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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cameroon

Cameroon - US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
Cameroon is a developing country in central Africa.
Although there are many natural and cultural attractions in Cameroon, facilities catering to Western-styl
tourism are quite limited.
The capital is Yaoundé, though Douala, the country's largest city, is its main port and commercial center.
Official languages are French and English, though French predominates in most of the country.
English may be used in Cameroon's two Anglophone provinces of Southwest and Northwest, and the larger cities.
The staff of major hotels in Cameroon’s large cities is usually bilingual.
In February 2008, social and political unrest led to civil unrest, although the immediate threat of violence has now receded.
For general information on Cameroon, read the Department of State Background Notes on Cameroon.

ENTRY/EXIT REQUIREMENTS:
A valid passport, visa, evidence of yellow-fever vaccination, and current immunization records are required, and travelers may be denied entry if they lack the proper documentation.
Travelers should obtain the latest information and details from the Embassy of the Republic of Cameroon, 2349 Massachusetts Avenue, NW, Washington D.C. 20008, tel: (202) 265-8790, fax: (202) 387-3826.
Visit the Embassy of Cameroon’s web site at http://www.ambacam-usa.org/ for the most current visa information.

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

SAFETY AND SECURITY:
During the week of February 25, 2008, Cameroon experienced significant civil unrest in half of its ten provinces, most notably in the port city of Douala.
Demonstrators clashed violently with police and then military personnel, resulting in the reported deaths of forty persons and arrest of over 1,600 individuals.
The unrest was marked by widespread road blockages, attacks on public and private vehicles, looting, burning of government and other buildings, and roaming crowds of malcontents.
This disturbance created shortages of fuel, food and other supplies throughout the country, and was ended through the deployment of military units and the use of significant force.

Following the restoration of order, some efforts have been made to address fuel and food prices that were among the key grievances of the demonstrators.
However, economic conditions, notably the high unemployment rate, remain difficult without the prospect for rapid improvement.
Political tensions also remain, particularly over a possible amendment to the Constitution that would allow President Biya to serve again.
Although a rapid resumption of violence is considered unlikely, Americans living in or visiting Cameroon are encouraged to stay abreast of local political and social developments that could signal additional difficulties for the country.

Embassy employees have been instructed to refrain from travel outside of city limits after dusk, and to monitor their movements in centrally located areas within cities and towns.
Private American citizens are urged to follow the same guidelines and are strongly advised against nighttime travel.
Armed highway bandits (most notably in border areas); poorly lit roads; hazardous, poorly maintained vehicles; and unskilled, aggressive and/or intoxicated drivers pose a threat to motorists.
Attacks and accidents are most common outside major towns, especially in the provinces bordering Chad and the Central African Republic but occur in all areas of the country.

The U.S. Department of State continues to warn U.S. citizens against travel to neighboring Central African Republic (CAR).
On occasion, conflict between insurgents and government security forces in CAR has spilled across the border into Cameroon, affecting outposts in both Adamawa and East Provinces.
Humanitarian and religious workers in eastern Cameroon are strongly encouraged to coordinate their efforts with the Embassy and the Office of the United Nations High Commission for Refugees (UNHCR) in Yaoundé.

In February 2008, an attack by rebel insurgents on Ndjamena, the capital of Chad, forced the evacuation of the Embassy in Chad and sent up to 50,000 refugees across the border into the town of Kousseri in Cameroon.
Although the attack was ultimately repelled, the possibility of further military action by the rebel forces remains.

In late 2006, inter-ethnic clashes were reported in the town of Kye-Ossi near the Cameroonian border with Gabon.
These confrontations were a result of a discord between moto-taxi drivers and the security forces, which resulted in demonstrations and roadblocks.
According to security authorities, tensions in the area are still high, despite the deployment of a large security force to the region.

Following a ruling from the International Court of Justice defining a section of the Cameroon-Nigeria border, Cameroon assumed administrative control of most of the Bakassi Peninsula, in August 2006, with Nigerian military forces withdrawing across the border.
Although the transition has generally gone smoothly, there was an attack on Cameroonian military forces in November 2007, reportedly by criminal elements from the Niger Delta not connected to the Nigerian government.
It is very difficult to reach Bakassi, but travelers thinking of going near there should exercise extreme caution as there is the potential for violence if tensions rise.

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

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

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

CRIME:
Crime is a serious and growing problem throughout Cameroon and U.S. citizens should exercise caution when traveling in Cameroon.
Internet-based crime is escalating rapidly, and Americans should be extremely skeptical of financial
transactions --
e.g. adoptions, hiring a service worker, such as a nanny, to come to the U.S., or purchasing a pet -- that involve sending money for goods or services not yet delivered (see below).
In February 2008, two European nationals were kidnapped by criminals posing as businessmen seeking to establish a palm oil export business. Although several perpetrators were arrested and the individuals were not harmed, the incident highlights a dangerous new confluence of internet-based and violent crime.
If you have concerns about the legitimacy of a transaction, such as adoption, in Cameroon contact the U.S. Embassy in Cameroon – see Registration/Embassy Location section below.
All foreigners are potential targets for theft with possible attendant violence.
Petty crimes, crimes against persons, thefts from vehicles, and of vehicles are the most common criminal activities.
Armed banditry is a growing problem throughout all ten provinces in Cameroon.
Specifically, incidents of armed highway-robbery have been reported in the North West, West, South West and East provinces.
Armed bandits have erected road barricades on major routes that link rural towns to provincial headquarters, and have taken as many as 100 cars in a single attack.
To curb banditry, security personnel may request persons to show their passport, residence card, driver's license, and/or vehicle registration at random checkpoints.
Certified copies of these important documents should be kept in a secure location separate from the originals.
Security personnel have been known to ask for bribes and may hurt citizens who refuse to pay.
The U.S. Government does not condone bribery or corruption of any kind.

Due to the frequency of criminal incidents involving public transportation, American citizens are advised that use of public taxis can be dangerous.
In April 2007, two American women were assaulted and robbed in a taxi.
Public taxis in Cameroon function more like the U.S. bus system with drivers stopping to pick up additional passengers as long as there is space left in the vehicle.
There have been numerous reports of assaults and robberies committed by "passengers" in shared taxis since crimes – rape and robbery being among the most common – are often a collaborative effort between the driver and "passengers."
If a traveler must use a taxi, the use of a private taxi – or a taxi hired for exclusive use by the individual for that particular trip – where the driver is known to the passenger is a better alternative to the use of shared taxis.
Taxi passengers should be particularly vigilant at night.

The risk of street and residential crime is high, and incidents of violent crime are on the rise throughout the country.
During the last year, the number of carjacking and armed burglary incidents in residences and restaurants, particularly in Yaoundé and Douala, continued to increase.
Carjacking and robbery has also been reported on rural highways, especially in the Northern provinces and regions near Cameroon's border with the Central African Republic.

On March 27, 2006, 11 armed men attacked a group of four U.S. citizens in a private residence (adjacent to a hotel frequented by expatriates) in Kribi, located in the Southern province.
A group of five armed bandits held up and robbed staff and guests of a hotel in Ngaoundere (Adamawa Province) on December 20, 2006.
Similar incidents occurred in the middle of the night at hotels in Bertoua (East Province) on April 22, 2007, and in Yaoundé (Central Province) on May 15, 2007 when assailants broke into hotel rooms and robbed the residents.
Americans were among the victims.
Crimes against property, such as carjacking and burglaries, have often been accompanied by violent acts and have resulted in fatalities.
There were four incidents of armed robberies in the month of April 2007, involving American citizens in or near restaurants in Yaoundé and Bertoua.

In January 2007, a French expatriate was fatally shot in the upscale Bastos neighborhood of Yaoundé.
The woman was dropping off a friend to her residence and interrupted an attempted home invasion.
Upon realizing what was happening, the friend returned to the vehicle and both women attempted to flee the scene.
As they were leaving, an armed bandit shot and fatally wounded the driver of the vehicle.

In September 2007, several expatriates suffered armed attacks.
In one incident, an Israeli citizen giving a ride to a friend was attacked in Bastos by two men with knives.
In the ensuing scuffle, the Israeli was critically wounded.
A Moroccan diplomat was fatally injured while walking near his residence.
Found unconscious by security guards, he was taken to a local hospital where he died the following day.
A Chinese business woman was also robbed and killed outside her home in a neighborhood near Bastos.
All incidents occurred late at night.

In December 2007, a police officer was arrested and jailed in Yaoundé after he and his accomplices surprised a couple returning from Europe and stole a briefcase and jewelry.

In January 2008, three bandits posing as passengers on a bus to Douala – and carrying locally made guns - were intercepted at Bafoussam and apprehended.
In Douala, armed bandits robbed a soap company at gun point, surprising the employees.
They attempted to loot the company’s computers, but were intercepted by a SWAT team and ran off.
Also in January, an Embassy employee using public transportation in the Northwest Province was the victim of highway robbers, who robbed the passengers (including a local mayor) and roughed-up those who did not have enough money.
In February 2008, Cameroon experienced a brief period of civil unrest during a taxi strike that involved road blockages, attacks on public and private vehicles, looting, burning of government and other buildings, and roaming crowds of malcontents.
This period was attended by a sharp increase in reported crimes, including the stabbing death of a night watchman at a residence in Yaoundé, an attack at the Brussels Airline travel agency in the Bonapriso district of Douala, an attack by a group of armed bandits on a motorbike rider who suffered a gunshot wound to the head, and numerous reports of rape and armed attacks with firearms and machetes in Douala.

Recently, many American citizens have become victims of Cameroonian advance-fee fraud and other scams offering antiques, exotic and domesticated animals, and even adoption services through the Internet.
Americans should be very cautious about sending money or traveling to Cameroon to meet someone contacted via the Internet.
Commercial scams targeting foreigners, including many U.S. citizens, continue to be a problem.
The scams generally involve phony offers of lucrative sales and repeated requests for additional funds to pay for unforeseen airport and/or customs fees.
No one should provide personal financial or account information to unknown parties.
The ability of U.S. Embassy officers to extricate U.S. citizens from unlawful business deals and the consequences is limited.
For more information on international financial scams, including those involving Internet dating, a promise of an inheritance windfall, a promise of a work contract overseas, overpayment for goods purchased on-line, or money-laundering, see the Department of State's publication International Financial Scams.

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

See our information on Victims of Crime .

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Cameroon are extremely limited.
Even in large cities, emergency care and hospitalization for major illnesses and surgery are hampered by the lack of trained specialists, outdated diagnostic equipment, and poor sanitation.
Medical services in outlying areas may be completely nonexistent.
Doctors and hospitals often require immediate payment for health services in cash.
Pharmacies in larger towns are well stocked, but in other areas many medicines are unavailable.
Travelers are advised to carry their own supply of needed prescription and anticipated over-the-counter medicines.

Malaria is a serious and sometimes fatal disease.
Plasmodium falciparum malaria, the type that predominates in Cameroon, is resistant to the antimalarial drug chloroquine.
Because travelers to Cameroon are at high risk for contracting malaria, the Centers for Disease Control and Prevention (CDC) advises that travelers should take one of the following antimalarial drugs: mefloquine (Lariam™), doxycycline, or atovaquone/proguanil (Malarone™) as prophylaxis to reduce this risk.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area, and up to one year after returning home, should seek prompt medical attention and tell the physician their travel history and what antimalarials they have been taking.
For additional information on malaria, including protective measures, see the CDC Travelers’ Health web site at http://www.cdc.gov/malaria/.
There are periodic outbreaks of cholera in Cameroon.
Yellow fever can cause serious medical problems, but the vaccine, required for entry, is very effective in preventing the disease.

In March 2006, avian influenza (H5N1) was confirmed in wild ducks in northern Cameroon.
There have been no reports of avian influenza among humans in Cameroon.
Avian influenza has been reported in both birds and humans in neighboring Nigeria.
For additional information on avian influenza as it affects American citizens residing abroad, please visit the U.S. Department of State’s Avian Influenza Fact Sheet.

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

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

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

Cameroon's road networks, both paved and unpaved, are poorly maintained and unsafe at all times of the year.
Vehicles are poorly maintained and there is no mechanism or requirement to inspect for roadworthiness.
During the rainy season, many roads are barely passable with four-wheel-drive vehicles.
Livestock and pedestrians create constant road hazards (especially at night) and road safety rules are frequently ignored.
There are few road and traffic signs; speed limits are neither posted nor enforced.
Buses and logging trucks travel at excessive speed and are a constant threat to other road traffic.

Travelers on roads near the borders with CAR and Chad should ensure that their vehicles are fully fueled, and that they have adequate cooking fuel, food, and water for several days as well as a reliable means of communication, such as a satellite or cell phone, or radio.

Visitors who are not in possession of a valid passport and a visa may experience difficulties at police roadblocks or other security checkpoints.
It is not uncommon for a uniformed member of the security forces to stop motorists on the pretext of a minor or non-existent violation of local motor vehicle regulations in order to extort small bribes.
Visitors are advised not to pay bribes and to request that the officer provide a citation to be paid at the local court.

Local law states that vehicles involved in an accident should not be moved until the police arrive and a police report can be made.
If an accident results in injury, drivers should be aware of the possibility that a "village justice" mentality may develop.
If an angry crowd forms, drive directly to the U.S. Embassy or another location where you can receive assistance.
Contact the local police once you are safely away from danger.
Cameroon has no real equivalent to 911-type service or roadside emergency telephone numbers, but you can dial 112 in major cities to contact ambulance services.
American citizens should contact the U.S. Embassy (237) 2220-1500 if emergency assistance is needed.
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 Cameroon, the U.S. Federal Aviation Administration (FAA) has not assessed Cameroon’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
While visiting game parks and reserves, tourists should bear in mind that they are ultimately responsible for maintaining their own safety.
Tourists should use common sense when approaching wildlife, maintain a safe distance from animals, and heed all instructions given by guides or trackers.
Even in the most serene settings, the animals in Cameroon's game parks are wild and can pose a threat to life and safety.

Cameroonian Customs authorities may enforce strict regulations concerning temporary importation into or export from Cameroon of items such as large quantities of medicine or wood products.
Customs regulations also restrict the importation of ivory.
Please see our information on customs regulations.

Cash in local currency, the Central African franc (CFA), is the only form of payment accepted throughout the country.
Larger hotels in Yaoundé and Douala will change U.S. dollars and cash traveler's checks, though at a disadvantageous rate.
Credit card cash advances are not available, and most banks do not cash personal or traveler's checks for non-clients.
While credit cards are accepted at some larger hotels and shops in Yaoundé and Douala, caution is urged, as identity theft is endemic in the region.
Some larger banks in Yaoundé and Douala have ATM facilities, and several banks in Cameroon have wire transfer services through Western Union.
The U.S. Embassy does not provide currency exchange, check cashing or other financial services.
Tourists and business travelers should also note that there is an increasing circulation of counterfeit U.S. and Cameroonian currency in the country.
In recent years, business travelers have experienced difficulty in obtaining adequate services from Cameroon's banking sector.
Business travelers are also advised that using the services of a local agent is strongly recommended in establishing a presence in the Cameroonian market.

While photography is not officially forbidden, security officials are sensitive about photographs taken of government buildings, military installations, and other public facilities, many of which are unmarked.
Photography of these subjects may result in seizure of photographic equipment by Cameroonian authorities.
Due to the threat of harassment and the lack of signs designating sites prohibited for photography, photography should be limited to private homes and among friends.
U.S. citizens are advised to seek proper permission before taking a photograph of a specific subject or location.

The government of Cameroon has recently started enforcing laws against homosexuality.
Charges of homosexuality and/or of corruption are also made and enforced indiscriminately in the course of business or personal disputes.

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.
Cameroonian law does not afford many of the protections to which Americans are accustomed, and legal proceedings tend to be complex, lengthy, and subject to inappropriate influence.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Additionally, the condition of detention centers, while improving, is poor.
Persons violating Cameroonian laws, even unknowingly, may be expelled, arrested or imprisoned.
During the February 2008 civil unrest, there were reports that people were arrested arbitrarily by law enforcement officials quelling the civil disorder that ensued.
Although no expatriates were known to have been arrested, the Department of State cautions Americans against venturing out during such periods of unrest.

Penalties for possession, use, or trafficking in illegal drugs in Cameroon are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Cameroon are encouraged to register with the U.S. Embassy through the State Department’s travel registration website so that they can obtain updated information on travel and security within Cameroon.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy in Yaoundé is located on Avenue Rosa Parks in the Mbankolo Quartier, adjacent to the Mount Febe Golf Club; mailing address P.O. Box 817; embassy tel. (237) 2220-1500, fax: (237) 2220-1572.
The Embassy Branch Office in Douala is located on the corner of Rue Ivy and Rue French in the Ecobank Building in Bonanjo, tel: (237) 3342-5331, fax: (237) 3342-7790.
Further information, including the U.S. Embassy's business hours, is available at the U.S. Embassy's web site: http://yaounde.usembassy.gov.
*

*

*
This replaces the Country Specific Information for Cameroon dated 7 June 2007, to update sections on Country Description, Entry and Exit Requirements, Safety and Security, Crime, Aviation Safety Oversight, Criminal Penalties, Children’s Issues, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Tue 9 Jul 2019
Source: Agence Cameroun Presse [in French, trans. Corr.SB, edited]

A highly contagious disease with faecal-oral transmission, cholera is transmitted by dirty hands or by food contamination and water (contaminated water). According to our colleague, [Journal du Cameroun], 48 deaths due to cholera have been recorded in the northern part of Cameroon.

According to figures compiled on Mon 8 Jul 2019 by the Ministry of Public Health (Minsante), the cholera epidemic, which is raging in the northern part of Cameroon, has already killed 48 people. The northern region, which has been particularly affected by this epidemic for almost a year, has a fatality rate of 6.2%.

Outside the North, the neighbouring Far North region is also affected by the disease, which raises fears of a spread of the disease with the onset of rains in this part of the country. Cholera had also been reported in the southern part of the country, particularly in the Central and Littoral regions, where one death had been registered.

According to the Journal du Cameroun, since the reappearance of the disease last February 2019, 775 reported cases have been counted and confirmed, revealing "an alarming epidemiological situation".

It should be noted that cholera 1st appeared in Cameroon in 1971. Since 1990, major epidemics have been recorded, particularly in 1991, 1996, 1998, 2004, 2010 and 2011. The general trend shows an annual increase in the number of cases. Between 2004 and 2016, epidemiological surveillance reported 50 007 cases with 2052 deaths, a high case fatality rate of 4.1%.

The main epidemics were recorded in the north, in the northern regions and the Far North and in the south of the country in the Littoral region, which is home to the economic capital Douala.  [Byline: Danielle Ngono Efondo]
Date: Thu, 30 May 2019 19:24:40 +0200

Yaoundé, May 30, 2019 (AFP) - Cameroon has declared a public emergency after reporting a polio case in its far north, four years after the virus disappeared from the country, the health ministry said on Thursday.   The confirmed case of polio type 2 was found in the Mada area in the remote north bordering Chad and Nigeria, the ministry said in a statement.   It declared a "new polio epidemic following the confirmation of a case of poliovirus type 2 detected in samples."

A source at the ministry said the outbreak may have been caused in part by a refusal of vaccinations and the cross-border movement of people in the area.   Polio is a highly infectious viral disease which mainly affects young children and can result in permanent paralysis. There is no cure and it can only be prevented through immunisation.   International polio vaccination efforts have run into problems in Pakistan and Afghanistan. Militants and religious leaders in rural areas often tell locals immunisation is part of a shadowy conspiracy to weaken their faith.
Date: Wed, 28 Nov 2018 11:40:16 +0100

Yaoundé, Nov 28, 2018 (AFP) - At least 29 people were wounded Wednesday when a women bomber blew herself up in a border town in Cameroon's Far North, a region frequently hit by Boko Haram jihadists, security sources said.    But a second bomber was shot dead by troops deployed in the town before she could detonate her explosives, the source said.    "A suicide bomber blew herself up this morning in Amchide" on the Nigerian border, a regional security source said, speaking on condition of anonymity and giving a toll of 29 wounded.

The attack occurred on market day when the town was filling up with early-morning shoppers, a local civil defence group official said.    "There were many people hurt, I saw about 20," he said. "After the attack, the market emptied."   A once-bustling trade hub, in 2014 Amchide was thrust into the forefront of a major battle between Cameroonian troops and Boko Haram militants who held the nearby Nigerian town of Banki for several months.    The violence forced most residents to flee the town, although some have now begun to return.    After pushing back Boko Haram, the Cameroonian army dug long trenches around Amchide and even inside the town to foil new incursions by the jihadists, with Wednesday's attack the first in many months.
Date: Fri 26 Oct 2018
Source: PLoS Negl Trop Dis 2018;12:e0006750 [edited]

Wanji S, Chounna Ndongmo WP, Fombad FF, et al. Impact of repeated annual community-directed treatment with ivermectin on loiasis parasitological indicators in Cameroon: implications for onchocerciasis and lymphatic filariasis elimination in areas co-endemic with _Loa loa_ in Africa. PLoS Negl Trop Dis 2018;12:e0006750.

Abstract
---------
Background
Loiasis is a filarial infection endemic in the rainforest zone of west and central Africa, particularly in Cameroon, Gabon, Republic of Congo, and Democratic Republic of the Congo. Repeated treatments with ivermectin have been delivered using the annual community-directed treatment with ivermectin (CDTI) approach for several years to control onchocerciasis in some _Loa loa_ and _Onchocerca volvulus_ co-endemic areas. The impact of CDTI on loiasis parasitological indicators is not known. Therefore, we designed this cross-sectional study to explore the effects of several rounds of CDTI on parasitological indicators of loiasis.

Methodology/principal findings
The study was conducted in the East, Northwest, and Southwest 2 CDTI projects of Cameroon. Individuals who consented to participate were interviewed for ivermectin treatment history and enrolled for parasitological screening using thick smears. Ivermectin treatment history was correlated with loiasis prevalence/intensity. A total of 3684 individuals were recruited from 36 communities of the 3 CDTI projects, and 900 individuals were from 9 villages in a non-CDTI district. In the East, loiasis prevalence was 29.3% (range, 24.2% to 34.6%) in the non-CDTI district but 16.0% (3.3% to 26.6%) in the CDTI district with 10 ivermectin rounds (there were no baseline data for the latter).

In the Northwest and Southwest 2 districts, reductions from 30.5% to 17.9% (after 9 ivermectin rounds) and from 8.1% to 7.8% (not significantly different after 14 rounds) were registered post-CDTI, respectively. Similar trends in infection intensity were observed in all sites. There was a negative relationship between adherence to ivermectin treatment and prevalence/intensity of infection in all sites. None of the children (ages 10 to 14 years) examined in the East CDTI project harboured high (8000 to 30,000 mf/mL) or very high (more than 30,000 mf/mL) microfilarial loads. Individuals who had taken more than 5 ivermectin treatments were 2.1 times more likely to present with no microfilaraemia than those with fewer treatments.

Conclusion
In areas where onchocerciasis and loiasis are co-endemic, CDTI reduces the number of and microfilaraemia in _L. loa_-infected individuals, and this, in turn, will help to prevent non-neurological and neurological complications post-ivermectin treatment among CDTI adherents.
====================
[Onchocerciasis (African River blindness) is a neglected tropical disease, but the invasive nematode _Loa loa_ is not on the list. The study clearly demonstrates that scheduled regular ivermectin against onchocerciasis also reduced the nematode burden of _L. loa_.

_L. loa_, the African eye worm, is a nematode transmitted by tabanid flies (Order: Diptera; Family: Tabanidae) of the genus _Chrysops_. _L. loa_ may cause skin oedema (Calabar swellings) and may occasionally invade the eye. As far as it is known, there is no animal reservoir. - ProMED Mod.EP]

[HealthMap/ProMED map:
Date: Sat, 6 Oct 2018 04:59:35 +0200
By Gregory WALTON

Buea, Cameroon, Oct 6, 2018 (AFP) - "For the peak season I would have about 280 persons climbing Mount Cameroon," said John Ngomba, a tour guide in the town of Buea, which has been at the forefront of Cameroon's anglophone separatist insurgency.   "But now there are no tourists coming. It's really crazy. The reason tourists are not coming is because of the crisis."

Since an independence declaration a year ago, Buea -- once a tourist hotspot -- has suffered near-daily clashes and visitors have all but disappeared.   The violence has claimed the lives of at least 420 civilians, 175 members of the security forces and an unknown number of separatists, according to the International Crisis Group think-tank.   "Sometimes I would receive 600 Germans a year. They would come through the cruise ships. I could have about 30 to 50 tourists a week who came to visit," said Ngomba in his hut in the town's Bismarck Fountain gardens.

Cameroon was once a German colony but was divided between Britain and France after World War I -- a separation that lies at the heart of the current conflict.   France's colony won independence in 1960, becoming Cameroon, and in 1961 the British-ruled Southern Cameroons was merged into it, giving the new state English-speaking majorities in the northwest and southwest.   "I am a father of five children. How am I living with them? It's impossible," said Ngomba, who has appealed for help from the German embassy, which assists with the upkeep of the garden containing a bust of Bismarck.

- Empty hotels -
"The fountain is not even working," he said, looking out over the restive town below and the former German governor's residence, which is now an army base.   But Ngomba insisted that the foothills above Buea remained safe.   "If the tourists arrive and get to this point, they are safe," he said.   "I tell people: after the election, things will be OK," he added of polls due on unday at which President Paul Biya will seek a seventh term.

But several countries including Germany, Britain, Canada and the United States have issued security advisories to their citizens about the anglophone regions.   "We used to have customers coming from many countries -- America, Europe, Nigeria," said Janet Nkowo, 30, a receptionist at the Eta Palace Hotel in downtown Buea.   "I think it's because of the crisis. The difference is really clear," she said.   "We have one-quarter of what we had, I don't know how the director does it. I think things will hopefully get better on Sunday."

Most of Buea's hotels are sitting empty, the majority of shops are shuttered and only a handful of students queued up at the town's university to register for the new academic term.   A total of 246,000 people have fled their homes in the southwest region that includes Buea -- and 25,000 have left the country altogether for Nigeria, according to UN figures.

At the town's weekly market, one of the few retail outlets still functioning, many stalls sat empty.   A man in a white vest shouted "French bastards" at passers-by, in French.   "Maybe if voting passes well, they will come back," said Fidelis Kum, a stallholder selling hair extensions, as customers haggled over live chickens nearby and women sat shelling snails.
More ...

South Korea

General Information
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The land mass of Korea is currently divided into North and South since World War 11. The South is a democratic Republic and there are extensive tourist facilities available throughout
he main urban areas. The national tourism organisation (KNTO) operates an English language web site (http://www.knto.or.kr) which provides useful information for intending tourists.
Weather Profile
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South Korea has four distinct seasons throughout the year. The winters can be very cold while the summers hot and very humid. The rainfall is mainly concentrated during the summer season.
Overcoming Jet Lag
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ry to arrange your flights so that you arrive in plenty of time before the first match. Allow 48 hours if at all possible to get over the inevitable jet lag. Walk about on the flight, drink plenty of water and stay off the alcohol. Flight crews are understandably very sensitive nowadays about any disturbance and the last thing you will want is to be dumped off the flight to make your own way home. Sleep on the plane if possible though remember this may increase the risk of blood clots so move your legs about when awake. Talk to your doctor about taking aspirin if you are at higher than normal risk (older age group, over weight, on the contraceptive pill, varicose veins etc).
Arriving into Seoul
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The new Incheon international airport is an hour or two away from Seoul and there are no subways or rail systems connecting the airport to the city. However, buses and taxis are easily available. Customs facilities are good but careful so remember not to carry any parcels for another unless you are certain of the contents. A departure tax may be payable on leaving South Korea.
Personal Safety
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In Seoul, like any other major city, there is an increased risk of petty crime (pickpocketing, purse snatching etc) so take extra care of your belongings - especially in crowded places like markets, local buses and football matches! The Itaewon and other large markets are known risk areas for this type of activity. Use the hotel safe for your main valuables and carry little of importance while out and about.
Emergency Numbers
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In South Korea the emergency number for the main services is 112. The operators will usually speak good English. There is also a 24/7 service available through the Korean National Police where travellers can report crime etc. The number in Seoul is 313-0842 and in other regions 02-313-0842.
Medical Services
****************************************
Generally the level of health facilities throughout most of the main urban centres is excellent. However, treatment can be expensive and the medical providers will expect payment before treatment is started. Make sure your travel health insurance is adequate for your journey.
Road Safety
****************************************
The road infrastructure throughout most of South Korea is excellent. However, accidents do occur and if hiring a car ‘defensive’ driving is essential at all times while abroad. Safety belts are compulsory at all times for both front and rear seats. Any accident tends to lead to long delays as the paperwork is sorted out. The Koreans may at times drive their motorbikes and scooters on foot pavements so care should be taken at all times.
Customs Regulations
****************************************
The level of security at South Korean immigration is high so beware of the delays which may be incurred.
Food & Water Care
****************************************
While travelling it is essential that care is taken to protect your stomach against unnecessary risk. Generally tourists will be keen to try out the local cuisine but this can lead to days of illness. In most circumstances it is wise to stick to hot, freshly cooked food fruit you peel yourself. Bivalve shell fish (mussels, clams, oysters etc) are seldom cooked sufficiently to sterilise them completely and are best avoided. Undercooked fish (Sushi) or any meats should also be avoided.
Heat & Humidity
****************************************
The summer months in South Korea are hot and sticky. It will be important to have the right clothing (light weight loosely fitted cotton) and to drink plenty of water to replace what is lost through dehydration. Salt will also need to be replaced and providing there is no medical contraindication eating crisps, salted nuts etc is an excellent way to replenish your levels.
Avoiding Prickly Heat
****************************************
The term prickly heat is used in a variety of ways but the cause is generally the same. In a hot climate the body perspires to maintain the internal temperature at a correct level. In the perspiration there will be fluid and your personal salts. The fluid evaporates but the salt dries against the skin. It is your individual reaction to this salt that leads to the ‘prickly heat rash’. The reaction to these salts can be minimised by removing the salts from the skin surface as soon as possible. Change your clothes regularly, use plenty of talcum powder to absorb the perspiration and dry off well after showering.
Breathing the air
****************************************
Any of the airborne diseases are most commonly spread when folks crowd together. International football matches, market places, local transport and the cinema are times when exposure and infection are most likely. Carrying some simple cold remedies might be a wise precaution and avoid the crowds where possible!
Vaccines for your trip
****************************************
In most cases the only particular problem for those visiting either Japan or South Korea will be the risk of Hepatitis A (food and water spread). Of course Tetanus and various other food and water problems can occur but generally the risk is small providing a sensible approach is taken to act sensibly.

Travel News Headlines WORLD NEWS

Date: Thu, 3 Oct 2019 10:18:25 +0200 (METDST)

Busan, South Korea, Oct 3, 2019 (AFP) - At least nine people were killed and several others missing after Typhoon Mitag lashed South Korea with heavy rain and strong winds, authorities said Thursday.   The storm hit southern parts of the country on Wednesday night, prompting flood warnings and triggering landslides in affected areas.   A total of nine people were killed across the country as of Thursday afternoon, the Ministry of Interior and Safety said, but the toll was expected to rise with several people missing.

A woman in her 60s was found dead after her home was buried in a landslide in the southern port city of Busan and around 600 rescue workers were trying to locate three others believed to be trapped beneath the rubble.   Park Young-hak was inside his tool shed -- later buried in the landslide -- and said he escaped after hearing a loud "roar".   "When I ran out to see what it was the house next to me had already disappeared," Park told AFP.   More than 1,000 homes were damaged and over 1,500 people evacuated their houses in advance, the ministry said.   Mitag is the 18th typhoon this year and seventh to hit the Korean peninsula.
Date: Thu, 3 Oct 2019 08:45:16 +0200 (METDST)

Busan, South Korea, Oct 3, 2019 (AFP) - At least six people were killed and several others missing after Typhoon Mitag lashed South Korea with heavy rain and strong winds, authorities said Thursday.   The storm hit southern parts of the country on Wednesday night, prompting flood warnings and triggering landslides in affected areas.   A woman in her 70s died after she was swept away by strong winds in the south-eastern city of Pohang while another woman was killed after heavy rain caused her house to collapse as she slept, the Ministry of the Interior and Safety said.   A total of six people were killed across the country but the toll was expected to rise with several people missing.

In the southern port city of Busan -- one of the hardest hit areas -- around 600 rescue workers were trying to locate four people believed to be trapped beneath a landslide.   "An enormous amount of sand and earth slid down several hundred metres and instantly buried a house and a restaurant," said a witness quoted by Yonhap news agency.   More than 100 homes were flooded and over 1,500 families evacuated their houses in advance, the ministry said.   Mitag is the 18th typhoon this year and seventh to hit the Korean peninsula.
Date: Thu 12 Sep 2019
Source: Korea Biomedical Review [abridged, edited]

The Korea Centers for Disease Control and Prevention (KCDC) said it has confirmed that contaminated fermented shellfish was the main culprit behind the hepatitis A outbreak this summer. The KCDC came to the conclusions after conducting an in-depth epidemiological investigation.

The agency randomly sampled 270 of the 2178 hepatitis A patients, diagnosed between 28 Jul and 24 Aug 2019, and surveyed whether they consumed fermented shellfish this summer. It found that 42% of the patients had eaten fermented shellfish during the incubation period. KCDC also found that 80.7% of the 26 patients diagnosed with hepatitis A in August 2019 also ate fermented shellfish, while discovering hepatitis A virus genes in 11 batches out of the 18 batches collected after the outbreak. Notably, 5 of these genes found in the research showed close relations with the virus detected in hepatitis A patients.

The agency recommended that the public should stop consuming salted clams until it can confirm that they are safe to eat. The Ministry of Food and Drug Safety also plans to conduct a full survey of fermented shellfish distribution products this month [September 2019]. As of now, the disease control agency has confirmed 10 products that have tested positive for the hepatitis A virus; 9 of them were imported from China, and one was made in Korea. The KFDC asked the producers of sauced clams to halt the distribution and sale of their products for the time being and to conduct the hepatitis A virus test for each product when importing fermented shellfish.  [Byline: Lee Han-soo]
Date: Thu 12 Sep 2019
Source: Korea Biomedical Review [abridged, edited]

The Korea Centers for Disease Control and Prevention (KCDC) said that it has confirmed that contaminated fermented shellfish was the main culprit behind the hepatitis A outbreak this summer of 2019.

The KCDC came to the conclusions after conducting an in-depth epidemiological investigation. The agency randomly sampled 270 of the 2178 hepatitis A patients, diagnosed between [28 Jul 2019] and [24 Aug 2019], and surveyed whether they consumed fermented shellfish this summer. It found that 42% of the patients had eaten fermented shellfish during the incubation period.

KCDC also found that 80.7% of the 26 patients diagnosed with hepatitis A in August 2019 also ate fermented shellfish, while discovering hepatitis A virus genes in 11 batches of the 18 batches collected after the outbreak. Notably, 5 of these genes found in the research showed close relations with the virus detected in hepatitis A patients.

The agency recommended that the public should stop consuming salted clams until it can confirm that they are safe to eat. The Ministry of Food and Drug Safety also plans to conduct a full survey of fermented shellfish distribution products this month [September 2019].

As of now, the disease control agency has confirmed 10 products that have tested positive to the hepatitis A virus. Nine of them were imported from China, and one was made in Korea. The KFDC asked the producers of sauced clams to halt the distribution and sale of their products for the time being and to conduct the hepatitis A virus test for each product when importing fermented shellfish.  [Byline: Lee Han-soo]
========================
[This outbreak in South Korea seems to be related to contaminated shellfish. In most developed countries, hepatitis A virus outbreaks are related to a definable food vehicle. This is not what has occurred in the USA in the past several years, where the huge increase in cases is related to poor hygiene and inadequate sanitation in marginalized populations. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Sat 4 May 2019
Source: Outbreak News Today [edited]

Officials with the Korea Centers for Disease Control and Prevention (KCDC) report (computer translated) the 1st case of the tickborne infection, severe fever with thrombocytopenia syndrome (SFTS) in a 55-year-old female from Chungcheongnam-do (Chungnam) province in the west of the country.

This has prompted health officials to advise the public to take precautions when doing outdoor activities to avoid tick bites.

The patient was gardening prior to the appearance of symptoms. On 28 Apr [2019], she presented with symptoms of fever and erythema and was hospitalized at the medical institution. SFTS testing returned positive.

Severe fever with thrombocytopenia syndrome (SFTS) is a newly emerging infectious disease. Symptoms and laboratory abnormalities are fever, thrombocytopenia, leukocytopenia, and elevated serum enzyme levels. Multiorgan failure occurs in severe cases, and 6%-30% of case-patients die. The syndrome is caused by the SFTS virus (SFTSV) (genus _Phlebovirus_, family Bunyaviridae).  Ixodid tick species are implicated as vectors of SFTSV.
=======================
[SFTS has been occurring sporadically in South Korea since 2013 and is endemic there. SFTSV can cause a serious disease and is of significant public health concern. Although SFTS virus infections may be serious, there is evidence for subclinical or mild infections as well. There is also some previous evidence for person-to-person direct transmission of the virus, and a previous report provides more objective evidence that aerosol transmission could occur (see Severe fever w/ thrombocytopenia synd. - South Korea: poss. aerosol transmission http://promedmail.org/post/20190108.6248997).

SFTS virus is a tick-transmitted phlebovirus in the Bunyavirus family. Images of a _Haemaphysalis longicornis_ tick, the SFTS vector, can be seen at

[HealthMap/ProMED map available at:
More ...

Bahamas

The Bahamas Consular Information Sheet
July 14, 2005

COUNTRY DESCRIPTION:
The Bahamas is a developed, English-speaking Caribbean nation composed of hundreds of islands covering a territory approximately the size of California.
To
rism and financial services comprise the two largest sectors of the economy. Independent from the United Kingdom since 1973, The Bahamas is a Commonwealth nation with a centuries-old democratic tradition.
The capital, Nassau, is located on New Providence Island.
Read the Department of State Background Notes on The Bahamas at http://travel.state.gov for additional information.

ENTRY/EXIT REQUIREMENTS:
On December 31, 2005, the U.S. Government will begin to phase in new passport requirements for U.S. citizens traveling in the Western Hemisphere.
By December 31, 2007, all U.S. citizens will be expected to depart and enter the United States on a valid passport or other authorized document establishing identity and U.S. citizenship.
The Department of State strongly encourages travelers to obtain passports well in advance of any planned travel.
Routine passport applications by mail take up to six weeks to be issued.
For further information, go to the State Department's Consular website: http://travel.state.gov/travel/cbpmc/cbpmc_2223.html.

U.S. citizens must present original proof of U.S. citizenship (valid U.S. passport or certified U.S. birth certificate with a government-issued photo ID) and a return ticket. A passport is recommended as it eases processing upon return to the United States.
Voter registration cards, Social Security cards, driver's licenses, affidavits, and other similar documents are not acceptable as proof of U.S. citizenship. U.S. citizens do not need to obtain visas for stays of up to one month. Travelers arriving via private watercraft are charged docking fees.
See our Foreign Entry Requirements brochure for information on entry to The Bahamas and other countries.
U.S. citizens may also contact The Embassy of The Bahamas at 2220 Massachusetts Ave., NW, Washington, DC 20008 (tel: 202-319-2660), its Consulates in Miami and New York, or by email at bahemb@aol.com.

For entry and exit requirements pertaining to dual nationality and the prevention of international child abduction, read our information at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1469.html.
For Customs Information see http://travel.state.gov/travel/cis_pa_tw/cis/cis_1468.html.

SAFETY AND SECURITY:
The water sports and scooter rental industries in The Bahamas are not carefully regulated.
Visitors should rent equipment only from reputable operators, and should insist on sufficient training before using the equipment.
Every year, people are killed or injured by the improper use of scooters, jet-skis, and personal watercraft or by the careless or reckless operation of such equipment by others.
You should insist on seeing proof that operators have sufficient medical and liability insurance. Travelers should also invest in low-cost traveler's insurance that includes medical evacuations, as most American insurance companies do not cover this.

For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site at http://travel.state.gov where the current Travel Warnings and Public Announcements, including the Worldwide Caution Public Announcement, can be found.

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State's pamphlet A Safe Trip Abroad at http://travel.state.gov/travel/tips/safety/safety_1747.html.

CRIME:
While The Bahamas has a relatively low crime rate, visitors should exercise caution and good judgment. Although most criminal incidents take place in a part of Nassau not usually frequented by tourists (the "over-the-hill" area south of downtown), crime and violence has moved into more upscale tourist and residential areas.
Criminals also target restaurants and nightclubs frequented by tourists.
The most common approach for criminals is to offer victims a ride, either as a "personal favor" or by claiming to be a taxi, and then robbing and/or assaulting the passenger once they are in the car. Visitors should take care to ride only in licensed taxis, identifiable by their yellow license plates.

In the last year the U.S. Embassy has received several reports of sexual assaults, including against teen-age girls. Most assaults have been perpetrated against intoxicated young women, some of whom were reportedly drugged. To minimize the potential for sexual assault, the Embassy recommends that young women stay in groups, consume alcohol in moderation or not at all, ride only in licensed taxis, and not accept rides or drinks from strangers.
Travelers should avoid walking alone after dark or in isolated areas, and avoid placing themselves in situations where they are alone with strangers. Be cautious on deserted areas of beaches at all hours. Hotel guests should always lock their doors and should never leave valuables unattended, especially on beaches.
Visitors should store passport/identity documents, airline tickets, credit cards, and extra cash in hotel safes. Avoid wearing expensive jewelry, particularly Rolex watches, which criminals have specifically targeted. Use only clearly marked taxis with yellow license plates and make a note of the license plate number for your records.

The legal age in the Bahamas for consumption of alcoholic beverages is 18. Parents should be aware, however, that enforcement of the drinking age is weak.
It is easy for teenagers to obtain alcoholic beverages and underage drinking is prevalent.
Many of the arrests, accidents and violent crimes suffered by U.S. citizens in The Bahamas involve alcohol.

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

See our information on Victims of Crime at http://travel.state.gov/travel/tips/emergencies/emergencies_1748.html.

MEDICAL FACILITIES AND HEALTH INFORMATION:
High quality medical care is generally available, but expensive, in Nassau and Freeport. Medical care is limited outside of Nassau and Freeport. Bahamian doctors and hospitals do not usually accept U.S. medical insurance policies and typically expect immediate cash payment for professional services. It is the patient's responsibility to seek reimbursement later from their insurance companies. Serious health problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars. Persons with serious or life-threatening conditions who wish to return to U.S. medical facilities for treatment normally must be airlifted.
There is a chronic shortage of blood at Princess Margaret Hospital in Nassau, where most emergency surgery is performed.
Travelers with rare blood types should know the names and locations of possible blood donors should the need arise.
The Lyford Cay Hospital has a hyperbaric chamber for treatment of decompression illness.
Ambulance service is available, but may not be able to respond quickly in the event of a major emergency or disaster.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention's hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747); fax 1-888-CDC-FAXX (1-888-232-3299), or via the CDC's Internet site at http://www.cdc.gov/travel.
For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith.

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 at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1470.html.

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

Traffic in The Bahamas moves on the left side of the roadway. Roads in Nassau and Freeport are generally adequate, but traffic congestion in those cities is endemic.
Rural roads can be narrow, winding, and in poor repair.
Flooding frequently occurs on roads in low-lying areas throughout The Bahamas, including Nassau and Freeport.
Drivers should be alert for unmarked construction zones throughout The Bahamas.
Travel by moped or bicycle can be quite hazardous, especially in the heavy traffic conditions prevalent in Nassau and Freeport. Travelers should exercise appropriate caution when renting motorbikes. Accidents involving U.S. tourists on motorbikes have caused severe injuries and fatalities. Those who choose to ride a moped or bicycle should wear helmets and drive defensively.
Pedestrians need to remember that vehicular traffic comes from the right.
Pedestrians have been hit by cars after failing to check properly for oncoming traffic.

Emergency ambulance service is generally available and can be reached by dialing 911. Roadside assistance is also widely available through private towing services, listed in the phone book.

For specific information concerning driver's permits, vehicle inspection, road tax, and mandatory insurance in The Bahamas, please contact The Bahamas Tourist Board in New York at http://bahamas.com, (tel:
1-800-823-3136).

Please refer to our Road Safety page for more information at http://travel.state.gov/travel/tips/safety/safety_1179.html.
Visit the website 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 The Bahamas as being in compliance with ICAO international aviation safety standards for oversight of The Bahamas' air carrier operations.
For more information, travelers may visit the FAA's Internet web site at http://www.faa.gov/avr/iasa/index.cfm.

SPECIAL CIRCUMSTANCES:
CUSTOMS:
The Bahamas customs authorities may enforce strict regulations concerning temporary importation into or exportation from The Bahamas of firearms. It is advisable to contact the Embassy of The Commonwealth of The Bahamas in Washington or one of the Bahamian consulates in the U.S. for specific information regarding customs requirements. Tourists who arrive by private boat are required to declare firearms to Bahamian Customs and leave firearms on the boat while in The Bahamas. Please see our information on customs regulations at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1468.html.

BOATING/FISHING:
Boaters should be aware that long-line fishing in Bahamian waters is illegal. All long-line fishing gear is required to be stowed below deck while transiting through Bahamian waters. Fishermen should note that stiff penalties are imposed for catching crawfish (lobster) or other marine life out of season or in protected areas.

TIME-SHARES:
U.S. citizens should exercise caution when considering time-share investments and be aware of the aggressive tactics used by some time-share sales representatives. Bahamian law allows time-share purchasers five days to cancel the contract for full reimbursement. Disputes that arise after that period can be very time-consuming and expensive to resolve through the local legal system.
HURRICANES:
The Bahamas, like all countries in the Caribbean basin, is vulnerable to hurricanes. Hurricane season officially runs from June 1 to November 30, although hurricanes have been known to occur outside that time period. Visitors to The Bahamas during hurricane season are advised to monitor weather reports in order to be prepared for any potential threats. General information about disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.

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 The Bahamas' laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in The Bahamas are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
For more information visit http://travel.state.gov/travel/cis_pa_tw/cis/cis_1467.html.

CHILDREN'S ISSUES:
For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website at http://www.travel.state.gov/family/family_1732.html.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in The Bahamas are encouraged to register with the nearest U.S. Embassy through the State Department's travel registration website, https://travelregistration.state.gov, and to obtain updated information on travel and security within The Bahamas.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located next to McDonald's restaurant on Queen Street in downtown Nassau; telephone (242) 322-1181, after hours: (242) 328-2206.
Consular Section hours are 1:00 p.m. - 4:00 p.m. Monday-Thursday and 10:00-12:00 on Fridays. The Embassy is closed on local and U.S. holidays.
You may wish to visit the Embassy's website at http://bahamas.usembassy.gov/ or contact the Consular Section by e-mail at acsn@state.gov .

The U.S. Embassy is also responsible for consular services in the Turks and Caicos Islands (TCIS), a United Kingdom (British) overseas territory.
U.S. citizens may obtain updated information on travel and security in TCIS from the U.S. Embassy in Nassau or the Consular Information Sheet for the Turks and Caicos.
*

*

*
This replaces the Consular Information Sheet dated October 15, 2004, to update Sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Traffic Safety and Road Conditions, Special Circumstances, and Registration/Embassy Location; to include a Section on Information For Victims of Crime; and to combine and update the Sections on Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Mon, 2 Sep 2019 11:42:27 +0200 (METDST)

Geneva, Sept 2, 2019 (AFP) - Hurricane Dorian has caused "extensive damage" across the Bahamas, the Red Cross said Monday, warning that as many as 13,000 houses may have been severely damaged or destroyed.   "We don't yet have a complete picture of what has happened," Sune Bulow, head of the International Federation of Red Cross and Red Crescent Societies' Emergency Operation Centre in Geneva, said in a statement.   "But it is clear that Hurricane Dorian has had a catastrophic impact," he said, adding that "we anticipate extensive shelter needs, alongside the need for short-term economic support, as well as for clean water and health assistance."

Hurricane Dorian battered the Bahamas with ferocious wind and rain on Sunday, the monstrous Category 5 storm wrecking towns and homes as it churned on an uncertain path toward the US coast where hundreds of thousands were ordered to evacuate.   There was no immediate word on casualties in the low-lying islands.   But IFRC said that up to 13,000 houses may have been severely impacted.

The organisation also warned that extensive flooding on the island of Abaco was believed to have contaminated wells with saltwater.   IFRC said it had released 250,000 Swiss francs ($252,000, 230,000 euros) from its Disaster Relief Emergency Fund to bolster the initial response to the crisis, and to provide some 500 families with emergency shelter assistance.   Packing sustained winds of 185 miles per hour (295 kilometre per hour), Dorian crashed onshore in the Abacos Islands, in the northwest of the Bahamas, as the strongest storm ever to hit the Caribbean chain.

After days of nerve-wracking uncertainty surrounding the storm's path, the southeastern US states of Florida, Georgia and South Carolina finally ordered coastal residents to evacuate in a mass exodus set to affect hundreds of thousands of people.    The American Red Cross estimated that some 19 million people live in areas that could be impacted by the storm, with as many as 50,000 people in Florida, Georgia and South Carolina potentially in need of emergency shelter, depending on the impact.   IFRC said that hundreds of Red Cross volunteers, emergency response vehicles and more than 30 truck loads of relief supplies were being mobilised to help people living in the path of the hurricane.
Date: Mon, 2 Sep 2019 00:55:48 +0200 (METDST)
By Leila MACOR

Riviera Beach, United States, Sept 1, 2019 (AFP) - Hurricane Dorian blasted the northern Bahamas as a monster Category 5 storm on Sunday, pummeling the low-lying island chain with torrential rains and winds of a violence unprecedented in its history.   Packing winds of 185 miles per hour (295 kilometers per hour), Dorian made landfall twice in the Bahamas' Abaco Islands, and was tied for the second most powerful hurricane ever in the Atlantic basin, the National Weather Service said.

Footage posted on social media showed major destruction. There was no immediate word on casualties.   Parts of the Abaco Islands were reported to be under water as forecasters warned it was facing a towering 18 to 23 foot storm surge. Winds were gusting over 220 mph, the National Hurricane Center in Miami said.   Video posted on the website of the Bahamian newspaper Tribune 242 showed water up to the roofs of wooden houses in what ppeared to be a coastal town. Capsized boats floated in muddy brown water dotted with wooden boards, tree branches and other debris.

In other social media footage of what appears to be an inland area, cars were smashed or turned over, telephone poles and trees were snapped like twigs and debris filled the yards of severely damaged homes. AFP could not immediately confirm the authenticity of any of this footage.   Bahamas Prime Minister Hubert Minnis broke down in tears as he addressed a news conference, calling it "probably the most sad and worst day of my life," the Nassau Guardian reported.   "We're facing a hurricane... one that we've never seen in the history of the Bahamas," he said.

Footage shot in Cooper's Town, Abaco and obtained by AFP showed waves crashing violently onshore, sending up huge clouds of spray along the coastline.   Local radio reported that people were calling for help after winds blew the roof off the Island Breezes Hotel in Marsh Harbour, a commercial hub in the Abacos.   "Things are really starting to rock and roll," a post on the Facebook page of the Hope Town Bulletin in Abacos said at 10:00 am local time.    As of 2200 GMT, the storm was 75 miles (120 kilometers) east of Freeport on the island of Grand Bahama and moving slowly west.   In Grand Bahama, thousands have evacuated to get out of Dorian's predicted path.   "It feels like we are standing in a line waiting for a beating," Yasmin Rigby, a resident of Freeport, the island's main city, told AFP.

- Strongest storm to hit Bahamas -
The NHC said Dorian had become "the strongest hurricane in modern records for the northwestern Bahamas."   Describing "catastrophic" conditions in the Abacos Islands, it said the storm was "heading with all its fury towards Grand Bahama," where it was expected Sunday night into Monday.  NHC director Ken Graham on Facebook Live said the Bahamas would be under major hurricane conditions for a punishing 30 hours or more.   "That's major hurricane winds, that's storm surge of 10 and even 20 feet in some of those areas," he said. "That's also torrential rainfall of 15 to 20 inches, isolated 30 inches."

In Washington, US President Donald Trump met with his emergency management chiefs and declared "this looks monstrous."   "We expect that much of the eastern seaboard will be ultimately impacted and some of it very, very severely," he said.   Tropical storm warnings were in effect for parts of the Florida coast, and residents up and down the Atlantic coast braced for a brush with danger.   Florida issued its first evacuation orders in parts of Palm Beach, home of Trump's Mar-a-Lago resort, and Martin Counties.

- 'Very great danger' -
Kevin McAleenan, acting homeland security secretary, said hurricane force winds could hit Florida, followed by a prolonged rain event combined with a storm surge.   "That's going to be very difficult as the storm starts to move northward, mostly like, up the coast of Florida and toward Georgia and South Carolina," he said on ABC's "This Week."   While Miami appeared likely to be largely spared, 30-year-old David Duque, picking up sandbags there on Saturday, noted that "everything could change... I know it could be a scare, but better prepare instead of doing nothing."   The Florida National Guard said roughly 2,000 service members had been mobilized, with another 2,000 poised to join them.

- 'Absolute monster' -
Trump has declared a federal state of emergency in Florida, authorizing US assistance to supplement state and local efforts.   Following a similar state order in Florida, South Carolina Governor Henry McMaster declared a state of emergency Saturday, saying, "Given the strength and unpredictability of the storm, we must prepare for every possible scenario."   Neighboring North Carolina also declared a state of emergency, and Georgia announced a state of emergency for 12 counties.   Orlando International Airport was to protectively halt commercial flights at 2:00 am (0600 GMT) Monday, and Florida's NASA Kennedy Space Center said it was moving an enormous mobile rocket launcher inside to protect it.
Date: Wed 25 Jul 2018
Source: Eyewitness News [edited]

Cases of reported conch poisoning are on the rise in the capital, according to Minister of Health Dr. Duane Sands. The health minister confirmed Tue 24 Jul 2018 that over 3 dozen persons have sought medical attention for conch poisoning since the Ministry of Health announced the new outbreak in New Providence nearly a month ago.

Luckily, there have been no reports of conch poisoning in the Family Islands. Dr. Sands confirmed that the outbreak has been isolated to New Providence. "We can now confirm 25 clinical cases with laboratory testing," he said. "There are an additional 15 clinical cases that meet the definition but are still awaiting finalization of their laboratory data, so there may be as many as 40 clinical cases that might have been presented to the hospital. There are some people who get conch poisoning but it's not severe enough for them to come to the hospital for treatment."

The health minister continued to issue warning to patrons and vendors. "I continue to say that this is a preventable problem, so to the vendors, you have to wash the conch in fresh water. To the patrons, it is a good idea to insist that [the conch] is washed in fresh water."

Conch poisoning occurs when raw conch meat is not thoroughly washed in fresh water. Bacteria that resides on the skin of conch is what leads to the treacherous poisoning. The most recent major outbreak of conch poisoning in the Bahamas dates back to the 1990s.  [Byline: Theo Sealy]
=====================
[The aetiology is _V. parahaemolyticus_, a bacterium in the same family as those that cause cholera. It lives in brackish saltwater and causes gastrointestinal illness in humans. Symptoms include watery diarrhoea, abdominal cramping, nausea, vomiting, and fever and chills. Usually these symptoms begin within 24 hours of exposure. Illness is usually self-limited and lasts approximately 3 days. Severe disease is rare and occurs more commonly in persons with weakened immune systems.

Infections with this organism, which can be normal microflora in seawater, have been associated with the consumption of raw, improperly cooked, or cooked and recontaminated fish and shellfish. A correlation exists between the probability of infection and warmer months of the year. Improper refrigeration of seafood contaminated with this organism will allow its proliferation, which increases the possibility of infection. ProMED-mail covered a large 2005 outbreak in Chile. It was impressive in its size (more than 10 000 cases), continued to spread despite early recognition, and involved clams and mussels rather than the classical oyster vehicle. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
New Providence Island, New Providence, Bahamas:
Date: 5 Jul 2018
Source: The Nassau Guardian [edited]

The Ministry of Health warned yesterday of a recent outbreak of conch poisoning. Health authorities yesterday [4 Jul 2018] confirmed 4 cases of conch poisoning stemming from Potter's Cay in the past 72 hours but said the outbreak of _Vibrio parahaemolyticus_ could easily be prevented by vendors washing their conch supplies in fresh water.

_V. parahaemolyticus_ is a bacterium found in brackish saltwater, which, when ingested, causes symptoms including abdominal cramps, vomiting, headache, diarrhea and fever. "This is a preventable illness that requires basic hygiene as it relates to conch preparation," said Minister of Health Dr. Duane Sands during a press conference at the Ministry of Health of Meeting Street. He continued, "I think there is no reason why we can't say we will ensure that every single vendor is reminded of the requirement to wash the conch with copious amounts of fresh, clean water. To those in the purchasing public, if your vendor does not have access to fresh tap water or distilled water, and is only washing the conch in seawater, until we get the all clear, don't buy from that vendor."

The 4 patients with confirmed cases of vibriosis are Bahamians. There were at least 6 more people exhibiting symptoms awaiting confirmation of conch poisoning.

Sands assured the public that health officials, who received reports of the cases yesterday morning [4 Jul 2018], have mobilized in conjunction with the Ministry of the Environment to take the necessary steps to protect the health of those affected and, through targeted interventions, prevent further cases. The minister also advised all conch vendors will be required to take a food-handling course and maintain fresh potable water at their stalls.

As it relates to the unconfirmed cases, Sands said those patients, who were admitted to the Emergency Room at Doctors Hospital and Princess Margaret Hospital in the past 24 hours with gastroenteritis, were awaiting lab results. "Bear in mind that gastroenteritis can occur for a number of reasons," he said, "And so, to ascribe a case of gastroenteritis to vibrio would require confirmatory testing."

Sands said one of the priorities of the ministry is to have the conversation with the public early and spread awareness. "The 2nd thing we would like to do and we have started to do is to ensure the environmental health teams speak directly with the vendors, but throughout New Providence [Bahamas] and anywhere else we may suspect a possibility of exposure," the minister said. "We learned back in the 1990s this is easily controlled if people practice very simple techniques of washing conch with fresh water, which minimizes, if not eliminates, the possibility of transmission. And so, we just redouble those efforts combined with public education."

Additionally, Sands advised conch purchasers to ask vendors and restaurants whether the conch has been washed in fresh water before purchasing and eating it. "If the answer is affirmative, then you ought to feel reasonably comfortable you can eat it," he said. "If the answer is no, then I wouldn't suggest you eat or purchase it." No vendor has been closed down as a result of the cases presented. Sands said that would be premature, noting that conch poisoning from _V. parahaemolyticus_ can be easily prevented.

Thousands of visitors frequent Potter's Cay and other venues to sample conch in the variety of ways it is prepared, such as conch salad, in which the conch is consumed raw with vegetables, pepper and lime. According to health officials, cooking the conch removes the chance of it being contaminated.

There were 223 cases of vibriosis in New Providence [Bahamas] in 2003. In 1991 and 1999, there were also outbreaks of conch poisoning with a combined 1100 cases, Sands said.

Regarding testing, Sands was asked whether the ministry has periodically tested random conch batches from vendors. "This is not an issue of the meat itself," he responded. "Vibrio is a bacteri[um] ordinarily living in sea water and is a part of the surface of the conch. The conch meat itself is not infected with _V. parahaemolyticus_, so you can wash it off. Testing the conch meat itself is not the issue."

Sands continued, "We have learned historically you can eliminate this problem by washing the conch in fresh water. If you are washing the conch with _Vibrio_-containing water, you are not going to solve the problem, even though the conch may appear clean on the surface." Sands said while this is a breaking matter and the ministry has a strategic plan, it has not gotten to the stage of testing batches of conch and the storage water, but "that does not mean that we won't get there."

Symptoms of conch poisoning from _V. parahaemolyticus_ can persist for 72 hours, and some patients may require hospitalization for treatment of dehydration. Those experiencing symptoms are asked to contact the ministry's surveillance unit at +1-242-502-4790 between 9 a.m. and 5 p.m. EDT.  [Byline: Torrell Glinton]
====================
[There is now confirmation the agent involved in the conch poisoning situation is the bacterium _Vibrio parahaemolyticus_. I apologize for the error regarding identification of the agent. Laboratory confirmation is always appreciated. [ProMED would like to thank Mr. Ryan Burke for bringing the laboratory confirmation to our attenttion. - ProMED Mod.JH]

_V. parahaemolyticus_ is a bacterium in the same family as those that cause cholera. It lives in brackish saltwater and causes gastrointestinal illness in humans. Symptoms include watery diarrhea, abdominal cramping, nausea, vomiting, and fever and chills. Usually these symptoms begin within 24 hours of exposure. Illness is usually self-limited and lasts approximately 3 days. Severe disease is rare and occurs more commonly in persons with weakened immune systems <http://www.health.state.mn.us/divs/idepc/diseases/vibrio/basics.html>.

Additional information regarding _V. parahaemolyticus_ may be found on the CDC fact sheet <https://www.cdc.gov/vibrio/faq.html> - ProMED Mod.TG]

[Infections with this organism, which can be normal microflora in seawater, have been associated with the consumption of raw, improperly cooked, or cooked and recontaminated fish and shellfish. A correlation exists between the probability of infection and warmer months of the year. Improper refrigeration of seafood contaminated with this organism will allow its proliferation, which increases the possibility of infection. ProMED-mail covered a large 2005 outbreak in Chile. It was impressive in its size (more than 10 000 cases), continued spread despite early recognition, and the involvement of clams and mussels rather than the classical oyster vehicle. - ProMED Mod.LL]

[HealthMap/ProMED-mail map: <http://healthmap.org/promed/p/11584>]
Date: Thu 5 Jul 2018
Source: EW News [edited]

With 4 confirmed cases of conch poisoning in New Providence, [Bahamas], the Ministry of Health cautioned Bahamians against consuming the delicacy in the wake of this latest outbreak. Health Minister Dr. Duane Sands confirmed the 4 Bahamians suffering from the illness. The earliest case, he said, dates back to [Sat 30 Jun 2018].

Dr. Sands revealed that an additional 6 persons have been hospitalized with symptoms of conch poisoning. He said even though the number of cases is considered minimal, the ministry's warning is a proactive measure to prevent future cases. The ministry, he said, is expected to begin dialogue with local vendors to ensure they are utilizing proper cleaning methods in the preparation of conch dishes.

"Conch should be washed with fresh water, and not salt water, to ensure that all bacteria is removed from the conch meat," suggested Dr. Sands. He urged Bahamians to ask local vendors about the processes they employ during the preparation of conch dishes. "If they do not wash the conch in fresh water during the process of preparing it, then do not purchase the conch," he warned.

The early onset of conch poisoning is said to be accompanied by watery diarrhoea and extreme abdominal cramps. Some cases, the health minister said, are severe and can lead to dehydration and subsequent hospitalization.

The last major outbreak of conch poisoning dates back to the 1990s, according to Dr. Sands.  [Byline: Theo Sealy]
=========================
[The group of conchs that are sometimes referred to as "true conchs" are marine gastropod molluscs in the family Strombidae, specifically in the genus _Strombus_ and other closely related genera. For example, see _Lobatus gigas_, the queen conch, and _Laevistrombus canarium_, the dog conch (<https://en.wikipedia.org/wiki/Conch>).

In ciguatera poisoning, the poisonous ingredient is ciguatoxin. This is a poison made in small amounts by certain algae and algae-like organisms called dinoflagellates. Environmental conditions are right for other organisms, mollusks, or fish to ingest the algae and dinoflagellates. Smaller organisms may be ingested by larger organisms, thus transferring the toxic agent to the larger animal.

Ciguatera is a foodborne illness (food poisoning) caused by eating fish that is contaminated by ciguatera toxin. Ciguatera toxin, a heat-stable, lipid-soluble compound produced by dinoflagellates and concentrated in fish organs, can cause nausea, pain, and cardiac and neurological symptoms in humans when ingested.

Ciguatera toxin is harmless to fish but poisonous to humans. The toxin is odorless and tasteless, and cooking does not destroy the toxin. The toxin activates voltage-dependent sodium channels, causing symptoms in gastrointestinal, cardiac, and nerve tissues of humans and other mammals.

Symptoms in people generally begin 6-8 hr after eating the contaminated fish but can occur as early as 2 or as late as 24 hr after ingestion. Symptoms include nausea, vomiting, diarrhea, muscle pain, numbness, tingling, abdominal pain, dizziness, and vertigo. There is no specific antitoxin available for ciguatera toxin.

Some investigators have suggested vomiting should be induced if the victim is awake and alert and has eaten ciguatera toxin-containing fish within the last 3-4 hr. Ipecac, a substance that causes vomiting, was suggested as the medication to use, but many investigators now think ipecac causes too much dehydration. Currently, some physicians recommend gastrointestinal decontamination with activated charcoal. Activated charcoal may absorb the toxin if administered 3-4 hr after ingestion.

Victims should maintain hydration. Intravenous fluids may be necessary for uncontrollable nausea and vomiting. Although there is no specific antidote available, supportive therapy and time usually is curative.

Portions of this comment were extracted from

[HealthMap/ProMED-mail map:
New Providence Island, New Providence, Bahamas:
More ...

World Travel News Headlines

Date: Tue, 22 Oct 2019 13:43:23 +0200 (METDST)

Capriata d'Orba, Italy, Oct 22, 2019 (AFP) - A taxi driver has drowned in Italy during violent storms in the north which flooded towns and destroyed a bridge, the fire service said Tuesday.   Farmers in the sweltering south meanwhile sounded the alarm over a draught expected to hit crops hard.   Over 100 people were evacuated Monday across the Alessandria province in the Liguria region, while firefighters carried out 900 operations across the north from Milan to Genoa, as rising waters surged across roads and railways.

The taxi was swept away in the town of Capriata d'Orba, where a bridge had also given way as the river burst its banks.   "There's water everywhere", driver Fabrizio Torre, 52, told his bosses before his phone line cut out, media reported.   His passenger managed to escape the vehicle and survived by clinging to a tree, the reports said.   Two men, aged 61 and 84, were found alive by firefighters after going missing in another part of the storm-hit region.   Rescue workers also pulled young children, their grandmother and the family's dog out of a house submerged by a landslide.   The Po river rose by more than 3.5 metres (11 feet) over a 24-hour period, according to Coldiretti, Italy's main agricultural association.   Lake Maggiore was also nearing a historic level.

Italy has seen "over three storms a day since the start of autumn, 18 percent more than the same period last year," it said.   "And while the north is under rain clouds... in the south, record heat and lack of rainfall has triggered a drought alarm."   Italy was seeing "the effects of climate change, with exceptional weather events becoming the norm".   It noted a "clear endency to tropicalisation" in the Mediterranean country, which was experiencing "a crazy autumn that ranks in the top ten of the hottest since 1800, with a temperature of 1.27 degrees above the average".   The high frequency of violent events was expected to continue, with the north pummelled by rains while farmers in the south risk losing crops.
Date: Tue, 22 Oct 2019 09:57:15 +0200 (METDST)
By Tupad POINTU

La Paz, Oct 22, 2019 (AFP) - Bolivia braced for a general strike on Tuesday hours after violence broke out in several cities when the main opposition candidate rejected presidential election results that seemed set to hand a controversial victory to long-time incumbent Evo Morales.   Opposition supporters reacted with fury, torching electoral offices in the southwestern cities of Sucre and Potosi, while rival supporters clashed in the capital La Paz.    Incidents were reported in cities across the South American country.   Carlos Mesa, who came a close second to Morales in Sunday's polls -- forcing a run-off, according to preliminary results -- denounced revised results released by election authorities as a "fraud."   "We are not going to recognize those results that are part of a shameful, consumated fraud, that is putting Bolivian society in a situation of unnecessary tension," said Mesa.

International monitors from the Organization of American States voiced "deep concern" at sudden changes to the election count to show Morales closing in on an outright victory in the first round.   Preliminary results released late Sunday showed neither Morales, 59, nor 66-year-old Mesa with a majority and "clearly indicated a second round," the OAS mission said.   The partial results put Morales in the lead with 45 percent of the votes, with Mesa on 38 percent, meaning Morales would have to contest a run-off for the first time.   But results released late Monday, after a long and unexplained delay, showed Morales edging towards an outright victory with 95 percent of the votes counted.   Mesa, a former president of the country between 2001-2005, accused Morales of colluding with the Supreme Electoral Tribunal (TSE) to tweak delayed results and avoid a run-off.

- Opposition call general strike -
The call for a general strike was issued by Fernando Camacho, head of an influential civil society organization in Bolivia's biggest city, Santa Cruz, where transport and businesses were expected to shut down from noon.   "Tomorrow we start at 12:00 to block this country," Camacho told opposition demonstrators late Monday, before holding talks with leaders from other regions.   Long lines formed at gas stations amid fears of shortages.   Riot-police dispersed a crowd who tried to storm the electoral offices in the Andean city of Oruro, south of La Paz.    Clashes were also reported in Tarija in the south, Cochabamba in the center and Cobija in the north.

- 'Subverting democracy' -
The United States' top diplomat for Latin America said the Electoral Tribunal was attempting "to subvert Bolivia's democracy by delaying the vote count and taking actions that undermine the credibility of Bolivia's elections."   "We call on the TSE to immediately act to restore credibility in the vote counting process," the official, Michael Kozak, said on Twitter.   The OAS observer mission in the country expressed "surprise at the drastic and hard-to-explain change in the trend of the preliminary results revealed after the closing of the polls," it said in a statement.   It urged the election authority to "firmly defend the will of the Bolivian people" and called for calm on the streets.   "It is extremely important that calm is maintained and any form of violence is avoided in this delicate situation."

- Longest serving president -
Morales, Latin America's longest-serving president, is controversially seeking a fourth term.   He obtained Constitutional Court permission in 2017 to run again for president even though the constitution allows only two consecutive terms.   The former coca farmer and leftist union leader has led the poor but resource-rich Latin American country for the past 13 years, though his popularity has waned amid allegations of corruption and authoritarianism.   He has led the country since taking office in 2006, when he became its first indigenous president.

A new mandate would keep him in power until 2025.   As leader of his Movement for Socialism Party (MAS), Morales points to a decade of economic stability and considerable industrialization as his achievements, while insisting he has brought "dignity" to Bolivia's indigenous population, the largest in Latin America.   He has come under severe criticism this year as wildfires in August and September ravaged Bolivia's forests and grasslands, with activists saying his policies encouraged the use of blazes to clear farmland.
Date: Tue, 22 Oct 2019 06:44:29 +0200 (METDST)

Papeete, Oct 22, 2019 (AFP) - A French tourist has been seriously injured in a rare shark attack in the palm-fringed Pacific islands of Polynesia, emergency services said Tuesday.   The 35-year-old woman was swimming during a whale-watching trip on Monday in the French overseas territory when the oceanic whitetip shark tore into her chest and arms.   "Luckily for her, there were two nurses on the scene who could deliver first aid," firefighter Jean-Jacques Riveta told AFP.   The woman lost both hands and a lot of blood in the attack and was airlifted to hospital, he said.
Date: Tue, 22 Oct 2019 05:13:16 +0200 (METDST)

Wellington, Oct 22, 2019 (AFP) - A huge fire at a construction site sent clouds of acrid black smoke billowing over Auckland on Tuesday, forcing large parts of the downtown area to be cordoned off as firefighters battled the blaze.   The fire broke out on the roof of the SkyCity convention centre site shortly after 1:10pm (0010 GMT) and quickly spread, Fire and Emergency NZ said.   Office workers were warned to stay inside and turn off air conditioning as a thick pall of smoke engulfed the centre of New Zealand's largest city, but there were no reports on injuries.   Unconfirmed reports said the fire was started by a construction worker using a blowtorch on the building, which is one of the venues for the 2021 APEC summit being held in Auckland.
Date: Mon, 21 Oct 2019 18:48:23 +0200 (METDST)

Harare, Oct 21, 2019 (AFP) - At least 55 elephants have died in a month in Zimbabwe  due to a lack of food and water, its wildlife agency said Monday, as the country faces one of the worst droughts in its history.   More than five million rural Zimbabweans -- nearly a third of the population -- are at risk of food shortages before the next harvest in 2020, the United Nations has warned.

The shortages have been caused by the combined effects of an economic downturn and a drought blamed on the El Nino weather cycle.   The impact is being felt at Hwange National Park, Zimbabwe's largest game reserve.   "Since September, we have lost at least 55 elephants in Hwange National Park due to starvation and lack of water," Zimbabwe National Parks spokesman Tinashe Farawo told AFP.   Farawo said the park was overpopulated and that food and water was scarce "due to drought".

Africa's elephant numbers have dropped from around 415,000 to 111,000 over the past decade, mainly due to poaching for ivory, according to the International Union for Conservation of Nature (IUCN).   But Zimbabwe, like other countries in the southern African region, is struggling with overpopulation.   "Hwange was meant for 15,000 elephants but at the moment we are talking of more than 50,000," Farawo said.   "The situation is dire. We are desperately waiting for the rains."   An adult elephant drinks 680 litres (180 gallons) of water per day on average and consumes 450 kilogrammes (990 pounds) of food.

Hungry elephants have been breaking out of Zimbabwe's game reserves and raiding human settlements in search for food, posing a threat to surrounding communities.   Farawo said 200 people have died in "human-and-animal conflict" in the past five years, and "at least 7,000 hectares (17,300 acres) of crop have been destroyed by elephants".   The authorities took action earlier this year by selling nearly 100 elephants to China and Dubai for $2.7 million.   Farawo said the money had been allocated to anti-poaching and conservation projects.   Botswana, Namibia, Zambia and Zimbabwe have called for a global ban on elephant ivory trade to be relaxed in order to cull numbers and ease pressure on their territories.
Date: Mon, 21 Oct 2019 13:34:35 +0200 (METDST)

Santiago, Oct 21, 2019 (AFP) - Chile, reeling from its worst social unrest in decades, has since the 1990s been considered a Latin American hub of political stability and economic growth after 17 years of dictatorship.   Here is some background.

- From dictatorship to democracy -
In 1973 General Augusto Pinochet toppled Socialist President Salvador Allende in a military coup. Allende committed suicide in the presidential palace as troops closed in.   Pinochet imposed a right-wing dictatorship that lasted for 17 years, during which at least 3,200 people were killed or disappeared as a result of political repression. Around 38,000 were tortured.   In 1988 he lost a plebiscite on remaining in power and handed over to democratically elected Patricio Aylwin in 1990, remaining head of the armed forces until 1998.    Pinochet died in 2006 without standing trial for atrocities under his regime.   In 2006 Socialist Michelle Bachelet became Chile's first female president. Re-elected in 2013, she was barred constitutionally from standing again immediately and appointed UN right commissioner in 2018.   The 2017 elections were won by conservative billionaire Sebastian Pinera, who had already been president in 2010-2014.

- Model economy -
Pinochet applied neo-liberal free-market methods, privatising healthcare, education and pensions.   Chile turned to exports and in the 1980s became the preferred Latin American host for foreign investors.   With this economic model still largely in place, growth reached a strong 4% in 2018. The country of 18 million people also has the highest per capita income of Latin America at $20,000.   GDP, however, fell to 1.8% in the first half of 2019 -- due to a challenging external context, adverse climatic conditions and a delay in reforms -- and is expected at 2.5 percent for the year.   Despite slashing poverty from 30% in 2000 to 8.6% in 2019, the country has high social inequalities including in healthcare, education and pensions.   It is the world's biggest producer of copper, with lithium, timber, fisheries, gold, silver, avocados and oil also driving exports.

- Paedophile priests scandal -
The staunchly Roman Catholic country has been rocked by allegations of sexual abuse within the church going back decades.   In May 2018 Pope Francis summoned all 34 Chilean bishops to Rome over the crisis and all tendered their resignations, although only a handful have been accepted.   Since 2000 about 80 priests have been reported to authorities in Chile for alleged sexual abuse, including of children and adolescents.   Prosecutors said in August 2018 they were investigating 158 members of the church, both priests and lay people.   Ultra-conservative Chile allowed divorce only from 2004 and legalised abortion in certain cases in 2017.

- World's most seismic -
Bordered by the Pacific Ocean to the west and the Andes mountain range to the east, long and narrow Chile is the world's most seismic country.   In 1960 it was struck by the most powerful earthquake ever registered which measured 9.5 and struck at Valdivia. More than 5,700 people were killed.   In 2010 a 8.8-magnitude quake in the south and centre unleashed a tsunami that swept away entire villages, leaving around 520 people dead.

- Astronomy heaven -
Benefitting from a totally clear sky for most of the year, northern Chile is home to some of the world's most powerful telescopes.   The construction of the planet's biggest telescope was launched in May 2017 in the Atacama desert by ESO, the European Organisation for Astronomical Research in the Southern Hemisphere.
Date: Sun 20 Oct 2019
Source: Pakistan today [edited]

The death toll from a mysterious throat virus has reached 9 children in Seerani and its surrounding localities in Badin district as one more child infected by the virus died, affected people said on [Sun 20 Oct 2019].

A child, R, son of RM, died after contracting the disease. The most affected areas are reported to be Seerani and its surrounding localities. Teams of the health department and other organizations reached Seerani and took blood samples of at least 30 children who were infected by the virus. The blood samples will be sent to Islamabad for the tests.

The people of the area are worried about this new throat viral disease and have demanded authorities to provide immediate health cover to them.
====================
[There is little information to go on other than the throats of children are affected and the case fatality rate is high (10 of at least 30). No other symptoms are provided, nor is the basis for concluding that a virus is involved or what the epidemiological data are (dates, ages, sex of children involved, and local conditions). ProMED-mail would welcome additional information. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: 21 Oct 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/polio-cases-reported-in-zambia-chad-and-togo-73820/>

Circulating vaccine-derived polio virus (cVDPV) type cases have been confirmed in 10 African countries through [16 Oct 2019] this year [2019]. Now, the World Health Organization (WHO) is reporting 3 additional countries from the continent that more recently reported circulating vaccine-derived polio virus type 2 (cVDPV2) cases: Zambia, Chad and Togo.

Zambia
The Ministry of Health of Zambia reported last week on a confirmed case of circulating vaccine-derived polio virus type 2 (cVDPV2) in a 2-year-old child in Chienge district, Luapula province on the border with Democratic Republic of the Congo. This is the 1st case of cVDPV2 reported from Zambia in 2019. [Date of onset of paralysis reported to be 16 Jul 2019 according to another media report <https://www.lusakatimes.com/2019/10/21/polio-case-has-been-recorded-in-zambias-luapula-province/>.

In addition to the initial case-patient, 34 stool samples were collected from healthy contacts, and 2 samples tested positive for VDPV2, which were genetically linked to the case-patient. No established links have so far been found with the ongoing outbreak of cVDPV2 in Democratic Republic of the Congo, where 37 cases have been reported in 2019. The last recorded case of indigenous polio in Zambia was in 1995, while between 2001 and 2002, 5 cases of wild polio virus were identified among Angolan refugees in the Western province of the country.

Chad
Last week, WHO was informed about cVDPV2 in Chad. A cVDPV2 was isolated from a 13-month-old case of acute flaccid paralysis (AFP), with onset of paralysis on [9 Sep 2019] in Chari Baguirmi province, bordering Cameroon. The isolated virus has 32 nucleotide changes from Sabin 2, and is genetically linked to a cVDPV2 detected in Borno, Nigeria and is part of the Jigawa emergence. The last indigenous wild poliovirus cases were reported in 2000 in Chad.

Togo
In addition, last week WHO was informed about cVDPV2 in Togo. A cVDPV2 was isolated from a 30-month-old case of AFP with onset of paralysis on [13 Sep 2019] in Plateaux province, bordering Benin and Ghana. The isolated virus has 32 nucleotide changes from Sabin 2 and is genetically linked to a cVDPV2 detected in Irewole state, Nigeria and is part of the Jigawa emergence as well. The last indigenous wild poliovirus case was reported in 1999 in Togo.
======================
[Three more countries are joining the list of cVDPV outbreak countries, all with cVDPV2 isolates. Two of the 3 countries (Togo and Chad) have viruses related to the Jigawa, Nigeria cVDPV2 outbreak. The case in Zambia is suspected to be associated with the ongoing cVDPV2 transmission in the Democratic Republic of the Congo (DR Congo), but genetic testing is presumably still pending or has been negative. See my comments below after the following section, as they are relevant to what is ongoing globally with respect to cVDPVs.

Below are the HealthMap/ProMED map links to countries where cVDPV cases/outbreaks have occurred in the past 12 months, a total of 20 countries.

Angola: <http://healthmap.org/promed/p/165>
Benin: <http://healthmap.org/promed/p/59>
Cameroon: <http://healthmap.org/promed/p/65>
Central African Republic: <http://healthmap.org/promed/p/66>
Chad: <http://healthmap.org/promed/p/57>
China: <http://healthmap.org/promed/p/155>
Democratic Republic of the Congo: <http://healthmap.org/promed/p/194>
Ethiopia: <http://healthmap.org/promed/p/95>
Ghana: <http://healthmap.org/promed/p/53>
Indonesia: <http://healthmap.org/promed/p/184>
Kenya: <http://healthmap.org/promed/p/174>
Mozambique: <http://healthmap.org/promed/p/177>
Myanmar: <http://healthmap.org/promed/p/148>
Niger: <http://healthmap.org/promed/p/58>
Nigeria: <http://healthmap.org/promed/p/62>
Papua New Guinea: <http://healthmap.org/promed/p/188>
Philippines: <http://healthmap.org/promed/p/158>
Somalia: <http://healthmap.org/promed/p/125>
Togo: <http://healthmap.org/promed/p/64>
Zambia: <http://healthmap.org/promed/p/170> - ProMED Mod.MPP]
Date: Fri 18 Oct 2019 07:32 PM EDT
Source: WSPA [edited]

North Carolina health officials say a 4th person has died from an outbreak of legionnaires' disease linked to a hot tub display at the North Carolina Mountain State Fair, which is held at the Western North Carolina Agricultural Center.

We've also learned another person, who did not attend the NC Mountain State Fair, was diagnosed with legionnaires' after attending a quilt show that was held inside the same building as the hot tub exhibit. That building is the Davis Event Center.

7 News spoke with folks who have been impacted by the outbreak. "We were like 'Oh no, I hope nobody gets sick,'" [LP] said. He attended the North Carolina Mountain State Fair-an event tied to at least 140 cases of legionnaires'. He said 2 people he knows, including his uncle, got sick after the fair. "They didn't actually have legionnaires', but they had respiratory problems that did come out of it," he said. [Perhaps Pontiac fever?] Even so, [LP] was back at the WNC Agricultural Center on [Fri 18 Oct 2019] to help host his club's annual Antique Tractor Show.

And while everything appeared to be business as usual, [LP] was concerned as another person was just diagnosed with the disease and didn't attend the fair. Instead, they were at a quilt show held at the WNC Agricultural Center 2 weeks later. "Anytime there's an outbreak of something, it's always going to have a thing in the back of your mind that says, 'I don't know if I want to do this or not,'" he said.

The Davis Event Center has since been closed; but health officials say it's possible the source for the newest case of legionnaires' may not have been at the WNC Agricultural Center. "There are other possible exposures that this person had, so it's hard. At this point, we can't pinpoint," Jennifer Mullendore with Buncombe County Health and Human Services said.

According to a statement by the WNC Agricultural Center, the hot water system in the Davis Event Center, and every other building on the grounds, went through a disinfecting process as a precautionary measure. "They did some cleaning and doing some real hot high-powered water through the water system here, and so we do have a clean bill of health," Phillips said.  It's unclear at this time when the Davis Event Center will re-open.  [Byline: Scottie Kay]
========================
[The latest status, as of 18 Oct 2019, of the legionellosis outbreak associated with the Mountain State Fair that was held in western North Carolina between 6 and 15 Sep 2019 at the Western North Carolina Agricultural Center (WNC Ag Center) in Fletcher, a town in Henderson County, can be found at <https://epi.dph.ncdhhs.gov/cd/legionellosis/outbreak.html>.

The source of the outbreak has still not as yet been confirmed. However, hot tub displays in one of the buildings (Davis Event Center) has been linked to the outbreak. A site map of the WNC Ag Center that shows the location of the Davis Event Center building can be found at <https://www.wncagcenter.org/p/mountainstatefair/competitions/map>.

One more case and an additional death have been reported since the last ProMED-mail post on this outbreak, but no cases linked to the outbreak had a symptom onset date more than 2 weeks after the end of the fair, that is, within the incubation period for legionnaires' disease (<https://www.cdc.gov/legionella/clinicians/clinical-features.html>). The latest case of legionnaires' disease didn't attend the fair, but instead attended a quilt show held 2 weeks later at the Davis Event Center, but the source for this case is thought possibly to have not been at the WNC Agricultural Center. The Davis Event Center has since been closed.

The number of confirmed cases of legionellosis by county are as follows: Buncombe, 49; Burke, 1; Caswell, 1; Cherokee, 1; Gaston, 1; Granville, 1; Haywood, 12; Henderson, 34; Jackson, 3; Madison, 6; McDowell, 5; Mecklenburg, 5; Mitchell, 2; Polk, 1; Rutherford, 3; Transylvania, 3; Union, 1; Watauga, 1; and Yancey, 1. 10 cases occurred out of state (in South Carolina). Total cases: 141. A map showing the location of the North Carolina counties can be found at <https://geology.com/county-map/north-carolina.shtml>.

Male, 82 (59%)*; female, 58 (41%)*. Median age in years (range): 61 (24-91). Hospitalizations: 94 (69%)*; deaths 4. *Some cases reported with unknown gender or hospitalization status.

A total of 133 (94%) have legionnaires' disease, the pneumonic form of the infection, and 8 (6%) have Pontiac fever, the non-pneumonic form of the infection.

The species of _Legionella_ detected in patients is not specified; however, the usual pathogen in the USA is _L. pneumophila_ serogroup 1 and one sample of water collected from the women's restroom in the Davis Event Center was previously reported to be positive for _L. pneumophila_. Genotyping clinical and environmental isolates will help identify clusters of cases with a common source and identify the source responsible for infection in these clusters. - ProMED Mod.ML]
 
[HealthMap/ProMED-mail map of North Carolina, United States:
Date: Sun 20 Oct 2019 12:52 AM IST
Source: Deccan Chronicle [edited]

The respite from cases of dengue, notwithstanding, the city [Hyderabad] is now caught in the grip of viral encephalitis, or brain fever. There is an alarming increase in the number of viral encephalitis cases being reported across city hospitals. This is ironic as October is medically termed as 'fair-weather' season. The rise in the number of cases has been worrisome and those getting inflicted include children and elders.

Many are complaining of fever of the brain with body temperature touching [106-107 deg F/41.1-41.6 deg C].

According to doctors, at least 3 cases are reported each week in the tertiary hospitals of which 7 major ones are in the city.

Dr Shyam Jaiswal, neurologist at Care Hospitals, explains, "Of late, we have been admitting viral encephalitis-affected children in the hospital. Most fall sick because of the body's low immunity. Immediate hospital care is a must as most complain of severe headache, delirium, and in some cases even loss of memory. The treatment takes between 2-3 days."

It is a medical nightmare that some elders are suffering from both chikungunya and viral encephalitis.

Dr Hari Kishan B, general physician with Apollo Hospitals, explains, "The combination of chikungunya and viral encephalitis has been noted earlier too. These are rare cases but do occur from time to time. The viral infections have been very high this year [2019] and those suffering from diabetes, hypertension, and other cardiovascular ailments, will suffer more when infected with these viruses."  [Byline: Kaniza Garari]
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[This report does not provide total case numbers, nor indicate how long 2-3 cases per week have been occurring. The virus suspected or confirmed as the etiology of these cases is not mentioned, but the comment that October is termed "a fair weather season" suggests that Japanese encephalitis virus may be involved with the usual transmission season declining in October. No mention is made of acute encephalitis syndrome, a clinical designation with a variety of suggested Aetiologies in other cases in north-eastern India. - ProMED Mod.TY]

[Maps of India: