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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our information on medical insurance overseas.

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Slovenia US Consular Information Sheet
March 02, 2009
COUNTRY DESCRIPTION:
Slovenia operates under a parliamentary democracy.
In May 2004, Slovenia became a member of the European Union.
Tourist facilities are widely available th
oughout the country.
Read the Department of State’s Background Notes on Slovenia for additional information.

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

Slovene authorities may confiscate passports with signs of damage, such as missing pages, as suspicious documents, potentially causing travel delays.
American citizens entering and exiting Slovenia by personal vehicle are required to have a valid U.S. and International Driver’s License (See our Road Safety page for further information) or they may be refused entry into the country and/or fined.

All non-EU citizens staying longer than 3 days in Slovenia must register with the local police within 3 days of arrival and inform the office about any change in their address. Registration of foreign visitors staying in hotels or accommodations rented through an accommodation company is done automatically by the hotelier or accommodation company, but visitors staying with family members must register themselves.
Registration is available 24 hours a day at police stations and is free of charge. Failure to register can result in a significant fine of up to 400 euros.

For further information on entry requirements for Slovenia, travelers may contact the Embassy of Slovenia at 2410 California Street, NW, Washington, DC
20008, tel. (202) 386-6610; the Consulate General of Slovenia in New York City, tel. (2l2) 370-3006; or the Consulate General in Cleveland, Ohio, tel. (216) 589-9220.
Visit the Embassy of Slovenia’s web site 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:
Slovenia remains largely free of terrorist incidents.
This assessment takes into account historical data relevant to terrorist activities and recent reporting indicating whether acts could be conducted without prior advance warnings.
However, like other countries in the Schengen area, Slovenia shares open borders with its Western European neighbors, allowing the possibility of terrorist groups entering/exiting the country with anonymity.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

There are occasional political demonstrations in city centers in Slovenia.
They occur most often in central Ljubljana in areas around Kongresni Trg (Congress Square), in front of the Parliament building, around other government facilities, and, at times, near the American Embassy.
These demonstrations are usually peaceful and generally are not anti-American in nature.
However, there have been demonstrations that voiced anti-American sentiments.
American citizens should keep in mind that even demonstrations intended to be peaceful can turn confrontational and possibly escalate into violence.
American citizens are therefore urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations.
For additional information, Americans are encouraged to check the Embassy’s website or call the Embassy at 386-1-200-5595 or 200-5599 (200-5556 after hours and on weekends/holidays).

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

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

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

CRIME:
Slovenia’s overall crime rate is low and violent crimes are relatively uncommon.
Most crimes tend to be non-violent and directed towards obtaining personal property, such as purse-snatching, pick-pocketing, and residential and vehicle break-ins.
Visitors should take normal security precautions and are requested to report any incidents to the local police.

Vehicle break-in/theft is a continuous problem in Slovenia.
Individuals should always lock vehicles, use vehicle anti-theft devices, park in well-lighted areas, and secure vehicles in residential or hotel garages.

Residential burglaries occur where there are security vulnerabilities and/or where residents are not implementing residential security practices.
American citizens should ensure their residence is properly secured at all times, as recent burglary reports indicate access was gained when doors were not secured with an appropriate lock.

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.

The local equivalent to the “911” emergency line in Slovenia is: 113.
Please see our information on Victims of Crime, including possible victim compensation programs in the United States.

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

MEDICAL FACILITIES AND HEALTH INFORMATION:
Adequate medical care is readily available.
Travelers to Slovenia may obtain a list of English-speaking physicians at the U.S. Embassy.
Antibiotics, as well as other American-equivalent prescription medications are available at local pharmacies.
In Slovenia all medications, including drugs considered over-the-counter and first aid supplies, are dispensed through pharmacies (“lekarna”).
For those persons who engage in outdoor activities, a vaccine to prevent tick-borne encephalitis is recommended.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Slovenia.
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 web site.
For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site.
Further health information for travelers is available from the WHO.

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

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

Slovenia has a well-developed road network that is safe for travel.
Highways connect to neighboring cities and countries and are clearly sign-posted; road signs and traffic rules are consistent with those used throughout Europe.
As the number of cars in Slovenia continues to rise, roads are becoming more heavily congested during the weekends on major routes and during rush hours.
Parking is difficult and can be expensive in the center of Ljubljana.
Traffic moves on the right.
Third-party liability insurance is required for all vehicles; coverage is purchased locally.
Travelers should be alert to aggressive drivers both in cities and on highways.
Many of the serious accidents in Slovenia occur as a result of high-speed driving.
Emergency roadside help and information may be found by dialing 1-987 for vehicle assistance and towing services, 112 for an ambulance or fire brigade, and 113 for police.
By Slovene law, the maximum legal blood-alcohol content limit for drivers is 0.05%.

U.S. visitors or U.S. residents in Slovenia must be in possession of both a valid U.S. driver’s license and an International Driver’s License in order to drive in Slovenia.
International Driver’s Licenses are valid for a maximum of one year, after which residents of Slovenia are required to obtain a Slovene driver's license.
Current information about traffic and road conditions is available in English by calling (01) 530-5300 and online from the Automobile Association of Slovenia and the Traffic Information Center for Public Roads.

The speed limit is 50kph/30 mph in urban areas, 130 kph/80 mph on expressways (the avtocesta).
Motorists are required to have their headlights on during the daytime; drivers and passengers alike must wear seat belts; motorcyclists and their passengers must wear approved helmets.
The use of handheld cellular telephones while driving is prohibited in Slovenia.

Highway vignettes are obligatory for all vehicles with the permissible maximum weight of 3,500 kg on motorways and expressways in Slovenia.
A one-year vignette costs EUR 55; a half-year vignette costs EUR 35; for motorcycles, the one-year vignette is EUR 27,50 and the half-year vignette is EUR 17,50.

A one-year vignette for the current year is valid from December 1st of the previous year to January 31st of the next year (a total of 14 months). The half-year vignette is valid for six months following the day of its purchase.
Using motorways and expressways without a valid and properly-displayed vignette in a vehicle is considered a violation of the law; violators may be fined between EUR 300 and 800. In addition to this fine, a new sticker must be purchased and displayed on the vehicle.
Vignettes can be purchased in Slovenia at petrol stations, newsstands, automobile clubs, post offices (Posta Slovenije), and some toll stations, and also at petrol stations in neighboring countries.

Please refer to our Road Safety page for more information.
Current information is also available at the website of Slovenia’s national tourist office, which is the national authority responsible for road safety.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Slovenia, the U.S. Federal Aviation Administration (FAA) has not assessed Slovenia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s website.

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 Slovenia are encouraged to register with the U.S. Embassy or through the State Department’s travel registration website so that they can obtain updated information on travel and security within Slovenia.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located at Presernova 31, Ljubljana 1000, Tel: (386)(1) 200-5500 or Fax: (386)(1) 200-5535.
*

*

*
This replaces the Country Specific Information for Slovenia dated July 29, 2008, to update the
Entry/Exit Requirements and Traffic Safety and Road Conditions sections.

Travel News Headlines WORLD NEWS

Date: Mon, 6 Aug 2018 12:06:36 +0200
By Bojan KAVCIC

Markovec, Slovenia, Aug 6, 2018 (AFP) - When he used to go hunting, Miha Mlakar would dream of killing a bear. But today the 33-year-old from Slovenia makes his living watching the animals, peacefully, in their natural forest environment.   The turnaround to shooting bears with a camera, not a rifle, puts Mlakar, who runs bear observation tours, in step with wider efforts in the small Alpine nation to promote the coexistence of humans and bears.

Once on the verge of extinction, Slovenia's brown bear population is booming, with the number roaming the sprawling forests having doubled in the last decade to around 1,000.   As a result, encounters with bears have increased -- not that it seems to unduly worry everyone.   "If you run into a bear, you have to step back... (But) there is no danger. The bear also prefers to move away," Ljubo Popovic, a 67-year-old pensioner who lives in the village of Banja Loka in the southern Kocevje region, told AFP.   Lying an hour to the west, near Markovec village, Mlakar has built 20 hides in a remote patch of forest reachable only by off-road vehicle and takes visitors, including foreign tourists, to observe the bears.   "I cannot imagine this forest without bears. Bears make the forest wild and pristine, natural, like it was a few hundred or thousand years ago... I feel a connection with bears," he tells AFP.

- Managing bears -
Slovenian bears are even sought after abroad.    Between 1996 and 2006, eight Slovenian bears were released in the French Pyrenees, and France currently has a population of about 40 bears, whose presence divides opinion in regions where they live.   In Slovenia, more than 60 percent of respondents in a 2016 survey carried out in areas where bears live said they were in favour of the bears' presence, even if many also said they would like to see the numbers regulated.   "We have an average of one to three cases of physical contact between bears and humans per year," Rok Cerne, of the Slovenia Forest Service in charge of wildlife, told AFP.

"Fortunately, we haven't registered any serious incident over the last years," he added, stressing they were "very active in preventive measures".   Removing food sources that could attract bears has been one such step.    In villages close to bear habitats, local authorities have replaced regular plastic waste and compost bins, which can be easily opened or flipped by the animals, with containers protected by heavy metal cages.

Meanwhile, damage to cattle from bear forays has remained stable, at up to 200,000 euros ($231,500) a year, despite the bear population increasing, Cerne said.   Farmers are entitled to an 80-percent subsidy for using electric fences to protect flocks and the loss of cattle due to bears is compensated.   If a bear becomes a habitual visitor to a village, special intervention groups step in to kill or relocate the animal with the help of local hunters.   Regular culling also keeps the population under control to ensure long-term cohabitation, Cerne said. This year, authorities have proposed culling 200 bears, twice as many as last year.

- Romania's 'Van Damme' bear -
Slovenia's approach could inspire neighbouring Romania, home to about 6,000 bears or 60 percent of Europe's estimated bear population, where tourists to villages in the Carpathian Mountains often post pictures online of bears waiting to be hand-fed.   Bears rummaging through waste containers on the outskirts of cities, such as Brasov in central Romania, have become a common sight.   And on a central motorway construction site, workmen have christened a regularly spotted sturdy male bear Van Damme after the Hollywood star.

Beyond tourists' anecdotes however, Romania has seen a "growing number of attacks" by bears, highlighted in a conservation plan published last month that recommends hunting to keep numbers at optimum levels.   Use of reinforced bins, as well as a proposal for building work to be limited in regions where bears live, are also included in the government plan.   Since the beginning of last year, 31 people, mostly shepherds, have been attacked, one of them fatally. 

Meanwhile, some 940 forays by bears into populated areas were registered last year, including attacks on sheep flocks and entry into gardens; so far this year, the figure is 120.   But environmental campaigners fear that "hunting will be the main instrument to keep bear populations under control", when other measures could work, said Livia Cimpoeru, of the WWF Romania.   The government has proposed 4,000 bears as the ideal number in the country of 20 million people.   Learning simple rules, such as how to avoid startling bears and not feeding them, as well as efficient management like accurate counting to ascertain trends, is crucial for reducing conflicts with humans, said Mareike Brix, of German-based EuroNatur foundation.   "There is a risk, and there can be problems... But it's also great (to have bears). Wild nature has become so rare in Europe," she tells AFP.
Date: Thu 13 Jun 2018
Source: STA [not open access; edited]

The UKC Maribor hospital has registered 3 new cases of measles infection, including a doctor and a nurse who treated 1 of the 3 patients who got measles earlier.

The rest of this story is by subscription....
===================
[A HealthMap/ProMED-mail map of Slovenia can be found at
Date: Mon 17 Oct 2016
Source: Outbreak News Today [edited]

The vaccine-preventable disease, tetanus, has been considered eradicated among children in the Central European country of Slovenia for the past 20 years; health officials report a case in an unvaccinated child as reported in local media Fri, 14 Oct 2016.

The National Public Health Institute (NIJZ) says while the disease has been considered eradicated among children for the past 2 decades, a few cases are reported every year among the elderly, who grew up before systemic vaccination against the disease was introduced. Tetanus vaccination has been available in Slovenia since 1951.

Tetanus is caused by a very potent toxin produced by the anaerobic bacterium, _Clostridium tetani_. The spores of this organism are very resistant to environmental factors and are found widely distributed in soil and in the intestines and feces of horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. Manure-treated soil may contain large numbers of spores. In agricultural areas, a significant number of human adults may harbor the organism.

These spores are usually introduced into the body through a puncture wound contaminated with soil, street dust, animal bites or animal or human feces, through lacerations, burns or trivial unnoticed wounds or by injecting contaminated drugs. So many times you hear about concern over stepping on a rusty nail; however the rust has nothing to do with tetanus. At this point the spores germinate into bacteria which multiply and produce toxin. Depending on the extent of the wound, the incubation of tetanus is around 10-14 days.

Some of the common symptoms of tetanus are lockjaw, followed by stiffness of the neck, difficulty swallowing, and rigidity of abdominal muscles. Other symptoms include fever, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes. Spasms continue for 3-4 weeks. The typical features of a tetanus spasm are the position of opisthotonos and the facial expressions known as "risus sardonicus". The death rate for this disease ranges from 10 to 80 percent depending on age and quality of care.

There are really no laboratory findings that are characteristic of tetanus. The diagnosis is entirely clinical and does not depend upon bacteriologic confirmation. This disease in not transmitted from person to person. Even if you had tetanus and recovered, this potent toxin produces no immunity.  [Byline: Robert Herriman]
======================
[Tetanus is a potentially fatal disease characterized by skeletal muscle rigidity and painful convulsive spasms, which are caused by a potent neurotoxin, tetanospasmin, produced by the vegetative form of _Clostridium tetani_, an anaerobic spore-forming Gram-positive bacillus. _C. tetani_ is a member of the normal intestinal flora of animals, including humans. Tetanus usually occurs following contamination of wounds by soil or animal feces in which the spores of _C. tetani_ can be found.

A newly published article demonstrates that the extracellular matrix proteins called nidogens (or entactins) appear to be the receptor for the tetanus neurotoxin to enter the neuromuscular junction (Bercsenyi K, Schmieg N, Bryson JB, et al: Tetanus toxin entry. Nidogens are therapeutic targets for the prevention of tetanus. Science. 2014;346(6213):1118-23. doi: 10.1126/science.1258138, abstract available at:  <http://science.sciencemag.org/content/346/6213/1118.long>).

Abstract:
"Tetanus neurotoxin (TeNT) is among the most poisonous substances on Earth and a major cause of neonatal death in nonvaccinated areas. TeNT targets the neuromuscular junction (NMJ) with high affinity, yet the nature of the TeNT receptor complex remains unknown. Here, we show that the presence of nidogens (also known as entactins) at the NMJ is the main determinant for TeNT binding. Inhibition of the TeNT-n idogeninteraction by using small nidogen-derived peptides or genetic ablation of nidogens prevented the binding of TeNT to neurons and protected mice from TeNT-induced spastic paralysis. Our findings demonstrate the direct involvement of an extracellular matrix protein as a receptor for TeNT at the NMJ, paving the way for the development of therapeutics for the prevention of tetanus by targeting this protein-protein interaction."

Tetanus may follow surgical procedures, burns, deep puncture wounds, crush wounds, otitis media, dental infection, animal bites, abortion, and pregnancy. The presence of necrotic tissue and/or foreign bodies increases risk for tetanus because they favor growth of _C. tetani_. Tetanus can also follow injection of contaminated illicit drugs. Neonatal tetanus occurs usually in developing countries in infants with infection of the umbilical stump who are born to a non-immune mother. Infants of actively immunized mothers acquire passive immunity that protects them from neonatal tetanus. Tetanus is not directly transmitted from person to person.

Tetanus occurs in people who are inadequately immunized, i.e., people who have not completed the primary series and received appropriate boosters. Recovery from tetanus is not necessarily associated with immunity, and primary immunization is indicated after recovery from tetanus. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Tue, 12 Jan 2016 20:27:43 +0100

Ljubljana, Jan 12, 2016 (AFP) - The Slovenian army on Tuesday began removing sections of a razor-wire border fence, erected to control the inflow of migrants from Croatia, due to flooding by the Kolpa river, local media reported.   Slovenian soldiers removed 200-300 metres of the fence in the Griblje and Dragatus areas, villages some 110 kilometres (70 miles) south of Ljubljana, after the Kolpa burst its banks and floodwaters threatened to tear down the fence, the STA news agency reported.

Since mid-November Slovenia has built over 150 kilometres of razor-wire fence along its border with Croatia, hoping to prevent an uncontrolled inflow of migrants across the "green border".   Over 400,000 migrants have crossed into Slovenia since mid-October, most hoping to carry on to Austria or Germany.

The Slovenian government's information office said Monday that the border fence would be removed in areas where the stream of the Kolpa river was strongest and replaced, in the near future, by a more resistant fence.   Situated in one of Slovenia's most attractive natural parks, the Kolpa river marks over 100 kilometres of the 670 kilometre-long Slovenia-Croatia border.   The fence has been criticised by environmentalists and civil groups in Slovenia and Croatia which claim the razor wire is a threat to wildlife.
Date: 4 Jan 2016
From: Maja Socan, M.D. Maja.Socan@nijz.si

In response to the request for information in the ProMED mail post "Undiagnosed gastroenteritis - Slovenia (GO): international athletes, RFI http://promedmail.org/post/20151228.3896510, the following information was received 4 Jan 2016 [edited]:

As a response to the ProMED request for information on 28 Dec 2015 quoting izvestia.ru from 19 Dec [2015] that 3 teams were affected by a viral epidemic during Biathlon World Cup in Pokljuka, Slovenia, an investigation has been carried out. Regional epidemiologists contacted the organizers, the hotel where athletes were staying, local outpatient clinics/emergency teams and both hospitals nearby. 
 
The organizers of the Biathlon World Cup in Slovenia were not aware of any communicable diseases affecting biathlon teams during the cup. One of the athletes was admitted to the hospital but the reason for the admission was non-infectious. Another athlete lost consciousness during the competition.
 
Neither emergency medical teams nor nearby hospitals were contacted for any health intervention except for the above-mentioned situations.
 
The hotel where the teams were staying was not informed about any gastrointestinal problems among its guests during the competition.
 
The findings of our investigation do not preclude that some of the athletes had health problems during the competition but apparently not severe enough to contact local health services. We assume that if high numbers of athletes had become ill with gastrointestinal problems the organizer would have been informed. According to the national algorithm for mass gatherings (with emphasis on the international ones), the National Institute of Public Health is obligated to provide in advance the information to the organizers about possible health issues during mass gatherings and measures which must be taken to stop the spread of communicable diseases or at least to mitigate the outbreak.
 
To conclude, we were not able to identify an outbreak of acute gastrointestinal or respiratory infection among competing athletes during the Biathlon World Cup in Pokljuka, Slovenia.
-------------------------------------------
Maja Socan, M.D.
Senior consultant
Communicable Diseases Centre
National Institute of Public Health
Ljubljana, Slovenia
========================
[ProMED thanks Dr. Socan for the thorough investigation into this report and for sharing the information with the ProMED community.

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

Bahrain

Bahrain - US Consular Information Sheet
June 27, 2008
COUNTRY DESCRIPTION:
Bahrain is a hereditary kingdom governed by the Al-Khalifa family. In 2002, the country adopted a new constitution that reinstated a parliament, which consists of o
e elected and one appointed chamber. Islamic ideals and beliefs provide the conservative foundation of the country's customs, laws and practices. Bahrain is a modern, developed country and tourist facilities are widely available. The capital is Manama. Read the Department of State Background Notes on Bahrain for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and a visa are required. Passports should be valid for at least six months after the date of arrival. U.S. passport holders outside of Bahrain may apply and pay for a two-week tourist visa online through the Bahraini government web site at http://www.evisa.gov.bh, or may obtain it upon arrival at the airport. U.S. diplomatic passport holders receive a no-fee two-week visa. Prior to travel, visitors may obtain five-year multiple-entry visas valid for stays as long as one month from Bahraini embassies overseas. Bahrain assesses heavy fines on visitors who fail to depart Bahrain at the end of their authorized stay. The amount of the fine is determined by a formula related to the visa type, duration, and location of issuance. An exit tax is included in the ticket price for flights out of Bahrain, and no additional exit fees are required upon departure. Residents of Bahrain who intend to return must obtain a re-entry permit before departing. For further information on entry/exit requirements, travelers may contact the Embassy of the Kingdom of Bahrain, 3502 International Drive NW, Washington, DC 20008, telephone (202) 342-1111; or the Bahrain Permanent Mission to the U.N., 2 United Nations Plaza, East 44th St., New York, NY 10017, telephone (212) 223-6200. Visit the Embassy of Bahrain web site at www.bahrainembassy.org for the most current visa information.

Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
Americans in Bahrain should maintain a high level of security awareness. Spontaneous demonstrations take place in Bahrain from time to time in response to world events or local developments. We remind American citizens that even demonstrations intended to be peaceful can turn confrontational and possible escalate into violence. American citizens are therefore urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations. American citizens should stay current with media coverage of local events and be aware of their surroundings at all times. Information regarding demonstrations in Bahrain can be found on the U.S. Embassy Manama’s web site at http://bahrain.usembassy.gov/information_for_travelers.html.

Visiting U.S. citizens should register with the U.S. Embassy in Manama upon arrival. The Department of State remains concerned about the possibility of terrorist attacks against U.S. citizens and interests throughout the world. Americans should maintain a low profile, vary routes and times for all required travel, and treat mail and packages from unfamiliar sources with caution. In addition, U.S. citizens are urged to avoid contact with any suspicious, unfamiliar objects, and to report the presence of the objects to local authorities. Please report any security concerns to the U.S. Embassy's Regional Security Office at telephone (973) 1724-2700 during office hours or (973) 1727–5126 after hours.
For the latest security information, Americans traveling abroad should regularly monitor the Department’s web site at http://travel.state.gov, where the current Worldwide Caution, Travel Warnings and Travel Alerts can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada or, for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their 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 crime rate in Bahrain is low and violent crime is rare. However, burglary, petty theft, and robberies do occur. Visiting Americans are urged to take the same security precautions in Bahrain that one would practice in the United States. Hotel room doors should be locked when visitors are in their rooms, and travelers are encouraged to store valuables in hotel room safes when they are available. Women are encouraged to keep their purses firmly under their arms, and men should avoid keeping their wallets in their hip pockets while in the old market area. The U.S. Embassy in Manama recommends that travelers using local taxis insist on the use of a meter since unexpectedly high fares may otherwise be charged. Bahrain has a professional police force, and visitors are encouraged to contact the police if problems are encountered.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the U.S. Embassy. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the U.S. Embassy for assistance. The Embassy staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how to transfer funds. 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.

The local equivalent to the “911” emergency line in Bahrain is 999.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Basic modern medical care and medicines are available in several hospitals and health centers in Bahrain. Two government hospitals, several private hospitals, and numerous private clinics located throughout the country offer a wide range of medical services. Cardiac care, general surgery, internal medicine, obstetrics, gynecology, pediatrics, orthopedics and dentistry services are readily available, as are x-rays, CT-scan and MRI testing. The government hospitals house both trauma and ICU units. Pharmacies are common throughout Bahrain and carry a wide range of medications. Prescriptions are normally required.
Payment at all medical facilities is due at the time of service. Some hospitals have limited direct billing capability for certain insurance carriers. Billing and insurance practices vary among the medical facilities.

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

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

Travel by road in Bahrain is generally safe although unsafe driving practices are common. Highways and major roads in the northern third of Bahrain are four to six lanes wide and well maintained; roads in villages and older parts of Manama and Muharraq are narrow and twisting. As in the United States, traffic in Bahrain moves on the right. Roundabouts (traffic circles) follow the British system, with those automobiles within the traffic circle having right of way over those attempting to enter. Although the Bahraini penal code calls for fines of up to 100 dinars ($270.00) or imprisonment of up to six months for driving above posted speed limits, it is not uncommon for drivers to drive well over the posted speed limits of 50-120 km per hour. The law allows the police to detain drivers for traffic violations until they can appear before a magistrate. It is illegal to use a cell phone while driving.

Under Bahraini law, any sign of having consumed alcohol may be taken as prima facie evidence of driving under the influence, which can lead to imprisonment and/or fines of up to 1,000 Bahraini Dinars (2,700 U.S. dollars). Except for minor accidents, drivers may not move their vehicles after an accident until a report has been filed with the traffic police. This is true even in cases of single-car accidents. Insurance companies may not provide coverage if the cars are moved. However, drivers involved in minor, non-injury accidents no longer need to wait at the scene for the police. Individuals should get their vehicles off the road to avoid further accidents. Drivers can call the accident hotline at 199 (if there are no injuries) or 999 (when someone is injured) where they will be directed to one of five centers to file the accident report. This report must be filed within 24 hours of the accident. Both drivers may be prohibited from leaving the country until the matter is resolved if an accident results in legal proceedings. The main switchboard at the traffic department is 1787-2222.
Emergency numbers are as follows:
Fire/Ambulance/Police: 999
Traffic/Accidents: 199 (no injuries) OR 999 (injuries)
Please refer to our Road Safety page for more information. Visit the web site of Bahrain’s national authority responsible for road safety at http://www.traffic.gov.bh/main.htm.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Bahrain, the U.S. Federal Aviation Administration (FAA) has not assessed Bahrain’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Individuals subject to Bahraini court orders arising from indebtedness, labor disagreements, or other legal disputes may be prevented from departing Bahrain until their cases are resolved. Instances have occurred in which departure was prohibited for several years, since the legal process can be both lengthy and complex. The Consular Section of the U.S. Embassy in Manama maintains a list of local attorneys capable of representing Americans.
Please see our Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Persons violating Bahrain’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for breaking the law can be more severe than in the United States for similar offenses. Disrespect to officials in word or deed can result in heavy fines. Travelers who are driving should be aware that one drink may be sufficient grounds for a DUI arrest. Penalties for possession, use, or trafficking in illegal drugs in Bahrain 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 Bahrain 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 Bahrain. 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 Bldg. 979, Road no. 3119, Zinj District (next to Al Ahli Sports Club). The mailing address is P.O. Box 26431, Manama, Bahrain. The telephone number is (973) 1724-2700. The after-hours number is (973) 1727-5126. The Consular Section’s fax number is (973) 1725-6242. The Embassy's web site, which includes consular information and the most recent messages to the American community in Bahrain is at http://bahrain.usembassy.gov/. The workweek in Bahrain is Sunday through Thursday.
* * *
This replaces the Country Specific Information for Bahrain dated November 23, 2007 without substantive changes.

Travel News Headlines WORLD NEWS

Date: Mon, 2 Oct 2017 19:26:47 +0200

Dubai, Oct 2, 2017 (AFP) - A "terrorist explosion" during a Shiite procession commemorating Ashura lightly wounded five policemen on Monday, the interior ministry in Sunni-ruled Bahrain announced.   "A terrorist explosion caused five light injuries among policemen deployed as security for a procession along Budaiya Avenue" in western Manama, a tweet from the ministry said.

Shiites in the tiny Gulf kingdom mark Ashura with processions in Manama and in villages around the capital.   The annual Ashura commemorations mark the killing of Imam Hussein by the forces of the Caliph Yazid in 680 AD -- a formative event in Shiite Islam.   Imam Hussein's death was part of a dispute over who should succeed the Prophet Mohammed, which eventually developed into a bitter schism between the Sunni and Shiite branches of Islam.

Bahrain, home to the US Fifth Fleet, has seen sporadic violence since the repression in 2011 of a protest movement by the Shiite majority, demanding a constitutional monarchy and an elected prime minister.   Hundreds of protesters, mainly but not all Shiites, were arrested and sentenced to lengthy prison terms for their role in the demonstrations.   Bahrain says it does not discriminate towards the country's Shiites, and regularly accuses Shiite Iran of meddling in its internal affairs, an allegation Tehran denies.
Date: Sun, 26 Feb 2017 20:11:48 +0100

Dubai, Feb 26, 2017 (AFP) - Four Bahraini policemen were wounded in a bomb attack Sunday near the village of Jaw, south of the capital Manama, the interior ministry said.   "Terrorist blast in police bus near Jua village. 4 policemen injured and they are in a stable condition. Necessary steps are being taken," the ministry said on its Twitter account.   It gave no further details.

On January 1, gunmen attacked the prison in Jaw, killing a policeman and allowing 10 inmates to escape.   Shiites convicted over anti-government protests in Sunni-ruled Bahrain were held at Jaw.   Tiny but strategic Bahrain, home to the US Fifth Fleet, has been rocked by unrest since the authorities crushed Shiite-led protests in 2011 demanding a constitutional monarchy and an elected prime minister.

Hundreds of Shiites have been arrested and many have faced trials over their role in the demonstrations.   One of those on trial is Sheikh Issa Qassem, the country's Shiite spiritual leader.   He was stripped of his citizenship last year for "serving foreign interests" -- a reference to Shiite Iran.   On Sunday, clashes broke out between security forces and protesters in several Shiite villages as a new hearing in Qassem's case was underway, witnesses said.   Protesters chanted anti-government slogans and carried portraits of Qassem, they said.
Date: Wed, 15 Feb 2017 11:55:11 +0100

Dubai, Feb 15, 2017 (AFP) - An explosion wounded two civilian passers-by in Bahrain, the interior ministry said early Wednesday, as demonstrators were marking the sixth anniversary of an anti-government uprising that was bloodily suppressed.   The ministry did not say what caused Tuesday evening's blast in a village outside the capital Manama but demonstrators sometimes throw petrol bombs during the sporadic protests that still grip the Sunni-ruled but Shiite-majority kingdom.   "Terrorist blast in Sitra causes minor injuries to a married couple passing the site. Police at the scene," the ministry said on its Twitter account without elaborating.   It also tweeted a picture of a black 4X4 with a shattered windscreen and significant damage to the front bonnet.   The blast came as demonstrators clashed with police in Manama and several nearby villages.   The demonstration in the capital ended when police fired tear gas and stun grenades, witnesses said.

Activists posted pictures of injured protesters online, but the interior ministry has not published any official statements about the reported demonstrations.   The Shiite-led protests of February 2011 sought a constitutional monarchy and an elected prime minister to replace the current government dominated by the ruling Al-Khalifa family.   Authorities crushed them the following month with the support of Saudi-led forces who secured key installations.   Since then, the authorities have banned the Shiite opposition and handed long jail terms to many of its leaders. Some have been stripped of their citizenship.   Tiny but strategic Bahrain lies just across the Gulf from Iran and is home to the US Navy's Fifth Fleet.
Date: Thu, 19 May 2016 21:53:48 +0000
From: Dr Manaf Alqahtani <drmanaf@gmail.com> [edited]
BDF Hospital, Bahrain
-----------------------------------
Measles is a highly infectious virus that spreads easily from person to person through the air, through breathing, coughing and sneezing. Although measles is largely considered a disease of children, we have noticed increasing numbers of adults infected. Since 9 May 2016, we had a total of 7 cases with measles. 4 were adults (30-40 years old) and 3 children (less than 12 months old). All adults were Bahraini (3 originally born in Yemen and one in Pakistan). All of the adults either have no documentation of MMR or received one dose MMR only.

Regarding the 3 children with measles, all were non-vaccinated and got infected from their infected adult family member.

3 out of 7 cases needed to be admitted for hydration and symptomatic treatment. Luckily, all our HCWs [health care workers] have documented 2 doses of MMR.

In the 2014 measles outbreak in Bahrain, 32 cases were registered, of which 27 were among children under 15 years and 5 among adults. Of the total, 14 cases were detected among expatriates.

Bahrain and the other member states of the EMR [Eastern Mediterranean Region] adopted a resolution for elimination of measles from the region by 2010. In 1996, the Ministry of Health (MOH) developed a plan for measles elimination that included a revised measles immunization schedule, introduction of case-based surveillance, and annual immunization campaigns of school children.

Most of recent measles cases are imported.
------------------------------
Dr. Manaf Alqahtani
BDF Hospital
Bahrain
=================
[ProMED thanks Dr. Alqahtani for sending this information.

Also see: JS Jawad et al. Toward Measles Elimination in Bahrain -- A Middle East Country Experience. The Journal of Infectious Diseases 2011;204:S299-S304

"Abstract
---------
Measles was a leading cause of infant and child morbidity and mortality in Bahrain before the introduction of measles vaccine in 1974. With the establishment of the Expanded Program on Immunization (EPI) in 1981 and the introduction of a 2nd dose of measles vaccine in 1985, coverage for 1st and 2nd doses of measles vaccine increased to 94 percent by 1997 and has been sustained greater than 97 percent since 2001. Measles, mumps, and rubella (MMR) immunization campaigns targeting 12-year-old students were conducted annually during 1998-2006 and achieved coverage of greater than 95 percent. As a result, the incidence of measles in Bahrain has declined markedly over the past 4 decades, to 2.7 cases per million persons in 2009. Recent confirmed measles cases have occurred sporadically, in under-vaccinated children or in infants too young or adults too old to receive measles vaccine. Bahrain has made significant progress toward measles elimination by sustaining high immunization coverage and strengthening case-based measles surveillance activities. Further success will depend on improved identification and immunization of under-vaccinated expatriate workers and their families."

A map of Bahrain can be accessed at <http://healthmap.org/promed/p/127>.
Bahrain is an archipelago in the middle of the Arabian Gulf encompassing 33 islands, the largest of which is Bahrain Island. - ProMED Mod.LK]
Date: Fri 6 Nov 2015
Source: Reuters [edited]

A cholera outbreak in Iraq has spread to Kuwait and Bahrain, and risks turning into a region-wide epidemic as millions of pilgrims prepare to visit the country, UNICEF's Iraq director has said. The disease, which can lead to death by dehydration and kidney failure within hours if left untreated, was detected west of Baghdad in September 2015 and has since infected at least 2200 people in Iraq and has killed 6.

"It [the outbreak] already has a regional dynamic and the risk of that can only be increased by people from all over the region coming into Iraq," UNICEF country director, Peter Hawkins, said on Thu 5 Nov 2015. Hawkins said cholera had spread to Bahrain, Kuwait and Syria, but in a later statement, UNICEF said the cases in Syria were not confirmed: "However, given the scale of the outbreak in Iraq the risk of cholera spreading across Iraq's borders remains high," it said.

Millions of Shi'ite Muslims are due to visit Iraq in December for Arbaeen, a religious ritual marking the end of an annual mourning period for the Prophet Mohammad's grandson Hussein, whose death in 680 AD entrenched the schism between Shi'ites and Sunnis.

Hawkins said UNICEF was working with clerics in the Shi'ite shrine cities of Najaf and Kerbala to convey information about how to guard against cholera, which is endemic in Iraq and the wider region. The outbreak can be traced to a number of factors including low water levels in the Euphrates and winter flooding that has contaminated the river and shallow wells with sewage water.

The war against [the so-called] Islamic State militants who control large swathes of territory in northern and western Iraq has also contributed to the outbreak. The conflict has displaced more than 3 million people, with many living in camps where conditions are conducive to the spread of cholera -- a bite of contaminated food or a sip of contaminated water is enough to cause infection.

Hawkins said UNICEF has only limited access to areas controlled by Islamic State, which swept across the Syrian border in mid-2014 in a bid to establish a modern caliphate.

Higher military expenditure and other costs associated with the battle against Islamist militancy has aggravated a cash crunch for Iraq, a major OPEC oil producer that has suffered from the drop in global crude prices over the past year. A higher proportion of the government budget is also being spent on security at the expense of other services and infrastructure such as water supply, Hawkins said.

1 in 5 of the confirmed cases in Iraq is among children, and in large parts of the country the start of the school year was delayed by a month as a precaution, UNICEF said in a statement. In response to the outbreak, UNICEF is providing bottled water, oral rehydration salts and installing community water tanks, but like most humanitarian operations in Iraq it is severely underfunded.  [byline: Isabel Coles]
=====================
[The conflicts in the Middle East have exacerbated the endemic cholera in Iraq, and it has spread beyond Iraq's borders. The number of cases of cholera in Kuwait and Bahrain are not reported, nor is it clear whether the cases were acquired in these countries or imported. UNICEF has not confirmed any cases in war-torn Syria, but there are informal reports circulating. - ProMED Mod.LL]

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

Papua New Guinea

Papua New Guinea - US Consular Information sheet
October 17, 2008
COUNTRY DESCRIPTION:
Papua New Guinea is a developing country in the Southwest Pacific. The capital is Port Moresby. Tourist facilities outside major towns are limited. Crim
is a serious concern throughout Papua New Guinea (please see the section on crime below). Read the Department of State Background Notes on Papua New Guinea for additional information.
ENTRY/EXIT REQUIREMENTS: Travelers must possess a valid passport, onward/return airline ticket, and proof of sufficient funds for the intended visit. Travelers may obtain business or tourist visas (valid for stays of up to 60 days, with extensions available for an additional 30 days) upon arrival at Jacksons International Airport in Port Moresby. All persons boarding international flights originating from Papua New Guinea pay a departure fee, which should be included in airline fares. Travelers may obtain more information on entry and exit requirements from the Embassy of Papua New Guinea, 1615 New Hampshire Avenue NW, Suite 300, Washington, DC 20009, tel. 202-745-3680, fax 202-745-3679, e-mail kunduwash@aol.com, or via the Papua New Guinea Embassy web site at http://www.pngembassy.org/
Travelers who plan to transit or visit Australia must enter with an Australian visa or, if eligible, an Electronic Travel Authority (ETA). The ETA replaces a visa and allows a stay of up to three months. It may be obtained for a small service fee at http://www.eta.immi.gov.au/. Airlines and many travel agents in the United States are also able to issue ETA’s. Travelers may obtain more information about Australian entry requirements from the Australian Embassy at 1601 Massachusetts Avenue NW, Washington, DC 20036, tel. 202-797-3000, or via the Australian Embassy's web site at http://www.austemb.org/.

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

SAFETY AND SECURITY:
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Civil Unrest/Political Tension: Tension between communal or clan groups, particularly in the Highlands region, occasionally leads to outbreaks of tribal fighting, often involving the use of firearms. Travelers should consult with their tour operator, the U.S. Embassy in Port Moresby, or with Papua New Guinean authorities before visiting the region.

Visitors intending to travel to the autonomous region of Bougainville Island should contact the U.S. Embassy in Port Moresby for updated security information. Bougainville Island is not peaceful, law enforcement is weak, and tourist and transportation facilities are limited. We advise travelers to Bougainville, as in other parts of Papua New Guinea, to exercise a high degree of caution. Areas near the Panguna mine, located on the southern part of the Island of Bougainville, have been officially designated “no go zones” by the Autonomous Government of Bougainville; Americans should avoid those areas.
Up-to-date information on 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 that travelers can take to protect themselves in an overseas environment, see the Department of State's pamphlet A Safe Trip Abroad.
CRIME: Papua New Guinea has a high crime rate. Numerous U.S. citizen residents and visitors have been victims of violent crime in recent years, and they have sometimes suffered severe injuries. Carjackings, armed robberies, and stoning of vehicles are problems in and around major cities such as Port Moresby, Lae, Mount Hagen, and Goroka, but can happen anywhere. Pickpockets and bag-snatchers frequent crowded public areas. Hiking or other travel in rural areas and visiting isolated public sites such as parks, golf courses, beaches, or cemeteries can be dangerous. Individuals traveling alone are at greater risk for robbery or gang rape than are those who are part of an organized tour or under escort. Visitors to Papua New Guinea should avoid using taxis or buses, known as Public Motor Vehicles (PMV's), and should instead rely on their sponsor or hotel to arrange for taxi service or a rental car.
Road travel outside of major towns can be hazardous because criminals set up roadblocks near bridges, curves in the road, or other features that restrict vehicle speed and mobility. Visitors should consult with the U.S. Embassy or with local law enforcement officials concerning security conditions before driving between towns. (See also Traffic Safety and Road Conditions below). Travel to isolated places in Papua New Guinea is possible primarily by small passenger aircraft; there are many small airstrips throughout the country. Security measures at these airports are rare. Organized tours booked through travel agencies remain the safest means to visit attractions in Papua New Guinea. The Embassy recommends that prospective visitors consult a Primer on Personal Security for Visitors to Papua New Guinea at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1757.html
Kokoda Track: Americans should exercise a high degree of caution when walking the Kokoda Track and traveling through the areas adjacent to each end of the track. Travelers should travel with guides from a reputable tour company. This is particularly important given occasional threats by villagers to close parts of the track because of local land and compensation disputes. Trekkers should ensure that their tour company provides a permit in return for fees paid for this purpose. The Kokoda Track Authority (KTA) has stationed rangers along the track and at airports to collect fees from trekkers who have not obtained a valid trekking permit. The KTA can be contacted on telephone (675) 325 6165 regarding payment of the applicable fee.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. embassy or consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. embassy or consulate for assistance. The embassy/consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends and explain how funds may be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you understand the local criminal justice process and to find an attorney, if needed.
The local equivalent to the “911” emergency line in Papua New Guinea is: 000
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities in Papua New Guinea vary from hospitals in Port Moresby and the larger towns to aid posts (including some missionary stations) in remote areas. Medical facilities vary in quality, but those in the larger towns are usually adequate for routine problems and some emergencies. However, equipment failures and sudden shortages of common medications can mean that even routine treatments and procedures (such as X-rays) may become unavailable. A hyperbaric recompression chamber for diving emergencies is available in Port Moresby. Pharmacies in Papua New Guinea are found only in urban centers and at missionary clinics. They are small and may be inadequately stocked. Doctors and hospitals often expect immediate cash payment for medical services.
Medical conditions arising as a result of diving accidents will almost always require medical evacuation to Australia, where more sophisticated facilities are available. Medical evacuation companies could charge thousands of dollars to transport a victim to Australia or the U.S. A last-minute, one-way commercial ticket from Port Moresby to Brisbane or Cairns costs upwards of US$250 for economy class and upwards of US$550 for business class. The most commonly used facilities are in Brisbane and Cairns, both in the Australian State of Queensland. Travelers who anticipate the possible need for medical treatment in Australia should obtain entry permission for Australia in advance. Entry permission for Australia can be granted by the Australian Embassy in Port Moresby, but it is easier to obtain it prior to leaving the United States (see section above on Entry/Exit Requirements).
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Papua New Guinea. The Government of Papua New Guinea does not currently have any policy guidelines that prevent entry into the country by short- and long-term travelers and/or residents.

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 (CDC) and Prevention's hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC's web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and if 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 Papua New Guinea is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Traffic in Papua New Guinea moves on the left. Travel on highways outside of major towns can be hazardous. Motor vehicle accidents are a common cause of serious injury in Papua New Guinea, especially when passengers are sitting in the open bed of a pickup truck. Drivers and passengers are advised to wear seatbelts. There is no countrywide road network. Roads are generally in poor repair, and flat tires occur routinely as a result of potholes and debris on the roadways. During the rainy season landslides can be a problem on some stretches of the Highlands Highway between Lae and Mount Hagen. Criminal roadblocks have occurred during the day and more widely after dark on the Highlands Highway. Visitors should consult with local authorities or the U.S. Embassy before traveling on the Highlands Highway.
Crowds can react emotionally and violently after road accidents. Crowds form quickly after an accident and may attack those whom they hold responsible, stoning and/or burning their vehicles. Friends and relatives of an injured party may demand immediate compensation from the party they hold responsible for injuries, regardless of legal responsibility. Persons involved in accidents usually should proceed directly to the nearest police station rather than stop at the scene of the accident.
Please refer to our Road Safety page for more information. Visit the website of Papua New Guinea’s national tourism office and national authority responsible for road safety. For specific information concerning Papua New Guinea driving permits, vehicle inspection, road tax and mandatory insurance, please contact Papua New Guinea’s Tourist Promotion Authority via the Internet at http://www.pngtourism.org.pg/.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Papua New Guinea, the U.S. Federal Aviation Administration (FAA) has not assessed Papua New Guinea’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Customs: Papua New Guinean and Australian customs authorities enforce strict regulations concerning temporary importation into or export from Papua New Guinea and Australia of items such as firearms, certain prescription drugs, wooden artifacts, exotic animals, food, and sexually explicit material. Other products may be subject to quarantine. It is advisable to contact the Embassies of Papua New Guinea and Australia in Washington, D.C. for specific information regarding each country’s customs requirements. (See the contact information in the section on Entry/Exit Requirements above.)
Natural Disasters: Papua New Guinea is prone to earthquakes, volcanic eruptions, and sudden tidal movements. There are numerous active volcanoes throughout Papua New Guinea. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.
Documentation: U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times, so that if questioned by local officials, proof of identity and U.S. citizenship is readily available.

Please see our Customs Information.
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offences. Persons violating Papua New Guinea‘s laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession or use of, or trafficking in illegal drugs in Papua New Guinea 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. Homosexual activity is illegal in Papua New Guinea. 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 AND CONSULATE LOCATIONS: Americans living or traveling in Papua New Guinea 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 Papua New Guinea. The U.S. Embassy website is http://portmoresby.usembassy.gov. Americans without Internet access may register directly at the Consular Section of the U.S. Embassy in Port Moresby and obtain updated information on travel and security within Papua New Guinea. The U.S. Embassy is located on Douglas Street, adjacent to the Bank of Papua New Guinea, in Port Moresby, Papua New Guinea. That address should be used for courier deliveries. The mailing address is P.O. Box 1492, Port Moresby, NCD 121, Papua New Guinea. The Embassy's telephone number is (675) 321-1455; after hour’s duty officer telephone number is (675-601-9689); fax (675) 321-1593. Americans may submit consular inquiries by e-mail to ConsularPortMoresby@state.gov
****
This replaces the Country Specific Information for Papua New Guinea dated July 18, 2008 to update the section on Safety and Security.

Travel News Headlines WORLD NEWS

Date: Tue, 1 Oct 2019 06:39:06 +0200 (METDST)

Kokopo, Papua New Guinea, Oct 1, 2019 (AFP) - Papua New Guinea's volatile Ulawun volcano erupted early Tuesday, sending a column of red lava shooting up into the sky and forcing the evacuation of recently returned residents.   Mount Ulawun, situated on the remote Bismarck Archipelago chain, displaced between 7,000 and 13,000 people from their homes when it last erupted in June.   Seismic activity started at midday on Monday before the volcano erupted at about 4:30am Tuesday, according to Rabaul Volcano Observatory assistant director Ima Itikarai.   "It was noiseless and in the dark just before dawn; the eruption was visible (with) a distinct shard (of) red incandescent glow shooting up less than 100 metres from the base," he told AFP.

As light dawned, billowing clouds of grey ash could be seen rising several hundred metres into the sky, he said, while local Chris Lagisa said residents could hear the noise of gushing gas and flowing lava.   Ulamona Volcano Observatory staffer Herman Volele said ash falls could affect Kimbe, the nearby capital of West New Britain province, while regular earthquakes were also occurring in the vicinity of the volcano.   While most people affected by the previous eruption had remained at evacuation centres, an official with the West New Britain Disaster Office said a number who had returned to tend to their homes and gardens at the base of the volcano had to be evacuated again.   The volcano is one of the world's most hazardous, featuring on a list of 16 "Decade Volcanoes" targeted for research because they pose a significant risk of large, violent eruptions.
Date: Thu 1 Aug 2019 12:55 PM NZST
Source: Radio New Zealand (RNZ) [edited]

Papua New Guinea health officials have been dispatched to the Eastern Highlands after dozens of people reportedly died in a disease outbreak. The provincial governor, Peter Numu, told local media 35 people at the local hospital died from curable diseases. He said 11 died over the weekend [27-28 Jul 2019], although he didn't specify when the others died.

PNG's Health Minister, Elias Kapavore, said health department officials alongside the World Health Organisation will arrive in Goroka town today [1 Aug 2019].  "I think it is to do with the lack of infection control monitoring and prevention in the hospital that has led to this particular unfortunate scenario that has affected the lives of many of our people there." Mr Kapavore, who said he would fly to Goroka to look at the situation, noted that media reports linked the deaths to _Klebsiella_, a rare disease often caused by poor infection control.

But according to him, the National Emergency Operations Centre hadn't received a formal report by the hospital or Provincial Health Authority regarding a disease outbreak. However the minister said the situation warranted investigation.
======================
[_Klebsiella pneumoniae_ is an enteric Gram-negative bacillus that has been known to cause hospital-acquired infections and infections in debilitated or immunocompromised patients. However, a distinctive syndrome caused by _K. pneumoniae_ was first seen in Taiwanese patients in the 1980's (<https://www.ncbi.nlm.nih.gov/pubmed/7613255>). Cases have since been reported worldwide.

The syndrome is characterized by life-threatening community-acquired _K. pneumoniae_ infection in relatively healthy hosts that includes liver abscess and bacteremia complicated by the ability of the responsible _K. pneumoniae_ to spread hematogenously to the lungs, brain, meninges, eyes, prostate, bones, joints, and psoas (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732457/>).

Approximately half of the reported patients had diabetes mellitus, with the remainder displaying no apparent underlying diseases. The _K. pneumoniae_ strains were susceptible to many antibiotics, but mortality rates were as high as 10% for liver abscess and 30-40% for those with metastatic meningitis.

Colonies of the strains causing this illness were noted to be unusually mucoviscous with a positive "string test," defined as the formation of a mucoviscous string of over 5 mm in length when using a bacteriology inoculation loop to touch and stretch a colony grown overnight on an blood agar plate at 35 C [95 F] (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685062/>). The strains were called hypervirulent _K. pneumoniae_ or hvKP, and their capsular polysaccharide serotypes were found to be either K1 or K2. Whole genome sequencing indicated that the hypervirulent K1 isolates belonged to clonal complex 23 (CC23) that grouped into a distinct monophyletic clade, with global spread by multiple international transmissions (<https://www.ncbi.nlm.nih.gov/pubmed/26199326>). The hvKP carried siderophores, which confer the ability to more efficiently acquire iron in iron poor environments. A large virulence plasmid, which encodes the siderophores and a regulator of the mucoid phenotype, was detected in all hvKP clonal lineages (<https://www.ncbi.nlm.nih.gov/pubmed/26199326>). The latest development was the acquisition of the virulence plasmid by multidrug resistant hospital-associated ST11 _K. pneumoniae_.

_Klebsiella_ have been known to develop multiple antimicrobial drug resistance, commonly due to production of beta-lactamases that destroy the class of beta-lactam antibiotics known as carbapenems, as well as all other beta-lactam antibiotics. These carbapenemases are referred to as KPCs, that is, _K. pneumoniae_ carbapenemases. Some multidrug resistant strains have also been found to produce extended-spectrum beta-lactamases (ESBLs). The genes that encode KPCs and ESBLs are plasmid-mediated, which readily facilitates horizontal gene transfer between bacteria. The genes that encode these beta-lactamases are often linked to genes that encode resistance to multiple other classes of antibiotics. The principal reservoir for these organisms is the gastrointestinal tract, and spread occurs from there on the contaminated hands of healthcare workers and environment.

More information on this fatal outbreak would be appreciated from knowledgeable sources.

The eastern part of the island of New Guinea forms the mainland of Papua New Guinea, which has been an independent country since 1975. The outbreak is said to be occurring in the Eastern Highlands. Goroka, with a population of about 19 000 residents, is the capital of the Eastern Highlands Province (<https://en.wikipedia.org/wiki/Goroka>). A map showing the location of Goroka can be found at <https://goo.gl/maps/f1PxnS7c9vCogDtw8>. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Papua New Guinea:
Date: Thu, 27 Jun 2019 07:13:48 +0200

Kokopo, Papua New Guinea, June 27, 2019 (AFP) - An erupting volcano in Papua New Guinea that has blanketed a town in ash has forced around 5,000 people from their homes, officials said Thursday.   Mount Ulawun -- one of the world's most hazardous volcanoes -- began spewing lava and smoke high into the air on Wednesday.   Chris Lagisa, a community elder, said people had gathered at a church hall to flee on lorries, trucks and 4x4s, clutching sacks filled with belongings.   In the nearby provincial capital of Kimbe, grey ash that had been shot more than 13 kilometres (8 miles) into the air, turning day to night, began to fall on cars and homes.   People downwind from the volcano were advised to take precautions to avoid the ashfall, which can cause respiratory ailments, eye irritation and skin problems.   Images of the volcano early Thursday appeared to show the ash flow easing.   "Parts of (the) erupting column collapsed, sending block and ash flows down the flanks," said Rabaul Volcano Observatory chief geodetic surveyor Steve Saunders.   Initial reports from the provincial disaster committee indicate lava flows had cut through the main coastal road.

Ulawun, on the remote Bismarck Archipelago chain, is listed as one of 16 "Decade Volcanoes" targeted for research because they pose a significant risk of large, violent eruptions.   Saunders said they will be deploying staff today to Ulamona to assess the situation as the eruption continues.   "We are monitoring instrumentally from Rabaul Volcano Observatory and have access to satellite data," he said.   "However due to the continuing eruption (and) the potential for unexpected resurgence, it is recommended that the alert be raised to Stage 2," Saunders said.   National airline Air Niugini cancelled all flights into Hoskins Airport in Kimbe for an indefinite period, and the Darwin Volcanic Ash Advisory Centre issued a "red" warning to international airlines.   Thousands of people live in the shadow of Ulawun, despite its being one of the most active volcanoes in the country.
Date: Wed, 26 Jun 2019 10:37:11 +0200
By Elizabeth Vuvu

Kokopo, Papua New Guinea, June 26, 2019 (AFP) - Papua New Guinea's volatile Ulawun volcano -- designated one of the world's most hazardous -- erupted Wednesday, spewing lava high in the air and sending residents fleeing.   A pilot for Niugini Helicopters flying near the crater witnessed a column of lava spurting vertically into the equatorial sky, along with ash that has been belching since early morning.   Ulawun, on the remote Bismarck Archipelago chain, is listed as one of 16 "Decade Volcanoes" targeted for research because they pose a significant risk of large, violent eruptions.   Witnesses said lava had cut off the main highway in north of the island.   "The volcanic activity at Mt Ulawun began at 7:00 am this morning after slight rumbling and light emission," Leo Porikura, an official with the West New Britain Disaster Office, told AFP earlier.   "The Rabaul Volcano Observatory has declared a stage one alert warning of a possible eruption."

Witnesses had reported ash spewing out of the 2,334 metre (7,657 foot) summit, sending trails spanning high overhead.    "The sky has turned black," said Kingsly Quou, manager of the nearby Mavo Estates palm plantation.   Quou said that villagers living at the base of the volcano had already been evacuated and he and his colleagues were gathering their belongings.   Japanese satellite imagery and sources on the ground had shown sulphur dioxide and now volcanic ash drifting from the crater.   Australia's Bureau of Meteorology said the ash reached more than 13 kilometres (44,000 feet) into the air.   The bureau's Darwin Volcanic Ash Advisory Centre issued a "red" warning to airlines, indicating the eruption was imminent, although there is not believed to be an immediate threat for flight routes.   Thousands of people live in the shadow of Ulawun, despite it being one of the most active volcanoes in the country.

Porikura said people living in the vicinity of the volcano had been instructed to move away to safer areas and a disaster team had been dispatched.   "The disaster team will liaise with the local community, local businesses and local level government authorities to prepare for a possible eruption," he said.   "Three crucial priority areas being addressed include transport plan, care centre preparations and getting the communities in the high-risk areas to prepare for an evacuation," Porikura said.   The nearby Rabaul Volcano Observatory said emissions from the volcano were getting darker, indicating a higher ash content -- which can cause breathing problems, eye irritation and skin irritation because of the high acid content.   A team of experts had visited earlier this month and reported the volcano was "quiet" adding "there is no indication of any change in its state of unrest."   The ash emissions had been proceeded by an increase in seismic activity, Porikura said.
Date: Tue, 7 May 2019 01:11:25 +0200

Port Moresby, May 6, 2019 (AFP) - A powerful but deep 7.2-magnitude earthquake rocked Papua New Guinea on Tuesday, officials said, cutting power and knocking items off shelves though there were no immediate reports of serious damage.

The quake struck at a depth of 127 kilometres (80 miles) about 30 kilometres (20 miles) from the town of Bulolo at 2119 GMT Monday according to the US Geological Survey, and was felt in the capital Port Moresby about 250 kilometres away.   Officials said there were no immediate reports of major damage and the depth of the tremor meant there was no tsunami threat.   "We have no reports as yet" of serious damage, Inspector Leo Kaikas, Bulolo police station commander, told AFP. "We are still assessing the situation," he said.

Staff at Bulolo's Pine Lodge hotel said there was very minor damage from objects falling off tables, but nothing more serious.   Residents in Lae, more than 100 kilometres away, said the quake knocked things off shelves and worktops and cut electricity in some areas.   "I had just woken up," Christopher Lam, a designer who lives in the city, told AFP. "It lasted a little more than 30 seconds. We had household items knocked off their shelves and the power got cut.   "Things seem to have returned to normal. No structural damage here, though I'm not sure about other buildings in the city."   There are estimated to be around 110,000 people living within 50 kilometres of the epicentre, according to UN data.

The Moresby-based National Disaster Management office said while there were no early reports of damage, but news from the quake zone could take time to trickle in.  "We are awaiting assessments," a spokesman told AFP.   The country's rugged highlands region was hit by a 7.5-magnitude quake in February last year that buried homes and triggered landslides, killing at least 125 people.

The scale of that disaster did not become apparent for days due to PNG's poor communications and infrastructure.   There are regular earthquakes in Papua New Guinea, which sits on the so-called Pacific Ring of Fire -- a hotspot for seismic activity due to friction between tectonic plates.   Along the South Solomon trench, an area of the Pacific that includes PNG, there have been 13 quakes of magnitude 7.5 or more recorded since 1900, according to USGS data.
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Finland

Finland - US Consular Information Sheet
January 13, 2009
COUNTRY DESCRIPTION:
Finland is a highly developed democracy with a modern economy.
It is a member of the European Union.
Tourist facilities are widely available.
Read
the Department of State Background Notes on Finland for additional information.
ENTRY REQUIREMENTS:
Finland is a party to the Schengen agreement.
As such, U.S. citizens may enter Finland for up to 90 days for tourist or business purposes without a visa.
The passport should be valid for at least three months beyond the period of stay.
For further details about travel into and within Schengen countries, please see our Schengen fact sheet.

Travelers can contact the Embassy of Finland at 3301 Massachusetts Avenue, N.W., Washington, DC 20008, tel: (202) 298-5800, or the Finnish Consulates General in Los Angeles or New York.
Additional information is available via the Internet at http://www.finland.org.
The U.S. Embassy in Helsinki is not able to assist private U.S. citizens in obtaining any necessary visas for neighboring countries, including Russia and other countries of the former Soviet Union.

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:
Finland remains largely free of terrorist incidents.
However, like other countries in the Schengen area, Finland’s open borders with its Western European neighbors allow the possibility of terrorist groups entering/exiting the country with anonymity.
Elements of organized crime groups operating in the former Soviet Union and Eastern Europe are present in Finland, but these do not represent a specific danger to U.S. citizen residents or tourists.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up to date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the United States and Canada, or for callers outside the United States and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

CRIME:
Although the crime rate in Finland is low compared to the U.S. and most European countries, it has increased in recent years; however, Finland remains a relatively safe environment.
Americans visiting Finland are seldom victims of crime, but visitors should not be complacent regarding personal safety or the protection of valuables.
The same precautions employed in the U.S. should be followed in Finland.
Finnish police services are excellent. Travelers should be aware that some police officers speak little English.
Due to the low crime rate, Finland has one of the lowest numbers of police officers of any European nation.
Outside of key sites in major urban centers, they rarely project a visible presence; consequently, response times to crisis situations may be unpredictable.
All forms of public transportation are considered safe.
Street crimes, such as muggings and pick-pocketing, remain uncommon, but do occur.

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

Finland has a program to provide financial compensation to victims who suffer serious criminal injuries.
According to existing regulations, the victim must report the incident to the police and file an application for compensation within 10 years of the date of the crime.
Finnish police routinely inform victims of serious crime of their right to seek compensation.
The relevant forms and further information can be obtained from http://www.treasuryfinland.fi.
The local equivalent to the “911” emergency line in Finland is 112.
Please see our additional information for Victims of Crime, including possible victim compensation programs in the United States.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country’s laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Finland’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Finland are strict and convicted offenders can expect jail sentences and heavy fines.
Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties
SPECIAL CIRCUMSTANCES:
Commercial and financial transactions in Finland are increasingly automated and on-line.
Cash is almost always acceptable (the currency is the euro), but most major credit cards are widely recognized.
Automatic Teller Machines are very common and many U.S.-issued bankcards are compatible with them.

MEDICAL FACILITIES and Health information:
In Finland, medical facilities and their staff are generally excellent and are widely available for emergency services.
English is commonly spoken by Finnish medical personnel.
Helsinki is a frequent medical evacuation point for emergency cases from the countries of the former Soviet Union.
The public hospital system and many private hospitals honor foreign credit cards.
Most pharmacies (“apteekki” in Finnish) are open during normal shopping hours and major cities have at least one 24-hour service pharmacy.
If you are a tourist or temporary visitor to Finland and you require immediate emergency medical assistance, you may visit a local medical center or clinic, called “ensiapuasema” (first-aid station) in Finnish.
Usually these stations are located at hospitals and provide a full range of services.
The emergency telephone number, 112, can be used throughout Finland to contact emergency medical services.
For more detailed information on medicines and medical issues, please visit the website of the Finnish Embassy in Washington, DC at http://www.finland.org.
Travelers with special medical needs should consult with their personal physicians and take appropriate precautions, including bringing adequate supplies of necessary medication.
Medicines may be brought into the country as long as they are intended for the traveler’s personal use, however, there are special requirements concerning the quantity.
Medications categorized as narcotics may only be brought into the country to cover the traveler’s personal use for a maximum of 14 days and must be accompanied by a medical certificate stating why the traveler needs them.
For more detailed information, please contact the Finnish Embassy in Washington, DC at http://www.finland.org
In addition, stringent Finnish customs regulations prohibit travelers from receiving drugs from abroad after having arrived in the country.
Travelers may also find local physicians reluctant to prescribe equivalent quantities of dosages.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Finland.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith.
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their 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 Finland is provided for general reference only and may not be totally accurate in a particular location or circumstance.
Finnish roads are comparable to those in the U.S., though secondary roads may be less heavily traveled due to Finland’s sparse population outside the major urban areas.
These secondary routes often narrow to two lanes with a wider shoulder.
Slower vehicles are expected to move onto the shoulder to allow faster moving vehicles to pass.
Finland has an extensive network of highways throughout the country, as well as excellent public transportation services.
A valid U.S. driver’s license may be used while visiting Finland, but drivers must be at least 18 years of age.
Driving in Finland is on the right.
Traffic approaching from the right usually has priority, even if entering a primary roadway from a secondary one.
Road signs use standard international symbols and Finnish text.
Many urban streets have traffic lanes reserved for public transportation only.
Unless otherwise noted on traffic signs, the speed limit is 50 km/h in urban areas, 80 km/h on open roads, and 120 km/h on expressways during summer (reduced to 100 km/h during winter).
Vehicles must use headlights at all times.
Use of seatbelts is mandatory for drivers and all passengers.
Minor children must be seated in approved child or booster seats.

Public transport in Finland is of good quality and is the recommended method of travel.
Passenger trains, intercity buses, and air flights provide regular service over longer distances.
Public transportation in urban centers includes buses, subways, trams, suburban trains, and taxis.
Taxis are more expensive than in major U.S. cities.
Most local residents use public transport in Helsinki as parking can be hard to find and expensive.
The bus, train, and subway systems are relatively safe.
Travelers should be aware that drunk-driving laws are strict and acceptable blood alcohol levels are much lower in Finland than in the U.S.
Police strictly enforce all traffic laws and institute random roadside breath analyzer tests.
Drivers who register .05 or above alcohol content are subject to immediate arrest.
Drivers should be aware that regulations and traffic signs differ significantly from those in the U.S.
Visitors should be familiar with both prior to operating a vehicle in Finland.
Driving in Finland during the winter months can be hazardous.
Daylight hours are very short and one should be comfortable with driving in darkness.
Icy road conditions are common.
If driving in Finland, the vehicle must be winterized with studded snow tires and engine heaters are strongly recommended.
When driving at night, drivers must be alert to moose wandering onto major roadways.
There have been incidents of moose being struck by vehicles, causing severe damage to the vehicle and injury, sometimes fatal, to the occupants.
For real-time updates on road conditions throughout Finland, see the Finnish Road Administration’s travel and traffic information web site at http://www.finnra.fi
Please refer to our Road Safety page for more information.
Visit the website of the country’s national tourist office and national authority responsible for road safety at http://www.mek.fi
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Finland’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Finland’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
Please see our information on customs regulations.

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

REGISTRATION AND EMBASSY LOCATION:
Americans living or traveling in Finland are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website, https://travelregistration.state.gov, so that they can obtain updated information on travel and security within Finland.
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 Itainen Puistotie 14B.
The telephone number for the American Citizens Services unit is 358-9-616-25-701, 0830 to 1700 Monday to Friday (after hours, 358-9-616-25-0); the fax number is 358-9-616-25-800; e-mail:
HelsinkiACS@state.gov.
The address of the Embassy’s Internet home page is http://www.usembassy.fi
*

*

*
This replaces the Consular Information Sheet dated May 23, 2008 to update the sections on Information for Victims of Crime and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Fri 14 Dec 2018
Source: UUTISET [edited]

An unvaccinated individual, who caught the contagious disease in Poland, attended a large church service in Tampere and infected at least 2 other people. Three adults have been diagnosed with measles in Tampere after attending a Catholic parish church event in late November along with more than 100 people, according to the Pirkanmaa Hospital District.

Two of the adults diagnosed have been vaccinated, so they are not contagious. The source of the outbreak is an unvaccinated person, who caught the measles in Poland. But according to the Pirkanmaa Hospital District, further cases may still arise.

In 1975 Finland began to administer a single dose of the measles vaccine to all one-year-olds and by 1982 Finland began administering the vaccine in 2 doses between the ages of 1 and 6. However some people born in the 1970s are among those who received only one jab. MMR is a triple-dose vaccine that provides protection against measles, mumps and rubella.

Measles spread at religious event
---------------------------------
The event in question was Tampere's Pyhan Ristin (Sacred Cross) Catholic Parish church mass on 25 Nov 2018. It was attended by more than 100 people, including children. Pirkanmaa Hospital District doctor Kirsi Valve, a specialist in infectious diseases, confirmed that the infected individual who caught the measles in Poland was at the church event. The cases came to light when 2 vaccinated individuals contracted high fevers and came down with skin rashes. The unvaccinated person, who infected the others, has had more severe symptoms than the vaccinated individuals.

"The individuals quickly got in touch with healthcare services owing to high fevers, and skin rashes that rapidly spread all over their bodies," says Valve. "It was confirmed that on 25 Nov 2018 the unvaccinated individual who caught the measles in Poland and brought it back to Finland was at the parish event and is the source of the outbreak."

As the source of the outbreak is known, healthcare officials are also looking into whether the person could have possibly exposed others.

Measles in the news
-------------------
Measles has been on the agenda this winter after an unvaccinated child in Ostrobothnia took ill with measles. Meanwhile, it also came to light that many adults in Finland may not have been vaccinated against measles during the early 1970s.

Measles is a rare disease. The previous outbreak was 2 summers ago when 4 vaccinated children caught measles in Italy and started showing symptoms after returning to Finland. The Pirkanmaa Hospital District recommends that anyone who attended the Catholic parish event in late November 2018 and exhibits symptoms that suggest measles or anyone who hasn't been vaccinated with the MMR vaccine contact their healthcare centre.

If those who attended the parish event are healthy, but have not been vaccinated, the Pirkanmaa Hospital District recommends that they contact their healthcare centre to be vaccinated. The measles vaccine is free and administered as part of the MMR shot, which also provides protection against rubella and the mumps.
Date: Fri 2 Nov 2018
Source: UUTISET [edited]

Around 1/3 of the ticks in Finland -- mostly found in the south -- carry at least one pathogen, and 2 percent of the persistent arachnids carry several disease-causing agents, researchers at Turku University said.

About 30 percent of common ticks and 24 percent of taiga tick populations have been found to carry one disease pathogen. Common ticks more commonly carry several disease-causing pathogens than taiga ticks, according to the researchers.

The most common pathogen found in the ticks was _Borrelia burgdorferi_, the bacterial species that causes Lyme disease in humans, an illness referred to locally as borreliosis. The pathogen was found in 17 percent of the ticks at the university's growing tick database bank.

Lyme disease cases are treated with aggressive antibiotics without necessarily determining which specific bacterium is responsible for the infection.

Thanks to a growing tick database at the University of Turku, researchers have new insights into the disease pathogens that the tiny, blood-sucking arachnids carry.

New research has revealed that ticks on the south coast carry the most pathogens, but the region is almost exclusively home to the most common ticks: _Ixodes ricinus_, or castor bean ticks).

Both castor bean ticks and taiga ticks [_Ixodes persulcatus_] are now commonly found in areas across central Finland, the researchers said. Even further north, the tick populations are quite similar to ones in central areas, but the taiga has become more common in the north.

About 3 years ago, researchers at the university asked members of the public to send in ticks they had found, and now the institution has received more than 20 000 ticks. The researchers say that they want to take advantage of the significant amount of information they can learn from the specimens.

Examination of those thousands of tiny arachnids have uncovered many types of disease-causing bacteria, and researchers have new insights into the arachnids themselves and the potential illnesses they carry.

The researchers said they hope to learn more about ticks, saying that their research has only begun, and that their study of the ticks will continue for several years. Ultimately, their goal is to find how tick-borne illnesses are transmitted, they said.
======================
[This is an interesting example of how a large group of people, many undoubtedly non-scientists, can contribute to an effort that requires many hours of collection effort. Although _Borrelia burgdorferi_ is endemic in Finland, finding it and possibly other bacterial pathogens in about 1/3 of the 20 000 ticks collected is of public health significance. _Ixodes ricinus_ is also the tick vector of European tick-borne encephalitis virus, but no mention is made of it in the above report. Perhaps it was not tested for. Images of both ticks can be found in the above report. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Date: Thu, 1 Nov 2018 16:46:12 +0100
From: topic@afp.com

Helsinki, Nov 1, 2018 (AFP) - Santa Claus has already begun his preparations in Lapland -- by protecting himself from winter viruses and making sure he hires enough elves.   On Thursday nurse Tiia Kahkonen administered an anti-influenza vaccine to Santa, at his village in the Arctic Circle town of Rovaniemi, northern Finland. 

The jab is likely to be a sensible precaution, as the flu season coincides with the busiest time of the year by far in Lapland.    In December last year 390,000 foreign visitors spent a night in Finnish Lapland, an increase of almost ten percent on the previous Christmas.    By far the largest group of Christmas holidaymakers were Brits, followed by Russian, French and German tourists, according to official statistics.

Meanwhile a recruitment agency in Finnish Lapland, inside the Arctic circle, has put out a call for Christmas elves to look after the hordes of tourists who come to visit Santa in his natural habitat during the winter months.   Prior experience is not essential as the advert, posted by the firm Lapland Staff, promises that training will be provided in "the required elfing and communication skills."   Successful applicants will also be given tips on how to deal with the cold in northern Finland where temeratures rarely rise above zero degrees Celsius, and can drop as low as minus 40.

Although handling Santa's reindeer is not listed among the job's duties, elves will need to herd groups of visitors on and off buses, as well as keep tourists entertained. "Looking after the fireplace and pouring hot juice" are also required, as is supervising the toboggan hill.   Tourism to Lapland has reached an all-time high in recent years, with visitors spending 3.5 million nights in Lapland across the whole year, up from 2.6 million a decade earlier, according to Statistics Finland.    Much of the recent growth has been driven by tourism from Asia.
Date: Sun, 17 Dec 2017 04:43:36 +0100
By Camille BAS-WOHLERT

Rovaniemi, Finland, Dec 17, 2017 (AFP) - In the run up to Christmas tourists from around the world flock to the Santa Claus Village, an amusement park in Finnish Lapland, where temperatures can hit nearly -15 degrees Celsius (5 Fahrenheit).    They buy soft toys and souvenirs from pricey gift shops while a bearded Santa receives hundreds of admirers a day throughout December before embarking on his world tour from the valleys of Finland to the skyscrapers of New York and beyond to deliver gifts.

Holding their winter beanie hats in their hands, visitors wait patiently in line for a brief encounter with "Joulupukki" -- the Finnish word for Santa Claus -- and a photo opportunity in exchange for hard currency.    "We've seen other Santas but that wasn't the real one. But we're told that is the real one," said Mary Gleadall, an eight-year-old tourist from Southampton in the UK, visiting the amusement park with her parents, brother and sister.    According to Christmas lore, Santa lives in a secret place in the middle of the snowy pines of the North Pole. But the question is where?     Since 2010, Rovaniemi, the capital of Finnish Lapland, has marketed itself as Santa's "official home".    Situated a few miles from the city, the Santa Claus Village is located in front of a huge gas station. 

Tourists rush to cross the Arctic Circle, marked by a white line, to meet Santa Claus in his wooden home with a pointed roof.    But entering his private cottage is out of the question as Mother Claus is reportedly protective of their privacy.    In a large room, the white-bearded old man sits in an armchair next to a chest full of letters.    Each year, he receives more than 300,000 visitors, a deluge he embraces with humility.    "I'm very happy. I'm not exhausted but, of course, I get tired once in a while" he says.    And how does Santa Claus regain his energy?    "I love to take nap every once and then. Fifteen minutes sleeping and then all is very good." he says.

- Exalted tourists -
Shizuka Kawahara and Saki Itoi, Japanese tourists in their thirties, flew for more than 24 hours to hug Santa for a few seconds in a precious moment immortalised with a photograph taken by an elf.    The price for one shot starts at 30 euros ($35). Photographing with one's own camera is forbidden as it would ruin the magic of the moment, says the staff of the house.     Four-year-old Harry Gleadall, Mary's brother, approaches Santa without fear.    He quickly states his list of what he wants for Christmas: Transformers and some more Transformers before he skeptically shakes Santa's hand.    "But what if it wasn't the real Santa Claus?" Harry asks with concern.    Eager to set the record straight -- and justify the long trip -- his mother quickly assures him that the chubby red-clothed man is indeed the real deal.    After a tour around the shop which sells hand-made "Lapland" emblems and tons of souvenirs, the family is back in the village square, surrounded by wooden homes, Christmas carols piped out of nearby speakers.

- Polar safari -
In this winter wonderland, tourists have the opportunity to go on a reindeer sleigh ride.    A snow "safari" of 400 metres costs 14 euros per child and 18 euros per adult, an exotic experience for many foreigners who seek to discover the arctic landscapes steeped in pink light.    The -13 degrees Celsius does not discourage the plucky visitors bundled up in their ski suits.    "Everything that have been told to me during childhood, it's come true," said Perpetua, a tourist from Dubai, describing the break from the year round desert climate as "heaven".   "We expected magic and this is what we found," added Max, an Italian tourist. "Everything seems to be magic, the lights, the place, everything here".   But Miriana, a 24-year-old Italian on a university exchange programme in southern Finland, was less convinced.   "The place is really nice. But I think nevertheless that it's a bit commercial," she said.
Date: Tue 18 Oct 2016
From: Tiina Nokireki <tiina.nokireki@evira.fi> [edited]

The Finnish Food Safety Authority (Evira) received a bat (Daubenton's bat, _Myotis daubentonii_) for laboratory analyses. The bat was found by a private person. The bat had neurological signs and then died.

Laboratory analyses conducted during the 13 and 14 Oct 2016, confirmed the presence of rabies by FAT. The virus was then identified as European Bat Lyssavirus type 2 (EBLV-2) by RT-PCR and partial sequencing of the gene for the nucleoprotein. Also cell culture is positive.

The bat originated from Inkoo in the province of Southern Finland and is part of the Uusimaa region. This is the 2nd case of EBLV-2 in a bat in Finland.
-----------------------------------------
Tiina Nokireki
Head of Section, DVM, Specialist in Veterinary Medicine, Infectious
Diseases
Finnish Food Safety Authority Evira
Research Department, Veterinary Virology
Mustialankatu 3,
FI-00790 Helsinki,
Finland
=========================
[Special thanks to Dr. Nokireki for this important contribution. Infections by European Bat Lyssavirus type 2 (EBLV-2) have been previously reported in Northern Europe, not only in bats, but also in humans. EBLV-1 appears to be more prevalent, accounting for the vast majority of all EBLV-infected bats. Reports of EBLV-2 correspond to Daubenton's bats (_Myotis daubentonii_), indicating that this bat species is the reservoir of this _Lyssavirus_ strain.

For a picture of a Daubenton's bat go to

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

Botswana - US Consular Information Sheet
August 29, 2008
COUNTRY DESCRIPTION:
Botswana is a country in southern Africa with a stable democratic government and a growing economy. Facilities for tourism are widely available. Read the Departm
nt of State Background Notes on Botswana for additional information.

ENTRY/EXIT REQUIREMENTS: A passport with at least six months of validity remaining is required. U.S. citizens are permitted stays up to 90 days without a visa. For additional information on entry requirements, travelers may contact the Embassy of the Republic of Botswana, 1531-1533 New Hampshire Avenue NW, Washington, DC 20036, telephone (202) 244-4990/1, fax (202) 244-4164 or the Permanent Mission of the Republic of Botswana to the United Nations, 103 E. 37th St., New York, NY, 10016, telephone (212) 889-2277, fax (212) 725-5061. There are also honorary consuls in Los Angeles, San Francisco and Houston. Visit the Embassy of Botswana’s web site at http://www.botswanaembassy.org/ for the most current visa information. As a general precaution, all travelers are advised to carry a photocopy of the photo/bio information page of their passport and keep it in a location separate from the passport.

Visitors to Botswana who also intend to visit South Africa should be advised that the passports of all travelers to South Africa must contain at least two blank (unstamped) visa pages each time entry to South Africa is sought; these pages are in addition to the endorsement/amendment pages at the back of the passport. Otherwise, the traveler, even when in possession of a valid South African visa, may be refused entry into South Africa, fined, and returned to their point of origin at the traveler’s expense.

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:
Civil unrest and disorder are rare. U.S. citizens should avoid crowds, political rallies, and street demonstrations and maintain security awareness at all times.

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

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

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

CRIME: Crime is a serious concern in Botswana. Visitors must be vigilant and take common-sense security precautions. The criminal threat is very similar to that of any large urban area. Petty street crime and crimes of opportunity, primarily the theft of money and personal property, are not uncommon. Home invasions ‘smash and grabs’ from vehicles, and cell phone thefts, often at knife point, are routinely reported to the police. Visitors should use care when talking on a cell phone while walking. Urban areas are particularly dangerous at night; pedestrians are advised to avoid walking in Gaborone and other urban areas in Botswana at night. Except for visits to the Gaborone Yacht Club during daylight hours, U.S. Embassy personnel are prohibited from traveling to the area surrounding the Gaborone Dam and to the Kgale Hill area, a popular Gaborone hiking venue, because of multiple incidents of violent crime. American citizens are urged to avoid these areas.

Travelers arriving in Botswana via South Africa should be aware that there is a serious baggage pilferage problem at OR Tambo (Johannesburg) and Cape Town International Airports. Travelers are encouraged to use an airport plastic wrapping service and to avoid placing electronics, jewelry, cameras, designer athletic gear, or other valuables in checked luggage. Also, make an inventory of items in checked baggage to aid in claims processing if theft does occur.

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.

Botswana has three numbers equivalent to the “911” emergency line. For police assistance, dial “999.” For an ambulance, dial “997.” In the event of a fire, dial “998.”

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities in Gaborone are adequate for simple medical problems, but facilities outside of Gaborone are limited. Adequately equipped emergency rooms and trained physicians are available in the capital but services are rudimentary elsewhere. Professional private emergency rescue services operate air and ground ambulances throughout the country, but care is rendered only after a patient’s ability to pay is established. Response times are often slow in less populated areas. Outside of Gaborone, most airports are either not equipped or have frequently malfunctioning night lighting capability, so airborne medical evacuations can usually only be conducted during daylight hours. Malaria is prevalent only in the north of the country, particularly around the Chobe and Okavango National Parks. Malaria prophylaxis is not required in Gaborone but is suggested for travel to the north. For advanced care Americans often choose to travel to South Africa. Many South African manufactured prescription drugs are available in Gaborone.

Approximately one-quarter of the population of Botswana is infected with HIV, the virus that causes AIDS. Travelers are advised to exercise appropriate precautions if engaging in sexual activity, or if exposed to blood products through injuries or rendering assistance to accident victims. Tuberculosis is also endemic to Botswana. Two cases of extensively drug resistant tuberculosis (XDR-TB) have been identified in Botswana since January 2008 when Botswana first obtained the ability to test for this form of TB. Individuals who plan to reside or stay in Botswana for extended periods are advised to obtain a tuberculosis skin test (PPD test) prior to arrival and again upon departure from Botswana.

There are occasional diarrhea outbreaks in areas affected by heavy rains. Travelers are encouraged to take necessary precautions when handling food and drinking water.

The Department of Immigration of Botswana does not impose any HIV/AIDS entry restrictions for visitors to or foreign residents of Botswana.

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

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

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

Driving in Botswana is challenging and motorists must drive defensively. Traffic circulates on the left in Botswana, as elsewhere in the region. While the roads in major population centers in Botswana are generally good, many roads have been damaged by heavy rains in December and January. Travel by automobile outside of large towns may be dangerous. The combination of long, tedious stretches of two-lane highways without shoulders, high speed limits, and poor lighting make driving at night on rural highways particularly hazardous. Recent rolling power outages mean that many traffic lights and street lamps do not work properly. Free-range domestic animals, even in urban centers, and large numbers of pedestrians and hitchhikers in the roadways make fatal accidents a frequent occurrence.

‘Smash and grab’ robberies from vehicles are not uncommon in Botswana, particularly in urban areas at traffic lights. Motorists should avoid carrying anything of value (hand bags, briefcases, purses, cell phones, etc.) in the passenger compartment that could attract potential assailants.

Please refer to our Road Safety page for more information. Visit the web site of Botswana’s national tourist office and national authority responsible for road safety at http://www.botswana-tourism.gov.bw.

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

SPECIAL CIRCUMSTANCES:
Since February 2008, rolling electric power outages have left many areas without power for several hours each week. This situation is likely to continue. Visitors are urged to carry flashlights. American citizens are also urged to be aware of how power outages might affect home security systems, garage doors and gates, and kitchen equipment, such as stoves and refrigerators. The power fluctuations could cause power surges that might harm computers, televisions, or other electrical appliances.

Botswana strictly enforces its laws controlling the trade in animal products. The hunting of lions is explicitly prohibited and leopards and elephants are covered under a strict quota regime. Botswana's Wildlife Conservation and National Parks Act makes it illegal to possess or remove from Botswana without a government permit any living or dead animal or animal trophy. A trophy is any horn, ivory, tooth, tusk, bone, claw, hoof, hide, skin, hair, feather, egg, or other durable portion of an animal, whether the item has been processed or not. Curio shops and vendors throughout the country sell items such as animal skins, plain and decorated ostrich eggs and eggshells, and carved bones or teeth of animals protected by this law. All of the souvenirs, although widely sold, are subject to this act. Travelers departing the country with a trophy must have a receipt from a store licensed to sell such items. Ivory and endangered rhinoceros horn products obtained in Botswana may not be removed from the country under any circumstances; elephant hair jewelry may be removed only with the appropriate license from the Department of Wildlife and National Parks. Trophies may not be taken from the wild without a permit. Violators are subject to arrest and may face a penalty of up to five years imprisonment and a substantial fine.

Wild animals may pose a danger to tourists. Tourists should bear in mind that, even in the most serene settings, the animals are wild and can pose a threat to life and safety. Tourists should use common sense when approaching wildlife, observe all local or park regulations, and heed all instructions given by tour guides. In addition, tourists are advised that potentially dangerous areas sometimes lack fences and warning signs. Exercise appropriate caution in all unfamiliar surroundings. Please see our Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Botswana’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Botswana 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 Botswana 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 Botswana. Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located in Gaborone on Embassy Drive in the Government Enclave. The mailing address is P.O. Box 90, Gaborone, telephone +267 395-3982; fax +267 318-0232; email consulargaborone@state.gov, and the after-hours emergency telephone is +267 395-7111.
* * *
This replaces the Country Specific Information for Botswana dated March 5, 2008, to update the sections on Information for Victims of Crime and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Tue, 22 Oct 2019 18:42:15 +0200 (METDST)

Gaborone, Botswana, Oct 22, 2019 (AFP) - More than 100 elephants have died in two months in Botswana's Chobe National Park due to drought, which has also affected wildlife in other countries in the region, the government said Tuesday.   Several southern African countries are enduring one of the worst droughts in decades, caused by months of over-average temperatures and erratic rainfall.   The drought has wilted grasslands and dried up water holes, making it increasingly difficult for animals to survive.    Botswana's environment ministry said it has recorded a spike in the number of elephant and other animal deaths since May.    "More than one hundred elephants are estimated to have died naturally in the past two months," the ministry said in a statement, adding that 13 deaths were recorded just this week.

In neighbouring Zimbabwe, Its wildlife agency has recorded at least 55 elephant deaths over the past month due to lack of food and water.  Preliminary investigations in Botswana have also suggested some of the elephants may have died from anthrax.   "Due to the severe drought, elephants end up ingesting soil while grazing and get exposed to the anthrax bacteria spore," the ministry said in a statement.   "The animals are also travelling long distances in search of food which leaves some highly emaciated, ending in death."   Anthrax is an infectious disease found naturally in soil. It is generally contracted by herbivores and is a common cause of death for both wild and domestic animals around the world.      The environment ministry said it would be burning "anthrax related carcasses" to prevent the disease from spreading to other animals.   It warned the public not to touch any animal carcasses they might find and report them to the authorities.
Date: Tue 22 Oct 2019 9:28 PM CAT
Source: Reuters [edited]

More than 100 elephants have died in Botswana in the past 2 months partly because of a suspected anthrax outbreak, the government said on [Tue 22 Oct 2019]. "Preliminary investigations suggest the elephants are dying from anthrax whilst some died from drought effects," a Department of Wildlife and National Parks statement said. "Due to the severe drought, elephants end up ingesting soil while grazing and get exposed to the anthrax bacteria spore," it said.

Elephants Without Borders said an aerial survey showed fresh elephant carcasses increased by 593% between 2014 to 2018, mostly from poaching and illegal hunting, with drought also a contributing factor. The wildlife authority said the latest deaths were in the Chobe River front and Nantanga areas in northern Botswana, where 14 dead elephants were found this week. It said it would be burning the carcasses to prevent the anthrax infection from spreading to other animals.

According to the Centers for Disease Control and Prevention in the United States, anthrax is a bacterium found naturally in soil and commonly affects domestic and wild animals when they breathe in or ingest spores in contaminated soil, plants, or water. Anthrax is not contagious and humans can only get infected by ingesting the bacteria. It can be prevented in animals via regular vaccination.

Botswana is home to almost 1/3 of Africa's elephants, around 130,000.  Botswana has lifted a ban on big-game hunting to combat a growing conflict between humans and wildlife. Botswana and its neighbors in southern Africa are experiencing a severe drought because of below-average rainfall since an El Nino weather system struck in 2015.  [Byline: Brian Benza, writing: Mfuneko Toyana; editing: Grant McCool)
====================
[Check CBC
which has a nice picture of 2 Okavango Delta bull elephants.

Elephants can graze, although they are usually browsers of branches and vegetation off trees. They are attracted to water. So the source is presently uncertain but might have been a secondary spread from a prior wildlife case that resulted in contaminated browse from blow flies or water from a contaminating carcass. Until a cheap and effective wildlife oral vaccine can be developed, these cases in Chobe will be a constant sporadic event. As elsewhere, the best control is to burn any carcasses and disinfect any contaminated soil. -

Chobe is on the northern border of Botswana abutting the Caprivi Strip of Namibia; see

[HealthMap/ProMED-mail map of Botswana:
Date: Fri, 30 Aug 2019 11:13:54 +0200 (METDST)

Maun, Botswana, Aug 30, 2019 (AFP) - A calf struggles neck-high in the stew-like mud, kicking frantically to make its way across the mire.   Around 38,000 livestock depend on the waters of Lake Ngami in northern Botswana, but the animals -- like the lake itself -- have been stricken by a crippling drought.   Grazers have to walk long distances in hopes of finding anything to eat. Some succumb to the heat and vultures can be seen feasting on their corpses in the sludge of the lake bed.

In May, President Mokgweetsi Masisi officially declared Botswana to be in drought after months of unevenly distributed rains, heat waves and dry spells.   Rural households have been especially hit, and are looking to the government for help.   Southern Africa has been hard hit by intensifying extreme weather conditions such as drought and floods, leaving millions in need of food aid.

Zambia is in the throes of a drought which has affected the 2018/19 farming season. Around 2.5 million people are facing food shortages, according to official figures.

In Zimbabwe, nearly a third of the 16 million population are in need of aid and at least half of these face acute hunger, according to the World Food Programme (WFP).   Lake Ngami is also home to around 100 hippos, half of whom have cannily migrated to parts where life is easier.   "Only the livestock is trapped in the muddy waters," the acting director of wildlife and national parks,  Moeti Batshabang, told AFP.
Date: Wed 15 Nov 2017 20:00 pm (GMT +2)
Source: MMEGI online [edited]

Dozens of Nthompe Koma Primary School pupils on Monday night [13 Nov 2017] thronged Mahalapye health facilities following a food poisoning incident allegedly caused by rape they ate at school.

Classes came to a halt yesterday [14 Nov 2017] as more students showed signs of food poisoning while health workers were present at the school and hospital to establish what could have caused the incident that led to at least 26 pupils being admitted at Mahalapye Hospital. According to a source, it is suspected that the students were fed rape, which was recently sprayed with pesticides.

"The students started vomiting and having diarrhoea at their homes after school. A huge number of them were rushed to the hospital and it was said that the newly treated vegetable was given to them," the source said.

Mahalapye Hospital Superintendent, Dr Kumal Bose said they are yet to establish the cause of diarrhoea and vomiting, whether it is the food they ate or not. "We attended to a total of 82 students of whom 26 were admitted and others discharged. More students were coming in this morning [15 Nov 2017].

We have sent our public health team to the school to investigate all possible causes," he said. Mahalapye chief education officer,

Maria Dikeme [Principal Education Officer] confirmed the incident. "It is true that a lot of students from the school were taken to various health facilities yesterday [14 Nov 2017].

The students were fed sorghum and rape at break time and the sorghum has been taken for tests by the public health team. All of the rape was cooked yesterday. We will, however, go to the source if there is still any left so that it can be tested," she said.

Dikeme said more students were taken to the hospital the following day as some developed signs late.

"We do not have a certain number currently, but we have recorded over 100 cases with 11 pupils still admitted at the hospital," she said.

She said they kept the pupils within the school so they could monitor them rather than sending them home while parents are at work.

Dikeme said there were some pupils who were in school yesterday [14 Nov 2017] who were not affected and that there was no report of any adult person having been diagnosed with the same problem.  [Byline: Innocent Selatlhwa]
===================
[Rape seed and soybeans are both grains. This article says a possible pesticide. The class of chemicals causing these clinical signs would be organophosphates. Grains are often treated with chemicals to prevent insect infestation and ruination of the crop. Therefore it is possible an organophosphate was used on the grain, and not washed or cleaned before being put into human consumption, could produce vomiting and diarrhoea. These could be signs associated with organophosphates. There are likely other crop chemicals capable of producing this, but the organophosphate class is large with numerous chemicals.

The article does not tell us if the pupils are being treated or if they are, what they are being treated with.

Consequently, the results of the testing is very important. Hopefully the testing will reveal the cause of this situation. - ProMED Mod.TG]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Tue 10 Oct 2017 15:55 pm (GMT + 2)
Source: MmegiOnline [edited]

The Department of Wildlife and National Parks (DWNP) has noted a high number of dead hippopotamuses along the Okavango River near Mohembo.

A statement from the from DWNP says the carcases are floating in the river from Namibia into Botswana. "The cause of death is not known at the moment. The veterinarians are working hard to establish it," says the statement.

The public is therefore warned not to touch any carcass found along the river or anywhere else. "Eating meat of these animals will be very dangerous as Anthrax is suspected to be causing the mortalities. Any sightings are to be reported to the nearest DWNP office, police station or kgotla".
=====================
[Mohembo is on the Botswana/Namibian border, and the Okavango river comes straight from the Bwabwata NP; see:

According to Wikipedia: "Before it enters Botswana, the river drops 4 metres in a series of rapids known as Popa Falls, visible when the river is low, as during the dry season." [<https://en.wikipedia.org/wiki/Okavango_River>] So these carcasses may be poor condition. But either way, the warning to the locals not to butcher them is very wise. - ProMED Mod.MHJ]

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

Georgia

Georgia US Consular Information Sheet
COUNTRY DESCRIPTION:
Georgia is a constitutional republic with a developing economy.
Tourist facilities outside of Tbilisi are not highly developed, and many of the goods and services taken for granted
in other countries are not yet available.
Read the Department of State Background Notes on Georgia for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport is required.
U.S. citizens visiting for 90 days or less do not need a visa to enter Georgia.
For further information, please contact the Embassy of Georgia at 2209 Massachusetts Avenue NW, Washington DC, 20008 tel. (202) 387-2390, fax: (202) 393-4537.
Visit the Embassy of Georgia web site at http://embassy.mfa.gov.ge/index.php?lang_id=GEO&sec_id=2&lang_id=ENG for the most current visa information.

Information on 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:
As a result of civil wars in the 1980s and early 1990s, there are two separatist regions in Georgia that are not under the control of the Government of Georgia:
South Ossetia, in north-central Georgia; and Abkhazia, in northwest Georgia.
Although armed conflict between the separatist regions and the central government has ceased, episodes of violence continue and political relations are tense. Political developments have the potential to result in open hostilities.
Due to the volatility of the political situation, high levels of crime, and inability of Embassy personnel to travel to Abkhazia or South Ossetia, the U.S. Embassy advises American citizens not to travel to these separatist-controlled areas.
Because of the restricted access of U.S. officials to Abkhazia and South Ossetia, the ability of the U.S. Government to assist American citizens in these regions is extremely limited, even in emergencies.
All travelers to these regions, regardless of purpose, should register with the U.S. Embassy. The U.S. Embassy recommends that Americans regularly monitor warden messages on the Embassy web site for the latest information on the security situation throughout Georgia.

Political tensions remain high between the Georgian Government and the South Ossetia separatist regime, based in Tskhinvali.
This situation culminated in sniper and mortar exchanges between South Ossetian and Georgian troops in 2004.
Although the fighting did not escalate into an all-out war, low-level violence continues between the two sides, periodically resulting in deaths, and underscoring the potential for instability in the region.
A tense truce also exists between the Georgian Government and the separatist de facto government of Abkhazia; since April 2008, several incidents have increased the tension to a point where cross-border military actions are a possibility.
Over the past several years, a number of attacks, criminal incidents, and kidnappings have occurred in Abkhazia.
While Abkhaz "border officials" may demand that travelers entering the region purchase "visas" from the so-called "Ministry of Foreign Affairs of Abkhazia," the U.S. Government recognizes the territorial integrity of Georgia.
American citizens in areas of western Georgia, near Abkhazia, are advised to be aware of their surroundings at all times and to avoid straying off main roads or traveling after dark.

American citizens should be aware that they cannot legally cross by land, air, rail, or sea between Russia and Georgia, even if in possession of valid Russian or Georgian visas.
In July 2006, the Russian Government closed the only border crossing between Georgia and Russia under the control of both governments (the only other crossings are through Georgia’s separatist regions).
Russian authorities said the closure, at Verkhny Lars, would be temporary, pending necessary repairs at the crossing, although it remains closed as of June 2008.
On August 6, 2007, a missile was fired from an aircraft near a village between the city of Gori and the separatist region of South Ossetia.
Although this was an isolated incident, it serves as a reminder that the situation near the separatist areas remains unpredictable.

Georgia's armed forces have periodically conducted operations against suspected international terrorists, Chechen fighters, and criminals who have taken refuge in the Pankisi Gorge.
American citizens should avoid all travel to the Pankisi Gorge, north of the city of Akhmeta.
American citizens are also advised to exercise caution when traveling in the northern mountainous areas of Georgia bordering the Russian Federation, especially the Chechnya and Dagestan sectors.

Political demonstrations take place from time to time in the capital city, Tbilisi, and normally take place in front of the Parliament building on Rustaveli Avenue.
While these demonstrations are normally peaceful, confrontational demonstrations have occurred, and we wish to remind all Americans that even demonstrations intended to be peaceful can turn confrontational and possibly escalate into violence.

Regardless of the region in Georgia one is planning to visit, American citizens are urged to review their personal security precautions, increase their levels of awareness, register with the consular section and as appropriate, take increased security measures.

In the past, religious minorities in Georgia have been targets of violent attacks.
The victims were primarily Jehovah's Witnesses, but also include Pentecostals, Baptists, and members of the Assembly of God.
Incidents included the burning of literature, the destruction of private property and the beating (sometimes severe) of believers, including American citizens.
Although Georgian authorities arrested, convicted and imprisoned the ringleader of the group responsible for these attacks in 2005, American citizens should remain cautious when engaging in missionary activity in Georgia.

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

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Crime is a very serious problem in Georgia.
There is a great disparity in affluence between foreigners and most Georgians.
Americans in particular are perceived as being wealthy, and are therefore specifically targeted for economic- and property-based crimes.
Incidents such as residential break-in, carjacking, car theft, petty theft, and armed robbery account for most of the crimes involving Americans that are reported to the Embassy.
Petty street crime, such as pick pocketing, purse snatching, and cell phone theft, is also common throughout the country. Furthermore, violent attacks have become more commonplace.
Because illegal firearms are readily available in Georgia, assailants are likely to be armed with firearms and other weapons.

Crime remains a particularly serious issue in Tbilisi, where criminal activity against foreigners remains at levels disproportionate to other metropolitan areas in Europe and the United States.
Many robberies and assaults have occurred in areas frequented by American citizens and foreigners, such as on side streets near Tbilisi’s city center; trouble spots include areas off the main avenues in the Vake and Vera districts, and Chavchavadze and Rustaveli avenues, as well as the Saburtalo region of Tbilisi.
These crimes often occurred when the victim was alone, after dark, and in unfamiliar surroundings.

Petty theft is also a problem on the Tbilisi metro system and in minivans, or “marshrutkas” used for public transport.
American citizens are advised to use personal vehicles or use taxis from established companies that carry passengers door-to-door.
While the security of overland travel in Georgia has improved, vehicular and rail traffic remains vulnerable to robbery.

The threat of kidnapping exists both within and outside of Tbilisi.
In the past, foreign businessmen have been abducted for ransom, and Americans in the Tbilisi area have received kidnapping threats.
The possibility of similar risk to Americans elsewhere in the country cannot be discounted.

Outside of Tbilisi, criminal activity is also a problem, especially in the separatist regions of Abkhazia and South Ossetia, due to the reduced capacity of law enforcement in those areas.
Other regions of concern include:
upper Svanetia, Samtskhe-Javakheti, the administrative border with Abkhazia (including Zugdidi city), and areas along the border with Russia.
When visiting or traveling through these regions, American citizens are urged to increase their vigilance, review their personal security precautions, and take appropriate security measures, e.g. traveling with a native Georgian escort familiar with the local area.

Despite much progress in the Georgian Government’s efforts to reform police and fight internal corruption, serious concerns remain as to the police’s ability to deter criminal activity or conduct effective post-incident investigations.
Although police emergency response is good (see below for contact information), criminals continue to have freedom of movement throughout Tbilisi day or night.

In light of the serious crime situation, all American citizens visiting Georgia are again strongly advised to exercise basic security precautions. American travelers should vary times and routes, especially from places of residence to work locations. Americans should maintain a low profile by not carrying large amounts of cash, not wearing excessive amounts of jewelry, and not behaving in a manner that would draw unnecessary attention.
Additionally, Americans should be aware of their surroundings, travel in pairs or groups, and stay on main streets and routes.
The Embassy recommends that those traveling throughout the country do so during daylight hours only and provide a travel itinerary and contact telephone numbers to a friend or business colleague.
Also, Americans should not hesitate to report any unusual incidents or suspicious vehicles or individuals to the Georgian authorities as soon as possible.
Finally, those that do become a victim of crime should not resist their assailant and should cooperate with the assailant as best they can.
Assailants are most interested in money and/or property; cooperation reduces the chance of being assaulted and/or injured.

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

The Georgian Ministry of Internal Affairs (MOIA) has established a police emergency hotline.
This service is currently limited to larger cities, but the MOIA is planning to expand this service countrywide.

The local “911” equivalent to contact police in an emergency is: “022”.
Please note that the police dispatcher speaks only Georgian or Russian.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care in Georgia is limited.
There is a severe shortage of basic medical supplies, including disposable needles, anesthetics, and antibiotics.
Elderly travelers and those with pre-existing health problems may be at risk due to inadequate medical facilities.
It is recommended that travelers who intend to visit Georgia for at least two weeks get the hepatitis A vaccine and a pre-exposure rabies vaccine.
Travelers are also encouraged to bring medicine to treat diarrhea, which regularly afflicts newcomers.
Georgian doctors and hospitals often expect immediate cash payment before rendering medical services.

Medical Information: Tuberculosis (TB) is an increasingly serious health concern in Georgia.
For further information, please consult the Centers for Disease Control and Prevention’s (CDC) Travel Notice on TB http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx
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 web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company before traveling abroad to confirm whether their policy applies overseas and if 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 Georgia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

As in the United States, vehicular traffic in Georgia moves along the right side of roadways.
Speed limits range from 80 to 100 km/hr on highways, and from 30 to 60 km/hr on urban thoroughfares.
Motorists are not permitted to make right turns on red traffic lights.
While legislation mandating seat belt use has yet to be enacted, drivers and passengers are nevertheless strongly advised to buckle up on Georgian roads.
Georgian law requires that children under seven (7) years of age be restrained in child-safety seats.
A driver with any blood alcohol concentration exceeding 0.00% is considered to be driving under the influence of alcohol.

Motorists should exercise extreme caution when driving in Georgia, as many local drivers do not operate their vehicles in accordance with established traffic laws.
Traffic signals and rules of the road are often completely ignored.
Motorists drive erratically, often recklessly, and at excessive speeds.
Motorists may frequently encounter oncoming high-speed traffic attempting to pass other vehicles at blind turns or over hilltops.
Pedestrians enjoy no right-of-way and need to be extremely careful when crossing streets.
The Georgian Patrol Police, who come under the authority of the Ministry of Internal Affairs, are responsible for maintaining traffic safety in Georgia, but enforcement of traffic regulations is haphazard.

Undivided two-lane roads connect most major cities in Georgia.
Roads are generally in poor condition and often lack shoulder markings and centerlines.
In addition, traffic signals may not work because of power outages or poor maintenance.
Driving at night can be especially dangerous.
Travel on mountain roads is treacherous in both rain and snow, and during winter, heavy snowfalls may make some roads impassable.

Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://tourism.gov.ge/start.php
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Georgia, the U.S. Federal Aviation Administration (FAA) has not assessed Georgia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

Travelers on regional airlines among the countries of the South Caucasus may experience prolonged delays and sudden cancellations of flights.
In addition to frequent delays, flights are often overcrowded or overbooked.
Basic safety features such as seat belts are sometimes missing.
Air travel to Georgia on international carriers via Europe is typically more reliable.
Ticketed passengers on flights departing from Georgia should reconfirm reservations with the airline 24 hours prior to departure.

SPECIAL CIRCUMSTANCES:
Georgia has been subject to energy crises in the last few years.
During the winter months, frequent and prolonged power outages are common, especially outside of Tbilisi.
The lack of lighting in public places, even when electricity is available, heightens vulnerability to crime (please see the Crime section above for details).

Georgia’s customs authorities may enforce strict regulations concerning the temporary import into or export from Georgia of items such as alcohol, tobacco, jewelry, religious materials, art or artifacts, antiquities, and business equipment.
Only personal medicines with a doctor’s statement can be imported without the permission of the Georgian Drug Agency section of the Ministry of Health.

American citizens may not import firearms into Georgia; however, hunting weapons may be brought into the country for a two-week period, based on valid Georgian hunting licenses.
While there is no limit to the amount of currency that can be imported, if more money is exported than was declared at the time of entry, the traveler is obligated to prove it was legally obtained.
There are limits on the amount of Georgian currency that may be exported.

American citizens should exercise extreme caution in purchasing property in Abkhazia.
Land for sale in that region rightfully may belong to internally displaced persons forced to leave Abkhazia in the early 1990s and may have improperly been placed on the market by the de facto authorities in Abkhazia.
In such cases, the government of Georgia considers the sale of property in Abkhazia illegal under Georgian law and the property could be reclaimed by original owners at a future date.

The Ministry of Culture, Department of Expertise and Evaluation must license any valuables such as artwork, antiques, jewelry, paintings, etc.
This license describes the object, assesses its value, and provides permission to export it from Georgia.
The U.S. Embassy in Tbilisi can provide more specific information on quantities of items that can be imported duty-free, as well as duties excised for specific items.
It is also advisable to contact the Embassy of Georgia in Washington, DC for specific information regarding customs requirements.
Please see our information on Customs Regulations.

While the Georgian lari is the only legal tender, dollars can be freely exchanged for laris at market rates.
ATMs are also becoming more widespread, but only within the city of Tbilisi.
Credit cards are rarely accepted outside of upscale hotels and restaurants, and travelers’ checks are difficult to cash.
American citizens in Georgia have reported incidents of credit card fraud and identity theft.

CRIMINAL PENALTIES:
While in a foreign country, an American citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offences.
Persons violating Georgian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Georgia 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 Georgia are strongly encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration web site, https://travelregistration.state.gov, and to obtain updated information on travel and security within Georgia.
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 Tbilisi is located at 11 George Balanchine Street.
Office hours from American Citizens Services are from 2 to 5 pm on weekdays; no appointment is necessary.
The telephone number is (995) (32) 27-70-00, which can also be reached after hours, and the fax number is: (995) (32) 53-23-10.
The U.S. Embassy in Tbilisi’s web site is http://georgia.usembassy.gov/.
*
*
*
This replaces the Country Specific Information dated October 3, 2007 to update the section on Entry and Exit Requirements, Safety and Security, Crime, Information of Victims of Crime, ion, Traffic Safety and Road Condition, Special Circumstances, and Aviation Safety Oversight.

Travel News Headlines WORLD NEWS

Date: Sat, 22 Jun 2019 21:45:46 +0200
By Anna SMOLCHENKO with Irakli METREVELI in Tbilisi

Moscow, June 22, 2019 (AFP) - Russia's government on Saturday banned Georgian airlines from flying into its territory, extending restrictions imposed by President Vladimir Putin as part of growing tensions between Moscow and its ex-Soviet neighbour.   Putin had signed a decree late Friday banning Russian airlines from flying to pro-Western Georgia from July 8 in response to anti-Moscow rallies in the Georgian capital Tbilisi.

The protests broke out after a Russian lawmaker addressed parliament from the speaker's seat earlier this week, a hugely sensitive move for two countries whose relations remain tense after a brief war in 2008.   The rallies have morphed into a broader movement against the Georgian authorities while the Kremlin has branded them a "Russophobic provocation".   On Saturday, protesters took to the streets of the Georgian capital for a third day of rallies, with some 3,000 demanding snap elections and electoral reform.   The crowd sang a profanity-laced, anti-Putin chant and some of the demonstrators held up placards insulting the Russian president.   Demonstrators also shot paper airplanes into the sky in response to the Russian bans.

Russia's transportation ministry said that from July 8 two Georgian airlines would be banned from flying to Russia, citing the need to ensure "aviation safety" and debt owned by the Georgian companies.   The Kremlin has said the ban against travel to Georgia was to "ensure Russia's national security and protect Russian nationals from criminal and other unlawful activities."

Authorities recommended travel companies stop selling holiday packages to Georgia and advised Russian tourists to return home.   Russia's travel industry and ordinary Russians hit out at the decision by the Kremlin, saying it was a politically motivated move that has little to do with safety concerns.   "Tourism in Georgia is on the rise, and the decision has shocked the whole industry," Aleksan Mkrtchyan, head of Pink Elephant, a chain of travel agencies, said in a statement.

- 'This is politics' -
The ban during high season is expected to hit the travel industry in both countries hard and become a major nuisance for Russian holidaymakers.   Russia and Georgia fought a brief but bloody war in 2008 and tensions between the two governments remain high.   But Georgia -- known for its picturesque Black Sea resorts, rich national cuisine and generous hospitality -- has emerged as one of the most popular destinations for Russian tourists over the past few years, with more than 1.3 million visiting last year.

Irina Tyurina, a spokeswoman for the Russian Tourism Union, said that most in the industry believed that Georgia was not a dangerous destination.   "Georgians have traditionally treated Russians well," Tyurina told AFP.    It was too early to estimate potential industry losses from the ban, she said.   More than 7,000 people have signed a petition calling on Moscow to resume flights.

Russian tourists in Tbilisi expressed regret at the restrictions.   "We are against the ban," Nina Guseva told AFP in the Georgian capital. "We are not guilty and we do not have to suffer."   Fellow traveller Mikhail Strelkov added: "This is politics and has nothing to do with people on holidays."   In Russia, many struck a similar note.   Elena Chekalova, a prominent chef and culinary blogger, said the latest Kremlin move "shocked" her.   "Why are they deciding for us what we cannot eat, where we cannot fly, who we cannot be friends with?" she wrote on Facebook.

- Simmering discontent -
Moscow has suspended flights to Georgia before -- during a spike in tensions in October 2006 and in August 2008 following the outbreak of the five-day war over the breakaway regions of Abkhazia and South Ossetia.   "Putin decided to punish Georgia because there are street protests there," opposition leader Alexei Navalny said on Twitter.   A senior government official in Tbilisi said the Kremlin ban was politically motivated.   "Putin's decision is of course political and has nothing to do with safety concerns," the official told AFP on condition of anonymity.

Analysts say the latest restrictions may further fuel simmering discontent with Kremlin policies.   Since 2014, Russians have been chafing under numerous rounds of Western sanctions over Moscow's role in Ukraine and other crises, with real incomes falling for the fifth year in a row.    During an annual phone-in with Russians this week, Putin dismissed calls to "reconcile" with the West to alleviate economic hardship, saying Moscow needed to protect its interests and "nothing" would change anyway.
Date: Thu, 6 Jun 2019 11:24:00 +0200

Tbilisi, June 6, 2019 (AFP) - Three people died on Thursday when a helicopter owned by one of Georgia's top luxury hotels crashed in a northern mountainous region of the country, emergency services said.   A chopper belonging to the Rooms luxury hotel "crashed in an unpopulated area near the Qulo mountain in the Kazbegi municipality," the spokesman of Georgia's emergency situations department, Rati Mujiri, told AFP.   "All three people onboard have died," he said.  "The helicopter pilot and two staff members of the Adjara Group (which owns Kazbegi Rooms hotel) have been killed in the accident," the company said in a statement.

The Rooms hotel operates Bell 505 Jet Ranger helicopters, according to the hotel's website.   Famed for its spectacular landscapes with snow-capped peaks of the Greater Caucasus mountain range, dramatic rocky gorges, and medieval churches, Kazbegi is a popular tourist destination.
Date: Thu 2 May 2019
Source: PLoS One [edited]

Citation
--------
Rao S, Traxler R, Napetavaridze T, et al. Risk factors associated with the occurrence of anthrax outbreaks in livestock in the country of Georgia: A case-control investigation 2013-2015. PLoS One. 2019;14(5):e0215228. doi: 10.1371/journal.pone.0215228

Abstract
--------
Introduction
Anthrax is considered endemic in livestock in Georgia. In 2007, the annual vaccination became the responsibility of livestock owners, while contracting of private veterinarians was not officially required. Six years later, due to increase in human outbreaks associated with livestock handling there is a need to find out the risk factors of livestock anthrax in Georgia.

Objective
To identify exposures and risk factors associated with livestock anthrax.

Methods
A matched case-control study design was used to recruit the owners of individual livestock anthrax cases that occurred between June 2013 and May 2015, and owners of unaffected livestock from within ("village control") and outside the village ("area control"). We collected data about the case and control livestock animals' exposure and risk factors within the one-month prior to the disease onset of the case livestock (or matched case for the controls). We used logistic regression analysis (univariate and multivariable) to calculate the odds ratios of exposures and risk factors.

Results
During the study period, 36 anthrax cases met the case definition and were enrolled in the study; 67 matched village control livestock and 71 matched area control livestock were also enrolled. The findings from multivariable logistic regression analysis demonstrate that vaccination within the last 2 years significantly reduced the odds of anthrax in cattle (OR = 0.014; 95% Confidence interval = or less 0.001, 0.99). The other factors that were significantly protective against anthrax were 'animals being in covered fence area/barn' (OR = 0.065; p-value = 0.036), and 'female animal being pregnant or milking compared to heifer' (OR = 0.006; p-value = 0.037).

Conclusions
The information obtained from this study has involved and been presented to decision makers, used to build technical capacity of veterinary staff, and to foster a One Health approach to the control of zoonotic diseases which will optimize prevention and control strategies. Georgia has embedded the knowledge and specific evidence that vaccination is a highly protective measure to prevent anthrax deaths among livestock, to which primary emphasis of the anthrax control program will be given. Education of livestock keepers in Georgia is an overriding priority.
------------------------------------------------------
Communicated by
Debby Reynolds
===============================
[The major benefits of this research project were not scientific but instructional in bringing home to all concerned at all levels that livestock anthrax is not inevitable but extremely preventable with many benefits in both animal health and public health. The article conclusions needed to be emphasised: "The control strategies that were recommended for anthrax included a combination of vaccination, quarantine, and proper carcass handling and disposal. Overall, the information obtained from this study has involved and been presented to decision makers, used to build technical capacity of regional and national veterinary staff, and fostered a One Health approach to the control of zoonotic diseases like anthrax, which will optimize prevention and control strategies. For example, a multi-agency anthrax One Health team was established to investigate cases and co-develop educational materials for farmers.

"The investigation process involved a series of trainings and workshops for participants and stakeholders to promote an understanding of epidemiological investigations and the economics of disease control with anthrax as a model. Georgia now has embedded the knowledge and specific evidence that vaccination is a highly protective measure to prevent anthrax deaths among livestock. Hence, primary emphasis for disease prevention will be given to vaccination, with a specific mark/tag for vaccination being desirable. Alternatively, a formal vaccination record given to the owner, or livestock registration is recommended. Education of livestock keepers in Georgia on the importance of vaccination is an overriding priority. Vaccination teams can play an increased role with more attention paid to delivery of standard memorable messages at the time of vaccination and to disseminating public announcements. It is overwhelmingly the case that vaccination of livestock against anthrax is protective and is an effective risk mitigation for anthrax in Georgia."

And if the Georgians can do it, anybody anywhere can do it. And you will note that their last outbreak was in 2017. Our thanks to Debby for forwarding this article. - ProMED Mod.MHJ]

[Maps of Georgia can be seen at
Date: Fri, 16 Mar 2018 16:59:07 +0100

Tbilisi, March 16, 2018 (AFP) - At least eight tourists, including a pregnant woman from Sweden, were injured on Friday when a chair lift ran out of control in the Georgian ski resort of Gudauri, officials said.   Video of the accident showed skiers being flung out of their chairs as they
turned a bend as other resort visitors screamed in terror. 

An emergency stop led to the chairs sliding back at high speed, Economy Minister Dimitry Kumsishvili told journalists, adding that the incident was "allegedly caused by an electricity outage".   "The interior ministry has launched a criminal probe into alleged violation of safety norms," he added.   Health Minister David Sergeenko said the tourists -- who were Georgiain, Russian, Swedish and Ukrainian -- did not suffer serious injuries.

"Two of them - including a pregnant woman from Sweden -- were airlifted to a hospital in (the Georgian capital) Tbilisi," he added.   Video footage (https://www.facebook.com/yanshyn/videos/10210410103119989/) of the accident posted on Facebook has been viewed more than 600,000 times.   The Caucasus nation of Georgia is an emerging ski destination.
Date: Wed 8 Nov 2017 8:36 PM GET
Source: KyivPost, Interfax-Ukraine report [edited]

Georgia's 2nd anthrax fatality this year [2017] has been confirmed. A Poti [Samegrelo-Zemo Svaneti region] resident, aged 28, died from exposure to anthrax, Maka Gabunia, an epidemiologist of the Georgian Healthcare Ministry's Poti regional laboratory, told reporters on [8 Nov 2017].

The tentative cause of death is that the woman sought medical aid too late, Gabunia said. The patient was showing symptoms of the disease when she was admitted to a hospital, she said. "The appropriate medical assistance was provided to the patient, but, unfortunately, doctors were unable to save her," Gabunia said.

Laboratory tests confirmed the diagnosis of anthrax exposure, she said. She said she believes that there are no reasons for panic among residents of Poti.

The 1st anthrax fatality this year [2017] was recorded in Adjara, Georgia, in September. A 58-year-old resident of the village of Akhalsopeli in the Khelvachauri district died following exposure to an infected animal, the Georgian National Center for Disease Control and Public Health told reporters.

The last time an anthrax fatality was recorded in Georgia was in 2013.
****************************
Date: Thu 9 Nov 2017
Source: Rosbalt.ru [in Russian, trans., edited]

A young Poti resident died of anthrax infection. The citizen turned to the doctors late, the Ministry of Health of Georgia informed. The 28-year-old woman died, despite the help she received from epidemiologists.

In September [2017], a man died from anthrax in Adjara.
------------------------------
Communicated by:
Sabine Zentis
Castleview English Longhorns
Gut Laach
D-52385 Nideggen
Germany
**************************
Date: Fri 10 Nov 2017
From: Ana Kasradze [edited]

Anthrax is an endemic zoonotic disease in Georgia. The majority of cases are cutaneous, generalized forms of the disease are rare; 1-2 gastrointestinal tract anthrax cases were registered in total. From August [2017], the human anthrax cases in the west part of Georgia were related to ongoing epizootics in one of the regions.

In the beginning of November 2017, a 28-year-old female was admitted to the hospital in the west part of the country with high temperature, severe sore throat, neck swelling, predominantly unilateral. Lymph nodes were swollen and a pseudomembranous plaque in the mouth -- predominantly on the right side -- was observed. The hospital suspected diphtheria and notified. For a bacteriological study, the sample was sent to NCDC's [National Center for Disease Control and Public Health] Regional Laboratory. The patient was transferred to the referral hospital in the same city, where the laboratory is located. After 24 hours, the culture was identified as anthrax.

Additional laboratory testing was conducted in the center of Lugar, and the bronchial aspirate sample was PCR positive for anthrax.

The condition of the patient was severe, and despite the specific treatment, she died on the 6th day of hospitalization.

Diagnosis: anthrax, oropharyngeal form.

The case was defined as unusual for Georgia, as no oropharyngeal anthrax cases had been identified before in the country. The suspected source of infection is minced meat, that case bought in the local market. Because of her severe condition, we were not able to interview her, but most likely she tasted the raw minced meat before cooking. The person selling the meat at the local market is a private merchant and the meat is not sold in the food chain. National Food Agency was notified. Environmental samples were collected from the slaughterhouse.
-------------------------------
EpiCore Global Surveillance Project member
Ana Kasradze
National Center for Disease Control and Public Health
=================
[Maps of Georgia can be seen at
and <http://healthmap.org/promed/p/63383>.

According to Wikipedia (<https://en.wikipedia.org/wiki/Poti>) Poti is a port city in Georgia, located on the eastern Black Sea coast in the region of Samegrelo-Zemo Svaneti in the west of the country. The city has become a major port city and industrial center since the early 20th century. It is also home to a main naval base and the headquarters of the Georgian navy. Adjacent to the Poti port area is the RAKIA owned Free Industrial Zone.

Poti, a busy city, is distant from the usual rural areas afflicted with livestock anthrax. As the third report notes the patient was confirmed to have oropharyngeal anthrax which is rare in humans though not uncommon in certain livestock. The suggestion that she had sampled the rare minced meat is logical, as we know from hamburgers such is very easy to cook and the cooked surface would have been sterile. The less cooked interior, if eaten, would have possibly resulted in an enteric infection. If the meat had been mixed with some fibrous matter it would have increased the chance of scratching the throat and have facilitated spore entry. Our thanks to Dr Kasradze for her very quick response. - ProMED Mod.MHJ]
More ...

World Travel News Headlines

Date: Tue, 10 Dec 2019 10:50:09 +0100 (MET)

Sydney, Dec 10, 2019 (AFP) - The death toll from New Zealand's White Island volcano eruption rose to six late Tuesday, after an injured person died in an Auckland hospital, police said.   "Police can confirm a further person has died following the eruption on Whakaari/White Island, bringing the official toll to six," a police statement said.   Eight more people who remain missing are presumed dead after the volcano erupted Monday.
Date: Tue, 10 Dec 2019 09:27:57 +0100 (MET)
By Andrew BEATTY, with Daniel de Carteret in Gosford

Sydney, Dec 10, 2019 (AFP) - Toxic haze blanketed Sydney Tuesday triggering a chorus of smoke alarms to ring across the city and forcing school children inside, as "severe" weather conditions fuelled deadly bush blazes along Australia's east coast.   Fire engines raced office-to-office in the city centre with sirens blaring, as inland bushfires poured smoke laden with toxic particles into commercial buildings.   Emergency services responded to an "unprecedented" 500 automatic call-outs inside a few hours according to New South Wales Fire and Rescue's Roger Mentha.

A regional fire headquarters miles from the nearest blazes was itself evacuated while throngs of mask-wearing commuters choked their way through thick acrid air and the organisers of a harbour yacht race declared it was unsafe to proceed.   "The smoke from all the fires is just so severe here on the harbour that you just can't see anything, so it's just too dangerous," said spokeswoman Di Pearson of an event that normally foreshadows the famed Sydney-Hobart yacht race. "The vision is just so poor."   Some of the city's commuter ferries were also cancelled "due to thick smoke" and school kids were kept inside at breaktime and sent home early as pollution levels soared far above "hazardous" levels.

For weeks the east of the country has been smothered in smoke as drought and climate-fuelled bushfires have burned. But the scale of the problem on Tuesday shocked even hardened residents.   Bruce Baker -- an 82-year-old who lives in Gosford, north of Sydney -- said he was skipping his daily morning walk because of the smoke.   "This is the worst it's been, for sure," he told AFP. "It dries your throat. Even if you're not asthmatic, you feel it."   Authorities recommended that the vulnerable cease outdoor activity altogether and that everyone stay inside as much as possible, although one couple braved the toxic air to get married on the waterfront in front of Sydney Harbour Bridge shrouded in smog.

A cricket match between New South Wales and Queensland also went ahead, despite a barely visible ball.   Tuesday had been expected to bring strong winds and high temperatures that made for "severe conditions where embers can be blown ahead of the fire into suburbs and threaten properties."   But New South Wales Rural Fire Service said "deteriorating fire conditions have been delayed by a thick blanket of smoke" over the east of the state.   As the day developed there were nearly 100 bushfire incidents in the state of New South Wales alone and dozens more in Queensland.   Total fire bans were put in place across much of the east of the country and in large parts of western Australia.   Temperatures in some inland areas eased past 44 degrees Celsius (111 Fahrenheit).

- The 'big dry' -
To the northwest of Sydney, several fires already burning for weeks have combined to create a "megafire" that has already destroyed 319,000 hectares (788,000 acres) of land, mostly inside national parks.   Prime Minister Scott Morrison  -- who for weeks has not commented on the smoke haze -- defended his government's handling of the fires and said there were no plans to professionalise the countryside's largely volunteer force.    "Our policy is sensible when it comes to addressing and taking action on climate change. Our actions on climate change are getting the results they're intended to get," he said.   Morrison's conservative coalition has been criticised by former fire chiefs for failing to heed warnings about climate change.   The crisis has been propelled by a prolonged drought that has made vegetation tinder dry.

The Bureau of Meteorology has reported that Australia experienced its driest November on record this year.   The "big dry" has left farmers desperate and small towns facing the prospect of running out of water completely.   A swathe of the east of the country has seen "rainfall deficiencies" since early 2017 -- almost three years.   Many dams in New South Wales are empty and almost all are well below capacity.   Firefighters south of Brisbane recently reported 1,000 litres of water were stolen from tanks at their station.   Amid the shortage, Tuesday also saw the toughest water restrictions in a decade being introduced for Sydney -- with curbs on everything from hosepipe use to washing cars.
Date: Tue, 10 Dec 2019 03:09:17 +0100 (MET)
By Allison JACKSON

Sao Paulo, Dec 10, 2019 (AFP) - Gripping the deadly snake behind its jaws, Fabiola de Souza massages its venom glands to squeeze out drops that will save lives around Brazil where thousands of people are bitten every year.   De Souza and her colleagues at the Butantan Institute in Sao Paulo harvest the toxin from hundreds of snakes kept in captivity to produce antivenom.    It is distributed by the health ministry to medical facilities across the country.

Dozens of poisonous snake species, including the jararaca, thrive in Brazil's hot and humid climate.    Nearly 29,000 people were bitten in 2018 and more than 100 died, official figures show.   States with the highest rates of snakebite were in the vast and remote Amazon basin where it can take hours to reach a hospital stocked with antivenom.   Venom is extracted from each snake once a month in a delicate and potentially dangerous process.

Using a hooked stick, de Souza carefully lifts one of the slithering creatures out of its plastic box and maneuvers it into a drum of carbon dioxide.    Within minutes the reptile is asleep.    "It's less stress for the animal," de Souza explains.    The snake is then placed on a stainless steel bench in the room where the temperature hovers around 27 degrees Celsius (80 degrees Fahrenheit).    De Souza has a few minutes to safely extract venom before the snake begins to stir.      "It's important to have fear because when people have fear they are careful," she says.

- Antivenom 'crisis' -
The snakes are fed a diet of rats and mice that are raised at the leafy institute and killed before being served up once a month.   After milking the snake, de Souza records its weight and length before placing it back in its container.    The antivenom is made by injecting small amounts of the poison into horses -- kept by Butantan on a farm -- to trigger an immune response that produces toxin-attacking antibodies.

Blood is later extracted from the hoofed animals and the antibodies harvested to create a serum that will be administered to snakebite victims who might otherwise die.   Butantan project manager Fan Hui Wen, a Brazilian, says the institute currently makes all of the country's antivenom -- around 250,000 10-15 millilitre vials per year.

Brazil also donates small quantities of antivenom to several countries in Latin America.    There are now plans to sell the life-saving serum abroad to help relieve a global shortage, particularly in Africa.    About 5.4 million people are estimated to be bitten by snakes every year, according to the World Health Organization (WHO). 

Between 81,000 and 138,000 die, while many more suffer amputations and other permanent disabilities as a result of the toxin.   To cut the number of deaths and injuries, WHO unveiled a plan earlier this year that includes boosting production of quality antivenoms.   Brazil is part of the strategy. It could begin to export antivenom as early as next year, Wen says.   "There is interest for Butantan to also supply other countries due to the global crisis of antivenom production," she says.
Date: Mon, 9 Dec 2019 14:14:15 +0100 (MET)

Dec 9, 2019 (AFP) - New Zealand, struck by a deadly volcanic eruption Monday, lies in a zone where Earth's tectonic plates collide, making it a hotspot for earthquakes and volcanic activity.   In one of its worst natural disasters, a huge mass of volcanic debris from the eruption of Mount Ruapehu triggered a mudslide in 1953 that washed away a bridge and caused a passenger train to plunge into a river with the loss of 151 lives.  After Monday's eruption on New Zealand's White Island, here is a recap of some of the deadliest volcanic eruptions around the world in the past 25 years.

- 2018: Indonesia -
In December the Anak Krakatoa volcano, a small island in the Sunda Strait between Java and Sumatra, erupts and a section of its crater collapses, sliding into the ocean and generating a tsunami. More than 420 people are killed and 7,200 wounded.

- 2018: Guatemala -
The June eruption of the Fuego volcano, about 35 kilometres (22 miles) from the capital, unleashes a torrent of mud and ash that wipes the village of San Miguel Los Lotes from the map. More than 200 people are killed.

- 2014: Japan -
The sudden eruption in September of Mount Ontake, in the central Nagano region, kills more than 60 people in Japan's worst volcanic disaster in nearly 90 years. The mountain is packed with hikers at the time. In 1991 an eruption of the southwestern Unzen volcano kills 43.

- 2014: Indonesia -
At least 16 people are killed on the island of Sumatra in February by a spectacular eruption of Mount Sinabung, which had lain dormant for 400 years before roaring back to life five months earlier. In 2016 villages are scorched and farmland devastated after another eruption kills seven.

- 2010: Indonesia -
Indonesia's most active volcano, Mount Merapi on Java island, starts a series of explosions in October, eventually killing more than 320 people. An 1930 eruption of the volcano killed 1,300 people and one in 1994 claimed more than 60 lives.

- 2002: DR Congo -
The eruption in July of Mount Nyiragongo in the eastern Democratic Republic of Congo destroys the centre of Goma town, along with several residential areas, and kills more than 100 people.

- 1997: Montserrat -
The capital of the small British colony, Plymouth, is wiped off the map and 20 are killed or left missing in avalanches of hot rock and ash clouds when its volcano erupts in June.

- 1995: The Philippines -
At least 70 are killed and another 30 missing after the crater of the Parker volcano in the south of the island of Mindanao collapses. Five years earlier the eruption of Mount Pinatubo, 80 kilometres north of the capital Manila, kills more than 800 people.

- Worst ever -
The explosion of Indonesia's Krakatoa volcano in 1883 is considered the worst ever seen. The eruption sent a jet of ash, stones and smoke shooting more than 20 kilometres (12 miles) into the sky, plunging the region into darkness, and sparking a huge tsunami that was felt around the world. The disaster killed more than 36,000 people.

The most famous eruption in history is that of Mount Vesuvius in modern-day Italy in 79 AD, which destroyed the towns of Herculaneum, Stabiae and Pompeii, wiping out an estimated 10 percent of the population of the three cities.
Date: Mon 9 Dec 2019
Source: Fox 29 Philadelphia [edited]

A total of 31 people have been sickened by salmonellosis at 4 health care facilities in south-eastern Pennsylvania. A majority of those cases occurred after individuals ate pre-cut fruit from New Jersey-based Tailor Cut Produce. The Food and Drug Administration (FDA) announced the salmonellosis outbreak in conjunction with the Pennsylvania Department of Health (DOH) on [Fri 6 Dec 2019]. The North Brunswick distributor has recalled its fruit mix with cantaloupe, honeydew, pineapple and grapes as a result.

Tailor Cut Produce reports that its products may be found in restaurants, banquet facilities, hotels, schools and institutional food service establishments in Pennsylvania, New Jersey and New York. "We recommend that any facility who use Tailor Cut Produce pre-cut fruit to immediately stop and throw it away," Pennsylvania Secretary of Health Dr. Rachel Levine said.

Salmonellosis is an infection caused by _Salmonella_ bacteria that generally affects the intestinal tract. People usually become infected by either eating or drinking contaminated food or water, by contact with infected people or animals, or through contact with contaminated environmental sources.
Date: Mon 9 Dec 2019
Source: Sixth Tone [edited]

Dozens of researchers in northwestern China's Gansu province have been infected with brucellosis, an animal-borne disease that causes flu-like symptoms and, potentially, lingering problems. In a statement [Fri 6 Dec 2019], the Lanzhou Veterinary Research Institute, an affiliated institute of the Chinese Academy of Agricultural Sciences, said that the 1st few grad students from the institute's foot-and-mouth disease prevention team tested positive for brucellosis antibodies on [28 Nov 2019]. The labs affected have been closed, the institute said, and national and local health authorities have assembled a team to investigate the outbreak.

Li Hui, an official at the health commission in Lanzhou, the provincial capital, told Sixth Tone on [Mon 9 Dec 2019] that the total number of brucellosis cases at the institute had climbed to 96. None have shown clinical symptoms, according to domestic media, and it remains unclear how they were exposed to the bacteria.

Brucellosis -- also known as Malta, Mediterranean, or undulant fever -- is a zoonotic disease that mainly affects animals, including livestock and dogs, which can in turn transmit the bacteria to humans through direct contact. Symptoms include fever, chills, sweating, lethargy, and aches and pains, according to the WHO. In the absence of early diagnosis and treatment, brucellosis can become a chronic condition that is difficult to cure.

In China, brucellosis is a Class B disease, ranking below a more serious category that includes cholera and plague. Human-to-human transmission has only been known to occur between lactating mothers and their babies. According to state broadcaster China National Radio, the brucellosis outbreak at the Gansu veterinary institute has prompted health checks among local students and staff who fear that they may have come into contact with infected animals.

One of the last brucellosis outbreaks in China occurred in 2011, when an agricultural university in the northeastern Heilongjiang province reported 28 cases stemming from infected goats being used in lab research. The school publicly apologized, fired 2 administrators, and offered each of the students' affected monetary compensation.

Scientific labs are subject to different experimental standards depending on their biosafety level, according to a researcher surnamed Yang at the Shanghai Institutes for Biological Sciences, an affiliate of the Chinese Academy of Sciences.

"If the protection levels don't keep pace (with biosafety levels), there will be a risk of infection," Yang, who studies viruses and works in a Biosafety Level 2+ lab, told Sixth Tone. As a result, labs generally require researchers to undergo safety training or even pass an exam to earn a certification, said Yang, who only used her surname because she was not authorized by her employer to speak to media.

The Lanzhou Veterinary Research Institute describes itself as "China's only authorized research center for working with the live virus that causes foot-and-mouth disease," a highly contagious disease affecting livestock. The institute is reportedly also one of the few in China with Biosafety Level 3 labs, which are required for _brucella_ pathogen studies, according to the National Health Commission.

As the local agriculture department tries to ascertain the source of the recent infections, Lanzhou's health commission said [Fri 6 Dec 2019], it is implementing precautionary measures so that brucellosis does not pose a threat to neighbouring communities. [Byline: Yuan Ye]
=================
[An earlier report suggested that 4 persons were clinically ill but this is not confirmed here.  Brucellosis (<http://www.medicinenet.com/brucellosis/article.htm>) is a disease that is thought to have existed since ancient times, as it was 1st described more than 2000 years ago by the Romans and Hippocrates. It was not until 1887 that a British physician, Dr. David Bruce, isolated the organism that causes brucellosis from several deceased patients from the island of Malta. This disease has had several names throughout its history, including Mediterranean fever, Malta fever, Crimean fever, Bang's disease, and undulant fever (because of the relapsing nature of the fever associated with the disease).

The symptoms and signs of brucellosis may develop from days to months after the initial exposure to the organism. While some individuals may develop mild symptoms, others may go on to develop long-term chronic symptoms. The signs and symptoms of brucellosis are extensive, and they can be similar to many other febrile illnesses, so recognition of potential exposure -- from ingestion of unpasteurized milk or cheese, employment as a veterinarian or veterinary student, in a slaughter house or meat processing plant, or working in a microbiology lab -- is vital. In this outbreak, it is not clear what symptoms the students had or whether they were just seropositive. ProMED would like more information about this episode. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Gansu Province, China: <http://healthmap.org/promed/p/333>]
Date: Tue 3 Dec 2019
Source: Outbreak News Today [edited]

In late November [2019], Uganda health authorities notified the World Health Organization of a fatal Rift Valley fever (RVF) case from Obongi district.  The case was a 35-year-old man from South Sudan who was living in the Palorinya Refugee camp in Obongi district, Uganda. The case had travel history to South Sudan between 12 and 19 Nov 2019 to harvest cassava. While in his home country, he developed fever and other symptoms and was treated for malaria; however, his condition got worse.  He later returned to the refugee camp in Uganda and his symptoms progressed and he was hospitalized. Viral hemorrhagic fever was suspected. Samples were collected and sent to the Uganda Virus Research Institute; however, the patient died. A safe and dignified burial was performed on 22 Nov 2019. As of 24 Nov 2019, a total of 19 contacts were recorded during the active case search including 10 healthcare workers.
===================
[The circumstances and specific location under which the man became infected with Rift Valley fever (RVF) virus in South Sudan is not mentioned. It is worth noting that there was an RVF outbreak in the Eastern Lakes region of South Sudan during the 1st 3 months of last year (2018). At the end of that outbreak, the OIE's follow-up report no. 3 reported: "The event cannot be considered resolved, but the situation is sufficiently stable. No more follow-up reports will be sent. Information about this disease will be included in the next 6-monthly reports."

There were more human cases than animal ones in that outbreak, prompting Mod.AS to comment: "Unfortunately, during the recent South Sudan RVF event, as in most -- if not all -- previous RVF events in other African countries, humans served as sentinels. Improved surveillance in animals is desperately needed in Africa, to allow timely measures applied, predominantly preventive vaccination, before the development of a full-blown epizootic involving secondary infection in humans." Intensified surveillance is needed in South Sudan in those localities where the affected man had been prior to his return to Uganda.

It is likely that RVF virus has persisted in this area in transovarially infected eggs of _Aedes_ mosquito vectors. These eggs can remain viable for long periods of time and hatch when flooded during future rain events, with the subsequent emergence of infected females ready to transmit the virus. This risk provides justification for maintaining livestock of the area well vaccinated into the future. This may have accounted for the reappearance of RVF in South Sudan in 2018, after nearly 2 years without additional reported cases in humans or livestock and again with this human case in 2019. - ProMED Mod.TY]

Obongi district, Uganda is located approximately 50 km (30 mi) from the South Sudan border.
HealthMap/ProMED-mail maps:

According to OIE's data, a total of 2 outbreaks of RVF affecting animals have been reported from Sudan during the event. The 1st outbreak started in the Arabaata dam area, Red Sea state, on 25 Sep 2019, affecting goats. The 2nd (and, so far, last) outbreak started 10 Oct 2019 in the River Nile state, affecting sheep and goats. Both outbreaks have been declared as 'resolved' on 14 Nov 2019.

Outbreak summary:
Total outbreaks = 2 (Submitted)
Species / Susceptible / Cases / Deaths / Killed and disposed of / Slaughtered
Goats / 1700 / 37 / 7 / 0 / 0
Sheep / 1550 / 37 / 5 / 0 / 0

According to the recent (5 Dec 2019) OCHA (UN Office for the Coordination of Humanitarian Affairs) update, the (human) RVF situation in Sudan, as of 26 Oct 2019, was the following: "a total of 345 suspected RVF cases -- including 11 related deaths -- reported in the states of Red Sea (128), River Nile (212), Khartoum (1), White Nile (1), Kassala (2), and Gedaref (1). The most affected age group is 15 to 45 years, which accounts for 83% of the total suspected cases. The male to female ratio is 2.6, with a high proportion of the cases being farmers (37.5 per cent). RVF is endemic in Sudan and 3 outbreaks affecting people have been documented in 1973, 1976, and 2008. During the outbreak in 2008, a total of 747 laboratory-confirmed cases were reported, including 230 deaths."

Egypt suffered its 1st RVF outbreak in 1977/78 with serious human disease and death as well as severe losses in livestock; several additional events have been recorded since. A recent historical review paper [1] concluded: "due to the availability and abundance of the potential vectors, the suitability of environmental conditions, continuous importation of livestock's from Sudan, and the close association of susceptible domestic animals with humans, the RVF virus could possibly occur and circulate in Egypt."   (https://tinyurl.com/whz3pz5)

Reference
---------
1. Kenawy MA, Abdel-Hamid YM, Beier JC. Rift Valley fever in Egypt and other African countries: Historical review, recent outbreaks, and possibility of disease occurrence in Egypt. Acta Trop. 2018; 181: 40-49; <https://doi.org/10.1016/j.actatropica.2018.01.015>  - ProMED Mods.AS/TY]
Date: Fri 6 Dec 2019 5:53 PM MST
Source: CTV News [edited]

A syphilis outbreak is worsening in Alberta [Canada], and the majority of new cases are in the Edmonton zone. Edmonton saw 1186 of the 1753 infectious syphilis [primary, secondary and early latent syphilis] cases reported in Alberta in 2019, a total of 68 per cent.

Alberta Health Services [AHS] declared an outbreak in July 2019, saying cases had 'increased dramatically' in the province since 2014. The number increased again in July [2019]  [<https://edmonton.ctvnews.ca/alberta-declares-province-wide-syphilis-outbreak-1.4510737>].

AHS sent a new public health alert to doctors on [27 Nov 2019], asking for their help to control the outbreak [<https://www.albertahealthservices.ca/assets/info/hp/phys/if-hp-phys-moh-ez-syphilis-outbreak.pdf>]. "It's very significant," said Dr Ameeta Singh, a clinical professor in infectious diseases. "That's an alarming rise in new syphilis cases in Alberta." She said it's the highest number of cases the province has seen since the 1940s.

According to Dr Singh, the increase in cases being reported is partially due to a greater number of people getting tested. "We know more people are coming in to get tested, but if we look a bit closer at the data we have, we do see there's, in fact, a [bigger] rise in the number of cases than we would expect to see," said Singh.

Another factor could be the rise in methamphetamine use in Edmonton. "I believe this is a major factor. Meth also stimulates risky sexual behaviour and increases the chance people will engage in multiple, usually casual or anonymous partners as well and not use precautions such as condoms to protect themselves during sex," she said.

What's also alarming, Singh said, is the spike in cases of congenital syphilis, where the disease is passed on to newborns. According to AHS, there have been 38 cases of congenital syphilis in 2019, 31 of which were in the Edmonton area. That accounts for more than half of the 61 cases of congenital syphilis reported since 2014.

"Those are not numbers we should be talking about in Canada ever...in a country that has universal access to health care, in a major city in Canada where syphilis testing is offered to all pregnant women who access prenatal care," she said. "What we're seeing with the congenital syphilis cases is many of the women are not accessing prenatal care until they come into the hospital to deliver and then the tests are being done."
===================
[A recent ProMED-mail post (Syphilis - Canada (04): (AB) RFI http://promedmail.org/post/20190718.6574300) reported a rise in "infectious syphilis" cases over a 4-year period: from 2014 to 2018 but made no mentioned of contributing factors. As illicit drug use has been cited as a contributing factor to recent increases in syphilis cases in the Canadian provinces of Ontario and Manitoba, I questioned in this prior ProMED-mail post if use of illicit drugs, in particular, methamphetamine, could similarly be contributing to the rise of syphilis cases in Alberta. The news article above reports that the rise in methamphetamine use in Edmonton, as well as increased testing for syphilis, are thought to be contributing factors in Alberta.

Methamphetamine can be swallowed, snorted, smoked or injected by needle and syringe

When methamphetamine is injected, transmission of syphilis may occur as a consequence of sharing a needle/syringe contaminated with infected blood from somebody who has primary or secondary syphilis (<https://ucsdnews.ucsd.edu/archive/newsrel/health/04-28TransmissionSyphilis.asp>); but syphilis can also be acquired by direct contact with an infected lesion during oral, vaginal, or anal sex when the drug is taken by any route of administration. Methamphetamine use is associated with sexual behaviors that increase the risk for acquiring syphilis and other sexually transmitted diseases, including having multiple sex partners, inconsistent condom use, and exchange of sex for drugs or money (<https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a4.htm>).

The linkage of methamphetamine use and syphilis transmission is reminiscent of the increase in syphilis among heterosexuals during the crack cocaine epidemic of the 1980s and 1990s, when the practice of trading sex with multiple partners for drugs, especially crack cocaine, played a major role in the transmission of syphilis. Under these circumstances, the identities of sex partners are often unknown, which weakens the traditional syphilis-control strategy of partner notification.

Bacteremia due to _Treponema pallidum_, the cause of syphilis, which occurs during primary, secondary, and latent syphilis, can result in transplacental transmission of this organism to the fetus during pregnancy and cause congenital syphilis. An increase in the incidence of syphilis in women in the population is commonly accompanied by increasing rates of congenital syphilis.

Edmonton, with a population of 932 546 residents in 2016, is the capital of the Canadian province of Alberta
(<https://en.wikipedia.org/wiki/Edmonton>).

A map showing the location of Edmonton can be found at
<https://goo.gl/maps/Rfq6XC2vvwi19ypb6>. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Alberta, Canada:
9 December 2019
https://www.who.int/bangladesh/news/detail/09-12-2019-cholera-vaccination-campaign-launched-to-protect-635-000-people-in-cox-s-bazar

Cox’s Bazar, Bangladesh

Over 635,000 Rohingya refugees and Bangladeshi host community will be vaccinated against cholera in a 3-week-long campaign beginning today at the refugee camps in Cox’s Bazar and nearby areas, to protect vulnerable population against the deadly disease amidst increasing number of cases of acute watery diarrhoea (AWD).


The Oral Cholera Vaccination (OCV) campaign will be implemented in the refugee camps from 8-14 December to reach 139,888 Rohingya aged 1 year and less than 5 years. In the host community, the campaign will take place from 8-31 December and aims to reach any person older than 1 year (495,197). In total, 635,085 people are expected to be reached.

Led by the Ministry of Health and Family Welfare, with support of the World Health Organization (WHO), UNICEF and other partners, the campaign aims to reach people who missed some or all previous cholera vaccination opportunities. The campaign, including operational costs, is funded by Gavi, the Vaccine Alliance.

“We want to equip these populations with more protection against diarrheal diseases. Despite the progresses made to ensure access to quality water and sanitation, such diseases remain an issue of concern: approximately 80% of host community living near the camps have not been targeted in previous OCV campaigns and are still vulnerable”, says Dr Bardan Jung Rana, WHO Representative in Bangladesh.

Earlier rounds of cholera vaccination, which have taken place since the beginning of the emergency response in 2017, have helped prevent outbreaks of the disease. To this date, over 1 million people were vaccinated against cholera.
6th December 2019
https://www.theguardian.com/world/2019/dec/06/flooding-hits-new-zealand-tourist-hubs-of-wanaka-and-queenstown

Heavy rain has led to rivers bursting their banks, forcing the closure of shops and restaurants

Streets in the South Island tourist towns of Wanaka and Queenstown were slowly going under water on Friday, after Lake Wanaka and Lake Wakatipu burst their banks earlier in the week, flooding businesses and sewerage systems.

Water and large debris closed the main street of Wanaka, a popular spot with Instagrammers thanks to its famous tree that appears to have grown out of the lake. On Friday businesses were sandbagging as heavy rain continued to fall.

Sewerage systems in the town were also at risk of contaminating the lake, with the Queenstown Lakes District council taking the precautionary measure of shutting down the sewer connection to a handful of premises.

Wanaka residents were told to be on “high alert” with heavy rain predicted all weekend.

The streets of the usually bustling tourist town were largely empty, and the popular cafes and restaurants on the lake shore were closed.