WORLD NEWS

Getting countries ...
Select countries and read reports below or

Andorra

General
************************************
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
**************
*********************
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
***************************************
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
************************************
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
************************************
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
************************************
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
************************************
The only standard vaccine to consider for Andorra would be tetanus in line with many other developed countries of the world.

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.
More ...

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 ...

New Zealand

New Zealand US Consular Information Sheet
September 22, 2008
COUNTRY DESCRIPTION:
New Zealand is a highly developed, stable parliamentary democracy, which recognizes the British monarch as sovereign. It has a modern economy, and tourist fa
ilities are widely available. The New Zealand Tourist Board, which has a wide range of information of interest to travelers, can be contacted via the internet at http://www.newzealand.com/USA/.
Read the Department of State Background Note on New Zealand for additional information.

ENTRY/EXIT REQUIREMENTS:
U.S. citizens eligible for a visa waiver do not need a visa for tourist stays of three months or less. For more information about visa waivers and entry requirements, contact the Embassy of New Zealand: 37 Observatory Circle NW, Washington, DC 20008, telephone (202) 328-4800; or the Consulate General of New Zealand in Los Angeles: 2425 Olympic Blvd Suite 600E, Santa Monica, CA 90404, telephone (310) 566-6555.
Visit the Consulate of New Zealand web site at http://www.nzcgla.com 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:
U.S. citizens in New Zealand should review their personal security practices, be alert to any unusual activity around their homes or businesses, and report any significant incidents to local police.

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

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

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

CRIME:
Crime rates in New Zealand are low but have increased in recent years. The most prevalent crime is theft or attempted theft from cars, camper vans and hostels. To help protect against theft, do not leave passports, or other valuable items in unattended vehicles. Violent crime against tourists is unusual; however, visitors who are traveling alone should be especially vigilant, and avoid isolated areas that are not frequented by the public.

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.
In New Zealand, a private organization called Victim Support works both independently and with the NZ Police to assist victims of crime. Victim Support is available 24 hours per day on 0800-842-846, 0800-Victim, by email at victim@xtra.co.nz.

The local equivalent to the “911” emergency line in New Zealand is 111.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Quality medical care is widely available, but waiting lists exist for certain types of treatment.
High-quality medication (both over-the-counter and prescription) is widely available at local pharmacies, though the products’ names may differ from the American versions.
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.

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

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of New Zealand.
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 New Zealand is provided for general reference only.

All traffic travels on the left in New Zealand, and drivers should exercise extra caution if accustomed to driving on the right. Driving on the wrong side of the road is a leading cause of serious injury and death for American tourists.
Cars turning left must yield to oncoming cars that are turning right.
Proceed carefully through intersections.
Red means “stop”—do not turn at a red light.

New Zealand has only 100 miles of multilane divided motorways. Most intercity travel is accomplished on two lane roads.
While these are in good condition, New Zealand's rugged terrain means motorists often encounter sharper curves and steeper grades than those found in the U.S. interstate highway system. Renting a car or camper is a popular way to enjoy New Zealand's natural beauty, but visitors unfamiliar with local conditions should drive particularly conservatively.
Posted speed limit signs should be observed. Drivers should use caution to avoid animals when driving in rural areas.

Pedestrians are advised to look carefully in all directions before crossing a street or roadway, and to use crosswalks.
Pedestrians do not have the right of way except in crosswalks.
New Zealand law requires that cars yield to pedestrians in a crosswalk, and that cars stop at least two meters (approximately 6 feet) from a crosswalk that is in use.

Traffic circles are common throughout New Zealand.
When approaching a traffic circle, always yield to traffic coming from the right –noting that traffic already in the circle has the right-of-way-- and merge to the left into the circle.

Public transportation, including buses, trains and taxis, is for the most part reliable and safe.
In case of emergency, phone the local police at 111.

Please refer to our Road Safety page for more information.
For specific information concerning the operation and rental of motor vehicles, contact the New Zealand Tourist Board via the Internet at http://www.newzealand.com/USA/ or the Land Transport Safety Authority at http://www.ltsa.govt.nz.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of New Zealand’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of New Zealand’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:
Some heavily populated parts of New Zealand are in areas of very high seismic activity. General information regarding disaster preparedness is available from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.

Many tourists come to New Zealand to participate in extreme adventure sports, such as bungee jumping, sky diving, hiking, rappelling, climbing, motorcycling, and kayaking.
All too often, injuries and even death result from participation in such activities.
Travelers are advised to employ caution and common sense when engaging in adventure sports.
Never participate in such sports alone, always carry identification, and let someone else know where you are at all times.
Before kayaking, check the river conditions and wear a life jacket.
When hiking, rappelling, or climbing, carry a first aid kit, know the location of the nearest rescue center, and bring a friend along.

New Zealand is an island nation, and the government is serious about preserving its delicate ecosystem.
The Ministry of Agriculture and Forestry (MAF) imposes strict regulations regarding what can be imported into New Zealand.
People failing to declare goods that could be quarantined can be fined up to $100,000 NZ and/or face up to five years in prison. People failing to declare risk goods such as fresh fruit, seeds, and plants can receive an instant fine of $200 NZ.
When importing a pet, thorough veterinary documentation and a quarantine period are required.
Unfinished wood products, used hiking shoes and gardening tools, fresh food items, and items such as used pet carriers may be seized and destroyed by MAF.
More information can be found at http://www.biosecurity.govt.nz/personal-travel-belongings-and-mail/arriving-by-air/what-you-cannot-bring
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 New Zealand laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession of, use of, or trafficking in illegal drugs in New Zealand 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 New Zealand 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 New Zealand.
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 Wellington is located at 29 Fitzherbert Terrace, Thorndon, Wellington.
The telephone number is (64) (4) 462-6000.
The fax number is (64) (4) 471-2380.
The Embassy’s web site is http://wellington.usembassy.gov.
The U.S. Embassy in Wellington does not have a consular section and thus cannot provide consular services to American citizens.
All consular services for American citizens are provided by the Consulate General in Auckland.
The U.S. Consulate General in Auckland is located on the third floor of the Citigroup Centre, 23 Customs Street East, between Commerce and Queen Streets. The telephone number is (64) (9) 303-2724. The fax number is (64) (9) 366-0870.
See information on services to Americans at http://wellington.usembassy.gov/service.html.
The Consulate General in Auckland handles all consular matters in New Zealand.

For after-hours emergencies anywhere in New Zealand, a duty officer can be contacted by telephone. Persons seeking after-hours assistance may call (64) (4) 462-6000; after listening to a brief recording, the caller may leave a message on the voice mail system, describing the nature of the emergency and giving a point of contact. The phone system will automatically call the duty officer in Wellington or in Auckland, who will listen to the message and take the appropriate action .
*

*

*
This replaces the Country Specific Information dated January 31, 2008, to update the Information for Victims of Crime, Medical Facilities and Health Information sections.

Travel News Headlines WORLD NEWS

Date: Wed, 5 Feb 2020 02:27:15 +0100 (MET)

Wellington, Feb 5, 2020 (AFP) - Severe flooding forced thousands of residents in New Zealand's South Island to flee their homes on Wednesday and left hundreds of tourists stranded at the remote Milford Sound beauty spot.   The Southland region declared a state of emergency after being deluged with more than 1,000 mm of rainfall in 60 hours, triggering landslides on major roads and causing rivers to burst their banks.

Authorities told residents in the low-lying areas of Gore and Mataura to evacuate immediately early on Wednesday as floodwaters in the Mataura river peaked, warning those further downstream in Wyndham to prepare to leave.   "We have issued notices to evacuate and to prepare to evacuate to 6,000 people across the region," an Emergency Management Southland (EMS) spokeswoman told AFP.

Residents were advised to grab medication, clothing and identification documents, then head to higher ground.   Power to affected areas was cut off as a precaution and evacuation centres were set up in local churches and schools.

Floodwaters washed away sections of the only road to Milford Sound, a popular hiking spot for international tourists, and EMS said almost 200 people were being airlifted to nearby Te Anau.   "The tourists... have been well catered for," it said.   "Morale has been high amongst the visitors and staff, as they received regular briefings and have been in contact with friends and family."   Only two minor injuries have been reported after a landslide hit a hut on the Routeburn walking track, with both people receiving treatment at the scene.
Date: Fri 24 Jan 2020
Source: Stuff [abridged, edited]

Authorities have sounded the alarm after a passenger infected with measles flew from Auckland to Tonga [and returned] in recent days.

People who were on the flights should be on guard for signs of the highly infectious disease, Auckland Regional Public Health Service (ARPHS) medical officer of health Maria Poynter said.

The same measles patient flew from Auckland to Tonga and back over 2 days.

[See URL for flights.]
Date: Wed 8 Jan 2020
Source: Stuff [abridged, edited]

More than 2400 people travelling on the Interislander over the holidays may have been exposed to measles. A child, whose family had chosen not to vaccinate, likely contracted the measles in Auckland, then crossed Cook Strait on the Interislander's Kaitaki ferry twice during the holiday period.

There were 1219 passengers on the 1st crossing and 1220 passengers on the 2nd. KiwiRail, which runs the Interislander, became aware of the issue after the Canterbury District Health Board (CDHB) publicly notified the case on Tuesday [7 Jan 2020].

The CDHB urged people who had not been vaccinated and may have come into contact with the child to isolate themselves. "We are contacting all passengers and crew who travelled on the 2 affected sailings to provide health advice from the Canterbury District Health Board," KiwiRail tourism and marketing executive general manager Ahleen Rayner said.  [See URL above for locations, dates of possible exposure.]  [Byline: Oliver Lewis]
Date: Fri 27 Dec 2019
Source: NZ Herald [abridged, edited]

A total of 7 new cases of measles have been confirmed in Hawke's Bay in the past 2 weeks, taking the total to 26 for the year [2019]. Hawke's Bay District Health Board Medical Officer of Health Dr. Rachel Eyre said the new cases were linked to an infant too young to be immunised, who had been hospitalised recently.

"Public health has worked hard over the Christmas break to identify other close contacts to identify those not immune (protected against measles) because of the high likelihood they could get it too," she said. Dr. Eyre said, as the cases were all closely linked, any risk to the wider general public was low.  [Byline: Christian Fuller]
Date: Fri, 13 Dec 2019 05:24:44 +0100 (MET)
By Neil SANDS

Wellington, Dec 13, 2019 (AFP) - Adventure tourism is a key part of New Zealand's international appeal but the White Island volcano eruption is a tragic reminder that such activities carry genuine risk that must be better explained to travellers, experts say.   The South Pacific nation offers a wealth of adrenaline-fuelled pursuits, from heli-skiiing on snow-capped mountains to ballooning and blackwater rafting through caves.

Some, such as bungee-jumping, jet-boating and zorbing -- where you hurl yourself down a hill inside an inflatable ball -- were invented or popularised in a country that prides itself on catering to intrepid visitors.   The tourism industry as a whole is among New Zealand's biggest earners, generating about NZ$16.2 billion ($10.7 billion) and attracting 3.8 million international visitors annually.     "Adventure tourism is a massive sector in New Zealand. We are promoting ourselves as the adventure capital of the world," professor Michael Lueck, a tourism expert at Auckland University of Technology, told AFP.

New Zealand is also renowned for its rugged landscapes, which feature prominently films such as Kiwi director Peter Jackson's "Lord of the Rings".   Day-trips to White Island combined both, taking tourists including cruise ship passengers to a desolately beautiful island off the North Island coast where they could experience the thrill of standing on an active volcano.   Instead, at least 16 people are believed to have died and dozens suffered horrific burns when 47 tourists and guides were caught on the island during Monday's eruption.

The disaster has raised questions about why tourists were allowed on a volcano where experts had recently raised threat levels, as well as broader issues about the regulation of risky activities in the tourism sector.   "There will be bigger questions in relation to this event," Prime Minister Jacinda Ardern told parliament after the eruption.   "These questions must be asked, and they must be answered."

- 'Slapdash' or world's best? -
The disaster on White Island -- also known as Whakaari -- is not the first mass-fatality accident to affect tourists in New Zealand.   In 2015, seven people were killed when a scenic helicopter flight crashed into Fox Glacier. Two years earlier, a hot-air balloon claimed 11 lives and in 2010 nine died when a plane carrying skydivers plunged into a paddock.

Briton Chris Coker's son Brad, 24, died in the skydive plane crash and since then he has campaigned from afar for tighter regulations in New Zealand's adventure tourism sector.   "In my opinion, the New Zealand authorities... are still slapdash about tourist safety," Coker told news website stuff.co.nz after the White Island eruption.   "To run tourists there is insane. I know they signed a waiver and so on, but it's not really taking care of people."

Trade body Tourism Industry Aotearoa disputes such assessments, saying operators are "working within a world's best regulatory framework", but could not eliminate risk completely.   "Operators put safety first, but adventure activity inherently carries some risk and it's critical that 'adventure' remains in adventure tourism," TIA chief executive Chris Roberts told AFP.   "Operators take all practical actions to minimise the risks and the safety culture of individual operators remains the key factor in preventing accidents."

Roberts said the issue was not tourism operators, but the alert system they relied on at volcanic destinations such as White Island, which attracts about 17,000 visitors a year.   The GeoNet monitoring agency raised White Island's threat level in the week before the eruption but also advised current activity "does not pose a direct hazard to visitors".   "The reviews need to look at the science and specifically the guidance provided about volcanic activity, and whether the operating practices followed for the past 30 years need to change," Roberts said.

- 'Understand the risks' -
Travel companies such as White Island Tours brief customers before setting off and require them to sign a waiver declaring they understand the risk, as well as supplying equipment such as hard-hats and gas masks.   However, some relatives of those affected by the eruption have expressed scepticism that their loved ones truly appreciated the potential danger they faced.   Options for legal redress are limited under New Zealand's Accident Compensation Commission scheme, which covers victims' medical bills and provides modest compensation but does not allow civil suits for damages.

Neither Roberts nor Lueck expected the White Island eruption to hit international arrivals in New Zealand, which have continued to climb despite major earthquakes in 2011 and 2016.   The nature of any review arising from White Island remains uncertain, but Lueck said at the very least tourists needed to be better informed about any risks.   "Operators and tourism boards should have tourists understand what these risks are, and not brush over quickly signing a waiver," he said.   "Only then can tourists make an informed decision and decide whether or not they want to take that particular risk."
More ...

Tanzania

General
Nowadays there are few areas of our planet where you can really experience the timeless wonder and separation from the hum drum we face in our daily lives. Visiting Africa is fascinating and provides a new perspective on another life, another
world. The vast, untamed and primitive landscape provides a perfect glimpse into a life which many miss as they go about their daily chores. A trip which includes the majestic splendour of Africa’s tallest peak, Mt Kilimanjaro, rates high on the list of the unofficial wonders of the world and one not to be missed if the opportunity arises.
Mt Kilimanjaro
This is the highest peak in all of Africa stretching 5895m above sea level. Actually a few years ago the height of the summit was reassessed and then dropped by approximately 10m with more accurate recording by global positioning satellite. However, this minimal change will not be noticed by most travellers! There are a number of routes up to the summit and obviously which route is taken will make a significant difference to both the difficulty of the trek and any potential medical difficulties. Travelling with sufficient and well experienced guides and porters, and being part of a well organised group, are probably the most important factors in protecting your health.
Travelling to Tanzania
Mt Kilimanjaro is situated just across the border from Kenya in the northern part of Tanzania. You can approach the region by a number of different routes including buses from Nairobi, travelling from Dar es Salaam or flights straight into Moshi. How you travel for your climb of Kilimanjaro makes quite a significant difference to some of the health issues which you may face along the way.
General Health Issues
Before you leave for your trip make sure you are in good enough general health. If you can’t even run up a flight of stairs without collapsing then a trip up Kilimanjaro might not be the best choice! If you are unsure then see your doctor and ask for his or her advice at an early stage - before you commit yourself to the trip.
Long-Haul Flights
Flying to either Nairobi or Dar es Salaam takes between 9 to 10 hours from most Western European centres. This is regarded as a ‘long-haul flight’ so make sure you realise the risks associated with blood clotting in the legs and drink plenty of still fluids (water is the best), walk around the plane and use compression stockings if you are at any particular risk. (DVT in travel - TMB)
Food & Water
In Africa, as in many other areas of the world, what you eat and what you drink are essential for your well being. Being part of a large group has its advantages but you also need to stick with food and water that suits you personally. Don’t take extra risks with what you eat or drink just because others seem to be okay. Have your own sensible rules and remember to care for your stomach! Dehydration is common while climbing in a hot climate just make sure the water you drink is pure. You will also lose salt through perspiration and this will need to be replaced by increasing the amount of salt you put on your food at meal times.
What shoes to wear
Remember this is a walking holiday so prepare well in advance. Obviously increase your walking at home before you leave but remember to also include some significant hill walks to test your shoes. Blisters and corns are regularly associated with poorly fitted and substandard boots so spend that extra to get a pair that suits you and supports both the arch of your foot and also your ankles. A slightly larger pair is essential to lessen the pressure on your feet. Good thick socks will help to absorb perspiration and cushion your feet against friction.
Clothes to bring
This is one of the most difficult areas to sort out. The weather and climate along your climb will vary from a beautiful Irish-like summer day, to a roasting hot, dehydrating scorcher to a chilly or freezing night when the sun retires after about 6 pm. You must pack light cotton clothing but warm enough for the chill of the evenings at altitude. A wide brimmed hat (and sun lotion) is essential to protect against sun burn.
Problems at Altitude
High altitude is defined as over approx 3500m and as you know Kilimanjaro is a whole lot higher. The affects of altitude can hit anybody but most commonly it is the fit younger traveller who experiences the most serious consequences and even death. The doctor who discusses your vaccines and malaria prophylaxis will talk through the issues relating to Altitude sickness and may prescribe a medication to lessen the risks in certain circumstances. But remember, this disease can kill so if you develop any possible symptoms (lightheadedness, headaches, altered gait etc) please report it to your guide immediately. (Altitude sickness - TMB)

Being part of a group
The main advantage of being part of a group is that each member can help look-out for others during the trip. Never get separated from your main party and always report it if you feel one of your group is not quite right medically. This may be the first signs of altitude sickness and you could quite literally save a life by your intervention.
Mosquitoes and Malaria
Mosquitoes do not tend to live above 2000m and so the risk of malaria while climbing Kilimanjaro does not occur. However, you have to get to that altitude first and so protection against mosquito bites and malaria prophylaxis will be essential for this trip. (Malaria protection - TMB)
Rabies Risks in Tanzania
Any warm blooded animal can transmit rabies and so it is extremely important that you avoid any contact with dogs, cats, monkeys, and other animals on the slopes of Mt Kilimanjaro such as hyrats and other beaver like creatures. Report any contact immediately to your group leader.
Vaccinations for visiting Tanzania
As you travel to Tanzania from Western Europe we normally recommend that you have a number of vaccinations to cover against a range of diseases. In certain patients it may also be worth considering further vaccination cover against conditions like Rabies and Hepatitis B. These should be talked through in detail with your vaccinating doctor.
After your visit
When you return home you must remember that certain diseases can present days, weeks or even months afterwards. If you develop any peculiar symptoms (fever, headache, diarrhoea, skin rash etc) please make contact so this can be urgently assessed.
In the vast majority of cases the traveller climbing Kilimanjaro will stay perfectly healthy and well providing they follow the main common sense rules. Have a great safe trip and enjoy some of the splendours that Africa has to provide.

Travel News Headlines WORLD NEWS

Date: Fri 6 Dec 2019
From: Paola De Benedictis <pdebenedictis@izsvenezie.it> [edited]

A 44-year-old man was admitted to a public hospital (ICU Bisceglie, Barletta-Andria-Trani province, Apulia region, Italy) on 8 Oct 2019 with a suspected rabies infection. At the time of admission, he presented acute respiratory distress. Due to his deteriorating clinical conditions, he was transferred to the ICU of a tertiary hospital (ICU Policlinico, Bari, Italy), where he died of rabies on 19 Nov 2019, after a hospital stay of 42 days. Antemortem laboratory diagnostic tests for rabies performed at the National and FAO Reference Centre for Rabies, IZSVe (Padova, Italy) confirmed the initial suspicion based on the patient's clinical history.

The man had been bitten on his right hand by an aggressive dog on 8 Sep 2019 on the Island of Zanzibar (Tanzania). He immediately underwent post-exposure prophylaxis, which consisted of wound washing with an antiseptic solution (Betadine and hydrogen peroxide) and rabies vaccination in absence of rabies immunoglobulin administration. However, the patient was immunocompromised due to a corticosteroid therapy prescribed to treat an autoimmune disease and, unfortunately, such an important anamnesis went unnoticed until the onset of the symptoms.

Despite the internationally coordinated efforts to achieve a global goal of zero human dog-mediated rabies deaths by 2030, rabies still reaps human victims. In most cases, appropriate post-exposure prophylaxis [PEP] can safely prevent the infection in humans. However, shortages in rabies immunoglobulin (RIG) still represent the main constraint for human death prevention. Pre-exposure prophylaxis (PrEP) makes administration of RIG unnecessary after a bite. In this particular case, PrEP and antibody titration of the victim before his travel might have saved his life. Of note, recent WHO recommendations reshape the PrEP protocol from 3 to 2 shots administered within one week (0-7). Moreover, we believe that enhanced awareness and information should be envisaged at different levels, and disseminated by travel health advisors, travel agents, and resorts or through official public health guidelines,  similarly to those recommended by the United States Centers for Disease Control (CDC-ATL, <https://wwwnc.cdc.gov/travel/destinations/traveler/none/Tanzania>, paragraph "Keep away from animals" under "Stay Healthy and Safe").
--------------------------------
Lidia Dalfino, MD, Bari hospital
Sergio Carbonara, MD, Bisceglie hospital
Paola De Benedictis, DVM, PhD, FAO RC, IZSVe
===================
[Zanzibar island is a popular tourist destination in a semi-autonomous region of Tanzania, located off the eastern coast of Africa. Its government has undertaken, with the support of NGOs, great efforts to control and eradicate canine rabies since the earlier decade of the century. This was done mainly by annual rabies vaccinations, leading to a significant decline in the number of clinically confirmed canine rabies cases. In 2015, the Zanzibar government felt close to officially declaring the island free from canine rabies but this goal was eventually not achieved. In October 2017, the Global Alliance for Rabies Control (GARC) informed that The local authorities were "working hard towards ensuring a 70% vaccination coverage across the entire island within next 2 months" and that Zanzibar "is very close to being declared the 1st region in Africa to be free from rabies." (<https://rabiesalliance.org/news/towards-freedom-canine-mediated-rabies-zanzibar-island-wide-strategic-dog-vaccination>). This end, unfortunately, has not yet been reached, as tragically demonstrated by the case described above.

According to media reports, the victim, a businessman from the city of Andria in southern Italy, was visiting Kiwengwa beach, a resort area in the northeast of the island. "The family had arrived only a day earlier in Zanzibar and was on an excursion in the area when the animal attacked him. The animal was reportedly suffering from rabies and the wound was treated by local medics, which included it being disinfected at the local hospital."

According to the report above, for which the authors, Drs De Benedictis, Dalfino, and Carbonara are gratefully acknowledged, PEP was applied in Zanzibar but did not include rabies immunoglobulin. The victim continued with his holiday before returning to Italy. "He showed no signs of ill health for 2 weeks after returning, but then towards the end of September (2019), he started to feel unwell. Speaking to a friend before he died, he said the symptoms had included high blood pressure and spasms." The friend told local media: "The rabies [pre-exposure] vaccination was not something he had because it was only recommended, and was not listed as compulsory. An absurdity. [He] was very unlucky." (<https://ananova.news/tourist-bitten-by-rabid-stray-dog-in-zanzibar-dies>.)

The US CDC website provides pre-travel vaccination advice to "all travellers", "most travelers", and "some travellers". Rabies is one of the 5 vaccines which "some travelers" to Tanzania should be vaccinated with "after consulting their doctors." It is recommended for the following groups:
- Travellers involved in outdoor and other activities (such as camping, hiking, biking, adventure travel, and caving) that put them at risk for animal bites;
- people who will be working with or around animals (such as veterinarians, wildlife professionals, and researchers);
- people who are taking long trips or moving to Tanzania;
- children, because they tend to play with animals, might not report bites, and are more likely to have animal bites on their head and neck. (<https://wwwnc.cdc.gov/travel/destinations/traveler/none/tanzania#vaccines-and-medicines>).

WHO's advice concerning pre-travel vaccination, for all destinations, fall in broad line with CDC's, while adding the following:

"Pre-exposure vaccination is also recommended for individuals travelling to isolated areas, or to areas where immediate access to appropriate medical care is limited, or to countries where modern rabies vaccines are in short supply and locally available rabies vaccines might be unsafe and/or ineffective." (<https://www.who.int/ith/vaccines/rabies/en/>).

Should immunocompromised travelers apply PrEP?
The availability of RIG at destination may influence such a decision. The advice of one's GP and/or travel medicine expert deserves to be sought in a timely fashion.

A report of previous cases of inadequate antibody response to rabies vaccine in an immunocompromised patient and a literature search revealing 15 additional immunocompromised patients, of whom 7 did not exhibit the minimum acceptable level of antibodies after a complete postexposure prophylaxis regimen, are available in ref 1 below.

Reference
---------
1. Kopel E, Oren G, Sidi Y, David D. Inadequate antibody response to rabies vaccine in immunocompromised patient. Emerg Infect Dis. 2012; 18(9): 1493-5;

[HealthMap/ProMED-mail maps:
Kiwengwa Beach, Zanzibar North, Tanzania:
Date: Sat, 28 Sep 2019 20:04:29 +0200 (METDST)

Nairobi, Sept 28, 2019 (AFP) - A Canadian tourist died Saturday while parachuting from the top of Mount Kilimanjaro, Africa's highest peak and Tanzania's top tourist attraction.   Justin Kyllo, 51, was killed after his parachute failed to open, Tanzanian National Parks spokesman Pascal Shelutete said.   Kyllo had arrived in the country on September 20, he said.   Around 50,000 people climb the nearly 6,000-metre mountain, located near the northeastern frontier with Kenya, every year.
Date: Fri 20 Sep 2019
From: Daniel R. Lucey MD, MPH [edited]

ProMED-mail reports since 14 Sep [2019] of a Tanzanian woman who died in Dar es Salaam on 8 Sep [2019] and was declared negative for Ebola by Tanzanian officials raises the question of what did cause her death. Given her travel to Uganda in August [2019], perhaps bat-associated Sosuga virus could be tested for if stored specimens exist. Similar to this young woman from Tanzania, the initial patient from the USA working in Uganda in 2012 in whom Sosuga virus was discovered had [experienced] fever, headache, rash, and diarrhoea (EID 2014; 20: 211-216). This virus was found from fruit bats in Uganda in 3 locations approximately 130 km [about 81 mi] apart (J Wildl Dis 2015; 51:774-779). An IgM and IgG test was developed at the US Centers for Disease Control and Prevention, and antiviral compounds active against this virus were reported in 2018.

Daniel R. Lucey MD, MPH
Consultant, ProMED
=======================
[The fatal case of a young Tanzanian woman studying in Uganda who died after travelling back to Tanzania for her field studies, as reported in ProMED-mail post http://promedmail.org/post/20190914.6674377, continues to elude an aetiological diagnosis. The initial concern for Ebola infection has since effectively been ruled out (see http://promedmail.org/post/20190914.6674377), but outside observers have called for greater transparency and information sharing given widespread rumours surrounding this case and its potential public health implications for neighbouring countries as well as Tanzania itself (see http://promedmail.org/post/20190918.6680252).

As discussed by ProMED Mod.LK, the Ebola-like symptoms manifested in this case can be caused by other viral haemorrhagic fevers and a variety of other pathogens (see http://promedmail.org/post/20190914.6674377). ProMED thanks Dr. Lucey for raising the intriguing possibility of Sosuga virus in his letter. We continue to seek any additional information about this case, as well as alternative etiologic diagnoses and how they could be tested for.

Citations and URLs for the articles referenced by Dr. Lucey are as follows:

Albarino CG et al.: Novel Paramyxovirus Associated with Severe Acute Febrile Disease, South Sudan and Uganda, 2012. Emerg Infect Dis. 2014; 20(2): 211-216. <https://dx.doi.org/10.3201/eid2002.131620>.

Amman BR et al.: A Recently Discovered Pathogenic Paramyxovirus, Sosuga Virus, is Present in _Rousettus aegyptiacus_ Fruit Bats at Multiple Locations in Uganda. J Wild Dis. 2015; 51(3): 774-779. <https://www.jwildlifedis.org/doi/10.7589/2015-02-044>. - ProMED Mod.LXL]

[HealthMap/ProMED-mail map:
28 Jul 2019

As many as 13 have died while 6677 have been infected across Tanzania. In Dar es Salaam region alone, 6631 cases and 11 deaths have occurred.

HealthMap/ProMED-mail map of Tanzania:
Date: 20 Aug 2019
Source: Outbreak News Today [edited]

A suspected aflatoxicosis outbreak is being reported in Tanzania. The World Health Organization (WHO) was informed of the situation by the Ministry of Health in late June 2019. Since 1 Jun 2019, sporadic cases presented with symptoms and signs of abdominal distention, jaundice, vomiting, swelling of lower limbs, with a few cases of fever and headache, from Dodoma and Manyara Regions in Tanzania. As of 11 Aug 2019, a total of 53 cases and 8 deaths have been reported from Chemba, Kondoa and Kiteto Districts. The situation is under investigation.

Aflatoxin is a potent toxin and a very serious health issue in many parts of the developing world. Major outbreaks have been seen in Africa, India, Malaysia and Taiwan over the years. This mycotoxin is a natural toxin produced as a secondary metabolite to certain strains of the fungus _Aspergillus_ spp, in particular _Aspergillus flavus_ and _Aspergillus parasiticus_.

Aflatoxins are contaminants of foods intended for people or animals as a result of fungal contamination. The commonest foods implicated are cereals like corn, wheat and rice, oilseeds like peanuts and sunflower, and spices. However, the toxin can affect a very wide range of food stuffs (see below).

Different factors contribute to aflatoxin contamination. In semi-arid climates, the effect of drought can increase the amount of _Aspergillus_ spp in the air causing pre-harvest contamination of certain crops. Crops grown and stored in more tropical environments where the temperature and humidity are high usually have a higher risk of both pre and post-harvest contamination. Of course, much of the problem lies with homegrown crops not harvested or stored properly.

Aflatoxin poisoning can be divided into acute and chronic disease depending on the amount of toxin ingested. When people (or animals) ingest aflatoxin contaminated foods, the liver is the main target for disease. There is a direct link between aflatoxin poisoning and liver cancer. Liver cancer or hepatocellular carcinoma is an important public health concern in many parts of the world due to aflatoxin. According to the CDC, acute aflatoxin poisoning results in liver failure and death in up to 40 per cent of cases in some regions.

Besides the obvious health risks, there is the massive economic loss occurring in parts of the world that can't afford it. Prevention and control of aflatoxin in developing countries is mainly focused on good agricultural practices. Because it is impossible to completely eliminate this danger, in the United States feeds and grains are laboratory tested for levels of aflatoxins, and food with unacceptable levels are removed from the market.

Foods most commonly affected by aflatoxins (from the USDA's Food Safety Research Information Office): [linked from:

- cereals (maize, corn, sorghum, pearl millet, rice, wheat)
- oilseeds (peanut, soybean, sunflower, cotton)
- spices (chilies, black pepper, coriander, turmeric, ginger)
- tree nuts (almonds, pistachio, walnuts, coconut)
- dried fruits (sultanas, figs)
- cocoa beans
- milk, eggs, and meat products*

* Milk, eggs, and meat products are occasionally contaminated due to the consumption of aflatoxin-contaminated feed by animals.
====================
["Aflatoxins are toxic metabolites produced by certain fungi in/on foods and feeds. They are probably the best known and most intensively researched mycotoxins in the world. Aflatoxins have been associated with various diseases, such as aflatoxicosis, in livestock, domestic animals and humans throughout the world. The occurrence of aflatoxins is influenced by certain environmental factors; hence the extent of contamination will vary with geographic location, agricultural and agronomic practices, and the susceptibility of commodities to fungal invasion during preharvest, storage, and/or processing periods. Aflatoxins have received greater attention than any other mycotoxins because of their demonstrated potent carcinogenic effect in susceptible laboratory animals and their acute toxicological effects in humans. As it is realized that absolute safety is never achieved, many countries have attempted to limit exposure to aflatoxins by imposing regulatory limits on commodities intended for use as food and feed.

"Fungal growth and aflatoxin contamination are the consequence of interactions among the fungus, the host and the environment. The appropriate combination of these factors determines the infestation and colonization of the substrate, and the type and amount of aflatoxin produced. However, a suitable substrate is required for fungal growth and subsequent toxin production, although the precise factor(s) that initiates toxin formation is not well understood. Water stress, high-temperature stress, and insect damage of the host plant are major determining factors in mold infestation and toxin production. Similarly, specific crop growth stages, poor fertility, high crop densities, and weed competition have been associated with increased mold growth and toxin production. Aflatoxin formation is also affected by associated growth of other molds or microbes. For example, preharvest aflatoxin contamination of peanuts and corn is favored by high temperatures, prolonged drought conditions, and high insect activity; while postharvest production of aflatoxins on corn and peanuts is favored by warm temperatures and high humidity.

"Humans are exposed to aflatoxins by consuming foods contaminated with products of fungal growth. Such exposure is difficult to avoid because fungal growth in foods is not easy to prevent. Even though heavily contaminated food supplies are not permitted in the marketplace in developed countries, concern still remains for the possible adverse effects resulting from long-term exposure to low levels of aflatoxins in the food supply.

"Evidence of acute aflatoxicosis in humans has been reported from many parts of the world, namely the 3rd World Countries, like Taiwan, Uganda, India, and many others. The syndrome is characterized by vomiting, abdominal pain, pulmonary edema, convulsions, coma, and death with cerebral edema and fatty involvement of the liver, kidneys, and heart.

"Conditions increasing the likelihood of acute aflatoxicosis in humans include limited availability of food, environmental conditions that favor fungal development in crops and commodities, and lack of regulatory systems for aflatoxin monitoring and control.

"Because aflatoxins, especially aflatoxin B1, are potent carcinogens in some animals, there is interest in the effects of long-term exposure to low levels of these important mycotoxins on humans. In 1988, the IARC placed aflatoxin B1 on the list of human carcinogens. This is supported by a number of epidemiological studies done in Asia and Africa that have demonstrated a positive association between dietary aflatoxins and Liver Cell Cancer (LCC). Additionally, the expression of aflatoxin-related diseases in humans may be influenced by factors such as age, sex, nutritional status, and/or concurrent exposure to other causative agents such as viral hepatitis (HBV) or parasite infestation.

"The economic impact of aflatoxins derives directly from crop and livestock losses as well as indirectly from the cost of regulatory programs designed to reduce risks to animal and human health. The Food and Agriculture Organization (FAO) estimates that 25% of the world's food crops are affected by mycotoxins, of which the most notorious are aflatoxins. Aflatoxin losses to livestock and poultry producers from aflatoxin-contaminated feeds include death and the more subtle effects of immune system suppression, reduced growth rates, and losses in feed efficiency. Other adverse economic effects of aflatoxins include lower yields for food and fiber crops.

"In addition, the ability of aflatoxins to cause cancer and related diseases in humans given their seemingly unavoidable occurrence in foods and feeds make the prevention and detoxification of these mycotoxins one of the most challenging toxicology issues of present time."  <http://poisonousplants.ansci.cornell.edu/toxicagents/aflatoxin/aflatoxin.html>.

Aflatoxins are a huge challenge in developing countries as they affect crops, animals and people and people and animals consuming the crops or drinking milk from affected animals. It should be noted that this is not the 1st time Tanzania has experienced this situation from aflatoxin. We hope the authorities are able to track down and remove the contaminated product and render appropriate medical care for the affected individuals. - ProMED Mod.TG]

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

Cyprus

Cyprus US Consular Information Sheet
December 30, 2009

Since 1974, Cyprus, a Mediterranean island nation, has been divided de facto into a government-controlled area comprising the southern two-thirds of the island, and a northern third (t
e self-declared “Turkish Republic of Northern Cyprus"), administered by Turkish Cypriots. The United States does not recognize the “Turkish Republic of Northern Cyprus” nor does any country other than Turkey. Facilities for tourism in Cyprus are highly developed. Cyprus joined the European Union in 2004. Read the Department of State Background Notes on Cyprus for additional information.
ENTRY/EXIT REQUIREMENTS: A passport is required for travel to Cyprus. A visa is not required for a stay of up to 90 days. For longer stays, a visa or residence permit is required. U.S. citizens should be mindful that the Government of Cyprus does not recognize the residence permits issued by Turkish Cypriot authorities for the portions of the island under Turkish Cypriot administration. The Government of Cyprus does not issue residency permits to individuals who live in the areas outside government control.
On occasion, Americans who resided in the area administered by Turkish Cypriots for more than 90 days without a Republic of Cyprus residence permit have been detained by officials at Larnaca airport and denied entry into the government-controlled area. They also may be subject to prosecution.

The U.S. Embassy encourages travelers to read the “Special Circumstances” section of this fact sheet for important additional information about entry requirements into the Turkish Cypriot-administered areas.
For further information on entry requirements for Cyprus, travelers can contact the Embassy of the Republic of Cyprus at 2211 R Street NW, Washington, DC 20008-4082, tel. (202) 462-5772, or the Cypriot Consulate in New York at 13 East 40th St., 5th Floor, New York, NY 10016, tel. (212) 686-6016/17. Visit the Embassy of Cyprus’ web site at http://www.cyprusembassy.net 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: Do not, under any circumstances, attempt to enter the U.N. buffer zone at any place other than a designated crossing point. This area is mined and militarized.
Never photograph military installations or anything that could be perceived as being of security interest (especially in the area administered by Turkish Cypriots). Pay particular attention to areas marked with “no photography” signs. Police on both sides strictly enforce these restrictions.

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.
CRIME: The crime rate in Cyprus is low. Visitors in urban areas should take the normal precautions they would take in any large city. Americans frequenting bars should avoid so-called “cabarets,” which sometimes employ women brought to Cyprus for sexual exploitation. These establishments can also present foreign patrons with grossly inflated bar tabs, threatening those customers who refuse to pay.

INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you in finding appropriate medical care, contacting family members or friends, and explaining how funds can be transferred. Although the investigation and prosecution of a crime in Cyprus 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.

The local equivalent to the “911” emergency line in the Republic of Cyprus is 199 or 112.

Emergency assistance is available in the area administered by Turkish Cypriots by calling 155.
Also see our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is available at both government hospitals and private clinics. Emergency rooms offer adequate care to stabilize patients, most of whom are then transferred to private hospitals. Many of the private-sector doctors have been trained in the United Kingdom or the United States. While fees are generally lower than those in the United States, medical supplies are often more expensive. Paramedics do not staff ambulances. The standard of medical care in the area administered by Turkish Cypriots is improving but still falls below that found in the government-controlled area. The World Health Organization considers Cyprus to be one of the healthiest areas of the Mediterranean. Water supplies are potable, and the refuse collection/sewage disposal system is adequate. Communicable diseases such as typhoid are rare. Respiratory ailments and allergies are sometimes exacerbated by the dry and dusty climate.

Some HIV/AIDS entry restrictions exist for visitors to and foreign residents of Cyprus.
Legislation mandates that aliens known to have certain communicable diseases and HIV be denied entry into the country.
American citizens who think they may be included in this restriction are encouraged to check with the Embassy of Cyprus at http://www.cyprusembassy.net before they travel.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s 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 Cyprus is provided for general reference only, and it may not be totally accurate in a particular location or circumstance.
In recent years, Cyprus ranked among the top three countries in Europe, on a per capita basis, in traffic fatalities. Speeding, tailgating, overtaking, and the running of caution lights are commonplace and major causes of accidents. Emergency assistance is available in the Republic of Cyprus by calling 112 or 199.
Emergency assistance is available in the area administered by Turkish Cypriots by calling 155.
There are few public buses and no rail lines. Taxis are widely available. Traffic moves on the left side of the road, British style, and modern motorways link the major cities. Secondary roads, especially in mountainous areas, tend to be narrow and winding, and they are not as well maintained as major highways. Traffic laws, signs and speed limits are consistent with the standards used throughout Europe. Traffic circles (roundabouts) are often utilized at major intersections.

The use of seat belts (in front seats) and child car seats is required. Motorcyclists are required to wear helmets and the use of cellular phones while driving is prohibited unless used with some form of hands-free kit. Liability insurance is mandatory.

Road safety conditions in the area administered by Turkish Cypriots are similar to conditions in the south, except that the road network is less developed. Insurance purchased in the government-controlled area is not valid in the area administered by Turkish Cypriots, but insurance for that area may be purchased near the U.N. "buffer zone" checkpoints.
Please refer to our Road Safety page for more information. For specific information concerning driving permits, vehicle inspection, road tax and mandatory insurance in Cyprus, contact the Cyprus Tourism Organization at 13 East 40th Street, New York, NY 10016, tel. (212) 683-5280, email: gocyprus@aol.com, web site: http://www.visitcyprus.com/wps/portal.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Cyprus, the U.S. Federal Aviation Administration (FAA) has not assessed Cyprus’ 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.

SPECIAL CIRCUMSTANCES: Since 1974, the Republic of Cyprus has designated Larnaca and Paphos international airports, and the seaports of Limassol, Larnaca, and Paphos, as the only legal points of entry into and exit from Cyprus. These ports are all in the government-controlled southern part of the island. Entry or exit via any other air or seaport is considered an illegal act by the Republic of Cyprus. Formerly, visitors choosing to arrive at non-designated airports and seaports in the area administered by Turkish Cypriots were not allowed to cross the U.N.-patrolled “buffer zone” to the government-controlled area in the south. Since 2004, when the Republic of Cyprus implemented new EU-related crossing regulations, Americans (and citizens of other non-EU countries not requiring visas) have been able to cross regardless of their port of entry into Cyprus.

Most American visitors to Cyprus are able to cross the “buffer zone” without hindrance, although on occasion difficulties are encountered at both the government and Turkish Cypriot checkpoints. Cypriot officials at the “buffer zone” checkpoints or at airports and seaports in the government-controlled area may detain and prosecute Americans who have been present for more than 90 days in the area administered by Turkish Cypriots if they do not possess a residency permit issued by the Government of Cyprus.

For visits of less than 90 days, American citizens may enter the Turkish Cypriot-administered area by displaying a valid U.S. passport.
Stays for 90 days or longer require a “temporary residency visa” issued by Turkish Cypriot authorities.
Turkish Cypriot authorities have deported foreigners who violate this law.
Turkish Cypriot authorities emphasize that the requirement to obtain a temporary residency visa within 90 days of arriving in the Turkish Cypriot-administered area cannot be avoided by periodically visiting the southern part of the island controlled by the Republic of Cyprus.
Policy and procedures regarding travel across the “buffer zone” are subject to change. More information on current procedures may be obtained at the U.N. “buffer zone” Ledra Palace checkpoint in Nicosia.
In an effort to prevent international child abduction, many governments have initiated strict identification 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 and departure. Although Cyprus is party to the Hague Convention on the Civil Aspects of International Child Abduction, the Convention cannot be used effectively to recover a child abducted to the area administered by Turkish Cypriots.

Cyprus customs authorities enforce strict regulations concerning temporary importation into or export from Cyprus of items such as firearms. There are no restrictions on contemporary religious materials and medication for personal use; however, Cyprus does restrict the export of Byzantine era ecclesiastical material.
It is advisable to contact the Embassy of the Republic of Cyprus in Washington, DC for specific information regarding customs requirements or visit http://www.mof.gov.cy/mof/customs/ced.nsf/DMLindex_en/DMLindex_en?OpenDocument.
In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines. Cyprus restricts the export of Byzantine period ecclesiastical material and all archaeological material, including ancient coins. The U.S. Customs Service may impose corresponding import restrictions in accordance with the Convention on Cultural Property Implementation Act. Also see our Customs Information.

In addition to being subject to all Cypriot laws affecting American citizens, individuals who also possess Cypriot nationality may be subject to laws that impose special obligations on citizens of Cyprus. For example, American citizens whom the Republic of Cyprus considers to be Cypriot citizens may be subject to compulsory military service and other aspects of Cypriot law while in Cyprus. American citizen males between the ages of 16 and 26 years who reside in the United States and whose parents or grandfather were Greek Cypriots or have Greek Cypriot names are advised to obtain a written confirmation that they reside permanently outside of Cyprus from the Cypriot Embassy in Washington, D.C. before they travel to Cyprus.
After their arrival in Cyprus, the young men should present their foreign residency confirmation statement to the Cypriot National Guard Registration office to obtain an exit permit. Those who believe they may be affected should inquire at the Embassy of the Republic of Cyprus regarding their status. American citizens whom the Turkish Cypriot authorities consider to be "citizens" may also be subject to compulsory military service in the area administered by Turkish Cypriots. The U.S. Embassy is unable to exempt dual nationals from such service.
For additional information, please see our dual nationality flyer.

American Citizens who buy or lease property, particularly in the area administered by Turkish Cypriots, may find their ownership challenged by people displaced as a result of the 1974 conflict. Prospective property buyers should always seek legal advice before buying. On October 20, 2006, the government of the Republic of Cyprus passed Article 303A of the Criminal Code which makes it a felony to buy, rent or sell property in Cyprus without the consent of the registered owner. Cypriot courts have used the law to prosecute people involved in the sale or purchase of property in the area administered by the Turkish Cypriots. The government of Cyprus has also attempted to enforce Cypriot legal judgments in property matters in other EU countries. Cypriot customs authorities routinely detain anyone arriving in Cyprus or crossing the buffer zone found to be in possession of documents relating to property purchases in the area administered by Turkish Cypriots.

In June 2006 the "Turkish Republic of Northern Cyprus" amended the laws governing its "Immovable Property Commission" to enable the Commission to accept claims for compensation or restitution from Greek Cypriots for property in the north.
The Government of the Republic of Cyprus does not recognize the legitimacy of the "Immovable Property Commission."
Some Greek Cypriots who have filed claims with the Commission have been subjected to intensive governmental and public pressure to withdraw their claims.
CRIMINAL PENALTIES: While in a foreign country, American citizens are 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 under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Cypriot laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Cyprus are strict, and convicted offenders can expect 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 Cyprus are encouraged to register with the U.S. Embassy through the State Department's travel registration web site
in order to obtain updated information on travel and security within Cyprus. 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 Metochiou and Ploutarchou Streets, Engomi, Nicosia, tel. 357-22-39-3939; fax 357-22-39-3344; e-mail consularnicosia@state.gov; web site http://cyprus.usembassy.gov/
The U.S. Government also maintains an office in the area administered by Turkish Cypriots. The office is located at 6 Serif Arzik Street, Koskluciftlik, Nicosia.
The telephone number when calling from the United States or the Republic of Cyprus is 0090-392-227-3930. When calling within the area administered by Turkish Cypriots, please dial 227-3930.
* * * * * *
This replaces the Country Specific Information dated June 27, 2008
to update sections on Entry and Exit Requirements, Information for Victims of Crime,
Special Circumstances, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Fri, 31 Jan 2020 20:08:08 +0100 (MET)

Nicosia, Jan 31, 2020 (AFP) - Cyprus said on Friday it was treating its first suspected case of coronavirus after a man arrived from China showing signs of the illness.   A statement by the Mediterranean island's Ministry of Health said: "A Chinese citizen residing in Cyprus who had visited China in the past few days presented symptoms similar to that of the coronavirus." Authorities in the European Union member state said all protocols were followed for dealing with coronavirus and the man was hospitalised in the capital Nicosia.   "The possibility of influenza A was ruled out after conducting the relevant examinations," the ministry said.   The ministry said it would "further investigate" the incident over the following days while the patient is kept in hospital for treatment.   "This is a suspected case (of coronavirus) and not confirmed," the ministry said.  "We will keep the public informed of any developments," it added.   According to Cypriot daily Phileleftheros, the man was quarantined after arriving at the airport where screening showed he had a high fever.
Date: Thu, 18 Oct 2018 07:16:17 +0200

Larnaca, Cyprus, Oct 18, 2018 (AFP) - Cypriot low-cost carrier Cobalt Air announced it was cancelling all flights from Thursday after just two years in operation, leaving passengers stranded and scrambling to get their money back.   The airline warned customers its offices would no longer be staffed and urged them to seek refunds through their travel agent or credit card company.   In a brief announcement issued on its website without prior warning late on Wednesday, the airline said it was cancelling all flights from 23:50 pm (2050 GMT) "due to indefinite suspension of Cobalt's operations".   "As a result, future flights or services provided by Cobalt will be cancelled and will no longer operate," it added without elaborating on the reasons.

The airline advised passengers who have tickets not to go to the Mediterranean holiday island's main airport at Larnaca on Thursday or attempt to contact its offices "as no Cobalt flights will operate and no Cobalt staff will be present".   "For refunds, please contact your credit card provider or travel agent," its statement said.   "We sincerely apologise once again and would like to thank our very loyal customers for their support over the last two years of Cobalt operations."   Cobalt, the largest Cypriot airline since the collapse of the state-owned flag carrier, ceased operations after reports that it had failed to reach a deal with a potential European investor.   It is not yet clear how many passengers have been affected by the sudden shutdown.   But the Cypriot transport ministry said passengers expecting to fly with Cobalt on Thursday should secure one-way tickets in economy class from another airline and keep their receipt to be reimbursed.

Nine flights had been scheduled to arrive and nine to depart from Larnaca airport on Thursday.   Transport Minister Vasiliki Anastasiadou said that any stranded passengers in Cyprus would be helped.   Reportedly, the company has only 15 million euros in its accounts, which it needed to pay its 200 staff.   There was speculation that the budget airline was facing cash flow problems after two of its aircraft were grounded for two days.   Although Cobalt refused to comment on the rumours, sources within the company reportedly attributed the liquidity problems to difficulties faced by Chinese investors in exporting capital due to Chinese government restrictions.   The airline's largest shareholder is AJ Cyprus, with 49 per cent of the shares. AJ Cyprus is owned by China's AVIC Joy Air.   Cobalt stepped in to replace bankrupt state-owned Cyprus Airways, which shut down in January 2015.   Cobalt started flight operations in 2016 and acquired six aircraft -- two Airbus 319s and four Airbus 320s -- flying to 23 destinations.
Date: Tue, 17 Jul 2018 16:48:37 +0200

Nicosia, July 17, 2018 (AFP) - More than 1.6 million tourists visited Cyprus in the six months to June, the largest number ever for the first half of the year, the island's statistics office said Tuesday.   Tourist arrivals in January-June rose 12.4 percent to 1.64 million from 1.46 million in the same period last year, according to the Cyprus Statistical Service (Cystat).   "This also outnumbers the total of arrivals ever recorded in Cyprus during the first six months of the year," it said.

An influx of tourists from main market Britain and an upswing from Sweden helped Cyprus mark another record as arrivals in June broke the 500,000 barrier, Cystat said.   "June 2018 had the highest volume of tourist arrivals ever recorded in Cyprus during the specific month," it said.   Arrivals reached 511,073 in June, an increase of 8.2 percent from last year's 472,450.   The statistical department noted however a 5.1 percent drop in the number of Russian tourists, as well as a 15.1 percent decrease in arrivals from Israel and a 11.3 percent decline from Germany.   Year-on-year tourist arrivals from number one market the United Kingdom rose by 9.9 percent in June to 164,477 while there was a 20.2 percent increase in tourists from Sweden.

Sweden has now become the island's third largest tourist market, with Russia still holding second place.   Industry officials argue that arrivals from Russia are down due to fluctuations of the ruble and the renewed popularity of Turkey -- a destination made more attractive by a weak Turkish lira.   The tourism boom has helped Cyprus return to growth following a 10-billion-euro bailout in March 2013 to rescue its crumbling economy and insolvent banks.   Income from tourism now accounts for about 15 percent of the eastern Mediterranean island's gross domestic product and is credited with underpinning a quick recovery.   A record 3.65 million tourists took holidays in Cyprus last year, spending an unprecedented 2.6 billion euros.
Date: Sun, 24 Jun 2018 22:13:43 +0200

Nicosia, June 24, 2018 (AFP) - A British tourist was killed in a hit-and-run incident on Sunday near the Cypriot resort city of Paphos, police said.    The 39-year-old man was found dead at the scene after police responded to reports of an incident in the south-western coastal resort of Peyia at around 2:30 am (1130 GMT on Saturday).   The car was later found by police after being dumped in the sea.   Police arrested a man and woman in connection to the man's death.

A Paphos court on Sunday extended their detention for eight days on suspicion of pre-meditated murder.    Police said a 32-year-old British man also hit by the car was being treated at hospital, describing his condition as "out of danger".   According to local media reports, the two suspects and the tourists were involved in an argument at a pub in Peyia earlier in the evening.   Neither the identity of the dead tourist nor the two suspects have been released.
Date: Mon, 5 Mar 2018 15:30:54 +0100

Nicosia, March 5, 2018 (AFP) - Cyprus saw its best ever receipts from tourism in 2017, official data showed on Monday, in a record year for the eastern Mediterranean holiday island considered a regional safe haven.   Tourism income last year reached 2.63 billion euros ($3.23 billion) beating the 2.36 billion record set in 2016, an 11.7 percent increase, according to the Cyprus statistical service.   The surge in tourist spending coincides with another record year in arrivals, with more than 3.65 million people visiting the island last year -- 14.6 percent up from the 3.18 million visitors in 2016.

The expenditure per person, per day for the period January to December 2017 recorded a decrease of 2.6 percent (from 78.07 euros to 76.07).   In December the Lebanese were the biggest spenders on an average 147.88 euros per day and the most frugal were the Norwegians on 25.81 euros per day.   The island has benefited from a surge in arrivals from its largest markets Britain and Russia as well as a revival in those coming from Germany, Sweden and Israel.

Cyprus is seen as a safe haven for tourists, with other traditionally popular destinations in the eastern Mediterranean having been hit by political upheaval and security fears.   The surge has helped Cyprus return to growth following a 10-billion-euro package to rescue its crumbling economy and insolvent banks in March 2013.   Income from tourism accounts for about 12 percent of the eurozone member's gross domestic product and is credited with ensuring a relatively quick recovery.
More ...

World Travel News Headlines

Date: Sun 23 Feb 2020
Source: Q Costa Rica News [edited]
<https://qcostarica.com/costa-rica-is-the-first-country-in-america-where-very-resistant-antibiotic-bacteria-for-meningitis-is-isolated/>

A 50-year-old man and a senior became the 1st 2 people in Costa Rica -- and in the Americas -- found to be infected with the bacteria most resistant to antibiotics used in the treatment of meningitis and meningococcal septicaemia that cause serious brain damage and even death. The Centro Nacional de Referencia en Bacteriolog­a (CNRB) -- National Center of Reference in Bacteriology, of the Instituto Costarricense de Investigacian y Enseaanza en Nutricin y Salud (Inciensa) -- Costa Rican Institute for Research and Education in Nutrition and Health (Incense), issued an alert, in early February [2020], after documenting the circulation of _Neisseria meningitidis_ (_N. meningitidis_) serogroup Y, resistant to penicillin and not sensitive to cefotaxime [and ceftriaxone?], two 3rd generation antibiotics, reports La Nation.
====================
[Invasive meningococcal disease (meningococcaemia and meningitis) is a life-threatening infection caused by _Neisseria meningitidis_ that evolves rapidly, often even when appropriate treatment has been started promptly. Because antimicrobial treatment for invasive meningococcal disease with a 3rd-generation cephalosporin (cefotaxime and ceftriaxone) is the widely accepted standard recommendation (<https://academic.oup.com/cid/article/39/9/1267/402080>), resistance of _N. meningitidis_ to cefotaxime and ceftriaxone is very worrisome.

The news report above says that 2 patients in Costa Rica were infected with _N. meningitidis_ serogroup Y resistant to penicillin and 2 3rd generation cephalosporins, one of which was cefotaxime. The other 3rd generation cephalosporin is not specified, but is perhaps ceftriaxone, the other 3rd generation cephalosporin usually used to treat this disease. We are also not told in the news report above if the 2 patients were epidemiologically linked, nor are we told the extent (that is, MICs [minimum inhibitory concentration] of penicillin or cefotaxime), the mechanisms of resistance, or resistance to any of the other antimicrobial drugs used to prevent or treat this disease.

More information would be appreciated from knowledgeable sources. Reduced susceptibility of _N. meningitidis_ to penicillin has been reported in the past in many countries, including the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>), usually due to decreased affinity of target penicillin-binding proteins for penicillin and less commonly to beta-lactamase production (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC89938/>, <https://pubmed.ncbi.nlm.nih.gov/3134848-relative-penicillin-g-resistance-in-neisseria-meningitidis-and-reduced-affinity-of-penicillin-binding-protein-3/>, and <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC162989/pdf/392577.pdf>).

Meningococcal isolates with reduced susceptibility to penicillin G usually were reported susceptible to 3rd-generation cephalosporins (cefotaxime and ceftriaxone). For example, despite the decrease in susceptibility to penicillin G in 33% of 2888 isolates of _N. meningitidis_, all isolates were susceptible to ceftriaxone in Brazil from 2009 to 2016 (<https://pubmed.ncbi.nlm.nih.gov/29717974-surveillance-of-antimicrobial-resistance-in-neisseria-meningitidis-strains-isolated-from-invasive-cases-in-brazil-from-2009-to-2016/>). Similar data have been reported for the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>).

However, one previous study reported 8 clinical isolates _N. meningitidis_ in Delhi, India in 2006 that were resistant to ceftriaxone and cefotaxime, with most also resistant to penicillin, ciprofloxacin, and chloramphenicol (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698303/>). All of the isolates were identified as serogroup A _N. meningitidis_, but no further details concerning these isolates were given in this report (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1865813/>).

Resistance to other antimicrobial agents that may be used for therapy of meningococcal infections or for prophylaxis of case contacts has been reported in several countries. This includes resistance to chloramphenicol, fluoroquinolones, and rifampin. Horizontal exchange of genes that encode resistance for penicillin, rifampin, and the fluoroquinolones from other _Neisseria_ species that share a common ecological niche with _N. meningitidis_ in the nasopharynx has been proposed as one possible mechanism of acquisition of meningococcal antibiotic resistance (<http://jac.oxfordjournals.org/cgi/content/full/49/3/545>). - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Costa Rica: <http://healthmap.org/promed/p/17>]
Date: Tue 25 Feb 2020
From: Anne Laudisoit, PhD [edited]
<laudisoit@ecohealthalliance.org>

A suspect plague outbreak cluster has been noted in the the Godjoka health area as of 19 Feb 2020. The chief medical officer of the Rethy Health zone, the head nurse and the laboratory team from the Rethy General reference hospital investigated the outbreak site. The Godjoka village is located in the Linga health zone, Djugu territory, Ituri province, in the Congo DR (N 02.01'47.9'' and E030.44'56.6'', 1940m) in the plague endemic area.
 
There have been 6 suspected cases of plague, including 5 deaths and 1 recovering patient. The index case is a young boy who died on 19 Feb 2020. His mother, the neighbour and her child all died on 21 Feb 2020 and were buried the night of 24 Feb 2020, under pressure from the villagers. Finally the traditional healer ["tradipraticien"] who took care of the mother (who was the 2nd case) died in turn on 25 Feb 2020, and samples were taken that same day. The rapid diagnostic test was positive for plague.  Because of their rapidly fatal course, pneumonic plague is suspected for one or more of the 5 fatal cases. 

The only survivor has been under treatment at the Godjoka Health center since 22 Feb; he is the 20 year-old brother of the index case. The test on the sputum of this patient was negative.
-------------------------------------
Francoise Ngave Nyisi, Rethy General Reference Hospital, DR Congo
Mandro Michel, Provincial Division of Health, Bunia, DR Congo
Adroba Pascal, Provincial Division of Health, Bunia, DR Congo
Laudisoit Anne, Ecohealth Alliance, New York, USA
=====================
[ProMED thanks Dr Laudisoit and her hardworking Congolese colleagues for this important report.  Thus far the diagnosis of plague rests on the single positive diagnostic test obtained from the traditional healer, as it appears that the first 4 fatal cases were buried before diagnostic tests could be obtained. Following this logic, It is possible that the sole survivor thus far has the bubonic form of the disease, and thus a negative sputum result.  We seek and hope to obtain further information on all of these cases, including age, nature and duration of symptoms, presence or absence of buboes, etc.

This putative plague cluster is in a known historic plague-endemic region, where there were 31 cases and 8 deaths between Jan - Oct 2019, as previously reported by ProMED (Plague - Congo DR (02): (IT) fatal http://promedmail.org/post/20191016.6731137).  The Ituri district, of course, has also been affected by the still smouldering North Kivu-Ituri Ebola outbreak that began in July 2018.  This district has also been, and continues to be, a region of great civil unrest, with multiple armed insurgency groups operating near and across the Ugandan border.

The following background information on plague by Mod.LL is copied from our most recent ProMED post on plague [see below under See Also]:

"The bacterium that causes plague is _Yersinia pestis_. Most cases of plague are due to bubonic plague following the bite of an infected rodent flea causing a swollen and very tender lymph gland. The swollen gland is called a "bubo." Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2-6 days after being bitten. At this point in the illness, there is no risk of person-to-person spread, so if this was indeed a case of bubonic plague, no isolation or quarantine is necessary.

When bubonic plague is left untreated, plague bacteria invade the bloodstream. As the plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition. Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The infected person may experience high fever, chills, cough, and breathing difficulty and may expel bloody sputum. If plague patients are not given specific antimicrobial therapy, the disease can progress rapidly to death. At this stage, as appears to have happened in this case, person-to-person spread can occur, causing other cases of "primary" plague pneumonia. - ProMED Mod.LL]

[A ProMED/HealthMap of DR Congo is available at: DR Congo:
Date: Thu, 27 Feb 2020 09:14:05 +0100 (MET)
By Anuj Chopra and Haitham El-Tabei

Riyadh, Feb 27, 2020 (AFP) - Saudi Arabia on Thursday suspended visas for visits to Islam's holiest sites for the "umrah" pilgrimage, an unprecedented move triggered by coronavirus fears that raises questions over the annual hajj.   The kingdom, which hosts millions of pilgrims every year in the cities of Mecca and Medina, also suspended visas for tourists from countries with reported infections as fears of a pandemic deepen.

Saudi Arabia, which so far has reported no cases of the virus but has expressed alarm over its spread in neighbouring countries, said the suspensions were temporary. It provided no timeframe for when they will be lifted.   "The kingdom's government has decided to take the following precautions: suspending entry to the kingdom for the purpose of umrah and visit to the Prophet's mosque temporarily," the foreign ministry said in a statement.   "Suspending entry into the kingdom with tourist visas for those coming from countries, in which the spread of the new coronavirus (COVID-19) is a danger."

The move comes as Gulf countries implement a raft of measures, including flight suspensions and school closures, to curb the spread of the disease from people returning from pilgrimages to Iran.  Even as the number of fresh coronavirus cases declines at the epicentre of the disease in China, there has been a sudden increase across the Middle East.

Since its outbreak, the United Arab Emirates has reported 13 coronavirus cases, Kuwait has recorded 43, Bahrain has 33 and Oman is at four cases.   Iran has emerged as a major hotspot in the region, with 19 fatalities from 139 infections -- the highest death toll outside China, where COVID-19 originated.   While no cases have been reported in Saudi Arabia, one citizen is reported to be infected in Kuwait along with four Saudi women in Bahrain -- all of whom had returned from Iran.

- 'Unprecedented' move -
The umrah, which refers to the Islamic pilgrimage to Mecca that can be undertaken at any time of year, attracts millions of devout Muslims from all over the globe each year.    There was no clarity over how the move would affect the annual hajj pilgrimage due to start in late July.   Some 2.5 million faithful travelled to Saudi Arabia from across the world to take part in last year's hajj -- one of the five pillars of Islam.

The event is a key rite of passage for Muslims and a massive logistical challenge for Saudi authorities, with colossal crowds cramming into relatively small holy sites.   "This move by Saudi Arabia is unprecedented," Ghanem Nuseibeh, founder of London-based risk consultancy Cornerstone Global Associates, told AFP.   "The concern for Saudi authorities would be Ramadan, which starts at the end of April, and hajj afterwards, should the coronavirus become a pandemic."

The holy fasting month of Ramadan is considered a favourable period by Muslim pilgrims to perform the Umrah.   Saudi Arabia's custodianship of Mecca and Medina -- Islam's two holiest sites -- is seen as the kingdom's most powerful source of political legitimacy.     But a series of deadly disasters over the years has prompted criticism of the Sunni kingdom's management of the pilgrimage.

In September 2015, a stampede killed up to 2,300 worshippers -- including hundreds of Iranians -- in the worst disaster ever to strike the pilgrimage.   The pilgrimage forms a crucial source of revenue for the government, which hopes to welcome 30 million pilgrims annually to the kingdom by 2030.   De facto ruler Crown Prince Mohammed bin Salman's Vision 2030 reform plan seeks to shift the economy of Saudi Arabia -- the world's top crude exporter -- away from oil dependency towards other sources of revenue, including religious tourism.
Date: Thu, 27 Feb 2020 05:04:04 +0100 (MET)

Kuala Lumpur, Feb 27, 2020 (AFP) - Badminton's German Open will not go ahead next week and the Polish Open has been postponed, officials said as two more Olympic qualifying events fell victim to the coronavirus.   It hasn't yet been decided whether the German Open, originally scheduled for March 3-8, will be postponed or cancelled entirely, the Badminton World Federation said late Wednesday.   New dates are being sought for the Polish Open, which was meant to take place on March 26-29, but it will not now fall in the qualifying period for the Tokyo Olympics.

Both events were in the same month as the All England Open, one of the biggest events in the badminton calendar, although that tournament is currently still set to go ahead.   "The BWF is continuing to monitor all official updates on COVID-19 with no change to the intention to stage other HSBC BWF World Tour or BWF-sanctioned tournaments," said a statement.   This week the Vietnam International Challenge, which also carried rankings points for the Olympics, was shifted from late March to early June.

The loss of qualifying tournaments will pose a problem for many players including two-time Olympic champion Lin Dan, who needs a rapid rise up the rankings to win a place on the Chinese team.   Many of China's players are currently in Britain and have been cleared to play during what is a "critical period" of Olympic qualifying, the Chinese Badminton Association said last weekend.   China have been the dominant force in badminton at recent Olympics, sweeping all five titles at London 2012 and winning the men's singles and doubles gold medals four years ago in Rio.
Date: Thu, 27 Feb 2020 09:58:42 +0100 (MET)

Tallinn, Feb 27, 2020 (AFP) - Estonia reported its first coronavirus case on Thursday, a day after the man returned to the Baltic nation of just 1.3 million people from his homeland Iran.    "The person, a permanent resident of Estonia who is not a citizen, arrived in Estonia on Wednesday evening," Social Affairs Minister Tanel Kiik told public broadcaster ERR.   He said the Iranian citizen is currently hospitalised.

Local media said the man arrived in Tallinn by bus from the Latvian capital Riga.   "For now, there are no plans of putting cities in quarantine following this one case," Kiik said.    "The patient is isolated, there is no risk of the disease spreading, now we have to identify all the people the patient was in contact with."   Iran has announced a total of 19 deaths and more than 130 infections, including the country's deputy health minister.   Iran's coronavirus death toll is the highest after that of China, where more than 2,700 people have died from the disease.
Date: Wed, 26 Feb 2020 19:27:33 +0100 (MET)

Vynnyky, Ukraine, Feb 26, 2020 (AFP) - Ukrainian authorities began the task of destroying 37,000 bottles of illicit adulterated vodka on Wednesday, a national "record" in a country where consumption of illegal alcohol regularly poisons and even kills.    Minister of Justice Denys Malyuska launched the operation in the city of Vynnyky in the central Lviv region where the bottles, holding 14 tonnes of alcohol, have been stored since their seizure in 2014.   "It is difficult to say what is in there but consumption is strictly not recommended," said the minister.    "This adulterated alcohol poses a huge threat to people's health and their lives."    In front of the media, the contents of several bottles were poured into plastic tanks or blue dye was added, to rule out any illegal re-sale of the beverage.

The procedure should last about a week, after which the liquid will be poured into the sewers at a secret location, according to the minister.   "This is the first time this procedure has been used so that everyone can see that the alcohol that has been seized is really destroyed," said Maliouska.   The minister said that in the past there had been "complaints" from the business community that because of corruption within the police, the illicit alcohol had often turned up in shops after being seized.   Cases of poisoning from adulterated drinks are a regular occurence in Ukraine, where the consumption of alcohol, especially spirits, remains high. And they are often fatal.

In 2016, 73 people died from a total of 150 people who were poisoned by adulterated alcohol.    The following year, six poisoning cases killed three people and, according to Ukrainian media, ten poisonings recorded by the authorities in 2018 led to nine deaths.   The tax department of the Lviv region told AFP on Wednesday that the most adulterated alcohol was vodka, which is then sold in shops in small towns or cafes located along the roads.
Date: Thu, 27 Feb 2020 07:21:09 +0100 (MET)

Copenhagen, Feb 27, 2020 (AFP) - Denmark reported its first coronavirus case Thursday, a man who had returned from a skiing holiday in northern Italy which has become a hotspot for the disease.   "The man who came back from a skiing trip with his wife and son on February 24 has been suffering since then from a cough and a temperature," Denmark's public health agency said in a statement.   "The man tested positive, but the results of his wife and son are negative," it said.   The man is relatively well and has returned to his home, where he remains in isolation with his family, it added.   According to public TV station TV2, the man is one of its employees.   Italy has reported 400 coronavirus cases, mostly in the north, and 12 deaths.
Date: Wed, 26 Feb 2020 23:18:10 +0100 (MET)

Bucharest, Feb 26, 2020 (AFP) - Romania reported its first confirmed case of the novel coronavirus on Wednesday -- a man who was in contact with an Italian who visited the country last week.    "The patient, who is in good health and is showing no symptoms, will be transferred to Bucharest's hospital of infectious diseases," Health Minister Victor Costache told a press conference.

Seven other people who live at the same address as the man in the south-eastern Gorj county have all tested negative but will be quarantined for 14 days as a precaution, emergency department official Raed Arafat said.   The Italian believed to be the source of Romania's first diagnosis tested positive for the deadly virus upon returning to Italy after a four-day visit to Gorj.

New cases have been emerging across Europe, many linked to the continent's coronavirus hotspot in northern Italy.    Several governments have advised against travel to Italy, which has now recorded 400 cases and 12 deaths.   The COVID-19 outbreak has killed over 2,700 people and infected more than 80,000 in 34 countries, although the vast majority of cases remain in China, according to the World Health Organization.
Date: Wed, 26 Feb 2020 21:33:56 +0100 (MET)

Oslo, Feb 26, 2020 (AFP) - Norwegian health authorities on Wednesday announced the first case of coronavirus in the Nordic nation in someone who returned from China last week, but said the patient was not "in danger".   "The person is not ill, they are in good health and do not present any symptoms," Line Vold, an official at the Norwegian Institute of Public Health, told reporters. "We think it is very unlikely that they have infected" others.   Routine tests had given a "weekly positive result" and detected traces of the new coronavirus, the institute said.
Date: Wed, 26 Feb 2020 20:03:47 +0100 (MET)

Tbilisi, Feb 26, 2020 (AFP) - Georgia on Wednesday announced its first confirmed case of the novel coronavirus in the South Caucasus region.   "A Georgian national has tested positive for the novel coronavirus," Health Minister Ekaterine Tikaradze told a news conference, adding that the infected man has been placed in isolation in a Tbilisi hospital.   "Three different tests of the 50-year-old man's nasopharyngeal smear gave positive results, but he is doing well, he is clinically healthy," head of Georgia's national centre for disease control, Amiran Gamkrelidze told journalists.

The man had arrived in Georgia from Iran via Azerbaijan, Gamkrelidze said.   Tikaradze said Georgia would introduce a two-week ban on Iranian nationals entering Georgia, but flatly dismissed fears of a coronavirus epidemic in the ex-Soviet country "at this point".   On Sunday, Georgia's neighbour Armenia closed its border with Iran and suspended flights as fears over an outbreak of coronavirus in Iran sent neighbouring countries scrambling to contain the outbreak.