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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: Thu, 16 Jan 2020 02:45:27 +0100 (MET)
By Ivelisse RIVERA, con Leila MACOR en Miami

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

An alert issued by the Tsunami Warning Center immediately following the earthquake was later cancelled.   Tuesday's quake was the strongest of a series of tremors that have shaken the island since December 28, topping Monday's 5.8 quake.   That earthquake toppled houses and caused power outages, but there were no reports of casualties.
Date: Mon, 6 Jan 2020 18:04:21 +0100 (MET)

Miami, Jan 6, 2020 (AFP) - A 5.8-magnitude earthquake shook Puerto Rico Monday, toppling houses and causing power outages and small landslides but there were no reports of casualties, the US Geological Survey said.   The quake, just off the US territory's southern Caribbean coastline, was felt throughout much of the island, including the capital San Juan.

Some 250,000 customers were hit by electric power outages after the quake, which struck at 6:32 am local time (1032GMT).   Images posted on social media showed houses tumbled from their supporting pillars, cracks in walls, cars crushed under collapsed houses and small scale landslides.   The quake was the strongest of a series that have rippled through the island since December 28, and it was followed by at least eight aftershocks, officials said.   No tsunami alerts were issued.
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Benin

Benin - US Consular Information Sheet
April 28, 2008

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Slovakia

Slovak Republic US Consular Information Sheet
July 09, 2008
COUNTRY DESCRIPTION:
The Slovak Republic is a rapidly developing European nation. Tourist facilities are not as developed as those found in Western Europe, particularly outside th
major cities, and some goods and services taken for granted in other European countries are occasionally unavailable.
Read the Department of State Background Notes on the Slovak Republic for additional information.

ENTRY/EXIT REQUIREMENTS: A passport is required. A visa is not required for stays for tourism or business up to 90 days within six months of the date of first entry into the Slovak Republic/Schengen zone. That period begins when you enter any of the Schengen countries: Austria, Belgium, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Slovakia, Slovenia, Spain and Sweden.
All foreigners seeking entry into the Slovak Republic must carry proof of a medical insurance policy contracted for payment of all costs for hospitalization and medical treatment in the Slovak Republic.
Border police have the right to request evidence of finances sufficient to pay for the proposed stay in the Slovak Republic in the amount of $50 per person per day.
Current information can be found on the Slovak Embassy’s web site at http://www.slovakembassy-us.org.

All persons in Slovakia over the age of 15 must carry official identification at all times. American citizens staying overnight in Slovakia must register with the local Border and Aliens Police within three working days.
Persons staying hotels are registered automatically.
Visit the Slovak Ministry of the Interior’s web site at http://www.minv.sk for the most current information.

NOTE: On December 21, 2007, Slovakia became a member of a group of countries collectively known as “Schengen countries” or the “Schengen zone.” Americans may enter and remain within the entire Schengen zone without a visa for no more than 90 days in any six-month period. If an American has just spent 60 days in another Schengen country, for example, he or she would be permitted to enter Slovakia only for the remaining 30 days. It is not possible to extend a tourist stay beyond 90 days in the Schengen zone. Once an American has used his/her 90 days, he/she cannot reenter Slovakia until he/she has spent at least three months outside the Schengen zone.

Although European Union regulations require that non-EU visitors obtain a stamp in their passport upon initial entry to a Schengen country, many borders are not staffed with officers carrying out this function. If an American citizen wishes to ensure that his or her entry is properly documented, it may be necessary to request a stamp at an official point of entry. Under local law, travelers without a stamp in their passport may be questioned and asked to document the length of their stay in Schengen countries, and could face possible fines or other repercussions if unable to do so.

Persons wishing to remain in Slovakia longer than 90 days or arriving for purposes other than tourism or business travel may apply for temporary residency and/or work permits shortly after arrival in Slovakia.
However, it is strongly recommended that such persons review the requirements and begin preparing their applications prior to travel, as many documents required of U.S. citizens are more easily obtained in the United States.
For example, U.S. citizens must submit a certificate not older than 90 days showing the result of a fingerprint records check by the FBI.
As authorities in Slovakia cannot take fingerprints for this purpose, it is extremely difficult to obtain this certificate after arrival in Slovakia.
In addition, Slovakia requires all documents (birth certificates, etc) intended for official use in Slovakia to be authenticated (e.g. to have an apostille). See our section on Judicial Assistance for more information.

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

SAFETY AND SECURITY:
Taking photographs of security/military installations (for example, military bases, government buildings, nuclear power plants, etc.) is prohibited. Violation of this law may result in confiscation of the camera, film or memory card, a reprimand or fine, or even expulsion from the country. Serious cases may be reported to and handled by local and/or military police.

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

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

CRIME:
The Slovak Republic has a medium rate of crime. Police forces suffer from a lack of manpower resources and equipment. Local police are not likely to speak English. Western visitors, especially short-term visitors such as tourists and students, are the primary foreign targets of street crime. The majority of street crime is non-violent and ranges from pickpocketing (particularly in the summer) and purse and cellular telephone snatchings to mugging, armed robbery, shooting, drugging and robbing of unsuspecting victims at nightspots and bars. Most reported thefts occur at crowded tourist sites (such as Bratislava’s Old Town area) or on public buses or trains. Thieves in the Slovak Republic often work in groups or pairs. In most cases, one thief distracts the victim, another performs the robbery, and a third person hands off the stolen item to a nearby accomplice. Groups of street children are known to divert tourists’ attention so that a member of their group can pickpocket the tourists while they are distracted. Do not leave personal items in unattended vehicles, even if locked.
Reports of racially motivated incidents against foreigners and minorities, particularly perpetrated by groups with a history of targeting persons of Roma, African, or Asian descent, have occurred in the Slovak Republic. In addition to incidents of assault, persons of Roma, African, or Asian heritage may be subject to various types of harassment, such as verbal abuse.

Both indigenous and foreign organized crime groups are well-established in the Slovak Republic. They do not target U.S. or other foreign individuals and tend to co-exist peacefully in the tourist district so as not to scare away tourist dollars. Though not common, violent incidents sometimes do occur outside of Old Town Bratislava.

INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy or Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
The local equivalent to the 911 emergency line in Slovakia is 155.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are available in the Slovak Republic, although the quality and availability varies within the country. Ambulances are only a means of transportation to the hospital; they may not have life support stabilization equipment on board. Only a limited number of doctors speak English.
Doctors and hospitals expect cash payment for health services unless the patient can present an insurance number from the Slovak National Insurance Company. Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost tens of thousands of dollars or more.

Medical prescriptions issued in the U.S. are not valid in the Slovak Republic. If needed, a local doctor must issue a prescription. Medicines are generally available locally, if not under the American name the doctor can be consulted for a substitute. The Ministry of Health of Slovak Republic administers the use of medicines and medicine brought to the Slovak Republic for personal use may become subject to comparison against the list of those authorized for use in the Slovak Republic.

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

Roads in the Slovak Republic typically are safe and well maintained. Four-lane highways exist in and around Bratislava. However, most roads outside of built-up areas are two lanes only, and aggressive drivers attempting to pass at unsafe speeds pose a serious hazard. Due to poor lighting and narrow, winding roads, nighttime driving outside of built-up areas is not recommended.

From November through March there is often heavy snowfall, which is not adequately cleared from many rural roads. Roads in the mountainous northern part of the country are particularly prone to hazardous conditions during winter months. Winter tires are recommended and chains are necessary in certain mountainous areas.

In the Slovak Republic, vehicles travel on the right side of the road. Headlights must be used at all times (day and night) from October 15 until March 15. The maximum legal speed on highways is 130 kilometers per hour (78 mph). On smaller roads the maximum speed in 90 kph (54 mph). The limit in towns is 60 kph (36 mph). Use of cellular phones while driving is strictly prohibited. Safety reflection vests and first aid kits are compulsory equipment of each vehicle.

Drivers must yield the right of way to all vehicles with flashing blue lights (police, ambulances, fire trucks, motorcades). Vehicles with yellow or orange lights usually mean that traffic must slow down. Drivers must always be cautious, however, as many slowly moving vehicles, such as agricultural vehicles, are not well marked.

Driving under the influence of alcohol is strictly prohibited. The blood alcohol tolerance level is zero percent.
Penalties for drivers involved in car accidents involving injury of death are decided by a court of law. Penalties for minor offenses are not generally large, but foreigners are sometimes targeted for additional sums. Anyone suspecting this has occurred should ask for a written receipt and note the name and number of the traffic officer imposing the fine.

Gasoline is readily available, although many gas stations are closed on Sunday, especially in rural areas. Gas stations typically do not offer repair service; private mechanics must be found. Most gas stations accept credit cards, but mechanics less frequently accept them, so travelers should expect to pay for these services in cash.

A highway user decal must be purchased for travel on most major roads outside of Bratislava. The decal is valid for the calendar year in which it is purchased, and is available at gas stations, post offices and some newspaper kiosks. The cost is 1100 Sk (Slovak crowns) for all vehicles up to 3.5 tons. A short-term decal valid for 30 days may be purchased for 300 Sk and for 7 days for 150Sk.

Taxi companies provide generally reliable, safe, and economical services. Avoid independent cabs that do not prominently display a company name. Visitors should be alert to the potential for substantial overcharging by taxis, particularly in areas frequented by tourists. Radio-dispatched taxis are often much more reliable.

Buses, trolleys, and trams are mechanically safe, but there have been reports of thefts on city transportation and of harassment by the transport police. On public transportation it is obligatory to have a time-ticket validated after entering the vehicle (valid for 10, 30, or 60 minutes), or a prepaid zone ticket (valid for 24,.48,. or 68-hours, and 1 month, 3 months or 1 year). Children from 6 to 15 years of age pay reduced fares. Passengers who are traveling without a valid ticket will be fined by the ticker inspector. The ticket inspector has to have an identification card and must provide a ticket for the fine. More information is provided in English at www.imhd.sk.

Inter-city travel is widely available by bus, train, or taxi and is generally safe (inquire about taxi fares in advance). There are regular international trains and buses which are mechanically safe. However, there is a danger of theft, even from locked compartments, particularly on international night trains serving Warsaw, Prague and Budapest. Taxi drivers with special permits may provide international taxi service.

A motorcycle driver’s license and helmet are required. Small motorcycles are not allowed on highways. All traffic regulations apply.

Tourists coming to the Slovak Republic are required to have an International Drivers’ Permit. A U.S. driver’s license alone is not sufficient to drive in Slovakia. The U.S. driver’s license must be accompanied by an International Driver’s Permit, obtainable in the United States from the American Automobile Association and the American Automobile Touring Alliance.

A Slovak Driver’s License can be applied for at the Dopravny Inspektorat in the district of the applicant’s place of residence in the Slovak Republic. Completion of the regular driving course and a written examination (in Slovak) are required for issuance of a Slovak driver’s license. For specific information concerning Slovak driver’s permit, vehicle inspection, road tax and mandatory insurance, contact the Slovak Embassy in Washington, DC.

Please refer to our Road Safety page for information.

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

SPECIAL CIRCUMSTANCES:
Slovak customs authorities enforce strict regulations concerning temporary importation into or export from the Slovak Republic of items such as firearms, antiquities, medications, business equipment, etc. It is advisable to contact the Embassy of the Slovak Republic in Washington, D.C, or one of the Slovak 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 Slovak laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Slovakia are strict and convicted offenders can expect jail sentences and heavy fines.
Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION/EMBASSY AND CONSULATE LOCATIONS:
Americans living in the Slovak Republic are encouraged to register with the nearest U.S. Embassy of Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within the Slovak Republic.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy in Bratislava is located at Hviezdoslavovo namestie 4, Bratislava telephone (421) (2)5443 0861; (421) (2) 5443 3338, fax (421) (2) 5441 8861; mailing address: U.S. Embassy, P.O. Box 309, 814 99 Bratislava, Slovak Republic; e-mail: consul@usembassy.gov; web site:http://slovakia.usembassy.gov
* * * *
This replaces the Country Specific Information for Slovakia dated December 17, 2007 without substantive changes.

Travel News Headlines WORLD NEWS

Date: Thu 2 Jun 2016
Source: The Slovak Spectator [edited]
<http://spectator.sme.sk/c/20179834/number-of-people-infected-with-tick-borne-encephalitis-rises.html>

The number of people suffering from tick-borne encephalitis in Košice increased again on 1 Jun [2016]. So far 27 infected patients have been hospitalised at the Infectology and Travel Medicine Department (KICM) of the Louis Pasteur University Hospital (UNLP) while another 5 are being monitored by doctors at outpatient departments. "This number is not necessarily definitive, as the incubation period of the disease (between 7-14 days - ed. note) has not expired yet," said Ladislava Šustova¡, the hospital's spokesperson, as cited by the SITA newswire.

Some patients have been released from the hospital already while doctors have not recorded any complications in treatment so far. Local tick-borne encephalitis broke out in Košice last weekend [28-29 May 2016]. Consumption of cheese produced from unpasteurized sheep's milk is said to have caused the infection. Symptoms of this infectious viral disease come in 2 stages: "The 1st presents as a mild flu, including a loss of appetite and intestinal problems," explained Šustova.

"After 3 or 4 days these problems fade and the so-called asymptomatic phase occurs, which can last up to 20 days. Then a 2nd phase sets in abruptly, featuring high fever, persistent headaches, vomiting, sensitivity to light, a stiff neck, and other symptoms characteristic of the involvement of the central nervous system." One of the most serious complications of the disease is meningitis. KICM records 6 cases of tick-borne encephalitis on average per year.

"Such a mass outbreak of tick-borne encephalitis has not been recorded at this hospital for the past 5 years," said Šustová. In total, Slovak doctors diagnosed 88 cases of tick-borne encephalitis in Slovakia last year [2015], 17 of which were found to be contracted via food. So far this year [2016], except for the local epidemic in Košice, 8 people have contracted the disease, none of them via food, Martina Merková from the Public Health Authority (ÚVZ) told the TASR newswire.
=======================
[Central and Eastern Europe countries are endemic for the European subtype of tick-borne encephalitis (TBE) virus and cases occur yearly there. Although castor bean ticks, _Ixodes ricinus_, are the main vectors that transmit TBE virus to people, individuals can become infected by consumption of unpasteurized milk and milk products coming from infected animals -- goats in the situation above.

Presumably, the public will be warned of this risk and advised of measures to avoid tick bites and be vaccinated as people become more active out of doors with the onset of warmer weather. The Standing Commission on Vaccination Recommendations at the Robert Koch Institute recommends vaccination against TBE for people who live or work in areas at risk of TBE and who are at risk of tick bites, and for people in endemic areas for other reasons if they are at risk of tick exposure. - ProMed Mod.TY]

[Maps of Slovakia can be seen at <http://www.ezilon.com/maps/images/europe/Slovakian-political-map.gif> and <http://healthmap.org/promed/p/53556>. - ProMed Sr.Tech.Ed.MJ]
   Date: Tue 14 Oct 2014
Source: Czech News Agency [edited]

Sanitary authorities registered dozens of cases of hepatitis A in southern Slovakia over the past few weeks, and due to the local epidemic, they ordered the suspension of activity at some schools and vaccination in the afflicted localities, the health authority in Nitra said today, 14 Oct 2014.

The hepatitis mainly spread in the Zlate Moravce and Levice districts, afflicting all age groups, the office said. In Zlate Moravce, most of the cases were confirmed with the local Romas and the people living in very poor sanitary conditions. As many as 14 infected persons lived at the same address in the village of caradice, without water and toilets.

"The number of ill is rising," the head of the teaching hospital in Nitra, Jozef Valocky, is quoted as saying. So far, at least 50 people have contracted hepatitis. In the afflicted localities, the sanitary officers have ordered the vaccination of about 1000 people as well as preventative vaccination of the children living in poor sanitary conditions.
====================
[Hepatitis A is a liver infection caused by the hepatitis A virus. The virus is spread by faecal-oral transmission. Hepatitis A is closely associated with inadequate sanitation and poor personal hygiene. Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms. Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. Waterborne outbreaks are usually associated with sewage contaminated- or inadequately treated water.

Casual contact among people does not spread the virus. In developing countries (where sanitary conditions are poor), most children experience infection in early childhood. As a consequence of poor sanitary conditions and hygienic practices, most children (up to 90 percent) have been infected with the hepatitis A virus before the age of 10. Those infected in childhood do not experience any noticeable symptoms. Consequently, epidemics are uncommon because older children and adults are generally immune. Symptomatic disease rates in these areas are low, and outbreaks are generally rare, although one seems to have occurred here. - ProMed Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sat 10 Nov 2012
Source: NOVINY.SK [in Slovak, trans., edited]

Farm in Staskovce quarantined because of anthrax
------------------------------------------------
In the past few days 4 oxen have died on a farm in the village of Staskovce, Stropkov [district, Presov region]. The diagnosis has been confirmed in one of the animals.

The animals died over a short period of some 3-4 hours and the event took everyone by surprise. The farmers claim that they have seen nothing like this in the previous 20 years. And they take pride in the quality of livestock -- cattle, pigs, horses -- that they produce.

The veterinarians are on the farm and the affected herd has been quarantined in the farm stables. The affected animals had appeared to be healthy and the owner was taken by surprise.

Anthrax had been seen previously in the district of Svidnik 2 years ago.
----------------------------------------
communicated by:
Sabine Zentis
Castleview Pedigree English Longhorns
Gut Laach
52385 Nideggen
Germany
=====================
[This report is abstracted from a TV news report and if you go to the site you can hear the full report in Slovak.

In July 2010, 3 farms in Svidnik, Presov region, were reported with outbreaks and 9 animals were affected (see <http://www.oie.int/wahis_2/public%5C..%5Ctemp%5Creports/en_fup_0000010361_20110314_165943.pdf>). From the OIE reports and map they would appear to have been adjoining farms. These 2010 outbreaks were the first since 1995 in Slovakia, which is regarded as essentially free. But they had a human case in 2003, not otherwise explained, which suggests that the their freedom was conditional, that is, there were some unreported background cases. This could hint at the farmer having bought contaminated hay grown in one of those disturbed fields and the hay got soil contaminated -- this can happen if it rains during haymaking and mud gets included in the hay.

These outbreaks out of the blue usually are a result of earth moving activities on the farm, which resulted in an old anthrax grave being disturbed or of a waste-pit at a now closed tannery, which is much the same thing epidemiologically. However a new risk has shown itself latterly of contaminated imported bone meals. If this were the case there will be essentially simultaneous outbreaks on other dairy farms in the area from the same bone meal shipment.

Let us hope that the Slovak veterinarians are investigating this outbreak to discover the source of the infection.

Date: Tue, 18 Sep 2012 15:08:54 +0200 (METDST)

Bratislava, Slovakia, Sept 18, 2012 (AFP) - Slovakia banned alcohol from the Czech Republic Tuesday amid a wave of poisoning from methanol-tainted bootleg spirits that has claimed 21 Czech lives and put four Slovaks in hospital. "As a neighbouring country, which imports a quarter of Czech-made alcohol, we decided to ban the import and sale of Czech alcohol, effective as of 5 pm (1500 GMT) today," Agriculture Minister Lubomir Jahnatek told journalists.  "This is a precautionary measure after we learned that grocery chains were planning a big sale on Czech alcohol for tomorrow," he added. So far Slovakia, a nation of 5.4 million, has not recorded any bootleg-related deaths. Four people were hospitalised on Sunday after drinking a bottle of Czech-made plum brandy ordered over the Internet, but were reported to be in good condition.

The Slovaks had bought the liquor for a 50th birthday party via the Internet and received it in plastic bottles, local media reported. Poland banned the sale of all Czech-made alcohol except for beer and wine on Sunday after five deaths were recorded in the past two weeks, though they were not necessarily linked. On Friday, the Czech health ministry imposed a blanket ban on sales of spirits with over 20 percent alcohol content for the first time in the history of the nation of 10.5 million, which has the world's second highest adult alcohol intake after Moldova.

The ban could last for months, Health Minister Leos Heger said. A health ministry analysis showed most of those affected had drunk one of two types of tainted liquor -- vodka or a local rum dubbed "tuzemak". The Czech Association of Spirits Producers and Importers meanwhile said it estimated the bootleg liquor sold on the black market "made up 20 percent of total Czech alcohol consumption." Czech police were still looking Tuesday for the primary source of the poisonings but 23 suspected bootleggers and their distributors had faced charges as of Tuesday.
Date: Wed, 11 Jul 2012 21:56:23 +0200 (METDST)

BRATISLAVA, July 11, 2012 (AFP) - An 18-year-old Belgian boy scout was killed by a lightning while hiking in the High Tatra mountains in northern Slovakia on Wednesday, local media reported. "A group of Belgian boy scouts were hiking in the High Tatra mountains when a lightning struck one of them" on the summit of Slavkovsky Stit, 2,452 metres (8,045 feet) above sea level, the TASR news agency said. "The scouts called the emergency and started resuscitating him but neither they nor the emergency team that arrived by helicopter succeeded and the boy died," it added.
More ...

Latvia

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

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

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

The U.S. Embassy is located at 7 Raina Blvd. Riga, LV-1510, and may be reached by dialing +371-703-6200. The fax number for the Consular American Citizen Services section is+371-781-4088. You can find the ACS section online at http://riga.usembassy.gov/
* * * * * *
This replaces the Consular Information Sheet dated March 12, 2008 with updated information on Entry Requirements.

Travel News Headlines WORLD NEWS

6th December, 2019
HSE Health Protection Surveillance Centre

There is a case of human rabies in Latvia. The case has been clinically and laboratory confirmed (immunofluorescence and PCR). The case is 55 years old female from city Daugavpils, located 35 km from Belarus and Lithuania borders. Symptoms appeared on November, 22, she died on November, 28. 
 
Possible exposures: 
• In May, 2018 she was bitten in both legs (ankles) by puppy travelling in India;
• She worked as volunteer in animal shelter in Daugavpils, in April this year she was bitten/scratched there by a dog, and the dog is healthy now;
• She fed stray cats and dogs in the courtyard of the house in Daugavpils, as well as in a country house outside the city near the forest. Information about bites or other possible exposures is not known.

In none of these cases the person received PEP. Now 61 contacts receive post-exposure treatment (vaccination), mostly as precautions: staff of two hospitals and medical emergency service, and close contacts, including household. In Latvia the last cases of rabies in wild animals were registered in 2010, in 2012 was registered the last case in domestic animals. In 2014, Latvia received the status of a country free of rabies. Latvia continues to implement wild animal’s vaccination progamme. Neighbour countries Belarus and Russian Federation is not rabies free and animals can cross the border.
 
A test report has been received on the results of the rabies virus genotype identification and sequencing reaction (EURL-Rabies Protocol, (AFSSA) P. Meyer, 2009). The rabies virus genotype 1 was detected in the sample. According to the GenBank database, the virus sequence has 99.17% identity to the RV2924 isolate of rabies virus from Nepal. Information and evidence obtained during an epidemiological investigation demonstrated that the human rabies case had a dog bites during her travel in India (Naggar and Manali, state Himachal Pradesh – close to Nepal), in May 2018. No post exposure treatment was received.

No cases of illegally exported pets as the potential source of infection were identified in the relation to this rabies case. According to the literature in rare cases a long (more than one year) incubation period of rabies is observed. Taking into account the epidemiological data and the result of the rabies virus sequencing, the Center for Disease Prevention and Control of Latvia believes that this human rabies case is not epidemiologically linked to Latvia.
Date: Thu, 7 Nov 2019 17:11:10 +0100 (MET)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Antigua and Barbuda - US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
Antigua and Barbuda is a dual island nation known for its beaches, and is a favorite destination for yachtsmen.
Tourist facilities are widely avai
able.
English is the primary language.
Banking facilities and ATMs are available throughout the island.
Read the Department of State Background Notes on Antigua and Barbuda for additional information.

ENTRY/EXIT REQUIREMENTS:
All Americans traveling by air outside the United States are required to present a passport or other valid travel document to enter or re-enter the United States.
This requirement will be extended to sea travel (except closed loop cruises), including ferry service, by the summer of 2009.
Until then, U.S. citizens traveling by sea must have government-issued photo identification and a document showing their U.S. citizenship (for example, a birth certificate or certificate of nationalization), or other WHTI compliant document such as a passport card for entry or re-entry to the U.S.
Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.

Applications for the new U.S. Passport Card are now being accepted.
We expect cards will be available and mailed to applicants in spring 2008.
The card may not be used to travel by air and is available only to U.S. citizens. Further information on the Passport Card is available at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html.
We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

Immigration officials are strict about getting exact information about where visitors are staying, and will often request to see a return ticket or ticket for onward travel, as well as proof of sufficient funds to cover the cost of the visitor’s intended stay.
There is a departure tax payable when departing the country.
For further information on entry requirements, travelers can contact the Embassy of Antigua and Barbuda, 3216 New Mexico Avenue NW, Washington, DC
20016, telephone (202) 362-5122, or consulates in Miami.
Additional information may be found on the home page of the Antigua and Barbuda Department of Tourism at http://www.antigua-barbuda.org.

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

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

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

CRIME:
Petty street crime does occur, and valuables left unattended on beaches, in rental cars or in hotel rooms are vulnerable to theft.
There has been an increase in crime in Antigua, including violent crimes, in the last six months.
However, this increase has not, for the most part, affected visitors to the island.
The Government of Antigua and Barbuda has taken steps to improve the effectiveness of the police in responding to crimes.
As everywhere, visitors to Antigua and Barbuda are advised to be alert and maintain the same level of personal security used when visiting major U.S. cities.

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:
There are many qualified doctors in Antigua and Barbuda, but medical facilities are limited to a public hospital and a private clinic and are not up to U.S. standards.
The principal medical facility on Antigua is Holberton Hospital, on Hospital Road, St. John's (telephone (268) 462-0251).
There is no hyperbaric chamber; divers requiring treatment for decompression illness must be evacuated from the island, to either Saba or Guadeloupe.
Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars.
Doctors and hospitals often expect immediate cash payment for health services, and U.S. medical insurance is not always valid outside the United States.
U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States.

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

Traffic in Antigua and Barbuda moves on the left.
Major roads are generally in good condition, but drivers may encounter wandering animals and slow moving heavy equipment.
There is relatively little police enforcement of traffic regulations.
Buses and vans are frequently crowded and may travel at excessive speeds.
Automobiles may lack working safety and signaling devices, such as brake lights.

Please refer to our Road Safety page for more information.
For specific information concerning Antigua and Barbuda driving permits, vehicle inspection, road tax, and mandatory insurance, contact the Antigua and Barbuda national tourist organization offices in New York via e-mail at info@antigua-barbuda.org.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Antigua and Barbuda’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Antigua and Barbuda’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:
Like all Caribbean countries, Antigua can be affected by hurricanes. The hurricane season normally runs from June to the end of November, but there have been hurricanes in December in recent years.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.
Please see 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 Antigua and Barbuda laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Antigua and Barbuda are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see information on Criminal Penalties.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Antigua and Barbuda are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov/, and to obtain updated information on travel and security within Antigua and Barbuda.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy in Bridgetown in located in the Wildey Business Park in suburban Wildey, south and east of downtown Bridgetown.
The main number for the Consular Section is (246) 431-0225; after hours, the Embassy duty officer can be reached by calling (246) 436-4950.
The web site for Embassy Bridgetown is http://barbados.usembassy.gov/. Hours of operation are 8:30 a.m. - 4:00 p.m., Monday-Friday, except local and U.S. holidays.

The U.S. Consular Agent, Rebecca Simon, in Antigua provides passport, citizenship and notarial services, and assists Americans in distress.
The Consular Agency is located in Suite #2, Jasmine Court, Friars Hill Rd, St. John’s, Antigua.
Contact information is as follows: telephone 1-268-463-6531, cellular 1-268-726-6531, or e-mail ANUWndrGyal@aol.com. The mailing address is P.O. Box W-1562, St. John’s, Antigua. The Consular Agent is available by appointment only.
The office is closed for local and U.S. Holidays.
*

*

*
This replaces the Country Specific Information for Antigua and Barbuda dated April 2, 2007, to update sections on Entry/Exit Requirements, Safety and Security, Medical Facilities and Health Information, Traffic Safety and Road Conditions, and Crime.

Travel News Headlines WORLD NEWS

Date: Wed, 21 Mar 2018 18:14:27 +0100
By Gemma Handy

St. John's, Antigua and Barbuda, March 21, 2018 (AFP) - Voters in the hurricane-wracked twin island nation of Antigua and Barbuda headed to the polls Wednesday to elect a new government after Prime Minister Gaston Browne called snap elections.   Browne's Antigua Barbuda Labour Party, which has led the eastern Caribbean country since 2014, is widely expected to secure a second consecutive term.   The prime minister announced general elections on February 24, 15 months before a constitutionally mandated deadline, giving opposition parties less than four weeks to prepare.

And there will be no polling stations on Barbuda, which was battered by Hurricane Irma in September.    As a result, the estimated 400 Barbudans who have since returned home will have to travel to Antigua to cast their ballot. The government has promised to pay for related transport, accommodation and meal expenses.   Just over 51,000 Antiguans and Barbudans are eligible to vote. Voter turnout was around 90 percent in 2014.

Browne says the government wants to protect half a billion US dollars worth of developments currently under construction in the tourism-dependent country, and provide investors with stability.    One of the most prominent -- and controversial -- projects is a $250 million mega resort being built by Hollywood star Robert De Niro on Barbuda which was devastated by Hurricane Irma in September.   Lowering the cost of living in the country of 100,000 people is high on the
agenda.

- Ruling party dominates -
Browne, a former businessman and banker, has pledged to reduce electricity bills, along with the cost of land, and provide more affordable housing, under the slogan "Rebuilding Together." His wife Maria is also running for a seat on an ABLP ticket.   On Sunday, thousands of Browne's supporters donned the party's red colours and walked alongside a motorcade in an event that culminated in a public rally.   The "Delivering Hope" campaign of the main opposition group, the United Progressive Party (UPP), cites revitalization of the tourism and agricultural sectors as key priorities.

Fifty-three candidates will vie for seats in the 17 single-member constituencies -- of which the ABLP currently holds 14 -- in a first-past-the-post system.    The ruling party is alone in presenting a full slate of 17 candidates. The UPP, led by former finance minister Harold Lovell, has put forward 16.    A new party, the Democratic National Alliance, headed by current lawmaker and former UPP representative Joanne Massiah has registered 13 candidates.    There is a handful of smaller parties, a single independent runner and one representing the Barbuda People's Movement (BPM) contesting the small island's sole seat.

Polling stations opened at 6:00 am (1000 GMT) and are due to close at 6:00 pm. Alcohol sales are restricted during those hours and all public schools are closed, as many are serving as polling stations.   Teams representing the Caribbean Community (CARICOM) are observing the elections.   On its path through the Caribbean in September, Irma caused "absolute devastation" on Barbuda where up to 30 percent of properties were demolished, and 95 percent damaged, Browne had said at the time.    After a 10-year hiatus, voters returned Browne's Labour Party to power during the last ballot four years ago, when he pledged to economically transform the country.   The country became fully independent from Britain in 1981.
Date: Sun, 25 Feb 2018 08:04:27 +0100

Georgetown, Guyana, Feb 25, 2018 (AFP) - Antigua and Barbuda, a hurricane-ravaged Caribbean tourist destination, will go to the polls next month more than a year earlier than scheduled, the prime minister said on Saturday.   The two-island nation's parliamentary elections were scheduled for June 2019, but will now be held on March 21, Gaston Browne said.   Voters will select the 17 members of Antigua and Barbuda's House of Representatives, its lower house. Members of the Senate are appointed.   "Our primary focus for calling elections early is not about politics but is about your development. God forbid for there to be change in government," Browne said on radio.

After a 10-year hiatus, voters returned Browne's Labour Party to power during the last ballot in 2014, when he pledged to economically transform the country.   On Saturday, Browne said there had been "significant gains" since and that the government wanted to guard against unpredictability in the investment climate.   He cited cheaper housing for ordinary people, better roads, two Marriott-branded hotels, as well as a new airport on the island of Barbuda, which was battered last year by Hurricane Irma.   On its path through the Caribbean in September, Irma caused "absolute devastation" on Barbuda where up to 30 percent of properties were demolished, and 95 percent damaged, Browne had said at the time.    Labour has ruled Antigua and Barbuda almost continuously since 1949. The country became fully independent from Britain in 1981.
Date: Sat, 9 Sep 2017 18:35:21 +0200
By Gemma Handy

Codrington, Antigua and Barbuda, Sept 9, 2017 (AFP) - Homes, shops and government buildings were destroyed when Hurricane Irma slammed the Caribbean island of Barbuda this week, while a huge stretch of its once glorious 11-mile west coast beach has been wiped out.   Destruction was so widespread that authorities have ordered the entire population of 1,800 to evacuate as Hurricane Jose approached the island over the weekend. 

By mid-day Saturday Jose, a Category Four hurricane, was tracking towards the north-west and no longer expected to hit Barbuda, but it remained under a Tropical Storm warning.   Authorities on Barbuda -- one of the two islands that make up the nation of Antigua and Barbuda -- have only begun to measure the damage caused when Irma struck the island as a powerful Category Five hurricane overnight Tuesday to Wednesday.   "Terrifying," "horrific" and the "worst damage seen in a lifetime" were some of the descriptions from residents as they emerged from their shelters after Irma's passage.    A child died when Irma, the strongest storm ever recorded to form in the Atlantic, struck the island.   Authorities said 30 percent of properties were demolished by the monster storm.

- Surviving in a wardrobe -
Barbudans swapped tales of hiding in wardrobes and showers as 157 mile (252 kilometer) per hour wind from Irma ripped off roofs, uprooted trees and knocked down walls.   Sira Berzas, 40, spent more than an hour huddled in a wardrobe with a friend after Irma tore the roof off the home they were hiding in.   "I have never been so scared in my life. Jackie and I were holding on to each other and basically saying our goodbyes," Berzas told AFP.

When the eye of the hurricane came, she said, "we ran outside in our underwear screaming for help. Luckily there was a police truck which took us to a safer building."   In the rush to safety "we had to leave Jackie's kitten behind," said Berzas, who lost her Pink Sand Beach home, bar and restaurant to the disaster.   Thankfully Houdini lived up to his name. The kitten was later found crouched in a corner of the ruined house, trembling but alive.

- Fleeing Hurricane Jose -
Hundreds of Barbudans were transported on Friday to Antigua via a Venezuelan military plane for safety ahead of Hurricane Jose.   Many have family to visit on the sister island, but others had no idea where they would stay when they arrived.   "I don't know where we are going when we get to Antigua -- or how we will get there," said Beautymey John, who was on a dock waiting to board a boat to safety with her five children.   "I would rather stay here, it doesn't feel right to leave. We have to try and start again," she told AFP.

Other Barbudans also said they were determined to rebuild their homes and livelihoods.   Teacher Maurice George, 30, said the small bag he was taking to Antigua contained the bare essentials, but vowed to return as soon as the secondary school he works in reopens.   "It is heart-breaking to see our island looking like this," he said.   "But where some people see devastation, I see an opportunity to rebuild," he added.
Date: Sat, 19 Mar 2016 13:18:00 +0100

Washington, March 19, 2016 (AFP) - A 6.0-magnitude earthquake hit off the coast of the Caribbean island nation of Antigua and Barbuda Saturday, US experts said, but caused no tsunami warning or immediate reports of damage or injury.   The strong quake, which hit at 1126 GMT, struck at a depth of 24 kilometres (15 miles) with its epicentre located 153 kilometres northeast of the capital of Saint John's, according to the US Geological Survey.
Date: Mon 14 Dec 2015
Source: Antigua Observer [edited]

Prison sources are still complaining that, despite the alleged outbreak of chicken pox at Her Majesty's Prison (HMP), not much has been done to ensure that the virus does not affect more people who either work there or are in custody. A source said since Observer media reported on the incident, last Thu 10 Dec 2015 that there has been another suspected case, bringing the number of affected persons to 19.

The source explained that this occurred even while the other 18 infected persons were already in isolation in the chapel in the prison yard. That source is suggesting that health authorities should to go into the jail to "clean it and spray out the cells" because the virus, according to research, can be picked up from contaminated surfaces.

An official at HMP, who is not authorized to speak with the media, said although the affected inmates are being housed in the chapel away from the rest of the prison population, they are still able to come and go to other parts of the jail, including the washroom and for breaks. Another source indicated that most of the affected persons are on remand and it is highly likely they will be released at any time, and then the virus would likely spread to communities outside the prison walls.

Observer media was unable to reach the prison boss, Superintendent Albert Wade, for comment.

In the meantime, Attorney General Steadroy "Cutie" Benjamin, who has responsibility for the prison, has given assurance that prison authorities have taken adequate steps to control the spread of chickenpox.
======================
[Outbreaks of chickenpox are not uncommon in closed communities where contagious virus can spread rapidly. Chickenpox is a very contagious disease caused by varicella-zoster virus (VZV), a herpes virus. It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. It spreads easily from infected people to others who have never had chickenpox or received the chickenpox vaccine. Chickenpox spreads in the air through coughing or sneezing. It can also be spread by touching or breathing in the virus particles that come from chickenpox blisters and can be transmitted by touching surfaces that have recently be contaminated by open lesions as well. Chickenpox most commonly causes an illness that lasts about 7-10 days.

The classic symptom of chickenpox is a rash that turns into itchy, fluid-filled blisters that eventually turn into scabs. The rash may 1st show up on the face, chest, and back, then spread to the rest of the body, including inside the mouth, eyelids, or genital area. It usually takes about a week for all the blisters to become scabs. Some people who have been vaccinated against chickenpox can still get the disease. However, the symptoms are usually milder with fewer blisters and mild or no fever. About 25 to 30 percent of vaccinated people who get chickenpox will develop illness as serious as chickenpox in unvaccinated persons.

Chickenpox vaccine is safe and effective at preventing the disease. Most people who get the vaccine will not get chickenpox. If a vaccinated person does get chickenpox, it is usually mild -- with fewer blisters and mild or no fever. The chickenpox vaccine prevents almost all cases of severe disease (for further information, see: <http://www.cdc.gov/chickenpox/index.html>). - ProMed Mod.LL]

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

Background
Greece offers a great variety of attractions for the international traveller. A beautiful climate linked with great beaches, a vibrant nightlife and historical monuments to rival any other location throughout the world. All of this located
within western Europe and a short flight away from many of the cooler northern destinations - like Ireland. Travellers from these regions descent on Greece in very significant numbers each year and for the vast majority of them they will have a splendid and healthy time. However for some this may not be the case and serious illness and accidents are regularly reported. Following some commonsense rules would go a long way to avoiding disaster and ensuring that this trip is truly one to be remembered for all the right reasons.
Climate
Situated in southern Europe the country enjoys mild winters but very hot summers. There may be occasional cool breezes (meltemia) but these can serve only to fool the traveller into thinking that they are unlikely to burn. Rain is very uncommon during the height of summer (July and August) and all travellers should be advised to use very adequate sun-block lotion at all times.
Slip, Slop, Slap
Following the Australian mantra of Slip, Slop and Slap makes perfect sense. Slip on a shirt, slop on sunscreen and slap on a hat when out and about during the day and this should help protect against the intense suns rays. Nevertheless, despite all their best intentions, travellers get burnt. This is particularly a problem in the first few days after their arrival when they do not realise the intensity of the suns rays and how easily they can be exposed. Falling asleep beside the hotel's swimming pool or on the beach is a very common problem and must be avoided against. The tips of the ears, shoulders (especially along the bra-strap line, ankles and behind the knees are commonly exposed and forgotten areas.
After Sun care
To treat significant sunburn it is important to increase fluid intake but also to take extra salt on your food (unless medically contraindicated for some specific condition like high blood pressure etc). Soothing water soluble lotions (especially ones containing a mild anaesthetic and/or steroid cream) are probably best but certainly avoid any of the ones which paste the skin with a thick layer - which is almost impossible to remove without causing serious pain! The more severe sunburn cases may need medical care and even hospitalisation which really ruins a holiday.
Food & Water
As a European destination Greece has a good level of food and water hygiene. Unfortunately this can vary - especially as you move away from the main tourist destinations and also as the summer temperatures rise and food goes 'off' more quickly. Eating hot food, avoiding cold foods (side-salads, lettuce etc) and never eating undercooked bivalve shellfish (mussels, oysters, clams etc) makes perfect sense. Eating food or taking fruit juice drinks from street vendors is a risk just not worth taking.
Insect bites
There may be both mosquitoes and sandflys about so having good repellents (DEET based ones) is worthwhile. The biggest problem will be early in the morning and towards the end of the daylight hours. However sitting in the shade while having lunch may be nice and cool but it is also often a place where these insects tend to hover looking for their next meal. Just don't allow that meal to be the blood in your unguarded ankle!
Seeing the Monuments
As mentioned previously Greece is covered with ancient monuments and these attract many thousands of tourists each year. The ruins are often not the most hospitable places for sun-sensitive tourists so taking care against the suns rays is essential - especially while standing carefully listening to the tour guide explain some complicated piece of history while the back of your legs get roasted! The other issue, for those trekking through the ruins, is the distinct possibility of a nasty twisted ankle.
Laser Night shows
Many of the ancient sites have beautiful night shows which depict something of the past splendour and are definitely worth seeing. However it is wise to wear good shoes as stumbling across loose stones is a particular problem at night and also bring a small torch, if possible, to guide your way. Getting separated from your travelling companions, or not being able to find your return bus, can lead to some understandable panic so listen carefully to any instructions and look out for some land marks before you get too far away into the night time crowd.
Animal bites
Some tourists may forget that rabies is a problem in many countries throughout the world and, even though Greece is regarded as rabies-free', there is always a problem if someone should get bitten. The possibility that this animal could have been recently smuggled into the country cannot be out ruled and so many would advise full post exposure treatment should this contact occur. Children may be at particular risk due to their inquisitive nature.
Swimming
Sunburn and swimming go hand in hand but drowning can also occur all too frequently within this region. Strong currents, swimming after meals (or alcohol) and the ever popular romantic midnight swim are all serious risk factors. Also children running around the deep end of the pool may lose their footing and topple in without warning. Unfortunately a very small child sinks instantly with very little sign of the emergency to those close by. Parents need to keep aware of this risk at all times.
The summer working holiday
Many of our students head towards Greece for 2 to 3 months during the summer to work. The attractions are obvious but commonsense and sensible life-style choices are needed throughout their stay to lessen the risk of illness or them returning home with an infection they had not bargained for. Unfortunately many return home with life-long illnesses which have been contracted from a single unprotected sexual contact.
Vaccinations for Greece
As a general rule the usual travel vaccines are not recommended for most short-term travellers to this region. However for the student planning to spend a more prolonged period it would be sensible to consider cover against both Hepatitis A and Hepatitis B and also to check that their Tetanus cover is up-to-date.
Summary
This is still one of the most popular destinations for northern European travellers and, in the vast majority of cases, they will have a fantastic time with only good memories. Unfortunately some less prepared folks will end up with serious sunburn and other illnesses or diseases which perhaps are frequently associated with their own lack of care and protection rather than anything specific to this beautiful country.

Travel News Headlines WORLD NEWS

6th December, 2019
HSE Health Protection Surveillance Centre

On 27/11/2019, a possible case of diphtheria was reported to the Department of Epidemiological Surveillance and Intervention through the Mandatory Notification System in Greece. It concerned an 8 years old boy of Greek nationality, who was hospitalized in the ICU of General Children's Hospital  where he died.  This child had underlying conditions (severe pulmonary hypertension) and was admitted to ICU  on 22/11/2019 with clinical presentation of laryngitis (without the presence of characteristic pseudo membranes) and pneumonia, immediately intubated, covered with double antibiotic regimen and died due to deterioration of his clinical presentation on 26/11/2019.
 
According to the epidemiological data given , there is no travel history, group living, no connection to another case and the child does not belong to a specific population group. Regarding his immunization status, the child was vaccinated with at least 3 doses against diphtheria-tetanus-pertussis.
 
Laboratory investigation of bronchial exudate isolated Corynebacterium diphtheriae via VITEK. Further laboratory testing was performed by the Public Health England  reference Laboratory for Corynebacteria. On Thursday 5/12/2019, the National Public Health Organization was informed that multiplex PCR testing was positive for C. Diphtheriae and positive for the diphtheria toxin gene. The Elek test was also positive for toxin production. The results of the child's post-mortem exam are pending.

Contact tracing and management is ongoing and has identified most of the close contacts of the patient. The National Public Health Organization provided recommendations on obtaining nasopharyngeal cultures in close contacts to evaluate carriage as well as the necessary preventive measures to protect the child's close contacts as well as the medical staff involved in direct patient care (i.e. awareness for potential compatible with diphtheria symptoms and administration of antibiotic prophylaxis together with booster or complete vaccination series as appropriate) according to the WHO’s Diphtheria Surveillance Standards (September 2018). In addition we have initiated the procedure for the procurement of a limited stockpile of DAT.
Date: Wed, 27 Nov 2019 09:20:47 +0100 (MET)

Athens, Nov 27, 2019 (AFP) - A strong 6.1-magnitude undersea earthquake shook the Greek island of Crete on Wednesday and was felt in other parts of the country, officials said.   "It was a major earthquake, the whole island shook but fortunately so far no damage has been reported," Crete regional governor Stavros Arnaoutakis told state TV ERT.   The Athens observatory said the quake struck at 9:23 am (0723 GMT) and had a depth of over 70 kilometres (44 miles).

The tremor occurred a day after a 6.4-magnitude earthquake in Albania that has left more than 20 dead and hundreds injured.   Shortly after the Albania tremor, a 5.4-magnitude shock hit Bosnia, the European-Mediterranean Seismological Center reported on Tuesday.   Greece lies on major fault lines and is regularly hit by earthquakes but they rarely cause casualties.   In July 2017, a 6.7-magnitude earthquake killed two people on the island of Kos in the Aegean sea, causing significant damage.
Date: Wed, 2 Oct 2019 12:31:30 +0200 (METDST)

Athens, Oct 2, 2019 (AFP) - Greek workers staged a fresh 24-hour strike Wednesday against government plans to deregulate the labour market, paralysing road and rail transport, closing banks and shutting down news outlets.   Buses and trams stayed in their depots, the Athens metro was shut down and ferries serving islands on both sides of Greece stayed in port. The action also hit rail services, including to Athens airport.   Banks were closed Wednesday and Poesy, the journalists' union, said there would be no news bulletins over the 24-hour strike period.

The strike caused long traffic jams in Athens as the GSEE, the largest union representing private-sector workers, organised a rally in the city centre to protest the planned legislation.    It denounced "the suppression of collective conventions" and what it said was an assault on the unions.   This was the second strike in a week against the planned reforms of conservative Prime Minister Kyriakos Mitsotakis, which he argues will open the way to investment and encourage growth of more than two percent.   A strike last week hit transport, hospitals, schools and the courts.   The unions say the proposed reforms will undermine collective agreements and make it harder to organise strikes.

The proposed law would require a more-than 50 percent turn-out of the workforce in any strike vote for it to be valid.   Union leaders have also denounced a law passed in August which they say makes it easier to sack people in the private sector.   Adedy, the federation of public-sector unions, which organised last week's strike, called on its members to join Wednesday's action.   Mitsotakis came to power in July, replacing the left-wing government of Alexis Tsipras.
Date: Thu 12 Sep 2019, 7:54 PM
Source: Ekathimerini [edited]

The death toll from the West Nile virus since June this year has risen to 20, according to this week's report by the National Health Organization (EODY).

Up until [12 Sep 2019], authorities had diagnosed a total of 176 cases of the mosquito-borne virus. Of these, 109 developed illnesses affecting the central nervous system such as encephalitis or meningitis.

EODY is urging the public to spray insect repellent on bare skin and clothing, to install mosquito nets and screens, to remove stagnant water from basins, vases and gutters, to regularly mow lawns and to water plants in the morning.
=============================
[The first report mentions 20 fatal human cases as compared to the latest ECDC update that mentions 19 and the total case number is 176 versus 171 (ECDC report).

West Nile fever is a disease caused by West Nile Virus (WNV), which is a _Flavivirus_ related to the viruses that cause St. Louis encephalitis, Japanese encephalitis, and yellow fever. It causes disease in humans, horses, and several species of birds. Most infected individuals show few signs of illness, but some develop severe neurological illness which can be fatal. West Nile Virus has an extremely broad host range. It replicates in birds, reptiles, amphibians, mammals, mosquitoes and ticks <https://www.oie.int/doc/ged/D14013.PDF>.

The reservoir of the virus is in birds. Mosquitoes become infected when they bite an infected bird ingesting the virus in the blood. The mosquitoes act as carriers (vectors) spreading the virus from an infected bird to other birds and to other animals. Infection of other animals (e.g. horses, and also humans) is incidental to the cycle [as also evident in the ECDC update above] in birds since most mammals do not develop enough virus in the bloodstream to spread the disease.

Key to preventing the spread of West Nile fever is to control mosquito populations. Horses should be protected from exposure to mosquitoes. Likewise, people should avoid exposure to mosquitoes especially at dusk and dawn when they are most active, use insect screens and insect repellents, and limit places for mosquitoes to breed. - ProMED Mod.UBA]

[HealthMap/ProMED maps available at:
Date: Sun, 15 Sep 2019 15:38:29 +0200 (METDST)

Athens, Sept 15, 2019 (AFP) - More than 160 firefighters on Sunday battled to contain a large fire near Athens blazing for a second day amid gale force winds, officials said.   And in another emergency, authorities evacuated dozens of people from two villages and a hotel on the island of Zakynthos after a new fire broke out on Sunday.

The fire department said the blaze near Athens burned in the mountains above Loutraki, a coastal resort some 60 kilometres (35 miles) west of Athens.   "The fire is burning near the top of the mountain," Stefanos Kolokouris, the fire department's deputy chief of operations, told state TV ERT.   "We are trying to create a perimeter but the terrain is very difficult, with ravines," he said.   Four water bombers and six helicopters were participating in operations. Given a lack of roads in the area, two squads of firefighters had to be carried to the mountaintop by Super Puma helicopter, state agency ANA said.   Officials had already evacuated 50 people from a local monastery when the fire broke out on Saturday, but stressed that other inhabited areas were not in danger.

On Zakynthos, officials ordered the evacuation of the villages of Agalas and Keri in the south of the island. Some 120 tourists were also relocated to a safe area.   The Greek fire department on Sunday said it had been called to nearly 80 fires over the past 24 hours.   It has already faced more than 9,600 rural and urban fires this year.
More ...

Guyana

Guyana US Consular Information Sheet
June 09, 2008
COUNTRY DESCRIPTION:
Guyana is a developing nation on the north coast of South America. Tourist facilities are not developed, except for hotels in the capital city of Georgetown and a limi
ed number of eco-resorts. The vast majority of Guyanese nationals live along the coast, leaving the interior largely unpopulated and undeveloped. Travel in the interior of Guyana can be difficult; many interior regions can only be reached by plane or boat and the limited roads are often impassable in the rainy seasons. Read the Department of State Background Notes on Guyana for additional information.

ENTRY/EXIT REQUIREMENTS: A valid U.S. passport is required for U.S. citizens to enter and depart Guyana. On arrival, Guyanese Immigration normally grants U.S. visitors a stay of up to 3 months. U.S.-Guyanese dual nationals may be granted an indefinite stay. Extensions of stay may be obtained from the Ministry of Home Affairs at 60 Brickdam Street, Georgetown. The Central Office of Immigration located on Camp Street, Georgetown, must note the extension in the visitor's passport. Travelers for purposes other than tourism should check with the Ministry of Home Affairs for information about requirements for work permits and extended stays. U.S.-Guyanese dual nationals departing Guyana for the United States using a Guyanese passport must present to Guyanese authorities a U.S. Certificate of Naturalization or other document establishing that they may legally enter the United States. For further information about entry, exit and customs requirements, travelers may consult the Embassy of Guyana at 2490 Tracy Place NW, Washington, DC 20008, telephone (202) 265-6900, the Consulate General in New York, or honorary consuls in California, Florida, Ohio, and Texas. Visit the Embassy of Guyana web site at www.guyana.org for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY: Driving in Guyana can be particularly dangerous, with a significant number of accidents and road fatalities occurring. See the section below on “Traffic Safety and Road Conditions” for additional information. In the past, demonstrations and protests occasionally occurred in Georgetown; however, these are increasingly rare. Past demonstrations have not been directed at U.S. citizens and violence against Americans in general is not common. Visitors should nevertheless remain alert and take prudent personal security measures to deal with the unexpected while in Guyana. It is advisable to avoid areas where crowds have congregated and to maintain a low profile when moving about Georgetown and other Guyanese cities. Most major eco-tourist resorts and hotels in Guyana do not have written emergency plans in place, and many of them have safety deficiencies, including a lack of easily identifiable lifeguards or no lifeguards at all. Many of these resorts also do not have adequately stocked first aid supplies. 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 Public Announcements, 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 United States 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: Serious crime, including murder and home invasion, continues to be a major problem; the murder rate in Guyana is three times higher than the murder rate in the United States. In early 2008, an attack in the Georgetown suburb of Lusignan and in the Essequibo River town of Bartica by heavily armed gangs resulted in the deaths of more than 20 persons, mostly innocent Guyanese civilians. An investigation into these attacks is continuing, but most of the perpetrators are still at large. In addition, there have been several instances of random shootings at night at police headquarters or police stations in Georgetown. U.S. citizens are encouraged to maintain a high level of vigilance, consider security issues when planning activities throughout Guyana, minimize movement when possible, and avoid traveling at night, when possible.

Armed robberies continue to rise, especially in major business and shopping districts. Hotel room strong-arm break-ins are also increasing, so travelers should use caution when opening their hotel room doors and should safeguard valuables left in hotel rooms. Criminals may act brazenly, and police officers themselves have been the victims of assaults and shootings. Vehicle occupants should keep their doors locked and be aware of their surroundings at all times. Robbery and theft occur with some frequency in Georgetown and New Amsterdam. U.S. citizens should avoid stopping in or traveling through the village of Buxton, which lies along the road between Georgetown and New Amsterdam, and Agricola, which is located on the East Bank highway. The Department of State recommends that Embassy staff using the public golf course at Lusignan, next to Buxton, do so in groups and only during daylight hours. Pickpocketing, purse snatching by thieves on bicycles, assault, and theft can occur in all areas of Georgetown. The areas adjacent to the sea wall and the National Park in Georgetown, although frequented by joggers, dogwalkers, and families are generally considered safe during daylight hours, have been the scenes of crimes in the past. Travelers should exercise extra care when visiting these areas after dusk. Pickpockets and thieves also frequent Stabroek and Bourda, the two major markets, and great care should be taken to safeguard personal property when shopping in these markets. U.S. passports and permanent residency cards are prized by thieves as they may be used for smuggling and identity theft. There have been numerous incidents of piracy in recent months in and around the waters of Guyana. Mariners are advised to be vigilant and take appropriate precautions. Travelers should avoid walking alone around Georgetown, even in the main areas and especially at night. Although bandits have been known to attack taxis, they are generally safe and remain the safest means of getting about town and to and from the airport for visitors. Only taxis from reputable companies should be used. Exercise constant vigilance. Do not dress ostentatiously, as there have also been reports of gold chains or other jewelry being snatched off of pedestrians. The response of local law-enforcement authorities to the increase in violent crime has been largely ineffectual; the police are cooperative but lack the resources to respond effectively to serious criminal incidents. Nevertheless, Americans who are victims of crime are encouraged to contact the police as well as the American Citizens Services Unit of the U.S. Embassy's Consular Section.

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 in finding appropriate medical care, contact family members or friends and explain how funds may 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 is available for minor medical conditions. Emergency care and hospitalization for major medical illnesses or surgery are limited, due to a lack of appropriately trained specialists, below standard in-hospital care, and poor sanitation. Ambulance service is limited to transportation without any medical care and is frequently not available for emergencies. An MRI (linked to the United States for interpretation) has been installed and is operational, but results may take up to 4 days. Visitors are advised to bring prescription medicine sufficient for their length of stay and should be aware that Guyana's humid climate may affect some medicines. Some prescription medicines (mainly generic rather than name-brand) are available. Special attention should be paid to HIV/AIDS in Guyana. In addition to infection rates as high as 45% in high-risk populations such as commercial sex workers and mobile populations such as miners or loggers, data from the World Health Organization estimate that 1.6% of the general population is infected with HIV; this is among the highest prevalence rates in Latin America and the Caribbean. 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 Guyana is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
In 2007, road fatalities increased more than 40% from the previous year. The rate of traffic accident fatalities in Guyana is 70% higher than in the United States. The Traffic Division of Guyana's National Police Force is responsible for road safety but is ill-trained and ill-equipped. Driving in Guyana is hazardous because of very poor road surfaces; farm animals sleeping or wandering on the roads; pedestrians walking on the road; and poor driving habits, including speeding, reckless driving, tailgating, cell phone use, quick stops without signaling, failure to dim headlights, and weaving in and out of traffic. Traffic lights installed in Georgetown are often ignored or simply flash, posing a risk to drivers and pedestrians. Visitors should exercise caution at all times while driving and avoid driving at night, when possible. The Department of State recommends that Embassy staff travel in groups of two or more vehicles when traveling outside Georgetown at night.
Travelers are advised to use caution traveling to and from Cheddi Jagan International Airport, especially at night. The Embassy requires its staff to use official vehicles when traveling this route between dusk and dawn due to a combination of most of the aforementioned characteristics of driving in Guyana.
Penalties for drivers involved in an accident resulting in injury or death are severe, including life imprisonment. If involved in an accident, call 911 for police and 913 for an ambulance. Please note that police may be slow to respond and an ambulance may not be available.
Drivers use the left side of the road in Guyana. Seatbelt use is required by law and is enforced; failure to use a seatbelt can result in a fine. There presently are no laws in Guyana concerning use of child car seats, but the use of age-appropriate seats is strongly recommended for child passengers. Both drivers and passengers on motorcycles must wear protective helmets that meet certain specifications.
Mini-buses (small 12- to 15-passenger vans) ply various routes both within and between cities. Mini-bus drivers have come under severe criticism from the government, press, and private citizens for speeding, aggressive and reckless driving, overloading of vehicles, poor vehicle maintenance and repair, and offensive remarks directed at passengers, but little change in their driving behavior has been noted. Mini-buses have been involved in the majority of fatal vehicular accidents in recent years.
Please refer to our Road Safety page for more information. Visit the web site of the country’s national tourist office and national authority responsible for road safety.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Guyana’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Guyana’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:
Air Travel: Flights on all airlines can be delayed, rerouted, or canceled without notice. Air travel within Guyana generally depends on demand. Flights that are not full may be canceled or passengers may be expected to pay for the empty seats. Travelers to the United States from Guyana have found narcotics planted in their luggage, both in bags registered under their names and in items they were carrying for others. Travelers should not carry any items they did not purchase and pack themselves and should take care that no additional bags are registered in their names. Travelers should hand carry medications, valuables, and perishable items.
Flooding: The coastal plain, which occupies about 5% of the country's area, is home to more than 90% of its inhabitants. The plain extends from the Corentyne River in the east to the Venezuelan border in the northwest. This coastal plain was created through the polder system, a technique that dams and then drains a water-covered area. The polder system consists of a front dam (the sea wall along the east coast) and a back dam (the freshwater conservancy) that is approximately 5 to 6 kilometers inland from the sea wall. The system is in a fragile state due to a chronic lack of maintenance. In addition, a dozen major drainage canals run from the base of the dam to the Atlantic Ocean across the polder itself. These main canals are, in turn, fed by literally thousands of lateral canals that run along both sides of almost every street and road. Seasonal rains (December-January and May-July), combined with the lack of maintenance and improper new construction, led to significant flooding in Greater Georgetown and along the East Coast in January 2005 and in the Mahaica-Mahaicony Abrary area, Canals 1 and 2, on the West Coast Demerara and the Pomeroon River catchment area in January 2006.
Drinking Water: An inadequate garbage removal system has resulted in illegal residential and commercial dumping on the roadside and into the drainage system. Decaying animal carcasses are periodically discovered in the intake canals for the Georgetown water supply. The water supply system throughout the country should be considered contaminated and travelers should treat or boil water before consumption, or purchase bottled water.
Changing Currency and Credit Card Use: Travelers should have enough cash or travelers checks to meet their expenses. With few exceptions, credit cards and ATM cards should not be used to withdraw cash from an overseas account, due to a high risk of stolen PIN data. Although credit cards are accepted at certain institutions in Georgetown, travelers should be careful when using them and check their receipts and statements to ensure that additional unauthorized purchases have not been made to their card. American citizens are advised to exchange currency only with banks, hotels, and licensed money exchange houses (“cambios”). Many foreigners who opt to exchange money on the streets, lured by promises of higher exchange rates, become victims of fraud or receive counterfeit currency. Foreigners have been mugged after completing bank transactions. There is no legal recourse unless the police are successful in apprehending the perpetrator; even then there is no guarantee that the money will be recovered.
Firearms: Guyanese customs authorities may enforce strict regulations concerning temporary importation into or export from Guyana of items such as firearms. If you plan to take your firearms or ammunition to or through Guyana, you should contact officials at the Embassy of Guyana to learn about its regulations and fully comply with those regulations before traveling. You may consult http://www.customs.gov for information on importing firearms into the United States.
Wildlife: Many plants and animals common in Guyana are globally threatened or endangered species protected by the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES at www.cites.org). The Guyanese Ministry of Agriculture will grant an export permit for taking an exotic bird out of the country only to those persons who have been legally residing in Guyana for more than one year. There have been several U.S. citizens arrested for attempting to leave Guyana carrying birds without having obtained an export permit. Americans who have legally resided in Guyana for more than a year and who would like to take back to the United States any birds or animals, including pets, that are listed in CITES Appendices I, II, and III, must also have an appropriate U.S. import permit from the U.S. Fish and Wildlife Service (USFWS). This is a U.S. regulation that applies regardless of distinctions among the three CITES Appendices. Individuals can obtain fact sheets and permit applications from the USFWS Office of Management Authority, Branch of Permits, 4401 N. Fairfax Drive, Arlington, VA 22203, telephone (703) 358-2104, fax (703) 358-2281, http://www.fws.gov/permits/.

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 Guyanese laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Guyana are severe, and convicted offenders can expect long jail sentences and heavy fines. Possession of unlicensed guns can result in fines and imprisonment. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime in Guyana and also prosecutable in the United States.

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 Guyana are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Guyana. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at 100 Young and Duke Streets, telephone 011-592-225-4900 through 225-4909, fax 011-592-225-8497, web site http://georgetown.usembassy.gov/. Hours of operation are Monday-Friday, 7:30 am to 4:00 pm, except local and U.S. holidays. For emergencies after hours, on weekends and on holidays, U.S. citizens are requested to call the U.S. Embassy duty officer at 011-592-623-1992.
* * *
This replaces the Country Specific Information dated November 21, 2007, to reflect changes to Safety and Security, Crime, and Wildlife.

Travel News Headlines WORLD NEWS

Date: Tue 16 Apr 2019
Source: Kaieteur News Online [edited]

The mystery illness, which was erroneously assumed to be H1N1 (swine flu) and as leptospirosis in 2 cases, affecting employees working in the Guyana Manganese Inc. tunnel in Matthew's Ridge, Region One, Barima-Waini has finally been determined to be histoplasmosis, an infection by a fungus found in the droppings of birds, bats and rats in humid areas. [Histoplasmosis is caused by a fungus _Histoplasma capsulatum_ that lives in soil enriched by bird or bat, not rat, droppings. - ProMED Mod.ML]

This was confirmed when the Ministry of Public Health held a press conference yesterday [15 Apr 2019] in its Mental Health Unit Boardroom to provide an update on the recent outbreak and related issues.

Samples were collected from all patients, and initially some testing was done at the National Public Health Reference Laboratory (NPHRL). Further samples were sent to the Caribbean Public Health Agency Laboratory (CARPHA) in Trinidad for confirmation.

The results initially were negative for influenza A and B inclusive of H1N1, chikungunya, Zika and dengue. All patients underwent malaria tests in Matthews Ridge, and they were also negative.

Chief Medical Officer (CMO) Dr. Shamdeo Persaud provided a detailed update.

Relating the developments sequentially, the CMO said that the 1st 4 cases were reported on 28 Mar [2019]; one died while receiving care at Pakera District Hospital in Region One. The following day, 4 more were brought in to Pakera District Hospital complaining of similar symptoms (fever, headaches, joint pains, mild shortness of breath). Subsequently, the 7 Chinese workers were transferred to the Georgetown Public Hospital Corporation (GPHC).

An additional 6 employees, including one Guyanese, were attended to at the Port Kaituma Hospital but later transferred to the GPHC. One of the 6 persons visited the hospital on his own. He was evaluated but not admitted.

Once the cases were reported, several teams visited the site from the regional level. The teams included the Regional Health Officer and the Regional Environmental Health Officer, along with some supporting medical staff.

"In the initial stage, we weren't sure what we were dealing with, but since it was a febrile illness with respiratory symptoms, we took all the necessary precautions to restrict access to both the site and the hospital where the patients were being kept. The additional staffers that were sent to the region set up a temporary facility at the community centre in Matthews Ridge where they were seeing the regular patients," the CMO recounted. "Following the transfer of the patients on 3 Apr [2019], they cleaned up the Pakera District Hospital and closed down the temporary sites. Work resumed as normal at the hospital for Maternal Child Health and other services."

"Two persons are dead; one died at Pakera District Hospital and one at GPHC. Of those admitted at the GPHC, 2 were discharged. An additional person was discharged from Pakera District Hospital. Ten workers were transferred to China on Mon 9 Apr [2019]. 16 Chinese workers were under care and treatment. Following the transfer, 2 more were admitted to Pakera Hospital bringing it to a total of 18."

Blood, sputum and urine samples were collected from those that were under care, while tissue samples were collected during the post mortem from the 2 deceased. Testing for these samples was done locally at the National Public Health Reference Laboratory (NPHRL), and confirmation was done at Caribbean Public Health Agency (CARPHA) in Trinidad.

"All tests were negative for influenza A & B, dengue, chikungunya and Zika. Even though [it was] reported we had 2 positive for leptospirosis, according to the NPHRL, those were later found negative through confirmation from CARPHA. On the weekend of 7 Apr [2019], a team was flown in to Matthews Ridge. The team included officers from the Environmental Protection Agency and Occupational Safety and Health, and they did an evaluation of the work site and looked at some of the risk factors relating to the environment. A community meeting was also held with residents," Dr. Persaud said.

It was disclosed that from 8-10 Apr [2019], 2 consultants from the Pan American Health Organization/World Health Organization (PAHO/WHO) along with the Chief Medical Officer and a team from the Ministry of Public Health visited the area. A team of 9 officers from the Centre for Disease Control (CDC), China was also part of the visiting team. "During the visit, the team met with the hospital staff. We reviewed their procedures for infectious disease control and prevention, and we met with company officials. Interviews were conducted with the persons who were working in the mine." A total of 23 Chinese workers were interviewed. They were working in the 4 different tunnels.

The CMO continued: "On 10 Apr [2019], we received word from CARPHA that 5 samples were tested for histoplasmosis; 4 were positive. The Chinese CDC tested an additional 6 persons, and 5 were positive for histoplasmosis.  One person tested showed weak positive hantavirus, but this may have been because of a past exposure to that germ. "Currently, we are monitoring persons at Matthews Ridge. During the last 2 days, 2 persons developed fever, and they were admitted to Pakera District Hospital and are under close observation and treatment for hantavirus, which is a fungal infection. [Hantavirus infection is a viral, not fungal infection. - Mod.ML] We also took samples from them, and they are presently being processed for shipment to CARPHA."

Meanwhile, the absence of safety gear for workers was highlighted. Interviews were done with employees who had not developed any illness. And this revealed the shortcomings. Officials were told that the safety gear was in the country but was not on site. They had not cleared customs at the wharf at that time. However, that claim was never confirmed. Occupational Safety and Health (OSH) Consultant Gwyneth King said, "Our information to date is that the workers were not wearing [any] personal safety gear. That is to say that they were not wearing respirators, so they were exposed to breathing in the fungus. If you have to do a job like that, you need to wear personal safety gear; otherwise, you could expose yourself."

King said that officials will be working within the confines of the Occupational Safety and Health Act to see what action, if any, can be taken against the company for this major inadequacy. However, they are only now going through their findings and preparing the report.
=====================
[As I assumed in my ProMED moderator comments in the last ProMED-mail post on this outbreak, the cause of the acute respiratory illness in workers in manganese mine tunnels in Guyana is apparently histoplasmosis.

We were initially told (ProMED-mail post (Undiagnosed resp. illness - Guyana: (Barima-Waini) manganese mine, fatal, RFI http://promedmail.org/post/20190401.6396933) that workers at a manganese mining company in Guyana, owned by a subsidiary of Chinese company Bosai Minerals Group Guyana Company Limited, developed what was said to be an influenza-like illness with "respiratory discomfort, rash, and high-grade fever." More than a dozen miners were affected, and 2 of the workers died. Post-mortem examinations on the 2 dead miners initially were said to have "revealed that they died from haemorrhagic pneumonia as a result of leptospirosis;" we now learn the diagnosis of leptospirosis was erroneous.

Initially, we were told that all infected persons were exposed to one common area, without evidence of person-to-person transmission (that is, presumably there were no secondary cases), but we were not told what that common area was. We were subsequently told the common area is the "Matthews Ridge tunnel site."

Manganese mines are usually open pits, which are subject to flooding that could lead to exposure to leptospirosis if there is also rat infestation. However, tunnels could be infested with bats and their guano, which would place mine workers at risk for histoplasmosis, a fungal pulmonary infection that follows unprotected inhalation of large inocula of _Histoplasma capsulatum_ spores. The fungus lives in soil fertilized by bird or bat droppings. Contaminated soil can remain potentially infectious for years. Microconidia spores become airborne when the contaminated soil is disturbed, for example, by digging in contaminated soil. Most infected individuals remain asymptomatic. Symptomatic illness is primarily caused by an intense exposure, and the severity of disease is related to the number of spores inhaled.

ProMED-mail previously reported on a histoplasmosis outbreak in tunnel workers in the Dominican Republic (see "See Also's" below).

Symptoms of histoplasmosis usually include non-specific flu-like symptoms (fever, chills, muscle aches, dry cough, and chest discomfort); potentially fatal adult respiratory distress syndrome (ARDS) may occur when larger inocula are inhaled (<http://journal.publications.chestnet.org/article.aspx?articleid=1047573> and <http://www.ncbi.nlm.nih.gov/pubmed/7244706?dopt=Abstract>). The pulmonary infection can disseminate throughout the body, and immunocompromised individuals may develop a severe form of histoplasmosis called progressive disseminated disease.

Histoplasmosis cannot be transmitted from person to person or from animals to people. The diagnosis can be made by culture of the organism from sputum or tissues, by serology, or by tests for antigen in urine and serum specimens. For treatment guidelines, see Clinical Practice Guidelines for the Management of Patients with Histoplasmosis: 2007 Update by the Infectious Diseases Society of America. Clin Infect Dis 2007; 45(7): 807-25. Available at <http://cid.oxfordjournals.org/content/45/7/807.full>. - ProMED Mod.ML]

[HealthMap/ProMED map available at:
Date: Sat 6 Apr 2019
Source: Outbreak News Today [edited]

Health officials in Guyana have reported a leptospirosis outbreak among Guyana Manganese Inc. (GMI) workers on [Fri 5 Apr 2019].  According to authorities, 2 Chinese nationals have been treated and released, while another mining employee, who was also tested positive for leptospirosis, is in "critical but stable condition".

One individual died from complications associated with leptospirosis on [Wed 3 Apr 2019] night while undergoing treatment at the Georgetown Public Hospital Corporation (GPHC). Chief Medical Officer (CMO) Dr. Shamdeo Persaud said that "all precautionary measures are still in place at the Matthews Ridge tunnel site and immediate surroundings and essential medical supplies are in stock to treat employees of the mining firm and residents of the area.

Since last week's outbreak, the area has been deemed a 'Red Zone' by Ministry of Public Health (MOPH) authorities and "no one is allowed to enter the site," Dr. Persaud reminded on [Thu 4 Apr 2019].
Date: Mon 1 Apr 2019
Source: DPI Guyana [edited]

Public health officials have ruled out swine flu (H1N1), Zika, Chikungunya, dengue, and influenza A and B as possible causes of the recent spate of illnesses and death in Matthew's Ridge. Thus far, there has been no evidence of person-to-person transmission of infection. It is noted that only persons who were directly exposed to one common area became ill.

As of Sunday, 31 Mar [2019], a response team comprising the Environmental Protection Agency (EPA), Surveillance, EH, doctors, and nurses were dispatched to region 1 to support the efforts taken in theregion to address the illnesses. The fortified health response focuses on providing uninterrupted health services to the residents of Matthew's Ridge, as well as on conducting health assessments of all persons working in the mining area.

The decision was taken to transfer all the patients with the acute respiratory illness, rash, and fever to our tertiary institution, the Georgetown Public Hospital (GPHC), where critical care can be provided should the need arise. While the specialists continue to work on the 7 patients admitted on Saturday [30 Mar 2019], results have shown that 2 patients tested positive for leptospirosis, which is known to be spread by direct contact with rat urine or faeces. Further tests are being conducted locally, and samples will be sent overseas with support from PAHO and CARPHA to get further tests done to rule out other possible infections.

The Public Health Ministry is taking all necessary precautions to ensure staff and members of the community at Matthew's Ridge are kept safe.

The mining company has been instructed to halt further exploration until the ministry and a team from the Occupational Health and Safety department of the Ministry of Social Protection can advise further. The Ministry of Public Health, along with partners, will continue to monitor the situation closely until resolution.
========================
[Leptospirosis is a bacterial disease that affects humans and animals. It is caused by bacteria of the genus _Leptospira_. In humans, it can cause a wide range of symptoms, some of which may be mistaken for other diseases. Some infected persons, however, may have no symptoms at all.

Without treatment, leptospirosis can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, respiratory distress, and even death  (<https://www.cdc.gov/leptospirosis/index.html>).

Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, such as farmers, mine workers, sewer workers, slaughterhouse workers, veterinarians and animal caretakers, fish workers, dairy farmers, and military personnel. The disease has also been associated with swimming, wading, kayaking, and rafting in contaminated lakes and rivers. As such, it is a recreational hazard for campers or those who participate in outdoor sports. The risk is likely greater for those who participate in these activities in tropical or temperate climates.

According to the above report, appropriate public health measures are being taken to contain the above "outbreak" and confirm any new cases as early as possible. - ProMED Mod.UBA]

[We were told in the initial ProMED-mail post (Undiagnosed resp. illness - Guyana: (Barima-Waini) manganese mine, fatal, RFI http://promedmail.org/post/20190401.6396933) that 8 individuals working at a manganese mining company in Guyana, owned by a subsidiary of Chinese company Bosai Minerals Group Guyana Company Limited, developed what was said to be an influenza-like illness with "respiratory discomfort, rash, and high-grade fever." One of the individuals died.

A subsequent update from Guyana Department of Public Information (above) says that swine flu (H1N1), Zika, chikungunya, dengue, and influenza A and B have been ruled out as possible causes of this outbreak, although 2 patients tested positive for leptospirosis, without specifying what tests were done to make that determination. All infected persons are said to have been exposed to one common area, without evidence of person-to-person transmission (that is, presumably there are no secondary cases), but we are not told what that common area is.

Leptospirosis is an infection 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_. The Bosai mine is an open pit mine, the usual way manganese is mined (<https://demerarawaves.com/2017/01/27/manganese-mining-in-north-west-district-to-create-hundreds-of-jobs-improved-infrastructure/>). Open pit mines are subject to flooding, which could lead to exposure to leptospirosis if there is also rat infestation.

The clinical presentation of leptospirosis is frequently nonspecific, with fever, headache, and myalgias. Patients often have a dry cough, which is usually mild and without any sequelae, that accompanies the other symptoms. Severe leptospirosis, known as Weil's disease, is characterized by liver damage (causing jaundice), renal failure, and bleeding. Meningoencephalitis and myocarditis may also be present. However, pulmonary involvement, which manifests itself as pulmonary hemorrhage, can be severe, with massive hemoptysis, respiratory insufficiency, and death (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519021/>). The diagnosis of leptospirosis can be made by PCR assays during the acute illness and ELISA (enzyme-linked immunosorbent assay) for the detection of _Leptospira_-specific IgM antibodies. The microscopic agglutination test (MAT), which detects antibodies to specific serovars using several reference strains, confirms the diagnosis.

Another disease transmitted by rodents is hantavirus infection. Infected rodents shed the virus in feces, urine, and saliva. Dr. Jan Clement in previous ProMED-mail posts (e.g., Leptospirosis - South Africa (02): (WC) fatal, prisoners, rat infestation, comment http://promedmail.org/post/20151004.3690652) has pointed out the need to consider hantavirus infection in the differential diagnosis of rodent-borne diseases such as leptospirosis. ProMED-mail moderator TY [ProMED Mod.TY] has indicated the presence of hantaviruses in this region of northeastern South America. See ProMED-mail post Hantavirus update 2010 - Americas (40): Chile, French Guiana http://promedmail.org/post/20101224.4542. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Barima-Waini region, Guyana: <http://healthmap.org/promed/p/3849>]
Date: Sun 31 Mar 2019
Source: Kaieteur News [edited]

One of several afflicted manganese workers is now dead, after exhibiting symptoms of a viral influenza, yesterday [30 Mar 2019]. The other 7, who are also Chinese nationals, are currently being treated at the Georgetown Public Hospital Corporation (GPHC).

A team of medical personnel was deployed to Matthews Ridge [Barima-Waini region] yesterday, from the Mabaruma Hospital after the members received these reports.

The 7 men were airlifted to Eugene F Correia International Airport, Ogle, and transported to GPHC for treatment.

A medical practitioner on the team informed this publication that the team has been extremely cautious, both, in its transport of the patients and with the level of care they're currently receiving.

This publication was informed that 2 floors of the Male Medical Ward of GPHC were cleared and restricted yesterday, to quarantine the victims of the undetermined illness.

The 7 workers had initially been taken to Pakera Hospital, Matthews Ridge, for treatment.

The medical personnel at the hospital have been running a battery of tests. Further testing is expected to be done to ascertain the exact nature of the illness. One doctor involved has dismissed speculation that swine flu [influenza A(H1N1)] is the cause of the symptoms.

The workers were reportedly stationed at a manganese mine owned by Guyana Manganese Inc. (GMI), a subsidiary of Chinese company, Bosai Minerals Group Guyana Company Limited, when they began showing signs of respiratory discomfort, rash, and [high grade fever].

Just [Fri 29 Mar 2019], Ministers of Natural Resources and Public Affairs, Raphael Trotman, and Dawn Hastings-Williams, visited the mine to inspect it, since operations there are expected to restart soon.

To date, 113 Guyanese and 23 expatriates have already been employed with GMI.

According to health officials, they are up on the alert for measles and immunisable diseases.
===================
[According to the report above, the clinical presentation of the cases includes high grade fever with a rash and respiratory symptoms. The report mentions 8 workers who developed symptoms but does not provide information on epidemiological factors such as whether the workers lived in close proximity prior to developing symptoms, any travel history or new arrivals to the mine, or any co-morbid conditions. Detection of the responsible pathogen or toxin is necessary to provide appropriate treatment and to protect the other workers. Any further information in this regard will be highly appreciated. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map of Guyana:
Date: Wed 13 Sep 2017
Source: Stabroek News [edited]

Residents of Wakapoa, in Region Two (Pomeroon-Supenaam), suspect that there is a typhoid outbreak in the community, where the absence of medical professionals and drugs at the community health centre has become the norm. At least 8 people from the village have been reported as having typhoid.

A resident sought to highlight the plight of those in her village in a recent Facebook post by calling on those in authority to look into the matter. "Hello my friends, with a feeling of anxiety and frustration I reach out to you this evening to ask if anyone can refer me to the relevant authorities for help for the folks of Wakapoa. Presently, there seems to be an outbreak of typhoid in my community! With 6 people from my family already sick and in need of treatment!! There's no doctor or medex at our health centre and it is apparent we do not have any treatment here right now... 4 members in my family [are] presently at Suddie Hospital talking treatment... But it is very expensive to travel to that hospital and the required tests are also expensive," she wrote, while asking for assistance to notify the Public Health Minister and other organizations that could help the community.
======================
[Typhoid fever, so-called enteric fever caused by _Salmonella enterica_ serotype Typhi, often has a totally different presentation from that of the commoner kinds of salmonellosis. Epidemiologically, usually spread by contaminated food or water, typhoid is not a zoonosis like the more common types of salmonellosis. Clinically, vomiting and diarrhoea are typically absent; indeed, constipation is frequently reported. As it is a systemic illness, blood cultures are at least as likely to be positive as stool in enteric fever, particularly early in the course of the infection, and bone marrow cultures may be the most sensitive.

The symptoms of classical typhoid fever typically include fever, anorexia, lethargy, malaise, dull continuous headache, non-productive cough, vague abdominal pain, and constipation. Despite the frequently high fever, the pulse is often only slightly elevated. During the 2nd week of the illness, there is protracted fever and mental dullness, classically called coma vigil. Diarrhoea may develop but usually does not. Many patients develop hepatosplenomegaly [both liver and spleen enlarged]. After the 1st week or so, many cases develop a maculopapular rash on the upper abdomen. These lesions ("rose spots") are about 2 cm [0.78 in] in diameter and blanch on pressure. They persist for 2-4 days and may come and go. Mild and atypical infections are common.

The word typhoid (as in typhus-like) reflects the similarity of the louse-borne rickettsial disease epidemic typhus and that of typhoid fever; in fact, in some areas, typhoid fever is still referred to as abdominal typhus.

Pomeroon-Supenaam (Region 2) is a region in Guyana, bordering the Atlantic Ocean to the north, the region of Essequibo Islands-West Demerara to the east, the region of Cuyuni-Mazaruni to the south and the region of Barima-Waini to the west. Pomeroon-Supenaam contains the towns of Anna Regina, Charity, Pickersgill, Spring Garden and Suddie. It can be seen on a map of the country at <https://en.wikipedia.org/wiki/Pomeroon-Supenaam>. - ProMED Mod.LL]

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

Brunei

Brunei US Consular Information Sheet
October 09, 2008
COUNTRY DESCRIPTION:
Brunei Darussalam is a small Islamic Sultanate on the northwest coast of the Island of Borneo.
It is divided into four districts: Brunei/Muara, Tutong, Belait
nd Temburong.
The capital, Bandar Seri Begawan, is its only major city.
Brunei’s official language is Malay, but English is widely understood and used in business.
Tourist facilities and services are generally available throughout the country.
For more information concerning Brunei, please see the Government of Brunei web site at http://www.brunei.gov.bn.
Read the Department of State Background Notes on Brunei for additional information.

ENTRY/EXIT REQUIREMENTS:
U.S. passport-holders must have at least six months’ validity remaining on their passport before entering Brunei for business or pleasure and are required to obtain a visa prior to arrival in Brunei for visits of 90 days or longer.
Diplomatic and official passport-holders are also required to apply for a visa to enter Brunei Darussalam.
There is an airport departure tax.
For further information about entry or exit requirements, travelers may consult the Consular Section of the Embassy of Brunei, 3520 International Court NW, Washington, DC
20008, tel. (202) 237-1838, or visit the Embassy of Brunei web site at http://www.bruneiembassy.org for the most current visa information.
As of June 12, 2004, immigration offenses are punishable by caning.
Workers who overstay their visas can face jail sentences and three strokes of the cane.
Those associated with violators, such as contractors or employers, are subject to the same penalties if the violator is found guilty.

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:
Following the October 2002, August 2003, September 2004 and October 2005 terrorist bombings in Indonesia, the Department of State continues to be concerned that terrorist groups such as Jemaah Islamiyah (JI) that have transnational capability to carry out terrorist attacks may do so in various Southeast Asian nations, including Brunei.
JI is known to have cells operating in Southeast Asia and to have connections with Al-Qaeda and other regional terrorist groups.
JI also has been tied to previous regional terrorist attacks.
As security is increased at official U.S. facilities, terrorists will seek softer targets.
These may include, but are not limited to, facilities where Americans and other Westerners are known to live, congregate, shop or visit, including, but not limited to, hotels, clubs, restaurants, shopping centers, housing compounds, transportation systems, places of worship, schools or outdoor recreation events.
Americans in Brunei should continue to be vigilant with regard to their personal security, maintain a low profile, vary times and routes during their daily routines and report any suspicious activity to the local police or to the U.S. Embassy's Regional Security Officer, who can be reached at the phone number listed at the end of this information sheet.

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 other callers, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

CRIME:
Though there is some crime, violent crime is rare.
Burglaries and theft are on the rise. Americans are reminded to be prudent in their own personal security practices.

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 provide a list of attorneys if needed.

In Brunei, the local equivalents to the “911” emergency line are:
993 for Brunei Police, 955 for
Fire
& Rescue and 998 for Search & Rescue.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
There is adequate care for basic medical conditions in Brunei; however, due to unpredictable shortages of materials and uncertain support staff, elective surgery or complicated care is best obtained in Singapore or elsewhere.

Brunei has imposed HIV/AIDS travel restrictions as part of a ban on communicable diseases.
In October 2003, Ministry of Health (MOH) of Brunei Darussalam required all travelers entering Brunei to fill out a Health Declaration Card and submit it to the Officer-In-Charge (MOH) upon disembarkation.
Under Section 7, Infectious Diseases Order 2003 of MOH, travelers may be subjected to a medical examination upon arrival in Brunei Darussalam.
Travelers also may be quarantined if infected or suspected to be infected with infectious disease or in if travelers have had contacted with such a person, under Section 15, Infectious Diseases Order 2003 of Ministry of Health Brunei.
Please inquire directly with the Embassy of Brunei at http://www.bruneiembassy.org before you travel.

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

Brunei has an extensive network of roads throughout the country of generally good, though varying quality.
Holders of foreign driving license are permitted to drive in Brunei Darussalam for 90 days only.
For longer stays, a foreign driving license must be endorsed to a Brunei driving license, available at any Land Transport Department office.
Drivers must obey traffic rules at all times and should take extra caution when approaching traffic signals.
In urban areas, some local drivers have run through red lights, resulting in several deadly accidents in recent years.

Please refer to our Road Safety page for more information.
Visit the website of the Brunei National Tourism at http://www.tourismbrunei.com/ and the web site of Brunei Land Transport Department at http://www.land-transport.gov.bn/ for more details on road safety information.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Brunei’s Department of Civil Aviation as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Brunei’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:
Immigration Violations:
Americans in Brunei are subject to the laws of the country and may be arrested for violation of immigration regulations, or any other law.
In such cases, the U.S. Embassy will provide consular services to American citizens arrested in Brunei, in accordance with international law and U.S. regulations.
However, the Embassy may not intervene in local judicial matters.
Americans should be aware that the immigration law is stringent and less flexible than the previous one, with harsher penalties.

The Embassy strongly recommends that U.S. citizens on contract in Brunei be fully aware of their immigration status, as well the status of employees and staff and of crucial dates regarding contract extensions and renewals and have employment documents in order.

Dual Nationality:
Brunei does not recognize or permit dual nationality.
Brunei nationals are expected to enter and exit on their Brunei passports.
Should Brunei authorities learn that a person is a dual national, they may require immediate renunciation of either the citizenship of the other nation or Brunei citizenship.

Customs Regulations:
Brunei customs authorities may enforce strict regulations concerning temporary importation into or export of items such as firearms, religious materials, antiquities, medications, business equipment, currency, ivory and alcohol.
For non-Muslims, limited amounts of alcohol for personal consumption are permitted.
It is advisable to contact the Embassy of Brunei in Washington, D.C. for specific information regarding customs requirements.
In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines. 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 Brunei laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in Brunei 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 Brunei are encouraged to register with the nearest U.S. embassy or consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Brunei.
Americans without Internet access may register directly with the nearest U.S. embassy or consulate.
By registering, American citizens make it easier for the embassy or consulate to contact them in case of emergency.
The U.S. Embassy is located on the 3rd floor, Teck Guan Plaza, at the corner of Jalan Sultan and Jalan McArthur, Bandar Seri Begawan BS 8811, Brunei Darussalam.
Mail sent from the United States can be addressed to the Embassy's address:
American Embassy, P.O. Box 2991, Bandar Seri Begawan BS8675, Negara Brunei Darussalam.
The telephone number is 673-222-0384, fax number (673) (2) 225-293 and e-mail address amEmbassy_BSB@state.gov.
The Consular section's e-mail address is: ConsularBrunei@state.gov.
The Embassy's after-hours number for emergency calls is (673) (8) 730-691.
* * *
This replaces the Country Specific Information for Brunei dated February 19, 2008, to update section on Entry/Exit Requirements, Information for Victims of Crime, Medical Facilities and Health Information, Traffic Safety and Road Conditions, Special Circumstances and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Brunei

- National. 9 May 2018. Brunei has recorded 37 dengue cases in the 1st 4 months of 2018, with half of them detected in Kampong Ayer, the Ministry of Health (MoH) said on [Tue 8 May 2018]. MoH expects the number of dengue cases to rise and is urging residents to maintain good hygiene.

[HealthMap/ProMED-mail map
Date: Sat 5 Dec 2015
From: Steve Berger <steve@gideononline.com> [edited]

Recently, ProMED reported that 2 tourists from Singapore acquired _Plasmodium knowlesi_ malaria in Brunei.

Malaria rates reported by both Brunei and Singapore have been strikingly similar since the 1990's, and Singapore has reported both autochthonous and imported cases of _P. knowlesi_ infection since 2007. See graph at <http://www.gideononline.com/wp/wp  content/uploads/BruneiMalaria.png>.

During the 1950's, Brunei reported low levels of malaria from the interior regions and coast adjacent to mountainous areas. The predominant infecting species and vector were _P. falciparum_ and _Anopheles leucosphyrus_, respectively [1]. Brunei was officially declared "malaria-free" by WHO in 1987. A single publication reported a case of _P. knowlesi_ malaria in this country in 2013.

Although official sources do not routinely recommend malaria prophylaxis for travelers, the recent report in ProMED suggests careful review of the current status of the disease in Brunei.

Reference:
[1] Berger SA. Infectious Diseases of Brunei, 2015. 374 pages, 60 graphs, 1448 references. Gideon e-books,
--------------------------------------------
Professor Steve Berger
Geographic Medicine
Tel Aviv Medical Center
Tel Aviv Israel
=========================
[ProMED thanks Steve Berger for this background information. The recent reports from northern Borneo indicate that _P. knowlesi_ may be emerging there. The ProMED report from 18 Nov 2015 "Malaria, P. knowlesi - Malaysia (03): (SA)" reports that _P. knowlesi_ is now the most common malaria species in humans in Sabah province, Malaysia.

_P. knowlesi_ is different from the other 4 plasmodia species infecting humans in that it is primarily a zoonosis, with the reservoir being Macaque monkeys. An increase in the Macaque reservoir, closer proximity to human habitats, or increases in the anopheles vectors are all possible explanations.

The importance of _P. knowlesi_ infections in humans was highlighted by a study published in 2004 (Singh B, et al. A large focus of naturally acquired _Plasmodium knowlesi_ infections in human beings. Lancet. 2004;363:1017-24), and data from before 2004 classified P. knowlesi and _P. malariae_.

Human to human transmission of _P. knowlesi_ has still not been demonstrated. - ProMed Mod.EP]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Wed 2 Dec 2015
From: Hsu Li Yang <hsuliyang@gmail.com> [edited]

_Plasmodium knowlesi_ malaria, human, Temburong National Park, Brunei
---------------------------------------------------------------------
We report 2 cases of _Plasmodium knowlesi_ malaria that occurred after a camping trip involving 24 teenagers and 3 adults in Temburong National Park, Brunei. The trip occurred between 2-9 Nov 2015, and the onset of illness was on 20 Nov 2015 for both individuals. Diagnosis of _P. knowlesi_ was made via PCR speciation. None of the participants of the trip received malaria prophylaxis.
------------------------------
Hsu Li Yang
Saw Swee Hock School of Public Health,
National University of Singapore,
Singapore
======================
[ProMED-mail would like to thank Dr. Hsu Li Yang for submitting this first hand report. - ProMed Mod.MPP]

[The report is in line with previous ProMED reports, especially the last report from 18 Nov 2015 (archive no http://promedmail.org/post/20151118.3801294), that _P. knowlesi_ is the most common malaria parasite found in humans with malaria in Northern Borneo (Malaysia, Sabah, and Sarawak and Brunei). - ProMed Mod.EP]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sun 27 Oct 2013
Source: Bru Direct [edited]

The Ministry of Health (MoH) issued a press release to inform the public about cases of Japanese encephalitis (JE) infections that have been recently detected in Brunei Darussalam.

According to the press release, JE is a viral infection that is transmitted by mosquitoes, similar to other infections such as dengue, malaria, chikungunya and filariasis. The JE [virus] infection is endemic in many countries in Asia.

Medical research has shown that most cases of JE [virus] infection do not present with any symptoms. However, in a small number of cases, infected persons may show signs and symptoms such as fever, headache, nausea and vomiting. After a few days, the infection may cause mental abnormalities, neurological symptoms, weakness and motor disturbances. Convulsions may also occur, especially among children.

JE [virus] infection has never been previously detected and reported in the Sultanate. However, since 17 Oct this year [2013], a total of 12 patients with symptoms of encephalitis have been reported. Of these, 9 cases are from the Belait District, 2 from Tutong and one from Brunei-Muara.

To date, 6 patients have recovered and were discharged home, and 2 patients who also have other pre-existing medical conditions are currently receiving intensive care in hospital. They are, however, in a stable condition.

Following detailed investigations on all patients, only 3 patients from the Belait District have been confirmed by laboratory tests to have been infected by the JE virus.

There are no specific treatments for JE infection. There is only supportive treatment to relieve symptoms, and there is close monitoring in hospital if required. Patients should take their medications as instructed by the doctors and have adequate rest and fluids.

The MoH will continue to monitor the situation and take necessary measures including informing the public of any developments.
=======================
[Brunei (Brunei Darussalam in the Malay language) is a sovereign state on the north coast of Borneo Island. It is geographically within the Japanese encephalitis virus (JEV) endemic area of Asia, so it is not surprising that the virus is there and causing cases of human disease. Rice cultivation was intensified as a governmental agricultural initiative beginning in 2009. An increase in rice paddies would doubtless be accompanied by an increase of the _Culex_ mosquito JEV vectors. Additional cases in the future can be expected.

A map showing the location of Brunei can be accessed at
<http://healthmap.org/r/8UJm>. - ProMed Mod.TY]
Date: Thu 29 Apr 2010
Source: Asia One Health [edited]
<http://health.asiaone.com/Health/News/Story/A1Story20100429-213104.html>

From January to the 1st week of April this year [2010], 77 people contracted dengue fever in the country. The number surpasses the 37 cases recorded for all of 2009, according to the Ministry of Health.

Senior Public Health Officer Kamaludin Mohamad Yassin from the Entomology and Parasitology Unit under the ministry's Environment Health Services, said the increase in the number of cases is alarming. This marks a rise of 24 cases during the 1st week of April alone this year [2010], as it was stated in an earlier report that there were only 53 cases from January to the beginning of April 2010. The report also stated that for the 1st time, Brunei has reported 2 cases of dengue haemorrhagic fever, which is a more virulent form of dengue [disease] whereby a patient bleeds through his skin, nose or eyes.

"Even though this figure is small compared with some of our neighbouring Southeast Asian countries, this is still a worrying figure when taking into context the size of our population," said the senior public health officer on the sidelines of the Ministry of Health's briefing on dengue fever and environmental hygiene yesterday [28 Apr 2010] at the Muhibah Hall, Brunei-Muara District Office. He told the media that a majority of these cases were from Kampong Ayer, where pools of stagnant water can be found due to poor sewage management. "There are areas in Kampong Ayer with a lot of rubbish floating in the water. This rubbish is not being cleared or taken care of appropriately, which results in a breeding place for the _Aedes_ mosquitoes," he said, explaining that the _Aedes_ mosquito is a known vector for carrying the dengue virus. [Rubbish can collect fresh water, the breeding sites for _Aedes_ mosquitoes. However, sewage is not a breeding site. - ProMed Mod.TY]

Kamaludin added that other possible causes for the increase of the disease, seen not only in Brunei but throughout the whole world, included the unusually high rainfall experienced in the Sultanate during the 1st 3 months of the year [2010] and also the storage of water in homes. "We have to keep the water covered to prevent the mosquitoes from breeding," the senior public health officer said. With this in mind, Kamaludin added that the public cannot be complacent in trying to prevent dengue fever.

During his presentation, the senior public health officer told participants of the briefing that of the total 77 cases recorded this year [2010], 67 were from the Brunei-Muara District. Kuala Belait had 5 cases followed by Tutong with 4 and Temburong, one case. As much as 86 percent of this year's infection was recorded from Kampong Ayer, a change in trend compared to the previous 5 years when only an average of 13 percent of the Sultanate's cases were from the water village.

Asked if there were any "serious" cases recorded recently, Kamaludin recalled only one, which occurred in 2009. "But this person had underlying chronic illnesses. ... The virus lowered his immunity, which made him more susceptible to other illnesses," said the senior public health officer.
==================
[The location of Brunei on the north coast of Borneo Island can be accessed on the HealthMap/ProMED-mail interactive map at <http://healthmap.org/promed/en?v=4.5,114.8,5>. - ProMed Mod.TY]
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Christmas Island

No Profile is available at present

Travel News Headlines WORLD NEWS

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

Mozambique US Consular Information Sheet
July 15, 2008
COUNTRY DESCRIPTION:
Mozambique is a developing country in southern Africa which has steadily rebuilt its economy and civic institutions since ending a 16-year civil war in 1992.
he country stabilized following Mozambique's first multi-party elections in October 1994, and a new president was elected in December 2004.
Despite high economic growth rates in recent years, Mozambique remains among the world's poorest countries.
Facilities for tourism in Maputo, the capital city, are steadily improving but remain limited in other areas as many of the goods and services taken for granted in other countries are not yet available.
The official language is Portuguese, although English is spoken in many tourist areas, and in some rural areas only local languages are widely spoken.
Read the Department of State Background Notes on Mozambique for additional information.
ENTRY/EXIT REQUIREMENTS:
A visa is required for entry into Mozambique.
It is recommended that travelers acquire the appropriate visa prior to departing for Mozambique, although a one-entry visa can be obtained at country points of entry, including airports.
Foreigners in Mozambique without a valid visa can expect to pay a substantial fine for each day they are in Mozambique illegally.
The fine can be assessed upon departure or if caught while in Mozambique by authorities.
The passports of all travelers who wish to enter Mozambique must be valid for six months upon arrival and must contain at least three clean (unstamped) visa pages each time entry is sought.
The Mozambican Embassy and Consulates in South Africa charge up to five times the amount charged in the U.S. or at border crossing points for a tourist visa to Mozambique.
In September 2007 the Mozambican Interior and Health Ministries decreed that all travelers entering Mozambique, having previously visited a country where yellow fever is present, must present a valid certification of vaccination against yellow fever.
We recommend all travelers be vaccinated to avoid complications at the border.
Any passenger who cannot present such a certificate at the port of entry will be vaccinated at a cost of $50 US dollars or the equivalent in metical.
Additionally, all travelers entering Mozambique must carry their yellow vaccination book.
For further information on entry requirements, contact the Embassy of Mozambique located at 1525 New Hampshire Avenue NW, Washington, DC 20036, telephone: (202) 293-7146, email: embamoc@aol.com, fax: (202) 835 0245, or the nearest Mozambican embassy or consulate. Visit the Embassy of Mozambique web site at http://www.embamoc-usa.org/ for the most current visa information.

Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
Overland travel after dark is extremely dangerous due to poor road conditions, lack of emergency services, and the increased potential for vehicle hijacking.
Visitors should be particularly vigilant when driving on the main thoroughfares connecting Mozambique and South Africa as incidents of vehicle theft, including assault and robbery, have been reported.
Official Americans serving in Mozambique are prohibited from overland travel outside Maputo city limits after dark and are encouraged to travel in convoys of two or more vehicles when outside of the city during daylight hours.
Accidents involving pedestrians are increasingly common, and some reports suggest pedestrians purposely throw themselves in front of vehicles driven by foreigners in order to extort reparation payment.
Due to residual landmines, overland travelers are advised to remain on well-traveled roads or seek local information before going off-road outside of Maputo and other provincial capitals.
Drivers should obey police signals to stop at checkpoints, which are common throughout Mozambique.
Foreigners in Mozambique for more than 90 days are required to have an International Driver’s License or to obtain a Mozambican driver’s license. Although demonstrations do occur in Mozambique, they are infrequent and there have been no recent demonstrations against U.S. interests.
If any demonstrations do occur, they should be avoided.
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:
Although the vast majority of visitors complete their travels in Mozambique without incident, the most serious threat facing U.S. citizens visiting Mozambique is crime.
Street crimes, including mugging, purse snatching and pick-pocketing are common, both in Maputo and in secondary cities.
Carjacking is increasingly common in Maputo.
Visitors must be vigilant when out in public areas and should not display jewelry or other expensive items.
Isolated areas should be avoided.
Joggers and pedestrians have frequently been mugged, even during daylight hours.
Visitors should take caution when walking at night, even in well-known tourist areas.

Mozambican police are not at the standard U.S. citizens are accustomed to in the United States and visitors should not expect the same level of police service.

Many airline trips from Mozambique to the U.S., Europe, or African destinations transit Johannesburg, South Africa.
Baggage pilferage is an ongoing problem at Johannesburg's Oliver Tambo International Airport.
Travelers are encouraged to secure their luggage, use an airport plastic wrapping service, and avoid placing currency, electronics, jewelry, cameras, cosmetics, running shoes, or other valuables in checked luggage.
Having a complete inventory of items placed in checked baggage can aid in processing a claim if theft does occur.

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.
There is no local equivalent to the “911” emergency line in Mozambique.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are rudimentary, and most medical providers do not speak fluent English.
Medicines are not always consistently available.
There are both public and private medical facilities in the city of Maputo and most provincial capitals.
All health care institutions and providers require payment at the time of service, and may even require payment before service is given.
While some private clinics accept credit cards, many medical facilities do not.
Doctors and hospitals outside Maputo generally expect immediate cash payment for health services.
Outside of Maputo, available medical care ranges from very basic to non-existent.

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

Tuberculosis is an increasingly serious health concern in Mozambique.
For further information, please consult the CDC's Travel Notice on TB
http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s 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 Mozambique is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
The main north-south thoroughfare is passable until the city of Caia (Sofala province), where vehicle passengers must disembark and cross the Zambezi River by ferryboat.
On the north side of the river, the road continues to the Northern provinces.
The road network connecting provincial capitals is in fair condition, but can be riddled with potholes and other obstacles.

The EN4 toll road between Maputo and South Africa is well-maintained.
Official Americans are prohibited from traveling outside cities after dark because of the increased risk of banditry, poor road conditions in some areas, poor maintenance of many vehicles in the country (e.g., no headlights or rear lights), as well as the threat imposed by livestock that graze on roadsides.
Travel outside Maputo often requires a four-wheel drive vehicle, which creates an additional security risk since these vehicles are high-theft items.
Public transportation is limited and often has poor safety standards.
Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office at http://www.turismomocambique.co.mz/.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Mozambique, the U.S. Federal Aviation Administration (FAA) has not assessed Mozambique’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:
Mozambican law requires that all persons carry an identity document, such as a passport, when out in public, and produce it if requested by police.
Notarized copies of both the biographic page of a passport and a valid Mozambican visa are acceptable forms of identification, although police will occasionally demand original documents.
There are certain areas in Mozambique where pedestrian traffic is prohibited and the ban is strictly enforced.
These areas include the front of the presidential offices located north of the Hotel Polana on the seaside of Avenida Julius Nyerere and the Praça dos Herois on Avenida Acordos de Lusaka near the airport, both in Maputo.

It is against the law to destroy Mozambican currency; offenders can expect a jail sentence or fine.
The limit for an undeclared amount of U.S. dollars one can take out of the country is $5,000.
The limit on local currency is 500 metical, which is approximately 20 U.S. dollars.
Some American travelers have reported having difficulties cashing traveler’s checks and have relied instead on ATMs and credit cards for money withdrawals in Mozambique.
Outside of the major hotels and restaurants, credit cards are not widely accepted in Mozambique.
The South African rand and U.S. dollar are sometimes accepted as legal tender, although this is more common in the southern part of the country or in tourist areas; all transactions must have a local currency (metical) payment option. 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 Mozambique’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Mozambique 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 Mozambique are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Mozambique.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located in Maputo at 193 Avenida Kenneth Kaunda, telephone (258) 21 49 2797.
The after-hours telephone number for use in emergencies is (258) 21 49 0723.
The Consular Section's fax number is (258) 21 49 0448.
The Consular Section's e-mail address is consularmaputo@state.gov.
The Embassy's web site is http://maputo.usembassy.gov/
*

*

*
This replaces the Country Specific Information for Mozambique dated January 14, 2008, to update sections on Entry/Exit requirements, Information for Victims of Crime, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Sat, 3 Aug 2019 12:59:45 +0200 (METDST)

Maputo, Aug 3, 2019 (AFP) - Mozambique on Saturday set up disease checkpoints along its border with Malawi as a precaution against any spreading of a deadly Ebola outbreak, a senior health ministry official said.   More than 1,800 people have died in eastern Democratic Republic of Congo since Ebola broke out there in August last year.   Mozambique has yet to report an Ebola case, but DRC's regional neighbours have been on high alert while the World Health Organization (WHO) has elevated the crisis to a global health emergency.

Checkpoints began operating in the Milage and Morrumbala districts in the Zambezia province and controls are expected to widen to other provinces of Mozambique that share borders with Malawi, according to a ministry of health official.   "Setting up Ebola checkpoints is a guideline given by decision of the Ministry of Health and World Health Organization to prevent the spread of the disease to other countries" Zambezia province health director, Hidayate Kassim told reporters.   "The checkpoints aim to track all people entering Mozambique having fevers or if they have had contact with anyone who has been in Congo," he said.   "Depending on this control we will determine whether there is a risk or not in our province," Kassim added.   Authorities characterised the screening of people entering Mozambique as a preventive control measure to prepare, prevent, detect and treat any Ebola case that could develop in the country.

The deadliest epidemic of Ebola broke out in West Africa in December 2013 and lasted more than two years, killing more than 11,300 of the 29,000 infected people recorded.   The current one-year old epidemic has left 1,823 dead, according to the DR Congo health ministry, making it second only to the 2013-2016 crisis.   Rwanda on Thursday shuttered its border with DRC after a third case of the deadly virus was detected in the border city of Goma.
Date: Fri 3 May 2019
Source: France24, Agence France-Presse (AFP) [edited]

Provincial authorities said Fri 3 May 2019 that 14 cholera cases have been confirmed in northern Mozambique following floods caused by a powerful cyclone that battered the country last week. The city of Pemba registered 11 cases of the disease while the neighbouring district of Mecufi had 3. "We were already prepared for that -- the healthcare sector has been on the alert since Cyclone Kenneth started," the provincial health director, Anastacia Lidimo, told reporters.

Cyclone Kenneth made landfall in northern Cabo Delgado province on 25 Apr 2019, packing winds up to 220 kilometres (137 miles) per hour -- hitting a region that has not experienced a tropical cyclone in the modern era.

According to the UN humanitarian agency OCHA, Pemba, a city of 200,000 people and the capital of Cabo Delgado province, is in one of the most cholera-endemic regions in Mozambique. In Beira, the impoverished and aid-dependent country administered nearly 900 000 doses of oral cholera vaccines after Cyclone Idai [4-9 Mar 2019] to avert an epidemic.
====================
[Maps of Mozambique:
Date: Fri, 3 May 2019 12:08:16 +0200

Maputo, May 3, 2019 (AFP) - Fourteen  cholera cases have been confirmed in northern Mozambique following floods caused by a powerful cyclone that battered the country last week, provincial authorities said Friday.   The city of Pemba registered 11 cases of the disease while the neighbouring district of Mecufi had three.   "We were already prepared for that - the health care sector has been on the alert since Cyclone Kenneth started," the provincial health director, Anastacia Lidimo, told reporters.

Cyclone Kenneth made landfall in northern Cabo Delgado province on April 25, packing winds up to 220 kilometres (137 miles) per hour -- hitting a region that has not experienced a tropical cyclone in the modern era.   It killed at least 41 people, with some 226,000 affected, destroyed thousands of homes and wrecked water supply systems.   It was the second massive storm to hit Mozambique in six weeks after Cyclone Idai devastated the port city of Beira 1,000 kilometres (600 miles) to the south, causing huge floods and more than 600 deaths.    Cholera is transmitted through contaminated drinking water or food and causes acute diarrhoea.

According to the UN humanitarian agency OCHA, Pemba, a city of 200,000 people and the capital of Cabo Delgado province, is in one of the most cholera-endemic regions in Mozambique.   In Beira, the impoverished and aid-dependent country administered nearly 900,000 doses of oral cholera vaccines after Cyclone Idai to avert an epidemic.    At least four deaths from cholera were recorded in Beira and surrounding districts out of 4,979 cases.
Date: Wed, 24 Apr 2019 19:23:46 +0200

Moroni, Comoros, April 24, 2019 (AFP) - Violent winds caused landslides and flooding and cut off roads in Comoros in the vanguard of tropical storm Kenneth, set to hit Wednesday evening before heading to recently cyclone-ravaged Mozambique, officials said.   As the storm neared, schools were closed and inter-island hopper flight suspended.    Chief of the Comoros Centre for Relief and Civil Protection Centre (COSEP) Mouigni Daho said the arrival of the cyclone on the island was preceded by strong winds and floods.    There have been no reports of injuries.   Comoros Interior Minister Mohamed "Kiki" Daoudou urged citizens Wednesday to "stay calm and follow the instructions."

After Comoros, Kenneth is expected to reach the far north of Mozambique late Thursday or early Friday, if it stays on its current course.   This comes a month after cyclone Idai ravaged the country and neighbouring Zimbabwe, claiming some 1,000 lives and causing about $2 billion in damage, according to the World Bank.   The Mozambique National Meteorology Institute (INAM) warned in a statement that the storm system was intensifying.    "The severe tropical storm has intensified in the past few hours into a Category Three tropical cyclone, and forecasts project that the cyclone could intensify to a Category Four on April 25," it said.

Heavy rains and winds of up to 140 kilometres per hour (87 miles per hour) would follow, it added.   Mozambique's National Institute of Disaster Management (INGC) cautioned Wednesday that 692,000 people could be affected.    The INGC said it would relocate rescue equipment, including boats and helicopters previously reserved in Sofala province for victims of Idai, to Cabo Delgado where Kenneth is expected.   "We have water, we have a generator, we are prepared. We've done everything we were told to," said a hotel owner in the small town of Mucojo which is projected to be close to the eye of the cyclone.

- 'Concerned' -
"We've learned with Idai that it's a good strategy to allocate the rescue means before the cyclone..." Augusto Maita, general director of INGC told AFP.   The province of Cabo Delgado, bordering Tanzania, is also dealing since 2017 with a wave of deadly violence attributed to a jihadist group that advocates the application of Islamic law.   Volunteers of the Red Cross and Red Crescent, who had assisted in cyclone Idai rescue efforts, said teams were already "on alert".   "We are concerned about the impact that this storm could have across the three countries," regional director for Africa for the International Federation of Red Cross and Red Crescent Societies (IFC), Dr Fatoumata Nafo-Traore said.   "We are especially concerned about its possible impact in Mozambique where communities are still recovering from the devastation of Cyclone Idai," she said.   In Mozambique alone, Idai killed more than 600 people and affected 1.85 million, while over 340 died in Zimbabwe.   "Typically cyclones occur in the rainy season which is already over. This cyclone at the end of April is unusual," Comoros environment ministry expert Youssouf Hamadi told AFP.   "It confirms the increasing intensity and frequency of cyclones in the Indian Ocean" -- a phenomenon some blame on global warming.
Date: Tue, 23 Apr 2019 17:10:55 +0200

Maputo, April 23, 2019 (AFP) - A tropical system off Mozambique threatens to unleash a cyclone on the northern Cabo Delgado province just weeks after the country's central parts were ravaged by a powerful storm, meteorologists warned Tuesday.   The poor southern African country is still reeling from the impact of deadly cyclone Idai -- the most powerful storm to hit the region in recent decades -- which left about 1,000 dead in Mozambique and Zimbabwe.   The storm is forecast to make landfall late this week in Cabo Delgado province, reeling from violence at the hands of Islamists who have been terrorising villagers in remote communities for the past 18 months.   "The (weather) system we are talking about was a low pressure and today evolved into tropical depression," Aniceto Tembe, spokesman for the Mozambique Meteorology Institute told AFP in the capital Maputo.

The depression was north of Madagascar island Tuesday, approaching the Mozambique Channel where warm conditions are conducive for it to grow into a cyclone.    "We are projecting that a severe tropical cyclone may arrive and if the conditions allow it can even reach Category 3 tropical cyclone" strength -- with winds of between 140 and 160 kilometres (87 to 99 miles) per hour, he added.   "The projections indicate that the system will approach the coast of Mozambique... mainly the northern part of Cabo Delgado and the southern part of Tanzania," Tembe told AFP.   In a statement Monday, the public works ministry issued a warning of strong winds and heavy rains that could cause flooding and destruction of property in the province of Cabo Delgado and its southern neighbouring province of Nampula.   It said 80,000 people were at risk.

The centre for disaster management issued a warning Tuesday of a tropical storm with wind speeds of between 80 and 120 kilometres per hour, expected to make landfall Friday in the gas-rich district of Palma, the nerve centre of Mozambique's nascent gas industry.   Hardline Islamists have launched several deadly attacks in the Muslim-majority, oil and gas-rich Cabo Delgado province in the past year, killing about 200 people, beheading some of them, and forcing thousands from their homes.   Last month Cyclone Idai cut a path of destruction through Mozambique, Malawi and Zimbabwe on the night of March 14-15, causing damage worth about $2 billion, according to the World Bank.   In Mozambique alone, more than 600 people died among the 1.85 million affected, while over 340 died in Zimbabwe.
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Kazakhstan

Kazakhstan US Consular Information Sheet
October 02, 2008
COUNTRY DESCRIPTION:
Kazakhstan is a constitutional republic with a strong presidency and a market economy. Kazakhstan's tourist facilities are not highly developed; the availabilit
of goods and services is better than in most neighboring countries, but not up to the standards found in North America and Western Europe. Internal travel and travel to neighboring countries, by air and land, can be subject to delays due to infrastructure shortcomings and winter weather. Read the Department of State Background Notes on Kazakhstan for additional information.
ENTRY/EXIT REQUIREMENTS: A valid passport and visa are required. The Embassy of Kazakhstan in Washington, D.C. and the Consulate of Kazakhstan in New York issue visas. The Embassy of Kazakhstan is located at 1401 16th Street NW, Washington, DC 20036, telephone (202) 232-5488 or 550-9617, fax (202) 232-5845 and the Consulate at 866 United Nations Plaza, Suite 586 A, New York, N.Y. 10017, telephone (212) 230-1900 or 230-1192, fax (212) 230-1172. An invitation is not required for single-entry business and tourist visas, but multiple-entry visas require an invitation from an individual or organizational sponsor in Kazakhstan. The U.S. Embassy in Astana and the U.S. Embassy Branch Office in Almaty do not issue letters of invitation to citizens interested in private travel to Kazakhstan. All travelers, even those simply transiting Kazakhstan, must obtain a Kazakhstani visa before entering the country. Travelers should be aware that overstaying the validity period of a visa will result in fines and delays upon exit. Travelers may be asked to provide proof at the border of their subsequent travel arrangements. Travelers transiting through Kazakhstan are reminded to check that their visas allow for a sufficient number of entries to cover each transit trip and to check the length of validity of the visa. Crossing the land border to and from the neighboring Kyrgyz Republic can result in delays or demands from border officials to pay fines.
Tourist visas cannot be extended in Kazakhstan. Business visas can be extended for up to 6 months total validity upon submission of a contract with a sponsoring Kazakhstani organization. Work visas can be extended in Kazakhstan up to the expiration date of the holder’s work permit, a separate document issued only in Kazakhstan.

NOTE: Due to changes in the labor law, foreigners who work in Kazakhstan for registered non-profit organizations and NGOs, other than designated Chief Representatives of those organizations, are no longer exempt from work permit regulations.

Travel to certain areas bordering China and cities in close proximity to military installations require prior permission from the Kazakhstani government. In 2001, the government declared the following areas closed to foreigners: Gvardeyskiy village, Rossavel village, and Kulzhabashy railway station in Zhambyl Oblast; Bokeyorda and Zhangaly districts in Western Kazakhstan Oblast; the town of Priozersk and Gulshad village in Karaganda Oblast; and Baykonur, Karmakshy, and Kazakly districts in Kyzylorda Oblast. Americans traveling within Kazakhstan have on occasion reported local officials demanding documentation authorizing travel within their area of jurisdiction, even though they received permission from the Department of Migration Police (formerly OVIR), currently part of the Ministry of Internal Affairs. Americans should report any trouble with local authorities to the U.S. Embassy in Astana or the U.S. Embassy Branch Office in Almaty.
Registration of American passports is conducted at the same time as the issuance of the visa in one of Kazakhstan’s embassies and consulates abroad or at the time of a border crossing. Americans are not required to register in Kazakhstan upon arrival at a local office of the Department of Migration Police. All registrations are valid for three months, regardless of where they are issued. To extend your registration beyond three months, please contact your local office of the Department of Migration Police. However, if you are not sure if you have been properly registered at the time of visa issuance or border crossing, please contact your local office of the Department of Migration Police.
Visitors to Kazakhstan engaging in missionary work or other religious activities must register with the Department of Justice office in the region (Akimat) where the activities will take place. This applies even if the religious activities are not the primary purpose of the visit. Attendance at a religious service does not itself require registration, however participation in the delivery of the service may. Americans have been fined and deported from Kazakhstan for addressing a congregation, leading prayers, and performing religious music without proper religious worker registration. In addition, representatives of faith-based non-governmental organizations are often considered subject to the registration requirement even if their activities are not religious in nature. If in doubt whether registration is required, visitors should contact the Department of Justice office responsible for the area of Kazakhstan where they intend to engage in religious activities and request a written decision. Religious worker registration is only valid for the locality where it is granted and visitors must register in each jurisdiction where they wish to engage in religious activities.
In an effort to prevent international child abduction, many governments have initiated procedures at entry/exit points. These often include requiring documentary evidence of relationship and permission for the child's travel from the parent(s) or legal guardian if not present. Having such documentation on hand, even if not required, may facilitate entry/departure. All children adopted in Kazakhstan after May 2003 must obtain exit stamps from both the Ministry of the Interior and Ministry of Foreign Affairs before departing the country.
Visit the Embassy of Kazakhstan’s web site at http://www.kazakhembus.com for the most current visa information.

Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
Supporters of extremist groups such as the Islamic Jihad Union, the Islamic Movement of Uzbekistan, al-Qaeda, and the Eastern Turkistan Islamic Movement remain active in Central Asia. These groups have expressed anti-U.S. sentiments and may attempt to target U.S. Government or private interests in the region, including in Kazakhstan. Attacks against foreign interests in Central Asia have occurred and new tactics, including the use of suicide bombers, have been employed by extremists in neighboring Uzbekistan. Terrorists do not distinguish between official and civilian targets. Because of increased security at official U.S. facilities, terrorists are also targeting “soft” civilian targets such as residential areas, clubs and restaurants, places of worship, hotels, schools, outdoor recreation events, resorts, beaches, maritime facilities, and aircraft.
Kazakhstani security personnel may at times place foreign visitors under surveillance. Hotel rooms, telephones and fax machines may be monitored, and personal possessions in hotel rooms may be searched. Taking photographs of anything that could be perceived as being of military or security interest may result in problems with authorities.
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: Travelers in Kazakhstan should exercise the same precautions concerning personal safety and protection of valuables as they would in any major U.S. city. Using good judgment and avoiding high-risk areas can reduce the crime threat. The most common crimes foreign tourists encounter are purse snatching, pick pocketing, assaults, and robberies. Pick pocketing or robberies occur most frequently in the vicinity of Western hotels, transportation sites, and at open-air markets, including the central open-air market in Almaty (known locally as the "green market"). Americans are advised to exercise caution in the vicinity of hotels, bus or train stations, and when shopping. The U.S. Embassy strongly recommends that Americans do not carry large sums of money on the street.
Identification checks by the police are common practice. U.S. visitors must produce either a passport or an Embassy-certified copy thereof upon request. Police are not required to demonstrate probable cause or reasonable suspicion to initiate ID checks. Given concerns with crime, the U.S. Embassy has made arrangements with the Kazakhstani Government to allow Americans in the Almaty Oblast to carry a certified copy of their passport and visa rather than the original. These copies can be obtained from either the U.S. Embassy’s Consular Section in Astana or the Branch Office in Almaty during business hours Monday to Friday, 9:00 a.m. to 5:00 p.m.
Be wary of persons representing themselves as police or other local officials. It is not uncommon for Americans to become victims of harassment and extortion by imposters, genuine law enforcement and other officials. A genuine police official should always present his own credentials when approaching someone on the street. If the officer cannot produce identification, he is most likely an imposter. Never voluntarily hand over your wallet to a police officer. If pressured, tell the officer that you will report his behavior to the U.S. Embassy and his supervisors. Authorities are concerned about these incidents and have cooperated in investigating such cases. Try to obtain the officer's name, badge number, and license plate number, and note where the incident happened because this information assists local officials in identifying the perpetrators. Report crimes committed against you by persons presenting themselves as police or other governmental authorities to a police station and the U.S. Embassy.
The "lost wallet" scam continues to be common in Kazakhstan. One version of this swindle involves the discovery of a lost wallet in your presence. A first person will discover the wallet and offer to divide its contents with you. Then, a second person will appear, claim to be the owner of the wallet, and demand compensation for the missing money. A second version involves a person looking for a lost wallet, asking you if have seen it. The person asks you to reveal the contents of your pockets or bag to prove that you do not have the missing wallet. The wallet seeker will then surreptitiously steal your exposed valuables. When initially approached by the “finder” or “seeker” of the lost wallet, simply walk away.

The embassy highly discourages taking private gypsy cabs in lieu of licensed taxicabs while in Kazakhstan. This applies especially to travel from the airport to the city upon arrival, where men posing as "meet and greet" airport facilitators have lured foreigners into cars purportedly to take them to their hotels. However, the driver then takes the passengers to a secluded destination and demands approximately $100 for gas to take the foreigner back to the city. All travelers should make prior arrangements with their contacts in Almaty for concrete identification upon arrival at the airport. Americans should not leave with anyone who does not show pre-arranged identification, even if the person is holding a sign with the traveler's name.
The Embassy has received reports from American residents and visitors being victims of violent, late-night muggings. Americans are advised to travel in groups or pairs. Lone individuals often make easy targets for muggers. At night, try to remain in well-lit, populated areas. Visitors are encouraged to leave restaurants or bars if fights break out.
Corruption by public officials, including law enforcement, has been reported frequently, especially at the airport in Almaty. Some foreigners have been told by customs or border guard officials that they must pay a $50-$500 fine for violating an undisclosed local regulation, despite the fact that the foreign citizen has fully complied with local laws. Some Americans have reportedly been asked to pay a large fine upon exiting Kazakhstan. When encountering such irregularities, U.S. citizens are advised to seek clarification from supervisory airport officials or contact the U.S. Embassy before paying.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends, and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

The local equivalent to the “911” emergency line in Kazakhstan is: 03
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in Kazakhstan is limited and well below North American and Western European standards. The U.S. Embassy maintains a list of English-speaking physicians. Basic medical supplies, including disposable needles, anesthetics, and antibiotics can be in short supply. Elderly travelers and those with pre-existing health problems may be at risk due to inadequate medical facilities. Most resident Americans travel to Western Europe for serious medical treatment. Such travel can be extremely expensive if undertaken under emergency conditions. Travelers requiring prescription medications or specific brand-name medicines should bring sufficient supplies of medications and not rely on local availability.
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.
Tuberculosis is an increasingly serious health concern in Kazakhstan. For further information, please consult the CDC's Travel Notice on TB at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.

Some HIV/AIDS restrictions exist for foreign residents of Kazakhstan. Visitors applying for a work or residency permit, required for Americans who wish to spend more than 6 months in Kazakhstan, must submit negative HIV test results with their application to the Migration Police in the city where they intend to work or reside. The results must be less than three months old. The city HIV clinic in the place of registration can conduct the test or may certify test results performed abroad. If the original test results are in a language other than Russian or Kazakh, they must be accompanied by an official translation. If a foreigner tests positive for HIV in Kazakhstan, he or she must depart the country. Please verify this information with the Kazakhstani sponsoring organization that can provide more information on the specific HIV testing procedures in the region of Kazakhstan where you intend to reside.

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 Kazakhstan is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Roads in Kazakhstan are in poor repair, especially in rural areas. Street lighting, especially on side streets, may be turned off at night. Drivers often ignore lane markings. Potholes are common, and are often dangerously deep. Pedestrians frequently dart out in front of cars. Visitors should drive defensively at all times as many local drivers do not follow traffic laws. Special caution should particularly be taken if driving at night. Road rage can be a problem, especially in and around Almaty, and a non-confrontational response to such behavior is strongly recommended. Accidents involving severe injury and/or death are common. Traffic police have reportedly stopped cars to extort bribes on main city streets and at periodic checkpoints on major highways.
The road between Almaty and Bishkek, Kyrgyzstan, is especially treacherous at night or during poor weather. Americans and other travelers have been killed in traffic accidents on that road, and travel at night should be undertaken with great caution or avoided.
Travelers should be particularly careful when using public transportation and taxis. Buses tend to be very crowded and can be unsafe and unreliable. Due to the danger of theft or assault, travelers should be selective regarding which taxi they contract and always avoid entering a cab that already contains persons other than the driver.
Americans wishing to drive in Kazakhstan should possess a valid international driver's license. For specific information, travelers may contact the Embassy of the Republic of Kazakhstan at 1401 16th Street NW, Washington, DC 20036, telephone (202) 232-5488.
Please refer to our Road Safety page for more information. Visit the web site of Kazakhstan’s national tourist office and national authority responsible for road safety at http://www.kazakhembus.com
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Kazakhstan, the U.S. Federal Aviation Administration (FAA) has not assessed Kazakhstan’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:
Kazakhstan remains largely a cash economy. Traveler's checks and credit cards are not widely accepted, except at large hotels and restaurants catering to international visitors. U.S. dollars can easily be exchanged for the local currency (Tenge) at local and authorized currency exchanges, but all denominations of U.S. currency except $1 bills must be new series (large portraits) and all must have been issued after 2000 and be in good condition (not worn or torn and without any writing or marks).
Kazakhstan, especially in the mountainous southeast region, is an earthquake-prone country. The U.S. Department of State has ranked the earthquake threat level within Almaty as a Level 4 (the highest level assigned). Building practices within Kazakhstan do not generally meet U.S. seismic standards. In addition, local authorities do not have sufficient resources to respond to a large-scale disaster. American citizens traveling to Kazakhstan are encouraged to register with either the U.S. Embassy or the U.S. Embassy’s Branch Office’s Consular Section to facilitate contact in the event of an emergency. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.
Kazakhstani customs authorities may enforce strict regulations concerning export from Kazakhstan of items such as antiquities. Foreigners must complete a customs declaration upon entering Kazakhstan and may face fines upon departure if unable to produce certificates verifying legal conversion of foreign currency. Travelers are strongly encouraged to declare all valuables, including computers, video cameras, and mobile telephones, upon entry in order to avoid paying duty on those items upon departure. Tenge, Kazakhstan's currency, can be exported by residents of Kazakhstan (including foreigners) in amounts up to $3,000 without declaration and without written certification of the origin of funds. Residents exporting between $3,000 and $10,000 must complete a customs declaration and prove the origin of the funds (e.g. proof of locally-paid salary). Travelers visiting Kazakhstan for short periods of time may not leave the country with more currency than they declared when entering Kazakhstan. For legal requirements on the export of Tenge, travelers should consult with local Customs officials. In practice, however, travelers should be wary of such officials at the airport, as visitors have been erroneously charged duty on Tenge exports or asked to surrender Tenge in the past. It is advisable to contact the Embassy of the Republic of Kazakhstan in Washington, D.C. for specific information at 140116th Street NW, Washington, DC 20036, telephone (202) 232-5488. Please see our Customs Information.
Foreigners are required to carry a valid passport while in Kazakhstan. American citizens are strongly urged to have a certified copy of their U.S. passport made at the either the U.S. Embassy’s Consular Section in Astana or the Branch Office in Almaty. Having a certified copy in their possession satisfies the local requirement to carry a passport and reduces the chances of a passport being lost or stolen.
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 Kazakhstan’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Kazakhstan 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 Kazakhstan are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Kazakhstan. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy in Astana and the U.S. Embassy Branch Office in Almaty are 11 hours ahead of U.S. Eastern Standard Time. The U.S. Embassy in Astana is located at Akbulak-4, St. 22-23, Building 3, 010010, Astana, tel. 7-7172-70-21-00, fax 7-7172-70-22-80, e-mail USAKZ@state.gov, or web site at http://kazakhstan.usembassy.gov. The U.S. Embassy Branch Office in Almaty is located at 97 Zholdasbekov St., Samal-2, Almaty 050059, tel. 7-727- 250-49-00, 250-49-01, fax 7-727-250-48-84.
* * *
This replaces the Country Specific Information dated February 05, 2008 to update the sections on Entry/Exit Requirements, Crime, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Tue 17 Sep 2019, 10:07 AM
Source: AKIpress [edited]

A total of 4 shepherds were hospitalized with anthrax in Zhambyl region, Informbureau reports. The diagnosis was confirmed by laboratory examination. Patients came to the hospital with eruptions on their bodies.

"The patients work on one of the farms and have direct contact with animals. All of them were took part in the slaughtering of a cow, and 7-10 days after that they started complaining of these signs," said Gulfaira Mirzabekova, an employee of the Zhambyl regional infectious hospital. According to doctors, those infected sought medical aid in time. Anthrax just started damaging the organs. They will be treated for at least 10 days, they said.

Local authorities are not going to quarantine in the village of Shakpak, where the patients were infected. No anthrax cases were registered among cattle, they claim.
Date: Wed 19 Aug 2019, 12:48 PM
Source: Kazakh Telegraph Agency [edited]

A total of 4 anthrax cases have been confirmed in the Akmola region, reports the health care department. "Up to [now] 5 [suspected cases of] anthrax have been recorded; lab tests have confirmed 4. The cause of contamination was cow butchering without a veterinary certificate in a private yard," said the interlocutor.

"Epidemiological situation in the Akmola region and Nur-Sultan is stable," said the department. "The situation is being constantly monitored by the committee," said Ludmila Burabekova, chairfigure of the committee of quality control and goods safety. "Anti-epidemic and anti-epizootic arrangements have been organized in the area," she added.
*****************************
Date: Wed 19 Aug 2019, 12:04 PM GMT
Source: Radio Free Europe [edited]

A village near the Kazakh capital, Nur-Sultan, is under quarantine after lab tests confirmed anthrax infections in several people.

The Health Ministry said on [19 Aug 2019] that 5 residents of the village of Olginka, 100 km [about 62 mi] east of Nur-Sultan, have been hospitalized in recent days with anthrax symptoms, 4 of whom tested positive for _Bacillus anthracis_ -- the bacterium that causes the infectious disease. According to the statement, the situation in the village in the Aqmola region is under the control of the authorities and all necessary measures are being taken to prevent the possible spread of the disease.

In 2016, in nearby Qaraghandy Oblast, 2 people died as a result of anthrax infections.

According to the United States Centers for Disease Control and Prevention (CDC), domestic and wild animals -- such as cattle, sheep, goats, antelope, and deer -- can become infected by inhaling or ingesting spores in contaminated soil, plants, or water. CDC says all types of anthrax infections can cause death if they are not treated with antibiotics.
========================
[Olginka is in north-central Kazajhstan; see:

There is a measure of rural poverty in northern half of Kazakhstan, with the result that sick and moribund animals get butchered and eaten. Fortunately, as this village is within 100 Km [about 62 mi] of the Kazakh capital the affected have had the advantage of hospital care and proper laboratory confirmation. The coincident 5th person may have just shown a fever when the medical authorities were looking for clinical cases or it may be a false negative.

Folk have a habit of self-treating with antibiotics and this would have reduced the number of circulating vegetative cells available to testing. My friend Benyamin Cherkasskyi, the Soviet anthrax expert, used to tell me that only some 30%-40% of cutaneous cases would test positive. You have to know to insert your needle in under the lesion to draw out the fluid there which will contain cells, blood, and toxins. - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Date: Thu 27 Sep 2018
Source: Informburo.kz [in Russian, ProMED Mod.AS, edited]

The quarantine, introduced because of anthrax in the East Kazakhstan region, will be removed on [5 Oct 2018], said Tursyn Kabduldanov, deputy chairman of the Committee for Veterinary Control and Supervision of the Ministry of Agriculture of the Republic of Kazakhstan.  "In case of anthrax, quarantine lasts only 15 days. It is not foot and mouth disease, nor nodular dermatitis. Quarantine is removed after the last case of cattle [animal death in fact as cases are not always clear. - ProMED Mod.MHJ]. We conduct quarantine measures, forced vaccination, disinfection and removal quarantine. In East Kazakhstan, we will remove quarantine on [5 Oct 2018]," added Tursyn Kabduldanov at a briefing in the press centre of the Ministry of Agriculture of the Republic of Kazakhstan.

According to him, without the knowledge of the veterinarian, a 4 month old bull was killed [by the disease]. On the question of whether this case may affect the supply of beef to China, the deputy head of the committee responded that he "would not particularly be affected".  As of today [Thu 27 Sep 2018], 30 Kazakhstani enterprises have submitted applications for beef exports to the PRC. They will be able to supply products after the inspection of their Chinese colleagues, which will be held in late October [2018]. A spokesman for the Ministry of Agriculture Rak Saken Kalkamanov said that this case should not affect the issuance of permits to Kazakhstani enterprises for the export of meat, since the cattle are vaccinated and there is no threat of the spread of the disease.

On [24 Sep 2018], it was reported that a citizen who died of anthrax had been treated by a healer for a week and did not go to doctors. Moreover, he escaped from the infectious disease ward, after which he was returned to the district hospital by the police [and died]. The 47 year old, head of a peasant farm in Katon-Karagai district, ate some of the meat and left the house, selling the rest to the inhabitants of the village of Malonarymka. The 1st symptoms of the disease appeared on [12 Sep 2018].

On [21 Sep 2018], a man died in the infectious diseases hospital of Ust-Kamenogorsk. The source of infection was the burial site of livestock that died from anthrax in 1972, 5 km [about 3 mi] from the current place of slaughter of the sick young bull.  [byline: Baurzhan Mukanov]
=====================
[Unless someone had been digging at that old 1972 anthrax burial site, I very much doubt that it was in fact the source. The cumulative effects of daily temperature changes, dry spells and UV light is enough to decontaminate surface soils within at most 3 years. Spore survival is seen in deeply buried spores in alkaline soils. And anthrax in calves is rare as they are still suckling, even at 4 months, and learning to graze. And at that age he would not have been vaccinated. If I were to guess, this calf got infected as the result of a previous adult anthrax case but as it did not involve humans, it was unobserved and unreported. Only when a human got infected did the bureaucratic system kick into gear.

Katon-Karagai is the site of the previous report of a bovine case to OIE: 27 Sep 2018 Anthrax - Kazakhstan (02): (EK) bovine, OIE
http://promedmail.org/post/20180927.6056669.

To find Katon-Karagai either check the OIE report, where it is mapped, or go to

My thanks to my colleague Arnon for the translation. - ProMED Mod.MHJ]
Date: Thu 7 Jun 2018
Source: mz.gov [in Kazakh, machine trans., summ., edited]

Epidemiological situation on meningococcal infection:
Since the beginning of 2018, 59 cases of meningococcal infection have been registered in the Republic of Kazakhstan, including 21 cases among children under 14 years of age. 13 of them have died: Almaty -- 6 cases; in Almaty region -- 4 cases; in South Kazakhstan -- 2 cases; and in Kyzylorda region -- 1 case.

The situation is under the control of the Ministry of Health.
-----------------------------------
communicated by:
Irene Lai, MD
International SOS
Global Medical Director
Sydney, Australia
********************************
Date: Wed 6 Jun 2018
Source: mz.gov [in Kazakh, machine trans., summ., edited]

Epidemiological situation with meningococcal infection: In the Republic of Kazakhstan, 58 cases of meningococcal infection have been registered since the beginning of 2018, including 21 cases among children under 14 years of age. 13 of them have died: Almaty -- 6 cases; in Almaty region -- 4 cases; in South Kazakhstan -- 2 cases; and in Kyzylorda region -- 1 case.

In May [2018], in the Republic of Kazakhstan meningococcal infection morbidity has increased. From [30 Apr to 5 May 2018] cases have been registered in the cities of Almaty, Astana, and Almaty and Kyzylorda oblasts.

The greatest number of people infected with meningococcal infections [is] in Almaty. From [30 Apr to 5 May 2018], 92 people were diagnosed with meningitis, 44 of whom were diagnosed with other diseases, 32 were diagnosed with meningococcal infection, and 16 cases were undergoing laboratory tests. The frequency of morbidity in 2011 -- 44 cases; in 2012 -- 23 cases; in 2013 -- 49; in 2014 -- 36 cases; in 2015 -- 66 cases; and in 2016 -- 16 cases.

In order to stabilize the situation, the Ministry of Health has approved a comprehensive plan for preventive and anti-epidemic measures.
---------------------------------------------
communicated by:
Irene Lai, MD
International SOS
Global Medical Director
Sydney, Australia
===========================
[We are not told the meningococcal serogroup(s) identified for the 2018 cases or if there is an outbreak strain with same genotype. We are also not told whether there are any epidemiological linkages among the cases. More information on this outbreak from knowledgeable sources would be appreciated.

Descriptions of the public health response of Kazakhstan authorities can be found at the source URLs above [in Kazakh]. A discussion of meningococcal outbreak management can be found in my moderator comments in ProMED-mail post Meningitis, meningococcal - Fiji (02): fatal, children http://promedmail.org/post/20180409.5735431.

Kazakhstan is divided administratively into 14 regions and 3 cities: Almaty, the largest city in Kazakhstan, with a population of about 1.8 million residents (about 8 per cent of the country's total population), Astana (the capital), and Baikonur. The regions are further subdivided into districts. Almaty is located within the Almaty region in the south east of the country, and Astana is located within the Akmola region in the north central part of the country. A map of Kazakhstan that shows the administrative regions and cities can be seen at <https://en.wikipedia.org/wiki/Regions_of_Kazakhstan>.

A HealthMap/ProMED-mail map can be seen at
<http://healthmap.org/promed/p/56>. - ProMED Mod.ML]
Date: Tue 29 May 2018
Source: AKIpress [edited]

Eight people have died of meningococcal disease in Kazakhstan since the start of 2018, chief sanitary doctor Jandarbek Bekshin said.

62 meningococcal disease cases were registered in total, including 29 cases in Almaty, 4 cases in East Kazakhstan, South Kazakhstan regions and Astana each, and 3 cases in Almaty region, he said.

"Of the 8 lethal cases registered since start of the year [2018], 4 cases were registered in Almaty and 2 cases in Almaty region and South Kazakhstan region each," the chief sanitary doctor said.

The Public Health Department of Almaty has asked people to wear facemasks while visiting mosques amid the outbreak of meningococcal disease.

30 patients with confirmed meningococcal disease still remain in hospitals.

The Health Department has asked the public to refrain from visits to crowded places, sport events, and swimming pools.
=======================
[Kazakhstan is divided administratively into 14 regions and 3 cities: Almaty (the largest city in Kazakhstan, with a population of about 1.8 million residents), about 8% of the country's total population, Astana (the capital), and Baikonur (<https://en.wikipedia.org/wiki/Regions_of_Kazakhstan>). The regions are further subdivided into districts. Almaty is located within the Almaty Region in the southeast of the country, and Astana is located within the Akmola Region in the north-central part of the country. A map of Kazakhstan that shows the administrative regions and cities can be found at <https://en.wikipedia.org/wiki/Regions_of_Kazakhstan>.

According to another news report, about 1/3rd (21 cases) of the 62 cases of meningococcal disease reported in the 1st 5 months of 2018, including 3 of the 8 fatal cases, occurred in the month of May 2018 (<https://www.interfax.kz/?lang=eng&int_id=21&news_id=31438>). However, we are not told the frequency of meningococcal meningitis in Kazakhstan in prior years for comparison or whether the 2018 cases had the same meningococcal serogroup or the same genotype, which, if they do, would suggest a common source outbreak. We are also not told whether there are any epidemiological linkages among the cases. A discussion of meningococcal outbreak management can be found in my moderator comments in a prior ProMED-mail post: "Meningitis, meningococcal - Fiji (02): fatal, children  http://promedmail.org/post/20180409.5735431."

More information on this outbreak would be appreciated from knowledgeable sources. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
More ...

World Travel News Headlines

Date: Fri, 17 Jan 2020 17:48:09 +0100 (MET)

Barcelona, Jan 17, 2020 (AFP) - Spain's Balearic Islands passed a bill Friday aimed at clamping down on alcohol-fuelled holidays in the Mediterranean archipelago which bans happy hours when drinks are offered a discount and open bars.   "This is the first law adopted in Europe which restricts the sale and promotion of alcohol in certain touristic areas," the regional government of the Balearic Islands which have long been a magnet for young German and British tourists, who often drink heavily and enjoy rowdy late-night clubbing.

The restrictions will apply to three areas with a reputation for excess: San Antoni on the island of Ibiza and El Arenal and Magaluf -- which has been nicknamed "Shagaluf" because of its reputation for drunken casual sex -- on Mallorca, the largest of the Balearic's four islands.   The law, which was drawn up in consultation with the tourism industry also bans pub crawls and two-for-one drink offers, prohibits the sale of alcohol in shops between 9:30 pm and 8 am and forbids advertising party boats in the designated areas.   Establishments that break the new rules risk fines of up to 600,000 euros ($669,000) and the threat of being closed down for three years.

The new law also takes aim at the so-called "balconing" craze, the term given to holidaymakers who decide to jump into a swimming pool from a hotel or apartment balcony, a stunt which claims several lives every year.   It bans "balconing" across the entire archipelago and requires hotels to evict anyone who does it. Those caught jumping from balconies face fines of up to 60,000 euros ($67,000).   Up until now only some resorts on the Balearics imposed fines for "balconing".

The regional government of the Balearics said the law, which stiffens measures already introduced in 2015, will "fight excesses in certain tourist zones" and "force a real change in the tourism model of those destinations".   Magaluf made global headlines in 2014 after a video showing a young woman performing oral sex on several men on the dance floor of a nightclub went viral.   Local shops sell souvenir T-shirts with the catchphrase "On it 'till we vomit".

The four islands which make up the Balearics -- Palma de Mallorca, Ibiza, Menorca and Formentera, received nearly fourteen million tourists in 2018, drawn by their crystal clear waters, and in many cases by all-inconclusive package holidays.   The archipelago is Spain's second most visited region. Spain is the world's second most visited country after France.
Date: Fri, 17 Jan 2020 12:55:16 +0100 (MET)

Rennes, France, Jan 17, 2020 (AFP) - Several oyster farmers along France's Atlantic and Mediterranean coasts have been forced to halt sales since December after their sites were contaminated by the highly contagious norovirus, which they blame on overflowing sewage treatment plants.   Authorities ordered the suspensions at 23 of the country's 375 designated fields, and recalls of affected oysters as well as mussels and clams, after tests revealed the virus, which can cause severe vomiting and diarrhoea.

The move came just before the year-end holidays, when oysters are a traditional delicacy on millions of French tables.   "The oysters are not sick. They're carrying the virus because it's in the water they are constantly filtering," Philippe Le Gal, president of France's national shellfish council (CNC), told AFP this week.   "They were in the wrong place at the wrong time," he said, adding the ban had prompted many people to stop eating oysters altogether.   Local officials say oyster farmers are paying the price of insufficient spending on wastewater treatment, with facilities strained to the limit even as development of coastal areas has surged in recent years.

Heavy rains before Christmas prompted treatment basins to overflow, they say, spilling tainted water into rivers.   "This was predictable -- they've kept issuing building permits even though treatment sites are already at full capacity," said Joel Labbe, a senator for the Morbihan region in Brittany.   Oyster farmers are demanding compensation, and a delegation met with agriculture ministry officials in Paris last week warning that more than 400 businesses had been impacted by the sales ban.

This week, angry growers dumped trash bins full of oysters and mussels in front of the offices of the regional ARS health authority in Montpellier over the decision to halt sales from a nearby basin on the Mediterranean coast.   "We're the victims, and we shouldn't have to suffer any financial damages," Le Gal said.
Date: Fri, 17 Jan 2020 04:44:41 +0100 (MET)

Suva, Fiji, Jan 17, 2020 (AFP) - Fiji opened evacuation centres and warned of "destructive force winds" Friday as a cyclone bore down on the Pacific island nation for the second time in three weeks.   Two people were missing after attempting to swim across a swollen river late Thursday when heavy rain fell ahead of the advancing Cyclone Tino, police said.   On the outer islands, locals prepared to go to emergency shelters while many tourists fled beach resorts and made their way to the capital Suva before regional flights and inter-island ferry services were suspended.

The Fiji Meteorological Service said Tino was strengthening as it headed for Fiji's second-largest island, Vanua Levu, warning of wind gusts of up to 130 kilometres per hour (80 mph), heavy rain, coastal flooding and flash flooding in low lying areas.    "I'm preparing to go to an evacuation centre soon with my family and wait for the cyclone to pass," Nischal Prasad, who lost his home in northern Vanua Legu when Cyclone Sarai struck just after Christmas, told AFP.   "Sarai destroyed my house and almost left my family homeless. My daughters had to hide under their bed from the strong winds. It was a scary experience," he said.

Russian tourist Inna Kostromina, 35, said she sought safety in Suva after being told her island resort was in the path of the cyclone.   "We didn't want to get stuck in there and with the authorities warning of coastal flooding, anything can happen. So we decided to move to Suva for now. I think we will be much safer here."    Police said a man and his daughter, believed to be aged nine or 10, were attempting to swim across a flooded river when they were caught in the strong currents.    The incident happened on Thursday before the storm developed into a tropical cyclone, but a police spokesman linked the tragedy to "heavy rain brought about by the current weather system (which) raised the river level".   Although the Pacific islands are popular tourist destinations in summer it is also the cyclone season, and Fiji is being targeted for the second time in three weeks.

In late December, Tropical Cyclone Sarai left two people dead and more than 2,500 needing emergency shelter as it damaged houses, crops and trees and cut electricity supplies.    On its present track, Tino would hit Tongatapu, the main island of neighbouring Tonga, on the weekend.    Two years ago, Tongatapu was hit by Cyclone Gina, with two people killed and nearly 200 houses destroyed.
Date: Thu, 16 Jan 2020 16:38:39 +0100 (MET)
By Hiroshi HIYAMA

Tokyo, Jan 16, 2020 (AFP) - Japan has confirmed a case of a mystery virus that first emerged in China and is from the same family as the deadly SARS pathogen, authorities said Thursday.   It appears to be only the second time the novel coronavirus has been detected outside China, after the World Health Organization (WHO) confirmed a case in Thailand.   Japan's health ministry said a man who had visited the central Chinese city of Wuhan, the apparent epicentre of the outbreak, was hospitalised on January 10, four days after his return to Japan. He reported a persistent fever.

Tests on the patient, who was released from hospital on Wednesday, confirmed he was infected with the new virus.   "This is the first domestic discovery of a pneumonia case related to the new coronavirus," the ministry said in a statement.   "We will continue active epidemiological research while also coordinating efforts with the World Health Organization and related agencies to conduct a risk assessment."   The outbreak has killed one person so far, with 41 patients reported in Wuhan.

The outbreak has caused alarm because the new virus is from the same family as the pathogen that causes SARS (Severe Acute Respiratory Syndrome), which killed 349 people in mainland China and 299 in Hong Kong in 2002 and 2003.   Authorities in Wuhan said a seafood market was the centre of the outbreak. It was closed on January 1.   Japanese authorities said the man had not visited the market and that it was possible he had been in contact with a person infected with the virus while in Wuhan.

- Outbreak in Japan 'unlikely' -
Health ministry official Eiji Hinoshita told reporters that the risk of the disease spreading from the patient was considered low, with careful checks done on those who had been in close contact with him.   "At this point, we feel it is unlikely this will lead to a dramatic outbreak," he said, adding that the patient was no longer suffering a fever and was recuperating at home.

Officials declined to give further information on the man, including his nationality, citing privacy concerns.   Local media said the patient was a Chinese national in his 30s living in Kanagawa, just southwest of Tokyo.   Public broadcaster NHK said he had already recovered and was resting at home, as quarantine officials at Tokyo's Narita airport boosted health checks on all travellers.

The health ministry urged people who develop a cough or fever after visiting Wuhan to wear a surgical mask and "swiftly visit a medical institution".   Hinoshita said Japan would need to be on guard ahead of the Lunar New Year, a popular travel period in China.   "It is expected that Japan will see many visitors from China," he said.   It is not yet clear whether the mystery virus can be transmitted between humans, but on Wednesday authorities said it was possible it had spread inside a family.

The woman diagnosed in Thailand, who is in a stable condition, also said she had not visited the Wuhan seafood market.   And WHO doctor Maria Van Kerkhove on Tuesday said she "wouldn't be surprised if there was some limited human-to-human transmission, especially among families who have close contact with one another".   Hong Kong authorities on Tuesday said several dozen people had been hospitalised with fever or respiratory symptoms after travelling to Wuhan, but no cases of the new virus have so far been confirmed.
Date: 20 Jan 2020
Source: News Joins [In Korean, machine trans. edited]
----------------------------
An unexplained pneumonia in China caused the Korean quarantine authorities to strengthen the quarantine, and a fever-sensing camera is installed to monitor the body temperature of Chinese tourists who entered Korea at Incheon Port 1 International Passenger Terminal. 

Pneumonia confirmed by the new coronavirus, which is prevalent in Wuhan, China, was confirmed for the first time on [20 Jan 2020]. According to health officials, a Chinese woman, A, who arrived at Incheon International Airport on a plane from Wuhan last weekend, was confirmed with pneumonia. The patient showed signs of pneumonia, including high fever and cough. The health authorities entered the airport at the same time, confirmed the symptoms of high fever, suspected pneumonia, and went into quarantine and testing. The Centers for Disease Control immediately quarantined A and entered treatment with a nationally designated quarantine bed. The Centers for Disease Control will hold an emergency press conference at 1:30 pm on [20 Jan 2020] and release the reporter A.
 
Meanwhile, Beijing's Daxing District Health and Welfare Committee said 2 fever patients who had been to Wuhan were confirmed as a new pneumonia patient on [19 Jan 2020]. They are currently being treated at a designated hospital and said they are stable. Daxing District is where Beijing New Airport opened last year [2019]. The Guangdong Provincial Health and Welfare Committee said on [19 Jan 2020] that a 66-year-old man who had visited a relative's home in Wuhan showed fever and lethargy and was diagnosed with Wuhan pneumonia. Confirmation patients have also emerged in Shenzhen, a neighbouring Hong Kong province in southern China, raising concerns that the new pneumonia has already spread throughout China.
 
The Chinese government has said that "there is no basis for human-to-human propagation," but domestic experts pointed out that "the nature of coronavirus is less likely to prevent human-to-human propagation."   [Byline: Esther Toile]
========================
[This is now the 4th international identification of the 2019-nCoV (novel coronavirus) associated illness reported outside of China.  To date, all 4 cases have reported being in Wuhan China in the 14 days preceding onset of illness.  Illness in each involved a history of fever and dry cough.  Cases were reported by Thailand (2 cases) and Japan, and now South Korea.  An update following a Ministry of Health Korea press conference mentioned that there were 5 individuals accompanying this woman, none of whom were currently showing symptoms. (<http://news1.kr/articles/?3821049>).

As mentioned in an earlier post (see Novel coronavirus (10): China (HU, GD, BJ) http://promedmail.org/post/20200119.6898567), there have also been cases confirmed in China outside of Wuhan City, with cases reported in Beijing, Guangdong and possibly Shanghai. It is becoming more difficult to conclude that there has been limited person-to-person transmission as the case numbers are climbing both inside of Wuhan City, elsewhere in China, and in individuals travelling from Wuhan China to other countries (Japan, Thailand and South Korea).

A map of South Korea can be found at:
Date: 15 Jan 2020
Source: Fox News [edited]

CDC is facing criticism over its response to a polio-like illness. The Centers for Disease Control and Prevention has confirmed 10 additional cases of acute flaccid myelitis.  An Ohio teen is determined to walk again despite doctors' warnings that she may not after she contracted a rare polio-like illness that's left her paralyzed from the waist down.  IK, a catcher on her middle school's softball team, said it started with what felt like a cramp in her leg on Christmas. "I just thought, 'Oh gosh, it's just growing pains or a Charley horse,'" NK, the 13-year-old's mother, told News 5 Cleveland.  But the next day, IK couldn't stand on her own, and her worried parents rushed her to Akron Children's Hospital, where she was diagnosed with acute flaccid myelitis (AFM). It's a rare but serious condition that affects the nervous system, specifically the grey matter of the spinal cord, which weakens the body's muscles and reflexes.

Health officials have noticed an increase of cases in children occurring every 2 years since 2014, according to the Centers for Disease Control and Prevention (CDC). And while it often is referred to as a "polio-like" illness, tests so far have tested negative for poliovirus.  Symptoms typically begin with sudden onset of arm or leg weakness and loss of muscle tone and reflexes, but can also include facial droop or weakness, difficulty moving eyes, drooping eyelids, difficulty swallowing,  slurred speech, and pain in the arms and legs.  Severe symptoms may include respiratory failure, or serious neurological complications, according to the CDC. Parents are encouraged to seek medical care right away if a child is suspected of developing any symptoms

Since her diagnosis, IK has been working in physical therapy and has received steroid treatments as well as multiple plasma exchange, according to the news outlet. Her mother said it's been like "a bad dream" for the family as they watch her struggle to gain strength.  "It's a lot, but I just try to go with the flow, just to push through," IK, who has received support from her teammates, classmates and members of the community, told News 5 Cleveland.  [Byline: Alexandria Hein]
======================
[Acute flaccid myelitis (AFM) is a rare but serious condition. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak.

In 2019, there were 33 total confirmed cases in 16 US states
[<https://www.cdc.gov/acute-flaccid-myelitis/cases-in-us.html>].

The case definition for AFM is based on clinical and lab criteria

Clinical Criteria: An illness with onset of acute flaccid limb weakness.
Laboratory Criteria:
Confirmatory Laboratory Evidence: a magnetic resonance image (MRI) showing spinal cord lesion largely restricted to grey matter and spanning one or more vertebral segments. Supportive Laboratory Evidence: cerebrospinal fluid (CSF) with pleocytosis (white blood cell count over 5 cells/mm3) Case Classification:
- Confirmed: Clinically compatible case AND Confirmatory laboratory evidence: MRI showing spinal cord lesion largely restricted to grey matter and spanning one or more spinal segments.
- Probable: Clinically compatible case AND Supportive laboratory evidence: CSF showing pleocytosis (white blood cell count over 5 cells/mm3)

With the high number of cases reported in 2018 and 2019, CDC enhanced AFM surveillance through collection of data at the national level by encouraging healthcare providers to recognize and report to their health departments all patients whom they suspect may have AFM; health departments are being asked to send this information to CDC to help us understand AFM activity nationwide. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Date: Sat 18 Jan 2020
From: Guido Calleri <guidocalleri@aslcittaditorino.it> [edited]

90 persons presented to the Infectious Diseases Hospital Amedeo di Savoia, Torino, North-West Italy between 24 Dec 2019 and 10 Jan 2020 after consuming raw sausages from a wild boar hunted in the area of Susa Valley, 50 km [31.1 mi] away from Torino, in late November 2019.

All of them either were symptomatic (fever, muscle and/or abdominal pain, nausea) or had peripheral blood eosinophilia over 500/cmm, or both. IgG serology for trichinella was performed by immunoblot (Trichinella E/S IgG kit, EFFEGIEMME, Milan, Italy) and resulted positive in 48/90 (53.3%), allowing a diagnosis of confirmed trichinella infection.

Otherwise, a diagnosis of suspected trichinella infection was made with a negative serology, probably due to performing the test too early, before the development of antibodies or possibly a false negative result. In a few cases (under 10 cases) an alternative diagnosis was considered.

All patients were treated with oral albendazole 400 mg twice daily for 10 days and prednisone 50 mg/day.

Most likely, all patients were infected after eating meat from a single animal, given the low prevalence of the infection in this area: no human case has ever been detected in Torino province, and only one wild boar has been found positive for trichinella at microscopy in Susa valley in the last 10 years.
---------------------------------------
Guido Calleri, Filippo Lipani, Giovanna Paltrinieri, Silvia Faraoni,
Valeria Ghisetti
ASL Citta di Torino, Infectious Diseases Unit and Microbiology Lab,
and ASL TO3,
Department of Prevention
Torino, Piedmonte, Italy
======================
[ProMED thanks Guido Calleri, Filippo Lipani, Giovanna Paltrinieri, Silvia Faraoni, and Valeria Ghisetti for sending us this information. The report underlines that _Trichinella_ are found in wild boars in Europe and should be assessed by a certified laboratory for _Trichinella_ before used for human consumption. Sausages made of smoked meat are especially dangerous, because the temperatures seldom reach what is needed to kill the trichinella larvae. - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Date: Fri 17 Jan 2020
Source: Outbreak News Today [edited]

Media sources in Bangladesh are reporting a Nipah virus infection in the city of Khulna. The reported case is a 20-year-old female who has been hospitalized since last Saturday [11 Jan 2020] at the Khulna Medical College Hospital (KMCH).

"A medical board has confirmed her infection by Nipah virus. As her infection is a risk to other patients, she is being treated separately at the hospital's Medicine unit 1," said SM Kamal Hossain, chief of KMCH Medicine Department.

According to the World Health Organization (WHO), in the Bangladesh and India outbreaks, consumption of fruits or fruit products (e.g. raw date palm juice) contaminated with urine or saliva from infected fruit bats was the most likely source of infection. Fruit bats of the family Pteropodidae -- particularly species belonging to the _Pteropus_ genus -- are the natural hosts for Nipah virus. There is no apparent disease in fruit bats.

In more recent outbreaks of the disease, person-to-person transmission has been seen in Bangladesh and India.

The disease in humans can range from asymptomatic infection to fatal encephalitis. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours.

The case fatality rate is estimated at 40% to 75%; however, this rate can vary by outbreak depending on local capabilities for surveillance investigations, according to the WHO.

Those who survive acute encephalitis make a full recovery, but around 20% are left with residual neurological consequences, such as persistent convulsions and personality changes.

There is no treatment or vaccine available for either people or animals.
======================
[Nipah virus infections occur sporadically in Bangladesh in a geographic area termed the Nipah belt and during certain seasons of the year when the reservoir fruit bat is abundant. As noted in the previous comment (ProMED-mail archive no. http://promedmail.org/post/20150204.3143251), giant fruit bats or flying foxes (_Pteropus_ of several species) are reservoirs of Nipah virus, and they contaminate date palm sap or fruit. This is the season for cases of Nipah virus infection to occur. The transmission season is usually January to April.

As noted earlier, it is unfortunate that the public awareness efforts have not prevented these cases from occurring. Perhaps because cases are sporadic and geographically scattered there is little public perception of risk of infection and serious disease. Until effective public education to prevent infection by avoiding eating contaminated fruit or date palm sap is implemented, sporadic cases will continue to occur.

Interestingly, a simple skirt constructed out of locally available materials can prevent access of the bats to the palm sap collecting pots, but apparently they are not commonly used. Boiling the palm sap would inactivate the virus, but local consumers indicated that it alters the flavour of the sap.

An image of a _Pteropus_ fruit bat can be found at

[HealthMap/ProMED map available at:
Khulna, Khulna, Bangladesh: <http://healthmap.org/promed/p/14886>]
Date: Wed 15 Jan 2020
Source: Hindustan Times [edited]

Government High School, Tajpur village, has been put under surveillance after 16 students of the school were found to be infected with mumps, a viral infection that swells up the saliva-producing glands of a person.

A rapid response team had been dispatched to the school last week, after the students, all aged between 11 and 14, were found infected. The school currently has 106 students [enrolled], and all are under observation. The team had also surveyed the entire village and collected samples, to be sent to the Integrated Diseases Surveillance Program (IDSP) lab for testing.

Lack of measles, mumps, and rubella [MMR] vaccination is what leaves a person prone to the infection. Mumps virus spreads from person to person through infected saliva. If an individual is not immune, they can contract the viral by breathing in saliva droplets from an infected person.

Dr. Divjot Singh, epidemiologist, district health department, said the situation is now under control. "We have asked the school's principal to relieve all students infected with mumps. The school will remain under surveillance for 15 more days. Medical officers are also carrying out awareness drive at the school and the village against mumps," said Dr. Divjot Singh.

Last year [2019], a mumps outbreak was reported from 2 areas of the district, including Andlu village in Raikot and Red Cross Bhavan, Sarabha Nagar, Ludhiana.  [Byline: Harvinder Kaur]
Date: Wed 15 Jan 2020
Source: Devon Live [abridged, edited]

An outbreak of 19 new cases of mumps has been reported across Devon in the last week. The contagious viral disease particularly affects under 25s. The new mumps figures have been released in the official Government weekly Statutory Notifications of Infectious Diseases report, with the highest number in Exeter.

It follows a warning that mumps is on the rise, particularly in university towns. Traditionally known as the "kissing disease" because it spreads fast between groups of young people, mumps is a contagious viral infection recognisable by the painful swellings in the side of the face under the ears (the parotid glands), giving a person a distinctive "hamster face" appearance.

In severe cases, it can develop into viral meningitis if it moves in the outer layer of the brain. Other complications include swelling of the testicles or ovaries (if the affected person has gone through puberty), which may affect a person's fertility.  [Byline: Colleen Smith]