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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The phone number for police/fire/ambulance emergency services - the equivalent of "911" in the U.S. - is “999” in the United Kingdom and “112” in Gibraltar.
This number should also be used for warnings about possible bombs or other immediate threats.
The UK Anti-Terrorist Hotline, at 0800 789 321, is for tip-offs and confidential information about possible terrorist activity.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings, Travel Alerts, as well as the Worldwide Caution can be found.
Recent communications from U.S. Embassy London to the local American citizen community, called Warden Messages, can be found on the U.S. Embassy's American Citizens' Services web site at http://london.usembassy.gov/cons_new/acs/index.html.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet, A Safe Trip Abroad.
CRIME:
The United Kingdom and Gibraltar benefit from generally low crime rates and rates decreased slightly in 2007 in significant categories, including violent crime.
The crime situation in the UK is similar to the United States, with typical incidents including pick-pocketing; mugging; “snatch and grab” thefts of mobile phones, watches and jewelry; and theft of unattended bags, especially at airports and from cars parked at restaurants, hotels and resorts.
Pickpockets target tourists, especially at historic sites, restaurants, on buses, trains and the London Underground (the “Tube,” or subway).
Thieves often target unattended cars parked at tourist sites and roadside restaurants, looking for laptop computers and hand-held electronic equipment, especially global positioning satellite equipment.
Walking in isolated areas, including public parks, especially after dark, should also be avoided, as these provide advantageous venues for muggers and thieves.
At night or when there is little foot traffic, travelers should be especially careful using the underground pedestrian tunnels.
As a general rule, either walk the extra distance to use a surface crossing or wait until there are other adult pedestrians entering the tunnel.

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

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate at the opening of the next business day.
The U.S. Embassy or Consulate only issues replacement passports during regular business hours.
If you are the victim of a crime while overseas, report it to local police.
The nearest U.S. Embassy or Consulate will also be able to assist by helping you to find appropriate medical care, contacting family members or friends, and explaining how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

Visit the “Victim Support” web site, maintained by an independent UK charity to helps people cope with the effects of crime: http://www.victimsupport.org.uk/
See our information for Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
While medical services are widely available, free care under the National Health System is allowed only to UK residents and certain EU nationals.
Tourists and short-term visitors will be charged for medical treatment in the UK.
Charges may be significantly higher than those assessed in the United States.
Hiking in higher elevations can be treacherous.
Several people die each year while hiking, particularly in Scotland, often due to sudden changes in weather.
Visitors, including experienced hikers, are encouraged to discuss intended routes with local residents familiar with the area, and to adhere closely to recommendations.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
If your medical insurance policy does not provide overseas coverage, you may want to purchase a short-term policy for your trip.
The Department of State provides a list of travel insurance companies that can provide the additional insurance needed for the duration of one’s trip abroad in its online at medical insurance overseas.
Remember also that most medical care facilities and medical care providers in the UK do not accept insurance subscription as a primary source of payment.
Rather, the beneficiary is expected to pay for the service and then seek reimbursement from the insurance company.
This may require an upfront payment in the $10,000 to $20,000 range

Please see our information on medical insurance overseas.

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

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

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

SPECIAL CIRCUMSTANCES:
The legal drinking age in the UK is generally lower than in the U.S. and social drinking in pubs is often seen as a routine aspect of life in Britain. Parents, organizers of school trips, and young travelers should be aware of the impact that this environment may have when combined with the sense of adventure that comes with being abroad.
Please see our Students Abroad web site as well Studying Abroad to help students plan a safe and enjoyable adventure.
The UK has strict gun-control laws, and importing firearms is extremely complicated. Travelers should consider leaving all firearms in the United States.
Restrictions exist on the type and number of weapons that may be possessed by an individual.
All handguns, i.e. pistols and revolvers, are prohibited with very few exceptions.
Licensing of firearms in the UK is controlled by the Police.
Applicants for a license must be prepared to show 'good reason' why they require each weapon.
Applicants must also provide a copy of their U.S. gun license, a letter of good conduct from their local U.S. police station and a letter detailing any previous training, hunting or shooting experience. Background checks will also be carried out.
Additional information on applying for a firearm certificate and/or shotgun certificate can be found on the Metropolitan Police Firearms Enquiry Teams web site at http://www.met.police.uk/firearms-enquiries/index.htm.
A number of Americans are lured to the UK each year in the belief that they have won a lottery or have inherited from the estate from a long-lost relative.
Americans may also be contacted by persons they have “met” over the Internet who now need funds urgently to pay for hospital treatment, hotel bills, taxes or airline security fees.
Invariably, the person contacted is the victim of fraud.
Any unsolicited invitations to travel to the UK to collect winnings or an inheritance should be viewed with skepticism.
Also, there are no licenses or fees required when transiting a UK airport, nor is emergency medical treatment withheld pending payment of fees.
Please see our information on International Financial Scams. Please read our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating British law, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the UK are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.
Many pocketknives and other blades, and mace or pepper spray canisters, although legal in the U.S., are illegal in the UK and will result in arrest and confiscation if detected.
A UK Metropolitan Police guide to items that are prohibited as offensive weapons is available at http://www.met.police.uk/youngpeople/guns.htm.
A UK Customs Guide, detailing what items visitors are prohibited from bringing into the UK, is available at http://customs.hmrc.gov.uk/channelsPortalWebApp/downloadFile?contentID=HMCE_CL_001734.
Air travelers to and from the United Kingdom should be aware that penalties against alcohol-related and other in-flight crimes (“air rage”) are stiff and are being enforced with prison sentences.
Please also see our information on customs regulations that pertain when returning to the US.

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Denmark

Denmark, Greenland and the Faeroe Islands US Consular Information Sheet
March 05, 2008
COUNTRY DESCRIPTION:
Denmark is a highly developed stable democracy with a modern economy.
Greenland is a self-governing dependency of Denmark.
>The Faroe Islands are a self-governing overseas administrative division of Denmark.
For additional information, visit the State Department page http://www.state.gov/p/eur/ci/da.

ENTRY REQUIREMENTS:
Passport and visa regulations are similar for Denmark, Greenland, and the Faroes.
A valid passport is required.
U.S. citizen tourist and business travelers do not need visas for visits of up to 90 days.
That period begins when entering any of the following countries which are parties to the Schengen agreement: Austria, Belgium, The Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, and Sweden.
Contact the Royal Danish Embassy at 3200 Whitehaven Street NW, Washington, DC
20008, telephone (202) 234-4300 or visit its web site at http://www.ambwashington.um.dk/en for the most current visa information.

Note:
Although European Union regulations require that non-EU visitors obtain a stamp in their passports upon initial entry to a Schengen country, many borders are not staffed with officers carrying out this function.
If an American citizen wishes to ensure that his or her entry is properly documented, it may be necessary to request a stamp at an official point of entry.
Under local law, travelers without a stamp in their passports may be questioned and asked to document the length of their stay in Schengen countries at the time of departure or at any other point during their visit, and could face possible fines or other repercussions if unable to do so.

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:
Denmark remains largely free of terrorist incidents, however, the country shares, with the rest of Western Europe, an increased threat of Islamic terrorism.
Like other countries in the Schengen area, Denmark’s open borders with its Western European neighbors allow the possibility of terrorist groups entering and exiting the country with anonymity.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

Public demonstrations occasionally occur in Copenhagen and other Danish cities and are generally peaceful events.
Prior police approval is required for public demonstrations, and police oversight is routinely provided to ensure adequate security for participants and passers-by.
Nonetheless, as with any large crowd comprised of diverse groups, situations may develop which could pose a threat to public safety.
U.S. citizens are advised to avoid areas where public demonstrations are taking place.

From time to time Copenhagen may experience protest activities from young people in their attempt to defend their self-proclaimed rights to either property (club activity buildings) or other privileges provided by Danish public means.
American citizens should be aware that participation in illegal demonstrations or street riots may result in immediate imprisonment and long term bans on re-entering Denmark.

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

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

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

CRIME:
Denmark, Greenland, and the Faroes all have relatively low violent crime rates, however, non-violent crimes of opportunity have increased over the last few years, especially in Copenhagen and other major Danish cities, where tourists can become targets for pickpockets and sophisticated thieves.
Criminals frequent airports, train stations, and cruise ship quays to take advantage of weary, luggage-burdened travelers.
Thieves also operate at popular tourist attractions, shopping streets, and restaurants.
In hotel lobbies and breakfast areas, thieves take advantage of even a brief lapse in attention to snatch jackets, purses, and backpacks.
Women’s purses placed either on the backs of chairs or on the floor are typical targets for thieves.
Due to the increase of crimes of opportunity, Embassy Copenhagen has experienced a high rise in passport thefts during the summer of 2007.
Car and home break-ins are also on the rise.

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

Denmark has a program to provide financial compensation to victims who suffer serious criminal injuries.
According to existing regulations, the victim must report the incident to the police within 24 hours.
Danish police routinely inform victims of serious crime of their rights to seek compensation.
The relevant forms can be obtained from the police or the Danish Victims’ Compensation Board:
Civilstyrelsen, Erstatningsnaevnet, Gyldenløvesgade 11, 1600 Copenhagen V, TEL:
(45) 33-92- 3334; FAX:
(45) 39-20-45-05; www.erstatningsnaevnet.dk; email: erstatningsnaevnet@erstatningsnaevnet.dk.
Claim processing time is a minimum of 3 months.
There is no maximum award limit.

See our information for Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Excellent medical facilities are widely available in Denmark.
In Greenland and the Faroe Islands, medical facilities are limited and evacuation is required for serious illness or injury.
Although emergency medical treatment is free of charge, the patient is charged for follow-up care.

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

MEDICAL INSURANCE:
The Department 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 Denmark is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

A valid U.S. driver's license may be used while visiting Denmark, but the driver must be at least 18 years old.
Driving in Denmark is on the right side of the road.
Road signs use standard international symbols.
Many urban streets have traffic lanes reserved for public transport only.
Unless otherwise noted on traffic signs, the speed limit is 50 km/h in urban areas, 80 km/h on open roads, and 130 km/h on expressways.

Use of seat belts is mandatory for drivers and all passengers.
Children under three years of age must be secured with approved safety equipment appropriate to the child's age, size, and weight.
Children from three to six years of age may use approved child or booster seats instead of seat belts.

Driving under the influence of alcohol or drugs is considered a very serious offense.
The rules are stringently enforced, and violations can result in stiff fines and possible jail sentences.

Copenhagen, the capital and largest city in Denmark, has an extensive and efficient public transportation system.
Trains and buses connect Copenhagen with other major cities in Denmark and to Norway, Sweden, and Germany.
Bicycles are also a common mode of transportation in Denmark.
Passengers exiting public or tourist buses, as well as tourists driving rental cars, should watch for bicycles on their designated paths, which are usually located between the pedestrian sidewalks and the traffic lanes.

Danish expressways, highways, and secondary roads are of high quality and connect all areas of the country.
It is possible to drive from the northern tip of Denmark to the German border in the south in just four hours.
Greenland has no established road system, and domestic travel is performed by foot, boat, or by air.
The majority of the Faroe Islands are connected by bridges or serviced by boat.
Although the largest islands have roads, most domestic travel is done on foot, horseback, boat, or by air.

The emergency telephone number for police/fire/ambulance in Denmark and the Faroe Islands is 112.
In Greenland contact the local police.

Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://www.denmark.org.
See also additional information on driving in Denmark at http://www.trafikken.dk/trafikken.asp?page=company&objno=7.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Denmark’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Denmark’s air carrier operations.
This rating applies to Greenland and the Faroe Islands as well.
For more information, travelers may visit the FAA’s web site at www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
The official unit of currency in Denmark is the Danish krone.
ATM machines are widely available throughout Denmark.
Please see our information on customs regulations.

For information concerning the importation of pets into Denmark, please visit the following website:
http://www.foedevarestyrelsen.dk.

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 protection 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 Denmark’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Denmark 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.
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 Denmark are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov, and to obtain updated information on travel and security within Denmark.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at Dag Hammarskjolds Alle 24; 2100 Copenhagen, telephone: (45) 33-41-71-00; Embassy fax: (45) 35-43-02-23; Consular Section fax: (45) 35-38-96-16; After-hours emergency telephone: (45) 35-55-92-70.
Information is also available via the U.S. Embassy’s web site at http://denmark.usembassy.gov/.
The United States has no consular presence in Greenland or the Faroe Islands.
* * *
This replaces the Consular Information Sheet dated August 23, 2007 to update the sections on Entry Requirements and Information for Victims of Crime.

Travel News Headlines WORLD NEWS

Date: Sat 5 Jan 2020
Source: Food Safety News [edited]

Several people part of a _Salmonella_ outbreak in Denmark tasted or ate raw or undercooked sausage, according to a recently published study. In November 2018, an outbreak of monophasic _Salmonella_ Typhimurium was detected. It sickened at least 49 people across the country.

A traditional form of raw Danish pork sausage called medister sausage was believed to be the source of illnesses. Product samples were negative for _Salmonella_, and investigations at the production site did not reveal the source of contamination. Medister sausage is often served in the late autumn months and Christmas season. It is a long, thick sausage made from ground pork, seasoned and stuffed into casings. Due to a control program, _Salmonella_ Enteritidis is all but eliminated in Danish broiler poultry and egg production, but _Salmonella_ Typhimurium still exists in pigs and pork.

In mid-November 2018, Statens Serum Institut (SSI) noted 8 cases of monophasic _Salmonella_ Typhimurium belonging to the same WGS cluster. The sequence type (ST) 5296 had not been detected before but was closely related to ST 34, which is often found in pork products.

In 8 initial hypothesis-generating interviews, 7 people said they had eaten a certain type of classic Danish raw pork sausage known as medister sausage, according to a study published in the journal Epidemiology and Infection. The median age was 65 years with a range from 11 months to 97 years, and 53 percent were male. Seven of 49 cases were children less than 18 years of age. 30 people were hospitalized, and 13 reported bloody diarrhea as one of the symptoms. There were no deaths. The onset date of illness was known for 38 of 49 patients and was between 14 Oct 2018, and 17 Jan 2019.

Almost all interviewed patients had eaten fresh pork, and 28 of them ate medister sausage in the week prior to becoming ill with Salmonella. Six patients said they had partly eaten the medister sausage raw or undercooked. Five people said they had failed to boil it prior to frying as is normally recommended on packages and by the Danish Veterinary and Food Administration (DVFA). In one family, a child had eaten medister sausage that was not thoroughly cooked.

"Consumers have to make sure that pork is handled correctly, in particular when it comes to raw products that need to be thoroughly cooked before consumption. Tasting raw meat or eating undercooked pork meat should be discouraged," said researchers.

Traceback investigations pointed to one manufacturer of minced meat and prepared meat products. A total of 90 batches of ground meat and of prepared meat, including 9 batches of medister sausage, were analyzed for _Salmonella_. Only one sample from a batch of minced pork patty sampled in January 2019 found _Salmonella_, but it was not related to the outbreak strain. Medister sausages were packed at the production site, and no handling of the sausage took place at supermarket level.

"No breaches in procedures or obvious incidents that could explain the presence of a specific type of _Salmonella_ in multiple batches of medister sausage in a prolonged period of several weeks were identified," according to researchers. The DVFA also investigated results of routine sampling at the slaughterhouse providing meat to the manufacturer. As part of mandatory sampling, one of every 1000 carcasses were swap sampled and analyzed for _Salmonella_. It was detected 8 times in these samples, but none were identical to the outbreak strain.

Because shelf life of medister sausage is short, and fresh meat is used for production, none of the raw material meat used to produce the batches suspected of having caused illness was available from the manufacturer by the time the outbreak was detected and investigation started. Researchers said it was likely the bacteria might be present in low numbers and unevenly distributed in the raw material, so the chance of detecting it at sampling might be limited. High fat content may also increase thermal resistance of bacteria so they are not fully eliminated by heating. "It is also likely that only a low _Salmonella_ dose is sufficient for patients to become ill, as medister sausage is a product with a high content of fat (10 to 20 percent) that protects the bacteria past the barrier of the gastric acid."

Samples of medister sausage from more manufacturers, as part of routine surveillance and companies own checks, were positive for Salmonella during the outbreak period. This includes finding the serovars Mbandaka, Typhimurium, and its monophasic variant, which was different from the outbreak strain.  [Byline: Joe Whitworth]
===================
[By monophasic, it is meant that the organism does not have the
complete set of flagellar serotypes. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Thu 24 Oct 2019
Source: Eurosurveillance 2019, 24(43) [edited]

[ref: Agergaard CN, Rosenstierne MW, Boedker R, et al. New tick-borne encephalitis virus hot spot in Northern Zealand, Denmark, October 2019. Euro Surveill. 2019; 24(43): pii=1900639]
---------------------------------------------------------------------
Abstract
--------
Tickborne encephalitis virus (TBEV), a member of the family Flaviviridae, genus _Flavivirus_, causes tickborne encephalitis (TBE). In Denmark, TBE is endemic only on the island of Bornholm, with an incidence of 4 per 100 000 inhabitants per year [1,2]. Here we report 3 clinical cases of TBE in patients hospitalised within a month [June/July 2019] and all residing at the boundary of the same forest, Tisvilde Hegn [Capital Region], in Northern Zealand.

Discussion
----------
The incidence of TBE has been increasing in Denmark, in its neighbouring countries as well and in the rest of Europe in recent years, which mirrors the increased abundance of ticks, the increased geographic spread and potentially climate changes [8-11]. The vector for the European virus subtype, TBEV-Eu, is _Ixodes ricinus_, which is prevalent in most of Europe and the dominant tick species in Denmark (greater than 90%) [12]. In 2009, 2 clinical cases of TBE were reported outside Bornholm and TBEV was detected in Northern Zealand in ticks collected in the forest of Tokkekebb Hegn, which is 40 km [25 mi] south east of Tisvilde Hegn, in 2009, 2010, and 2011 [4,5]. Surprisingly, TBEV was no longer detected in the same area in Tokkekoeb Hegn during 2016 and 2017 [13]. In 2018, another 2 human cases of TBE outside Bornholm were identified on the Island of Funen and in Jutland, respectively, but no new micro foci of TBEV has been localized [14], (data not shown).

All 3 patients presented here live close to Tisvilde Hegn in Northern Zealand, and had typical biphasic disease starting with fever, gastrointestinal or influenza-like symptoms and fatigue, followed by a few days of recovery before clinical meningitis/meningoencephalitis at hospitalisation and neurologic sequelae in terms of primarily fatigue and dizziness.

Subsequent collection of _I. ricinus_ ticks from a part of Tisvilde Hegn surrounding a well-visited forest playground, where Case 3 recalled a tick bite, identified a specific area adjacent to the playground to be an acute, new, high-risk TBEV micro-focus in Northern Zealand. The estimated high prevalence of TBEV is 8% at the centre of the focus which exceeds recent prevalence estimates of 0.6% from endemic Bornholm, as well as Denmark's neighbouring countries and most European countries [4,5,8,10,11,13,15]. The presence of the virus in nymphs, but not adult ticks, and the molecular evolutionary analyses of the homogeneous TBEV sequences suggests a single TBEV introduction in 2019, probably by migrating birds from Norway. Tisvilde Hegn and the forest playground is well-visited by Danish and international tourists, and containment measures such as fencing, grass cutting and signage along the playground's eastern side have been made in order to minimise the risk of further infections and spreading.
====================
[The complete article including figures, tables, and references is available at the source URL above.  There were previous reports of human cases TBE virus infection in Denmark in 2009 and again in 2018. The authors note that TBE virus was not found in ticks in the area in 2016 and 2018, nor were any human cases identified there then. They speculate that the virus was introduced by ticks on migratory birds.

TBE is caused by 3 different subtypes of tick borne encephalitis virus: Western European TBE virus, Far Eastern TBE virus, and Siberian TBE virus. Western European TBE (also known as Central European encephalitis) is endemic in western and central European countries and is expanding its range. - ProMED Mod.TY]

Date: Fri 26 Jul 2019
Source: Food Safety News [edited]
<https://www.foodsafetynews.com/2019/07/wgs-project-helps-denmark-uncover-campylobacter-outbreak/>

Fifty people are ill in Denmark from campylobacteriosis after eating chicken meat but authorities believe the actual number of patients may be much higher. Statens Serum Institut (SSI), Danish Veterinary and Food Administration (Fødevarestyrelsen) and DTU Food -- National Food Institute are investigating the _Campylobacter jejuni_ outbreak. _Campylobacter_ is the main cause of bacterial intestinal infections in Denmark and more than 4500 cases were registered in 2018. The same type of _Campylobacter_, sequence type 122, identified in patients by whole genome sequencing has also been found in chicken meat from one slaughterhouse, named as HKScan in Vinderup, a town in North-western Jutland.

HKScan is a Nordic meat and meals company employing more than 600 people in Denmark at production units in Vinderup and Skovsgaard. The Danish Veterinary and Food Administration is continuing to investigate and officials have been sent to help the company track and eliminate the source of infection. Those sick are 20 women and 30 men aged 14 to 87 with a median age of 49 years. As part of a project this year [2019] involving the Clinical Microbiology Department (KMA) in Aalborg, the Danish Veterinary and Food Administration and SSI; _Campylobacter_ isolates from patients diagnosed in Aalborg since March 2019 have been collected, sent to SSI and whole genome sequenced. _Campylobacter_ isolates are not routinely submitted and sequenced so the outbreak has been detected due to the project and may otherwise have gone unnoticed. In the past it has been difficult to detect and solve such outbreaks.

Some isolates also come from other KMA's as part of the Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP) project. Steen Ethelberg, a senior scientist at SSI, said patients have fallen sick over a couple of months and are still being reported. "The most recent estimate for how many more cases are in the population relative to the diagnosed laboratory controlled cases is a factor of 12 so there would be more cases that are actually ill in any outbreak," he told Food Safety News. "The reason we know about this outbreak is because we are running a project in one part of the country where all the patient isolates are being collected and subjected to whole genome sequencing.

Since the outbreak is mainly based on one of the 10 labs only you would expect patients all over the country. It seems likely that there could be more cases and we also have some smaller clusters detected in the project." Ethelberg said the project is trying to see how WGS may be helpful in understanding _Campylobacter_. "It is about collecting patient isolates from one lab and at the same time analysing chicken meat and subjecting the _Campylobacter_ isolates in chicken meat to WGS and then comparing the sequences. In the project we are learning about the aetiology of _Campylobacter_ but we also see outbreaks in real time.

This outbreak is big enough that we thought it should be reported to the public but in a sense it is not so different because we know many people are ill from _Campylobacter_ from poultry products." The Danish Veterinary and Food Administration has been taking samples for _Campylobacter_ of various cuts of chicken from different stores and these have been sequenced. Annette Perge, from the agency, told Food Safety News that it was still too early to conclude the outbreak was over. "The slaughterhouse produces both fresh and frozen products hence we can't rule out that products may still be on the market or bought and stored frozen at private households.

Based on patient interviews it has not been possible to point out specific products, places of purchase, or periods of purchase," she said. "Furthermore there is no legal requirements stating that _Campylobacter_ is prohibited in poultry meat. However even without legal requirements foods used as intended should not result in illness. The slaughterhouse is a large establishment and their products are sold at all the major Danish retail chains." The agency does not yet know if a link was limited to one farm or establishment, according to Perge. "The link between food isolates and routine samples taken at the slaughterhouse, samples of thigh skin from chickens taken routinely for analyses, and the patient isolates was seen when comparing whole genome sequencing results.

However it has not been possible to verify the link through interview with patients. We have no indication that this outbreak is due to a contamination persisting in the slaughterhouse. They have been allowed to continue production. They are assisting us in any way possible to solve the case." Perge said samples from chickens from a specific farm showed a close resemblance to the patients. "The farm has been visited by the audit team from the slaughterhouse and corrections to practices have been made. At the moment no chickens are delivered for slaughter as they are not yet old enough. Meat from chickens slaughtered from that farm will be tested for _Campylobacter_ and eventual isolates will be sequenced and compared to the outbreak strain. If the meat contains larger numbers of _Campylobacter_, the use of the meat will be restricted." [Byline: Joe Whitworth]
========================
[The source of the outbreak may we'll be chicken, a common vehicle for this enteric pathogen. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Denmark:
<http://healthmap.org/promed/p/111>]
Date: Tue 28 May 2019
Source: Food Safety News [edited]
<https://www.foodsafetynews.com/2019/05/ongoing-yersinia-outbreak-traced-to-fresh-spinach-more-than-50-sick/>

An outbreak of yersiniosis in Denmark and Sweden with more than 50 cases has been linked to fresh spinach. Statens Serum Institut, a public health research institute in Denmark, reports 20 people have been infected in the country. One person needed hospital treatment. The Public Health Agency of Sweden has recorded 37 confirmed cases. In March 2019, 20 cases of _Yersinia enterocolitica_ [infection] were found in Denmark. There were 11 women and 9 men aged 2 to 74 years old, with most cases aged 20 to 30. Patients were distributed throughout Denmark in Hovedstaden, Sjaelland, Syddanmark, Midtjylland, and Nordjylland.

The link to spinach was based on a case control study and the traceback investigation, which indicated spinach from Italy was responsible. In March 2019, most fresh spinach in Denmark comes from Spain or Italy. No specific batch of product was found to be the source of the outbreak and no product testing was conducted. After interviews with patients, Statens Serum Institut did a study in which healthy people of the same gender and age, and who lived in the same municipality as those sick, were asked if they had eaten certain foods that many of the yersiniosis patients ate. The study showed patients had consumed fresh spinach to a far greater extent than the control people.

The investigation found spinach was bought in Netto and a supermarket chain in Sweden. Danish officials said the implicated product is no longer on the market because the country had not seen any cases since March 2019 and given duration of the outbreak it was likely only one batch that was contaminated. The cause of the outbreak was _Yersinia enterocolitica_ serotype O3, biotype 4. Whole genome sequencing found all patients were infected with the same bacterial strain. "Although the outbreak is over, we can use this knowledge to prevent it from happening again. It is also a good reason to remind consumers that leafy greens always must be washed thoroughly before eating," said Luise Müller, an epidemiologist from Statens Serum Institut.

Denmark sees about 400 _Yersinia enterocolitica_ cases a year, with 366 having been reported in 2018. In Sweden, the increase in _Yersinia_ infections started in March [2019] and the 37 cases were from across the country. 7 men and 20 women with an age range from 6 to 62 years fell ill. Swedish officials said they were not able to analyse food samples since no case had spinach left at home and their case-control study did not identify a specific food item. Infection with yersinia is relatively rare in Sweden, with between 200 to 300 cases reported annually. Previous outbreaks have been caused by raw or undercooked meat consumption and contaminated ready-to-eat vegetables.

After an incubation period of 3 to 7 days, symptoms includes fever, diarrhoea, and abdominal pain in the right lower part of the abdomen. [byline: Joe Whitworth]
========================
[It is not specifically stated whether the strains in Denmark and Sweden are genetically related. The 2 species of _Yersinia_ associated with foodborne disease are _pseudotuberculosis_ and _enterocolitica_. The latter species can be associated with abdominal pain as a hallmark symptom. As a mesenteric lymphadenitis, yersiniosis can mimic appendicitis but may also cause infections of other sites, such as wounds, joints, and the urinary tract.

As noted in the FDA "Bad Bug Book" (<https://wayback.archive-it.org/7993/20170406190140/https://www.fda.gov/Food/FoodborneIllnessContaminants/CausesOfIllnessBadBugBook/ucm070040.htm>, "Strains of _Y. enterocolitica_ can be found in meats (pork, beef, lamb, etc.), oysters, fish, and raw milk.

The exact cause of the food contamination is unknown. However, the prevalence of this organism in soil, water, and animals, such as beavers, pigs, and squirrels, offers ample opportunities for it to enter our food supply. Poor sanitation and improper sterilization techniques by food handlers, including improper storage, cannot be overlooked as contributing to contamination." In addition, some strains of these organisms can be associated with blood transfusion-associated illnesses due to an ability to grow at refrigerator temperatures. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps:
Denmark: <http://healthmap.org/promed/p/111>
Sweden: <http://healthmap.org/promed/p/108>]
Date: Wed 2 May 2019
Source: CPH Post [edited]

A bacterial infection found in the intestines of many animals and common in pigs, _Yersinia enterocolitica_, has been found in 18 Danes since 30 Mar 2019. So far, 10 women and 8 men aged 2-74 from all over Denmark have been diagnosed with the rare infection, reported BT.  "Right now, we have an outbreak of the bacterium _Yersinia enterocolitica_. It is a disease like salmonella that typically infects people via food," said Luise Muller from the State Serum Institute (SSI).

The disease is not common in Denmark. Over the last 5 years, there have only been 3 outbreaks. SSI is trying to localise the source of the infection by looking for common threads in the infected people's diet.

Typical symptoms are generally feeling under the weather, violent stomach pains, fever, and diarrhoea. The incubation period is usually 3-7 days. "The best advice we can give people is to cook meat thoroughly and wash fruit and vegetables carefully," said Muller.

Sweden has seen a similar outbreak, and the Danish and Swedish authorities are working together to map the infection.

In the 1980s, the infection used to be just as common as salmonellosis and campylobacteriosis, but it has become rarer nowadays. In 2014 there were 414 registered cases.  [Byline: Stephen Gadd]
==========================
[The 2 species of _Yersinia_ associated with food-borne disease are _pseudotuberculosis_ and _enterocolitica_. The latter species can be associated with abdominal pain as a hallmark symptom. As a mesenteric lymphadenitis, yersiniosis can mimic appendicitis but may also cause infections of other sites, such as wounds, joints, and the urinary tract.

As noted in the FDA "Bad Bug Book" (<https://wayback.archive-it.org/7993/20170406190140/https://www.fda.gov/Food/FoodborneIllnessContaminants/CausesOfIllnessBadBugBook/ucm070040.htm>), "Strains of _Y. enterocolitica_ can be found in meats (pork, beef, lamb, etc.), oysters, fish, and raw milk. The exact cause of the food contamination is unknown. However, the prevalence of this organism in soil, water, and animals, such as beavers, pigs, and squirrels, offers ample opportunities for it to enter our food supply. Poor sanitation and improper sterilization techniques by food handlers, including improper storage, cannot be overlooked as contributing to contamination."

Additionally, some strains of these organisms can be associated with blood transfusion-associated illnesses due to an ability to grow at refrigerator temperatures. - ProMED Mod.LL]

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

Saudi Arabia

Travelling to the Hajj
============================
Background
Every devout Muslim seeks to perform the Hajj on at least one occasion during their life. This pilgrimage, which is a central duty of Islam, brings Muslims from all over the wor
d together as they visit the holy cities of Mecca and Medina in Saudi Arabia. Each year over two million gather to celebrate the five 'pillars' of Islam.
Coping with the Climate
The dates for this festival vary from year to year but this year it is in December. In the evenings it can be significantly cold in 'tent city' and so travellers should bear this in mind when packing.
Travel Restrictions
With this massive influx of people travel in and out of Saudi can be difficult and, where possible, plans should be made well in advance.
Care for the pilgrims
The Saudi government seek to provide the highest level of health care possible for those visiting their Kingdom. This has involved the setting up of a series of rules and regulations which need to be observed. Nevertheless every pilgrim should ensure that their own personal health is sufficient before agreeing to travel. This may involve a consultation with their GP - especially if they have any underlying medical conditions.
Food Restrictions
No food is allowed into Saudi during this time and will be confiscated on arrival.
Vaccine Requirements
In order to reduce the risk of certain diseases the Saudi authorities insist on all travellers providing correctly certified evidence of vaccination against some diseases.
Meningitis
All travellers are required to provide evidence of vaccination against Meningococcal Meningitis (ACYW-135). This vaccine has to have been given to every traveller within the previous three years and at least 10 days before arrival into Saudi Arabia. (Other vaccinations against Meningitis C or Meningococcal A&C are not acceptable.)
Compulsory Medications
Some travellers arriving from what are regarded as 'higher risk' countries will also be given prophylactic antibiotics to lessen the possibility of their carrying Meningococcal Meningitis into the country. This is a compulsory requirement - though the medication given varies depending on the age of the individual and whether or not the female traveller is pregnant.
Yellow Fever
It is also essential for some travellers to have evidence of Yellow Fever vaccination certification. Generally this is only required for those arriving from the countries of Africa and South America. This vaccine needs to have been given within the previous 10 years and at least 10 days before arrival.
Other Recommended Vaccines
Even though it is not a requirement of entry to perform the Hajj or visit Saudi Arabia, travellers are strongly advised to consider the following vaccinations;
Influenza / Pneumococci
These are air-borne diseases and the close proximity of so many pilgrims will make the risk of contracting either or both of these highly infectious diseases much higher. Influenza vaccine needs to be given each year where as Pneumococcal vaccine is often only given on one occasion in a lifetime.
Poliomyelitis
This viral disease is disappearing from much of the world and may be eradicated within a few years. However during 2005 a significant number of outbreaks occurred in various African countries and India. The Hajj was linked to outbreaks in Yemen and Saudi Arabia itself. Vaccination is recommended for all unprotected travellers.
Hepatitis A / Typhoid
With such a massive number of people to be catered for it is hardly surprising that the level of food and water borne disease is high. These vaccines are strongly recommended for all travellers. They provide excellent protection but all travellers will still need to exercise extra care to lessen their personal exposure.
Hepatitis B
The main specific risk of contracting Hepatitis B probably relates to the ritual head shaving which is performed as part of the celebrations. Professional barbers are used and long lines of men wait for their turn. In some cases the blade is not changed between shaves and this potentially presents a serious risk of contamination with Hepatitis B infection.
Ritual sacrifice
It should also be noted that during the celebrations a ritual sacrifice of a small animal is performed. Pilgrims are strongly advised not to undertake the actual act of sacrifice themselves - unless they are very experienced - as otherwise they could seriously injury themselves.
Avoiding Accidents and Dehydration
The desire to perform the Hajj is strong and it is an emotional time for any Muslim. Unfortunately the presence of so many other pilgrims in a very confined space at the same time does increase the risk of various diseases and accidents. This includes the risk of being crushed, as has occurred with disastrous consequences in the past. The degree of dehydration can also be high as there is a significant amount of exercise and walking involved. A good pair of comfortable walking shoes is certainly worth the investment. It will also be important to bring some plasters to treat minor injuries and blisters.
Being Separated from Companions
Due to the numbers involved it is very easy to become separated from travelling companions. It is wise to have a plan in place before arriving so that each member of the party knows where to meet.
Overview
It is extremely important that all those undertaking this pilgrimage recognise the necessity to stay constantly alert to the personal health and accident risks which are present and do everything within their power to avoid them. The Tropical Medical Bureau centres throughout Ireland usually carry both the required and the recommended vaccines for travellers to the Hajj. Appointments should be made well in advance of visa application to ensure that these are given in sufficient time.

Travel News Headlines WORLD NEWS

Date: 1 Dec 2019
Source: Saudi MOH (14 Nov 2019 to 1 Dec 2019) [edited]

In the period since the last update (13 Nov 2019, MERS-CoV (69): Saudi Arabia (RI, AS, MK) http://promedmail.org/post/20191113.6776647), there have been a total of 3 newly confirmed cases of MERS-CoV infection reported by Saudi Arabia and 11 newly reported outcomes (2 deaths and 9 recoveries).
Date: Mon, 28 Oct 2019 12:42:34 +0100 (MET)

Riyadh, Oct 28, 2019 (AFP) - Seven people have been killed and 11 injured in floods after heavy rain lashed northeastern parts of Saudi Arabia, Al-Ekhbariya state television reported Monday.   Rescue services in the northeastern city of Hafer al-Batin, about 100 kilometres southwest of Kuwait, said that 16 people were forced to evacuate their homes.   Seven affected by the rain were provided with shelter, it added.  Schools in Hafer al-Batin suspended classes on Monday due to the weather.   In January, 12 people were killed in floods in Saudi Arabia.  Ten died in the northwestern city of Tabuk, one in the Islamic holy city of Medina and another in a northern border area.
Date: Sun, 6 Oct 2019 12:04:37 +0200 (METDST)

Riyadh, Oct 6, 2019 (AFP) - Saudi Arabia announced Sunday it would allow unmarried foreign couples to rent hotel rooms together as the ultraconservative kingdom begins offering up tourist visas for the first time.   The tourism authority said in a statement published on Twitter that Saudi women travelling alone would also be able to check into a hotel by presenting valid ID.

In the past, couples wanting to stay in a hotel had to prove they were married.    "This is no longer required for tourists," the statement said.   Saudi Arabia announced on September 27 it was opening its doors to holidaymakers with the goal of diversifying its oil-dependent economy.   The kingdom had previously only issued visas to Muslim pilgrims, foreign workers, and recently to spectators at sporting or cultural events.

Kickstarting tourism is one of the centrepieces of Crown Prince Mohammed bin Salman's Vision 2030 reform programme to prepare the biggest Arab economy for a post-oil era.   Citizens from 49 countries are now eligible for online e-visas or visas on arrival, including the United States, Australia and several European nations.   On September 28, Saudi authorities warned that tourists who violated "public decency", including with immodest clothing and public displays of affection, would be subject to fines.
Date: Sun, 29 Sep 2019 17:39:45 +0200 (METDST)

Riyadh, Sept 29, 2019 (AFP) - Five people were injured in a fire that broke out at a new high-speed train station in Saudi Arabia's western city of Jeddah on Sunday, state television reported, with huge palls of smoke seen rising into the air.    The station serves the main Haramain High Speed Rail system. The route opened to the public in October last year, transporting passengers between Mecca and Medina, Islam's holiest sites.

"Five people who sustained minor injuries because of the fire were transported to hospital," Al-Ekhbariya state television reported.   The General Directorate of Saudi Civil Defence said in an earlier tweet that it was working to extinguish the fire.   A video uploaded on Twitter by the Mecca provincial government showed plumes of grey smoke rising from what looked like the inside of the complex.   An AFP correspondent said security forces closed the main road linking Mecca and Jeddah and cordoned off the site.   The blaze erupted at 12:35 pm local time (0935 GMT), according to the Haramain High Speed Rail's Twitter account.

The railway runs 450 kilometres (280 miles) via the Red Sea port of Jeddah, transporting passengers at speeds of up to 300 kilometres per hour.   Saudi King Salman inaugurated the railway in September 2018. Officials described it as the biggest transportation project in the region.   In 2011, the kingdom signed a deal for a Spanish consortium to build the rail track, supply 35 high-speed trains and handle a 12-year maintenance contract.   Saudi is boosting its infrastructure spending and expanding its railways -- including a $22.5 billion metro system under construction in the capital Riyadh -- as it seeks to diversify its oil-dependent economy.
Date: Sat, 28 Sep 2019 19:56:29 +0200 (METDST)

Riyadh, Sept 28, 2019 (AFP) - Saudi Arabia on Saturday said it would impose fines for violations of "public decency", including immodest clothing and public displays of affection, a day after the austere kingdom opened up to foreign tourists.   The interior ministry said it had identified 19 such "offences" but did not specify the penalties, as the ultra-conservative Islamic country begins issuing tourist visas for the first time as part of a push to diversify its oil-reliant economy.   "The new regulations require men and women to dress modestly and to refrain from public displays of affection. Women are free to choose modest clothing," a statement said.   "The regulations are meant to ensure that visitors and tourists in the kingdom are aware of the law relating to public behaviour so that they comply with it."

Saudi Arabia on Friday said citizens from 49 countries are now eligible for online e-visas or visas on arrival, including the United States, Australia and several European nations.   Kickstarting tourism is one of the centrepieces of Crown Prince Mohammed bin Salman's Vision 2030 reform programme to prepare the biggest Arab economy for a post-oil era.   But the conservative country, which forbids alcohol and is notorious for sex segregation, is seen as an unlikely destination for global tourists aside from Muslim pilgrims visiting holy sites in Mecca and Medina.   Men and women must avoid "tight fitting clothing" or clothes with "profane language or images", read an instruction on an English language website launched by the tourism authority.   "Women should cover shoulders and knees in public," it added.

But tourism chief Ahmed al-Khateeb said foreign women were not obligated to wear the body-shrouding abaya robe that is still mandatory public wear for Saudi women.   Prince Mohammed has sought to shake off his country's ultra-conservative image -- lifting a ban on cinemas and women drivers while allowing gender-mixed concerts and sporting extravaganzas.   The relaxed social norms in a kingdom have been welcomed by many Saudis, two-thirds of whom are under 30.   But new public decency guidelines, first approved by cabinet in April, are widely perceived to be vague and have sparked public concern that they would be open to interpretation.   They have also stoked fears of a revival of morality policing.   Saudi Arabia's religious police once elicited widespread fear, chasing men and women out of malls to pray and berating anyone seen mingling with the opposite sex.   But the bearded enforcers of public morality, whose powers have been clipped in recent years, are now largely out of sight.
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Antigua and Barbuda

Antigua and Barbuda - US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
Antigua and Barbuda is a dual island nation known for its beaches, and is a favorite destination for yachtsmen.
Tourist facilities are widely avai
able.
English is the primary language.
Banking facilities and ATMs are available throughout the island.
Read the Department of State Background Notes on Antigua and Barbuda for additional information.

ENTRY/EXIT REQUIREMENTS:
All Americans traveling by air outside the United States are required to present a passport or other valid travel document to enter or re-enter the United States.
This requirement will be extended to sea travel (except closed loop cruises), including ferry service, by the summer of 2009.
Until then, U.S. citizens traveling by sea must have government-issued photo identification and a document showing their U.S. citizenship (for example, a birth certificate or certificate of nationalization), or other WHTI compliant document such as a passport card for entry or re-entry to the U.S.
Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.

Applications for the new U.S. Passport Card are now being accepted.
We expect cards will be available and mailed to applicants in spring 2008.
The card may not be used to travel by air and is available only to U.S. citizens. Further information on the Passport Card is available at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html.
We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

Immigration officials are strict about getting exact information about where visitors are staying, and will often request to see a return ticket or ticket for onward travel, as well as proof of sufficient funds to cover the cost of the visitor’s intended stay.
There is a departure tax payable when departing the country.
For further information on entry requirements, travelers can contact the Embassy of Antigua and Barbuda, 3216 New Mexico Avenue NW, Washington, DC
20016, telephone (202) 362-5122, or consulates in Miami.
Additional information may be found on the home page of the Antigua and Barbuda Department of Tourism at http://www.antigua-barbuda.org.

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:
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:
Petty street crime does occur, and valuables left unattended on beaches, in rental cars or in hotel rooms are vulnerable to theft.
There has been an increase in crime in Antigua, including violent crimes, in the last six months.
However, this increase has not, for the most part, affected visitors to the island.
The Government of Antigua and Barbuda has taken steps to improve the effectiveness of the police in responding to crimes.
As everywhere, visitors to Antigua and Barbuda are advised to be alert and maintain the same level of personal security used when visiting major U.S. cities.

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:
There are many qualified doctors in Antigua and Barbuda, but medical facilities are limited to a public hospital and a private clinic and are not up to U.S. standards.
The principal medical facility on Antigua is Holberton Hospital, on Hospital Road, St. John's (telephone (268) 462-0251).
There is no hyperbaric chamber; divers requiring treatment for decompression illness must be evacuated from the island, to either Saba or Guadeloupe.
Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars.
Doctors and hospitals often expect immediate cash payment for health services, and U.S. medical insurance is not always valid outside the United States.
U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States.

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

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

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

Traffic in Antigua and Barbuda moves on the left.
Major roads are generally in good condition, but drivers may encounter wandering animals and slow moving heavy equipment.
There is relatively little police enforcement of traffic regulations.
Buses and vans are frequently crowded and may travel at excessive speeds.
Automobiles may lack working safety and signaling devices, such as brake lights.

Please refer to our Road Safety page for more information.
For specific information concerning Antigua and Barbuda driving permits, vehicle inspection, road tax, and mandatory insurance, contact the Antigua and Barbuda national tourist organization offices in New York via e-mail at info@antigua-barbuda.org.

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

SPECIAL CIRCUMSTANCES:
Like all Caribbean countries, Antigua can be affected by hurricanes. The hurricane season normally runs from June to the end of November, but there have been hurricanes in December in recent years.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.
Please see 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 Antigua and Barbuda laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Antigua and Barbuda 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 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 Antigua and Barbuda are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov/, and to obtain updated information on travel and security within Antigua and Barbuda.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy in Bridgetown in located in the Wildey Business Park in suburban Wildey, south and east of downtown Bridgetown.
The main number for the Consular Section is (246) 431-0225; after hours, the Embassy duty officer can be reached by calling (246) 436-4950.
The web site for Embassy Bridgetown is http://barbados.usembassy.gov/. Hours of operation are 8:30 a.m. - 4:00 p.m., Monday-Friday, except local and U.S. holidays.

The U.S. Consular Agent, Rebecca Simon, in Antigua provides passport, citizenship and notarial services, and assists Americans in distress.
The Consular Agency is located in Suite #2, Jasmine Court, Friars Hill Rd, St. John’s, Antigua.
Contact information is as follows: telephone 1-268-463-6531, cellular 1-268-726-6531, or e-mail ANUWndrGyal@aol.com. The mailing address is P.O. Box W-1562, St. John’s, Antigua. The Consular Agent is available by appointment only.
The office is closed for local and U.S. Holidays.
*

*

*
This replaces the Country Specific Information for Antigua and Barbuda dated April 2, 2007, to update sections on Entry/Exit Requirements, Safety and Security, Medical Facilities and Health Information, Traffic Safety and Road Conditions, and Crime.

Travel News Headlines WORLD NEWS

Date: Wed, 21 Mar 2018 18:14:27 +0100
By Gemma Handy

St. John's, Antigua and Barbuda, March 21, 2018 (AFP) - Voters in the hurricane-wracked twin island nation of Antigua and Barbuda headed to the polls Wednesday to elect a new government after Prime Minister Gaston Browne called snap elections.   Browne's Antigua Barbuda Labour Party, which has led the eastern Caribbean country since 2014, is widely expected to secure a second consecutive term.   The prime minister announced general elections on February 24, 15 months before a constitutionally mandated deadline, giving opposition parties less than four weeks to prepare.

And there will be no polling stations on Barbuda, which was battered by Hurricane Irma in September.    As a result, the estimated 400 Barbudans who have since returned home will have to travel to Antigua to cast their ballot. The government has promised to pay for related transport, accommodation and meal expenses.   Just over 51,000 Antiguans and Barbudans are eligible to vote. Voter turnout was around 90 percent in 2014.

Browne says the government wants to protect half a billion US dollars worth of developments currently under construction in the tourism-dependent country, and provide investors with stability.    One of the most prominent -- and controversial -- projects is a $250 million mega resort being built by Hollywood star Robert De Niro on Barbuda which was devastated by Hurricane Irma in September.   Lowering the cost of living in the country of 100,000 people is high on the
agenda.

- Ruling party dominates -
Browne, a former businessman and banker, has pledged to reduce electricity bills, along with the cost of land, and provide more affordable housing, under the slogan "Rebuilding Together." His wife Maria is also running for a seat on an ABLP ticket.   On Sunday, thousands of Browne's supporters donned the party's red colours and walked alongside a motorcade in an event that culminated in a public rally.   The "Delivering Hope" campaign of the main opposition group, the United Progressive Party (UPP), cites revitalization of the tourism and agricultural sectors as key priorities.

Fifty-three candidates will vie for seats in the 17 single-member constituencies -- of which the ABLP currently holds 14 -- in a first-past-the-post system.    The ruling party is alone in presenting a full slate of 17 candidates. The UPP, led by former finance minister Harold Lovell, has put forward 16.    A new party, the Democratic National Alliance, headed by current lawmaker and former UPP representative Joanne Massiah has registered 13 candidates.    There is a handful of smaller parties, a single independent runner and one representing the Barbuda People's Movement (BPM) contesting the small island's sole seat.

Polling stations opened at 6:00 am (1000 GMT) and are due to close at 6:00 pm. Alcohol sales are restricted during those hours and all public schools are closed, as many are serving as polling stations.   Teams representing the Caribbean Community (CARICOM) are observing the elections.   On its path through the Caribbean in September, Irma caused "absolute devastation" on Barbuda where up to 30 percent of properties were demolished, and 95 percent damaged, Browne had said at the time.    After a 10-year hiatus, voters returned Browne's Labour Party to power during the last ballot four years ago, when he pledged to economically transform the country.   The country became fully independent from Britain in 1981.
Date: Sun, 25 Feb 2018 08:04:27 +0100

Georgetown, Guyana, Feb 25, 2018 (AFP) - Antigua and Barbuda, a hurricane-ravaged Caribbean tourist destination, will go to the polls next month more than a year earlier than scheduled, the prime minister said on Saturday.   The two-island nation's parliamentary elections were scheduled for June 2019, but will now be held on March 21, Gaston Browne said.   Voters will select the 17 members of Antigua and Barbuda's House of Representatives, its lower house. Members of the Senate are appointed.   "Our primary focus for calling elections early is not about politics but is about your development. God forbid for there to be change in government," Browne said on radio.

After a 10-year hiatus, voters returned Browne's Labour Party to power during the last ballot in 2014, when he pledged to economically transform the country.   On Saturday, Browne said there had been "significant gains" since and that the government wanted to guard against unpredictability in the investment climate.   He cited cheaper housing for ordinary people, better roads, two Marriott-branded hotels, as well as a new airport on the island of Barbuda, which was battered last year by Hurricane Irma.   On its path through the Caribbean in September, Irma caused "absolute devastation" on Barbuda where up to 30 percent of properties were demolished, and 95 percent damaged, Browne had said at the time.    Labour has ruled Antigua and Barbuda almost continuously since 1949. The country became fully independent from Britain in 1981.
Date: Sat, 9 Sep 2017 18:35:21 +0200
By Gemma Handy

Codrington, Antigua and Barbuda, Sept 9, 2017 (AFP) - Homes, shops and government buildings were destroyed when Hurricane Irma slammed the Caribbean island of Barbuda this week, while a huge stretch of its once glorious 11-mile west coast beach has been wiped out.   Destruction was so widespread that authorities have ordered the entire population of 1,800 to evacuate as Hurricane Jose approached the island over the weekend. 

By mid-day Saturday Jose, a Category Four hurricane, was tracking towards the north-west and no longer expected to hit Barbuda, but it remained under a Tropical Storm warning.   Authorities on Barbuda -- one of the two islands that make up the nation of Antigua and Barbuda -- have only begun to measure the damage caused when Irma struck the island as a powerful Category Five hurricane overnight Tuesday to Wednesday.   "Terrifying," "horrific" and the "worst damage seen in a lifetime" were some of the descriptions from residents as they emerged from their shelters after Irma's passage.    A child died when Irma, the strongest storm ever recorded to form in the Atlantic, struck the island.   Authorities said 30 percent of properties were demolished by the monster storm.

- Surviving in a wardrobe -
Barbudans swapped tales of hiding in wardrobes and showers as 157 mile (252 kilometer) per hour wind from Irma ripped off roofs, uprooted trees and knocked down walls.   Sira Berzas, 40, spent more than an hour huddled in a wardrobe with a friend after Irma tore the roof off the home they were hiding in.   "I have never been so scared in my life. Jackie and I were holding on to each other and basically saying our goodbyes," Berzas told AFP.

When the eye of the hurricane came, she said, "we ran outside in our underwear screaming for help. Luckily there was a police truck which took us to a safer building."   In the rush to safety "we had to leave Jackie's kitten behind," said Berzas, who lost her Pink Sand Beach home, bar and restaurant to the disaster.   Thankfully Houdini lived up to his name. The kitten was later found crouched in a corner of the ruined house, trembling but alive.

- Fleeing Hurricane Jose -
Hundreds of Barbudans were transported on Friday to Antigua via a Venezuelan military plane for safety ahead of Hurricane Jose.   Many have family to visit on the sister island, but others had no idea where they would stay when they arrived.   "I don't know where we are going when we get to Antigua -- or how we will get there," said Beautymey John, who was on a dock waiting to board a boat to safety with her five children.   "I would rather stay here, it doesn't feel right to leave. We have to try and start again," she told AFP.

Other Barbudans also said they were determined to rebuild their homes and livelihoods.   Teacher Maurice George, 30, said the small bag he was taking to Antigua contained the bare essentials, but vowed to return as soon as the secondary school he works in reopens.   "It is heart-breaking to see our island looking like this," he said.   "But where some people see devastation, I see an opportunity to rebuild," he added.
Date: Sat, 19 Mar 2016 13:18:00 +0100

Washington, March 19, 2016 (AFP) - A 6.0-magnitude earthquake hit off the coast of the Caribbean island nation of Antigua and Barbuda Saturday, US experts said, but caused no tsunami warning or immediate reports of damage or injury.   The strong quake, which hit at 1126 GMT, struck at a depth of 24 kilometres (15 miles) with its epicentre located 153 kilometres northeast of the capital of Saint John's, according to the US Geological Survey.
Date: Mon 14 Dec 2015
Source: Antigua Observer [edited]

Prison sources are still complaining that, despite the alleged outbreak of chicken pox at Her Majesty's Prison (HMP), not much has been done to ensure that the virus does not affect more people who either work there or are in custody. A source said since Observer media reported on the incident, last Thu 10 Dec 2015 that there has been another suspected case, bringing the number of affected persons to 19.

The source explained that this occurred even while the other 18 infected persons were already in isolation in the chapel in the prison yard. That source is suggesting that health authorities should to go into the jail to "clean it and spray out the cells" because the virus, according to research, can be picked up from contaminated surfaces.

An official at HMP, who is not authorized to speak with the media, said although the affected inmates are being housed in the chapel away from the rest of the prison population, they are still able to come and go to other parts of the jail, including the washroom and for breaks. Another source indicated that most of the affected persons are on remand and it is highly likely they will be released at any time, and then the virus would likely spread to communities outside the prison walls.

Observer media was unable to reach the prison boss, Superintendent Albert Wade, for comment.

In the meantime, Attorney General Steadroy "Cutie" Benjamin, who has responsibility for the prison, has given assurance that prison authorities have taken adequate steps to control the spread of chickenpox.
======================
[Outbreaks of chickenpox are not uncommon in closed communities where contagious virus can spread rapidly. Chickenpox is a very contagious disease caused by varicella-zoster virus (VZV), a herpes virus. It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. It spreads easily from infected people to others who have never had chickenpox or received the chickenpox vaccine. Chickenpox spreads in the air through coughing or sneezing. It can also be spread by touching or breathing in the virus particles that come from chickenpox blisters and can be transmitted by touching surfaces that have recently be contaminated by open lesions as well. Chickenpox most commonly causes an illness that lasts about 7-10 days.

The classic symptom of chickenpox is a rash that turns into itchy, fluid-filled blisters that eventually turn into scabs. The rash may 1st show up on the face, chest, and back, then spread to the rest of the body, including inside the mouth, eyelids, or genital area. It usually takes about a week for all the blisters to become scabs. Some people who have been vaccinated against chickenpox can still get the disease. However, the symptoms are usually milder with fewer blisters and mild or no fever. About 25 to 30 percent of vaccinated people who get chickenpox will develop illness as serious as chickenpox in unvaccinated persons.

Chickenpox vaccine is safe and effective at preventing the disease. Most people who get the vaccine will not get chickenpox. If a vaccinated person does get chickenpox, it is usually mild -- with fewer blisters and mild or no fever. The chickenpox vaccine prevents almost all cases of severe disease (for further information, see: <http://www.cdc.gov/chickenpox/index.html>). - ProMed Mod.LL]

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

Mongolia US Consular Information Sheet
November 21, 2008
COUNTRY DESCRIPTION:
Mongolia is a vast country of mountains, lakes, deserts and grasslands approximately the size of Alaska.
It peacefully abandoned its communist system in 199
and has been successfully making the transition to a parliamentary democracy.
Economic reforms continue, although the country’s development will depend on considerable infrastructure investment, particularly in the mining, energy, transportation, and communication sectors.
Travelers to Mongolia should be aware that shortcomings in these areas might have an impact on travel plans.
Read the Department of State Background Notes on Mongolia for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid passport is required for American visitors.
No visa is required for Americans visiting for fewer than 90 days; however, visitors planning to stay in Mongolia for more than 30 days are required to register with the Office of Immigration, Naturalization and Foreign Citizens in Ulaanbaatar within the first seven days of arrival.
American visitors who fail to register and who stay longer than 30 days, even for reasons beyond their control, will be stopped at departure, temporarily denied exit, and fined.
It is recommended that visitors who will be in Mongolia beyond 30 days register with the Office of
Immigration, Naturalization and Foreign Citizens within the first seven days of their arrival.

Americans planning to work or study in Mongolia should apply for a visa at a Mongolian embassy or consulate outside of Mongolia.
Failure to do so may result in authorities denying registration, levying a fine, and requiring that the visitor leave the country.
Travelers arriving or departing Mongolia through China or Russia should be aware of Chinese and Russian visa regulations (transiting twice will require a double- or multiple-entry visa) and note that some land-entry points have varying days and hours of operation. Many small land border posts do not operate on a fixed schedule.
Travelers need to check with immigration authorities to make certain the post they intend to use will be open when they want to enter. Travelers planning travel to Russia should get visas prior to arriving in Mongolia, because they are difficult to obtain at the Russian Embassy in Mongolia. For more information on these requirements, see the Country Specific Information for Russia and China.

Travelers without Mongolian visas are subject to an exit tax payable either in U.S. dollars or Mongolian Tugrugs upon departure.
American citizen visitors to Mongolia do not require a visa if they stay less than 30 days and no fee is payable if they depart within the 30 day period.
If they stay longer without having registered with immigration, a penalty fee will be assessed at time of departure.
Travelers should inquire whether the exit tax is included with the price of the airline ticket at the time of purchase. In an effort to prevent international child abduction, many governments have initiated procedures at entry/exit points.
These often include requiring documentary evidence of relationship and permission for the child’s travel from the parent(s) or legal guardian if not present.
Having such documentation on hand, even if not required, may facilitate entry/departure.

Visit the Embassy of Mongolia web site at http://www.mongolianembassy.us for the most current visa information.
Travelers can also contact the Embassy of Mongolia at 2833 M Street NW, Washington, DC
20007, telephone (202) 333-7117 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:
There have been no significant acts of terrorism or extremism in Mongolia. There are no regions of instability in the country.
U.S. citizens are advised to avoid all protests, including political protests, and street demonstrations that occur occasionally in Ulaanbaatar, as the demonstrations may become violent.

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

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

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

CRIME:
Over the past few years there has been a significant rise in street crime in Mongolia, particularly in Ulaanbaatar, the capital.
Violent crime, particularly aggravated assault, is increasing, and it is not advisable to walk alone through the city after dark.
The most common crimes against foreigners are pick pocketing and bag snatching.
There are reports of organized groups operating in open areas, usually after dark, who surround, grab, and choke an individual in order to search the victim’s pockets.
Thieves have also sliced victims’ clothing in attempts to reach wallets, cell phones and other valuables.
U.S. citizens who detect pick pocket attempts should not confront the thieves, as they may become violent.
Caution is advised when using public transportation and in crowded public areas, such as open-air markets, the Central Post Office and the Gandan Monastery.
Crime rises sharply before, during and after the Naadam Summer Festival in July and throughout the summer tourist season, as well as during and after Tsagaan Sar, the Winter Festival, in January or February.

Travelers should be extremely cautious at these specific locations:
Chinggis Khan International Airport in Ulaanbaatar: tourists arriving at and departing from this airport are frequently targeted for robbery and pick pocketing by organized groups.
The State Department Store:
tourists are targeted by organized pick pocket gangs at the entries/exits/elevators and the area surrounding the store.
Naran Tuul Covered Market:
Organized criminal groups look for and target foreigners for robbery and pick pocketing.
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.
American victims of crime in Mongolia should be prepared to hire their own translators and lawyers if they intend to pursue a criminal complaint against a Mongolian.

The local equivalent to the “911” emergency line in Mongolia are 102 to contact the police department and 103 for a medical emergency.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Mongolia are very limited and do not meet most Western standards, especially for emergency health care requirements.
Many brand-name Western medicines are unavailable.
Ulaanbaatar, the capital, has the majority of medical facilities inside the country; outside of Ulaanbaatar, medical facilities and treatment are extremely limited or non-existent.
Specialized emergency care for infants and the elderly is not available.
Infectious diseases, such as plague, meningococcal meningitis, and tuberculosis, are present at various times of the year. Sanitation in some restaurants is inadequate, particularly outside of Ulaanbaatar.
Stomach illnesses are frequent.
Bottled water and other routine precautions are advisable.

Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost tens of thousands of dollars.
A June 2005 medical evacuation from Ulaanbaatar to Seoul, Korea, cost the patient $87,000.
Doctors and hospitals usually expect immediate payment in cash for health services.
Medical evacuation companies will not initiate an evacuation without a fee guarantee beforehand and in full.
Please see Medical Information for Americans traveling abroad.

Local hospitals generally do not contact the Embassy about ill or injured Americans in their care; hospitalized American citizens who need Consular assistance from the Embassy should ask the doctor or hospital to contact the U.S. Embassy in Ulaanbaatar.
For more information, please contact the U.S. Embassy in Ulaanbaatar, which has a list of medical facilities available to foreigners (also available on the U.S. Embassy web site at http://mongolia.usembassy.gov/) or the Centers for Disease Control and Prevention’s international traveler’s hotline (see below).
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Mongolia.

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

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

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

Driving in Ulaanbaatar can be extremely difficult due to poorly maintained streets, malfunctioning traffic lights, inadequate street lighting, a shortage of traffic signs, and undisciplined pedestrians.
There has been a dramatic increase in the number of vehicles on the roads in recent years, but the knowledge and skills of the driving population have not kept pace with the growth in the number of automobiles on the streets. There are many metered taxis in Ulaanbaatar.
There are a few car rental companies, but safety and maintenance standards are uncertain, and rental vehicles should be utilized with caution.
Cars with drivers can be obtained from local tourist companies.
Public transportation within the capital is extensive, cheap, and generally reliable, but it is also extremely crowded (see Information on Crime above), with the result that pickpockets often victimize foreigners.
For specific information concerning Mongolian drivers permits, vehicle inspection, road tax, and mandatory insurance, contact the Embassy of Mongolia at: 2833 M Street NW, Washington, DC
20007, telephone (202) 333-7117.

Please refer to our Road Safety page for more information.
Visit the web site of Mongolia’s national tourist office and national authority responsible for road safety at http://www.mongolianembassy.us/default.php.

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

The U.S. Embassy prohibits U.S. government personnel from using the domestic services of Mongolian International Air Transport (MIAT) for official travel because of uncertainties regarding service and maintenance schedules, aircraft certification and insurance status.
This prohibition does not extend to MIAT’s international flights or to the domestic flights of other carriers.
SPECIAL CIRCUMSTANCES:
Traveler’s checks in U.S. dollars are accepted at some hotels and may be converted to dollars or Tugrugs at several banks.
Credit cards can be used at a variety of hotels, restaurants, and shops in Ulaanbaatar.
Outside of the capital, travelers should have cash.
Cash advances against credit cards are available at some commercial banks such as Trade and Development Bank, Golomt Bank, Khan Bank, and Xac Bank.
International bank wire transfers are also possible.
There are a handful of VISA and Maestro/Cirrus ATM machines in Ulaanbaatar, but they do not always function and are not reliable.
ATM machines do not exist outside the capital.

U.S. consular offiers may not always receive timely notification of the detention or arrest of a U.S. citizen, particularly outside of Ulaanbaatar.
American citizens are encouraged to carry a copy of their passport with them at all times, so that, if questioned by local officials, evidence of identity and citizenship are readily available.
Severe fuel shortages and problems with central heating and electrical systems may cause seriously reduced heating levels and power outages in Ulaanbaatar and other cities during the winter.
Smaller towns in the countryside may have no heat or electricity at all.
The Embassy advises all American residents in Mongolia to be prepared to depart if there is a complete energy failure.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.

Mongolian customs authorities enforce strict regulations concerning import and export of items such as firearms, ammunition, and antiquities.
Import of firearms or ammunition requires prior approval from the Government of Mongolia.
Export of antiquities requires a special customs clearance certificate issued by authorized antique shops at the time of purchase. For additional information contact the Embassy of Mongolia at: 2833 M Street NW, Washington, DC
20007, telephone: (202) 333-7117.
Please see our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than those in the United States for similar offenses.
Persons violating Mongolia’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in Mongolia 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 Mongolia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Mongolia.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at: at Micro Region 11, Big Ring Road, Ulaanbaatar.
The telephone number is (976) 11-329-095, the Consular Section fax number is (976) 11-353-788, and the Embassy’s web site is http://mongolia.usembassy.gov/.
The Consular Section can be emailed directly at cons@usembassy.mn.
The Consular Section is open for American Citizens Services Monday and Thursday from 1-3 p.m., except on U.S. and Mongolian holidays.
*

*

*
This replaces the Country Specific Information for Mongolia dated September 22, 2008 to update the sections on Safety and Security, and Aviation Safety Oversight.

Travel News Headlines WORLD NEWS

Date: Mon, 6 May 2019 17:00:57 +0200

Ulaanbaatar, May 6, 2019 (AFP) - A Mongolian couple has died of the bubonic plague after eating raw marmot kidney, triggering a quarantine that left tourists stranded in a remote region for days, officials said Monday.

The ethnic Kazakh couple died on May 1 in Mongolia's westernmost province of Bayan-Ulgii, which borders Russia and China.   "The two dead were local people," said local governor Aipiin Gilimkhaan. "There were no cases reported after them."   A six-day quarantine was declared on residents in the region, preventing nine tourists from Russia, Germany and Switzerland from leaving.   "We are all fine. No one is ill," said a German tourist named Teresa, who did not want to give her last name.

Sebastian Pique, a 24-year-old American Peace Corps volunteer who has lived in the region for two years, said he and the tourists were invited to the governor's office on Friday to be informed about the situation.    "After the quarantine (was announced) not many people, even locals, were in the streets for fear of catching the disease," Pique told AFP.   The quarantine was expected to be lifted late Monday after no other cases of the plague were reported.   Authorities have warned people against eating raw marmot meat because it can carry Yersinia pestis, the plague germ.

At least one person dies of the plague every year in Mongolia, mostly due to consuming such meat, according to the National Center for Zoonotic Disease.   Some people ignore the warnings as they believe that consuming the innards of the large rodent is good for their health.   The Black Death wiped out millions of people in the Middle Ages but cases are now very rare.    Its most common form is bubonic, which is spread by fleas and causes swelling of the lymph node. The more virulent form is pneumonic plague, which can be transmitted between humans through coughing.
Date: Fri 3 May 2019
Source: Mirror [edited]

A married couple has died, leaving their 4 children orphaned after an outbreak of the bubonic plague, which sparked plane panic.

The man, 38, named only as Citizen T, and his pregnant wife, 37, are thought to have fallen ill after hunting and eating contaminated marmot, a large species of squirrel, in Mongolia. The man died on 27 Apr [2019], and the woman died 3 days later, reports the Siberian Times.

The highly contagious bacterial disease is spread by fleas living on wild rodents. It has sparked fears of an outbreak, and urgent measures and precautions have been put in place to stop the infection spreading. Around 158 people have been put under intensive medical supervision after coming into contact directly or indirectly with the couple.

There were dramatic scenes when a flight from Bayan, Ulgii and Khovd in Mongolia -- the area where the couple fell ill -- was met by workers in white anti-contamination suits as [the plane] landed in the country's capital of Ulaanbaatar. Eleven passengers from the west of the country were held at the airport and sent immediately for hospital checks. Others were examined in a special facility at the airport. Paramedics in anti-contamination boarded the flight as soon as it landed.

Some frontier checkpoints with Russia are reported to have been closed, leading to foreign tourists being stranded in Mongolia.

Dr N. Tsogbadrakh, director of National Centre for Zoonotic Dermatology and Medicine, said, "Despite the fact that eating marmots is banned, Citizen T hunted marmot. He ate the meat and gave it to his wife, and they died because the plague affected his stomach. Four children are orphaned."

Bubonic plague is believed to be the cause of the Black Death that spread through Asia, Europe, and Africa in the 14th century, killing an estimated 50 million people.

The plague is a bacterial disease that is spread by fleas living on wild rodents such as marmots. The disease can kill an adult in less than 24 hours if not treated in time, according to the World Health Organisation.  [Byline: Will Stewart and Amber Hicks]
========================
[HealthMap/ProMED-mail map:
Bayan-Olgiy Aymag, Bayan-Olgiy, Mongolia:
Date: Fri, 15 Mar 2019 02:55:29 +0100
By Khaliun Bayartsogt

Bornuur, Mongolia, March 15, 2019 (AFP) - In the world's coldest capital, many burn coal and plastic just to survive temperatures as low as minus 40 degrees -- but warmth comes at a price: deadly pollution makes Ulaanbataar's air too toxic for children to breathe, leaving parents little choice but to evacuate them to the countryside.   This exodus is a stark warning of the future for urban areas in much of Asia, where scenes of citizens in anti-pollution masks against a backdrop of brown skies are becoming routine, rather than apocalyptic.   Ulaanbaatar is one of the most polluted cities on the planet, alongside New Delhi, Dhaka, Kabul, and Beijing. It regularly exceeds World Health Organisation recommendations for air quality even as experts warn of disastrous consequences, particularly for children, including stunted development, chronic illness, and in some cases death.

Erdene-Bat Naranchimeg watched helplessly as her daughter Amina battled illness virtually from birth, her immune system handicapped by the smog-choked air in Mongolia's capital.   "We would constantly be in and out of the hospital," Naranchimeg told AFP, adding that Amina contracted pneumonia twice at the age of two, requiring several rounds of antibiotics.   This is not a unique case in a city where winter temperatures plunge towards uninhabitable, particularly in the districts that rural workers moved to in search of a better life.   Here row upon row of the traditional tents -- known as gers -- are warmed by coal, or any other flammable material available. The resulting thick black smoke shoots out in plumes, blanketing surrounding areas in a film of smog that makes visibility so poor it can be hard to see even a few metres ahead.   Hospitals are packed and young children are vulnerable, common colds can quickly escalate into life-threatening illness.

- Birth defects -
The situation was so bad that doctors told Naranchimeg the only solution was to send her little girl to the clean air of the countryside.   Now aged five, Amina is thriving. She lives with her grandparents in Bornuur Sum, a village 135 kilometres away from the capital.   "She hasn't been sick since she started living here," said Naranchimeg, who makes the three-hour round trip to see Amina every week.   "It was very difficult in the first few months," she said. "We used to cry when we talked on the phone."   But like many parents in Ulaanbaatar, she felt the move was the only way to protect her child.

The levels of PM2.5 -- tiny and harmful particles -- in Ulaanbaatar reached 3,320 in January, 133 times what the World Health Organisation (WHO) considers safe.   The effects are terrible for adults but children are even more at risk, in part because they breathe faster, taking in more air and pollutants.   As they are smaller, children are also closer to the ground, where some pollutants concentrate, and their still-developing lungs, brains, and other key organs are more vulnerable to damage.   Effects to prolonged exposure range from persistent infections and asthma to slowed lung and brain development.   The risks apply in utero, too, because gases and fine particles can enter a mother's bloodstream and placenta, causing miscarriage, birth defects and low birth weights, which can also affect a child for the rest of their lives.   Researchers are now investigating whether pollution, like exposure to tobacco smoke, has health effects that could even be passed down to the next generation.

- 'Terribly afraid' -
Buyan-Ulzii Badamkhand and her husband need to stay in capital for work, but they have decided to send their two-year-old son Temuulen more than 1,000 kilometres away.   The 35-year-old mother-of-three struggled with the decision, even moving from one ger district to another in the hope her son's health would improve.   But successive bouts of illness, including bronchitis that lasted a whole year, finally convinced her to send Temuulen to his grandparents.   Hours after he arrived, she called her mother-in-law to discuss her son's medicines.   "But my mother-in-law asked me 'does he still need medicine? He isn't coughing anymore," she said.   "I tell myself that it doesn't matter that I miss him and who raises him, as long as he is healthy, I am content."   Respiratory problems are the most obvious effect of air pollution, but research suggests dirty air can also put children at greater risk for diabetes and cardiovascular disease later in life.   And the WHO links it to leukaemia and behavioural disorders.   When air pollution peaks in winter, Ulaanbaatar's playgrounds empty and those who are able to are increasingly travelling abroad to wait out the smog.

In desperation, Luvsangombo Chinchuluun, a civil society activist, borrowed money to take her granddaughter to Thailand for all of January.   "We can't let her play outside (in Ulaanbaatar) because of the air pollution, so we decided to leave," she said.   The persistent smog has caused tensions in the city, with those living in wealthier areas blaming the ger residents for the pollution and even calling for the tent districts to be cleared.   But the ger residents say coal is all they can afford.   "People come to the capital because they need sustainable income," said Dorjdagva Adiyasuren, a 54-year-old mother of six.   "It's not their fault," she added.    In a bid to tackle the problem, the local government banned domestic migration in 2017, and a ban on burning coal comes into force from May.   But it is unclear whether the moves will be enough to make a difference.   For Naranchimeg, the problems are serious enough to make her consider whether she wants more children.    She explained: "Now, I am terribly afraid of to give birth again. It is risky to carry a child and what will happen to the child after it is born in this amount of pollution?"
Date: Tue 19 Feb 2019
Source: AFP [edited]

Mongolian authorities have temporarily closed all KFC restaurants in the country after more than 200 customers suffered food poisoning symptoms, and dozens were hospitalized.

The 1st cases emerged earlier this month [February 2019], with 16 people showing symptoms of food poisoning, including diarrhoea, vomiting and high fever after eating at the fried chicken franchise. Ulaanbaatar's Metropolitan Professional Inspection Department said 247 similar cases have been reported, and 42 people have been hospitalized.

The department decided to shut down the country's 11 KFC restaurants, all based in the capital, while it investigates what happened.

A preliminary investigation found that 35 employees at a restaurant were not thoroughly vetted to handle food, with most of them having blank medical examination reports, which is illegal. The restaurant also lacked internal hygiene management.

A bacterium known as _Klebsiella_ spp was detected in water at the restaurant. Traces of _E. coli_ were also found in a soda machine, and 4 people contracted _Shigella, -- which causes diarrhoea and fever -- after coming into contact with KFC staff.
=========================
[The aetiology is not directly stated, but if contacts of the cluster have been diagnosed with shigellosis, the primary illness may well be the same.

Ulaanbaatar, formerly anglicized as Ulan Bator (literally "Red Hero"), is the capital and largest city of Mongolia. The city is not part of any aimag (province) (<https://en.wikipedia.org/wiki/Ulaanbaatar>). - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Ulan Bator, Ulaanbaatar, Mongolia:
Date: Tue, 19 Feb 2019 11:40:36 +0100

Ulaanbaatar, Feb 19, 2019 (AFP) - Mongolian authorities have temporarily closed all KFC restaurants in the country after more than 200 customers suffered food poisoning symptoms and dozens were hospitalised.   The first cases emerged earlier this month, with 16 people showing symptoms of food poisoning, including diarrhoea, vomiting and high fever after eating at the fried chicken franchise.   Ulaanbaatar's Metropolitan Professional Inspection Department said 247 similar cases have been reported and 42 people have been hospitalised.   The department decided to shut down the country's 11 KFC restaurants -- all based in the capital -- while it investigates what happened.

A preliminary investigation found that 35 employees at a restaurant were not thoroughly vetted to handle food, with most of them having blank medical examination reports, which is illegal. The restaurant also lacked internal hygiene management.   A strong bacteria known as Klebsiella spp was detected in water at the restaurant. Traces of E-coli were also found in a soda machine, and four people contracted the Shigella germ -- which causes diarrhoea and fever -- after coming into contact with KFC staff.
More ...

World Travel News Headlines

Date: Wed, 22 Jan 2020 17:37:27 +0100 (MET)
By Helen ROXBURGH

Beijing, Jan 22, 2020 (AFP) - A new SARS-like virus has killed 17 people in China, infected hundreds and reached as far as the United States, with fears mounting about its spread as hundreds of millions travel for Lunar New Year celebrations, which start Friday.   Many countries have stepped up screening of passengers from Wuhan, the Chinese city identified as the epicentre, and the World Health Organization has called an emergency meeting.   Here's what we know so far about the virus:

- It's entirely new -
The pathogen appears to be a never-before-seen strain of coronavirus -- a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS), which killed 349 people in mainland China and another 299 in Hong Kong between 2002 and 2003.   Arnaud Fontanet, head of the department of epidemiology at the Institut Pasteur in Paris, told AFP the current virus strain was 80 percent genetically identical to SARS.   China has already shared the genome sequencing of this novel coronavirus with the international scientific community.   It has been named "2019-nCoV".

- It's being passed between humans -
The WHO said Monday it believed an animal source was the "primary source" of the outbreak, and Wuhan authorities identified a seafood market as the centre of the epidemic.   But China has since confirmed that there was evidence the virus is now passing from person to person, without any contact with the now-closed market.

The virus has infected more than 400 people across the country, with most cases in Wuhan, according to officials. Li Bin of China's National Health Commission on Wednesday said 1,394 people were still under medical observation.   Doctor Nathalie MacDermott of King's College London said it seems likely that the virus is spread through droplets in the air from sneezing or coughing.   Doctors at the University of Hong Kong published an initial paper on Tuesday modelling the spread of the virus which estimated that there have been some 1,343 cases in Wuhan -- similar to a projection of 1,700 last week by scientists at Imperial College, London.   Both are much higher than official figures.

- It is milder than SARS -
Compared with SARS, the symptoms appear to be less aggressive, and experts say the death toll is still relatively low.   "It's difficult to compare this disease with SARS," said Zhong Nanshan, a renowned scientist at China's National Health Commission at a press conference this week. "It's mild. The condition of the lung is not like SARS."   However, the milder nature of the virus can also cause alarm.

The outbreak comes as China prepares for the Lunar New Year Holiday, with hundreds of millions travelling across the country to see family.   Professor Antoine Flahault, director of the Institute of Global Health at the University of Geneva, told AFP that the fact that the virus seems milder in the majority of people is "paradoxically more worrying" as it allows people to travel further before their symptoms are detected.   "Wuhan is a major hub and with travel being a huge part of the fast approaching Chinese New Year, the concern level must remain high," said Jeremy Farrar, Director of the Wellcome Trust.

- International public health emergency? -
The WHO will hold a meeting on Wednesday to determine whether the outbreak constitutes a "public health emergency of international concern" and if so, what should be done to manage it.   Cases have so far been confirmed in Thailand, Japan, Taiwan, South Korea, Macau and the United States.

The WHO has only used the rare label a handful of times, including during the H1N1 -- or swine flu -- pandemic of 2009 and the Ebola epidemic that devastated parts of West Africa from 2014 to 2016.   The Chinese government announced Tuesday it was classifying the outbreak in the same category as the SARS outbreak, meaning compulsory isolation for those diagnosed with the disease and the potential to implement quarantine measures on travel.   But if the WHO decides to take this step, it would put the Wuhan virus in the same category as a handful of very serious epidemics.

- Global precautions -
As the number of confirmed deaths and infections has risen, so has concern worldwide about the disease spreading to other countries.   In Thailand, authorities have introduced mandatory thermal scans of passengers arriving at airports in Bangkok, Chiang Mai, Phuket and Krabi from high-risk areas in China.

In Hong Kong, where hundreds died during the SARS outbreak of 2002-2003, authorities have said they are on high alert, carrying out scans at the city's airport -- one of the world's busiest -- and at other international land and sea crossing points.

The United States also ordered the screening of passengers arriving on direct or connecting flights from Wuhan, including at airports in New York, San Francisco and Los Angeles.   Taiwan has issued travel advisories, and went to its second-highest alert level for those travelling to or from Wuhan. Vietnam has also ordered more border checks on its border with China.
Date: Wed, 22 Jan 2020 16:53:32 +0100 (MET)
By Beiyi SEOW

Beijing, Jan 22, 2020 (AFP) - The death toll from a new SARS-like virus that has infected hundreds in China rose to 17 on Wednesday, as authorities urged people to steer clear of the city at the centre of the outbreak.   The coronavirus has caused alarm because of its similarity to SARS (Severe Acute Respiratory Syndrome), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.   With hundreds of millions of people travelling across China this week for the Lunar New Year holiday, the National Health Commission announced measures to contain the disease -- including sterilisation and ventilation at airports and bus stations, as well as inside planes and trains.

In Wuhan, the epicentre of the epidemic, large public events were cancelled and international football matches were moved to a new location. Visitors were urged to stay away, while residents were advised to not to leave the central city, which is home to 11 million people.   "If it's not necessary we suggest that people don't come to Wuhan," Wuhan Mayor Zhou Xianwang told state broadcaster CCTV.    The illness is mainly transmitted via the respiratory tract and there "is the possibility of viral mutation and further spread of the disease", health commission vice minister Li Bin told a news conference in Beijing.   More than 500 cases have now been reported, with the majority in Wuhan, capital of Hubei province.

The virus has now infected at least 444 people in Hubei province alone, said provincial officials at a press conference, adding that the death toll had risen from nine to 17.   Major cities, including Beijing, Shanghai, and Chongqing have also reported cases, as well as provinces in northeastern, central, and southern China.   The World Health Organization started an emergency meeting Wednesday to decide whether or not to declare a rare global public health emergency over the disease, which has now been detected in the United States, Taiwan, Thailand, Japan, South Korea and Macau.

The Chinese government has classified the outbreak in the same category as the SARS epidemic, meaning compulsory isolation for those diagnosed with the illness and the potential to implement quarantine measures.   But they still have not been able to confirm the exact source of the virus.   "We will step up research efforts to identify the source and transmission of the disease," Li said, adding that "the cases are mostly linked to Wuhan".   Countries have intensified efforts to stop the spread of the pathogen -- known by its technical name 2019 Novel Coronavirus (2019-nCoV).   Passengers are facing screening measures at five US airports and a host of transport hubs across Asia. Britain and Italy on Wednesday also announced enhanced monitoring of passengers from Wuhan.

- Virus source -
A prominent expert from China's National Health Commission confirmed this week that the virus can be passed between people.   However, animals are suspected to be the primary source of the outbreak.   A Wuhan market is believed to be the epicentre of the outbreak.

A price list circulating online in China for a business there lists a menagerie of animals or animal-based products including live foxes, crocodiles, wolf puppies and rats. It also offered civets, the animal linked to SARS.   "We already know that the disease originated from a market which conducted illegal transaction of wild animals," said Gao Fu, director of the Chinese centre for disease control and prevention.   He said it was clear "this virus is adapting and mutating".   Hong Kong and British scientists have estimated that between 1,300 and 1,700 people in Wuhan may have been infected.

- Containment -
Health authorities are urging people to wash their hands regularly, avoid crowded places, get plenty of fresh air and wear a mask if they have a cough.   Anyone with a cough or fever was urged to go to hospital.   In Wuhan, city authorities made it mandatory to wear a mask in public places on Wednesday, according to state-run People's Daily.

In response to skyrocketing demand for masks -- which were starting to sell out at pharmacies and on some popular websites -- China's industry and information technology ministry said it would "spare no effort in increasing supply", state media reported.   "These days, I wear masks even in places that are not too crowded, although I wouldn't have done so in the past," said Wang Suping, 50, who works at a Beijing arts school.   At the capital's main international airport, the majority of people were wearing masks.

Hong Kong flag carrier Cathay Pacific said it had agreed to allow staff to wear surgical masks on mainland China flights, and that passengers from Wuhan would be offered masks and antiseptic wipes.   In Wuhan, police were conducting vehicle spot checks for live poultry or wild animals leaving and entering the city, state media said.   Officials also screened people on roads, the airport and the train station for fever.   The local government has cancelled major public activities and banned tour groups from heading out of the city.   Women's Olympics football qualifiers scheduled for February 3-9 in Wuhan have been moved to the eastern city of Nanjing.
Date: Wed, 22 Jan 2020 15:49:25 +0100 (MET)

Montreal, Jan 22, 2020 (AFP) - A Canadian guide died and five French tourists were missing after at least one snowmobile plunged through ice in northern Quebec, police said Tuesday.   The group were riding close to where a river exits the Saint-Jean lake, and were outside the approved area for snowmobiles, police spokesman Hugues Beaulieu told AFP.   Nine people, including the guide, were on the trip on Tuesday evening when the ice broke underneath them.   Police said they were alerted by two of the tourists who had rescued a third tourist from the freezing water.

The 42-year-old guide was pulled out by emergency response teams and taken to hospital, but he died overnight, Beaulieu said, adding "five French tourists are still missing."   The police and army were searching the area on Wednesday, assisted by divers.   "This sector was not part of a marked trail, they were off-piste," said the spokesman.
Date: Wed, 22 Jan 2020 04:55:57 +0100 (MET)

Hong Kong, Jan 22, 2020 (AFP) - Macau on Wednesday reported its first confirmed case of the new SARS-like coronavirus as authorities announced all staff in the city's bustling casinos had been ordered to wear face masks.   The former Portuguese colony is a huge draw for mainland tourists as the only place in China that allows gambling.

With the Lunar New Year approaching this weekend, a huge influx of mainland tourists is expected in the city.   Asian countries have ramped up measures to block the spread of the new virus, which emerged in the Chinese city of Wuhan and has so far killed at least nine people.

On Wednesday, Macau announced its first confirmed case -- a 52-year-old businesswoman from Wuhan who arrived in the city by high-speed rail on Sunday, via the neighbouring city of Zhuhai.    "A series of tests found that she was positive for the coronavirus and had symptoms of pneumonia," Lei Chin-lon, the head of Macau's health bureau, told reporters.    The woman had been staying at the New Orient Landmark Hotel with two friends who were being monitored since her admission to hospital on Tuesday.

Ao Ieong Iu, Macau's Secretary for Social Affairs and Culture, said staff in all casinos would be required to wear masks while anyone arriving at entry ports along the city's border with the mainland would need to fill out health declaration forms.    "We have not banned tourism groups from Wuhan but we are not encouraging them," Ao Ieong said.    "We will stay in close contact with tourism agencies and require them to notify us of all groups going to and coming from Wuhan," she added.
Date: Tue, 21 Jan 2020 22:23:22 +0100 (MET)
By Issam Ahmed with Helen Roxburgh

Washington/Beijing, Jan 21, 2020 (AFP) - The United States on Tuesday announced its first case of a new virus that has claimed six lives in China and sickened hundreds, joining countries around the world in ramping up measures to block its spread.   The man, a US resident in his 30s who lives near Seattle, is in good condition, according to federal and state officials, and approached authorities himself after reading about the SARS-like virus in news reports.   He is "currently hospitalized out of an abundance of precaution, and for short term monitoring, not because there was severe illness," said Chris Spitters, a Washington state health official.  "This is an evolving situation and again, we do expect additional patients in the United States and globally," added Nancy Messonier, a senior official at the Centers for Disease Control and Prevention (CDC), but stressed that the overall risk to Americans remained low.

The man entered the country on January 15 after traveling to Wuhan, two days before the US began deploying health officials at major airports to screen passengers arriving from that central Chinese city which is at the heart of the outbreak. The efforts are to be extended now to a total of five US airports.   It came as countries ramped up measures to block the spread of the virus -- known by its technical name 2019 Novel Coronavirus or 2019-nCoV -- as the number of cases surpassed 300, raising concerns in the middle of a major Chinese holiday travel rush.

Fears of a bigger outbreak rose after a prominent expert from China's National Health Commission confirmed late Monday that the virus can be passed between people.   That conclusion is shared by the CDC, which said "person-to-person spread is occurring, although it's unclear how easily the virus spreads between people," even as the World Health Organization (WHO) adopted a more cautious approach, saying it is still investigating.   The UN agency will hold an emergency meeting Wednesday to determine whether to declare a rare global public health emergency over the disease, which has also been detected in Thailand, Japan and South Korea and Taiwan.

- Holiday rush -
Authorities previously said there was no obvious evidence of person-to-person transmission and animals were suspected to be the source, as a seafood market where live animals were sold in Wuhan was identified as the center of the outbreak.   Hundreds of millions of people are criss-crossing China this week in packed buses, trains and planes to celebrate the Lunar New Year with relatives.

More than 80 new cases have been confirmed, bringing the total number of people hit by the virus in China to 315, with the vast majority in Hubei, the province where Wuhan lies, according to officials.   But cases have also been confirmed around the country, including Beijing and Shanghai.   The first case on the self-ruled island of Taiwan was also confirmed Tuesday, with a woman taken to hospital on arrival at the airport from Wuhan.   Wuhan mayor Zhou Xianwang told state broadcaster CCTV Tuesday that the death toll had risen from four to six.   The coronavirus has caused alarm because of its genetic similarities to Severe Acute Respiratory Syndrome (SARS), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.

- Fever checks -
At four airports in Thailand, authorities introduced mandatory thermal scans of passengers arriving from high-risk areas of China.   In Hong Kong, authorities said they were on "extreme high alert," with passengers from Wuhan required to fill out health declarations and face possible jail time if they do not declare symptoms.   Enhanced screening measures have also been set up at airports in Australia, Bangladesh, Nepal, Singapore and Russia, Malaysia and Vietnam.   A man showing symptoms of the disease who had travelled to Wuhan has been put in isolation in Australia as health officials await test results, authorities said Tuesday.   In China, the government announced it was classifying the outbreak in the same category as SARS, meaning compulsory isolation for those diagnosed ith the disease and the potential to implement quarantine measures on travel.

In Wuhan, authorities banned tour groups and police were conducting spot checks for animals in vehicles leaving and entering the city, state media said.   It added that city health authorities had scheduled 800 beds to be made available in three hospitals and 1,200 more would soon be ready, and passengers were being screened for fever at the airport, railway stations and bus terminals.   Doctors at the University of Hong Kong released a study on Tuesday estimating that there have been 1,343 cases of the new virus in Wuhan.   The WHO has only called a global public health emergency a handful of times, including during the H1N1 -- or swine flu -- pandemic of 2009 and the Ebola epidemic that devastated parts of West Africa from 2014 to 2016.
Date: Tue, 21 Jan 2020 20:58:18 +0100 (MET)

Lima, Jan 21, 2020 (AFP) - Peru is installing security cameras at its world renowned Machu Picchu site after it was damaged earlier this month by foreign tourists, authorities said Tuesday.   "We are going to strengthen security at Machu Picchu by installing high-tech cameras," Jose Bastante, head of the archaeological park, told AFP.   Bastante said 18 cameras will be located at three strategic points of the citadel as well as access points from surrounding mountains.   "This will allow us to better control visitors and avoid any action or infraction to the regulations, also any type of risk," he said, adding that drones were also being used for security.

Five tourists accused of damaging the iconic site were deported to Bolivia last week and barred from returning to the country for 15 years.    A sixth, from Argentina, was fined $360 and must pay $1,500 to the culture ministry for repairs after he admitted to damaging the Temple of the Sun at the ancient Inca sanctuary.

The Argentine, 28-year-old Nahuel Gomez, also received a suspended sentenced of three years and four months, but can leave the country once the fines are paid.   Gomez admitted to causing a stone slab to fall from a temple wall. It was chipped when it fell, causing a crack in the floor.   "The damaged caused is significant. The integrity of Machu Picchu has been broken," Bastante said.   Members of the group were also suspected of defecating inside the 600-year-old temple.

The Machu Picchu complex -- which includes three distinct areas for agriculture, housing and religious ceremonies -- is the most iconic site from the Inca empire, which ruled over a large swath of western South America for 100 years before the Spanish conquest in the 16th century.   Machu Picchu, which means "old mountain" in the Quechua language indigenous to the area, is at the top of a lush mountain and was built during the reign of the Inca emperor Pachacuti (1438-1471).
Date: Tue, 21 Jan 2020 17:28:23 +0100 (MET)

Johannesburg, Jan 21, 2020 (AFP) - Beleaguered national airline South African Airways (SAA) announced on Tuesday it was cancelling 10 domestic and one international flight in an effort to streamline services and save cash.   The cash-strapped airline was last month placed under a state-approved business rescue plan to avoid total collapse following a costly week-long strike by thousands of its workers.   SAA said in was dropping 10 domestic flights between Johannesburg, Cape Town and Durban, while canning its direct route between Johannesburg and Munich.

Passengers on cancelled domestic flights will be accommodated on its budget sister airline, Mango, while international travellers would be re-routed via its flights between Johannesburg and Frankfurt, and London Heathrow.   "These decisions are in line with SAA's usual policy of reviewing flights and consolidating services with low demand," it said in a statement.   "Furthermore, during the current process of business rescue, these cancellations represent a responsible strategy to conserve cash and optimise the airline's position ahead of any further capital investment."

The company said there might be further flight schedule changes over the coming days.   Aviation analyst Phuthego Mojapele said a spate of cancellations by clients were exacerbating problems for SAA.   "At the moment SAA's perception out there ... it's not really looking good because there is negative news that is being perpetuated on the wires every single day," Mojapele told local television station, eNCA.   "However, SAA's records in terms of safety, in terms of the service has always been excellent," he added.

The debt-ridden carrier, which has failed to make a profit since 2011 and survives on government bailouts, has been awaiting a two-billion rand ($138 million) payout from the Treasury to fund a rescue plan announced in December.   Finance Minister Tito Mboweni last week told journalists that the government was still trying to "find a solution to finance the airline".    Local media have reported that SAA is selling nine older aircraft to make way for new planes, part of a separate plan to rid itself of its most costly aircraft.   SAA, Africa's second largest airline after Ethiopian Airlines, employs more than 5,000 workers. It has a fleet of more than 50 aircraft flying to more than more 35 domestic and international destinations.
Date: Tue, 21 Jan 2020 12:26:16 +0100 (MET)

Taipei, Jan 21, 2020 (AFP) - Taiwan on Tuesday reported its first confirmed case of the new SARS-like coronavirus as the government warned the public against travelling to Chinese city where it emerged.    The patient is a Taiwanese woman in her fifties, living in Wuhan, who returned to the island on Monday with symptoms including fever, coughing and a sore throat.   Asian countries have ramped up measures to block the spread of the new virus as the death toll in China rose to six and the number of cases jumped to almost 300 since it first emerged in the central Chinese city of Wuhan.

The Taiwan patient reported her symptoms to quarantine officials on arrival at Taoyuan airport and was immediately taken to a hospital for treatment, said the island's Centers for Disease Control (CDC).    The woman told officials that she had not visited any local markets or had contact with birds or wild animals while in Wuhan.    Authorities are monitoring some 46 passengers and crew from the same flight, the agency said.

The CDC raised its alert on Wuhan to the highest level, urging the public against travelling to the city unless necessary.    "We ask the public not to panic as the individual was taken to hospital directly from the airport and did not step into the community," it said in a statement, adding that it reported the case to the World Health Organization and China authorities.   The coronavirus has spread to Thailand, Japan, South Korea and Taiwan.
Date: Tue, 21 Jan 2020 12:08:14 +0100 (MET)

Kathmandu, Jan 21, 2020 (AFP) - Eight Indian tourists, including four children, have died after they were found unconscious in their room at a hill resort in Nepal on Tuesday, police said.   The eight -- two couples and their children -- had slept in one room at a hotel in Daman, a popular tourist destination in Makwanpur district about 55 kilometres (34 miles) from Kathmandu.   "They were found unconscious this morning and airlifted to Kathmandu but died during treatment," police spokesman Shailesh Thapa Chettri told AFP.

The families, from the south-eastern state of Kerala, used a gas heater in their room to keep warm, a district official told AFP.   "We suspect they died of suffocation, but autopsy reports will confirm the cause," Chettri added.   India is Nepal's biggest source of tourists, making up some 16 percent of visitors to the Himalayan nation.
Date: Sun, 19 Jan 2020 14:17:42 +0100 (MET)

Kathmandu, Jan 19, 2020 (AFP) - Avalanches, heavy snow and poor visibility hampered the search Sunday for four South Koreans and three Nepalis caught in an avalanche in the popular Annapurna region of the Himalayas, officials said   Relatives of the missing Koreans have arrived in Kathmandu alongside several officials sent by Seoul to help with the emergency rescue efforts, Ang Dorjee Sherpa of the Korean Alpine Federation told AFP.

The missing group was near the Annapurna base camp around 3,230 metres (10,600 feet) above sea level when the avalanche struck after heavy snowfall on Friday.   "Our team reached the area but could not proceed with their search because of more avalanches. We are exploring ways to move the operation forward," said Mira Acharya from Nepal's tourism department.

Rescuers were working with Korean officials to deploy drones in the search on Monday, said Dilip Gurung of the tourism management committee in Chhomrong, which lies on the trekking route.   "It is difficult for people to go. We will try to fly drones to help find something," Gurung said.   Helicopters were sent out on Saturday to rescue about 200 people stranded around Annapurna and other nearby mountains after the incident.

Guesthouses and the trekking route were blanketed in a thick layer of snow.   "The snow was very deep and it took us more than double the time to dig through and walk," said Jeevan Dahal, a guide who was rescued by helicopter.   "We saw the avalanche-hit area from the helicopter. Everything was white."   Tek Gurung, a guesthouse owner aiding the search operation, said more than two metres of snow (6.6 feet) had fallen on the trekking trails and it was "extremely difficult" to search the snow-covered area on foot.

Six of the missing were part of the same expedition, while one Nepali porter was escorting a different group.   The four foreigners -- two men and two women -- were part of an 11-member team of South Korean nationals. Others have safely descended.    Education officials in Seoul said they were part of a team of volunteer teachers working with children in Nepal.

Two more South Koreans were due to arrive in Nepal on Sunday to help with the search, the country's foreign ministry said.   Sherpa said it had snowed heavily around Annapurna in recent days, making the trek risky.   "The weather and snow got worse and, feeling it was becoming dangerous and difficult, they decided to turn. As they were heading back the avalanche hit," Sherpa told AFP on Saturday.

Annapurna is an avalanche-prone and technically difficult mountain range with a higher death rate than Everest, the world's highest peak.    Thousands of trekkers visit the route every year for its stunning views of the Himalayas.   A snowstorm killed about 40 people on the circuit in 2014, in one of the biggest trekking tragedies to hit Nepal.