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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]
=====================
[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: Sun, 15 Mar 2020 23:58:27 +0100 (MET)

San Juan, March 15, 2020 (AFP) - The US territory of Puerto Rico on Sunday ordered a 9:00 pm to 5:00 am curfew to stem the spread of the novel coronavirus, the strongest measure yet taken on American soil.   It took effect immediately and lasts until March 30.   "Faced with the possibility of transmission and propagation of the virus, I have ordered the imposition of a curfew for all residents of Puerto Rico," Governor Wanda Vazquez announced in a video message.   "We must take every precaution to ensure that we do not become potential carriers," Vazquez said.

The Caribbean territory of 2.9 million, whose residents are US citizens, also will close many businesses from Sunday until the end of the month, she said.   That includes malls, movie theaters, concert venues, gyms, bars and other businesses that bring together large crowds on the island popular with tourists.   The exceptions will be businesses in the food supply chain, and in the medical care system, as well as drugstores, gas stations, banks and senior citizens' group homes.

At night, only those who are providing or receiving medical care, or carrying out essential duties, will be allowed to be on Puerto Rico's streets.   Anyone defying the curfew faces a six-month jail term and a fine of up to $5,000.   The island declared a state of emergency when its first cases were reported March 12. The island has reported five cases.   On Friday, Vazquez accepted the resignation of Health Secretary Rafael Rodriguez Mercado, who was under fire for his handling the coronavirus emergency.

Recently, island residents were irate when two warehouses were found to be filled with abandoned supplies, apparently never used after Hurricanes Irma and Maria in 2017.   The storms' one-two punch left Puerto Ricans without power for months and killed nearly 3,000 people, according to the local government's official numbers.   President Donald Trump has accused the Puerto Rican government of incompetence and siphoning off hurricane relief money.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
Date: Thu, 16 Jan 2020 02:45:27 +0100 (MET)
By Ivelisse RIVERA, con Leila MACOR en Miami

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

An alert issued by the Tsunami Warning Center immediately following the earthquake was later cancelled.   Tuesday's quake was the strongest of a series of tremors that have shaken the island since December 28, topping Monday's 5.8 quake.   That earthquake toppled houses and caused power outages, but there were no reports of casualties.
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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 ...

Virgin Islands

British Virgin Islands US Consular Information Sheet
April 03, 2006
COUNTRY DESCRIPTION: The British Virgin Islands (BVI) are a British overseas territory, part of the British West Indies, lying about 60 miles east of Puerto Rico. There are abo
t 50 islands in the BVI, many of them uninhabited. Tortola is the main island; other islands include Virgin Gorda, Jost Van Dyke, and Anegada. Tourist facilities are widely available.
ENTRY/EXIT REQUIREMENTS: For tourist stays of up to six months, U.S. citizens need a valid U.S. passport or other proof of U.S. citizenship (original or certified birth certificate, Certificate of Naturalization or Certificate of Citizenship as well as photo identification), onward or return tickets, and sufficient funds for their stay. Upon initial entry, no more than 60 days will be granted. At the end of 60 days, visitors must report to the Immigration Department's main office in Road Town for an extension. Extensions of up to 90 days are issued at the discretion of the Immigration Officer subsequent to an interview. For further information on travel to the British Virgin Islands, travelers should contact the BVI Department of Immigration at 1-284-494-3471. Visit the Embassy of the British Government web site at for the most current visa information.
See Entry and Exit Requirements for more information pertaining to dual nationality and the international child abduction . Please refer to our Customs Information to learn more about customs regulations.

SAFETY AND SECURITY For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site, where the current Travel Warnings and Public Announcements , including the Worldwide Caution Public Announcement , 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: Thefts and armed robberies do occur in the BVI. Visitors should take common-sense precautions against petty crime. Avoid carrying large amounts of cash and use hotel safety deposit facilities to safeguard valuables and travel documents. Do not leave valuables unattended on the beach or in cars. Always lock up boats when going ashore.
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 care in the British Virgin Islands consists of a small general hospital with an emergency room staffed 24-hrs/day by physicians, several clinics on Tortola, and one clinic in Virgin Gorda. Ambulances staffed with paramedics serve both islands. There are no medical facilities on the other islands. A volunteer organization, Virgin Islands Search and Rescue (VISAR), responds 24-hrs/day to medical emergencies at sea or on outer islands. VISAR transports casualties to the nearest point for transfer to ambulance. To reach VISAR, dial SOS (767) or call on Marine Channel 16.
There is no hyperbaric chamber in the BVI. Patients requiring treatment for decompression illness are transferred to St. John, U.S. Virgin Islands. Most sensitive medical cases are transferred to San Juan, Puerto Rico.
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 internet site at . For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at . Further health information for travelers is available at .
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 British Virgin Islands is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Vehicles drive on the left (the British side) with most steering wheels on the left (the "American" side). Road signs are limited and seatbelts are required by law. Drivers often fail to yield the right-of-way to pedestrians, even at painted crosswalks. Speeding and reckless driving are fairly common in the BVI. Drivers can encounter nighttime drag racing on main thoroughfares and livestock on roads. Roads in Tortola's interior can be steep and extremely slippery when wet. Travelers planning to drive across the island should consider requesting four-wheel drive vehicles and should ensure that tires and brakes are in good operating condition on any rental vehicle. Please refer to our Road Safety page for more information, as well as the website of the BVI's national tourist office and national authority responsible for road safety at
.
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the British Virgin Islands as being in compliance with ICAO international aviation safety standards for oversight of BVI's air carrier operations. For more information, travelers may visit the FAA's Internet web site at .
CUSTOMS REGULATIONS: BVI customs authorities may enforce strict regulations concerning temporary importation into or export from the British Virgin Islands of items such as drugs and firearms. Visitors to BVI carrying firearms must declare them upon entry into any port in the territory. Firearms must be bonded and are held by the proper authorities until time of departure. Contact BVI Customs & Immigration at 1-284-494-3475, the Embassy of the United Kingdom in Washington, D.C. or one of the UK's consulates in the United States for specific information regarding customs requirements. 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 British Virgin Island laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the BVI 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 .
DISASTER PREPAREDNESS: All Caribbean countries 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).
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website.
REGISTRATION/EMBASSY AND CONSULATE LOCATIONS: Americans living or traveling in the British Virgin Islands are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website , and to obtain updated information on travel and security within the BVI. 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 nearest U.S. Embassy to the BVI is located in Bridgetown, Barbados. The Consular Section is located in the American Life Insurance Company (ALICO) Building, Cheapside, telephone 1-246-431-0225 or fax 1-246-431-0179, email ConsularBridge2@state.gov , or . The U.S. Consular Agent in Antigua, located at Jasmine court, St. John's, tel. 1-268-463-6531, is closer to the BVI and can also assist in some limited non-emergency cases, by previous appointment only.
****
This replaces the British Virgin Islands Consular Information Sheet dated April 26, 2005 to update all sections.

Travel News Headlines WORLD NEWS

Date: Thu 19 Sep 2019
Source: Emerg Infect Dis [edited]

Citation:
Guendel I, Ekpo LL, Hinkle MK, Harrison CJ, Blaney DD, et al.: Melioidosis after Hurricanes Irma and Maria, St. Thomas/St. John District, US Virgin Islands, October 2017. Emerg Infect Dis. 2019; 25(10): 1952-1955. doi: 10.3201/eid2510.180959.

Melioidosis is caused by _Burkholderia pseudomallei_, a saprophytic, gram-negative bacillus endemic to tropical regions worldwide (1). Diagnosis is difficult because of wide-ranging clinical manifestations (2), and this bacterium is innately resistant to many antimicrobial drugs, making treatment options limited, complex, and lengthy (3). Infection occurs by percutaneous exposure, inhalation, or ingestion.

Melioidosis is rare in the USA, and cases are usually travel related (4,5). However, regional endemicity has been documented in Puerto Rico (6), and sporadic human cases have been reported in the Caribbean (5,7). In September 2017, the US Virgin Islands were affected by 2 category 5 hurricanes, Irma and Maria; widespread flooding continued for weeks. We describe the clinical manifestations, management, and outcome of post-hurricane melioidosis cases in 2 women in St. Thomas and St. John, US Virgin Islands.

The study
Despite major damage to the 2 hospitals in the territory during the 2 hurricanes, the Virgin Islands Department of Health (VIDOH) maintained surveillance at both emergency departments. Two isolates were recovered from each patient. Local specimen analysis for organism identification was performed by using the MicroScan WalkAway System (Siemens Healthcare Diagnostics, <https://www.siemens-healthineers.com>). All isolates were confirmed as _B. pseudomallei_ at the CDC. Whole-genome sequencing and single-nucleotide polymorphism analysis were performed (National Center for Biotechnology Information, <https://www.ncbi.nlm.nih.gov>. Genomes from a given patient were clonal to each other. However, representative genomes from both patients had differences (greater than 5600 single-nucleotide polymorphisms), indicating the presence of different strains in these infections. Genomic comparison with a reference panel indicated that the isolates were within the previously described Western Hemisphere clade and subclade associated with the Caribbean (8).

Patient 1 was an 80-year-old female resident of St. Thomas who had a history of cardiomyopathy and type II diabetes mellitus. She came to the emergency department (ED) at Schneider Regional Medical Center (St. Thomas, US Virgin Islands) because of shortness of breath (symptom onset 28 days after Hurricane Irma and 9 days after Hurricane Maria). Her symptoms were worsened orthopnea, increased abdominal girth, and edema, consistent with her symptoms at previous admissions. The patient was admitted for management of acute decompensated heart failure.

The patient had a temperature of 98.5 deg F [36.9 deg C]; diffuse pulmonary crackles; jugular venous distension; normal heart sounds; and bilateral, lower extremity pitting edema. Examination showed a focal area on the anterior left thigh that had a central, firm, warm, erythematous, tender, subcutaneous nodule about 2 cm [approximately 0.8 in] in diameter with a central fluctuant area and a small pinhole. Incision and drainage was performed, and a swab specimen of purulent drainage was sent for culture.

The patient was given intravenous clindamycin (600 mg every 8 h for 5 d) and was discharged while receiving oral clindamycin, but the treatment course was not completed. Cultured wound showed growth of _B. pseudomallei_ at 5 days. However, culture growth was not yet positive before patient discharge. The isolate was susceptible to trimethoprim/sulfamethoxazole (Table 1 [for Tables and Figure, see original URL - ProMED Mod.LL]).

Patient 1 returned to the ED 2 weeks later because of manifestations similar to those at the 1st visit. She was afebrile and admitted for diuresis. The left thigh lesion had progressed into a 2 cm [about 0.8 in], tender, shallow ulcer productive of purulent material surrounded by erythema and a focal area of induration (Figure). Laboratory data reflected a leukocyte count within reference ranges and mild renal insufficiency with estimated glomerular filtration rate of 40.47 mL/min (Table 2). A 2nd wound culture was collected, and the patient was given intravenous meropenem (1 g every 8 h). Culture was presumptively positive for _B. pseudomallei_ and _Serratia marcescens_ after 48 hours, confirmed after 8 days. Both isolates showed the same resistance pattern and were susceptible to meropenem and trimethoprim/sulfamethoxazole: the MIC for meropenem was <1 microgram/mL (Table 2). Meropenem was continued for 8 days, and ulcer improvement was observed. The patient was discharged while receiving oral trimethoprim/sulfamethoxazole (800 mg/160 mg 2x/d) to complete maintenance therapy. The patient completed a 3-month course of trimethoprim/sulfamethoxazole and achieved resolution.

Patient 2 was a 60-year-old female who had diabetes and was a resident of St. John. She was referred to the ED at Schneider Regional Medical Center by her primary care physician because of hyperglycemia, productive cough, and malaise for one week (symptom onset 46 days after Hurricane Irma and 33 days after Hurricane Maria). The patient was admitted to the intensive care unit because of community-acquired pneumonia.

The patient was lethargic and had a temperature of 101 deg F [38.3 deg C]; heart rate was 99 beats/min, respiratory rate 22 breaths/min, and blood pressure 142/81 mm Hg. Blood gas testing showed pO2 of 47.6 mm Hg with an oxygen saturation of 87.2% on 2-liter nasal cannula. A chest radiograph showed a left-sided mild infiltrate, and her leukocyte count was markedly increased (28 300 cells/mm3) (Table 2).

The patient was given intravenous ceftriaxone (1 g/d) and azithromycin (500 mg/d) after blood and sputum cultures were prepared. She required bilevel positive airway pressure but eventually required mechanical ventilation. The patient then became hypotensive and required norepinephrine to maintain a main arterial pressure greater than 65 mm Hg. Ceftriaxone was discontinued, and she was given intravenous piperacillin/tazobactam (3.375 g every 6 h). Trimethoprim/sulfamethoxazole- and ceftazidime-sensitive _B. pseudomallei_ were identified from sputum culture after 72 hours (Table 1). Methicillin-sensitive _Staphylococcus aureus_ and _Candida glabrata_ were also identified. One of 2 blood cultures was positive for gram-negative rods. Piperacillin/tazobactam was discontinued, and the patient was given meropenem (1 g every 8 h).

The patient remained critically ill and was transferred to a tertiary-care hospital in the continental USA. She died in a long-term care facility during October 2018 without showing signs of neurologic improvement.

Isolates from both patients showed susceptibility to routinely tested antimicrobial drugs (10,11). Isolates from patient 1 showed resistance to ceftazidime during preliminary analysis (Table 1). However, broth microdilution confirmatory testing performed at CDC indicated ceftazidime susceptibility, highlighting the need for additional antimicrobial resistance confirmation.

Both patients were interviewed to determine travel history and possible exposure sources. Patient 1 traveled occasionally to the southeastern USA; her last travel date was 3 months before her illness. This patient reported flooding and water damage to her home from the hurricanes but did not report contact with flood waters. Patient 2 reported no travel history before the hurricanes.

VIDOH has investigated and confirmed a subsequent case-patient with pulmonary melioidosis in St. Thomas during December 2018 (I. Guendel et al., unpub. data). This case-patient reported no recent travel and might have had occupational exposure as a professional gardener. This person had 2 risk factors (type II diabetes mellitus and heavy use of alcohol).

Conclusions
Given regional occurrence, detection of melioidosis in the US Virgin Islands is not surprising. Furthermore, emergence of melioidosis after extreme weather events has been well documented, and cases were likely acquired locally from storm-related exposure to flooded soil, surface water runoff, or generation of coarse aerosols (12,13). Although detection of _B. pseudomallei_ has yet to be confirmed in the environment, it might be endemic to the US Virgin Islands, as in Puerto Rico.

In January 2018, melioidosis was listed as a reportable disease in the US Virgin Islands. Future actions include disease education efforts for physicians and laboratory staff because misdiagnosis is common (14). Awareness campaigns highlighting preventive measures for the public are necessary because risk factors are prevalent in the local population (e.g., diabetes and other chronic disease) and might be exacerbated under disaster settings (e.g., respiratory effects and open wounds). VIDOH has implemented rapid diagnostic testing by using Active Melioidosis Detect (InBios International, <https://inbios.com>) on suspected specimens for prompt on-island case identification while routine ED diagnostic cultures are performed (5). All confirmatory testing is conducted at CDC.

References
-------
On Request
======================
[This infection is found primarily in southeast Asia and the Northern Territory of Australia. Despite this, cases of melioidosis have been acquired in other parts of the world including the Americas. Flooding from the increasing number of severe tropical storms related to climate change is increasing.

Melioidosis is a disease of the rainy season in its endemic areas. It mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (most common risk factor), renal disease, cirrhosis, thalassemia, alcohol dependence, immunosuppressive therapy, chronic obstructive lung disease, cystic fibrosis, and excess kava consumption (kava is an herbal member of the pepper family that can be associated with chronic liver disease).

Melioidosis may present at any age but peaks in the 4th and 5th decades of life, affecting men more than women. In addition, although severe fulminating infection can and does occur in healthy individuals, severe disease and fatalities are much less common in those without risk factors.

The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, and chest pain, and -- although the cough can be nonproductive -- respiratory secretions can be purulent, significant in quantity, and associated with on-and-off bright red blood. The lung infection can be rapidly fatal -- with bacteremia and shock -- or somewhat more indolent.

Acute melioidosis septicaemia is the most severe complication of the infection. It presents as a typical sepsis syndrome with hypotension, high cardiac output, and low systemic vascular resistance. In many cases, a primary focus in the soft tissues or lung can be found. The syndrome, usually in patients with risk factor comorbidities, is characteristically associated with multiple abscesses involving the cutaneous tissues, lung, liver, and spleen, and a very high mortality rate of 80-95%. With prompt optimal therapy, the case fatality rate can be decreased to 40-50%.

The melioidosis bacillus is intrinsically insensitive to many antimicrobials, and in fact, bioterrorism strains may be engineered to be even more resistant. _Burkholderia pseudomallei_ is usually inhibited by tetracyclines, chloramphenicol, trimethoprim-sulfamethoxazole (SXT), antipseudomonal penicillins, carbapenems, ceftazidime, and amoxicillin/clavulanate or ampicillin/sulbactam. Ceftriaxone and cefotaxime have good in vitro activity but poor efficacy, and cefepime did not appear, as well, to be equivalent to ceftazidime in a mouse model. The unusual antimicrobial profile of resistance to colistin and polymyxin B and the aminoglycosides but sensitivity to amoxicillin/clavulanate is a useful tool to consider in treatment of infection with the organism.

The randomized and quasi-randomized trials comparing melioidosis treatment have been reviewed, and it was found that the formerly standard therapy of chloramphenicol, doxycycline, and SXT combination had a higher mortality rate than therapy with ceftazidime, imipenem/cilastatin, or amoxicillin/clavulanate (or ampicillin/sulbactam). The betalactam-betalactamase inhibitor therapy, however, seemed to have a higher failure rate.

Source: Tolaney P, Lutwick LI: Melioidosis. In: Lutwick LI, Lutwick SM (eds). Bioterror: the Weaponization of Infectious Diseases. Totowa NJ: Humana Press, 2008. pp 145-58. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
US Virgin Islands: <http://healthmap.org/promed/p/479>]
Date: Fri 31 Jan 2014
Source NBC News [edited]

The Explorer of the Seas outbreak was caused by norovirus, one of the worst outbreaks in 20 years, the Centers for Disease Control and Prevention (CDC) said. The Explorer of the Seas cruise ship returned to port after hundreds of passengers became ill. Federal health officials confirmed on Friday [31 Jan 2014] that norovirus was the culprit that sickened nearly 700 people on a cruise ship this week, and said it was one of the biggest norovirus outbreaks in 20 years. But the source of the outbreak on the Royal Caribbean ship Explorer of the Seas, which returned early to New Jersey on Wednesday [29 Jan 2014], may never be known, CDC said: "CDC has been investigating the outbreak since last Sunday [26 Jan 2014] but no particular source has been identified and it's quite possible a source won't be identified."

The report comes after passengers streamed off the Caribbean Princess on Friday morning [31 Jan 2014], the 2nd cruise cut short this week amid reports of illness on board. The ship, operated by Princess Cruises, returned to Houston [Texas] a day early with a confirmed outbreak of norovirus. "The ship was forced to return to Houston one day early because we were informed that dense fog was expected to close the port for much of the weekend," the company said in a statement. "The ship did not return early because of the increased incidence of norovirus on board, despite some media reports."

At least 178 people on board became ill during the cruise, according to the cruise line and CDC. Sick patients were quarantined to their rooms, and other passengers said they no longer had access to buffet tongs as crew members handed out hand sanitiser. CDC health officials met the Caribbean Princess at the Bayport Cruise Terminal in Pasadena, Texas. The vessel launched on a 7-day cruise to the western Caribbean on [25 Jan 2014] and had been scheduled to return on Saturday [1 Feb 2014]. Princess Cruises said the outbreak was over by the time the ship returned to Houston. "As a result of our actions, case numbers declined significantly and by the end of the cruise there were no passengers with active symptoms," the company said. "Over the course of the cruise 178 passengers (5.7 per cent) and 11 crew (1 per cent) reported ill to the Medical Center."

CDC officials also helped Royal Caribbean clean up the Explorer of the Seas, and said it had been approved to go back out again with a new batch of passengers Friday afternoon [31 Jan 2014]. Royal Caribbean officials say they cleaned the ship, which carried more than 3000 passengers, 3 times. It's the 3rd cruise ship outbreak to occur this year [2014]. A Norwegian Cruise Line ship, the Norwegian Star, reported that 130 passengers and 12 crew members became ill on 2-week cruise that launched [5 Jan 2014] from Miami.

About 20 million passengers take cruises in the US each year, fuelling a USD 37.8 billion annual industry, according to the American Association of Port Authorities. There were 9 vessel outbreaks in 2013 and 16 in 2012, according to the CDC. Norovirus is a common culprit in outbreaks on cruise ships, in nursing homes, and other confined places. It is a fast-moving gut bug typically spread by infected people or contaminated food or water. Norovirus is the most common cause of acute gastroenteritis in the US, resulting in about 21 million illnesses, between 56 000 and 71 000 hospitalizations and as many as 800 deaths, CDC says.

The virus lingers on surfaces and spreads very easily. Thorough hand washing with hot water and soap and meticulous environmental cleaning can help stop the spread. CDC says it's the season for norovirus. "Norovirus outbreaks wit high attack rates are common during this time of year," the agency said. "Most outbreaks occur between January and April."   [byline: Maggie Fox]
*****
Date: Wed 29 Jan 2014
Source: NBC News [edited]

Beleaguered passengers finally fled a Royal Caribbean cruise ship on Wednesday [29 Jan 2014] after a 10-day vacation cut short by a nasty gut bug that sickened nearly 700 people. One woman aboard the Explorer of the Seas yelled, "We made it!" as the ship docked in Bayonne [New Jersey], 2 days ahead of schedule. Other passengers stood on deck wrapped in blankets to watch the ship pull in. One person was removed from the Explorer of the Seas on a stretcher and taken away by ambulance. Others walked under their own power after the vessel arrived. Several passengers recounted a week full of tension and drama, but also professionalism and care from the cruise line crew.

Still, the ordeal on the 1020-foot ship -- whose relaxing voyage to the US Virgin Islands was thwarted by suspected norovirus -- may linger a little longer for people still showing signs of the fast-moving infection, health officials said. "We have passengers who are still exhibiting active disease," said Burnadette Burden, a spokeswoman for the Centers for Disease Control and Prevention. People who are still sick may be too ill to travel home -- and too contagious to use public transportation like trains and buses, health experts say. Royal Caribbean officials said Wednesday [29 Jan 2014] that they'd pay for hotels or make sure that ill passengers get additional medical care. "Should a guest feel sick enough that they want to go to the hospital, we will arrange for transportation," Royal Caribbean spokeswoman Cynthia Martinez said in an email. "We will work with the small number of guests that still feel ill to make them as comfortable as possible."

At least 630 of the ship's 3071 passengers and at least 54 of the 1166 crew members came down with diarrhea and vomiting -- classic signs of norovirus. Most of the cases occurred early in the cruise, which left New Jersey on [21 Jan 2014], and many passengers had already recovered. It's hard to say that the outbreak was the worst on record because of inconsistencies in record-keeping. But it's a bad one, Burden said. "It would be fair to say this is one of the largest numbers in the last 20 years or so," she said. One of the closest outbreaks to compare occurred in 2006, when a Carnival Cruise ship, the Carnival Liberty, was hit with an outbreak of norovirus that sickened 679 passengers and crew on a November trip to the US Virgin Islands.

CDC officials have not confirmed that norovirus is the culprit on the Explorer of the Seas, though it's a common cause of illness on cruise ships. Officials said testing was delayed by a treacherous winter snowstorm that closed the agency's Atlanta headquarters and results aren't expected until Friday [31 Jan 2014]. But if it is the germ, it's highly contagious for the one to 2 days when people are actively sick -- and for a few days afterward. The virus actually lingers in people's stool for 2 weeks or more, according to the CDC. That means that anyone who fell ill -- and those who were around them -- should pay extra attention to washing their hands and other kinds of cleanliness, said Dr Ruth Lynfield, outgoing head of the public health committee of the Infectious Diseases Society of America.

Cleanliness will be the key for the cruise line, too. Officials said they plan another scrub, a so-called "barrier sanitation" program to ensure that any remaining traces of illness are removed from the ship. Norovirus is a notoriously difficult bug to eradicate, health experts say. "It will be the 3rd aggressive sanitizing procedure the ship has undertaken since we became aware of the issue, and will additionally provide a window of more than 24 hours where there are no persons aboard the ship," officials said in a statement.   [byline: JoNel Aleccia]
******
Date: Fri 31 Jan 2014
Source: CDC, National Center for Environmental Health, Division of
Emergency and Environmental Health Services, Vessel Sanitation Program (VSP) [edited]

Cruise ship: Explorer of the Seas -- voyage dates: 21-31 Jan 2014
-----------------------------------------------------------------
- number of passengers who reported being ill during the voyage out of total number of passengers onboard: 634 of 3071 (20.6 per cent)
- number of crew who reported being ill during the voyage out of total number of crew onboard: 55 of 1166 (4.7 per cent)
- predominant symptoms: vomiting, diarrhea
- Causative agent: Norovirus

Actions: in response to the outbreak, Royal Caribbean Cruise Line and the crew aboard the ship took the following actions:
- increasing cleaning and disinfection procedures according to their outbreak prevention and response plan;
- making announcements to both notify onboard passengers of the outbreak and encourage case reporting;
- collecting stool specimens from ill passengers and crew for submission to the CDC lab;
- making multiple daily reports of gastrointestinal illness cases to the VSP [Vessel Sanitation Program];
- preparing additional crew members to join the ship mid-voyage to assist with case management and intensified sanitation procedures;
- consulting with CDC on plans for: passenger notification procedures and the planned delayed embarkation schedule in Bayonne, NJ on [31 Jan 2014], and disembarkation plans for active cases, terminal, and transport infection control procedures.

One CDC Vessel Sanitation Program epidemiologist, one contract epidemiologist, and one VSP environmental health officer boarded the ship in St Thomas, [US Virgin Islands] and are sailing on the ship as it travels back to port in New Jersey. This team is conducting an epidemiologic investigation, environmental health assessment, and evaluating the outbreak and response activities on board. One additional CDC Vessel Sanitation Program environmental health officer will board the ship upon arrival on [29 Jan 2014] to assist with the evaluation of the disinfection process. The team will continue the investigation and evaluation on the ship thru the boarding of new passengers for the next voyage. 5 clinical specimens were shipped to the CDC lab for testing on [26 Jan 2014].
**************************
Date: Fri 31 Jan 2014
Source: CDC, National Center for Environmental Health, Division of
Emergency and Environmental Health Services, Vessel Sanitation Program (VSP) [edited]

Cruise ship: Caribbean Princess -- voyage dates: 25 Jan-1 Feb 2014
------------------------------------------------------------------
- number of passengers who reported being ill during the voyage out of total number of passengers onboard: 181 of 3102 (5.8 per cent)
- number of crew who reported being ill during the voyage out of total number of crew onboard: 11 of 1148 (0.96 per cent)
- predominant symptoms: vomiting, diarrhea
- causative agent: Norovirus

Actions: in response to the outbreak, Princess Cruise Lines and the crew aboard the ship took the following actions:
- increasing cleaning and disinfection procedures according to their outbreak prevention and response plan;
- making announcements to both notify onboard passengers of the outbreak and encourage case reporting;
- collecting stool specimens from ill passengers and crew for submission to the CDC lab. Samples tested with the vessel's onboard rapid norovirus test were positive for norovirus. The specimens will be sent to the CDC lab for confirmatory analysis;
- making multiple daily reports of gastrointestinal illness cases to the VSP;
- consulting with CDC on plans for: passenger notification procedures and the planned delayed embarkation schedule in Houston, TX on [1 Feb 2014], and disembarkation plans for active cases, and terminal and transport infection control procedures.

Two CDC Vessel Sanitation Program environmental health officers will board the ship in Houston, TX on [31 Jan and 1 Feb 2014] to conduct an epidemiologic investigation, environmental health assessment, and evaluate the outbreak and response activities. Specimens are being collected and will be sent to the CDC lab for testing.
=====================
[ProMED-mail does not normally report outbreaks of norovirus-related gastroenteritis because of their ubiquity during the winter months. (Hence the alternate designation 'winter vomiting bug'). Norovirus infection is very contagious and can be contracted from an infected person, contaminated food or water, or by touching contaminated surfaces. The virus causes acute gastroenteritis with stomach pain, nausea, and diarrhea and vomiting. Anyone can be infected with norovirus and acquire norovirus illness repeatedly throughout life. Norovirus is the commonest cause of acute gastroenteritis in the United States. Each year, it causes 19-21 million cases and contributes to 56 000-71 000 hospitalizations and 570-800 deaths. Norovirus is also the commonest cause of foodborne disease outbreaks in the United States. There's no vaccine to prevent norovirus infection and no drug to treat it.

Norovirus illness is usually not serious. Most people get better in 1 to 3 days. But norovirus illness can be serious in young children, the elderly, and people with other health conditions. It can lead to severe dehydration, hospitalisation but rarely death. Most outbreaks of norovirus illness happen when infected people spread the virus to others. But, norovirus can also spread by consumption of contaminated food or water and by touching contaminated surfaces.

Health care facilities, including nursing homes and hospitals, are the most commonly reported places for norovirus outbreaks in the United States. Over half of all norovirus outbreaks reported in the United States occur in long-term care facilities. Outbreaks of norovirus illness appear to be occurring more frequently in cruise ships and similar environments. - ProMed Mod.CP]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/8vcv>.]
Date: Tue 13 Dec 2011
Source: Virgin Islands Daily News [edited]

The Centers for Disease Control and Prevention [CDC] has linked 5 past cases of Legionnaires' disease -- reported between March 2010 and August 2011 -- with stays at Marriott's Frenchman's Reef and Morning Star Beach Resort and Marriott's Frenchman's Cove [in Saint Thomas], prompting remediation work to the resorts' water systems. The VI [Virgin Islands] Health Department has been "working closely" with a team of CDC specialists to monitor the remediation efforts at the resorts, after an investigation into the 5 past cases, according to a statement the Health Department released Monday [12 Dec 2012].

The illness was found in stateside residents who had been guests at the resorts, said Health Department spokeswoman Eunice Bedminster. They required hospitalization but have since recovered, she said. There have been no reports of employees affected at either site, according to the Health Department statement.

The statement indicates that Frenchman's Reef and Morningstar Beach Resort has hired a consultant who led a cleaning project of the affected areas and treated the water system. Test results show no existence of _Legionella_ bacteria, although the Health Department statement said the test results have not yet been evaluated independently by the CDC.

The Health [Department] had asked the resorts to notify those who could potentially be affected by the bacteria: guests and employees, Bedminster said. The properties asked for an extension on a deadline that had been set, and it was granted, but the deadlines passed last week [week of 5 Dec 2011] without the notification to guests and employees going out, Bedminster said. She did not know if, after the deadline, the properties had made the requested notifications, she said.

The hotel provided The Daily News with a written statement that did not address guest notification: "Marriott takes hotel hygiene and cleanliness very seriously. As soon as we were notified of the possibility of the presence of _Legionella_ bacteria we immediately began to work with the USVI Department of Health (DOH) to address the situation. The Frenchman's Reef and Morning Star Beach Resorts hired a consultant who led a cleaning project of affected areas and the treatment of the water system. The latest test results taken after the implementation of these measures show no existence of _Legionella_ bacteria in the samples tested. We have complied with the recommendations provided by the DOH, and we have successfully addressed the issue at the resort. The DOH has allowed the hotel to remain fully open for business and welcome our guests."

The Daily News spoke with Marriott Frenchman's Reef and Morning Star Beach Resort General Manager Jose Gonzalez Espinosa by phone and asked for comment on the Health Department's assertion that the resort did not make the notifications it was supposed to make by the deadline. Gonzalez would not answer the questions unless they were in writing. The Daily News has a policy against submitting questions in writing because written Q and A stifles and slows follow-up and response. The resort underwent a major renovation during the summer, closing 3 May 2011 and reopening on 6 Oct 2011.

Legionnaires' disease is a pneumonia caused by the _Legionella_ bacteria, which live in warm water supplies, said Dr Lauri Hicks, a medical epidemiologist with the CDC. The bacteria that cause the disease do not pass from person to person. "It really requires exposure to water aerosol that contains _Legionella_," she said, Exposure may occur from showering or with time spent in a whirlpool or hot tub where the bacteria that lead to Legionnaires' disease are present, Hicks said.

Only a fraction of people -- typically those with certain risk factors, such as compromised immune systems -- exposed to the bacteria become ill, she said.

According to the Health Department statement, from 2000 through 2009, a total of 22 418 cases of legionellosis were reported to CDC from the 50 states and the District of Columbia. The CDC informed the Health Department in October [2011] of the 5 Legionnaires' disease cases among past guests at the resorts, and the Health Department asked for the agency's help in investigating. From 18 to 22 Oct 2011, CDC specialists conducted testing, and the properties were alerted about the possible _Legionella_ contamination, Bedminster said. On 3 Nov 2011, the Health Department notified each property of the CDC's conclusive findings and ordered them to immediately work on their water systems, including cleansing, superheating, chlorinating, and hiring a private consultant experienced in eliminating _Legionella_ from building water systems, according to the release. More than 6 weeks later, the Health Department notified the public with the statement it released Monday [12 Dec 2011].

Bedminster said that there had been no delay -- and that remediation work began immediately. "We have worked in good faith with both the resorts during what I have said was a monitoring process. We had some agreed-upon deadlines that had not been met, so we had to let the public know," she said.

Bedminster said that Health Department officials had discussed the possibility of enforcement actions with the Department of Labor and the Department of Planning and Natural Resources to get those deadlines met, but she did not know the outcome of the discussions. "Safeguarding the public's health, including that of employees and guests, from exposure and threats are of the utmost importance to the Department of Health," acting Health Commissioner Mercedes Dullum said in the prepared statement. "DOH will continue to monitor this situation with assistance from the CDC. People should not be discouraged from traveling to or within the US Virgin Islands."  [Byline: Joy Blackburn]
---------------------------------------------
Communicated by:
Denis Green
denis@gatesit.com.au
=======================
[The following has been extracted from the US CDC document Travel-Associated Legionnaires' Disease (<http://www.cdc.gov/legionella/faq.htm>):

"About 20-25 percent of all Legionnaires' disease reported to CDC is travel-associated. Legionnaires' disease is important to diagnose and to report because its identification implies the presence of an environmental source to which other susceptible individuals are likely to be exposed. Clusters of Legionnaires' disease associated with travel to hotels or aboard cruise ships are rarely detected by individual clinicians or health departments; travelers typically disperse from the source of infection before developing symptoms. Therefore, a travel history should be actively sought from patients with community-acquired pneumonia and _Legionella_ testing should be performed for those who have traveled in the 2 weeks before onset of symptoms.

"_Because of the multi-state nature of travel in the US, national-level surveillance is necessary to detect outbreaks of travel-associated Legionnaires' disease. CDC relies upon state and local health departments to conduct this surveillance. Surveillance through the National Notifiable Diseases Surveillance System (NNDSS) is still important for monitoring national trends; all cases should be reported through NNDSS."

"Because of the public health importance of timely reporting, inform CDC of travel-associated cases by emailing about the patient's movements in the 2-10 days before onset."

"Environmental sampling/testing should only be conducted after careful consideration of the epidemiologic evidence linking a case(s) to a particular location."

The following article is linked to the CDC document: Barbaree JM, et al: Protocol for Sampling Environmental Sites for Legionellae. Applied Environmental Microbiol 1987; 53(7): 1454-8 (<http://www.cdc.gov/legionella/files/sampling_protocol1987.pdf>): "Since legionellae not related to disease may be found in many of the sites sampled, an epidemiologic association with the probable source should be established before intervention methods, such as disinfection, are undertaken."

"Random sampling without an epidemiologic evaluation and comparing isolates from the environment and from patients could lead to false conclusions about sources of epidemic strains."

Potential environmental sampling sites for _Legionella_ spp that the CDC document suggests include: internal surfaces of faucets, aerators, and shower heads; and water from incoming water main, holding tanks and cisterns, water heater tanks, decorative fountains, irrigation equipment, fire sprinkler system (if recently used), whirlpools, and spas. Because _Legionella_ may be found in water supplies without linkage to any cases, the actual causative source should be demonstrated by matching the genotype of the environmental isolates with that of any clinical isolates to assure frequently costly corrective measures are carried out on the actual source (<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC86783/>; and <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730281/>).

The Virgin Islands are located in the Leeward Islands of the Lesser Antilles, which form the border between the Caribbean Sea and the Atlantic Ocean. Politically, the eastern islands form the British Virgin Islands and the western ones form the United States Virgin Islands. The US Virgin Islands consist of the main islands of Saint Croix, Saint John, and Saint Thomas (<http://en.wikipedia.org/wiki/United_States_Virgin_Islands >). They can be seen on the HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/1xng>. - ProMed Mod.ML]
Date: Sat 18 Sep 2010
Source: Virgin Islands Daily News [edited]
<http://virginislandsdailynews.com/dengue-outbreak-confirmed-in-1.1018284>

After 19 cases of suspected dengue fever -- and at least one death -- reported in the St Thomas-St John District, the VI Health Department issued a statement Friday [17 Sep 2010] saying that the district is experiencing a dengue fever outbreak. According to the Health Department statement released [Fri 17 Sep 2010], 9 of the 19 suspected cases have been laboratory-confirmed as dengue fever in the St Thomas-St John District since June [2010]. On St Croix, there have been 4 suspected cases with no confirmed cases. There is no requirement in the territory that people with suspected dengue fever undergo testing to confirm whether or not they have the mosquito-borne virus, said Health Department epidemiologist Eugene Tull.

His experience with a 2005 outbreak on St Croix leads him to believe that the number of dengue cases this year [2010] is higher than reported, Tull said, adding that he is now receiving anecdotal information about more cases in the community. According to the release, the strain causing the current outbreak is [dengue virus] type 2, which was responsible for the 2005 outbreak on St Croix.
================
[An interactive HealthMap/ProMED-mail map showing the location of the Virgin Islands in the Caribbean can be accessed at
<http://healthmap.org/r/01tp>. - ProMed Mod.TY]
Date: Fri 27 Aug 2010
Source: Virgin Islands Daily News [edited]
<http://virginislandsdailynews.com/news/dengue-fever-possible-cause-of-death-of-st-john-woman-1.977556>

A St John woman who was transferred last week [week of 16 Aug 2010] to a Miami hospital with possible dengue fever symptoms died there 20 Aug [2010] from complications, her husband said. VI [Virgin Islands] Health Department epidemiologist Eugene Tull said earlier this week [week of 23 Aug 2010] that he had no information about a possible death from dengue fever.

Health Department spokeswoman Eunice Bedminster said Thursday [26 Aug 2010] that the department was not aware of any deaths from the territory's dengue fever cases but had been investigating since receiving inquiries from reporters Monday [23 Aug 2010].

Tull said earlier this week that so far this year [2010], there have been 8 confirmed, laboratory positive cases of dengue fever in the territory, 3 probable cases with lab results pending, and 15 suspected cases. All of those were in the St Thomas/St John District, except for 2 of the suspected cases, which were on St Croix, he said. [Byline: Joy Blackburn]
=====================
[The attribution of the woman's death to dengue virus infection is speculative. ProMED-mail awaits confirmation (or not) as further information becomes available. It is clear, however, that locally acquired dengue virus infections are occurring there.

Maps showing the location of the US Virgin Islands can be accessed at <http://www.worldatlas.com/webimage/countrys/carib.htm>. and the HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/01tp> - ProMed Mod.TY]
More ...

World Travel News Headlines

Date: Mon, 1 Jun 2020 10:23:53 +0200 (METDST)

Yerevan, June 1, 2020 (AFP) - Armenian Prime Minister Nikol Pashinyan and his family have tested positive for the coronavirus, he said Monday, as the rate of new infections soared in the Caucasus nation.   "My coronavirus test was positive yesterday," Pashinyan said in a self-recorded video message on Facebook, adding that his family were also infected.   He said he had no "viable symptoms" of the virus and would be working from home.   The prime minister and his wife Anna Hakobyan, who is a journalist, have four children.   The ex-Soviet republic of some three million has so far reported 9,492 cases of the coronavirus and 139 deaths.

Coronavirus patients have overwhelmed Armenia's hospitals and last week health officials said that intensive care treatment could be soon restricted to patients with the best chance of survival.   Pashinyan's announcement came nearly one month after Armenia on May 4 lifted a state of emergency imposed in March to slow the spread of the coronavirus.

The prime minister acknowledged his government had failed to enforce anti-virus measures and there had been widespread quarantine violations.   Pashinyan was elected prime minister in the wake of mass popular protests he led two years ago against veteran leader Serzh Sarkisian and his Republican Party.   He has since led a relentless crusade against graft and initiated sweeping judicial reforms.
Date: Mon, 1 Jun 2020 09:17:15 +0200 (METDST)

San Salvador, June 1, 2020 (AFP) - Tropical Storm Amanda triggered flash floods, landslides and power outages as it barrelled through El Salvador and Guatemala Sunday, killing 14 people, authorities said, warning of further heavy rain to come.   El Salvador President Nayib Bukele declared a 15-day state of emergency to cope with the effects of the storm, which he estimated to have caused $200 million in damage, but which weakened later in the day as it moved into Guatemala.

Amanda, the first named storm of the season in the Pacific, unleashed torrents of floodwater that tossed vehicles around like toys and damaged about 200 homes, the head of the Civil Protection Service William Hernandez said.   The fatalities were all recorded in El Salvador, Interior Minister Mario Duran said, warning that the death toll could rise.   One person is still missing, senior government official Carolina Recinos added.   "We are experiencing an unprecedented situation: one top-level emergency on top of another serious one," San Salvador mayor Ernesto Muyshondt said, referring to the coronavirus pandemic.

He added that half of those killed died in the capital, and that 4,200 people had sought refuge in government-run shelters after losing their homes or being forced to leave because they were in high-risk areas.   In some flooded areas, soldiers worked alongside emergency personnel to rescue people.   "We lost everything, we've been left with nowhere to live," said Isidro Gomez, a resident of hard-hit southeastern San Salvador, after a nearby river overflowed and destroyed his home.

Another victim, Mariano Ramos, said that at dawn residents of his San Salvador neighborhood were slammed by an avalanche of mud and water. An elderly man died in the area, officials said.   El Salvador's environment ministry warned residents of the "high probability" of multiple landslides that could damage buildings and injure or kill people.

Nearly 90 percent of El Salvador's 6.6 million people are considered vulnerable to flooding and landslides due to its geography.   In neighboring Guatemala, officials said roads had been blocked by at least five landslides and some flooding was reported, but no evacuations were underway.   Even though Amanda weakened to tropical depression status, Guatemalan officials warned that heavy rain would continue, with swollen rivers and possible "landslides affecting highways ... and flooding in coastal areas."
Date: Mon, 1 Jun 2020 06:55:18 +0200 (METDST)

Lima, June 1, 2020 (AFP) - Peru on Sunday reported 8,800 new COVID-19 infections, setting a new daily record for a country that already has the second highest number of novel coronavirus cases in Latin America after Brazil.   The death toll is now at 4,506, the third highest in the region -- itself the new hotspot of the deadly disease -- after Brazil and Mexico, with President Martin Vizcarra warning the country is only halfway through the crisis.

Infections have jumped in Peru despite a months-long mandatory lockdown and a nigh time curfew and the government ordering international borders to be closed.   The spike is concentrated around the capital Lima, where one third of the population lives, and put tremendous strain on Peru's economy and healthcare system.   Four out of every ten Peruvians lost their source of income when the lockdown began, according to one study, and last week Peru secured a two-year, $11 billion credit line from the International Monetary Fund.

- 'Tremendous challenge' in Chile -
Neighbouring Chile on Sunday reported 57 more fatalities in the past 24 hours, a new record that brings the country's COVID-19 death toll to 1,054.   "We are facing the largest pandemic of the past 100 years," said Deputy Health Minister Paula Daza, as she announced the latest figures.    "It is a tremendous challenge; we are living very difficult times in our country."

In Santiago, where the 80 percent of the virus cases were reported, 96 percent of the emergency room beds were taken, officials said.   Officials reported a sharp increase in cases over the past two weeks.   In early May the government of President Sebastian Pinera said that the number of virus cases had hit a plateau, and lockdown restrictions would be loosened.
Date: Mon, 1 Jun 2020 03:38:38 +0200 (METDST)
By Anna SMOLCHENKO

Moscow, June 1, 2020 (AFP) - Shopping malls and parks are set to reopen in Moscow on Monday as the Russian capital eases coronavirus restrictions despite having the world's third-largest caseload.   The relaxation of the confinement orders in Moscow, the epicentre of Russia's outbreak with a population of more than 12 million, comes after President Vladimir Putin announced the epidemic had passed its peak in the country.

Under lockdown since March 30, residents of Europe's most populous city were until now only allowed to leave their homes for brief trips to shop, walk dogs or travel to essential jobs with a permit.   While Muscovites welcomed the opportunity to return to parks and malls after weeks of being cooped up at home, many ridiculed the Moscow mayor's "experiment" aimed at regulating people's walks and exercise.

As a two-week test measure, Sergei Sobyanin said residents of Moscow will be allowed to take walks according to a staggered schedule based on their home address.   "Regular walks are allowed between 9am and 9pm but no more than three times a week -- twice on weekdays and once on a weekend," said Sobyanin on his blog, adding that a detailed schedule would be released separately.   People can jog or exercise between 5am and 9am but must wear masks, according to the new rules.   Sobyanin said he feared that without limits on walking, people would throng the streets in scenes reminiscent of May Day outpourings in Soviet times.

- 'Sheer lunacy' -
The new regulations unleashed a flood of mockery on social media, with political commentator Alexander Golts calling them "sheer lunacy".   Critics quipped that life in Moscow was beginning to imitate dystopian fiction such as the novels of Aldous Huxley and Yevgeny Zamyatin.

Popular comedian Maxim Galkin, who has nearly eight million followers on Instagram, released a sketch in which Putin and Sobyanin discuss a "breathing schedule" for Moscow residents.   The five-minute parody has been viewed nearly six million times over the past few days.   When the restrictions are relaxed, dry-cleaners, laundry services and repair workshops will be allowed to reopen, while restaurants, cafes and cinemas will remain closed for now.

Moscow authorities also said that no mass gatherings would be allowed during the city-wide quarantine that will remain in place until at least June 14.   On Thursday authorities sentenced prominent reporter and activist Ilya Azar to 15 days in jail for staging a lone protest in central Moscow.   Dozens of his supporters have also been briefly detained over the past few days.   Rights organisations including Amnesty International and the Council of Europe have warned Moscow against using the coronavirus lockdown as a pretext to muzzle activists.

Many critics have also questioned the move to lift the restrictions as Russia reported more than 9,000 new infections on Sunday.   With more than 405,000 confirmed infections and over 4,600 deaths, the country has the world's third-largest caseload after the United States and Brazil.   Analysts say Putin is keen to open up the Russian economy and has recently ordered a World War II victory parade postponed by the contagion to be held on June 24.   The 67-year-old leader is also widely expected to announce a new date for a vote on constitutional reforms that could pave the way for him to potentially stay in power until 2036.
Date: Sun, 31 May 2020 11:16:20 +0200 (METDST)

Mogadishu, May 31, 2020 (AFP) - At least 10 people died and 12 were wounded when an explosive device ripped through a minibus outside the Somali capital Mogadishu on Sunday, the government said.   The deadly explosion occurred near Lafole village along the Afgoye-Mogadishu where the passenger bus was travelling early in the day.   "At least 10 civilians were killed in an explosion at Lafole area this morning, those who died were all civilians," the information ministry said in a statement, adding that the victims were on their way to a funeral.

Witnesses said the minibus was completely destroyed, and described an horrific scene with everyone on board either dead or wounded and many bodies ripped apart or burned beyond recognition.   "This was a horrible incident this morning, the explosive device went off as the bus was passing by the area and destroyed it completely," said Daud Doyow, a witness.   "Bodies of civilians were strewn in pieces and most of the people died," he added.   "There were more than 20 people on board and 10 of them were confirmed dead while the rest are seriously wounded and taken to hospital, this is a horrible scene here," said another witness, Abdirisak Adan.   No group immediately claimed responsibility for the bombing, but Somalia's al Qaeda-aligned Shabaab group carries out regular attacks in and around the capital, often killing civilians.
Date: Wed, 27 May 2020 17:58:12 +0200 (METDST)

Nairobi, May 27, 2020 (AFP) - Kenya said Wednesday it had documented a record 123 cases of coronavirus in the past 24 hours, a "staggering" figure although one also explained in part by wider testing.   "Today, I come to you with sombre news," Health Minister Mutahi Kagwe said.   "Our figures today are staggering. Out of the 3,077 samples tested, we have 123 positive cases. For the first time we have hit a triple digit.    "This is the highest number of positive cases we have ever recorded in a single day since we recorded the first case on March 13."

A total of 1,471 cases of COVID-19 have been recorded in Kenya since the start of the epidemic. Of these, 55 have been fatal.   The tally of infections has doubled since mid-May but the country has also tripled its number of daily tests, from less than 1,000 to nearly 3,000, which has helped unearth more cases.

Kagwe sounded a warning about the vulnerability of crowded slums in the capital Nairobi, which leads the list of new cases followed by the port city of Mombasa.   "There is a raging number of infections in these areas," he said, adding: "No-one should have a false sense of security about their immunity to COVID-19."   Among its anti-coronavirus measures, Kenya has a national 7pm-5am curfew, which is currently in force until June 6, and has a ban on entering or exiting the cities of Nairobi, Mombasa, Kilifi, Kwale and Mandera.
Date: Wed, 27 May 2020 16:38:21 +0200 (METDST)

Nicosia, May 27, 2020 (AFP) - Cyprus hopes to attract tourists after its coronavirus lockdown by paying the medical costs of anyone who tests positive for COVID-19 while holidaying on the island, officials said Wednesday.   The plan was outlined in a letter to tour operators and airlines detailing the measures Cyprus is taking to ensure the safety of its tourism sector.   The letter was made public Wednesday and signed by the ministers of foreign affairs, transport, and tourism.

The Mediterranean island is marketing itself as a safe holiday destination during the global pandemic.   The Republic of Cyprus has reported 939 novel coronavirus cases and only 17 deaths.   The government said it is "committed to taking care of all travellers who test positive during their stay, as well as their families and close contacts".   It pledged to cover accommodation, dining and medical care if a tourist falls ill with the virus.   The "traveller will only need to bear the cost of their airport transfer and repatriation flight," it said.

- 'Quarantine hotels' -
A 100-bed hospital will be available exclusively for tourists who test positive, with more beds available "at very short notice if required".   An additional 112 beds in intensive care units with 200 respirators will be reserved for critically ill patients.   Designated "quarantine hotels" will have 500 rooms available for family members and close contacts of patients.

Other hotels on the island will be allowed to remain open if a guest tests positive, but their room will "undergo a deep clean".   Authorities have forecast a 70 percent decline in tourist arrivals in 2020.    Tourism earned Cyprus EUR2.68 billion ($2.94 bn) in 2019 -- about 15 percent of gross domestic product -- down one percent from the previous year, which was bolstered by a record 3.97 million arrivals.   Cyprus plans to reopen its airports on June 9 to arrivals from 13 countries considered low risk.   These include Israel, Greece, Germany, Austria and Malta but the island's two biggest markets Britain and Russia are not on the approved list.

hose arriving between June 9-19 will need to provide a health certificate proving they do not have the virus.   That requirement will be dropped from June 20, when another six countries will be added to the approved list, including Switzerland and Poland.   Cyprus says it will update the list of approved countries on a weekly basis based on scientific advice.

Officials will administer temperature checks and free random testing of arrivals.   Having tested over 10 percent of its population, Cyprus says it has one of the lowest coronavirus infection rates in Europe.   "Very few countries worldwide, especially in the Mediterranean, can boast about such statistics," the letter said.
Date: Wed, 27 May 2020 14:45:11 +0200 (METDST)

Stockholm, May 27, 2020 (AFP) - Airline SAS said Wednesday it would resume flights on several domestic and international routes in June, over two months after the operator grounded most of its fleet over the new coronavirus' impact on travel.   "This primarily includes domestic flights within and between the Scandinavian countries, but flights to New York, Chicago and Amsterdam from Copenhagen are also set to resume," SAS said in a statement.

The Scandinavian airline announced in mid-March it was halting most of its traffic and furloughing around 90 percent of its staff.   In late April the airline, whose two largest shareholders are the Swedish and Danish states, announced it was laying off about 5,000 people, representing 40 percent of the company's workforce.

In early May the company secured a state-guaranteed credit line of 3.3 billion Swedish kronor ($344 million or 313 million euros) to help it navigate the impact of the new coronavirus.   Even with the resumption of some flights, the airline continues to operate at a reduced capacity, but the added routes means an effective doubling of the aircraft in use from 15 to 30, according to SAS.   Finnair, of Nordic neighbour Finland, announced early last week it would start resuming its long-haul flight to Asia in July.
Date: Wed, 27 May 2020 14:25:21 +0200 (METDST)

Yerevan, May 27, 2020 (AFP) - Virus cases have overwhelmed Armenia's hospitals, officials said Wednesday, raising the prospect that intensive care treatment could be restricted to patients with the best chance of survival.   The tiny Caucasus nation of some three million has so far reported 7,774 coronavirus cases and 98 deaths.   At a cabinet meeting on Wednesday, Prime Minister Nikol Pashinyan said "the situation with the coronavirus pandemic is very severe in Armenia."

Health ministry spokeswoman Alina Nikoghosyan told AFP: "if the current situation persists, in the coming days, intensive care will only be available for the patients with the best survival chances."   Health Minister Arsen Torosyan said Sunday that out of the country's 186 intensive care beds for coronavirus patients, only 32 remained empty and would soon be filled.

The prime minister called for stricter enforcement of measures aimed at containing the outbreak such as the wearing of face masks in public spaces.   This comes after the country lifted a state of emergency on May 4 which it had declared in March because of the pandemic.   Pashinyan said his government had failed to enforce anti-virus measures and there had been widespread quarantine violations.   "Our mistake was that we put too much trust in our citizens' sense of responsibility," he said.

Deputy Prime Minister Tigran Avinyan said he did not rule out that the government could have to impose a fresh nationwide lockdown.   Analysts have criticised the government's handling of the crisis, saying a decision to close borders was taken too late and officials sent the public "confusing messages."   "Officials were calling for the wearing of face masks, but they themselves didn't wear them until recently," said analyst Tatul Hakobyan.
Date: Wed, 27 May 2020 09:53:01 +0200 (METDST)

New Delhi, May 27, 2020 (AFP) - India is wilting under a heatwave, with the temperature in places reaching 50 degrees Celsius (122 degrees Fahrenheit) and the capital enduring its hottest May day in nearly two decades.   The hot spell is projected to scorch northern India for several more days, the Meteorological Department said late Tuesday, "with severe heat wave conditions in isolated pockets".   As global temperatures rise, heatwaves are a regular menace in the country -- particularly in May and June. Last year dozens of people died.

Met officials said Churu in the northern state of Rajasthan was the hottest place on record on Tuesday, at 50 Celsius, while parts of Punjab, Haryana and Uttar Pradesh sweltered in the high 40s.   Parts of the capital, New Delhi, recorded the hottest May day in 18 years with the mercury hitting 47.6 Celsius.   No deaths have been reported so far this year, but last year the government said the heat had killed 3,500 people since 2015. There have been fewer
fatalities in recent years.

The country of 1.3 billion people suffers from severe water shortages with tens of millions lacking running water -- to say nothing of air conditioning.   Parts of Delhi and elsewhere regularly see scuffles when tankers arrive to deliver water. Last year Chennai made international headlines when the southern city ran out of water entirely.   The heatwave adds to problems the country already has dealing with the spread of coronavirus.   India now has the 10th highest number of coronavirus cases globally, climbing above 150,000 on Wednesday with almost 4,500 deaths.

Last week cyclone Amphan killed more than 100 people as it ravaged in eastern India and Bangladesh, flattening villages, destroying farms and leaving millions without power.   Huge swarms of desert locusts, meanwhile, have destroyed nearly 50,000 hectares (125,000 acres) of crops across western and central India, and may enter Delhi in coming days.   The north-eastern states of Assam and Meghalaya are also currently experiencing floods, with more heavy rainfall forecast in the coming days.