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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 ...

Malta

Malta US Consular Information Sheet
November 26, 2008

COUNTRY DESCRIPTION:
Malta is a small, developed, democratic Mediterranean island nation, positioned as a cultural stepping-stone between Europe and North Africa.
Malta became
a member of the European Union with nine other new member states on May 1, 2004, and became a full member of the Schengen area in March 2008.
Tourist facilities of all categories are widely available.
Read the Department of State Background Notes on Malta for additional information.

ENTRY/EXIT REQUIREMENTS:
Malta is a party to the Schengen agreement.
As such, U.S. citizens may enter Malta 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.
For further information concerning entry requirements for Malta, travelers should contact the Embassy of Malta at 2017 Connecticut Avenue, NW, Washington DC
20008, tel.: (202) 462-3611, web site: http://www.foreign.gov.mt/default.aspx?MLEV=47&MDIS=505, or the Maltese Consulate in New York City, tel.: (212) 725-2345.

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:
Malta remains largely free of terrorist incidents. No indigenous terrorist or extremist groups are known to be active in Malta, and no foreign terrorist organization has carried out an attack against U.S. interests in Malta in recent years.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

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

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

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

CRIME:
Malta has a low rate of violent crime.
Theft of unattended personal property and car stereos from vehicles is a common problem.
Visitors are strongly encouraged to secure their valuables, and be aware of pickpockets and purse snatchers.
Such criminals focus on areas and establishments frequented by tourists.
Caution is particularly urged in the Paceville nightclub area, where excessive drinking and poor crowd control have led to instances of violent behavior.
Poverty, homelessness, and panhandling are almost non-existent in Malta.
All visitors to Malta should practice the same good, common sense personal security precautions that are part of everyday life in urban areas within the U.S., particularly when spending time in areas frequented by tourists.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. The crime victim’s assistance agency is ‘APPOGG’- Support Line, tel: 179;
web site: www.appogg.gov.mt.
To learn about resources in the U.S. if you are the victim of a violent crime overseas, please also see our information on Victims of Crime.

The local equivalents to the “911” emergency line in Malta are: Police 191; Ambulance 196; Fire 199.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is available through public and private hospitals.
The quality of medical care in Malta is excellent.
Private hospitals generally offer a higher standard of service than the public hospitals, and the majority of the best doctors practice in private medical facilities.

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
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Malta.
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 Malta is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Traffic in Malta flows on the left, requiring attentiveness and caution from visitors from right-hand drive countries such as the United States.
In addition, drivers may be erratic or undisciplined. Roads flood easily, and are often narrow, winding, and congested, with poor visibility around curves.
Traffic arteries are prone to bottlenecks and accidents.
Buses are the primary means of public transportation.
Though the bus fleet is being modernized, most buses are old, cramped, and not air-conditioned.
Taxis are safe but expensive and are not metered; it is a good practice to agree with the driver in advance on the charge.

Please refer to our Road Safety page for more information.
There is a Malta Tourist Information Office located at Freedom Square Valletta, tel. 21-237-747, web site: http://www.visitmalta.com/getting-around
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Malta’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Malta’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:
Malta customs authorities may enforce strict regulations concerning currency restrictions and temporary importation into or export from Malta of items such as firearms, antiquities, and any item that might be deemed to have resalable value.
It is advisable to contact the Embassy of Malta in Washington or the Consulate of Malta in New York City for specific information regarding customs requirements.
Malta’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 U.S. Council for International Business, 1212 Avenue of the Americas, New York, N.Y. 10036, issues and guarantees the ATA Carnet in the United States.
For additional information call (212) 354-4480, send an e-mail to atacarnet@uscib.org or visit http://uscib.org for details.

For more 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 Malta’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Malta are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime prosecutable in the United States. Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Malta 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 Malta.
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 on the third floor of the Development House, St. Anne Street, Floriana, Valletta, telephone (356) 2561-4000.
The Consular Section’s telephone number is (356) 2156-4115, fax: (356) 2124-3229, web site: http://malta.usembassy.gov/uscit_intro.html.
The Consular Section is open to the public Monday, Wednesday, and Friday from 8:00 a.m. to 11:00 a.m.
* * *
This replaces the Country Specific Information for Malta dated April 29, 2008, to update sections on Safety and Security and Exit and Entry Requirements.

Travel News Headlines WORLD NEWS

Date: Fri 16 Aug 2019
Source: Times of Malta [abridged, edited]

The number of measles cases in Malta has soared to an unprecedented level this year [2019], with 30 cases reported in the 1st 6 months, according to the World Health Organisation.

Data recently published by the health body showed that the figures until June 2019 are in stark contrast to those for the previous years. According to the WHO data, between 2011 and 2018, there were only 11 cases reported. There were no cases reported in a number of these years, and, between 2012 and 2017, there were only 2 cases reported, one in 2013 and another 2 years later.

Earlier this year [2019], the WHO had flagged the issue [slipping vaccine rates] with a rapid increase in measles cases on a global level. At the time, preliminary figures had shown that measles cases rose 300% worldwide through the 1st 3 months of 2019 when compared to the same period last year [2018].

According to the Superintendent of Public Health, Charmaine Gauci, after a number of years with no cases of the disease, in 2018, there were 5 imported cases and one local transmission.

Most of the cases occurred in adults who were not vaccinated. "This year [2019], we have already seen over 15 locally acquired cases. Most of the cases occurred in adults who were not vaccinated," Dr Gauci said when the preliminary figures came out.

In its report on this year's [2019] data, the WHO noted a "dramatic resurgence of measles compared to previous years" in the European region, with 49 of the 53 countries in the region together having reported over 160 000 measles cases and over 100 measles-related deaths by the end of May 2019.

"High national-level coverage can mask pockets of low coverage at the local level, resulting in an accumulation of susceptible individuals that often goes unrecognised until outbreaks occur. An enhanced response is needed to protect all populations in the region from this dangerous disease," WHO said. It has set the ambitious goal of achieving measles and rubella elimination in at least 5 of its regions by 2020.  [Byline: Claire Caruana]
Date: Sun 29 Jul 2018 17:28 CEST
Source: Times of Malta [summ., edited]

The number of salmonellosis cases reported to the health authorities so far in July 2018 has surpassed that in previous years, peaking at 20 cases in July alone.

Figures supplied to The Sunday Times of Malta by the health authorities showed that so far this month [July 2018], 20 cases of the food poisoning infection have been reported, up from 11 in 2017. Since the beginning of 2018, 67 cases have been brought to the authorities' attention.

Salmonellosis is a type of foodborne illness caused by bacteria and is often more common in summer. The infection is contracted when food contaminated with the bacteria is consumed, with young children, older adults, and those with impaired immune systems being more susceptible to severe infection. Symptoms include diarrhoea, fever, and abdominal cramps and usually develop 12 to 72 hours after the infection is contracted. It usually lasts 4 to 7 days.

Just this week, the health authorities confirmed _Salmonella_ had been found in eggs from St Joseph Farm [Southern region] during sampling by the veterinary authorities as part of the Veterinary National Control programme for _Salmonella_. Eggs packed by this farm have since been recalled, with the public being advised not to consume them. The Superintendent of Public Health warned that food that has been listed as recalled should not be consumed, while the general handling of eggs should also be done with caution.

Eggs, she said, should always be cooked until both the yolk and the white are firm, while egg dishes should be cooked to an internal temperature of 71 deg C [160 deg F] or hotter. The eggs used in sauces or any other items that contain raw or lightly-cooked eggs should be pasteurized, Dr Gauci said. Hands, and any implements that come in direct contact with raw eggs, should always be thoroughly washed.  [Byline: Claire Caruana]
============================
[While undercooked eggs are a common source for human salmonellosis, it is not unclear if the finding of contaminated eggs on Malta is related to the upswing of human cases. No information is given regarding the human and egg isolates to assess if they are related. - ProMED Mod. LL]

[HealthMap/ProMED-mail map of Il-Hamrun, Malta:
Date: Mon 13 Mar 2018
From: Christian Lenart <christian@lenart.at> [edited]

We report a case of _Leishmania donovani_/_L. infantum_ in a 56-year-old man from Austria. He travelled to Malta in June 2017 and complained about itchy, partly exulcerated papules in November 2017. His wife too was suffering from the same lesions but did not consult a dermatologist, since the lesions regressed spontaneously.

The patient first contacted a dermatologist, who performed an excision showing _Leishmania_ negative granulomatous inflammation as a histological result. He was then referred to the dermatological ward of the municipal hospital. The lesions were up to 2 cm [0.8 in] in size, disseminated on all extremities.

Another excision was performed, showing plenty of amastigotes affected macrophages. He then was checked for signs of visceral manifestation, but showed no hepatosplenomegaly. The blood sample showed no conspicuity with normal haematological results and normal CRP [C-reactive protein]. The PCR test for _Leishmania_ sp. DNA was positive.

The Western blot (IgG) was positive as well, whilst immunoaffinity chromatography was negative. Skin biopsy genotyping proved a diagnosis of _Leishmania infantum_/_L.donovani_. Since the patient had multiple lesions treatment with miltefosine was initiated.

Leishmania in Malta
-----------------------------------------
While especially leishmaniasis was quite common in the early 20th century in Malta, there were hardly any cases of cutaneous leishmaniasis at the end of the century. For the last years the incidence has been stable with about 3 to 4 cases of visceral leishmaniasis, VL, per year (1).  In 2012, 3 VL and no CL cases were reported (2). All cases of leishmaniasis are caused by _L. infantum_ in Malta, transmitted from dogs to humans by _Phlebotomus perniciosus_. The 2 identified zymodemes in Malta are MON 1, causing visceral and MON 78, causing cutaneous leishmaniasis (3).

References
---------------------------------------
1. Alvar J, Vélez ID, Bern C, et al and the WHO Leishmaniasis Control Team. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012; 7(5): e35671. doi: 10.1371/journal.pone.0035671; available at <http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035671>.
2. Government of Malta, Ministry for Health, the Elderly and Community Care: Annual report 2012; p. 46; available at <https://www.gov.mt/en/Government/Publications/Documents/Annual%20Reports/MHEC.pdf>.
3. Pace D, Williams TN, Grochowska A, et al. Manifestations of paediatric _Leishmania infantum_ infections in Malta. Travel Med Infect Dis. 2011; 9(1):37-46. doi: 10.1016/j.tmaid.2010.11.005; available at <http://www.travelmedicinejournal.com/article/S1477-8939(10)00196-1/fulltext>.
--------------------------------------
Dr Christian Lenart
Department of Emergency Medicine
Krankenhaus Hietzing (Municipal Hospital Vienna-Hietzing)
Austria
christian@lenart.at
===============================
[Leishmaniasis is endemic in Malta and cases imported from Malta to other countries are not unusual. _Leishmania infantum_ usually results in visceral leishmaniasis and the genotyping in this case could not distinguish between _L. donovani_/_L. infantum_. Miltefosine is the drug of choice for cutaneous leishmaniasis. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps: Austria: <http://healthmap.org/promed/p/63886> Malta: <http://healthmap.org/promed/p/77>]
Date: Tue, 20 Feb 2018 18:18:07 +0100

Valletta, Feb 20, 2018 (AFP) - Malta International Airport was brought to a standstill on Tuesday by a fire that left flights suspended and hundreds of passengers stranded.   Passengers were evacuated from the airport as smoke billowed through the arrivals and departure lounges, an AFP reporter at the scene said.   Firefighters worked for two hours to put out the small blaze, which began at around 1:15 pm and caused no injuries.

Airport operators said 10 outbound international flights were delayed. They added later in an online statement that operations at the terminal were resuming.   The airport said the blaze broke out in the pump room for the airport's small aquarium, located in the arrivals concourse.   "Terminal operations are now resuming, and Malta International Airport's recovery plan has been activated," it said in a statement in the late afternoon.

Hundreds of passengers were left standing outside the airport and some even on the apron.   One flight to nearby Catania in Sicily was expected to take off 11 hours later than scheduled, according to the departures timetable.   Flights to Stockholm, Cyprus, Krakow, London Gatwick and Dublin were also delayed.   Flights from British airports Heathrow and Gatwick were diverted to Catania.
Date: Fri 24 Feb 2017
Source: Times of Malta [edited]

The meningitis B vaccine shortage [is] likely to persist. Malta will have to wait its turn, manufacturers say. Global demand for the vaccine outstrips supply, manufacturers say.

A one-year-old baby died of [meningococcal] meningitis [serogroup] B, a disease against which vaccines are currently unavailable, this newspaper is informed. Sources said the baby died last month [January 2017] after contracting the disease that affects the lining around the brain and spinal cord. The Central Procurement and Supplies Unit (CPSU) was informed that the local agent for the meningitis B vaccine had a stock of vaccines available in a number of local pharmacies, a Health Ministry spokeswoman said.

The representatives of international pharmaceutical company GlaxoSmithKline (GSK) in Malta were in liaison with their suppliers to hasten further delivery, and the CPSU was in liaison with both companies to monitor the situation, the spokeswoman added.

The ministry was also asked about the baby's death, but no reference was made to it in its reply late yesterday [23 Feb 2017] evening.

The government does not supply the vaccine against the specific strain that affected the infant, which can, however, be purchased from private hospitals and pharmacies. Paediatricians said private hospitals had purchased the vaccine from pharmacies abroad, but these too had since run out.

According to one paediatrician, the unavailability of such a vaccine in light of the baby's death was very worrying, particularly to parents. Another paediatrician, however, warned against the matter getting out of hand, saying the issue was not as worrying as parents were making it out to be. Babies who were not vaccinated were not in any immediate danger, he said.

A spokeswoman for the local representative of GSK confirmed that the vaccine was not available and it would not be for some time. She said no fixed date had yet been given as to when a supply would be made available to the local market. According to the spokeswoman, the vaccine was in high demand all over the world, and as GSK [GlaxoSmithKline] had agreements with a number of governments abroad, supplies would be shipped to these countries 1st. At present, demand exceeded the quantity manufactured.

"It's important to understand that, in these cases, we need to stock enough for boosters, so before sufficient doses are available, this will not be made available," the GSK spokeswoman said.

According to the Maltese Paediatric Association, about 10 cases of meningitis have been reported among children. The signs of meningitis are fever, severe headache, neck stiffness, vomiting, dislike of bright light and drowsiness. Infants and younger children may not always show such symptoms but, instead, feed poorly or become very lethargic.  [Byline: Claire Caruana]
===================
[Although there are at least 13 _ Neisseria meningitidis_ serogroups, based on the antigenic specificity of their capsular polysaccharides, disease due to serogroups A, B, C, Y, and W is most common. Meningococcal vaccines contain capsular polysaccharide for _Neisseria meningitidis_ serogroups A, C, Y, and W, either alone or conjugated to protein. The conjugate capsular polysaccharide vaccines are preferable, because, unlike the polysaccharide vaccines, conjugate vaccines immunize infants, reduce the carriage of meningococci in the throat and thus its transmission, as well as confer a more sustained immune response, and, therefore, longer-term protection than the polysaccharide vaccines.

Serogroup B vaccines are based upon meningococcal B outer membrane vesicle protein antigens, because group B polysaccharide is poorly immunogenic in humans and is a potential auto-antigen. At least 2 serogroup B meningococcal vaccines -- Bexsero (GlaxoSmithKline, GSK) and Trumenba (Pfizer) -- are available.

Meningococcal disease often occurs without warning and frequently progresses rapidly to death, even when it is treated appropriately. In addition, about 10-20 percent of survivors of meningococcal disease will suffer disabilities such as hearing loss, brain damage, and amputations. Vaccines are used to prevent meningococcal disease, not treat someone already ill from the disease. Immunity following use of a meningococcal vaccine is specific for the type of capsular polysaccharide the vaccine contains regarding the A, C, Y, and W polysaccharide or conjugate vaccines or the surface proteins regarding serogroup B vaccines, with no cross-protection against infection due to other meningococcal groups.

Vaccines are frequently used to prevent spread of meningococcal disease in the face of an institutional or community outbreak (<https://www.cdc.gov/meningococcal/downloads/interim-guidance.pdf>). Antibiotics are also used to prevent spread of meningococcal disease in persons who are at high risk because they have been in close contact (coughing or kissing) or lengthy contact, especially among people living in the same household.

According to the 2017 Malta National Immunization Schedule, meningococcal vaccines are not included in the series of vaccines for infants and children (<https://health.gov.mt/en/phc/pchyhi/Pages/National-Immunisation-Schedule.aspx>). In the U.S., vaccination against meningococcal disease due to serogroups A, C, Y, and W is only recommended for children aged 2 months through 10 years who are at increased risk for meningococcal disease, i.e., have complement component deficiencies, have functional or anatomic asplenia (including sickle cell disease), are in the risk group for an outbreak for which vaccination is recommended, or are traveling to or residing in regions where meningitis is epidemic or hyper-endemic (for specifics, see Table at <https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6324a2.htm#Tab>). The serogroup B vaccines Bexsero and Trumenba have been licensed by the U.S. Food and Drug Administration (FDA) only for individuals aged 10 through 25 years. However, the European Medicines Agency has approved Bexsero for use in individuals of 2 months of age and older, and Bexsero has been added to the routine childhood immunization schedule in the UK and Ireland (<http://www.meningitis.org/menb-vaccine>).

Malta, a member of the EU, is a southern European island country consisting of an archipelago in the Mediterranean Sea, 80 km (50 miles) south of Italy, with a population of just under 450,000 residents (<https://en.wikipedia.org/wiki/Malta>). - ProMED Mod.ML]

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

Trinidad and Tobago

Trinidad and Tobago - US Consular Information Sheet
March 04, 2009
COUNTRY DESCRIPTION:
Trinidad and Tobago is a developing nation in the Caribbean composed of two islands.
The islands gained independence from the British in 1962.
>The country is one of the most prosperous in the Caribbean, largely as a result of petroleum and natural gas industries.
Tourist travel is mostly to the smaller of the two sister islands, Tobago.
Tourist facilities are widely available.
Read the Department of State Background Notes on Trinidad and Tobago for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid passport is required of U.S. citizens for entry to Trinidad and Tobago.
U.S. citizens do not need a visa for tourism or business-related visits of 90 days or less.
Work permits are required for compensated and some non-compensated employment, including missionary work.
Visas may be required for travel for purposes other than business or tourism.
For further information concerning entry, employment and customs requirements, travelers may contact the Embassy of Trinidad and Tobago, 1708 Massachusetts Avenue NW, Washington, DC
20036, telephone (202) 467-6490, or the Trinidad and Tobago Consulates in Miami or New York City.
Visit the Embassy of Trinidad and Tobago’s web site.

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:
American citizens traveling to or residing in Trinidad and Tobago should avoid large crowds and demonstrations.
While non-violent demonstrations occur on occasion, widespread civil disorder is not typical.
The downtown area of Port of Spain experienced four bombings in 2005.
While no similar incidents have occurred since that time, the perpetrator(s) have not been arrested and their identities and motive remain unknown.
Americans visiting or residing in Port of Spain are advised to exercise caution, especially in crowded urban areas.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, 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:
Incidents of violent crime have been steadily on the rise on both islands.
Visitors to Trinidad and Tobago should exercise caution and good judgment as in any large urban area. Particular caution should be exercised when traveling after dark from Trinidad's Piarco Airport as incidents have been reported involving armed robbers trailing arriving passengers from the airport and accosting them in remote areas of the airport parking lot, on the highway leading from the airport to downtown Port of Spain, and outside the gates of residences.
Areas of metro Port of Spain to avoid include Laventille, Morvant, Sea Lots, South Belmont, scenic rest stops (after dark), walking across the Queen’s Park Savannah, and downtown Port of Spain (after dark), as tourists are particularly vulnerable to pick pocketing and armed assaults in these locations.
Holiday periods, especially Christmas and Carnival, often see an increase in criminal activity.
Violent crimes, including assault, kidnapping for ransom, sexual assault and murder, have involved foreign residents and tourists, including U.S. citizens.
The perpetrators of many these crimes have not been arrested.
Burglaries of private residences are common.
Robbery is a risk, particularly in urban areas and especially near ATMs and shopping malls.
Visitors should avoid wearing expensive jewelry or displaying large amounts of money in public.
One victim was targeted for driving an expensive new car.
In some cases, robberies of Americans have turned violent and resulted in injuries after the victim resisted handing over valuables.
In Tobago, the media have reported an increase in the incidence of violent crimes.
While local authorities have announced increased measures to fight crime, the U.S. Embassy advises that when making reservations at private accommodations, visitors should ensure that 24-hour security is provided.
There have been reports of home invasions in the Mt. Irvine area, and robberies occurring at the waterfalls and on isolated beaches in Tobago where visitors are not in a group.
Visitors to Tobago should ensure that all villas or private homes have adequate security measures.
Visitors to Trinidad and Tobago are also advised to be cautious when visiting isolated beaches or scenic overlooks where robberies can occur.
Visitors should not walk alone or in unfamiliar areas.
Valuables left unattended on beaches and in other public places are vulnerable to theft.
Visitors should avoid neighborhoods known for high crime rates.
When in doubt, consult the establishment where you are staying to identify areas to be avoided.
Taxis available at the major hotels or through pre-arranged pick-ups with reputable companies are generally safe and reliable.
The U.S. Embassy urges caution in the use of the small buses or vans in Trinidad, known as "Maxi Taxis" (full-size inter-city buses are usually safe.)
Unmarked shared taxis authorized to pick up passengers will have the letter 'H' as the first letter on their license plates.
Some shared taxis and maxi taxis have been linked to petty crime and serious traffic accidents.
Valuables including travel documents should not be left unattended in parked cars, especially in parking lots, as several thefts have been reported.

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

The local equivalent to the “911” emergency line in Trinidad and Tobago is:
Police 999 or 555, Fire 990, Ambulance-Trinidad 811, Ambulance-Tobago 639-4444, and Coast Guard (yachting emergencies) 634-4440.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
We strongly recommend that you obtain comprehensive travel and medical insurance before traveling.
Medical care is limited compared to that in the United States.
Care at public health facilities is significantly below U.S. standards for treatment of serious injuries and illness, with limited access to supplies and medications.
While care at some private facilities is better than at most public health facilities, patients may be expected to prove their ability to pay before assistance is given, even in emergency situations.
Patients requiring blood transfusions are expected to arrange for at least the same amount to be donated on their behalf.
Physicians and nurses may go on strike, causing serious strain on both public and private medical resources.
Ambulance service is extremely limited both in the quality of emergency care and in the availability of vehicles in many parts of the country.
According to the Trinidad & Tobago Ministry of Health, recent monkey deaths on the island of Trinidad have been laboratory confirmed as due to yellow fever.
Although no human cases have been reported since 1979, the virus appears to be permanently embedded in forested areas of the central/south region of the island of Trinidad.
Evident outbreaks among monkeys may appear every 10-20 years after long periods of epidemiologic silence.
CDC continues to recommend yellow fever vaccine for travel to Trinidad & Tobago.
Dengue fever presents significant risk in urban and rural areas.
Precautions against insect bites are recommended such as wearing long sleeved shorts/trousers, the use of bed nets and insect repellants which contain DEET, picaridin (KBR 3023), Oil of Eucalyptus/PMD, or IR 3535.
Ciguatera poisoning is prevalent and results from eating reef fish such as grouper, snapper, amberjack, and barracuda.
The toxin remains even when fish is well cooked.
Marine hazards include corals, jellyfish, sharks, and sea urchins.
Heed posted warnings at organized beaches, and do not bathe at unmarked, unpatrolled beaches.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Trinidad and Tobago.
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.
For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site.
Further health information for travelers is available from the WHO.
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

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

Traffic moves on the left in Trinidad and Tobago.
Most vehicles are right-hand drive, but left-hand drive vehicles are permitted.
Rental cars are available, and are generally right-hand drive.
A U.S. driver's license and/or an International Driving Permit are valid for up to 90 days after arrival.
Seatbelts are required for drivers and front seat passengers, and cars may be pulled over and drivers fined for not wearing seatbelts.
Trinidad has several good four-lane highways and one controlled-access highway.
However, road quality decreases quickly on secondary roads.
Rural roads are narrow and often have deep drainage ditches on either side.
Some are in poor repair, and are frequently congested.
Night travel should be avoided other than on major highways.
Roadside assistance exists, but is limited and may be subject to lengthy delays.
The Beetham Highway, a main thoroughfare in and out of the city, is dangerous if your vehicle has broken down.
If your vehicle is drivable get out of the area before seeking help.
The Ministry of Works and Transport is responsible for road conditions and safety in the country.
Emergency ambulance services exist but may take prolonged amounts of time to reach the site of an accident and may not provide service in rural areas.
Trinidadian drivers may use hand signals to indicate turning, stopping, or slowing, which do not necessarily correspond to hand signals used in the United States.
Trinidadian drivers are generally courteous, but can be flexible with the rules of the road.
For example, cars traveling north on a two way street may cross into the southbound lane to stop and let passengers out.
Visitors need to be attentive and alert.
Intoxicated drivers on the road are a particular concern on the weekends, especially after dark when many locals are going to or returning from social events.
Drivers should take extra precaution on narrow and winding roads leading in and out of beaches and small towns in Trinidad and Tobago.
As always, defensive driving is strongly encouraged.
The country has an extensive system of taxis, maxi-taxis (vans) and some larger buses.
Although the larger inter-city buses are generally safe, the maxi-taxis have been linked to many road accidents and some instances of crime.
Fares should be agreed upon in advance.
Taxis will often stop at any point along the road to pick up or discharge passengers, often with little or no warning.

Please refer to our Road Safety page, and the Trinidad and Tobago’s Ministry of Tourism home page for more information.

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

MARINE SAFETY AND OVERSIGHT:
Visitors arriving in Trinidad and Tobago aboard a private vessel must register any firearms with local customs authorities.
Failure to declare firearms or making false customs declarations is a serious offense.
U.S. citizens have been jailed and fined for possession of unlicensed firearms and ammunition, attempting to export ammunition, making false customs declarations and not declaring their firearms.
There is a small community of private boat owners who stay in Trinidad temporarily during the hurricane season.
There have been several incidents within the past few months in which vessels were boarded and the occupants were assaulted and robbed.
Sailors should report any incidents to the Coast Guard and local police, and are encouraged to check with the Trinidad and Tobago Coast Guard and yacht facility managers for current information.

SPECIAL CIRCUMSTANCES:
Trinidad and Tobago is prone to occasional earthquakes, though no major earthquake has hit in recent history.
Tobago has suffered extensive damage from only two hurricanes since 1963.
In 2004, parts of Tobago were severely affected by flooding and mudslides from Hurricane Ivan and several other major storms that followed soon thereafter.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) website.

Travelers are cautioned against wearing military or camouflage clothing in public, as it is against local laws to do so, unless they are in Trinidad and Tobago on official military business.

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 Trinidad and Tobago laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Trinidad and Tobago 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.

Many of the US citizens incarcerated in Trinidad and Tobago were arrested attempting to transport suitcases or packages containing drugs in or out of the country.
Even if a package or suitcase is being carried for someone else, the traveler is liable for its contents.
Americans should be aware that cursing and use of foul language in public is a criminal offense in Trinidad and Tobago subject to arrest and fines.
Several Americans have been arrested for this offense. While the penalty for public cursing is usually a fine, it can cause considerable disruption in travel plans due to arrest procedures, requirements to appear at hearings, and even incarceration if bail cannot be posted.

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 Trinidad and Tobago 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 Trinidad and Tobago.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Embassy is located at 15 Queen's Park West, telephone 868-622-6371, Consular Section fax 868-822-5555.
American Citizen Services public hours of operation are 8:00 AM – 11:30 AM, and 1:00 PM through 3:00 PM, Monday - Friday, except U.S. and Trinidad and Tobago national holidays.
For additional information, you may send email inquiries.
*

*

*
This replaces the Country Specific Information for Trinidad and Tobago dated April 13, 2007, to update sections on Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed 27 Nov 2019
Source: Jamaica Observer [edited]

At least 16 people have died so far this year [2019] as health authorities embark on a "robust nationwide influenza vaccination drive" to protect the population against the flu virus. The Ministry of Health said that as of last Friday [22 Nov 2019], the number of suspected cases for this flu season had reached 2738 and that there had been 16 confirmed deaths. The ministry said that the cumulative number of vaccines administered to the public so far was 16 301.

"The influenza virus is serious and is generally more severe than the common cold. The flu vaccine is available, at no cost, at all health centres," the Ministry of Health said, adding that children and people with chronic medical conditions should be among those getting the vaccine. It said that the flu season runs until May next year [2020] and that individuals in the healthcare and essential-services sectors should also ensure that they receive the vaccine.
Date: Mon 10 Jun 2019
Source: Saturday Express [edited]

There have been 17 malaria cases thus far in Trinidad and Tobago in 2019, and 13 are Venezuelans. One case is a Trinbagonian, one is from Uganda, one is from Ghana, and one is from Guyana.

This was disclosed by health minister Terrence Deyalsingh as he responded to a question from Oropouche West MP Vidia Gayadeen-Gopeesingh on whether there was truth to social media reports that many Venezuelan nationals seeking medical attention at Port of Spain and San Fernando general hospitals have malaria and are HIV-positive.  [Byline: Ria Taitt]
=========================
[It is noteworthy that 13 of the 17 imported cases are from Venezuela. Over the past few years, malaria has surged in Venezuela and is not endemic and widespread, with no control policy and a lack of basic drugs. This is a clear threat to neighbouring countries, where imported cases can start new local transmission, so-called "introduced malaria."

"Trinbagonian" refers to a native or inhabitant of Trinidad and Tobago. All malaria cases are imported, and Trinidad and Tobago is indeed regarded as a malaria-free country. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps:
Date: Thu 29 Mar 2018
Source: Daily Express [edited]

This media source quotes the Health Minister as saying they're imported cases:

"speaking during a news conference at the Ministry of Health in Port of Spain, Deyal Singh, said the cases of malaria in T&T are persons who visited other countries where malaria is present and returned to the country."  [Byline: Camille Hunte]
----------------------------------------
Communicated by
Viki Hansen-Landis
International SOS
=======================
[ProMED thanks Viki Hansen-Landis, International SOS, for informing us about the statement by Deyal Singh that all the 13 cases diagnosed in Trinidad and Tobago are imported cases. However, with a tropical climate and the presence of Anopheles mosquitoes, there is always a risk that malaria may be reintroduced.

A map of Trinidad & Tobago: <http://healthmap.org/promed/p/28>. - ProMED Mod.EP]
Date: Fri 27 Apr 2018
Source: News Day [edited]

With the start of the wet season less than 2 months away, former Health Minister Dr Fuad Khan has described the resurgence of the mosquito-borne disease malaria as "worrying" due to flooding, which occurs in central and south Trinidad every year.

Khan was commenting on World Malaria Day (WMD) 2018 observances themed: "Ready to Beat Malaria."

He observed that while Trinidad and Tobago has been relatively malaria free since 1965, he said the nation was witnessing a "re-emergence of this dreaded disease," as the Ministry of Health has reported 13 cases as of 30 Mar 2018.

He said the number of malaria cases has ranged between 7 and 24 cases over the past 10 years.

"This new development is worrying for a society that has constant issues with flooding, particularly in central and southern areas of Trinidad. Even though malaria was said to be eradicated in 1965, because of our tropical conditions, vast swamplands and thickly forested areas, our environment is still an easy target for the importation of the female anopheles mosquito containing a plasmodium parasite that is then transmitted from one person to another by that infected mosquito," he said. "Therefore, its eradication should not be taken for granted."

Khan said TT was able to begin to get ahead of the malaria problem when in 1944, the New York-based Rockefeller Foundation came to Trinidad to begin testing for the anopheles mosquito utilizing dichlorodiphenyltrichloroethane, commonly known as DDT, which is a larvacide for the spraying of the mosquitoes.

"While we acknowledge the dangers malaria poses to the people of Trinidad and Tobago, we must emphasize the need for the population to do its part in preventing the spread of this disease. We can do so by getting rid of pools of stagnant water, clearing bushes from around houses and planting lemon grass, which can all reduce the number of mosquitoes nearby," he said. "Do your part. Be responsible," he said.

According to the Centres for Disease Control and Prevention, people with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die.
================
[It is not clearly stated in the text, but we presume that the 13 cases were infected in Trinidad and Tobago and are not imported cases. If that is the case, the previous Minister of Health is indeed right that it is a serious situation because the island thus has sustained local transmission or autochthonous malaria. However, Trinidad and Tobago is not listed as a country with malaria in the 2017 WHO World Malaria Report (<http://www.who.int/malaria/publications/world-malaria-report-2017/wmr2017-regional-profiles.pdf?ua=1>), and thus the 13 cases may indeed be imported cases.

It is also not clear whether it was _Plasmodium falciparum_ or _Plasmodium vivax_. ProMED will be happy for a clarification from the authorities. - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Trinidad & Tobago: <http://healthmap.org/promed/p/28>]
Date: Fri 10 Nov 2017
Source: Loop [edited]

Agricultural economist Omardath Maharaj is calling for Government to be more proactive regarding post-flooding food safety policies after a number of leptospirosis cases were reported in South Trinidad. According to media reports, 13 cases of leptospirosis were reported at the San Fernando General Hospital.

It is thought the cases connected to unhygienic conditions due to recent flooding in parts of South Trinidad.

Newsday reported that 2 people have since died from the disease.

Maharaj, who represents the Tableland Pineapple Farmers Association and the Felicity Charlieville Fishing Association, is asking what extra measures are being put in place for testing of local produce, meat and shellfish to ensure that the disease is not being spread.

"There has been minimal, if any, information being distributed to the national community as it relates to flooding, food security, diseases (leptospirosis, cholera, meningitis etc) and bacteria (_Salmonella_, _E. coli_, etc)."

"Certainly, I am not aware of any national lessons learnt post-Tropical Storm Bret and the more recent flooding disaster towards mitigating the unsustainability and vulnerability of the local food system as it relates to preserving national food and nutrition security."

"Research suggests that the lack of important information and active surveillance compounds the fact that the level of awareness of these issues is low in the country."

"Leptospirosis, particularly, is still under-reported, and considered to be of significant public health importance. The recent food poisoning of young Tobagonian students in receipt of meals from the School Nutrition Programme is a living case study of our vulnerability," Maharaj said. Maharaj is asking the Ministry to update the public as to whether that has been an increase in the number of persons seeking medical aid for infections or diseases related to recent flooding, such as leptospirosis.

He is also asking what public awareness messages are being conveyed to the public in order to take extra precautions. He added that vendors and farmers should also be advised as to sanitary and safety protocols to ensure their harvests are not tainted. Maharaj is also asking for an update on the planned National Public Health Laboratory, which was recently announced by Health Minister Terrence Deyalsingh.

"There is a vacuum in the national conversation...these issues and inherent discussions are of national importance and every individual, family, and organization should participate in the dialogue contributing to our national development agenda," Maharaj said.
=============
[Leptospirosis is a zoonotic spirochetal infection that occurs worldwide and is transmitted to humans by exposure to soil, fresh water or food 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.

Though the CDC considers leptospirosis can be a foodborne disease, estimating an actual percentage of cases that can be attributed to food is complicated since this disease has various ways of transmission, such as contact with contaminated flood water following heavy rains that may also be simultaneously operative (<https://wwwnc.cdc.gov/eid/article/17/9/10-1766-techapp1.pdf>). - ProMED Mod.ML]

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

General Information
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Tourists are now beginning to return to Sri Lanka after years of trouble throughout the country. Since 1983 the civil war between the Tamil Tigers and Government has occasionally
affected tourists. Nevertheless, those who have visited the country usually return home with glowing reports about the beauty of the country and the welcoming pleasant nature of the local population. The recent moves toward developing the peace processes throughout the country are extremely encouraging but it will be important that tourists and business travellers recognise that it is still early days and that care should continue to be exercised at all times.
Climate
**********************************************
Sri Lanka is situated like a tear drop off the southeastern tip of India close to the equator. The climate is fairly steady throughout the year with temperatures generally above 20c and a moderately high humidity throughout the year - especially along the coastal resorts. Most rainfall tends to fall during April, May and June and again during October and November. It will be important to ensure that the correct clothing is brought to cope with the climatic conditions.
Avoiding Prickly Heat
**********************************************
The term prickly heat is used in a variety of ways but the cause is generally the same. In a hot climate the body perspires to maintain the internal temperature at a correct level. In the perspiration there will be fluid and also your personal salts. The fluid evaporates but the salt dries against the skin. It is your individual reaction to this salt that leads to the ‘prickly heat rash’. The reaction to these salts can be minimised by removing the salts from the skin surface as soon as possible. Change your clothes regularly, use plenty of talcum powder to absorb the perspiration and dry off well after showering. Sometimes it may be worth considering antihistamines to lessen the irritation.
Safety and Security
**********************************************
Travellers will seldom visit the main insecure regions of Sri Lanka which are situated in the north and east of the country. The tourist resorts along the beaches in the southwest of the country are generally safe. However, like many other countries it is important to recognise that petty crime remains the most common problem for many tourists. Never flaunt personal wealth and always use the safety boxes in your hotel if they are available. Wandering about the streets at night is unwise. Unfortunately, in a country with such a long history of armed conflict, there are many gangs with guns willing to hold up unwary tourists. Always check with your tour representative on arrival and be sensible enough to avoid obviously risky situations. Having a form of identity with you and the business card from your hotel may be a wise precaution. Don’t easily befriend strangers and single women visitors in particular should take care.
Local Customs
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The Sri Lankan authorities treat any drug offences very seriously. Make sure any medications are clearly marked and never carry any items for another person unless you are certain of the contents. If visiting Buddhist temples remove any head covering and make sure your arms and legs are covered. Don’t take pictures of police, military or any government buildings. Taking pictures of individuals standing next to a statue of Buddha can cause offence.
Road Travel in Sri Lanka
**********************************************
The traffic in Sri Lanka moves on the left side of the road but the streets are very congested. The maintenance of vehicles may be very substandard and accidents may occur due to faulty breaks, wandering animals or energetically ridden bicycles and mopeds etc. Hiring a car and driving by yourself throughout even the south eastern parts of the country is probably unwise due to the security situation. Hiring a car with a driver from a reputable firm will be a safer option.
Touring the country
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Many tourists want to visit other regions of the country and will aim for places like the Cultural Triangle of Kandy, Anuradhapura and Polonnaruwa. These are in the low risk region for malaria and so prophylaxis is not recommended. However, road transport can be hazardous and you should ensure that you are travelling with a reputable guide. There have been a number of incidents involving tourists at the Yala National Park.
Medical Care
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The level of medical care varies greatly throughout the country. It is important to carry any required medications for your trip - though make sure they are clearly marked showing they for your own personal use.
Sun Exposure
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The climatic conditions are such that many tourists will develop significant sun burn if they are not careful. This is particularly true for the first few days as you acclimatise. Use high sunblock creams and take particular care to ensure that the children are well protected while swimming.
Rabies in Sri Lanka
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The transmission of Rabies by warm blooded animals in Sri Lanka is known and so it is essential that all travellers know that any contact with dogs, cats etc should be avoided at all times.
Swimming
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Take care while sea swimming to follow any local advice. There can be dangerous currents and strong rip tides. Watch any children at all times and make sure they don’t get burnt or dehydrated. If possible, eating salted crisps and peanuts may help.
Mosquitoes and Bites
**********************************************
Fortunately malaria does not occur in the main regions of the country visited by tourists in the southwestern part of the country. However, Dengue Fever (a viral disease transmitted by day-time biting mosquitoes) is a constant problem throughout the country.
Vaccines for Sri Lanka
**********************************************
Coming from Western Europe there are no vaccines which are compulsory for entry or exit. However, tourists are strongly advised to consider vaccination cover against the following;
*
Tetanus & Polio (childhood booster)
*
Typhoid (food & water borne)
*
Hepatitis A (food & water borne)
Those travelling for longer periods or to more remote regions may need to consider other vaccines including protection against Rabies, Hepatitis B and Japanese B Encephalitis. Malaria prophylaxis may also be required for these particular travellers.

Travel News Headlines WORLD NEWS

5 Aug 2019

47 people died and over 200 000 were infected by the dengue virus across Sri Lanka in the 1st 7 months of this year [2019], government figures revealed on Monday [5 Aug 2019]. Until the end of July [2019], a total of 234 078 dengue cases were reported, with the highest number of cases reported from the Colombo district, followed by Gampaha and Kalutara, reports Xinhua news agency.

The government's epidemiology unit said it had identified 5 high-risk districts: Colombo, Gampaha, Galle, Kalutara, and Ratnapura. Medical experts have urged people to seek immediate medical attention if they suffered from high fever, uncontrolled vomiting, abdominal pain, and dizziness.

HealthMap/ProMED-mail map of Sri Lanka:
Date: Wed, 24 Jul 2019 10:03:29 +0200

Colombo, July 24, 2019 (AFP) - Sri Lanka has re-introduced and expanded a visa-free entry scheme for visitors in a bid to revive its flagging tourism sector after the deadly Easter bombings, officials said Wednesday.   The concession for tourists from 39 nations was suspended after Islamists bombed three churches and three luxury hotels in Colombo on April 21 killing 258 people, including 45 foreigners.   "As the security situation has improved, the cabinet of ministers decided to revive the visa-free scheme and also extended it to seven more countries," the government said in a statement.

A tourism official said foreign governments have relaxed travel advisories for Sri Lanka since the attacks.   There has also been a lift in the number of arrivals, which nosedived soon after the bombings blamed on a home-grown jihadist group, the official said.   The new countries added to the expanded scheme -- which already allows travellers from the European Union, Australia and the United States to enter Sri Lanka without a visa -- include China and India.   Visitors still have to obtain a visa on arrival, but the government has waived the $35 fee from August 1.

Sri Lanka initially projected a 30 percent dip in the number of foreign holidaymakers after the attacks.   The following month the number of tourists plunged to 37,800, down from 166,975 in April, according to official figures.   But they improved last month with some 63,000 visitors, although numbers are still down from 146,828 in June 2018.   Sri Lanka welcomed a record 2.33 million tourists in 2018, and was named the world's top travel destination for 2019 by the Lonely Planet travel guide.
Date: Thu, 6 Jun 2019 14:18:11 +0200

London, June 6, 2019 (AFP) - Britain on Thursday relaxed its travel advice on Sri Lanka after earlier warning against "all but essential travel" following the April terror attacks that claimed more than 250 lives. "If you're visiting or resident in Sri Lanka, you should continue to remain vigilant and keep up to date with developments," the Foreign Office said on its website.

Tourists were still warned that "terrorists are very likely to try to carry out attacks.   "Attacks could be indiscriminate, including in places visited by foreigners," it said.   Over 250,000 Britons visited Sri Lanka in 2018, making it the third-highest source of tourism behind India and China, with the two countries retaining strong links since Sri Lanka became independent of colonial rule in 1948.

The suicide bombings against three Christian churches and three luxury hotels were blamed on a local jihadi group, the National Thowheeth Jama'ath.   Police say just over 100 people, including 10 women are in custody in connection with the attacks.   Security forces also detained a further 100 suspects in four days of cordon-and-search operations, according to military officials.
12th May 2019

Sri Lanka - National.
3 May 2019. 15 people have died and over 15,000 infected by the dengue virus across Sri Lanka in the 1st 4 months of this year [2019], the Epidemiology Unit said here Friday [3 May 2019]. Till 30 Apr 2019, a total of 15 407 dengue cases were reported, with the highest number of cases reported from the Colombo district with 3405 cases, followed by Gampaha in the outskirts of Colombo with 2007 cases and Jaffna in the north with 1783 cases.

- National. 23 Apr 2019.Health officials have reported nearly 14,000 dengue through 18 Apr [2019].
Date: Thu, 25 Apr 2019 11:55:34 +0200

Colombo, April 25, 2019 (AFP) - Sri Lanka's government said Thursday it was suspending plans to grant citizens of 39 countries visa-free entry during the country's tourism low season after deadly Easter bombings that killed hundreds.   "Although arrangements were in place to issue visas on arrival for citizens of 39 countries, we have now decided to hold it for the time being in consideration of the current security situation," Tourism Minister John Amaratunga said in a statement.   "Investigations have revealed foreign links to the (Easter) attacks and we don't want this programme to be abused."

Sri Lanka had announced last month a plan to allow visa-free entry to tourists from 39 countries, including EU members, Australia and the United States, during the low season, from May 1.   The scheme did not include China and India, from where many of Sri Lanka's visitors come.   The devastating Easter Sunday suicide bombings against churches and hotels killed 359 people, including dozens of foreigners.   The blasts have rocked the country's burgeoning tourism industry, which is one of the most important foreign exchange earners for the island.   Sri Lanka received 740,600 foreign tourists in the first three months of the year, up 4.6 percent from the same period a year earlier.   It welcomed a record 2.33 million tourists in 2018, and was named the world's top travel destination for 2019 by the Lonely Planet guide book.
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Georgia

Georgia US Consular Information Sheet
COUNTRY DESCRIPTION:
Georgia is a constitutional republic with a developing economy.
Tourist facilities outside of Tbilisi are not highly developed, and many of the goods and services taken for granted
in other countries are not yet available.
Read the Department of State Background Notes on Georgia for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport is required.
U.S. citizens visiting for 90 days or less do not need a visa to enter Georgia.
For further information, please contact the Embassy of Georgia at 2209 Massachusetts Avenue NW, Washington DC, 20008 tel. (202) 387-2390, fax: (202) 393-4537.
Visit the Embassy of Georgia web site at http://embassy.mfa.gov.ge/index.php?lang_id=GEO&sec_id=2&lang_id=ENG for the most current visa information.

Information on 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:
As a result of civil wars in the 1980s and early 1990s, there are two separatist regions in Georgia that are not under the control of the Government of Georgia:
South Ossetia, in north-central Georgia; and Abkhazia, in northwest Georgia.
Although armed conflict between the separatist regions and the central government has ceased, episodes of violence continue and political relations are tense. Political developments have the potential to result in open hostilities.
Due to the volatility of the political situation, high levels of crime, and inability of Embassy personnel to travel to Abkhazia or South Ossetia, the U.S. Embassy advises American citizens not to travel to these separatist-controlled areas.
Because of the restricted access of U.S. officials to Abkhazia and South Ossetia, the ability of the U.S. Government to assist American citizens in these regions is extremely limited, even in emergencies.
All travelers to these regions, regardless of purpose, should register with the U.S. Embassy. The U.S. Embassy recommends that Americans regularly monitor warden messages on the Embassy web site for the latest information on the security situation throughout Georgia.

Political tensions remain high between the Georgian Government and the South Ossetia separatist regime, based in Tskhinvali.
This situation culminated in sniper and mortar exchanges between South Ossetian and Georgian troops in 2004.
Although the fighting did not escalate into an all-out war, low-level violence continues between the two sides, periodically resulting in deaths, and underscoring the potential for instability in the region.
A tense truce also exists between the Georgian Government and the separatist de facto government of Abkhazia; since April 2008, several incidents have increased the tension to a point where cross-border military actions are a possibility.
Over the past several years, a number of attacks, criminal incidents, and kidnappings have occurred in Abkhazia.
While Abkhaz "border officials" may demand that travelers entering the region purchase "visas" from the so-called "Ministry of Foreign Affairs of Abkhazia," the U.S. Government recognizes the territorial integrity of Georgia.
American citizens in areas of western Georgia, near Abkhazia, are advised to be aware of their surroundings at all times and to avoid straying off main roads or traveling after dark.

American citizens should be aware that they cannot legally cross by land, air, rail, or sea between Russia and Georgia, even if in possession of valid Russian or Georgian visas.
In July 2006, the Russian Government closed the only border crossing between Georgia and Russia under the control of both governments (the only other crossings are through Georgia’s separatist regions).
Russian authorities said the closure, at Verkhny Lars, would be temporary, pending necessary repairs at the crossing, although it remains closed as of June 2008.
On August 6, 2007, a missile was fired from an aircraft near a village between the city of Gori and the separatist region of South Ossetia.
Although this was an isolated incident, it serves as a reminder that the situation near the separatist areas remains unpredictable.

Georgia's armed forces have periodically conducted operations against suspected international terrorists, Chechen fighters, and criminals who have taken refuge in the Pankisi Gorge.
American citizens should avoid all travel to the Pankisi Gorge, north of the city of Akhmeta.
American citizens are also advised to exercise caution when traveling in the northern mountainous areas of Georgia bordering the Russian Federation, especially the Chechnya and Dagestan sectors.

Political demonstrations take place from time to time in the capital city, Tbilisi, and normally take place in front of the Parliament building on Rustaveli Avenue.
While these demonstrations are normally peaceful, confrontational demonstrations have occurred, and we wish to remind all Americans that even demonstrations intended to be peaceful can turn confrontational and possibly escalate into violence.

Regardless of the region in Georgia one is planning to visit, American citizens are urged to review their personal security precautions, increase their levels of awareness, register with the consular section and as appropriate, take increased security measures.

In the past, religious minorities in Georgia have been targets of violent attacks.
The victims were primarily Jehovah's Witnesses, but also include Pentecostals, Baptists, and members of the Assembly of God.
Incidents included the burning of literature, the destruction of private property and the beating (sometimes severe) of believers, including American citizens.
Although Georgian authorities arrested, convicted and imprisoned the ringleader of the group responsible for these attacks in 2005, American citizens should remain cautious when engaging in missionary activity in Georgia.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affair’s 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 security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or, for callers outside the United States and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. eastern time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Crime is a very serious problem in Georgia.
There is a great disparity in affluence between foreigners and most Georgians.
Americans in particular are perceived as being wealthy, and are therefore specifically targeted for economic- and property-based crimes.
Incidents such as residential break-in, carjacking, car theft, petty theft, and armed robbery account for most of the crimes involving Americans that are reported to the Embassy.
Petty street crime, such as pick pocketing, purse snatching, and cell phone theft, is also common throughout the country. Furthermore, violent attacks have become more commonplace.
Because illegal firearms are readily available in Georgia, assailants are likely to be armed with firearms and other weapons.

Crime remains a particularly serious issue in Tbilisi, where criminal activity against foreigners remains at levels disproportionate to other metropolitan areas in Europe and the United States.
Many robberies and assaults have occurred in areas frequented by American citizens and foreigners, such as on side streets near Tbilisi’s city center; trouble spots include areas off the main avenues in the Vake and Vera districts, and Chavchavadze and Rustaveli avenues, as well as the Saburtalo region of Tbilisi.
These crimes often occurred when the victim was alone, after dark, and in unfamiliar surroundings.

Petty theft is also a problem on the Tbilisi metro system and in minivans, or “marshrutkas” used for public transport.
American citizens are advised to use personal vehicles or use taxis from established companies that carry passengers door-to-door.
While the security of overland travel in Georgia has improved, vehicular and rail traffic remains vulnerable to robbery.

The threat of kidnapping exists both within and outside of Tbilisi.
In the past, foreign businessmen have been abducted for ransom, and Americans in the Tbilisi area have received kidnapping threats.
The possibility of similar risk to Americans elsewhere in the country cannot be discounted.

Outside of Tbilisi, criminal activity is also a problem, especially in the separatist regions of Abkhazia and South Ossetia, due to the reduced capacity of law enforcement in those areas.
Other regions of concern include:
upper Svanetia, Samtskhe-Javakheti, the administrative border with Abkhazia (including Zugdidi city), and areas along the border with Russia.
When visiting or traveling through these regions, American citizens are urged to increase their vigilance, review their personal security precautions, and take appropriate security measures, e.g. traveling with a native Georgian escort familiar with the local area.

Despite much progress in the Georgian Government’s efforts to reform police and fight internal corruption, serious concerns remain as to the police’s ability to deter criminal activity or conduct effective post-incident investigations.
Although police emergency response is good (see below for contact information), criminals continue to have freedom of movement throughout Tbilisi day or night.

In light of the serious crime situation, all American citizens visiting Georgia are again strongly advised to exercise basic security precautions. American travelers should vary times and routes, especially from places of residence to work locations. Americans should maintain a low profile by not carrying large amounts of cash, not wearing excessive amounts of jewelry, and not behaving in a manner that would draw unnecessary attention.
Additionally, Americans should be aware of their surroundings, travel in pairs or groups, and stay on main streets and routes.
The Embassy recommends that those traveling throughout the country do so during daylight hours only and provide a travel itinerary and contact telephone numbers to a friend or business colleague.
Also, Americans should not hesitate to report any unusual incidents or suspicious vehicles or individuals to the Georgian authorities as soon as possible.
Finally, those that do become a victim of crime should not resist their assailant and should cooperate with the assailant as best they can.
Assailants are most interested in money and/or property; cooperation reduces the chance of being assaulted and/or injured.

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.

The Georgian Ministry of Internal Affairs (MOIA) has established a police emergency hotline.
This service is currently limited to larger cities, but the MOIA is planning to expand this service countrywide.

The local “911” equivalent to contact police in an emergency is: “022”.
Please note that the police dispatcher speaks only Georgian or Russian.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care in Georgia is limited.
There is a severe shortage of basic medical supplies, including disposable needles, anesthetics, and antibiotics.
Elderly travelers and those with pre-existing health problems may be at risk due to inadequate medical facilities.
It is recommended that travelers who intend to visit Georgia for at least two weeks get the hepatitis A vaccine and a pre-exposure rabies vaccine.
Travelers are also encouraged to bring medicine to treat diarrhea, which regularly afflicts newcomers.
Georgian doctors and hospitals often expect immediate cash payment before rendering medical services.

Medical Information: Tuberculosis (TB) is an increasingly serious health concern in Georgia.
For further information, please consult the Centers for Disease Control and Prevention’s (CDC) Travel Notice on TB http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx
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 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 before traveling abroad to confirm whether their policy applies overseas and if 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 Georgia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

As in the United States, vehicular traffic in Georgia moves along the right side of roadways.
Speed limits range from 80 to 100 km/hr on highways, and from 30 to 60 km/hr on urban thoroughfares.
Motorists are not permitted to make right turns on red traffic lights.
While legislation mandating seat belt use has yet to be enacted, drivers and passengers are nevertheless strongly advised to buckle up on Georgian roads.
Georgian law requires that children under seven (7) years of age be restrained in child-safety seats.
A driver with any blood alcohol concentration exceeding 0.00% is considered to be driving under the influence of alcohol.

Motorists should exercise extreme caution when driving in Georgia, as many local drivers do not operate their vehicles in accordance with established traffic laws.
Traffic signals and rules of the road are often completely ignored.
Motorists drive erratically, often recklessly, and at excessive speeds.
Motorists may frequently encounter oncoming high-speed traffic attempting to pass other vehicles at blind turns or over hilltops.
Pedestrians enjoy no right-of-way and need to be extremely careful when crossing streets.
The Georgian Patrol Police, who come under the authority of the Ministry of Internal Affairs, are responsible for maintaining traffic safety in Georgia, but enforcement of traffic regulations is haphazard.

Undivided two-lane roads connect most major cities in Georgia.
Roads are generally in poor condition and often lack shoulder markings and centerlines.
In addition, traffic signals may not work because of power outages or poor maintenance.
Driving at night can be especially dangerous.
Travel on mountain roads is treacherous in both rain and snow, and during winter, heavy snowfalls may make some roads impassable.

Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://tourism.gov.ge/start.php
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Georgia, the U.S. Federal Aviation Administration (FAA) has not assessed Georgia’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.

Travelers on regional airlines among the countries of the South Caucasus may experience prolonged delays and sudden cancellations of flights.
In addition to frequent delays, flights are often overcrowded or overbooked.
Basic safety features such as seat belts are sometimes missing.
Air travel to Georgia on international carriers via Europe is typically more reliable.
Ticketed passengers on flights departing from Georgia should reconfirm reservations with the airline 24 hours prior to departure.

SPECIAL CIRCUMSTANCES:
Georgia has been subject to energy crises in the last few years.
During the winter months, frequent and prolonged power outages are common, especially outside of Tbilisi.
The lack of lighting in public places, even when electricity is available, heightens vulnerability to crime (please see the Crime section above for details).

Georgia’s customs authorities may enforce strict regulations concerning the temporary import into or export from Georgia of items such as alcohol, tobacco, jewelry, religious materials, art or artifacts, antiquities, and business equipment.
Only personal medicines with a doctor’s statement can be imported without the permission of the Georgian Drug Agency section of the Ministry of Health.

American citizens may not import firearms into Georgia; however, hunting weapons may be brought into the country for a two-week period, based on valid Georgian hunting licenses.
While there is no limit to the amount of currency that can be imported, if more money is exported than was declared at the time of entry, the traveler is obligated to prove it was legally obtained.
There are limits on the amount of Georgian currency that may be exported.

American citizens should exercise extreme caution in purchasing property in Abkhazia.
Land for sale in that region rightfully may belong to internally displaced persons forced to leave Abkhazia in the early 1990s and may have improperly been placed on the market by the de facto authorities in Abkhazia.
In such cases, the government of Georgia considers the sale of property in Abkhazia illegal under Georgian law and the property could be reclaimed by original owners at a future date.

The Ministry of Culture, Department of Expertise and Evaluation must license any valuables such as artwork, antiques, jewelry, paintings, etc.
This license describes the object, assesses its value, and provides permission to export it from Georgia.
The U.S. Embassy in Tbilisi can provide more specific information on quantities of items that can be imported duty-free, as well as duties excised for specific items.
It is also advisable to contact the Embassy of Georgia in Washington, DC for specific information regarding customs requirements.
Please see our information on Customs Regulations.

While the Georgian lari is the only legal tender, dollars can be freely exchanged for laris at market rates.
ATMs are also becoming more widespread, but only within the city of Tbilisi.
Credit cards are rarely accepted outside of upscale hotels and restaurants, and travelers’ checks are difficult to cash.
American citizens in Georgia have reported incidents of credit card fraud and identity theft.

CRIMINAL PENALTIES:
While in a foreign country, an American citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offences.
Persons violating Georgian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Georgia 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 Georgia are strongly encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration web site, https://travelregistration.state.gov, and to obtain updated information on travel and security within Georgia.
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 Tbilisi is located at 11 George Balanchine Street.
Office hours from American Citizens Services are from 2 to 5 pm on weekdays; no appointment is necessary.
The telephone number is (995) (32) 27-70-00, which can also be reached after hours, and the fax number is: (995) (32) 53-23-10.
The U.S. Embassy in Tbilisi’s web site is http://georgia.usembassy.gov/.
*
*
*
This replaces the Country Specific Information dated October 3, 2007 to update the section on Entry and Exit Requirements, Safety and Security, Crime, Information of Victims of Crime, ion, Traffic Safety and Road Condition, Special Circumstances, and Aviation Safety Oversight.

Travel News Headlines WORLD NEWS

Date: Sat, 22 Jun 2019 21:45:46 +0200
By Anna SMOLCHENKO with Irakli METREVELI in Tbilisi

Moscow, June 22, 2019 (AFP) - Russia's government on Saturday banned Georgian airlines from flying into its territory, extending restrictions imposed by President Vladimir Putin as part of growing tensions between Moscow and its ex-Soviet neighbour.   Putin had signed a decree late Friday banning Russian airlines from flying to pro-Western Georgia from July 8 in response to anti-Moscow rallies in the Georgian capital Tbilisi.

The protests broke out after a Russian lawmaker addressed parliament from the speaker's seat earlier this week, a hugely sensitive move for two countries whose relations remain tense after a brief war in 2008.   The rallies have morphed into a broader movement against the Georgian authorities while the Kremlin has branded them a "Russophobic provocation".   On Saturday, protesters took to the streets of the Georgian capital for a third day of rallies, with some 3,000 demanding snap elections and electoral reform.   The crowd sang a profanity-laced, anti-Putin chant and some of the demonstrators held up placards insulting the Russian president.   Demonstrators also shot paper airplanes into the sky in response to the Russian bans.

Russia's transportation ministry said that from July 8 two Georgian airlines would be banned from flying to Russia, citing the need to ensure "aviation safety" and debt owned by the Georgian companies.   The Kremlin has said the ban against travel to Georgia was to "ensure Russia's national security and protect Russian nationals from criminal and other unlawful activities."

Authorities recommended travel companies stop selling holiday packages to Georgia and advised Russian tourists to return home.   Russia's travel industry and ordinary Russians hit out at the decision by the Kremlin, saying it was a politically motivated move that has little to do with safety concerns.   "Tourism in Georgia is on the rise, and the decision has shocked the whole industry," Aleksan Mkrtchyan, head of Pink Elephant, a chain of travel agencies, said in a statement.

- 'This is politics' -
The ban during high season is expected to hit the travel industry in both countries hard and become a major nuisance for Russian holidaymakers.   Russia and Georgia fought a brief but bloody war in 2008 and tensions between the two governments remain high.   But Georgia -- known for its picturesque Black Sea resorts, rich national cuisine and generous hospitality -- has emerged as one of the most popular destinations for Russian tourists over the past few years, with more than 1.3 million visiting last year.

Irina Tyurina, a spokeswoman for the Russian Tourism Union, said that most in the industry believed that Georgia was not a dangerous destination.   "Georgians have traditionally treated Russians well," Tyurina told AFP.    It was too early to estimate potential industry losses from the ban, she said.   More than 7,000 people have signed a petition calling on Moscow to resume flights.

Russian tourists in Tbilisi expressed regret at the restrictions.   "We are against the ban," Nina Guseva told AFP in the Georgian capital. "We are not guilty and we do not have to suffer."   Fellow traveller Mikhail Strelkov added: "This is politics and has nothing to do with people on holidays."   In Russia, many struck a similar note.   Elena Chekalova, a prominent chef and culinary blogger, said the latest Kremlin move "shocked" her.   "Why are they deciding for us what we cannot eat, where we cannot fly, who we cannot be friends with?" she wrote on Facebook.

- Simmering discontent -
Moscow has suspended flights to Georgia before -- during a spike in tensions in October 2006 and in August 2008 following the outbreak of the five-day war over the breakaway regions of Abkhazia and South Ossetia.   "Putin decided to punish Georgia because there are street protests there," opposition leader Alexei Navalny said on Twitter.   A senior government official in Tbilisi said the Kremlin ban was politically motivated.   "Putin's decision is of course political and has nothing to do with safety concerns," the official told AFP on condition of anonymity.

Analysts say the latest restrictions may further fuel simmering discontent with Kremlin policies.   Since 2014, Russians have been chafing under numerous rounds of Western sanctions over Moscow's role in Ukraine and other crises, with real incomes falling for the fifth year in a row.    During an annual phone-in with Russians this week, Putin dismissed calls to "reconcile" with the West to alleviate economic hardship, saying Moscow needed to protect its interests and "nothing" would change anyway.
Date: Thu, 6 Jun 2019 11:24:00 +0200

Tbilisi, June 6, 2019 (AFP) - Three people died on Thursday when a helicopter owned by one of Georgia's top luxury hotels crashed in a northern mountainous region of the country, emergency services said.   A chopper belonging to the Rooms luxury hotel "crashed in an unpopulated area near the Qulo mountain in the Kazbegi municipality," the spokesman of Georgia's emergency situations department, Rati Mujiri, told AFP.   "All three people onboard have died," he said.  "The helicopter pilot and two staff members of the Adjara Group (which owns Kazbegi Rooms hotel) have been killed in the accident," the company said in a statement.

The Rooms hotel operates Bell 505 Jet Ranger helicopters, according to the hotel's website.   Famed for its spectacular landscapes with snow-capped peaks of the Greater Caucasus mountain range, dramatic rocky gorges, and medieval churches, Kazbegi is a popular tourist destination.
Date: Thu 2 May 2019
Source: PLoS One [edited]

Citation
--------
Rao S, Traxler R, Napetavaridze T, et al. Risk factors associated with the occurrence of anthrax outbreaks in livestock in the country of Georgia: A case-control investigation 2013-2015. PLoS One. 2019;14(5):e0215228. doi: 10.1371/journal.pone.0215228

Abstract
--------
Introduction
Anthrax is considered endemic in livestock in Georgia. In 2007, the annual vaccination became the responsibility of livestock owners, while contracting of private veterinarians was not officially required. Six years later, due to increase in human outbreaks associated with livestock handling there is a need to find out the risk factors of livestock anthrax in Georgia.

Objective
To identify exposures and risk factors associated with livestock anthrax.

Methods
A matched case-control study design was used to recruit the owners of individual livestock anthrax cases that occurred between June 2013 and May 2015, and owners of unaffected livestock from within ("village control") and outside the village ("area control"). We collected data about the case and control livestock animals' exposure and risk factors within the one-month prior to the disease onset of the case livestock (or matched case for the controls). We used logistic regression analysis (univariate and multivariable) to calculate the odds ratios of exposures and risk factors.

Results
During the study period, 36 anthrax cases met the case definition and were enrolled in the study; 67 matched village control livestock and 71 matched area control livestock were also enrolled. The findings from multivariable logistic regression analysis demonstrate that vaccination within the last 2 years significantly reduced the odds of anthrax in cattle (OR = 0.014; 95% Confidence interval = or less 0.001, 0.99). The other factors that were significantly protective against anthrax were 'animals being in covered fence area/barn' (OR = 0.065; p-value = 0.036), and 'female animal being pregnant or milking compared to heifer' (OR = 0.006; p-value = 0.037).

Conclusions
The information obtained from this study has involved and been presented to decision makers, used to build technical capacity of veterinary staff, and to foster a One Health approach to the control of zoonotic diseases which will optimize prevention and control strategies. Georgia has embedded the knowledge and specific evidence that vaccination is a highly protective measure to prevent anthrax deaths among livestock, to which primary emphasis of the anthrax control program will be given. Education of livestock keepers in Georgia is an overriding priority.
------------------------------------------------------
Communicated by
Debby Reynolds
===============================
[The major benefits of this research project were not scientific but instructional in bringing home to all concerned at all levels that livestock anthrax is not inevitable but extremely preventable with many benefits in both animal health and public health. The article conclusions needed to be emphasised: "The control strategies that were recommended for anthrax included a combination of vaccination, quarantine, and proper carcass handling and disposal. Overall, the information obtained from this study has involved and been presented to decision makers, used to build technical capacity of regional and national veterinary staff, and fostered a One Health approach to the control of zoonotic diseases like anthrax, which will optimize prevention and control strategies. For example, a multi-agency anthrax One Health team was established to investigate cases and co-develop educational materials for farmers.

"The investigation process involved a series of trainings and workshops for participants and stakeholders to promote an understanding of epidemiological investigations and the economics of disease control with anthrax as a model. Georgia now has embedded the knowledge and specific evidence that vaccination is a highly protective measure to prevent anthrax deaths among livestock. Hence, primary emphasis for disease prevention will be given to vaccination, with a specific mark/tag for vaccination being desirable. Alternatively, a formal vaccination record given to the owner, or livestock registration is recommended. Education of livestock keepers in Georgia on the importance of vaccination is an overriding priority. Vaccination teams can play an increased role with more attention paid to delivery of standard memorable messages at the time of vaccination and to disseminating public announcements. It is overwhelmingly the case that vaccination of livestock against anthrax is protective and is an effective risk mitigation for anthrax in Georgia."

And if the Georgians can do it, anybody anywhere can do it. And you will note that their last outbreak was in 2017. Our thanks to Debby for forwarding this article. - ProMED Mod.MHJ]

[Maps of Georgia can be seen at
Date: Fri, 16 Mar 2018 16:59:07 +0100

Tbilisi, March 16, 2018 (AFP) - At least eight tourists, including a pregnant woman from Sweden, were injured on Friday when a chair lift ran out of control in the Georgian ski resort of Gudauri, officials said.   Video of the accident showed skiers being flung out of their chairs as they
turned a bend as other resort visitors screamed in terror. 

An emergency stop led to the chairs sliding back at high speed, Economy Minister Dimitry Kumsishvili told journalists, adding that the incident was "allegedly caused by an electricity outage".   "The interior ministry has launched a criminal probe into alleged violation of safety norms," he added.   Health Minister David Sergeenko said the tourists -- who were Georgiain, Russian, Swedish and Ukrainian -- did not suffer serious injuries.

"Two of them - including a pregnant woman from Sweden -- were airlifted to a hospital in (the Georgian capital) Tbilisi," he added.   Video footage (https://www.facebook.com/yanshyn/videos/10210410103119989/) of the accident posted on Facebook has been viewed more than 600,000 times.   The Caucasus nation of Georgia is an emerging ski destination.
Date: Wed 8 Nov 2017 8:36 PM GET
Source: KyivPost, Interfax-Ukraine report [edited]

Georgia's 2nd anthrax fatality this year [2017] has been confirmed. A Poti [Samegrelo-Zemo Svaneti region] resident, aged 28, died from exposure to anthrax, Maka Gabunia, an epidemiologist of the Georgian Healthcare Ministry's Poti regional laboratory, told reporters on [8 Nov 2017].

The tentative cause of death is that the woman sought medical aid too late, Gabunia said. The patient was showing symptoms of the disease when she was admitted to a hospital, she said. "The appropriate medical assistance was provided to the patient, but, unfortunately, doctors were unable to save her," Gabunia said.

Laboratory tests confirmed the diagnosis of anthrax exposure, she said. She said she believes that there are no reasons for panic among residents of Poti.

The 1st anthrax fatality this year [2017] was recorded in Adjara, Georgia, in September. A 58-year-old resident of the village of Akhalsopeli in the Khelvachauri district died following exposure to an infected animal, the Georgian National Center for Disease Control and Public Health told reporters.

The last time an anthrax fatality was recorded in Georgia was in 2013.
****************************
Date: Thu 9 Nov 2017
Source: Rosbalt.ru [in Russian, trans., edited]

A young Poti resident died of anthrax infection. The citizen turned to the doctors late, the Ministry of Health of Georgia informed. The 28-year-old woman died, despite the help she received from epidemiologists.

In September [2017], a man died from anthrax in Adjara.
------------------------------
Communicated by:
Sabine Zentis
Castleview English Longhorns
Gut Laach
D-52385 Nideggen
Germany
**************************
Date: Fri 10 Nov 2017
From: Ana Kasradze [edited]

Anthrax is an endemic zoonotic disease in Georgia. The majority of cases are cutaneous, generalized forms of the disease are rare; 1-2 gastrointestinal tract anthrax cases were registered in total. From August [2017], the human anthrax cases in the west part of Georgia were related to ongoing epizootics in one of the regions.

In the beginning of November 2017, a 28-year-old female was admitted to the hospital in the west part of the country with high temperature, severe sore throat, neck swelling, predominantly unilateral. Lymph nodes were swollen and a pseudomembranous plaque in the mouth -- predominantly on the right side -- was observed. The hospital suspected diphtheria and notified. For a bacteriological study, the sample was sent to NCDC's [National Center for Disease Control and Public Health] Regional Laboratory. The patient was transferred to the referral hospital in the same city, where the laboratory is located. After 24 hours, the culture was identified as anthrax.

Additional laboratory testing was conducted in the center of Lugar, and the bronchial aspirate sample was PCR positive for anthrax.

The condition of the patient was severe, and despite the specific treatment, she died on the 6th day of hospitalization.

Diagnosis: anthrax, oropharyngeal form.

The case was defined as unusual for Georgia, as no oropharyngeal anthrax cases had been identified before in the country. The suspected source of infection is minced meat, that case bought in the local market. Because of her severe condition, we were not able to interview her, but most likely she tasted the raw minced meat before cooking. The person selling the meat at the local market is a private merchant and the meat is not sold in the food chain. National Food Agency was notified. Environmental samples were collected from the slaughterhouse.
-------------------------------
EpiCore Global Surveillance Project member
Ana Kasradze
National Center for Disease Control and Public Health
=================
[Maps of Georgia can be seen at
and <http://healthmap.org/promed/p/63383>.

According to Wikipedia (<https://en.wikipedia.org/wiki/Poti>) Poti is a port city in Georgia, located on the eastern Black Sea coast in the region of Samegrelo-Zemo Svaneti in the west of the country. The city has become a major port city and industrial center since the early 20th century. It is also home to a main naval base and the headquarters of the Georgian navy. Adjacent to the Poti port area is the RAKIA owned Free Industrial Zone.

Poti, a busy city, is distant from the usual rural areas afflicted with livestock anthrax. As the third report notes the patient was confirmed to have oropharyngeal anthrax which is rare in humans though not uncommon in certain livestock. The suggestion that she had sampled the rare minced meat is logical, as we know from hamburgers such is very easy to cook and the cooked surface would have been sterile. The less cooked interior, if eaten, would have possibly resulted in an enteric infection. If the meat had been mixed with some fibrous matter it would have increased the chance of scratching the throat and have facilitated spore entry. Our thanks to Dr Kasradze for her very quick response. - ProMED Mod.MHJ]
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.