airline announced in mid-March it was halting most of its traffic and furloughing around 90 percent of its staff.   In late April the airline, whose two largest shareholders are the Swedish and Danish states, announced it was laying off about 5,000 people, representing 40 percent of the company's workforce.

In early May the company secured a state-guaranteed credit line of 3.3 billion Swedish kronor ($344 million or 313 million euros) to help it navigate the impact of the new coronavirus.   Even with the resumption of some flights, the airline continues to operate at a reduced capacity, but the added routes means an effective doubling of the aircraft in use from 15 to 30, according to SAS.   Finnair, of Nordic neighbour Finland, announced early last week it would start resuming its long-haul flight to Asia in July.
Date: Wed, 27 May 2020 14:25:21 +0200 (METDST)

Yerevan, May 27, 2020 (AFP) - Virus cases have overwhelmed Armenia's hospitals, officials said Wednesday, raising the prospect that intensive care treatment could be restricted to patients with the best chance of survival.   The tiny Caucasus nation of some three million has so far reported 7,774 coronavirus cases and 98 deaths.   At a cabinet meeting on Wednesday, Prime Minister Nikol Pashinyan said "the situation with the coronavirus pandemic is very severe in Armenia."

Health ministry spokeswoman Alina Nikoghosyan told AFP: "if the current situation persists, in the coming days, intensive care will only be available for the patients with the best survival chances."   Health Minister Arsen Torosyan said Sunday that out of the country's 186 intensive care beds for coronavirus patients, only 32 remained empty and would soon be filled.

The prime minister called for stricter enforcement of measures aimed at containing the outbreak such as the wearing of face masks in public spaces.   This comes after the country lifted a state of emergency on May 4 which it had declared in March because of the pandemic.   Pashinyan said his government had failed to enforce anti-virus measures and there had been widespread quarantine violations.   "Our mistake was that we put too much trust in our citizens' sense of responsibility," he said.

Deputy Prime Minister Tigran Avinyan said he did not rule out that the government could have to impose a fresh nationwide lockdown.   Analysts have criticised the government's handling of the crisis, saying a decision to close borders was taken too late and officials sent the public "confusing messages."   "Officials were calling for the wearing of face masks, but they themselves didn't wear them until recently," said analyst Tatul Hakobyan.
Date: Wed, 27 May 2020 09:53:01 +0200 (METDST)

New Delhi, May 27, 2020 (AFP) - India is wilting under a heatwave, with the temperature in places reaching 50 degrees Celsius (122 degrees Fahrenheit) and the capital enduring its hottest May day in nearly two decades.   The hot spell is projected to scorch northern India for several more days, the Meteorological Department said late Tuesday, "with severe heat wave conditions in isolated pockets".   As global temperatures rise, heatwaves are a regular menace in the country -- particularly in May and June. Last year dozens of people died.

Met officials said Churu in the northern state of Rajasthan was the hottest place on record on Tuesday, at 50 Celsius, while parts of Punjab, Haryana and Uttar Pradesh sweltered in the high 40s.   Parts of the capital, New Delhi, recorded the hottest May day in 18 years with the mercury hitting 47.6 Celsius.   No deaths have been reported so far this year, but last year the government said the heat had killed 3,500 people since 2015. There have been fewer
fatalities in recent years.

The country of 1.3 billion people suffers from severe water shortages with tens of millions lacking running water -- to say nothing of air conditioning.   Parts of Delhi and elsewhere regularly see scuffles when tankers arrive to deliver water. Last year Chennai made international headlines when the southern city ran out of water entirely.   The heatwave adds to problems the country already has dealing with the spread of coronavirus.   India now has the 10th highest number of coronavirus cases globally, climbing above 150,000 on Wednesday with almost 4,500 deaths.

Last week cyclone Amphan killed more than 100 people as it ravaged in eastern India and Bangladesh, flattening villages, destroying farms and leaving millions without power.   Huge swarms of desert locusts, meanwhile, have destroyed nearly 50,000 hectares (125,000 acres) of crops across western and central India, and may enter Delhi in coming days.   The north-eastern states of Assam and Meghalaya are also currently experiencing floods, with more heavy rainfall forecast in the coming days.