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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

United Kingdom and Gibraltar (England, Wales, Scotland, Northern Ireland) US Consular Information Sheet
June 03, 2008
COUNTRY DESCRIPTION:
The United Kingdom of Great Britain and Northern Ireland is a highly developed constitutional monarc
y comprised of Great Britain (England, Scotland and Wales) and Northern Ireland.
Read the Department of State Background Notes on the United Kingdom for additional information.
Gibraltar is a United Kingdom Overseas Territory bordering Spain and located at the southernmost tip of Europe at the entrance to the Mediterranean Sea.
It is one of thirteen former British colonies that have elected to continue their political links with London.
Tourist facilities are widely available.

ENTRY/EXIT REQUIREMENTS:
A visa is not required for tourist or business visits to the UK of less than six months in duration.
Visitors wishing to remain longer than one month in Gibraltar should regularize their stay with Gibraltar immigration authorities.
Those planning to visit the UK for any purpose other than tourism or business, or who intend to stay longer than six months, should consult the website of the British Embassy in the United States at http://britainusa.com for information about current visa requirements.
Those who are required to obtain a visa and fail to do so may be denied entry and returned to their port of origin.
The British government is currently considering reducing the visa-free period from six months to 90 days.
Travelers should be alert to any changes in legislation.
The U.S. Embassy cannot intervene in UK visa matters.
In addition to the British Embassy web site at http://britainusa.com, those seeking current UK visa information may also contact UK consular offices via their premium rate telephone service at 1-900-656-5000 (cost $3/minute) or 1-212-796-5773 ($12 flat fee).
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
The United Kingdom is politically stable, with a modern infrastructure, but shares with the rest of the world an increased threat of terrorist incidents of international origin, as well as the potential, though significantly diminished in recent years, for isolated violence related to the political situation in Northern Ireland (a part of the United Kingdom).
On July 7, 2005, a major terrorist attack occurred in London, as Islamic extremists detonated explosives on three underground trains and a bus in Central London, resulting in over 50 deaths and hundreds of injuries.
Following the attacks, the public transportation system was temporarily disrupted, but quickly returned to normal.
A similar but unsuccessful attack against London’s public transport system took place on July 21, 2005.
UK authorities have identified and arrested people involved in these attacks.
Similarly, those involved in terrorist incidents in London and Glasgow during the summer of 2007 were identified and arrested.
Like the US, the UK shares its national threat levels with the general public to keep everyone informed and explain the context for the various increased security measures that may be encountered. UK threat levels are determined by the UK Home Office and are posted on its web site at http://www.homeoffice.gov.uk/security/current-threat-level/.
Information from the UK Security Service, commonly known as MI5, about the reasons for the increased threat level and actions the public can take is available on the MI5 web site at http://www.mi5.gov.uk/.
On August 10, 2006, the Government of the United Kingdom heightened security at all UK airports following a major counterterrorism operation in which individuals were arrested for plotting attacks against US-bound airlines.
As a result of this, increased restrictions concerning carry-on luggage were put in place and are strictly enforced.
American citizens are advised to check with the UK Department for Transport at http://www.dft.gov.uk/transportforyou/airtravel/airportsecurity/ regarding the latest security updates and carry-on luggage restrictions.
The British Home Secretary has urged UK citizens to be alert and vigilant by, for example, keeping an eye out for suspect packages or people acting suspiciously at subway (called the “Tube” or Underground) and train stations and airports and reporting anything suspicious to the appropriate authorities.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.
For more information about UK public safety initiatives, consult the UK Civil Contingencies Secretariat web site at http://www.ukresilience.gov.uk.
The political situation in Northern Ireland has dramatically improved since the signing of the Good Friday Agreement in 1998, the announcement by the Irish Republican Army (IRA) on July 28, 2005, that it would end its armed campaign, and the agreement to set up a power-sharing government on May 8, 2007.
The potential remains, however, for sporadic incidents of street violence and/or sectarian confrontation. American citizens traveling to Northern Ireland should therefore remain alert to their surroundings and should be aware that if they choose to visit potential flashpoints or attend parades sporadic violence remains a possibility. Tensions may be heightened during the summer marching season (April to August), particularly during the month of July around the July 12th public holiday.

The phone number for police/fire/ambulance emergency services - the equivalent of "911" in the U.S. - is “999” in the United Kingdom and “112” in Gibraltar.
This number should also be used for warnings about possible bombs or other immediate threats.
The UK Anti-Terrorist Hotline, at 0800 789 321, is for tip-offs and confidential information about possible terrorist activity.
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, Travel Alerts, as well as the Worldwide Caution can be found.
Recent communications from U.S. Embassy London to the local American citizen community, called Warden Messages, can be found on the U.S. Embassy's American Citizens' Services web site at http://london.usembassy.gov/cons_new/acs/index.html.
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 United Kingdom and Gibraltar benefit from generally low crime rates and rates decreased slightly in 2007 in significant categories, including violent crime.
The crime situation in the UK is similar to the United States, with typical incidents including pick-pocketing; mugging; “snatch and grab” thefts of mobile phones, watches and jewelry; and theft of unattended bags, especially at airports and from cars parked at restaurants, hotels and resorts.
Pickpockets target tourists, especially at historic sites, restaurants, on buses, trains and the London Underground (the “Tube,” or subway).
Thieves often target unattended cars parked at tourist sites and roadside restaurants, looking for laptop computers and hand-held electronic equipment, especially global positioning satellite equipment.
Walking in isolated areas, including public parks, especially after dark, should also be avoided, as these provide advantageous venues for muggers and thieves.
At night or when there is little foot traffic, travelers should be especially careful using the underground pedestrian tunnels.
As a general rule, either walk the extra distance to use a surface crossing or wait until there are other adult pedestrians entering the tunnel.

In London, travelers should use only licensed “black taxi cabs,” or car services recommended by their hotel or tour operator.
Unlicensed taxis or private cars posing as taxis may offer low fares, but are often uninsured and may have unlicensed drivers.
In some instances, travelers have been robbed and raped while using these cars.
You can access 7,000 licensed “Black Cabs” using just one telephone number – 0871 871 8710. This taxi booking service combines all six of London’s radio taxi circuits, allowing you to telephone 24 hours a day if you need to “hail a cab.” Alternatively, to find a licensed minicab, text “HOME” to 60835 on your mobile phone to get the telephone number to two licensed minicab companies in the area. If you know in advance what time you will be leaving for home, you can pre-book your return journey.
The “Safe Travel at Night” partnership among the Metropolitan Police, Transport for London, and the Mayor of London maintains a website with additional information at http://www.cabwise.com/.
Travelers should not leave drinks unattended in bars and nightclubs.
There have been some instances of drinks being spiked with illegal substances, leading to incidents of robbery and rape.
Due to the circumstances described above, visitors should take steps to ensure the safety of their U.S. passports.
Visitors in England, Scotland, Wales, Northern Ireland, and Gibraltar are not expected to produce identity documents for police authorities and thus may secure their passports in hotel safes or residences.
Abundant ATMs that link to U.S. banking networks offer an optimal rate of exchange and they preclude the need to carry a passport to cash travelers’ checks.
Travelers should be aware that U.S. banks might charge a higher processing fee for withdrawals made overseas.
Common sense personal security measures utilized in the U.S. when using ATMs should also be followed in the UK.
ATM fraud in the UK is becoming more sophisticated, incorporating technologies to surreptitiously record customer ATM card and PIN information.
Travelers should avoid using ATMs that look in any way “temporary” in structure or location, or that are located in isolated areas.
Travelers should be aware that in busy public areas, thieves use distraction techniques, such as waiting until the PIN number has been entered and then pointing to money on the ground, or attempting to hand out a free newspaper.
When the ATM user is distracted, a colleague will quickly withdraw cash and leave.
If distracted in any way, travelers should press the cancel transaction button immediately and collect their card before speaking to the person who has distracted them.
If the person’s motives appear suspicious, travelers should not challenge them but remember the details and report the matter to Police as soon as possible.
In addition, travelers should not use the ATM if there is anything stuck to the machine or if it looks unusual in any way.
If the machine does not return the card, report the incident to the issuing bank immediately.

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 at the opening of the next business day.
The U.S. Embassy or Consulate only issues replacement passports during regular business hours.
If you are the victim of a crime while overseas, report it to local police.
The nearest U.S. Embassy or Consulate will also be able to assist by helping you to find appropriate medical care, contacting family members or friends, and explaining 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.

Visit the “Victim Support” web site, maintained by an independent UK charity to helps people cope with the effects of crime: http://www.victimsupport.org.uk/
See our information for Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
While medical services are widely available, free care under the National Health System is allowed only to UK residents and certain EU nationals.
Tourists and short-term visitors will be charged for medical treatment in the UK.
Charges may be significantly higher than those assessed in the United States.
Hiking in higher elevations can be treacherous.
Several people die each year while hiking, particularly in Scotland, often due to sudden changes in weather.
Visitors, including experienced hikers, are encouraged to discuss intended routes with local residents familiar with the area, and to adhere closely to recommendations.
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.

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.
If your medical insurance policy does not provide overseas coverage, you may want to purchase a short-term policy for your trip.
The Department of State provides a list of travel insurance companies that can provide the additional insurance needed for the duration of one’s trip abroad in its online at medical insurance overseas.
Remember also that most medical care facilities and medical care providers in the UK do not accept insurance subscription as a primary source of payment.
Rather, the beneficiary is expected to pay for the service and then seek reimbursement from the insurance company.
This may require an upfront payment in the $10,000 to $20,000 range

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

UK penalties for driving under the influence of even minimal amounts of alcohol or drugs are stiff and often result in prison sentences.
In contrast to the United States and continental Europe, where traffic drives on the right side of the road, in the UK, it moves on the left.
The maximum speed limit on highways/motorways in the UK is 70MPH.
Motorways generally have a hard shoulder (breakdown lane) on the far left, defined by a solid white line.
It is illegal to stop or park on a hard shoulder unless it is an emergency.
In such cases, you should activate your hazard lights, get out of your vehicle and go onto an embankment for safety.
Emergency call boxes (orange telephone booths with “SOS” printed on them) may be found at half-mile intervals along the motorway.
White and blue poles placed every 100 yards along the motorway point in the direction of the nearest call box.
Emergency call boxes dial directly to a motorway center.
It is best to use these phones rather than a personal cell phone, because motorway center personnel will immediately know the location of a call received from an emergency call box.
Roadside towing services may cost approximately £125.
However, membership fees of automotive associations such as the RAC or AA (Automobile Association) often include free roadside towing service.
Visitors uncomfortable with, or intimidated by, the prospect of driving on the left-hand side of the road may wish to avail themselves of extensive bus, rail and air transport networks that are comparatively inexpensive.
Roads in the UK are generally excellent, but are narrow and often congested in urban areas.
If you plan to drive while in the UK, you may wish to obtain a copy of the Highway Code, available at http://www.highwaycode.gov.uk.
Travelers intending to rent cars in the UK should make sure that they are adequately insured.
U.S. auto insurance is not always valid outside the U.S., and travelers may wish to purchase supplemental insurance, which is generally available from most major rental agents.
The city of London imposes a congestion charge of £8 (eight pounds sterling, or approximately U.S. $16.00) on all cars entering much of central London Monday through Friday from 7:00 a.m. to 6:30 p.m.
Information on the congestion charge can be found at http://www.cclondon.com.
Public transport in the United Kingdom is excellent and extensive.
However, poor track conditions may have contributed to train derailments resulting in some fatalities.
Repairs are underway and the overall safety record is excellent.
Information on disruptions to London transportation services can be found at http://www.tfl.gov.uk and information about the status of National Rail Services can be found at http://www.nationalrail.co.uk.
Many U.S. pedestrians are injured, some fatally, every year in the United Kingdom, because they forget that oncoming traffic approaches from the opposite direction than in the United States.
Extra care and alertness should be taken when crossing streets; remember to look both ways before stepping into the street.
Driving in Gibraltar is on the right-hand side of the road, as in the U.S. and Continental Europe.
Persons traveling overland between Gibraltar and Spain may experience long delays in clearing Spanish border controls.
Please refer to our Road Safety Overseas page for more information.
For specific information concerning United Kingdom driving permits, vehicle inspection, road tax and mandatory insurance, refer to the United Kingdom’s Department of Environment and Transport web site at http://www.dft.gov.uk, the Driving Standards Agency web site at http://www.dsa.gov.uk or consult the U.S. Embassy in London’s web site at http://london.usembassy.gov/.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Kingdom’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the UK’s air carrier operations.
For further information, travelers may visit the FAA's web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
The legal drinking age in the UK is generally lower than in the U.S. and social drinking in pubs is often seen as a routine aspect of life in Britain. Parents, organizers of school trips, and young travelers should be aware of the impact that this environment may have when combined with the sense of adventure that comes with being abroad.
Please see our Students Abroad web site as well Studying Abroad to help students plan a safe and enjoyable adventure.
The UK has strict gun-control laws, and importing firearms is extremely complicated. Travelers should consider leaving all firearms in the United States.
Restrictions exist on the type and number of weapons that may be possessed by an individual.
All handguns, i.e. pistols and revolvers, are prohibited with very few exceptions.
Licensing of firearms in the UK is controlled by the Police.
Applicants for a license must be prepared to show 'good reason' why they require each weapon.
Applicants must also provide a copy of their U.S. gun license, a letter of good conduct from their local U.S. police station and a letter detailing any previous training, hunting or shooting experience. Background checks will also be carried out.
Additional information on applying for a firearm certificate and/or shotgun certificate can be found on the Metropolitan Police Firearms Enquiry Teams web site at http://www.met.police.uk/firearms-enquiries/index.htm.
A number of Americans are lured to the UK each year in the belief that they have won a lottery or have inherited from the estate from a long-lost relative.
Americans may also be contacted by persons they have “met” over the Internet who now need funds urgently to pay for hospital treatment, hotel bills, taxes or airline security fees.
Invariably, the person contacted is the victim of fraud.
Any unsolicited invitations to travel to the UK to collect winnings or an inheritance should be viewed with skepticism.
Also, there are no licenses or fees required when transiting a UK airport, nor is emergency medical treatment withheld pending payment of fees.
Please see our information on International Financial Scams. Please read 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 British law, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the UK 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.
Many pocketknives and other blades, and mace or pepper spray canisters, although legal in the U.S., are illegal in the UK and will result in arrest and confiscation if detected.
A UK Metropolitan Police guide to items that are prohibited as offensive weapons is available at http://www.met.police.uk/youngpeople/guns.htm.
A UK Customs Guide, detailing what items visitors are prohibited from bringing into the UK, is available at http://customs.hmrc.gov.uk/channelsPortalWebApp/downloadFile?contentID=HMCE_CL_001734.
Air travelers to and from the United Kingdom should be aware that penalties against alcohol-related and other in-flight crimes (“air rage”) are stiff and are being enforced with prison sentences.
Please also see our information on customs regulations that pertain when returning to the US.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the United Kingdom 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 Kingdom.
By registering, Americans make it easier for the Embassy or Consulate to contact them in case of emergency, and to relay updated information on travel and security within the United Kingdom.
The Embassy and Consulates regularly send security and other information via email to Americans who have registered.
As noted above, recent communications from U.S. Embassy London to the local American citizen community, called Warden Messages, can be found on the embassy’s web site.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
The Consular Section also disseminates a newsletter every month.
Those wishing to subscribe to the monthly consular newsletter in London should send a request by email to SCSLondon@state.gov.
The U.S. Embassy is located at 24 Grosvenor Square, London W1A 1AE; telephone: in country 020-7499-9000; from the U.S. 011-44-20-7499-9000 (24 hours); Consular Section fax: in country 020-7495-5012; from the U.S. 011-44-20-7495-5012, and on the Internet at http://london.usembassy.gov.
The U.S. Consulate General in Edinburgh, Scotland, is located at 3 Regent Terrace, Edinburgh EH7 5BW; Telephone: in country 0131-556-8315, from the U.S. 011-44-131-556-8315.
After hours: in country 01224-857097, from the U.S. 011-44-1224-857097.
Fax: in country 0131-557-6023; from the U.S. 011-44-131-557-6023.
Information on the Consulate General is included on the Embassy’s web site at http://london.usembassy.gov/scotland.
The U.S. Consulate General in Belfast, Northern Ireland, is located at Danesfort House, 228 Stranmillis Road, Belfast BT9 5GR; Telephone: in country 028-9038-6100; from the U.S. 011-44-28-9038-6100.
Fax:
in country 028-9068-1301; from the U.S. 011-44-28-9068-1301.
Information on the Consulate General is included on the Embassy’s web site at: http://london.usembassy.gov/nireland.
There is no U.S. consular representation in Gibraltar.
Passport questions should be directed to the U.S. Embassy in Madrid, located at Serrano 75, Madrid, Spain, tel (34)(91) 587-2200, and fax (34)(91) 587-2303.
The web site is http://madrid.usembassy.gov.
All other inquiries should be directed to the U.S. Embassy in London.
* * *
This replaces the Consular Information Sheet dated December 12, 2007, to update the sections on Entry Requirements, Safety and Security, Crime, Victims of Crime, Medical Facilities, Medical Insurance, Traffic Safety and Road Conditions, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Thu 24 Aug 2017
Source: Gibraltar Chronicle [edited]
<http://chronicle.gi/2017/08/tiger-mosquito-found-in-gibraltar-but-no-cause-for-concern-officials-say/>

An aggressive species of mosquito known to transmit viral diseases has been detected in Gibraltar, but public health officials insist there is no cause for alarm. Public Health Gibraltar and the Environmental Agency confirmed that the mosquito of the species _Aedes albopictus_, also known as the tiger mosquito, has been found in Gibraltar.

Last June [2017] after 9 months of intensive surveillance, officials said no tiger mosquito had been found in Gibraltar. But this has now changed after the 1st tiger mosquito was found in the urban dome   stic environment within Gibraltar. "This finding alone does not however materially alter any health risks in Gibraltar and there is no immediate cause for public concern," the government said in a statement. Public Health Gibraltar was first alerted in January 2016 to the discovery of the mosquito in Malaga and Algeciras [in Andalusia, Spain]. Since then, together with the Environmental Agency, it began working with international experts to mount surveillance in Gibraltar.

World Health Organization experts visited Gibraltar and gave advice on setting traps and monitoring locations, but no tiger mosquito had been detected until now. The tiger mosquito is not native to Gibraltar and has not been previously found here. It is common in other countries where it transmits viral diseases like Zika, dengue, and chikungunya. It is a domestic species, breeds in water in urban areas -- water butts, blocked drains, rainwater gullies -- and is able to reach high abundance around residential areas.

It is also a day-time mosquito, that aggressively bites humans. "Health risks to the public only arise if the virus causing these diseases is also present, which is not the case in Gibraltar," the government said.  "The virus can, however, be imported by travellers returning from an overseas country and if this happens, there is a risk of spread, but only if the mosquito bites within a small window period of about a week after the fever starts."

Public Health Gibraltar has been raising awareness of travel risk amongst travellers through its publication A Factsheet for Travellers and recommends the following precautions:
- before travelling to affected areas, consult your doctor or seek advice from a travel clinic, especially if you have an immune disorder or severe chronic illness;
- if you are pregnant or are considering pregnancy, consider postponing non-essential travel;
- when staying in a mosquito-prone area, wear mosquito repellents and take mosquito bite prevention measures;
- if you have symptoms within 3 weeks of return from an affected country, contact your doctor;
- if you have been diagnosed with any of the diseases Zika, dengue, or chikungunya, take strict mosquito bite prevention measures for 10 days after the fever starts.
========================== 
[The appearance of _Aedes albopictus_ in Gibraltar is not surprising. A map of the distribution of this species as of April this year (2017) shows it present around the Mediterranean Basin and up to Gibraltar on the west (<https://ecdc.europa.eu/en/publications-data/aedes-albopictus-current-known-distribution-europe-april-2017>).

Now it has been found in Gibraltar. The concerns are real about transmission of dengue, chikungunya, and Zika viruses should populations of _Ae. albopictus_ become established. In 2015 there were a few locally acquired cases of dengue in the south of France. This also happened on a larger scale in Emilia Romagna, Italy, when a viraemic man introduced chikungunya virus into Italy and sparked an outbreak.

One hopes that mosquito surveillance will continue in Gibraltar, perhaps be intensified, and help guide vector control efforts. - ProMED Mod.TY]

[A HealthMap/ProMED-mail map can be accessed at: <http://healthmap.org/promed/p/517>.]
Date: Wed, 1 Jun 2011 01:46:48 +0200 (METDST)

GIBRALTAR, June 1, 2011 (AFP) - A fuel tank exploded and caught fire near a cruise ship in the British territory of Gibraltar Tuesday, injuring at least 15 people, most of them on the vessel, local officials and the ship's owners said. The blast was probably caused by a spark from welding operations, Chief Minister Peter Caruana told Radio Gibraltar. But police were not ruling out any possibility including that of an attack, he added. Flames several metres high could be seen coming out of the tank with dense black smoke billowing across the port as firefighters directed jets of water at the blaze from tugboats. The fire continued late into the night, with Radio Gibraltar reporting more explosions were heard. The tank was close to the giant cruise ship, Independence of the Seas, which had arrived in Gibraltar Tuesday morning. The ship made an emergency departure immediately after the blast Tuesday afternoon.

The Gibraltar government and the ship's owners, Royal Caribbean International, both said 12 people on the ship had been hurt. Gibraltar officials said one of the passengers had suffered a fractured arm. Two Spanish welders working on the tank were injured, including one who was in critical condition in a burns unit at a hospital in the southern Spanish city of Seville, Radio Gibraltar said. A police officer was also slightly injured in the rescue attempt, police said. "The lid of the tank was blown off by the blast," a police spokesman said. The statement from Royal Caribbean International said: "Immediately after the explosion, the ship retracted the gangway and moved a safe distance from the dock. "Twelve guests sustained minor injuries and have received medical treatment onboard." The boat was on a two-week cruise, having left the southern English port of Southampton on Saturday, the company added.

Air services to Gibraltar were suspended and offices in the port area evacuated. The police spokesman said the possibility of adjacent tanks overheating and exploding could not be ruled out. Caruana described it as a serious incident but said there was "no cause for concern". "Once it was established that there were welding operations going on, on top of the very tank at the time it exploded, (that) makes that a frontrunner for a likely explanation, but all possibilities are being kept open," he told Radio Gibraltar. "The police are obviously keeping their minds open to the possibility of maybe a security incident. It's looking unlikely but all possibilities are being looked into if only to be excluded."

"The plan is to allow it to carry on burning itself off," he said later Tuesday, but warned that the wind was due to change during the night, which could bring the smoke over land. Spanish tugs from a private company were helping the local fire services, he added. One witness said he was in his office nearby when he heard three loud explosions. "We started running out and saw one of the main tanks set alight. My concern was the poor people who were working there," he told Radio Gibraltar. The public was being advised to keep away from the area and keep windows closed due to the smoke. Gibraltar is a 6.5-square-kilometre (2.6-square-mile) British territory of around 30,000 people off the tip of southern Spain. Madrid ceded it to London in 1713 under the Treaty of Utrecht, but it has long fuelled tensions between the two countries.
Date: Tue, 10 Aug 2010 20:08:15 +0200 (METDST)

GIBRALTAR, Aug 10, 2010 (AFP) - Gibraltar on Tuesday condemned as "illegal" a proposal by the neighbouring Spanish town of La Linea to impose a tax on cars entering or leaving the tiny British territory by road.   The decision comes amid thorny relations between Madrid and London over the disputed British possession off the tip of southern Spain.

La Linea mayor Alejandro Sanchez on Monday announced the "congestion charge" of no more than five euros (6.5 dollars) on cars crossing into and out of Gibraltar, saying the measure will be imposed in October once it is passed by the town council.   He said lorries carrying debris and other materials used in Gibraltar to reclaim land from the sea will pay more, but the exact amount has not yet been determined.   Sanchez, a member of Spain's conservative opposition Popular Party, said the tax is needed partly to compensate the municipality for austerity measures imposed by the socialist government in Madrid.   La Linea residents would be exempt, but it was not clear if Gibraltarians would also have to pay.

The Gibraltar government reacted angrily and said it has contacted the Spanish authorities over the decision.   "The confused statements by the mayor of La Linea in respect of the proposed toll describe a litany of illegalities under EU Law and probably also under Spanish law," it said in a statement.   "The mayor of La Linea is clearly engaged in a political manoeuvre with his central government, which is unlikely to allow the proposal.

"The mayor's proposals are wholly unacceptable both legally and politically and in the unlikely event that these measures should be introduced, the (Gibraltar) government will take appropriate steps."   Spain ceded Gibraltar to Britain in 1713 under the Treaty of Utrecht but has retained first claim on the tiny peninsula should Britain renounce sovereignty.

"The Rock" has long fuelled tensions between Spain and Britain, with Madrid arguing the 6.5-square-kilometre (2.6-square-mile) territory that is home to roughly 30,000 people should be returned to Spanish sovereignty.   But its people overwhelmingly rejected an Anglo-Spanish proposal for co-sovereignty in a referendum in 2002.   In recent months British and Spanish naval and police boats have engaged in a series of cat and mouse games in the waters off Gibraltar, which lies at the strategic western entrance to the Mediterranean.
Date: Thu 23 Oct 2008
Source: Panorama.gi [edited]
---------------------------------
During the last 10 weeks, Gibraltar has experienced an outbreak of measles. "We have so far been notified of over 250 cases and notifications are still coming in at around 4-6 cases per day," said the Gibraltar Health Authority [GHA], who believe that the actual numbers are greater as many people with mild attacks have chosen not to report them. While the majority of infections in the outbreak have been mild, some have been severe and a few patients including babies have needed intensive care.  Measles is an unpleasant disease with fever, sore throat, streaming eyes, diarrhoea, and rash. Most people recover within a week or so, but complications like fits, bacterial infection, or pneumonia can develop. Long-term complications can also arise in very young children.

Says the GHA: It is important that all persons with symptoms suggestive of measles should report the illness to their doctor to enable complications to be detected at an early stage. In addition to medical advice, persons with the illness should follow general hygiene practices such as limiting contact with other people, carefully discarding soiled tissues, and washing their hands. Anyone who has had measles infection is immune for life and cannot get measles again. There is no basis for the rumour that some people have had measles twice. It is possible that infection with rubella (German measles, a different disease) may have caused the confusion. Vaccination with the MMR [measles, mumps, and rubella] vaccine is the only way to prevent measles infection.

[So far], the 250 cases have been in persons who are unvaccinated or partly vaccinated (one dose only). Not a single case has occurred in a person who has had a full course of MMR vaccine. MMR vaccine has been available free to children [from] Gibraltar's health service since 1989, although the boosters were only introduced in 2002. It is also a very safe and effective vaccine, with an impressive track record," they say. Gibraltar Health Authority adds that it is continuing to advise all parents of children who have not had the MMR vaccine to immunise their children. There had been some difficulties in obtaining vaccine recently due to an international shortage, but fresh supplies have now been received. The course consists of 2 injections, approximately 3 months apart. Please note that BOTH the doses are needed for adequate immunity. They add: If your child has received only one dose, either now or in the past, he or she could still be at risk. Arrangements have been made to offer additional  vaccination to all unimmunised children as follows: During October and November [2008], the Child Welfare Clinics (primary care centre) will be open on Mondays (2:00 pm to 4:00 pm), Wednesdays (9:00 am to 11:00 am) and Fridays (9:00 am to 11:00 am) for immunisations. Appointments are not necessary.
-------------------------------
[The Rock of Gibraltar is located at the entrance of the Mediterranean. Gibraltar is connected to Spain by a sandy isthmus, by a ferry to Morocco, and by flights to London. By virtue of its geographical position and political status Gibraltar is vulnerable to introduction of infectious disease from diverse sources. No information has been provided regarding the source of the measles virus responsible for this outbreak. In this respect it will be relevant to determine the genotype of the measles virus involved (see comment in ProMED-mail "Measles - Gibraltar 20080814.2529"). The outbreak has escalated from the 17 cases reported on 14 Aug 2008 to the current 250 cases. Despite the availability of free MMR vaccination it is clear that there is an appreciable number of unimmunised individuals in the community who remain susceptible to measles virus infection. It is encouraging that efforts are underway to expand vaccine coverage.


and the HealthMap/ProMED-mail interactive map at <http://healthmap.org/promed?g=2411586&amp;v=36.133,-5.35,7>. - ProMed Mod.CP]
Date: Wed, 16 Apr 2008 14:56:40 +0200 (METDST) GIBRALTAR, April 16, 2008 (AFP) - Animal rights groups have expressed outrage over a plan by Gibraltar's government to cull its famous Barbary Apes, which are posing a hazard as they roam the town in search of food. The government of the tiny British territory off Spain's southern coast plans to cull 25 of the simians, whose population has exploded to around 200. The mischievous primates climb over cars and pull out antennas, open rubbish bags and rifle through handbags left unattended in the popular tourist destination. Officially, the management of the apes is the responsibility of the Gibraltar Ornithological and Natural History Society (GONHS), on contract from the government. But the society said it has not approved the cull. "Our policy is that culling can be a population management solution but only in extreme cases when there is no other more suitable option," GONHS general secretary Dr. John Cortes said on Tuesday. "We would only ever recommend a cull after very careful assessment of the situation from a veterinary and a genetic point of view." However, Environment Minister Ernest Britto said a licence has been issued for the cull and two of the apes have already been given lethal injections. Helen Thirlway, the head of Britain's International Primate Protection League, said the government was failing to manage the apes "in a responsible manner." "There have been many advances and pilot studies in recent years on different methods of controlling free-roaming monkeys," she was quoted as saying in the local media Wednesday. "We are more than happy to work with the government of Gibraltar and with GONHS to help them develop more efficient, alternative solutions, but this needless slaughter has to stop." According to legend, if the apes disappear, Britain will lose control of Gibraltar. When wartime British prime minister Winston Churchill heard their population was low, British consuls in North Africa -- from where the apes originally came -- were tasked with sending new young simians to the Rock. At one time, the apes were looked after by the British army stationed in Gibraltar, which selected a place up the Rock where they were fed daily to keep them from loitering downtown. Spain ceded Gibraltar to Britain in 1713, but has retained a constitutional claim should Britain renounce sovereignty. The vast majority of the 30,000 people want to retain their links with Britain.
More ...

Afghanistan

Afghanistal US Consular Information Sheet March 03, 2009


COUNTRY DESCRIPTION:


Afghanistan has made significant progress since the Taliban were deposed in 2001, but still faces daunting challenges, including de

eating terrorists and insurgents, recovering from over three decades of civil strife, dealing with years of severe drought and rebuilding a shattered physical, economic and political infrastructure. Coalition and NATO forces under ISAF work in partnership with Afghan security forces to combat Taliban and al-Qa’ida elements who seek to terrorize the population and challenge the government. Violence in 2008 reached unprecedented levels, as both ISAF/Afghan forces and the Taliban initiated more battles than ever before. President Hamid Karzai was sworn in as President of the Islamic Republic of Afghanistan on December 7, 2004 and the Afghan Parliament was subsequently convened in late 2005. The government is working to develop a more effective police force, a more robust legal system, and sub-national institutions that work in partnership with traditional and local leaders to meet the needs of the population. The U.S. works closely with the international community to provide coordinated support for these efforts. An Afghanistan-hosted Peace Jirga with Pakistan resulted in a commitment to cooperate in combating terrorism, facilitate the return of Afghan refugees, and support regional economic activity. Read the Department of State Background Notes on Afghanistan for additional information.


ENTRY/EXIT REQUIREMENTS:


 A passport and valid visa are required to enter and exit Afghanistan. Afghan entry visas are not available at Kabul International Airport or any other ports of entry in Afghanistan. American citizens who arrive without a visa are subject to confiscation of their passport and face heavy fines and difficulties in retrieving their passport and obtaining a visa, as well as possible deportation from the country. Americans arriving in the country via military air usually have considerable difficulties if they choose to depart Afghanistan on commercial air, because their passports are not stamped to show that they entered the country legally. Those coming on military air should move quickly after arrival to legalize their status if there is any chance they will depart the country on anything other than military air. Visit the Embassy of Afghanistan web site at http://www.embassyofafghanistan.org for the most current visa information. The Consular office of the Embassy of Afghanistan is located at 2233 Wisconsin Avenue NW, Suite 216, Washington, DC 20007, phone number 202-298-9125. Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.


SAFETY AND SECURITY:


The latest Travel Warning for Afghanistan emphasizes that the security situation remains critical for American citizens. The Taliban and associated insurgent groups, al-Qaida network terrorist organizations, and narco-traffickers oppose the strengthening of a democratic government. These groups aim to weaken or bring down the Government of Afghanistan and to drive Westerners out of the country. They do not hesitate to use violence, including targeting civilians. Terrorist activities may include, but are not limited to bombings -- including improvised explosive devices and car bombs -- assassinations, carjackings, rocket attacks, assaults and kidnappings. There were over 120 suicide attacks in 2008. There is an ongoing threat to attack and kidnap U.S. citizens and Non-Governmental Organization (NGO) workers throughout the country. In 2008,, more than 30 NGO workers were killed (six foreigners) and at least 78 NGO staff members (seven foreigners) were abducted. Over 25 other foreign civilians, including journalists, were kidnapped. Kabul continues to experience suicide bombings against Afghan government personnel and installations, Afghan and coalition military assets, and international civilians. Riots -- sometimes violent -- have occurred in response to various political or other issues. Crime, including violent crime, remains a significant problem. Official Americans' use of the Kabul-Jalalabad, Kabul-Kandahar highways and other roads throughout the country is often restricted or completely curtailed because of security concerns. Insurgents continue to use roadside and car bombs to conduct attacks and abductions along major highways. Millions of unexploded land mines and other ordinance present a constant danger. The country faces a difficult period in the near term, and American citizens could be targeted or placed at risk by unpredictable local events. Americans should not come to Afghanistan unless they have made arrangements in advance to address security concerns. The absence of records for ownership of property, differing laws from various regimes and the chaos that comes from decades of civil strife have left property issues in great disorder. Afghan-Americans returning to Afghanistan to recover property, or Americans coming to the country to engage in business, have become involved in complicated real estate disputes and have faced threats of retaliatory action, including kidnapping for ransom and death. Large parts of Afghanistan are extremely isolated, with few roads, mostly in poor condition, irregular cell phone signals, and none of the basic physical infrastructure found in Kabul or the larger cities. Americans traveling in these areas who find themselves in trouble may not even have a way to communicate their difficulties to the outside world. For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found. Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.


CRIME:


 A large portion of the Afghan population is unemployed, and many among the unemployed have moved to urban areas. Basic services are rudimentary or non-existent. These factors may directly contribute to crime and lawlessness. Diplomats and international relief workers have reported incidents of robberies and household burglaries as well as kidnappings and assault. Any American citizen who enters Afghanistan should remain vigilant for possible banditry, including violent attacks.


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 U.S. Embassy in Kabul. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the U.S. Embassy in Kabul 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 the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to provide a list of attorneys if needed. The local equivalent to the "911" emergency line in Afghanistan is: 119 Please see our information on Victims of Crime, including possible victim compensation programs in the United States.


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 Afghanistan’s laws, even unknowingly, may be expelled, arrested or imprisoned. During the last several years, there have been incidents involving the arrest and/or detention of U.S. citizens. Arrested Americans have faced periods of detention—sometimes in difficult conditions—while awaiting trial. Penalties for possession or use of, or trafficking in illegal drugs in Afghanistan are severe, and convicted offenders can expect long jail sentences and heavy fines. Another sensitive activity is proselytizing. Although the Afghan Constitution allows the free exercise of religion, proselytizing is often viewed as contrary to the beliefs of Islam and considered harmful to society. Proselytizing may lead to arrest and/or deportation. 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.


SPECIAL CIRCUMSTANCES:


Because of the poor infrastructure in Afghanistan, access to banking facilities is limited and unreliable. Afghanistan's economy operates on a "cash-only" basis for most transactions. Credit card transactions are not available. International bank transfers are limited. Some ATM machines exist at Standard Charter Bank and Afghan International Bank (AIB) in the Wazir Akbar Khan neighborhood of Kabul, but some travelers have complained of difficulties using them. International communications are difficult. Local telephone networks do not operate reliably. Most people rely on satellite or cellular telephone communications even to make local calls. Cellular phone service is available locally in Kabul and some other cities, but can be unreliable. Injured or distressed foreigners could face long delays before being able to communicate their needs to family or colleagues outside of Afghanistan. Internet access through local service providers is limited. In addition to being subject to all Afghan laws, U.S. citizens who are also citizens of Afghanistan may also be subject to other laws that impose special obligations on Afghan citizens. U.S. citizens who are also Afghan nationals do not require visas for entry into Afghanistan. The Embassy of Afghanistan issues a letter confirming your nationality for entry into Afghanistan. However, you may wish to obtain a visa as some Afghan-Americans have experienced difficulties at land border crossings because they do not have a visa in their passport. For additional information on dual nationality in general, see the Consular Affairs home page for our dual nationality flyer. U.S. citizens are encouraged to carry a copy of their U.S. passport with them at all times, so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available. As stated in the Travel Warning, consular assistance for American citizens in Afghanistan is limited. Islam provides the foundation of Afghanistan's customs, laws and practices. Foreign visitors -- men and women -- are expected to remain sensitive to the Islamic culture and not dress in a revealing or provocative manner, including the wearing of sleeveless shirts and blouses, halter-tops and shorts. Women in particular, especially when traveling outside of Kabul, may want to ensure that their tops have long sleeves and cover their collarbone and waistband, and that their pants/skirts cover their ankles. Almost all women in Afghanistan cover their hair in public; American women visitors should carry scarves for this purpose. Afghan customs authorities may enforce strict regulations concerning temporary importation into or export from Afghanistan of items such as firearms, alcoholic beverages, religious materials, antiquities, medications, and printed materials. American travelers have faced fines and/or confiscation of items considered antiquities upon exiting Afghanistan. It is advisable to contact the Embassy of Afghanistan in Washington for specific information regarding customs requirements. Travelers en route to Afghanistan may transit countries that have restrictions on firearms, including antique or display models. If you plan to take firearms or ammunition to another country, you should contact officials at that country's embassy and those that you will be transiting to learn about their regulations and fully comply with those regulations before traveling. Please consult http://www.customs.gov for information on importing firearms into the United States. Please see our Customs Information sheet.


MEDICAL FACILITIES AND HEALTH INFORMATION:


Well-equipped medical facilities are few and far between throughout Afghanistan. European and American medicines are available in limited quantities and may be expensive or difficult to locate. There is a shortage of basic medical supplies. Basic medicines manufactured in Iran, Pakistan, and India are available, but their reliability can be questionable. Several western-style private clinics have opened in Kabul: the DK-German Medical Diagnostic Center (www.medical-kabul.com), Acomet Family Hospital (www.afghancomet.com), and CURE International Hospital (ph. 079-883-830) offer a variety of basic and routine-type care; Americans seeking treatment should request American or Western health practitioners. Afghan public hospitals should be avoided. Individuals without government licenses or even medical degrees often operate private clinics; there is no public agency that monitors their operations. Travelers will not be able to find Western-trained medical personnel in most parts of the country outside of Kabul, although there are some international aid groups temporarily providing basic medical assistance in various cities and villages. For any medical treatment, payment is required in advance. Commercial medical evacuation capability from Afghanistan is limited and could take days to arrange. Even medevac companies that claim to service the world may not agree to come to Afghanistan. Those with medevac insurance should confirm with the insurance provider that it will be able to provide medevac assistance to this country. There have been outbreaks of Avian Influenza in poultry in Afghanistan, to include the areas of Nangahar, Laghman, and Wardak provinces, and in the city of Kabul, however, there have been no reported cases of the H5N1 virus in humans. Updates on the Avian Influenza situation in Afghanistan are published on the Embassy’s web site at http://kabul.usembassy.gov/information_for_travelers.html. For additional information on Avian Influenza, please refer to the Department of State's Avian Influenza Fact Sheet available at http://travel.state.gov/travel/tips/health/health_1181.html Tuberculosis is an increasingly serious health concern in Afghanistan. For further information, please consult the CDC's Travel Notice on TB. http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx| The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Afghanistan. However, if one has questions, please inquire directly with the Embassy of Afghanistan at http://www.embassyofafghanistan.org before you travel. Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site. For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site. Further health information for travelers is available from the WHO.


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 Afghanistan is provided for general reference only, and may not be totally accurate in a particular location or circumstance. All drivers face the potential danger of encountering improvised-explosive devices and land mines that may have been planted on or near roadways. An estimated 5-7 million landmines and large quantities of unexploded ordinance exist throughout the countryside and alongside roads, posing a danger to travelers. Robbery and kidnappings are also prevalent on highways outside of Kabul. The transportation system in Afghanistan is marginal, although the international community is constructing modern highways and provincial roads. Vehicles are poorly maintained, often overloaded, and traffic laws are not enforced. Vehicular traffic is chaotic and must contend with numerous pedestrians, bicyclists and animals. Many urban streets have large potholes and are not well lit. Rural roads are not paved. Please refer to our Road Safety page for more information.


AVIATION SAFETY OVERSIGHT:


As there is no direct commercial air service to the United States by carriers registered in Afghanistan, the U.S. Federal Aviation Administration (FAA) has not assessed Afghanistan’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa. U.S. Government personnel are not authorized to travel on Ariana Afghan Airlines or any other airline falling under the oversight of the Government of Afghanistan’s Civil Aviation Authority, owing to safety concerns; however, U.S. Government personnel are permitted to travel on international flights operated by airlines from countries whose civil aviation authorities meet international aviation safety standards for the oversight of their air carrier operations under the FAA’s International Aviation Safety Assessment (IASA) program.


CHILDREN'S ISSUES:


 For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction. R


EGISTRATION / EMBASSY LOCATION:


Americans living or traveling in Afghanistan 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 Afghanistan. Americans without internet access may register directly with the U.S. Embassy. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located in Kabul on Great Massoud (Airport) Road, local phone number 0700-108-001 or 0700-108-002, and for emergencies after hours 0700-201-908. The web site is http://kabul.usembassy.gov/ * * * * * This replaces the Country Specific Information dated June 16, 2008 to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Information for Victims of Crime, Criminal Penalties, Special Circumstances, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed 11 Dec 2019
Source: MENA FN [edited]

Officials in the Ministry of Public Health has said that 2 fresh positive cases of polio have been registered in southern Uruzgan [Oruzgan] and northern Baghlan provinces.

According to health officials, the families of the polio-affected children live in Dand-e-Ghori [Dahana-i-Ghori] and Khas Uruzgan districts, [respectively], and the areas were out of the government's control and deprived of medical facilities.

Dr. Abdul Qayum Khplwak, head of the medical institute for the southern part of Afghanistan, said that one of the 2 children has been deprived of polio vaccination in Khas Uruzgan district of the province. He said that despite tremendous efforts towards fighting polio, there are great obstacles against the implementation of the process.

"Until every child receives polio vaccination, our efforts would not reach a complete goal," he said, adding that "the fresh case in Uruzgan shows that southern provinces are facing serious polio threats."

Meanwhile, a local medical in charge for polio affairs in Baghlan, Marjan Rasikh, has put the age of the polio-affected child at 4 years old, saying that the case has marked the initial positive polio in the province.

Over 24 positive polio cases have been recorded from the beginning of 2019: more than 8 cases in Uruzgan, 5 in Helmand, 4 in Kandahar, 2 in Paktia, and 3 other cases in Badghis, Nangarhar, and Kunar provinces.

To prevent the positive cases of polio, the health officials said that anti-polio vaccination should be implemented across the country.
===================
[The addition of these 2 newly confirmed cases will increase the total number of cases reported from Afghanistan with dates of onset during 2019 to 24. There was a newly confirmed case from Kandahar reported in last week's GPEI (Global Polio Eradication Initiative) report with date of onset 10 Nov 2019.

Again, the common denominator in the occurrence of WPV1 (wild poliovirus type 1)-associated AFP (acute flaccid paralysis) cases (presumed to be WPV cases) and in cVDPV (circulating vaccine-derived poliovirus)-associated cases is the presence of a significant susceptible population, or, in other words, areas with suboptimal vaccination coverages.

A map of Afghanistan showing provinces can be found at
The HealthMap/ProMED-mail map of Afghanistan can be found at
Date: Mon 2 Dec 2019
Source: China.org.cn, Xinhua News Agency report [edited]

One fresh polio case had been detected in Afghanistan's southern Kandahar province, a local newspaper reported on [Mon 2 Dec 2019].

"With this new case, the total number of polio cases in 2019 reaches 22 in the country. The latest polio case has been reported from Kandahar city, capital of Kandahar province which permanently paralyzed an 18-month-old child," Daily Afghanistan-e-Ma reported.

The paper added that polio is a crippling and potentially fatal infectious disease.

"Most of the Afghan children affected by poliovirus this year [2019] are living in areas where kids do not have access to health facilities and regular anti-polio vaccination campaign. However, this time a child has been affected in a large city where anti-polio vaccination had been conducted repeatedly this year," the report said.

There is no cure for polio and the polio vaccine is the only safe and effective way to protect children.

The ongoing conflicts have been hindering the efforts to stamp out the infectious disease in the mountainous country.
===================
[The addition of 3 newly confirmed cases of polio (all 3 due to WPV1, as per End Polio Pakistan <https://www.endpolio.com.pk/polioin-pakistan/polio-cases-in-provinces>) in Pakistan and one newly confirmed case of polio in Afghanistan brings the total number of WPV1 associated cases with date of onset in 2019 to 116 (94 in Pakistan and 22 in Afghanistan). The key question here is whether Afghanistan and Pakistan, with all the challenges in vaccinating the susceptible populations due to a variety of anti-vaccination impediments, will be able to interrupt transmission of the WPV1 in both countries simultaneously.

Maps of Afghanistan:
and <http://healthmap.org/promed/p/137>. - ProMED Mod.MPP]
Date: Sun 1 Sep 2019
Source: MENAFN - Afghanistan Times [edited]

Two new polio cases have surfaced separately in capital city of Tirinkot and Chora district of southern Uruzgan [Oruzgan] province, a statement from the relevant ministry said [Sun 1 Sep 2019].

A 30-month-old child and another 6-month-old infant were permanently paralyzed as a result of the polio virus.

According to a statement issued by the Ministry of Public Health (MoPH), the total number of polio cases in 2019 reached 15 with the 2 new cases, saying all of these cases had been reported from inaccessible areas.

"Of the 15 polio cases this year [2019], 14 have been reported from the southern region of Afghanistan,' the statement said, adding "7 positive cases came from [Oruzgan], 5 from Helmand, and 2 other from Kandahar."

Only 1 out of 12 polio cases was reported from eastern Kunar province while the rest happened in the southern zone.

"Access to health services is the right of every citizen of the country," said Dr Ferozuddin Feroz, the Minister of Public Health. "We are deeply concerned about the increasing polio cases and the number of children who still don't have consistent and proper access to vaccination," he added.

He said the virus could spread further in the country and more children would be affected and paralyzed by polio virus.

He called upon people to 'work together and protect innocent children against polio and facilitate a safe and secure environment for our frontline workers in order to enable them administer vaccine drops to children in every nook and cranny of the country."

Polio is a crippling and potentially fatal infectious disease. There is no cure and the vaccine is the only safe and effective way to protect children.

The polio vaccine is safe and harmless for new-born children whether they are sick or not. It is very important that new-borns and sick children get the vaccine because they may have lower immunity which makes them more susceptible to the virus.

Polio vaccination has also been strongly endorsed by national and global Islamic scholars.
========================
[As I mentioned in the moderator comment of the last post (Poliomyelitis update (71): global (Pakistan, Congo DR) http://promedmail.org/post/20190901.6651501), "While there have been no newly confirmed cases reported from Afghanistan this week nor have there been positive environmental samples reported from either Pakistan or Afghanistan, it doesn't mean the virus is not still circulating, just that there aren't new confirmations." Unfortunately there were cases under investigation.

As correctly stated in the media report above, the addition of these 2 newly confirmed cases brings the number of confirmed WPV1 cases reported by Afghanistan during 2019 to date to 15.

Oruzgan is located in the central part of Afghanistan, sharing southern and southwestern borders with Kandahar and Helmand provinces where other polio cases have been reported this year (2019) as well (<http://www.lib.utexas.edu/maps/middle_east_and_asia/afghanistan_admin-2009.jpg>).

HealthMap/ProMED-mail map of Afghanistan:
Date: Mon, 19 Aug 2019 13:26:06 +0200 (METDST)

Jalalabad, Afghanistan, Aug 19, 2019 (AFP) - Scores of people including children were wounded Monday after a series of explosions shook the eastern Afghan city of Jalalabad, as the country's independence day was marred by bloodshed.

As many as 10 blasts were reported in and around the city in Nangarhar province, authorities said, and casualty numbers rose as the day wore on.   "The explosions were caused by IEDs in different parts of the city and as groups of people were celebrating independence day," the Nangarhar governor's spokesman Attaullah Khogyani said, referring to improvised explosive devices.   Jalalabad is the scene of frequent bomb attacks, and the surrounding terrain is home to both Taliban fighters and the Islamic State group's local affiliate.

At least 52 people were wounded, Khogyani said. Zaher Adel, a spokesman for a local hospital, said 66 wounded people had been brought in. An AFP correspondent saw children among the victims.   This year's August 19 celebrations mark 100 years of Afghan independence from British influence.   The day was supposed to be one of national pride and unity, but was overshadowed by an IS suicide attack Saturday on a crowded Kabul wedding hall that killed at least 63 people.

In Kabul, locals took to the streets to wave the black-red-and-green Afghan flag, but several public events to commemorate the date were scrapped as Kabul mourns and due to fears of a fresh attack.    "We postponed the celebrations to honour the victims, but we will definitely take revenge for our people," Afghan President Ahraf Ghani said.   "We will avenge the blood of our people, every drop of it."

Mayhem from Afghanistan's war continues to wreak havoc on Afghans every day, even though the US and the Taliban are in final negotiations for a deal that would see US troops begin to quit Afghanistan and could potentially lead to a reduction in violence.
Date: Sun, 18 Aug 2019 11:47:26 +0200 (METDST)
By By Emal Haidary and Mushtaq Mojaddidi

Kabul, Aug 18, 2019 (AFP) - Joy and celebration turned into horror and carnage when a suicide bomber targeted a packed Afghan wedding hall, killing at least 63 people in the deadliest attack to rock Kabul in months, officials and witnesses said Sunday.   The massive blast, which took place late Saturday in west Kabul, came as Washington and the Taliban finalise a deal to reduce the US military presence in Afghanistan and hopefully build a roadmap to a ceasefire.   The groom recalled greeting smiling guests in the afternoon, before seeing their bodies being carried out hours later.

The attack "changed my happiness to sorrow", the young man, who gave his name as Mirwais, told local TV station Tolo News.   "My family, my bride are in shock, they cannot even speak. My bride keeps fainting," he said.   "I lost my brother, I lost my friends, I lost my relatives. I will never see happiness in my life again."   Interior ministry spokesman Nasrat Rahimi said at least 63 people had been killed and 182 injured.   "Among the wounded are women and children," Rahimi said. Earlier he stated a suicide bomber carried out the attack.

Afghan weddings are epic and vibrant affairs, with hundreds or often thousands of guests celebrating for hours inside industrial-scale wedding halls where the men are usually segregated from the women and children.   "The wedding guests were dancing and celebrating the party when the blast happened," recounted Munir Ahmad, 23, who was seriously injured and whose cousin was among the dead.   "Following the explosion, there was total chaos. Everyone was screaming and crying for their loved ones," he told AFP from his bed in a local hospital, where he is being treated for shrapnel wounds.

Images from inside the hall showed blood-stained bodies on the ground along with pieces of flesh and torn clothes, hats, sandals and bottles of mineral water. The huge blast ripped parts of the ceiling off.   The wedding was believed to be a Shia gathering. Shia Muslims are frequently targeted in Sunni-majority Afghanistan, particularly by the so-called Islamic State group, which is also active in Kabul but did not immediately issue any claim of responsibility.

Wedding guest Hameed Quresh told AFP the young couple were saying their vows when the bomb went off.    "We fainted following the blast, and we don't know who brought us to the hospital," sobbed Quresh, who lost one brother and was himself wounded.   Another guest told Tolo that some 1,200 people had been invited. With low security, weddings are seen as easy targets.   The attack sent a wave of grief through a city grimly accustomed to atrocities. President Ashraf Ghani called it "barbaric", while Afghanistan's chief executive Abdullah Abdullah described it as a "crime against humanity".

- Withdrawal deal expected -
The attack underscores both the inadequacy of Afghanistan's security forces and the scale of the problem they face. While the police and army claim they prevent most bombings from ever happening, the fact remains that insurgents pull off horrific attacks with chilling regularity.   On July 28, at least 20 people were killed when attackers targeted Ghani's running mate Amrullah Saleh as he campaigned in presidential elections.    The incident showed how even amid tight security and known threats, insurgents can conduct brazen attacks.   The issue also goes to the heart of a prospective deal between the US and the Taliban that would see Washington begin to withdraw its approximately 14,000 soldiers from Afghanistan.

The deal relies on the Taliban providing guarantees they will stop jihadist groups such as Al-Qaeda and IS from using Afghanistan as a safe haven. Saturday's attack suggests any such promise would be tough to keep.   The "Taliban cannot absolve themselves of blame, for they provide platform for terrorists," Ghani said.   Few believe such a deal will bring quick peace.

Many Afghans fear the Taliban could return, eroding hard-won rights for women in particular and leading to a spiralling civil war.   Meanwhile, in the northern province of Balkh, 11 members of the same family were killed when their car hit a roadside bomb, officials said. The provincial governor blamed the Taliban for planting the device.
More ...

Guyana

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

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

SAFETY AND SECURITY: Driving in Guyana can be particularly dangerous, with a significant number of accidents and road fatalities occurring. See the section below on “Traffic Safety and Road Conditions” for additional information. In the past, demonstrations and protests occasionally occurred in Georgetown; however, these are increasingly rare. Past demonstrations have not been directed at U.S. citizens and violence against Americans in general is not common. Visitors should nevertheless remain alert and take prudent personal security measures to deal with the unexpected while in Guyana. It is advisable to avoid areas where crowds have congregated and to maintain a low profile when moving about Georgetown and other Guyanese cities. Most major eco-tourist resorts and hotels in Guyana do not have written emergency plans in place, and many of them have safety deficiencies, including a lack of easily identifiable lifeguards or no lifeguards at all. Many of these resorts also do not have adequately stocked first aid supplies. For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs web site, where the current Travel Warnings and Public Announcements, including the Worldwide Caution, can be found. Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the United States and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME: Serious crime, including murder and home invasion, continues to be a major problem; the murder rate in Guyana is three times higher than the murder rate in the United States. In early 2008, an attack in the Georgetown suburb of Lusignan and in the Essequibo River town of Bartica by heavily armed gangs resulted in the deaths of more than 20 persons, mostly innocent Guyanese civilians. An investigation into these attacks is continuing, but most of the perpetrators are still at large. In addition, there have been several instances of random shootings at night at police headquarters or police stations in Georgetown. U.S. citizens are encouraged to maintain a high level of vigilance, consider security issues when planning activities throughout Guyana, minimize movement when possible, and avoid traveling at night, when possible.

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

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

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is available for minor medical conditions. Emergency care and hospitalization for major medical illnesses or surgery are limited, due to a lack of appropriately trained specialists, below standard in-hospital care, and poor sanitation. Ambulance service is limited to transportation without any medical care and is frequently not available for emergencies. An MRI (linked to the United States for interpretation) has been installed and is operational, but results may take up to 4 days. Visitors are advised to bring prescription medicine sufficient for their length of stay and should be aware that Guyana's humid climate may affect some medicines. Some prescription medicines (mainly generic rather than name-brand) are available. Special attention should be paid to HIV/AIDS in Guyana. In addition to infection rates as high as 45% in high-risk populations such as commercial sex workers and mobile populations such as miners or loggers, data from the World Health Organization estimate that 1.6% of the general population is infected with HIV; this is among the highest prevalence rates in Latin America and the Caribbean. Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

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

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Guyana is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
In 2007, road fatalities increased more than 40% from the previous year. The rate of traffic accident fatalities in Guyana is 70% higher than in the United States. The Traffic Division of Guyana's National Police Force is responsible for road safety but is ill-trained and ill-equipped. Driving in Guyana is hazardous because of very poor road surfaces; farm animals sleeping or wandering on the roads; pedestrians walking on the road; and poor driving habits, including speeding, reckless driving, tailgating, cell phone use, quick stops without signaling, failure to dim headlights, and weaving in and out of traffic. Traffic lights installed in Georgetown are often ignored or simply flash, posing a risk to drivers and pedestrians. Visitors should exercise caution at all times while driving and avoid driving at night, when possible. The Department of State recommends that Embassy staff travel in groups of two or more vehicles when traveling outside Georgetown at night.
Travelers are advised to use caution traveling to and from Cheddi Jagan International Airport, especially at night. The Embassy requires its staff to use official vehicles when traveling this route between dusk and dawn due to a combination of most of the aforementioned characteristics of driving in Guyana.
Penalties for drivers involved in an accident resulting in injury or death are severe, including life imprisonment. If involved in an accident, call 911 for police and 913 for an ambulance. Please note that police may be slow to respond and an ambulance may not be available.
Drivers use the left side of the road in Guyana. Seatbelt use is required by law and is enforced; failure to use a seatbelt can result in a fine. There presently are no laws in Guyana concerning use of child car seats, but the use of age-appropriate seats is strongly recommended for child passengers. Both drivers and passengers on motorcycles must wear protective helmets that meet certain specifications.
Mini-buses (small 12- to 15-passenger vans) ply various routes both within and between cities. Mini-bus drivers have come under severe criticism from the government, press, and private citizens for speeding, aggressive and reckless driving, overloading of vehicles, poor vehicle maintenance and repair, and offensive remarks directed at passengers, but little change in their driving behavior has been noted. Mini-buses have been involved in the majority of fatal vehicular accidents in recent years.
Please refer to our Road Safety page for more information. Visit the web site of the country’s national tourist office and national authority responsible for road safety.

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Leptospirosis is an infection transmitted to humans by exposure to soil or fresh water contaminated with the urine of wild and domestic animals (including dogs, cattle, swine, and especially rodents) that are chronically infected with pathogenic _Leptospira_. The Bosai mine is an open pit mine, the usual way manganese is mined (<https://demerarawaves.com/2017/01/27/manganese-mining-in-north-west-district-to-create-hundreds-of-jobs-improved-infrastructure/>). Open pit mines are subject to flooding, which could lead to exposure to leptospirosis if there is also rat infestation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nigeria

Nigeria US Consular Information Sheet
June 02, 2008
COUNTRY DESCRIPTION:
Nigeria is a developing country in western Africa that has experienced periods of political instability. It has the largest population on the continent, estimated at
44 million people, and its infrastructure is not fully functional or well maintained. Read the Department of State’s Background Notes on Nigeria for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. The visa must be obtained in advance from a Nigerian Embassy or Consulate. Visas cannot be obtained on arrival at the airport. Promises of entry into Nigeria without a visa are credible indicators of fraudulent commercial schemes in which the perpetrators seek to exploit the foreign traveler's illegal presence in Nigeria through threats of extortion or bodily harm. U.S. citizens cannot legally depart Nigeria unless they can prove, by presenting their entry visas, that they entered Nigeria legally. Entry information may be obtained at the Embassy of the Federal Republic of Nigeria, 3519 International Court NW, Washington, DC 20008, telephone (202) 822-1500, or at the Nigerian Consulate General in New York, telephone (212) 808-0301. Overseas, inquiries may be made at the nearest Nigerian embassy or consulate.

Visit the Embassy of Nigeria web site at http://www.nigeriaembassyusa.org/ for the most current visa information.

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

SAFETY AND SECURITY:
The Department of State continues to caution U.S. citizens about the possible dangers of travel to some parts of Nigeria. [Please also see the Crime Section below.] In light of the risk of kidnapping, crime, militant activity, or armed attacks, the U.S. Mission restricts the travel of U.S. government personnel to the following states to official travel only: Delta, Bayelsa, Rivers and Akwa Ibom in the Niger Delta, and Edo and Imo in the south. Only essential travel by non-official Americans is recommended to these areas. In addition, the military's Joint Task Force patrols the creeks in the Niger Delta because of ongoing militant and piracy incidents, especially against oil-related facilities or infrastructure, so individuals may be questioned, detained or arrested when traveling in these sensitive areas without evidence of permission from the Nigerian government or for carrying electronic equipment such as cameras, recorders, etc. Periodically, travel by U.S. mission personnel is restricted in certain parts of Nigeria based on changing security conditions, often due to crime, general strikes, or student/political demonstrations or disturbances. See the Department of State’s Travel Warning for Nigeria for more information.

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 current Travel Warnings, Travel Alerts, and the Worldwide Caution can be found.

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

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

CRIME: Violent crime committed by individual criminals and gangs, as well as by some persons wearing police and military uniforms, is a problem, especially in Lagos, Abuja and other large cities, although it can occur anywhere. Some visitors and resident Americans have experienced armed muggings, assaults, burglary, carjacking, kidnappings and extortion, often involving violence. Home invasions are on the rise in Lagos, with armed robbers accessing even guarded compounds by following, or tailgating, residents or visitors arriving by car into the compound, subduing guards and gaining entry into homes or apartments. Armed robbers in Lagos also access waterfront compounds by boat. U.S. citizens, as well as Nigerians and other expatriates, have been victims of armed robbery on roads to airports during both daylight and evening hours. Law enforcement authorities usually respond to crimes slowly or not at all, and provide little or no investigative support to victims. U.S. citizens and other expatriates have experienced harassment and shakedowns at checkpoints and during encounters with Nigerian officials.

Nigerian-operated fraud scams, known as 419s, are noted for their cleverness and ingenuity. These scams target foreigners worldwide, posing risks of both financial loss and personal danger to their victims. Scams are often initiated through internet postings or from internet cafes, by unsolicited emails, faxes, and letters, or can involve credit card use. As anywhere else, no one should provide personal or financial information to unknown parties or via Nigerian telephone lines. The expansion of bilateral law enforcement cooperation, which has resulted in numerous raids on commercial fraud premises, has reduced the overall level of overt fraud activity, but new types of sophisticated scams are introduced daily.

American citizens are very frequently the victims of Nigerian confidence artists offering companionship through internet dating websites. These confidence artists almost always pose as American citizens visiting or living in Nigeria who unexpectedly experience a medical, legal, financial or other type of “emergency” that requires the immediate financial assistance of the American citizen in the United States. In these cases, we strongly urge the American citizen in the United States to be very cautious about sending money to any unknown person purportedly acting on their behalf, or traveling to Nigeria to meet someone with whom their sole communications have been via the internet. Other common scams involve a promise of an inheritance windfall, work contracts in Nigeria, or an overpayment for goods purchased on-line. For additional information on these types of scams, see the Department of State's publication, International Financial Scams.

Commercial scams or stings that targets foreigners, including many U.S. citizens, continue to be a problem. One needs to be alert to scams that may involve U.S. citizens in illegal activity, resulting in arrest, extortion or bodily harm. These scams generally involve phony offers of either outright money transfers or lucrative sales or contracts with promises of large commissions or up-front payments, or improperly invoke the authority of one or more ministries or offices of the Nigerian government and may cite, by name, the involvement of a Nigerian government official. In some scams, government stationery and seals are also improperly used to advance the scam. The ability of U.S. consular officers to extricate U.S. citizens from unlawful business deals or scams and their subsequent consequences is extremely limited. U.S. citizens have been arrested by police officials and held for varying periods on charges of involvement in illegal business activity or scams. Nigerian police or other law enforcement officials do not always inform the U.S. Embassy or Consulate immediately of the arrest or detention of a U.S. citizen. The U.S. Department of Commerce has advisories to the U.S. business community on a variety of issues that should be seriously reviewed with respect to doing business in Nigeria. To check on a business’s legitimacy while in the United States, contact the Nigeria Desk Officer at the International Trade Administration, Room 3317, Dept. of Commerce, Washington, D.C. 20230, telephone 1-800-USA-TRADE or (202) 482-5149, fax (202) 482-5198. If you are abroad, contact the nearest U.S. Embassy or Consulate.

The Department of State encourages all travelers abroad to register their travel. The most convenient way to do so would be through the online travel registration page. Travelers may also register in person at the U.S. Embassy in Abuja or the U.S. Consulate General in Lagos. See the section on Registration / Embassy Location below.

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, for example, can provide you with a list for appropriate medical care, or contact family members or friends and explain how funds could be transferred to you to cover unexpected costs. 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 the Department of State’s information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: While Nigeria has many well-trained doctors, medical facilities in Nigeria are in poor condition, with inadequately trained nursing staff. Diagnostic and treatment equipment is most often poorly maintained, and many medicines are unavailable. Caution should be taken as counterfeit pharmaceuticals are a common problem and may be difficult to distinguish from genuine medications. This is particularly true of generics purchased at local pharmacies or street markets. Hospitals often expect immediate cash payment for health services.

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

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their health insurance policy applies overseas and whether it will cover emergency expenses such as a medical evacuation from a foreign country to the United States or another location. Please see the our brochure 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 Nigeria is provided for general reference only and may not be totally accurate in a particular location or circumstance.

Roads in many areas are generally in poor condition, causing damage to vehicles and contributing to hazardous traffic conditions. There are few working traffic lights or stop signs. The rainy season from May to October is especially dangerous because of flooded roads and water-concealed potholes.

Excessive speed, unpredictable driving habits, and the lack of basic maintenance and safety equipment on many vehicles are additional hazards. Motorists seldom yield the right-of-way and give little consideration to pedestrians and cyclists. Gridlock is common in urban areas. Chronic fuel shortages have led to long lines at service stations, which disrupt or block traffic for extended periods.

Public transportation vehicles are unsafe due to poor maintenance, high speeds and overcrowding. Motorbikes, known in Nigeria as "okadas," are a common form of public transportation in many cities and pose particular danger to motorists, their own passengers and pedestrians. Motorbike drivers frequently weave in and out of traffic at high speeds and observe no traffic rules. Motorbikes are banned within Abuja's city limits. Passengers in local taxis have been driven to secluded locations where they were attacked and robbed. Several of the victims required hospitalization. The U.S. Mission advises that public transportation throughout Nigeria be avoided.

It is recommended that short-term visitors not drive in Nigeria. A Nigerian driver's license can take months to obtain, and to date an international driving permit is not recognized. Major hotels offer reliable car-hire services complete with drivers. Reliable car-hire services can also be obtained at the customer service centers at the airports in Lagos, Abuja, and Kano. Inter-city travelers must also consider that roadside assistance is extremely scarce, and as noted above medical facilities and emergency care are poor, meaning that being involved in a traffic incident might result in a lack of available medical facilities to treat either minor or life-threatening injuries.

All drivers and passengers are reminded to wear seat belts, lock doors, and raise windows. It is important to secure appropriate automobile insurance. It is also important to be aware that drivers and passengers of vehicles involved in accidents resulting in injury or death have experienced extra-judicial actions, i.e., mob attacks, official consequences such as fines and incarceration or involvement with the victim's family. Night driving should be done with extreme caution, but it is recommended to avoid driving between 6:00 p.m. and 6:00 a.m. as bandits and police roadblocks are more numerous at night. Streets are very poorly lit, and many vehicles are missing one or both headlights, tail lights, and reflectors.

The Government of Nigeria charges the Federal Road Safety Commission with providing maps and public information on specific road conditions. The Federal Road Safety Commission may be contacted by mail at: Ojodu-Isherri Road, PMB 21510, Ikeja, Lagos; telephone [243] (1) 802-850-5961 or [234] (1) 805-684-6911.
Please refer to our Road Safety page for more information.

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

The Port Harcourt International Airport, which was closed in mid-2006 for rehabilitation, resumed operations in December 2007 for domestic daylight flights. Installations and improvements needed for international flights and night operations are expected to be completed in 2008.

For additional information on aviation safety concerns, see the Department of State’s Travel Warning for Nigeria.
SPECIAL CIRCUMSTANCES:
Permission is required to take photographs or videotape any government buildings, airports, bridges, and in areas where the military is operating throughout the country. These sites include, but are not limited to, Federal buildings in the Three Arms Zone (Presidential palace area, National Assembly, Supreme Court/Judiciary) of the capital of Abuja, other government buildings around the country and foreign Embassies and Consulates. Many restricted sites are not clearly marked, and application of these restrictions is subject to interpretation by the Nigerian security services and can result in detention. Permission may be obtained from Nigeria's State Security Services, but even permission may not prevent the imposition of penalties or detention. Penalties for unauthorized photography or videography may include confiscation of the still or video camera, exposure of the film or deletion of film footage, a demand for payment of a fine or bribe, and/or detention, arrest, or physical assault. For these reasons, visitors to Nigeria should avoid taking still photos or videotaping in and around areas that are potentially restricted sites, including any government sites.

The Nigerian currency, the naira, is non-convertible. U.S. dollars are widely accepted. Nigeria is a cash economy, and it is usually necessary to carry sufficient currency to cover the expenses of a planned visit, which makes travelers an attractive target for criminals. Credit cards are rarely accepted beyond a few upscale hotels. Due to credit card fraud in Nigeria and by cohorts in the United States, credit card use should be considered carefully. While Citibank cashes some traveler’s checks, most other banks do not. American Express does not have offices in Nigeria; however, Thomas Cook does. Inter-bank transfers are often difficult to accomplish, though money transfer services such as Western Union are available. For further information, visitors may contact the U.S. Embassy or Consulate.

Please see the Department of State’s information on Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Nigerian laws, even unknowingly, may be expelled, detained, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Nigeria 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 the Department of State’s information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Nigeria are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Nigeria and other general information.Americans withoutInternet 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 1075 Diplomatic Drive, Central Area, Abuja. American citizens can call [234] (9) 461-4176 during office hours (Monday through Thursday, 7:30 a.m. to 4:30 p.m.; Friday, 7:30 a.m. to 1:30 p.m.). For after-hours emergencies, call [234] (9) 461-4000. The email address for the Consular Section in Abuja is ConsularAbuja@state.gov.

The U.S. Consulate General is located at 2 Walter Carrington Crescent, Victoria Island, Lagos. American citizens can call [234] (1) 261-1215 during office hours (7:30 a.m. to 4:00 p.m.). For after-hours emergencies, call [234] (1) 261-1414, 261-0050, 261-0078, 261-0139, or 261-6477. The e-mail address for the Consular Section in Lagos is Lagoscons2@state.gov.

The Embassy and Consulate website is http://nigeria.usembassy.gov/.
* * *
This replaces the Consular Information Sheet dated April 16, 2007, to update sections on Country Description, Safety and Security, Crime, Traffic Safety and Road Conditions, Aviation Safety Oversight, Special Circumstances and Registration / Embassy Location.

Travel News Headlines WORLD NEWS

Date: Fri 24 Jan 2020
Source: Eagle [edited]

The commissioner for health in Edo state, Dr. Patrick Okundia, on Friday [24 Jan 2020] in Benin said 76 out of 175 suspected cases of Lassa fever tested positive to the epidemic.

Okundia made this known during a Lassa fever committee meeting chaired by the state deputy governor, Philip Shaibu, and a representative of the World Health Organization.

He said: "A total of 76 suspected cases of Lassa fever were confirmed yesterday [Thu 23 Jan 2020] in the state, and they are currently on admission in the Irrua Specialist Teaching Hospital. We have not recorded any new death but have also reduced our case fatality rate to less than 10%. The number of cases in the ward now is 34, and we have discharged over 28 patients that have been fully treated and cured."

In his remarks, Shaibu called on all hospitals across the 18 local government areas [LGAs] of the state to refer any suspected cases to Irrua Specialist hospital and isolation centres.

He said: "Ministries of environment, agriculture, education, information, and other relevant ministries should also step up in the area of public awareness of the people. The 18 local government councils of the state should call for an emergency meeting, which will include private health practitioners for the purpose of early referral."

On her part, the state coordinator of the World Health Organisation, Faith Ireye, revealed that contact tracing in the state is the best in the country. Ireye called on the people to practice simple handwashing to avert contracting the disease.
=================
[Edo state has had many Lassa fever cases in recent years. The state is prepared to deal with treatment of Lassa fever patients in its Imua Specialist Teaching Hospital. Presumably, all the confirmed cases acquired their infections from the environment that has been contaminated by Lassa fever virus shed by rodent hosts, rather than in hospitals and health centres. Handwashing is always a good practice but will not prevent virus exposure from contamination of food materials by infected rodents. A public health education campaign at the village level is necessary to prevent infections.

Images of the rodent reservoirs of Lassa fever virus:
_Mastomys natalensis_:
_Mastomys erythroleucus_ and _Hylomyscus pamfi_:

The pygmy mouse (_Mus baoulei_) has recently been implicated as a reservoir species in West Africa but not in Nigeria.

There is no specific mention in the plans above of public education for avoidance of contact with these rodents and their excreta. - ProMED Mod.TY]

[Maps of Nigeria:
Date: Tue 21 Jan 2020
Source: Channels TV [edited]

In Ondo state, 16 people have been confirmed killed as a result of a Lassa fever outbreak. The state chief epidemiologist, Dr Steven Fagbemi, disclosed this on Tuesday [21 Jan 2020] at the governor's office in the Government House in Akure, the state capital.

Dr Fagbemi made the disclosure while briefing Governor Oluwarotimi Akeredolu as well as the local government chairmen from Ondo North and Central senatorial districts of the state. He also revealed that 84 cases have been reported so far in the state since 1 Jan 2020.

According to the epidemiologist, 16 of the patients have passed on, as their cases had reached the advanced stage before they were taken to the hospital. He added that 47 patients on admission were responding to treatment, while 21 others had already been treated and discharged.

The outbreak is said to have affected Owo, Akoko South-West, Akure South, and Ondo West LGAs of the state.

Also confirming the outbreak, the commissioner for health, Dr Wahab Adegbenro, noted that the disease has been occurring in the state for some years, especially during the dry season. He therefore advised Nigerians to visit hospitals when they noticed symptoms of fever.

Earlier, Governor Akeredolu advised the local government chairmen in the state to deploy cleaners to markets and public places to prevent the outbreak of diseases. He also called on residents to maintain a high level of hygiene to curtail further spread of the Lassa virus in the state.
====================
[The 81 new confirmed and 159 suspected cases in week 3 of 2020 indicate that Lassa fever (LF) virus transmission is continuing to accelerate. The 1st report above confirms that Ondo state has the majority of cases, tied with Edo state. Nigeria is now entering the period of the year when fewer cases usually occur, as illustrated in the graph in Figure 6 (at the source URL above). There has been a peak in case numbers between weeks 1 and 11 (January-March) over the past 3 years and probably will be the case again this year (2020).

Transmission of LF virus occurs when individuals are in contact with rodent reservoir host excreta or are within healthcare facilities. It would be interesting to know whether the prevalence of Lassa fever virus has been increasing in populations of rodent hosts in areas where human cases are occurring.

Images of the rodent reservoirs of Lassa fever virus:
_Mastomys natalensis_: <https://www.inaturalist.org/taxa/45326-Mastomys-natalensis>
_Mastomys erythroleucus_ and _Hylomyscus pamfi_: <http://punchng.com/nigerias-large-rat-population-threatens-lassa-fever-war/>

The pygmy mouse (_Mus baoulei_) has recently been implicated as a reservoir species in West Africa but not in Nigeria.

There is no specific mention in the plans above of public education for avoidance of contact with these rodents and their excreta. - ProMED Mod.TY]

[Maps of Nigeria:
Date: Sun 19 Jan 2010, 3:25 AM
Source: The Guardian [edited]

Of the 141 suspected yellow fever cases in Jos North, Wase, Bassa, Kanam and Riyom Local Governments of Plateau State, 25 cases have been confirmed.

Following the yellow fever outbreak, the rapid response team from the Nigeria Centre for Disease Control, Abuja and National Primary Healthcare Development Agency was dispatched to the state for analysis and investigation.

Briefing the State Commissioner of Health, Dr. Lar Ndam alongside other stakeholders, the leader of the response team, Dr. Clement Da'am, revealed that after visiting the affected local governments, 141 suspected cases were discovered, of which 25 were confirmed.

He said the late detection of the outbreak, poor yellow fever mass vaccination campaigns, poor routine immunisation coverage, hard to reach settlements, understaffing and insufficient cold change equipment were some of the challenges and gaps that must be addressed, particularly in Wase Local Council, to forestall future outbreaks.

Da'am commended the state government, the state Primary Healthcare Board and other critical stakeholders and partners for being pro-active in the wake of the outbreak and solicited more surveillance.

Health commissioner, represented by the Ministry's permanent secretary, commended the response team for the prompt intervention, considering one case of yellow fever is considered an outbreak, promising to take seriously the Centre's recommendations.  [Byline: Isa Abdulsalami Ahovi]
=====================
[A 29 Dec 2019 The World Health Organization (WHO) report confirmed 13 cases of yellow fever (YF), with 3 deaths in 4 local government areas of Plateau State (see Yellow fever - Africa (01): Nigeria (PL) http://promedmail.org/post/20200101.6862783). Now, the case count has increased to 25 coming from 5 different local government areas. One hopes that the planned increase surveillance and vaccination cam paignscan be carried out promptly. Vaccination is the best YF preventive measure. YF spread can get out-of-hand quickly in an under-vaccinated population. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Plateau State, Nigeria: <http://healthmap.org/promed/p/616>]
Date: Mon, 6 Jan 2020 21:10:44 +0100 (MET)

Kano, Nigeria, Jan 6, 2020 (AFP) - A bomb ripped through a crowded market on a bridge along Nigeria's border with Cameroon on Monday, killing nine people and injuring several others, security sources said.    The bomb exploded around 1520 GMT on the Nigerian side of the El Beid bridge, which separates the town of Gamboru in Nigeria from Fotokol in Cameroon.    "Preliminary findings revealed that nine people were killed... and all are Nigerians," an army officer said, speaking on condition of anonymity.

Twenty-six people were injured, including 21 Nigerians and five Cameroonians, the officer said.   Many on the bridge jumped into the river, witnesses said.    The leader of a local civilian militia told AFP that the victims included young children selling groceries on the bridge.   The Boko Haram jihadist group operates on both sides of the border and has frequently carried out deadly suicide attacks.   Gamboru, a trading hub, has been rocked by violence since August 2014 when Boko Haram jihadists seized the town along with nearby Ngala.

Nigerian troops retook both towns in September 2015 with the help of Chadian forces after months of fierce battles.   But jihadist fighters continue to launch sporadic attacks, ambushing troops and vehicles, farmers and attacking refugee camps.   Boko Haram and its rival Islamic State West Africa Province (ISWAP), which split from it in 2016, are known to operate in areas around Gamboru and Ngala.   Boko Haram's decade-long conflict has killed 36,000 people and displaced around two million from their homes in northeast Nigeria.   The violence had spread to neighbouring Niger, Chad and Cameroon, prompting a regional military coalition to fight the militants.
Date: Sun 29 Dec 2019
Source: The Guardian [edited]

The World Health Organisation (WHO) has confirmed 13 cases of yellow fever, which has resulted in 3 deaths in 4 local government areas of Plateau State.

WHO State Coordinator, Wonk Vingey Bassey, confirmed the incident while presenting a report on a survey conducted on affected councils during an emergency stakeholders' meeting in Jos. The meeting followed the outbreak of the disease in Jos North, Bassa, Riyom and Wase local government areas of the state.

Bassey, who gave the breakdown according to councils, said the deaths were recorded in Wase local government [area]. The coordinator, represented by the consultant Elizabeth Ahinchi, advocated early inspection and reporting of cases of the outbreak, in addition to intensified routine campaigns in communities.

State Commissioner for Health, Dr. Ninkwom Ndam, said the state government is working in collaboration with federal authority and other partners to strengthen healthcare services to citizens. Also, Executive Secretary, Plateau State Healthcare Board, Dr. Livinus Niamkwap, noted that the recent outbreak in the 4 councils calls for proactive measures to avert escalation to other areas.

Participants at the meeting discussed extensively on the way forward, laying emphasis on the need for the provision of mosquito nets, surveillance, awareness campaigns in media stations and worship centres, as well as financial support, among others.  [Byline: Isa Abdulsalami Ahovi]
====================
[A 17 Dec 2019 report indicated that from 1 Jan through 10 Dec 2019, a total of 4189 suspected yellow fever (YF) cases were reported from 604 of 774 local government area (LGAs) across all the 36 states and the federal capital territory in Nigeria (see Yellow fever - Africa (27): Nigeria, WHO http://promedmail.org/post/20191217.6845662). Although that report indicated that there have been YF cases in all 36 states, previous reports do not specifically mention Plateau State. Although the need for the provision of mosquito nets, surveillance, and awareness campaigns in media stations and worship centres is real, it is curious that no mention is made of a vaccination campaign or of the proportion of the populations in the affected areas that have been vaccinated previously. Vaccination is the best YF preventive measure. - ProMED Mod.TY]

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

World Travel News Headlines

Date: Sat, 25 Jan 2020 11:49:16 +0100 (MET)
By Su Xinqi, Jerome TAYLOR

Hong Kong, Jan 25, 2020 (AFP) - Hong Kong on Saturday declared a new coronavirus outbreak as an "emergency" -- the city's highest warning tier -- as authorities ramped up measures to reduce the risk of further infections.   The announcement came as city leader Carrie Lam faced criticism in some quarters over her administration's response to the crisis.

Of the five people who have tested positive for the virus in Hong Kong so far, four arrived via a newly built high-speed train terminal which connects with the mainland.   That led to calls from some medical experts and politicians to limit, or even halt, arrivals from China, the epicentre of the outbreak with 41 people dead.

Lam held emergency meetings with health officials on Saturday morning after returning from Davos.   "Today I declare the lifting of the response level to emergency," she told reporters.   Schools and universities, which are currently on a Lunar New Year break, would remain closed until 17 February, Lam said.   All mainland arrivals to Hong Kong will now need to sign health declaration forms, she added, while public events including a new year gala and next month's marathon, would also be called off.    "We haven't seen serious and widespread infections (in Hong Kong), but we are taking this seriously and we hope to be ahead of the epidemic," Lam said.

- Tragic past -
Hong Kong has a recent experience of deadly viral outbreaks.    Nearly 300 people were killed by SARS in 2003, a tragedy that left a profound psychological impact on one of the most densely populated places on earth.   The city's ability to combat the crisis was hampered by moves in mainland China to cover up and play down the outbreak, leaving a lasting legacy of distrust among many Hong Kongers.   Animosity towards the mainland has intensified in recent years as Beijing tightens political control over the semi-autonomous territory.

The outbreak also comes at a sensitive time for Lam, who currently boasts record low approval ratings after seven months of pro-democracy protests.   "We must stand united so that we can prevent and control the disease," she said, in a nod to the political unrest.   The often violent protests have battered Hong Kong's reputation for stability and helped tip it into recession, with the recent virus outbreak compounding the city's economic woes.

Hospitals are already struggling with the winter flu season, but officials are isolating anyone with a history of travel to central China and those exhibiting respiratory tract infections that look similar to the virus.   So far some 300 people have been tested and monitored for the virus. Quarantine centres have been set up in remote holiday parks for anyone found to have come into close contact with people who tested positive.   On Saturday, officials announced a newly built but still-empty public housing block would be used for medical staff on the frontline who did not want to risk returning to their families.
Date: Sat, 25 Jan 2020 06:46:59 +0100 (MET)
By Mahmut Bozarslan and Fulya Ozerkan in Istanbu

Elazig, Turkey, Jan 25, 2020 (AFP) - A powerful earthquake has killed at least 20 people and injured more than 1,000 in eastern Turkey, as rescue teams searched through the rubble of collapsed buildings for survivors on Saturday.    At least 30 people were missing following the magnitude 6.8 quake on Friday night, which had its epicentre in the small lakeside town of Sivrice in the eastern province of Elazig.   "It was very scary, furniture fell on top of us. We rushed outside," 47-year-old Melahat Can, who lives in the provincial capital of Elazig, told AFP.   President Recep Tayyip Erdogan said all steps were being taken to aid people affected by the quake, which caused widespread fear.   "We stand by our people," Erdogan said on Twitter.

The Turkish government's disaster and emergency management agency (AFAD) said the quake hit Sivrice at around 8.55 pm (1755 GMT). Turkey lies on major faultlines and is prone to frequent earthquakes.    Turkish television showed images of people rushing outside in panic, as well as a fire on the roof of a building.   Interior, environment and health ministers, who were in the quake zone, said the casulties were in Elazig province and in the neighbouring province of Malatya, which lies to the southwest.

At least 20 people died and 1,015 others were wounded, according to AFAD.   "There is nobody trapped under the rubble in Malatya but in Elazig search and rescue efforts are currently under way to find 30 citizens," Interior Minister Suleyman Soylu said on Friday.   Rescue teams were searching for survivors trapped in a five-storey collapsed building in a village some 30 kilometres from Elazig, according to AFP journalists at the scene. One person was pulled alive from the rubble.   Emergency staff and people waiting at the scene lit fires in the streets to stay warm in freezing temperatures.   Sports centres, schools and guest houses had been opened to accommodate quake victims in Malatya.

- 'Everybody is in the street' -
Sivrice -- a town with a population of about 4,000 people -- is situated south of Elazig city on the shores of Hazar lake -- one of the most popular tourist spots in the region and the source of the Tigris river.   The lake is home to a "Sunken City", with archaeological traces dating back 4,000 years in its waters.

The tremor was felt in several parts of eastern Turkey near the Iraqi and Syrian borders, the Turkish broadcaster NTV reported, adding that neighbouring cities had mobilised rescue teams for the quake area.   "Everybody is in the street, it was very powerful, very scary," said Zekeriya Gunes, 68, from Elazig city, after the quakes caused a building to collapse on her street.   "It lasted quite long, maybe 30 seconds," added Ferda, 39. "I panicked and was undecided whether to go out in this cold or remain inside."

The US Geological Survey assessed the magnitude as 6.7, slightly lower than AFAD, adding that it struck near the East Anatolian Fault in an area that has suffered no documented large ruptures since an earthquake in 1875.   "My wholehearted sympathy to President @RTErdogan and the Turkish people following the devastating earthquake that has hit Turkey. Our search and rescue teams stand ready to assist," Greek Prime Minister Kyriakos Mitsotakis wrote on Twitter.   In Athens, the Greek premier's office said later that Mitsotakis had spoken by phone to Erdogan.   "The Turkish president... said Turkish teams had the situation under control for now and that it would be re-evaluated in the morning," his office added.

In 1999, a devastating 7.4 magnitude earthquake hit Izmit in western Turkey, leaving more than 17,000 people dead including about 1,000 in the country's largest city Istanbul.    In September last year, a 5.7-magnitude earthquake shook Istanbul, causing residents to flee buildings in the economic capital.   Experts have long warned a large quake could devastate the city of 15 million people, which has allowed widespread building without safety precautions.
Date: Fri, 24 Jan 2020 17:43:54 +0100 (MET)
By Albert Kambale with Samir Tounsi in Kinshasa

Masisi, DR Congo, Jan 24, 2020 (AFP) - In eastern DR Congo, thousands have fled violence to camps in the remote mountain forests where they battle cholera, hunger and misery in a forgotten humanitarian disaster.   Eastern Democratic Republic of Congo has long struggled with violence from several militia groups, a legacy of the 1990s Congo wars that dragged in neighbouring Uganda and Rwanda.   The region is now also the epicentre of the latest Ebola epidemic, which has killed more than 2,200 people since August 2018.

Away from the Ebola headlines, tens of thousands of people are scattered in squalid camps across the mountains around Masisi, where they have fled, traumatised by violence, starving and with no chance to return home.   "I fled my village after clashes broke out," said Gentille, a 26-year-old Hutu Congolese. "We could no longer go to the fields. Many people died because clashes broke out in the middle of the village, very early one morning."

That fighting broke out in November and December involving one of the so-called Mai-Mai militia, the Nduma Defense of the Congo-Renove (NDC-R) and a coalition of other armed rivals, according to UN experts.   Now Gentille, a mother of five lives in a camp of 8,000 displaced people.  Along with the unsanitary conditions, a lack of clean water and food, since late last year, a cholera and measles outbreak has worsened life in the camps.    Several anti-cholera treatment units have been opened by Doctors without Borders (MSF), which reports 520 cases and two deaths.    "Three of my children got cholera. One died," says Gentille. "Here in the camp, we do not have enough toilets. More than 180 people use the same toilet. Since it is always busy, the children defecate outside and all around."

Around 685,000 displaced people survive in the mountainous areas, estimates MSF, a figure the aid group hopes will draw attention of the donors.   A year after coming to power, President Felix Tshisekedi has promised far-reaching reforms and a crackdown on corruption. But militia violence and ethnic clashes still undermine security of populations in the east.
Date: Fri, 24 Jan 2020 18:26:22 +0100 (MET)

Kathmandu, Jan 24, 2020 (AFP) - Health authorities in Nepal on Friday confirmed that a student who returned from Wuhan, China tested positive for the new coronavirus, becoming the first South Asian country to report the deadly disease.   The 32-year-old student arrived in Nepal on January 9, and entered the Sukraraj Tropical and Infectious Disease Hospital in Kathmandu four days later after running a fever and reporting trouble breathing, hospital spokesperson Anup Bastola told AFP.

The health ministry confirmed the case in a statement.   "The results of a sample, sent to Hong Kong, have returned positive," Bastola told AFP.    "He was discharged after recovery. We are monitoring the patient and he and his family members are healthy. So are all the health workers in the hospital," Bastola said.

Nepal's health ministry also said in a statement that surveillance has been increased at the airport, "and suspicious patients entering Nepal are being monitored with correct manpower and equipment".   At least 26 people have been killed by the previously unknown SARS-like coronavirus. Cases have been reported in half a dozen countries, including the United States.
Date: Fri, 24 Jan 2020 20:16:23 +0100 (MET)

Antananarivo, Jan 24, 2020 (AFP) - At least 26 people have died in Madagascar after almost a week of heavy rain in the north-west of the island, the government said on Friday.   The tropical Indian Ocean nation is in the midst of an intense six-month rainy season that often results in casualties and widespread damage.   Flooding in the districts of Mitsinjo and Maevatanana has claimed at least 26 lives since Sunday, and 15 more people are still missing and thousands have been displaced, the National Bureau of Disaster Risk Management (BNGRC) announced on Friday.   Strips of road were swept away by the rains and access to affected areas has been cut off.

The BNGRC warned that flooding in lowland and rice-growing areas also posed a risk of "food insecurity and malnutrition".   A disruption in the supply of basic goods could also lead to surge in prices, it added.   Prime Minister Christian Ntsay declared the situation a "national loss".   "The government is calling on national figures and international partners to help the Malagasy people with emergency aid, early recovery, rehabilitation and reconstruction," spokeswoman Lalatiana Andriatongarivo said in a statement.   The rainy season usually stretches from October to April in Madagascar, a former French colony off Africa's south-eastern coast.

Global warming has increased the risk and intensity of flooding, as the atmosphere holds more water and rainfall patterns are disrupted.    Built-up urban areas with poor drainage systems are especially vulnerable to heavy downpours, scientists say.   Nine people were killed in January 2019 after heavy rains caused a building to collapse in the capital Antananarivo.   During this period, the country is also often hit by cyclones and other tropical storms.   Cyclone Belna landed in the northwest last month, killing at least two people and displacing hundreds.
Date: Fri 24 Jan 2020
Source: Fernando Eid (@fernandoeidok) via Twitter [in Spanish, trans. ProMED Mod.TY, edited]

The 1st case of [a] hantavirus [infection] was confirmed in our country [this year in 2020]. The affected individual is an adolescent who contracted the disease in the tropical area of Cochabamba [department].  [Byline: Fernando Eid]
============================
[El Dia has a video clip available on the above Twitter URL with additional information (in Spanish, trans. ProMED Mod.TY):

The affected individual is a 15-year-old boy who was just released from the hospital ICU. He had a febrile disease. He had been in the forested area in tropical Cochabamba. He is believed to have acquired his infection from virus in faeces of the long-tailed rat. There have been10 cases of hantavirus infections in Cochabamba with one death [over what period of time? - ProMED Mod.TY]].
======================
[Unfortunately, the specific circumstances under which this youth or the previous 2019 cases acquired their infections is not mentioned. Presumably they were in contact with excreta from infected rodent hosts. Infected rodents shed the virus in faeces, urine, and saliva. Sporadic cases of hantavirus pulmonary syndrome occur in the Bolivian tropics, including Cochabamba department.

The specific hantavirus involved in these or previous cases in 2013 or those in 2012, in Bolivia, is not given. In the lowland Amazon basin of Bolivia, the hantaviruses that are likely to be in tropical Cochabamba department and might be involved in these hantavirus pulmonary syndrome cases are Laguna Negra viruses with its rodent hosts, _Calomys laucha_, the small vesper mouse (<https://www.flickr.com/photos/cdtimm/4367939127/in/photolist-otqNuS-EwTizo-7DYQ8i-278Fjfq-owyXyD-osEZQs>), and _C. callosus_, the large vesper mouse (<http://www.faunaparaguay.com/calomyscallosus.html>), as well as Rio Mamore virus with _C. laucha_ and _Oligoryzomys microtis_, the small-eared pygmy rice rat (<https://www.reservacostanera.com.ar/wp-content/uploads/2011/02/colilargo-menor-oligoryzomys-flavescens2-JGV-e1298896507790.jpg>). - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Cochabamba, Bolivia: <http://healthmap.org/promed/p/55162>]
Date: Fri 24 Jan 2020
Source: Eagle [edited]

The commissioner for health in Edo state, Dr. Patrick Okundia, on Friday [24 Jan 2020] in Benin said 76 out of 175 suspected cases of Lassa fever tested positive to the epidemic.

Okundia made this known during a Lassa fever committee meeting chaired by the state deputy governor, Philip Shaibu, and a representative of the World Health Organization.

He said: "A total of 76 suspected cases of Lassa fever were confirmed yesterday [Thu 23 Jan 2020] in the state, and they are currently on admission in the Irrua Specialist Teaching Hospital. We have not recorded any new death but have also reduced our case fatality rate to less than 10%. The number of cases in the ward now is 34, and we have discharged over 28 patients that have been fully treated and cured."

In his remarks, Shaibu called on all hospitals across the 18 local government areas [LGAs] of the state to refer any suspected cases to Irrua Specialist hospital and isolation centres.

He said: "Ministries of environment, agriculture, education, information, and other relevant ministries should also step up in the area of public awareness of the people. The 18 local government councils of the state should call for an emergency meeting, which will include private health practitioners for the purpose of early referral."

On her part, the state coordinator of the World Health Organisation, Faith Ireye, revealed that contact tracing in the state is the best in the country. Ireye called on the people to practice simple handwashing to avert contracting the disease.
=================
[Edo state has had many Lassa fever cases in recent years. The state is prepared to deal with treatment of Lassa fever patients in its Imua Specialist Teaching Hospital. Presumably, all the confirmed cases acquired their infections from the environment that has been contaminated by Lassa fever virus shed by rodent hosts, rather than in hospitals and health centres. Handwashing is always a good practice but will not prevent virus exposure from contamination of food materials by infected rodents. A public health education campaign at the village level is necessary to prevent infections.

Images of the rodent reservoirs of Lassa fever virus:
_Mastomys natalensis_:
_Mastomys erythroleucus_ and _Hylomyscus pamfi_:

The pygmy mouse (_Mus baoulei_) has recently been implicated as a reservoir species in West Africa but not in Nigeria.

There is no specific mention in the plans above of public education for avoidance of contact with these rodents and their excreta. - ProMED Mod.TY]

[Maps of Nigeria:
Date: Fri 24 Jan 2020
Source: Uganda Ministry of Health Tweets [edited]

[This series of tweets is drawn from a video interview that is also available at the above Twitter URL.]

The Ugandan Health Minister confirms an outbreak of yellow fever in Moyo District, West Nile region and Buliisa District in the Hoima region of Uganda.

Original public tweets
------------------------
Minister of Health, @JaneRuth_Aceng confirms the outbreak of Yellow Fever in Moyo District in West Nile region and Buliisa District in Hoima region in #Uganda.

@WHOUganda country representative, @tegegny speaks about the Yellow fever vaccine. "The Yellow Fever vaccine is one of those vaccines where you need to be vaccinated only once," he says.

@MinofHealthUG has also applied to @gavi and WHO for inclusion of the Yellow Fever vaccination into the routine immunisation schedule. Having faced 4 outbreaks, #Uganda now qualifies to introduce Yellow Fever vaccine as a long term measure to prevent Yellow Fever outbreaks.

@JaneRuth_Aceng: We anticipate that within the next 2 weeks, vaccines will be available and vaccination will commence in Moyo and Buliisa districts.

@JaneRuth_Aceng: @MinofHealthUG has requested for the Yellow Fever vaccines from the International Coordination Group that manages global stock piles of Yellow Fever and Meningitis vaccines.

@MinofHealthUG working with partners have dispatched Rapid Response Teams to Moyo and Buliisa Districts to support investigations, active search for cases, community mobilization and sensitization.

@JaneRuth_Aceng: At this time, there was little suspicion, however, his blood sample was withdrawn and sent to @UVRIug [Uganda Virus Research Institute] for testing and results showed positive for Yellow fever virus.

@JaneRuth_Aceng: In Buliisa, there are also 2 confirmed cases. A 37-year old male and his 38-year old wife. The husband was a cattle farmer trading in milk between Uganda and the Democratic Republic of Congo (DRC).

They presented with symptoms of:
- fever
- vomiting
- diarrhea
- fatigue
- headache
- abdominal and joint pain
- confusion
- unexplained bleeding.

@JaneRuth_Aceng: Upon arrival, they got ill and on [3 Jan 2020] were admitted at Logobo Health Center III in Moyo District. They were later referred to Moyo General Hospital.

@JaneRuth_Aceng: In Moyo District, there are 2 confirmed cases, both are males who were dealing in cutting and trading timber between Uganda and South Sudan. On [2 Jan 2020], the 2 cases travelled from South Sudan to Moyo.
==========================
[These 2 small (2 infected individuals in each locality) yellow fever (YF) outbreaks are not interconnected, having occurred at 2 sites at far distances from each other. It is reassuring to learn that the Ministry of Health will be investigating these 2 sites and initiating vaccination in these areas in 2 weeks. There is no indication of the proportion of the residents in these areas who have been vaccinated for YF previously.

Yellow fever is no stranger in Uganda, and outbreaks occur sporadically. The most recent previous outbreak reported by the Ugandan Ministry of Health was in May 2019 after laboratory-confirmed cases were reported from Koboko in the Northern region and Masaka in the Central region districts -- regions 600 km (375 mi) apart. These cases are spillover from endemic sylvan (forest) maintenance of the virus. Maintaining 80%-90% vaccination coverage in these areas is important to prevent initiation of urban transmission of the virus that can quickly get out of hand.

A map showing the location of Buliisa District in the center-west part of Uganda can be accessed at <https://en.wikipedia.org/wiki/Buliisa_District>, and another showing Moyo District in the far north of the country can be seen at <https://en.wikipedia.org/wiki/Moyo_District>. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Date: Fri, 24 Jan 2020 12:26:57 +0100 (MET)

Beijing, Jan 24, 2020 (AFP) - China has quarantined cities and shut major tourist attractions from Disneyland to the Forbidden City and a section of the Great Wall as it scrambles to stop a deadly SARS-like virus from spreading further.   The drastic moves come as hundreds of millions of people criss-crossed the country in recent days to celebrate the Lunar New Year holiday, which officially started Friday and is typically a joyous time of gatherings and public celebration.   Here is a rundown of the measures taken so far in an unprecedented quarantine effort:

- Cities under lockdown -
Public transport has been stopped in 13 cities in central Hubei province, with train stations shut, events cancelled and theatres, libraries and karaoke bars closed in some locations.   The epicentre of the outbreak is provincial capital Wuhan, the biggest city on lockdown, where the government has halted all travel out of the Yangtze River metropolis of 11 million.   Wuhan residents have been told to stay home and authorities are limiting the number of taxis allowed on roads. There are few flights available to the city, deepening the isolation.   Similar quarantine measures are being taken in the other, smaller cities. These include strict controls on weddings and funerals, temperature screening of people as they arrive and the suspension of online taxi services.   More than 41 million people in total are affected by the city shutdowns.

- Festivities cancelled -
Wuhan and Beijing have cancelled public events that usually attract hundreds of thousands of people to temples during the New Year holiday.   Gao Fu, head of the Chinese Center for Disease Control and Prevention, has asked China's 1.4 billion citizens to forego New Year gatherings and confine themselves at home until all is clear.   To discourage nationwide travel, the government also said all tickets for rail, air, road, or water transport could be refunded.

- Attractions closed -
The historic Forbidden City, a sprawling imperial palace in Beijing that is one of the country's most revered cultural sites, will temporarily close from Saturday.   Other famous landmarks including a section of the Great Wall, the Ming Tombs and Yinshan Pagoda are also not open to visitors.   Shanghai Disneyland said it would shut for an indefinite period "to ensure the health and safety of our guests and cast".   Women's Olympics football qualifiers scheduled for February 3-9 in Wuhan have been moved to the eastern city of Nanjing.

- Temperature checks -
Staff in full body protective suits were seen checking the temperatures of people entering a subway station in Beijing on Friday.   The country has ordered sterilisation and ventilation at airports and bus stations, as well as inside planes and trains, while travellers are being screened for fever.   Health authorities are urging people to wash their hands regularly, avoid crowded places, get plenty of fresh air and wear a mask if they have a cough.   In Wuhan, city authorities have made it mandatory to wear a mask in public places.   In response to skyrocketing demand for masks -- starting to sell out at pharmacies and on some popular websites -- China's industry and information technology ministry said it would "spare no effort in increasing supply".

- A new hospital -
In Wuhan, authorities are rushing to build a new hospital in a staggering 10 days as a rising number of patients are infected by the new coronavirus.   The facility is expected to be in use by February 3 and will have a capacity of 1,000 beds spread over 25,000 square metres, according to state media.   Dozens of excavators and trucks were filmed working on the site by state broadcaster CCTV.   Its construction began after reports surfaced of bed shortages in hospitals designated as dealing with the outbreak, which has now infected 830 people across China.
Date: Fri, 24 Jan 2020 11:22:00 +0100 (MET)

Beijing, Jan 24, 2020 (AFP) - China announced Friday it will close a section of the Great Wall and other famous Beijing landmarks to control the spread of a deadly virus that has infected hundreds of people across the country.   A range of Lunar New Year festivities have been cancelled to try to contain the virus, and Beijing's Forbidden City and Shanghai's Disneyland have also been closed temporarily.

The Ming Tombs and Yinshan Pagoda will also be closed from Saturday, the authority that oversees the sites said, while the Bird's Nest stadium -- the site of the 2008 Olympic Games -- was shuttered from Friday.   The Great Wall attracts around 10 million tourists a year and is a popular destination for visitors during the New Year holiday.   The Juyongguan section will close, while the Great Wall temple fair was cancelled at the Simatai section of the famous landmark.

Tourists at the Gubei water town by the Simatai section will have their temperature tested, the authority said in a statement on the WeChat social media app.   The Bird's Nest will be closed until January 30 in order to "prevent and control" the spread of the virus, authorities said. An ice and snow show taking place on the pitch will be closed.   The measures in the capital are the latest to try and control the outbreak of the new coronavirus, after authorities rapidly expanded a mammoth
quarantine effort that affected 41 million people in central Hubei province.

The previously unknown virus has caused alarm because of its similarity to SARS (Severe Acute Respiratory Syndrome), which killed hundreds across mainland China and Hong Kong in 2002-2003.   Although there have only been 29 confirmed cases in Beijing, city authorities have cancelled large-scaled Lunar New Year events this week.   The city government said it would call off events including two popular temple fairs, which have attracted massive crowds of tourists in past years.   Beijing's Forbidden City -- which saw 19 million visitors last year -- is usually packed with tourists during the Lunar New Year festival, when hundreds of millions of people travel across China.