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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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Cook Islands

No Profile is available at present

Travel News Headlines WORLD NEWS

8 Aug 2019

Dengue-type1 outbreak was declared on the 27 Feb 2019 following a laboratory (NZLabPlus) confirmation of 7 dengue type 1 cases. From 28 Jan-4 Aug 2019, a cumulative number of 78 dengue cases have been reported (22 confirmed, and 56 probable-NS1Ag positives). Rarotonga and Aitutaki are the only islands affected and most of the cases have been from the main island of Rarotonga. Aitutaki has managed to contain its number of cases to 3. The last case was reported on 18 Apr 2019. A total of 42 cases have been hospitalised and given free mosquito nets to take and use at home. Apart from some severe cases, the hospitalisation was also an effort to contain and minimise the spread of the infection into the community. Unfortunately, some cases refused to be admitted but were given some health advice and mosquito precautionary measures. No deaths reported.

- Cook Islands. 17 Aug 2019. 78 dengue cases have been reported in Cook Islands since the outbreak began early in the year [2019]. The Cook Islands News reports the Ministry of Health saying 22 were confirmed cases while 56 have been deemed probable positives.

HealthMap/ProMED-mail map of Cook Islands:
- Cook Islands. 12 Apr 2019

As of Wednesday [10 Apr 2019], the Ministry for Health has 18 confirmed and 12 probable dengue fever cases. This is a total of 30 cases compared to 24 previously identified.
Date: Thu, 2 Jul 2015 05:34:35 +0200 (METDST)

Wellington, July 2, 2015 (AFP) - Airport authorities in the Cook Islands on Thursday warned thrill seekers to stay away from their runway's jet blast zone after three tourists were injured when a plane was taking off.   The main road in the tiny Pacific nation passes by the bottom of the runway and daring plane-spotters often stand in the wash of jet engines, clinging to the airport's fence as aircraft hit maximum thrust for ascent.   "If you don't hang onto anything, you'll be knocked over," Cook Islands Airport Authority chief executive Joe Ngamata told AFP.   "You get the young people and tourists looking for thrills going down there."

Ngamata said three tourists were blown over by the power of the jet blast last Thursday and were lucky to only receive cuts and bruises.   "It can be dangerous," he said, adding that the area was clearly marked with red danger signs to deter the practice.    "We might need to look at extra barriers or fences to keep people away."   However, stopping it may be difficult, with the national tourism authority including the jet blast in a recent marketing video showing "the top 10 reasons to come to the Cook Islands".
Date: Tue 1 Apr 2014
From: Dr Alyssa Pyke <Alyssa.Pyke@health.qld.gov.au> [edited]

A female patient in Townsville, Queensland, Australia has been diagnosed with Zika virus infection following a recent trip to the Cook Islands, where the virus is currently circulating. A serum sample collected in March 2014 was positive by 2 separate Zika virus TaqMan real-time RT-PCRs and a pan-Flavivirus RT-PCR. Nucleotide sequencing and phylogenetics revealed 99.1 per cent homology with a previous Cambodia 2010 sequence within the Asian lineage. Flavivirus IgG and IgM antibodies were also detected in the serum sample.

This is the 1st known imported case of Zika virus infection into northern Queensland, where the potential mosquito vector _Aedes aegypti_ is present, and only the 2nd such case diagnosed within Australia.
----------------------------------------------------
Dr Alyssa Pyke
Public Health Virology
Forensic and Scientific Services
Coopers Plains, Queensland
Australia
==============================
[As of 25 Mar 2014, there were 49 confirmed cases of Zika virus infection in the Cook Islands, the source of the virus in the case above. Concern for Zika virus introduction into northern Queensland where vector mosquitoes are present is a serious concern. Transport of this virus by viremic individuals has been the mechanism for its introduction into several Pacific islands. Dengue viruses have been introduced into Townsville, northern Queensland, by infected individuals and started small outbreaks there. Since that has happened with dengue viruses, it can happen with Zika virus as well.

ProMED thanks Alyssa Pyke for sending in this report.

A HealthMap showing the location of Queensland state can be accessed
at <http://healthmap.org/promed/p/285>, and the Cook Islands at
<http://healthmap.org/promed/p/4035>. - ProMed Mod.TY]
Date: Tue 25 Mar 2014
Source: Radio New Zealand [edited]

There are now 49 confirmed cases of Zika virus [infection] in the Cook Islands, and as many as 630 people are believed to have suffered from the mosquito-borne disease.

Last month [February 2014], health authorities 1st thought they were dealing with dengue fever, but the 1st batch of test results confirmed 18 cases of Zika [virus infection].

The Director of Community Health Services, Dr Rangi Fariu, says further results from French Polynesia, where the disease 1st broke out in the region, take the number to 49.

He says scientists there are still determining the exact nature of the strain. "Tahiti just asked for those who were already shown positive; they wanted more samples to find out if the Zika [virus] strain that we have here is similar to the one that they have in Tahiti."

Dr Rangi Fariu says doctors have reported about 630 cases of suspected Zika virus [infection] in the Cook Islands and says the real number would be much higher.
========================
[This is the 1st report of Zika virus infections in the Cook Islands. The virus has been circulating in the islands of French Polynesia, New Caledonia and Easter Island. Although the distances between these islands is significant, the virus is being moved by viraemic people who travel between them. One can expect further spread to localities where there are populations of vector mosquitoes that can initiate new outbreaks. Zika virus is a flavivirus. Symptoms of Zika fever may include fever, headache, red eyes, rash, muscle aches, and joint pains. The illness is usually mild and lasts 4-7 days. No fatalities caused by Zika virus infection have been reported.

A HealthMap/ProMED-mail map showing the location of the Cook Islands in the Pacific can be accessed at
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Eritrea

Eritrea US Consular Information Sheet
November 26, 2008
COUNTRY DESCRIPTION:
Eritrea is a poor but developing East African country, the capital of which is Asmara. Formerly a province of Ethiopia, Eritrea became an independent country on M
y 24, 1993, following a 30-year struggle that culminated in an overwhelming referendum vote for independence. Tourism facilities are very limited. Read the Department of State Background Notes on Eritrea for additional information.

ENTRY/EXIT REQUIREMENTS:
All travelers should have a passport and valid visa prior to arrival; visas are not available at the airport unless specifically pre-authorized by the Eritrean government.
Travelers visiting Eritrea using a foreign passport do not need an exit visa, provided they leave before their entrance visa expiration date.
Persons staying beyond their entrance visa expiration date may be subject to fines or imprisonment, or be required to remain in Eritrea for an extended period while their case is reviewed in court.
All long-term residents, regardless of citizenship, must obtain an exit visa 30 days prior to departure, unless they hold a difficult-to-obtain multiple entry visa.
Upon entry and exit, visitors must declare all foreign currency, and may be asked to declare electronic equipment such as cameras, computers and video equipment.
Visitors must save all receipts for foreign exchange and present these upon departure to account for all foreign currency spent in Eritrea.
Failure to report foreign currency or meet customs requirements usually results in both a fine and imprisonment.
There is also a $20 airport departure tax.
Information about the airport tax and entry/exit requirements is available from the Embassy of Eritrea, 1708 New Hampshire Avenue NW, Washington, DC 20009; telephone (202) 319-1991; fax (202) 319-1304.
Overseas, inquiries may be made at the nearest Eritrean embassy or consulate.

U.S. citizens born in Eritrea, to Eritrean parents, or who in any other way appear to have Eritrean origins, are required to register with the Immigration and Nationality office in Asmara within seven business days of their entry into the country.
The Eritrean government sometimes subjects U.S. citizens of Eritrean heritage to the same entry/exit requirements as Eritrean citizens.
See the “Special Circumstances” section below for more information about dual nationality.

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:
Eritrea and Ethiopia fought a border war from 1998-2000.
United Nations peacekeepers patrolled the border until March 2008, when Government of Eritrea diesel fuel restrictions resulted in the peacekeepers’ withdrawal.
Both Eritrea and Ethiopia maintain large military presences along the border and currently all border crossings into Ethiopia from Eritrea remain closed.
U.S. citizens are strongly advised to avoid travel near the Eritrean-Ethiopian border and to register their presence in Eritrea with the U.S. Embassy in Asmara.

Since April 2008, large numbers of Eritrean troops have been deployed along the northeastern border of Djibouti.
U.S. citizens are strongly advised to avoid non-essential travel to the Southern Red Sea region of Eritrea, including the port of Assab.

Landmines and unexploded ordnance remain a serious problem throughout the country.
There are reports of accidents and numerous incidents where vehicles and people occasionally detonate mines.
Many detonations occurred on relatively well-traveled roads in and near the Gash Barka region of western Eritrea; subsequent investigations indicated that several mines had been recently laid.
Vast areas of the country still have not been certified free of mines and unexploded ordnance left over from both the 30-year war for independence and the subsequent 1998-2000 conflict with Ethiopia.
Americans should avoid walking alone and hiking in riverbeds or areas that local government officials have not certified as safe.

Although Eritrea and Sudan have diplomatic relations, the procedures for crossing their common border are not clear and subject to change.
Overland travel between the two countries is dangerous and ill advised.
Travelers crossing from Eritrea to Sudan north and west of the Keren-Barentu road risk becoming victims of banditry or Islamic extremist insurgent activity.
Several incidents were reported in 2007, apparently involving insurgents or criminals in this area.
The U.S. Embassy also received reports of sporadic bombings of vehicles and government facilities in the Gash Barka region near Sudan in 2007 and 2008.
If travel near the Eritrean-Sudanese border is essential, travelers should consult both the Eritrean authorities and the U.S. Embassy in advance.
Foreign travelers who wish to visit any area outside of Asmara must apply at least ten days in advance for a travel permit from the Eritrean government.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ website 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 pamphletA Safe Trip Abroad.
CRIME:
Although still a safe city by many measures, Asmara reported significant increases of street crime, such as theft, robbery, and assault in 2008.
Travelers should exercise vigilance in their personal security and safety precautions regarding what valuables they carry and which areas they visit.

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 Eritrea are extremely limited.
Travelers must carry their own supplies of prescription drugs and preventative medicines because pharmaceuticals are in short supply.
Food and water-borne illnesses are very common among travelers, so drink only bottled or purified water and eat foods that are cooked or peeled.
Malaria is a serious risk to travelers in the lowlands of Eritrea, but Asmara is generally considered free of the disease.

There is no HIV testing requirement for temporary or permanent entry into Eritrea.
Please verify this information with the Embassy of Eritrea before you travel.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control 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) website 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 Eritrea is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

The roads between major cities (Asmara, Massawa, Mendefera, Dekemhare, Barentu, and Keren) are paved and in relatively good condition.
However, secondary roads and those in remote areas are usually unpaved and in poor condition.
U.S. citizens should avoid traveling on these roads, especially at night.
Bad weather can also make the condition of poor roads worse.
If you must take unpaved roads, check first with local government and village officials as new minefields continue to be discovered.

Landmines and unexploded ordnance litter the countryside in many areas, occasionally causing injuries and deaths.
Although the UN conducted de-mining efforts until late 2007, evidence of new mines has been reported, particularly in areas near the Ethiopian border.
All areas that are not well traveled are potentially dangerous due to live mines, especially north and west of Keren.
There are also minefields near Massawa, Ghinda, Agordat, Barentu, south of Tessenae, Nakfa, Adi Keih, Arezza, Dekemhare, and in a roughly 40-kilometer wide region just west of the Eritrean-Ethiopian border between the Setit and Mereb Rivers.

Many Eritreans use inexpensive public transportation, especially bus service.
Travelers should avoid taking buses due to extreme over-crowding.
Taxis are plentiful and inexpensive in Asmara, but usually carry multiple passengers along pre-defined routes.
If an empty taxi is available, a customer may request a "contract" taxi, which accepts no additional passengers, for a significantly higher fixed price.
Drivers should be aware of heavy and erratic pedestrian and bicycle traffic obstructing vehicle flow.
Occasionally horse-drawn carts, cattle, or goats add to the obstacles.
Other hazards are children and the elderly, who sometimes wander into the path of moving traffic, as well as small, slow, motorized carts.
Elderly or disabled people usually drive these carts and do not always yield to faster moving traffic.
When parallel parking on city streets, watch for pedestrians as you back into the space.
Please refer to our Road Safetypage for more information.

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

SPECIAL CIRCUMSTANCES:
Due to Eritrean government restrictions impacting Embassy operations, the consular section of the U.S. Embassy in Asmara does not provide routine services to American citizens in Eritrea, including reports of birth, passports, and notaries.
Americans traveling or residing in Eritrea who require such services must travel to a U.S. Embassy or Consulate outside Eritrea, and should plan accordingly.

American citizens should also be aware that U.S. diplomatic personnel are subject to travel restrictions.
The Government of Eritrea requires resident diplomats to apply 10 days in advance for travel outside of Asmara city limits; often travel permission is not given.
This restriction can delay or prevent U.S. Embassy emergency assistance to American citizens outside of Asmara.

The consular section of the U.S. Embassy in Asmara has been closed for visa services since January 2007.
Eritrea has complicated citizenship laws and does not recognize renunciation of Eritrean citizenship.
Dual nationals who enter the country on Eritrean documents are treated as Eritrean citizens, regardless of their other citizenship.
U.S. citizens born in Eritrea, or who otherwise are considered to have acquired Eritrean citizenship, may be subject to certain obligations, including being drafted into national service, regardless of the documents they present at entry.
(National service is approximately six months of military training, followed by an often unspecified number of years in military or other government service.)

U.S.-Eritrean dual nationals who enter the country on an Eritrean passport or national ID card must obtain an exit visa prior to departure.
Exit visa applications can significantly delay travel plans or be denied, even for persons who entered Eritrea legally.
Eritrean dual nationals are also required to pay a 2% income tax on overseas earnings to the Eritrean Government prior to being granted an exit visa.
Additionally, Eritrean authorities sometimes to not allow Eritreans who left the country after 1993 to depart Eritrea after visiting the country, even if they have a U.S. passport and a valid Eritrean visa.

The government of Eritrea does not inform the U.S. Embassy of the detention of American citizens, and does not allow Embassy officials to visit incarcerated Americans.

Visitors are advised to exercise caution when taking photographs in Eritrea.
Foreigners in Asmara have been harassed and detained by local police and plain clothes security officials for taking photographs of street scenes in the city.
No law has been cited, but the arresting officials' justifications have been that (unmarked) government buildings are in the background and/or that the pictures are being taken (illegally) for commercial reasons.

All foreign nationals in Eritrea are required to apply for permits to travel outside of Asmara.
Travel permits must be presented at all checkpoints.
Checkpoints are found on major roads through Eritrea, but locations may change without notice.
Applications for travel permits are available at the Ministry of Tourism located on Harnet Avenue.
There is a high risk of earthquakes in Eritrea.
General information about natural disaster preparedness is available on the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.
Please see our information on Customs Regulations.

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 Eritrean laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Eritrea 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 Eritrea are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration web site, and to obtain updated information on travel and security within Eritrea.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at 179 Alaa Street, PO Box 211, Asmara; telephone (291-1) 12-00-04; fax (291-1) 124-255 and (291-1) 127-584; the Embassy’s web site is located at http://eritrea.usembassy.gov/
*

*

*
This replaces the Country Specific Information for Eritrea dated April 28, 2008, to update sections on Entry/Exit Requirements, Safety and Security, Crime,
Medical Facilities and Health Information, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Sat 10 Sep 2016
Source: Asmarino Independent [edited]

Activists have reported a serious cholera outbreak in the Upper Gash-Barka Region of Eritrea, which is proving difficult to control. The outbreak was 1st observed at Barentu Referral Hospital 2 weeks ago when people who had travelled from the upper Gash region were reported to be suffering from an illness that was not diagnosed easily. However, as a result of the extended time taken for accurate diagnosis of cholera due to a severe shortage of expertise and infrastructure, the outbreak spread widely, affecting areas of the Gash-Barka Region.

It has now been a week since the Ministry of Health acknowledged the outbreak as being a potential national epidemic and has briefed health professionals in the region to that effect.

So far, the effort to curb the spread is proving futile, and the impact of the outbreak is being felt across the region. Markets were deserted as a result of the spread, and even cattle markets in small villages outside Barentu have been cordoned off to prevent the spread. An expert at the Ministry of Health's public health section for preventing such epidemics stated: "There is currently no national emergency response team to prevent and control such outbreaks; we are, therefore, prone to such epidemics, as it always takes time to pull such a team together to both control the outbreak and treat victims."

Already, the current epidemic is said to have spread from the Upper Gash Region to the Southern Region and particularly to the area of Mai Dima, where an epidemic control team has been dispatched.

According to health experts in the region, when such an outbreak occurs, even able-bodied adults find it impossible to cope with the acute loss of bodily fluids. Without appropriate medical assistance, it is impossible for patients to recover, and the situation is considerably worse for pregnant women and children.

Given the lack of public health awareness, Arbi Harnet calls on the people to take preventive actions by strictly adhering to personal and public hygiene practices.
======================
[A HealthMap/ProMED-mail map showing Eritrea is available at
Date: Sat, 23 Jan 2016 12:14:06 +0100

Nairobi, Jan 23, 2016 (AFP) - Eritrean President Isaias Afwerki on Saturday dismissed fears the Horn of African nation faces a food crisis, despite sweeping drought across the wider region leaving millions in need of aid.   Floods and failed rains caused by the El Nino weather phenomenon have sparked a dramatic rise in the number of people going hungry in east Africa.

But authoritarian and isolated Eritrea has long rejected UN food aid in favour of a policy of self reliance, and Isaias said he was not worried.    "In view of the harvest shortfall that has affected the whole Horn of Africa region, President Isaias stated that the country will not face any crisis in spite of reduced agricultural output," the information ministry said, after he was interviewed by state-run media.   Isaias praised the government's "judicious policy and approaches of bolstering its strategic food reserves."

In November, the UN warned that Eritrea was among the countries at risk, like all the other nations in the wider region. "The current El Nino pattern, being the strongest ever recorded, has caused severe drought in the Horn of Africa nation, resulting in crop reduction by 50 to 90 percent; even failure in some regions," the United Nations said earlier this month.   In Ethiopia, over 10 million people need food aid, it added.    In Eritrea, few if any major foreign aid agencies are allowed operate, while the UN has limited access across the country, and most assessments are dependent on government reports.

Thousands of Eritreans flee the county each month, saying they are escaping conscription and rampant rights abuses.   Refugees from the repressive Red Sea state make up the third-largest number of people risking the dangerous journey to Europe after Syrians and Afghans, running a gauntlet of ruthless people smugglers to make the treacherous Mediterranean crossing.
Date: Thu 30 Jul 2015
Source: Eurosurveillance edition 2015; 20(30) [edited]

Louse-borne relapsing fever (_Borrelia recurrentis_) in asylum seekers from Eritrea, the Netherlands, July 2015
----------------------------------------------------------------------
[Authors: Wilting KR, Stienstra Y, Sinha B, Braks M, Cornish D, Grundmann H]

Two patients from Eritrea, recently arrived in the Netherlands, presented with fever and were investigated for malaria. Bloodfilms showed spirochetes but no blood parasites. Louse-borne relapsing fever caused by _Borrelia recurrentis_ was diagnosed. Treatment was complicated by severe Jarisch-Herxheimer reactions [inflammatory reaction observed after antimicrobial treatment of several infectious diseases] in both patients. Physicians should be aware of the possibility of _B. recurrentis_ infection in migrant populations who travel under crowded conditions, especially after passing through endemic areas such as Ethiopia and neighbouring countries.

_Borrelia recurrentis_ has for many centuries caused infections of often epidemic proportions known as relapsing fever. Since the infection is exclusively transmitted by body lice and humans are their only host, large scale outbreaks are only expected under circumstances conducive to louse infestation. We here report the 1st introduction of louse-borne relapsing fever into the Netherlands after World War II.

Case descriptions
-----------------
Patient 1
On 4 Jul 2015, a young adult from Eritrea was referred from the National Reception Centre for Asylum Seekers (Asielzoekercentrum, AZC) to a regional hospital in the northern Netherlands with a 5-day history of headache, dizziness, right upper quadrant pain, myalgia, and fever (39.3 deg C [102.7 deg F]). Malaria was suspected. The patient had been in the Netherlands for only 2 days after arriving in Europe 14 days earlier. En route to Europe, they travelled through Ethiopia, Sudan, and Libya. Previously, they had noticed chills while sheltering in an unofficial street camp in Rome where they stayed with a small group of fellow Eritreans before travelling to the Netherlands.

Thick and thin bloodfilms did not show malaria parasites and commercial malaria antigen tests were negative. However, filamentous unidentified structures were reported in the thick film by the laboratory of the peripheral hospital. The patient received empirical treatment with a single dose of ceftriaxone (2000 mg intravenously) for suspected bacterial septicaemia. After administration, their condition deteriorated and the patient was transferred within the next 2 hours to the University Medical Center Groningen (UMCG) where they arrived at the emergency department with headache, peripheral hypothermia (35.3 deg C [95.5 deg F]), hypotension (systolic/diastolic blood pressure 78/52 mmHg, heart rate of 106 beats per minute), abdominal pain but no hepatosplenomegaly, and shortness of breath (respiratory rate 23 breaths/min). Laboratory analysis showed leucocytopenia (leucocytes: 1.6 x 10(9)/L, norm: 4.5-10 x 10(9)/L), anaemia (haemoglobin: 6.5mmol/L, norm: 8.6-11.2 mmol/L) and thrombocytopenia (thrombocytes: 16x10(9)/L, norm: 150-450x10(9)/L). C-reactive protein (CRP) was 254 mg/L (norm: less than 1 mg/L). Kidney function was normal. The patient's liver function tests showed mildly elevated transaminases (alanine transaminase: 58 U/L, norm: 7-56 U/L; aspartate transaminase: 108 U/L, norm: 10-40 U/L; alkaline phosphatase: 124 U/L, norm 20-140 U/L; gamma-glutamyl transferase: 93 U/L, norm 0-51 U/L) and total bilirubin levels of 38 micromole/L (norm: less than 26 micromol/L) and direct bilirubin 35 micromol/L (norm: less than 7 micromol/L). Oxygen saturation was 91 percent (norm: 95-100 percent). Giemsa-stained thick and thin films revealed spirochetes in large numbers (Figure 1 [available at the source URL]) and no malaria parasites.

Given the patient's travel history, louse-borne relapsing fever was suspected. The clinical deterioration was provoked by the ceftriaxone administration leading to a severe Jarisch-Herxheimer reaction [1]. Treatment was switched to doxycyline 200 mg per day intravenously intravenously to reduce the risk of relapse [2]. The patient was transferred to the intensive care unit (ICU) for fluid resuscitation, cardiac support with noradrenalin, and supportive oxygen delivery via high flow nose mask.

_B. recurrentis_ was confirmed by 16S rDNA PCR and sequencing directly from blood 2 days later. The patient stayed at the ICU for 2 days, made a full recovery and was discharged after 6 days. The body louse _Pediculus humanus humanus_ was recovered from [the patient's clothing (Figure 2 [available at the source URL]).

Patient 2
In 9 Jul 2015, a 2nd young adult from Eritrea was directly referred by the responsible physician at the AZC to the UMCG. On arrival, the patient presented with general malaise, headache, fever (38.5 deg C [101.3 deg F]) and cough. Blood tests showed elevated inflammatory parameters (leucocytes: leucocytes: 12.7 x 10(9)/L, CRP: 320 mg/L), normal kidney function and slightly elevated transaminases, but the blood sample was haemolytic. Thick and thin films showed spirochetes and treatment was started with doxycyline 200 mg orally. 2 hours later the patient developed a severe Jarisch-Herxheimer reaction [that] required admission to intensive care where they received fluid resuscitation, inotropic treatment with noradrenalin, and oxygen via a face-mask. _B. recurrentis_ was confirmed by 16S rDNA sequencing.

The patient reported symptoms of chills and fever 2 weeks before presentation at our hospital. Their journey through North Africa followed the same route as that of Patient 1, but Patient 2 had arrived in Europe a week earlier. Patient 2 had camped out in the streets for 5 days in Rome (as had Patient 1). Patient 2 arrived in the Netherlands 2 weeks before presenting at our hospitals after travelling through Austria and Germany. The patient made a full recovery and was discharged after 5 days. Lice could not be recovered from the clothing.

Discussion
----------
_B. recurrentis_ should be suspected in patients presenting with fever and a recent history of migration from or through endemic countries (Ethiopia, Sudan, Eritrea, and Somalia). The infection is transmitted through body lice (_P. humanus humanus_, formally known as _P. humanus corporis_), which typically lives and breeds in the seams of clothes but can occasionally also be found in bed linens. Immigrants may share their clothing and that can pose an additional risk of transmission. The incubation period for relapsing fever is usually 4 to 8 days with a range of 2 to 15 days [3]. It should be noted that head lice (_P. humanus capitis_), which are not uncommon in Northern Europe, are incompetent vectors and cannot transmit _B. recurrentis_. The spirochetes are easily visible under a microscope in a Giemsa-stained thick or thin blood film as used for the diagnosis of _Plasmodium_ spp [4]. In our patients, the diagnosis was confirmed in both cases by 16S rDNA PCR and sequencing from blood.

Published evidence supports a single dose of tetracycline 500 mg intravenously as the conventional treatment, but considering the limited availability of this drug, doxycycline 200 mg can be used as an effective alternative [2,5]. In young children, pregnant women, or patients with a tetracycline allergy, erythromycin 500 mg can be used instead [6].

Both patients had travelled independently along a similar route before arriving in the Netherlands. Given the incubation period, it cannot be ruled out that the infection was acquired within Europe. Crucial information about risk factors such as exact travel history, recollection of louse infestation or bites and onset of symptoms was, however, impossible to obtain from our patients. Apart from being very sick and the fact that communication required an interpreter versed in Tigre our patients appeared to be traumatised and intimidated and not eager to volunteer information for fear of legal consequences.

Both patients developed a severe Jarisch-Herxheimer reaction after starting antibiotic treatment. _B. recurrentis_ evades host immune defences, resulting in very high bacterial loads (10(6)-10(8)/microl), and effective antibiotic therapy is followed by severe reactions characterised by sudden rigors, fever, and hypotension in virtually all treated patients [3]. Clinical symptoms are associated with increased plasma concentrations of tumour necrosis factor alpha (TNF-alpha), interleukin-6 and interleukin-8 [7]. Treating physicians should be aware of this complication and the chances that ICU admission may be warranted. It is advised that patients receive 2 well-placed intravenous lines for rapid fluid resuscitation. Treatment of Jarisch-Herxheimer reaction consists mainly of supportive care. Corticosteroids seem to have limited beneficial effect but studies suggests that TNF-alpha blockers may be useful [8].

An ad hoc survey at the AZC on [16 Jul 2015] found body lice on 2 newly arrived Eritreans. Since then, all asylum seekers arriving from endemic countries to the AZC have been segregated into a different compound, where they turn over all of their personal clothes in exchange for disposable overalls. Personal clothes are then washed and returned on the next day. Used overalls and bed linen are subsequently destroyed. In addition to delousing, all arrivals receive a single dose of ivermectin as pre-emptive treatment against scabies and Eritreans who arrive with clinically manifest scabies (about 80 percent of all new arrivals) receive a 2nd dose a week later. No new cases of _B. recurrentis_ infection have been identified since mandatory delousing was implemented.

Conclusion
----------
Because infections with _B. recurrentis_ pose a significant health risk to other migrants, aid workers, healthcare personnel, and arguably to the general population, screening and delousing should be considered for arriving migrants already at ports of entry into the European Union. Our patients may have acquired body lice before arriving in Europe but transmission of infected lice between migrants after arrival in Europe cannot be ruled out and could pose an additional public health challenge.

[Figures and references are available at the source URL above.]
======================
[Relapsing fever is a bacterial infection caused certain species of the spirochete _Borrelia_. These organisms are able to periodically change their surface protein molecules to evade the host's immune response, thus causing a relapsing illness. Following an incubation period of about 7 days, the illness is characterized by recurring episodes of high fever, headache, muscle and joint pain, nausea and vomiting, each episode lasting several days, followed by a several-day asymptomatic interval. There may be up to 3-4 recurrences. Complications may include involvement of the lungs (ARDS; acute respiratory distress syndrome), central nervous system, spinal cord, eyes, heart, and liver. The bacteremia is intense (more than 10,000 organisms per ml of blood) during febrile episodes, which allows detection of organisms on a Wright-Giemsa stained blood smear. Thick blood smears are more sensitive than thin smears.

There are 2 types of relapsing fever: Tick-borne relapsing fever (TBRF) and louse-borne relapsing fever (LBRF). LBRF is more severe than TBRF, with case-fatality rates without antimicrobial treatment of 30 to 70 percent in outbreaks. TBRF occurs in the Western hemisphere, Africa, Asia, the Mediterranean region and the Middle East. In the western United States, TBRF is usually associated with sleeping in rustic, rodent-infested cabins in mountainous areas. In the United States, 3 species, _Borrelia hermsii_, _B. parkerii_, and _B. turicatae_, transmitted by the bite of soft-bodied ticks (genus _Ornithodoros_) cause TBRF. A recently discovered _Borrelia_ species, _Borrelia miyamotoi_, has been found in hard-bodied ticks (_Ixodes_) in regions where Lyme disease is endemic.

LBRF is caused by a single species, _Borrelia recurrentis_, transmitted through abraded skin when the body louse is crushed during scratching. LBRF is endemic in Ethiopia, Sudan, Eritrea, and Somalia. Outbreaks are found in developing regions affected by war and in refugee camps characterized by overcrowding and poor personal hygiene. While mammals and reptiles may serve as a reservoir for tick-borne _Borrelia_ species, humans are the only host of _B. recurrentis_.

Treatment of relapsing fever consists of either a tetracycline (such as, doxycycline), a macrolide (such as, erythromycin), penicillin, or other beta-lactam antibiotics (such as, ceftriaxone). LBRF can be treated effectively with a single dose of the antibiotic (<http://jid.oxfordjournals.org/content/137/5/573.abstract>), whereas treatment of TBRF requires 7-10 days to prevent relapse. When initiating antibiotic therapy, all patients should be observed for a Jarisch-Herxheimer reaction. The reaction, caused by massive release of tumor necrosis factor alpha (TNF-alpha), interleukin-6, interleukin-8, and other cytokines, is manifest by a worsening of symptoms with rigors, tachycardia, sweating, hypotension, and high ever, occurs in over 50 percent of cases. The Jarisch-Herxheimer reaction can be fatal. Pretreatment with anti TNF-alpha antibody has been found to suppress Jarisch-Herxheimer reactions (<http://www.nejm.org/doi/full/10.1056/NEJM199608013350503>).

Corticosteroids and antipyretic agents have little or no effect (<http://jid.oxfordjournals.org/content/137/5/573.abstract> and <http://www.ncbi.nlm.nih.gov/pubmed/6132178?dopt=Abstract>), whereas meptazinol, an opioid agonist-antagonist, has been reported to reduce the severity of the reaction (<http://www.ncbi.nlm.nih.gov/pubmed/6132178?dopt=Abstract>). Treatment with intravenous fluids and vasopressors to maintain adequate blood pressure may be required. - ProMed Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Fri, 20 Jan 2012 13:40:00 +0100 (MET)

ADDIS ABABA, Jan 20, 2012 (AFP) - Addis Ababa said Friday that two Germans kidnapped during a deadly attack by unidentified gunmen on a group of tourists in northern Ethiopia had been taken to neighbouring Ethiopia. Germany said it was still investigating the pair's whereabouts. "There is news that they are in Eritrea by now," foreign ministry spokesman Dina Mufti told AFP.

The Germans are believed to have been abducted when gunmen attacked a group of tourists in Ethiopia's remote Afar region earlier this week. Five people were killed in the attack: two Germans, two Hungarians and one Austrian. The German foreign ministry said three members of Germany's Federal Crime Agency were dispatched to Ethiopia to assist search efforts.  "The Federal Crime Agency (has) sent staff to Ethiopia in order to support the Embassy," a spokeswoman for Germany's foreign ministry told AFP from Berlin.  "They are trying to investigate where the two missing Germans could be." Six other Germans were among twelve survivors, some of them wounded, who were flown back to Addis Ababa on Wednesday. A Belgian citizen with gunshot wounds remains in hospital in Mekele in northern Ethiopia. The five bodies have been flown to the capital.

The attack took place near the famed Erte Ale volcano in Ethiopia's sparsely populated Danakil desert, close to the tense Ethiopia-Eritrea border.  The area, which boasts spectacular moon-like landscapes and is famed to be the hottest place on earth, is popular among travellers.  No group has claimed responsibility for the killings, but Ethiopia blamed arch-foe Eritrea for carrying out the attack. Eritrea vehemently denied being behind the incident, calling Ethiopia's claim "ludicrous" and a "smear campaign." The two Horn of Africa countries fought a bloody border war from 1998 to 2000 which killed 70,000 people. The border remains contested, with Ethiopian troops occupying land that international courts say belongs to Eritrea.
Date: Tue, 30 Aug 2011 12:41:08 +0200 (METDST)
by Jenny Vaughan

Shire, Ethiopia, Aug 30, 2011 (AFP) - In Ethiopias Endabaguna refugee camp, rows of gaunt Eritreans clad in rubber sandals give vent to their exasperation after days of trekking and dodging soldiers in an attempt to escape failed crops, hunger and an autocratic government. Over 12 million people across the Horn of Africa are struggling from the region's worst drought in decades, but secretive Eritrea is the only country to deny it has been affected by the crisis. "This year I farmed, but there was lack of rain. I dont know whats going to happen, only God knows," said Mehreteab, a refugee. He escaped from the army, risking death or jail if caught crossing the heavily militarized border, leaving his wife and three children behind. "There is no food and no grain in the home," he said. "I dont have any idea whats going to happen to them." Camps in northern Ethiopia receive about 900 refugees every month from Eritrea, one of the regions most isolated countries. A former colony of Italy and then part of Ethiopia, Eritrea fought a 30-year war with Ethiopia and only gained independence in 1991. A subsequent border conflict with Ethiopia from 1998-2000 still simmers.  Former rebel leader Issaias Afewoki, who has been in power since 1991 without elections, has cracked down on all dissidents and severely restricted press and religious freedom.

The majority of those arriving in the Ethiopian camps are young men escaping conscription, which forces men above 16 to serve in the military for decades on minimal pay. The UN recently called for tighter economic sanctions after releasing a report linking Eritrea to a failed bomb plot at the African Union. According to satellite imagery from the weather monitoring group FEWSNET, rainfall in parts of Eritrea this year has been "below average" - less than 10 percent of normal levels in some areas. Aid workers admit it is nearly impossible to know just how gravely the Eritrea is affected because access to information is so limited in the country where the only media is state-run. "Its been a black hole for us, we dont know whats going on there," said Matthew Conway, spokesman for the UN humanitarian coordination office in Nairobi. "But thats not to say its not happening."

The US ambassador to the United Nations has said she is "deeply concerned" that Eritrea is facing extreme hunger, and urged the government to allow humanitarian access. "The people of Eritrea who most likely are suffering the very same food shortages that were seeing throughout the region are being left to starve," Susan Rice told reporters in New York. And much like other countries in the region, such as Ethiopia and Kenya, Eritrea is vulnerable to increased food prices, exacerbating the crisis. According to the UN agriculture agency, global food prices jumped 33 percent in the last year. "High international prices affected every country in the world, so from that you can assume Eritrea is affected," said Shukri Ahmed, an economist at the Food and Agriculture Organization. Fiercely self-reliant Eritrea stopped sending market information to FAO about three years ago, Ahmed said, so it is impossible to know how much food prices have risen in the country. "Unfortunately, we dont have any information on the ground," he told AFP by phone from Rome.

Over half of Eritrea's food is imported, the FAO estimate, leaving it vulnerable to market fluctuations for staples such as sorghum and maize. Eritrean refugee Berhane, 35, said the cost of food has surged in recent years, though wages have remained the same. Intermittent work as a labourer earned him about $5 per day. But the cost of grain is about $3 per kilo and a sheep is about $170, more than he could make in a month, he told AFP. "How is someone with no money or daily work supposed to buy this?" he asked. "It is too expensive." Facing steep food costs, he relied on a small plot of land to feed his family. But the rains were two months late this year and his harvest failed. "The government doesnt do anything. Nothing. There are no rations," he told AFP.

The Eritrean authorities deny the country is facing food scarcity. "This nonsense about a hidden famine in Eritrea is utterly false," the Eritrea's information ministry said in an online statement last week. Instead, Asmara claims last year's harvest was the best in a decade, while state run media heap praise on government-run food security programs. But refugee Gebrielxavier, 25, said this is not true. He left Eritrea last November because his crop failed, he could not find work and his family went hungry. "We couldnt live. We were famished," he said. "And the government? It did nothing." He is now running a café in the refugee camp, where he earns less than $2 a  day and relies on UN food rations, but says he is still better off. "I got my freedom," he said.
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Monaco

France and Monaco US Consular Information Sheet
December 22, 2008
COUNTRY DESCRIPTION:
France is a developed and stable democracy with a modern economy.
Monaco is a developed constitutional monarchy.
Tourist facilities are widely
available.
Read the Department of State Background Notes on France and Monaco for additional information.
ENTRY/EXIT REQUIREMENTS:
France is party to the Schengen agreement.
As such, U.S. citizens may enter France for up to 90 days for tourist or business purposes without a visa.
A passport is required and should be valid for at least three months beyond the period of stay.
Anyone intending to stay more than 90 days must obtain the appropriate visa issued by one of the French Consulates in the U.S., prior to departure for France.
This also applies to anyone considering marriage in France.
For further information about travel into and within Schengen countries, please see our fact sheet.
A passport is required to enter Monaco. A visa is not required for tourist/business stays up to 90 days in Monaco.
For further information concerning entry requirements for France, travelers may contact the Embassy of France at 4101 Reservoir Road NW, Washington, DC
20007, tel. (202) 944-6000, email: info@ambafrance-us.org, or the French Consulates General in Atlanta, Boston, Chicago, Houston, Los Angeles, Miami, New Orleans, New York, or San Francisco.

For further information on entry requirements to Monaco, travelers may contact the Embassy of the Principality of Monaco. 2314 Wyoming Avenue, NW Washington, DC
20008, Tel: 202-234-1530, email: embassy@monaco-usa.org, or the Consulate General of Monaco, 565 Fifth Avenue – 23rd floor, New York, NY 10017, tel.: 212-286-0500, email: info@monaco-consulate.com.
For more information, visit the Embassy of France web site at www.consulfrance-washington.org or the Embassy of the Principality of Monaco web site at http://www.monaco-usa.org for the most current visa information.

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

SAFETY AND SECURITY:
The Government of France maintains a threat rating system, known locally as “Vigipirate,” similar to the U.S. Department of Homeland Security Advisory System.
Under this plan, in times of heightened security concerns, the government augments police with armed forces and increases visibility at airports, train and metro stations, and other high-profile locations such as schools, major tourist attractions, and government installations.
Over the last few years, there have been numerous arrests of suspected Islamic militants involved in various terrorist plots.
As with other countries in the Schengen area, France maintains open borders with its European neighbors, allowing the possibility of terrorist operatives entering/exiting the country with anonymity.

Political assassinations and bombings have occurred in France.
The National Front for the Liberation of Corsica (FLNC), as part of its decades-long bombing campaign on the island of Corsica, continues to conduct limited operations in the south of France and on Corsica.
In the 1990s there was a wave of bombings and attacks in Paris carried out by Algerian terrorists.
Today, numerous radical Islamic groups claim sympathizers within France’s large immigrant community, as evidenced by arrests over the last few years.

Although Americans have not been specifically targeted in terrorist attacks in France within the past few years, travelers should maintain vigilance.
Immediately report unattended packages observed in public places or any other suspicious activities. French law enforcement authorities are proactive and will respond immediately.
If there is a security incident or suspicious package, do not linger in the area to observe.

Although violent civil disorder is rare in France, in the past, student demonstrations, labor protests, and other types of demonstrations have developed into violent confrontations between demonstrators and police.
This was the case in March/April 2006, when a series of large demonstrations took place in central Paris. Several weeks of unrest occurred in the suburbs of Paris, as well as in other French cities and towns, in November 2005.
Neither of these periods of disorder exhibited any anti-U.S. sentiment, but it is important to remember that even a passer-by can be harmed should demonstrations devolve into violence.
Americans are advised to avoid street demonstrations, particularly if riot police are on the scene.

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

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

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

CRIME:
While both France and Monaco have relatively low rates of violent crime, a limited number of neighborhoods in the larger French cities merit extra caution.
Additionally, although the overall crime rate has fallen slightly in recent years, the violent crime rate has increased.
Thieves commonly target vehicles with non-local license plates, and work in or near tourist attractions such as museums, monuments, restaurants, hotels, beaches, trains, train stations, airports, and subways.
Americans in France and Monaco should be particularly alert to pickpockets in train stations and subways.
Travelers should keep photocopies of travel documents and credit cards separate from the originals, along with key telephone numbers to contact banks for credit card replacement.

Although thieves may operate anywhere, the U.S. Embassy in Paris receives frequent reports of theft from several areas in particular:
Paris: The Paris Police Prefecture published a pamphlet entitled “Paris in Complete Safety,” which provides practical advice and useful telephone numbers for visitors and can be accessed at http://www.prefecture-police-paris.interieur.gouv.fr/prevention/article/paris_securite_anglais.htm. Thieves operate on the rail link (RER) from Charles de Gaulle Airport to downtown Paris, where they prey on jet-lagged, luggage-burdened tourists.
In one common ruse, a thief distracts a tourist with a question about directions while an accomplice steals a momentarily unguarded backpack, briefcase, or purse.
Thieves also time their thefts to coincide with train stops so they may quickly exit the car just before the automatic doors close.
Travelers should consider taking an airport shuttle bus or taxi from the airport into the city.
Reports of stolen purses, briefcases, and carry-on bags at Charles de Gaulle Airport are not uncommon.
Travelers should monitor their bags at all times and never leave them unattended.
As thieves commonly target laptop bags, travelers should avoid carrying passports and other valuables in computer bags.
Another common method involves picking up a traveler’s shoulder bag that has been placed on the floor while the traveler is busy at the ticket counter. Also be aware that unattended bags are subject to destruction by airport security.

There are reports of robberies in which thieves on motorcycles reach into a moving car by opening the car door or accessing an open window or even breaking the window to steal purses and other bags visible inside.
The same technique is used against pedestrians walking with purses/bags/cameras slung over their street-side shoulder.
Those traveling by car should remember to keep the windows up and the doors locked and items that may be attractive to thieves out of sight.
Pedestrians are encouraged to remain aware of their surroundings at all times, and to keep bags slung across the body, with the bag hanging away from the street.

Many thefts occur on the Number One Subway Line, which runs through the center of Paris by many major tourist attractions (including the Grand Arch at La Défense, the Arc de Triomphe, the Champs Elysées, Place de la Concorde, the Louvre, and the Bastille).
Pickpockets are especially active on this metro line during the summer months and use a number of techniques.
The most common, and unfortunately the most successful, is the simple “bump and snatch,” where an individual bumps into the tourist while at the same time reaching into the pockets/purse/bag.
Visitors should be particularly careful when metro doors are closing, as this is a favored moment for the less-sophisticated pickpockets to simply grab valuables and jump through the closing doors, leaving the victim helplessly watching as the thief flees.
Visitors are encouraged NOT to confront thieves aggressively; they often operate in groups and may become violent if cornered.
Simply drawing attention to an attempted theft will most likely stop the operation, and result in a tactical withdrawal by the thief.

Gare du Nord train station, where the express trains from the airport arrive in Paris, is also a high-risk area for pocket-picking and theft.
Travelers should also beware of thefts that occur on both overnight and day trains, especially on trains originating in Spain, Italy, and Belgium.
These involve the theft of valuables while passengers are sleeping, or when the bags are left unattended.

In hotels, thieves target lobbies and breakfast rooms, and take advantage of a minute of inattention to snatch jackets, purses, and backpacks.
While many hotels do have safety latches that allow guests to secure their rooms from inside, this feature is not as universal as it is in the United States.
If no chain or latch is present, a chair placed up against the door and wedged under the handle is usually an effective obstacle to surreptitious entry during the night.
There are, however, reports of thieves breaking into hotel rooms on lower floors through open windows while the occupants are sleeping.
To guard against this, hotel room windows should be kept locked at all times. Whenever possible, valuables should be kept in the hotel safe.

Many Americans report thefts occurring in restaurants and nightclubs/bars, where purses are stolen from the back of a chair or from under the table.
Again, keep valuables on your person and do not leave them unattended or out of sight.
Thefts also occur at the major department stores such as Galeries Lafayette and Printemps where tourists often place wallets, passports, and credit cards on cashier counters during transactions.

Automated Teller Machines (ATMs) are very common in France and provide ready access to cash, allowing travelers to carry as much money as they need for each day.
The rates are competitive with local exchange bureaus, and an ATM transaction is easier than cashing a traveler’s check.
However, crime involving ATMs is increasing.
Travelers should not use ATMs in isolated, unlit areas or where loiterers are present.
Travelers should be especially aware of persons standing close enough to see the Personal Identification Number (PIN) being entered into the machine.
Thieves often conduct successful scams by simply observing the PIN as it is entered and then stealing the card from the user in some other location.
If the card becomes stuck, travelers should immediately report it to the bank where the machine is located.

Large criminal operations in Paris involving the use of ATMs that “eat” the user’s ATM card have been reported.
This most often happens during a weekend or at night when the bank is closed.
The frustrated traveler often walks away after unsuccessfully trying to retrieve the card, with plans to return the first day the bank is open.
In such cases, a criminal gang has modified the machine using an add-on device equipped with a microchip that records the user’s PIN when it is typed in, and also prevents the card from being ejected.
The criminal retrieves the card from the device once the visitor departs, downloads the recorded PIN and then goes to other ATMs and withdraws as much cash as possible.
ATM users are strongly encouraged to carry a 24-hour emergency number for their ATM card and bank account that will enable the immediate prevention of withdrawals from the account if difficulties occur.

Pigalle is the “adult entertainment district” of Paris.
Many entertainment establishments in this area engage in aggressive marketing and charge well beyond the normal rate for drinks.
Reports of threats of violence to coerce patrons into paying exorbitant beverage tabs are not uncommon.
There have also been several violent confrontations between rival gangs in the district, including one in August 2007 one block from the famous Moulin Rouge cabaret.
Visitors are encouraged to avoid this area unless touring with a well-organized and reputable tour company.

Normandy:
There has been an increase in break-ins and thefts from vehicles in the parking lots at the Normandy beaches and American cemeteries common.
Valuables should not be left unattended in a car, and locking valuables in the trunk should not be considered a safeguard.
Thieves often pry open car trunks to steal bags inside.

Southern France: Thefts from cars with unlocked doors or open windows stopped at red lights or caught in slow traffic are very common, particularly along the Riviera of the Nice-Antibes-Cannes area, and in Marseille.
Car doors should be kept locked and windows raised at all times to prevent incidents of "snatch-and-grab" thefts.
In this type of scenario, the thief is usually a passenger on a motorcycle. Break-ins of parked cars are also fairly common.
Valuables should not be left in the car, not even in the trunk, when the vehicle is unattended.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends, and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
Under French law, compensation is available to victims of crime committed on French soil under certain circumstances. To learn about resources in the U.S., including possible compensation, see our information on Victims of Crime
The local equivalents to the “911” emergency line in France are as follows: 17 (police emergency), 18 (fire department) and 15 (emergency medical/paramedic team/ambulance).
In Monaco, the numbers are 17 (police emergency), 18 (fire department) and 9375-2525 (medical/paramedic team/ambulance).

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care comparable to that found in the United States is widely available. In France, the phone number for emergency medical services is 15.
In Monaco, the phone number for emergency medical services is 9375-2525.

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

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning France and Monaco is provided for general reference only, and it may not be totally accurate in a particular location or circumstance.
Roads in France are generally comparable to those in the United States, but traffic engineering and driving habits pose special dangers.
Usually, lane markings and sign placements are not as clear as in the United States.
Drivers should be prepared to make last-minute maneuvers, as most French drivers do.
The French typically drive more aggressively and faster than Americans, and tend to exceed posted speed limits.
Right-of-way rules in France may differ from those in the United States.
Drivers entering intersections from the right have priority over those on the left (unless specifically indicated otherwise), even when entering relatively large boulevards from small side streets.
Many intersections in France are being replaced by traffic circles, where the right-of-way belongs to drivers in the circle.

On major highways, service stations are situated at least every 25 miles.
Service stations are not as plentiful on secondary roads in France as they are in the United States.
Paris, the capital and largest city in France, has an extensive and efficient public transportation system.
The interconnecting system of buses, subways, and commuter rails serves more than 4 million people a day with a safety record comparable to or better than the systems of major American cities.
Similar transportation systems are found in all major French cities. Between cities, France is served by an equally extensive rail service, which is reliable.
High-speed rail links connect the major cities in France. Many cities are also served by frequent air service.

Please refer to our Road Safety page for more information.
Visit the web site of the French and Monegasque National Tourist Office at http://us.franceguide.com/.
The website contains specific information concerning French and Monegasque driver's permits, vehicle inspection, road tax, and mandatory insurance.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of France's Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of France's air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa
SPECIAL CIRCUMSTANCES:
French and Monegasque customs authorities enforce strict regulations concerning temporary importation into or export from France of items such as firearms, antiquities, medications, business equipment, sales samples, and other items.
It is advisable to contact the Embassy of France in Washington, DC, one of France's consulates in the United States, or the Consulate General of Monaco in New York for specific information regarding customs requirements.
Please see our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating French or Monegasque laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in France or Monaco 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 AND CONSULATE LOCATIONS:
Americans living or traveling in France or Monaco are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, so they can obtain updated information on travel and security within France and Monaco.
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 cases of emergency.

The U.S. Embassy/Consular Section in Paris is located at 4 avenue Gabriel, 75008 Paris (Place de La Concorde, métro stop Concorde), telephone: in country 01-43-12-22-22; from the U.S. 011-33-1-43-12-22-22 (24 hours); fax for Passport Services in country 01-42-96-28-39; from the U.S. 011-33-1-42-96-28-39; for Special Consular Services (emergencies) fax: in country 01-42-61-61-40; from the U.S. 011-33-1-42-61-61-40. Further information can be obtained at the U.S. Embassy's web site at http://france.usembassy.gov/
The Consulate General in Marseille is located at Place Varian Fry, 13006 Marseille, telephone: in country 04-91-54-92-00; from the U.S. 011-33-4-91-54-92-00 (24 hours); Consular Section fax: in country 04-91-55-56-95 and main fax 04-91-55-09-47; Consular Section fax from the U.S. 011-33-4-91-55-56-95, and main fax from the U.S. 011-33-4-91-55-09-47.
Web site: http://france.usembassy.gov/marseille.html.

The Consulate General in Strasbourg is located at 15 Avenue d'Alsace, 67082 Strasbourg, telephone: in country 03-88-35-31-04; from the U.S. 011-33-3-88-35-31-04; fax: in country 03-88-24-06-95; from the U.S. 011-33-3-88-24-06-95.
Web site: http://france.usembassy.gov/strasbourg.html.

The Consulate General in Strasbourg does not produce passports on the premises.
American citizens in this area whose passports are lost or stolen and have urgent travel needs should contact the U.S. Embassy in Paris.

The U.S. Government also has consular representation in Bordeaux, Lyon, Rennes, Nice and Toulouse that provide limited services to Americans, by appointment only.

The American Presence Posts in Bordeaux, Lyon and Rennes do not produce passports on the premises.
American citizens in this area whose passports are lost or stolen and have urgent travel needs should contact the Consular Section of the U.S. Embassy in Paris.

The American Presence Post in Toulouse and the Consular Agency in Nice do not produce passports on the premises.
American citizens in this area whose passports are lost or stolen and have urgent travel needs should contact the U.S. Consulate General in Marseille.

The American Presence Post in Bordeaux is located at 10 place de la Bourse, 33076 Bordeaux (entry on 1 rue Fernand Philippart); telephone: in country 05-56-48-63-80; from the U.S. 011-33-5-56-48-63-80; fax: in country 05-56-51-61-97; from the U.S. 011-33-5-56-51-61-97.
Web site: http://france.usembassy.gov/bordeaux.html
The American Presence Post in Lyon is located at 1, quai Jules Courmont, 69002 Lyon; telephone: in country 04-78-38-33-03; from the U.S. 011-33-4-78-38-33-03; fax: in country 04-72-41-71-81; from the U.S. 011-33-4-72-41-71-81.
Web site: http://france.usembassy.gov/lyon.html
The American Presence Post in Rennes is located at 30, quai Duguay Trouin, 35000 Rennes; telephone: in country 02-23-44-09-60; from the U.S. 011-33-2-23-44-09-60; fax: in country 02-99-35-00-92; from the U.S. 011-33-2-99-35-00-92.
Web site: http://france.usembassy.gov/rennes.html
The American Presence Post in Toulouse is located at 25, Allée Jean Jaures, 31000 Toulouse; telephone: in country 05-34-41-36-50; from the U.S. 011-33-5-34-41-36-50; fax: in country 05-34-41-16-19; from the U.S. 011-33-5-34-41-16-19. Web site: http://france.usembassy.gov/toulouse.html
The Consular Agency in Nice is located at 7, Avenue Gustave V, 3rd floor, 06000 Nice, telephone: in country 04-93-88-89-55; from the U.S.
011-33-4-93-88-89-55; fax: in country 04-93-87-07-38; from the U.S. 011-33-4-93-87-07-38. Web site: http://france.usembassy.gov/nice.html
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This replaces the Country Specific Information for France and Monaco dated May 5, 2008, to update the sections on Entry/Exit Requirements, Safety & Security, Crime, Medical Facilities and Health Information, Children’s Issues and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Fri 24 Sep 2010
Source: Maville.com [in French, trans. ProMed Corr.SB. summ., edited]
<http://www.monaco.maprincipaute.com/actu/actudet_--Monaco-Premier-cas-de-dengue-importee-_loc-1522542_actu.Htm>

A young resident, aged 18, returned from the Caribbean with the disease. Since early September 2010, the government has been strengthening mosquito control.  "Monaco does not have any indigenous dengue cases," said Stephane Valeri, Government Counsellor for Social Affairs and Health. "However, we have identified a case of imported dengue fever in early September [2010]. There is nothing to worry about for this young 18 year old resident of Monaco, who returned from the Caribbean with the disease. He is now in perfect health," said Stephane Valeri.

However, with the announcement of the 1st indigenous dengue fever cases in Nice, mosquito control, already assiduous in gardens and public spaces, has been strengthened. The 1st objective is to kill the tiger mosquito larvae. "The tiger mosquito [_Aedes albopictus_. - ProMed JW] has been located in our area for 3 years now, says Philip Porcu, Territory Chief Technician, Directorate of Planning and Urban Development.
====================
[All it takes to initiate a dengue outbreak is the presence of a viremic individual in an area where there is a significant population of _Aedes_mosquito vectors, as has been the case in nearby Nice, France this month (September 2010). The concern and vigorous preventive actions by Monaco health authorities are justified. Although ProMED does not normally report imported dengue cases with no subsequent local transmission, the risk of transmission elicited this report.

A HealthMap/ProMED-mail interactive map of Monaco can be accessed at
<http://healthmap.org/promed/en?v=43.7,7.4,5>. - ProMed Mod.TY]
Date: Sun, 30 May 2004 11:17:10 +0200 (METDST) MONACO, May 30 (AFP) - A strong blast damaged Monaco's Louis II stadium and a nearby building overnight, the principality's press office said Sunday. Nobody was injured by the explosion, the cause of which was not immediately known. "A major fire" broke out following the 2:00 am (midnight GMT) blast, which hit one of the stadium entrances adjoining administrative offices, the press office said. The industrial building facing that entrance also suffered damage. An enquiry has been opened into the blast, headed by the prosecutor general and "no possibility, accidental or criminal, is being ruled out," the office said. The stadium is the home playing field of the Monaco football team, which lost in the Champions League final on Wednesday to Portugal's FC Porto. The match was played in Germany. Access to the building and the damaged building facing it were blocked off Sunday. An inquiry led by Monaco's official security service was under way.
6 Dec 1999 MONTE CARLO, Monaco (AP) - Fortunes are won and lost through the night in the smoke-filled, exclusive backrooms of Monaco's casino, built by the architect of the Paris Opera House. Jewelry stores and Belle Epoque hotels with Italian-style frescoes and pink marble columns overlook the Mediterranean, where huge private yachts are moored year-round. But for all its wealth, this tiny, sun-kissed tax haven, smaller than New York's Central Park and for decades a magnet for the international jet set, seems to lack soul. "It's like a film set," Marco Peruzzi, a day-tripper from nearby Italy, said as he gazed at the sand-colored royal palace where the Grimaldi dynasty has ruled for seven centuries. "You may get a glimpse of celebrities. But you're left with an empty feeling." See http://www.infobeat.com/stories/cgi/story.cgi?id=2562433955-79a
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Ethiopia

Ethiopia - US Consular Information Sheet
November 26, 2008
COUNTRY DESCRIPTION:
The Federal Democratic Republic of Ethiopia is a developing country in East Africa.
It is comprised of nine states and two city administrations (Addis Aba
a and Dire Dawa).
The capital is Addis Ababa.
Tourism facilities can be found in the most populous regions of Ethiopia, but infrastructure is basic.
The ruling EPRDF party and Prime Minister Meles Zenawi maintain strong control of the government and economy.
Despite several years of high economic growth, the country remains vulnerable to external economic shocks and recurring drought.

Read the Department of State Background Notes on Ethiopia for additional information.

ENTRY/EXIT REQUIREMENTS:
To avoid possible confusion or delays, travelers are advised to obtain a valid Ethiopian visa at the nearest Ethiopian Embassy prior to arrival, and must do so if entering across any land port-of-entry.
For example: travelers wishing to enter Ethiopia from Kenya at the land border at Moyale, must obtain an Ethiopian visa first.
Ethiopian visas ARE NOT available at the border crossing point at Moyale.
Travelers should apply for Ethiopian visas at the Ethiopian Embassy in Nairobi or at other Ethiopian embassies in other countries.
Ethiopian visas are available to U.S. citizens upon arrival at Bole International Airport in Addis Ababa.
U.S. citizens may obtain one-month or three month, single-entry tourist visas or 10-day single-entry business visas upon arrival at Bole International Airport.
This service is available only at Bole International Airport and is not available at any other ports of entry in Ethiopia.
The visa fee at Bole International Airport is payable in U.S. dollars.
Such visas can be extended by applying at the Main Immigration Office in Addis Ababa.
Business visas of up to three-months validity can also be obtained at Bole International Airport upon arrival if the traveler has a sponsoring organization in Ethiopia that has made prior arrangements for issuance through the Main Immigration Office in Addis Ababa.
Travelers whose entry visa expires before they depart Ethiopia, must obtain a visa extension and pay a monthly penalty fee of $20 USD per month.
Such travelers may also be required to pay a court fine of up to 4000 ETB (USD $435) before being permitted to depart from Ethiopia.
Travelers are required to pay the penalty fee before they will be able to obtain an exit visa (USD $20) permitting them to leave Ethiopia.

Individuals intending to stay in Ethiopia for a prolonged period of time are advised to contact the Ethiopian Embassy in Washington prior to traveling.
The Ethiopian Embassy is located at 3506 International Drive NW, Washington, DC 20008; telephone (202) 364-1200; fax (202) 587-0195.
For the most current visa information, visit the Embassy’s web site at www.ethiopianembassy.org.
Inquiries by Americans located overseas may be made at the nearest Ethiopian embassy or consulate.

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:
While Ethiopia is generally stable, domestic insurgent groups, extremists from Somalia, and the heavy military buildup along the northern border pose risks to safety and security, particularly along Ethiopia’s border areas and in the Somali region.
In the past year, there has been an increase in targeted bombings in Addis Ababa and in other parts of Ethiopia.
In November 2008, the Government of Ethiopia issued a warning to its citizens alerting them of the potential for terrorist attacks and subsequently increased security measures to unprecedented levels.

Throughout Ethiopia:
Americans are strongly advised to review their personal safety and security posture, to remain vigilant and to be cautious when frequenting prominent public places and landmarks.
Targeted bombings in Addis Ababa and south eastern Ethiopia in 2008 resulted in numerous injuries and deaths.
Americans are advised to avoid public gatherings and public places, including hotels, if possible, and using public transportation and transportation hubs.
They are advised to beware of unattended baggage or packages left in any location, including in mini-buses and taxis.

Ethiopia/Eritrea Border Area:
Ethiopia and Eritrea signed a peace agreement in December 2000 that ended their border war.
However, the border remains an issue of contention between the governments of Ethiopia and Eritrea.
The border area is a militarized zone where there exists the possibility of armed conflict between Ethiopian and Eritrean forces.
American citizens are advised to avoid travel in the areas along the Eritrean/Ethiopian border (within 50 km/30 miles of the Ethiopian/Eritrean border) because of the dangers posed by land mines and because of the possibility of conflict between Ethiopian and Eritrean defense forces.
Due to abductions and banditry, Americans are advised to avoid travel within 30 miles of the Ethiopian-Eritrean border west of Adigrat to the Sudanese border, with the exception of the town of Axum, and within 60 miles east of Adigrat to the Djiboutian border.
Embassy personnel are permitted to travel in these areas only on a case-by-case basis. Travel to the northern Afar Region towards the Eritrean border is also discouraged.
Embassy personnel are permitted to travel there only on a case-by-case basis.

Somali Region:
Since the mid-1990's the members of the Ogaden National Liberation Front (ONLF) have clashed with Ethiopian government forces near the city of Harar and in the Somali regional state, particularly in the Ogaden zones.
In April 2007, the ONLF claimed responsibility for attacking a Chinese oil exploration installation south of Jijiga, in Ethiopia's Somali region.
The attack resulted in deaths, kidnappings and the wounding of dozens of Chinese and Ethiopian citizens.
In 2008, a hotel in the town of Jijiga was bombed and two hotels in the town of Negele Borena were bombed.

American citizens are reminded that the U.S. Embassy strongly discourages travel to Ethiopia's Somali region and that a Travel Warning for Somalia has been issued that advises against all travel to that country.
Armed insurgent groups operate within the Somali, Oromiya and Afar regions of Ethiopia.
In December 2006, the Ethiopian Government, at the invitation of the Transitional Federal Government of Somalia, began military operations against extremists in Somalia.
As of November 2007, military operations continue in Mogadishu, where an African Union peacekeeping force, AMISOM, is deployed.
In 2008, two staff members of a non-governmental organization (NGO) were abducted in the Somali region.

Gambella Region:
Sporadic inter-ethnic clashes remain a concern throughout the Gambella region of western Ethiopia following outbursts of violence there in 2003 - 2004.
There is a heavy military and police presence in the town of Gambella.
While the security situation in the town of Gambella is calm, it remains unpredictable throughout the rest of the region, and violence could recur without warning.
Travel to this region is discouraged.

Travel in Ethiopia via rail is discouraged due to past episodes of derailment, sabotage, and bombings.
In southern Ethiopia along the Kenyan border, banditry and incidents involving ethnic conflicts are also common.
Travelers should exercise caution when traveling to any remote area of the country, including the borders with Eritrea, Somalia, Kenya and Sudan.
Ethiopian security forces do not have a widespread presence in those regions.

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:
Pick-pocketing, “snatch and run” thefts, and other petty crimes are common in Addis Ababa.
These are generally crimes of opportunity rather than planned attacks.
Travelers should exercise caution in crowded areas and should avoid visiting the Mercato in Addis Ababa, a large open-air market.
Violence in the Mercato has been on the rise.
In 2008 an explosion in the Mercato killed several and wounded more than a dozen individuals.
Also in 2008, there was a shooting in the Mercato.
Travelers should limit the amount of cash they carry and leave valuables, such as passports, jewelry, and airline tickets in a hotel safe or other secure place.
Travelers should keep wallets and other valuables where they will be less susceptible to pick-pockets.
Travelers should be cautious at all times when traveling on roads in Ethiopia.
There have been reports of highway robbery, including carjacking, by armed bandits outside urban areas.
Some incidents have been accompanied by violence.
Travelers are cautioned to limit road travel outside major towns or cities to daylight hours and travel in convoys, if possible.

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.

There is no local equivalent to the “911” emergency line in Ethiopia.
Distress calls should be made to the local police station, the telephone number of which can be obtained by calling directory assistance at 997.
This is the number for directory assistance throughout Ethiopia.
In Addis Ababa, the number for police is 991, for the fire brigade 939, and for an ambulance 907.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Health facilities in Addis Ababa are very limited and are generally inadequate outside the capital.
Even the best hospitals in Addis Ababa suffer from inadequate facilities, antiquated equipment, and shortages of supplies (particularly medicines).
There is a shortage of physicians.
Emergency assistance is limited.
Psychiatric services and medications are practically nonexistent.
Serious illnesses and injuries often require travelers to be medically evacuated from Ethiopia to a location where adequate medical attention is available.
Such “medevac” services are very expensive and are generally available only to travelers who either have travel insurance that covers medevac services or who are able to pay in advance the considerable cost of such services (often in excess of USD 40,000).
See Medical Insurance below.
Travelers must carry their own supplies of prescription drugs and preventive medicines, as well as a doctor's note describing the medication.
If the quantity of drugs exceeds that which would be expected for personal use, a permit from the Ministry of Health is required.
Malaria is prevalent in Ethiopia outside of the highland areas.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and explain to the health care provider their travel history and which anti-malarials they have been taking.
For additional information on malaria, protection from insect bites, and anti-malarial drugs, please visit the CDC Travelers' Health web site at http://www.cdc.gov/malaria/index.htm.
Tuberculosis is an increasingly serious health concern in Ethiopia.
For further information, please consult the CDC's Travel Notice on TB at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx

Ethiopia is a mountainous country and the high altitude may cause health problems, even for healthy travelers.
Addis Ababa is located at an altitude of 8,300 feet.
Travelers may experience shortness of breath, fatigue, nausea, headaches, and inability to sleep.
Individuals with respiratory (including asthma) or heart conditions should consult with a health care professional before traveling to Ethiopia.
Travelers to Ethiopia should also avoid swimming in any lakes, rivers, or still bodies of water.
Most bodies of water have been found to contain parasites.
Travelers should be aware that Ethiopia has a high prevalence of HIV/AIDS.
Ethiopia has had outbreaks of acute watery diarrhea, possible cholera, typhoid, or other bacterial diarrhea in the recent past, and the conditions for reoccurrences continue to exist.
Further information on prevention and treatment of cholera and other diarrheal diseases can be found at the CDC web site at http://wwwn.cdc.gov/travel/contentDiseases.aspx.
Ethiopian authorities are monitoring the possibility of avian influenza following the deaths of poultry and birds; preliminary results are negative.
For additional information on avian flu please visit the CDC website at http://www.cdc.gov/flu/avian/.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Ethiopia.
Please verify with the embassy of Ethiopia before you travel.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Specific medevac insurance, which generally covers evacuation of a patient from Ethiopia to a location where adequate medical attention is available, is often inexpensive and available through a variety of companies that can be accessed online.
Medicare and Medicaid recipients are not covered overseas and are advised to purchase supplemental health and medical evacuation insurances.
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 Ethiopia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
According to the World Health Organization (WHO), Ethiopia has the highest rate of traffic fatalities per vehicle in the world.
Roads in Ethiopia are poorly maintained, inadequately marked, and poorly lighted.
Road travel after dark outside Addis Ababa and other cities is dangerous and discouraged due to hazards posed by broken-down vehicles left in the road, pedestrians walking in the road, stray animals, and the possibility of armed robbery.
Road lighting in cities is inadequate at best and nonexistent outside of cities.
Excessive speed, unpredictable local driving habits, pedestrians and livestock in the roadway, and the lack of basic safety equipment on many vehicles are daily hazards on Ethiopian roads.
While travel during daylight hours on both paved and unpaved roads is generally considered safe, land mines and other anti-personnel devices can be encountered on isolated dirt roads that were targeted during various conflicts.
Before undertaking any off-road travel, it is advisable to inquire of local authorities to ensure that the area has been cleared of mines.
Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Ethiopia’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Ethiopia’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa/.
The Ethiopian government has closed air routes near the border with Eritrea and has referred to the airspace as a “no-fly zone.”
The FAA currently prohibits U.S. aircraft and U.S. pilots from flying in Ethiopian airspace north of 12 degrees north latitude, the area along the country's northern border with Eritrea.
For complete information on this flight prohibition, travelers may visit the FAA's web site at http://www.faa.gov/airports_airtraffic/air_traffic/publications/notices/2008-11-20/PART3_SEC1.cfm.
SPECIAL CIRCUMSTANCES:
Ethiopia does not recognize dual nationality.
The government of Ethiopia considers Ethiopians who have become naturalized U.S. citizens to be Americans.
Such individuals are not subject to Ethiopian military service.
The Ethiopian government has stated that Ethiopian-Americans in almost all cases are given the same opportunity to invest in Ethiopia as Ethiopians.
Several years ago the government of Ethiopia arrested people of Eritrean origin who initially failed to disclose their U.S. citizenship.
However, this has not occurred in recent years.
Ethiopian officials have recently stated that Eritrean-Americans are treated as U.S. citizens and are not subject to arrest simply because of their ties to Eritrea.
For additional information, see our dual nationality flyer.
Permits are required before exporting either antiques or animal skins from Ethiopia.
Antique religious artifacts, including "Ethiopian” crosses, require documentation from the National Museum in Addis Ababa for export.
Foreign currency should be exchanged in authorized banks, hotels and other legally authorized outlets and proper receipts should be obtained for the transactions.
Exchange receipts are required to convert unused Ethiopian currency back to the original foreign currency.
Penalties for exchanging money on the black market range from fines to imprisonment.
Credit cards are not accepted at most hotels, restaurants, shops, or other local facilities, although they are accepted at the Hilton and Sheraton Hotels in Addis Ababa.
Some hotels and car rental companies, particularly in Addis Ababa, may require foreigners to pay in foreign currency or show a receipt for the source of foreign exchange if paying in local currency.
However, many hotels or establishments are not permitted to accept foreign currency or may be reluctant to do so.

Ethiopian institutions have on occasion refused to accept 1996 series U.S. currency, although official policy is that such currency should be treated as legal tender.
Ethiopian law strictly prohibits the photographing of military installations, police/military personnel, industrial facilities, government buildings, and infrastructure (roads, bridges, dams, airfields, etc.).
Such sites are rarely marked clearly.
Travel guides, police, and Ethiopian officials can advise if a particular site may be photographed.
Photographing prohibited sites may result in the confiscation of film and camera.
There is a risk of earthquakes in Ethiopia.
Buildings may collapse due to strong tremors.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/
Please see 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 Ethiopia’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Ethiopia 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 Ethiopia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Ethiopia.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at Entoto Avenue, P.O. Box 1014, in Addis Ababa; telephone: 251-11-124-2424; emergency after-hours telephone: 251-11-124-2400; consular fax: 251-11-124-2435; web site: http://ethiopia.usembassy.gov/
* * *
This replaces the Country Specific Information for Ethiopia dated April 30, 2008 to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Thu, 26 Mar 2020 20:22:40 +0100 (MET)

Abidjan, March 26, 2020 (AFP) - Almost all of Africa's airlines are currently grounded because of the coronavirus pandemic and several could go bankrupt, the African Airlines Association (AFRAA) warned Thursday.   "Today, 95 percent of African planes are grounded owing to the pandemic, save for cargo flights," AFRAA secretary general Abderrahmane Berthe told AFP.

A large number of African states have closed their airports and borders because of the virus, forcing carriers to scrap inter-African as well as inter-continental flights.   "If the African carriers do not receive support they will find themselves insolvent come the end of June," warned Berthe, who calculated that the sector would require a bailout of between $2.5 to 3 billion (2.3 to 2.8 billion euros) in emergency aid or tax concessions.

"African carriers were already in a precarious state well before the COVID-19 pandemic. They have been making losses for a decade while other companies elsewhere were making money," Berthe said.   "The past fortnight has been catastrophic for African carriers whose planes are grounded. They have no revenue while at the same time they face costs they cannot squeeze" such as plane hire, maintenance, insurance and parking fees.   AFRAA's 45 member carriers account for 85 percent of inter-African traffic totalling 93 million passengers a year.   Although Africa accounts for just a two percent share of global air traffic, passenger numbers on the continent have been doubling every 15 to 20 years.
Date: Mon, 23 Mar 2020 15:36:01 +0100 (MET)

Addis Ababa, March 23, 2020 (AFP) - Ethiopia on Monday shut its land borders to nearly all human traffic as part of efforts to curb the spread of the coronavirus.    Africa's second-most populous country has so far recorded just 11 infections and no deaths, but officials have struggled in recent days to enforce prevention measures including bans on large gatherings, raising fears the tally could climb.    The land border closure was part of a set of new measures announced Monday by Prime Minister Abiy Ahmed's office.   Soldiers will be empowered "to halt the movement of people along all borders, with the exception of incoming essential goods to the country," a statement said.

Security forces will also play a role in enforcing existing measures prohibiting large gatherings and meetings, it added.   Ethiopia has so far refrained from imposing the kind of shutdown seen in other East African countries like Rwanda and Mauritius.    But even its more limited measures have not been fully enforced, and Abiy's Prosperity Party has been criticised on social media for holding large meetings in various parts of the country where attendees have sat close together.    Monday's statement said political parties would "adhere to social distancing and preventative measures when convening meetings."

Ethiopia has kept its main airport open for international flights, although Ethiopian Airlines has been forced to suspend services to destinations in nearly 40 countries, according to its website.    Monday marked the first day of a new rule requiring all passengers arriving in Ethiopia to be quarantined in hotels for two weeks at their own expense.    Ethiopia shares land borders with countries including Eritrea, Sudan, Kenya, Djibouti and Somalia -- all of which have confirmed coronavirus cases.    Djibouti announced its second case on Monday.

Eritrea, with one case, on Monday announced new measures of its own including a ban on gatherings of more than 10 people.   The country's health ministry also urged residents to avoid public transportation and said Eritreans currently living abroad should refrain from returning.   Ethiopia's refugee population of more than 735,000 includes large numbers from neighbouring South Sudan, Somalia, Eritrea and Sudan.

The UN refugee agency UNHCR has voiced concern about how border restrictions implemented to fight the coronavirus could affect the rights of asylum seekers.    The UN "requests that measures be put in place to take into account access to territory of asylum seekers for those fleeing persecution," Ann Encontre, UNHCR's Ethiopia representative, told AFP on Monday.
Date: Mon 2 Mar 2020
Source: Teller Report [edited]

A mysterious disease has appeared in Ethiopia causing bleeding from the nose and mouth before the patient fell dead due to an infection [or poisoning - ProMed Mod.TG], according to what was reported by the British Daily Mail newspaper on Sunday [1 Mar 2020]. [It is thought this syndrome is] due to the emergence of this disease [related] to toxic waste resulting from oil drilling operations carried out by Chinese companies there.

The newspaper reported the disease, which was said to have spread to villages close to a gas project in Somalia, turns the eyes of its victims yellow before causing them to overheat, swelling their bodies and ultimately [causing] their death. In addition to other symptoms, including yellowing of the palms, lack of appetite and insomnia, according to a report published by Al-Hurra, quoting the British newspaper, the report also included the denial [by] officials in Addis Ababa, published by the Guardian newspaper, [of] allegations of a health and environmental crisis in the region.

The Daily Mail said the cause of the disease is unclear, although many suspect it is the result of chemical waste having poisoned water supplies in the area. The newspaper quoted a former engineer with the Chinese company who claimed there have been regular spills of drilling fluids, including sulfuric acid, over the 3 years he worked at the site in Calop. [Regular spills? This sounds like a planned release of sulfuric acid. - ProMed Mod.TG]

Another said: "These people die from the raw toxins having been spilled as a result of utter negligence. The companies operating in Calop have abandoned their duty to protect the local population." At the same time, the newspaper indicated these chemical spills are historical, or may be caused by companies [of] Ethiopian transport.

For its part, said Kitsila Tadese, director of licenses at the Federal Ministry of Mines and Oil in Ethiopia, according to the Daily Mail, "All gas wells in Kalop and elsewhere in the Ogaden basin are closed, safe and secure...according to international standards."

Ethiopia, located in eastern Africa, had found large quantities of gas in the eastern Ogaden basin in the 1970s. POLY-GCL has been developing the Club and Hilal fields there since the signing of the production-sharing agreement with Ethiopia in 2013. Calub, southeast Jijiga, will start commercial gas production soon.
Date: Thu 31 Oct 2019
Source: News 18 [abridged, edited]

For the past 10 months, Ethiopia has been experiencing a measles outbreak, which began in Oromio region and later affected 3 additional regions: Afar, Amhara and Somali. Since the beginning of the year [2019], a total of 8514 suspected measles cases, including 57 deaths (case fatality ratio 0.67%), were reported.

The World Health Organisation (WHO) says measles is endemic in Ethiopia with outbreaks reported annually. A quarter of the people affected during the current outbreak are 15 years and above, and more than 82.6% of cases were either not vaccinated or their vaccination status was unknown.
Date: Sun 20 Oct 2019
Source: WHO-AFRO [abridged, edited]

Weekly bulletin on outbreaks and other emergencies Week 42: 14-20 Oct 2019
Summary: Cases: 8514; deaths: 57; CFR [case fatality ratio]: 0.67%

Description
=======================
Ethiopia has been experiencing a measles outbreak since late December 2018. The outbreak was initially reported in Oromia region and later affected 3 additional regions: Afar, Amhara, and Somali.

In week 41 (week ending 13 Oct 2019), 24 suspected cases with no deaths were reported. Between week 1 and week 41 in 2019, a total of 8514 suspected measles cases, including 57 deaths (CFR 0.67%), were reported. Of the 8514 suspected cases, 180 samples were tested, and 14 tested IgM-positive for measles virus infection at the Ethiopian Public Health Institute laboratory in Addis Ababa. The peak of the outbreak was reached in week 9 (week ending 3 Mar 2019), with 642 cases reported, followed by a gradual decline in the number of cases to 24 cases reported in week 41.

A total of 4 regions have confirmed measles outbreaks, including 28 zones and 113 woreda [districts]. Oromia region is the most affected, accounting for 58% of the total reported cases, followed by Somali (28%), Amhara (8%), and Afar (6%) regions.

The majority of affected cases are children under 5 years old, comprising 50.4% of all cases, followed by the age group 15-44 years (25.4%) and 5-14 years (23.3%). Upon investigation of the vaccination status of the cases, it was noted that 72.6% had never received a single measles dose.

Public health actions
======================
- A national coordination committee was set up at the Ethiopian Public Health Institute to coordinate the response to the measles outbreak as well as regional coordinating committees in each of the affected regions.
- Enhanced surveillance activities continue to enable the early detection of cases and prompt treatment.
- The Ethiopian government together with WHO, UNICEF, and other partners supported a responsive vaccination campaign in Somali region.
- In early February 2019, Ethiopia launched a measles vaccine 2nd dose (MCV2) vaccination into the routine immunization programme in the 2nd year of life.
- Management of measles cases is ongoing at healthcare facilities in the affected regions.

Situation interpretation
======================
Measles is endemic in Ethiopia with outbreaks reported annually. A quarter of the people affected during the current outbreak are 15 years and above, and more than 82.6% of cases were either not vaccinated or their vaccination status was unknown. In addition, an effective cold-chain system for storage and transport of the vaccine is lacking in a number of regions, especially Afar and Somali regions. The estimated measles vaccine 1st dose (MCV1) coverage by WHO and UNICEF in 2018 was 61%, and the administrative coverage for the same period was 88%. This is suboptimal to protect a community against an outbreak (to achieve herd immunity, usually 95% and above coverage is required).

There is a need to apply simple yet innovative approaches to address the health system challenges that impact the effective delivery of measles vaccines, and other vaccines, to the population, especially those located in the hard-to-reach areas of the country. Routine measles vaccination for children, combined supplemental immunization activities (SIAs) and strong community engagement are key public health strategies to reduce the incidence of the disease.
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[Also see
and
More ...

Russia

General Information
***************************************
Russia is one of the largest land masses throughout the world covering an expanse of 6,592,849 sq. miles. The country stretches from the Baltic sea in Europe to the Pacific Ocean in the
east and from the Arctic Ocean in the north to the Black Sea in the south. Moscow, the capital city, is situated in the western region of the country. The nation is undergoing profound political and economic changes. There have been Bank closures and this can make access to funds more difficult for travellers.
Safety & Personal Security
***************************************
Certain regions of the country are closed to travellers and it is important to confirm your itinerary before leaving. Entry to the Caucasus region is restricted. Kidnapping of tourists is well reported in some outlying regions. Good tourist facilities are present in Moscow, St Petersburg and many of the other large cities but many shortages can occur at times. Crime against foreigners can be a problem and it is essential not to flaunt personal wealth and to take care if you need to travel at night. The underground walkways, subway, train stations and airports are particular risk locations. Don’t share a taxi with strangers.
Customs Regulations
***************************************
On entry you will need to complete a form declaring all items of value. Keep this form safe as it will be required on leaving. Take care to obtain receipts for any expensive items to purchase while in Russia.
Stringent controls at Customs when leaving the country may cause significant delays if it is felt that the traveller is trying to export items of historical value.
General Health Precautions
***************************************
The medical services available throughout Russia may not reach Western European standards. Severe shortages of even basic medical supplies are regularly reported. It is wise for travellers to ensure that they are in good general health and that dental work should not be required while abroad. Carry an adequate supply of any medications which you normally take, as these may not be available in many parts of Russia. Adequate travel insurance is essential for your trip.
Diphtheria in Russia
***************************************
Again, according to press reports, over 4000 cases of diphtheria were reported during the outbreak in the early 1990’s. Approximately 104 deaths occurred. At that stage the disease was mainly found in St Petersburg, Moscow and Krasnodar and in the eastern parts of Valdivostok and Saratov. Vaccination (with Tetanus) is usually recommended for all travellers. As Diphtheria is mainly an airborne disease it is usually wise to avoid local public transport if possible.
AIDS risk in Russia
***************************************
The blood supply throughout Russia may not be fully screened against blood borne pathogens and so blood transfusion should be avoided where at all possible. The most common reason that a traveller requires blood is following a road accident. Take special care crossing roads etc. The actual extent of the AIDS problem throughout Russia is uncertain with inaccurate reporting of statistics at this time. Obviously all care should be taken to avoid possible infection. AIDS testing is required for persons staying 3 months or longer.
Hiking in Russia
***************************************
Tick-borne encephalitis has been reported in the vicinity of Novosibirsk, Vladivostok and in the Sverdlovsk Oblast.
Pre-exposure vaccination against this disease is recommended for anyone who will be spending prolonged periods outdoors in the infested areas of Russia. Hikers should wear protective clothing and insect repellent against tick bites throughout rural Russia. Any bite should be reported to competent medical personnel as soon as possible.
Insect Bites
***************************************
Mosquitoes do occur during the summer months. Though there is thought to be no risk of malaria in Russia itself, though there are reports from some of the surrounding CIS countries. Sandflys may also be found during the summer months in the hotter southern areas.
Food Precautions
***************************************
Eat only well cooked foods while they are still hot or fruit that you peel yourself. Always avoid roadside stands and street vendors as the level of hygiene is usually far below acceptable standards. Only purchase ice-cream products from established shops and never from the street side seller. Only pasteurised dairy products should be consumed. Outbreaks of a parasitic disease known as Trichinellosis has been reported from some regions of Russia. This disease is transmitted through eating undercooked meat so all food should never be rare when consumed.
Water Precautions
***************************************
Smell the tap water for a distinct chlorine odour. In many regions the water supply may not be potable and so travellers should where possible drink bottled beverages or beverages made from boiled water (tea/coffee). Do not use ice-cubes in your drinks and never use the mains tap water for drinking or brushing your teeth.
Occasional outbreaks of Typhoid, Cholera are reported and the St Petersburg mains water supply has been closely linked with an intestinal parasite, Giardia lambia.
General Vaccine Information
***************************************
Due to the general economic situation throughout Russia it is reported that there has been a significant shortage of vaccines to combat diseases such as measles, polio, diphtheria, tetanus and pertussis. This has led to a worsening of the risk for the local population and the possibility that travellers may be more exposed.
Vaccines for Travellers
***************************************
Most travellers to Russia will need to consider routine vaccination cover against the following;
Poliomyelitis, Typhoid,
Tetanus & Diphtheria and Hepatitis A.
Longer term travellers or those trekking may also need to consider vaccination cover against Rabies, Hepatitis B, Meningococcal Meningitis and Tick Borne Encephalitis.
Summary
***************************************
The majority of travellers to Russia who exercise due caution will remain in good health. Special care must be taken regarding your food and water consumption. Care against accidents and sensible precautions to avoid petty crime are also essential. If trekking about the country check your itinerary carefully and keep those at home in touch with your plans.

Travel News Headlines WORLD NEWS

Date: Mon, 30 Mar 2020 09:48:42 +0200 (METDST)

Moscow, March 30, 2020 (AFP) - Moscow on Monday imposed a lockdown in a bid to slow the spread of the coronavirus as Russian Prime Minister Mikhail Mishustin asked regional authorities to make similar preparations.    The enforcement of the tough new rules, which were suddenly announced by Moscow Mayor Sergei Sobyanin late Sunday, coincide with the beginning of a "non-working" week declared by President Vladimir Putin last week.   Europe's largest city announced the strict new isolation measures after many Muscovites refused to heed official recommendations and self-isolate at the weekend and instead went to parks for barbecues.

On Monday, the streets of Moscow were deserted following the closure of all non-essential shops, including restaurants and cafes, but traffic was still seen on the roads in the city centre.   "I ask regional heads to work on the introduction of quarantines similar to the one introduced in Moscow," Mishustin said at a government meeting.   In a rare televised address last Wednesday, Putin announced that Russians would not be required to go to work this week, but would still get paid.   The country has so far reported 1,534 cases of coronavirus and eight deaths, with more than one thousand infections in the capital.   The new restrictions apply to all of the city's residents, regardless of age.

Muscovites will only be allowed to leave their homes in cases of a medical emergency, to travel to jobs judged essential, and to shop for food or medicines.   People will be allowed to take out trash and walk their dogs within a 100-metre (330-foot) radius of their homes.   The new isolation rules, which will be policed by a vast system of facial-recognition cameras in Moscow, come into force as Russia closes its borders as part of increasingly stringent measures to stop the spread of COVID-19.
Date: Thu, 26 Mar 2020 08:58:29 +0100 (MET)

Moscow, March 26, 2020 (AFP) - Russia will halt all international flights from midnight on Friday under a government decree listing new measures against the coronavirus outbreak.   The decree published on Thursday orders aviation authorities to halt all regular and charter flights, with the exception of special flights evacuating Russian citizens from abroad.   Russia's civil aviation agency Rosaviatsiya will halt "regular and charter air travel from Russian airports to airports of foreign states and back," according to the decree published on the government's website.

The grounding starts at midnight Friday, or 2100 GMT Thursday.   The decree said that flights authorised by the Russian government would be exempt from the rule. The new measures do not apply to domestic flights within Russia.   The government said Russians who were unable to return due to restrictions imposed by countries they are in should take measures to stay safe.    The decree also called on the finance ministry to allocate funds to repatriate Russians, adding that returnees would be subject to health checks and a two-week quarantine.

In a rare televised address to the nation Wednesday, President Vladimir Putin said he was postponing a national vote on April 22 to green light constitutional reforms that would allow him to run for two more terms after 2024.   He also took the unusual step of declaring March 28 to April 5 a non-working week in order to slow the spread of the virus, urging Russians to stay at home.   Putin also unveiled measures to boost the economy, including breaks on consumer loans and mortgage payments.   Russia has reported 658 cases of the coronavirus and Moscow announced two COVID-19 related deaths Wednesday.   The country closed borders to foreigners last week, while Moscow has imposed its own stricter measures, requiring people over 65 to shelter at home.
Date: Wed, 25 Mar 2020 04:40:10 +0100 (MET)

Moscow, March 25, 2020 (AFP) - A 7.5-magnitude quake hit off Russia's Kuril Islands on Wednesday, the US Geological Survey said.   The quake hit at a depth of 59 kilometres (37 miles), around 1,400 kilometres (around 850 miles) northeast of the Japanese city of Sapporo, USGS added.   The US National Tsunami Warning Center said it was "analyzing the event to determine the level of danger".   "This earthquake has the potential to generate a destructive tsunami in the source region," it added.   The four southernmost islands of the Kuril chain -- Habomai, Shikotan, Etorofu and Kunashiri -- have been disputed between Moscow and Tokyo since the end of World War II.   The Kurils are known as the Northern Territories in Japan.
Date: Mon, 2 Mar 2020 13:04:23 +0100 (MET)

Moscow, March 2, 2020 (AFP) - Russian authorities on Monday confirmed the first case of coronavirus in Moscow, saying the patient had recently returned from Italy.   The anti-coronavirus task force said in a statement quoted by Russian news agencies that the "young man" had fallen ill on February 21 while on vacation to Italy.

The man, who resides outside Moscow, returned to Russia on February 23, and started showing signs of a respiratory viral infection, it said.   He sought medical help and was hospitalised on February 27. Testing confirmed the infection on Monday and his symptoms were not severe, the statement said.   Nearly 90,000 people have been infected in over 60 countries and more than 3,000 people have been killed by COVID-19.    Russia has so far managed to avoid a large number of infections and introduced a range of travel and visa restrictions.

Russia repatriated and quarantined a number of  passengers from the Diamond Princess cruise ship in Japan, three of whom tested positive for the virus.    Two Chinese citizens in Russia were also infected and treated in Siberia.   Moscow has imposed a near blanket ban on Chinese visitors over coronavirus fears and has closed rail links with China and halted most flights.    Authorities have also announced restrictions on travel to Russia from Iran and South Korea, two countries hit by the outbreak, and most recently advised against all non-essential foreign travel.
Date: Wed, 18 Dec 2019 20:28:33 +0100 (MET)

Moscow, Dec 18, 2019 (AFP) - Moscow registered the warmest December weather in over a century on Wednesday, as an unusually snowless month put winter activities on hold and confused plants into blooming.   One weather station in northern Moscow registered a temperature of 5.4 degrees Celsius (41.7 degrees Fahrenheit), said the Fobos weather centre.   "This is a new record of maximum air temperature for 18 December," surpassing a previous record of 5.3 degrees set in 1886, it said.   The Russian capital, normally covered with a blanket of snow by mid-December, thus far has had a snowless and cloudy winter, and the Russian weather service warned Wednesday that it may get even warmer.

A botanical garden in Moscow this week announced that its snowdrop flowers, which normally indicate the first signs of spring, were blooming because they "confused winter and spring."   "Gardeners are worried that the sakura will start blooming soon," the Apothecary Garden said on its website.   In Sokolniki park, popular with skiers and figure skaters in the winter, even the skiing track using artificial snow closed due to weather conditions.   One resident of Siberian city of Omsk even posted a jokey online "Snow for Sale" item, offering "natural snow" for R1,000 per cubic metre ($16).    "Moscow residents can use a seven percent discount when ordering more than 15 cubes," the notice on the Avito.ru popular online market said.
More ...

Uruguay

Uruguay - US Consular Information Sheet
May 01, 2008
COUNTRY DESCRIPTION:
Uruguay is a constitutional democracy with a large, educated middle class and a robust developing economy.
The capital city is Montevideo .
Tourist facilit
es are generally good with many 5-star accommodations at resort destinations such as Punta del Este and Colonia de Sacramento.
The quality of tourist facilities varies according to price and location.
Travelers are encouraged to seek travel agency assistance in making plans to visit Uruguay .
Read the Department of State Background Notes on Uruguay for additional information.

ENTRY/EXIT REQUIREMENTS:
All United States citizens entering Uruguay for business or pleasure must have a valid passport.
U.S. citizens traveling on a regular passport do not need a visa for a visit of less than three months.
U.S. citizens traveling on diplomatic or official passports require a visa.
Air travelers are required to pay an airport tax upon departure.
This fee may be paid in U.S. dollars or in Uruguayan pesos.
For further information on entry requirements, contact the Embassy of Uruguay at 1913 “Eye” Street NW, Washington, DC 20006, tel. (202) 331-4219; e-mail: conuruwashi@uruwashi.org.
Travelers may also contact the Consulate of Uruguay in New York, Miami, Chicago, Los Angeles, and Puerto Rico.
Visit the Embassy of Uruguay web site at http://www.uruwashi.org/ for the most current visa information.

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

SAFETY AND SECURITY:
Regular protests, some with an anti-American flavor, take place outside Congress, City Hall and the “University of the Republic.”
U.S. citizens visiting or residing in Uruguay are advised to take common-sense precautions and avoid any large gatherings or any other event where crowds have congregated to demonstrate or protest.
If travelers encounter a protest they should walk the other way or enter a commercial establishment until the protest passes.
Taking pictures of protesters is not a good idea.

Although there have been no past instances of violence directed at U.S. citizens from cross-border extremist groups, U.S. citizens traveling or residing in the more remote areas of Uruguay near the border with Argentina and Brazil are urged to exercise caution.

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

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

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

CRIME:
Petty street crime is prevalent in Montevideo .
The criminals tend to be non-violent.
However, criminals often resort to violence if the victims resist.
Travelers should exercise reasonable caution to minimize their exposure to crime.
Criminals prey on the unaware, particularly those carrying cameras, pocketbooks, laptops, or backpacks.
Travelers are advised to lock most valuables in secure hotel safes and to download their wallets of excess credit cards and cash.
If dining at an outdoor restaurant take extra care with pocketbooks or bags.
There are no “off limits” areas of the city and parts of “Ciudad Vieja” are popular tourist attractions.
However the only sections of Ciudad Vieja with continual police patrols are Plaza Independencia, the pedestrian street Sarandi, and the Mercado del Puerto.
Mugging is common in other parts of Ciudad Vieja - particularly for travelers walking alone, or couples walking at night.
A smart alternative is to call for a taxi for evening travel between restaurants, bars, and hotels.

Victims are usually foreign tourists, individuals openly carrying valuable items, and motorists in unlocked vehicles stopped at busy intersections, particularly on Montevideo 's riverfront road known as the Rambla. Drivers should keep all car doors locked, the driver's window open only one inch, and purses, bags, briefcases and other valuables out of sight on the floor or in the trunk. Parked cars, particularly in the Carrasco neighborhood, are also increasingly targeted for break-ins. During the summer months (December-March), beach resort areas such as Punta del Este attract tourists, and petty street crimes and residential burglaries--similar to those that occur in Montevideo --rise significantly. Visitors are advised to exercise common sense in the conduct of their activities around Montevideo and in Uruguayan resort areas. They should be very attentive to personal security and their surroundings in the aforementioned areas.

Those planning to live in Montevideo should note that burglaries and attempted burglaries seem to be on the rise in upscale neighborhoods.
The perpetrators are mostly non-confrontational but determined teenagers.
A combination of preventive measures including rigorous use of locks and alarms, strong grillwork on all windows, guard dogs, keeping a residence occupied as much as possible, and using a security service is highly recommended.

Montevideo continues to experience armed robberies of patrons at crowded restaurants in the Pocitos neighborhood.
Most of these crimes have occurred very late at night.
Restaurant patrons should exercise extreme caution for late night dining.

Uruguayan law enforcement authorities have increased the number of uniformed policemen on foot in areas where criminal activity is concentrated and the number of patrol cars in residential areas. The clearly marked patrol cars are equipped with cellular phones and the phone numbers are conspicuously painted on the vehicles.

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 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:
Facilities for medical care are considered adequate. Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost tens of thousands of dollars.


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

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

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

The Uruguayan Ministry of Transportation is responsible for maintaining safe road conditions countrywide. The Uruguayan Ministry of Interior highway police (tel. 1954) are responsible for traffic safety on highways and other roads beyond city limits. In urban and suburban areas, transit police and municipal employees share road safety responsibilities.

Driving is on the right-hand side of the road. Wearing seat belts and using headlights on highways and other inter-city roads 24 hours a day are mandatory. Children under 12 must ride in the back seat. Motorcyclists must wear helmets. The use of cellular phones while driving is prohibited. Right turns on red lights and left turns at most intersections marked with a stoplight are not permitted. Drivers approaching an intersection from the right or already in traffic circles have the right of way.
Flashing high beams indicate intent to pass or continue through unmarked intersections.
Many drivers ignore speed limits and traffic signs.
If you plan to drive, use extreme caution and drive defensively.

For driving under the influence, violators are fined and confiscated licenses may be retained for up to six months. In accidents causing injury or death, drivers are brought before a judge who decides if incarceration is warranted.

Inter-city travel is via bus, taxi, car service (remise), car, and motorcycle. Speed limits are posted on highways and some main roads. Most taxis have no seat belts in the back seat. Cycling outside the capital or small towns is hazardous due to a scarcity of bike paths, narrow road shoulders and unsafe driving practices.

Illumination, pavement markings, and road surfaces are sometimes poor. Route 1, which runs between Montevideo and Colonia or Punta del Este, and Route 2, between Rosario and Fray Bentos, are particularly accident-ridden because of heavy tourist traffic. Road accidents rise during the austral summer beach season (December to March), Carnaval (mid-to-late February), and Easter Week.

Within Montevideo , the emergency number to contact the police, fire department, rescue squad, or ambulance service is 911. In the rest of the country, dial 02-911 to connect with the Montevideo central emergency authority, which will then contact the local emergency service. The Automobile Club of Uruguay responds to emergency calls for roadside assistance at 1707, “Car Up” at 0800-1501 and the Automobile Center of Uruguay at 2-408-6131/2091. SEMM (tel. 159) and UCM (tel. 147), Montevideo-based ambulance services manned by doctors, have agreements with emergency medical units in other cities.

Please refer to our Road Safety page for more information.
You may also telephone Uruguay ’s national tourist office and national authority responsible for road safety in Miami at (305) 443-7431.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed Uruguay ’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Uruguay ’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Uruguay 's customs authorities may enforce strict regulations concerning temporary importation into or export from Uruguay of items such as precious jewels, gold, firearms, pornography, subversive literature, inflammable articles, acids, prohibited drugs (medications), plants, seeds, and foodstuffs as well as some antiquities and business equipment. It is advisable to contact the Embassy of Uruguay in Washington, D.C., or one of Uruguay 's consulates in the U.S. for specific information regarding customs requirements. Note: Travelers entering Uruguay with precious jewels or gold worth more than $500.00 ( U.S. ) must declare them to customs officers at the port of entry or face possible detention or seizure of the goods and charges of contraband or evasion of customs controls. Visitors are expected to comply with local law and regulations by approaching a customs officer before routine inspection of all incoming baggage, conducted on standard security equipment.
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 Uruguay ’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Uruguay 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.

The Uruguayan Ministry of Agriculture and Fishing strictly enforces all regulations regarding hunting permits, as well as seasonal and numerical limits on game. Visitors who contravene local law have been detained by the authorities and had valuable personal property (weapons) seized. Under Uruguayan law, seized weapons can only be returned after payment of a sum equivalent to the value of the property seized. Hunters are also subject to stiff fines for practicing the sport without all appropriate permits.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Uruguay 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 Uruguay .
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy is located at Lauro Muller 1776; telephone (598) (2) 418-7777; fax (598) (2) 418-4110 or -8611. Internet: http://uruguay.usembassy.gov/, email: MontevideoACS@state.gov. Consular Section hours for American Citizen Services are Monday to Thursday, 9:00 a.m. to 11:00 p.m. and 2:00 p.m. to 4:00 p.m., except U.S. and Uruguayan holidays.
* * *
This replaces the Consular Information Sheet dated August 28, 2007 to update Sections on Entry/Exit Requirements, Safety and Security, Crime, Aviation Safety Oversight, Children’s issues, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Sun, 29 Mar 2020 11:48:20 +0200 (METDST)

Montevideo, March 29, 2020 (AFP) - Uruguay reported its first death linked to the novel coronavirus on Saturday, a former minister and ally of the ruling party, the government said.   "With deep sadness we announce the first death due to coronavirus in Uruguay," Secretary of the Presidency Alvaro Delgado told a press conference, naming the victim as Rodolfo Gonzalez Rissotto.

Gonzalez Rissotto was one of nine patients with the coronavirus who were in intensive care, Delgado said, adding his death was "all the more reason to reinforce the request to everyone to take care of themselves and stay home."   President Luis Lacalle Pou paid tribute in a tweet.   "A big hug for the family and friends of Rodolfo Gonzalez Risotto. Friend and counselor. RIP."   Uruguay has reported 304 confirmed cases of the virus.
20th June 2019
https://en.mercopress.com/2019/06/20/torrential-rains-in-uruguay-forces-7.400-to-abandon-their-homes
Troops will continue monitoring the situation because “there are many people who do not want to leave their homes due to fear of being looted” Bayardi said.Torrential rains in central and southern Uruguay in the past several days have caused massive floods and forced some 7,400 people to leave their homes, according to the latest update by the country's National Emergency System.  The central city of Durazno is the most affected, with 5,299 evacuees, according to official reports.

Defense Minister Jose Bayardi visited one of the camp sites managed by the military to help the displaced.  ”We have established a high level of experience (in the face of these catastrophes) which we have succeeded in institutionalizing,“ he told the media. Troops will continue monitoring the situation because ”there are many people who do not want to leave their homes due to fear of being robbed and looted” Bayardi said.

The National Highway Police also said that 12 national highways remain cut-off in different directions. Uruguay's National Meteorological Institute said that between June 11 and 16, some southern regions of the country received around 270 mm of rain.  On Wednesday morning, the Yi River, which had been 11.8 meters higher than its normal water level in the Durazno area, was falling at a rate of 11 cm per hour, according to local media reports.

Date: Tue 12 Mar 2019
Source: Carmelo Portal [in Spanish, trans. Mod. TY, edited]

The departmental health director, Dr Jorge Mota, confirmed for Carmelo Portal the death in our city of a young 17 year old girl from [a] hantavirus [infection]. "In Colonia department, there are on average 3 cases per year. The evolution of the disease is in thirds. One-third of the [infected] people do not have notable symptoms; another third have serious symptoms, especially respiratory symptoms and ones in all the systems, but with adequate treatment, [the infected people] survive, sometimes with sequelae. There is another third that die. It is those few with the virus that die with an evolution so drastic, such as is the case of this girl, sadly," Dr Mota stated.

The department health director said that hantaviruses are not contagious person-to-person. "It is transmitted from an intermediate animal, the field mouse. Only 3% of these mice have [a] hantavirus. To become infected, one must be in contact with an [infected] mouse's secretions that have dried, are mixed with dust, and are in a closed space, away from sunlight and ventilation. A spa, a shed, or a wood pile [are examples of such a space]. The person had to have been moving around there and inhaled the dust," he explained.

Dr Mota spoke about the epidemiological surveillance that is carried out. "We tracked places where the person was, even those that could be identified 2 months before contracting the virus; sometimes we found the place, but sometimes not." As a preventive measure, Mota stated that in these cases, ventilate these closed spaces for at least half an hour. Wet down floors and shelves with water [with 10% bleach]. Use masks [and gloves].
==========================
[The report above does not mention the circumstances under which the infection might have been acquired nor which hantavirus was responsible for this or earlier cases in Uruguay. Hantaviruses that cause hantavirus pulmonary syndrome (with rodent hosts found in Uruguay) include Laguna Negra virus (_Calomys laucha_), Maciel virus (_Necromys benefactus_), Central Plata virus, Lechiguanas virus (_Oligoryzomys flavescens_, complex of rodents), and Anajatuba virus and Juquitiba virus (_Ologoryzomys fornesi_).

The rodent reservoir hosts shed the virus in its saliva, urine, and faeces, contaminating the environment in which they live and breed.

A HealthMap/ProMED-mail map showing the location of Uruguay in South America can be accessed at
<http://healthmap.org/promed/p/28995>.

A map of Colonia department in southern Uruguay is available at
<https://en.wikipedia.org/wiki/Colonia_del_Sacramento>
and <http://healthmap.org/promed/p/27367>. - ProMED Mod.TY]
Date: Thu, 19 Jul 2018 03:23:55 +0200
By Lucia LACURCIA

Montevideo, July 19, 2018 (AFP) - Enrique Curbelo is delighted. Selling cannabis has allowed the affable 76-year-old to keep his privately owned pharmacy in Montevideo open in a market dominated by big chains.   "I had to sell what they didn't sell," he told AFP. "For me it's like selling aspirin."   It's been this way for a year now.   Every Wednesday, Ismael Fernandez receives a WhatsApp message from his local pharmacist telling him a new stock of cannabis has arrived.   After leaving work, he heads there and buys the 10 grams that Uruguayan law permits, costing 400 pesos, around $13.

Fernandez then heads home and rolls a joint "to relax" with his partner Stefania Fabricio.   No longer do they need to surreptitiously contact a dealer and pay more for Paraguayan or Brazilian marijuana that's been "pressed, mixed (and is) sometimes very bad and full of chemicals."   "Now it's much easier than when it started," Fernandez, a 31-year-old who works for a cleaning company, told AFP.   It has been four and a half years since marijuana use became legal in Uruguay and a year since it has been sold in pharmacies -- up to 40 grams a month per person.

Initially, there was insufficient supply, leaving people standing in long queues as stocks sometimes ran out. Pharmacies are better prepared now.   "They send you a message with a number which you use later to go and collect it, and in my pharmacy you can order it online," added Fernandez, the father of a three-year-old.   Hairdresser Fabricio, also 31, says "it's good quality," but not too strong.   "It doesn't send your head spinning, but it's not meant to. You get a hit but you can still do things perfectly."   - 'Privileged' -   She says she feels "privileged" to live in a country that enacted a law to "get tons of people out of the black market."   As a result, she said, the stigma attached to those who smoke pot is changing, "albeit slowly."

The system is simple: to buy cannabis in a pharmacy you must be at least 18, live in Uruguay and sign up as a "buyer" at the post office.   An initial stumbling block arose when banks refused to work with establishments selling cannabis due to international rules against drug-trafficking.   But the country plowed on, and last year it became the first in the world to fully legalize its sale.   But Enrique Curbelo had to get over his own prejudices before deciding to join the select band of pharmacies selling the plant.   There are 14, half of them in the capital, serving the 24,812 registered buyers.

- 'Normal people' -
Users can choose between two brands and two types of cannabis -- sativa and indica -- both provided by an official distributor.   Customers are generally not the stereotypical grubby-looking student or idle waster.    On this day in Curbelo's store they include two young women, a man in his 50s and an older lady -- "normal people," says the pharmacist.   Official statistics say 70 percent of buyers are male and 49 percent are between the ages of 18 and 29.

To keep anyone from exceeding their monthly allowance, a fingerprint machine is used to register every sale.   Along with the ability to purchase cannabis in a pharmacy, Uruguayans have the right to grow their own -- up to a six-plant maximum -- or to join a cannabis club, which can have up to 45 members and 99 plants.   Federico Corbo, a 41-year-old gardener, grows cannabis in his garden on the outskirts of Montevideo. He experiments by crossing species in an attempt to improve quality and optimize the flowering period.   Corbo is not impressed with the quality on offer in pharmacies.   "It's not the worst, but it's low," he said, insisting quality control needs to be improved.   "Marijuana that doesn't reach the minimum standards -- with crushed flowers, no aroma, low quality -- shouldn't be sold in the pharmacy.   "Maybe, as I'm a grower, I'm very demanding, but there is a cost associated to the product and it must be offered to the public in the best way possible."

According to the Institute of Cannabis Regulation and Control (Ircca), an average cultivator or club member supplies cannabis to two other people, while those who buy it in a pharmacy share it with one other.   "Approximately half of marijuana users have access to regulated cannabis," says Ircca.   The rest prefer to continue buying the drug on the black market, put off by the need to register as a user.   "It's wrong -- if they legalize it they have to do so in a way in which the state doesn't keep a paternalistic role in overseeing how much you smoke or stop smoking," one clandestine user, who wished to remain anonymous, told AFP.   This 48-year-old lawyer simply doesn't trust the authorities. He pointed to the danger a change of government could bring, or even the return of dictatorship.   "Right now that seems impossible," he said, "but you can never discount it."
Date: Thu 1 Feb 2018 23:02hs UYT
Source: LaRed 21 [in Spanish, machine trans. edited]

The Ministry of Public Health (MSP) issued a statement through which it reports that it has detected cases of infection by the bacterium _Vibrio vulnificus_ in Montevideo, Canelones, and Maldonado [departments]. The State Secretariat assured that every year there are cases of this bacterium, but so far in 2018, 4 serious cases have been reported, of which 3 died. All of them had underlying illnesses.

"90 percent of these cases, in the world, are associated with the consumption of undercooked or raw seafood. Infrequently, the infection can be acquired when entering the sea with open wounds, especially in elderly people or people with diseases that affect the immune system," explained the MSP. It is an event "extremely rare in our country," said the State Secretariat. It also indicated that fewer than 10 cases per year are registered per year for this bacterium.

It is an infection that "can be serious and in some cases fatal, so it is recommended to avoid the consumption of undercooked or raw sea products (as well as their handling without protection measures) and in the same way, avoid entering the sea with wounds or cuts on the skin." The bacteria can be found in coastal marine waters and estuaries in areas of tropical and subtropical climates that have a moderate degree of salinity and temperatures that usually exceed 18 C [64.4 F].
====================
[The following is extracted from the previous edition of the "Bad Bug Book," Center for Safety and Applied Nutrition, US FDA (Food and Drug Administration). The newest version is available at:  <https://www.fda.gov/downloads/Food/FoodborneIllnessContaminants/UCM297627.pdf>:

"_Vibrio vulnificus_, a lactose-fermenting, halophilic, Gram-negative, opportunistic pathogen, is found in estuarine environments and associated with various marine species such as plankton, shellfish (oysters, clams, and crabs), and finfish. Environmental factors responsible for controlling numbers of _V. vulnificus_ in seafood and in the environment include temperature, pH, salinity, and amounts of dissolved organics. It may be normal flora in salt water, and acquiring this organism from shellfish or water exposure does not imply that the water is contaminated by sewage.

"Wound infections result either from contaminating an open wound with sea water harbouring the organism, or by lacerating part of the body on coral, fish, etc., followed by contamination with the organism. The ingestion of _V. vulnificus_ by healthy individuals can result in gastroenteritis."

The "primary septicaemia" form of the disease follows consumption of raw seafood containing the organism by individuals with underlying chronic disease, particularly liver disease. The organism can also enter through damaged skin. In these individuals, the microorganism enters the blood stream, resulting in septic shock, rapidly followed by death in many cases (about 50 percent). Over 70 percent of infected individuals have distinctive bullous skin lesions (shown at <http://safeoysters.org/medical/diagnosis.html>).

There are 2 points to be emphasized: that vibrios are normal flora in warm saltwater (not indicative of any sewage contamination) and that most of the life-threatening illnesses occur in individuals with underlying medical illnesses, including immunocompromised states, chronic liver disease, and diabetes. So-called normal individuals often just develop gastroenteritis. The range of disease due to _V. vulnificus_ can involve more northern geographical areas as overall global warming takes effect. - ProMED Mod.LL]

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World Travel News Headlines

Date: Sat, 4 Apr 2020 16:10:44 +0200 (METDST)

London, April 4, 2020 (AFP) - Britain on Saturday reported 708 more deaths from COVID-19 in a new daily high, as the number of confirmed cases rose to nearly 42,000.   The health ministry said 4,313 people who tested positive for the virus in hospital had died as of 1600 GMT Friday while there were 41,903 confirmed cases as of 0800 GMT Saturday, up 3,735.   The toll has been steadily increasing at more than over 500 deaths a day this week and the country is bracing for an expected peak in the next week to 10 days.   Prime Minister Boris Johnson, who is in self-isolation after developing mild symptoms of the disease, ordered a three-week lockdown of the country on March 23 to try to cut infections.

But there has been concern that warmer weather forecast for this weekend could tempt people from their homes to green spaces and public parks.   "I just urge you not to do that," Johnson said in a video message on Friday. "Please, please stick with the guidance now."   Health Secretary Matt Hancock also warned against any relaxation in social distancing. "If we do, people will die," he told a daily briefing on the government's response on Friday.   A special address on the crisis by Queen Elizabeth II is to be broadcast on Sunday evening.

Imperial College London epidemiologist Neil Ferguson, who is advising the government, told BBC radio on Saturday a peak was expected around the Easter weekend.   "We still think things will plateau but we'll be at quite high levels of infection for weeks and weeks rather than seeing quite a rapid decline as the type seen in China," he said.   But he said that was dependent on people staying at home. If that happened, it could lead to less stringent measures in place "at least by the end of May", he added.

The announcement of another record rise in deaths came after 13 residents at a care home in Glasgow died in one week in a suspected outbreak of coronavirus.   The Burlington Court Care Home in the Cranhill area of the city said those who died had underlying medical conditions and two staff members were being treated for COVID-19.

Tests for coronavirus are currently carried out on the most serious cases that require hospital treatment, suggesting the true extent of confirmed cases and deaths is an under-estimate.   The government meanwhile announced that up to 4,000 low-risk prisoners near the end of their sentence could be release from jails in England and Wales to try to stop the spread of COVID-19.   A total of 88 prisoners and 15 prison staff have tested positive for the virus, and there is concern it could spread rapidly because of shared cells and overcrowding.   The justice ministry said those released would be electronically tagged and temporarily released on licence in stages. High-risk offenders will not be considered for early release.
Date: Sat, 4 Apr 2020 15:38:20 +0200 (METDST)

Madrid, April 4, 2020 (AFP) - Spanish Prime Minister Pedro Sanchez announced Saturday the extension of the country's lockdown until April 25 in order to curb the spread of the novel coronavirus.   "The cabinet on Tuesday will again ask for authorisation from parliament to extend for a second time the state of alert until Saturday April 25 at midnight,' Sanchez said in a televised speech.
Date: Sat, 4 Apr 2020 15:26:30 +0200 (METDST)

Istanbul, April 4, 2020 (AFP) - Turkey stepped up controls Saturday on crowded public spaces including markets and ferries in Istanbul a day after President Recep Tayyip Erdogan imposed the use of face masks to curb the coronavirus outbreak.    Turkey has so far recorded 425 coronavirus-related deaths and nearly 21,000 cases, most of them in the country's economic capital Istanbul, according to official figures.   From Saturday, all those going out to shops or markets must wear a face mask, Erdogan said, calling on the population to maintain a distance of "three paces" from each other when outside.

At an Istanbul bazaar in the Besiktas neighbourhood open every Saturday, police and local municipal employees handled the use of masks and hand disinfectants, while checking the temperature of incoming customers at the entrance.   Veli Yildirim, 50, who sells vegetables including tomatoes, said the measures came "too late."   "We are the latest compared to the rest of the world. Even this is not enough, there should be a complete lockdown" in Istanbul, he told AFP.    A 60-year-old customer in the bazaar, Asuman Karaman wearing a mask, agreed: "If these measures had been taken one or two months earlier, maybe the virus would not have been so widespread."   The bazaar looked quite calm -- in stark contrast to its usual noisy and crowded state.

Vendors complained their business was hit badly.    "This has a had a big impact, there is no one at the market, at this time of the day, we have nothing to do here," said Abbas Kose, who sells vine leaves.   At the ferries in Istanbul, passengers were seen wearing face masks.    The city's mayor Ekrem Imamoglu has been calling for total confinement but authorities have so far stopped short of that.    As part of the measures taken nationwide, authorities suspended international flights, issued a confinement order for everyone aged under 20 and over 65 and shut schools.   Erdogan on Friday also said vehicles would no longer be able to leave or enter 31 towns and cities, including Istanbul, for 15 days.
Date: Sat, 4 Apr 2020 15:22:33 +0200 (METDST)

Geneva, April 4, 2020 (AFP) - Switzerland on Saturday saw the number of cases of the new coronavirus in the country pass 20,000, as its death toll in the pandemic swelled past 500.   The health ministry said 20,201 people in Switzerland had tested positive for COVID-19 as of Saturday morning -- nearly 1,000 more than a day earlier.   The small Alpine country of some 8.5 million people is thus one of the worst hit compared to population size, now counting 236 registered infections per 100,000 people.    At the same time, an additional 76 people died over the past 24 hours, bringing Switzerland's death toll in the pandemic to 540, the health ministry said.   "We have not yet reached the peak," health ministry official Daniel Koch told reporters.

Worldwide, well over 1.1 million cases have been registered across 188 countries, while close to 60,000 people have died, according to a tally compiled by AFP Saturday from official sources.   The high incidence in Switzerland could in part be linked to the fact that it is among the countries that have administered most tests per capita.   Since the first case surfaced in the country on February 24, more than 150,000 tests have been administered with around 15 percent coming up positive.   Drive-in testing stations have been set up in several places, including in the capital Bern, to help simplify safe testing for COVID-19.   In the past 24 hours, the country has conducted nearly 7,000 tests, including 975 that were positive, the health ministry said.

Switzerland's southern canton of Ticino, which borders hard-hit Italy, has registered most cases, followed by Geneva.   As in other countries, men seemed to suffer more from the virus. Slightly more women had tested positive for the virus, but men accounted for 64 percent of the deaths, the ministry found.   Switzerland has unblocked some $60 billion to buffer the harsh blow to its economy from the pandemic and the measures taken to halt the spread of the virus.   The economic affairs ministry said Saturday some 1.3 million people, or a quarter of the country's workforce, have applied for temporary unemployment benefits since the start of the crisis.
Date: Sat, 4 Apr 2020 07:04:32 +0200 (METDST)

Honiara, April 4, 2020 (AFP) - At least 28 ferry passengers were swept overboard in a powerful storm off the Solomon Islands, reports said Saturday, with the captain unaware he had lost anyone until the boat docked.   The passengers were heading from the capital Honiara to West Are'are, more than 120 kilometres (75 miles) away, under a government programme to evacuate people to their home villages during the global coronavirus epidemic.

The MV Taimareho set sail on Thursday night as tropical cyclone Harold bore down on the Solomons, and with weather forecasters warning against any unnecessary voyages.   But the captain ignored advice not to sail, the nation's leader said, as survivors reported dozens of people were swept overboard by huge waves and strong winds. Local media put the death toll at 28.

But police said it was impossible to verify the number.   "Initial reports say the captain of the boat had no knowledge of the missing people until he was informed when the boat arrived at her destination at Are'are," police marine department chief Charles Fox Sau said.    "At this stage we cannot confirm how many people are missing as the investigation into this sad incident continues."

In an address to the nation, Prime Minister Manasseh Sovagare said a search and rescue operation was under way.    "It is with deep regret to learn that a number of passengers are missing at sea after being washed overboard from a passenger vessel which departed ... from Honiara, despite the several weather warnings issued," he said.    Disaster authorities in the Solomons, which has limited healthcare facilities, have been stretched as they prepared for the impact of coronavirus while the region was being battered by tropical cyclone Harold.

The island nation, with a population of just over 600,000, is one of a dwindling number of countries where there have been no reported coronavirus cases so far.   Harold, packing winds of up to 160 kilometres per hour (100 mph), downed trees and damaged homes before heading away and was expected to intensify before reaching Vanuatu late Sunday.   Although the government has not yet completed a damage assessment, Australia has donated Aus$100,000 (US$60,000) in immediate emergency funding.
Date: Sat, 4 Apr 2020 06:20:31 +0200 (METDST)

London, April 4, 2020 (AFP) - The Falklands Islands government has confirmed the territory's first case of the new coronavirus.   A patient tested positive after being admitted to hospital with symptoms on March 31, according to a statement released on Friday that said they were in isolation and in "stable condition".   Located in the southern Atlantic Ocean, the British overseas territory had been among a dwindling number of remote places that have reported no COVID-19 cases during the pandemic.

Health authorities in the Falklands -- home to 3,400 people -- have been sending samples to the UK for testing, the statement said.   "In some respects we are fortunate that we have been COVID-19 free until now, as we have taken this time to plan our approach," Chief Medical Officer Dr Rebecca Edwards said.   "We have reorganised the hospital and staffing arrangements, and put our supplies and pharmaceuticals in place, which many countries were not in a position to do before they identified their first cases."

The disparate group of places to officially remain untouched by the pandemic include Samoa, Turkmenistan, North Korea and bases on the frozen continent of Antarctica.   Argentina, which invaded and briefly occupied the territory in 1982, claims sovereignty over the islands and calls them Las Islas Malvinas.
Date: Fri, 3 Apr 2020 23:54:18 +0200 (METDST)

Kinshasa, April 3, 2020 (AFP) - The Democratic Republic of Congo is prepared to take part in testing of any future vaccine against the coronavirus, the head of the country's taskforce against the pandemic said on Friday.   "We've been chosen to conduct these tests," said the head of the national biological institute, Jean-Jacques Muyembe.    "The vaccine will be produced in the United States, or in Canada, or in China. We're candidates for doing the testing here," Muyembe told a news briefing in comments that sparked controversy in DR Congo amid charges the population was being used as guinea pigs.

Muyembe suggested that clinical trials could begin in July or August.    "At some point, COVID-19 will be uncontrollable," the virologist said.   "The only way to control it will be a vaccine, just like Ebola. It was a vaccine that helped us end the Ebola epidemic."   Muyembe's comments came as two leading French doctors came under a storm of criticism after discussing on a television programme the idea of testing a vaccine for coronavirus in Africa.   Camille Locht, head of research at the National Institute of Health and Medical Research (INSERM) in Lille, and Jean-Paul Mira, head of intensive care at the Cochin hospital in Paris, suggested that Africa offered better conditions for testing the vaccine.

Their remarks sparked furious criticism, with the French anti-racism NGO, SOS Racisme, saying, "No, Africans aren't guinea pigs".    Even former international and Ivory Coast football star Didier Drogba joined in.    "It is inconceivable that we continue to accept this. Africa is not a laboratory. I strongly denounce these very serious, racist and contemptuous words," the former Chelsea and Marseille striker wrote on his Facebook page and on Twitter.   "Help us save lives in Africa and stop the spread of the virus that is destabilising the whole world instead of seeing us as guinea pigs. It is absurd."   The tenth Ebola epidemic in DR Congo is set to be declared over on April 12, after it killed more than 2,200 people in the east of the country since its outbreak on August 1, 2018.    More than 320,000 people were given two different experimental vaccines to stop the spread.
Date: Fri, 3 Apr 2020 21:56:23 +0200 (METDST)

Libreville, April 3, 2020 (AFP) - Gabon on Friday banned the sale and eating of bats and pangolins, which are suspected of sparking the novel coronavirus in China where they are highly prized in traditional medicine.   President Ali Bongo Ondimba also announced the government was planning to lock down the capital Libreville and unveiled an emergency package for those hard hit by the pandemic.   The novel coronavirus is believed to have come from bats, but researchers think it might have spread to humans via another mammal.   Pangolins are critically endangered and have long been protected, but they are sold in the markets of the capital Libreville, as are bats, and their meat is popular.

The central African nation is 88 percent covered in forest and hunting and bush meat have long been a way of life.   The water and forest ministry said the novel coronavirus was a "combination of two different viruses, one close to bats and the other closer to pangolins", and claimed to be quoting a scientific study published in Nature.   Gabon has declared 21 COVID-19 infections, but none from animals, the ministry said.   "A similar decision was taken by the authorities when our country was affected by the Ebola virus -- a ban on eating primates," Forestry Minister Lee White said.

The national parks agency ANPN announced in mid-March that tourists would no longer be allowed to interact with great apes to avoid any risk of contamination by the coronavirus.   The pangolin, the world's most heavily trafficked mammal, also called the scaly anteater, is believed to have possibly been a vector in the leap of the novel coronavirus from animal to human at a market in China's Wuhan city last year.   Its body parts fetch a high price on the black market as they are commonly used in traditional Chinese medicine, although scientists say they have no therapeutic value.

Gabon has also put in place a raft of measures such as grounding international flights, closing schools and ordering a night curfew to stop the spread of the coronavirus.   On Friday, Bongo said Libreville would be put under lockdown "in the coming days" but gave no precise date.   All but one of Gabon's reported 21 cases are in the city, where a large proportion of the country's two million residents live.   Bongo also announced an aid package of 250 billion CFA francs (380 million euros) to help both individuals and businesses whose livelihoods have suffered because of the crisis.
Date: Fri, 3 Apr 2020 20:36:36 +0200 (METDST)

Istanbul, April 3, 2020 (AFP) - Turkish President Recep Tayyip Erdogan on Friday issued a mandatory confinement order for everyone aged under 20 starting from midnight, as part of tougher measures to stem the spread of the coronavirus in Turkey.    In a television address, Erdogan also announced that vehicles would no longer be able to leave or enter 31 towns and cities, including Istanbul and Ankara, for 15 days.   People aged over 65 or those with chronic medical conditions are already subject to mandatory confinement in Turkey.    "Throughout the country, people aged under 20, that is to say born after January 1, 2000, will not be allowed to go out on the street" from midnight on Friday, Erdogan said.

Also, from Saturday, all those going out to shops or markets will be obliged to wear a face mask, the Turkish leader added, calling on the population to maintain a distance of "three paces" from each other when outside.   Turkey has registered over 20,000 coronavirus cases, 425 of which have been fatal.   Health Minister Fahrettin Koca warned on Friday that the country is just at the beginning of the outbreak, which has left over 50,000 people dead worldwide.   More than half of the Turkish cases have been in the economic capital Istanbul, which has a population of around 16 million people.

The city's mayor Ekrem Imamoglu has been calling for total confinement.    Erdogan's announcements on Friday are the latest moves to stem the spread of the virus in Turkey in recent weeks.   Schools have been closed down, flights grounded and gatherings banned.   Next week the Turkish parliament is set to consider a draft law to free 90,000 prisoners, a third of the population of the overcrowded prisons.   It will concern several categories of prisoners, among them pregnant women and older people with medical conditions.   But it excludes convicted murderers, sexual offenders and narcotics criminals, as well as political prisoners charged under Turkey's controversial anti-terrorism laws.
Date: Fri, 3 Apr 2020 11:49:00 +0200 (METDST)

Singapore, April 3, 2020 (AFP) - Singapore will close schools and workplaces while people are being told to stay home, as the city-state ramps up curbs to stem the spread of coronavirus, the premier said Friday.   The country has won praise for its handling of the outbreak, and had largely kept the crisis in check by carrying out large numbers of tests and tracing close contacts of those infected.   Authorities had slowly been introducing curbs, such as closing bars and nightclubs, but had so far avoided the kind of tough restrictions seen in worse-hit nations.

However, after a jump in the number of locally transmitted cases in recent days, Prime Minister Lee Hsien Loong said it was time to apply a "circuit breaker" to halt the virus's spread.   Workplaces except for essential services, such as supermarkets and hospitals, and those deemed to be in key economic sectors will be closed from Tuesday, he said in a televised address.

Schools will also be closed from next week except for children of those who have to continue to work and cannot make alternative arrangements, he said.   People are being told to stay at home as much as possible, and only go out for essentials -- such as buying food and getting exercise.   "Looking at the trend, I am worried that unless we take further steps, things will gradually get worse, or another big cluster may push things over the edge," Lee said.   Singapore has reported 1,114 virus infections including five deaths. Globally, the number of confirmed cases has soared past one million and deaths have topped 50,000.