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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Benin - US Consular Information Sheet
April 28, 2008

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Suriname - US Consular Information Sheet
December 19, 2008
COUNTRY DESCRIPTION:
The Republic of Suriname is a developing nation located on the northern coast of South America. Tourist facilities are widely available in the capital city of
aramaribo; they are less developed and in some cases non-existent in the country's rugged jungle interior. English is widely used, and most tourist arrangements can be made in English. Please read the Department of State Background Notes on Suriname for additional information.

ENTRY/EXIT REQUIREMENTS: A passport, valid visa, and, if traveling by air, return ticket are required for travel to Suriname. There is a processing fee for business and tourist visas, and visas must be obtained before arrival in Suriname. A business visa requires a letter from the sponsoring company detailing the reason for the visit. There is an airport departure charge and a terminal fee, normally included in the price of airfare. Travelers arriving from Guyana, French Guiana, and Brazil are required to show proof of a yellow fever vaccination. For further information, travelers can contact the Embassy of the Republic of Suriname, 4301 Connecticut Avenue, NW, Suite 460, Washington, DC 20008, telephone (202) 244-7488, email: embsur@erols.com, or the Consulate of Suriname in Miami, 7235 NW 19th Street, Suite A, Miami, Fl 33126, telephone (305) 593-2697.
Visit the Embassy of Suriname web site at www.surinameembassy.org for the most current visa information.

Important information for foreigners who have the intention of staying longer than three months:
s of October 1, 2008, persons who intend to stay longer than three months in Suriname must apply for an Authorization for Temporary Stay (MVK) before travel to Suriname. The above implies that foreigners who need a visa (with the exception of foreigners of Surinamese origin) who have traveled to Suriname on a tourist or business visa will not be able to apply for residence during their stay in Suriname.

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

SAFETY AND SECURITY:
Demonstrations do occur, primarily in the capital or second cities, and are usually peaceful, but American citizens traveling to or residing in Suriname should take common-sense precautions and avoid large gatherings or other events where crowds have congregated to demonstrate or protest. Travelers proceeding to the interior may encounter difficulties due to limited government authority. Limited transportation and communications may hamper the ability of the U.S. Embassy to assist in an emergency situation.

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

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

CRIME:
Criminal activity throughout the country is on the rise and foreigners, including Americans, may be viewed as targets of opportunity. Burglary, armed robbery, and violent crime occur with some frequency in Paramaribo and in outlying areas. Pick-pocketing and robbery are increasingly common in the major business and shopping districts of the capital. Visitors should avoid wearing expensive or flashy jewelry or displaying large amounts of money in public.
There have been several reports of criminal incidents in the vicinity of the major tourist hotels and night walks outside the immediate vicinity of the hotels are therefore to be avoided.
Visitors should avoid the Palm Garden area (“Palmentuin” in Dutch) after dark, as there is no police presence and it is commonly the site of criminal activity.

Theft from vehicles is infrequent, but it does occur, especially in areas near the business district. Drivers are cautioned not to leave packages and other belongings in plain view in their vehicles. There have been reports of carjackings within Paramaribo, particularly in residential areas. When driving, car windows should be closed and doors locked. The use of public minibuses is discouraged, due to widespread unsafe driving and poor maintenance.
Travel to the interior is usually trouble-free, but there have been reports of tourists being robbed. Police presence outside Paramaribo is minimal, and banditry and lawlessness are occasionally of concern in the cities of Albina and Moengo and the district of Brokopondo, as well as along the East-West Highway between Paramaribo and Albina and the Afobakka Highway in the district of Para. There have been reports of attempted and actual carjackings committed by gangs of men along the East-West Highway. Travelers proceeding to the interior are advised to make use of well-established tour companies for a safer experience.

The emergency number 115 is used for police, fire, and rescue and normally does not provide English-language services.
Fire and rescue services provide a relatively timely response, but police response, especially during nighttime hours, is a rarity for all but the most serious of crimes.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime are solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care, including emergency medical care, is limited and does not meet U.S. standards. There is one public emergency room in Paramaribo with only a small ambulance fleet providing emergency transport with limited first response capabilities. The emergency room has no neurosurgeon, and other medical specialists may not always be available. As a rule, hospital facilities are not air-conditioned, although private rooms with individual air-conditioning are available at extra cost and on a space-available basis. Emergency medical care outside Paramaribo is limited and is virtually non-existent in the interior of the country.

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

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Suriname is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Traffic moves on the left in Suriname; left-hand-drive cars are allowed on the road. Excessive speed, unpredictable movements by vehicles, and motorcyclists/bicycles, unusual right of way patterns, poorly maintained roads, and a lack of basic safety equipment on many vehicles are daily hazards on Surinamese roads. As of January 2007, seatbelts are required for all passengers of automobiles, and drivers must use a hands-free device if using a mobile phone while driving. Visitors are encouraged to use automobiles equipped with seat belts and to avoid the use of motorcycles or scooters. An international driver's license is necessary to rent a car.
The major roads in Paramaribo are usually paved, but not always well maintained. Large potholes are common on city streets, especially during the rainy seasons, which last from approximately mid-November to January, and from April to July (rainy seasons can differ from year to year by as much as six weeks). Roads are often not marked with traffic lines. Many main thoroughfares do not have sidewalks, forcing pedestrians, motorcycles, and bicycle traffic to share the same space.
The East-West Highway, a paved road that stretches from Nieuw Nickerie in the west to Albina in the east, runs through extensive agriculture areas; it is not uncommon to encounter slow-moving farm traffic or animals on the road. Travelers should exercise caution when driving to and from Nieuw Nickerie at night due to poor lighting and sharp road turns without adequate warning signs.
There are few service stations along the road, and western style rest stops are non-existent.
The road is not always well maintained, and during the rainy season, large, sometimes impassable, sink holes develop along the road.
Police recommend that travelers check with the police station in Albina for the latest safety information regarding travel between Paramaribo and Albina.
Roads in the interior are sporadically maintained dirt roads that pass through rugged, sparsely populated rain forest. Some roads are passable for sedans in the dry season, but they deteriorate rapidly during the rainy season. Interior roads are not lit, nor are there service stations or emergency call boxes. Bridges in the interior are in various states of repair. Travelers are advised to consult with local sources, including The Foundation for Nature Conservation in Suriname, or STINASU, at telephone (597) 421-683 or 476-579, or with their hotels regarding interior road conditions before proceeding.

For specific information concerning Suriname driving permits, vehicle inspection, road tax, and mandatory insurance, please contact the Embassy of Suriname in Washington, D.C., or the Consulate of Suriname in Miami.
Please refer to our Road Safety page for more information.
Visit the website of the country’s national tourist office and national authority responsible for road safety at http://www.suriname-tourism.org/cms/
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Suriname’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Suriname’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:
Credit cards are not widely accepted outside the major hotels and upscale restaurants. Travelers should contact their intended hotel or tour company to confirm that credit cards are accepted. Currently, only one bank, Royal Bank of Trinidad and Tobago (RBTT), has Automatic Teller Machines (ATMs) accepting foreign ATM cards. In order to withdraw money from the ATM machines of other banks, you must have a local Surinamese bank account and ATM card. Visitors can exchange currency at banks, hotels, and official exchange houses, which are called “cambios.” Exchanging money outside these locations is illegal and can be dangerous. Telephone service within Suriname can be problematic, especially during periods of heavy rains. 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 Surinamese laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Suriname 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 residing or traveling in Suriname 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 Suriname.
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 Dr. Sophie Redmondstraat 129, telephone (011) (597) 472-900, web site http://suriname.usembassy.gov. The Consular Section hours of operation for routine American citizen services are Mondays and Wednesdays from 8:00 to 10:00 AM, or by appointment, except on American and Surinamese holidays. U.S. citizens requiring emergency assistance on evenings, weekends, and holidays may contact an Embassy duty officer by cell phone at (011) (597) 088-08302. The U.S. Embassy in Paramaribo also provides consular services for French Guiana.
* * *
This replaces the Country Specific Information for Suriname dated April 11, 2008, to update the sections on Entry/Exit Requirements, Crime, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Tue 28 Mar 2017
Source: WHO Disease Outbreak News [edited]

On Thu 9 March 2017, the National Institute for Public Health and the Environment (RIVM) in the Netherlands reported a case of yellow fever to WHO. The patient is a Dutch adult female traveller who visited Suriname from the middle of February until early March 2017. She was not vaccinated against yellow fever.

The case was confirmed for yellow fever in the Netherlands by RT-PCR in 2 serum samples taken with an interval of 3 days at the Erasmus University Medical Center (Erasmus MC), Rotterdam. The presence of yellow fever virus was confirmed on Thu 9 Mar 2017 by PCR and sequencing at Erasmus MC, and by PCR on a different target at the Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.

While in Suriname, the patient spent nights in Paramaribo and visited places around Paramaribo, including the districts of Commewijne (Frederiksdorp and Peperpot) and Brokopondo (Brownsberg), the latter is considered to be the most probable place of infection. She experienced onset of symptoms (headache and high fever) on Tue 28 Feb 2017 and was admitted to an intensive care unit (University Medical Center) in the Netherlands on Fri 3 Mar 2017 with liver failure. The patient is currently in critical condition.

Suriname is considered an area at risk for yellow fever and requires a yellow fever vaccination certificate at entry for travellers over one year of age arriving from countries with risk of yellow fever, according to the WHO list of countries with risk of yellow fever transmission; WHO also recommends yellow fever vaccination to all travellers aged 9 months and older. This is the 1st reported case of yellow fever in Suriname since 1972.

Public health response

This report of a yellow fever case in the Netherlands with travel history to Suriname has triggered further investigations. Following this event, health authorities in Suriname have implemented several measures to investigate and respond to a potential outbreak in their country, including:
 - Enhancing vaccination activity to increase vaccination coverage among residents. Suriname will continue with its national vaccination programme and will focus on the district of Brokopondo. A catch-up vaccination campaign is also being conducted to increase coverage in Brownsweg.
 - Enhancing epidemiologic and entomologic surveillance including strengthening laboratory capacity.
 - Implementing vector control activities in the district Brokopondo.
 - Carrying out a survey of dead monkeys in the suspected areas.
 - Conducting social mobilization to eliminate _Aedes aegypti_ breeding sites (e.g. by covering water containers/ barrels).
 - Issuing a press release to alert the public.
 - Mapping of the suspect area of Brownsweg, as well as the Peperpot Resort.
================
[This case would suggest local transmission of yellow fever in Suriname which isn't surprising given the on-going outbreak in Brazil. This case would also suggest travelers to the area consider getting vaccinated for yellow fever prior to entering the country. One wonders if perhaps the local wildlife may be acting as a reservoir as well based on the outbreaks seen in monkeys in Brazil. - ProMED Mod.JH]

[A HealthMap/ProMED-mail map can be accessed at:
Eurosurveillance, Volume 22, Issue 11, 16 March 2017
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22744

A Dutch traveller returning from Suriname in early March 2017, presented with fever and severe acute liver injury. Yellow fever was diagnosed by (q)RT-PCR and sequencing. During hospital stay, the patient’s condition deteriorated and she developed hepatic encephalopathy requiring transfer to the intensive care. Although yellow fever has not been reported in the last four decades in Suriname, vaccination is recommended by the World Health Organization for visitors to this country.

Yellow fever virus (YFV) is known to be enzootic in South America, causing periodic outbreaks of disease in monkeys and humans in some countries. In Brazil, there has been an outbreak of yellow fever ongoing since December 2016 with 1,500 cases as at 9 March [1,2]. Here we report an imported case of human infection with YFV in a traveller returning from Suriname, on the north-eastern coast of South America, from where the last case of yellow fever was reported 45 years ago.

Case description

In March 2017, a Dutch Caucasian female in her late 20s from the Netherlands was referred to the University Medical Center Groningen in the Netherlands because of high fever and signs of severe acute liver injury after returning from a two-week stay in Suriname. She had no co-morbidities apart from obesity (body mass index around 40 kg/m2, norm: 18.5–25 kg/m2). During her visit she stayed in the capital of Suriname, Paramaribo, and she made several daytrips by boat and car, of which two in the tropical rainforest (Figure).

Figure

Timeline of events and diagnostic results, case of yellow fever in a traveller returning from Suriname to the Netherlands, March 2017

/images/dynamic/articles/22744/17-00187-f1

P: Paramaribo; RNA: ribonucleic acid; UMCG: University Medical Center Groningen; YFV: yellow fever virus.

She recalled having been bitten by mosquitoes during her hike at Brownsberg, a nature resort in the rainforest with wildlife. Before her travel, she did not visit a travel clinic and did not receive yellow fever vaccination. On day 12 of her visit in Suriname, she experienced mild muscle pain, headache and nausea and she developed a high-grade fever. She returned to the Netherlands on day 15 and visited the emergency department of a secondary care centre, from where she was referred to our University hospital. At physical examination she was not icteric. Except for a temperature of 39.9 °C, vital parameters were normal. The results of the remaining physical examination were unremarkable. Laboratory testing revealed leukopenia (leukocytes 0.9x109/L, norm: 4.0–10.0x109/L) and massive liver injury (aspartate aminotransferase 5,787 U/L, norm: <31 U/L; alanine aminotransferase 4,910 U/L, norm: <34 U/L), with mildly elevated bilirubin levels (total bilirubin 20 µmol/L, norm: <17 µmol/L). Liver synthesis was impaired as revealed by increased clotting times (activated partial thromboplastin time (APTT): 49s, norm: 23–33s; prothrombin time (PT): 26.6s, norm: 9.0–12.0s) and reduced antithrombin (49%, norm: 80–120%). Fibrinogen was diminished suggestive of diffuse intravascular coagulation. Renal function was normal apart from severe albuminuria (up to 22.6 g/24h, norm: 0g/24h). Malaria, viral hepatitis (A, B, C, E, Epstein Barr virus, cytomegalovirus, herpes simplex virus), dengue, chikungunya and Zika were ruled out (Table). Diagnostic tests to exclude leptospirosis performed on day 6 post onset of symptoms (dps 6) were inconclusive (Table) and a convalescent serum was going to be tested at the time of publication. Because of the combination of fever, leukopenia, thrombocytopenia, liver injury and travel history, yellow fever was included in the differential diagnosis. Real-time reverse transcriptase PCR (qRT-PCR) was positive for YFV in serum taken on dps 3. On dps 7 the patient’s condition deteriorated due to hepatic encephalopathy (ammonia 149 µmol/L, norm: 15–45 µmol/L). Cerebral oedema and bleeding was ruled out by computed tomography (CT)-scan. The patient was transferred to the intensive care unit for close observation of vital parameters. Vitamin K was administered. Hepatic encephalopathy was treated with rifaximin and lactulose. Ceftriaxone (2g per day intravenously) was given for 7 days as antibiotic prophylaxis. Consequently, possible leptospirosis was also treated. Her neurological condition stabilised on dps 10 together with the coagulation parameters. On dps 13 the patient was transferred back to the ward.

Table

Pathogens for which laboratory tests were performed, yellow fever case, the Netherlands, March 2017


Pathogen Blood (day 3 post onset of symptoms)
Plasmodium spp. Thick smear negative, antigen test negative
Hepatitis A virus IgM and IgG negative
Hepatitis B virus Serological screening negative
Hepatitis C virus Serological screening negative
Hepatitis E virus PCR negative
Epstein Barr virus IgM and IgG negative
Cytomegalovirus IgM and IgG negative
Herpes simplex virus type 1 and 2 PCR negative
Dengue virus PCR negative, IgM and IgG negative
Chikungunya virus PCR negative, IgM and IgG negative
Zika virus PCR negative, IgM and IgG negativea
Leptospira spp. PCR negative, microscopic agglutination test negative, IgM 1:80b

a Performed on day 5 post onset of symptoms (dps 5).

b ELISA (in-house ELISA Dutch Leptospirosis Reference Center) performed on dps 6 showed IgM 1:80 (cut-off positive IgM ≥1:160). IgM results were negative on dps 3 and dps 7 using Leptocheck-WB (Zephyr Biomedicals, Goa, India).

Virology findings

qRT-PCR and/or pan-flavivirus RT-PCR on blood samples on dps 3 did not detect chikungunya virus (CHIKV), dengue virus (DENV), or Zika virus (ZIKV) (Table) [3,4]. In four consecutive samples of dps 3–6, YFV-RNA was detected (Figure) [4-6], with increasing Ct values (from 23 to 31 from dps 3 to dps 5 [5] and 39 on dps 6 [6]). Sequencing of a 176 bp pan-flavivirus hemi-nested RT-PCR product, targeting part of the NS5 genomic region confirmed YFV infection [4]. The sequence was deposited in the GenBank database under the following accession number: KY774973.

On dps 3, indirect immunofluorescence assays (IFA) was negative for IgM and IgG against YFV (Flavivirus Mosaic, Euroimmun AG, Luebeck, Germany). A convalescent sample of dps 6 was clearly positive for YFV IgM (titre 1:10, Figure), with non-reactive IgG. This anti-YFV IgM response on dps 6 is in line with literature stating that IgM antibodies usually appear during the first week of illness. Neutralising IgG antibodies are likely to appear towards the end of the first week after onset of illness and will be tested for in convalescent serum [7].

Background

YFV is a mosquito-borne virus in the genus Flavivirus, family Flaviviridae, related to DENV, ZIKV, tick-borne encephalitis virus and West Nile virus. YFV is maintained in a sylvatic cycle between non-human primates and so-called ‘jungle’-mosquitoes (Hemagogus and Sabethes spp. in South America) [8]. Sporadic infection of humans with sylvatic YFV can occur when unprotected humans are exposed while entering the habitats where the viruses circulate. Subsequent introduction of a viraemic human case to urban areas with high population densities and Aedes aegypti mosquitoes can initiate an urban transmission cycle [9]. YFV is endemic in (sub)tropical areas of South America and Africa. The risk for YFV infection in South America is the highest in tropical regions and during the rainy season (January–May) when mosquito population densities peak [10]. In 2011, Suriname was identified by the World Health Organization (WHO) as one of 14 South American countries at risk for YFV transmission based on current or historic reports of yellow fever, plus the presence of competent mosquito vectors and animal reservoirs [11].

Since December 2016, an outbreak of sylvatic YFV is ongoing in Brazil; as at 9 March 2017, there were 371 confirmed and 966 suspected human cases, while a total of 968 epizootics in non-human primates have been reported, of which 386 were confirmed [2]. So far, there has been no evidence for a change from sylvatic to an urban transmission cycle [1]. In addition, Bolivia, Colombia and Peru have reported suspected and confirmed yellow fever cases in 2017 [2].

A subclinical infection with YFV is believed to occur in most infected people. In symptomatic cases, symptoms of general malaise occur after an incubation period of 3–6 days (range 2–9 days), followed by remission of the disease in the majority of patients. However, 15-25% of symptomatic persons develop a complicated course of illness, in which symptoms recur after 24–48 hours, with a reported mortality of 20-60% [7,12]. This phase is characterised by fever, abdominal symptoms, severe hepatic dysfunction and jaundice, multi-organ failure and haemorrhagic diathesis. As no specific antiviral treatment is currently available, treatment consists of supportive care [7,12].

Discussion

Although Suriname is considered to be endemic for YFV, no human cases have been officially reported since 1971 [13]. With a population of ca 570,000 people, Suriname has a YFV vaccination coverage of 80–85% in infants [14]. Although WHO recommends vaccination for travellers to countries with risk of YFV transmission like Suriname, sporadic cases of imported yellow fever in returning travellers have been reported for example in Europe, the United States and Asia [15-17], with three reported cases related to the ongoing YFV outbreaks in South America in European travellers since 2016 [18,19]. The establishment of ongoing YFV circulation in Suriname extends the current YFV activity in South America to five countries [2]. However, despite the presence of competent Ae. albopictus mosquitoes in France [20] and Ae. aegypti in Madeira, the risk for YFV transmission in Europe is currently considered to be very low due to the lack of vector activity [18]. An effective, safe live-attenuated YFV vaccine is available for people aged ≥ 9 months and offers lifelong immunity [7]. Vaccination is advised by the WHO for all travellers to Suriname, for the coastal area as well as the inlands [21]. With regard to yellow fever, pre-travel health advice should take into account destination, duration of travel, season and the likelihood of exposure to mosquitoes (in rural areas, forests versus urban areas), and potential contraindications for vaccination with a live-attenuated vaccine.

The multi-country YFV activity might reflect current, wide-spread ecological conditions that favour elevated YFV transmissibility among wildlife and spill-over to humans. Thorough sequence analysis of currently circulating strains in Brazil, Bolivia, Colombia, Peru and Suriname should provide insight whether the human cases in these countries are epidemiologically linked or represent multiple, independent spill-over events without extensive ongoing community transmission. Because of its potential public health impact, our case of yellow fever was notified to the WHO and the European Union Early Warning and Response System on 9 March 2017, according to the international health regulations [22].

Conclusion

Clinicians in non-endemic countries should be aware of yellow fever in travellers presenting with fever, jaundice and/or haemorrhage returning from South America including Suriname. This case report illustrates the importance of maintaining awareness of the need for YFV vaccination, even for countries with risk of YFV transmission that have not reported cases for decades.

Date: Fri 11 Dec 2015
From: Abraham Goorhuis, MD <a.goorhuis@amc.nl> [edited]

We report a confirmed case of Zika virus infection in a 60-year-old and otherwise healthy female patient, who had returned from Suriname on 29 Nov 2015, following a 3-week holiday. She had visited Paramaribo, Carolina Kreek, Klaaskreek and the Commewijne province. On the day of return to the Netherlands, she developed fever, itching in the hands and a red skin rash on the face, neck, trunk and extremities. The skin was painful upon touch and the joints of her fingers and ankles felt stiff. She also reported swelling of both lower legs. She reported multiple insect bites. She presented at our outpatient clinic at the AMC in Amsterdam, the Netherlands, on 2 Dec 2015, the 3rd day of her illness.

Physical examination showed an afebrile patient who was not acutely ill. She had a pronounced macular skin rash of her trunk, extremities, neck and face, as well as a marked conjunctival injection. In addition, she had pitting oedema on both lower legs.

Laboratory investigation showed a normal red and white blood cell count, with atypical lymphocytes in the differential. Renal function and liver enzymes were normal, except for a slightly elevated LDH of 297 IU/l.

One day after her initial presentation, the skin rash had improved markedly. She recovered quickly. Upon follow-up on 11 Dec 2015, her only complaints were arthralgias that seemed to further improve.

The clinical diagnosis of Zika virus infection was confirmed by PCR (Erasmus MC, Rotterdam), on a sample taken on 2 Dec 2015 (the 3rd day of illness).

To date, Zika virus infection has been rarely reported as cause of febrile illness among returned travellers and this is the 1st confirmed case in the Netherlands. Because symptomatology and clinical course are often mild, it is likely that the diagnosis is easily missed. Given the expanding base of information regarding complications possibly associated with this disease (such as neurologic manifestations and the reported increase of infants born with microcephaly in endemic areas), it is important to facilitate diagnostic capacities. This case underscores the fact that changing epidemiology of infectious disease also affects the spectrum of disease in returned travelers. Among other arboviral infections, such as dengue and chikungunya, Zika virus infection should be included in the differential diagnosis of any febrile traveler who has returned from an endemic area, such as Suriname.
------------------------------------
Abraham Goorhuis, MD, on behalf of the medical team
Center of Tropical and Travel Medicine
Academic Medical Center
Amsterdam
The Netherlands
=====================
[Although ProMED does not normally post case reports of arboviruses imported into countries with no possibility of ongoing mosquito transmission unless there is something unusual about them, this case is important for the very reasons noted above. With Zika virus expanding its geographic range in the Americas, we are likely to see more cases imported into a variety of localities where it has not occurred before. The sound advice of Dr. Goorhuis and colleagues to include Zika virus, along with dengue and chikungunya viruses in differential diagnoses when patients with histories of travel to Zika-endemic countries seek medical attention for febrile disease with rash is prudent. This case also illustrates the need to obtain patient travel histories. And clinicians should not forget that there was good evidence of sexual transmission when an infected man infected in Africa returned to his home in a country where Zika virus was not present ((see ProMED-mail archive no.  http://promedmail.org/post/20150516.3367156).

ProMED thanks Dr. Goorhuis and colleagues for submitting this case report.

It was not surprising that Zika virus arrived in Suriname, since 2 other countries in northern South America -- adjacent Brazil and somewhat more distant Colombia -- have reported ongoing cases. Transmission of the virus is continuing there.

A map showing the location of Suriname in northeastern South America can be accessed at
<http://healthmap.org/promed/p/37>. - ProMed Mod.TY]
Date: Tue 3 Nov 2015
Source: Loop [edited]

There are 2 confirmed cases of the Zika virus, also known as Zik-V.

These cases were confirmed by the AZP [Academisch Ziekenhuis Paramaribo, a scientific research center in Paramaribo, Suriname]. The Bureau of Public Health (BOG) has made it known that it requires external confirmation of these results. This stance has dismayed AZP Lab director John Codrington, who stated that it shows a lack of confidence in local authority.

The BOG has made it clear why they have come to this decision. They will conduct further tests through the CARPHA [Caribbean Public Health Agency] because this is the 1st possible instance of the virus locally; the virus is similar in presentation to other ailments such as dengue fever and chikungunya, also known as Chik-V; and the positive test cases may have brought it back from foreign travels.

The call for further study will not disrupt any preventative measures as doctors have been armed with the necessary information that the public requires regarding the nature and procedures surrounding the virus. Its similarity to dengue and Chik-V means that a similar approach to prevention is required.

People need to ensure that their homes and communities are free of mosquito-friendly breeding grounds. As with the chikungunya virus, there is no vaccine or preventive drug for Zik-V, and only treatment of symptoms is possible. Usually non-steroid anti-inflammatories and/or non-salicylic analgesics are used.

While there is no cure or vaccine for the virus, health officials urge people to reduce the risk of contracting Zika virus infection by using the following measures:

Use anti-mosquito devices (insecticide-treated bed nets, coils, smudge pots, spray, repellents) and wearing long sleeves and clothes with long legs, especially during the hours of highest mosquito activity (morning and late afternoon).

Mosquito repellent based on a 30 per cent DEET concentration is recommended -- for new-born children under 3 months, repellents are not recommended; instead, insecticide-treated bed nets should be used.

Before using repellents, pregnant women and children under the age of 12 years should consult a physician or pharmacist.

Unlike Chik-V, Zik-V can also be transmitted through sexual contact.

[byline: Jonathan Stuart]
=================
[It would not be surprising if Zika virus has arrived in Suriname, since 2 other countries in northern South America -- adjacent Brazil and somewhat more distant Colombia -- have reported ongoing cases. The report does not indicate if these 2 cases are locally acquired or are imported cases of Zika virus infection. Sending samples to an outside international reference laboratory is prudent in situations when a new pathogen appears. The AZP laboratory should welcome confirmation of their test results.

A map showing the location of Suriname in north eastern South America can be accessed at
<http://healthmap.org/promed/p/37>. - ProMED Mod.TY]
Monday 30th January 2012
A ProMED-mail post
<http://www.promedmail.org>

- Suriname. 25 Jan 2012. "Up to now more than 300 dengue cases have been registered at the Academic hospital lab, while other labs also confirm cases," the health ministry said in a press release. With the dengue outbreak now a month old, health authorities said they believe cases of the mosquito-borne disease are peaking. Due to overcrowding in hospitals, patients were being treated in the army's health facilities.
======================
[A HealthMap/ProMED-mail interactive map of Suriname can be accessed at <http://healthmap.org/r/1GZ2>. - ProMed Mod.TY]
More ...

Estonia

Estonia US Consular Information Sheet
October 28, 2008
COUNTRY DESCRIPTION:
Estonia is a stable democracy with an economy that has developed rapidly in recent years.
Tourist facilities in Tallinn are comparable to other western Europe
n cities, but some amenities may be lacking in rural areas.
Some goods and services may not be available outside of major cities.
Please read the Department of State Background Notes on Estonia for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid passport is required.
Estonia is a party to the “Schengen” –Agreement. As such, U.S. citizens may enter Estonia 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 Schengen Fact Sheet.
For further information concerning entry requirements and residency permits, contact the Estonian Embassy, located at 2131 Massachusetts Ave., NW, Washington, DC 20008, telephone (202)588-0101, or the Consulate General of Estonia in New York City, telephone (212) 883-0636. Visit the Embassy of Estonia web site at http://www.estemb.org for the most current visa information. American citizens who wish to reside in Estonia (e.g. for work, studies, retirement, etc.) can also consult with the Estonian Citizenship and Migration Board at http://www.mig.ee
Information about dual nationality and 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 generally is not a problem in Estonia, and there have been no incidents of terrorism directed toward American interests. Large public gatherings and demonstrations may occur on occasion in response to political issues, but these have been, with few exceptions,
without incident in the past.

During periods of darkness, (roughly October through April), reflectors must be worn by pedestrians.
Violators of this law may be subject to a fine of up to 600 EEK (Estonian Kroon), or up to 6,000 EEK if the pedestrian is under the influence of alcohol. Reflectors are inexpensive and are available at most supermarkets and many smaller shops.
To meet legal requirements, the reflector’s packaging must include a reference to European safety standard EN13356.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s web site where the current Worldwide Caution, Travel Warnings and Travel Alerts can be found.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

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 others 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:
Estonia is a relatively safe country, although crime in Tallinn’s “Old Town” is an ongoing concern, particularly during the summer tourist season.
Travelers should exercise the same precautions with regard to their personal safety and belongings they would take in major U.S. cities.
The most common crimes encountered by foreign tourists are purse snatching, pick-pocketing, and mugging.
Tourists are often targeted by individuals and small groups of thieves working together.
In public places such as the “Old Town,” in particular the Town Hall Square (“Raekoja Plats”), as well as the airport, train stations, bus stations and the Central Market, one must exercise special care in safeguarding valuables against purse-snatchers and pickpockets.
Valuables should never be left unattended in vehicles and car doors should be kept locked at all times.
Some violent crime does occur, mainly at night and often in proximity to nightlife areas.
Public drunkenness, car theft and break-ins also continue to be a problem in Tallinn.

The Estonian Police agencies are modern, well-equipped law enforcement entities on a standard comparable to most Western European police, with only isolated instances of corruption. However, large-scale reductions in the police force are scheduled for this year, which may decrease some of their capabilities. Many police officers speak only very limited English.

Credit card fraud is an ongoing concern, as is internet-based financial fraud and “internet dating” fraud.
Travelers should take precautions to safeguard their credit cards and report any suspected unauthorized transaction to the credit card company immediately.
Racially motivated verbal harassment and, on occasion, physical assault of Americans and other nationals of non-Caucasian ethnicity has occurred.
If an incident occurs, it should be reported to the police and to the Embassy.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft of a U.S. passport abroad 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 Estonia is: 112. The level of English spoken by the operator answering may be minimal.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
The quality of medical care in Estonia continues to improve but still falls short of Western standards.
Estonia has many highly trained medical professionals, but hospitals and clinics still suffer from a lack of equipment and resources.
Elderly travelers and those with health problems may be at increased risk.
Visitors to forest areas in warm weather should also guard against tick-borne encephalitis.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Estonia.
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.
In recent years, a number of American citizens have been disembarked from cruise ships and hospitalized due to serious medical problems. Holding a policy providing for medical evacuation coverage can be critical to ensure access to timely emergency medical care. 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 is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Driving in Estonia can be more dangerous than in much of the United States.
Many roads, especially in rural areas, are poorly lit and are not up to Western standards.
Some drivers can be aggressive, recklessly overtaking vehicles and traveling at high speed, even in crowded urban areas.
Despite strict Estonian laws against driving under the influence of alcohol, accidents involving intoxicated drivers are very frequent. It is not uncommon for the police to set up checkpoints on major streets and highways; drivers should pull over when asked.
Drivers should always remain alert to the possibility of drunk drivers and drunken pedestrians.

Estonian traffic laws require drivers to stop for all pedestrians in marked crosswalks.
Nevertheless, Estonian motorists do not always comply with this regulation, and pedestrians should always be careful when crossing the streets.
In rural areas, wild animals, such as deer and moose, and icy road conditions can create unexpected hazards.
Dark-clothed or drunken pedestrians walking along unlit roads or darting across dimly-lit streets or highways pose a risk to unsuspecting drivers.
Winter roads are usually treated and cleared of snow, but drivers should remain vigilant for icy patches and large potholes.

Estonian laws against driving under the influence are strict and follow a policy of zero tolerance. Penalties are severe for motorists caught driving after consumption of even a small amount of alcohol. Local law requires that headlights be illuminated at all times while driving.
Use of a seatbelts by all passengers is required, and children too small to be secure in seatbelts must use child car seats.
The speed limit is 50 km/h in town and 90 km/h out of town unless otherwise indicated.
A right turn on a red light is prohibited unless otherwise indicated by a green arrow.
According to Estonian law vehicles involved in accidents should not be moved to the side of the road until the police reach the scene. Americans planning to drive in Estonia must obtain an international driving permit prior to arrival.

For information about international driving permits, contact AAA or the American Automobile Touring Alliance.
The Eesti Autoklubi (Estonian Auto Club – www.autoclub.ee), which is affiliated with AAA, provides emergency roadside assistance.
Drivers do not need to be a member to receive assistance; however, the fees charged are higher for non-members.
The number to call for roadside vehicle assistance and towing service is 1888.
For ambulance, fire or police assistance the number is 112.
Please note that for both numbers, the level of English spoken by the operator answering may be minimal.

Please refer to our Road Safety page for more information.
You may also visit the website of Estonia’s national tourist office at http://www.visitestonia.com.
For specific information concerning Estonian driving permits, vehicles inspections and road tax mandatory insurance, contact the Estonian Motor Vehicle Registration Center at http://www.ark.ee/atp.
Additional information may be obtained from the website of the Estonian Road Administration at http://www.mnt.ee/atp, or from Baltic Roads at http://www.balticroads.net
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Estonia, the U.S. Federal Aviation Administration (FAA) has not assessed the Estonian 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:
Commercial and financial transactions in Estonia are increasingly automated and on-line.
Cash is almost always acceptable. The national currency is the Estonian Kroon (EEK), the value of which is pegged to the Euro (15.65 EEK= 1 Euro). Most credit cards are widely recognized throughout the country.
ATM machines are common and many U.S.-issued bankcards are compatible with them. Bank checks are virtually unknown, and checks drawn on a U.S. bank are of little use in the country.

Estonia’s customs authorities encourage the use of an ATA (Admission Temporaire/Temporary Admission) Carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes.
ATA Carnet Headquarters, located at the U.S. Council for International Business, 1212 Avenue of the Americas, New York, NY 10036, issues and guarantees the ATA Carnet in the United States.
For additional information call (212) 354-4480, send and email to acarnet@uscib.org, or visit http://www.uscib.org for details.

Please see our information on Customs Regulations.
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 Estonian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Estonia 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 both in Estonia as well as in the United States.
Please see our information on Criminal Penalties.

DUAL NATIONALITY:
Estonian law requires that individual with dual nationality must choose between Estonian citizenship and his of her other citizenship at age 18. After that time, Estonian law does not permit the individual to carry passports of two (or more) different countries. However, the Estonian government reportedly has not regularly enforced this law in the past with respect to persons of Estonian background, and thus a number of individuals have continued to carry both Estonian and American passports. Any American citizen who also carries an Estonian passport should be aware that the Estonian government may not recognize the person as an American citizen in certain circumstances, thus limiting the consular services that can be provided by the U.S. Embassy (e.g. in case of arrest, etc.).

Please note that this discussion of dual nationality relates only to person who have a claim to Estonian citizenship, and not to persons who merely acquire an Estonian “residence” permit. For more information on citizenship and dual nationality, please see our web page.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Estonia are encouraged to register with the U.S Embassy in Tallinn through the State Department’s travel registration web site, and to obtain updated information on travel and security within Estonia.
Americans without Internet access may register directly with the U.S. Embassy in Tallinn by visiting in person.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The latest security information is available from the Embassy, including on its web site, http://estonia.usembassy.gov.

The U.S. Embassy is available 24 hours a day for emergency assistance for American citizens visiting or residing in Estonia. The Embassy is located approximately 1 km outside of Tallinn’s “Old Town.” The address is: Kentmanni 20, 15099 Tallinn, Estonia.
The Embassy’s main switchboard number is telephone (372) 668-8100.
The Consular Section can be reached directly at (372 668-8128, 8111, 8197 or 8129. The Consular Section’s fax number is (372) 668-8267. The Consular Sections’ email address for American Citizen Services is ACSTallin@state.gov. For after-hours emergencies, an Embassy Duty Officer may be contacted by mobile phone at (372) 509-2129, if dialing from the U.S., and 509-2129 if dialed from within Estonia.
The Embassy’s web site is http://estonia.usembassy.gov.
The American Citizen Services Unit email address is ACSTallinn@state.gov
* * *
This replaces the Consular Information Sheet dated March 26, 2008 to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Medical Insurance, Traffic Safety and Road Conditions, Special Circumstances, Criminal Penalties, Dual Nationality, and Registration/Embassy location.

Travel News Headlines WORLD NEWS

Date: Sat 14 Apr 2018 09:35
Source: Err [edited]

A man who had returned from an overseas trip and a woman with whom he came in contact were diagnosed with measles in Saaremaa this week [week of Sun 8 Apr 2018].

This year [2018], 4 cases of measles have been diagnosed in Estonia, which in 2016 had been listed by the World Health Organization (WHO) as among the countries which had eliminated endemic measles. Last month [March 2018], an unvaccinated child contracted the disease on an overseas trip; their mother caught it in turn upon their return to Estonia.

It is not currently known whether the woman to contract measles this week [week of Sun 8 Apr 2018] was vaccinated or not; the man had been vaccinated with only 1 of 2 doses of the measles vaccine.

In the course of the Health Board's epidemiological study, persons who have been in contact with the 2 individuals as well as their vaccination status were determined. Those who have come in contact with them were also advised regarding the nature of the disease, prevention measures as well as vaccination.

Last week [week of Sun 1 Apr 2018], a case of rubella was diagnosed in Rapla County as well. The previous 2 instances of rubella in Eesti were recorded in 2013.

Measles and rubella are considered highly contagious diseases, but the modern measles, mumps and rubella (MMR) vaccine is over 95 percent effective in preventing measles and rubella.

According to the immunization schedule in Estonia, children are administered the 1st dose of the MMR vaccine at 1 year of age and the 2nd dose at age 13. The MMR vaccine is free for children in Estonia.

Measles symptoms
Some of the earliest symptoms in the onset of measles include fever, malaise, cough, runny nose, conjunctivitis and light sensitivity. A few days later, the signature rash appears, which begins behind the ears and spreads to the face and neck before covering the entire body. A measles patient is contagious beginning 4 -- 5 days before and for up to 5 days following the onset of the rash.

There is no treatment for the disease itself; only symptoms can be treated. Complications can include pneumonia, middle ear infections and inflammation of the brain.  [Byline editor: Aili Vahtla]
====================
[According to <https://news.err.ee/591626/number-of-unvaccinated-children-in-estonia-on-rise>, despite the fact that a number of serious infectious diseases have been beaten due to vaccination [in Estonia], there has been a steady increase in the number of parents refusing vaccination and number of children being left unprotected from various diseases.

"While the percentage of refusals in relative to the total number of vaccinations isn't high -- 3-3.9 percent in 2016 -- the steady increase of those refusing and the steady growth in the number of children being left unprotected from a number of infectious diseases is worrisome," said Director General of the Health Board Tiiu Aro.

For example, at the end of 2016, 95.4 percent of children ages 1-14 were vaccinated against measles, mumps and rubella (MMR).

"Considering the World Health Organization's (WHO) recommended level of vaccination for halting the spread of diseases, which is 95 percent, we should be satisfied, however the coverage level among children up to 2 years of age was 93.2 percent, which means that we did not achieve the recommended level of coverage," Aro noted.

As of the end of 2016, a total of 7481 children were unvaccinated against MMR, over 60 percent of whom live in Tallinn.

A Healthmap/ProMED of Estonia can be found at
Date: Wed, 13 Feb 2013 13:51:13 +0100 (MET)

TALLINN, Feb 13, 2013 (AFP) - Officials in Estonia raised the alarm Wednesday after a report into drug use in Europe found that the small Baltic nation had the highest incidence of deaths from drug overdoses in the EU. Last year, 160 people died from overdoses, data from the Europe Monitoring Centre for Drugs and Drug Addictions (EMCDDA) showed, an increase of 21 percent from last year. Most of the deaths were caused by taking a highly addictive form of synthetic heroin known as China White, which is often smuggled in from Russia.

"More people per million inhabitants perish in Estonia than in any other EU country due to drug overdoses, and most of these deaths are related to drugs called 'China White'," Ave Talu, head of Estonia's Drug Monitoring Centre, told AFP. While the average number of deaths from overdoses across the 27-member EU bloc stands at up to 20 people per million, in Estonia the figure is five times higher, at over 100 per million. In 2011, 132 people died from overdoses in the former Soviet nation of 1.3 million people.

Most of the people who died in 2012 were ethnic Russian men, the EMCDDA data showed. Using a new antidote to synthetic heroin, naloxone, could "cut the death rates from overdose nearly in half," Talu said. But the drug is not yet available on a community outreach basis, she said. "In Estonia, naloxone is used only by medical staff and unlike some other countries like the US, we do not yet have community-based naloxone distribution and training programmes, but they are urgently needed."
Date: Fri, 21 Dec 2012 16:42:17 +0100 (MET)

TALLINN, Dec 21, 2012 (AFP) - Pilots at the struggling Baltic carrier Estonian Air announced on Friday they would go on strike from January 7, demanding a return to a collective pay deal that was voided by the company.   The Estonian Airline Pilots Association, which represents all of the carrier's 75 pilots, warned that it could not accept plans to end a five-year-old agreement from February.   "We expect most of the pilots to be on strike," Rauno Menning, chairman of the association's board, told AFP.   In a statement, Estonian Air said the strike call was a surprise.

"Estonian Air has offered pilots a collective agreement that is line with the market and competitive situation and follows all EU flight safety requirements," the carrier's chief executive Jan Palmer was quoted as saying.   Menning faulted that stance.   "We are surprised that the company is surprised by the strike news, because we made the decision in November to go strike if needed, so Estonian Air knew this was a possibility," he told AFP.   Estonian Air had just warded off industrial action by other employees through a deal last week with the Estonian Air Cabin Crew Union, which is valid to the end of 2013.   State-controlled Estonian Air has made repeated efforts to cut its losses.   In November, the airline said it would slash staff numbers by half, from 318 to 146.   Estonian Air operates a small fleet of 10 planes.

Created in 1991, the year the Baltic republic of 1.3 million regained its independence from the Soviet Union, the airline has had mixed fortunes.   It was privatised in 1996, and from 2003 to 2010 was almost evenly split between the state, which owned 51 percent, and Scandinavian carrier SAS, with 49 percent.   Since then, the state has gradually raised its holding to the current 97 percent, but says its wants to find a new strategic investor.   Estonian Air's revenues in the first nine months of 2012 were 70.4 million euros ($93 million), compared with 58.7 million euros in the same period of 2011.   But nine-month losses reached 20.2 million euros, up from 11.2 million euros in the same period a year earlier.
Date: Mon, 8 Oct 2012 14:00:20 +0200 (METDST)

TALLINN, Oct 08, 2012 (AFP) - Striking Estonian doctors on Monday extended their week-long labour action to major hospitals in the Baltic state's capital and second city Tartu and curbed inpatient care in some other regions. The Estonian Doctors' Union said however that emergency care and treatment for children, pregnant women and patients with cancer would not be affected.

Terming the union's wage demands "unrealistic", the Estonian authorities last week repeated an offer to raise doctors' salaries by 6.6 percent as of January, but the union turned it down. It is demanding a 20 percent increase in the minimum wage to 1,400 euros ($1,800) next year and another 20 percent hike in 2014. The average monthly income of doctors in the EU state and eurozone member was 1,700 euros ($2,185) in 2011, compared to a national average of 839 euros ($1,078), according to Estonia's social affairs ministry.

After failed talks last week between the Estonian Health Insurance Fund, Hospital Union and the Doctors' Union, the delegations were to resume negotiations Monday. European Commission deputy chief Siim Kallas, a former Estonian prime minister, weighed into the dispute at the weekend saying the Estonian health care system created 20 years ago "has failed" and called for major reforms to give patients the option to choose from a number of health insurance providers. "Patients are not the priority in Estonia's current health care system," Kallas added.
Date: Mon, 1 Oct 2012 11:13:00 +0200 (METDST)

TALLINN, Oct 1, 2012 (AFP) - Doctors in Estonia's capital Tallinn and the Baltic state's second city of Tartu went on strike on Monday over pay, threatening to extend their protest nationwide if their demands are not met. The Estonian Doctors' Union said members at Tallinn and Tartu's hospitals were cancelling outpatient appointments, but that emergency room treatment would not be affected. In addition, the union pledged that the strike would not affect children, pregnant women and patients with cancer.

Estonian health authorities had on Friday tried to head off the strike by offering a 6.6 percent pay increase, double their previous offer, from next January, but the union turned it down. The union is demanding a written pledge for a gradual 20 percent increase of its members' minimum wage to 1,400 euros ($1,800). According to Estonia's ministry of social affairs, the average monthly income of doctors in the country was 1,700 euros ($2,185) in 2011, compared to an average national salary of 839 euros ($1,078). The doctors' union has said if its demands are not met, the strike will expand next week to other towns.

Patients' rights groups are angry, saying work stoppage is not the way to resolve problems in the health sector in the former Soviet-ruled nation of 1.3 million, which joined the European Union in 2004. "We do not support the doctors' strike, because it's not in the interest of patients," Anne Veskimeister, spokeswoman of the Estonian Patients' Association, told AFP. "The main problems in Estonian healthcare are the lack of choice of doctor or medical institution, too long a waiting time to see the doctor even in some urgent cases, an unwillingness of state and medical officials to admit and deal with medical errors, and complete lack of objective surveillance in healthcare," she added.
More ...

Ukraine

Ukraine - US Consular Information Sheet
March 28, 2008
COUNTRY DESCRIPTION:
Ukraine is undergoing profound political and economic change as it moves from its Soviet past toward a market economy, multi-party democracy, and integration into
uro-Atlantic and other international institutions.
In recent years, the availability of goods and services has increased along with increased rates of growth in Ukraine's economy, and facilities for travelers have improved somewhat.
Nonetheless, the availability of travel and tourist services remains uneven throughout the country, and Ukraine still lacks the abundance of many of the goods and services taken for granted in other countries.
Read the Department of State Background Notes on Ukraine for additional information.

ENTRY/EXIT REQUIREMENTS: Depending on the length and purpose of travel, U.S. citizens may or may not be required to get a Ukrainian visa prior to coming to Ukraine.
A passport valid for six months beyond the planned date of travel is required.
According to Ukrainian Presidential Decree #1008, dated June 30, 2005, U.S. citizens are exempt from the requirement to have a Ukrainian visa as long as the duration of their stay in Ukraine does not exceed 90 days and the purpose of their travel is tourism, private travel, or business. U.S. citizens whose planned stay in Ukraine exceeds 90 days, and so consequently bears the characteristics of a long-term stay, must have visas authorizing their entry into Ukraine. If the purpose of their visit is other than tourism, private travel, or business, an appropriate visa must be obtained. U.S. citizens may apply for all types of visas through Ukrainian Embassies and Consulates overseas. A list of required documents for the visa application will be determined based on the purpose and length of travel on a case-by-case basis. Contact details for Ukrainian Embassies and Consulates are available on the Ministry of Foreign Affairs of Ukraine web site at http://www.mfa.gov.ua/mfa/en/305.htm.

Visas may be obtained from the Consular Office of the Embassy of Ukraine in Washington, DC, or from Ukrainian Consulates General in New York, Chicago, or San Francisco.
For additional information about Ukrainian visas and related policy, please contact the Ukrainian Embassy or Consulate nearest you.

Embassy of Ukraine
3350 M Street, NW
Washington, D.C. 20007
Tel: (202) 333-0606
Fax: (202) 333-0817
Web site: http://www.mfa.gov.ua/usa/en/
Consulate General of Ukraine in New York
240 East 49th Street
New York, NY 10017
Tel: (212) 371-5690
Fax: (212) 371-5547
Web site: http://www.ukrconsul.org/
Consulate General of Ukraine in San Francisco
530 Bush Street, Suite 402
San Francisco, CA 94108
Tel: (415) 398-0240
Fax: (415) 398-5039
Web site: http://www.ukrainesf.com/
Consulate General of Ukraine in Chicago
10 East Huron St.
Chicago, IL 60611
Tel: (312) 642 4388
Fax: (312) 642 4385
Web site: http://www.ukrchicago.com/
The Government of Ukraine does not issue visas at the point of entry into Ukraine.
Travelers whose purpose of travel puts them in a category that requires a visa must obtain the correct Ukrainian visa prior to arrival; otherwise they will be turned back to the United States or will have to travel to another country to obtain a visa.

Please check your visa carefully upon receipt and pay careful attention to validity dates.
Each traveler is responsible for understanding the type of visa issued and the provisions of the visa.
Frequently, American citizens are refused entry to Ukraine because they thought they possessed a multiple entry visa, but in fact their visa was valid for only a single entry; Americans occasionally try to reenter Ukraine after using their single-entry visa, believing they have unlimited travel for six months.
In some cases, Americans attempt to enter Ukraine before their visa becomes valid.
This is a common mistake, since in Ukraine the date is written day-month-year, not month-day-year.
Thus, a visa issued on 01/05/07 is valid from May 1, 2007 and NOT from January 5, 2007.
Such travelers can be detained at the port of entry, refused admission and sent back to the country from which they traveled.
The U.S. Embassy in Kyiv is unable to assist travelers in these situations.

All foreigners entering or staying in Ukraine must be registered with Ukrainian authorities. American Citizens traveling to or staying in Ukraine are reminded that recent changes to Ukrainian immigration law change the registration procedures for short-term stays. The registration for short-term visits of up to 90 days is completed at the border by the customs offices.
Such registration is valid for 90 days out of each period of 180 days; the calculation of the 90-day period begins from the date of first entry into Ukrainian territory.

The initial registration for both short- and long-term visits to Ukraine, with or without a visa, is accomplished at the border when entering Ukraine.
Future extensions for stays exceeding 90 days are completed through the Ukrainian Ministry of Internal Affairs’ Office of Citizenship, Immigration and Registration (OVIR).
Most cities will have several OVIR offices.
Extensions are not automatic, however, and are valid only for continued presence in the country.
It is not possible to depart Ukraine and return on the extension, nor can an adjustment to visa status be made from within Ukraine. Applications for extension of registration should be submitted at least three days before the current registration expires.

Travelers who intend to visit Russia from Ukraine must also have a Russian visa.
The Consular Section of the Russian Embassy in Ukraine is located at Prospekt Kutuzova 8, tel.: (380-44) 284-6816, fax 284-7936, e-mail: general@rucons.kiev.ua, http://www.embrus.org.ua.

Visitors to Ukraine should also note that Ukrainian law requires them to obtain mandatory health insurance.
For more information see the section on Medical Insurance below.

Visit the Embassy of Ukraine’s web site at http://www.mfa.gov.ua/usa/en/1609.htm for the most current visa information.
Also, see the Ukrainian Ministry of Foreign Affairs’ web site at http://www.mfa.gov.ua/usa/en or http://www.ukraineinfo.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 Regulations sheet and visit the Ukrainian State Customs Service web site at http://www.customs.gov.ua/dmsu/control/en/index.

SAFETY AND SECURITY:
Ukraine is largely free of significant civil unrest or any organized anti-American domestic political movements.
However, occasionally, mass demonstrations occur in larger cities, such as Kyiv, and are usually sponsored by individual political forces.
In 2008, there has been an upsurge in the number of pro-Russian anti-NATO protests.
These protests are likely to increase in size and frequency as Ukraine pursues closer ties to the alliance.
While the majority of these protests are small and peaceful, they can still result in violence and it is best to avoid such gatherings.

There also have been increasing incidents of racially-motivated violence; groups of “skinheads” and neo-Nazis target people of Asian, African, or other non-European descent, as well as religious minorities, in Kyiv and throughout Ukraine (see the section on Crime below).

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

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

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

CRIME:
Ukraine is undergoing a significant economic, political, and social transformation, and income disparities have grown sharply.
As a result, foreign visitors may be perceived as wealthy targets for criminals.
Americans often stand out in Ukraine, and are therefore more likely to be targeted than in Western European countries, where incomes are higher and Americans may blend in better.

Most street crime ranges from various scams, simple pocket picking, purse snatching, and theft of personal items from parked cars, to mugging, armed robbery, or the drugging of unsuspecting victims at nightspots and bars (where they are then robbed).
Cases of assaults in apartment building corridors, elevators, and stairwells, as well as armed break-ins and crimes involving small caliber firearms have also been reported.
Please see the Embassy’s web site for additional security information for Americans at http://kyiv.usembassy.gov/amcit_security_eng.html.

A commonly reported scam in Kyiv is”The Wallet Scam”, which involves a person dropping a wallet or a packet of money near a potential victim. After the victim picks up the wallet and attempts to return it to the individual who “dropped” it, the perpetrator then claims that the wallet is missing money which the victim stole.
The perpetrator either threatens to call the police if the victim does not pay, or asks the victim to show his or her wallet to the perpetrator to ensure that the victim did not take any money.
When the victim produces his or her wallet, the perpetrator grabs the money and flees.
Another variant involves a second person who claims to be a police officer – who is of course involved in the crime – who approaches the victim after the wallet has been picked-up.
This second person also asks to see the wallet, grabbing the money and fleeing or, through sleight-of-hand, stealing the victim’s money.

While most travelers do not encounter problems with crime in Ukraine, there has been an increase in the number of hate crimes directed at ethnic and religious minorities over the past few years. Many of these incidents are conducted by “skinheads” or neo-Nazis in Kyiv, but similar crimes have also been reported throughout the country. In Kyiv, these incidents have occurred without provocation in prominent downtown areas commonly frequented by tourists.
While the majority of people targeted have been of Asian, African, or other non-European descent, all travelers should exercise caution.
In addition to incidents of assault, racial minorities may be subject to various types of harassment, such as being stopped on the street by both civilians and law enforcement officials. Individuals belonging to religious minorities have also been harassed and assaulted in Kyiv and throughout Ukraine.

The police and government’s slow response to hate crimes is a continuing concern.
Although senior Government of Ukraine officials (including the President and Prime Minister) have publicly deplored these hate crimes and groups, Ukrainian street level law enforcement activities are unable to effectively deter hate crimes or adequately protect racial minorities.
The Embassy has received numerous reports from victims of violent hate crimes, as well as from bystanders, stating that uniformed police officers observed the assaults and did nothing to prevent the attacks, to assist the victims afterward, or to investigate and apprehend the attackers.
The Government of Ukraine took initial steps to address the problem in the final months of 2007 with the establishment of special law enforcement units to prevent and investigate hate crimes in Ukraine.
It remains to be seen if these units will be effective.

Credit card and ATM fraud is widespread.
Ukraine operates as a cash economy, and money scams are widespread.
Although credit card and ATM use among Ukrainians is increasingly common, it is nevertheless strongly recommended that visitors and permanent residents of Ukraine refrain from using credit cards or ATM cards except at major international establishments.

Burglaries of apartments and vehicles represent a significant threat to long-term residents.
Although few cars are actually stolen, primarily because of increased use of alarm systems and security wheel locks, vehicular break-ins and vehicular vandalism are common.

Ukraine lacks reliable tourist and travel services for foreign victims of crime.
Transferring funds from the United States, replacing stolen traveler’s checks or airline tickets, or canceling credit cards can be difficult and time consuming.
There are few safe low-cost lodgings, such as youth hostels.
Public facilities in Ukraine are generally not equipped to accommodate persons with physical disabilities.

Over the past several years, the Embassy has received a number of reports of harassment and intimidation directed against foreign businesspersons and interests.
While these reports have become much less frequent in recent years, they have not ended entirely.
Reported incidents range from physical threats (possibly motivated by rival commercial interests tied to organized crime), to local government entities engaging in such practices as arbitrary termination or amendment of business licenses, dilution of corporate stock to diminish U.S. investor interest, delays of payment or delivery of goods, and arbitrary “inspections” by tax, safety or other officials that appear designed to harm the business rather than a genuine attempt at good governance. American business entities are encouraged to read the Corruption, Money Laundering and Organized Crime section of the 2007 Crime Report for Ukraine at http://kyiv.usembassy.gov/amcit_crimereport_eng.html.
American businesses and other private sector organizations are also encouraged to read the most recent Overseas Security Advisory Council (OSAC) Annual Crime and Safety Report for Ukraine at https://www.osac.gov/Regions/country.cfm?country=42.

Computer fraud is also becoming more common in Ukraine.
Internet scams appear to be on the rise.
The Embassy suggests refraining from wiring money unless the recipient is well-known and the purpose of business is clear.
American citizens have reported transferring money to Ukraine to pay for goods purchased from residents of Ukraine via online auction sites, but never receiving the goods in return.
The Embassy regularly receives complaints from Americans regarding scams involving marriage and dating services.
Numerous Americans have lost money to agencies and individuals that claimed they could arrange for student or fiancée visas to the U.S.
Additional information is available on our web site in a document titled “Marriage Brokers” at http://kyiv.usembassy.gov/amcit_marriage_eng.html and on the Department of State’s web site under Ukraine: Internet and Other Fraud Schemes.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm.

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
In December 2005, Ukraine reported the first cases of H5N1 (“avian influenza,” "avian flu," "bird flu," "chicken flu") among birds in Crimea.
Further outbreaks followed in 2006.
On January 18, 2008, another outbreak of the H5N1 avian influenza virus was detected at a poultry farm in the Krasnogvardiyskyi Rayon in Crimea. There are no registered human cases of H5N1 in Ukraine.
For detailed information on H5N1, please review the Avian Influenza Fact Sheet.

The U.S. Embassy maintains a list of hospitals and clinics with some English-speaking staff.
Many facilities have only limited English speakers.
There are no hospitals in Ukraine that provide a level of medical care equal to that found in American hospitals, or which accept American health insurance plans for payment (see the section on Medical Insurance below).
Some facilities are adequate for basic services.
Basic medical supplies are available; however, travelers requiring prescription medicine should bring their own.
Elderly travelers and those with existing health problems may be at risk due to inadequate medical facilities.
When a patient is hospitalized, the patient, relative, or acquaintance must supply bandages, medication, and food.
The Embassy recommends that ill or infirm persons not travel to Ukraine.
The Embassy also recommends that travelers obtain private medical evacuation insurance prior to traveling to Ukraine.

Medical evacuation remains the best way to secure western medical care.
This option, however, is very expensive and could take at least several hours to arrange.
Travelers may wish to purchase medical evacuation insurance prior to travel, or have access to substantial lines of credit to cover the cost of medical evacuation.
The Consular Section of the U.S. Embassy has information on various air ambulance companies that perform medical evacuations to Europe or to the U.S.
Serious medical problems requiring hospitalization and/or medical evacuation to other European countries can cost from $25,000 to $50,000, and to the U.S. as much as $70,000 or more.
More information can be found on the U.S. Embassy's web site in the document “Medical Services in Kyiv” at http://usembassy.kiev.ua/amcit_medical_serv_eng.html.

Please note that while the Embassy can help American travelers and their families make contact with a medical evacuation service, the U.S. Government cannot pay for medical evacuation.
Travelers should make sure they have medical evacuation insurance, which is available from many private companies, or have funds available for evacuation, should the need arise.

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, http://wwwn.cdc.gov/travel/default.aspx.
Tuberculosis is an increasingly serious health concern in Ukraine.
For further information, please consult the CDC’s Travel Notice on TB at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.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.

RADIATION AND NUCLEAR SAFETY:
In 1986, the Chornobyl incident resulted in the largest short-term, unintentional, accidental release of radioactive materials to the atmosphere ever recorded.
The highest areas of radioactive ground contamination occurred within thirty kilometers of the Chornobyl nuclear power station.
The city of Kyiv was not badly affected because of the wind direction, but it was not completely spared.
The last operating reactor at the Chornobyl Nuclear Power Plant site closed officially on December 15, 2000. All identified stabilization measures on the existing sarcophagus are complete, and preparatory work to start construction of the new shelter is almost nearing completion. The contract for the new Chornobyl shelter was awarded in September 2007 and its construction is projected to be completed in 2012.

The Ukrainian government has an effective program of monitoring fresh foods and meats sold in local markets.
Street purchase of produce should be avoided.
Wild berries, mushrooms, and wild fowl and game should be avoided, as these have been found to retain higher than average levels of radiation.
Background levels of radiation are monitored regularly by the Embassy and, to date, have not exceeded the level found on the Eastern seaboard of the United States. If external radiation levels are high enough to require evacuation, the U.S. Embassy will notify the American community through the Embassy warden e-mail and text messaging system.

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.

The Ukrainian parliament passed a law in 1997 whereby all visitors to Ukraine are required to obtain mandatory health insurance. According to information from the Ukrainian authorities, the cost of this medical insurance depends on the anticipated length of a foreigner's stay in Ukraine.
The cost for the insurance is approximately 25 cents per day (more for short stays).
This required insurance can be purchased after arrival and covers only the costs of basic medical care inside Ukraine; it does not cover medical evacuation.
Failure to purchase mandatory health insurance often results in refusal of treatment at Ukrainian public hospitals and clinics.
Private clinics do not require Ukrainian public health insurance, but can be as expensive as similar clinics in the United States and may require payment in advance
More information can be found online in Ukrainian at http://www.pro100.com.ua, or by calling +38 (044) 206 2885 from abroad or 8-800-500-1080 from within Ukraine.

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

Generally, roads in Ukraine outside major urban areas are in poor condition and are poorly lit.
Visitors should drive defensively at all times, since local drivers often disregard traffic rules.
Drivers are often poorly trained or drive without a valid driver's license.
Drivers can also be very aggressive, and they normally do not respect the rights of pedestrians, even at clearly marked pedestrian crossings.
Pedestrians should also be aware of cars driving or attempting to park on sidewalks.
Many cars do not meet the safety standards common in America.

Due to heavy traffic and congested roads, vehicle accidents are a common occurrence in larger Ukrainian cities, especially in Kyiv. In Ukraine, it is mandatory for motorists involved in vehicle accidents not to remove the vehicle from the site of the accident, unless it presents a clear safety concern. Local police must be notified and will report to the scene to conduct an investigation. Persons should be prepared to wait until the police arrive and complete their report. Due to traffic and slow response, it may take up to several hours for police to arrive. When police arrive, they will ascertain responsibility, take the drivers’ personal information, and file a report of the accident.

Cross-country travel at night and in winter can be particularly dangerous.
The Embassy strongly recommends that visitors and permanent residents of Ukraine refrain from driving their private vehicles after dark outside of major cities.
However, major roads are drivable during daylight hours.
Roadside services such as gas stations and repair facilities are becoming more common, particularly on the main national and regional overland highways and in large and mid-size cities.

Nonetheless, such services are far from American standards, and travelers should plan accordingly.
There have been isolated reports of carjackings of western-made or foreign-registered cars.
There has also been an increase in the number of documented reports of criminal acts (primarily theft) occurring on trains and other modes of public transport.

Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Ukraine’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Ukraine’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:
Ukraine does not recognize dual nationality.
American citizens entering Ukraine with a Ukrainian passport will be treated as Ukrainian citizens by the local authorities.
This may include being required to perform mandatory military service.
Also, Ukrainians who have immigrated to the U.S. without obtaining the proper exit visa from Ukrainian authorities may be subject to civil or criminal penalties, and will be required to obtain an exit visa before returning to the U.S.
For additional information, see the Consular Affairs web site at http://travel.state.gov/index.html for our Dual Nationality flyer.

Ukraine is a cash economy.
Traveler’s checks and credit cards are gaining wider acceptance in larger cities.
Even in Kyiv, however, acceptance of credit cards is not nearly as widespread as in the U.S. or in Western European countries.
Expect credit card use to be limited to major hotels, upscale restaurants, international airlines, and the rapidly growing, but still select number of up-market stores.

Exchanging U.S. dollars into the national Ukrainian currency, hryvnya, is simple and unproblematic, as licensed exchange booths are widespread, and exchange rates are normally clearly advertised.
Currency exchange is only legal at such licensed exchange booths, banks, and currency exchange desks at hotels; anyone caught dealing on the black market can expect to be detained by the local militia.

There are many banks and licensed currency exchange booths located in major cities.
ATMs (a.k.a. bankomats) are becoming more common throughout Ukraine, particularly in Kyiv and in other larger cities.
In smaller cities and towns, ATMs are still virtually non-existent.
Most ATMs disperse cash only in the local currency, hryvnya. The difficulties of a currency shortage can be avoided by coming to Ukraine with a sufficient supply of hard currency to cover necessary obligations during travel.
Funds may be transferred by wire, advances may be drawn on credit cards, and traveler’s checks may be cashed at many locations.
Again, the Embassy emphasizes that the incidence of credit card and ATM bankcard fraud is high, and strongly recommends that visitors and permanent residents of Ukraine refrain from using local ATMs.

Customs regulations prohibit sending cash, traveler’s checks, personal checks, credit cards, passports, or other forms of identification through the international mail system, as well as via courier mail (FedEx, DHL, etc.).
Customs authorities regularly confiscate these items as contraband.
Ukrainian customs authorities may also enforce strict regulations concerning temporary importation into or export from Ukraine of items such as firearms, antiquities, currency, etc.
It is advisable to contact the Embassy of Ukraine in Washington, or one of Ukraine's consulates in the United States for specific information regarding customs requirements.
As 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.

Ukrainian law requires that travelers declare all cash and jewelry, regardless of value, upon entering Ukraine.
Travelers should fill out a customs declaration and ask customs officials to stamp it.
According to Ukrainian law, foreign citizens may bring up to $15,000 in cash, or up to $30,000 in traveler’s checks, into Ukraine without a special license.
A traveler must declare the imported currency.
If customs officials determine that a traveler entering or exiting the country is carrying undeclared currency, they can and often do confiscate the undeclared funds.
When leaving the country, foreign travelers are only allowed to take out a maximum of $3,000 in cash, or as much cash as they declared upon their entry into Ukraine.
If a traveler wants to take out more than $3,000, the traveler must have a customs declaration proving that he or she in fact brought the corresponding sum of money into the country.

Travelers desiring to bring more than $15,000 into Ukraine must obtain a special license AFTER entering the country.
Details for obtaining this license are available on the Embassy's web site in the document “Ukrainian Customs: Procedures for Transporting Currencies, Monetary Instruments, or Precious Metals” at http://kyiv.usembassy.gov/amcit_travel_ukrcustoms_eng.html.
Ukraine has strict limitations for the export of antiques and other goods and artifacts deemed to be of particularly important historical or cultural value.
This includes any items produced before 1950.

Ukraine is a developing democratic nation undergoing significant political, economic, and governmental reform.
This includes reform of police and emergency services.
Visitors should be aware that although Ukrainian police and emergency services have made much progress, they still generally remain below Western European and U.S. standards in terms of training, responsiveness, and effectiveness.
American citizens have reported waiting sometimes hours for Ukrainian police and ambulance services to respond to calls for emergency assistance.
Although this may generally be atypical, it does nevertheless occur.

It is advisable to contact the Embassy of Ukraine in Washington, or one of Ukraine's consulates in the United States, for specific information regarding customs requirements.
Please see our information on Customs Regulations.

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 Ukraine’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Ukraine 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 Ukraine are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and to obtain updated information on travel and security within Ukraine.
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 Consular Section of the U.S. Embassy is located at #6 Mykoly Pymonenka St., 01901 Kyiv, Ukraine. Telephone: (38-044) 490-4422, fax 486-3393. The American Citizen Services unit is located at the same address and can be reached at (38-044) 490-4445
The Embassy is located at #10 Yuriy Kotsyubynsky St. 01901 Kyiv, Ukraine. Tel.: (38-044) 490-4000.
* * *
This replaces the Country Specific Information Sheet dated February 15, 2008 to update the sections on Safety and Security and Crime.

Travel News Headlines WORLD NEWS

Date: Mon 18 Nov 2019
Source: 112.UA [edited]

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

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

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

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

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

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

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

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

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

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

HealthMap/ProMED-mail map:
Odesa oblast, Ukraine: <http://healthmap.org/promed/p/51897>]
Date: Mon 28 Oct 2019, 12:41 PM
Source: 112 International [edited]

"A total of 15 students of the secondary school No. 7 in Chernihiv were hospitalized with suspicion of hepatitis A on [28 Oct 2019]," the press service of Ukraine's State Emergency Service reports. It is noted that at the moment a complex of epidemic prevention measures are being carried out.

Besides, a 2018 hepatitis outbreak was spotted in Mykolaiv -- 47 people were hospitalized with a confirmed diagnosis.
========================
[With this number of cases admitted with the suspicion of acute hepatitis A on the same day, it is likely that a point-source outbreak related to a food or water source occurred. The definitive test for the disease is the finding of IgM anti-HAV in the blood.

Chernihiv, also known as Chernigov, is a historic city in northern Ukraine, which serves as the administrative centre of the Chernihiv Oblast (province), as well as of the surrounding Chernihiv Raion (district) within the oblast. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Thu 24 Oct 2019 (accessed Mon 28 Oct 2019)
Source: Ministry of Health, Ukraine, press release [in Ukrainian, machine trans., edited]

In Ukraine, the 1st confirmed case of vaccine-associated paralytic polio has occurred in a 2 year old child from Volyn Oblast. The parents deliberately refused the vaccinations provided by medical standards. Recent cases of illness in Ukraine were recorded in 2015 and 2017.

Pathogenesis of the disease
---------------------------
Sources of the disease: a person who is ill or a carrier that carries the virus asymptomatically. Fecal-oral routes (dirty hands, water, contaminated food, excrement) and airborne droplets are considered as transmission routes.

Symptoms: In most cases, the disease first goes unnoticed, which worsens the patient's chances of recovery; then there are signs that are different in nature, depending on the form of the virus. You can learn more about the symptoms on the website of the Public Health Center at <https://old.phc.org.ua/pages/diseases/other_social_diseases/poliomyelitis>  [in Ukrainian]

The incubation period of the disease is 2-35 days, more often 7-14 days. The following types of disease are classified: with and without lesions of the central nervous system (CNS). It should be noted that even atypical poliomyelitis (without lesion of the CNS) is capable of seriously harming the patient. They all pose a significant threat to the unvaccinated person and cause irreversible processes that can lead to death.

Myths and refutations
---------------------
On World Polio Day [24 October], the Ministry of Health of Ukraine dispels myths that provoke refusal of immunization. Common among parents is talk about the dangers of vaccination and the side effects of vaccination. You can read more about refuting these stereotypes at <https://moz.gov.ua/article/health/9-mifiv-pro-vakcinaciju> [in Ukrainian].

Why are vaccines safe?
----------------------
The Global Polio Eradication Initiative is using several vaccines to combat the disease. In Ukraine, there are 2 types -- the inactivated polio vaccine (IPV) and the oral polio vaccine (OPV). Both vaccines are purchased through the United Nations Children's Fund (UNICEF) and have a World Health Organization  ualification that guarantees quality and ongoing monitoring of manufacturers. For more information on vaccine production standards, go to: <https://moz.gov.ua/article/news/nichogo-krim-pravdi-5-faktiv-pro-vakcini>  [in Ukrainian]

The WHO website explains:
- OPV is one of the safest vaccines invented by humanity and used to immunize newborns;
- it is so safe that it can be used even when the baby is sick;
- OPV is used several times to achieve the maximum immunity of the vaccine, but the increase in the number of vaccinations does not increase the risk of side effects.

Where, when, and who should be vaccinated?
------------------------------------------
Polio vaccination is required from the birth of a baby. Vaccination must be carried out in a comprehensive manner, without missing any dose, to increase the body's resistance to the disease.
1st dose - at 2 months of baby's life;
2nd dose - at 4 months;
3rd dose - at 6 months;
4th dose - at 18 months;
5th dose - at 6 years;
6th dose - at 14 years.

Free polio vaccination is available from your family doctor or pediatrician at public health facilities, as well as from private contractors with the National Health Service of Ukraine. More information is available at <https://moz.gov.ua/article/immunization/chomu-v-aptekah-i-privatnih-klinikah-mozhe-ne-buti-vakcin-ta-de-zrobiti-scheplennja-bezoplatno> [in Ukrainian].

The only way to protect yourself and your children from the effects of this disease is vaccination, as there is no specific treatment. The Ministry of Health of Ukraine recommends that you consult the calendar of preventive vaccinations at <https://moz.gov.ua/article/immunization/kalendar-profilaktichnih-scheplen>  [in Ukrainian]
--------------------------------------
communicated by:
Viki Hansen-Landis, RN, MPH
Medical Information and Analysis team, International SOS
======================
[According to information from the Global Polio Eradication Initiative, Ukraine had 2 cases of cVDPV1 confirmed in 2015 (see <http://polioeradication.org/polio-today/polio-now/this-week/circulating-vaccine-derived-poliovirus/> for table of cVDPVs by type and year, and see Poliomyelitis update (05): Ukraine, vaccine-derived, WHO http://promedmail.org/post/20150901.3616558 and Poliomyelitis update (04): Ukraine, 2 cases, RFI http://promedmail.org/post/20150901.3616015 for details on these cases). No additional cases of cVDPV were reported by the Ukraine to WHO in 2017. If there is additional information on case(s) reported in 2017, ProMED-mail would greatly appreciate receiving it, as well as information on the serotype of cVDPV associated with this current case.

The addition of this case will bring the total number of cVDPV associated cases confirmed with date of onset in 2019 to 103, and the number of countries reporting cVDPV associated paralytic cases to 20.

Maps of Ukraine can be seen at
and <http://healthmap.org/promed/p/123>.
Volyn oblast is located in the north west of Ukraine, sharing a border with Poland to the west and Belarus to the north. - ProMED Mod.MPP]
Date: Thu, 22 Aug 2019 19:34:04 +0200 (METDST)

Kiev, Aug 22, 2019 (AFP) - Around 200 anti-vaccine protesters rallied in central Kiev Thursday after authorities threatened to ban unvaccinated children from schools in Ukraine, which has been hit by a deadly measles outbreak.   Ukraine has one of the lowest vaccination rates in Europe and has recorded more than 57,000 measles cases since the start of the year, including 18 deaths.

This is a record number of cases since the country gained independence from the Soviet Union in 1991.    "I came here with my child to protect her right for education without vaccination, without injecting poison into her blood," said 29-year-old Iryna Lazutkina, who was at the protest with her young daughter.   "Vaccination is a ticking time bomb," she said, suggesting that it could lead to allergies, autoimmune diseases and even cancer -- claims which are not backed up by medical research.    Authorities blame distrust of vaccines among a section of the population, as well as an earlier shortage of medical supplies, for the current outbreak.   In mid-August, the government threatened to ban unvaccinated children from schools.    This year the health ministry organised mass vaccinations in schools in areas most affected by the crisis.

Acting health minister Ulyana Suprun last week warned of the likelihood of diphtheria and tetanus outbreaks because of low vaccination rates.   But the protesters, many of them young parents with children, insisted they had the right to refuse vaccinations.    "I am for free choice and against discrimination," said Alla Fedorchuk, a 25-year-old who travelled to the capital from the western city of Lutsk.    Her three-year-old son has not been vaccinated. Fedorchuk said a relative suffered side effects after vaccination.

Some protesters carried banners that read "Forced medical intervention is a crime."    Kateryna Bulavinova, a consultant with the UN children's agency UNICEF, said local doctors' lack of knowledge about vaccines was a reason why many missed out on them.   Bulavinova said that doctors and nurses must explain to patients in detail how the vaccine works and what kind of reactions are normal.    "When there is this understanding, the fear goes away," she said.   According to the UNICEF survey, Ukrainians were most likely to be put off vaccines because of fears of side effects or a distrust of the manufacturers.   There is growing concern over global public resistance to vaccinations.

Measles cases nearly tripled globally during the first seven months of the year compared to the same period in 2018, the World Health Organization (WHO) said this month.    Measles, which is highly contagious, can be entirely prevented through a two-dose vaccine, but the WHO has in recent months sounded the alarm over vaccination rates.    The airborne infection causing fever, coughing and rashes can be deadly in rare cases and had been officially eliminated in many countries with advanced healthcare systems.
Date: Wed 14 Aug 2019
Source: Unian [abridged, edited]

Director of the Department of Health of Kyiv Valentyna Hinzburh has said that an outbreak of measles in Kyiv has become the largest since the independence of Ukraine.

According to her, over 5000 people fell ill with measles in Kyiv in 6 months of 2019, of which almost 3000 were adults. This is 3 times the figure recorded in the same period of 2018. About 50% of patients required hospitalization due to the severe course of the disease. This year [2019], 2 adults died from measles, as they were not vaccinated and reported to the doctor too late.

Ukraine is among the countries that have reported the highest numbers of measles cases in 2019.

"Today, nothing but vaccines will protect Kyiv from outbreaks and epidemics of vaccine-preventable infectious diseases," Hinzburh said. She said the current situation in the capital and Ukraine as a whole was a result of reduced collective immunity. "Here are just a few figures that are staggering. In 2015, 5 people got measles in Kyiv, 3 in 2016, 87 in 2017, 3045 in 2018, and over 5000 for 6 months in 2019!" she said.
More ...

Norway

Norway US Consular Information Sheet
November 10, 2008
COUNTRY DESCRIPTION:
Norway is a highly developed stable democracy with a modern economy.
The cost of living in Norway is high and tourist facilities are well developed and widely
available.
Read the Department of State Background Notes on Norway for additional information.

ENTRY/EXIT REQUIREMENTS:
Norway is a party to the Schengen agreement.
As such, U.S. citizens may enter Norway 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.

Contact the Royal Norwegian Embassy at 2720 34th Street NW, Washington, DC
20008-2714, Tel: 1-202-333-6000, web site: http://www.norway.org or the nearest Norwegian Consulate.
Consulates are located in Houston, Minneapolis, New York City, and San Francisco.
Information can also be obtained from the Norwegian Directorate of Immigration at http://www.udi.no.

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:
Norway remains largely free of terrorist incidents.
However, like other countries in the Schengen area, Norway’s open borders with its European neighbors allow the possibility of terrorist groups entering/exiting the country with anonymity.
The U.S. government remains deeply concerned about the heightened threat of terrorist attacks against U.S. citizens and interests abroad.
In the post-9/11 environment, Norway shares with the rest of the world an increased threat of international Islamic terrorism. Norway was among a list of countries named as legitimate targets in al-Qa’ida audiotapes released as recently as, 2006.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

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

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

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

CRIME INFORMATION:
Norway has a relatively low crime rate.
Most crimes involve the theft of personal property.
Residential burglaries, auto theft, and vandalism to parked cars also occur.
Most high-end value vehicles, especially in Oslo, have visible alarm system indicators to discourage joy riders or thieves.
Persons who appear affluent or disoriented may become targets of pick-pockets and purse-snatchers, especially during the peak tourist season (May-September).
Thieves frequently target tourists in airports, train stations, and hotels, particularly lobby/reception and restaurant areas.
Often such thieves work in pairs and use distraction as a method to steal purses or briefcases.
While passports are frequently stolen in the course of these thefts, money, credit cards, and jewelry are the actual objects of interest.
In some cases stolen passports are recovered.
Violent crime, although rare, occurs and appears to be increasing.
Some thieves or burglars may have weapons.

In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. embassy or consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. embassy or consulate for assistance.
The embassy/consulate staff can, for example, assist you to find appropriate medical care, 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.

Norway has a program to provide financial compensation to victims who suffer serious criminal injuries.
Claimants can obtain application forms from the Norwegian Criminal Injuries Compensation Authority at http://www.voldsoffererstatning.no/index.php?id=10.
Please contact the U.S. Embassy in Oslo for further information. For further information about possible U.S. compensation, see our information for Victims of Crime.

The national emergency telephone numbers in Norway, equivalent to the “911” emergency line, are: Police 112, Fire 110, Ambulance 113.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are widely available and of high quality, but may be limited outside the larger urban areas.
The remote and sparse populations in northern Norway, and the dependency on ferries to cross fjords of western Norway, may affect transportation and ready access to medical facilities.
The U.S. Embassy in Oslo maintains a list of emergency clinics in major cities.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Norway.
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:
Healthcare in Norway is very expensive and healthcare providers sometimes require payment at time of service.
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 Norway is provided for general reference only, and may not be totally accurate in a particular location or circumstance.


Public transportation in Norway is generally safe, and the maintenance and condition of urban roads are generally good.
Rural road conditions are fair and the availability of roadside assistance is limited.
Most roadways beyond the city limits of Oslo and other major cities tend to be simple two-lane roads.
In mountainous areas of Norway, the roads also tend to be narrow and winding, with many tunnels.
The northerly latitude can also cause road conditions to vary greatly, depending on weather and time of year.
Many mountain roads are closed due to snow from late fall to late spring.
The use of winter tires is mandatory on all motor vehicles from November to April.

Norwegian law requires that drivers always use their vehicle headlights when driving.
Norwegian law also requires drivers to yield to vehicles coming from the right.
In some, but not all, instances, major roads with “right of way” are marked.
Seatbelts are mandatory for drivers and passengers.

Norway has some of the strictest laws in Europe concerning driving under the influence of alcohol; those laws prescribe heavy penalties for drivers convicted of having even a low blood alcohol level.
Frequent road checks with mandatory breathalyzer tests and the promise of stiff jail sentences encourage alcohol-free driving.
The maximum legal blood alcohol content level for driving a car in Norway is .02 per cent.

Automatic cameras placed by the police along roadways help to maintain speed limits, which are often lower than in other European countries.
Fines – and sometimes even jail time – are imposed for violations.


Please refer to our Road Safety page for more information.
For specific information concerning Norwegian driver's permits, vehicle inspection, road tax and mandatory insurance, contact the Norwegian Tourist Board office at P.O. Box 4649, Grand Central Station, New York, New York 10163-4649 (tel.: 212-885-9700; fax: 212/885-9710) or visit their web site at http://www.norway.org/travel
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Norway’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Norway’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:
Please see our information on customs regulations.

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

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

REGISTRATION / EMBASSY LOCATION:
Americans living in or visiting Norway 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 Norway. 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 Oslo near the Royal Palace at Henrik Ibsensgate 48; tel. 47/2244-8550 (24 hours), consular fax 47/2256-2751.
The Embassy’s web site is http://norway.usembassy.gov
*
*
*
*
*
This replaces the Consular Information Sheet dated April 23, 2008 to update the sections on Crime, Safety and Security, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Tue 3 Sep 2019
Source: Food Safety News [edited]
-------------------------------------------------------------
More than 100 people have fallen ill in Norway from norovirus likely in a frozen seaweed salad from China. The 1st outbreak of norovirus suspected to be linked to the seaweed salad occurred in mid-June 2019 and the most recent was at the beginning of August 2019. The implicated product was also shipped to Denmark.

"It is suspected that seaweed from China was the cause of more than 100 cases of gastroenteritis from at least 11 eateries in different areas of Norway. Most of the outbreaks were in June and July 2019. Investigations are still ongoing. Norovirus was detected in patients from at least 2 of these eateries," Guri Aanderud, senior adviser in the seafood section at the Norwegian Food Safety Authority (Mattilsynet) told Food Safety News.

"We have no information regarding individual cases such as age, sex, place of residence, or hospitalization related to these outbreaks as norovirus is not notifiable in Norway. However, symptoms of norovirus are generally mild and self-limiting. All involved restaurants have received and served seaweed salad from two different lots in the relevant time period. Many of the people who reported illness have stated that they have eaten dishes containing seaweed salad."

On 22 Aug 2019, Goma Wakame Seaweed salad bags of 1000-gram imported into Norway by Ostlandske Formidling AS (Ofas) were withdrawn from the market due to suspected norovirus. Product was sold to the food service sector in Norway but distribution may have included several stores across the country. It was imported into Denmark by World Seafood and is produced by Dalian Kowa Foods Co. in China. Affected bags have item number 8032 and lot number 1904, which was manufactured on 14 Mar 2019, and lasts until 13 Mar 2021, and lot number 1811, which was made on 8 Nov 2018 and lasts until 7 Nov 2020.

Since withdrawing the product, no further outbreaks linked to seaweed salad have been reported.

The Norwegian Food Safety Authority took product samples that have not yet been fully analyzed and the Norwegian Institute of Public Health (FHI) has informed the European Centre for Disease Prevention and Control (ECDC) via the Epidemic Intelligence Information System (EPIS).

Aanderud added it also knew of a Spanish RASFF [Rapid Alert System for Food and Feed] alert from 13 Aug 2019 related to a foodborne outbreak caused by norovirus GI and GII in frozen seaweed salad from China, via Germany. Countries part of this notice include Austria, Germany, Greece, Italy, Portugal, Romania, Slovakia, Spain, and the United Kingdom. The International Food Safety Authorities Network (INFOSAN) was mentioned in both RASFF notifications.

Adam Bradshaw, technical officer in the Department of Food Safety and Zoonoses at the World Health Organization, said INFOSAN was working with colleagues at the European Commission's RASFF because the frozen seaweed salad suspected to be responsible for the outbreak was distributed from China. He added it does not have the authority to disclose non-public information on behalf of countries involved in the outbreak when asked which countries had reported cases and how many.

"To better understand the potential international aspects of this event, we have been in contact with the INFOSAN emergency contact point in China to seek details as to whether the implicated frozen seaweed salad has been distributed from China to any other countries. Once further information is available, we will update all INFOSAN members through the INFOSAN community website," said Bradshaw.  [Byline: Joe Whitworth]
===========================
[It should be noted that the prototypic norovirus, Norwalk virus, was originally isolated in Norwalk, Ohio, the state where an outbreak popped up at the Republican National Convention in 2016. Norovirus infections and outbreaks are usually more common in cooler, winter months. About half of all cases occur from December through February in countries above the equator and June through August in countries below the equator. However, in places closer to the equator, norovirus may be less seasonal. This may be because of temperature or the timing of the rainy season, but may also be associated with the birth rate. Worldwide, norovirus is the leading cause of gastroenteritis outbreaks. New norovirus strains emerge about every 2 to 4 years. Often, but not always, these new strains lead to an increase in outbreaks worldwide. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps:
Date: Tue 11 Jun 2019
Source: Associated Press [edited]

Norwegian authorities said Tuesday [11 Jun 2019] they were trying to identify the source of water contamination that has sent dozens of people in southern Norway to the hospital. Since Thursday [6 Jun 2019], 55 people, including 13 children from Askoy, an island north of Bergen, have been hospitalized following the contamination. All have been discharged. Norwegian news agency NTB reported that in all, some 2000 people had fallen sick.

A one-year-old child on the island died last week [week of Mon 3 Jun 2019] of an infection in the digestive tract, but it was not clear whether it was linked to the contamination.

"None of the patients are critically ill," said Oeyvind Kommedal, a doctor with the Haukeland university hospital that carried out laboratory tests. "We have a good control of the situation." He said tests showed that the bacterium _Campylobacter_ has been found in 36 cases.

On Monday [10 Jun 2019], Baard Espeli, deputy mayor of the municipality of Askoy, also said that _E. coli_ was found in a reservoir that supplied part of the area's drinking water. Espeli said that reservoir has been closed, but it remains unclear how the bacteria contaminated it in the 1st place.

_Campylobacter_ is one of the main causes of diarrheal diseases and is considered the most common bacterial cause of human gastroenteritis. Infections are generally mild but can be fatal among very young children and the elderly.
========================
[It is not specifically stated that all the cases are on the island. The finding of _E. coli_ in the water reflects faecal contamination but not necessarily that _E. coli_ was a pathogen. The outbreak, as many from contaminated water, may be related to multiple pathogens.

Askoy is a municipality in Hordaland county, Norway. The island municipality is located in the Midhordland district of the county, sitting in a large group of islands immediately northwest of the city of Bergen. The administrative centre of the municipality is the urban village of Kleppesto on the south-eastern shore of the island of Askoy. Its location can be found on a map at <https://en.wikipedia.org/wiki/Ask%C3%B8y>. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Hordaland county, Norway: <http://healthmap.org/promed/p/32342>]
Date: Mon 6 May 2019
Source: News in English (Norway) [edited]

A Norwegian woman in her 20s who was bitten by a dog while travelling in Southeast Asia 2 months ago died Monday night [6 May 2019]. Hospital officials confirm that the woman was infected with the deadly rabies virus.

She's the 1st person to have [died of] rabies on the Norwegian mainland since 1815. Rabies is extremely seldom on the Scandinavian peninsula.

The woman was originally from Hordaland but lived in the county of Sogn og Fjordane. She died at the hospital in Forde, where she'd been in intensive care since last week [week of 29 Apr 2019].

Norwegian Broadcasting (NRK) reported that she was bitten by a dog while on a tour of Southeast Asia 2 months ago. The hospital wasn't alerted to her case until last [2 May 2019], when she was admitted after falling seriously ill. Test results confirmed the rabies virus on [Sat 4 May 2019].

There were several other Norwegians in her tour group from various places around the country. All of them have been alerted to her rabies infection and are being followed up by their local health care centres.
=======================
[This tragic event lacks detail. Reportedly, the victim was in a "tour group" to "South East Asia" (which country/ies?) including participants from various places in Norway.

Travellers must be aware of the rabies status in countries they are to visit. And a tourist, or, as a matter of fact, anybody getting bitten by a (stray?) dog in a rabies-endemic country, should immediately seek medical treatment, after thoroughly washing the bite wound.

Several worrying questions arise. Had the participants been informed, prior to travel, about health risks, rabies being just one of the potential hazards? Were medical care and advice sought following the bite? Were other co-travellers bitten as well?... - ProMED Mod.AS]

[HealthMap/ProMED-mail maps:
Date: Mon 1 Apr 2019
Source: GIDEON (Global Infectious Disease Epidemiology Network) [edited]

re: ProMED-mail Tick-borne encephalitis - Norway: cattle
----------------------------------------------------------------------
Tick-borne encephalitis (TBE) is one of 8 zoonoses carried by ticks in Norway (the others are anaplasmosis, babesiosis, louping ill, Lyme borreliosis, relapsing fever, rickettsial spotted fever, and tularemia). As displayed in the following graphs, rates of human TBE are considerably lower than those of other tick-borne diseases in Norway, and below TBE rates reported by neighbouring countries. [1-3]

See graphs at

References
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1. Berger S. Infectious Diseases of Norway, 2019. 387 pages , 138 graphs, 858 references. Gideon e-books
2. Berger S. Tick-borne Encephalitis: Global Status, 2019. 89 pages , 49 graphs , 787 references. Gideon e-books
3. Gideon multi-graph tool,
-----------------------------------------------
Communicated by:
Prof Steve Berger
Geographic Medicine
Tel Aviv Medical Center
Israel
==========================
[ProMED-mail thanks Dr Berger for pointing out that TBE virus is not the only tick-borne zoonotic pathogen in Norway. The objective of the author's study, as they defined it, was narrowly focused on TBE in cattle. They chose to analyse unpasteurized cow milk for TBEV RNA and to study the presence of IgG antibodies to TBEV in the same animals. They found evidence for TBE virus infection in cattle in certain areas and pointed out potential risk of infection of humans who consume unpasteurized milk from positive herds. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Date: Tue 15 Jan 2019
Source: Food Safety News [abridged, edited]

A traditional Norwegian fish dish has been recalled due to a link with a case of botulism. Torpet Fiskeoppdrettsanlegg AS recalled rakfisk due to suspicions that consumption can cause botulism. Rakfisk is a traditional Norwegian fish dish made from trout or char, salted and then fermented for up to a year before being eaten without cooking. The withdrawal applies to all varieties of the product that the company produced in 2018.

Rakfisk was sold via various market stalls in Trondelag, direct delivery from Torpet Fiskeoppdrettsanlegg AS, and via COOP stores in Alen, Brekken, Roros, and Os, according to the Norwegian Food Safety Authority (Mattilsynet). The one reported case is in a person who lives in Trondelag, in central Norway.

The Norwegian Institute of Public Health (Folkehelseinstituttet) said rakfisk from the company is the suspected source for the case of foodborne botulism. People who have rakfisk of this type in the refrigerator should throw the product out and not eat it. Those who have eaten it and have symptoms consistent with botulism should consult a doctor. The agency said toxins can develop under certain adverse conditions in the production of certain foods, such as rakfisk, cured meats, and canned items.

Previous botulism cases in Norway have been associated with rakfisk and home canned meats.

Botulism is a rare but life-threatening condition caused by toxins produced by _Clostridium botulinum_ bacteria. Onset of symptoms varies from a few hours to several days after exposure to the bacteria or toxins. Symptoms can include blurred or double vision, facial muscle weakness, difficulty swallowing, slurred speech and breathing difficulties.  [Byline: Joe Whitworth]
===================
[Given the vehicle, botulism type E is the likely culprit here.

The following was extracted from ProMED-mail Botulism, smoked fish - Finland ex Canada http://promedmail.org/post/20060721.2000: _Clostridium botulinum_ type E is naturally highly prevalent in aquatic environments and fish, leading to a high risk of contamination. The hot-smoking processes are usually too low to eliminate botulinum spores. Growth and toxin production from spores in vacuum-packed smoked fish products with anaerobic atmosphere and limited preservative factors is likely during extended storage at temperatures above 3 deg C (37.4 deg F). Therefore the most important factors controlling _C. botulinum_ growth and toxin production are efficient heat treatments, restricted shelf life, and continuous storage below 3 deg C (37.4 deg F). - ProMED Mod.LL]

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

Barbados

General
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Barbados is an island country in the West Indies. This Caribbean Island gained its independence from Britain in 1966 and enjoys a pleasant climate throughout much of the year. The main rainfall occurs betwe
n May to October and it may be affected by hurricanes along with many other Caribbean countries during September or October. The tourism facilities are well developed and Barbadian English is the main spoken language.
Safety & Security
******************************
The level of street crime is low but tourists are encouraged to maintain a close eye on personal processions and to use the hotel safety boxes for any particular valuables. Take care when walking through crowded market places, using a body pouch for your belongings. Ask advice before walking along deserted beaches at nighttime. If necessary, use an authorised taxi at all times to and from nightclubs.
Medical Facilities
******************************
Health care facilities throughout the main tourist regions are good but if travelling around the island you should be aware that these facilities are less developed. It is wise to ensure that you carry sufficient personal medication for the duration of your trip though medical supplies within Barbados are usually excellent.
Road Travel
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The traffic in Barbados travels on the left side of the road and generally the infrastructure is well maintained along the tourist routes. Nevertheless, hiring cars or mopeds is usually not recommended due to the high risk of accidents. Hiring a taxi is usually a safer option.
Local Customs
******************************
Many countries (including Barbados) have strict rules regarding the possession of illegal drugs. Never carry any item for another individual and always make sure your own personal medications are well marked at all times. Sometimes it is wise to have an official letter from your prescribing doctor outlining the reason for your medication.
Swimming
******************************
As always when abroad, make sure you take heed of local advice before swimming in the Caribbean. Strong currents can occur and occasionally passing cruise ships or tankers may pollute the sea. Never swim alone, away from the main tourist resorts or soon after a meal. Take care to watch children at all times even around the hotel swimming pools. If planning to undertake water sports while abroad make sure your travel insurance is sufficient and always check that the company you use has well maintained equipment and that good safety procedures are in place. Talking to other tourists or the hotel representative before booking will help give you a clearer picture of the facilities on offer.
Sun Exposure & Dehydration
******************************
The temperature in Barbados is generally similar throughout the year with levels between 20 to 30C at most times. Sun exposure most commonly occurs in those who do not cover up sufficiently and particularly if asleep beside the pool, exhausted due to jet lag, soon after arrival. Take care that children are kept cool, drink plenty of fluids and take extra salt in their diet (crisps, salted biscuits etc) to help overcome these effects.
Food & Water
******************************
The level of food hygiene in the main tourist resorts is high but care should be taken with regard to the consumption of seafood. Contamination of fish and shellfish has been reported in the past. Ciguatera poisoning associated with consumption of snappers, parrot fish, mackerel, moray eels and barracudas has been reported. Water hygiene is usually excellent though drinking bottled water is usually a wise precaution while abroad.
Rabies risks
******************************
Barbados has been rabies free for over 150 years. Nevertheless, avoiding animal bites is still a wise option and particularly take care that young children do not befriend any animals including birds, monkeys, cats and dogs.
Malaria & Mosquito Bites
******************************
Malaria transmission does not occur within the West Indies including Barbados. However other mosquito borne diseases such as Dengue Fever can be a significant problem. Mosquitoes that tend to bite in urban areas during the daylight hours transmit this disease and so care against insect bites is encouraged throughout the whole day.
Vaccinations for Barbados
******************************
There are no vaccines required for entry to Barbados from Ireland. However, most tourists would be encouraged to consider cover against the following:
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Tetanus (childhood booster)
*
Typhoid (food & water borne)
*
Hepatitis A (food & water borne)
Those planning a more extensive trip or undertaking adventure sports should also consider cover against Hepatitis B.
Summary
******************************
The majority of tourists to Barbados will enjoy a healthy time on the island with little reason for concern providing they follow some simple commonsense rules regarding seafood consumption, sun exposure and dehydration. Further information, including any recent news reports, is available through the Tropical Medical Bureau at the numbers below.

Travel News Headlines WORLD NEWS

Date: Fri 17 Aug 2018
Source: Outbreak News Today [edited]

Barbados health officials are reporting an increase in syphilis in pregnant women in recent years. The health ministry is now seeing an abnormally high rate of syphilis in pregnant women and, by extension, an increase in the number of babies born at risk for congenital syphilis.

Statistics show a rise from the average one or 2 cases a year of syphilis in pregnant women to 17 in 2016. According to the Ministry official, preliminary analyses from 2017 show a similarly high rate.

Dr. Anton Best, senior medical officer of health with responsibility for the HIV/STI programme, said that effective prevention and detection of congenital syphilis depends on the identification of the sexually transmitted infection (STI) in pregnant women. He noted that the Ministry of Health and Wellness' guidelines make it clear that all pregnant women should be offered a screening test for syphilis at booking and at 28 weeks gestation.
===================
[The number of syphilis cases in Barbados was reported to have started to increase in 2012, from 24 in 2011 to 41 in 2012 and to 112 in 2013, and then to have stabilized in 2014 (100 cases), 2015, and 2016 (<http://www.nationnews.com/nationnews/news/98007/stis-major-concern-ministry-health>).  72 percent of new syphilis cases reportedly occurred in men between the ages of 15 and 49 years old, with the average age being 34; more than 95 percent of pregnant women were screened for syphilis during pregnancy, and no increase in syphilis cases in pregnant women occurred during a 4-year study (2011-2014), with only one case of syphilis being transmitted through birth in 2014  (<https://caribbeannewsservice.com/now/syphilis-outbreak-in-barbados/>).

However, the news report above says that, although only one or 2 cases a year of syphilis occurred in pregnant women previously, 17 cases occurred in 2016, and a similar number occurred in 2017, but we are not given the number treated or outcome of these pregnancies.

Syphilis is a bacterial infection caused by the spirochete _Treponema pallidum_. Transmission from mother to fetus occurs via the bloodstream during maternal spirochetal infection. Transmission may also occur during delivery if maternal genital lesions are present. Late abortion, stillbirth, and neonatal death may result from congenital infection in untreated pregnancies. Among survivors, manifestations that develop in the 1st 2 years of life are called "early" and are similar to adult secondary syphilis; manifestations that develop after age 2 years are called "late" and include tooth abnormalities (Hutchinson teeth), bone changes (saber shins), "Clutton's joints" (bilateral painless swelling of the knee joints), neurological involvement, blindness, and deafness.

Control of congenital syphilis is achieved by antenatal screening and treatment of mothers who are infected. Routine serologic screening should be done at the 1st prenatal visit in all pregnant women, and, in communities and populations in which the risk for congenital syphilis is high, serologic testing and a sexual history also should be obtained at 28 weeks gestation and at delivery. Groups at high risk include uninsured women, women living in poverty, sex workers, illicit drug users, women diagnosed with sexually transmitted diseases, and those living in communities with high syphilis morbidity (<http://www.ahrq.gov/clinic/uspstf09/syphilis/syphpgsum.htm>). No mother or neonate should leave the hospital without maternal serologic status having been documented at least once during pregnancy and, if the mother is considered high risk, also at delivery.

Barbados, with a population of 277 821 residents, is a sovereign country and the easternmost island in the Caribbean region of North America; its capital and largest city is Bridgetown  (<https://en.wikipedia.org/wiki/Barbados>).

A map showing the location of Barbados can be found at
<https://en.wikipedia.org/wiki/West_Indies#/media/File:Caribbean_general_map.png>. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Date: Tue, 9 Feb 2016 20:01:58 +0100

Miami, Feb 9, 2016 (AFP) - Barbados on Tuesday confirmed three cases of Zika in pregnant women, bringing to seven the number of people on the Caribbean island with the virus, which is believed to be linked to birth defects.   The women will be given specialized obstetric care, the Ministry of Health said in a statement. The new cases were announced on the Barbados government information services Facebook page.

Zika, a primarily mosquito-borne illness, has spread rapidly through Latin America and the Caribbean. It generally causes mild symptoms but has been blamed for a rapid rise in the number of children born with microcephaly -- abnormally small heads and brains.   Barbados said that link has not been confirmed.    "The situation is still evolving and information is being updated regularly," the Ministry of Health said.   The World Health Organization has declared a global medical emergency to combat Zika and individual countries and regions are beginning to mobilize. With no cure or vaccine for the virus, some countries have taken the extraordinary step of urging women to delay getting pregnant.

According to the Pan-American Health Organization, 26 countries have confirmed cases, spanning 7,000 kilometres (4,400 miles) from Mexico to Paraguay.   The hardest hit country is Brazil, which hosts the Summer Olympics starting in August.   Brazil has warned pregnant women not to travel there but Games organizers have said by the time the Olympics start, the main mosquito season will be over and they don't expect the illness to affect the sporting extravaganza.
Date: Tue, 18 Feb 2014 11:17:11 +0100 (MET)

WASHINGTON, Feb 18, 2014 (AFP) - An earthquake measuring 6.7 struck Tuesday in the Caribbean near the island of Barbados, the US Geological Survey said.   The quake hit at 0927 GMT about 170 kilometers (110 miles) northeast of the town of Bathsheba on Barbados, the USGS said.   It struck at a depth of 172 kilometers (11 miles).   There were no immediate reports of damage or injuries in Barbados media outlets.   The Daily Nation newspaper said people called radio stations to report the quake.
Date: Mon, 8 Jul 2013 11:53:25 +0200 (METDST)

MIAMI, United States, July 08, 2013 (AFP) - Tropical Storm Chantal, which formed in the Atlantic overnight, headed towards the Caribbean Sea on Monday, the US National Hurricane Center reported.   At 0900 GMT Chantal was located about 1,130 kilometers (705 miles) east of Barbados packing maximum sustained winds of 65 kilometers (40 miles) per hour, the NHC said.

The storm is moving in a northwesterly direction at 43 kilometers per hour.   If it continues on its current path it will reach southern Puerto Rico and the island of Hispaniola -- shared by the Dominican Republic and Haiti -- on Wednesday or Thursday, according to the NHC forecast.   Tropical storm warnings are in effect for the French islands of Martinique and Guadeloupe, as well as for Barbados, Dominica and Santa Lucia, the NHC said.

Chantal is expected to strengthen during the next 48 hours and "produce rain accumulations of two to four inches over the Leeward and Windward Islands, with maximum amounts of six inches possible," the NHC said.   Poverty-stricken Haiti, which is still recovering from a devastating earthquake in January 2010, is especially prone to landslides triggered by heavy rain.
Date: Fri, 3 Aug 2012 06:28:26 +0200 (METDST)

MIAMI, Aug 3, 2012 (AFP) - Tropical storm Ernesto, the fifth of the Atlantic hurricane season, threatened Barbados and the Windward Islands Friday as it advanced across the Atlantic with winds of 85 kilometers per hour.

At 0300 GMT, the storm's center was 130 kilometers (80 miles) east of Barbados and 295 kilometers (185 miles) east of St Lucia, the Miami-based National Hurricane Center said. "The center of Ernesto should pass near Barbados later tonight, be near the northern Windward Islands by early Friday and emerge over the eastern Caribbean sea by Friday afternoon," the center said. It said tropical storm warnings were up in Barbados, St Vincent and the Grenadines, Dominica, St Lucia, Martinique and Guadeloupe.

Ernesto formed on Thursday from a tropical depression, becoming the fifth tropical storm of the current hurricane season, which runs from June 1 to November 30. The storm was expected to strengthen somewhat over the next two days, the center said. US weather forecasters have said they expect this to be a relatively mild hurricane season, with nine to 15 topical storms and between four and eight hurricanes.
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World Travel News Headlines

Date: Fri, 6 Dec 2019 10:30:54 +0100 (MET)

Moscow, Dec 6, 2019 (AFP) - More than 50 polar bears have gathered on the edge of a village in Russia's far north, environmentalists and residents said, as weak Arctic ice leaves them unable to roam.   The Russian branch of the World Wildlife Fund said climate change was to blame, as unusually warm temperatures prevented coastal ice from forming.   The WWF said 56 polar bears had gathered in a one-square-kilometre (0.4-square-mile) area near the village of Ryrkaipy in Chukotka on the north-eastern tip of Russia.

There were concerns they could enter the village, home to fewer than 1,000 people, and patrols had been set up to monitor their movements.   "The number of human and predator encounters in the Arctic is increasing," the WWF said in statement.    "The main reason is the decline of sea ice area due to the changing climate. In the absence of ice cover, animals are forced to go ashore in search of food."

Residents had gathered walrus carcasses in the area to try to keep the bears from wandering into the village.   "We have created a feeding point with walrus carcasses that we gathered along the coast," Tatyana Minenko of the local "Bear Patrol" told news agency RIA Novosti.   "As long as there is no big freeze, the sea ice will not form and the bears will stay on the coast," she said.

Russia's weather service said temperatures in the region should fall from Saturday and that coastal ice should freeze by December 11.    Polar bears regularly visit areas inhabited by humans in Arctic Russia to search for food, often in rubbish tips.   But the number of visits has been growing as the melting of Arctic ice from climate change forces the bears to spend more time on land where they compete for food.
Date: Fri, 6 Dec 2019 10:28:26 +0100 (MET)
By Joseph Schmid

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

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

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

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

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

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

The minimum pension age in France is 62, one of the lowest among developed countries, but there are 42 "special regimes" for railway workers, lawyers, opera employees and others offering earlier retirements and other benefits.   The government says a single system will be fairer for everyone while ensuring its financial viability while acknowledging that people will gradually have to work longer.
Date: Fri, 6 Dec 2019 04:23:51 +0100 (MET)

Sydney, Dec 6, 2019 (AFP) - Three hundred animals have been evacuated from a wildlife park north of Sydney as massive bushfires encircled Australia's largest city and foreign firefighters arrived to relieve beleaguered local forces.   Walkabout Wildlife Park said it had shipped out lizards, dingoes, peacocks and marsupials, as firefighters battled more than 100 fires up and down the eastern seaboard.   "This fire has been doing some crazy things, so we have to be prepared," general manager Tassin Barnard told AFP.

Prolonged drought has left much of eastern Australia tinder dry and spot fires have raged every day for the past three months, leaving firefighters struggling to cope.   New South Wales rural fire chief Shane Fitzsimmons said Friday that some US and Canadian firefighters had arrived to help out, easing the strain on the exhausted largely volunteer Australian force.

The incident-management and aviation specialists will help ease "fatigue and crew rotations" he said.   "We are not only appreciative of their presence here today, but of their sacrifice," said Fitzsimmons -- who has become a fixture on Australian television screens for weeks, updating the public on blazes in towns, national parks and backwaters.    "They are volunteering to sacrifice time from loved ones, from families, to give up that special time of the year around Christmas and New Year to come down here and lend us a hand," he said.

More than 600 homes have been destroyed and six people have died since the crisis began in September. That is many fewer than Australia's deadliest recent fire season in 2009 when almost 200 people died, but 2019's toll belies the scale of devastation.    Millions of hectares have burned -- the size of some small countries -- across a region spanning hundreds of kilometres (miles).   Bushfires are common in Australia but scientists say this year's season has come earlier and with more intensity due to a prolonged drought and climatic conditions fuelled by global warming.

The fires have taken a toll in Sydney and other major cities, which have been blanketed in toxic smoke for weeks and occasionally sprinkled with snow-like embers.   Fitzsimmons said he could not "overstate the effect that this profound drought is having" as he warned of a long, painful summer ahead.   "There is an absolute lack of moisture in the soil, a lack of moisture in the vegetation... you are seeing fires started very easily and they are spreading extremely quickly, and they are burning ridiculously intensely."
Date: Fri, 6 Dec 2019 03:03:18 +0100 (MET)
By Pierre-Henry DESHAYES

Half Moon Island, Antarctica, Dec 6, 2019 (AFP) - The swimsuit-clad tourists leap into the icy water, gasping at the shock, and startling a gaggle of penguins.   They are spectators at the end of the world, luxury visitors experiencing a vulnerable ecosystem close-up.   And their very presence might accelerate its demise.   Antarctica, a vast territory belonging to no one nation, is a continent of extremes: the coldest place on Earth, the windiest, the driest, the most desolate and the most inhospitable.   Now, it's also a choice destination for tourists.

All around Half Moon Island, off the Antarctic Peninsula, blocks of ice of all sizes float by on a calm sea, their varying forms resembling weightless origami shapes.    On this strip of land, that juts out of the Antarctic Polar and towards South America, visitors can see wildlife normally only viewed in zoos or nature documentaries along with spectacular icy landscapes.   The ethereal shades of white that play across the pillowy peaks change with the light, acquiring pastel hues at dawn and dusk.   "Purity, grandeur, a scale that's out of this world," says Helene Brunet, an awestruck 63-year-old French pensioner, enjoying the scene.    "It's unbelievable, totally unbelievable. It's amazing just to be here, like a small speck of dust."

AFP joined the 430 passengers on board the Roald Amundsen, the world's first hybrid electric cruise ship, on its maiden voyage in the Southern Ocean.    "It's not your typical beach, but it's awesome to do it," says a numb Even Carlsen, 58, from Norway, emerging from his polar plunge in the three-degree C (37.4 F) water.   When tourists go ashore, bundled up in neon-coloured windbreakers and slathered in SPF50 sunscreen, they have to follow strict rules: clean your personal effects so you don't introduce invasive species, keep a respectful distance from wildlife to avoid distressing them, don't stray from the marked paths and don't pick up anything.   "We mucked up the rest of the world. We don't want to muck up Antarctica too," says an English tourist, as she vacuums cat hair off her clothes before going ashore.

- 'Heart of the Earth' -
The Antarctic peninsula is one of the regions on Earth that is warming the fastest, by almost three degrees Celsius in the past 50 years, according to the World Meteorological Organization -- three times faster than the global average.    In March 2015, an Argentinian research station registered a balmy 17.5 degrees Celsius, a record.    "Every year you can observe and record the melting of glaciers, the disappearance of sea ice... (and) in areas without ice, the recolonisation of plants and other organisms that were not present in Antarctica before," said Marcelo Leppe, director of the Chilean Antarctic Institute.

Antarctica is "like the heart of the Earth," he added, saying that it expands and contracts like a heart beating, while the mighty current which revolves around the continent is like a circulatory system as it absorbs warm currents from other oceans and redistributes cold water.   The Antarctic Treaty, signed 60 years ago by 12 countries -- it now has 54 signatories -- declared the area a continent dedicated to peace and science, but tourism has gradually increased, with a sharp rise in the past few years.   Tourism is the only commercial activity allowed, apart from fishing -- the subject of international disputes over marine sanctuaries -- and is concentrated mainly around the peninsula, which has a milder climate than the rest of the continent and is easier to access.

Cruise ships have roamed the region for around 50 years, but their numbers only started to increase from 1990, as Soviet ice-breakers found new purposes in the post-Cold War era.   Some 78,500 people are expected to visit the region between November and March, according to the International Association of Antarctica Tour Operators (IAATO).   That's a 40-percent increase from last year, due in part to short visits by a few new cruise ships carrying more than 500 passengers, too many to disembark under IAATO regulations.     "Some might say 'Well, 80,000 people, that doesn't even fill a national stadium'... (and that it) is nothing like Galapagos which welcomes 275,000 a year," says IAATO spokeswoman Amanda Lynnes.    "But Antarctica is a special place and you need to manage it accordingly."

- 'Leave Antarctica to the penguins' -
It is Antarctica's very vulnerability that is attracting more and more visitors.   "We want to see this fantastic nature in Antarctica before it's gone," Guido Hofken, a 52-year-old IT sales director travelling with his wife Martina, says.    They said they had paid a supplement to climate compensate for their flight from Germany.

But some question whether tourists should be going to the region at all.   "The continent probably would be better off being left to penguins and researchers, but the reality is, that is probably never going to happen," said Michael Hall, professor and expert on polar regions at the University of Canterbury in New Zealand.   "Vicarious appreciation never seems to be enough for humans. So with that being the case, it needs to be made as low risk to the Antarctic environment and as low carbon as possible," said Hall.    "However, when the average tourist trip to Antarctica is over five tonnes of CO2 emissions per passenger (including flights), that is a serious ask."

Soot or black carbon in the exhaust gases of the scientific and cruise ships going to the region is also of concern, said Soenke Diesener, transport policy officer at German conservation NGO Nabu.   "These particles will deposit on snow and ice surfaces and accelerate the melting of the ice because the ice gets darker and will absorb the heat from the sun and will melt much faster," he told AFP.   "So the people who go there to observe or preserve the landscape are bringing danger to the area, and leave it less pristine than it was," he added.

- Responsible tourism -
Antarctic tour operators insist they are promoting responsible tourism.   The trend is for more intimate, so-called expedition cruises, in contrast to popular giant cruise liners elsewhere which are criticised for being invasive and polluting.   With greener ships -- heavy fuel, the most commonly used for marine vessels, has been banned in Antarctica since 2011 -- cruise companies have sought to make environmental awareness a selling point, occasionally earning them accusations of greenwashing.

Global warming, pollution and microplastics are the result of human activities on other, faraway continents, say tour operators.   Here, their motto is "Take nothing but photographs, leave nothing but footprints, keep nothing but memories".   But before they've even set foot on the cruise ships departing from South America -- the most common itinerary -- visitors to Antarctica will already have flown across the world, causing emissions that harm the very nature they have come so far to admire.

Most visitors hail from the Northern Hemisphere, and almost half are from the United States and China, IAATO says.   "I'm a tourist who feels a little guilty about taking a flight to come here," admits Francoise Lapeyre, a 58-year-old globetrotter om France.   "But then again, there are priorities. There are some trips I just won't take, because they leave a big footprint and they're not worth it.   "Crisscrossing the planet to go to a beach for example," she says.

- Don't mention climate change -
Like other expedition cruises where accessible science is part of their trademark, the Roald Amundsen, owned by the Hurtigruten company, has no dance floor or casino.  Instead, there are microscopes, science events and lectures about whales and explorers like Charles Darwin.   But they steer clear of climate change, which is only mentioned indirectly.   That's a deliberate decision as the subject has proven "quite controversial", said Verena Meraldi, Hurtigruten's science coordinator.   "We held several lectures dedicated specifically to climate change but it leads to conflicts. There are people who accept it as a fact, others who don't," she said.   Onboard, "passengers" are referred to as "guests" and "explorers" rather than "cruisers".   "Explorers" are typically older, well-heeled, often highly travelled pensioners who are handed walking sticks as they step ashore.   "My 107th country," says a Dane, stepping ashore onto Antarctica.

The Roald Amundsen "guests" choose between three restaurants, from street food to fine dining -- a far cry from the conditions endured by the Norwegian adventurer for whom the ship is named, who had to eat his sled dogs to survive his quest to reach the South Pole in 1911.   They have paid at least 7,000 euros ($7,700) each for an 18-day cruise in a standard cabin, and up to 25,000 euros ($27,500) for a suite with a balcony and private jacuzzi.   Other cruises are banking on ultra-luxury, with James Bond-like ships equipped with helicopters and submarines, suites of more than 200 square metres (2,153 square feet) and butler services.   With a seaplane to boot, the mega-yacht SeaDream Innovation will offer 88-day cruises "from Pole to Pole" starting in 2021. The two most expensive suites, with a price tag of 135,000 euros per person, are already booked.
 
- Worlds collide -
Outside, in the deafening silence, wildlife abounds.   All around are penguins, as awkward on land as they are agile in water. Massive and majestic whales slip through the waves, and sea lions and seals laze in the sun.   On Half Moon Island, chinstrap penguins -- so called because of a black stripe on their chin -- strut about in this spring breeding season, raising their beaks and screeching from their rocky nests.   "This is to tell other males 'This is my space' and also, maybe, 'This is my female'," ornithologist Rebecca Hodgkiss, a member of the Hurtigruten's scientific team, explains, as a group of tourists stroll around ashore.   The colony of 2,500 penguins has been gradually declining over the years, but it's not known if that is man's fault or they have just moved away, according to Karin Strand, Hurtigruten's vice president for expeditions.   Invisible to the naked eye, traces of humankind are however to be found in the pristine landscape.   Not a single piece of rubbish is in sight but microplastics are everywhere, swept in on ocean currents.   "We've detected them in the eggs of penguins for example," Leppe told AFP.

- Venice under water -
The Antarctic, which holds the world's largest reserve of freshwater, is a ticking time bomb, warn experts and studies.   They say that the future of millions of people and species in coastal areas around the world depends on what is happening here.   As a result of global warming, the melting ice sheet -- especially in the western part of the continent -- will increasingly contribute to rising sea levels, radically re-drawing the map of the world, says climate scientist Anders Levermann, of the Potsdam Institute for Climate Impact Research.   This meltwater will contribute 50 centimetres (almost 20 inches) to the global sea level rise by 2100, and much more after that, he said.   "For every degree of warming, we get 2.5 metres of sea level rise. Not in this century, but in the long run," he said.

Even if the international community meets its obligations under the Paris Agreement to limit global warming to under two degrees Celsius, sea levels will still rise by at least five metres.   "Which means that Venice is under water, Hamburg is under water, New York, Shanghai, Calcutta," he said.   It's impossible to predict when, but the scenario appears unavoidable, says Levermann.   In the same way that a cruise ship powering ahead at full speed can't immediately stop, sea levels will continue to rise even if all greenhouse gas emissions were to cease immediately, a study has said.

- Changing the world? -
The tourism industry says it hopes to make "ambassadors" out of Antarctica visitors.   "It's good for the animal life and for the protection of Antarctica that people see how beautiful this area is, because you cherish what you know and understand," said Hurtigruten chief executive Daniel Skjeldam.   Texan tourist Mark Halvorson, 72, says he is convinced.   "Having seen it, I am that much more committed to having a very high priority in my politics, in my own inner core convictions to being as environmentally friendly in my life as I can," he said.   So, do Guido and Martina Hofken see themselves as future "ambassadors of Antarctica"?    "Just a little bit, probably. But I don't think I will change the world," Guido Hofken concedes.    "The best thing would be for nobody to travel to Antarctica."
Date: Thu, 5 Dec 2019 16:37:37 +0100 (MET)

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

France's civil aviation authority meanwhile told airlines to cut 20 percent of their flights in and out of airports in Paris, Beauvais, Lyon, Marseille, Toulouse and Bordeaux on Friday, the same proportion as on Thursday.   Striking transport workers, air traffic controllers, teachers, fire fighters, lawyers and other groups all fear they will have to work longer or receive reduced pensions under the government's proposal to scrap 42 special pension schemes and replace them with a single plan.   Anticipating the worst travel chaos in years, many employees opted to work from home on Thursday. Those who did venture out travelled mainly by car, bicycle, electric scooter or on foot.
Date: Thu, 5 Dec 2019 12:19:45 +0100 (MET)
By Sofia CHRISTENSEN

Johannesburg, Dec 5, 2019 (AFP) - South African Airways was placed under a state-approved rescue plan on Thursday to avoid the embattled airline's collapse following a costly week-long strike last month.   Thousands of South African Airways (SAA) staff walked out on November 15 after the flag carrier failed to meet a string of demands, including higher wages and job in-sourcing.   The strike was called off the following week after SAA management and unions eventually clinched a deal.

But the walkout dealt a severe blow to the debt-ridden airline, which has failed to make a profit since 2011 and survives on government bailouts.   "The Board of SAA has adopted a resolution to place the company into business rescue," said a statement by South Africa's Public Enterprises Minister Pravin Gordhan, adding that the decision was also supported by the government.   "It must be clear that this is not a bailout," said Gordhan. "This is the provision of financial assistance in order to facilitate a radical restructure of the airline."   The business rescue process will be directed by an independent practitioner. It is meant to prevent a "disorderly collapse of the airline", he added.   Gordhan said the government would provide 2 billion rand ($136 million) to SAA in "a fiscally neutral manner".   Existing lenders will also provide a 2 billion rand loan guaranteed by the government.

- 'Financial challenges' -
South Africa is struggling to get state-owned companies back on track after nine years of corruption and mismanagement under former president Jacob Zuma.   Its national airline -- which employs more than 5,000 workers and is Africa's second largest airline after Ethiopian Airlines -- had been losing 52 million rand ($3.5 million) a day during the strike.   SAA's board said the business rescue, scheduled to start immediately, was decided after consultations with shareholders and the public enterprises department "to find a solution to our company's well-documented financial challenges".

"The considered and unanimous conclusion has been to place the company into business rescue in order to create a better return for the company's creditors and shareholders," said the SAA board of directors in a statement.   The rescue plan will include a "new provisional timetable" and ensure "selected activities... continue operating successfully".   With a fleet of more than 50 aircraft, SAA flies to over 35 domestic and international destinations.   "SAA understand that this decision presents many challenges and uncertainties for its staff," said the board.   "The company will engage in targeted communication and support for all its employee groups at this difficult time.

- 'Lesser evil' -
Unions told AFP they would comment later on Thursday.   They have agreed to a 5.9-percent wage increase backdated to April, but which would only start to be paid out next March depending on funding.   SAA had initially refused any pay rise.    The cash-strapped airline needs two billion rand ($136 million) to fund operations through the end of March. But it was unable to cover all of its staff salaries last month.    "Business rescue allows for the airline to continue to operate while it is being restructured, as opposed to liquidation," analyst Daniel Silke told AFP.   He said the rescue was a "lesser evil for SAA" and would save more jobs than a "shutdown".

But Silke still expected jobs to be cut as SAA attempted to reduce costs.   "Various divisions that make of SAA could be privatised," he said. "There will be a review of SAA aircraft and routes covered by SAA."   Unions had already demanded a three-year guarantee of job security following an announcement last month that almost 1,000 SAA employees could lose their jobs as part of another restructuring plan.   SAA pledged to defer that process to the end of January as part of the deal that ended the strike.
Date: Wed 4 Dec 2019
Source: Stock Daily Dish [edited]

Out of the 7 patients who were admitted to the hospital suspecting Nipah virus infection, one has been tested positive while the other 6 have been tested negative.

Kerala health minister K K Shailaja said at a press briefing in Kochi on Thursday [28 Nov 2019] that of "7 patients admitted to the hospital, one patient's result is positive for Nipah virus, while 6 patients' results are negative. No one has been discharged from the isolation ward. The source of the virus is not confirmed yet."

On the other hand, 2 persons suffering from high fever were put under observation at Trivandrum Medical College on Thursday [28 Nov 2019]. Their samples have been sent for examination.

On 4 Jun [2019], a 23-year-old-man had tested positive for Nipah virus infection, which killed 17 people in Kerala last year [2018].

As of now, a total of 15 people are under observation in the state.

Union minister for health and family welfare Dr Harsh Vardhan had said on 4 Jun [2019] that the centre had rushed a team of doctors to Kerala for investigation in the wake of the scare of Nipah virus. Vardhan had asserted that he was "very vigorously" following the situation.

Nipah virus is transmitted from animals [bats] to humans and then spreads through people to people, causing respiratory illness. Its symptoms include fever, muscle pain, headache, fever, dizziness, and nausea.

The Health Department in Karnataka issued a circular asking administration in Chamarajanagar, Mysuru, Kodagu, Dakshina Kannada, Uttara Kannada, Udupi, Shivamogga, and Chikkamagaluru districts to immediately convene interdepartmental coordination committee meetings, including the veterinary department, the Indian Medical Association, and the Indian Academy of Pediatrics.

Authorities in these 8 districts have been directed to identify 2 isolation beds to quarantine suspected human cases. They have been asked to keep all the logistics available at all levels, read the circular. The department has also asked district authorities to direct government and private hospitals to keep an eye on suspected cases.

Once a patient shows symptoms of Nipah, the hospitals have to monitor for acute encephalitis syndrome, check all vital parameters, and take a travel history of the patients.

The district hospitals should have an ICU with ventilator facilities and capacity to receive emergency cases, the circular read.

The department asked the districts to furnish a daily outbreak report regarding Nipah virus. It also directed authorities to sensitise health assistants and ASHA workers.
==================
[This is the 3rd case of Nipah virus infection [NVI] in Kerala state this year (2019). It is prudent that surveillance and patient-care capacity have been increased. Last year (2018), as of 17 Jul 2018, a total of 19 Nipah virus (NiV) cases, including 17 deaths, were reported from Kerala state: 18 of the cases were laboratory confirmed, and the deceased index case was suspected to have NVI but could not be tested. The 2018 outbreak was localized to 2 districts in Kerala state: Kozhikode and Malappuram.

The exact circumstances under which this or the previous confirmed Nipah virus cases this year (2019) acquired their infections are not stated in the above or in previous reports, nor is it stated whether these individuals had contact with flying fox fruit bats (_Pteropus giganteus_), the reservoir hosts of Nipah virus, or fruit that the bats may have contaminated. It is interesting to note that 12 of 36 fruit bats tested at the National Institute of Virology were positive for Nipah virus. Although Kerala health minister KK Shailaja officially had declared Ernakulam district Nipah-free, it may have been free of human cases but is unlikely to have been free of the virus in _Pteropus giganteus_ fruit bats. - ProMED Mod.TY]

[Maps of India:
Date: Wed 4 Dec 2019
Source: Stock Daily Dish [edited]

Bihar Health Minister Mangal Pandey on [Sat 30 Nov 2019] said the state government is doing its best to save children, as the death toll due to acute encephalitis syndrome [AES] in Muzaffarpur mounted to 73.

Pandey said doctors and nurses are being called in from Patna for additional help. "We are trying everything and anything that can save children's lives. Everything is being made available from medicines to doctors. We have even called doctors and nurses from AIIMS in Patna," he said. "There is a protocol regarding what kind of medicines and facilities should be given and we are doing the same. We are monitoring things regularly and trying to save our children."

Recalling the situation that prevailed 5 years ago, Pandey said a team that was formed to ascertain the cause of this disease concluded that sleeping empty stomach at night, dehydration due to humidity and eating lychee on empty stomach were some of the causes of encephalitis.

"Our government has tried to spread awareness which will be beneficial as well. Advertisement in newspapers, radio jingles, pamphlets and mic [microphone] announcements are going to spread awareness regarding the disease. Health ministry is also working on it," he said.

On being asked about spread of ASE in Gorakhpur last year [2018], he said, "From Gorakhpur to Muzaffarpur region, this disease had spread last year and the Union government had worked on this and we will continue to fight it now."

"This incident in Muzaffarpur is very saddening and we also feel bad when children of our nation die like this. Not the whole district is affected but a large part is suffering from it," he added.

From [1 Jan 2019], until now [5 Dec 2019], 220 children were admitted in Sri Krishna Medical College and Hospital in Muzaffarpur due to AES, out of which 62 lost their lives.

As per the data of SKMCH hospital, 235 children were admitted, of which 89 died; in 2013 - 90 children were admitted, of which 35 died; in 2014 - 334 children were admitted, of which 117 died; in 2015 - 37 children were admitted, of which 15 died; in 2016 - 31 children were admitted, of which 6 died; in 2017 - 44 children were admitted, of which 18 died; and in 2018 - 43 children were admitted, of which 12 died.

Meanwhile, Minister of State for Union ministry for home affairs, Nityanand Rai, visited Sri Krishna Medical College and Hospital to review the situation after the outbreak of AES.

Encephalitis is a viral disease, which causes mild flu-like symptoms such as high fever, convulsions and headaches and has been claiming lives in the district for the past few weeks.
======================
[The dates within which these AES cases have occurred is not stated. The urgency that has prompted Behar health officials to request the aid of physicians and nurses from adjoining Patna suggests that the AES outbreak is going on currently. The uncertainty about the etiology of AES continues. It is curious that the above report makes no mention of negative or positive tests for Japanese encephalitis among the AES patients, although that virus is endemic in northeastern India, including Bihar state. Neighboring Uttar Pradesh state has had JE cases as well this summer (2019) but has intensified its JE vaccination program.

The issue of the aetiology of AES has been under discussion for a long time. Lychee fruit contain toxins. Encephalopathy and hypoglycaemia have been associated with consumption of lychee fruit contains phytotoxins, specifically alpha-(methylenecyclopropyl)glycine (see ProMED-mail archive no. http://promedmail.org/post/20150201.3132842). However, the current cases cannot be due to lychee consumption, since the season for that fruit has passed.

AES has continued to be attributed to a variety of aetiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_). A recent publication (reference below) states that dengue virus is one of the 3 most common agents identified in AES, but existing surveillance for AES does not include routine testing for dengue. Until the etiology (or etiologies) of these AES cases is determined, effective and efficient prevention of these cases will not be possible.

Reference:
Ravi V, Hameed SKS, Desai A, et al. Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): results from a 4-year AES surveillance study of Japanese encephalitis in selected states of India. Int J Infect Dis 2019;84 Suppl:19-24. <https://doi.org/10.1016/j.ijid.2019.01.008>.

Available at:

[Maps of India:
HealthMap/ProMED maps available
at:<http://healthmap.org/promed/p/364>, and Bihar, India:
Date: Thu 5 Dec 2019 6:11 PM EET
Source: Enab Baladi [edited]

[Leishmaniasis] is spreading widely among residents of Deir ez-Zor, and especially children. Some of the areas affected are controlled by the Kurdish self-administration while others are under the control of the Syrian regime. Medical sources counted hundreds of infected civilians and confirmed the disease's rapid spread.

According to Atef al-Tawil, a manager of the Leishmania & Environmental Health Programme at the Syrian regime's Ministry of Health, most infections in eastern Deir ez-Zor are spread among school children.

In a Facebook comment on a post by Twasol agency, al-Tawil claimed that cases of leishmaniasis were detected, at the end of November [2019], in primary schools in eastern Deir ez-Zor and its surrounding villages (al-Jalaa, al-Salihiyah, al-Tawtha, al-Abbas, al-Mujawdeh, al-Hasarat, al-Saial, al-Ghabrah).

According to al-Tawil, 455 infections of children were detected. A treatment team of 10 members was formed in the affected locations, to help control the disease to aid in early detection.

The Syrian Ministry of Health acted after several appeals by civilians residing in the area as they noticed the disease spreading among their children. Al-Tawil said that this rapid spread was due to the fact that all the infected people have lately returned to their original areas which lack medical centers.

Autonomous administration areas
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According to Euphrates Post network, leishmaniasis is also widely spread in areas controlled by the Syrian Democratic Forces (SDF). In its post on [Sun 1 Dec 2019], the network claimed that the spread of leishmaniasis is mostly concentrated in the eastern countryside of Deir ez-Zor.

According to the network, unofficial statistics by the SDF-affiliated local council shows more than 7000 leishmaniasis infections among children in al-Baghouz, Hajin, Diban, al-Sha'afa, al-Kishkiye, Abu Hamam, and Gharanij. The local councils' attempts of controlling the disease are still substandard, according to the Euphrates Post.

The network also quoted doctors and nurses calling for international organizations to interfere and provide hospitals and clinics with the required vaccine [there is no vaccine for leishmaniasis; ed.], and to train specialized medical staff in each clinic to deal with the disease.

The autonomous-administration-affiliated media center in Deir ez-Zor also confirmed the spread of leishmaniasis and pointed out that the authorities took actions, by the end of November [2019], to provide treatments.

According to the media center, special medical teams and cadres were distributed among the clinics to provide 12,000 ampoules of the required [medicine] to treat leishmaniasis with the support of the World Health Organization.

Leishmaniasis is a parasitic disease transmitted by the bite of infected female phlebotomine sandflies -- a very small yellow fly that is active at night and makes no sound when it bites -- and the main cause for its spread is dirt and lack of hygiene.  [Byline: Enab Baladi]
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[Deir ez-Zor is east and south of the locations in the previous ProMED reports (see below), indicating further increase in cases of cutaneous leishmaniasis beyond its historical concentration in western Syria (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861536/>) and beyond the area of the MENTOR initiative in northern Syria (<https://wwwnc.cdc.gov/eid/article/24/11/17-2146_article>).

Cutaneous leishmaniasis is endemic in Syria with its reservoir in rodents. It has been a problem throughout the Syrian civil war and in ISIS controlled areas during the war due to a breakdown in rodent and vector control. - ProMED Mod.EP]

[Maps of Syria:
Date: Tue 3 Dec 2019
Source: Twitter feed in Arabic [machine trans., edited]

Taiz health official: 24 laboratory-confirmed cases of West Nile virus and more than 300 suspected cases. #Republic_Yemen
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[Any information on the actual number of WNV cases, their lab confirmation, and public health response activities in this regard will be highly appreciated. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map of Yemen: