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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: 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:
Date: Thu, 19 Oct 2017 16:37:27 +0200
By Ricardo ARDUENGO, con Nelson DEL CASTILLO en San Juan y Leila MACOR en Miami

Utuado, Puerto Rico, Oct 19, 2017 (AFP) - It's been a month since Hurricane Maria ripped through Puerto Rico and Samuel de Jesus still can't drive out of his isolated, blacked-out town.   In fact, much of the US territory in the Caribbean is still a crippled mess four weeks after that fierce Category Four storm.

The bridge connecting Rio Abajo to the rest of the island was swept away when Maria slammed the island on September 20. For two weeks Rio Abajo, located in a mountainous region in central-western Puerto Rico, was cut off and forgotten, without power or phone service.   "We didn't know what to do. We were literally going crazy," said de Jesus, 35.   "Those were difficult, desperate days. We could not find a way out, and the hurricane caused extensive damage," he told AFP.

During the two long weeks following Maria, the 27 families living in Rio Abajo saw their supplies quickly deplete.   De Jesus, who has diabetes, needed to keep his insulin refrigerated. The storm blew away the island's already decrepit power grid, so people resorted to emergency generators.   "But I was running out of gasoline to run the generator," he said.   A helicopter now makes regular deliveries of food, water and medicine because with the bridge washed out, there is no other way in or out of town.

People can't wade across the river because it is contaminated with human waste after a pipe broke when the bridge went.   Some brave souls use a precarious ladder rigged to get across the water, but for most people it is too dangerous.   We need a bridge "to take out our vehicles and leave in case of emergency, or if there is a landslide," he said.   Where the bridge once stood, residents set up a system of ropes, pulleys and buckets to move supplies over the river, which has been contaminated with sewer water since the hurricane.   Over the remains of the bridge locals hung the single-star, red, white and blue flag of Puerto Rico and a sign that reads "the campsite of the forgotten."

- Desperate need for electricity -
Puerto Rico Governor Ricardo Rossello visited the surrounding municipality of Utuado on Wednesday to deliver supplies, but he did not stop in Rio Abajo.   "Utuado is certainly one of the most severely affected municipalities in all of Puerto Rico," Rossello said.   "Our commitment is to give it support and aid during the whole road to recovery."   Eighty-one percent of Puerto Rico remains blacked out one month after Maria struck. Clean water for drinking, cooking and bathing is scarce, too.

Puerto Ricans' main obstacle to getting back to some semblance of normality is the slowness of the Puerto Rico Electric Power Authority in getting the power grid back up and running.   The lack of power has paralyzed a key industry -- pharmaceutical production -- and most businesses including restaurants are closed or operating at great cost through the use of diesel powered generators.

This nightmare comes about a year after the US government established an external fiscal control board for the island after it declared bankruptcy because of 73 billion dollars in debt.   Economist Joaquin Villamil told AFP that damage from Hurricane Maria is estimated at 20 billion dollars -- four times that of Hurricane Georges in 1998, when measured in 2016 dollars.

Villamil said reconstruction money provided by the Federal Emergency Management Agency and from insurance companies will have a positive impact on the island's economy in the second half of fiscal 2018 and in fiscal 2019, but this boost will just be temporary.   "From an economic point of view there is not much net gain," said Villamil, who works for a consulting firm called Estudios Tecnicos.   He said the economy has been shrinking since 2006 and Maria will delay any prospect of recovery.   It will take at least until 2026 to get back to the GDP level of 2006, he added.

Making things worse, people are leaving the island for the mainland US. Forecasts are that the population now at 3.4 million will go down to 3.1 million or even less by 2026, said Villamil.   The government of Florida estimates that since October 3 -- the day a state of emergency to deal with an influx of Puerto Ricans was declared -- more than 36,000 people from the island have poured in.
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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".
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Saint Helena

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Wed, 22 Nov 2017 14:01:02 +0100
By Beatrice DEBUT

Jamestown, Nov 22, 2017 (AFP) - Cut off from the rest of the world for centuries, St. Helena, which lies isolated in the middle of the Atlantic Ocean, is now reachable by plane for the first time.   The aviation breakthrough promises to lift the British-run territory from obscurity and bring it within reach of international tourists.   The arrival of the first commercial flight was also a relief for islanders frustrated by a delay to the opening because of high winds.

After years of procrastination, London gave the green light in 2011 a full runway on the island.    The ambition was to bring it within six hours of mainland Africa instead of the five days previously needed to make the ocean voyage from Cape Town.   British officials hoped that 30,000 tourists a year would visit the island, which is home to just 4,500 residents -- known as "Saints".   Just don't expect white sandy beaches and palm trees.

Rather, the island is known as a paradise for hikers and divers with dramatic scenery and its volcanic origins, and boasts history as rich as its flora and fauna.   The British have detained various opposition forces on the island over the centuries, including the defeated Napoleon after the Battle of Waterloo who died in exile on St. Helena in 1821.   It was also temporarily home to 25,000 former slaves after they were released in the 19th century on the island, which lay on the slave-trading route from Africa to America and the Caribbean.

- 'We had already invested' -
Encouraged by London's upbeat estimates, islanders began investing in tourism, sensing an opportunity in an economy where the average annual salary is just £7,280 (8,150 euros, $9,600).   Local businessman Johnny Herne runs a pleasure boat that he imported from Scotland 8,000 kilometres (5,000 miles) away on which guests can spot humpback whales and dolphins along the craggy coastline.   He has so far invested £182,000 in his business but now is drowning in debt as a result of the airport delay, which he says contributed to his divorce.   "It ruined my life," he said.

Entrepreneur Paul Hickling produces a cactus liqueur and a local coffee and has invested more than £100,000.   "The government said: 'Invest because the airport is coming... all these people are going to come'," he said.   "Unfortunately the airport got delayed -- but we had already invested the money."   In April 2016, just three weeks before the £285-million airport's grand opening, disaster struck.   Unforeseen winds meant that takeoffs and landings were ruled too dangerous, leaving islanders dismayed.

- 'Big relief' -
Hazel Wilmot, a hotelier in the capital Jamestown, had had large quantities of food and drink shipped to St. Helena and her property was fully booked.   But with the delay, tourists cancelled their trips.   "I had four containers at sea full of food, full of booze that I could not use," she said. In 2016 she says she lost at least £200,000.    Local officials set up a scheme to help businesses affected by the delay -- but no one has yet claimed, according to the island's trade board.

But overly strict criteria and a complex claiming process have deterred claimants, locals say.   After the 18-month delay, the first commercial flight finally touched down on October 14 this year.   A sense of euphoria swept through the cabin as champagne was served and the island edged into view. On the ground, islanders celebrated the long-awaited arrival.   "It was a big relief when the airport finally opened. It has not been easy," said Craig Yon, a manager of a hotel that opened in 2012.

- 'Not going to stop' -
But the island may never experience a tourism boom on the scale that was promised.   For safety reasons, the passenger capacity of the aircraft serving the island is far smaller than planned.   And the single weekly flight from Johannesburg will serve the island at a cost of about £800 return.   "South Africans would prefer to go for three weeks in Thailand than to go to St. Helena," said one South African travel agent, who organises trips to the island.   For this Christmas, Wilmot has just five bookings so far.    "Where are all these tourists we were told were going to swamp the island?" she said.   Tourism chief Helena Bennett now thinks the goal of 30,000 visitors was "unrealistic" -- indeed the small plane can bring less than 4,000 people, including residents, to the island each year.

Even today, the island has just 121 guest beds including a new hotel funded by the local government.   None of the properties have a website, while roads are so small that often only one car can pass.    But with the air link, the flow of tourists will at least be more constant.    "During the two-week period when the Royal Mail Ship is away, the island is dead," said Bennett, referring to the passenger and cargo vessel that calls at the island.   "With the plane, we are going to have visitors every week. The island is not going to stop anymore."
Date: Sat, 14 Oct 2017 22:35:34 +0200
By Beatrice DEBUT

Jamestown, Oct 14, 2017 (AFP) - The first regular commercial flight landed at St. Helena Saturday, opening the small British island in the South Atlantic to the world after centuries of isolation.   Around 100 islanders came out to the airport to watch the historic landing of the Embraer 190 jet which came from Johannesburg.   On the tarmac, some 60 incoming passengers were welcomed by the island's smiling governor, Lisa Phillips.   "It is connecting us to the world and it is opening us to the world," said Niall O'Keeffe, in charge of economic development on the island.

St. Helena, with just over 4,000 residents known as "Saints", is best known as the rocky outcrop where French emperor Napoleon Bonaparte saw out his final days.   After five years of construction, controversy and embarrassing delays due to high winds, the airport built at a cost of £285 million (318 million euros) finally opened for business.   "It will bring in tourists and we will be able to get a better standard of living," said Phillips.

The volcanic tropical island itself measures just 122 square kilometres (47 square miles) and is located almost exactly halfway between Africa and South America.   Its isolated location meant it was chosen as a place of exile for those who suffered defeat at the hands of the British,  with Napoleon held there from 1815 until his death in 1821.

Several thousand Boer prisoners of war were also detained there at the start of the 20th century.   Until Saturday, St. Helena was one of the world's most inaccessible locations.   It has been only reachable by sea, a five-day voyage from Cape Town aboard a Royal Mail vessel that chugs along at a speed of just 15 knots (28 kilometres an hour).   Every three weeks, the RMS St. Helena has been the islanders' link to the outside world, bringing a cargo of food, post, visitors and vehicles.

- Major engineering challenge -
The new flight route, via Windhoek in Namibia, makes the island reachable by air from South Africa in just six hours.   The airport has been a colossal civil engineering challenge.   The island had no suitable flat surface to construct the necessary 1,950 metre-long airstrip.   Engineers were forced to chip away a mountain peak and fill in a valley to create enough of an even surface.   The runway is located on a breathtaking mountain just 300 metres from the sea.   Because of high winds, Comair abandoned plans to operate the route with a Boeing 737, paving the way for AirLink's smaller Embraer 190 jet.

- High winds setback  -
The winds meant that the airport could not be opened in 2016 as originally planned with a ribbon-cutting by Prince Edward, Queen Elizabeth II's youngest son.   The conditions made take-offs and landings much more difficult than expected and just weeks before the scheduled ceremony, it was cancelled and the airport became practically unused.   After more than a year of test flights and studies, the decision was taken to use the Embraer 190.   The island will be served by a weekly service from Johannesburg costing about £800 return ($1,060). The average salary on St. Helena is just £7,280.   "It's more expensive that a flight to London" from South Africa, said
Jacqui Wilson, who saved up to take the "historic" flight.

But on the personal side people are just so glad there is an airport.   "Now we will be able to go home more often. Our family and friends will be able to visit, which is very great," said Catherine Man, the only veterinarian on the island.:   It is also hoped that the air link will help reduce the island's dependence on aid from London which cost the British taxpayer £53.5 million in 2015 alone.   When the RMS St. Helena is retired from service next year, the island will become almost completely dependent on its airport.   But with its Napoleonic heritage, rare birds and exotic plant life, hopes are high that the island will become a nirvana for curious travellers.
Date: Mon 19 Sep 2016, 9:23 AM
Source: Today [edited]

There has been a noticeable increase in cases of hand foot and mouth disease, the Collective Prevention Services (CPS) says in a press release and urges parents and guardians, day care centres and play schools to be on alert for an increase in clusters of the disease amongst the school population. CPS advises to take extra measures to prevent outbreaks by washing of hands often with soap and water.

Hand foot and mouth disease is a common viral illness that usually affects infants and children who are 10-years of age or younger. It can sometimes occur in adults. There is no vaccine to protect against the viruses that cause it.

People with symptoms should consult their family physician and take measures to mitigate an increase in the number of cases.

Symptoms include cold-like conditions, fever, mouth sores, loss of appetite, cough, and a skin rash; a non-itchy red rash that develops on the hand and the feet, and sometimes the rash can develop into painful blisters; painful mouth ulcers.
=====================
[The causative agent for hand foot and mouth disease (HFMD) is an enterovirus. It is not the same as other diseases that have similar names: foot-and-mouth disease (sometimes called hoof-and-mouth disease). See previous ProMED post Hand, foot & mouth disease - USA (04): (CA) http://promedmail.org/post/20160505.4204778 for a discussion of HFMD.

[A map of St. Maarten in the Caribbean can be accessed at
Date: Fri, 15 Jul 2016 16:14:56 +0200

Johannesburg, July 15, 2016 (AFP) - The mail boat that is the only link to St Helena, one of the world's most remote islands, has had its retirement delayed after a new airport failed to open due to dangerous winds.   The airport, constructed between soaring mountains and the South Atlantic Ocean, was designed to boost tourism and revive the community on the British territory where Napoleon was exiled and died in 1821.

But the 250-million-pound ($330 million) facility has been closed indefinitely for more data to be gathered after the first test flights in April measured severe air turbulence.   The RMS St Helena mail boat, which was due to be decommissioned this year after the airport's scheduled opening, takes about five days to reach the island from Cape Town.

The St Helena government said Friday that the boat would be kept in service until at least July 2017.   "Intensive work continues to mitigate wind conditions experienced at St Helena Airport," it added in a statement. "Getting this right will take some time."   Located nearly 2,000 kilometres (1,200 miles) from the African coast, St Helena has about 4,200 residents, one bank, and no cash machines.   A mountain ridge had to be lowered and a small valley filled in during the construction of the airport.
Date: Thu, 28 Apr 2016 14:25:36 +0200

Johannesburg, April 28, 2016 (AFP) - The opening of an airport on St Helena, one of the world's most remote islands, has been postponed indefinitely after test flights revealed dangerous wind conditions, officials said Thursday.   The airport, constructed between soaring mountains and the South Atlantic Ocean, was designed to boost tourism and revive the community on the British territory where Napoleon was exiled and died in 1821.   An opening ceremony to be attended by Prince Edward, the Earl of Wessex, had been scheduled for next month to mark the start of weekly commercial flights from Johannesburg, four and half hours away.   But the 250-million-pound ($360 million) airport will remain closed after a test flight last week measured severe turbulence and wind data.

The only way to reach the island is a five-day journey by sea from Cape Town by a mail boat that is due to be decommissioned this year.   "It is quite a disappointment, but when you are talking about airports, everything revolves around safety," Ian Jones, the St Helena government spokesman, told AFP, speaking from the island's capital Jamestown.   "There are some side winds and wind shear that we knew about, but it is not until you land a full-size aircraft that you fully understand the conditions.   "We did not realise how serious it was."   Jones said the airport had no new opening date, but analysis of wind data, new observational equipment and adjustments to the approach route would be considered to enable the runway to open.

An amateur video on the Internet showed the Boeing 737 test flight aborting its first landing attempt seconds before touchdown and climbing steeply back into the air.   "Difficult wind conditions, including turbulence and windshear, are encountered and safely managed at many airports around the world," the island's government said in a statement.   "Everyone involved remains committed to commencing commercial flights to and from St Helena at the earliest possible opportunity."   A mountain ridge had to be lowered and a small valley filled in during the construction of the airport, which has a 1,950-metre long runway.   It was first due to open in February, but building work was not yet completed.   Located nearly 2,000 kilometres (1,200 miles) from the African coast, St Helena has about 4,200 residents, one bank, and no cash machines.
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Venezuela

Venezuela US Consular Information Sheet
May 05, 2008
COUNTRY DESCRIPTION:

Venezuela is a medium income country whose economy is dominated by a substantial oil industry.
The political climate in Venezuela is highly polarized and
olatile.
Violent crime is a continuing problem.
Assaults, robberies, and kidnappings occur throughout the country.
Scheduled air service and all-weather roads connect major cities and most regions of the country.
Venezuela’s tourism infrastructure varies in quality according to location and price.
For an in depth country description of Venezuela, please read the Department of State Background Notes on Venezuela.
ENTRY/EXIT REQUIREMENTS:
A valid passport and a visa or tourist card are required.
Tourist cards are issued on flights from the U.S. to Venezuela for persons staying less than ninety days.
Persons traveling for reasons other than tourism, however, should consult the Venezuelan Embassy or nearest Venezuelan consulate regarding possible visa requirements for their specific purpose of travel.
Venezuelan immigration authorities may require that U.S. passports have at least six months validity remaining from the date of arrival in Venezuela.
Some U.S. citizens have been turned back to the United States if their passports will expire in less than six months. Passports should also be in good condition, as some U.S. citizens have been delayed or detained overnight for having otherwise valid passports in poor condition.
U.S. citizens residing in Venezuela should be careful to obtain legitimate Venezuelan documentation appropriate to their status.
There have been numerous cases in the last several months of U.S. citizens who, having employed intermediaries, received what they believed to be valid Venezuelan resident visas and work permits.
They were subsequently arrested and charged with possessing fraudulent Venezuelan documentation.
ONIDEX, the Venezuelan government agency responsible for immigration documents, has informed the Embassy that the only valid resident visas are those for which the bearer has personally signed at ONIDEX headquarters in Caracas.

Venezuelan law requires Venezuelan citizens to enter and depart Venezuela using Venezuelan passports and Venezuelan immigration authorities are increasingly enforcing this requirement.
In order to comply with U.S. and Venezuelan law, persons who hold dual American-Venezuelan nationality must plan to travel between Venezuela and the United States with valid U.S. and Venezuelan passports.
Please see our information on dual nationality for entry and exit requirements pertaining to dual nationals.
Venezuela's child protection law mandates that minors (under 18) who are citizens or non-citizen residents of Venezuela and who are traveling alone, with only one parent, or with a third party, must present a copy of their birth certificate and written, notarized authorization from the absent parent(s) or legal guardian, specifically granting permission to travel alone, with one parent, or with a third party.
This authorization must reflect the precise date and time of the travel, including flight and/or other pertinent information.
Without this authorization, immigration authorities will prevent the child's departure from Venezuela.
The Venezuelan Government no longer recognizes blanket or non-specific travel authorizations.
When a parent is deceased, a notarized copy of the death certificate is required in lieu of the written authorization.
If documents are prepared in the United States, the authorization and the birth certificate must be translated into Spanish, notarized, and authenticated by the Venezuela Embassy or a Venezuelan consulate in the United States.
If documents are prepared in Venezuela, only notarization by a Venezuelan notary is required.
A permission letter prepared outside Venezuela is valid for 90 days.
A permission letter prepared in Venezuela is valid for 60 days.
Travelers entering Venezuela from certain countries are required to have a current yellow fever vaccination certificate.
The Venezuelan government recommends that all travelers, regardless of their country of departure, be vaccinated for yellow fever before entering Venezuela.
Mosquito-borne diseases such as malaria and dengue fever are also common in some areas and travelers should take precautions to prevent infection.

An exit tax and airport fee must be paid when departing Venezuela by airline.
The exit tax is currently 46 Bolívares Fuertes, and the airport fee is currently 115 Bolívares Fuertes (a total of approximately 75 USD calculated at the official exchange rate). In many instances, especially with non-U.S. airlines, the exit tax and airport fee are not included in the airline ticket price and must be paid separately at the airport upon departure.
Authorities usually require that payment be made in local currency.
Both the departure tax and the airport fee are subject to change with little notice.
Travelers should check with their airlines for the latest information.
For current information concerning entry, tax, and customs requirements for Venezuela, travelers may contact the Venezuelan Embassy at 1099 30th Street, NW, Washington DC
20007, tel: (202) 342-2214, or visit the Embassy of Venezuela web site at http://www.embavenez-us.org/.
Travelers may also contact the Venezuelan consulates in New York, Miami, Chicago, New Orleans, Boston, Houston, San Francisco, or San Juan.
Additional information about vaccination requirements for travel to Venezuela, as well as to other international destinations, 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); fax 1-888-CDC-FAXX (1-888-232-3299), or via CDC's Internet site at http://wwwn.cdc.gov/travel/default.aspx.

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:
Violent crime in Venezuela is pervasive, both in the capital, Caracas, and in the interior.
The country has one of the highest per-capita murder rates in the world.
Armed robberies take place in broad daylight throughout the city, including areas generally presumed safe and frequented by tourists.
A common technique is to choke the victim into unconsciousness and then rob them of all they are carrying.
Well-armed criminal gangs operate with impunity, often setting up fake police checkpoints.
Kidnapping is a particularly serious problem, with more than 1,000 reported during the past year alone.
Investigation of all crime is haphazard and ineffective.
In the case of high-profile killings, the authorities quickly round up suspects, but rarely produce evidence linking these individuals to the crime.
Only a very small percentage of criminals are tried and convicted.

Travel to and from Maiquetía Airport, the international airport serving Caracas, can be dangerous and corruption at the airport itself is rampant.
Travelers at the airport have been victims of personal property theft, as well as mugging and “express kidnapping” in which individuals are taken to make purchases or to withdraw as much money as possible from ATMs, often at gunpoint.
The Embassy has received multiple, credible reports that individuals with what appear to be official uniforms or other credentials are involved in facilitating or perpetrating these crimes.
For this reason, American citizen travelers should be wary of all strangers, even those in official uniform or carrying official identification.
There are also known drug trafficking groups working from the airport.
Travelers should not accept packages from anyone and should keep their luggage with them at all times.

Because of the frequency of robberies at gunpoint, travelers are encouraged to arrive during daylight hours.
If not, travelers should use extra care both within and outside the airport.
The Embassy strongly advises that all arriving passengers make advance plans for transportation from the airport to their place of lodging.
If possible, travelers should arrange to be picked up at the airport by someone who is known to them.
The Embassy has received frequent reports of armed robberies in taxicabs going to and from the airport at Maiquetía.
There is no foolproof method of knowing whether a taxi driver at the airport is reliable.
The fact that a taxi driver presents a credential or drives an automobile with official taxi license plates marked “libre” is no longer an indication of reliability.
Incidents of taxi drivers in Caracas overcharging, robbing, and injuring passengers are common.
Travelers should take care to use radio-dispatched taxis or those from reputable hotels.
Travelers should call a 24-hour radio-dispatched taxi service from a public phone lobby or ask hotel, restaurant, or airline representatives to contact a licensed cab company for them.
A list of transportation services used by members of the U.S. Embassy community is available on the U.S. Embassy web site at http://venezuela.usembassy.gov/.
The Embassy does not vouch for the professional ability or integrity of any specific provider.
The list is not meant to be an endorsement by the Department of State or the Embassy.
Likewise, the absence of any individual or company does not imply lack of competence.
While visiting Venezuela, Americans are encouraged to carry as little U.S. currency on them as possible and to avoid wearing expensive or flashy watches and jewelry.
Due to the poor security situation, the Embassy does not recommend changing money at the international airport.
Visitors should bring a major credit card, but should be aware of widespread pilfering of credit card data to make unauthorized transactions.
Travelers’ checks are not recommended as they are honored in only a few locations.
It is possible to exchange U.S. currency at approved exchange offices near major hotel chains in Caracas (personal checks are not accepted) and at commercial banks with some restrictions.
Due to currency regulations, hotels cannot provide currency exchange.
There are ATM machines throughout Venezuela.
Malfunctions are common, however, and travelers should be careful to use only those in well-lit public places.
ATM data has also been hacked and used to make unauthorized withdrawals from user’s accounts.
Popular tourist attractions, such as the Avila National Park, are increasingly associated with violent crime.
Americans planning to participate in outdoor activities in potentially isolated areas are strongly urged to travel in groups of five or more and to provide family or friends with their itineraries prior to departure.
Cross-border violence, kidnapping, drug trafficking, smuggling, and cattle-rustling occur frequently in areas along the 1,000-mile long border between Venezuela and Colombia.
Some kidnap victims have been released after ransom payments, while others have been murdered.
In many cases, Colombian terrorists are believed to be the perpetrators.
Colombia's National Liberation Army (ELN) has had a long history of kidnapping for ransom, and the Revolutionary Armed Forces of Colombia (FARC) are active in the kidnapping trade.
Common criminals are also increasingly involved in kidnappings, either dealing with victim's families directly or selling the victim to terrorist groups.

In-country travel by U.S. Embassy employees, both official and private, within a 50-mile area along the entire Venezuela/Colombia border, is prohibited.
The State Department warns American citizens not to travel within a 50-mile area along the entire Venezuela/Colombia border.
U.S. citizens who elect to visit areas along the border region with Colombia despite this warning, apart from the Colombian terrorist threat, could encounter Venezuelan military-controlled areas and may be subject to search and arrest.
The U.S. Embassy must approve in advance the official travel to Venezuela of all U.S. Government personnel.
Private travel by U.S. military personnel to Venezuela requires advance approval by the U.S. Embassy.
Please consult the Department of Defense Foreign Clearance Guide at https://www.fcg.pentagon.mil/ for further information.
Non-military employees of the U.S. Government do not need Embassy approval for private travel.
Political marches and demonstrations are frequent in Caracas and often pass without incident.
Nevertheless, travelers should be aware that violence, including exchanges of gunfire, has occurred at political demonstrations in the past.
Demonstrations tend to occur at or near university campuses, business centers, and gathering places such as public squares and plazas.
Marches generally occur on busy thoroughfares, significantly impacting traffic.
Most major tourist destinations, including coastal beach resorts and Margarita Island, have not in the past been generally affected by protest actions.
The city of Merida, however, a major tourist destination in the Andes, has been the scene of frequent student demonstrations, some of them violent, including the use of firearms.
Travelers should keep informed of local developments by following the local press, radio and television.
Visitors should also consult their local hosts, including U.S. and Venezuelan business contacts, hotels, tour guides, and travel organizers.
As circumstances warrant, the Embassy sends out messages to U.S. citizens who have registered on-line.
These messages are also posted on the U.S. Citizens page of the Embassy’s web site at http://venezuela.usembassy.gov/.
U.S. citizens traveling or residing in Venezuela are advised to take common-sense precautions and avoid large gatherings and demonstrations, no matter where they occur.
Harassment of U.S. citizens by pro-government groups, Venezuelan airport authorities, and some segments of the police occurs but is quite limited. Venezuela’s most senior leaders, including President Chavez, regularly express anti-American sentiment.
The Venezuelan government’s rhetoric against the U.S. government, its American culture and institutions, has affected attitudes in what used to be one of the most pro-American countries in the hemisphere.

Venezuela is an earthquake-prone country and is occasionally subject to torrential rains, which can cause major disasters such as the one in Vargas State in 1999.
Travelers who intend to rent or purchase long-term housing in Venezuela should choose structures designed for earthquake resistance.
Such individuals may wish to seek professional assistance from an architect or civil/structural engineer, as does the Embassy, when renting or purchasing a house or apartment in Venezuela.
Americans already housed in such premises are also encouraged to seek a professional structural assessment of their housing.

For further information on seismic activity, you may wish to visit:

1. The Multidisciplinary Center for Earthquake Engineering Research (MCEER) web site at http://mceer.buffalo.edu/infoservice/Quakeline_Database/default.asp
2. The Global Seismic Hazard Assessment Program web site at www.seismo.ethz.ch/GSHAP
3. The Caribbean Disaster Mitigation Project web site at www.oas.org/CDMP
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts including the Worldwide Caution can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: Venezuela and its capital, Caracas, have one of the highest per capita murder rates in the world.
Virtually all murders go unsolved.
The poor neighborhoods that cover the hills around Caracas are extremely dangerous.
These areas are seldom patrolled by police and should be avoided.
Armed robberies are common in urban and tourist areas throughout Venezuela, even areas presumed safe and visited by tourists.
Crimes committed against travelers are usually money-oriented crimes, such as theft and armed robbery.
Incidents occur during daylight hours as well as at night.
Many criminals are armed with guns or knives and will use force.
Jewelry attracts the attention of thieves.
Travelers are advised to leave jewelry items, especially expensive-looking wristwatches, at home.
Gangs of thieves will often surround their victims and use a chokehold to disable them, even in crowded market areas where there is little or no police presence.
Theft from hotel rooms and safe deposit boxes is a problem, and theft of unattended valuables on the beach and from rental cars parked near isolated areas or on city streets is a common occurrence.
A guarded garage or locked trunk is not a guarantee against theft.
Pickpockets concentrate in and around crowded bus and subway stations in downtown Caracas.
Subway escalators are favored sites for "bump and rob" petty thefts by roving bands of young criminals.
Many of these criminals are well dressed to allay suspicion and to blend in with crowds using the subways during rush hour.
Travelers should not display money or valuables.
"Express kidnappings," in which victims are seized in an attempt to get quick cash in exchange for their release, are a problem.
Kidnapping of U.S. citizens and other foreign nationals, from homes, hotels, unauthorized taxis and the airport terminal has occurred.
U.S. citizens should be alert to their surroundings and take necessary precautions.
The Department has received reports of robberies during nighttime and early morning hours on the highways around and leading to Caracas.
Reports have specifically involved cars being forced off the La Guaira highway leading from Caracas to the Maquetía International Airport, and the "Regional del Centro" highway leading from Caracas to Maracay/Valencia, at which point the victims are robbed.
The Department recommends avoiding driving at night and in the early morning where possible.
Drivers traveling on highways during nighttime and early morning hours should exercise caution.
Police responsiveness and effectiveness in Venezuela vary drastically but generally do not meet U.S. expectations.
U.S. travelers have reported robberies and other crimes committed against them by individuals wearing uniforms and purporting to be police officers or National Guard members.
Incidents of piracy off the coast of Venezuela remain a concern.
Some of these incidents have been especially violent, including the severe beating of a U.S. citizen in 2002, the fatal shooting of an Italian citizen in January 2004, and a machete attack on a U.S. citizen in 2005.
U.S. citizen yachters should exercise a heightened level of caution in Venezuelan waters.
Please consult the U.S. Coast Guard web site at http://www.uscg.mil/hq/g-o/g-opr/g-opr.htm for additional information on sailing in Venezuela.

Rules governing the sale of fuel to foreign sailors in Venezuela vary by state.
U.S. citizen yachters should inquire about specific state procedures prior to attempting to purchase fuel in any given location.
Failure to comply with a state’s particular requirements can result in arrest and criminal charges.

The Embassy is aware of several instances where women lured American men to Venezuela after establishing “relationships” with them over the Internet.
Some of these men were robbed shortly after they arrived in Venezuela.
Others were recruited to act as narcotics couriers or “drug mules.”
In three instances, the Americans were arrested at the airport with narcotics in their possession and served extended jail terms in Venezuela.
In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm.
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 are solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care at private hospitals and clinics in Caracas and other major cities is generally good.
Public hospitals and clinics generally provide a lower level of care and basic supplies at public facilities may be in short supply or unavailable.
Cash payment is usually required in advance of the provision of medical services at private facilities, although some facilities will accept credit cards.
Patients who cannot provide advance payment may be referred to a public hospital for treatment.
Private companies that require the patient to be a subscriber to the service or provide cash payment in advance generally provide the most effective ambulance services.
Public ambulance service is unreliable.
U.S. citizens should be aware that due to the currency restrictions in effect in Venezuela they might find it difficult to receive wire transfers from abroad, whether through a bank or Western Union.
Such wire transfers cannot be used reliably as a source of emergency funds.
U.S. citizens traveling to Venezuela may also find it difficult to obtain certain prescription drugs, particularly name brands, and should ensure that they have sufficient quantities of all medications for the duration of their stay.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Venezuela is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving regulations in Venezuela are similar to those in the United States, although many drivers do not obey them.
Defensive driving is a necessity.
Child car seats and seatbelts are not required and are seldom available in rental cars and taxis.
Outside the major cities, night driving can be dangerous because of unmarked road damage or repairs in progress, unlighted vehicles, and livestock.
Even in urban areas, road damage is often marked by a pile of rocks or sticks left by passersby near or in the pothole or crevice, without flares or other devices to highlight the danger.
Traffic jams are common within Caracas during most of the day and are frequently exploited by criminals. Stops at National Guard and local police checkpoints are mandatory.
Drivers should follow all National Guard instructions and be prepared to show vehicle and insurance papers and passports.
Vehicles may be searched.
Inexpensive bus service is available to most destinations throughout the country, but the high incidence of criminal activity on public transportation makes bus travel inadvisable.
Peak holiday travel occurs during summer and winter school breaks and major civil and religious holidays, including Carnival, Easter, Christmas and New Year's holidays.
Lengthy delays due to road congestion are common during these peak periods.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Venezuela’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Venezuela’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: In February 2007, the National Assembly granted President Chavez the authority to rule by decree in 11 general areas for 18 months.
Laws issued by President Chavez under this authority become effective immediately after their publication in the government legislative gazette.
As a result, laws directly impacting U.S. Citizens or their interests in Venezuela may come into force with little or no warning.
U.S. Citizens are advised to carefully monitor changes in Venezuelan law. Venezuela is also slated to hold gubernatorial and mayoral elections nation-wide in late 2008.
These electoral races are expected to generate extensive political campaigning from pro-government and opposition parties.
The government of Venezuela implemented rigid foreign exchange controls in 2003, including a fixed official rate of exchange.
Foreign exchange transactions must take place through exchange houses or commercial banks at the official rate.
As of October 2005 it is no longer possible to exchange money at hotels.
Currency exchange for tourists can be arranged at "casas de cambio" (exchange houses).
There are exchange houses located near most major hotels.
It is also possible to exchange money at commercial banks; however, visitors should be aware that the exchange would not be immediate.
Exchanges through commercial banks must first be approved by the Commission for Administration of Foreign Currencies (CADIVI).
This requires a registration process, which delays the exchange.
The exchange control mechanisms also require the exchange houses and commercial banks to obtain authorization from CADIVI to trade Bolívares Fuertes (the local currency) into U.S. dollars.
Outside the major cities, a good supply of Venezuelan currency is necessary, as it may be difficult to find exchange houses.
The Embassy cannot provide currency exchange services.
Travelers will likely encounter individuals in Venezuela who are willing to exchange Bolívares Fuertes for U.S. dollars at a rate significantly higher than the official rate of exchange.
These "parallel market" currency exchanges are prohibited under the Venezuelan foreign exchange controls.
Travelers engaging in such activity may be detained by the Venezuelan authorities.
Additionally, in accordance with an October 2005 law, any person who exchanges more than 10,000 U.S. dollars in the course of a year through unofficial means is subject to a fine of double the amount exchanged.
If the amount exceeds 20,000 U.S. dollars the penalty is two to six years imprisonment.
Any person who transports more than 10,000 U.S. dollars into or out of Venezuela by any means must declare this amount to customs officials.
Credit cards are generally accepted at most upscale tourist establishments, but foreign exchange controls have made credit card acceptance less common than in the past.
Visa, MasterCard, and American Express have representatives in Venezuela.
Due to the prevalence of credit card fraud in Venezuela, travelers should exercise caution in using their credit cards and should check statements regularly to ensure that no unauthorized charges have been made.
Most major cities have ATMs with 24-hour service where users may withdraw local currency, but many of these ATMs will not accept U.S.-issued debit cards.
Venezuelan customs authorities may enforce strict regulations concerning temporary importation into or export from Venezuela of items such as plant and animal products, firearms, medications, archaeological or "cultural heritage" items, and pirated copies of copyrighted articles.
It is advisable to contact the Embassy of Venezuela in Washington or one of Venezuela's consulates in the United States for specific information regarding customs requirements.
Please see our Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Venezuela’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Venezuela 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 Venezuela are encouraged to register with the U.S. Embassy in Caracas through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Venezuela.
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 to contact them in case of emergency.
The Consular Section is open for American Citizen Services from 8:00 a.m. to 10:30 a.m. Monday through Friday, excluding U.S. and Venezuelan holidays.
The U.S. Embassy is located at Calle Suapure and Calle F, Colinas de Valle Arriba, Caracas.
The telephone number during regular business hours (8:00 a.m. to 5:00 p.m.) is (58) (212) 975-6411.
In case of an after-hours emergency, callers should dial (58) (212) 907-8400.
The Embassy’s web site, http://venezuela.usembassy.gov/ , contains complete information about services provided and hours of operation.
A part-time consular agent in Maracaibo provides services for U.S. citizens in western Venezuela.
The agent is available to the public every Monday from 8:15 am to 12:15 pm, at the Centro Venezolano Americano del Zulia (CEVAZ), Calle 63 No. 3E-60, Maracaibo; telephone 58)(0261) 793-2101 or 793-3488.
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This replaces the Consular Information Sheet dated November 1, 2007, and updates all sections.

Travel News Headlines WORLD NEWS

Date: Sat, 25 May 2019 03:37:38 +0200
By Andrea TOSTA

Caracas, May 25, 2019 (AFP) - If it weren't for the Center for Malaria Studies in Caracas, Francelis Pacheco would have been unable to get treatment for a disease she has contracted around 20 times.   Pacheco, 25, sells clothes and cigars in the claustrophobic tunnels of gold mines in southern Venezuela's Bolivar state, where a type of malaria-carrying mosquito is particularly active.   "If it weren't for (treatment) here, honestly I don't know what I would have done," Pacheco told AFP as she waited in the clinic for a new diagnosis, having spent several months in Bolivar state and neighboring Guyana, some 600 kilometres (370 miles) from her Caracas home.

The clinic, though, is not immune to Venezuela's economic crisis and is struggling to treat patients.   This is a country that lacks 85 percent of the medicines it needs, according to the pharmaceuticals industry.   With a tiny budget, the malaria clinic, which was opened in 1973, relies on donations.   Between 20 and 30 people a day from all over the country come get diagnosed and receive medication to alleviate the symptoms of a disease that can be fatal.

- 'Zero funding' -
Scientists who would later work for this clinic contributed in 1961 to helping Venezuela become the first country to eradicate malaria.   However, there was a resurgence seven years ago, worsening to become an epidemic in 2016, according to the Red de Epidemiologia NGO.   Today the clinic is in a sorry state: yellowed microscopes, a dishwasher stained by purple chemicals, refrigerators corroded by rust.   Over the years, fridges, freezers and air conditioners have stopped working and there's been no budget to  repair or replace them. Maintenance costs $1,000 a month.   Until 2007, the clinic received state funding for studies, but the money dwindled and then disappeared, Oscar Noya, the institution's director, told AFP.   "In Venezuela, scientific and investigative funding is zero!" he said.

The clinic has eight staffers who are paid salaries equivalent to $7 to $11 a month.   "We're at extreme poverty levels," said Noya, adding that "a full-time researcher should earn $4,000 to $5,000 a month."   Despite this, the center continues to propose malaria research projects to universities in France, Spain or Scotland, which allows them to secure funding.   According to the World Health Organization, Venezuela registered more than 400,000 malaria cases in 2017, making it one of the hardest-hit countries in the Americas.   Noya, though, believes the true extent of the epidemic is "close to two million" people affected.   The clinic treated 3,500 patients in 2018 alone, a figure that was "150 times greater than the past but with the same number of staff."

- Surviving on donations -
The government stopped publishing its epidemiology bulletins in 2016 when it acknowledged 240,000 cases.   Venezuela is blighted by the worst economic crisis in its recent history with basic necessities such as food and medicine in short supply.   Oil production, on which Venezuela is almost entirely dependent, has dropped alarmingly in the last decade while the International Monetary Fund predicts inflation will reach a staggering 10 million percent this year.

President Nicolas Maduro's government blames the country's woes on US sanctions, which the socialist leader claims have cost Venezuela $30 billion.   The malaria clinic survives on donations from NGOs such as Doctors Without Borders, Aid For Aids and the Rotary Club, as well as through international partnerships.   The money raised is spent on medicine, quick test kits, gloves and chlorine to clean the facilities.   In 2018, they also received anti-malaria medication from the Pan American Health Organization after two years without any, Noya said.   "Today, we're on the mat... but we're fighters and that's why we're still here, even though we've had many offers to leave the country" for work, he added.
Date: Sun, 10 Mar 2019 00:58:06 +0100

Caracas, March 9, 2019 (AFP) - Fifteen Venezuelans with advanced kidney disease have died after being unable to get dialysis during the country's extended power outage, an NGO reported Saturday.   "Between yesterday and today, there were 15 deaths for lack of dialysis," said Francisco Valencia, director of the Codevida health rights group.

"The situation of people with kidney failure is very difficult, critical, we are talking about 95 percent of dialysis units, which today likely hit 100 percent, are paralyzed, due to the power outage," Valencia added.   He warned that there are more than 10,200 dialysis-dependent people nationwide who were at risk by the blackout.   Venezuelans since Thursday afternoon have been in the grips of the worst blackout in the history of the oil-producing country.   President Nicolas Maduro government has charged that a US-led war on electric power supply was under way.

The United States backs the interim presidency of opposition leader Juan Guaido. He is now recognized as interim president for more than 50 countries.   Maduro told supporters Saturday that almost 70 percent of power had been restored but at midday there was another cyber "attack at one of the generators that was working perfectly and that disturbed and undid everything we had achieved."   Although Caracas and the states of Miranda and Vargas -- home to the country's international airport and main port -- had intermittent power, the western regions of Barinas, Tachira and Zulia remained without electricity.
Date: Tue, 29 Jan 2019 18:36:21 +0100

Washington, Jan 29, 2019 (AFP) - The United States on Tuesday urged its citizens to avoid all travel to crisis-torn Venezuela, citing risks of crime and arrest and the US embassy's limited ability to assist.   "Do not travel to Venezuela due to crime, civil unrest, poor health infrastructure and arbitrary arrest and detention of US citizens," the State Department said in an updated travel advisory.   "There are shortages of food, electricity, water, medicine and medical supplies throughout much of Venezuela," it said.   Venezuela becomes the only country in the Western Hemisphere to be slapped with the State Department's "Level 4" warning against all travel, joining war zones such as Syria and Yemen. Americans, however, are not legally forbidden from going.

The US State Department had earlier listed Venezuela as Level 3, meaning that Americans should reconsider visits.    While the new travel advisory concerns security of US citizens, it comes as the United States is pressing leftist President Nicolas Maduro to step down faced with Venezuela's economic collapse and mounting street protests.   The United States has recognized opposition leader Juan Guaido as the interim president.   Washington has refused Maduro's orders to close down the embassy but has pulled out non-emergency staff and families due to security risks.   The travel advisory said that the United States "has limited ability to provide emergency services" in Venezuela.
Date: Mon 3 Dec 2018 8:47 PM
Source: ZME Science [abridged, edited]

Decades of progress in reducing the spread of measles have been stymied by outbreaks in Europe and the Americas, particularly in Venezuela. According to a recent report [see reference below] authored by the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC), the number of cases of the highly contagious disease reported worldwide has jumped by 31% between 2016 and 2017.

Measles is the leading cause of vaccine-preventable infant deaths.

Before the introduction of measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every 2-3 years and measles caused an estimated 2.6 million deaths each year. Thanks to modern healthcare and vaccination policies, the spread of the disease has been greatly reduced. For instance, between 2000 and 2017, reported measles cases dropped by 80% worldwide (from 853 479 to 173 330). During this time, researchers estimate that vaccination prevented 21.1 million deaths.

However, when vaccination coverage is poor, measles can easily resurface even in regions where it had previously been eradicated, largely due to international travellers carrying the virus. Just 2 years ago, the WHO stated that measles was no longer circulating in the Americas. Today, endemic measles is back on the American continents, largely due to a terrible outbreak in Venezuela: the country where inflation reached 1 million percent and whose public system has gone into disarray could no longer afford to properly organize vaccination campaigns. Today, there are 3545 confirmed cases of measles in Venezuela since 2016, which have resulted in 62 deaths.

From there, Venezuelan refugees have spread the disease to other parts of the continent -- especially in Brazil.

Measles outbreaks have also appeared elsewhere, including Europe and some parts of the United States. This time, however, the stead of the disease was not triggered by civil upheaval and economic collapse, but rather by the refusal of some parents to vaccinate their children. >From 2016-2017, the number of cases of measles in Europe rose by 458%, to 24,356.

According to the latest entry in the Morbidity and Mortality Weekly Report, there were 173 300 cases of measles reported worldwide in 2017, compared to only 132 328 in 2016. That's still a much better situation than the world was facing only 2 decades ago. However, it's disappointing to see how so much hard-earned progress is [lost].

This study shows just how vulnerable populations can be, even in places where measles had been previously all but eradicated.

[Reference
---------
Dabbagh A, Laws RL, Steulet C, et al. Progress toward regional measles elimination -- worldwide, 2000-2017. MMWR Morb Mortal Wkly Rep 2018; 67(47); 1323-29;
=========================
[The report contains a very nice figure showing the estimated annual number of measles deaths with and without vaccination programs -- worldwide, 2000-2017. Credit: CDC] - ProMED Mod.LK]
Date: Sun, 25 Nov 2018 03:15:36 +0100
By Plableysa Ostos, Margioni Bermudez

Ciudad Guayana, Venezuela, Nov 25, 2018 (AFP) - Yoli Cabeza was sent from one hospital to another before finally giving birth to her daughter Yusmari in the corridor of a maternity ward because her contractions came quicker than medical help.   The 37-year-old was diagnosed with a high-risk pregnancy but that didn't spare her from Venezuela's medical "roulette" -- the practice of referring patients from hospital to hospital due to a lack of personnel, supplies or sanitary conditions.

Cabeza told AFP she "did the tour of every hospital in" Ciudad Guyana, the biggest town in the state of Bolivar, before returning to the place she started at, the Negra Hipolita maternity unit where "they took me in."   Incredibly, her case isn't rare in a country where many women are forced to give birth in the street because they can't get into a state medical facility.   At the beginning of November, a woman was filmed giving birth to her son squatting by a tree in front of the biggest hospital in Bolivar.   Venezuela is in the midst of an economic meltdown triggered by mismanagement and a slump in oil prices followed by US sanctions.   The United Nations says some 2.3 million people have fled Venezuela since 2015 and amongst them have been many doctors.

- Bring your own supplies -
According to a study by a dozen non-profits, some 22,000 doctors, more than half the former total, emigrated between 2012 and 2017.   Added to that, more than 6,000 nurses (74 percent of that industry's workforce) and 6,600 lab technicians have left while there's a shortage of 90 percent of necessary medicines and supplies.   Often, patients are turned away "because there are no surgical materials, no anesthesiologists. They don't even have chlorine to clean the cubicles," said Silvia Bolivar, a nurse at Concepcion Palacios, the biggest maternity unit in the capital Caracas.   Pregnant women are sometimes expected to bring their own disinfectant and garbage bags.   Venezuela has been suffering from four years of recession in which poverty is on the rise as food has become short in supply.   A caesarean section kit costs the equivalent of $100 at the black market rate while the minimum wage is 1,800 bolivars ($6) a month.   Inflation, which the International Monetary Fund predicts will reach 1.35 million percent this year has crippled the currency as United States sanctions saw foreign investment dry up.

- Surging infant mortality -
The effect on pregnant women has been devastating.   Yusmari Vargas, 24, was suffering from preeclampsia, a condition marked by high blood pressure that can develop into a more serious one that puts both the mother and baby's lives at risk.   When she arrived at the maternity unit, it was closed. The hours passed, the contractions became stronger and her baby ended up on the floor, welcomed into the world with a bump to its head.   "When he fell, they didn't even help me pick him up, there was nothing to cut the umbilical cord. It was a mess," she said.

Carolina Rojas, 22, almost lost her daughter after her caesarian section was postponed several times.   "One day there was no specialist, the next the pediatrician or the anesthesiologist didn't turn up," said Rojas.   Her daughter swallowed amniotic fluid and spent eight days in hospital after she was born.   Infant mortality rose 30 percent in 2016, with the deaths of 11,466 babies up to a year old, according to the latest Health Ministry figures.   Despite refusing to acknowledge the country's public health problems, President Nicolas Maduro launched a program to reduce the number of caesarian section births, but a year later he admitted it hadn't provided the expected results.

- 'Terrible year' - 
Suffering from post-natal pain, 32-year-old Yohanni Guarayote forced her way into the Negra Hipolita maternity unit, which locks its doors at night due to crime in the area.   She was only able to have two prenatal check-ups because she couldn't pay for a private clinic as her husband is unemployed.   "Some days the doctor didn't turn up, others there was no water, and so on," she said.   Her arms are so thin they look like a child's. During the pregnancy, she barely reached 43 kilograms (95 pounds), eating mostly sardines, yucca and squash.   "Now, I'm like a stick," she said, reclining in a sweltering room with six beds but no sheets.   She receives government subsidies but with another three children to feed, she says it's "not enough."   "This year has been terrible for pregnant women. They need to show more love to motherhood."
More ...

World Travel News Headlines

31st May 2019

A volcano on the Indonesian island of Bali erupted Friday, spewing a plume of ash and smoke more than 2,000 metres (6,500 feet) into the sky. Mount Agung, about 70 kilometres from the tourist hub of Kuta, has been erupting periodically since it rumbled back to life in 2017, sometimes grounding flights and forcing residents to flee their homes.
Mount Agung is about 70 kilometres from the tourist hub of Kuta

The latest shortly before noon on Friday shot a cloud of volcanic ash high into the sky, but caused no disruption to flights, Indonesia's geological agency said.  Agung remained at the second highest danger warning level, and there is a four-kilometre no-go zone around the crater.

Last summer, dozens of flights were cancelled after Agung erupted, while tens of thousands of locals fled to evacuation centres after an eruption in 2017.

The last major eruption of Agung in 1963 killed around 1,600 people.

Indonesia is situated on the Pacific "Ring of Fire", a vast zone of geological instability where the collision of tectonic plates causes frequent quakes and major volcanic activity.

31st May 2019

Heatwaves across India have exacted heavy casualties this year, including dozens of deaths by sunstroke and other heat-related causes. The deaths have been mainly reported from states like Maharashtra (particularly Vidarbha), Andhra Pradesh (mainly Rayalseema) and Telangana, due to the temperature extremes in these regions. What's worrying is, a study suggests that the heatwave conditions are likely to increase from next year and continue till 2064 because of El Niño Modoki and depletion in soil moisture. Here's how the heatwave is taking a toll in the above states.

Maharashtra

Parts of Maharashtra have been reeling under high temperatures accompanied by severe heatwave condition during this summer. According to a report in The Times Of India, a 50-year old man in Beed succumbed to death because of heatstroke recently, taking the overall number to 8. Reports show a total of 456 cases of heat-related illnesses in Maharashtra this summer. Last year, the number of cases reported was 568. However, the death toll this year is more than last year's figure of 2 victims.

Regions like Nagpur and Akola show the most number of deaths and illnesses in the Vidarbha region. About 163 cases of heat-related illness were reported in Nagpur and 76 ailments were reported in Latur region. Recently, Chandrapur in Maharashtra (which lies 150km south of Nagpur) registered a day temperature of 48°C, the highest recorded in India this summer.

Andhra Pradesh

Parts of Andhra Pradesh have been experiencing temperatures of 45°C and more since the last few days. These conditions have persisted in the state after the heavy rains caused by Cyclone Fani.

Two women going on a two-wheeler and covered themselves with scarfs to protect themselves from the heat wave, in Vijayawada
(Mahesh G, TOI, BCCL, Vijayawada.)

Three people have died in Andhra Pradesh due to heat-related causes this year. Also, 433 people have been diagnosed with heatstroke. Earlier this month, electrical transformers had blown up in many parts of Krishna and Guntur districts, disrupting power supply for more than five hours and intensifying the effects of heatwave conditions and the severe temperatures.

In 2015, Andhra Pradesh experienced the most number of heat deaths in the country: 1,369 people died that year from heat-related illnesses.

Telangana

Seventeen people have succumbed in Telangana over the last 22 days. However, the number of unconfirmed deaths is expected to be higher. The region saw 541 heat-related deaths in 2015, and 27 in 2018. The farmers and those who work in the sun are usually the ones to be affected the most by high temperatures and heatwave conditions.

As heat blankets the country, make sure you stay protected. Follow official guidelines and do not step out in the Sun, especially in the afternoon hours, unless absolutely necessary.

(With inputs from The Times Of India.)

11th June 2019
https://afro.who.int/news/confirmation-case-ebola-virus-disease-uganda

Kampala, 11 June 2019 - The Ministry of Health and the World Health Organization (WHO) have confirmed a case of Ebola Virus Disease in Uganda. Although there have been numerous previous alerts, this is the first confirmed case in Uganda during the Ebola outbreak on-going in neighbouring Democratic Republic of the Congo.

The confirmed case is a 5-year-old child from the Democratic Republic of the Congo who travelled with his family on 9th June 2019. The child and his family entered the country through Bwera Border post and sought medical care at Kagando hospital where health workers identified Ebola as a possible cause of illness. The child was transferred to Bwera Ebola Treatment Unit for management. The confirmation was made today by the Uganda Virus Institute (UVRI). The child is under care and receiving supportive treatment at Bwera ETU, and contacts are being monitored.

The Ministry of Health and WHO have dispatched a Rapid Response Team to Kasese to identify other people who may be at risk, and ensure they are monitored and provided with care if they also become ill. Uganda has previous experience managing Ebola outbreaks. In preparation for a possible imported case during the current outbreak in DRC, Uganda has vaccinated nearly 4700 health workers in 165 health facilities (including in the facility where the child is being cared for); disease monitoring has been intensified; and health workers trained on recognizing symptoms of the disease. Ebola Treatment Units are in place.

In response to this case, the Ministry is intensifying community education, psychosocial support and will undertake vaccination for those who have come into contact with the patient and at-risk health workers who were not previously vaccinated.  

Ebola virus disease is a severe illness that is spread through contact with the body fluids of a person sick with the disease (fluids such as vomit, faeces or blood). First symptoms are similar to other diseases and thus require vigilant health and community workers, especially in areas where there is Ebola transmission, to help make diagnosis. Symptoms can be sudden and include:
  • Fever
  • Fatigue
  • Muscle pain
  • Headache
  • Sore throat
People who have been in contact with someone with the disease are offered vaccine and asked to monitor their health for 21 days to ensure they do not become ill as well.

The investigational vaccine being used in DRC and by health and frontline workers in Uganda has so far been effective in protecting people from developing the disease, and has helped those who do develop the disease to have a better chance of survival. The Ministry strongly urges those who are identified as contacts to take this protective measure.

Investigational therapeutics and advanced supportive care, along with patients seeking care early once they have symptoms, increase chances of survival.

The Ministry of Health has taken the following actions to contain spread of the disease in the country:
  • The District administration and local councils in the affected area have been directed to ensure that any person with Ebola signs and symptoms in the community is reported to the health workers immediately and provided with advice and testing.
  • The Ministry of Health is setting up units in the affected district and at referral hospitals to handle cases if they occur.
  • •Social mobilization activities are being intensified and education materials are being disseminated.

There are no confirmed cases in any other parts of the country.

The Ministry is working with international partners coordinated by the World Health Organization.

The Ministry of Health appeals to the general public and health workers to work together closely, to be vigilant and support each other in helping anyone with symptoms to receive care quickly. The Ministry will continue to update the general public on progress and new developments.
Date: Mon, 10 Jun 2019 14:24:43 +0200

Lima, June 10, 2019 (AFP) - Peru has declared a health emergency in five regions, including Lima, after the deaths of at least four people linked to Guillain-Barre syndrome, an autoimmune disorder that attacks the nervous system.   Health Minister Zulema Tomas said Sunday that in addition to the deaths there were currently 206 cases of the disease.   "We have an outbreak, there has been a brusque increase" since June 5, Tomas said on state-run TV Peru, adding that health authorities were taking steps to control and contain the disease.

While the syndrome is not contagious, a 90-day health emergency was declared because the current cases "have unusual and atypical characteristics that require rapid or immediate initial treatment," Peru's Institute of Neurological Sciences said.   The precise cause of the disorder is unknown, but most cases develop after a person has been sick with diarrhoea or a respiratory infection.

The Centers for Disease Control and Prevention in the US says its research suggests that the syndrome is "strongly associated" with the Zika virus, a mosquito-borne illness.   The regions affected by GBS include three on the country's northern coast -- Piura, Lambayeque, La Libertad -- tourist destinations known for their archaeological sites and beaches.   Also included was the central region of Junin and Lima, which has nine million inhabitants.   Two deaths were reported in Piura, one in La Libertad and another in Junin.
Date: Mon, 10 Jun 2019 16:39:03 +0200

Madrid, June 10, 2019 (AFP) - Three tourists have fallen from their hotel balconies in Spain's Balearic Islands in recent days, one of them dying on impact, police said Monday as the summer season in the party archipelago begins.   The incidents came as Britain's foreign office warned holidaymakers heading to Spain against "balcony falls" and asked them not to "take unnecessary risks... particularly if you're under the influence of drink or drugs."   On Friday in Magaluf, a party resort notorious for its booze-fuelled tourism, a 19-year-old British man fell to his death from the second floor of his hotel, Spain's Civil Guard police force said.

A spokesman said police were looking at two theories -- either "he threw himself off voluntarily, or he fell by accident."   He did not know whether the victim had consumed drugs or alcohol.   On Thursday, a 35-year-old German man fell from the second floor of his hotel too, this time in Palma de Majorca, and was seriously injured, police said.   A source close to the probe, who declined to be named, said the man had drunk, dozed off, woken up and subsequently fallen from the balcony, possibly disorientated.   And on Monday, an Australian man in his early thirties fell from the second floor of his hotel in Ibiza and was seriously hurt, police said, without giving further details.

Balcony falls happen every year in the Balearic Islands and other party resorts in Spain, most of them due to excessive drinking or drug-taking/   Some are accidental slips, while others happen when tourists miss while trying to jump into pools or onto another balcony -- a practice known as "balconing."   The British foreign office's online travel advice for Spain has an entire section warning against "balcony falls".   "There have been a number of very serious accidents (some fatal) as a result of falls from balconies," says the website.    "Many of these incidents have involved British nationals and have had a devastating impact on those involved and their loved ones."
Date: Mon, 10 Jun 2019 06:44:54 +0200

Sydney, June 10, 2019 (AFP) - Australian police said Monday they were scouring bushland for a Belgian teenage tourist missing in a popular surf town for more than a week.   Theo Hayez, an 18-year-old backpacker, was last seen on May 31 at a hotel in the coastal tourist town of Byron Bay -- some 750 kilometres (470 miles) north of Sydney -- New South Wales state police said.   "We have a large amount of resources searching... in bushland that is towards the east and northeast of the town," police Chief Inspector Matthew Kehoe said in a statement.   "We are advised that this disappearance is completely out of character for him."   Police said they were alerted to his disappearance on Thursday after he failed to return to a hostel he was staying in.   Hayez's passport and personal belongings were all left at the hostel, and police believe he had not made any financial transactions since his disappearance or used his mobile phone.
Date: Sat 8 Jun 2019
Source: New Jersey 101.5 [edited]

The potentially deadly Powassan tick-borne virus has been confirmed in 2 Sussex county residents, one of whom died last month [May 2019], state health officials confirmed [Sat 8 Jun 2019].

The Powassan virus is spread by the deer tick [_Ixodes scapularis_]. The illness is rarer than Lyme disease, which is also spread by the tick, but 10% of people who contract the [Powassan virus] illness die from it.

A Department of Health official on [Sat 8 Jun 2019] said that the department had not determined the cause of death for the patient who died last month [May 2019] but said that lab results this week [week of 3 Jun 2019] confirmed that he had the virus.

A 2nd victim continues to recover at home.

Symptoms of the virus include brain swelling, meningitis, fever, headache, vomiting, weakness, confusion, loss of coordination, trouble speaking, and memory loss. Symptoms can appear a week to a month after a tick bite, although some people show no symptoms and do not require treatment.

There is no vaccine or cure for the disease. Treatment includes hospitalization, support for breathing, and intravenous fluids.

Prevention involves the same precautions that should be taken to avoid Lyme disease: avoid wooded areas with tall grasses, use insect repellent while outdoors, and check for ticks after being outdoors.

Powassan [virus] -- first discovered in Powassan, Ontario, in 1958 -- has been confirmed in recent years in New Jersey, with one case each in 2013, 2014, and 2015, and 4 cases in 2017, the most recent year for which data is available. The cases were reported in Sussex, Warren, Morris, and Essex counties.

Between 2008 and 2017, there were 125 confirmed cases in the entire country and 9 deaths.

A person who said they were close to the man who died last month [May 2019] posted on Facebook that the man was bitten in the arm by a tick while gardening and fell ill about 2 weeks later. The Facebook post said that there was no bull's-eye mark around the bite -- a known tell-tale sign for Lyme infection. About a day before he was hospitalized, the man reported feeling like he was coming down with a cold and had a high fever.

State health department's tip sheet for preventing Powassan [virus infection]:
- avoid contact with ticks by avoiding wooded areas with high grass;
- when hiking, stay on the center of the trail;
- picnic in areas away from wooded and bushy areas;
- keep children on playground equipment and away from tall grass and shrubs;
- when outdoors, apply insect repellents;
- wear light-colored clothes so it is easy to see and remove ticks;
- wear long-sleeve shirts and pants;
- tuck long pants into socks so ticks cannot crawl under pants;
- do tick checks every couple hours while outdoors and before coming indoors;
- if you see a tick during tick checks, remove it right away;
- keep grass mowed short;
- keep children's toys, playground equipment, pools, and lawn furniture at least 15 feet [4.6 m] from wooded areas;
- create a woodchip or mulch border between your yard and wooded areas;
- keep areas under bird feeders and pet dishes clean, so they do not attract animals that may carry ticks;
- keep trash in closed containers or areas so it does not attract animals that may carry ticks.  [Byline: Sergio Bichao]
=======================
[Powassan virus is endemic in New Jersey, and cases occur there sporadically. The tick vector is the deer tick, _Ixodes scapularis_. Humans become infected with POWV during spillover transmission from the natural transmission cycles. In humans, POWV can be a causative agent of a severe neuroinvasive illness, with 50% of survivors displaying long-term neurological sequelae. Individuals living or visiting areas where the deer tick occurs, should follow the above recommendations to avoid tick bites. If a tick is found feeding, it should be removed with forceps or tweezers grasping the tick at skin level and then gentle, constant force applied. The tick should never be removed by grasping it with thumb and forefinger, as squeezing the tick may cause inoculation of contents containing the pathogenic agent into the feeding site.

POWV was recognized as a human pathogen in 1958, when a young boy died of severe encephalitis in Powassan, Ontario, Canada. In that case, POWV was isolated from the brain autopsy. There are 2 distinct genetic lineages now recognized: POWV (lineage I) and deer tick virus (lineage II). Since the index case in 1958, over 100 human cases of POWV have been reported, with an apparent rise in disease incidence in the past 16 years. This recent increase in cases may represent a true emergence of POWV in regions where the tick vector species are prevalent, or it could represent an increase in POWV surveillance and diagnosis. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of New Jersey, United States:
New Jersey county map:
Date: 6 Jun 2019
Source: Washington Post [edited]

Dominican government officials released more-detailed autopsy results on Thursday [6 Jun 2019] for 3 American tourists who died at adjacent beach resorts owned by the same hotel company during the last week of May 2019.

All 3 victims experienced eerily similar symptoms and internal trauma before their deaths, according to a news release from Dominican authorities. Pathologists said autopsies showed the 3 had internal haemorrhaging, pulmonary oedema, and enlarged hearts.

Toxicology reports are pending [These are likely to be the most interesting. - ProMED Mod.TG].

A U.S. State Department official said authorities have not yet established a connection between the 30 May 2019 deaths of 49-year-old CAD, and 63-year-old NEH, both of Prince George's County, MD, and the death on 25 May 2019 of 41-year-old MSW of Pennsylvania.

The FBI is providing Dominican law enforcement with "technical assistance with the toxicology reports," the State Department official said.

MSW had just checked into the Luxury Bahia Principe Bouganville, in the town of San Pedro de Macoris, and was taking pictures from her room balcony when she started to feel ill.

Less than 2 hours later, she was dead, local authorities said.

The bodies of CAD and HEH were found inside their room at the Grand Bahia Principe La Romana after relatives grew concerned because they had not checked out of the resort.

The hotels are located next to each other on the island's southern coast, about 60 miles from the tourist-heavy Punta Cana area.

Dominican authorities initially did not run toxicology tests for MSW because there were no signs of violence, said Ramon Brito, a spokesman for the National Police's special tourism unit. After the Maryland couple was found, investigators ordered a set of tests to determine whether anything the 3 Americans consumed may have led to their deaths, Brito said.  [Byline: Arelis R. Hernandez]
Date: 31 May 2019
Source: 4 News [edited]

The Alachua County Health Department is warning residents that there are 12 confirmed cases of mumps, primarily from college students at the University of Florida.  "This is a little more than usual," says Steve Orlando, University of Florida spokesman.

Alachua County normally receives around 2 reported cases a year, and UF believes more students could be infected.  "So, it's curious because these are individuals who are vaccinated, and that's what we are seeing nationwide," says Paul Myers, Alachua County Health Department administrator.

Officials say it is still unclear why there has been an uptick with the virus. So far, the CDC shows 736 people have contracted mumps nationwide in 2019.

"The sharing of the utensils, sharing of the cups, sharing of the water bottles, you know it is a very common thing for students to share those things, and that's exactly the kind of thing that could lead to transmission," says Orlando.
Date: Sat 8 Jun 2019
Source: Business Standard [edited]

As many as 14 children have died due to acute encephalitis syndrome (AES) in the district, while over a dozen are admitted in hospitals with high fever and other symptoms of the infection.

Sunil Shahi, Superintendent of Shri Krishna Medical College and Hospital (SKMCH), told ANI, "We have received 38 patients so far; most of them have a deficiency of glucose in their blood. Of these, 2 have also tested JE [Japanese encephalitis] positive; the overall casualty till now is 14."

Dr Gopal Sahni, head of Critical Care Unit, said, "When heat and humidity rise, the body's sweat cannot evaporate. The humidity level is over 50 per cent in the last few days. We have about 15 such children admitted in the hospital currently, and 89 such cases come regularly."

Encephalitis is a viral infection, which causes mild flu-like symptoms such as a fever or a headache.
=======================
[Again, this year (2019), cases of AES and JE are appearing in north-western India. Of the 14 AES cases, 2 tested positive for JE. The aetiology of the remaining cases is not stated, but the majority are reported as hypoglycaemic. As noted previously, frequently, in reports of JE cases in India, acute encephalitis syndrome (AES) of undefined aetiology is often mentioned with JE cases that are a minority of those hospitalized.

The determination of the aetiology or aetiologies of AES has been confusing and elusive. Various etiological agents have been proposed in recent years as responsible for AES cases. AES has continued to be attributed to a variety of aetiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_). Recently, scrub typhus has been implicated in many AES cases. A recent publication (reference below) states that dengue virus is one of the 3 most common agents identified in acute encephalitis syndrome (AES). Unfortunately, existing surveillance for AES does not include routine testing for dengue. Dengue accounts for 5% of AES cases in India, especially in the absence of laboratory evidence for other pathogens tested. Dengue should be added to the list of possible AES etiological agents.

Reference:
Vasanthapuram Ravi, Shafeeq Keeran Shahul Hameed, Anita Desai, Reeta Subramaniam Mani, Vijayalakshmi Reddy, et al.: Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): Results from a 4-year AES surveillance study of Japanese encephalitis in selected states of India. International Journal of Infectious Diseases. 2019. doi: <https://doi.org/10.1016/j.ijid.2019.01.008>.

Maps of India:

[HealthMap/ProMED map available at: