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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: 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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Ghana

Ghana US Consular Information Sheet
23rd September 2008
DESCRIPTION:
Ghana is a developing country on the West Coast of Africa. The capital is Accra. Facilities for tourism are available in the population centers of the greater Accra regio
, Kumasi in the Ashanti region, and in the Cape Coast area of the Central region, but they are limited in the more remote areas of the country. Read the Department of State Background Notes on Ghana for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required, as is evidence of a yellow fever vaccination. Travelers should obtain the latest information and details from the Embassy of Ghana, 3512 International Drive NW, Washington, DC
20008; telephone (202) 686-4520. Consular services are also available at the Ghana Permanent Mission to the UN at 19 East 47th Street, New York, NY
10017, telephone (212) 832-1300, and the Honorary Consulate of Ghana, 3434 Locke Lane, Houston, TX, telephone (713) 960-8806. Overseas, inquiries should be made at the nearest Ghanaian embassy or consulate. Visit the Embassy of Ghana web site at www.ghanaembassy.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:
Due to the potential for violence, U.S. citizens should avoid political rallies and street demonstrations and maintain security awareness at all times. There will be frequent political rallies across Ghana in the run-up to the presidential and parliamentary elections on December 7, 2008.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for other callers, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Pick-pocketing, purse snatching, and various types of scams are the most common forms of crime confronting visitors. U.S. travelers have reported these types of theft at crowded markets, beaches, parks, and tourist attractions. Incidences of violent crime, such as armed robbery, are on the rise, including reports of armed robberies in expatriate residential areas. Victims who resist attackers run a high risk of serious physical injury. Take security measures, such as traveling in groups and avoiding travel at night. Avoid travel in communal taxis. Travelers who limit their display of jewelry and handle their cash discreetly reduce their vulnerability to crime. Travelers are advised to carry limited amounts of cash and only photocopies of key documents.

Use of credit cards in Ghana should be avoided if possible, as a growing number of travelers have been victims of credit card fraud.

In recent years, U.S. citizens have reported substantial financial losses from questionable transactions involving gold and other precious metals. The Government of Ghana maintains strict regulations on these natural resources. All agents must be licensed and all transactions must be certified. (See Special Circumstances below).

Perpetrators of business fraud often target foreigners, including Americans. Such fraud schemes are now prevalent throughout West Africa, including Ghana.
Please refer to the Country Commercial Guide for Ghana at http://www.buyusa.gov/ghana/en/doing_business_in_ghana.html, for further information.

American citizens frequently consult the Embassy regarding questionable business offers sent by people in Ghana. These are scams and typically begin with an unsolicited communication (usually by e-mail) from an unknown individual who describes a situation that promises quick financial gain, often by assisting in the transfer of a large sum of money or valuables out of the country.
A series of “advance fees” must be paid in order to conclude the transaction, such as fees to open a bank account or to pay certain taxes.
In fact, the final payoff does not exist; the purpose of the scams is simply to collect money from the victim.
The Embassy has also received reports of fraudulent charities soliciting contributions through the Internet or direct mail. If you receive such business offers or charity requests, carefully check them out before you commit any funds, provide any goods or services, or undertake any travel. Check with the U.S. Embassy in Ghana at telephone (233-21) 741-100 for an assessment of the offer’s credibility.

Another type of fraud is committed by persons claiming to live in Ghana or who claim to be traveling to Ghana on business, and who profess friendship or romantic interest over the Internet. Once a relationship has been established, the correspondent typically asks the American to send money for living expenses, travel expenses, or visa costs. Sometimes a “hospital” or “doctor” telephones to say that the friend has suffered an “accident” and needs immediate financial assistance to cover medical bills. There are other variations of this scam, but the common goal is to fraudulently obtain as much money as possible from the victim.
Americans have reported losing thousands of dollars through such scams. The anonymity of the Internet means that the victim cannot be sure of the real name, age, marital status, nationality, or even gender of the correspondent. In most cases reported to the Embassy, the correspondent turned out to be a fictitious persona created to lure Americans into sending money.

Visitors to Ghana should also be wary of overly-friendly locals offering tours, discounted lodging or other services that seem too good to be true.
Tourists are often targeted by touts and scam artists.
Some Americans have been the victims of false criminal accusations and have found themselves separated from time, money and trust as they seek to resolve these difficult situations.

For additional information, please see the Department of State brochure International Financial Scams.

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.
Ghana maintains a specialized Domestic Violence Victim Support Unit (DOVVSU) within the Ghana Police Service to assist victims of domestic violence, especially women and children. In addition to its law enforcement responsibilities, the Unit can refer victims to medical providers and counselors, as well as to community support services. Further information is available by following the DOVVSU link at www.ghanapolice.org
The local equivalent to the “911” emergency line in Ghana is: 191
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Ghana are limited, particularly outside Accra, the capital. Travelers should carry adequate supplies of any needed prescription medicines, along with copies of their prescriptions, the generic name of the drugs, and a supply of preferred over-the-counter medications. For information on avian influenza (bird flu), please refer to the Department of State's Avian Influenza Fact Sheet.
Documentation of Yellow fever vaccination is required upon arrival from all countries.
There are no HIV/AIDS entry restrictions for visitors to or foreign residents of Ghana.

Motor vehicle accidents, drownings and water-related accidents due to Ghana’s rough surf, muggings and other violent attacks, and the development of sexually transmitted diseases—including HIV—are
health and safety concerns that have been reported by U.S. citizens and can be at least partially mitigated by using common-sense safety precautions.

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 Ghana is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Primary roads are generally paved and well maintained. However, some side roads within major cities and roads outside of major cities are in poor condition. The road from Accra to the central region tourist area of Cape Coast continues to be the site of many accidents. Travel in darkness, particularly outside the major cities, is extremely hazardous, due to poor street lighting and the unpredictable behavior of pedestrians, bicyclists and farm animals, particularly goats and sheep. Aggressive drivers, poorly maintained vehicles and overloaded vehicles pose serious threats to road safety.

The safety standards of the small private buses that transit roads and highways are uncertain. Travelers are encouraged to consider this when making travel arrangements.

Travelers are routinely stopped at police checkpoints throughout Ghana, and vehicles and passengers may be searched. Drivers must possess an international driver’s license (available from AAA and the American Automobile Touring Alliance). Foreign nationals should carry documentation of their status, such as a passport and visa.

Please refer to our Road Safety page for more information. Visit the website of Ghana’s national tourist office at http://www.touringghana.com/default.asp and the national authority responsible for road safety at http://www.mrt.gov.gh/
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Ghana’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Ghana’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.

Service provided by a number of regional air carriers is reported to be unreliable. The airlines may alter scheduled stops, cancel or postpone flights on short notice, and regularly overbook flights. Travelers may experience unexpected delays even after checking in. Passengers should get the required seat reconfirmation stamped on the ticket, have enough emergency funds for food and lodging in case of unexpected delays, and arrive at the airport at least two hours before the scheduled departure time.

SPECIAL CIRCUMSTANCES:
Effective July 1, 2007, the Government of Ghana redenominated the local currency, the cedi, introducing new banknotes (Ghana Cedi) and coins (Ghana Pesewa). 10,000 cedis = 1 Ghana Cedi = 100 Ghana Pesewas. The old cedi was taken out of circulation on December 31, 2007, and as of January 1, 2008, can be converted only at commercial banks or the Bank of Ghana. Travelers should be alert to persons who may try to defraud them with the old and new bills. The Government of Ghana established a web site in 2007, www.ghanacedi.gov.gh, to inform the public about the redenomination exercise. The web site includes a useful currency converter.

Visitors arriving or departing Ghana with more than $5,000 in cash are required to declare the amount at the border. Currency exchange is available at most banks and at licensed foreign exchange bureaus, but currency transactions with private citizens are illegal. The Government of Ghana also prohibits departing travelers from carrying more than 5,000,000 cedis (500 Ghana Cedis) out of the country. Ghanaian currency must either be spent or exchanged before departure, or it will be confiscated.

Strict customs regulations govern temporary importation into or export from Ghana of items such as gold, diamonds and precious natural resources. Only agents licensed by the Precious Metals and Mining Commission, telephone (233-21) 664-635 or 664-579, may handle import-export transactions of these natural resources. Any transaction without the commission’s endorsement is illegal and/or fraudulent. All transactions must be completed through the commission at the price set daily by the London exchange. Any transaction that discounts this price, or includes a previously negotiated price, is either illegal or fraudulent. Export of gold dust is rare as it encourages dangerous and environmentally destructive practices, and transactions involving the export of gold dust are probably fraudulent. Attempts to evade regulations are punishable by imprisonment. It is advisable to contact the Embassy of Ghana in Washington, DC, or one of the Ghanaian consulates in the United States, for specific information regarding customs requirements.

In rare instances, visitors arriving in Ghana with sophisticated electronic equipment (video cameras and laptop computers) may have to deposit 17.5 per cent of the item's value with the Customs and Excise office at the airport. To get the deposit refunded, visitors must apply to the Customs and Excise Office in central Accra 48 hours before departure.

Taking pictures near sensitive installations, including military sites and some government buildings, is prohibited. These sites are not always clearly marked and application of these restrictions is subject to interpretation. Permission may be obtained from Ghanaian security personnel. Permission should also be obtained before photographing anyone in uniform (e.g., police officers and military officers). In some cases, film and cameras have been confiscated. For security reasons, taking photographs of the U.S. Embassy is also prohibited.

It is strictly prohibited to wear any military apparel such as camouflage jackets or trousers, or any clothing or items that may appear military in nature.

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 Ghana laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Ghana 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 Ghana are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Ghana. 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 No. 24 Fourth Circular Road, Cantonments, Accra; telephone (233-21)741-000. The public entrance to the Consular Section is No. 19 Fifth Link Road, Cantonments, Accra; telephone (233-21) 741-100; fax (233-21) 741-362 or 741-426; after-hours (233-21) 741-775.
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This replaces the Country Specific Information for Ghana dated February 21, 2008, to update sections on safety and security, crime, information for victims of crime, and medical facilities and health information.

Travel News Headlines WORLD NEWS

Date: Sat, 28 Mar 2020 09:41:43 +0100 (MET)

Accra, March 28, 2020 (AFP) - Ghana has announced a two-week lockdown in the country's two main regions starting Monday to curb the spread of coronavirus.   The move came as the authorities reported 137 confirmed cases, including four deaths.   President Nana Akufo-Ado said there would be "restrictions on movement of persons in the Greater Accra Metropolitan Area and the Greater Kumasi Metropolitan Area and contiguous districts for a period of two weeks."

He said residents would only be allowed to go out to buy food, water and medicines and to use public toilets.   "There shall be, during this period, no inter-city movement of vehicles and aircrafts for private or commercial purposes.. except for vehicles and aircrafts providing essential services and those carrying cargo," he said.   Ghana has already closed schools, suspended public events and banned large gatherings.
Date: Mon, 16 Mar 2020 11:02:11 +0100 (MET)

Accra, March 16, 2020 (AFP) - Ghana on Monday closed all schools and universities and suspended public events to stop the spread of coronavirus as a string of African nations imposed tighter restrictions to stem the spread of the global pandemic.    President Nana Akufo-Addo announced in an address to the west African nation that the authorities were shutting schools and universities "until further notice".   Public gatherings -- including conferences, religious services, sports matches and political rallies -- have also been suspended for four weeks, he said.

Ghana on Sunday announced it would start barring entry to the country from Tuesday for any non-Ghanaian citizen or resident "who, within the last 14 days, has been to a country that has recorded at least 200 cases".   The move came as the authorities reported a rise in the number of confirmed cases of COVID-19 from two to six, with the new cases all arrivals from abroad.   Numerous nations in sub-Saharan Africa -- including Senegal, Kenya and South Africa -- have begun imposing entry restrictions or closing schools as the continent scrambles to halt the spread of the virus.
Date: Thu 9 Jan 2020
Source: All Africa/Ghanaian Times [edited]

A total of 3 cases of poliomyelitis with 2 deaths have been recorded in the Bono, Bono East and Ahafo regions.

The 1st case reported, in the Bono Region, was a 24-month-old girl from Asiri in Goka, a subdistrict in the Jaman North District. The 2nd case was a 33-month-old girl resident in Sissala line in the Techiman West submunicipality in the Bono East Region, and the 3rd case was a 37-month-old boy from Kwasuso in the Asutifi South District of the Ahafo Region.

Poliomyelitis is highly infectious viral disease that mainly affects young children. The virus is transmitted from person to person, spread mainly through the faecal-oral route or less frequently by a common vehicle (via contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and cause paralysis.

According to the Bono Regional Health Directorate of the Ghana Health Service (GHS), the cases were detected in October and November last year [2019] with the latest one in January 2020.

The Deputy Regional Director of Public Health, Dr. John Ekow Ottoo, who briefed journalists here in Sunyani yesterday [8 Jan 2020], said the 3rd victim, in a critical and paralysed condition, was being treated.

According to Dr. Ottoo, initial symptoms of polio include fever, fatigue, headache, vomiting and stiffness in the neck and pain in the limbs, saying the disease had no cure but could only be prevented by immunisation.

The Deputy Public Health Director stressed the need for the general improvement of sanitation across the country, noting that the virus was in the system due to poor sanitary condition in the affected areas. He said the GHS had deployed staff and volunteers to the affected areas, including the various borders within the jurisdiction for the immunisation exercises.

Dr. Ottoo urged the public to cooperate with the GHS as the immunisation began on Wednesday [8 Jan 2020].  [Byline: Daniel Dzirasah]
====================
[According to the most recent GPEI (Global Polio Eradication Initiative) update, during 2019, Ghana reported 11 cases of cVDPV2 associated disease, with most recent date of onset recorded as 7 Nov 2019 (see Poliomyelitis update (03): global (WPV1 Afghan., Pak., cVDPV2 Zambia), Pakistan http://promedmail.org/post/20200110.6881006). While it is unclear if all 3 of the cases reported in the above media report are newly confirmed cases, this is the 1st report we've seen of a case with onset in January 2020.

More information on these cases would be greatly appreciated with clarification of the situation in Ghana.

A map of Ghana showing new regions after the referendum:

[HealthMap/ProMED-mail maps:
Date: Mon 17 Dec 2019
Source: Peace FM Online [edited]

There has been a surge in the number of polio cases across the country [Ghana] since July this year [2019], and this has been an issue of concern for both the Government and other health partners. Government and donor partners, are therefore, making frantic efforts at addressing the issue while the Ghana Health Service (GHS) and its partners have embarked on a number of measures to contain the situation. In some few years back, the country was nearly declared polio-free as it had chalked a lot of success in eradicating the disease, and so the current trend is disturbing phenomenon for most stakeholders in the health sector.

Briefing journalists on the status of the Polio disease in the country, Dr. Franklin Asiedu-Bekoe, Director, Diseases Control, GHS, "said the new virus started as a case from the environment seen in Tamale and later some cases was seen in humans". He said at now there have been 10 cases reported in humans while some viruses from the environment have been isolated.

Dr. Asiedu-Bekoe was speaking on the side-lines of the 2nd Ghana Field Epidemiology and Laboratory Trainings Programme (GFELTP) and Scientific Conference and Competency Graduation held in Accra where 58 health professionals involving Frontline, Intermediate and Advanced level trainees graduated after going through various levels of training.

He said following the Tamale outbreak, "as an intervention, we have had a number of vaccination exercises in several regions and districts. We have vaccinated the whole of Northern Region, Upper East and Greater Accra and we are going to do some vaccination in Oti and Bono Ahafo Regions come next week." He said hopefully, early next year [2020], the GHS would start a nationwide Polio vaccination campaign to cover the whole country, adding that a lot of work was also being done by the health partners to ensure that there was no complications or minimal effects with the current vaccines. "We are using both the oral and injectable polio vaccines in the country currently."

Explaining the seemingly upsurge in Polio cases, Dr. Asiedu-Bekoe said the world has been polio-free for most countries excerpt for Nigeria, Pakistan and Afghanistan, but until recently, there had been surge of the disease in some African countries including Ghana, Cote d'Ivoire, and Togo. "Apparently, there was a gap that has arisen because some children who were supposed to be vaccinated were not. The thinking was that we thought the global immunity was huge enough to protect us against the disease. Unfortunately some of the children were prone, and they are those who have gotten the disease. And that is why we are going to do this nationwide vaccination campaign to protect all the children who were left out from an earlier planned vaccination exercise, so that the protection will be assured".

He said children from 9 months up to 4 years would be covered in the nationwide campaign while those under 5 would be involved in the oral polio vaccine. He explained that Ghana was now doing a multiple-prone approach to address the threat of Polio, which included "ensuring that our vaccination is intact".

There was also the surveillance system, which was being made very sensitive to be able to comb all the communities and health facilities to detect if the disease was present anywhere while the third approach was ensuring a clean environment.

According to Dr. Asiedu-Bekoe, keeping a clean environment was very important as Polio was a faecal-oral disease and so "we need to make sure that our environment is clean so that children will not go and pick the Polio virus from the soil and put them in their mouths.

"So these are the approach we are to use to make sure that the Polio menace does not get out of hands. But we are certain that we will actually be able to get Polio eradicated globally. He gave the assurance that the combined effort of government and other partners like UNICEF, WHO, Centre for Disease Control and Prevention (CDC) and Rotary Club were all on board in the fight against Polio.

Mr. Fred Osei Sarpong, Immunisation Focal Person, World Health Organisation, said with Polio cases being reported in Angola, Nigeria, Benin and other neighbouring countries, "Ghana isn't safe. The virus is in the sub-region that is why we have to make sure everyone is protected, that is why we will call on all caregivers to make sure they send their kids for vaccination. Once your child is protected you don't have a cause to worry". He said children without protection were going down with the disease so all parents should avail their children to ensure that they were all vaccinated and protected from the virus that was in circulation.
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[First, congratulations to Ghana and the FELTP Groups in Ghana for graduating 58 Health Professionals from their Field Epidemiology Training Program initiatives this year (2019).

According to the most recent Global update from the Global Polio Eradication Initiative / WHO data, there had been 9 cases of cVDPV2 associated disease, with a virus genetically related to the Jigawa Nigeria outbreak (Poliomyelitis update (99): global (WPV & cVDPV), Pakistan (KP), Afghanistan (BL) http://promedmail.org/post/20191212.6837355). The above media report mentions there were 10 cases. No further information was provided. More information from knowledgeable sources would be greatly appreciated including verification of this additional case and demographics including age and geographic location of case, and vaccination history as well as virus type.

HealthMap/ProMED map of Ghana: <http://healthmap.org/promed/p/53> - ProMED Mod.MPP]
Date: Fri, 18 Oct 2019 15:43:29 +0200 (METDST)

Accra, Oct 18, 2019 (AFP) - Floods caused by eight days of torrential downpours in north-eastern Ghana have left 28 people dead and displaced hundreds, officials said Friday.     "At the moment the death toll is 28. About 640 people in some six communities have been displaced and we are providing shelters for them," George Ayisi, spokesman for the National Disaster Management Organisation, told AFP.    "We've counted about 286 collapsed houses during this disaster and that is making life difficult for the people."

Relief items were being transported 800 kilometres (500 miles) by road from the capital Accra to the affected region on the border with Burkina Faso as meteorologists warned the rains could last into November.    "We have to just prepare for anything," Ayisi said.   So far this year 46 people have been killed in floods in the West African nation, the disaster relief agency said.   Flooding in northern and other parts of Ghana happens each year during the rainy season.    Last year, 34 people died in northern Ghana during flooding caused by heavy rains and waters spilling from a dam in Burkina Faso.
More ...

Norway

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

ENTRY/EXIT REQUIREMENTS:
Norway is a party to the Schengen agreement.
As such, U.S. citizens may enter Norway for up to 90 days for tourist or business purposes without a visa.
The passport should be valid for at least three months beyond the period of stay.
For further details about travel into and within Schengen countries, please see our fact sheet.

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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


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

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

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

REGISTRATION / EMBASSY LOCATION:
Americans living in or visiting Norway are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov, and to obtain updated information on travel and security within Norway. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located in Oslo near the Royal Palace at Henrik Ibsensgate 48; tel. 47/2244-8550 (24 hours), consular fax 47/2256-2751.
The Embassy’s web site is http://norway.usembassy.gov
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This replaces the Consular Information Sheet dated April 23, 2008 to update the sections on Crime, Safety and Security, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed, 26 Feb 2020 21:33:56 +0100 (MET)

Oslo, Feb 26, 2020 (AFP) - Norwegian health authorities on Wednesday announced the first case of coronavirus in the Nordic nation in someone who returned from China last week, but said the patient was not "in danger".   "The person is not ill, they are in good health and do not present any symptoms," Line Vold, an official at the Norwegian Institute of Public Health, told reporters. "We think it is very unlikely that they have infected" others.   Routine tests had given a "weekly positive result" and detected traces of the new coronavirus, the institute said.
Date: Thu, 20 Feb 2020 19:02:28 +0100 (MET)

Oslo, Feb 20, 2020 (AFP) - Two German tourists were killed Thursday in an avalanche while on a snowmobile tour in Norway, authorities said.    A helicopter carrying rescue personnel and a sniffer dog were dispatched to search for the missing pair, who were discovered dead in the Svalbard archipelago, about a thousand kilometres (miles) from the North Pole.    "Two German citizens are confirmed dead in an avalanche," the office of the Governor of Svalbard said in a statement.

They had been on a snowmobile tour run by a Russian tour operator, about 15 to 20 kilometres (about 9 to 12 miles) south of Barentsburg, the second largest settlement on Svalbard, according broadcaster NRK.    Authorities said they received reports that two people were missing shortly before 3:00 pm (1400 GMT), and a few hours later the pair were discovered.    The Svalbard archipelago covers an area twice the size of Belgium and is home to some 2,900 inhabitants who rely on tourism, scientific research and mining.
Date: Tue 3 Sep 2019
Source: Food Safety News [edited]
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More than 100 people have fallen ill in Norway from norovirus likely in a frozen seaweed salad from China. The 1st outbreak of norovirus suspected to be linked to the seaweed salad occurred in mid-June 2019 and the most recent was at the beginning of August 2019. The implicated product was also shipped to Denmark.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

United Arab Emirates

United Arab Emirates US Consular Information Sheet
28th February 2008
COUNTRY DESCRIPTION: The United Arab Emirates (UAE) is a federation of seven independent emirates, each with its own ruler.
The federal government is a constitutional re
ublic, headed by a president and council of ministers.
Islamic ideals and beliefs provide the conservative foundation of the country's customs, laws and practices. The UAE is a modern, developed country, and tourist facilities are widely available. Read the Department of State Background Notes on the United Arab Emirates for additional information.

ENTRY/EXIT REQUIREMENTS: A passport is required. For stays of less than 60 days, U.S. citizens holding valid passports may obtain visitor visas at the port of entry for no fee. For a longer stay, a traveler must obtain a visa before arrival in the UAE. In addition, an AIDS test is required for work or residence permits; testing must be performed after arrival. A U.S. AIDS test is not accepted. For further information, travelers can contact the Embassy of the United Arab Emirates, 3522 International Court NW, Washington, DC 20037, telephone (202) 243-2400.
Visit the web site of the UAE's Ministry of Information regarding tourism, business, and residence in the UAE at http://www.uaeinteract.org.

Unlike other countries in the region that accept U.S. military ID cards as valid travel documents, the UAE requires U.S. military personnel to present a valid passport for entry/exit.

UAE authorities will confiscate any weapons, weapon parts, ammunition, body armor, handcuffs, and/or other military/police equipment transported to or through a civilian airport.
Americans have been arrested and jailed for transporting such weapons and equipment without the express written authorization of the UAE government, even though airline and U.S. authorities allowed shipment on a US-originating flight.

U.S. citizens and citizens of other countries that are not members of the Gulf Cooperation Council (GCC), who depart the UAE via land are required to pay a departure fee. This fee is 20 UAE dirhams and is payable only in the local UAE dirham currency.

Visit the Embassy of the United Arab Emirates web site at http://uae-embassy.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: Americans in the United Arab Emirates should exercise a high level of security awareness. The Department of State remains concerned about the possibility of terrorist attacks against U.S. citizens and interests throughout the world. Americans should maintain a low profile, vary routes and times for all required travel, and treat mail and packages from unfamiliar sources with caution. In addition, U.S. citizens are urged to avoid contact with any suspicious, unfamiliar objects, and to report the presence of the objects to local authorities.
U.S. Government personnel overseas have been advised to take the same precautions. In addition, U.S. Government facilities may temporarily close or suspend public services from time to time as necessary to review their security posture and ensure its adequacy.

Taking photographs of potentially-sensitive UAE military and civilian sites, or foreign diplomatic missions, including the U.S. Embassy, may result in arrest, detention and/or prosecution by local authorities.
In addition, engaging in mapping activities, especially mapping which includes the use of GPS equipment, without coordination with UAE authorities, may have the same consequences.

On several occasions in the past three years, small groups of expatriate recreational boaters were detained by the Iranian Coast Guard for alleged violation of Iranian territorial waters while fishing near the island of Abu Musa, approximately 20 miles from Dubai.
The UAE and Iran have had a long-standing dispute concerning jurisdiction of Abu Musa.
Fishing or sailing in these waters may result in seizure of vessels and detention of passengers and crew in Iran.
Obtaining consular assistance in Iran is difficult and can only be done through the Swiss Embassy in Tehran, which acts as a Protecting Power, providing limited U.S. consular services.

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 overseas, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME: Crime generally is not a problem for travelers in the UAE. However, the U.S. Embassy advises U.S. citizens to take normal precautions against theft, such as not leaving a wallet, purse, or credit card unattended. Although vehicle break-ins in the UAE are rare, U.S. citizens are encouraged to ensure that unattended vehicles are locked and that valuables are not left out in plain sight.

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.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Basic modern medical care and medicines are available in the principal cities of the UAE, but not necessarily in outlying areas.

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); fax 1-888-CDC-FAXX (1-888-232-3299), or via the CDC's web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning the United Arab Emirates is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

The police emergency number and ambulance number is 999. Mobile phones are widely used throughout the UAE, so passers-by usually request emergency police and medical services quickly. Response time by emergency services is adequate. However, medical personnel emphasize transport of the injured to the hospital rather than treatment on site. Traffic accidents are a leading cause of death in the UAE because drivers often drive at high speeds. Unsafe driving practices are common, especially on inter-city highways. On highways, unmarked speed bumps and drifting sand create additional hazards.

Country-wide traffic laws impose stringent penalties for certain violations, particularly driving under the influence of alcohol.
In the UAE, there is zero tolerance for driving after consumption of alcohol.
Penalties may include hefty jail sentences and fines over $6,000 and, for Muslims (even those holding U.S. citizenship), lashings. Persons involved in an accident in which another party is injured automatically go to jail, until the injured person is released from the hospital. Should a person die in a traffic accident, the driver of the other vehicle is liable for payment of compensation for the death (known as "dhiyya"), usually the equivalent of 55,000 U.S. dollars. Even relatively minor accidents may result in lengthy proceedings, during which both drivers may be prohibited from leaving the country.

In order to drive, UAE residents must obtain a UAE driver's license. Foreign driver's licenses are not recognized. However, a non-resident visitor to the UAE can drive if he/she obtains a valid international driver's license issued by the motor vehicle authority of the country whose passport the traveler holds. The UAE recognizes driver's licenses issued by other Gulf Cooperation Council (GCC) states only if the bearer is driving a vehicle registered to the same GCC state. Under no circumstances should anyone drive without a valid license.

Please refer to our Road Safety page for more information.
You may also visit the web site of the UAE’s national tourist office and national authority responsible for road safety at http://www.uaeinteract.org.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Arab Emirates’ Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the United Arab Emirates' 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: The UAE government does not recognize dual nationality.
Children of UAE fathers automatically acquire UAE citizenship at birth and must enter the UAE on UAE passports. UAE authorities have confiscated U.S. passports of UAE/U.S. dual nationals in the past. This act does not constitute loss of U.S. citizenship, but should be reported to the U.S. Embassy in Abu Dhabi or the U.S. Consulate General in Dubai. In addition to being subject to all UAE laws, U.S. citizens who also hold UAE citizenship may also be subject to other laws that impose special obligations on citizens of the UAE.
For additional information, please refer to our Dual Nationality flyer.

U.S. citizens have at times become involved in disputes of a commercial nature that have prompted local firms or courts to take possession of the U.S. citizen's passport. Travel bans may also be enforced against U.S. citizens involved in financial disputes with a local sponsor or firm. Such travel bans, which are rigidly enforced, effectively prevent the individual from leaving the UAE for any reason until the dispute is resolved. Although it is customary for a local sponsor to hold an employee's passport, it is illegal to do so under UAE law. Most contractual/labor disputes can be avoided by clearly establishing all terms and conditions of employment or sponsorship in the labor contract at the beginning of any employment. Should a dispute arise, the UAE Ministry of Labor has established a special department to review and arbitrate labor claims. A list of local attorneys capable of representing Americans in such matters is available from the Consular and Commercial sections of the U.S. Embassy in Abu Dhabi and the U.S. Consulate General in Dubai.

Codes of behavior and dress in the UAE reflect the country's Islamic traditions and are more conservative than those of the United States. Visitors to the UAE should be respectful of this conservative heritage, especially in the Emirate of Sharjah where rules of decency and public conduct are strictly enforced. Female travelers should keep in mind the cultural differences among the many people who coexist in the UAE and should be cognizant that unwitting actions may invite unwanted attention to them. Isolated incidents of verbal and physical harassment of Western women have occurred. Victims of harassment are encouraged to report such incidents to the U.S. Embassy in Abu Dhabi or the Consulate General in Dubai.

American citizens intending to reside and work in the UAE may have to present personal documents authenticated by the Department of State's Office of Authentications in Washington, D.C. before traveling to the UAE. This can be a complex process involving local, state and federal offices and requiring several weeks to complete.
For procedural information, the Office of Authentications may be contacted by telephone from within the United States at 800-688-9889 or 202-647-5002, by fax at 202-663-3636, or by e-mail at aoprgsmauth@state.gov.
In order to meet UAE government requirements for school registrations and residency sponsorship for family members, Americans intending to bring their families to reside with them in the UAE will need to have their marriage certificate and children's birth certificates, or custody/adoption decrees, if appropriate, authenticated by the Department of State in Washington, DC.
The U.S. Embassy and Consulate General cannot authenticate U.S. local- and state-issued personal, academic or professional documents; they will only be able to authenticate the final authentication document from the Department of State.
Additional information on authentication of documents can be found at http://www.state.gov/m/a/auth/.
In terms of employment, a recent change to UAE labor law requires local sponsors to have employees' diplomas, academic and/or occupational/professional certificates validated through a “Degree Verification” process established in the UAE.
Prospective employees will be required to submit photocopies of such documents for verification to a firm under contract to the Ministry of Labor.

In addition, persons in the education and health professions reportedly have to meet two requirements for validation of their educational credentials at this time – the formal “chain” authentication of academic/professional credentials in the U.S. and the “Degree Verification” process in the UAE.
Different UAE Ministries have different requirements in this regard.
Determining these requirements with one’s prospective employer is strongly recommended before arrival in the UAE.

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 UAE laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the UAE 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.

Legislation enacted in January 1996 imposes the death sentence for convicted drug traffickers. Since January 2006, possession of even trace amounts of illegal drugs has resulted in sentences of four years imprisonment for foreign citizens transiting the UAE. American citizens transiting and entering the UAE’s airports and in possession of illegal drugs have been discovered, arrested and prosecuted by UAE authorities.
As mentioned, in such cases the minimum penalty is four years imprisonment.

Some drugs normally taken under a doctor's supervision in the United States, and even some over-the-counter U.S. drugs and medications, are classified as narcotics in the UAE and are illegal to possess.
A doctor's prescription should be carried along with any medication that is brought into the country.
A person may be subject to arrest and prosecution if possession of prescribed medicines (especially those containing codeine and similar narcotic-like ingredients) comes to the attention of local authorities.
The U.S. Embassy’s web site includes an unofficial list of such medicines, obtained from the UAE Ministry of Health.
Most medications available in the U.S. are also available by doctors’ prescription through hospitals and pharmacies in the UAE.

In addition, the UAE's tough anti-narcotics program also includes poppy seeds, widely used in other cultures, including the U.S., for culinary purposes, on its list of controlled substances. The importation and possession of poppy seeds in any and all forms is strictly prohibited. Persons found to possess even very small quantities of controlled substances listed by the UAE are subject to prosecution by the authorities and may be given lengthy prison terms of up to 15 years. Travelers with questions regarding the items on the list of controlled substances should contact the U.S. Embassy in Abu Dhabi or the U.S. Consulate General in Dubai. If suspected of being under the influence of drugs or alcohol, individuals may be required to submit to blood and/or urine tests and may be subject to prosecution.

Crimes of fraud, including passing bad checks and non-payment of bills (including hotel bills), are regarded seriously in the UAE and can result in imprisonment and/or fines. Bail generally is not available to non-residents of the UAE who are arrested for crimes involving fraud.

Drinking or possession of alcohol without a Ministry of Interior liquor permit is illegal and could result in arrest and/or fines and imprisonment. Alcohol is served at bars in most major hotels but is intended for guests of the hotel. Persons who are not guests of the hotel, and who consume alcohol in the restaurants and bars, technically are required to have their own personal liquor licenses. Liquor licenses are issued only to non-Muslim persons who possess UAE residency permits. Drinking and driving is considered a serious offense. Penalties generally are assessed according to religious law.

While individuals are free to worship as they choose, and facilities are available for that purpose, religious proselytizing is not permitted in the UAE.
Persons violating this law, even unknowingly, may be imprisoned or deported.

If arrested, U.S. citizens should contact the U.S. Embassy or Consulate General for assistance. The U.S. Consul will provide information on the local judicial system and a list of local attorneys. In Dubai, the U.S. Consul can also arrange for U.S. citizen detainees to meet with an ombudsman from the Human Rights Department of the Dubai police headquarters, if the detainee believes he or she is not being treated fairly.

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 LOCATION:
Americans living or traveling in the United Arab Emirates 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 the United Arab Emirates. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Embassy in Abu Dhabi is located at Embassies District, Plot 38, Sector W59-02, Street No. 4, P.O. Box 4009. The telephone number is (971) (2) 414-2200, and the Consular Section fax number is (971) (2) 414-2241. The email address for American Citizens Services inquiries, including passport questions, is abudhabiacs@state.gov. The after-hours telephone number is (971) (2) 414-2500. The Embassy Internet web site is http://uae.usembassy.gov.

The U.S. Consulate General in Dubai is located on the 21st floor of the Dubai World Trade Center, P.O. Box 9343. The telephone number is (971) (4) 311-6000 (for after-hours emergencies, contact the Embassy at (971)(2) 414-2200 for the Dubai Duty Officer, and the Consular Section fax number is (971) (4) 311-6213. The email address for American Citizens Services inquiries, including passport questions, is dubaiwarden@state.gov. The web site for the U.S. Consulate General in Dubai is http://dubai.usconsulate.gov.

The workweek for both the Embassy in Abu Dhabi and the Consulate General in Dubai is Sunday through Thursday.
* * *
This replaces the Country Specific Information for the UAE dated July 06, 2007, to update the sections on Traffic Safety and Road Conditions and Criminal Penalties.

Travel News Headlines WORLD NEWS

Date: Thu, 2 Apr 2020 12:24:14 +0200 (METDST)

Dubai, April 2, 2020 (AFP) - Emirates Airline said Thursday it is to resume a limited number of outbound passenger flights from April 6, less than two weeks after its coronavirus-enforced stoppage.   "Emirates has received approval from UAE authorities to restart flying a limited number of passenger flights," its chairman, Sheikh Ahmed bin Saeed Al-Maktoum, said on Twitter.   "From April 6, these flights will initially carry travellers outbound from UAE," he said, adding that details would be announced soon.      Dubai-owned carrier Emirates, the largest in the Middle East with 271 wide-body aircraft, grounded passenger operations last week as the UAE halted all passenger flights to fight the spread of coronavirus.

The UAE, which groups seven emirates including Dubai, has declared 814 coronavirus cases along with eight deaths.   It has imposed a sweeping crackdown, including the flight ban and closure of borders.   Sheikh Ahmed said Emirates, which owns the world's largest fleet of Airbus A-380 superjumbos with 113 in its ranks, was looking to gradually resume passenger services.   "Over the time, Emirates looks forward to the gradual resumption of passenger services in line with lifting of travel and operational restrictions, including assurance of health measures to safeguard our people and customers," he said.

When Emirates suspended flights, it cut between 25 percent and 50 percent of the basic salary of its 100,000-strong staff for three months, saying it wanted to avert layoffs.   Dubai's crown prince, Sheikh Hamdan bin Mohammed bin Rashid Al-Maktoum said Tuesday that Dubai will support the airline by injecting new capital.   Tourism, aviation, hotels and entertainment are key contributors to Dubai's mostly non-oil economy.
Date: Mon, 23 Mar 2020 00:45:56 +0100 (MET)

Dubai, March 22, 2020 (AFP) - The United Arab Emirates announced on Monday it will temporarily suspend all passenger and transit flights amid the novel coronavirus outbreak.    The Emirati authorities "have decided to suspend all inbound and outbound passenger flights and the transit of airline passengers in the UAE for two weeks as part of the precautionary measures taken to curb the spread of the COVID-19", reported the official state news agency, WAM.   It said the decision -- which is subject to review in two weeks -- will take effect in 48 hours, adding: "Cargo and emergency evacuation flights would be exempt."

The UAE, whose international airports in Abu Dhabi and Dubai are major hubs, announced on Friday its first two deaths from the COVID-19 disease, having reported more than 150 cases so far.   Monday's announcement came hours after Dubai carrier Emirates announced it would suspend all passenger flights by March 25.    But the aviation giant then reversed its decision, saying it "received requests from governments and customers to support the repatriation of travellers" and will continue to operate passenger flights to 13 destinations.

Emirates had said it will continue to fly to the United Kingdom, Switzerland, Hong Kong, Thailand, Malaysia, the Philippines, Japan, Singapore, South Korea, Australia, South Africa, the United States and Canada.   "We continue to watch the situation closely, and as soon as things allow, we will reinstate our services," said the airline's chairman and CEO, Sheikh Ahmed bin Saeed Al-Maktoum.   Gulf countries have imposed various restrictions to combat the spread of the novel coronavirus pandemic, particularly in the air transport sector.   The UAE has stopped granting visas on arrival and forbidden foreigners who are legal residents but are outside the country from returning.
Date: Mon, 6 Jan 2020 17:38:26 +0100 (MET)

Dubai, Jan 6, 2020 (AFP) - The United Arab Emirates on Monday introduced a multiple-entry visa scheme valid for five years for all nationalities, with the aim of turning the Gulf state into a tourism hub.   "#UAE Cabinet chaired by @HHShkMohd, approves new amendment for tourist visas in #UAE," the government of Dubai Media Office tweeted, referring to Sheikh Mohammed bin Rashid Al Maktoum, the UAE prime minister and ruler of Dubai.   "The new tourist visa will be valid for 5 years and can be used for multiple entries and is open for all nationalities," the Dubai Media Office wrote.

Sheikh Maktoum said on Twitter that the UAE currently attracts 21 million tourists a year.   Travellers from Africa, some South American countries, Arab states outside the Gulf, and European states from outside the European Union and former Soviet Union previously needed visas.   In October, Dubai is to host Expo 2020, a big-budget global trade fair.
Date: Thu 26 Sep 2019
Source: Gulf Business [edited]

Dubai Municipality has shut down a restaurant in Jumeirah after 15 people fell ill following an outbreak of _Salmonella_ infection, local media reported. An initial investigation revealed that the outbreak was likely caused by raw eggs served in a hollandaise sauce.

Officials received a report that several people, including a child, fell sick with symptoms such as diarrhoea, fever, and vomiting after eating at the restaurant. They collected samples and conducted tests, following which they found that the chef had used raw eggs in violation of the food safety rules.

The chef and person-in-charge (PIC) of food safety have been held, the municipality said. The food safety department has also downgraded the rating of the outlet and revoked its PIC certificate, Gulf News reported. The unnamed American outlet will be under "strict monitoring" for the next 6 months once it is allowed to reopen.

The municipality banned the use of raw eggs in ready-to-eat products in 2012 after authorities found them to be a cause for _Salmonella_ infections. Following the recent incident, the department has issued a fresh alert to restaurants reminding them about the ban.
=======================
[Salmonellosis is often thought to be associated with cracked eggs or eggs dirty with fecal matter, a problem controlled by cleaning procedures implemented in the egg industry. It is clearly the case, however, that most of the salmonellosis outbreaks linked to eggs were associated with uncracked, disinfected grade A eggs, or foods containing such eggs. The undamaged eggs become contaminated during ovulation, and thus were contaminated with the bacteria before the eggshell was formed. To avoid this, uncooked eggs should only be used as an ingredient if pasteurized. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Dubai, United Arab Emirates: <http://healthmap.org/promed/p/3442>]
Date: Sat 24 Aug 2019 3:39:38 PM PKT
Source: Mena FN[edited]

A resident of Swabi district has succumbed to Congo fever in Sharjah hospital and was laid to rest there on [Sat 24 Aug 2019].

According to details, the man was cutting meat on Eid day, when he accidentally cut one of his fingers. He didn't take it seriously, but after few days, he felt unwell and was taken to the hospital in Sharjah where he was told that he is suffering from a lethal infection known as Crimean-Congo haemorrhagic fever.

Doctors have told him that while he was cutting meat, the deadly Congo virus entered into his body. He was unaware of it while the virus was gradually spreading in his veins, killing him a slow death.

And finally, the virus shattered his body to an extent that he was unable to recover. He was admitted to a hospital in Sharjah in an isolated ward and was kept away from his relatives so that they may not contract the virus. His dead body was laid to rest in Sharjah and was not allowed to be taken to his home town in Swabi due to the fear of virus spread. The man was a resident of Cham village in Daghai, in District Swabi and was living with his family in Sharjah.
=======================
[The report above does not signify how the case was confirmed, and whether any contact follow up was done post confirmation, since there is an incubation period between possible exposure and appearance of symptoms.

CCHF virus has the greatest geographic range of any tick-borne virus and there are reports of viral isolation and/or disease from more than 30 countries in Africa, Asia, Eastern and Southern Europe, and the Middle East. Numerous domestic and wild animals, such as cattle, goats, and sheep, and small mammals, such as hares and rodents, serve as asymptomatic hosts for amplification of the virus, which is transmitted through _Ixodid_ ticks, especially _Hyalomma_ spp that act as both reservoirs and vectors  (<https://www.biorxiv.org/content/biorxiv/early/2018/12/20/502641.full.pdf>).

CCHF was first reported in the United Arab Emirates (UAE; Sharjah is one Emirate) in 1979, when 6 cases were reported among the staff of a hospital in Dubai. An outbreak of CCHF occurred during 1994-1995 with 35 human infections. In 1994, 35 clinical CCHF cases were reported in 1994,and between January 1998 and October 2013, 5 more cases and 2 deaths were reported from the UAE (Ince Y, Yasa C, Metin M, et al. Crimean-Congo hemorrhagic fever infections reported by ProMED. Int J Infect Dis 2014; 26: 44-6;  <https://www.ijidonline.com/article/S1201-9712(14)01499-4/fulltext>).

As the vector is widely distributed and impending climatic changes are likely to widen this spectrum, there is need for the development and implementation of a strategic framework for the prevention and control of CCHF through a coordinated 'One Health' approach. - ProMED Mod.UBA]

[Maps of United Arab Emirates:
More ...

North Korea

Democratic People's Republic of Korea US Consular Information Sheet
April 29, 2008
Prior to departing the United States, U.S. citizens planning to transit China on their visit to North Korea are encouraged to register on line with the U.S. Emba
sy in Beijing; U. S. citizens transiting South Korea to take the Mount Kumgang or Kaesong City tours should register with the U.S. Embassy in Seoul.
U. S. citizens visiting North Korea should also register with the Swedish Embassy in Pyongyang (U.S. Protective Power).
Please see the Registration/Embassy Location section below.

COUNTRY DESCRIPTION: The Democratic People’s Republic of Korea (North Korea or the DPRK) is a highly militaristic Communist state located on the Korean Peninsula between northeast China and the Republic of Korea (South Korea or ROK), with land borders with China, Russia and South Korea.
The DPRK is one of the world’s most isolated countries.
The continuing dispute over North Korea’s development of nuclear programs and nuclear weapons has resulted in tensions in the region and between the United States and the DPRK.
North Korea limits trade and transportation links with other countries and tightly restricts the circumstances under which foreigners may enter the country and interact with local citizens.
Telephone and fax communications are unavailable in many areas of the country and foreigners can expect their communications to be monitored by DPRK officials.
In the past few years, North Korea has experienced famine, flooding, fuel and electricity shortages, and outbreaks of disease.
Many countries, including the United States, have contributed to international relief efforts to assist the people of North Korea.

Foreign tourists are a means for North Korea to earn much needed foreign currency, but an underdeveloped service sector, inadequate infrastructure, and political tensions with surrounding countries have stymied any significant tourist flow.
North Korean efforts to expand tourism have focused primarily on group tours from China, as well as from South Korea primarily to the Mount Kumgang tourist area and the city of Kaesong.

The United States does not maintain diplomatic or consular relations with the DPRK.
The Swedish Embassy located in Pyongyang acts as the United States’ interim consular protective power and provides basic consular services to U.S. citizens traveling in North Korea.
Please refer to Special Circumstances for additional information.

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

ENTRY/EXIT REQUIREMENTS: North Korean visas are required for entry.
The U.S. Government does not issue letters to private Americans seeking North Korean visas, even though in the past such letters have sometimes been requested by DPRK embassies.
Prospective travelers entering and departing North Korea through China must also obtain a two-entry visa for China, as a valid Chinese visa is essential for departing North Korea at the conclusion of a visit or in an emergency.
While the ROK government is attempting to open direct travel routes to the DPRK, routine travel from the ROK to the DPRK is currently prohibited.
Travel across the demilitarized zone (DMZ) is allowed only infrequently for official and government-authorized cultural and economic exchanges, or aid shipments, and for tours limited to Mt. Kumgang and Kaesong City.
There are no regularly operating direct commercial flights from South Korea to North Korea.
U.S. citizens who arrive in North Korea without a valid U.S. passport and North Korean visa may be detained, arrested, fined or denied entry.
Travelers to North Korea report that fees for local travel costs (taxi, tolls, permits and the cost for security personnel assigned to escort foreigner visitors) can be high and arbitrary.

Where to obtain a North Korean visa: There is no DPRK embassy in the United States.
U.S. citizens and residents planning travel to North Korea must obtain DPRK visas in third countries, for example in Beijing, China.
For information about entry requirements and restricted areas, contact the DPRK Mission to the United Nations in New York.
Address inquiries to:

The Permanent Representative of the Democratic
People’s Republic of Korea to the United Nations
820 Second Avenue
New York, NY
10017
Tel: (212) 972-3105
Fax: (212) 972-3154

Americans living abroad can contact the DPRK embassy, if any, in their country of residence.
U.S. citizens traveling to North Korea may obtain their visas at the DPRK Embassy in Beijing, China, which will issue visas only after receiving authorization from the DPRK Foreign Ministry in Pyongyang.
Prior to traveling to the region, travelers may wish to confirm that authorization to issue their visa has been received from Pyongyang.
Americans can call the North Korean Embassy in Beijing prior to their travel by telephone at (86-10) 6532-1186 or (86-10) 6532-1189 (fax: (86-10) 6532-6056).

Information on dual nationality or the prevention of international child abduction can be found on our website.
For further information about customs regulations, please read our Customs Information sheet.
Please see those sections below under Special Circumstances.

SAFETY AND SECURITY: DPRK government security personnel closely monitor the activities and conversations of foreigners in North Korea.
Hotel rooms, telephones and fax machines may be monitored, and personal possessions in hotel rooms may be searched.
Photographing roads, bridges, airports, rail stations, or anything other than designated public tourist sites can be perceived as espionage and may result in confiscation of cameras and film or even detention.
DPRK border officials routinely confiscate visitors’ cell phones upon arrival, returning the phone only upon departure.
Foreign visitors to North Korea may be arrested, detained or expelled for activities that would not be considered criminal outside the DPRK, including involvement in unsanctioned religious and political activities, engaging in unauthorized travel, or interaction with the local population.
For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site
at where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on worldwide security can also be obtained by calling 1-888-407-4747 toll free in the United States and Canada, or for callers outside the United States and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

CRIME: The North Korean government does not release statistics on crime.
Violent crime is rare and street crime is uncommon in Pyongyang.
Petty thefts have been reported, especially at the airport in Pyongyang.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and to the Swedish Embassy.
If you are a victim of any crime while in North Korea, in addition to reporting to local police, please contact the Swedish Embassy for assistance (address and phone number below).

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Persons with medical problems should not travel to North Korea.
For decades, medical facilities in the DPRK have suffered from a lack of resources and electricity, as well as inadequate and often outdated skills among the medical staff.
Hospitals in Pyongyang can perform basic examinations and lifesaving measures but functioning x-ray facilities are not generally available.
Surgery should be avoided.
For accidents outside Pyongyang, transport back to the capital can be a lengthy trip without medical assistance.
Persons requiring regular medication are encouraged to bring sufficient stocks of drugs for personal use since most drugs are impossible to obtain locally.
Hospitals will expect immediate U.S. dollar cash payment for medical treatment.
Credit cards and checks have not been honored in the past, according to diplomatic personnel stationed in the DPRK.
Local DPRK hosts are often not aware of available evacuation options and might claim that no such options exist.
In case of serious medical problems, it is important to insist on immediate contact with the Swedish Embassy.
The Swedish Embassy can arrange a medical evacuation to Beijing within approximately 5-10 hours.

Vaccinations.
All necessary vaccinations should be received prior to traveling to North Korea.
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 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.
Travelers with special dietary requirements are advised to bring food with them to North Korea, as the restaurants available to foreigners may have limited menus that lack variety and nutritional adequacy.

Medical Vaccinations. In the case of a critical illness or accident, the Swedish Embassy will attempt to arrange flight clearances for air ambulances performing emergency medical evacuations.
Medical air evacuation costs vary, but average approximately $40,000 to $50,000 for medical, personnel, aircraft and clearance costs.
Clearances can usually be arranged within one day.
Medical evacuation by regularly scheduled airlines can be arranged, but is limited to the very few flights that operate from Pyongyang to Beijing, Dalian, Shenyang and Macau.
Chinese visas for injured foreigners and any escorts must be obtained prior to the evacuation from North Korea in order to transit China.
Even in the case of a medical emergency, transit visas may take several days to arrange.
Evacuation across the DMZ to South Korea is not allowed.

If an American citizen falls ill or is injured while traveling in the DPRK, accompanying travelers or family members should immediately contact the Swedish Embassy using the phone numbers listed below.

The Embassy of Sweden,
Munsu-Dong District,
Pyongyang, DPRK

Telephone and fax numbers for the Swedish Embassy (U.S. Protective Power) are:
Tel:
(850-2) 3817 485 (Reception)


(850-2) 3817 904, 907(First Secretary)


(850-2) 3817 908, 905 (Ambassador)
Fax:
(850-2) 3817 663
Email:
ambassaden.pyongyang@foreign.ministry.se
Notification also should be made to the U.S. Embassy’s American Citizen Services (ACS) Unit in Beijing, China, using the phone numbers listed below:

U.S. Embassy, Beijing
American Citizen Services
2 Xiushui Dong Jie
Beijing, China 100600
Telephone: (86-10) 6532-3431
Fax: (86-10) 6532-4153.

After hours, please call (86-10) 6532-3431 and ask for the Embassy duty officer.
Americans who wish to contact U.S. consular officials in China can e-mail amcitbeijing@state.gov
Companies that may be able to arrange evacuation services include, but are not limited to those listed below.
Travelers may wish to contact these or other emergency medical assistance providers for information about their ability to provide medical evacuation insurance and/or assistance for travelers to North Korea.

SOS International (www.intsos.com)
U.S. telephone:
(1-800) 468-5232
China telephone:
(86-10) 6462-9111/9118

Medex Assistance Corporation (www.medexassist.com)
U.S. telephone:
(410) 453-6300 / 6301
Toll free:
108888-800-527-0218 (call from China)
China telephone:
(86-10) 6595-8510)

Global Doctor (www.globaldoctor.com.au/default.php)
China telephone: (86-10) 83151914).









(86-24) 24330678 in Shenyang, Liaoning Province

Useful information on medical emergencies abroad, including overseas insurance programs, is provided in the Department of State’s Bureau of Consular Affairs brochure Medical Information for Americans Traveling Abroad , available via the Bureau of Consular Affairs home page.

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 if it will cover emergency expenses such as 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 North Korea is provided for general reference only, and may not be totally accurate in a particular location or situation.

Foreigners not holding a valid DPRK driver’s license are not allowed to drive in North Korea.
Foreigners generally are not allowed to use public buses or the subway.
North Korea has a functioning rail transport system; however delays occur often, sometimes for days.
On occasion, service may cease altogether before a traveler reaches his/her final destination.
Bicycles are unavailable for rental or purchase.
Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service between the United States and North Korea, the U.S. Federal Aviation Administration (FAA) has not assessed North Korea’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 web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:

Interim Consular Protecting Power: The United States does not maintain diplomatic or consular relations with the DPRK.
The U.S. Government therefore cannot provide normal consular protective services to U.S. citizens in North Korea.
On September 20, 1995, a consular protecting power arrangement was implemented, allowing the Swedish Embassy in the DPRK capital of Pyongyang to provide basic consular protective services to U.S. citizens traveling in North Korea who are ill, injured, arrested or who have died while there.

Consular Access:
There is no United States diplomatic or consular presence in the DPRK.
Americans traveling in the DPRK may receive limited consular services from the Swedish Embassy in Pyongyang.
Please see section above on “Medical Insurance” for address and contact information for the Swedish Embassy in Pyongyang.
U.S. citizens are encouraged to carry photocopies of their passport data and photo pages with them at all times so that, if questioned by DPRK officials, evidence of their U.S. citizenship is readily available. The U.S.- DPRK Interim Consular Agreement provides that North Korea will notify the Swedish Embassy within four days of an arrest or detention of an American citizen and will allow consular visits within two days after a request is made by the Swedish Embassy.
However, consular access has not been readily granted in cases where American citizens have been reported as being detained or held against their will by DPRK officials.
Moreover, delegations with ethnic Korean individuals, or delegations representing Korean-affiliated organizations in the U.S., are handled by DPRK structures that are well beyond the reach of diplomatic missions in Pyongyang.
Hence, in case of a situation requiring consular assistance, the Embassy’s access is even more limited.

Customs Regulations:
DPRK authorities may seize documents, literature, audio and videotapes, compact discs and letters deemed by North Korean officials to be pornographic, political or intended for religious proselytizing.
Persons seeking to enter North Korea with religious materials in a quantity deemed to be greater than that needed for personal use can be detained, fined and expelled.
It is advisable to contact the DPRK Mission to the United Nations or a DPRK embassy or a DPRK consulate in a third country for specific information regarding customs requirements.
Please see our information on customs regulations.

Dual Nationality:
The DPRK does not recognize dual nationality.
U.S. citizens of Korean heritage may be subject to military obligations and taxes on foreign source income.
For further information see our dual nationality flyer.
Additional questions on dual nationality may be directed to Overseas Citizens Services, SA-29, 4th Floor, 2201 C Street NW, Washington, DC
20520 or by telephone at 1-888-407-4747.

U.S. Government Economic Sanctions Against North Korea:
At this time, goods of North Korean origin may not be imported into the United States either directly or indirectly without prior notification to and approval of the U.S. Treasury Department’s Office of Foreign Assets Control (OFAC).
Exports to North Korea may be subject to licensing requirements.
Check with the Commerce Department’s Bureau of Industry and Security.
Most financial transactions between U.S. and North Korean citizens are authorized, provided they meet the criteria outlined in the June 19, 2000, and subsequent amendments to OFAC regulations.
All transactions ordinarily incident to travel to, from and within North Korea and to maintenance within North Korea are authorized, and U.S. travel service providers are allowed to organize group travel to North Korea.
Commercial U.S. ships and aircraft carrying U.S. goods are allowed to call at North Korean ports with prior clearance.
In May 2006, OFAC began prohibiting U.S. persons from “owning, leasing, operating or insuring any vessel flagged by North Korea.”
Full text of the regulation can be found in the Federal Register at http://www.fas.usda.gov/info/fr/2000/061900-a.txt.

The U.S. maintains various export controls and other sanctions on North Korea for counter- terrorism, nonproliferation and other reasons.
Exports of military and sensitive dual-use items are prohibited, as are most types of U.S. economic assistance.
The U.S. also abides by multilateral restrictions and sanctions with respect to North Korea, including those contained in recent United Nations Security Council Resolutions in response to the North Korean missile launches and nuclear test in July and October 2006.

For additional information, consult the U.S. Department of the Treasury, Office of Foreign Assets Control (OFAC) home page on the Internet at http://www.treasury.gov/offices/enforcement/ofac/.

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.
Local laws also may not afford the protections available to U.S. citizens under U.S. law.
Penalties for breaking local laws can be more severe than those in the United States for similar offenses.
Persons violating the law, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession of, use of, or trafficking in illegal drugs are strict, and convicted offenders often face long jail sentences and heavy fines.
North Korean security personnel may view unescorted travel inside North Korea by Americans who do not have explicit official authorization as espionage, especially when the U.S. citizens are originally from South Korea or are thought to understand the Korean language.
Security personnel may also view any attempt to engage in unauthorized conversations with a North Korean citizen as espionage.
Foreigners are subject to fines or arrest for unauthorized currency transactions or for shopping at stores not designated for foreigners.
It is a criminal act in North Korea to show disrespect to the country's current and former leaders, Kim Jong-Il and Kim Il-Sung, respectively.
Foreign journalists have been threatened when questioning the policies or public statements of the DPRK or the actions of the current leadership.

Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see additional 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: There is no U.S. embassy or consulate in North Korea.

U.S. citizens planning to visit North Korea are encouraged to register prior to departing the United States with the U.S. Embassy in Beijing if entering North Korea from China.
U.S. citizens planning to visit the Mount Kumgang tourism area or Kaesong from South Korea should register with the U.S. Embassy in Seoul.
Registration can be done on line through the State Department's travel registration web site
or in person, by telephone or fax, at the U.S. Embassy.

The Embassy of Sweden (U.S. Protective Power).
Americans who have a medical or consular emergency and who wish to contact the Swedish Embassy are reminded first to communicate this need to their North Korean escorts or guides.
Do not attempt to travel to the Swedish Embassy unescorted.
The Swedish Embassy (U.S. Protective Power) is located at Munsu-Dong District, Pyongyang.
The telephone and fax numbers for the Swedish Embassy (U.S. Protective Power) are:

Tel:
(850-2) 3817 485 (reception)
Tel:
(850-2) 3817 904, (850-2) 3817 907 (First Secretary)
Tel:
(850-2) 3817 908, (850-2) 3817 905 (Ambassador)
Fax:
(850-2) 3817 663

U.S. Embassy Beijing.
The American Citizen Services Unit of the U.S. Embassy in Beijing, China, is located at:
2 Xiushui Dong Jie, Beijing.
The Embassy is located near Ritan Park.
Telephone: (86-10) 6532-3431.
Fax: (86-10) 6532-4153.
Email: amcitbeijing@state.gov.
The Embassy Beijing web site is http://beijing.usembassy-china.org.cn/.

For after-hours emergencies please call (86-10)6532-3431 and ask for the Embassy duty officer.
U.S. Embassy Seoul.
The American Citizen Services Unit of the U.S. Embassy in Seoul, South Korea, is located at:
32 Sejong-no, Jongno-gu, Seoul.
The Embassy is located across the street from Sejong Cultural Center and next to the Ministry of Information and Communication/KT Building.

Telephone: (82-2) 397-4114.
Fax: (82-2) 2-397-4101.
E-mail: seoul_acs@state.gov.
The Embassy Seoul web site is http://seoul.usembassy.gov/.

For after-hours emergencies please call (82-2) 721-4114 and ask for the Embassy duty officer.
*
*
*
*
This replaces the Consular Information Sheet dated October 15, 2007, to update the sections on Country Description, Medical Insurance, Special Circumstances, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu, 2 Apr 2020 13:02:41 +0200 (METDST)

Seoul, April 2, 2020 (AFP) - North Korea remains totally free of the coronavirus, a senior health official in Pyongyang has insisted, despite mounting scepticism overseas as confirmed global infections near one million.   The already isolated, nuclear-armed North quickly shut down its borders after the virus was first detected in neighbouring China in January, and imposed strict containment measures.

Pak Myong Su, director of the anti-epidemic department of the North's Central Emergency Anti-epidemic Headquarters, insisted that the efforts had been completely successful.   "Not one single person has been infected with the novel coronavirus in our country so far," Pak told AFP.   "We have carried out preemptive and scientific measures such as inspections and quarantine for all personnel entering our country and thoroughly disinfecting all goods, as well as closing borders and blocking sea and air lanes."

Nearly every other country has reported coronavirus cases, with the World Health Organization saying on Wednesday that there were nearly one million confirmed infections globally.   Aside from China, South Korea endured one of the worst early outbreaks of the virus, which has claimed more than 45,000 lives around the world.   Experts have said the North is particularly vulnerable to the virus because of its weak medical system, and defectors have accused Pyongyang of covering up an outbreak.

The top US military commander in South Korea, General Robert Abrams, said Thursday that Pyongyang's assertion it had no cases was "untrue".   "I can tell you that is an impossible claim based on all of the intel that we have seen," Abrams told VOA News.   The North's military was "locked down" for 30 days in February and early March over the epidemic, he said.   "They took draconian measures at their border crossings and inside their formations to do exactly what everybody else is doing, which is to stop the spread," he added.

US President Donald Trump said previously North Korea "is going through something" and offered "cooperation in the anti-epidemic work", in a personal letter to North Korean leader Kim Jong Un.   And Choi Jung-hun, a former North Korean doctor who fled to the South in 2012, told AFP: "I heard there are many deaths in North Korea but the authorities are not saying that it's caused by the coronavirus."

-- 'Strict control' --
As part of its anti-virus efforts Pyongyang put thousands of its own people and hundreds of foreigners -- including diplomats -- into isolation and mounted disinfection drives, with state media constantly exhorting citizens to obey health directives.   Published images have shown universal face mask use, with the exception of leader Kim, who has never been seen wearing one, even though for several weeks the officers alongside him when he supervised firing exercises donned black coverings.

More recently his aides have also been seen without face masks, although defector Choi said that did not signal the North's containment efforts had been widely successful.   Pyongyang -- which is subject to multiple international sanctions over its nuclear and ballistic missile programmes -- has sought virus-related aid.   In February, Russia's foreign ministry said it provided Pyongyang with 1,500 coronavirus diagnostic test kits at its request "due to the persisting risk of the new COVID-19".

The United Nations has granted sanctions exemptions to relief groups including Doctors without Borders and UNICEF on items such as diagnostic kits, face masks, protective equipment and disinfectants.   Both Doctors Without Borders and UNICEF -- whose shipments were requested by North Korean authorities -- said that their supplies had arrived overland from China.   "DPRK has an overall lack of medical supplies and the latest diagnostic equipment," a Doctors Without Borders spokesperson told AFP, using the initials of the country's official name.   The World Health Organisation plans to spend $900,000 to support Pyongyang's coronavirus response activities, according to data posted on the UN Office for the Coordination of Humanitarian Affairs website.
Date: Fri, 21 Feb 2020 10:38:16 +0100 (MET)

Seoul, Feb 21, 2020 (AFP) - North Korea has cancelled the Pyongyang Marathon -- its biggest tourist money-spinner of the year -- because of the novel coronavirus outbreak, tour companies said Friday.   Beijing-based Koryo Tours, the official partner of the marathon, said on its website it had "received official confirmation today that the Pyongyang Marathon 2020 is cancelled".   "This is due to the ongoing closure of the North Korean border and COVID-19 virus situation in China and the greater region," it added.   Young Pioneer Tours, which specialises in budget trips to the isolated country, issued a similar statement.

The annual marathon is held in April as part of the anniversary commemorations for founder Kim Il Sung's birth in 1912, and attracts curious foreigners eager to run through the streets of the tightly controlled city.   Almost 1,000 Westerners took part last year, according to organisers, paying entry fees of up to $150 to do so.

North Korea has put itself into self-imposed isolation to protect itself from the outbreak raging in neighbouring China, which has infected more than 75,000 people and killed over 2,200.   Pyongyang has suspended flights and train services, banned tourists, and imposed 30 days of quarantine on resident foreigners.   North Korea is subject to multiple international sanctions over its nuclear and ballistic missile programmes and its medical infrastructure is weak, with chronic shortages of medicines and equipment.

As a result an outbreak would wreak havoc, analysts say.   It has taken similar measures before: it banned tourists for more than four months from October 2014 to keep out the Ebola virus, even though no cases had been reported in Asia.   North Korea clamped down for six months during the Severe Acute Respiratory Syndrome (SARS) outbreak of 2002-03, which killed nearly 650 people across mainland China and Hong Kong.
Date: Mon 23 Sep 2019
Source: Chosun [edited]

A paratyphoid fever epidemic has broken out recently in North Korea in the aftermath of Typhoon Lingling. The illness, which causes high fever and diarrhoea, has been spreading in South Hamgyong and South Pyongan provinces since typhoon Lingling hit the North, a source said Sunday [22 Sep 2019]. It is mainly transmitted by dirty water and human feces in the superannuated sewage systems and contaminated water supply.

The regime is reportedly restricting the movement of trains and vehicles to and from the 2 provinces. Meanwhile, the flooding of paddy and other grain fields in Hwanghae and Pyongan provinces is expected to devastate this year's [2019's] harvest.  [Byline: Kim Myong-song]
====================
[Paratyphoid fever is similar to typhoid fever in that both are enteric fever types of disease, although the former can be, but is not necessarily, less severe. The paratyphoid salmonellas are divided into A, B, and, rarely now, C. _Salmonella_ Paratyphi, also referred to as _S. enterica_ serotype Paratyphi, types B and C also have species, now serotypes, Schottmuelleri and Hirschfeldii, respectively. Like typhoid, paratyphoid is generally considered not to be a zoonosis, with [only] humans as the reservoir, but the paratyphoid bacillus has been isolated from domestic animals and fish.

In India, paratyphoid A has become an increasing problem, accounting for up to 45% of cases of enteric fever in 1998 (1). Although initially quite sensitive to antimicrobials, strains have become more resistant to quinolones; in contrast, _S._ Typhi has manifested resistance for some time.

In a report regarding differential risk factors for typhoid and paratyphoid in Indonesia, the authors found that the infections seemed to have distinct routes of transmission (2). Typhoid was associated with factors within a household (recent case in the house, no soap for handwashing, sharing of food from the same plate, no toilet in the house), whereas paratyphoid was associated with sources outside the household such as food from street vendors and flooding.

References
-------
1. Sood S, Kapil A, Dash N, et al.: Paratyphoid fever in India: an emerging problem. Emerg Infect Dis. 1999; 5: 483-4.
2. Vollaard AM, Ali S, van Asten Hagh, et al.: Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia. JAMA. 2004; 291: 2607-15.

A map of North Korea showing the location of these 2 adjacent provinces in the central part of the country can be seen at <http://annamap.com/north-korea/>. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps:
South Hamgyeong Province, North Korea:
South Pyongan Province, North Korea:
Date: Sun, 8 Sep 2019 14:18:07 +0200 (METDST)

Seoul, Sept 8, 2019 (AFP) - North Korean state media said Sunday five people had been killed in a powerful typhoon that destroyed farmland and damaged hundreds of buildings.   Typhoon Lingling, called Typhoon-13 in North Korea, hit the reclusive nuclear-armed state on Saturday afternoon, reported the official KCNA news service.

The impoverished and isolated country is vulnerable to natural disasters, especially floods, due in part to deforestation and poor infrastructure.   "According to data available from the State Emergency Disaster Committee, five persons were dead and three persons injured. The injured persons are now under treatment at hospitals," KCNA said.   More than 460 houses and at least a dozen public buildings were "completely or partly destroyed or inundated" by the typhoon, it said.

Crops were wiped out or damaged in 46,000 hectares (110,000 acres) of farmland -- roughly the area of the small European country of Andorra -- the report said, adding that recovery efforts were underway.   It came after South Korea's disaster agency reported three deaths caused by the same typhoon, according to Yonhap news agency.   On Saturday, KCNA reported that North Korean leader Kim Jong Un had berated officials for their "easygoing" attitude to the approaching storm.   According to that dispatch, Kim had convened an emergency meeting on Friday and said "dangerous circumstances" caused by the typhoon were "imminent", but that many in positions of authority were ill-prepared.
Date: Tue, 18 Jun 2019 06:40:09 +0200
By Sebastien BERGER

Pyongyang, June 18, 2019 (AFP) - On a grey stone column in Pyongyang, a mural shows Chinese and North Korean soldiers rushing into battle against US-led forces in the Korean War. Decades later, the monument is a regular stop for new waves of Chinese going to the North, this time as tourists.   Hundreds of soldiers and workers have been sprucing up the obelisk and its grounds in recent days ahead of a state visit to Pyongyang by Chinese President Xi Jinping this week.   An inscription on it lauds "the Chinese People's Volunteer Army, who fought with us on this land and smashed down the common enemy".   Their "immortal exploits" will "last forever", it proclaims, as will "the friendship forged in blood between the peoples of the People's Republic of China and the Democratic People's Republic of Korea".   Nearly 70 years after Mao Zedong sent millions of soldiers to save Kim Il Sung's troops from defeat as General Douglas MacArthur's men marched up the peninsula, China remains the isolated, nuclear-armed North's key diplomatic backer and main provider of trade and aid.

Now the Friendship Tower, as the monument is known, attracts growing hordes of Chinese tourists -- and the renovations suggest it may also be on Xi's itinerary.   Ordinary Chinese pay travel companies around 2,500 yuan ($360) for a standard three-day trip, arriving overland by train in Pyongyang to tour the capital's highlights, from the Arch of Triumph to Kim Il Sung Square.   The following day they head south to the Demilitarized Zone that has divided the peninsula since the two sides fought each other to a stalemate in 1953, before returning home.   "I'm very interested in North Korea and wanted to come to see what North Korea looks like," said Yu Zhi, a retiree from Anhui province visiting Pyongyang, telling AFP that she had a "special feeling" for the country.   "China is very friendly with North Korea," added her fellow traveller, a woman surnamed Jin. "We have been friends for generations."

- Lips and teeth -
It was not always so. Mao -- whose eldest son Mao Anying was among those killed in what China still calls the "War to Resist US Aggression and Aid the DPRK" -- described the neighbours as "as close as lips and teeth".   Ties then waxed and waned during the Cold War, when founder Kim Il Sung was adept at playing his Soviet and Chinese allies off against each other, and his grandson, the current leader Kim Jong Un, did not visit Beijing to pay his respects for more than six years after inheriting power.   But as he embarked on a flurry of diplomacy last year he made sure that Chinese President Xi Jinping was the first foreign head of state he met, and he has since done so three more times -- more often than Kim has seen any other leader.    Now Xi is going to reciprocate.

At the same time Chinese tourism to the North has reached record highs, according to travel industry sources -- so much so that Pyongyang has imposed a limit on arrivals.   No official figures are available from authorities on either side, but Simon Cockerell, general manager of Koryo Tours, the market leader for Western visitors, said there had been "a huge increase in Chinese tourists".   At peak times 2,000 people a day had been arriving in Pyongyang, he said. "That's far too many because there is no infrastructure to accommodate that many tourists, so problems with train tickets, with plane tickets, hotel space."   As a result North Korean authorities had themselves set a 1,000-a-day cap, he added, although it was unclear whether this applied across the industry or solely to Chinese, who make up the vast majority of arrivals.   "There are issues with just hundreds of people showing up at the same time."

- 'Choices being made' -
China has a proven willingness to use tourism as a geopolitical negotiating weapon -- it banned group tours to South Korea after it deployed a US anti-missile system, THAAD.   With nuclear negotiations at a stalemate the North remains subject to multiple UN Security Council sanctions, and the US imposed a travel ban on its own citizens visiting following the death of student Otto Warmbier, who had been jailed after trying to steal a propaganda poster.   But tourism is not among the sectors targeted by the UN, potentially enabling Beijing to use it as an incentive for its sometimes wayward ally.

The Chinese travel phenomenon is market-driven, rather than prompted by state order -- as well as the market offered by China's huge population, the two countries' border enables cheap overland journeys.   But simply enabling it to take place, said John Delury of Yonsei University in Seoul, meant "We can infer some choices are being made" by Beijing.   "We know it's a lever they can turn on and off," he said.   Even with the diplomatic process at a standstill, he added, "The Chinese think you have to use this window of opportunity to move things forward. There has to be a path on both sides and so something like opening up tourism is a good way to enable that."   At the Monument to the Three Charters for Reunification on the edge of Pyongyang, where two giant stone women form an arch over a road, a secondary school teacher from Shanghai called Peng said: "We are both socialist countries. I feel there are more Chinese coming to visit."
More ...

El Salvador

El Salvador - US Consular Information Sheet
May 01, 2008
COUNTRY DESCRIPTION: El Salvador is a democratic country with a developing economy. Tourism facilities are not fully developed. The capital is San Salvador, accessible by El Salvador's In
ernational Airport at Comalapa. Both the U.S. Dollar and the Salvadoran Colon are legal tender in El Salvador. While Colones are still accepted, the primary currency of El Salvador is the U.S. Dollar. Americans traveling with U.S. Dollars should not exchange them for Colones. Read the Department of State Background Notes on El Salvador for additional information.

ENTRY/EXIT REQUIREMENTS:
To enter the country, U.S. citizens must present a current U.S. passport and either a Salvadoran visa or a one-entry tourist card.
The tourist card may be obtained from immigration officials for a ten-dollar fee upon arrival in country.
U.S. travelers who plan to remain in El Salvador for more than thirty days can apply in advance for a multiple-entry visa, issued free of charge, from the Embassy of El Salvador in Washington, DC or from a Salvadoran consulate in Boston, Chicago, Dallas, Houston, Las Vegas, Long Island, Los Angeles, Miami, New York City, or San Francisco.
Travelers may contact the Embassy of El Salvador at 1400 16th Street NW, Washington, DC
20036, tel. (202) 265-9671, 265-9672; fax (202) 232-3763; e-mail: correo@elsalvador.org or visit the Embassy's web site at http://www.elsalvador.org.
When applying for a visa, travelers may be asked to present evidence of U.S. employment and adequate finances for their visit at the time of visa application or upon arrival in El Salvador.
For passengers departing by air, El Salvador has an exit tax of $32.00 which is usually included in the price of the airline ticket.

Travelers should be aware that El Salvador's entry requirements vary in accordance with agreements the country has with foreign governments.
Citizens of several countries in addition to the United States may enter El Salvador with a current passport and either a visa or tourist card.
Citizens of many other countries, including many Latin American and western European nations, may enter with only a current passport.
However, citizens of most nations are required to present both a current passport and a visa to enter El Salvador.
Non-U.S. citizen travelers are advised to contact a Salvadoran embassy or consulate to determine the entry requirements applicable to them.

In June 2006, El Salvador entered into the “Central America-4 (CA-4) Border Control Agreement” with Guatemala, Honduras, and Nicaragua.
Under the terms of the agreement, citizens of the four countries may travel freely across land borders from one of the countries to any of the others without completing entry and exit formalities at immigration checkpoints.
U.S. citizens and other eligible foreign nationals, who legally enter any of the four countries, may similarly travel among the four without obtaining additional visas or tourist entry permits for the other three countries.
Immigration officials at the first port of entry determine the length of stay, up to a maximum period of 90 days.
Foreign tourists who wish to remain in the four-country region beyond the period initially granted for their visit must request a one-time extension of stay from local immigration authorities in the country where the traveler is physically present, or they must leave the CA-4 countries and reapply for admission to the region.
Foreigners “expelled” from any of the four countries are excluded from the entire CA-4 region.
In isolated cases, the lack of clarity in the implementing details of the CA-4 Border Control Agreement has caused temporary inconvenience to some travelers and has resulted in others being fined more than one hundred dollars or detained in custody for 72 hours or longer.

Airlines operating out of El Salvador International Airport require all U.S. citizen passengers boarding flights for the United States (including U.S.-Salvadoran dual nationals) to have a current U.S. passport.
U.S. citizens applying for passports at the U.S. Embassy in San Salvador are reminded that proof of citizenship and identity are required before a passport can be issued.
Photographic proof of identity is especially important for young children because of the high incidence of fraud involving children.
Since non-emergency passports are printed in the United States, and not at the U.S. Embassy in El Salvador, citizens submitting applications in El Salvador should be prepared to wait approximately one week for receipt of their new passports.

The U.S. Embassy in El Salvador reminds U.S. citizen travelers that their activities in El Salvador are governed by Salvadoran law and the type of visa they are issued.
Under Salvadoran law, all foreigners who participate directly or indirectly in the internal political affairs of the country (i.e. political rallies, protests) lose the right to remain in El Salvador, regardless of visa status or residency in El Salvador.

Visit the Embassy of El Salvador’s web site at http://www.elsalvador.org
for the most current visa information.

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

In an effort to prevent international child abduction, many governments have initiated procedures at entry/exit points.
These often include requiring documentary evidence of relationship and permission for the child's travel from the parent(s) or legal guardian if not present.
Having such documentation on hand, even if not required, may facilitate entry/departure.
Minors traveling on Salvadoran passports and who are traveling alone, with one parent or with a third party must have the written permission of the absent parent(s) or legal guardian to depart El Salvador.
A Salvadoran notary must notarize this document.
If the absent parent(s) or legal guardian is (are) outside of El Salvador, the document must be notarized by a Salvadoran consul.
If a court decree gives custody of the child traveling on a Salvadoran passport to one parent, the decree and a passport will allow the custodial parent to depart El Salvador with the child.
Although Salvadoran officials generally do not require written permission for non-Salvadoran minors traveling on U.S. or other non-Salvadoran passports, it would be prudent for the parents of minor children traveling on U.S. passports to provide similar documentation if both parents are not traveling with their children.

SAFETY AND SECURITY: Most travelers to El Salvador experience no safety or security problems, but the criminal threat in El Salvador is critical.
Random and organized violent crime is endemic throughout El Salvador.
U.S. citizens have not been singled out by reason of their nationality, but are subject to the same threat as all other persons in El Salvador.
See the section below on Crime for additional related information.
Political or economic issues in the country may give rise to demonstrations, sit-ins or protests at any time or place, but these activities occur most frequently in the capital or on its main access roads.
U.S. citizens are cautioned to avoid areas where demonstrations are being held and to follow local news media reports or call the U.S. Embassy for up-to-date information.
Information about demonstrations also is available as “Security Alerts” on the U.S. Embassy home page at http://elsalvador.usembassy.gov.
Many Salvadorans are armed, and shootouts are not uncommon.
Foreigners, however, may not carry guns even for their own protection without first obtaining a firearms license from the Salvadoran government.
Failure to do so will result in the detention of the bearer and confiscation of the firearm, even if it is licensed in the United States.
Armed holdups of vehicles traveling on El Salvador's roads are increasing, and U.S. citizens have been victims in various incidents.
In one robbery, an American family was stopped by gunmen while driving during the day on the Pan American highway in the Santa Ana Department.
In another incident, an American citizen passenger was robbed after the van in which she was riding was carjacked by armed men.
The van was stopped at a traffic light on the busy road between Comalapa International Airport and San Salvador shortly after dark.
Strong undertows and currents can make swimming at El Salvador's Pacific Coastal beaches extremely dangerous for even strong and experienced swimmers.
As an example of this hazard, during a single seven-day holiday period, nine Salvadoran citizens drowned while swimming at Pacific beaches.
In one month alone, three U.S. citizens drowned while swimming at Pacific beaches in La Libertad and La Paz Departments.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, including the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: The U.S. Embassy considers El Salvador a critical crime-threat country.
The homicide rate in the country increased 25 percent from 2004 to 2007, and El Salvador has one of the highest homicide rates in the world.
Violent crimes, as well as petty crimes are prevalent throughout El Salvador, and U.S. citizens have been among the victims. The Embassy is also aware that there has been at least one rape of an American minor and one attempted rape of an American adult in the past year.
Travelers should avoid displaying or carrying valuables in public places.
Passports and other important documents should not be left in private vehicles.
Armed assaults and carjacking take place both in San Salvador and in the interior of the country, but are especially frequent on roads outside the capital where police patrols are scarce.
Criminals have been known to follow travelers from the international airport to private residences or secluded stretches of road where they carry out assaults and robberies.
Armed robbers are known to shoot if the vehicle does not come to a stop.
Criminals often become violent quickly, especially when victims fail to cooperate immediately in surrendering valuables.
Frequently, victims who argue with assailants or refuse to give up their valuables are shot.
Kidnapping for ransom continues to occur, but has decreased in frequency since 2001.
U.S. citizens in El Salvador should exercise caution at all times and practice good personal security procedures throughout their stay.
The U.S. Embassy warns its personnel to drive with their doors locked and windows raised, to avoid travel outside of major metropolitan areas after dark, and to avoid travel on unpaved roads at all times because of criminal assaults and lack of police and road service facilities.
Travelers with conspicuous amounts of luggage, late-model cars or foreign license plates are particularly vulnerable to crime, even in the capital.
Travel on public transportation, especially buses, both within and outside the capital, is risky and not recommended.
The Embassy advises official visitors to use radio-dispatched taxis or those stationed in front of major hotels.
U.S. citizens using banking services should be vigilant while conducting their financial exchanges either inside local banks or at automated teller machines.
There have been several reports of armed robberies in which victims appear to have been followed from the bank after completing their transactions.
Visitors to El Salvador should use caution when climbing volcanoes or hiking in other remote locations.
Armed robberies of climbers and hikers are common.
Mine-removal efforts ceased several years ago, but land mines and unexploded ordnance in backcountry regions still pose a threat to off-road tourists, backpackers, and campers.
The Embassy strongly recommends engaging the services of a local guide certified by the national or local tourist authority when hiking in backcountry areas, even when within the national parks.
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 U.S. Embassy.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the U.S. Embassy for assistance.
The Embassy 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 crime is solely the responsibility of local authorities, consular officers can help you understand the local criminal justice process and find an attorney if needed.

Victims of crime should bear in mind that law enforcement resources are limited and judicial processes are uneven in El Salvador.
Many crimes in the country go unsolved and the likelihood for redress through the judicial system is limited.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: There are few private hospitals with an environment that would be acceptable to visiting Americans.
The Embassy recommends that these hospitals be used only for emergency care, to stabilize a condition prior to returning to the U.S. for definitive evaluation and treatment.
Private hospitals and physicians expect upfront payment (cash or, for hospitals, credit card) for all bills.
Priority Ambulance (503-2264-7911) is the only ambulance service in San Salvador that has trained personnel and medical equipment to manage most emergencies.
Not all medicines found in the U.S. are available in El Salvador.
Medicines often have a different brand name and are frequently more expensive than in the U.S.
No specific vaccinations are required for entry into El Salvador from the United States. Travelers coming from countries where yellow fever is endemic must have had a yellow fever vaccination in order to enter the country.
For more information visit El Salvador’s Immigration web site at http://www.seguridad.gob.sv/Web-Seguridad/Migracion/migracion.htm.

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

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
It may be possible to purchase supplemental coverage for travel.
U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States.
Separate insurance should be obtained for medical evacuation, as it may cost in excess of $50,000.
Many travel agents and private companies offer insurance plans that will cover health care expenses incurred overseas, including emergency medical services and even transportation of remains, in the event of death.
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 El Salvador is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Road conditions throughout El Salvador are not up to U.S. standards.
However, the rebuilding of major roads following the earthquakes in 2001 is nearly completed.
Mini-buses, buses, and taxis are often poorly maintained.
Drivers are often not trained, and generally do not adhere to traffic rules and regulations.
The U.S. Embassy recommends that its personnel avoid using mini-buses and buses, and use only taxis that are radio-dispatched or those stationed in front of major hotels.
Robberies and assaults on buses are commonplace.
Because of inconsistent enforcement of traffic laws in El Salvador, drivers must make an extraordinary effort to drive defensively.
Passing on blind corners is commonplace.
Salvadoran law requires that the driver of a vehicle that injures or kills another person must be arrested and detained until a judge can determine responsibility for the accident.
This law is uniformly enforced.
Visitors to El Salvador may drive on their U.S. license for up to thirty days.
After that time, a visitor is required to obtain a Salvadoran license.
Please refer to our Road Safety page for more information.
Visit the web site of El Salvador’s national tourist office and national authority responsible for road safety at http://www.elsalvadorturismo.gob.sv/.
Further information on traffic and road conditions is available in Spanish from Automovil Club de El Salvador, at telephone number 011-503-2221-0557.
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of El Salvador’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of El Salvador’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:
Travelers intending to carry cell phones from the United States should check with their service provider to determine if the service will be available in El Salvador.
Credit cards are acceptable for payment in many-but not all-retail stores and restaurants in major cities.
Automatic teller machines with access to major U.S. bank networks are widely available in San Salvador, but less prevalent elsewhere in the country.
Please see our information on Customs Information.
DISASTER PREPAREDNESS:
El Salvador is an earthquake-prone country.
Flooding and landslides during the rainy season (June to November) also pose a risk.
On October 4, 2005, the Government of El Salvador declared a nation-wide state of emergency following major flooding caused by a series of storms.
More than 50 deaths were confirmed as attributed to landslides and flooding at that time and over 34,000 residents were evacuated to temporary shelter.
The Llamatepec Volcano, located approximately 50 kilometers west of San Salvador, erupted briefly on October 1, 2005, casting rocks and volcanic ash onto neighboring regions and producing two confirmed deaths.
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/.
An earthquake measuring 7.6 on the Richter scale devastated much of El Salvador on January 13, 2001.
A second earthquake on February 13, 2001, measured 6.6 on the Richter scale, and caused significant additional damage and loss of life.
Reconstruction efforts are largely complete and the country has returned to normal.
Additional information in Spanish about earthquakes (sismos) in El Salvador can be found on the Government of El Salvador’s web page at http://www.snet.gob.sv/.
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 offences.
Persons violating El Salvador’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in El Salvador 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.

Guns:
El Salvador has strict laws requiring a locally obtained license to possess or carry a firearm in the country.
The Embassy strongly advises persons without a Salvadoran firearms license not to bring guns into the country or use a firearm while in El Salvador.
During a three-month period in 2006, three U.S. citizens were arrested in separate incidents for firearms violations.
In each instance, the individuals complied with airline procedures, declared the firearm on a Customs form upon arrival at El Salvador's Comalapa International Airport, and were allowed to depart the airport without hindrance.
However, when the individuals returned to the airport and declared the weapons to airline employees, they were arrested by Salvadoran police, not for violating aviation regulations but for having carried an unlicensed firearm while in El Salvador.
The Embassy cannot intervene in the judicial process when a U.S. citizen is charged with a firearms violation.
Conviction for possessing an unlicensed firearm can carry a prison sentence of three to five years.

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 El Salvador are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, and to obtain updated information on travel and security within El Salvador.
Americans without Internet access may register directly with the Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The Consular Section of the U.S. Embassy in San Salvador is located at Final Boulevard Santa Elena Sur, Urbanizacion Santa Elena, Antiguo Cuscatlan, La Libertad, telephone 011-503-2501-2999, fax 011-503-2278-5522, e-mail: CongenSansal@state.gov.
The Embassy's web site can be accessed at http://sansalvador.usembassy.gov/.
The Consular Section is open for U.S. citizens’ services from 8:15 a.m. to 11:30 a.m. weekdays, excluding U.S. and Salvadoran holidays.
After business hours, the Embassy can be contacted by telephone at 011-503-2501-2316 or 011-503-2501-2253.
For any questions concerning U.S. visas for either temporary travel to or permanent residence in the U.S., please contact our regional U.S. Visa Information Center.
From El Salvador, the Visa Information Center may be reached by calling 900-6011 from any landline operated by Telecomm, or by purchasing a VISAS-USA calling card from any location that sells Telefonica phone cards.
Calling instructions are on the back of the card.
Calls using the 900 number cost approximately $2.15 per minute and will be charged to the caller's telephone bill.
The Telefonica phone card costs $15.00 and permits a seven-minute call.
From the U.S., the Visa Information Center can be contacted by dialing 866-730-2089 and charging the call to a Visa or MasterCard credit card.
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This replaces the Country Specific Information for El Salvador dated October 2007, to update the format and sections on Entry/Exit Requirements, Crime, Information for Victims of Crime, Medical Facilities and Health Information, Disaster Preparedness, and Registration and Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu, 30 May 2019 14:19:59 +0200

San Salvador, May 30, 2019 (AFP) - A 6.6 magnitude earthquake struck off the coast of El Salvador on Thursday near the capital but authorities said there were no initial reports of casualties or damage.   The quake was so strong it was likely felt throughout Central America, officials said.   The quake struck in the Pacific Ocean around 25 miles (40 kilometres) south of San Salvador at a depth of 40 miles (65 km), according to the US Geological Survey.

The Salvadoran environment ministry said the quake was even stronger, with a magnitude of 6.8.   The Pacific Tsunami Warning Center did not issue an alert for the quake. But the Environment Ministry issued one of its own, predicting sea level variations of up to 12 inches (30 centimetres).   However, Environment Minister Lina Pohl said the alert was sent "as a protocol."   Coastal residents should avoid entering the water for four hours after the quake, the ministry said on Twitter.

President-elect Nayib Bukele, who takes office on Saturday, said on Twitter that the earthquake was felt "throughout 100 percent of the country."   Police and firemen fanned out across the country to evaluate the situation and reported "no serious or generalized damage," the Civil Protection department said on Twitter.   The Education Ministry cancelled classes in coastal areas.   In the coastal town of Puerto de la Libertad, authorities evacuated families who live near the water.   Rattled residents stood outside their homes Thursday morning digesting the quake.   "The quake was very strong. Thank God, nothing happened to me. But we are taking precautions," one of them, Maria Valencia, told Canal 21 television.

The Environment Ministry reported as many as 12 aftershocks ranging from 3.3 to 4.9 in magnitude.   In San Salvador, police and soldiers patrolled streets but people largely stayed indoors despite the scare from the quake.   The government gave slightly different figures for its location.   It placed it more shallow than the USGS at 48 kilometres, and said the epicentre was a bit further out to sea, some 66 kilometres from Puerto de La Libertad.
Date: Mon 1 Apr 2019
Source: La Prensa Grafica, El Salvador [in Spanish, trans., edited]

According to MINSAL [El Salvador's Ministry of Public Health] figures for week 12 (updated till 23 Mar) 2019, the number of cases of typhoid fever remains high. They have reported 517 cases in 2019, compared to 313 cases in 2018, which is equivalent to an increase of 65%.

The head of health surveillance of the ISSS [El Salvador's Social Security Institute], Jose Adan Martinez, said that the figures themselves reflect an increase of 44%. It is worth mentioning that the MINSAL presents the data at the national level, which include those of the ISSS, FOSALUD [El Salvador Solidarity Fund for Health], and other institutions.

"We have been experiencing this upward trend in the disease since the beginning of 2019, and it has increased in the last week," Martinez said.

He also recalled that this is a disease transmitted by water or food contamination. "Given the scarcity of water that has been in some sectors of San Salvador, which is the most affected department, [the increase] could be due to the lack of hygiene measures that the population is taking, both for the preparation of food and for water consumption," he added.  [Byline: Edwin Teos]
========================
[Vaccine intervention is an important step, as increasing antimicrobial resistance in the typhoid bacillus in Asia has made treatment more difficult.

Typhoid fever, so-called enteric fever caused by _Salmonella enterica_ serotype Typhi, has a totally different presentation from that of the more common kinds of salmonellosis. Epidemiologically, usually spread by contaminated food or water, typhoid is not a zoonosis like the more commonly seen types of salmonellosis. Clinically, vomiting and diarrhoea are typically absent; indeed, constipation is frequently reported. As it is a systemic illness, blood cultures are at least as likely to be positive as stool in enteric fever, particularly early in the course of the infection, and bone marrow cultures may be the most sensitive.

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

[HealthMap/ProMED-mail map:
Date: Sun 29 Jul 2018
Source: La Prensa Grafica, El Salvador [in Spanish, machine trans. edited]
<https://www.laprensagrafica.com/elsalvador/Casos-de-tifoidea-se-duplicaron-y-triplicaron-20180728-0055.html>

All the departments of the country experienced significant rises in typhoid fever in the 1st 6 months of 2018, with the exception of Cabanas, in comparison with the figures for the 1st 6 months of 2017. The statistics were provided by the Information and Response Office of the Ministry of Health (MINSAL), at the request of The Graphic Press. According to the data, the departments that registered the highest increases were San Miguel, San Salvador, La Paz and Sonsonate. Throughout 2017, San Miguel, for example, reported 9 cases of typhoid fever; while only between January and June 2018, cases rose to 17.

In San Salvador, cases for 2017 totalled 427, but during the 1st months of 2018 only, they totalled 653. Although the increase was noticed by the Salvadoran Social Security Institute (ISSS), through a press release issued on 8 Feb 2018, the Ministry of Health (MINSAL) spent several weeks without issuing any report with official data and did not speak of the outbreak until several months later, a few days after the end of June 2018. After the ISSS report, some physicians and infectious disease experts also reported an increase in cases of infection caused by the _Salmonella_ Typhi bacterium in private clinics and hospitals.

By mid-February 2018, MINSAL confirmed that there was a 30% increase in cases, compared to the same period in 2017: from 56 to 73. However, it did not include the statistics in its weekly epidemiological surveillance bulletins, for which the medical association denounced the lack of transparency with respect to the preventive management of the disease, which if not treated in time can be fatal. The Minister of Health, Violeta Menja­var, even admitted at that time that there was no vaccine against typhoid fever in the public health network. "In the vaccination scheme, there is not one; so that we can produce a vaccine against typhoid, we have to wait for the one being prepared by the Pan American Health Organization (PAHO), since there is not one that meets the conditions; we have incorporated it into the vaccination scheme," he explained.

The abysmal difference between 622 confirmed cases in the ISSS network, which serves only 17% of the population, and zero confirmed cases in the national public network, which serves more than 80% of the population, generated even more doubts than certainties about the management of the disease by the MINSAL. Finally, in the 2nd half of June 2018, Minister Menja­var acknowledged that there was an outbreak of typhoid fever that affected mainly 28 municipalities in the country, although she suggested that the effect was moderate and not high. "This year [2018], we have almost double that of 2017; it has happened that in 28 municipalities we have an epidemic outbreak; it is not epidemic because that would have to be in the entire country," she said.

The total numbers of cases of 2017 were 675, while the total between January and June of 2018 rose to 937. The authorities have reiterated on several occasions that this disease is directly related to the hygiene habits of people, so they have emphasized, to the point of exhaustion, that the population should take necessary precautions to avoid contagion, especially with surveillance of water quality in water used to cook food or for consumption. Drinking water, however, is the product that has been most scarce in recent months. At the end of March 2018, there was chaos due to lack of drinking water at the start of Holy Week, as the Water and Sewerage Administration (ANDA) reported one of its 48-inch main pipes damaged, which affected the San Pedro Metropolitan Area, Salvador (AMSS).

Less than a month ago, ANDA again left a million inhabitants of the AMSS without water, also due to another fault in the same 48-inch pipeline. The municipalities with the highest figures of typhoid fever between January and June 2018 were San Salvador, (205), Mejicanos (70), Soyapango (59) and Apopa (54), in the capital of the country. After San Salvador, which totaled 653 cases in that period, is La Libertad, with 85 cases. [Byline: Evelyn Machuca]
===========================
[Typhoid fever, so-called enteric fever caused by _Salmonella enterica_ serotype Typhi, has a totally different presentation from that of the commoner kinds of salmonellosis. Epidemiologically, usually spread by contaminated food or water, typhoid is not a zoonosis like the more commonly seen types of salmonellosis. Clinically, vomiting and diarrhoea are typically absent; indeed, constipation is frequently reported.

As it is a systemic illness, blood cultures are at least as likely to be positive as stool in enteric fever, particularly early in the course of the infection, and bone marrow cultures may be the most sensitive. The symptoms of classical typhoid fever typically include fever, anorexia, lethargy, malaise, dull continuous headache, non-productive cough, vague abdominal pain, and constipation. Despite the (often high) fever, the pulse is often only slightly elevated.

During the 2nd week of the illness, there is protracted fever and mental dullness, classically called coma vigil. Diarrhoea may develop but usually does not. Many patients develop hepatosplenomegaly (both liver and spleen enlarged). After the 1st week or so, many cases develop a maculopapular rash on the upper abdomen. These lesions ("rose spots") are about 2 cm (0.78 in) in diameter and blanch on pressure. They persist for 2-4 days and may come and go.

Mild and atypical infections are common. The word typhoid (as in typhus-like) reflects the similarity of the louse-borne rickettsial disease epidemic typhus and that of typhoid fever; in fact, in some areas, typhoid fever is still referred to as abdominal typhus. -  ProMED Mod.LL]

[HealthMap/ProMED map available at: El Salvador:
<http://healthmap.org/promed/p/21>]
Date: Fri 15 Jun 2018 12:02 AM CST
El Mundo, El Salvador [in Spanish, trans., edited]
<http://elmundo.sv/ministerio-de-salud-dice-hay-un-brote-epidemico-de-fiebre-tifoidea/>

The Minister of Public Health, Violeta Menja­var, said that there is an epidemic outbreak of typhoid fever in some 26 municipalities, not in the entire country. "We have salmonellosis and within it some typhoid cases, an increase of cases in 26 municipalities, which have a mild to moderate affectation ... What does that mean? We are talking about an epidemic outbreak because it is localized; it is not a national epidemic, "Menja­var said on [14 Jun 2018].

The head of the health surveillance unit, Hector Ramos, said that they had 644 cases suspected of typhoid but that it is too early to speak of a decrease. "We have to wait but it seems that it is starting to level off and we hope that it will continue to decrease," said Minister Menja­var. The minister explained that the increase was a surprise because the winter was early as a result of the La Nina phenomenon.

The municipalities moderately affected are:
San Antonio Pajonal in the department of Santa Ana;
Santa Tecla in La Libertad;
and Apopa, Cuscatancingo, San Salvador, Mejicanos, Panchimalco, Ilopango,
and Soyapango in the department of San Salvador.
**************************************
Date: Tue 12 Jun 2018 12:00 AM CST
Source:  El Mundo, El Salvador [in Spanish, trans. ProMED Sr.Tech.Ed.MJ, summ., edited]
<http://elmundo.sv/tifoidea-ha-afectado-nueve-municipios-moderadamente/>

The epidemiological bulletin of the Salvador Ministry of Public Health and Social Assistance (MINSAL) reported moderate activity of typhoid fever in 9 of the country's 262 municipalities. From January 2018 to date, 469 suspected cases of typhoid fever have been hospitalized, of which 346 have been confirmed by blood culture.

In addition to the 9 municipalities moderately affected, there are 19 municipalities mildly affected and none severely affected. During the week of 4 Jun 2018, the epidemiological bulletin reported 644 suspected cases between January and May 2018. 376 cases were reported during the same period in 2017. One person has died in 2018 and one person died in 2017.
========================= 
[Typhoid fever, so-called enteric fever caused by _Salmonella enterica_ serotype Typhi, has a totally different presentation from that of the commoner kinds of salmonellosis. Epidemiologically, usually spread by contaminated food or water, typhoid is not a zoonosis like the more commonly seen types of salmonellosis. Clinically, vomiting and diarrhoea are typically absent; indeed, constipation is frequently reported.

As it is a systemic illness, blood cultures are at least as likely to be positive as stool in enteric fever, particularly early in the course of the infection, and bone marrow cultures may be the most sensitive. The symptoms of classical typhoid fever typically include fever, anorexia, lethargy, malaise, dull continuous headache, non-productive cough, vague abdominal pain, and constipation.

Despite the often high fever, the pulse is often only slightly elevated. During the 2nd week of the illness, there is protracted fever and mental dullness, classically called coma vigil. Diarrhoea may develop but usually does not. Many patients develop hepatosplenomegaly (both liver and spleen enlarged). After the 1st week or so, many cases develop a maculopapular rash on the upper abdomen.

These lesions ("rose spots") are about 2 cm (0.78 in) in diameter and blanch on pressure. They persist for 2-4 days and may come and go. Mild and atypical infections are common. The word typhoid (as in typhus-like) reflects the similarity of the louse-borne rickettsial disease epidemic typhus and that of typhoid fever; in fact, in some areas, typhoid fever is still referred to as abdominal typhus. - ProMED Mod.LL]

[Maps of El Salvador: <http://www.lib.utexas.edu/maps/americas/elsalvador.jpg>
and <http://healthmap.org/promed/p/21>.]
Date: Sat 12 May 2918
Source: The New England Journal of Medicine (NEJM) [edited]

ref: Gomez CA, Banaei N. _Trypanosoma cruzi_ reactivation in the brain. N Engl J Med. 2018; 378(19):1824. doi: 10.1056/NEJMicm1703763.
----------------------------------------------------------------------
A 31-year-old man who had recently received a diagnosis of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome [AIDS] presented to the emergency department with headache, confusion, and gait instability.

He had immigrated to the United States from El Salvador 6 years earlier. Fever (temperature, 38.9 deg C [102 deg F]) and an ataxic gait were noted on physical examination.

Laboratory test results were notable for a CD4 positive cell count of 60 per cubic millimeter, an HIV viral load of 409 000 copies per milliliter, a positive result for IgG antibodies to _Toxoplasma gondii_, and a negative result for IgM antibodies to _T. gondii_.

Magnetic resonance images of the brain showed a mass measuring 8 by 7 by 6 cm in the corpus callosum and the white matter of the right parietal and occipital subcortical lobes.

Cytologic examination of a brain aspirate revealed intracellular organisms, with prominent kinetoplasts (masses of mitochondrial DNA) visible within macrophages and astrocytes.

The organisms were identified as _Trypanosoma cruzi_ on the basis of partial protozoal 28S ribosomal RNA sequencing. After vector-borne transmission, which occurs mainly in Central America, South America, and some rural areas in Mexico, _T. cruzi_ infection can persist asymptomatically. Immunosuppression predisposes patients to _T. cruzi_ reactivation in the brain, which can manifest as a brain abscess or meningoencephalitis.

The patient received benznidazole, followed by the initiation of antiretroviral therapy. After 2 weeks of treatment, clinical improvement was noted in his mentation and gait.
======================
[The case underlines that one has to expect the unusual in immunocompromised patients and underlines that biopsy is needed also from the brain in order to reach the correct diagnosis. The guide to the suspicion of a _T. cruzi_ infection is the history of immigration from an endemic area. We do not know if the patient was seropositive for _T. cruzi_ antibodies. - ProMED Mod.EP]

[HealthMap/ProMED-mail map
More ...

World Travel News Headlines

Date: Mon, 6 Apr 2020 13:48:38 +0200 (METDST)

Vienna, April 6, 2020 (AFP) - Austria could start easing its coronavirus lockdown measures from next week, Chancellor Sebastian Kurz said Monday, but warned that this depended on citizens abiding by social distancing rules.   "The aim is that from April 14... smaller shops up to a size of 400 square metres, as well as hardware and garden stores can open again, under strict security conditions of course," Kurz said at a press conference.

He said that as of April 14, the current obligation to cover one's mouth and nose in supermarkets will be extended to other shops and on public transport.   He added that if the government's timetable goes to plan, larger shops will reopen on May 1.   From mid-May hotels, restaurants and other services could also start to open their doors again in stages, Kurz said, adding that a decision on this would be taken at the end of April.

- 'Strongest decline in EU' -
However, he said that the restrictions on movement that Austria has introduced to fight the spread of COVID-19 remained in place.   He urged Austrians not to celebrate Easter with people outside their household, adding that he would not be seeing his own parents.   Schools will remain closed until at least mid-May and public events will remain banned until the end of June.

If trends in infection begin to worsen again, the government "always has the possibility to hit the emergency brake" and re-introduce restrictions, Kurz said.   He pointed to the example of Singapore, which initially had managed to contain the spread of the virus but was now facing a second wave of infections.   Kurz also warned that international travel would continue to be severely hampered for the foreseeable future, with discussions ongoing at an EU level as to how restrictions could be eased.   Kurz was speaking alongside several cabinet colleagues who entered wearing face masks before taking them off to speak behind specially erected screens.

- Reopening parks -
Interior Minister Karl Nehammer announced that the government also hoped to re-open public parks on April 14.   He clarified that the punishment for not adhering to mask-wearing in shops and on public transport would be 50 euros ($54).   Health Minister Rudolf Anschober said he was encouraged by the downward trend in the growth rate for infections, adding: "We have the strongest coronavirus decline in the EU".   The country of 8.8 million people currently has 12,058 confirmed infections, with 204 deaths and 2,998 recoveries.   In mid-March the increase in infections was running at around 40 percent, which unchecked would have led to two million people in Austria contracting the virus by now, Anschober said.

The daily rate of increase is now at 1.6 percent with a successful flattening of the curve, Anschober said, although he emphasised the rate must be brought down yet further.   Anschober also welcomed the fact that Austria was "well ahead" of many other countries when it comes to testing, with 111,000 tests carried out so far.   He said that great progress was being made on antibody tests and that he hoped these could be used in infection "hotspots".   Also on Monday authorities in western Tyrol, Austria's worst hit region, said that the quarantine ordered for the region's 750,000 people would be lifted on Tuesday.
Date: Mon, 6 Apr 2020 13:40:30 +0200 (METDST)

Berlin, April 6, 2020 (AFP) - Germany will put all arriving travellers in quarantine for 14 days, the interior ministry said Monday, as Berlin ramps up entry curbs to fight the coronavirus pandemic.   The measure, which will come into force on April 10, is expected to affect mostly German or EU nationals and residents, as the European Union has already banned all arrivals from outside the bloc.

Workers in the health sector living outside Germany in border regions will be exempted from the restriction, which will also not apply for business travellers entering for a short period of time.   Chancellor Angela Merkel's government had decided on the toughened rule during a cabinet meeting focus on the battle against the coronavirus pandemic.

During the same meeting, which is ongoing, ministers agreed that 100 percent of loans made by banks to small- and medium-sized firms will be guaranteed by the state.   The federal government will stand fully behind 500,000 euros ($540,000) of lending to companies with up to 50 employees and 800,000 euros for larger ones, upping its guarantee level from a previous 80 percent for large firms or 90 percent for smaller ones.
Date: Mon, 6 Apr 2020 13:26:30 +0200 (METDST)

Madrid, April 6, 2020 (AFP) - Spain declared Monday a fourth consecutive drop in the number of coronavirus-related deaths with 637 over the past 24 hours, the lowest number in nearly two weeks.   Fatalities, which were sharply down on the record 950 on Thursday, brought the total deaths in the country to 13,055, second only to Italy.   The official figures represent an increase of 5.1 percent over the last 24 hours, compared to a 4.8 percent rise on Sunday and a 32.63 percent leap as recently as March 21.

The number of new infections also slowed, rising 3.3 percent to 135,032, down from a rise of 24.8 percent on March 21.   "These figures confirm again this downwards tendency which we have been observing," said Maria Jose Sierra of the health ministry's emergencies coordination unit.   Over 40,000 coronavirus patients have been discharged from hospital, or nearly 30 percent of all confirmed cases of the disease, she added.   With deaths and new infections falling the Spanish government is studying how to gradually ease the lockdown imposed on the country of 47 million people on March 14. It has been  extended until April 25.

The government plans to ramp up testing to be able to isolate people who are infected but not showing symptoms and is mulling requiring all people to wear face masks in public to curb the spread of the disease.   Four Spanish firms are currently producing 245,000 coronavirus tests per week, Foreign Minister Arancha Gonzalez Laya said during a television interview on Monday.   "During the coming weeks we will multiply by three the capacity of our companies to supply the market" with tests, she added.   As for face masks, the minister said "we will probably all have to learn to use them as a prophylactic, at least until there is a vaccine" against COVID-19.
Date: Mon, 6 Apr 2020 12:53:51 +0200 (METDST)

Kinshasa, April 6, 2020 (AFP) - Kinshasa on Monday closed off its upmarket business district for two weeks and began a large-scale disinfection operation in a bid to clean up DR Congo's main suspected source of coronavirus.   Access to Gombe, which houses the country's main institutions and foreign embassies, was barricaded off to everyone except local residents with a pass, an AFP journalist saw.   "The choice of this district is linked to the fact that it's from Gombe that the virus is spreading little by little to other districts," the health authorities said in a daily statement.   "Massive disinfection has been scheduled during this period. The offices and main buildings in Gombe district are concerned. Once everything has been cleaned in Gombe, other areas will targeted," it said.   On Thursday, Kinshasa Governor Gentiny  Ngobila announced that Gombe, one of the capital's 26 districts, would be "placed in quarantine" from April 6-20.   The district "is considered to be the epicentre of the epidemic in the city," he said.

According to the Democratic Republic of Congo's official figures, the sprawling country has recorded 161 cases of coronavirus, 18 of them fatal.    Almost all have occurred in the capital, with a handful of other cases in the  volatile east.   During the partial lockdown, anti-coronavirus teams in Kinshasa will "look for sick people but also investigate risk contacts and asymptomatic cases" for testing and treatment, the authorities said.   People who go to work in Gombe -- drivers, gardeners and so on -- will be tested in their districts of residence and will be quarantined if they have the virus.
6th April 2020

Twinkling flames from candles and traditional lamps lit up India's night sky Sunday in a nine-minute show to mark the fight against the coronavirus pandemic, which has left the vast nation in lockdown.   Across major cities and towns in the world's second-most populous country of 1.3 billion people, many heeded the call of Prime Minister Narendra Modi to turn off their lights at 9:00 pm local time.
6th April 2020

South Korea reported fewer than 50 new coronavirus cases for the first time in more than six weeks, having once been the hardest-hit country outside China, where the virus first emerged.   The South confirmed 47 new cases on the previous day, the Korea Centers for Disease Control and Prevention said, taking its total to date to 10,284. It was the lowest increase since late February.
6th April 2020

The city-state has put nearly 20,000 migrant workers under quarantine for two weeks after a growing number of coronavirus infections were detected in their dormitories.   Authorities reported 120 new virus cases Sunday, the highest jump for the country in a single day, with many linked to foreign workers' dorms.    Many workers from less affluent countries, particularly parts of South Asia, come to Singapore to work in construction and are typically housed in large dormitory complexes.
6th April 2020

The Japanese government may declare a state of emergency this week to contain the coronavirus outbreak, media reports said.    Prime Minister Shinzo Abe is reportedly set to make the declaration for parts of Japan including Tokyo, as the number of people infected with the virus continues to increase.   The news pushed up Tokyo stocks, with investors seeing the move as positive for containing the outbreak, analysts said.
Date: Mon, 6 Apr 2020 09:16:37 +0200 (METDST)
By Philippe Carillo

Port Vila, Vanuatu, April 6, 2020 (AFP) - A deadly Pacific cyclone intensified as it hit Vanuatu on Monday, threatening a natural disaster that experts fear will undermine the impoverished nation's battle to remain coronavirus-free.   Tropical Cyclone Harold, which claimed 27 lives when it swept through the Solomon Islands last week, strengthened to a scale-topping Category 5 superstorm overnight, Vanuatu's meteorology service said.

The cyclone is now packing winds of up to 235 kilometres per hour (145 miles per hour), prompting red alerts across several provinces.   It made landfall on the remote east coast of Espiritu Santo island on Monday morning and was heading directly for Vanuatu's second-largest town Luganville, which has a population of 16,500.   The slow-moving storm is expected to pass north of the capital Port Vila early Tuesday.   "For now, we don't have any reports of injury, but lots of damage," Red Cross Vanuatu secretary general Jacqueline de Gaillande told AFP.

Another concern is the impact a large natural disaster could have on Vanuatu's attempts to remain one of the world's few countries without any reported COVID-19 infections.   The nation has sealed its international borders to avoid the virus but emergency measures including bans on public meetings have been temporarily suspended so people can gather in evacuation centres.   "There have been no confirmed cases of COVID-19 in Vanuatu, but a significant disaster at this time could present serious logistical challenges to delivering life-saving aid," Oxfam's Vanuatu director Elizabeth Faerua said.

- Widespread destruction -
A major international relief effort was needed the last time a Category 5 system, Cyclone Pam, hit Vanuatu in 2015.   If a similar operation were needed in the wake of Cyclone Harold, it would run the risk of importing the virus to a nation that lacks the health infrastructure to deal with even a mild outbreak.

New Zealand Prime Minister Jacinda Ardern raised concerns about the cyclone and said the Kiwi military was ready to deploy if needed, even though New Zealand is on COVID-19 lockdown.   "(Harold) looks like it's coming into the Pacific with considerable force," she told reporters.   "Our defence force is at the ready, that's the role they play regardless of what's going on in New Zealand."   Cyclone Pam flattened Port Vila, killed 11 people and left a swath of destruction that the World Bank estimated wiped out almost two-thirds of Vanuatu's economic capacity.

De Gaillande said Vanuatu's government could face a balancing act between helping cyclone-devastated communities and potentially importing the virus by allowing in international aid.   "We will need international aid, but we're hoping initially it will be through funding only, so we can buy supplies and help those most in need," she said.   "We have a lot of skilled people on the ground here already (to carry our disaster operations)."   Cyclone Harold has already caused widespread damage in he Solomon Islands, where an inter-island ferry ignored weather warnings and 27 people were washed off its decks.

Solomons police said Sunday that the bodies of five passengers from the MV Taimareho had been recovered and the search would resume the next day.   "I would like to thank everyone... involved in the search for the missing 27 people so far as we try as much as possible to find the bodies so their grieving relatives can give them a proper burial," chief superintendent Richard Menapi said.   The ferry set off from Honiara for Malaita island on Thursday night, packed with more than 700 people as part of a government evacuation programme in response to the virus crisis.
Date: Mon, 6 Apr 2020 01:32:44 +0200 (METDST)

Abidjan, April 5, 2020 (AFP) - Residents in a working-class district of the Ivory Coast city of Abidjan on Sunday destroyed a coronavirus testing centre that was under construction, police and health ministry officials said.   Videos posted on social media, showed several dozen people dismantling the building, some of them shouting: "We don't want it!"

The incident happened in Yopougon district of the city of five million inhabitants, which is the country's commercial capital.   Locals had demonstrated against the centre because they thought it was too close to their homes and right in the middle of a residential district, one police officer told AFP on condition of anonymity.   But the building, which was still under construction, had never been intended as a treatment centre for virus patients -- only as a testing centre, said a health ministry official, who also asked not to be named.

This was the first violent incident connected to the COVID-19 outbreak in the country, which so far appears to have been relatively untouched by the virus, at least according to official figures.   They put the number of cases at 261, with three deaths so far.

Nevertheless, the authorities are trying to increase their capacity to treat the outbreak.   President Alassane Ouattara declared a state of emergency on March 23.   Abidjan has already been placed under quarantine, effectively cut off from the rest of the country, and a nationwide overnight curfew is in force.

Schools, churches and non-essential shops have been closed and gatherings have been banned.   On Saturday, senior health officials recommended that people wear masks in public places to try to slow the spread of the virus.   So far however, the government has not ordered a full lockdown.   Last Tuesday, the government announced a 2.6-billion-euro plan ($2.8 billion) to tackle the economic and social effects of the pandemic, which is forecast to halve the country's growth rate to 3.6 percent in 2020.