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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Benin - US Consular Information Sheet
April 28, 2008

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Latvia

Latvia US Consular Information Sheet
October 02, 2008
COUNTRY DESCRIPTION:
Latvia is a stable democracy with a developing economy. Most tourist facilities found in a western European city are available in the capital city of Riga. However,
some of the goods and services taken for granted in other countries are not yet available in other parts of the country. Read the Department of State Background Notes on Latvia for additional information.
ENTRY/EXIT REQUIREMENTS: Latvia is a party to the Schengen agreement. As such, U.S. citizens may enter Latvia for up to 90 days for tourist or business purposes without a visa. The passport should be valid for at least three months beyond the period of stay. For further details about travel into and within Schengen countries, please see our fact sheet. Travelers remaining in Latvia for more than 90 days, including 180 day periods that cross over two half-calendar years, must apply for temporary residence. All travelers must have a valid insurance policy, covering medical expenses while in Latvia. Repatriation costs, including funeral and disposition of remains costs also have to be covered by the policy. In addition, upon entering or exiting the country, travelers must declare cash in excess of 10,000 euros to Latvian customs. For more information, travelers may contact the Latvian Embassy, at 2306 Massachusetts Avenue NW, Washington, DC 20008, tel. (202)328-2840, fax (202) 328-2860. For further information, visit http://www.latvia-usa.org. Within Latvia, contact the Ministry of Interiors Office of Citizenship and Migration Affairs at Ciekurkalna 1, linija 1,k,3,Riga, LV 1026. Tel. (371)67219645, (371)67219679, (371)80007657, fax (371)67219654, e-mail: pmlp@pmlp.gov.lv, web site http://www.ocma.gov.
Any traveler to Russia, even in transit, is advised to obtain a visa prior to entry into Latvia. The process of obtaining a visa at the Russian Embassy in Riga can be lengthy, and involve surrender of the passport for an undetermined period of time. Visit the Embassy of Latvia web site at http://www.latvia-usa.org for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information.
SAFETY AND SECURITY:
Civil unrest is not a problem in Riga. Nonetheless, in the past, Riga has seen large, peaceful demonstrations related to internal political issues. While demonstrations have been peaceful, American citizens are nevertheless cautioned to avoid any large public demonstrations. There have been no incidents of terrorism directed toward American interests. Incidents of anti-Americanism are rare. However, instances of racially motivated verbal harassment, and on occasion, physical assaults on non-Caucasian foreigners, have occurred in Riga. There have also been reports of non-Caucasian foreigners being subjected to extra scrutiny by security guards in shops and malls in Riga. Additionally, individuals displaying alternative lifestyles have experienced harassment.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution can be found.
Up-to-date information on security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or, for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s notice A Safe Trip Abroad.
CRIME: Crime in Riga is generally non-violent. The majority of non-violent crime tends toward acts of pickpocketing, identity theft, and personal scams. However, there have been instances of serious violent assaults and robberies. Street crime is a serious problem, particularly for tourists. In addition to pickpockets in all public areas, there are numerous scam artists targeting foreigners in the tourist pubs and restaurants. There have been a number of reports recently of foreign tourists being charged xorbitant prices for drinks in bars. Some have then been assaulted or forced to withdraw money from an ATM to pay the bill. You can avoid situations like this by ensuring that you check the price of drinks before ordering, pay for one round at a time and seek recommendations for bars from trustworthy sources. There have also been a few cases of tourists and residents being drugged in bars and restaurants and then taken outside or to their residences and robbed. In any public area, one should always be alert, particularly to being surrounded by two or more people at once. It is not uncommon for groups of pickpockets to attempt to overwhelm their victim. Gangs of professional pickpockets are specifically targeting foreigners, particularly those carrying backpacks. In addition, Riga has one of the highest rates of car theft in the world.
Internet crime is a growing concern in Latvia. Common fraudulent schemes involve both Internet auction sites and Internet job search sites. In the first scam, criminals offer valuable items for sale at low prices on Internet auctions and request that payments be sent by wire transfer to a bank in Latvia or through a fraudulent escrow site that they have created themselves. In this scheme, the money passes through a bank in Latvia and is quickly withdrawn by ATM or transferred to a bank in another country. It is very difficult in these cases to discover the identities of the account holders or recover the funds.
The second common scam involves identity theft through false job offers. In this scheme, a company claiming to be located in Latvia, but which has a non-existent address, offers the victim employment as a U.S. – based agent or freight forwarder. When the victim responds to the job offer, commonly posted on one of several popular Internet job sites, a Social Security Number and other identifying information needed for the identity theft is required under the guise of conducting a background check.

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 or Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. For more information, see Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in Latvia is steadily improving, but remains limited in several important respects. There are a few private clinics with medical supplies and services, including disposable needles and basic modern diagnostics, which are nearly equal to Western Europe or U.S. standards. However, because of the lack of equipment and resources, most major invasive procedures or surgeries in Latvia are not recommended. Hospital services have shown good progress but are still not equal to Western standards. Elderly travelers and those with existing health problems may be at risk due to inadequate medical facilities. Most, but not all, antibiotics and prescription medications are available but as they are generally produced in Europe or Latvia, they often have different names and instructions are usually not printed in English. Diphtheria, hepatitis and tick-borne encephalitis are present. According to the World Health Organization, tuberculosis is a significant problem in Latvia, with 9% of all cases being multi-drug resistant. For further information, please consult the CDC’s Travel notice on TB at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx. State ambulance service for emergencies is available by dialing 112 anywhere in Latvia. However, response time is poor in rural areas. Air ambulance service is available for medical evacuations. In general, private air ambulance services are very expensive and require advance payment before the patient is transported.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Latvia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Foreign visitors to Latvia planning to operate a motor vehicle are required to obtain an International Driving Permit. These may be obtained through the American Automobile Association (AAA) or the American Automobile Touring Alliance for a small fee. A U.S. state driver’s license is not sufficient. These requirements apply to those operating rental cars as well, whether or not the rental company chooses to enforce the requirement as a condition of rental. Individuals driving without an International Driving Permit may have their vehicle confiscated by the police. Americans resident in Latvia for more than six months are required to apply for a Latvian driver’s license. Upon receipt of a Latvian driver’s license, American citizens are required to surrender their US driver’s license to the Latvian authorities. The licenses are then returned to their respective states of issuance. For more information, visit the Latvian Road and Traffic Safety Department at http://www.csdd.lv
Latvia has one of the highest rates of automobile accidents and fatalities in Europe. While recent reports show a decrease in the number of traffic accident fatalities, there are still a number of hazards to watch out for. Drivers should be alert for pedestrians and slow moving vehicles in traffic. Additionally, violation of traffic rules is common, and it is not unusual to be overtaken by other automobiles traveling at high speeds, even in crowed urban areas. Drivers do not always yield to pedestrians, even at marked intersections. During winter, most major roads are cleared of snow. However, drivers should be alert for fog, snow, and ice while driving. Driving while intoxicated is a very serous offense and carries heavy penalties. Local authorities use roadblocks and Breathalyzer tests as enforcement tools. Drivers and pedestrians should be alert to the possibility of drunk drivers and drunken pedestrians wandering on the road. Drivers must use their headlights at all times. Speed limits are usually 50 km/hr in the city and 90 km/hr on the highways. Public transportation is generally considered safe, but travelers are encouraged to select well-marked taxis. Emergency services are fair but improving (See section on Medical Facilities above); response time may be especially slow in traffic or in rural settings. Dial 112 for ambulance service.
Please refer to our Road Safety page for information. Visit the website of Latvia’s national tourist office at http://latviatourism.lv/info.php and the national authority responsible for road safety at http://www.csdd.lv/
AVIATION SAFETY OVERSIGHT:As there is no direct commercial air service to the United States by carriers registered in Latvia, the U.S. Federal Aviation Administration (FAA) has not assessed Latvia’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 www.faa.gov/safety/programs_initiatives/oversight/iasa
SPECIAL CIRCUMSTANCES:
Banks and currency exchange counters may refuse to accept U.S. currency that is crumpled, torn, discolored or defaced (even small pen stokes, hand written numbers and letters are considered defacing). If such notes are accepted for exchange, an additional processing fee, based on the size of the transaction, may be charged. ATMs are widely available in Riga and in major towns. For security purposes, it is recommended that visitors use ATMs located inside major hotels or shopping malls, versus those located on the street, in high-volume tourist areas. Telephone connections with the United States are reliable. However, 1-800 numbers cannot be accessed from Latvia. Please check with your long distance carrier before departure to see if they offer service in Latvia. Local Internet cafés offer computer access, and fax machines are widely available.
Latvian customs authorities may enforce strict regulations concerning temporary importation into or export from Latvia of items such as firearms, religious materials, antiquities, medications, business equipment, drugs, etc. It is advisable to contact the Embassy of Latvia in Washington or one of the Latvian consulates in the United States for specific information regarding customs requirements at http://www.latvia-usa.org.
Please see our information on 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 Latvian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Latvia are strict and convicted offenders can expect jail sentences and heavy fines. Engaging in illicit 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 web pages on intercountry adoption and international parental child abduction.
REGISTRATION/EMBASSY AND CONSULATE LOCATIONS: Americans living or traveling in Latvia are encouraged to register with the nearest U.S. Embassy of Consulate through the State Department’s travel registration website, https://travelregistration.state.gov/ibrs/ui/ and to obtain updated information on travel and security within Latvia. 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 7 Raina Blvd. Riga, LV-1510, and may be reached by dialing +371-703-6200. The fax number for the Consular American Citizen Services section is+371-781-4088. You can find the ACS section online at http://riga.usembassy.gov/
* * * * * *
This replaces the Consular Information Sheet dated March 12, 2008 with updated information on Entry Requirements.

Travel News Headlines WORLD NEWS

Date: Thu, 7 Nov 2019 17:11:10 +0100 (MET)

Riga, Nov 7, 2019 (AFP) - Thousands of doctors and nurses rallied Thursday in front of the Latvian parliament in Riga calling for better pay in what was the Baltic state's largest protest in over a decade.   Police said more than 5,000 people, including patients, turned out for the protest, which featured coffins and signs with slogans such as "United for health", "I only want to work one job" and "Patients supporting doctors and nurses".   The LVSADA medical labour union organised the rally to condemn lawmakers for planning to increase their own salaries next year while reneging on a promise to boost wages in the chronically underfunded medical profession.   "We won't allow the healthcare system to be starved again," LVSADA chief Valdis Keris said at the rally, which state hospital employees attended by taking a day of unpaid leave.

Some doctors also participated in the protest by only performing emergency surgery and tending to emergency patients on Thursday while rescheduling everything else.    "The average monthly wage for a doctor at a Latvian public hospital is only between 1,000-3,000 euros ($1,100-$3,300)," protester and doctor Roberts Furmanis said in a statement sent to media.    "I work my daily shift at one hospital, at night I also work overtime driving around in an ambulance, plus sometimes I lecture at medical schools on my rare days off," he added.   "I get less than 3,000 euros a month for those jobs combined. How am I supposed to support my family?"   Last year, lawmakers voted to raise wages for almost all employees of the government-run healthcare system, but now say that they are unable to find the necessary funds in the 2020 state budget.    "I express deep regret for last year's promise, which we cannot carry out," speaker of parliament Inara Murniece told the rally.

Those protesting, however, point out that the 2020 state budget exceeds 10 billion euros for the first time ever in the country of just 1.9 million people -- or 700 million more euros than this year.    Medical workers are upset that while there is no room for better healthcare wages in the new budget, the country's lawmakers and ministers plan to increase their own salaries next year and have also earmarked taxpayer money for their respective political parties.    Thursday's rally was Latvia's largest since some 10,000 people attended a January 2009 protest against government cuts, which grew violent and resulted in dozens of arrests.
Date: Sat 21 Sep 2019
Source: Food Safety News [edited]
<https://www.foodsafetynews.com/2019/09/latvian-officials-investigate-salmonella-and-e-coli-illnesses/>

Officials in Latvia are investigating 40 _Salmonella_ and Shiga toxin-producing _E. coli_ illnesses with mostly children affected. A total of 36 children and 4 employees of educational institutions are ill, according to the Latvian Centre for Disease Prevention and Control (SPKC). Salmonellosis has been laboratory confirmed in 9 children with symptoms of acute intestinal infection thought to have occurred from [9 to 11 Sep 2019]. Patients have been recorded at Levina and Tornisi kindergartens. Shiga toxin-producing also called enterotoxigenic _E. coli_ (EHEC) infections have been linked to schools identified as Levina, Saulite and Piladzitis in Sigulda, a town in the country.

At least 4 children aged 3 to 6 years old have developed hemolytic uremic syndrome (HUS) after EHEC infection from early September 2019 in Sigulda. HUS is a type of kidney failure associated with EHEC infection. It can occur in people of any age but is most common in children under 5 years old. The SPKC has surveyed parents of sick children, visited preschools to obtain information on absent children and staff and the cause, analysed food menus and possible risk factors. A total of 19 infections at 3 other pre-school facilities in Ikskile, Garkalne and Ogre are not thought to be related to those ill in Sigulda.

The Latvian Food and Veterinary Service (PVD) has been investigating catering units at the 3 sites linked to _E. coli_ infection where catering comes from one company. Initial suspicions pointed to contaminated watermelons. Inspections at the catering units did not reveal violations of hygiene requirements that could contribute to the spread of infection. The sites also underwent cleaning and disinfection. PVD suspended operations of a vegetable processing firm called "Jelgavas Augļi" due to violations of hygiene requirements, product traceability and inadequate storage temperature for pre-packed vegetables that were stored at 13 deg. C [approx. 55 deg. F] instead of the required 6 deg. C [approx. 42 deg. F].

The company, through Baltic Restaurants Latvia, supplies fresh fruits and vegetables to Sigulda educational institutions but a connection to the outbreak has not been established. Testing at the firm so far has not found _E. coli_. Other results are pending but the company will be allowed to resume operations if they are negative and when it corrects the deficiencies identified by authorities. Authorities have also found issues with transportation of food by the company "Point to Point" Ltd between educational institutions.
=================
[These are two outbreaks of enteric pathogens that appear to be related to food supplied to schools. The EHEC outbreak has been possibly linked to watermelon. With 9 cases of EHEC and 4 of them developing HUS, it is possible that the strain is a hyperproducer of Shiga toxin but most likely related to use of antimicrobials early in the infection which increases the risk of HUS. - ProMED Mod.LL]

[HealthMap/ProMED map available at: Latvia: <http://healthmap.org/promed/p/119>]
Date: Wed, 15 May 2019 19:20:02 +0200

Riga, May 15, 2019 (AFP) - A second Albanian soldier has died of his injuries from a World War II landmine blast last week during a NATO exercise in Latvia, the Baltic state's defence minister said Wednesday.   Klodian Tanushi, who held the rank of major, died following surgery at a Riga hospital over the weekend, days after the landmine explosion that also killed another soldier.    "I would like to express my deepest sympathy to the soldiers' relatives and friends, to their fellow service members and to the people of Albania," Latvian Defence Minister Artis Pabriks told AFP.    "Latvia is very grateful to our ally Albania for contributing to NATO's expanded presence in Latvia."

In 2016, NATO deployed four multinational battalions to Poland and the Baltic states to guard against possible Russian adventurism.   The defence group's rotating battalion in Latvia is led by Canada and also includes soldiers from Albania, the Czech Republic, Italy, Montenegro, Poland, Slovakia, Slovenia and Spain.   Tanushi, a father-of-three, was the commanding officer of the Albanian contingent stationed at the NATO base in the central village of Adazi.    Both world wars left Latvia littered with many unexploded sea and landmines as well as artillery shells, which continue to be found on a daily basis.    Clearing areas of such explosives is a frequent focus of NATO military exercises in the region.
Date: Sun, 22 Jul 2018 18:58:20 +0200

Riga, July 22, 2018 (AFP) - Fires raging for five days have destroyed more than 800 hectares (2,000 acres) of western Latvia, authorities said Sunday, with continuing extreme temperatures hampering firefighters' efforts.   Satellite images showed the fires have wiped out 170 acres of forest, 257 hectares of scrubland and nearly 400 hectares of peatland.

A peat fire in the Courland region broke out last Tuesday and spread eastwards, with the smoke noticeable in the resort town of Jurmala, more than 100 kilometres (60 miles) away in the neighbouring Riga region.   "Peatland fires burn downward, but when there's wind, which brings oxygen, the fires can erupt into flames," Latvian fire services spokesman Inta Palkavniece told reporters.   "The main goal is to prevent the fires from spreading," he added.   The fire services said on its website that firefighting efforts would be "long and troublesome".    "The weather is unfavourable to firefighting and will remain so over the next days," it said.

The Courland region is sparsely populated, with few roads and many areas inaccessible because of its vast marshes.   Residents of Stikli, a village that was evacuated because of the fire, began to return home after the wind changed "of their own accord", the mayor of its municipality Ventspils, Aivars Mucenieks, told reporters.   Pupils of a school for disabled children in Stikli will not return until the situation is fully under control, he added.

Meteorologists warned that the high temperatures are persisting and no rain is expected for the next two weeks.   Latvia has experienced severe drought over the last few months, prompting authorities to declare a natural catastrophe in the agricultural sector.   The Baltic country has not yet asked for help from other European countries and has no proposals to do so for the time being.   But other countries in Europe have been in the grip of an unusually long heatwave for recent weeks with little prospect of rain for the time being.

In Sweden, where temperatures are the highest for a century, farmers are even sending their animals to slaughter because there is no hay left to feed them.   It has asked for help from other European countries, because of the lack of manpower and capacity to tackle such natural catastrophes.   Poland has asked the EU for financial aid after more than 91,000 farms were affected by an unusual spring drought, according to the agriculture ministry.   In Germany, which suffered a drought in May and June, agricultural producers warned the harvest this year will be down by between 20 and 50 percent.
Date: Wed, 18 Jul 2018 19:41:17 +0200

Riga, July 18, 2018 (AFP) - Latvian authorities on Wednesday ordered the evacuation of a village threatened by a wildfire in the west of the Baltic state as firefighters struggled to control the blaze.   Clouds of smoke and ash from the fire choked the small community of Stikli, forcing the evacuation of dozens of residents including handicapped children from a boarding school, the state fire and rescue service said.   The fire broke out in a peat bog in the Kurzeme region on Tuesday before quickly engulfing bone-dry forests nearby.

The blaze covers an area of nearly 200 football pitches (180 hectares, 444 acres), according to firefighters.   "Firefighting is very problematic, as this part of Kurzeme is only sparsely populated, the roads are few and narrow and many areas are inaccessible due to vast marshlands," said Zigmunds Jaunkirkis, an official with the State Forestry Department.   The army and national guard deployed a specialised helicopter on Wednesday to help firefighters fight the flames.

Neighbouring Lithuania has also sent a helicopter while residents from the nearby port city of Ventspils have started to form volunteer units.   Daytime temperatures of up to 30 degrees Celsius (86 Fahrenheit) and strong winds have fanned the flames amid a long heatwave.   No substantial rain is forecast for the next two weeks.    An EU and NATO member of 1.9 million people, Latvia has suffered from severe drought in recent months, forcing its government to declare a national disaster in the farm sector in June.
More ...

Romania

Romania US Consular Information Sheet
March 02, 2009
COUNTRY DESCRIPTION:
Romania joined NATO in 2004 and the European Union in 2007.
Read the Department of State Background Notes on Romania for additional information.

ENTR
/EXIT REQUIREMENTS:
A valid passport is required.
U.S. citizen visitors are granted 90 days of stay without a visa within a given six-month period.
For stays longer than 90 days, an extension of stay may be obtained in Romania from the Romanian Immigration Office in the area of residence.
An exit visa must be obtained in cases of overstay.
The Romanian Government is enforcing visa regulations more vigorously and a record of visa overstay can result in the assessment of large fines and the denial of entry without a visa for a specified time.
Visit the Embassy of Romania web site for the most current visa information or contact the Romanian Embassy at 1607 23rd St. NW, Washington, D.C. 20008, telephone number (202) 232-4747, or the Romanian Consulates in Los Angeles, Chicago, or New York City.
.

Foreigners are required to carry identification documents at all times. Americans who obtained a temporary or permanent stay permit must be able to present the document upon the request of any “competent authorities.”
Foreigners who do not have a stay permit should present their passports.
(The Embassy recommends carrying a copy of the relevant document).

U.S. visa information for Romanians and other foreign citizens can be found on the web site of the U.S. Embassy in Bucharest
or the Department’s travel website.

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

SAFETY AND SECURITY:
American citizens are reminded to exercise caution, remain vigilant with regard to their personal security, and monitor media reports.
Prior police notice is required for public demonstrations and police oversight is routinely provided.
Nonetheless, even demonstrations intended to be peaceful can turn confrontational and possibly escalate into violence.
American citizens are therefore urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations.
Information on specific demonstrations can be found on the Embassy web site on the demonstration notices page.

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. 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 overseas, see the Department of State’s A Safe Trip Abroad.

CRIME:
While most crimes in Romania are non-violent and non-confrontational, crimes do occur in which victims suffer personal harm.
Crimes against tourists, including robbery, mugging, pickpocketing and confidence schemes, remain a problem in Romania.
Organized groups of thieves and pickpockets, sometimes including minors, operate in train stations and on trains, subways, and buses in major cities.
A number of thefts and assaults have occurred on overnight trains, including thefts from passengers in closed compartments.
The Embassy recommends using the highest class available for train travel, and suggests traveling with at least one other person. As is always the case, travelers should never leave personal belongings unattended, maintaining control over them at all times.

The Embassy has received reports of bar/night club scams.
These scams involve unsuspecting patrons being charged exorbitant prices when they receive their bar bills.
Another scam involves patrons of “adult” establishments (strip clubs) who are charged for the female worker’s drinks or time while talking to the customers.
Because strip clubs frequently are fronts for organized crime, the Embassy recommends avoiding these establishments.
Patrons may be forced to pay the bills or risk physical confrontation.
If you find yourself in this situation, you should pay the bill and make a police report once the incident is over.

Money exchange schemes targeting travelers are common in Romania.
Some of these ploys have become rather sophisticated, involving individuals posing as plainclothes policemen, who approach the potential victim, flash a badge, and ask for the victim's passport and wallet.
In many of these cases, the thieves succeed in obtaining passports, credit cards, and other personal documents.

Credit card and Internet fraud remain among the most common crimes affecting foreigners in Romania.
Romania is largely a "cash only" economy.
While an increasing number of businesses accept credit cards, travelers are advised to use cash for goods and services rendered due to the prevalence of credit card fraud.
Vendors have been known to misuse credit card information by making illegal purchases on a customer’s account.
To make a credit card purchase, a PIN is usually required.
There are an increasing number of ATMs located throughout major cities, and increasingly sophisticated identity theft rings are targeting them.
Travelers should try to use ATMs located inside banks and check for any evidence of tampering with the machine before use.
Travelers' checks are of limited use but may be used to purchase local currency at some exchange houses.

Americans should exercise caution when traveling to Romania to meet individuals known only through contact over the Internet.
A significant number of confidence scams have been uncovered involving Romanians who contact their prospective American victims through chat rooms or personal advertisements. They generally identify themselves as young Romanian women and develop a “relationship” with their victim over time.
Variations of this scam have emerged but money extortion remains the ultimate goal.
Americans who suspect they may have fallen victim to this kind of scam should contact American Citizens Services at the U.S. Embassy.

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 the 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 understand the local criminal justice process and find an attorney if needed.

The local equivalent to the "911" emergency line in Romania is: 112.
English speaking operators are available.
Please see our information on Victims of Crime, including possible victim compensation programs in the United States.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Romania’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in Romania 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.

Under Romanian law, engaging in sexual conduct with a minor under the age of 15 or a minor between the ages of 15 and 18 where the adult has abused the minor’s trust or had influence/authority over the minor is a crime punishable with a 3-10 year prison sentence.
Engaging in illicit sexual conduct with someone who has a physical or psychological disability is punishable with a 3-12 year prison sentence.
Distribution of obscene materials depicting minors is a crime punishable with a 1-5 year prison sentence.
Prostitution is illegal in Romania, regardless of the age of the participants.

SPECIAL CIRCUMSTANCES:
Abandoned dogs are commonplace in Romania and generally tolerated.
Strays are often fed and are seen frequently on a daily basis especially in or near parks.
Some statistics report one dog bite hourly in Bucharest, the capital city. Because the immunization status of stray dogs is unknown, precautions to prevent rabies are recommended.
See the CDC’s web site for more details.
If you encounter dogs that appear aggressive, it is best to change your path to avoid contact with them.

In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. More information on this serious problem is available at the U.S. Department of Justice, Computer Crime and Intellectual Property Section.

Romania's customs authorities may enforce strict regulations concerning temporary importation into or export from Romania of items such as firearms, antiquities, and medications.
Romanian law allows travelers to bring cash into or out of Romania; however, sums larger than 10,000 Euros or the equivalent must be declared.
Travelers are advised to contact the Embassy of Romania in Washington or one of Romania's consulates in the United States for specific information regarding customs requirements.

DISASTER PREPAREDNESS:
Romania is situated in a seismically active region and has a history of devastating and deadly earthquakes.
While responsibility for caring for disaster victims, including foreigners, rests with Romanian authorities, disaster preparedness is also a personal responsibility.
Additional information is available from the U.S. Embassy in Bucharest.
General information about natural disaster preparedness is available from the U.S. Federal Emergency Management Agency (FEMA).

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care in Romania is generally not up to Western standards, and basic medical supplies are limited, especially outside major cities.
Some medical providers that meet Western quality standards are available in Bucharest and other cities but can be difficult to identify and locate.
Travelers seeking medical treatment should therefore choose their provider carefully.
A list of hospitals and physicians is available on the website of the U.S. Embassy in Bucharest.
Information regarding health threats or other medical issues affecting visitors to Romania can also be found at this site. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Romania.

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 (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site.
For
information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) website
Further health information for travelers is available from the WHO.

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.

Americans who wish to extend their stay in Romania must present proof of health insurance that applies overseas for the duration of their intended stay in Romania.
Useful information on medical emergencies abroad, including overseas insurance programs, is provided on the Department of State's web page, Medical Information for Americans Traveling Abroad.
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 Romania is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Traffic accidents are arguably the single most dangerous threat for American citizens visiting Romania. The World Economic Forum ranks Romania 126 out of 134 states for road quality.
Currently Romania has a total of only 270 kilometers of freeways.
While major streets in larger cities and major inter-city roads are generally in fair to good condition, many other roads are in poor repair, unpaved, badly lighted, or narrow, or lack marked lanes.
Part of the problem is that the infrastructure has failed to keep pace with the dramatic increase in motor vehicles since 1990.

Roads, especially in the mountains, can be particularly dangerous when wet or covered with snow or ice.
Pedestrians, animals, cyclists, and horse-drawn carts share many roads with motor vehicles and can be extremely difficult to see, particularly at night in rural areas.
Vehicles often block sidewalks, forcing pedestrians to walk in the streets.
Maintain vigilance when driving to avoid hitting those who are walking in the streets.
Cross the street only in crosswalks and always look both ways before crossing.
Crosswalks are generally poorly marked and drivers may ignore crosswalks even if there is a traffic light.

Driving practices in Romania can be aggressive and/or inattentive.
Combined with the substandard road conditions noted above, the result is a significant traffic mortality rate.
According to the European Union Road Federation, Romania has the highest per vehicle rate of traffic fatalities of any country in the E.U.
It is essential for drivers to practice defensive driving techniques.


Romanian traffic laws are very strict.
The traffic police can confiscate any form of driver's license or permit for 1-3 months, and payment of fines may be requested at the time of the infractions.
Some examples when this might occur are failure to yield the right of way, failure to stop at a red light or stop sign, or failure to yield to pedestrians at crosswalks.
While, in theory, drivers must yield to pedestrians at all marked pedestrian crosswalks, many of these are poorly maintained, difficult to see, and sometimes located in unexpected places for foreign drivers.
Pedestrians must take extreme caution when crossing any road.

Romanian traffic laws provide for retention of a driver’s license by the police and possible imprisonment for driving under the influence of alcohol or for causing an accident resulting in injury or death.
There is zero tolerance for driving under the influence of alcohol and police are required to give breathalyzer tests on the scene to all drivers involved in an accident.
Refusal to take a breathalyzer test will result in criminal penalties regardless of whether or not alcohol was involved.

U.S. driver's licenses are only valid in Romania for up to 90 days.
Before the 90-day period has expired, U.S. citizens must either obtain an international driving permit in addition to their U.S. driver's license or a Romanian driver's license.
Wearing a seat belt is mandatory.
Children under 12 years of age may not be transported in the front seat.

Unless otherwise marked with road signs, speed limits are as follows:
·


Inter-city traffic on highways

o
130 km/hr for cars and motorcycles (80 miles/hr)

o
110 km/hr for vans (65 miles/hr)

·


Urban traffic - 50 km/hr (30 miles/hr)

·


Express and European roads

o
100 km/hour for cars and motorcycles (60 miles/hr)

o
90 km/hour for vans (55 miles/hr)

·


All other roads

o
90 km/hr for cars and motorcycles (55 miles/hr)

o
80 km/hr for vans (50 miles/hr)

·


Motor vehicles with trailers and drivers with less than one year of driving experience have speed limits 20 km/hr (or 12 miles) slower than those listed above.

Inter-city travel is generally done via trains and buses, which vary in terms of quality, safety, cost, and reliability.
Pickpockets pose a danger on night trains and in train stations.
Inter-city travel by taxi is much more expensive, and safety depends on the quality of the driver.
Many older taxis are not equipped with seat belts.
To avoid being overcharged, passengers should request the taxi by phone through a reputable company and make sure the taxi has an operational meter or agree upon a price before entering the taxi.
The meter rate per km is posted on both sides of the taxi vehicle.

The host country authority responsible for road safety is the Traffic Police of the Romanian Ministry of Interior.
Emergency roadside help and information may be reached by dialing 9271 for vehicle assistance and towing services.
For ambulance services, fire brigade, or police, dial 112.

Please refer to our Road Safety page and the Bucharest Metropolitan Police Department web site for more information.
Also visit the website of Romania’s national tourist office.

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

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
In 2005, Romania banned intercountry adoptions except by biological grandparents.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Romania are encouraged to register with the U.S. Embassy through the State Department’s travel registration website, and to obtain updated information on travel and security within Romania.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located at Strada Tudor Arghezi 7-9, telephone (40) 21-200-3300.
In emergencies, an after-hours duty officer may be reached by calling (40) 21-200-3433.
Consular services for U.S. citizens are performed at the Consular Section located at Strada Filipescu 26 (formerly Strada Snagov), one block from the U.S. Embassy at the corner of Strada Batistei.
The Consular Section can be reached through the Embassy operator at (40) 21-200-3300, and faxes can be sent to (40) 21 200-3381 or 200-3578.
*

*

*
This replaces the Country Specific Information sheet dated July 18, 2008 to update the information on Safety and Security, Crime, Traffic Safety and Road Conditions, Special Circumstances, and Disaster Preparedness.

Travel News Headlines WORLD NEWS

Date: Sun 12 Aug 2018
Source: Outbreak News Today [edited]

In a follow-up on the West Nile virus (WNV) situation in Romania, the National Center for Communicable Disease Surveillance and Control reported (computer translated) since the start of surveillance on [2 May 2018], 23 meningitis/meningo-encephalitis have been reported due to West Nile virus infection and a death in the case of a 79-year-old patient who had comorbidities.

Officials say the cases in Romania are sporadic and there is currently no risk of an epidemic.

In addition to Romania (23), in 2018, as of [9 Aug 2018], the EU Member States reported 231 human cases. Italy reported 123 cases, Greece 59 cases, Hungary 23 cases, and France 3 cases. The EU neighbouring countries reported 104 human cases. Serbia reported 102 cases and Kosovo reported 2 cases.

To date, a total of 17 deaths due to West Nile fever have been reported by Serbia (9), Italy (3), Greece (3), Kosovo (1), and Romania (1).
=======================
[In view of the increase in number of WNV cases, the Ministry of Health has advised Romanians to avoid exposure to mosquitoes, to wear shirts and long pants, and to use special window nets so as to minimise the danger of mosquitoes accessing their homes, at the same time maximising their personal health security measures. - ProMED Mod.UBA]

[A HealthMap/ProMED-mail map showing Romania and the other countries mentioned in the report above can be seen at
<http://healthmap.org/promed/p/122>. - ProMed Sr.Tech.Ed.MJ]
Date: 27 Jul 2018
Source: Balkaneu [edited]

Five citizens in Romania have been diagnosed with meningitis caused by the West Nile virus.  The Romanian Ministry of Health recommends to local authorities to take pest control measures as soon as possible to prevent the spreading of the virus, stiri.tvr.ro reported, adding that 80 percent of the people that were infected or get infected have no symptoms.

The only signs and tangible proof that something might be seriously wrong are high fever and headaches. In this case, specialists suggest an immediate visit to the nearest clinic, hospital, or local health centre.

Romanians are advised to avoid exposure to mosquitoes, to wear shirts and long pants, and to use special window nets so as to minimise the danger of mosquitoes accessing their homes, and at the same time, maximize their personal health security measures.  [Byline: Lida Filippakis]
========================
[West Nile virus (WNV) is a significant human, equine and wild bird health problem in the Americas, Europe and the Middle East.

Most WNV infections in people are asymptomatic, and only one infected person in 5 develops fever, headache, body aches, joint pains, vomiting, diarrhoea, or rash. Most individuals recover completely, but fatigue and weakness can last for weeks or months. About one person in 150 will develop neurological disease affecting the central nervous system such as encephalitis or meningitis, and some die [<https://www.cdc.gov/westnile/symptoms/index.html>].

Suspected outbreaks of West Nile virus (WNV) infection have been reported in Romania since the 1950s. Outbreaks of encephalitis, which were serologically confirmed to be caused by WNV infection, were recorded in 1955 in central Transylvania, followed by an outbreak in 1964 in Banat county (central Romania). The largest outbreak of WNV infection in Europe to date was in Romania, when in 1996, over 800 clinical cases of neuro-invasive disease were reported, 393 of which were confirmed for WNV. A total of 17 deaths were reported in this outbreak. The majority of cases were resident (and probably infected) in the capital, Bucharest.

Following this outbreak, Romania implemented a surveillance system for WNV infection. The epidemiological situation until 2009 was characterised by sporadic cases reported from the southern part of the country (south of the Carpathian Mountains). Data from studies conducted between 1997 and 2000 show that 39 confirmed cases were detected. National surveillance data indicate that between 1997 and 2004, a total of 82 neuroinvasive cases were reported in this area (unpublished data; Romanian National Institute of Public Health). Another major outbreak was reported in 2010  [<https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/1104_MIR_West_Nile_outbreak_Romania.pdf>].

There have been studies in Romania that provide evidence that wild birds are involved in local West Nile disease enzootic and epizootic cycles. This, in turn, allows virus maintenance and spread and also enhances the chance of new outbreaks [<https://www.ncbi.nlm.nih.gov/pubmed/26824796>]. This indicates that the virus is in circulation in the country, resulting in periodic outbreaks among humans similar to the one reported above. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Date: Thu, 19 Apr 2018 05:38:24 +0200
By Mihaela RODINA

Boldesti-Scaieni, Roumanie, April 19, 2018 (AFP) - Measles still claims young lives in Romania, where nearly 40 children have died in an outbreak that many blame on parents being misled by scare stories that vaccinating them is dangerous.   Some 12,000 people have contracted measles since late 2016 in the European Union's second-poorest country, 46 of them died.

Among the dead, 39 were children under the age of three who had not been vaccinated, making Romania one of the worst affected countries in the ongoing measles outbreak in Europe.   "People are mistrustful because they read all sorts of things on the internet," said Dr Silvana Dan, from the southern regional Prahova Public Health Authority, citing persistent rumours that vaccination causes autism.   A girl aged just 11 months died in the region in March after her parents refused to vaccinate her.

Measles is a highly contagious viral disease that affects children in particular but it has largely been brought under control.   The World Health Organization (WHO) says deaths caused by measles plunged from 550,100 in 2000, to just under 90,000 in 2016.   Paradoxically, and to the horror of health authorities worldwide, this very success has seen the public let down its guard and question whether vaccination is now really necessary.

Local officials say health workers are "on the barricades," doing all they can to get the message across, especially in rural areas, that measles is a killer which can be stopped.   It is not straightforward.   "The reasons for people not being vaccinated are different in different population groups," local WHO representative Miljana Grbic told AFP.   "Our research shows that there are specificities such as convenience of services, education, support of family doctors, community support and peer support that play a big role here," Grbic said.

- Roma especially vulnerable -
In Valea Seaca, some 250 kilometres (150 miles) northeast of Prahova, another baby girl of just 10 months died of measles in February.   "Her parents refused, in writing, to have their children vaccinated after seeing reports on television that vaccines kill," local mayor Ioan Pravat told AFP.   The National Centre for the Supervision and Control of Transmissible Diseases says most measles cases are found in more vulnerable, disadvantaged communities, Roma for the most part, who often do not have access to a family doctor or if they do, only ask them for help in an emergency.

The local authorities hope that Roma health workers can help ease that problem.   Aurelia Oprisan, one of them, makes her rounds every day in Boldesti-Scaieni, to the south, knocking on doors to spread the vaccination message.   "Many people are negatively influenced by the press so I tell them that what they are hearing is not true," Oprisan told AFP.   There are signs this approach may be working.   "I don't want to lie to you. At the beginning I, too, was afraid because I had heard that there could be problems, like causing paralysis," said Anisoara Iorga.   "But then I did get my children vaccinated and they had no problems at all."

- Progress but below target -
If there is progress overall, there is also still a way to go.   The WHO recommends a vaccination rate of 95 percent for effective control. But in Romania, it is 87 percent for the first inoculation and only 75 percent for the second, according to the latest official figures from 2016.   Some critics say the authorities share part of the blame because the supply of vaccine is irregular and insufficient.

Stung into action, the government has pledged to improve vaccination rates by making 10 child vaccines compulsory but debates on a draft law submitted last year have made little progress.   "We have received lots of amendments which we are in the process of analysing," said Florin Buicu, a doctor and Social Democrat MP who chairs parliament's health committee.

Many of these have been submitted by anti-vaccine groups who have become increasingly active, Buicu said.   Medical professionals are outraged.   "We have to defend the scientific work (underlying vaccines) while information which has no such basis is taken as the truth," said Dr Alexandru Rafila, head of Romania's microbiology society.
Date: Mon 16 Oct 2017
Source: Romania Insider [edited]

Almost 400 new measles cases have been confirmed in the last month in Romania, according to data from the National Center for Supervision and Control of Transmissible Diseases, quoted by News.ro.

This has brought the total number of confirmed measles cases in the country to more than 9600 since the authorities officially announced the outbreak of this epidemic, at the end of September 2016.

Half of the new cases in the last month have been reported in Brasov county, and a high number of new cases were also reported in Cluj, Satu Mare and Harghita counties.

Overall, in the last 2 years, over 1000 cases were confirmed in Timis county (1228), Caras-Severin county (1112), and Arad county (1014), all in Western Romania.

Since the start of the measles epidemic, 34 people died in Romania because of the disease. Nine deaths were reported Timis county, 6 in Arad, 7 in Dolj, 3 in Caras-Severin, and 1 in Bihor, Cluj, Calarasi, Neamt, Satu Mare, Vaslui, Galati, Mures, and Bucharest, each.

The disease has spread to 41 counties. Tulcea is the only county in Romania where no measles case has been officially recorded yet.

This July [2017], the Romanian Ministry of Health started a vaccination campaign against measles with the involvement of local authorities, which have to identify the children who have not been vaccinated yet and the places where they will be immunized.
=====================
[A HealthMap/ProMED-mail map of Romania can be found at
Date: Mon 16 Oct 2017 at 9:52:16 AM EDT
Source: Outbreak News Today [edited]

Since January 2016, some 19,000 measles cases were reported in Europe, including 44 deaths. (In 2016, 12 deaths occurred in Romania and one in the UK. In 2017, 31 deaths were reported from Romania, Italy [4], Bulgaria [1], Germany [1], Portugal [1], France [1] and Spain [1].)

The list of countries affected is long, with only Latvia, Liechtenstein, Malta and Norway not reporting any cases in 2017.

The most heavily affected continue to be Romania (9539 cases, including 34 deaths with more than 7500 reported in 2017), Italy (4617 cases, including 4 deaths this year), and Germany (891 cases in 2017).

Of all measles cases reported across the one-year period from 1 Sep 2016-31 Aug 2017 with known vaccination status, 87% were not vaccinated.

The latest available figures on vaccination coverage collected by WHO (2016) show that the vaccination coverage for the 1st dose of measles was below 95% in 18 of 30 EU/EEA countries; for the 2nd dose of measles, it was below 95% in 20 of 27 EU/EEA countries reporting 2nd dose coverage data.

According to the European Centre for Disease Prevention and Control (ECDC), in order to achieve the measles elimination goal, the vaccination coverage rates for children targeted by routine vaccination programmes should increase in a number of countries, as the vaccination coverage of the 2nd dose must be at least 95% to interrupt measles circulation and achieve herd immunity.
=====================
[A Google map of Europe may be found at <bit.ly/2t5juKQ>. - ProMED Mod.LK]
More ...

Tanzania

General
Nowadays there are few areas of our planet where you can really experience the timeless wonder and separation from the hum drum we face in our daily lives. Visiting Africa is fascinating and provides a new perspective on another life, another
world. The vast, untamed and primitive landscape provides a perfect glimpse into a life which many miss as they go about their daily chores. A trip which includes the majestic splendour of Africa’s tallest peak, Mt Kilimanjaro, rates high on the list of the unofficial wonders of the world and one not to be missed if the opportunity arises.
Mt Kilimanjaro
This is the highest peak in all of Africa stretching 5895m above sea level. Actually a few years ago the height of the summit was reassessed and then dropped by approximately 10m with more accurate recording by global positioning satellite. However, this minimal change will not be noticed by most travellers! There are a number of routes up to the summit and obviously which route is taken will make a significant difference to both the difficulty of the trek and any potential medical difficulties. Travelling with sufficient and well experienced guides and porters, and being part of a well organised group, are probably the most important factors in protecting your health.
Travelling to Tanzania
Mt Kilimanjaro is situated just across the border from Kenya in the northern part of Tanzania. You can approach the region by a number of different routes including buses from Nairobi, travelling from Dar es Salaam or flights straight into Moshi. How you travel for your climb of Kilimanjaro makes quite a significant difference to some of the health issues which you may face along the way.
General Health Issues
Before you leave for your trip make sure you are in good enough general health. If you can’t even run up a flight of stairs without collapsing then a trip up Kilimanjaro might not be the best choice! If you are unsure then see your doctor and ask for his or her advice at an early stage - before you commit yourself to the trip.
Long-Haul Flights
Flying to either Nairobi or Dar es Salaam takes between 9 to 10 hours from most Western European centres. This is regarded as a ‘long-haul flight’ so make sure you realise the risks associated with blood clotting in the legs and drink plenty of still fluids (water is the best), walk around the plane and use compression stockings if you are at any particular risk. (DVT in travel - TMB)
Food & Water
In Africa, as in many other areas of the world, what you eat and what you drink are essential for your well being. Being part of a large group has its advantages but you also need to stick with food and water that suits you personally. Don’t take extra risks with what you eat or drink just because others seem to be okay. Have your own sensible rules and remember to care for your stomach! Dehydration is common while climbing in a hot climate just make sure the water you drink is pure. You will also lose salt through perspiration and this will need to be replaced by increasing the amount of salt you put on your food at meal times.
What shoes to wear
Remember this is a walking holiday so prepare well in advance. Obviously increase your walking at home before you leave but remember to also include some significant hill walks to test your shoes. Blisters and corns are regularly associated with poorly fitted and substandard boots so spend that extra to get a pair that suits you and supports both the arch of your foot and also your ankles. A slightly larger pair is essential to lessen the pressure on your feet. Good thick socks will help to absorb perspiration and cushion your feet against friction.
Clothes to bring
This is one of the most difficult areas to sort out. The weather and climate along your climb will vary from a beautiful Irish-like summer day, to a roasting hot, dehydrating scorcher to a chilly or freezing night when the sun retires after about 6 pm. You must pack light cotton clothing but warm enough for the chill of the evenings at altitude. A wide brimmed hat (and sun lotion) is essential to protect against sun burn.
Problems at Altitude
High altitude is defined as over approx 3500m and as you know Kilimanjaro is a whole lot higher. The affects of altitude can hit anybody but most commonly it is the fit younger traveller who experiences the most serious consequences and even death. The doctor who discusses your vaccines and malaria prophylaxis will talk through the issues relating to Altitude sickness and may prescribe a medication to lessen the risks in certain circumstances. But remember, this disease can kill so if you develop any possible symptoms (lightheadedness, headaches, altered gait etc) please report it to your guide immediately. (Altitude sickness - TMB)

Being part of a group
The main advantage of being part of a group is that each member can help look-out for others during the trip. Never get separated from your main party and always report it if you feel one of your group is not quite right medically. This may be the first signs of altitude sickness and you could quite literally save a life by your intervention.
Mosquitoes and Malaria
Mosquitoes do not tend to live above 2000m and so the risk of malaria while climbing Kilimanjaro does not occur. However, you have to get to that altitude first and so protection against mosquito bites and malaria prophylaxis will be essential for this trip. (Malaria protection - TMB)
Rabies Risks in Tanzania
Any warm blooded animal can transmit rabies and so it is extremely important that you avoid any contact with dogs, cats, monkeys, and other animals on the slopes of Mt Kilimanjaro such as hyrats and other beaver like creatures. Report any contact immediately to your group leader.
Vaccinations for visiting Tanzania
As you travel to Tanzania from Western Europe we normally recommend that you have a number of vaccinations to cover against a range of diseases. In certain patients it may also be worth considering further vaccination cover against conditions like Rabies and Hepatitis B. These should be talked through in detail with your vaccinating doctor.
After your visit
When you return home you must remember that certain diseases can present days, weeks or even months afterwards. If you develop any peculiar symptoms (fever, headache, diarrhoea, skin rash etc) please make contact so this can be urgently assessed.
In the vast majority of cases the traveller climbing Kilimanjaro will stay perfectly healthy and well providing they follow the main common sense rules. Have a great safe trip and enjoy some of the splendours that Africa has to provide.

Travel News Headlines WORLD NEWS

Date: Sat, 28 Sep 2019 20:04:29 +0200 (METDST)

Nairobi, Sept 28, 2019 (AFP) - A Canadian tourist died Saturday while parachuting from the top of Mount Kilimanjaro, Africa's highest peak and Tanzania's top tourist attraction.   Justin Kyllo, 51, was killed after his parachute failed to open, Tanzanian National Parks spokesman Pascal Shelutete said.   Kyllo had arrived in the country on September 20, he said.   Around 50,000 people climb the nearly 6,000-metre mountain, located near the northeastern frontier with Kenya, every year.
Date: Fri 20 Sep 2019
From: Daniel R. Lucey MD, MPH [edited]

ProMED-mail reports since 14 Sep [2019] of a Tanzanian woman who died in Dar es Salaam on 8 Sep [2019] and was declared negative for Ebola by Tanzanian officials raises the question of what did cause her death. Given her travel to Uganda in August [2019], perhaps bat-associated Sosuga virus could be tested for if stored specimens exist. Similar to this young woman from Tanzania, the initial patient from the USA working in Uganda in 2012 in whom Sosuga virus was discovered had [experienced] fever, headache, rash, and diarrhoea (EID 2014; 20: 211-216). This virus was found from fruit bats in Uganda in 3 locations approximately 130 km [about 81 mi] apart (J Wildl Dis 2015; 51:774-779). An IgM and IgG test was developed at the US Centers for Disease Control and Prevention, and antiviral compounds active against this virus were reported in 2018.

Daniel R. Lucey MD, MPH
Consultant, ProMED
=======================
[The fatal case of a young Tanzanian woman studying in Uganda who died after travelling back to Tanzania for her field studies, as reported in ProMED-mail post http://promedmail.org/post/20190914.6674377, continues to elude an aetiological diagnosis. The initial concern for Ebola infection has since effectively been ruled out (see http://promedmail.org/post/20190914.6674377), but outside observers have called for greater transparency and information sharing given widespread rumours surrounding this case and its potential public health implications for neighbouring countries as well as Tanzania itself (see http://promedmail.org/post/20190918.6680252).

As discussed by ProMED Mod.LK, the Ebola-like symptoms manifested in this case can be caused by other viral haemorrhagic fevers and a variety of other pathogens (see http://promedmail.org/post/20190914.6674377). ProMED thanks Dr. Lucey for raising the intriguing possibility of Sosuga virus in his letter. We continue to seek any additional information about this case, as well as alternative etiologic diagnoses and how they could be tested for.

Citations and URLs for the articles referenced by Dr. Lucey are as follows:

Albarino CG et al.: Novel Paramyxovirus Associated with Severe Acute Febrile Disease, South Sudan and Uganda, 2012. Emerg Infect Dis. 2014; 20(2): 211-216. <https://dx.doi.org/10.3201/eid2002.131620>.

Amman BR et al.: A Recently Discovered Pathogenic Paramyxovirus, Sosuga Virus, is Present in _Rousettus aegyptiacus_ Fruit Bats at Multiple Locations in Uganda. J Wild Dis. 2015; 51(3): 774-779. <https://www.jwildlifedis.org/doi/10.7589/2015-02-044>. - ProMED Mod.LXL]

[HealthMap/ProMED-mail map:
28 Jul 2019

As many as 13 have died while 6677 have been infected across Tanzania. In Dar es Salaam region alone, 6631 cases and 11 deaths have occurred.

HealthMap/ProMED-mail map of Tanzania:
Date: 20 Aug 2019
Source: Outbreak News Today [edited]

A suspected aflatoxicosis outbreak is being reported in Tanzania. The World Health Organization (WHO) was informed of the situation by the Ministry of Health in late June 2019. Since 1 Jun 2019, sporadic cases presented with symptoms and signs of abdominal distention, jaundice, vomiting, swelling of lower limbs, with a few cases of fever and headache, from Dodoma and Manyara Regions in Tanzania. As of 11 Aug 2019, a total of 53 cases and 8 deaths have been reported from Chemba, Kondoa and Kiteto Districts. The situation is under investigation.

Aflatoxin is a potent toxin and a very serious health issue in many parts of the developing world. Major outbreaks have been seen in Africa, India, Malaysia and Taiwan over the years. This mycotoxin is a natural toxin produced as a secondary metabolite to certain strains of the fungus _Aspergillus_ spp, in particular _Aspergillus flavus_ and _Aspergillus parasiticus_.

Aflatoxins are contaminants of foods intended for people or animals as a result of fungal contamination. The commonest foods implicated are cereals like corn, wheat and rice, oilseeds like peanuts and sunflower, and spices. However, the toxin can affect a very wide range of food stuffs (see below).

Different factors contribute to aflatoxin contamination. In semi-arid climates, the effect of drought can increase the amount of _Aspergillus_ spp in the air causing pre-harvest contamination of certain crops. Crops grown and stored in more tropical environments where the temperature and humidity are high usually have a higher risk of both pre and post-harvest contamination. Of course, much of the problem lies with homegrown crops not harvested or stored properly.

Aflatoxin poisoning can be divided into acute and chronic disease depending on the amount of toxin ingested. When people (or animals) ingest aflatoxin contaminated foods, the liver is the main target for disease. There is a direct link between aflatoxin poisoning and liver cancer. Liver cancer or hepatocellular carcinoma is an important public health concern in many parts of the world due to aflatoxin. According to the CDC, acute aflatoxin poisoning results in liver failure and death in up to 40 per cent of cases in some regions.

Besides the obvious health risks, there is the massive economic loss occurring in parts of the world that can't afford it. Prevention and control of aflatoxin in developing countries is mainly focused on good agricultural practices. Because it is impossible to completely eliminate this danger, in the United States feeds and grains are laboratory tested for levels of aflatoxins, and food with unacceptable levels are removed from the market.

Foods most commonly affected by aflatoxins (from the USDA's Food Safety Research Information Office): [linked from:

- cereals (maize, corn, sorghum, pearl millet, rice, wheat)
- oilseeds (peanut, soybean, sunflower, cotton)
- spices (chilies, black pepper, coriander, turmeric, ginger)
- tree nuts (almonds, pistachio, walnuts, coconut)
- dried fruits (sultanas, figs)
- cocoa beans
- milk, eggs, and meat products*

* Milk, eggs, and meat products are occasionally contaminated due to the consumption of aflatoxin-contaminated feed by animals.
====================
["Aflatoxins are toxic metabolites produced by certain fungi in/on foods and feeds. They are probably the best known and most intensively researched mycotoxins in the world. Aflatoxins have been associated with various diseases, such as aflatoxicosis, in livestock, domestic animals and humans throughout the world. The occurrence of aflatoxins is influenced by certain environmental factors; hence the extent of contamination will vary with geographic location, agricultural and agronomic practices, and the susceptibility of commodities to fungal invasion during preharvest, storage, and/or processing periods. Aflatoxins have received greater attention than any other mycotoxins because of their demonstrated potent carcinogenic effect in susceptible laboratory animals and their acute toxicological effects in humans. As it is realized that absolute safety is never achieved, many countries have attempted to limit exposure to aflatoxins by imposing regulatory limits on commodities intended for use as food and feed.

"Fungal growth and aflatoxin contamination are the consequence of interactions among the fungus, the host and the environment. The appropriate combination of these factors determines the infestation and colonization of the substrate, and the type and amount of aflatoxin produced. However, a suitable substrate is required for fungal growth and subsequent toxin production, although the precise factor(s) that initiates toxin formation is not well understood. Water stress, high-temperature stress, and insect damage of the host plant are major determining factors in mold infestation and toxin production. Similarly, specific crop growth stages, poor fertility, high crop densities, and weed competition have been associated with increased mold growth and toxin production. Aflatoxin formation is also affected by associated growth of other molds or microbes. For example, preharvest aflatoxin contamination of peanuts and corn is favored by high temperatures, prolonged drought conditions, and high insect activity; while postharvest production of aflatoxins on corn and peanuts is favored by warm temperatures and high humidity.

"Humans are exposed to aflatoxins by consuming foods contaminated with products of fungal growth. Such exposure is difficult to avoid because fungal growth in foods is not easy to prevent. Even though heavily contaminated food supplies are not permitted in the marketplace in developed countries, concern still remains for the possible adverse effects resulting from long-term exposure to low levels of aflatoxins in the food supply.

"Evidence of acute aflatoxicosis in humans has been reported from many parts of the world, namely the 3rd World Countries, like Taiwan, Uganda, India, and many others. The syndrome is characterized by vomiting, abdominal pain, pulmonary edema, convulsions, coma, and death with cerebral edema and fatty involvement of the liver, kidneys, and heart.

"Conditions increasing the likelihood of acute aflatoxicosis in humans include limited availability of food, environmental conditions that favor fungal development in crops and commodities, and lack of regulatory systems for aflatoxin monitoring and control.

"Because aflatoxins, especially aflatoxin B1, are potent carcinogens in some animals, there is interest in the effects of long-term exposure to low levels of these important mycotoxins on humans. In 1988, the IARC placed aflatoxin B1 on the list of human carcinogens. This is supported by a number of epidemiological studies done in Asia and Africa that have demonstrated a positive association between dietary aflatoxins and Liver Cell Cancer (LCC). Additionally, the expression of aflatoxin-related diseases in humans may be influenced by factors such as age, sex, nutritional status, and/or concurrent exposure to other causative agents such as viral hepatitis (HBV) or parasite infestation.

"The economic impact of aflatoxins derives directly from crop and livestock losses as well as indirectly from the cost of regulatory programs designed to reduce risks to animal and human health. The Food and Agriculture Organization (FAO) estimates that 25% of the world's food crops are affected by mycotoxins, of which the most notorious are aflatoxins. Aflatoxin losses to livestock and poultry producers from aflatoxin-contaminated feeds include death and the more subtle effects of immune system suppression, reduced growth rates, and losses in feed efficiency. Other adverse economic effects of aflatoxins include lower yields for food and fiber crops.

"In addition, the ability of aflatoxins to cause cancer and related diseases in humans given their seemingly unavoidable occurrence in foods and feeds make the prevention and detoxification of these mycotoxins one of the most challenging toxicology issues of present time."  <http://poisonousplants.ansci.cornell.edu/toxicagents/aflatoxin/aflatoxin.html>.

Aflatoxins are a huge challenge in developing countries as they affect crops, animals and people and people and animals consuming the crops or drinking milk from affected animals. It should be noted that this is not the 1st time Tanzania has experienced this situation from aflatoxin. We hope the authorities are able to track down and remove the contaminated product and render appropriate medical care for the affected individuals. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Date: Thu 29 May 2019 Source: XinHuaNet [edited] <http://www.xinhuanet.com/english/2019-05/30/c_138100702.htm>
Cholera has killed one and left 32 others hospitalized in Tanzania's commercial capital, Dar es Salaam, Tanzanian health minister Ummy Mwalimu said on Wed 28 May 2019. "The outbreak of the disease has been caused by failure to abide by hygienic regulations," the minister said.
She directed all municipal councils in the commercial capital to enact by-laws that impose stern punishment to people who empty cesspool tanks in the open when it rains. Instructions have been given to municipal council authorities to mete out stern punishment to anybody disposing sewage in their compounds, Mwalimu said.
Dar es Salaam chief medical officer Yudas Ndungile said most cholera patients came from Mchikichini, in Kariakoo, and places hardly reached by sewage vehicles, and that efforts should be put in place to reach those areas. ========================
[With the start of the rainy season in this area of East Africa, the number of cases of cholera will rise. The mortality from cholera and most diarrheal illnesses is related to non-replacement of fluid and electrolytes from the diarrheal illness.
As stated by Lutwick and colleagues (Lutwick LI, Preis J, Choi P. Cholera. In: Chronic illness and disability: the pediatric gastrointestinal tract. Greydanus DE, Atay O, Merrick J, editors. New York: Nova Bioscience; 2018:113-127), oral rehydration therapy can be life-saving in outbreaks of cholera and other forms of diarrhea:
"As reviewed by Richard Guerrant et al. (1), it was in 1831 that cholera treatment could be accomplished by intravenous replacement, and, although this therapy could produce dramatic improvements, not until 1960 was it 1st recognized that there was no true destruction of the intestinal mucosa, and gastrointestinal rehydration therapy could be effective, and the therapy could dramatically reduce the intravenous needs for rehydration. Indeed, that this rehydration could be just as effective given orally as through an orogastric tube (for example, refs 2 and 3) made it possible for oral rehydration therapy (ORT) to be used in rural remote areas and truly impact the morbidity and mortality of cholera. Indeed, Guerrant et al. (1) highlight the use of oral glucose-salt packets in war-torn Bangladeshi refugees, which reduced the mortality rate from 30% to 3.6% (4) and quotes sources referring to ORT as "potentially the most important medical advance" of the 20th century. A variety of formulations of ORT exist, generally glucose or rice powder-based, which contain a variety of micronutrients, especially zinc (5).
"The assessment of the degree of volume loss in those with diarrhoea to approximate volume and fluid losses can be found in ref 6 below. Those with severe hypovolemia should be initially rehydrated intravenously with a fluid bolus of normal saline or Ringer's lactate solution of 20-30 mL/kg followed by 100 mL/kg in the 1st 4 hours and 100 mL/kg over the next 18 hours with regular reassessment. Those with lesser degrees of hypovolemia can be rehydrated orally with a glucose or rice-derived formula with up to 4 L [4.2 qt] in the 1st 4 hours, and those with no hypovolemia can be given ORT after each liquid stool with frequent re-evaluation."
More ...

Vietnam

General:
************************************
Viet Nam is becoming a more popular tourist destination with Irish travellers each year. In many cases these will be those who have no defined itinerary and so their travel plans may change at short
otice. Facilities for tourists vary greatly throughout the country and this needs to be borne in mind when considering some of the serious health issues which can occur throughout the country. The climate is cooler in the north and more tropical further south. There is a monsoon season from May to November each year and the Mekong Delta is prone to significant flooding. Transport during this time can be very difficult and there will be a higher incidence of various diseases during and soon after times of flooding.
Further local information on health issues in Viet Nam is available at http://www.doctorkot.com/index.htm
Safety & Security:
************************************
The majority of those visiting Viet Nam will have no particular difficulty though street crime can be a problem in the main cities of Hanoi and Ho Chi Ming. Generally this is in the form of pick-pocketing, or snatch and grab incidents. Take care of your personal belongings at all times and tourists should not flaunt their relative wealth. Be careful while walking along the footpaths as occasionally a motorcyclist may grab at your bag or camera. Use the hotel safe to store belongings. Attacks against ships in the South China Sea are reported and it is sensible to be vigilant at all times.
Local Laws & Customs:
************************************
Drug smuggling offences carry the death penalty. Don’t take photographs of any military or police installation and avoid any large gathering as the mood can suddenly change. Travel to some of the border areas of the country can be very restricted and so should be avoided. Religious freedom in Viet Nam is quite restricted and those attending gatherings may be detained and fined. Police may occasionally raid hotel rooms without notice. Seizure of documents, pornographic material, compact disks and other goods have lead to high fines and detention.
Road Transport:
************************************
Traffic accidents are becoming more common throughout the country and tourists are occasionally involved with serious consequences. Hiring your own means of transport (car, motorbike etc) is generally unwise. International driving licences are not valid and those wishing to drive will need to obtain a Vietnamese licence. The streets are crowded and many road users will stop suddenly to make purchases from roadside vendors. Traffic laws are often unobserved and horns and gesticulations are used to indicate right of way! Outside the cities, buses and trucks often travel at high speed and accidents are a regular occurrence.
Food & Water:
************************************
The level of food and water hygiene varies greatly throughout the country. Many tourists become ill following consumption of food from both street vendors and also from good quality hotels. Care should be taken at all times. Undercooked or reheated food should be avoided and tap water must be checked for the smell of chlorine. Make sure that a sealed bottle of water is brought to your table during meals. Carbonated water is safer. Bivalve shellfish meals are high risk and previously peeled fruit should not be eaten. Typhoid is reported as a particular problem in the Mekong Delta.
Malaria Risks:
************************************
Viet Nam is endemic for malaria and the risk of transmission occurs in many regions of the country. However, the risk is highest during the monsoon season (May to November) and in the southernmost provinces of Ca Mau and Bac Lieu. The urban areas of Hanoi, Ho Chi Minh City, the Red River Delta and the coastal plain north of Nha Trang are regarded as low risk regions throughout the year.
Mosquito Borne Diseases:
************************************
The other two main mosquito borne diseases are Dengue Fever and Japanese B Encephalitis. Both of these viral conditions can cause serious disease and it is essential that all travellers continually take special care to avoid mosquitoes. The mosquitoes which transmit Dengue tend to bite in the main urban areas while the ones that transmit Japanese B (and malaria) are more common out of the large cities.
Sun Exposure:
************************************
The direct sunlight in Viet Nam can be very intense and both burn and dehydration can easily occur. After a long-haul flight this is a particular concern as many travellers will sleep beside the hotel pool to recover from their journey. After just a short while they may have become significantly burnt. Those trekking should increase their fluids and also take more salt in their diet if possible.
Entertainment Problems:
************************************
Viet Nam has a reputation of a location where it is too easy to obtain sexual exposure for those unaware of the risks. This is particularly true following the consumption of alcohol. The risk of AIDS and other serious STD’s is very high and so contact should be avoided at all costs. A number of otherwise healthy male travellers have suddenly died during the past few years following what is thought to have been laced alcoholic drinks.
Rabies Risk:
************************************
Rabies occurs throughout Viet Nam and any contact with warm-blooded animals should be avoided at all times. Dogs, Cats and Monkeys are most commonly involved in transmitting the disease to humans. Treat any exposure very seriously and wash out the wound, apply an antiseptic and seek urgent medical attention immediately.
Vaccinations for Viet Nam:
************************************
There are no essential vaccines for entry to Viet Nam from Western Europe. However, for personal health, it is advised that all travellers consider cover against;
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food and water borne disease)
*
Hepatitis A (food & water borne disease)
For those trekking within the country there are a number of other vaccines which should be considered including Hepatitis B, Rabies, Japanese B and Meningitis.
Summary:
************************************
The biggest risks within Viet Nam tend to be associated with food and water borne diseases, mosquito bites and the traffic. Commonsense and care is needed at all times to ensure a good safe holiday.

Travel News Headlines WORLD NEWS

Date: Thu, 10 Oct 2019 13:13:57 +0200 (METDST)

Hanoi, Oct 10, 2019 (AFP) - Selfie-snapping tourists railed against the closure of Hanoi's 'train street' on Thursday after police blocked off the Instragram-famous tracks for safety reasons.   The narrow railway corridor in central Hanoi has become a hotspot among visitors seeking the perfect holiday snap on the tracks -- often dodging trains that rumble through daily.    But Hanoi authorities said this week they would block people from the tracks to avoid accidents, and police on Thursday erected barricades to keep out disappointed visitors.    "I'm very frustrated because today I can't go in and take a picture," Malaysian tourist Mustaza bin Mustapha told AFP, vowing to come back later.

Dozens of other tourists were turned away, though some managed to get onto still-open sections of the railway, moving out of the way as an afternoon train chugged past.    Built by former colonial rulers, the railway once shipped goods and people across France's former Indochina colony and remains in use today by communist Vietnam's state-run railway company.    The stretch of the tracks was once known as a rough part of town, occupied by drug users and squatters until their recent discovery by camera-wielding holidaymakers who have splashed images of the area across social media.

Cafe owners complained that business would be hurt thanks to the new regulations, and that tourists always moved out of the way for oncoming trains.   "There has never been any regretful accidents here," said Le Tuan Anh, who runs a cafe from his home along the tracks.   "Compared to traffic density elsewhere in the city, this is much safer," he said, referring to Hanoi's chaotic, motorbike-clogged streets.   New signs were installed in the area Thursday, warning passersby not to take photos or videos in the "dangerous area", much to the chagrin of British tourist Harriet Hayes.   "People come from all over the world to Hanoi just to see the train go past," she told AFP.   "It's such a shame that we come and have been told that we have to leave."
Date: Wed 11 Sep 2019
Source: Saigon Giai Phong [edited]

The Hanoi-based Bach Mai Hospital yesterday [Tue 10 Sep 2019] warned of a high possibility of death from rare Whitmore's disease [melioidosis], as the disease re-occurred and killed 4 people in August [2019].

Moreover, the fatal disease infected 12 patients including a woman suffering from a severe abscess on her nose. The case was very rare, and the hospital treated such cases for the 1st time, said Director of the hospitals' Tropical Disease Center Dr. Do Duy Cuong. The patient was misdiagnosed as having sepsis caused by a staphylococcal infection at a local hospital. However, tests from her wound carried out at the center were positive for the Whitmore bacterium, _Burkholderia pseudomallei_.

The doctors had to change the treatment regimen; otherwise the patient could have died, as Dr. Cuong said. After 2 weeks of treatment, her wound had improved. However, she will still be undergoing treatment for at least 3 months under the close watch of doctors to avoid disease recurrence.

Dr. Cuong added that there have been around 20 cases of melioidosis in the past 5 to 10 years, but since the beginning of the year [2019], the center has admitted 20 cases, mostly from the northern and central provinces.

Melioidosis is an infectious disease caused by the bacterium _Burkholderia pseudomallei_. that can affect humans or animals. It is predominately a disease of tropical climates, especially in Southeast Asia and northern Australia where it is widespread.

The bacteria causing melioidosis are found in contaminated water and soil. It is spread to humans and animals through direct contact with the contaminated source. Patients developing the disease may die without proper treatment.  [Byline: Minh Khang - Translated by Uyen Phuong]
=======================
[Melioidosis is a disease of the rainy season in its endemic areas. It mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (most common risk factor), renal disease, cirrhosis, thalassemia, alcohol dependence, immunosuppressive therapy, chronic obstructive lung disease, cystic fibrosis, and excess kava consumption (kava is an herbal member of the pepper family that can be associated with chronic liver disease).

Melioidosis may present at any age but peaks in the 4th and 5th decades of life, affecting men more than women. In addition, although severe fulminating infection can and does occur in healthy individuals, severe disease and fatalities are much less common in those without risk factors.

The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, and chest pain, and -- although the cough can be nonproductive -- respiratory secretions can be purulent, significant in quantity, and associated with on-and-off bright red blood. The lung infection can be rapidly fatal -- with bacteremia and shock -- or somewhat more indolent.

Acute melioidosis septicemia is the most severe complication of the infection. It presents as a typical sepsis syndrome with hypotension, high cardiac output, and low systemic vascular resistance. In many cases, a primary focus in the soft tissues or lung can be found. The syndrome, usually in patients with risk factor comorbidities, is characteristically associated with multiple abscesses involving the cutaneous tissues, lung, liver, and spleen, and a very high mortality rate of 80-95%. With prompt optimal therapy, the case fatality rate can be decreased to 40-50%.

The melioidosis bacillus is intrinsically insensitive to many antimicrobials, and in fact bioterrorism strains may be engineered to be even more resistant. _Burkholderia pseudomallei_ is usually inhibited by tetracyclines, chloramphenicol, trimethoprim-sulfamethoxazole (SXT), antipseudomonal penicillins, carbapenems, ceftazidime, and amoxicillin/clavulanate or ampicillin/sulbactam. Ceftriaxone and cefotaxime have good in vitro activity but poor efficacy; and cefepime did not appear, as well, to be equivalent to ceftazidime in a mouse model. The unusual antimicrobial profile of resistance to colistin and polymyxin B and the aminoglycosides but sensitivity to amoxicillin/clavulanate is a useful tool to consider in treatment of infection with the organism.

The randomized and quasi-randomized trials comparing melioidosis treatment have been reviewed, and it was found that the formerly standard therapy of chloramphenicol, doxycycline, and SXT combination had a higher mortality rate than therapy with ceftazidime, imipenem/cilastatin, or amoxicillin/clavulanate (or ampicillin/sulbactam). The betalactam-betalactamase inhibitor therapy, however, seemed to have a higher failure rate.

Source: Tolaney P, Lutwick LI: Melioidosis. In: Lutwick LI, Lutwick SM (eds). Bioterror: the Weaponization of Infectious Diseases. Totowa NJ: Humana Press, 2008 pp 145-58. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Fri, 10 May 2019 11:12:19 +0200

Ha Long Bay, Vietnam, May 10, 2019 (AFP) - Most visitors to Vietnam's famed Ha Long Bay opt for cruise views of the UNESCO heritage site but from Friday tourists can hop on a helicopter to see the area's famous karst rock formations from the skies.    Nervous flyers beware.   A pair of five-seater helicopters soared up to 300 metres (1,000 feet) to offer passengers aerial views of the limestone towers, cruise ships and the odd houseboat dotting Ha Long's green waters for the maiden flights on Friday.

Helicopter manufacturer Bell said the trips, which start at $125 for 12 minutes, were aimed at tapping into a growing number of tourists to Vietnam -- many from the world's second biggest economy.    "With the Chinese economy growing, you're seeing more tourists come here," said David Sale, Bell's managing director for Asia-Pacific.

The number of visitors to Vietnam grew nearly 20 percent last year, with one-third of the total coming from its powerful communist neighbour to the north.    Domestic tourism is also booming among Vietnam's fast-growing middle class with expanding appetites -- and budgets -- for travel.   Ha Long Bay is one of the country's top draws, with as many as 500 cruise ships in the bay every day and a newly-opened airport helping to funnel visitors into the area.

But the tourist boom has also prompted environmental concerns in the once-pristine bay in Quang Ninh province, also home to home to rapid industrialisation.    "We're under pressure from the coal industry, the urbanisation process, the arrival of more tourists and the population increase," said Le Minh Tan, deputy director of Quang Ninh's tourism department.    He added that a waste-water management system is set to be rolled out soon to deal with sewage spewed out by cruise ships daily.   "We're launching many programs in the area to ensure the environment of Ha Long is green and clean."
Date: Tue, 9 Apr 2019 13:43:38 +0200

Hanoi, April 9, 2019 (AFP) - Three divers who helped rescue a Thai football team last year have made a fresh discovery in Vietnam where they explored a tunnel that could expand the footprint of the world's largest cave.   The team was invited to descend into a waterlogged pit in the Son Doong cave in central Vietnam that has never been explored and is believed to connect to nearby chambers.    They were forced back at 77 meters (252 feet) because they did not have enough oxygen to push further, but they think the tunnels could be 120 meters deep.   If the tunnel connects to another cave, it would make Son Doong "easily the largest cave in the world and it would never be overtaken," British cave expert Howard Limbert, who helped organise the dive, said Tuesday at a press conference announcing the find.

The three divers -- Rick Stanton, Jason Mallinson and Chris Jewell -- were part of the daring rescue to save 12 Thai footballers and their coach who were trapped in a cave for eighteen days last year.    Stanton -- who found the boys on a ledge -- said the painstaking task of safely leading the group out of the tunnel alive helped to prepare for the mission in Vietnam.    "Our planning and preparation is without parallel," he said.   The team plans to return to Vietnam next year to try to link the tunnel to another cave near Son Doong, which is so big that it has its own ecosystem and weather patterns.

The cave in central Quang Binh province was first found by a local forager in 1991, but was not re-discovered for another 19 years because its entrance was hidden by thick surrounding jungle.   Only 30 percent of Vietnam's Phong Nha national park -- where Son Doong and a network of adjacent caves are located -- has so far been explored.     Son Doong is the world's largest cave by volume, big enough to house a New York city block -- including 40-storey skyscrapers -- according to Oxalis, which runs tours into the caves. 

Proposed plans to build a cable car in the area have sparked anger among the Vietnamese public who fear it will harm the area's wildlife and pristine views.      An official said Tuesday there were no plans to move ahead with the project despite offers from several companies.   "That is only in theory, in truth, to build a cable car there is no such project yet," the vice chairman of Quang Binh province Tran Thien Dung said Tuesday.       Vietnam's tourism industry is booming among domestic and foreign travellers alike, but the communist country has come under fire for failing to preserve landscapes as it rapidly expands the sector.
Date: Fri, 25 Jan 2019 12:21:09 +0100
By Jenny VAUGHAN

Vu Thu, Vietnam, Jan 25, 2019 (AFP) - Tran Huu Hoa was scared, desperate and on the verge of suicide after his leprosy diagnosis in 1958, fearing he'd never work or marry in an age when lepers were completely shunned from Vietnamese society.   He could not imagine he would find new life at the leprosy hospice where he has been living for 61 years, a walled off compound in northern Thai Binh province where he met his wife, worked as a union boss and took in needy children.    "There were about 2,000 people here then, mostly young people. It was fun because we started a teen union," the 80-year-old told AFP, sitting on his bed with his wife Teo of 54 years. 

Today there are only 190 patients at the hospital, all cured but living with disabilities caused by leprosy.    Many walk with prosthetic legs. Others like Hoa have lost fingers. Some are so severely disabled they spend the day bent over in bed, covered with thick blankets to keep the cold at bay.    Founded in 1900, Van Mon is the oldest leprosy hospital in northern Vietnam.    At its peak it treated 4,000 patients a year -- a number that has dwindled as leprosy cases have dropped across Vietnam thanks to improved healthcare, hygiene and greater awareness of the disease.   World Leprosy Day is January 27.

There were 248 people being treated for leprosy in 2017 in Vietnam, down by more than half from a decade earlier, according to data from the World Health Organization.    But as numbers have decreased so have the live-in patients at the Van Mon centre.   Meandering days are punctuated with a morning and midday meal. Some pass the time worshipping at the on-site chapel or pagoda, while most watch TV or listen to the radio during the day when they are not sleeping.    "I have no one to count on, I'm so lonely, so I just follow God. When I die I will follow God then too," said Pham Van Bac, 83, who has been at the centre since 1960. 

His daughter no longer visits and his grandchildren come only once a year, so he has little to look forward to most days, he says.    But many like Bac chose to stay, fearing they will be a burden on their families, or lose the care and small stipend provided at the government-run hospital.   Some, like Hoa, have found companions in the centre.   "It's a source of encouragement and motivation and they can have a happier and better life," said Nguyen Thi Thai, deputy director of the hospital where both her parents were once treated for leprosy.    And even though stigma against leprosy sufferers has largely faded outside the walls of the hospice, many prefer to remain at Van Mon.    Hoa said: "This is my second home, I will live here until my death."
More ...

World Travel News Headlines

Date: Wed, 20 Nov 2019 22:35:51 +0100 (MET)

Manila, Nov 20, 2019 (AFP) - Philippine police were ordered Wednesday to arrest anyone caught vaping in public, just hours after Philippine President Rodrigo Duterte announced he would ban e-cigarettes.   The abrupt prohibition, revealed by Duterte late Tuesday adds to a growing global backlash against a product once promoted as less harmful than tobacco smoking.

Duterte, a former smoker, called the devices "toxic" and said vaping introduced "chemicals" into the user's body.   He ordered the arrest of anyone vaping publicly in a country that already has some of Asia's toughest anti-smoking rules.    No formal, written order has been made public that spells out the scope of the ban or penalties for violations.   Duterte is notorious internationally for his deadly anti-narcotics crackdown, but he has also targeted tobacco with a wide-ranging ban on smoking in public.   Citing "the order of the president", on Wednesday a statement from the head of the Philippine police ordered "effective today, all police units nationwide to enforce the ban on use of vapes; ensure that all violators will be arrested".

The ban came days after Philippine health authorities reported the nation's first vaping-related lung injury, which resulted in a 16-year-old girl being hospitalised.   Vaping has taken off in the Philippines, with speciality shops and vapers puffing away in public a common sight.     E-cigarette users were caught off guard by the ban and questioned the utility of arresting people who, at worst, were hurting themselves.   "It's inappropriate. In any case, we don't hurt people, the environment or animals," said 22-year-old student Alexis Martin.   "Why are vapers being targeted?"

E-cigarettes warm flavoured liquid to produce vapour that is free of the estimated 7,000 chemicals in tobacco smoke, but does contain a number of substances that could potentially be harmful.  Critics say that apart from being harmful in themselves, the multiple exotic flavours of e-cigarette liquids appeal particularly to youngsters and risk getting them addicted to nicotine.

The devices have become hugely popular in the past decade but a rash of vaping-linked deaths and illnesses in the United States is feeding caution about the product, already banned in some places.   In September 2019 India became the latest country to ban the import, sale, production and advertising of e-cigarettes, citing in particular concerns for its youth.   The devices are already banned in several places such as Brazil, Singapore, Thailand and the US state of Massachusetts.
Date: Wed, 20 Nov 2019 17:17:39 +0100 (MET)

Lagos, Nov 20, 2019 (AFP) - Nigerian President Muhammadu Buhari on Wednesday announced a campaign to end defecation in public, in a country where tens of millions of people going to the toilet outside poses a major health risk.    "Nigeria has committed to end open defecation throughout the country by 2025," a statement by the presidency said a day after the United Nations marked World Toilet Day.     The decree set up a new body called the Clean Nigeria Campaign Secretariat to ensure "that all public places including schools, hotels, fuel stations, places of worship, market places, hospitals and offices have accessible toilets and latrines within their premises". 

According to the United Nations children agency, UNICEF, Nigeria has amongst the highest number of people practising open defecation in the world, estimated at over 46 million people -- almost a quarter of the population.   Around Nigeria each year 87,000 children die from diarrhoea, with more than 90 per cent of deaths caused by a lack of water, sanitation and hygiene, according to the World Bank.   The new agency will be disbanded when the goal of ending open defecation has been met, the presidency said.
Date: Wed, 20 Nov 2019 12:59:15 +0100 (MET)

Kampala, Nov 20, 2019 (AFP) - Global health charity Marie Stopes said Wednesday it had recalled hundreds of thousands of faulty condoms on sale in Uganda, where HIV rates are among the highest in the world.   The recall followed a warning from Uganda's National Drug Authority (NDA) that the Life Guard brand condoms had failed manufacturing "quality tests" because they contained holes and may burst.   The affected condoms were manufactured by India-based MHL Healthcare in April 2019 and have an expiry date of April 2024, the government regulator said.   Marie Stopes Uganda spokesman David Kamu told AFP on Wednesday that the two affected batches each contained "around 400,000" condoms.

Earlier reports had suggested millions of condoms could have been involved but NDA spokesman Fred Ssekyana told AFP the figure was below one million.   Marie Stopes Uganda said more than half of the condoms of concern had been recalled.   "While the LifeGuard brand follows strict quality controls, unfortunately two recent batches have fallen short of the quality we demand," the charity's country director, Carole Sekimpi, said in a statement Tuesday.   Marie Stopes is the largest and most specialised sexual reproductive health organisation in Uganda, the charity says on its website.   According to UNAIDS, 1.4 million Ugandans are living with HIV.   Last year 53,000 people were newly infected with the disease in the East African country, the UN agency said.
Date: Wed, 20 Nov 2019 15:08:18 +0100 (MET)

Luanda, Nov 20, 2019 (AFP) - Angola recorded an outbreak of polio this week after almost a decade without cases of the paralysing viral disease, the government said.   The highly infectious condition mainly affects children under the age of five. It attacks the nervous system and can lead to total paralysis, or in some cases death.   "After seven years without polio we are unfortunately confronted with a difficult situation," Angola's health minister Sante Silvia Lutucuta said on Monday, at the launch of a new vaccination campaign in the capital Luanda.   "We have recorded 44 new cases in ten of the country's 18 provinces," she added.

The vaccination campaign is expected to reach 2.5 million children aged five and under.   "All children must be protected by three doses of the oral anti-poliomyelitis vaccine," said Lutucuta, adding that the campaign would span over two weeks to "control the epidemic".   Two out of three strains of the wild polio virus have been eradicated so far, according to the World Health Organization (WHO).           While only 33 wild polio cases were reported globally last year, vaccine-derived polio still breaks out sporadically in some parts of Africa and Asia.    The Centers for Disease Control and Prevention has recommended that all travellers to Angola be fully vaccinated against the virus.
Date: Thu, 21 Nov 2019 01:34:32 +0100 (MET)

Bangkok, Nov 21, 2019 (AFP) - A 6.1-magnitude earthquake hit north-western Laos near the Thai border early Thursday, the United States Geological Survey reported.    The shallow quake hit at 6:50 am local time (2350 Wednesday GMT), USGS said. 
Date: Thu, 21 Nov 2019 01:25:15 +0100 (MET)

Sydney, Nov 21, 2019 (AFP) - The fire danger was elevated across wider swathes of southern Australia on Thursday, with residents warned to avoid at-risk areas as smoke from bushfires choked Sydney and other major cities.   Devastating fires along the country's east coast have claimed six lives and destroyed more than 500 homes since mid-October, with climate change and unseasonably hot, dry conditions fuelling the unprecedented blazes.   Now the fire danger has moved into states further south, with a so-called "Code Red" -- the highest possible fire risk in Victoria -- being declared in the state's northwest for the first time in a decade.   "What that means is that if we see fires in those areas they will be fast moving, they will be unpredictable, they will be uncontrollable," emergency management commissioner Andrew Crisp told reporters.

Country Fire Authority chief Steve Warrington told people living in rural areas to leave for the safety of cities.   "We are saying, 'do not be there, do not be there when a fire occurs, because you will not survive if you are there'," he said.   "There is a good chance if a fire occurs that your home will be destroyed."   The fire danger was also elevated to "severe" in the island state of Tasmania off mainland Australia's southeastern coast,  where a total fire ban was declared.   Two bushfires in the state's northeast did not pose an immediate threat to residents, the Tasmania Fire Service said.

For the second time in two days, smoke from bushfires blanketed Sydney, Australia's biggest city and home to more than five million people, sending air quality plummeting to hazardous levels.   More than 110 fires are still burning in worst-hit New South Wales and neighbouring Queensland, while in South Australia more than 40 fires broke out during catastrophic fire conditions Wednesday.    A South Australia Country Fire Service spokeswoman said all of those blazes had been brought under control or extinguished by Thursday, with the exception of a major fire on the Yorke Peninsula that had come perilously close to a small town.

Conditions were expected to ease in the coming days in South Australia, where the state capital Adelaide was also shrouded in bushfire smoke and residents were being told to stay indoors for health reasons.   Bushfire-prone Australia has experienced a horror start to its fire season, which scientists say is beginning earlier and becoming more extreme as climate change pushes temperatures higher and saps moisture from the environment after months of severe drought.   Growing calls to curb fossil fuels and drastically cut greenhouse gas emissions are being ignored by the country's conservative government, which is eager to protect its lucrative mining industry.   The country is bracing for challenging fire conditions to continue throughout the Southern Hemisphere summer.
Date: Mon 18 Nov 2019
Source: 112.UA [edited]

Eight school classes in Odesa [Odessa] have been closed for quarantine. More than 30% of school students in these classes are sick with Coxsackie virus, a highly contagious respiratory disease, said Olena Buynevych, the director of the city hall's department for science and education, as quoted by UNN news agency.

"More than 30% of students in these classes are sick wi h acute
respiratory diseases, which include cases of cases and Coxsackievirus," the official said. She urged the parents to keep the children away from schools in case they have any symptoms of acute respiratory diseases.

The symptoms are basically the same as flu; the key difference is the rash on the palms, in case of the Coxsackievirus.

Coxsackievirus is a member of a family of viruses called enteroviruses. Enteroviruses are made up of a single strand of ribonucleic acid (RNA). The enteroviruses are also referred to as picornaviruses ("pico" means "small," so, "small RNA viruses"). They are present all over the world and spread by fecal-oral route. About 90% of infections don't cause symptoms or present with a fever only. Infants and young kids are particularly susceptible to symptomatic coxsackie.
======================
[Coxsackievirus belongs to a family of nonenveloped, linear, positive-sense, single-stranded RNA viruses, Picornaviridae and the genus _Enterovirus_, which also includes poliovirus and echovirus. Enteroviruses are among the most common and important human pathogens, and ordinarily its members are transmitted by the fecal-oral route. Coxsackieviruses share many characteristics with poliovirus. With control of poliovirus infections in much of the world, more attention has been focused on understanding the nonpolio enteroviruses such as coxsackievirus.

Coxsackieviruses are divided into group A and group B viruses based on early observations of their pathogenicity in neonatal mice. In general, group A coxsackieviruses tend to infect the skin and mucous membranes, causing herpangina, acute hemorrhagic conjunctivitis, and hand, foot, and mouth (HFM) disease. Both group A and group B coxsackieviruses can cause nonspecific febrile illnesses, rashes, upper respiratory tract disease, and aseptic meningitis.

Group B coxsackieviruses tend to infect the heart, pleura, pancreas, and liver, causing pleurodynia, myocarditis, pericarditis, and hepatitis (inflammation of the liver not related to the hepatotropic viruses). Coxsackie B infection of the heart can lead to pericardial effusion.

The development of insulin-dependent diabetes (IDDM) has recently been associated with recent enteroviral infection, particularly coxsackievirus B pancreatitis.

It is common for the coxsackievirus to cause a febrile upper respiratory tract infection with sore throat and/or a runny nose. Some patients have a cough resembling bronchitis. Less commonly, coxsackievirus may cause pneumonia. Some people with coxsackievirus have a rash. In many, this is a nonspecific generalized red rash or clusters of fine red spots. The rash may not appear until the infection has started to get better.

Coxsackievirus is spread from person to person. The virus is present in the secretions and bodily fluids of infected people. The virus may be spread by coming into contact with respiratory secretions from infected patients. If infected people rub their runny noses and then touch a surface, that surface can harbor the virus and become a source of infection. People who have infected eyes (conjunctivitis) can spread the virus by touching their eyes and touching other people or surfaces. Conjunctivitis may spread rapidly and appear within one day of exposure to the virus. Coxsackieviruses are also shed in stool, which may be a source of transmission among young children. The virus can be spread if unwashed hands get contaminated with fecal matter and then touch the face. This is particularly important for spread within  day-care centers or nurseries where diapers are handled. Diarrhoea is the most common sign of coxsackievirus intestinal infection.

Most infections are self-limiting, and no specific treatment is required or available. Some options include intravenous immune globulin (IVIG), which contains antibodies and may be somewhat effective.

HealthMap/ProMED-mail map:
Odesa oblast, Ukraine: <http://healthmap.org/promed/p/51897>]
Date: Tue 19 Nov 2019 6:07 AM GMT
Source: 3 FM [edited]

There's been an outbreak of a highly contagious disease among wood pigeons on [Isle of Man]. That's according to Manx Wild Bird Aid (MWBA) which says its already taken in a number of the animals from Douglas, Groudle, and Crosby which are suffering with 'canker'.

The infection isn't harmful to humans or mammals but the organisation says it can cause growths in the birds' mouths which can lead them to starve to death.

MWBA is offering advice to people about how to help stop it spreading, including strict hygiene on bird-feeding tables and if you come across a sick pigeon to take it to the nearest vet as soon as possible.  [Byline: Rob Pitchard]
========================
[_Trichomonas gallinae_ is a common protozoan parasite of pigeons (Columbiformes) which principally infects the upper alimentary tract where it can cause necrotic ingluvitis. Epidemic mortalities in columbiform species are sporadically reported, and the parasite may infect other avian taxa such as birds of prey and songbirds. (<http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0012215>). - ProMED Mod.PMB]

[HealthMap/ProMED-mail map of the Isle of Man:

HealthMap/ProMED map available at:
Date: Tue 19 Nov 2019
Source: Caracas Chronicles [edited]

The Venezuelan Public Health Society and the Let's Defend The National Epidemiology Network issued an alert after a case of yellow fever was confirmed in the state of Bolivar, after 14 years without the disease. The Health Ministry hasn't published information about the case or issued an alert, but Venezuela must formally report it to international institutions, due to the risk to a population that isn't vaccinated, having the vector (mosquitoes) in all of the territory (increasing the odds of an epidemic), and the poor access to an epidemiologic report [about the case]. Doctor Julio Castro wrote about the case for Prodavinci.  [Byline: Naky Soto]
======================
[There is little information about this case: where and when it occurred in Bolivar state, tests used to diagnose the case, condition of the patient, and any follow-up measures taken by public health authorities. Yellow fever (YF) virus is endemic in Venezuela as it is in many South American countries.

The most recent ProMED-mail report of YF in Venezuela was in 2010, in Anzoategui state, where there were 3 probable YF cases in monkeys. This outbreak was enzootic, as determined by the Ministry of Health (see Yellow fever - South America: Venezuela (AN) monkey, susp http://promedmail.org/post/20101112.4114).

Presumably, this current case is one of spill-over from the sylvan (forest) transmission cycle. Maintenance of a high level (80-90%) of coverage is essential to prevent cases and avoid outbreaks involving the urban cycle with _Aedes aegypti_ transmission. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Venezuela:
Date: Thu 14 Nov 2019
Source: WHO Emergencies preparedness, response, Disease Outbreak News (DONs) [edited]

On 10 Oct 2019, the National IHR Focal Point for Sudan notified WHO of 47 suspected [human] cases of Rift Valley fever (RVF), including 2 deaths in Arb'aat Area, Towashan Village, in El Qaneb locality, Red Sea State. The suspected cases presented with high-grade fever, headaches, joint pain, vomiting. There were no hemorrhagic signs or symptoms observed. The 1st case presented to the health facility on 19 Sep 2019.

On 28 Sep 2019, a total of 14 samples were sent to the National Public Health Laboratory in Khartoum, and 5 tested positive for RVF by immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) and reverse-transcriptase polymerase chain reaction (RT-PCR). These samples were also tested for malaria and were found negative.

On 13 Oct 2019, a total of 10 suspected RVF cases were recorded in Barbar and Abu Hamed localities, of River Nile State. Of the 10 suspected RVF cases, 5 samples were tested and 4 were found positive for RVF. From 19 Sep 2019 until 11 Nov 2019, a total of 293 suspected human RVF cases, including 11 associated deaths have been reported from 6 states; including the Red Sea (120), River Nile (168), Kassala (2), White Nile (1), Khartoum (1), and Al Qadarif (1) States. The most affected age group is 15-45 years old, which accounts for 83% of the total suspected cases. The male to female ratio is 2.6, with a high proportion of the cases being farmers (37.5%).

These human RVF cases are concomitant with abortions and deaths among goats in the areas where the human suspected and confirmed cases have been reported. From 25 Sep through 3 Nov 2019, 21 goats in Red Sea State were reported as positive for RVF, including 4 deaths; and in River Nile State 16 goats, with 3 deaths, and 37 sheep, with 5 deaths, were confirmed positive for RVF by ELISA test at the Central Veterinary Research Laboratory in Khartoum.

Public health response
----------------------
Red Sea State
-------------
- Activation of RVF task force committee;
- printing and distribution of RVF guidelines;
- deployment of surveillance teams for daily reporting and active case finding in the affected areas;
- establishment of 2 health centers and one dispensary with a capacity of 11 beds, laboratory items, drugs, and supplies to provide health services in the affected villages;
- conducting household inspections and fogging: In Arb'aat area, a total of 452 households were inspected, out of which 30 were found positive for the presence of a competent vector; in Port Sudan, out of 1225 households inspected, 29 were found positive for the competent vector, and fogging was provided to 1949 households;
- the Veterinary Epidemiology Department of the Ministry of Animal Resources conducted vector control in 4 animal enclosures in the affected villages.

River Nile State
- A joint investigation conducted by the State Ministry of Health (SMoH) and WHO on 12 Oct 2019;
- initiation of an RVF Action plan by the SMoH and WHO;
- initiation of Integrated Vector Management (IVM), surveillance, case management, and Rapid Response Team (RRT) activities.

WHO risk assessment
-------------------
RVF is endemic in Sudan. There have been 3 outbreaks affecting humans previously documented in 1973, 1976, and 2008. During the outbreak in 2008, a total of 747 laboratory-confirmed cases were reported, including 230 deaths.

The recent floods, following heavy rains on 13 Aug 2019, caused flash floods in 17 of the 18 states, including Abyei area in West Kordofan State. These floods have favored vector abundance, distribution, and longevity. The current RVF outbreak started on 19 Sep 2019 and has affected states impacted by the floods.

The uncontrolled movements of animal populations within and outside the country borders may increase the spread of the disease to new areas.

RVF can cause significant economic losses due to livestock travel and trade restrictions, as well as high mortality and abortion rates among infected animals.

In a country where the export of livestock is one of the major sources of the national income, the current RVF outbreak, in the context of political unrest and a debilitated health system requires an urgent need for external assistance.

WHO advice
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Rift Valley fever (RVF) is a mosquito-borne viral zoonosis that primarily affects animals but also has the capacity to infect humans. The majority of human infections result from direct or indirect contact with the blood or organs of infected animals. Herders, farmers, slaughterhouse workers, and veterinarians have an increased risk of infection.

Awareness of the risk factors of RVF infection and measures to prevent mosquito bites is the only way to reduce human infection and deaths. Public health messages for risk reduction should focus on:
- reducing the risk of animal-to-human transmission resulting from unsafe animal husbandry and slaughtering practices;
- practicing hand hygiene as well as wearing gloves or other personal protective equipment when handling sick animals or their tissues and when slaughtering animals;
- reducing the risk of animal-to-human transmission arising from the unsafe consumption of raw or unpasteurized milk or animal tissue. in endemic regions, all animal products should be thoroughly cooked before eating;
- reducing the risk of mosquito bites through the implementation of vector control activities (e.g. insecticide spraying and use of larvicidal to reduce mosquito breeding sites), use of insecticide-impregnated mosquito nets and repellents, light-coloured clothing (long-sleeved shirts and trousers);
- restricting or banning the movement of livestock to reduce the spread of the virus from infected to uninfected areas;
- routine animal vaccination is recommended to prevent RVF outbreaks. Vaccination campaigns are not recommended during an outbreak as they may intensify transmission among the herd through needle propagation of the virus;
- outbreaks of RVF in animals precede human cases, thus the establishment of an active animal health surveillance system is essential in providing early warning for veterinary and public health authorities.

WHO advises against the application of any travel or trade restrictions with the affected country based on the current information available on this event.
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[The report above provides a good overview of the development of the current Rift Valley fever outbreak. Surveillance and responses require a One Health approach since both humans and animals are affected and environmental change, in this situation extensive flooding, has promoted vector abundance. Effective vector control over extensive geographical areas is difficult to achieve and is expensive. Maintenance of herd immunity through vaccination of animals can be a successful preventive measure prior to the occurrence of cases. - ProMED Mod.TY]

[Neighbouring Egypt, which suffered introductions of RVF from Sudan in the past, has undertaken preventive measures. This relates initially to the 2 governorates bordering Sudan, namely the Red Sea and the New Valley governorates. In the Red Sea governorate, vaccination has already started. Reportedly, as of 18 Nov 2019, a total of 12 801 animals have been vaccinated, including 11 568 sheep and goats, 712 camels, and 421 cows and buffalo. The vaccination, which is free of charge, is being continued. In the New Valley governorate, 62 guidance seminars about RVF for animal breeders in the 5 provincial centers have been undertaken; the implementation of a "magnified immunization campaign for a month" is said to commence "next Saturday" (23 Nov 2019), "aimed at immunizing 120 000 cattle, goats, and sheep." Intensified surveillance in animals has, reportedly, been applied in both governorates; no suspected cases detected. - ProMED Mod.AS]