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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 ...

Northern Mariana Islands

General:
**********************************
Cuba is an independent island country situated in the Caribbean. It is the largest of the islands and covers 42,000sq miles. The climate is sub tropical throughout the year with most of the rainfall in
the northern parts of the country. Temperatures of between 20C to 35C are fairly standard throughout the year. Generally the winter effects of the American continent only last for short periods.
Safety & Security:
**********************************
The majority of tourists visiting Cuba will have no difficulty but bag snatching and other street crime appears to be increasing. The old Havana area and other major tourist resorts may be particular areas of concern in this regard. On arrival be careful to only use your recognised tour operator. If you are taking a taxi at any stage make sure it is a registered one and not a private vehicle. It is unwise to carry large quantities of money or jewellery away from your hotel and try not to flaunt wealth with your belongings. Pickpockets are too common an occurrence on buses and trains and at train stations so be careful with your essential documents and credit cards. Valuables should not be stored in suitcases when arriving in or departing from Havana as there have been a number of thefts from cases during the time the cases are coming through baggage handling. There is an airport shrink-wrap facility for those departing Havana which reduces the risk of tampering. Remember to carry a photocopy of your main documents (passport, flight tickets etc).
Road Safety:
**********************************
Following a number of serious road accidents involving tourists, you are advised not to use mopeds for travelling around Cuba or in Havana. Also, if you are involved in any accident a police investigation will be required to clear you and this may significantly delay your travel plans. On unlit roads at night there have been a number of accidents associated with roaming cattle (sounds like Ireland!). The traffic moves on the right side of the roads. There is a main highway running the length of the country but many of the country roads are in poor repair.
Local Laws & Customs:
**********************************
When arriving into Cuba make sure you are not carrying any items which could be considered offensive. Any illicit drug offense is treated very seriously and Cuban law allows for the death penalty to be used under these circumstances. If you require personal medication for your health, make sure it is in original packing and carry a letter from your doctor describing the medication. Never agree to carry any item for another individual and always secure your cases once they are packed. Taking photographs of military or police installations or around harbours, rail and airport facilities is strictly forbidden.

Currency:
**********************************
Since 1993 it is now possible to use US dollars for all transactions within Cuba. Remember, there is a 20$ airport departure tax. Certain travellers cheques and credit cards may not be acceptable within Cuba. This is particularly true of American Express cheques and cards but check your situation with the travel operator before departure.
Health Facilities:
**********************************
Generally healthcare facilities outside of Havana are limited and many standard medications may not be available. It is important to carry sufficient quantities of any medications which may be required for the duration of your time in Cuba.
Food & Water:
**********************************
The level of food and water hygiene varies throughout the country and between resorts. On arrival check the hotel cold water supply for the smell of chlorine. If it is not present then use sealed bottled water for both drinking and brushing your teeth throughout your stay. Cans and bottles of drinks are safe but take care to avoid pre-cut fruit. Peel it yourself to make sure it is not contaminated. Food from street vendors should be avoided in most cases. Bivalve shellfish are also a high risk food in many countries and Cuba is no exception in this regard. (Eg Mussels, Oysters, Clams etc)
Malaria & Mosquito Borne Diseases:
***********************************************
Malaria transmission does not occur within Cuba and so prophylaxis is not required. However, a different mosquito borne disease called Dengue has begun to reoccur in the country over the past few years. This viral disease can be very sickening and even progress to death. It is rare for tourists to become infected but avoiding mosquito bites is a wise precaution.
Swimming, Sun & Dehydration:
************************************
The extent of the Cuban sun (particular during the summer months (April to October) can be very excessive so make sure your head and shoulders are covered at all times when exposed. Watch children carefully as they will be a significant risk. Drink plenty of fluids to replace what will be lost through perspiration and, unless there is a reason not to,
take extra salt either on your food or in crisps, peanuts etc. Take care if swimming in the Caribbean to stay with others and to listen to local advice. Never swim after a heavy meal or alcohol.
Rabies Risk in Cuba:
**********************************
This viral disease does occur throughout Cuba and it is essential that you avoid any contact with all warm blooded animals. Dogs, cats and monkeys are the most commonly involved in spreading the disease to humans. Don't pick up a monkey for a photograph! If bitten, wash out the wound, apply an antiseptic and seek urgent medical attention.
Vaccinations for Cuba:
**********************************
There are no essential vaccines for entry / exit if coming from Ireland. However, for your own personal protection travellers are advised to have cover against the following;
*
Tetanus (childhood booster)
*
Typhoid (food & water borne disease)
*
Hepatitis A (food & water borne disease)
For those planning a longer or more rural trip vaccine cover against conditions like Hepatitis B and Rabies may also need to be considered.
Summary:
**********************************
Cuba is becoming a popular destination for tourists and generally most will stay very healthy. However commonsense care against food and water borne disease is essential at all times. Also take care with regard to sun exposure, dehydration and mosquito bites.

Travel News Headlines WORLD NEWS

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Macedonia

Macedonia US Consular Information Sheet
August 15, 2008
COUNTRY DESCRIPTION:
Macedonia is a parliamentary democracy that is steadily transforming its economy. Tourist facilities are available in the capital, Skopje, and other major towns.
In tourist centers, such as Skopje and Ohrid, European-standard hotels and other travel amenities are available, while the standard of facilities throughout the rest of the country varies considerably. Read the Department of State Background Notes on Macedonia for additional information.

ENTRY/EXIT REQUIREMENTS:
Short trip for business or tourism:
A valid passport is required for travel to Macedonia.
A visa is not required for U.S. passport holders for tourist and business trips up to 90 days during a six-month period.
Entry stamps are issued at airports or land border crossing points, which grant permission to remain 90 days.
All foreign citizens must register with local police within 24 hours of arrival.
Those staying in private accommodation or renting an apartment should register in person at the police station nearest his/her place of residence, and should be accompanied to the station by the owner or landlord of the apartment.
Hotels are responsible for the registration of foreign guests.
If the foreigner changes address in Macedonia, he or she should notify the police station where s/he initially registered and reregister with the police station closest to the new place of residence.

An unaccompanied minor U.S. citizen who enters Macedonia should be in possession of a parental or guardian statement of consent to enter and stay in the country.
The statement of consent must be certified by a competent authority of the country from which s/he arrives or by a diplomatic or consular mission of the Republic of Macedonia abroad.

NOTE:
A U.S. citizen who possesses more than one passport is required to leave the country with the travel document used for entry into the country.

Temporary residence:
Individuals intending to work, study or remain longer then 90 (ninety) days in Macedonia, must obtain an entry visa prior to their arrival in Macedonia.
The practice of switching from tourist status to long-term status when already in Macedonia is no longer allowed.
Those wanting to do so must leave Macedonia and apply for a long-term visa at a Macedonian Embassy of Consulate.
Macedonian visas, as opposed to entry stamps, can only be issued at a Macedonian Embassy or Consulate in a foreign country.

American citizens resident in the United States may apply at:
Macedonian Embassy in Washington D.C.2129 Wyoming Avenue, NW, Washington, D.C. 20008, Tel: (202) 667-0501; Fax: (202) 667-2131;
E-mail: washington@mfa.gov.mk; usoffice@macedonianembassy.org, Website: http://www.macedonianembassy.org.

The passport should be valid for at least three months longer than the validity of the visa.
For additional information about the conditions and procedures for visa issuance, the applicant should contact the Embassy or Consulate of the Republic of Macedonia.
Using the list of diplomatic and consular missions of the Republic of Macedonia abroad (which can be found at the Ministry of Foreign Affairs’ website at www.mfa.gov.mk), a visa applicant can choose the most convenient Embassy/Consulate to the submit the visa application.

Travelers should be aware that all
border areas apart from designated border crossings are restricted zones. Presence in these zones is forbidden without prior official permission.

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: The security situation in Macedonia is stable, although occasional criminal violence does occur. Americans should avoid areas with demonstrations, strikes, or roadblocks where large crowds are gathered, particularly those involving political causes or striking workers.

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 overseas callers, 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: Crime in Macedonia is low by U.S. standards, and violent crime against Americans is rare. Pickpocketing, theft, and other petty street crimes do occur, however, particularly in areas where tourists and foreigners congregate. American travelers are advised to take the same precautions against becoming crime victims as they would in any U.S. city. Valuables, including cell phones and electronic items, should not be left in plain view in unattended vehicles. Windows and doors should be securely locked when residences are not occupied. Organized crime is present in Macedonia; organized criminal activity occasionally results in violent confrontations between members of rival organizations. ATM use is safe, as long as standard safety precautions are taken.
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 a 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, 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 find an attorney if needed.

The local equivalent to the “911” emergency line in Macedonia is:
police 192 and ambulance 194
If you are outside the city of Skopje you need to dial 02 first.

For additional assistance see our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Although many Macedonian physicians are trained to a high standard, and a number of well-equipped private clinics are available especially in Skopje, most public hospitals and clinics are not equipped and maintained at U.S. or Western European standards. Basic medical supplies are usually available, but specialized treatment may not be obtainable. Travelers with previously diagnosed medical conditions may wish to consult their physician before travel.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of [country]. Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en/
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Macedonia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Driving safely in Macedonia requires excellent defensive driving skills. Many drivers routinely ignore speed limits and other traffic regulations, such as stopping for red lights and stop signs. Drivers may make illegal left turns from the far right lane, or drive into oncoming lanes of traffic. The combination of speeding, unsafe driving practices, poor vehicle maintenance, the mixture of new and old vehicles on the roads, and poor lighting contributes to unsafe driving conditions. Pedestrians should exercise extreme caution when crossing the street, even when using crosswalks, as local drivers rarely slow down or stop for pedestrians.

A valid U.S. driver’s license in conjunction with an International Driving Permit is required for Americans driving in Macedonia. Driving is on the right side of the road. Speed limits are generally posted. Most major highways are in good repair, but many secondary urban and rural roads are poorly maintained and lit. Horse-drawn carts, livestock, dead animals, rocks, or other objects are sometimes found in the roadway. Some vehicles are old and lack standard front or rear lights. Secondary mountain roads can be narrow and poorly marked, lack guardrails, and quickly become dangerous in inclement weather. Overall, public transportation in Macedonia is dilapidated. Roadside emergency services are limited.
In case of emergency, drivers may contact the police at telephone 192, the Ambulance Service at telephone 194, and Roadside Assistance at telephone 196.

Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Macedonia, the U.S. Federal Aviation Administration (FAA) has not assessed Macedonia’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://faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: Macedonian customs authorities may enforce strict regulations concerning temporary importation to or exportation from Macedonia of certain items, including items deemed to be of historical value or significance. Taking photographs of anything that could be perceived as being of military or security interest may result in problems with authorities. Visitors should always observe “no photographing” signs. If in doubt, please ask permission before taking photographs.

The local currency is the denar. While credit cards are accepted in larger stores and restaurants, cash in local currency is advised for purchases in small establishments.

Upon entry into Macedonia, every foreigner must declare all cash amounts of foreign currency greater than EUR 2,000 at the Customs Control Office. Failure to report funds in excess of this amount may result in the confiscation of the entire amount by the customs service. After going through the court system, an individual is normally required to pay a fine and the National Bank will also keep a certain percentage of the undeclared amount before it is released.
Please also 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 Macedonian laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Macedonia 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. Prostitution is illegal in Macedonia. 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 Macedonia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and to obtain updated information on travel and security within Macedonia. 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 in Skopje is located at Ilindenska bb, 1000 Skopje, tel. (389) (2) 311-6180, fax (389) (2) 321-3767, email: consularskopje@state.gov; web site: http://macedonia.usembassy.gov
* * *
This replaces the Country Specific Information for Macedonia dated March 05, 2008 to update the section on Entry/Exit Requirements.

Travel News Headlines WORLD NEWS

Date: Mon 29 Jul 2019
Source: Institute of Public Health of Republic of North Macedonia [abridged, edited]

Information on the situation of measles in the Republic of North Macedonia in 2018-2019, 25 Jul 2019
--------------------------------------------------------------------------------
In the period from 20 Jul-25 Jul 2019, a total of 5 cases of measles were reported. From the total number of newly reported cases, 4 cases are from Skopje, while one is from Kumanovo.

In total, since the onset of the epidemic in December 2018 as of 25 Jul 2019, 1870 cases of measles have been registered in the Republic of North Macedonia with a disease rate of 90.4 per 100,000 inhabitants.

Due to the epidemiological criteria, a measles epidemic is ongoing in the entire territory of the Republic of North Macedonia.

According to the place of permanent living, measles cases are registered in 24 towns, of which 979 cases are from Skopje, Kumanovo 231, Tetovo 194, Struga 112, Kicevo 59, Veles 53, Gostivar 69, Ohrid 35, Gevgelija 19, Debar 22, Prilep 11, Stip 40, and in other cities less than 10 cases were registered (Chart 1). The highest incidence is registered in Skopje (158.5/100 000, Struga (165.1/100 000, Kumanovo 161.9/100 000)

According to the vaccine status, 1501 or 80.3% of diseased people are unvaccinated, incompletely vaccinated or with unknown vaccine status. >From the non-vaccinated persons, 320 (21.3%) are under the age of 12 months and are not subject to vaccination, according to the Immunization Calendar.

According to the results obtained from the samples sent to Luxembourg's reference measles laboratory, the B3 Dublin genotype circulates in the country, which is circulating also in the neighbouring countries.
 
The total number of immunized people aged 14 years with MRP [morbilli, rubella, and parotitis epidemica/MMR measles, mumps, rubella] vaccine since the start of the epidemic in the republic is 33,729.  From the beginning of the epidemic to present date, in the Centers for Public Health, a total of 6032 people have been vaccinated, of which more than 60% are health workers, students, and pupils in secondary medical schools, the rest are persons over 14 years of age.

[Available at the source URL:]
Chart 1. Geographic distribution of measles in N. Macedonia, December 2018-July 2019
----------------------------------------------
Communicated by:
Aleksandar Jovicic
==========================
[HealthMap/ProMED-mail map of Republic of North Macedonia:
Date: Fri 29 Mar 2019
Source: Institute of Public Health of Republic of Macedonia [abridged, edited]

Information on the situation of measles in the Republic of North Macedonia in 2018-2019, 29 Mar 2019
-------------------

In the period 23 Mar-29 Mar 2019, a total of 109 cases of measles (laboratory confirmed or related to the epidemiological link) were reported.

Out of the total number of newly reported cases, 49 cases are from Skopje, with 89.8% of them incomplete vaccinated, unvaccinated, or with unknown vaccine status. The remaining 60 patients are from 11 other cities in North Macedonia:

- From Kumanovo and Struga, 30 cases (15 cases in each) were reported, of which 90% were unvaccinated, incomplete vaccinated, or with unknown vaccine status;
- From Tetovo and Debar: in 7 cases from Tetovo, 6 were unvaccinated, incomplete vaccinated, or with unknown vaccine status; from Debar, one case was unvaccinated and one with unknown vaccine status;
- From Gostivar, there are 6 cases, of which 5 are unvaccinated, incomplete vaccinated, or with unknown vaccine status;
- 4 cases were reported from Kicevo, with 2 of them unvaccinated and incomplete vaccinated;
- From Veles, 2 cases, with 1 unvaccinated and 1 incomplete vaccinated;
- 1 new case each was reported from Stip (unknown vaccine status), Ohrid (incomplete vaccinated), Radovis (not vaccinated), and Prilep (completely vaccinated).

In total, since the onset of the epidemic in Skopje in December 2018, as of 29 Mar 2019, 767 measles cases were registered in the Republic of North Macedonia, of which 575 were epidemiologically related and reported in the epidemic in Skopje.

According to the place of permanent living, measles cases were registered in 20 towns in Macedonia, of which 521 were from Skopje, 63 from Tetovo, 61 from Kumanovo, 27 from Struga, 18 cases from Gevgelija and Debar, 15 from Gostivar, 12 from Veles, 11 from Kicevo, 4 from Kocani and Shtip, and in sporadic cases in the other 9 cities. The highest incidence per 100 000 inhabitants is registered in Struga (97.3), Skopje (84.4), Debar (64.9), Kumanovo (42.8), and Gevgelija (41.8).

The largest number of cases are from the age group over 30 years, with 305 or 39.8% of the total. A high percentage of patients is also registered in the age group of 0-4 years, with 37.9% of the total number of cases (n = 291).

Out of 150 children aged 1-4 years, 137 or 91.3% were unvaccinated or with unknown vaccine status; from 412 patients in persons over 20 years of age, 69.2% (n = 285) were unvaccinated, incomplete vaccinated, or with unknown vaccine status.

Out of the total number of 767 registered cases of measles, the highest number and percentage, 369 or 48.1%, are laboratory confirmed, 193 or 25.2% are epidemiologically linked, while 205 cases (26.7%) are measles with clinical features.

>From the beginning of the epidemic in Skopje, the total number of vaccinated people under 14 years of age who are subject to 1st or 2nd vaccination is 11 475 children. In the rest of the republic, from the beginning of the epidemic, the total number of vaccinated people up to 14 years of age with a 1st or 2nd dose is 6776 children.

The total number of immunized people aged 14 years with the MRI vaccine since the beginning of the epidemic is 18,251.  Submitted by: Aleksandar Jovicic.
=========================
[HealthMap/ProMED map of North Macedonia
http://healthmap.org/promed/p/55666. - ProMED Mod.MPP]
Date: Fri 8 Mar 2019
Source: IPH (Institute of Public Health of Republic of Macedonia) [abridged, edited]

This week [week of Mon 4 Mar 2019], a total of 81 cases of measles have been reported (laboratory confirmed or with an epidemiological link). A total of 45 cases of measles have been reported from Skopje (of whom 73.3% were incompletely vaccinated, unvaccinated, or with unknown vaccine status) while the other 36 are from 9 other cities in Macedonia.

From Gevgelija, 7 cases were reported, 6 of them unvaccinated. From Kumanovo, 8 cases were reported, 7 unvaccinated. From Tetovo, 7 new cases were reported, 6 of which were not vaccinated, with incomplete vaccine status. From Struga, 5 cases were reported, of which 3 were incompletely vaccinated with unknown vaccine status. Three new cases have been reported from [each of] Debar and Veles; [of these,] 5 persons have been incomplete vaccinated or with unknown vaccine status. Also, one new case from [each of] Kriva Palanka (not vaccinated), Kicevo (unknown vaccine status), and Kocani (completely vaccinated) [were reported].

A total of 493 cases of measles have been registered in Macedonia since the beginning of the epidemic in Skopje since December 2018, of which 410 have been linked to the epidemic in Skopje.

According to the place of permanent living, measles cases were registered in 17 towns in Macedonia, of which 366 cases were from Skopje, 39 from Tetovo, 25 from Kumanovo, 16 from Gevgelija, 9 from Debar, 7 from Struga, 6 from Gostivar, 6 from Veles, 5 from Kichevo, and 4 from Kocani, and the other 7 cities are sporadic cases.

The largest number of cases are from the age group 0-4 years: 220, or 44.6% of the total. A high percentage of patients is also registered in elderly groups. Persons older than 30 years account for 36.9% (n = 182) and persons from 20-29 years for 10.3% (n = 51).

Out of a total of 122 cases of children aged 1-4 years, 105 (86%) were unvaccinated, and out of 233 cases in people over 20 years of age, 70.8% (n = 165) were unvaccinated, incompletely vaccinated, or had unknown vaccine status.

From the total number of registered 493 cases of measles, the highest number and percentage -- 278 (56.4%) -- are laboratory confirmed; 117 (23.7%) are epidemiologically related, while 98 cases (19.9%) are measles [presumably this means clinically diagnosed but not laboratory confirmed. - ProMED Mod.SH].

Since the onset of the epidemic, in Skopje, total of 9958 children under 14 years of age have been vaccinated as part of the response to the outbreak with a 1st or 2nd dose. In the rest of the republic, since the epidemic began, a total of 5193 children up to 14 years have been vaccinated with a 1st or 2nd dose. The total number of those aged 14 years [and under] who have received MRP vaccine since the start of the epidemic in the Republic of Macedonia is 15 151.
Date: Sat 9 Feb 2019
Source: China.org.cn, a Xinhua report [edited]

The Macedonian Health Minister Venko Filipce confirmed on [Fri 8 Feb 2019] the death of a 6-month-old baby related to measles. According to Filipce, the baby was under treatment for lung complications and was not vaccinated.

The minister said vaccination in Macedonia should continue in order to strengthen the immunity of the population after the significant drop on vaccination coverage in 2014.  Filipce also confirmed that 2 children are treated for lung complications but are not in life-threatening conditions. The minister made the remarks after his visit at the Neurology Clinic in Skopje. On [2 Jan 2019], the Health Ministry in Macedonia declared the outbreak of measles in the capital of Skopje.
Date: Wed 2 Jan 2019
Source: Outbreak News Today [abridged, edited]

Health officials in Macedonia are reporting a measles outbreak in the capital city of Skopje. Minister of Health Assoc. Dr. Venko Filipce announced the outbreak declaration today [2 Jan 2019].

In addition to the 7 cases that appeared in the Skopje settlement Radishani 10 days ago, there are now 12 new cases from almost all municipalities in Skopje, of which 6 are officially laboratory confirmed and 6 have a clear clinical picture and are awaiting official laboratory confirmation. The outbreak has affected both children and adults, all of whom were unvaccinated.

"Of the 15 000 unvaccinated children with vaccine calls, only 310 were vaccinated, which is a small figure. It is a good circumstance that schools [were closed] because of the holidays.

"But, of course, we have the situation under control. This is an extremely serious disease that, unfortunately, is sometimes fatal to the lives of children. Any disregard for the recommendations is an additional risk for the health of the whole population," said Minister Filipche (computer translated).  [Byline: Robert Herriman]
=========================
[A total of 310 children vaccinated of 15 000 is only 2% of the children immunized. This is an unacceptably high risk for the children. - ProMED Mod.LK]

[HealthMap/ProMED-mail map:
Skopje, Macedonia (FYROM): <http://healthmap.org/promed/p/1999>]
More ...

Cuba

General:
**********************************
Cuba is an independent island country situated in the Caribbean. It is the largest of the islands and covers 42,000sq miles. The climate is sub tropical throughout the year with most of the rainfall in
the northern parts of the country. Temperatures of between 20C to 35C are fairly standard throughout the year. Generally the winter effects of the American continent only last for short periods.
Safety & Security:
**********************************
The majority of tourists visiting Cuba will have no difficulty but bag snatching and other street crime appears to be increasing. The old Havana area and other major tourist resorts may be particular areas of concern in this regard. On arrival be careful to only use your recognised tour operator. If you are taking a taxi at any stage make sure it is a registered one and not a private vehicle. It is unwise to carry large quantities of money or jewellery away from your hotel and try not to flaunt wealth with your belongings. Pickpockets are too common an occurrence on buses and trains and at train stations so be careful with your essential documents and credit cards. Valuables should not be stored in suitcases when arriving in or departing from Havana as there have been a number of thefts from cases during the time the cases are coming through baggage handling. There is an airport shrink-wrap facility for those departing Havana which reduces the risk of tampering. Remember to carry a photocopy of your main documents (passport, flight tickets etc).
Road Safety:
**********************************
Following a number of serious road accidents involving tourists, you are advised not to use mopeds for travelling around Cuba or in Havana. Also, if you are involved in any accident a police investigation will be required to clear you and this may significantly delay your travel plans. On unlit roads at night there have been a number of accidents associated with roaming cattle (sounds like Ireland!). The traffic moves on the right side of the roads. There is a main highway running the length of the country but many of the country roads are in poor repair.
Local Laws & Customs:
**********************************
When arriving into Cuba make sure you are not carrying any items which could be considered offensive. Any illicit drug offense is treated very seriously and Cuban law allows for the death penalty to be used under these circumstances. If you require personal medication for your health, make sure it is in original packing and carry a letter from your doctor describing the medication. Never agree to carry any item for another individual and always secure your cases once they are packed. Taking photographs of military or police installations or around harbours, rail and airport facilities is strictly forbidden.

Currency:
**********************************
Since 1993 it is now possible to use US dollars for all transactions within Cuba. Remember, there is a 20$ airport departure tax. Certain travellers cheques and credit cards may not be acceptable within Cuba. This is particularly true of American Express cheques and cards but check your situation with the travel operator before departure.
Health Facilities:
**********************************
Generally healthcare facilities outside of Havana are limited and many standard medications may not be available. It is important to carry sufficient quantities of any medications which may be required for the duration of your time in Cuba.
Food & Water:
**********************************
The level of food and water hygiene varies throughout the country and between resorts. On arrival check the hotel cold water supply for the smell of chlorine. If it is not present then use sealed bottled water for both drinking and brushing your teeth throughout your stay. Cans and bottles of drinks are safe but take care to avoid pre-cut fruit. Peel it yourself to make sure it is not contaminated. Food from street vendors should be avoided in most cases. Bivalve shellfish are also a high risk food in many countries and Cuba is no exception in this regard. (Eg Mussels, Oysters, Clams etc)
Malaria & Mosquito Borne Diseases:
***********************************************
Malaria transmission does not occur within Cuba and so prophylaxis is not required. However, a different mosquito borne disease called Dengue has begun to reoccur in the country over the past few years. This viral disease can be very sickening and even progress to death. It is rare for tourists to become infected but avoiding mosquito bites is a wise precaution.
Swimming, Sun & Dehydration:
************************************
The extent of the Cuban sun (particular during the summer months (April to October) can be very excessive so make sure your head and shoulders are covered at all times when exposed. Watch children carefully as they will be a significant risk. Drink plenty of fluids to replace what will be lost through perspiration and, unless there is a reason not to,
take extra salt either on your food or in crisps, peanuts etc. Take care if swimming in the Caribbean to stay with others and to listen to local advice. Never swim after a heavy meal or alcohol.
Rabies Risk in Cuba:
**********************************
This viral disease does occur throughout Cuba and it is essential that you avoid any contact with all warm blooded animals. Dogs, cats and monkeys are the most commonly involved in spreading the disease to humans. Don't pick up a monkey for a photograph! If bitten, wash out the wound, apply an antiseptic and seek urgent medical attention.
Vaccinations for Cuba:
**********************************
There are no essential vaccines for entry / exit if coming from Ireland. However, for your own personal protection travellers are advised to have cover against the following;
*
Tetanus (childhood booster)
*
Typhoid (food & water borne disease)
*
Hepatitis A (food & water borne disease)
For those planning a longer or more rural trip vaccine cover against conditions like Hepatitis B and Rabies may also need to be considered.
Summary:
**********************************
Cuba is becoming a popular destination for tourists and generally most will stay very healthy. However commonsense care against food and water borne disease is essential at all times. Also take care with regard to sun exposure, dehydration and mosquito bites.

Travel News Headlines WORLD NEWS

Date: Fri, 18 Oct 2019 22:45:46 +0200 (METDST)

Washington, Oct 18, 2019 (AFP) - The US moved to further hurt Cuba's vital tourism industry by tightening the ability of the country's airlines to lease aircraft.   The US Department of Commerce said it was revoking existing licenses for US companies leasing aircraft to Cuban carriers, and will deny future applications for aircraft leases.   The move could make it harder for Cuba to service its rapidly growing tourism sector, a key source of foreign revenue for the poor country.

Washington has stepped up pressure on Havana due to its support for the embattled regime of Venezuelan President Nicolas Maduro.   "This action by the Commerce Department sends another clear message to the Cuban regime -- that they must immediately cease their destructive behaviour at home and abroad," Secretary of Commerce Wilbur Ross said in a statement.

It was not immediately clear how many aircraft the move would impact.   Cuba's cash-poor carriers depend on aircraft rented from leasing companies or other airlines, which are often very old.   In May 2018, 112 people died in the crash of a 39-year-old Boeing 737 leased by national carrier Cubana de Aviacion from a small Mexican firm, Global Air.

In June of this year, US President Donald Trump announced a US ban on cruise ship stopovers by Americans on the island, forcing Havana to cut its 2019 tourism target by 15 percent to 4.3 million visitors.   Nearly 900,000 tourists visited the island on cruise ships last year, and almost 40 percent were American, according to official figures.   The announcement Friday also expanded restrictions on imports from Cuba and on products with US content that can be sold to the country.
Date: Wed 3 Jul 2019
Source: 660 City News [edited]

A Newfoundland woman is warning travellers to do their research before adventurous excursions abroad after she and several other Newfoundlanders became ill from a mysterious disease traced back to a cave she visited in Cuba. The illness was eventually identified as a respiratory infection called histoplasmosis, or "cave disease," caused by spores from bird or bat droppings in damp soil. [She] of Paradise, NL, travelled to Cuba with her husband on 27 Apr [2019], but her fever-like symptoms didn't appear until 21 May [2019], weeks after she returned home. X-rays showed nodules in her lungs and tests showed low blood counts. Her condition baffled local doctors, who initially thought her lung infection could be some form of pneumonia. The clue to her illness came from a chance meeting she'd made on the trip with a family of Newfoundlanders who had a mutual friend. [She] and her husband had travelled with the group on a tour that included cave diving in the Matanzas province of Cuba.

Back in Canada, a number of their new friends had also fallen ill. [She] and the travellers informed their doctors that they knew each other and were experiencing the same symptoms, and their illness was identified as a respiratory infection called histoplasmosis, or "cave disease." [She] said pinpointing the source of her condition offered some relief from what she called a terrible, alarming health issue that she feared might have been cancerous. "You didn't want to be too excited about the fact that somebody else was sick, but at least cancer was off the table," [she] said by phone Wednesday [3 Jul 2019].

Eastern Health, [her] local health authority, has issued an advisory for travellers heading to the Americas, Africa, East Asia and Australia to avoid contracting the disease. Histoplasmosis is a treatable disease, contracted by breathing in airborne spores where bird or bat droppings are disturbed in damp soil. Eastern Health described its symptoms as including "cough and chest pain, shortness of breath, fever and chills, headaches and flu-like illness." The disease is treatable and most people who contract it never show symptoms, but it can be serious for infants or people with compromised immune systems. The health authority said the advisory was issued after a low number of histoplasmosis cases were confirmed in the Eastern Health region. An exact number of cases could not be provided for privacy reasons, but [the patient] said she's heard of at least 5 others.

While the disease is treatable, it is rare in Newfoundland, making treatment more complicated. [The patient] said she's waiting to receive an anti-fungal medication that had to be approved from outside of the province, and she's been told she'll have to take the drug for treatment for the next 3 months to a year. [The patent] said she's still experiencing fatigue and a persistent cough, and her voice is still scratchy and strained from an illness she contracted from what was one of the most breathtaking excursions on her vacation. "It was absolutely amazing," she said of the cave. "It was so pristine and so nice-looking when we went in."

[She] said she'd advise other travellers to do a thorough background check on the regions they're visiting and any planned excursions. "It's without a doubt that you have to go and you have to research the excursion that you're going on," she said. "You have to know the region, the areas, 100%. [She] wrote a Facebook post about her experience that's been shared thousands of times, and she said people as far as France have written to her about experiencing similar, undiagnosed symptoms after travelling abroad.  [Byline: Holly McKenzie-Sutter]
====================
[_Histoplasma capsulatum_, a dimorphic fungus that grows in a mycelial form at ambient temperatures and as yeast at body temperature in mammals, is found worldwide in soil enriched by bird or bat droppings. Contaminated soil can be potentially infectious for years. Fungal spores become airborne during activities that disturb the contaminated soil, such as spelunking, mining, construction, excavation, demolition, roofing, chimney cleaning, farming, or gardening, which can lead to clusters of cases of histoplasmosis that follow inhalation of the aerosolized spores. The spores can travel distances downstream from the source in currents of air. Because of the presence of bats in caves, cave exploration is a known risk factor for histoplasmosis, which is sometimes known as "cave fever" (<https://www.ncbi.nlm.nih.gov/pubmed/10403317>). Physicians should be aware of the association between histoplasmosis and caving when caring for individuals who develop an acute febrile respiratory illness after cave exploration (<http://tinyurl.com/yxjust7x>).

Another disease that has also acquired the name "cave fever" is tick-borne relapsing fever (TBRF). See ProMED-mail posts Tick-borne relapsing fever - Israel: spelunkers, tourists http://promedmail.org/post/20180422.5761531 and Tick-borne relapsing fever - USA: (TX) cave workers, 2017 http://promedmail.org/post/20180420.5759542.

Although birds cannot be infected by the _H. capsulatum_ and do not transmit the disease, bats can become infected by _H. capsulatum_ and may harbor the fungus in their gut (<https://academic.oup.com/jtm/article/15/2/133/1801173>).

In the US, histoplasmosis is endemic in the Ohio, Missouri, and Mississippi River valleys, where it is caused by _H. capsulatum_ var. _capsulatum_. Histoplasmosis has also been reported in Mexico, Central and South America, Oceania, Asia, Africa, and Europe (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4535725/>). In Africa, histoplasmosis occurs most commonly in west and central Africa, where it is caused by the _duboisii_ variety, which has yeast cells that average about twice the size of _H. capsulatum_ var. _capsulatum_  (<http://www.reviberoammicol.com/1997-14/155159.pdf>).

Most individuals with histoplasmosis are asymptomatic. Those who develop clinical manifestations are usually immunocompromised or are exposed to a large number of spores. Disseminated disease is especially more common in HIV/AIDS co-infected cases. - ProMED Mod.ML]

[HealthMap/ProMED-mail maps:
Newfoundland, Newfoundland and Labrador, Canada:
Date: Wed, 5 Jun 2019 03:22:19 +0200
By Paul HANDLEY

Washington, June 5, 2019 (AFP) - The Trump administration clamped down on US tourist visits to Cuba Tuesday, aiming to cut the flow of dollars to a country that Washington accuses of helping prop up Venezuelan President Nicolas Maduro.

The Treasury Department banned group educational travel, cruise ship and private yacht visits by Americans, taking aim at the most common ways US tourists and Cuban-Americans visit the Caribbean island.   The move could constitute a heavy hit on Cuba, which saw more than a quarter-million US visitors in the first four months of 2019, almost double the figure from a year earlier.   "The United States holds the Cuban regime accountable for its repression of the Cuban people, its interference in Venezuela, and its direct role in the man-made crisis led by Nicolas Maduro," the State Department said in a news release.   "Empowered by Cuba, he has created a humanitarian disaster that destabilizes the region."

White House National Security Advisor John Bolton said the aim was to end what the administration considers "veiled tourism" to Cuba.   "We will continue to take actions to restrict the Cuban regime's access to US dollars," Bolton said on Twitter.   The Cuban government condemned the move, which could cost the country's economy tens of millions of dollars a year in lost income.   "They seek to stifle the economy and damage the standard of living of Cubans to wrest political concessions," said Foreign Affairs Minister Bruno Rodriguez in a tweeted statement. "They'll fail again."

- Reverses Obama's historic opening -
American tourism in Cuba took off after then-president Barack Obama moved to ease the half-century trade embargo against the communist government in 2014 -- even though continuing restrictions kept visits nominally in the realm of cultural and artistic exchanges and business dealings.   Cuba and the US restored ties in 2015 and Obama himself visited Havana in a historic presidential trip in March 2016, meeting with then-president Raul Castro. Weeks later, the ban was lifted on US commercial ship visits, opening the door for the Caribbean cruise ship industry to expand stops in Cuba.

But President Donald Trump came into office attacking the Obama opening, and within months began tightening relations, first by banning individual visits and limiting commercial interactions.   The State Department tied the new ban directly to Havana's support for Maduro -- whose embattled regime faces a direct challenge from US-backed opposition leader Juan Guaido, the self-declared acting president of Venezuela.  "Veiled tourism has served to line the pockets of the Cuban military, the very same people supporting Nicolas Maduro in Venezuela and repressing the Cuban people on the island," the State Department said.

- 'Political grandstanding' -
Collin Laverty, president of Cuba Educational Travel, one of the US agencies which arranges visits to Cuba, accused the Trump administration of playing politics by trying to appease conservative anti-Havana Cuban immigrants in Florida, an important election swing state where they carry significant political weight.   "This political grandstanding aimed at Florida in the run up to the 2020 elections is so unfortunate for the millions of Cubans that will feel the crunch from less US visitors," said Laverty.   "This has nothing to do with empowering the Cuban people and has everything to do with empowering a handful of people in Florida that have never even been to Cuba."   Travel industry officials said that people who are booked on tours now will be able to go, ensuring that advanced-booked cruise ships will likely be operating from Florida to Havana throughout this year.   But Royal Caribbean Cruises said ships leaving Wednesday and Thursday of this week will skip previously scheduled stops in Cuba as the company examines the new US policy.

Norwegian Cruise Lines said they are seeking additional information on the new policy to see how it will affect future travel.   Tessia Aral, the owner of ABC Charters in Miami, said it could have a huge impact on her business, which arranged trips to Cuba for about 10,000 people last year.   She said it will hurt not only companies like hers but also those of the many entrepreneurs in Cuba who have built businesses to serve tourists.   "The people making the rules have never been to Cuba. They don't know how things have changed" in recent years, she said.   "What they are doing is counter-productive. I believe it's really going to hurt the private entrepreneurs in Cuba -- all the private restaurants, all the private homes" who serve tourists.
Date: Sun, 10 Mar 2019 04:13:11 +0100
By Katell ABIVEN

Havana, March 10, 2019 (AFP) - In Havana, there's a shop selling a camera for more than $25,000 -- roughly 850 times the average monthly wage in Cuba.   The eye-popping sum earned predictable scorn on social media, but it begins to make sense when seen through the lens of the island's fledgling bid to tap into the luxury tourism market.

The exclusive camera store and other boutiques featuring A-list brands like Versace and Armani are located in a shopping gallery on the ground floor of the swanky Gran Hotel Manzana.   The mere existence of the shops certainly seems incongruous in a country that has been governed as a one-party communist state since 1959, and where the average wage is $30 a month.   But the hotel isn't exactly looking for locals to buy in -- it attracts "a clientele of private airplanes... princes and celebrities," according to general manager Xavier Destribats.

The Gran Hotel Manzana, the first ever five-star establishment in Havana, opened in 2017 in a sumptuous historic building that was, at the beginning of the 20th century, the island's first shopping mall.   The property run by Swiss group Kempinski is "the first genuine luxury hotel in Havana," said Destribats.   "It's the first hotel with a 1,000-square-meter spa," he said. All the rooms are at least 40 square meters (430 square feet), with prices ranging from $370 for a basic room in low season to $5,000 for the presidential suite.   "There was a certain type of clientele that didn't travel to Havana, or Cuba, because there wasn't the standard of luxury five-star hotel like in cities such as Paris or London," Destribats added.

- 'Feels like Miami' -
The hotel terrace offers stunning views over Havana's colorful historic neighbourhood, where many Cubans live in dilapidated buildings that have fallen into disrepair or have vegetation sprouting from them.   "It really doesn't feel like Cuba, clearly not -- it feels like being in the United States, Miami or Puerto Rico," said Celia Liegeois, a 26-year-old tourist from Paris.   Having traveled around the island nation for three weeks, she and a friend had decided to spend their last few days relaxing by the hotel's rooftop pool.

Nearby, Suki Lu, a recently arrived 28-year-old Chinese television presenter, is impressed at what she sees.   "It's beautiful. Look at the sunset! It's truly addictive," she said.   "I live in Dubai so when you talk about luxury hotels, the level there is really high, but I think I'll like this hotel," she said, while her friend used a drone to get an aerial view of the building.   The largest single group of visitors to the Gran Hotel Manzana -- one-fifth of the total -- are tourists from the United States, although there are plenty of visitors from Europe, Asia and the Middle East.

The Kempinski group, which hopes to open two or three more hotels in Cuba, is of course not the only chain to show an interest in the ultra-luxury market.   In September 2018, Spain's Iberostar opened its second five-star hotel, the Grand Packard.   French hotel giant Accor is planning on opening its own luxury establishment on the Malecon, Havana's famous seaside boulevard, in September.   It will include a chocolate shop on its ground floor and a restaurant and concert space on its roof.   The employees' outfits will be designed by Spanish fashion designer Agatha Ruiz de la Prada.

- US blacklist -
However, there is a slight catch: in every case, the hotels are owned by Gaviota, the Cuban army's branch dedicated to tourism.   The foreign hotel groups are only allowed to run the establishments, all built by French group Bouygues, which has a long-standing local presence.   Authorities don't publish the army's revenues, but this alliance between hoteliers and the military landed the luxury hotels on Washington's blacklist.

US tourists are technically banned from staying in the hotels -- but the restriction can be easily circumvented by either paying in cash or booking through travel agents.   Beyond hotels, developers have more ideas to entice those with deep pockets.   "There's a plan to build golf courses in partnership with real estate groups," said industry expert Jose Luis Perello.   The opening of a luxury hotel means Cuba has turned a corner, he said.   "Since it opened up to international tourism more than 20 years ago, Cuba has focused all its plans and strategies" on "sun and beach tourism" for the masses, Perello said.   That category currently accounts for 73 percent of the 70,000 hotel rooms on offer in Cuba. And those who rent them usually don't spend much money.

The same goes for cruise ship tourists -- while the number of cruises docking in Cuba has exploded, passengers only spend an average of $15 a day on land.   That isn't great news for Cuba, which welcomed 4.7 million tourists in 2018 -- it needs the cash.   The government, which has been subjected to US sanctions since 1962, used to depend on aid from its oil-rich ally Venezuela.   But with Venezuela in turmoil, Cuba is scrambling for other sources of hard currency and its economic growth has stagnated at around one percent -- not enough to cover the population's basic needs.   Opening luxury hotels is "a new stage," but also "a necessity," Tourism Minister Manuel Marrero Cruz says.
Date: Mon, 4 Feb 2019 03:08:04 +0100

Havana, Feb 4, 2019 (AFP) - The number of people killed in the powerful tornado that ripped through part of Havana last week has risen to six, authorities said Sunday.    Public Health Minister Jose Angel Portal Miranda said in state media that "sadly, two people have died among the 13 who were in critical condition." The earlier death toll was four.

The storm which hit Havana area towns including Regla, Guanabacoa, San Miguel de Padron and 10 de octubre late January 27, has been confirmed as a F4 storm, with F5 the strongest.    Its powerful winds overturned trees and homes and cars, and several areas a number of blocks wide were all but wiped off the map.
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Portugal

Portugal US Consular Information Sheet
November 18, 2008

COUNTRY DESCRIPTION:
Portugal is a developed and stable democracy with a modern economy.
Tourist facilities are widely available.
Read the Department of State Backgrou
d Notes on Portugal for additional information.
ENTRY/EXIT REQUIREMENTS:
Portugal is a party to the Schengen agreement.
As such, U.S. citizens may enter Portugal 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.

Portuguese law requires some non-European Union foreign nationals to register with immigration officials within three working days of entering Portugal.
The law affects those who transit another Schengen area country by air en route to Portugal and stay at noncommercial accommodations.

Travelers may also contact the Embassy of Portugal at 2012 Massachusetts Avenue NW, Washington, DC
20036, tel. (202) 350-5400, or the Portuguese Consulates in Boston, MA; New Bedford, MA; Providence, RI; New York, NY; Newark, NJ; San Francisco, CA; or Los Angeles, CA.
Visit the Government of Portugal’s web site at http://embassyportugal-us.org/ for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
Portugal remains largely free of terrorist incidents.
However, like other countries in the Schengen area, Portugal’s open borders with its Western European neighbors allow the possibility of terrorist groups entering/exiting the country with anonymity. Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.
Brief general strikes and public protests by public sector employees, industrial workers and/or university student groups take place with some frequency, but are usually publicized in advance and are rarely violent.

For the latest security information, Americans living and 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 A Safe Trip Abroad.
CRIME:
Portugal has a relatively low rate of violent crime.
Travelers may become targets of pickpockets and purse snatchers, particularly at popular tourist sites, restaurants, or on public transportation.
Rental cars and vehicles with non-local license plates can be targets for break-ins; travelers should remove visible luggage from vehicles upon parking.
Travelers should also avoid using automatic teller machines in isolated or poorly lit areas. Drivers in Portugal should keep car doors locked when stopped at intersections.
In general, visitors to Portugal should carry limited cash and credit cards on their person, and leave extra cash, credit cards, and personal documents at home or in a hotel safe.
While thieves may operate anywhere, the U.S. Embassy receives most reports of theft from the following areas:
Lisbon:
Pickpocketing and purse snatching in the Lisbon area sometimes occurs in buses, restaurants, the airport, trains, train stations, and trams, especially aboard tram number 28 to the Castle of São Jorge.
Theft of purses, briefcases and wallets also occurs in hotel lobbies, restaurants and elevators.
At restaurants, items hung over the backs of chairs or placed on the floor may be stolen.
There have been incidents of theft of unattended luggage from the Lisbon Airport.
Special care should be taken in the Santa Apolonia and Rossio train stations, the Alfama and Bairro Alto districts, the Castle of São Jorge and the area of Belém. Though violent crime against tourists is uncommon, an American man was attacked by knife-wielding robbers in September 2008 while walking down the street in Cascais (a popular seaside town near Lisbon) in the early morning hours.

Outside Lisbon:
Thefts have been reported in the towns of Sintra, Cascais, Mafra, Fatima and in the Algarve.
Automobile break-ins sometimes occur in parking areas at tourist attractions and near restaurants.
Special care should be taken in parking at the Moorish Castle and Pena Palace in Sintra and at the beachfront areas of Guincho, Cabo da Roca, and Boca do Inferno.

Azores:
Pickpocketing and purse snatching are not common occurrences in the Azores. There are no reports of organized crime or gangs.

Madeira:
Pickpocketing, while infrequent, may occur in the Old Town and Santa Catarina Park areas of Funchal.

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.

Portugal has a crime victim’s assistance program, administered through an organization known by its acronym, "APAV."
Click here for more information (translated into English). Office hours are weekdays, 10 a.m. to 1 p.m., and 2 – 5 p.m. Phone: [351] 707 20 00 77.
To learn about possible sources of American compensation, see our information on Victims of Crime.
The local equivalent to the “911” emergency line in Portugal is: 1-1-2.
English-speaking operators are normally available.

MEDICAL FACILITIES AND HEALTH INFORMATION: Good medical care is available, but facilities may be limited outside urban areas.
Public hospitals offer services at a lower cost generally than private hospitals but sometimes do not maintain the same standards as hospitals in the United States.
Travelers are encouraged to obtain insurance that would cover medical services from a private Portuguese hospital or clinic.
Private hospitals will ask for a credit card or other form of payment upon admission.
In a life-threatening emergency, an ambulance can be requested by calling the national emergency response telephone number 1-1-2.
On the other hand, private ambulances should only be used for transport, not life-threatening emergencies, and usually require on-the-spot payment.
Note that the responsiveness of emergency services is often not up to U.S. standards.

PRESCRIPTION MEDICINES: Travelers sometimes request that relatives or friends in the U.S. mail prescription medicines to them in Portugal, but to do so violates Portuguese law and usually results in the shipment of medications being impounded by Portuguese Customs.
When this occurs, the medications may not be released.
Travelers who use prescription medicine should bring a sufficient supply with them to cover their anticipated stay in Portugal, along with a copy of their physician's prescription.
Should an unforeseen need for prescription refills or new medications arise, Portuguese pharmacies generally carry equivalent medications to those found in the United States, however, they may be sold under a different brand, may not be available in the same dosage, and may require a prescription from a local doctor.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Portugal.

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

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Portugal is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Portugal has one of the highest rates of automobile accidents and related fatalities in Europe.
Drivers should use extreme caution, as local driving habits, high speeds, and poorly marked roads pose special hazards.
In Portugal, fines for traffic violations are substantial and usually must be paid on the spot. Taxis are a reliable means of transportation, though travelers should be alert to possible discrepancies between the meter fare and the amount requested by the driver.
Buses are reliable and inexpensive.

In the Azores, driving can be treacherous due to narrow cobblestone streets, blind curves, unprotected embankments, herds of cows in the countryside roads, and the high speeds of other drivers.
In contrast to the situation on the Portuguese mainland, traffic violations are registered by radar and later forwarded to the offender via the postal service; payments are not made on the spot.
Taxis do not have meters.
The fare consists of a base fee plus a posted rate per kilometer traveled.
Public buses are inexpensive.
Bus services begin at 7:00 a.m. and generally operate until 8:00 p.m. depending on the destination.

U.S. visitors to Portugal may drive with a valid U.S. driver's license for up to six months. For international driving permits, please contact AAA or the National Auto Club.
For specific information concerning Portuguese driver's permits, vehicle inspection and mandatory insurance, please contact the Portuguese National Tourist Office by telephone at 1-800-767-8842 or visit the website for the Portuguese Directorate-General for Traffic at www.dgv.pt.
Please refer to our Road Safety page for more information. Visit the website of Portugal’s national authority responsible for road safety at www.dgv.pt
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Portugal's Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Portugal’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa/.

SPECIAL CIRCUMSTANCES:
Portuguese customs authorities may enforce strict regulations concerning temporary importation into or export from Portugal of such items as firearms, antiquities, medications, business equipment, sales samples and other items.
It is advisable to contact a Portuguese Embassy or Consulate in the United States for specific information regarding customs requirements.
Portugal's customs authorities encourage the use of an ATA (Admission Temporaire/ Temporary Admission) carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes.
ATA Carnet Headquarters, located at the U.S Council for International Business, 1212 Avenue of The Americas, New York, NY 10036, issues and guarantees the ATA carnet in the United States.
For additional information, please telephone (212) 354-4480, or send an e-mail to atacarnet@uscib.org, or visit http://www.uscib.org for details.
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 Portugal’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Portugal 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 Portugal are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Portugal. 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 on Avenida das Forças Armadas, in the neighborhood of Sete Rios.
Telephone 351-21-727-3300, fax 351-21-727-2354, home page: portugal.usembassy.gov.

The U.S. Consulate in the Azores is located in the city of Ponta Delgada on the island of San Miguel. The address is Av. Principe do Monaco, 6-2o, telephone 351-296-282-216, fax 351-296-28-72-16.

There is a part-time U.S. Consular Agency in Funchal, on the island of Madeira, on Rua Alfandega, no. 10-2, Room A-B, telephone 351-291-235-636, fax 351-291-229-360.
The Consular Agency is open Monday through Friday, from 10:00 a.m. to 12:00 p.m.
*

*

*
This replaces the Country Specific Information for Portugal dated April 25, 2008, to update sections on entry/exit requirements, safety and security, information for victims of crime, crime, and medical facilities and health information.

Travel News Headlines WORLD NEWS

Date: Sun, 18 Aug 2019 23:01:00 +0200 (METDST)

Lisbon, Aug 18, 2019 (AFP) - Portuguese fuel tanker drivers whose strike has caused fuel shortages at the summer holiday season on Sunday ended their industrial action.   Drivers have been staging a strike since Monday to demand further wage increases in 2021 and 2022, prompting the government to declare an energy crisis.   "Since all the conditions are now in place to negotiate, we decided to end the strike," Pedro Pardal Henriques, spokesman for the National Union of Dangerous Goods Carriers (SNMMP), told reporters.

A meeting is scheduled for Tuesday, the union President Francisco Sao Bento said, adding that the union did not "rule out new strikes being called if Antram (the employers association) adopts an uncompromising attitude".   Police had launched an operation to escort fuel tankers with extra supplies and Portugal also mobilised about 500 members of the security forces to replace the strikers and drive the trucks.   Despite the shortages, Energy Minister Joao Pedro Matos Fernandes said about two-thirds of the country's 3,000 or so petrol stations had not run dry.
Date: Sun, 11 Aug 2019 15:52:22 +0200 (METDST)

Lisbon, Aug 11, 2019 (AFP) - Many Portuguese petrol stations were sold out Sunday after drivers rushed to fill up before a strike by fuel-tanker drivers kicks off at the height of the summer holidays.   "Empty" signs hung on pumps in Lisbon and elsewhere across the country a few hours before the strike was to begin at midnight (2200 GMT).

"There was enormous anticipation" by car owners, Prime Minister Antonio Costa said, noting that sales had almost doubled in recent days.   An internet site that compiles reports from drivers,  https://janaodaparaabastecer.vost.pt, said that almost 15 percent of the country's 3,000-plus stations were partially or fully sold out.   The open-ended strike appeared certain after an ultimate meeting of unions on Saturday failed to satisfy truck driver's demands for a pay raise.   They staged a four-day strike in April, shortly before Easter weekend, that also caused significant fuel shortages.

The truck drivers, led by a union founded in November 2018, suspended that movement after receiving the wage increase they demanded of at least 1,400 euros ($1,580).   But they are now asking employers to give them new increases in 2021 and 2022.   The government has declared an "energy crisis" which allows it to ration fuel -- to 25 litres (6.6 US gallons) for car owners and 100 litres for trucks.   It has also decreed that tanker drivers will have to deliver a minimum of 50 percent of their normal shipments.

Airports are another priority for fuel deliveries, and around 500 soldiers and paramilitary police could be called upon to drive tanker trucks if the minimum level of deliveries is not adhered to.   Costa did not rule out requisitioning drivers if the situation called for it, while warning that even if the minimum level of service was provided "the strike is going to affect consumers deeply."
Date: Tue, 23 Jul 2019 14:20:24 +0200
By Levi FERNANDES

Lisbon, July 23, 2019 (AFP) - Hundreds of Portuguese firefighters aided by overnight rain gained the upper hand Tuesday against massive wildfires raging for four days and said they hoped to bring them completely under control later in the day before winds pick up and temperatures rise again.

Meanwhile Portugal's civil protection agency rejected critism that not enough resources were deployed to battle the blazes which have ripped through the heavily forested Castelo Branco region, 200 kilometres (120 miles) north of Lisbon, scorching large areas and leaving a trail of blackened destruction.   "The work carried out throughout the night has born its fruits," commander Luis Belo Costa of the agency told a news conference.

"It has been a constant effort. Let's see if we can finish the job," he said, adding that firefighters had managed to stop the advance of the flames in hard-to-reach areas.   Light rains overnight raised humidity levels, aiding the battle against the blazes which the authorities suspect were deliberately started.   But Costa warned winds were expected to pick up in the afternoon, which could complicate the task.

Portugal's civil protection agency had said on Monday morning the wildfires were "90 percent controlled", but strong winds fanned the flames into life again in the afternoon.   At least 7,000 hectares (17,300 acres) have so far been scorched, according to the EU's European Forest Fire Information System.   Nearly 1,300 firefighters were still deployed, Portugal's civil protection agency said Tuesday.
Date: Thu, 18 Apr 2019 03:07:58 +0200

Canico, Portugal, April 18, 2019 (AFP) - Twenty-nine German tourists were killed when their bus spun off the road and tumbled down a slope before crashing into a house on the Portuguese island of Madeira.   Drone footage of the aftermath of the accident showed the badly mangled wreckage of the bus resting precariously on its side against a building on a hillside, the vehicle's roof partially crushed and front window smashed.

Rescue workers attended to injured passengers among the undergrowth where the bus came to rest, some of them bearing bloodied head bandages and bloodstained clothes, others appearing to be more seriously hurt.   Local authorities said most of the dead were in their 40s and 50s.   They were among the more than one million tourists who visit the Atlantic islands off the coast of Morocco each year, attracted by its subtropical climate and rugged volcanic terrain.   "Horrible news comes to us from Madeira," a German government spokesman tweeted after the crash.   "Our deep sorrow goes to all those who lost their lives in the bus accident, our thoughts are with the injured," he added.

German holidaymakers were the second largest group after British tourists to visit the islands -- known as the Pearl of the Atlantic and the Floating Garden in the Atlantic -- in 2017, according to Madeira's tourism office.    The islands are home to just 270,000 inhabitants.    Filipe Sousa, mayor of Santa Cruz where the accident happened, said 17 women and 11 men were killed in the crash, with another 21 injured.    A doctor told reporters another woman died of her injuries in hospital.   "I express the sorrow and solidarity of all the Portuguese people in this tragic moment, and especially for the families of the victims who I have been told were all German," President Marcelo Rebelo de Sousa told Portuguese television.   He said he would travel to Madeira overnight.

- 'Profound sadness' -
Portuguese Prime Minister Antonio Costa added on Twitter that he had contacted German Chancellor Angela Merkel to convey his condolences   "It is with profound sadness that I heard of the accident on Madeira," he wrote on the government's Twitter page.   "I took the occasion to convey my sadness to Chancellor Angela Merkel at this difficult time," he added.  The regional protection service in Madeira confirmed 28 deaths in the accident that happened at 6:30 pm (1730 GMT) Wednesday, while hospital authorities said another woman later died of her injuries.

The bus had been carrying around 50 passengers.   Regional government Vice President Pedro Calado said it was "premature" to speculate on the cause of the crash, adding that the vehicle was five years old and that "everything had apparently been going well".   Judicial authorities had opened an investigation into the circumstances of the accident, the Madeira public prosecutor's office told the Lusa news agency.   Medical teams were being sent from Lisbon to help local staff carry out post-mortems on the dead.
Date: Wed, 17 Apr 2019 13:13:10 +0200

Lisbon, April 17, 2019 (AFP) - Lines stretched out at petrol stations in Portugal on Wednesday as supplies were hit by a fuel haulers strike days before a long holiday weekend.   The queue at one filling station was one kilometre long, according to local media, which said nearly 3,000 were already dry across the country.   An estimated 800 filling stations were out of petrol in the region around the capital Lisbon and 400 around the northern city of Porto.   The union which represents a majority of Portuguese truck drivers who haul dangerous materials went on strike on Monday seeking a wage hike and special protections.

The government on Tuesday ordered a certain number of drivers back to work in order to ensure a minimum service to airports, ports, emergency services, public transport and 40 percent of filling stations in the Lisbon and Porto regions as the country begins marking a three-day holiday weekend for Easter on Friday.   "The minimum service will be enlarged if necessary," Prime Minister Antonio Costa told lawmakers in a debate on Wednesday.   Negotiations held on Tuesday made no progress.
More ...

France

France and Monaco US Consular Information Sheet
December 22, 2008
COUNTRY DESCRIPTION:
France is a developed and stable democracy with a modern economy.
Monaco is a developed constitutional monarchy.
Tourist facilities are widely
available.
Read the Department of State Background Notes on France and Monaco for additional information.
ENTRY/EXIT REQUIREMENTS:
France is party to the Schengen agreement.
As such, U.S. citizens may enter France for up to 90 days for tourist or business purposes without a visa.
A passport is required and should be valid for at least three months beyond the period of stay.
Anyone intending to stay more than 90 days must obtain the appropriate visa issued by one of the French Consulates in the U.S., prior to departure for France.
This also applies to anyone considering marriage in France.
For further information about travel into and within Schengen countries, please see our fact sheet.
A passport is required to enter Monaco. A visa is not required for tourist/business stays up to 90 days in Monaco.
For further information concerning entry requirements for France, travelers may contact the Embassy of France at 4101 Reservoir Road NW, Washington, DC
20007, tel. (202) 944-6000, email: info@ambafrance-us.org, or the French Consulates General in Atlanta, Boston, Chicago, Houston, Los Angeles, Miami, New Orleans, New York, or San Francisco.

For further information on entry requirements to Monaco, travelers may contact the Embassy of the Principality of Monaco. 2314 Wyoming Avenue, NW Washington, DC
20008, Tel: 202-234-1530, email: embassy@monaco-usa.org, or the Consulate General of Monaco, 565 Fifth Avenue – 23rd floor, New York, NY 10017, tel.: 212-286-0500, email: info@monaco-consulate.com.
For more information, visit the Embassy of France web site at www.consulfrance-washington.org or the Embassy of the Principality of Monaco web site at http://www.monaco-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 sheet.

SAFETY AND SECURITY:
The Government of France maintains a threat rating system, known locally as “Vigipirate,” similar to the U.S. Department of Homeland Security Advisory System.
Under this plan, in times of heightened security concerns, the government augments police with armed forces and increases visibility at airports, train and metro stations, and other high-profile locations such as schools, major tourist attractions, and government installations.
Over the last few years, there have been numerous arrests of suspected Islamic militants involved in various terrorist plots.
As with other countries in the Schengen area, France maintains open borders with its European neighbors, allowing the possibility of terrorist operatives entering/exiting the country with anonymity.

Political assassinations and bombings have occurred in France.
The National Front for the Liberation of Corsica (FLNC), as part of its decades-long bombing campaign on the island of Corsica, continues to conduct limited operations in the south of France and on Corsica.
In the 1990s there was a wave of bombings and attacks in Paris carried out by Algerian terrorists.
Today, numerous radical Islamic groups claim sympathizers within France’s large immigrant community, as evidenced by arrests over the last few years.

Although Americans have not been specifically targeted in terrorist attacks in France within the past few years, travelers should maintain vigilance.
Immediately report unattended packages observed in public places or any other suspicious activities. French law enforcement authorities are proactive and will respond immediately.
If there is a security incident or suspicious package, do not linger in the area to observe.

Although violent civil disorder is rare in France, in the past, student demonstrations, labor protests, and other types of demonstrations have developed into violent confrontations between demonstrators and police.
This was the case in March/April 2006, when a series of large demonstrations took place in central Paris. Several weeks of unrest occurred in the suburbs of Paris, as well as in other French cities and towns, in November 2005.
Neither of these periods of disorder exhibited any anti-U.S. sentiment, but it is important to remember that even a passer-by can be harmed should demonstrations devolve into violence.
Americans are advised to avoid street demonstrations, particularly if riot police are on the scene.

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

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

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

CRIME:
While both France and Monaco have relatively low rates of violent crime, a limited number of neighborhoods in the larger French cities merit extra caution.
Additionally, although the overall crime rate has fallen slightly in recent years, the violent crime rate has increased.
Thieves commonly target vehicles with non-local license plates, and work in or near tourist attractions such as museums, monuments, restaurants, hotels, beaches, trains, train stations, airports, and subways.
Americans in France and Monaco should be particularly alert to pickpockets in train stations and subways.
Travelers should keep photocopies of travel documents and credit cards separate from the originals, along with key telephone numbers to contact banks for credit card replacement.

Although thieves may operate anywhere, the U.S. Embassy in Paris receives frequent reports of theft from several areas in particular:
Paris: The Paris Police Prefecture published a pamphlet entitled “Paris in Complete Safety,” which provides practical advice and useful telephone numbers for visitors and can be accessed at http://www.prefecture-police-paris.interieur.gouv.fr/prevention/article/paris_securite_anglais.htm. Thieves operate on the rail link (RER) from Charles de Gaulle Airport to downtown Paris, where they prey on jet-lagged, luggage-burdened tourists.
In one common ruse, a thief distracts a tourist with a question about directions while an accomplice steals a momentarily unguarded backpack, briefcase, or purse.
Thieves also time their thefts to coincide with train stops so they may quickly exit the car just before the automatic doors close.
Travelers should consider taking an airport shuttle bus or taxi from the airport into the city.
Reports of stolen purses, briefcases, and carry-on bags at Charles de Gaulle Airport are not uncommon.
Travelers should monitor their bags at all times and never leave them unattended.
As thieves commonly target laptop bags, travelers should avoid carrying passports and other valuables in computer bags.
Another common method involves picking up a traveler’s shoulder bag that has been placed on the floor while the traveler is busy at the ticket counter. Also be aware that unattended bags are subject to destruction by airport security.

There are reports of robberies in which thieves on motorcycles reach into a moving car by opening the car door or accessing an open window or even breaking the window to steal purses and other bags visible inside.
The same technique is used against pedestrians walking with purses/bags/cameras slung over their street-side shoulder.
Those traveling by car should remember to keep the windows up and the doors locked and items that may be attractive to thieves out of sight.
Pedestrians are encouraged to remain aware of their surroundings at all times, and to keep bags slung across the body, with the bag hanging away from the street.

Many thefts occur on the Number One Subway Line, which runs through the center of Paris by many major tourist attractions (including the Grand Arch at La Défense, the Arc de Triomphe, the Champs Elysées, Place de la Concorde, the Louvre, and the Bastille).
Pickpockets are especially active on this metro line during the summer months and use a number of techniques.
The most common, and unfortunately the most successful, is the simple “bump and snatch,” where an individual bumps into the tourist while at the same time reaching into the pockets/purse/bag.
Visitors should be particularly careful when metro doors are closing, as this is a favored moment for the less-sophisticated pickpockets to simply grab valuables and jump through the closing doors, leaving the victim helplessly watching as the thief flees.
Visitors are encouraged NOT to confront thieves aggressively; they often operate in groups and may become violent if cornered.
Simply drawing attention to an attempted theft will most likely stop the operation, and result in a tactical withdrawal by the thief.

Gare du Nord train station, where the express trains from the airport arrive in Paris, is also a high-risk area for pocket-picking and theft.
Travelers should also beware of thefts that occur on both overnight and day trains, especially on trains originating in Spain, Italy, and Belgium.
These involve the theft of valuables while passengers are sleeping, or when the bags are left unattended.

In hotels, thieves target lobbies and breakfast rooms, and take advantage of a minute of inattention to snatch jackets, purses, and backpacks.
While many hotels do have safety latches that allow guests to secure their rooms from inside, this feature is not as universal as it is in the United States.
If no chain or latch is present, a chair placed up against the door and wedged under the handle is usually an effective obstacle to surreptitious entry during the night.
There are, however, reports of thieves breaking into hotel rooms on lower floors through open windows while the occupants are sleeping.
To guard against this, hotel room windows should be kept locked at all times. Whenever possible, valuables should be kept in the hotel safe.

Many Americans report thefts occurring in restaurants and nightclubs/bars, where purses are stolen from the back of a chair or from under the table.
Again, keep valuables on your person and do not leave them unattended or out of sight.
Thefts also occur at the major department stores such as Galeries Lafayette and Printemps where tourists often place wallets, passports, and credit cards on cashier counters during transactions.

Automated Teller Machines (ATMs) are very common in France and provide ready access to cash, allowing travelers to carry as much money as they need for each day.
The rates are competitive with local exchange bureaus, and an ATM transaction is easier than cashing a traveler’s check.
However, crime involving ATMs is increasing.
Travelers should not use ATMs in isolated, unlit areas or where loiterers are present.
Travelers should be especially aware of persons standing close enough to see the Personal Identification Number (PIN) being entered into the machine.
Thieves often conduct successful scams by simply observing the PIN as it is entered and then stealing the card from the user in some other location.
If the card becomes stuck, travelers should immediately report it to the bank where the machine is located.

Large criminal operations in Paris involving the use of ATMs that “eat” the user’s ATM card have been reported.
This most often happens during a weekend or at night when the bank is closed.
The frustrated traveler often walks away after unsuccessfully trying to retrieve the card, with plans to return the first day the bank is open.
In such cases, a criminal gang has modified the machine using an add-on device equipped with a microchip that records the user’s PIN when it is typed in, and also prevents the card from being ejected.
The criminal retrieves the card from the device once the visitor departs, downloads the recorded PIN and then goes to other ATMs and withdraws as much cash as possible.
ATM users are strongly encouraged to carry a 24-hour emergency number for their ATM card and bank account that will enable the immediate prevention of withdrawals from the account if difficulties occur.

Pigalle is the “adult entertainment district” of Paris.
Many entertainment establishments in this area engage in aggressive marketing and charge well beyond the normal rate for drinks.
Reports of threats of violence to coerce patrons into paying exorbitant beverage tabs are not uncommon.
There have also been several violent confrontations between rival gangs in the district, including one in August 2007 one block from the famous Moulin Rouge cabaret.
Visitors are encouraged to avoid this area unless touring with a well-organized and reputable tour company.

Normandy:
There has been an increase in break-ins and thefts from vehicles in the parking lots at the Normandy beaches and American cemeteries common.
Valuables should not be left unattended in a car, and locking valuables in the trunk should not be considered a safeguard.
Thieves often pry open car trunks to steal bags inside.

Southern France: Thefts from cars with unlocked doors or open windows stopped at red lights or caught in slow traffic are very common, particularly along the Riviera of the Nice-Antibes-Cannes area, and in Marseille.
Car doors should be kept locked and windows raised at all times to prevent incidents of "snatch-and-grab" thefts.
In this type of scenario, the thief is usually a passenger on a motorcycle. Break-ins of parked cars are also fairly common.
Valuables should not be left in the car, not even in the trunk, when the vehicle is unattended.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends, and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
Under French law, compensation is available to victims of crime committed on French soil under certain circumstances. To learn about resources in the U.S., including possible compensation, see our information on Victims of Crime
The local equivalents to the “911” emergency line in France are as follows: 17 (police emergency), 18 (fire department) and 15 (emergency medical/paramedic team/ambulance).
In Monaco, the numbers are 17 (police emergency), 18 (fire department) and 9375-2525 (medical/paramedic team/ambulance).

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care comparable to that found in the United States is widely available. In France, the phone number for emergency medical services is 15.
In Monaco, the phone number for emergency medical services is 9375-2525.

The U.S. State Department is unaware of any HIV/AIDS related entry restrictions for visitors to or foreign residents of France.
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 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 France and Monaco is provided for general reference only, and it may not be totally accurate in a particular location or circumstance.
Roads in France are generally comparable to those in the United States, but traffic engineering and driving habits pose special dangers.
Usually, lane markings and sign placements are not as clear as in the United States.
Drivers should be prepared to make last-minute maneuvers, as most French drivers do.
The French typically drive more aggressively and faster than Americans, and tend to exceed posted speed limits.
Right-of-way rules in France may differ from those in the United States.
Drivers entering intersections from the right have priority over those on the left (unless specifically indicated otherwise), even when entering relatively large boulevards from small side streets.
Many intersections in France are being replaced by traffic circles, where the right-of-way belongs to drivers in the circle.

On major highways, service stations are situated at least every 25 miles.
Service stations are not as plentiful on secondary roads in France as they are in the United States.
Paris, the capital and largest city in France, has an extensive and efficient public transportation system.
The interconnecting system of buses, subways, and commuter rails serves more than 4 million people a day with a safety record comparable to or better than the systems of major American cities.
Similar transportation systems are found in all major French cities. Between cities, France is served by an equally extensive rail service, which is reliable.
High-speed rail links connect the major cities in France. Many cities are also served by frequent air service.

Please refer to our Road Safety page for more information.
Visit the web site of the French and Monegasque National Tourist Office at http://us.franceguide.com/.
The website contains specific information concerning French and Monegasque driver's permits, vehicle inspection, road tax, and mandatory insurance.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of France's Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of France's air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa
SPECIAL CIRCUMSTANCES:
French and Monegasque customs authorities enforce strict regulations concerning temporary importation into or export from France of items such as firearms, antiquities, medications, business equipment, sales samples, and other items.
It is advisable to contact the Embassy of France in Washington, DC, one of France's consulates in the United States, or the Consulate General of Monaco in New York for specific information regarding customs requirements.
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 French or Monegasque laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in France or Monaco 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 AND CONSULATE LOCATIONS:
Americans living or traveling in France or Monaco are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, so they can obtain updated information on travel and security within France and Monaco.
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 cases of emergency.

The U.S. Embassy/Consular Section in Paris is located at 4 avenue Gabriel, 75008 Paris (Place de La Concorde, métro stop Concorde), telephone: in country 01-43-12-22-22; from the U.S. 011-33-1-43-12-22-22 (24 hours); fax for Passport Services in country 01-42-96-28-39; from the U.S. 011-33-1-42-96-28-39; for Special Consular Services (emergencies) fax: in country 01-42-61-61-40; from the U.S. 011-33-1-42-61-61-40. Further information can be obtained at the U.S. Embassy's web site at http://france.usembassy.gov/
The Consulate General in Marseille is located at Place Varian Fry, 13006 Marseille, telephone: in country 04-91-54-92-00; from the U.S. 011-33-4-91-54-92-00 (24 hours); Consular Section fax: in country 04-91-55-56-95 and main fax 04-91-55-09-47; Consular Section fax from the U.S. 011-33-4-91-55-56-95, and main fax from the U.S. 011-33-4-91-55-09-47.
Web site: http://france.usembassy.gov/marseille.html.

The Consulate General in Strasbourg is located at 15 Avenue d'Alsace, 67082 Strasbourg, telephone: in country 03-88-35-31-04; from the U.S. 011-33-3-88-35-31-04; fax: in country 03-88-24-06-95; from the U.S. 011-33-3-88-24-06-95.
Web site: http://france.usembassy.gov/strasbourg.html.

The Consulate General in Strasbourg does not produce passports on the premises.
American citizens in this area whose passports are lost or stolen and have urgent travel needs should contact the U.S. Embassy in Paris.

The U.S. Government also has consular representation in Bordeaux, Lyon, Rennes, Nice and Toulouse that provide limited services to Americans, by appointment only.

The American Presence Posts in Bordeaux, Lyon and Rennes do not produce passports on the premises.
American citizens in this area whose passports are lost or stolen and have urgent travel needs should contact the Consular Section of the U.S. Embassy in Paris.

The American Presence Post in Toulouse and the Consular Agency in Nice do not produce passports on the premises.
American citizens in this area whose passports are lost or stolen and have urgent travel needs should contact the U.S. Consulate General in Marseille.

The American Presence Post in Bordeaux is located at 10 place de la Bourse, 33076 Bordeaux (entry on 1 rue Fernand Philippart); telephone: in country 05-56-48-63-80; from the U.S. 011-33-5-56-48-63-80; fax: in country 05-56-51-61-97; from the U.S. 011-33-5-56-51-61-97.
Web site: http://france.usembassy.gov/bordeaux.html
The American Presence Post in Lyon is located at 1, quai Jules Courmont, 69002 Lyon; telephone: in country 04-78-38-33-03; from the U.S. 011-33-4-78-38-33-03; fax: in country 04-72-41-71-81; from the U.S. 011-33-4-72-41-71-81.
Web site: http://france.usembassy.gov/lyon.html
The American Presence Post in Rennes is located at 30, quai Duguay Trouin, 35000 Rennes; telephone: in country 02-23-44-09-60; from the U.S. 011-33-2-23-44-09-60; fax: in country 02-99-35-00-92; from the U.S. 011-33-2-99-35-00-92.
Web site: http://france.usembassy.gov/rennes.html
The American Presence Post in Toulouse is located at 25, Allée Jean Jaures, 31000 Toulouse; telephone: in country 05-34-41-36-50; from the U.S. 011-33-5-34-41-36-50; fax: in country 05-34-41-16-19; from the U.S. 011-33-5-34-41-16-19. Web site: http://france.usembassy.gov/toulouse.html
The Consular Agency in Nice is located at 7, Avenue Gustave V, 3rd floor, 06000 Nice, telephone: in country 04-93-88-89-55; from the U.S.
011-33-4-93-88-89-55; fax: in country 04-93-87-07-38; from the U.S. 011-33-4-93-87-07-38. Web site: http://france.usembassy.gov/nice.html
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This replaces the Country Specific Information for France and Monaco dated May 5, 2008, to update the sections on Entry/Exit Requirements, Safety & Security, Crime, Medical Facilities and Health Information, Children’s Issues and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon, 9 Dec 2019 11:12:25 +0100 (MET)
By Clare BYRNE

Paris, Dec 9, 2019 (AFP) - France's transport chaos deepened Monday on the fifth day of a nationwide strike over pension reforms, ramping up tensions at the start of a crucial week in President Emmanuel Macron's battle with trade unions.   With only two of the Paris metro's 16 lines running as normal and suburban trains also heavily disrupted, many commuters slipped behind the wheel to try to get to work in torrential rain, causing major gridlock.

By 9 am, the tailbacks in the Paris area ran to 600 kilometres (370 miles), twice the normal level, the Sytadin monitoring website said.   Large queues formed at bus stops following an announcement that one out of two buses would be running but striking workers blocked seven out of 25 bus depots, leaving more travellers stranded.   With many having opted to work from home last week and only now returning to the workplace, this week will test public support for the strike.

A poll Sunday in the Journal du Dimanche newspaper showed 53 percent of the French supporting the strike or expressing sympathy for their demands, up six points in a week.   Unions have called a second day of mass protests for Tuesday, a day before the government unveils the full details of its plans for a single points-based pension scheme that does away with dozens of more advantageous plans enjoyed by train drivers, sailors, lawyers and other professions.

- 'A monstrosity' -
Critics argue that the shake-up will require people in both the public and private sector to work longer for a smaller retirement payout.   Teachers are expected to walk out again for the second time in a week Tuesday, leading to widespread school closures.

Firefighters, electricity workers and "yellow vest" anti-government demonstrators have also joined railway workers in the streets in recent days.   The government's pensions envoy Jean-Paul Delevoye, who drafted the reforms, and Health Minister Agnes Buzyn will meet with trade unions on Monday to try to negotiate an end to the deadlock.   But the unions have sounded an uncompromising note.   "I will not negotiate over the implementation of what I describe as a monstrosity which endangers tomorrow's pensioners," said Yves Veyrier, the head of the militant Force Ouvriere union.

The strike has squeezed retailers in the run-up to Christmas, raising the prospect of another bleak year-end after the unrest caused by the yellow vests in late 2018.   The first day of the stoppage already caused an average 30 percent drop in sales, according to the Alliance of Commerce, which represents 27,000 supermarkets and clothing and shoe stores with almost 200,000 workers.   A hotel association said reservations in the larger Paris region dropped by 30 to 40 percent on the first day of the strike.    Regional and international trains, including the Eurostar to London and Thalys to Brussels, have also been hobbled by the unrest, and several flights were cancelled on the first days of the strike.

- Fairer system for all? -
Over 800,000 people took to the streets when the strike was launched on December 5, many accusing Macron of trying to weaken France's generous social safety net.   The president, Prime Minister Edouard Philippe and senior cabinet ministers met late Sunday to discuss the changes, which they argue will ensure a fairer and more sustainable system for all.   "If we do not carry out a far-reaching, serious and progressive reform today, someone else will do a really brutal one tomorrow," Philippe told Le Journal du Dimanche.

The strike has drawn comparisons with late 1995 when three weeks of strikes forced the then centre-right government to withdraw its pension reforms.   Adrien Quatennens, a lawmaker from the far-left France Unbowed party, acknowledged on LCI radio that the strike was hard on businesses and commuters, but said: "It's better to endure a few weeks of hassle than... years of hardship" in retirement.
Date: Fri, 6 Dec 2019 10:28:26 +0100 (MET)
By Joseph Schmid

Paris, Dec 6, 2019 (AFP) - Travellers across France endured a second day of chaos on Friday as unions vowed to keep up their strike until President Emmanuel Macron backs down on controversial pension overhauls.   Rail operator SNCF said 90 percent of high-speed TGV trains were again cancelled, and several airlines dropped flights including Air France, EasyJet and Ryanair.

Nine of the capital's 16 metro lines were shut and most others severely disrupted, sparking some 350 kilometres (220 miles) of traffic jams in the Paris region, well above the usual 200 km, the traffic website Sytadin reported.   Many employees were unable to get to work and several schools again provided only daycare, though fewer teachers were on strike compared with Thursday when some 800,000 people demonstrated across the country according to the interior ministry.   Bike paths were crowded with bikes and electric scooters, with metro operator RATP sponsoring special deals for commuters with a range of ride-hailing companies and other transportation alternatives.

The walkout is the latest test for Macron after months of protests from teachers, hospital workers, police and firefighters as well as the "yellow vest" movement demanding improved living standards.   Unions say his "universal" pension system, which would eliminate dozens of separate plans for public workers, forces millions of people in both public and private sectors to work well beyond the legal retirement age of 62.   Health Minister Agnes Buzyn said Friday that the government had "heard" the protesters' anger and would meet with union leaders to discuss the reform on Monday.   The government has yet to lay out the details of its plan, and Buzyn told Europe 1 radio that "there is indeed a discussion going on about who will be affected, what age it kicks in, which generations will be concerned -- all that is still on the table".

- Macron 'determined' -
Yves Veyrier, head of the hardline FO union, warned Thursday the strike could last at least until Monday if the government did not take the right action.   But it remains to be seen if the protests will match the magnitude of the 1995 strikes against pension overhauls, when France was paralysed for three weeks from November to December in an action that forced the government to back down.

Macron, a former investment banker, has largely succeeded in pushing through a series of controversial reforms, including loosening labour laws and tightening access to unemployment benefits.   But this is the first time the various disgruntled groups have come together in protest.   So far Macron has not spoken publicly on the stoppages though a presidential official, who asked not to be named, said Thursday that the president was "calm" and "determined to carry out this reform" in a mood of "listening and consultation".

While most of Thursday's rallies were peaceful, police fired tear gas to disperse dozens of black-clad protesters smashing windows and throwing stones during the Paris march, with one construction trailer set on fire. Sporadic clashes were also reported in some other cities.   Many people were bracing for further disruptions over the weekend, including the prospect of fuel shortages as unions blocked most of the country's eight oil refineries.

The minimum pension age in France is 62, one of the lowest among developed countries, but there are 42 "special regimes" for railway workers, lawyers, opera employees and others offering earlier retirements and other benefits.   The government says a single system will be fairer for everyone while ensuring its financial viability while acknowledging that people will gradually have to work longer.
Date: Thu, 5 Dec 2019 16:37:37 +0100 (MET)

Paris, Dec 5, 2019 (AFP) - French rail operator SNCF said Thursday that it had cancelled 90 percent of all high-speed TGV trains and 70 percent of regional trains for Friday due to a strike over the government's pension reforms.   SNCF said that services would "still be very disrupted" on the second day of the biggest transport strike in the country in years, with the Eurostar service to Britain and the Thalys service to northern Europe set to be "very heavily disrupted".   In Paris, where only two of 16 metro lines were operating normally Thursday, public transport workers voted to remain on strike until Monday.

France's civil aviation authority meanwhile told airlines to cut 20 percent of their flights in and out of airports in Paris, Beauvais, Lyon, Marseille, Toulouse and Bordeaux on Friday, the same proportion as on Thursday.   Striking transport workers, air traffic controllers, teachers, fire fighters, lawyers and other groups all fear they will have to work longer or receive reduced pensions under the government's proposal to scrap 42 special pension schemes and replace them with a single plan.   Anticipating the worst travel chaos in years, many employees opted to work from home on Thursday. Those who did venture out travelled mainly by car, bicycle, electric scooter or on foot.
Date: Thu, 5 Dec 2019 09:54:04 +0100 (MET)
By Joseph Schmid

Paris, Dec 5, 2019 (AFP) - A nationwide strike shut down public transport, schools and other services across France on Thursday as unions kicked off an open-ended strike against President Emmanuel Macron's plans for a "universal" pension system they say will force millions of people to work longer.

Parents scrambled to organise daycare as teachers walked off the job or were unable to get to work, and many employees were working from home or forced to take the day off as trains, metros and buses were cancelled.   Union leaders have vowed to keep up their protest unless Macron drops the pension overhaul, the latest move in the centrist president's push to reform wide swathes of the French economy.   "The idea of social concertation that Macron says is so important in fact doesn't exist," the head of the CGT union, Philippe Martinez, said on BFM television Thursday.

Around 90 percent of high-speed TGV trains as well as regional lines were cancelled, and Air France has axed 30 percent of domestic flights and 15 percent of short-haul international routes.   In Paris, 11 of the 16 metro lines were shut down and others had just bare-bones service during the morning rush hour, and the Eiffel Tower turned away tourists because of the strike.   "There are not enough employees to open the monument in secure conditions," the tower's operator said in a statement.

The strike -- which is open-ended and could last several days -- has drawn comparisons with the showdown between government and unions over pensions in November-December 1995, when the country was paralysed for around three weeks.   Unions won that battle, and are banking on widespread support from both public and private-sector workers against Macron's reform.   The government has yet to unveil the details of the project, but officials have conceded that people will have to work longer for the system to remain financial viable.

- Outcome uncertain -
The strikes will be a major test of whether Macron, a former investment banker who came to power on the back of a promise to transform France, has the political strength to push through one of his key campaign pledges.   He has already succeeded in controversial labour and tax reforms aimed at encouraging hiring, as well as an overhaul of the state rail operator SNCF, long seen as an untouchable union bastion.

He has also largely seen off the "yellow vest" protests against declining living standards that erupted a year ago, but that anger could feed into the latest protest.   "The moment of truth for Macron," the Le Monde daily wrote in Thursday's edition. "The next days are a decisive test for the head of state."   The SNCF said international lines including the Eurostar and Thalys services were severely disrupted, and Education Minister Jean-Michel Blanquer said Wednesday that he expected just three in 10 schools would be able to open.

- 'Special regimes' -
The strike is the latest in a series of protests against Macron this year by the "yellow vests" as well as police, firefighters, teachers, hospital workers and lawyers.   Macron wants to implement a "universal" retirement system that would do away with 42 "special regimes" for sectors ranging from rail and energy workers to lawyers and Paris Opera employees, which often grant workers higher pensions or early retirement.

But unions say the changes would effectively require millions of private-sector workers to work beyond the legal retirement age of 62 if they want to receive the full pension they have been promised.   Prime Minister Edouard Philippe, who has acknowledged French workers will gradually have to work longer, is set to unveil details of the reform on December 12.

Interior Minister Christophe Castaner said Wednesday that some 250 demonstrations are expected nationwide, warning that a radical fringe of protesters could cause trouble.   Paris police chief Didier Lallement said around 6,000 members of the security forces would be deployed in the capital alone, with 180 motorbikes used to respond fast to any rioting.   Two major demonstrations are planned for Paris that will converge on the Place de la Nation, with officials ordering Paris businesses along the routes to close on Thursday.   British low-cost carrier EasyJet has cancelled 223 domestic and short-haul international flights and warned others risk being delayed.
Date: Mon, 2 Dec 2019 02:52:39 +0100 (MET)

Nice, France, Dec 2, 2019 (AFP) - Two people were killed on Sunday by floods in the French Riviera, which has been hit by fresh torrential rains a week after extreme weather left six dead, authorities said.   In the Var region, a shepherd was swept away as he was trying to cross a ford in his 4x4 while tending to his flock. His body was found in his vehicle late Sunday night 300 metres (330 yards) downstream from where he was last seen, the prefecture said early Monday.

Elsewhere in the region, the owner of a stables was found dead two hours after he was also washed away while out watching over his animals, it said.   The Var and the neighbouring Alpes-Maritimes region were on red alert for floods which disrupted train services and cut the A8 motorway for four hours Sunday evening.   Many cultural and sporting events were also called off due to the bad weather, including Paris Saint-Germain's Ligue 1 match at Monaco.   During the previous weekend, heavy rains caused the deaths of six people in the Var.
More ...

World Travel News Headlines

Date: Tue, 10 Dec 2019 10:50:09 +0100 (MET)

Sydney, Dec 10, 2019 (AFP) - The death toll from New Zealand's White Island volcano eruption rose to six late Tuesday, after an injured person died in an Auckland hospital, police said.   "Police can confirm a further person has died following the eruption on Whakaari/White Island, bringing the official toll to six," a police statement said.   Eight more people who remain missing are presumed dead after the volcano erupted Monday.
Date: Tue, 10 Dec 2019 09:27:57 +0100 (MET)
By Andrew BEATTY, with Daniel de Carteret in Gosford

Sydney, Dec 10, 2019 (AFP) - Toxic haze blanketed Sydney Tuesday triggering a chorus of smoke alarms to ring across the city and forcing school children inside, as "severe" weather conditions fuelled deadly bush blazes along Australia's east coast.   Fire engines raced office-to-office in the city centre with sirens blaring, as inland bushfires poured smoke laden with toxic particles into commercial buildings.   Emergency services responded to an "unprecedented" 500 automatic call-outs inside a few hours according to New South Wales Fire and Rescue's Roger Mentha.

A regional fire headquarters miles from the nearest blazes was itself evacuated while throngs of mask-wearing commuters choked their way through thick acrid air and the organisers of a harbour yacht race declared it was unsafe to proceed.   "The smoke from all the fires is just so severe here on the harbour that you just can't see anything, so it's just too dangerous," said spokeswoman Di Pearson of an event that normally foreshadows the famed Sydney-Hobart yacht race. "The vision is just so poor."   Some of the city's commuter ferries were also cancelled "due to thick smoke" and school kids were kept inside at breaktime and sent home early as pollution levels soared far above "hazardous" levels.

For weeks the east of the country has been smothered in smoke as drought and climate-fuelled bushfires have burned. But the scale of the problem on Tuesday shocked even hardened residents.   Bruce Baker -- an 82-year-old who lives in Gosford, north of Sydney -- said he was skipping his daily morning walk because of the smoke.   "This is the worst it's been, for sure," he told AFP. "It dries your throat. Even if you're not asthmatic, you feel it."   Authorities recommended that the vulnerable cease outdoor activity altogether and that everyone stay inside as much as possible, although one couple braved the toxic air to get married on the waterfront in front of Sydney Harbour Bridge shrouded in smog.

A cricket match between New South Wales and Queensland also went ahead, despite a barely visible ball.   Tuesday had been expected to bring strong winds and high temperatures that made for "severe conditions where embers can be blown ahead of the fire into suburbs and threaten properties."   But New South Wales Rural Fire Service said "deteriorating fire conditions have been delayed by a thick blanket of smoke" over the east of the state.   As the day developed there were nearly 100 bushfire incidents in the state of New South Wales alone and dozens more in Queensland.   Total fire bans were put in place across much of the east of the country and in large parts of western Australia.   Temperatures in some inland areas eased past 44 degrees Celsius (111 Fahrenheit).

- The 'big dry' -
To the northwest of Sydney, several fires already burning for weeks have combined to create a "megafire" that has already destroyed 319,000 hectares (788,000 acres) of land, mostly inside national parks.   Prime Minister Scott Morrison  -- who for weeks has not commented on the smoke haze -- defended his government's handling of the fires and said there were no plans to professionalise the countryside's largely volunteer force.    "Our policy is sensible when it comes to addressing and taking action on climate change. Our actions on climate change are getting the results they're intended to get," he said.   Morrison's conservative coalition has been criticised by former fire chiefs for failing to heed warnings about climate change.   The crisis has been propelled by a prolonged drought that has made vegetation tinder dry.

The Bureau of Meteorology has reported that Australia experienced its driest November on record this year.   The "big dry" has left farmers desperate and small towns facing the prospect of running out of water completely.   A swathe of the east of the country has seen "rainfall deficiencies" since early 2017 -- almost three years.   Many dams in New South Wales are empty and almost all are well below capacity.   Firefighters south of Brisbane recently reported 1,000 litres of water were stolen from tanks at their station.   Amid the shortage, Tuesday also saw the toughest water restrictions in a decade being introduced for Sydney -- with curbs on everything from hosepipe use to washing cars.
Date: Tue, 10 Dec 2019 03:09:17 +0100 (MET)
By Allison JACKSON

Sao Paulo, Dec 10, 2019 (AFP) - Gripping the deadly snake behind its jaws, Fabiola de Souza massages its venom glands to squeeze out drops that will save lives around Brazil where thousands of people are bitten every year.   De Souza and her colleagues at the Butantan Institute in Sao Paulo harvest the toxin from hundreds of snakes kept in captivity to produce antivenom.    It is distributed by the health ministry to medical facilities across the country.

Dozens of poisonous snake species, including the jararaca, thrive in Brazil's hot and humid climate.    Nearly 29,000 people were bitten in 2018 and more than 100 died, official figures show.   States with the highest rates of snakebite were in the vast and remote Amazon basin where it can take hours to reach a hospital stocked with antivenom.   Venom is extracted from each snake once a month in a delicate and potentially dangerous process.

Using a hooked stick, de Souza carefully lifts one of the slithering creatures out of its plastic box and maneuvers it into a drum of carbon dioxide.    Within minutes the reptile is asleep.    "It's less stress for the animal," de Souza explains.    The snake is then placed on a stainless steel bench in the room where the temperature hovers around 27 degrees Celsius (80 degrees Fahrenheit).    De Souza has a few minutes to safely extract venom before the snake begins to stir.      "It's important to have fear because when people have fear they are careful," she says.

- Antivenom 'crisis' -
The snakes are fed a diet of rats and mice that are raised at the leafy institute and killed before being served up once a month.   After milking the snake, de Souza records its weight and length before placing it back in its container.    The antivenom is made by injecting small amounts of the poison into horses -- kept by Butantan on a farm -- to trigger an immune response that produces toxin-attacking antibodies.

Blood is later extracted from the hoofed animals and the antibodies harvested to create a serum that will be administered to snakebite victims who might otherwise die.   Butantan project manager Fan Hui Wen, a Brazilian, says the institute currently makes all of the country's antivenom -- around 250,000 10-15 millilitre vials per year.

Brazil also donates small quantities of antivenom to several countries in Latin America.    There are now plans to sell the life-saving serum abroad to help relieve a global shortage, particularly in Africa.    About 5.4 million people are estimated to be bitten by snakes every year, according to the World Health Organization (WHO). 

Between 81,000 and 138,000 die, while many more suffer amputations and other permanent disabilities as a result of the toxin.   To cut the number of deaths and injuries, WHO unveiled a plan earlier this year that includes boosting production of quality antivenoms.   Brazil is part of the strategy. It could begin to export antivenom as early as next year, Wen says.   "There is interest for Butantan to also supply other countries due to the global crisis of antivenom production," she says.
Date: Mon, 9 Dec 2019 14:14:15 +0100 (MET)

Dec 9, 2019 (AFP) - New Zealand, struck by a deadly volcanic eruption Monday, lies in a zone where Earth's tectonic plates collide, making it a hotspot for earthquakes and volcanic activity.   In one of its worst natural disasters, a huge mass of volcanic debris from the eruption of Mount Ruapehu triggered a mudslide in 1953 that washed away a bridge and caused a passenger train to plunge into a river with the loss of 151 lives.  After Monday's eruption on New Zealand's White Island, here is a recap of some of the deadliest volcanic eruptions around the world in the past 25 years.

- 2018: Indonesia -
In December the Anak Krakatoa volcano, a small island in the Sunda Strait between Java and Sumatra, erupts and a section of its crater collapses, sliding into the ocean and generating a tsunami. More than 420 people are killed and 7,200 wounded.

- 2018: Guatemala -
The June eruption of the Fuego volcano, about 35 kilometres (22 miles) from the capital, unleashes a torrent of mud and ash that wipes the village of San Miguel Los Lotes from the map. More than 200 people are killed.

- 2014: Japan -
The sudden eruption in September of Mount Ontake, in the central Nagano region, kills more than 60 people in Japan's worst volcanic disaster in nearly 90 years. The mountain is packed with hikers at the time. In 1991 an eruption of the southwestern Unzen volcano kills 43.

- 2014: Indonesia -
At least 16 people are killed on the island of Sumatra in February by a spectacular eruption of Mount Sinabung, which had lain dormant for 400 years before roaring back to life five months earlier. In 2016 villages are scorched and farmland devastated after another eruption kills seven.

- 2010: Indonesia -
Indonesia's most active volcano, Mount Merapi on Java island, starts a series of explosions in October, eventually killing more than 320 people. An 1930 eruption of the volcano killed 1,300 people and one in 1994 claimed more than 60 lives.

- 2002: DR Congo -
The eruption in July of Mount Nyiragongo in the eastern Democratic Republic of Congo destroys the centre of Goma town, along with several residential areas, and kills more than 100 people.

- 1997: Montserrat -
The capital of the small British colony, Plymouth, is wiped off the map and 20 are killed or left missing in avalanches of hot rock and ash clouds when its volcano erupts in June.

- 1995: The Philippines -
At least 70 are killed and another 30 missing after the crater of the Parker volcano in the south of the island of Mindanao collapses. Five years earlier the eruption of Mount Pinatubo, 80 kilometres north of the capital Manila, kills more than 800 people.

- Worst ever -
The explosion of Indonesia's Krakatoa volcano in 1883 is considered the worst ever seen. The eruption sent a jet of ash, stones and smoke shooting more than 20 kilometres (12 miles) into the sky, plunging the region into darkness, and sparking a huge tsunami that was felt around the world. The disaster killed more than 36,000 people.

The most famous eruption in history is that of Mount Vesuvius in modern-day Italy in 79 AD, which destroyed the towns of Herculaneum, Stabiae and Pompeii, wiping out an estimated 10 percent of the population of the three cities.
Date: Mon 9 Dec 2019
Source: Fox 29 Philadelphia [edited]

A total of 31 people have been sickened by salmonellosis at 4 health care facilities in south-eastern Pennsylvania. A majority of those cases occurred after individuals ate pre-cut fruit from New Jersey-based Tailor Cut Produce. The Food and Drug Administration (FDA) announced the salmonellosis outbreak in conjunction with the Pennsylvania Department of Health (DOH) on [Fri 6 Dec 2019]. The North Brunswick distributor has recalled its fruit mix with cantaloupe, honeydew, pineapple and grapes as a result.

Tailor Cut Produce reports that its products may be found in restaurants, banquet facilities, hotels, schools and institutional food service establishments in Pennsylvania, New Jersey and New York. "We recommend that any facility who use Tailor Cut Produce pre-cut fruit to immediately stop and throw it away," Pennsylvania Secretary of Health Dr. Rachel Levine said.

Salmonellosis is an infection caused by _Salmonella_ bacteria that generally affects the intestinal tract. People usually become infected by either eating or drinking contaminated food or water, by contact with infected people or animals, or through contact with contaminated environmental sources.
Date: Mon 9 Dec 2019
Source: Sixth Tone [edited]

Dozens of researchers in northwestern China's Gansu province have been infected with brucellosis, an animal-borne disease that causes flu-like symptoms and, potentially, lingering problems. In a statement [Fri 6 Dec 2019], the Lanzhou Veterinary Research Institute, an affiliated institute of the Chinese Academy of Agricultural Sciences, said that the 1st few grad students from the institute's foot-and-mouth disease prevention team tested positive for brucellosis antibodies on [28 Nov 2019]. The labs affected have been closed, the institute said, and national and local health authorities have assembled a team to investigate the outbreak.

Li Hui, an official at the health commission in Lanzhou, the provincial capital, told Sixth Tone on [Mon 9 Dec 2019] that the total number of brucellosis cases at the institute had climbed to 96. None have shown clinical symptoms, according to domestic media, and it remains unclear how they were exposed to the bacteria.

Brucellosis -- also known as Malta, Mediterranean, or undulant fever -- is a zoonotic disease that mainly affects animals, including livestock and dogs, which can in turn transmit the bacteria to humans through direct contact. Symptoms include fever, chills, sweating, lethargy, and aches and pains, according to the WHO. In the absence of early diagnosis and treatment, brucellosis can become a chronic condition that is difficult to cure.

In China, brucellosis is a Class B disease, ranking below a more serious category that includes cholera and plague. Human-to-human transmission has only been known to occur between lactating mothers and their babies. According to state broadcaster China National Radio, the brucellosis outbreak at the Gansu veterinary institute has prompted health checks among local students and staff who fear that they may have come into contact with infected animals.

One of the last brucellosis outbreaks in China occurred in 2011, when an agricultural university in the northeastern Heilongjiang province reported 28 cases stemming from infected goats being used in lab research. The school publicly apologized, fired 2 administrators, and offered each of the students' affected monetary compensation.

Scientific labs are subject to different experimental standards depending on their biosafety level, according to a researcher surnamed Yang at the Shanghai Institutes for Biological Sciences, an affiliate of the Chinese Academy of Sciences.

"If the protection levels don't keep pace (with biosafety levels), there will be a risk of infection," Yang, who studies viruses and works in a Biosafety Level 2+ lab, told Sixth Tone. As a result, labs generally require researchers to undergo safety training or even pass an exam to earn a certification, said Yang, who only used her surname because she was not authorized by her employer to speak to media.

The Lanzhou Veterinary Research Institute describes itself as "China's only authorized research center for working with the live virus that causes foot-and-mouth disease," a highly contagious disease affecting livestock. The institute is reportedly also one of the few in China with Biosafety Level 3 labs, which are required for _brucella_ pathogen studies, according to the National Health Commission.

As the local agriculture department tries to ascertain the source of the recent infections, Lanzhou's health commission said [Fri 6 Dec 2019], it is implementing precautionary measures so that brucellosis does not pose a threat to neighbouring communities. [Byline: Yuan Ye]
=================
[An earlier report suggested that 4 persons were clinically ill but this is not confirmed here.  Brucellosis (<http://www.medicinenet.com/brucellosis/article.htm>) is a disease that is thought to have existed since ancient times, as it was 1st described more than 2000 years ago by the Romans and Hippocrates. It was not until 1887 that a British physician, Dr. David Bruce, isolated the organism that causes brucellosis from several deceased patients from the island of Malta. This disease has had several names throughout its history, including Mediterranean fever, Malta fever, Crimean fever, Bang's disease, and undulant fever (because of the relapsing nature of the fever associated with the disease).

The symptoms and signs of brucellosis may develop from days to months after the initial exposure to the organism. While some individuals may develop mild symptoms, others may go on to develop long-term chronic symptoms. The signs and symptoms of brucellosis are extensive, and they can be similar to many other febrile illnesses, so recognition of potential exposure -- from ingestion of unpasteurized milk or cheese, employment as a veterinarian or veterinary student, in a slaughter house or meat processing plant, or working in a microbiology lab -- is vital. In this outbreak, it is not clear what symptoms the students had or whether they were just seropositive. ProMED would like more information about this episode. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Gansu Province, China: <http://healthmap.org/promed/p/333>]
Date: Tue 3 Dec 2019
Source: Outbreak News Today [edited]

In late November [2019], Uganda health authorities notified the World Health Organization of a fatal Rift Valley fever (RVF) case from Obongi district.  The case was a 35-year-old man from South Sudan who was living in the Palorinya Refugee camp in Obongi district, Uganda. The case had travel history to South Sudan between 12 and 19 Nov 2019 to harvest cassava. While in his home country, he developed fever and other symptoms and was treated for malaria; however, his condition got worse.  He later returned to the refugee camp in Uganda and his symptoms progressed and he was hospitalized. Viral hemorrhagic fever was suspected. Samples were collected and sent to the Uganda Virus Research Institute; however, the patient died. A safe and dignified burial was performed on 22 Nov 2019. As of 24 Nov 2019, a total of 19 contacts were recorded during the active case search including 10 healthcare workers.
===================
[The circumstances and specific location under which the man became infected with Rift Valley fever (RVF) virus in South Sudan is not mentioned. It is worth noting that there was an RVF outbreak in the Eastern Lakes region of South Sudan during the 1st 3 months of last year (2018). At the end of that outbreak, the OIE's follow-up report no. 3 reported: "The event cannot be considered resolved, but the situation is sufficiently stable. No more follow-up reports will be sent. Information about this disease will be included in the next 6-monthly reports."

There were more human cases than animal ones in that outbreak, prompting Mod.AS to comment: "Unfortunately, during the recent South Sudan RVF event, as in most -- if not all -- previous RVF events in other African countries, humans served as sentinels. Improved surveillance in animals is desperately needed in Africa, to allow timely measures applied, predominantly preventive vaccination, before the development of a full-blown epizootic involving secondary infection in humans." Intensified surveillance is needed in South Sudan in those localities where the affected man had been prior to his return to Uganda.

It is likely that RVF virus has persisted in this area in transovarially infected eggs of _Aedes_ mosquito vectors. These eggs can remain viable for long periods of time and hatch when flooded during future rain events, with the subsequent emergence of infected females ready to transmit the virus. This risk provides justification for maintaining livestock of the area well vaccinated into the future. This may have accounted for the reappearance of RVF in South Sudan in 2018, after nearly 2 years without additional reported cases in humans or livestock and again with this human case in 2019. - ProMED Mod.TY]

Obongi district, Uganda is located approximately 50 km (30 mi) from the South Sudan border.
HealthMap/ProMED-mail maps:

According to OIE's data, a total of 2 outbreaks of RVF affecting animals have been reported from Sudan during the event. The 1st outbreak started in the Arabaata dam area, Red Sea state, on 25 Sep 2019, affecting goats. The 2nd (and, so far, last) outbreak started 10 Oct 2019 in the River Nile state, affecting sheep and goats. Both outbreaks have been declared as 'resolved' on 14 Nov 2019.

Outbreak summary:
Total outbreaks = 2 (Submitted)
Species / Susceptible / Cases / Deaths / Killed and disposed of / Slaughtered
Goats / 1700 / 37 / 7 / 0 / 0
Sheep / 1550 / 37 / 5 / 0 / 0

According to the recent (5 Dec 2019) OCHA (UN Office for the Coordination of Humanitarian Affairs) update, the (human) RVF situation in Sudan, as of 26 Oct 2019, was the following: "a total of 345 suspected RVF cases -- including 11 related deaths -- reported in the states of Red Sea (128), River Nile (212), Khartoum (1), White Nile (1), Kassala (2), and Gedaref (1). The most affected age group is 15 to 45 years, 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 per cent). RVF is endemic in Sudan and 3 outbreaks affecting people have been documented in 1973, 1976, and 2008. During the outbreak in 2008, a total of 747 laboratory-confirmed cases were reported, including 230 deaths."

Egypt suffered its 1st RVF outbreak in 1977/78 with serious human disease and death as well as severe losses in livestock; several additional events have been recorded since. A recent historical review paper [1] concluded: "due to the availability and abundance of the potential vectors, the suitability of environmental conditions, continuous importation of livestock's from Sudan, and the close association of susceptible domestic animals with humans, the RVF virus could possibly occur and circulate in Egypt."   (https://tinyurl.com/whz3pz5)

Reference
---------
1. Kenawy MA, Abdel-Hamid YM, Beier JC. Rift Valley fever in Egypt and other African countries: Historical review, recent outbreaks, and possibility of disease occurrence in Egypt. Acta Trop. 2018; 181: 40-49; <https://doi.org/10.1016/j.actatropica.2018.01.015>  - ProMED Mods.AS/TY]
Date: Fri 6 Dec 2019 5:53 PM MST
Source: CTV News [edited]

A syphilis outbreak is worsening in Alberta [Canada], and the majority of new cases are in the Edmonton zone. Edmonton saw 1186 of the 1753 infectious syphilis [primary, secondary and early latent syphilis] cases reported in Alberta in 2019, a total of 68 per cent.

Alberta Health Services [AHS] declared an outbreak in July 2019, saying cases had 'increased dramatically' in the province since 2014. The number increased again in July [2019]  [<https://edmonton.ctvnews.ca/alberta-declares-province-wide-syphilis-outbreak-1.4510737>].

AHS sent a new public health alert to doctors on [27 Nov 2019], asking for their help to control the outbreak [<https://www.albertahealthservices.ca/assets/info/hp/phys/if-hp-phys-moh-ez-syphilis-outbreak.pdf>]. "It's very significant," said Dr Ameeta Singh, a clinical professor in infectious diseases. "That's an alarming rise in new syphilis cases in Alberta." She said it's the highest number of cases the province has seen since the 1940s.

According to Dr Singh, the increase in cases being reported is partially due to a greater number of people getting tested. "We know more people are coming in to get tested, but if we look a bit closer at the data we have, we do see there's, in fact, a [bigger] rise in the number of cases than we would expect to see," said Singh.

Another factor could be the rise in methamphetamine use in Edmonton. "I believe this is a major factor. Meth also stimulates risky sexual behaviour and increases the chance people will engage in multiple, usually casual or anonymous partners as well and not use precautions such as condoms to protect themselves during sex," she said.

What's also alarming, Singh said, is the spike in cases of congenital syphilis, where the disease is passed on to newborns. According to AHS, there have been 38 cases of congenital syphilis in 2019, 31 of which were in the Edmonton area. That accounts for more than half of the 61 cases of congenital syphilis reported since 2014.

"Those are not numbers we should be talking about in Canada ever...in a country that has universal access to health care, in a major city in Canada where syphilis testing is offered to all pregnant women who access prenatal care," she said. "What we're seeing with the congenital syphilis cases is many of the women are not accessing prenatal care until they come into the hospital to deliver and then the tests are being done."
===================
[A recent ProMED-mail post (Syphilis - Canada (04): (AB) RFI http://promedmail.org/post/20190718.6574300) reported a rise in "infectious syphilis" cases over a 4-year period: from 2014 to 2018 but made no mentioned of contributing factors. As illicit drug use has been cited as a contributing factor to recent increases in syphilis cases in the Canadian provinces of Ontario and Manitoba, I questioned in this prior ProMED-mail post if use of illicit drugs, in particular, methamphetamine, could similarly be contributing to the rise of syphilis cases in Alberta. The news article above reports that the rise in methamphetamine use in Edmonton, as well as increased testing for syphilis, are thought to be contributing factors in Alberta.

Methamphetamine can be swallowed, snorted, smoked or injected by needle and syringe

When methamphetamine is injected, transmission of syphilis may occur as a consequence of sharing a needle/syringe contaminated with infected blood from somebody who has primary or secondary syphilis (<https://ucsdnews.ucsd.edu/archive/newsrel/health/04-28TransmissionSyphilis.asp>); but syphilis can also be acquired by direct contact with an infected lesion during oral, vaginal, or anal sex when the drug is taken by any route of administration. Methamphetamine use is associated with sexual behaviors that increase the risk for acquiring syphilis and other sexually transmitted diseases, including having multiple sex partners, inconsistent condom use, and exchange of sex for drugs or money (<https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a4.htm>).

The linkage of methamphetamine use and syphilis transmission is reminiscent of the increase in syphilis among heterosexuals during the crack cocaine epidemic of the 1980s and 1990s, when the practice of trading sex with multiple partners for drugs, especially crack cocaine, played a major role in the transmission of syphilis. Under these circumstances, the identities of sex partners are often unknown, which weakens the traditional syphilis-control strategy of partner notification.

Bacteremia due to _Treponema pallidum_, the cause of syphilis, which occurs during primary, secondary, and latent syphilis, can result in transplacental transmission of this organism to the fetus during pregnancy and cause congenital syphilis. An increase in the incidence of syphilis in women in the population is commonly accompanied by increasing rates of congenital syphilis.

Edmonton, with a population of 932 546 residents in 2016, is the capital of the Canadian province of Alberta
(<https://en.wikipedia.org/wiki/Edmonton>).

A map showing the location of Edmonton can be found at
<https://goo.gl/maps/Rfq6XC2vvwi19ypb6>. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Alberta, Canada:
9 December 2019
https://www.who.int/bangladesh/news/detail/09-12-2019-cholera-vaccination-campaign-launched-to-protect-635-000-people-in-cox-s-bazar

Cox’s Bazar, Bangladesh

Over 635,000 Rohingya refugees and Bangladeshi host community will be vaccinated against cholera in a 3-week-long campaign beginning today at the refugee camps in Cox’s Bazar and nearby areas, to protect vulnerable population against the deadly disease amidst increasing number of cases of acute watery diarrhoea (AWD).


The Oral Cholera Vaccination (OCV) campaign will be implemented in the refugee camps from 8-14 December to reach 139,888 Rohingya aged 1 year and less than 5 years. In the host community, the campaign will take place from 8-31 December and aims to reach any person older than 1 year (495,197). In total, 635,085 people are expected to be reached.

Led by the Ministry of Health and Family Welfare, with support of the World Health Organization (WHO), UNICEF and other partners, the campaign aims to reach people who missed some or all previous cholera vaccination opportunities. The campaign, including operational costs, is funded by Gavi, the Vaccine Alliance.

“We want to equip these populations with more protection against diarrheal diseases. Despite the progresses made to ensure access to quality water and sanitation, such diseases remain an issue of concern: approximately 80% of host community living near the camps have not been targeted in previous OCV campaigns and are still vulnerable”, says Dr Bardan Jung Rana, WHO Representative in Bangladesh.

Earlier rounds of cholera vaccination, which have taken place since the beginning of the emergency response in 2017, have helped prevent outbreaks of the disease. To this date, over 1 million people were vaccinated against cholera.
6th December 2019
https://www.theguardian.com/world/2019/dec/06/flooding-hits-new-zealand-tourist-hubs-of-wanaka-and-queenstown

Heavy rain has led to rivers bursting their banks, forcing the closure of shops and restaurants

Streets in the South Island tourist towns of Wanaka and Queenstown were slowly going under water on Friday, after Lake Wanaka and Lake Wakatipu burst their banks earlier in the week, flooding businesses and sewerage systems.

Water and large debris closed the main street of Wanaka, a popular spot with Instagrammers thanks to its famous tree that appears to have grown out of the lake. On Friday businesses were sandbagging as heavy rain continued to fall.

Sewerage systems in the town were also at risk of contaminating the lake, with the Queenstown Lakes District council taking the precautionary measure of shutting down the sewer connection to a handful of premises.

Wanaka residents were told to be on “high alert” with heavy rain predicted all weekend.

The streets of the usually bustling tourist town were largely empty, and the popular cafes and restaurants on the lake shore were closed.