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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our information on medical insurance overseas.

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Tuvalu

Tuvalu US Consular Information Sheet
December 17, 2008
COUNTRY DESCRIPTION:
Tuvalu is a South Pacific island nation consisting of four reef islands and five atolls.
A self governing member of the British Commonwealth, Tuvalu has a par
iamentary system of government.
Read the Department of State Background Notes on Tuvalu for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport, onward/return ticket, and proof of sufficient funds for the stay in Tuvalu are required.
Visitor permits valid for up to three months are issued upon arrival.
For further information about entry requirements, travelers may wish to contact the Tuvalu Permanent Mission to the United Nations in New York, Suite 400 B, 800 2nd Avenue, NY 10017, tel.: (212) 490-0534, fax: (212) 808-4975.
This is particularly true for those persons planning to enter by sea.

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 Tuvalu requiring immediate emergency assistance should call the 24-hour police command center in Tuvalu at (688) 20726.

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

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

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

CRIME:
Tuvalu has a low crime rate.
However, visitors should not be complacent regarding personal safety or the protection of valuables.

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 may be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical and dental care is very limited in Tuvalu, including in the capital, Funafuti.
Serious medical problems are referred to Guam or Hawaii.
Serious medical conditions requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars.
Doctors and hospitals often expect immediate cash payment for health services.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) 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.

HIV/AIDS restrictions:
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Tuvalu.

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

Traffic moves on the left in Tuvalu.
The main roads on Funafuti have been paved, but roads on these tiny islands are generally unpaved.
Animals and unwary pedestrians walking in the road make night driving on unlit secondary roads hazardous.
For specific information concerning Tuvalu driving permits, vehicle inspection, road tax and mandatory insurance, contact the Tuvalu Permanent Mission to the United Nations in New York.

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.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Tuvalu, the U.S. Federal Aviation Administration (FAA) has not assessed Tuvalu’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:
In Tuvalu, the Australian dollar is the legal currency.
Traveler’s checks and all major currencies are accepted by banks and may also be exchanged for local currency at some local hotels.
Although Visa and MasterCard are accepted at most hotels, connectivity problems often make credit card payments impossible.
Travelers should be prepared to pay cash for hotel bills.
Tuvalu’s customs authorities may enforce strict regulations concerning temporary importation into or export from Tuvalu of items such as agricultural products.
It is advisable to contact the Office of the Tuvalu Permanent Representative in New York, for specific information regarding customs requirements.
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, proofs of identity and U.S. citizenship are readily available.
If detained, U.S. citizens are encouraged to request that a consular officer at the U.S. Embassy in Suva, Fiji, be notified.

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 Tuvalu’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or, use of, or trafficking in illegal drugs in Tuvalu 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:
There is no U.S. Embassy or diplomatic post in Tuvalu.
The U.S. Embassy in Fiji provides assistance for U.S. citizens in Tuvalu.
Americans living or traveling in Tuvalu are encouraged to register with the U.S. Embassy in Suva through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Tuvalu.
Americans without Internet access may register directly with the U.S. Embassy in Suva, Fiji.
The U.S. Embassy in Fiji is located at 31 Loftus Street in the capital city of Suva.
The telephone number is (679) 331-4466; the fax number is (679) 330-2267.
Information may also be obtained by visiting the Embassy’s home page at http://samoa.usembassy.gov.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
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This replaces the Consular Information Sheet dated June 16, 2008, to update Medical Facilities and Health Information, and Special Circumstances.

Travel News Headlines WORLD NEWS

10 Aug 2019

Dengue1 outbreak declared on the 27 Mar 2019; 509 dengue-like illness (DLI) cases were reported in Funafuti from 25 Mar-3 Aug [2019], and 210 of them were confirmed. DLI cases in Funafuti peaked in weeks 14, 19, and 25. Only one (1) DLI suspected case was reported on Funafuti week 31. DLI cases from the Southern Outer Islands (OIs) follow the same downward trend now as in Funafuti but had peaked twice and at higher levels from Funafuti since end of June [2019] (week 26). Demographics: age range: 0-65 years; female: male ratio: 1:1.2; total average: 58%; median age: 9 years; majority of cases are children (5-9yrs).

HealthMap/ProMED-mail map of Tuvalu:
Date: Fri, 9 Feb 2018 11:06:04 +0100

Wellington, Feb 9, 2018 (AFP) - The Pacific nation of Tuvalu -- long seen as a prime candidate to disappear as climate change forces up sea levels -- is actually growing in size, new research shows.   A University of Auckland study examined changes in the geography of Tuvalu's nine atolls and 101 reef islands between 1971 and 2014, using aerial photographs and satellite imagery.   It found eight of the atolls and almost three-quarters of the islands grew during the study period, lifting Tuvalu's total land area by 2.9 percent, even though sea levels in the country rose at twice the global average.

Co-author Paul Kench said the research, published Friday in the journal Nature Communications, challenged the assumption that low-lying island nations would be swamped as the sea rose.   "We tend to think of Pacific atolls as static landforms that will simply be inundated as sea levels rise, but there is growing evidence these islands are geologically dynamic and are constantly changing," he said.   "The study findings may seem counter-intuitive, given that (the) sea level has been rising in the region over the past half century, but the dominant mode of change over that time on Tuvalu has been expansion, not erosion."   It found factors such as wave patterns and sediment dumped by storms could offset the erosion caused by rising water levels.

The Auckland team says climate change remains one of the major threats to low-lying island nations.   But it argues the study should prompt a rethink on how such countries respond to the problem.   Rather than accepting their homes are doomed and looking to migrate to countries such as Australia and New Zealand, the researchers say they should start planning for a long-term future.   "On the basis of this research we project a markedly different trajectory for Tuvalu's islands over the next century than is commonly envisaged," Kench said.   "While we recognise that habitability rests on a number of factors, loss of land is unlikely to be a factor in forcing depopulation of Tuvalu."

The study's authors said island nations needed to find creative solutions to adapt to climate change that take into account their homeland's evolving geography.   Suggestions included moving populations onto larger islands and atolls, which have proved the most stable and likely to grow as seas rise.   "Embracing such new adaptation pathways will present considerable national scale challenges to planning, development goals and land tenure systems," they said.   "However, as the data on island change shows there is time (decades) to confront these challenges."
Date: Mon 3 Oct 2011
Source: Central News Agency (CNA) report [edited]

The Ministry of Foreign Affairs (MOFA) [of Taiwan] issued a yellow travel alert for Tuvalu Monday 3 Oct 2011, after suspected cases of cholera were reported in the Pacific island nation. The alert, the 2nd-least serious in the MOFA's 4-color travel advisory system, warns travelers there to heighten vigilance over their personal safety and advises would-be visitors to have 2nd thoughts about their travel plans.

The MOFA noted that Tuvalu is suffering from a drought and has declared a state of emergency due to a severe shortage of fresh water. Anyone traveling in Tuvalu should be on guard and should pay close attention to hygiene conditions, the MOFA said.  [Byline: Emmanelle Tzeng, Lilian Wu]
====================
[The Tuvalu Islands are located in the Western Pacific and have had no reported cases of cholera since the early 1990s based on the Weekly Epidemiologic Report (WER) of WHO. In WER, Tuvalu had 27 cases in 1990 and 293 cases in 1992.

The current severe drought involving the islands causes the small population to seek alternative sources of water, which are more likely to be less safe. - ProMed Mod.LL]

[A HealthMap/ProMED-mail interactive map showing the location of Tuvalu can be seen at
<http://healthmap.org/r/1j9Q>. - ProMed Sr.Tech.Ed.MJ]
Date: Mon, 3 Oct 2011 08:49:22 +0200 (METDST)

Wellington, Oct 3, 2011 (AFP) - The tiny Pacific nation of Tuvalu has declared a state of emergency due to severe water shortages, prompting New Zealand to airlift in fresh supplies, officials in Wellington said Monday. New Zealand Foreign Minister Murray McCully said an air force transport plane carrying containers of water and two desalination units arrived in Tuvalu on Monday.

"Tuvalu has declared a state of emergency relating to water shortages in the capital, Funafuti, and a number of outer islands," McCully said in a statement. He said New Zealand officials were working with aid agencies including the Red Cross to ease the crisis in Tuvalu, one of the world's smallest independent nations with about 10,500 residents.

A Red Cross situation report released last week said the former British colony relied mostly on rainwater, which had been scarce this year because of a La Nina weather pattern across the Pacific. La Nina causes extreme weather, including both drought and floods, and was blamed for deluges in Australia, Southeast Asia and South America over late 2010 and early 2011.
Date: Fri, 7 Nov 2008 09:32:32 +0100 (MET)
 
SYDNEY, Nov 7, 2008 (AFP) - A strong earthquake with a magnitude of 6.4 struck off the south Pacific island of Vanuatu on Friday, but there was no immediate tsunami warning or reports of casualties, seismologists said.   The quake struck at 6:19 pm (0719 GMT), 320 kilometres (195 miles) north of the capital Port Vila, the US Geological Survey said.   The quake was registered at a depth of 35 kilometres.   Two aftershocks with magnitudes of 5.4 and 5.3 struck roughly the same spot in the next half-hour.   The Pacific Tsunami Warning Centre in Hawaii did not issue a tsunami alert for the region.   Vanuatu sits on the so-called Pacific Rim of Fire, where the meeting of continental plates causes high volcanic and seismic activity.
More ...

Netherlands

The Netherlands - US Consular Information Sheet
January 04, 2007
COUNTRY DESCRIPTION:
The Netherlands is a highly developed, stable democracy.
Tourist facilities are available throughout the Kingdom.
Read the Department of State
ackground notes on The Netherlands for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport is required.
Visas are not required for U.S. citizens for tourist visits of up to 90 days.
That period begins when you enter any of the Schengen group of countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden.
To be admitted into the Netherlands, travelers must have a passport with a validity that exceeds their intended stay, a return airline ticket, and enough money to finance the planned stay.
For further information on entry requirements, contact the Embassy of the Netherlands at 4200 Linnean Ave. N.W., Washington, D.C. 20008, telephone (202) 244-5300, or one of the Dutch consulates in Chicago, Houston, Los Angeles, New York or Miami.
Additional information is available on the Netherlands' National Bureau for Tourism's Internet web site at http://www.goholland.com.
See our Foreign Entry Requirements brochure for more information on the Netherlands and other countries.
Visit the Embassy of the Netherlands web site at http://www.netherlands-embassy.org/homepage.asp for the most current visa information.
Information on work, residency and immigration requirements in the Netherlands can be found on the web site of the Dutch immigration authorities at www.ind.nl.

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

See Entry and Exit Requirements for more information pertaining to dual nationality and the prevention of international child abduction.
Please refer to our Customs Information to learn more about customs regulations.

SAFETY AND SECURITY:
In 2004, the Dutch government implemented heightened security measures in response to concerns of international Islamic extremist terrorist activity on Dutch soil.
The November 2004 murder of Dutch filmmaker Theo van Gogh by an Islamic extremist in Amsterdam further increased concerns over Islamic extremist activity in the Netherlands.
One individual was arrested and later sentenced to life in prison for van Gogh's murder and related Islamic extremist activities.
Since the murder, the Dutch government has remained on heightened alert.

U.S. citizens in the Netherlands are encouraged to monitor media reports, and are reminded to maintain a high level of vigilance and to take appropriate steps to increase their security awareness.
As with other countries in the Schengen area, the Netherlands' open borders with its European neighbors allow the possibility of terrorist groups entering/exiting the country with anonymity.
Demonstrations are commonplace in the Netherlands and may range in number from a few people to several thousand.
Prior police approval is required for public demonstrations, and police oversight is routinely provided.
Nonetheless, situations may develop which could pose a threat to public safety.
U.S. citizens are advised to avoid areas in which public demonstrations are taking place.

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

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State's pamphlet A Safe Trip Abroad.
CRIME:
While the rate of violent crime in the Netherlands is low, tourists are often targets of thieves.
Visitors frequently fall prey to pickpockets, bag snatchers and other petty burglars.
Theft from automobiles and hotel rooms are also on the rise.
Never leave baggage or other valuables unattended.

While thieves may operate anywhere, the U.S. Consulate General in Amsterdam receives frequent reports of thefts from specific areas.
Within Amsterdam, thieves are very active in and around train and tram stations, the city center and public transport.
More specifically, trains to and from Schiphol Airport are considered to be high risk, and theft of laptop computers has increased.
Thieves often work in pairs; one distracts the victim, often by asking for directions, while the accomplice moves in on the victim's momentarily unguarded handbag, backpack, laptop or briefcase.
The timing of these thefts usually coincides with train stops, enabling the thieves to escape.
In addition, many Americans have reported that their purses and briefcases have been stolen while eating in downtown restaurants, including hotel breakfast rooms.
A good rule of thumb is to never leave your personal items unattended when going to the restroom, buffet table, etc.

Confidence artists have victimized a number of Americans.
Typically, a U.S. citizen is notified via email of a winning lottery ticket, an inheritance, or other offer, which requires his/her assistance and cooperation to conclude.
The American is asked to forward advance payments for alleged"official expenses," "taxes," etc. and, often, to come to Amsterdam to conclude the operation.
Several Americans have lost tens of thousands of dollars in such scams.
Funds transferred in response to such offers cannot be recovered.
Information on fraud schemes can be found on the U.S. Embassy's web page.
For additional information, please contact the nearest office of the U.S. Secret Service or visit that agency's web site at www.secretservice.gov.
Additional information is also provided in the Department of State's pamphlet, Advance Fee Business Scams.
Travelers may also contact the Fraud Unit, Amsterdam Police, Police Headquarters, PB 2287, 1000 CG Amsterdam, Netherlands, tel. (31) (20) 559-2380, fax (31) (20) 559-5755.

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.
In the Netherlands, the U.S. Consulate General in Amsterdam provides all passport and American citizen services.
A lost or stolen passport can usually be replaced within a few hours during normal working hours for those with immediate travel plans.
If you are the victim of a crime while in the Netherlands, in addition to reporting to local police, please contact the U.S. Consulate General for assistance.
It is a good idea to make a photocopy of the "biographic page" of your passport, to bring extra passport photos, and to keep these separate from your actual passport just in case it is lost or stolen.
Consulate staff can, for example, help you 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.
Contact information is provided at the bottom of this document.

The Criminal Injuries Compensation Fund (CICF) of the Netherlands provides financial compensation, under specific circumstances, for victims of crime and for those who have suffered injuries and consequent loss caused by such incidents.
The fund also provides for dependents or immediate family members of homicide victims.
For more information, contact the Dutch Ministry of Justice at (31) (70) 414-2000.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Good medical facilities are widely available.
Emergency medical response can be accessed by calling 1-1-2.
Reputable pharmacies are widely available and can assist with emergency prescription needs.
Some common medications are not available in the Netherlands without a prescription, and some prescription drugs cannot be mailed into the country.
Travelers are therefore urged to carry an adequate supply of prescription drugs in their original container while traveling.
Some U.S. over-the-counter medications are not available in the Netherlands and travelers should carry an adequate supply of these as well.
Those traveling with any preexisting medical problems should bring a letter from the attending physician, describing the medical condition and any prescription medications, including the generic name of prescribed drugs.

Vaccinations are not required for travel to the Netherlands.
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 Internet site at http://www.cdc.gov/travel.
For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Medical evacuations cost thousands of dollars and are not always covered by travel insurance.
Foreign doctors and hospitals usually require payment at the time service is rendered, and this too may not be covered by a traveler's policy.
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 Netherlands is provided for general reference only, and it may not be totally accurate in a particular location or circumstance:

Travel in, around, and between cities is possible via a highly advanced national train, light rail, tram, and bus network, by use of an extensive system of bike paths, and by automobile and motorcycle on the modern highway system.
Rail is often a convenient alternative to driving, particularly in the areas around Amsterdam, The Hague, and Rotterdam, where road congestion is frequent.
Rail network information is available at http://www.ns.nl.

Intercity travel by road is relatively safe in comparison with some other European countries.
Nonetheless, more than 1,000 people die and another 10,000 are injured in traffic accidents in the Netherlands each year.
More than two thirds of the fatal accidents occur outside urban areas.

A valid driver's license issued by a Department of Motor Vehicles in the U.S. is valid for use in the Netherlands for up to 180 days.
Seat belt and child seat use is compulsory.
Driving is on the right side of the road.
The maximum speed limit on highways is 120 km/h, with a highway speed limit of 100 km/h posted in most urban areas.
Secondary roads and some urban area highways have a speed limit of 80 km/h.
The speed limit in towns and cities is 50 km/h, with 30 km/h posted in residential areas.
The Dutch government has reduced speed limits on certain roads near cities in an effort to reduce air pollution.
During traffic jams, authorities also reduce speed limits; drivers should be sure to check for revised limits posted on electronic billboards above the highways.
Please note that drivers must yield the right-of-way to drivers and bikers coming from the right at intersections or traffic circles, unless otherwise posted.
The maximum allowable blood alcohol level in the Netherlands is 0.5 per mille.
The use of cellular telephones while driving is illegal without the use of a "hands-free" device.

Lanes at the center of many urban two-way streets are reserved for buses, trams and taxis.
In cities, pedestrians should be mindful of trams, which often cross or share bicycle and pedestrian paths.
Motorists must be especially mindful of the priority rights of bicyclists.
Pedestrians should not walk along bicycle paths, which are often on the sidewalk and usually designated by red pavement.
Travelers should also be watchful for one-way roads.

Taxi service in the Netherlands is safe but expensive.
Trams and buses are both convenient and economical, but often frequented by pickpockets.

Please refer to our Road Safety page for more information.
Visit the website of the Netherlands Bureau for Tourism at http://www.goholland.com.
Information also is available from the Netherlands Ministry of Transportation, Public Works and Water Management (Ministerie van Verkeer en Waterstraat) at http://www.minvenw.nl.

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

SPECIAL CIRCUMSTANCES:
Dutch customs authorities stringently enforce regulations concerning importation into the Netherlands of items such as firearms and other controlled materials.
Contact the Embassy of the Netherlands in Washington, D.C., or one of the Dutch consulates in Chicago, Houston, Los Angeles or New York for specific information regarding customs requirements.
Please see our Customs Information sheet.

Everyone age 14 and above is required to carry identification at all times while in the Netherlands.
Accepted forms of identification for U.S. citizens are either a Dutch residence card, issued by the Ministry of Foreign Affairs, or a U.S. passport.

U.S. citizens who obtain Dutch nationality may be required by the Dutch authorities to relinquish their U.S. citizenship.
For further information visit http://www.ind.nl/EN/verblijfwijzer/ and/or http://netherlands.usembassy.gov/dual_nationality.html.

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 Dutch laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use or trafficking in illegal drugs in the Netherlands 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.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the Netherlands are encouraged to register with the U.S. Consulate General through the State Department's travel registration website, and to obtain updated information on travel and security within the Netherlands.
Americans without Internet access may register directly with the U.S. Consulate General in Amsterdam.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency and to provide periodic information on issues of interest to American citizens.

The U.S. Embassy is located in The Hague, at Lange Voorhout 102; tel. (31) (70) 310-2209.
However, all requests for consular assistance should be directed to the Consulate General in Amsterdam at Museumplein 19, tel. (31) (20) 575-5309.
The after-hours emergency telephone number is (31) (70) 310-2209.
The U.S. Embassy and Consulate General web site at http://netherlands.usembassy.gov/ answers many questions of interest to Americans visiting or residing in the Netherlands.
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This replaces the Consular Information Sheet dated June 28, 2006, to update the sections on Safety and Security and Aviation Safety Oversight.

Travel News Headlines WORLD NEWS

Date: Fri 4 Oct 2019
Source: Dutch News [edited]

A total of 3 people have died and one woman has had a miscarriage after eating cold meat contaminated with _Listeria_, the public health institute RIVM [Netherlands National Institute for Public Health and the Environment] said on Friday [4 Oct 2019]. All are thought to have become ill after eating meat products from the Offerman company over the past 2 years, the agency said.

In total, at least 20 people have become ill after eating Offerman cold cuts. The company issued a health warning on Friday [4 Oct 2019], and Jumbo, which stocks 135 different products from Offerman, ordered an immediate recall. Aldi too has recalled its Offerman products, which were also widely sold to company canteens.

The source of the infection was traced by the RIVM and product safety board NVWA [Netherlands Food and Consumer Product Safety] after an analysis of the different types of _Listeria_ infection this week. "It has only been recently possible to use this technique and without it, we would not have been able to identify the source," the RIVM said. [Probably they are referring to whole genome sequencing. - ProMED Mod.ML]

The factory where the bacteria originate[d] is located in Aalsmeer and has been closed pending a thorough clean-up, the AD reported on Friday afternoon [4 Oct 2019]. According to broadcaster NOS, the NVWA had ordered Offerman to take extra hygiene measures because there were suspicions that something was going wrong. "But this would appear not to have done the job," an NVWA spokesman told the broadcaster.

_Listeria_ is found in meat that has not been properly cooked and in raw foods [that] have been kept [refrigerated?] for a long time, the RIVM said. Most people suffer mild flu-like symptoms, but the bacteria can cause serious symptoms in the elderly, new-borns and people with weak immune systems. It is particularly dangerous to pregnant women and can cause miscarriages. Every year about 80 cases of [listeriosis] are reported to the RIVM.
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[Genotyping, e.g., by whole genome sequencing, clinical isolates of _Listeria monocytogenes_ can identify clusters of cases that have a common source, and genotyping the isolates from the food and environmental surfaces at food processing facilities can confirm the source, if genotypes match, as likely happened in the outbreak described above.

Refrigerated cold cut meats that are not cooked before eating (i.e., ready-to-eat) are well-recognized sources for listeriosis. Even if initial contamination adds only a few _Listeria_ organisms to the food, the contamination can be significant for refrigerated foods because _L. monocytogenes_ can subsequently multiply at refrigerator temperatures to a sufficient number to cause disease. People at increased risk for disseminated listeriosis include pregnant women (and their new-borns), adults aged 65 years or older, and people with weakened immune systems. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Date: Sat 28 Sep 2019
Source: Food Safety News [abridged, edited]

About 30 people are part of a _Salmonella_ outbreak in the Netherlands linked to eggs from Spain. The Dutch Food and Consumer Product Safety Authority (NVWA) in August 2019 advised people not to eat eggs stamped with the code 3-ES-4624944A because of _Salmonella_ contamination. The agency added it was important to wash hands after touching them, as the _Salmonella_ can be found on the outside of the eggs. The eggs were supplied to neighborhood supermarkets, market stalls and catering establishments that may have further processed them into various dishes. They are not thought to have been sold at large supermarket chains in the country.

Salmonellosis is not a notifiable infection in the Netherlands. There were an estimated 27 440 patients with acute gastroenteritis due to salmonellosis in 2017.

A total of 30 patients have been reported with an identical _Salmonella_ Enteritidis type based on whole genome sequencing, some of which fell ill last year, in 2018. At least 5 patients are known to have eaten eggs from the batch the NVWA issued a warning about, according to the Dutch National Institute for Public Health and the Environment (RIVM).

Harald Wychgel, a RIVM spokesman, said because these studies ask people what they have eaten in recent weeks, it is not expected consumption of eggs can be confirmed for all patients. "The outbreak has been going on since 2018 with a number of patients that is insufficient to initiate source detection. RIVM linked a small cluster of patients to a batch of eggs that were withdrawn from the market at the end of August [2019]," he told Food Safety News.

"Although there has been a recall, it may still be the case that patients will be found because they may still have products at home. The eggs in question have been traced by the NVWA and are withdrawn from the market."

Information from the Rapid Alert System for Food and Feed (RASFF) shows the eggs were also distributed to Belgium.  [Byline: Joe Whitworth]
==========================
[Salmonellosis is often thought to be associated with cracked eggs or eggs dirty with faecal matter, a problem controlled by cleaning procedures implemented in the egg industry. It is clearly the case, however, that most of the salmonellosis outbreaks linked to eggs were associated with uncracked, disinfected grade A eggs, or foods containing such eggs. The undamaged eggs become contaminated during ovulation, and thus were contaminated with the bacteria before the eggshell was formed. To avoid this, uncooked eggs should only be used as an ingredient if pasteurized. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Mon 23 Sep 2019
Source: NL Times [edited]

A Hyalomma tick, commonly referred to as a giant tick, was found in Wageningen. This is the 3rd specimen of this type of tick, which can carry dangerous diseases like Crimean Congo virus and spotted fever, to be found in the Netherlands this year [2019]. The other sightings were in Drenthe and in the Achterhoek in July 2019.

This latest giant tick was found on a pony in Wageningen, according to Omroep Gelderland. It was previously thought that the Netherlands is too cold for the giant tick to grow into adulthood, but due to climate change, the conditions in the Netherlands are increasingly favourable for the animal. It is believed that this type of tick enters the Netherlands through migratory birds.

The Hyalomma tick is known as the giant tick because it is much larger than a normal tick. It can be recognized by the line pattern on its legs. Unlike other ticks that passively wait for a host to pass by, this type of tick actively hunts its host, according to the European center for disease control. They've been known to follow a host for 10 minutes or more, covering a distance of up to 100 meters.

This type of tick is a known carrier of the Crimean-Congo virus, which causes Crimean-Congo haemorrhagic fever. This is a serious disease that has a fatality rate of up to 50 percent, according to the American Centers for Disease Control. The tick found in Drenthe earlier this year [2019] was tested for this virus and was not a carrier, public health institute RIVM said at the time.

The Drenthe tick was a carrier of the _Rickettsia aeschlimannii_ bacterium, which causes the rare spotted fever. "Spotted fever is easy to diagnose and treat with antibiotics," Dutch health agency RIVM said in a statement released over the summer.  Several Dutch agencies track sightings of the tick. Those who have seen the Hyalomma tick should report it to the NVWA, the agency said.  [Byline: Janene Pieters]
========================
[With the discovery of this tick in the 3rd locality in the Netherlands, one wonders whether it is as yet undiscovered in other parts of the country. This giant tick that was found earlier this year (2019) in Drenthe was confirmed as a _Hyalomma marginatum_, a species originating in tropical climates and previously confined to southern parts of Europe. Specimens of the tick have been found in several other northern European countries, including Germany, where it is thought to have overwintered, and in Sweden. Most have been found on livestock, primarily horses. Fortunately, Crimean-Congo virus has not been found in any of the ticks in the Netherlands,

An image of _Hyalomma marginatum_ can be accessed at the source URL above. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Sun, 1 Sep 2019 17:22:26 +0200 (METDST)

The Hague, Sept 1, 2019 (AFP) - Dutch national carrier KLM will scrap 10 European flights Monday due to a two-hour strike by ground staff demanding higher wages, an airline spokeswoman said Sunday.   The move, which will see ground staff down tools between 8.00 am and 10.00 am (0600 GMT to 0800 GMT), comes after the airline and Dutch union federation FNV failed to reach an agreement.   "KLM have preventively decided to annul 10 European flights because of the strike," Manel Vrijenhoek said.   "We are still looking at which flights at this stage," she told AFP.

Air France, Delta and other SkyTeam airlines as well as no-frills carrier Transavia are also set to be affected by the strike, KLM spokeswoman Vrijenhoek confirmed.   The FNV said Saturday it was demanding a four percent increase for some 15,000 members of ground staff, with KLM's latest offer stalling at two percent.   "It's no good. Therefore we are calling a work stoppage," FNV campaign leader Joost van Doesburg said.   "If KLM retains its position after the strike, new labour actions cannot be excluded," he said in a statement.   A strike by public transport workers in May forced dozens of flights to be cancelled at Schiphol, one of Europe's busiest air travel hubs.   More than 41 million passengers passed through Schiphol in the first six months of the year, according to the latest airport figures.
Date: Thu, 25 Jul 2019 13:14:32 +0200

The Hague, July 25, 2019 (AFP) - Thousands of travellers flying to and from Amsterdam's Schiphol airport were met with another day of cancellations on Thursday. Dozens of flights were suspended after a malfunction in the kerosene refuelling system on Wednesday, which was later resolved.  But the disruptions went on to wreak further havoc on Thursday with Dutch airline KLM announcing it had cancelled 61 flights from Schiphol, one of the world's busiest transport hubs.   "We are restarting our operations gradually," a KLM spokeswoman told AFP.    The airport was not able to give an exact figure on the number of flight delays and cancellations.

On Wednesday night, around 300 flights from Amsterdam-Schiphol were cancelled due to a malfunction by the only company at the airport which supplies the fuel system, Aircraft Fuel Supply. Tens of thousands of passengers were affected with many stuck on aircrafts that were grounded.    Some travellers whose planes could not take off on Wednesday were forced to spend the night at the airport, a spokeswoman for Amsterdam-Schiphol said.
More ...

Iraq

Iraq US Consular Information Sheet
2nd October 2008
COUNTRY DESCRIPTION:
In 2005, Iraqi citizens adopted a new constitution and participated in legislative elections to create a permanent, democratic government, and in May 2006, a new Gove
nment of Iraq (GOI), led by Prime Minister Nouri al-Maliki, was sworn in. Although the GOI has made political, economic and security progress, Iraq still faces many challenges, including overcoming three decades of war and government mismanagement that stunted Iraq's economy, sectarian and ethnic tensions that have slowed progress toward national reconciliation, and ongoing (even if abating) insurgent, sectarian, criminal, and terrorist violence. Conditions in Iraq are extremely dangerous. While Iraqi Security Forces now take the lead in providing security in most provinces, Multinational Force-Iraq (MNF-I) continues to assist the Iraqi government in providing security in many areas of the country. The workweek in Iraq is Sunday through Thursday. Visit the Department of State Background Notes on Iraq for the most current visa information.
ENTRY/EXIT REQUIREMENTS: Passports valid for at least six months and visas are required for most private American citizens. An Iraqi visa may be obtained through the Iraqi Embassy in Washington, D.C. Travelers should not rely on obtaining a visa upon arrival at an airport or port of entry in Iraq. Visitors to Iraq who plan to stay for more than 10 days must obtain a no-fee residency stamp. In Baghdad, the stamps are available for all visitors at the main Residency Office near the National Theater. Contractors in the International Zone may also obtain exit stamps at the Karadah Mariam Police Station (available Sunday and Wednesday, 10:00-14:00.). There is a 10,000 Iraqi dinar (USD 8) penalty for visitors who do not obtain the required residency stamp. In order to obtain a residency stamp, applicants must produce valid credentials or proof of employment, two passport-sized photos, and HIV test results. An American citizen who plans to stay longer than two months must apply at the Residency Office for an extension. Americans traveling to Iraq for the purpose of employment should check with their employers and with the Iraqi Embassy in Washington, D.C. for any special entry or exit requirements related to employment. American citizens whose passports reflect travel to Israel may be refused entry into Iraq or may be refused an Iraqi visa, although to date there are no reported cases of this occurring.
U.S. citizens who remain longer than 10 days must obtain an exit stamp at the main Residency Office before departing the country. In Baghdad, they are available for all visitors at the main Residency Office near the National Theater. Contractors in the International Zone may also obtain exit stamps at the Karadah Mariam Police Station (available Sunday and Wednesday, 10:00-14:00). Exit stamp fees vary from USD 20 to USD 200, depending on the length of stay, entry visa and other factors. Those staying fewer than 10 days do not need to get an exit stamp before passing through Iraqi immigration at the airport. Visitors who arrive via military aircraft but depart on commercial airlines must pay a USD 80 departure fee at the airport.
Note: For information on entry requirements for other countries, please go to the Entry/Exit Requirements section in the Country Specific Information Sheet for the country you are interested in at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1765.html. You may also contact the U.S. embassy or consulate of that country for further information.
Visit the Iraqi Embassy web site at http://www.iraqiembassy.us for the most current visa information. The Embassy is located at 1801 P Street NW, Washington, DC 20036; phone number is 202-742-1600; the fax is 202-333-1129.
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 risk of terrorism directed against U.S. citizens in Iraq remains extremely high. The Department of State continues to strongly warn U.S. citizens against travel to Iraq, which remains very dangerous.

Remnants of the former Baath regime, transnational terrorists, criminal elements and numerous insurgent groups remain active throughout Iraq. Multinational Force-Iraq (MNF-I) and Iraqi Security Forces (ISF)-led military operations continue, and attacks persist against MNF-I and the ISF throughout the country. Turkish government forces have carried out operations against elements of the Kongra-Gel (KGK, formerly Kurdistan Worker’s Party, or Partiya Karkeren Kurdistan (PKK)) terrorist group that are located along Iraq’s northern border. Despite recent improvements in the security environment, Iraq remains dangerous, volatile and unpredictable. Attacks against military and civilian targets throughout Iraq continue, including in the International (or “Green”) Zone. Targets include hotels, restaurants, police stations, checkpoints, foreign diplomatic missions, and international organizations and other locations with expatriate personnel. Such attacks can occur at any time. Kidnappings still occur; the most recent kidnapping of an American citizen occurred in July 2008. Improvised Explosive Devices (IEDs), Explosively Formed Penetrators (EFPs), and mines often are placed on roads, concealed in plastic bags, boxes, soda cans, dead animals, and in other ways to blend with the road. Grenades and explosives have been thrown into vehicles from overpasses and placed on vehicles at intersections, particularly in crowded areas. Rockets and mortars have been fired at hotels, and vehicle-borne IEDs have been used against targets throughout the country. Occasionally, U.S. Government personnel are prohibited from traveling to certain areas depending on prevailing security conditions. In addition to terrorist and criminal attacks, sectarian violence occurs often. Detailed security information is available on the Embassy's web site at http://iraq.usembassy.gov and at http://www.centcom.mil.
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, including the Travel Warning for Iraq, and Travel Alerts, as well as the Worldwide Caution, can be found. Travelers are also referred to the U.S. Embassy Baghdad’s Warden Notices which are available on the Embassy web site at http://iraq.usembassy.gov.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State's pamphlet A Safe Trip Abroad and Tips for Traveling Abroad.
CRIME: The U.S. Embassy and MNF-I are working with Iraqi authorities to establish law enforcement and civil structures throughout the country. U.S. and British military personnel are providing police protection as well, as the security situation permits. Petty theft is common in Iraq, including thefts of money, jewelry, or valuable items left in hotel rooms and pick-pocketing in busy places such as markets. Carjacking by armed thieves is very common, even during daylight hours, and particularly on the highways from Jordan and Kuwait to Baghdad. Foreigners, primarily dual American-Iraqi citizens, and Iraqi citizens are targets of kidnapping. The kidnappers often demand money but have also carried out kidnappings for political/religious reasons.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to 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. While U.S. Consular Services in Iraq are limited due to security conditions, the Embassy/Consulate staff can, for example, assist you 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.See our information on Victims of Crime.There is no 911-equivalent emergency telephone number in Iraq.
MEDICAL FACILITIES AND HEALTH INFORMATION: Basic modern medical care and medicines are not widely available in Iraq. The recent conflict in Iraq has left some medical facilities non-operational and medical stocks and supplies severely depleted. The facilities in operation do not meet U.S. standards, and the majority lack medicines, equipment and supplies. Because the Baghdad International Airport has limited operations for security reasons, it is unlikely that a private medical evacuation can be arranged.
Iraq does not allow visitors with HIV/AIDS to enter the country. At this time there is no waiver available for this ineligibility. However, please inquire directly with the Embassy of Iraq at http://www.iraqiembassy.org before you travel for any changes.

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://www.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.
AVIAN INFLUENZA: The WHO and Iraqi authorities have confirmed human cases of the H5NI strain of avian influenza, commonly known as the "bird flu." Travelers to Iraq and other countries affected by the virus are cautioned to avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to be contaminated with feces from poultry or other animals. In addition, the CDC and WHO recommend eating only fully cooked poultry and eggs. For the most current information and links on avian influenza, see the State Department's Avian Influenza Fact Sheet.
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 as well as whether medical evacuation would be possible from Iraq. 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 Iraq is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
All vehicular travel in Iraq is extremely dangerous. There have been numerous attacks on civilian vehicles, as well as military convoys. Attacks occur throughout the day, but travel at night is exceptionally dangerous and should be avoided. There have been attacks on civilian vehicles as well as military convoys on Highways 1, 5, 10 and 15, even during daylight hours. Travelers are strongly urged to travel in convoys with at least four vehicles in daylight hours only. Travel in or through Ramadi and Fallujah, in and between al-Hillah, al-Basrah, Kirkuk, and Baghdad and between the International Zone and Baghdad International Airport, and from Baghdad to Mosul is particularly dangerous. Occasionally, U.S. Government personnel are prohibited from traveling to select areas depending on prevailing security conditions. There continues to be heavy use of Improvised Explosive Devices (IEDs) and/or mines on roads, particularly in plastic bags, soda cans, and dead animals. Grenades and explosives have been thrown into vehicles from overpasses, particularly in crowded areas. Travel should be undertaken only when absolutely necessary and with the appropriate security.
Buses run irregularly and frequently change routes. Poorly maintained city transit vehicles are often involved in accidents. Long distance buses are available, but are often in poor condition and drive at unsafe speeds. Jaywalking is common. Drivers usually do not yield to pedestrians at crosswalks and ignore traffic lights (if available), traffic rules and regulations. Roads are congested. Driving at night is extremely dangerous. Some cars do not use lights at night and urban street lights may not be functioning. Some motorists drive at excessive speeds, tailgate and force other drivers to yield the right of way. Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by air carriers registered in Iraq, the U.S. Federal Aviation Administration (FAA) has not assessed Iraq's Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
There is credible information that terrorists are targeting civil aviation. Military aircraft arriving and departing from Baghdad International Airport (ORBI) have been subjected to small arms and missile fire. Travelers choosing to utilize civilian aircraft to enter or depart Iraq should be aware that, although there have been no recent attacks on civilian aircraft, the potential threat still exists. Official U.S. Government (USG) personnel are strongly encouraged to use U.S. military or other USG aircraft when entering or departing Iraq. All personnel serving in Iraq under Chief of Mission (COM) authority are prohibited from entering or departing ORBI on commercial airlines unless they receive COM approval, which is granted on a case-by-case basis for emergency purposes only. Other personnel not under COM authority must be guided by their own agencies. Personnel under COM authority assigned to the Erbil and Sulaymaniyah areas are permitted to use commercial flights in and out of Erbil on a case-by-case basis.

SPECIAL CIRCUMSTANCES:
As of September 21, 2006, Iraqi law prohibits adult Iraqis and foreigners from holding and transporting more than U.S. $10,000 in cash out of Iraq. In addition, it permits adult Iraqi and resident foreigners to hold and transport no more than 200,000 Iraqi dinars to cover travel expenses. Iraqi law also prohibits taking more than 100 grams of gold out of the country. Iraqi customs personnel are taking action to enforce these laws and may pose related questions to travelers during immigration and customs exit procedures. (Civil customs personnel also will verify passport annotations related to any items such as foreign currency, gold jewelry, or merchandise that were declared by passengers upon entry into Iraq on Form-8.)
All U.S. citizens are reminded that it is their duty to respect Iraqi laws, including legal restrictions on the transfer of currency outside of Iraq. If you are detained at the airport or at any other point of exit regarding your attempt to transfer currency out of Iraq, you should contact – or ask that Iraqi authorities immediately contact -- the American Embassy.

Transporting large amounts of currency is not advisable. Almost all of the international companies working in Iraq have the capability to make payments to their employees and at least four Iraqi banks are also able to convert cash into an international wire transfer directed to a bank account outside Iraq. Branches of the Credit Bank of Iraq on Al-Sa’adoon St., Baghdad (creditbkiq@yahoo.com), Dar Es Salaam Bank (info@desiraq.com), Iraqi Middle East Investment Bank (coinvst@iraqimdlestbank.com) and Al-Warqaa Investment Bank (warkabank@hotmail.com) all have this capability. Please be aware that large wire transfers may require Central Bank of Iraq approval because of measures in place to combat money laundering. Such approvals can be obtained by the sending bank, if information on the origin of the funds and the reason for its transfer are provided. Additional information on banking in Iraq is available at the Central Bank of Iraq web site http://www.cbi.iq/.
Customs and MNF-I officers have the broad authority to search persons or vehicles at Iraq ports of entry. Officers may confiscate any goods that may pose a threat to the peace, security, health, environment, or good order of Iraq or any antiquities or cultural items suspected of being illegally exported. Goods that are not declared may be confiscated by an officer. Persons may also be ordered to return such goods, at their expense, to the jurisdiction from which they came. Please see our Customs Information.
The banking and financial infrastructure has been disrupted and is in the process of rebuilding. Hotels usually require payment in foreign currency. Automatic Teller Machines (ATMs) are extremely limited but the Trade Bank of Iraq (TBI) provides ATM services in dinars and U.S. dollars at the TBI head office in central Baghdad and two other locations (See http://www.tbiraq.com.)
Telecommunications are very poor. There is limited international phone service in Iraq at this time. Local calls are often limited to a neighborhood network. There are no public telephones in the cities; however, calls may be made from hotels, restaurants or shops. Limited cellular telephone service and Internet service are available in Iraq.
Due to security conditions, the Consular Section of the U.S. Embassy is able to provide only limited emergency services to U.S. citizens. Because police and civil structures are in the process of being rebuilt, emergency service and support will be limited.
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 Iraqi laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Iraq 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: The U.S. and international media have occasionally reported on the difficult situation faced by Iraq's children, and it is completely understandable that some American citizens want to respond to such stories by offering to open their homes and adopt these children in need. However Iraqi law does not permit full adoptions as they are generally understood in the United States. It is not possible to adopt Iraqi children at this time. For more information on this issue, please refer to our flyer Intercountry Adoptions – Iraq.
Iraq is not party to the Hague Convention on the Civil Aspects of International Child Abduction, nor are there any international or bilateral treaties in force between Iraq and the United States dealing with international parental child abduction. The security situation in Iraq limits consular access to children. For more information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
REGISTRATION / EMBASSY LOCATION:
The Travel Warning on Iraq urges U.S. citizens to defer travel to Iraq. However, Americans living or traveling in Iraq despite that Warning 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 Iraq. 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. U.S. citizens may also contact the consular section of the U.S. Embassy in Baghdad, Iraq located in the International Zone via e-mail at baghdadacs@state.gov, via landline at 1-240-553-0581, extension 2413 (this number rings in Baghdad) or the U.S. Embassy's web site at http://iraq.usembassy.gov. The after-hours number in case of extreme emergency is GSM 1-914-822-1370 or Iraqna 07901-732-134.
* * * * * *
This replaces the Country Specific Information for Iraq dated January 22, 2008, to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, Aviation Safety Oversight, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu 5 Jul 2018
Source: IraqiNews.com [edited]

Mosul, Iraq's former Islamic State (IS) capital, is witnessing a growing rate of scabies infections in its western region, medical workers reported as the city struggles to overcome destruction resulting from the war against the extremist group. Moamen Shahwani, a doctor at the health department in Mosul, was quoted by the Iraqi website Sky Press in a press statement that western Mosul has recorded 150 scabies cases, warning that parasites causing the disease are spreading in the city.

He attributed the spread of the disease to several factors, most importantly the return of displaced families to the regions, which are still scarred by the war against Daesh (IS) and the resulting waste matter. "Garbage, debris and remains of corpses are almost at every corner; moreover, there is a shortage in water, electricity and other essential services," Shahwani said.

The doctor noted that, besides registered cases, there are other unregistered ones, with infected persons seeking treatment at outpatient clinics or resorting to herbal medicines. "The disease is highly dangerous and rapidly progressing, and it is difficult to contain it in a short period [in] an environment that lacks the simplest services," he added.

Mosul was IS's capital and base of operations in Iraq. It was from its Grand Nuri Mosque that IS founder, Abu Bakr al-Baghdadi, proclaimed the group's rule. Iraqi forces recaptured the city last July [2017] after an operation that lasted for more than 8 months. Most of the city's infrastructure was demolished due to battles, and authorities continue to extract dead bodies from under the debris.  [Byline: Mohamed Mostafa]
====================
[Scabies is found worldwide and is an indicator of poor hygienic conditions, including lack of personal hygiene and clean clothes, crowded sleeping conditions and inadequate water resources. Thus, it is not surprising that scabies is found in Mosul under the present circumstances. More importantly, scabies can be an indicator of infections transmitted by human lice, like _Borrelia recurrentis_, _Rickettsia prowazekii_ and _Bartonella quintana_. Thus, those treating persons with severe febrile illness in Mosul should consider these infections. - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Date: Tue 26 Jun 2018
Source: Rudaw [edited]
<http://www.rudaw.net/english/middleeast/iraq/26062018>

After 3 reported deaths caused by viral haemorrhagic fever in Iraq's Euphrates Valley, a rights group has called on the government to undertake measures to prevent the disease from spreading, while officials say: "The situation doesn't call for worry." "The Iraqi High Commission for Human Rights warns of spreading the viral haemorrhagic fever, which causes human deaths and has great dangers to public health and the economy of Iraq," read a statement from IHCHR on Tuesday [26 Jun 2018].

The virus is spread by mosquitoes, ticks, rodents, and bats into livestock and humans, or when humans butcher already-infected livestock. "We call on the Ministry of Health and Diwaniyah Health Department to fumigate animal sheds in the province and carry out rapid preventive measures to prevent the spreading of the disease to Iraq's provinces," added the rights group.

They call for butchers only to work at licensed locations and for the police and relevant administrations to issue instructions. Additionally, posters should be displayed, and seminars should be offered as part of an educational campaign. "After 2 people lost their lives due to the hemorrhagic fever in the Diwanyah province, our ministry has swiftly undertaken the necessary measures to prevent the disease and provide necessary medications," Sayf Badir, a spokesperson for the ministry, said in a statement.

A source from the Diwanyah Hospital told Baghdad Today of another death on Monday [25 Jun 2018], increasing the number to 3. The Provincial Council of Diwanyah held a meeting in the presence of the governor and the head of the province's police to discuss the issue. Dr. Sabah Mahdi, the director of the National Center for Containing and Preventing Diseases, said on Monday [25 Jun 2018] that the 1st recorded case of the disease in Iraq was in 1979. He revealed that there are continuous efforts by the veterinaries to spray pesticides on cattle fields.

"To prevent this disease, we advise all ranchers, laboratory employees, and veterinary employees to wear personal protection gear while dealing with animals," added Mahdi. "The preventive measures are continuous, and by following up on all the cases, the situation doesn't call for worry." The World Health Organization defines viral haemorrhagic fever as "a general term for a severe illness, sometimes associated with bleeding, that may be caused by a number of viruses." Symptoms are sudden and include fever, muscle ache, dizziness, neck pain, backache, headache, and sore eyes, among other symptoms. The mortality rate is 30 percent. There is no vaccine available for humans or animals. There have been no reported cases outside of Diwanyah.
======================
[If the virus is believed to be spread by mosquitoes, ticks, rodents, and bats into livestock and humans, the identity of the virus has not been determined. However, if it is transmitted to humans when they butcher livestock, that raises the possibility that the etiological agent is Congo-Crimean haemorrhagic fever (CCHF) virus.

Cases in Iraq would not be surprising because cases have occurred this year (2018) across the region, including Iran and Afghanistan, and was suspected in 2 fatal and 4 suspected cases in Iraq in 2010. Crimean-Congo hemorrhagic fever (CCHF) is caused by infection with a tick-borne Nairovirus in the family Bunyaviridae. It is a viral zoonosis (animal to human) caused by infection with a tick-borne virus.

The hosts of the CCHF virus are mostly wild and domestic animals, including cattle, sheep and goats. Human transmission may occur when human beings come into contact with infected ticks (through tick bites) or direct contact with blood or tissues of an infected animal. CCHF can be transmitted from one infected human to another by contact with infectious blood or body fluids. In humans, until the etiological agent is identified, effective prevention will be difficult. ProMED-mail would appreciate receiving the name of the virus involved and the laboratory tests used to identify it. - ProMED Mod.TY]

[HealthMap/ProMED-mail map: Qadisiyyah Governorate, Iraq:
<http://healthmap.org/promed/p/25538>]
Date: Mon 9 Oct 2017
Source: MedPage Today [edited]

US service members deployed to Iraq showed signs of having been infected with latent visceral leishmaniasis during their service, researchers said.

In one study, latent visceral leishmaniasis was identified in asymptomatic Operation Iraqi Freedom soldiers (10.2 percent of 88), potentially putting them at risk of activation of the disease if they are immunosuppressed, according to Edgie-Mark Co of the William Beaumont Army Medical Center in El Paso, Texas <https://academic.oup.com/ofid/article/4/suppl_1/S122/4295608/A-Stealth-Parasite-Prevalence-and-Characteristics>.

In another study, 20 veterans with asymptomatic latent visceral leishmaniasis had no active disease, although it was not clear how likely the condition was to resurface and cause serious health problems, reported Nate Copeland of the Clinical Trials Center at Walter Reed Army Institute in Bethesda, Maryland, and colleagues <https://academic.oup.com/ofid/article/4/suppl_1/S122/4295606/Clinical-Evaluation-of-Latent-Visceral>.

Both studies were presented at the annual ID Week meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

Leishmaniasis is spread by sand flies and is common in the Middle East. The zoonotic parasitic disease can cause chronic fever, weight loss, spleen problems, and pancytopenia. Bacterial infections, malnutrition, and severe bleeding can also occur. Researchers are concerned because visceral leishmaniasis, unlike the more common cutaneous form, can cause serious health problems.

"Visceral leishmaniasis can be severe, and even life-threatening if not recognized and treated appropriately," Copeland told MedPage Today.

He said that more than 20 cases of active visceral leishmaniasis were reported among US service members in the Iraq region from 2000-2013, along with hundreds of cutaneous cases.

The study by Copeland [et al.] checked 88 soldiers from the El Paso area who'd served in areas with endemic visceral leishmaniasis from 2002-2011 (86 percent male, median age 39). Via various tests, they found that 10.2 percent showed signs of asymptomatic visceral leishmaniasis.

"If you have a healthy immune system, it shouldn't be an issue. That's what your immune system does, it suppresses the disease," Co told MedPage Today. "But once you have conditions that weaken the system, that's when the disease reactivates." HIV, treatment with immunosuppressant drugs, and the use of steroids could put these soldiers at risk of emergence of active disease, he said.

"Reactivation has been reported in the literature among immunocompromised patients such as solid organ transplants patients and rheumatologic patients with immunosuppressive treatment," said Kanokporn Mongkolrattanothai of Children's Hospital of Los Angeles, who has treated leishmaniasis patients.

Mongkolrattanothai, who was not involved with the studies, told MedPage Today that the new studies are "useful" in light of the life-threatening nature of visceral leishmaniasis.

In the study of 20 soldiers with active visceral leishmaniasis (all male, median age 38.5), "the majority tested positive with a test showing a good cell-mediated immune response, which is essential for control of the _leishmania_ parasites," Copeland said. "These service members were all counseled on the clinical syndrome of visceral leishmaniasis as well as potential risk factors for activation based on what is known at this time."

These patients will be able to visit for re-checks every 1 or 2 years, Copeland said, "but if they remain asymptomatic they likely do not need further care in light of being a healthy and immune-competent group."

Tests revealed that another 2 service members showed signs of genetic material from leishmania parasites in their blood. "While they are also without symptoms, we are following them very closely, every 3-6 months, and monitoring their levels of parasite," Copeland said. "We have also been doing some evaluation as to whether these individuals have any evidence of an immunodeficiency allowing them to have parasites circulating in their blood stream."

"Neither service member is being treated at this point, " he said, "because there are definite known risks to treatment, but no clearly defined benefit to treating people without symptoms. [But] if they were to develop symptoms, there would be a very low threshold to treat them."

The next steps are to understand the risk to service members of latent visceral leishmaniasis infection and gain insight into risk factors for activation, he said.

"In tuberculosis, we have a very similar disease, conceptually," he said. "You have a parasite that most often causes no problems in healthy people exposed, but a certain subset go on to active disease early on after exposure, and others reactivate months to years later, often as a result of some risk factor."

"While we are not sure if the later reactivation is the case in leishmaniasis, we are concerned it may be," Copeland added. "In tuberculosis, there is clear evidence that if you treat those with latent infection, especially those with risk factors for reactivation, you can decrease the risk of future active disease. So that begs the question, would the same be true in leishmaniasis? In other words, can we treat these asymptomatic people now and prevent them from ever getting disease?"  [Byline: Randy Dotinga]
========================
[We know very little about latent Leishmaniasis in healthy subjects. There is no doubt that the exposure to leishmaniasis in the US armed forces in Iraq was extensive (see ProMED reports below from 2001 to 2004).

The tests described here respond with an Interferon-gamma response to stimulation with Leishmania antigens. The test may be false positive or negative and we have no data showing that even if the tests correctly identify people who have been exposed to Leishmania, they will eventually become ill with clinical visceral leishmaniasis.

The authors draw a comparison with tuberculosis. We know a lot more about latent tuberculosis but even here treating latent tuberculosis based on a positive quantiferon test in healthy, asymptomatic individuals is controversial. These people, if treated, are exposed to side effects and the benefit is not well quantified. It is a good rule in clinical medicine, that we treat patients and not laboratory results. Thus a sensible scenario would be to do follow up in Leishmania test positive, asymptomatic individuals.

For subjects with a confirmed (repeated) positive PCR for Leishmania in their blood or other samples like a bone marrow, the infection is no longer asymptomatic and should be treated accordingly, probably with liposomal amphotericin B. - ProMED Mod EP]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sun 24 Sep 2017
Source: Alghad Press [in Arabic, trans. Mod.NS, edited]

The Parliamentary Health and Environment Committee revealed on [Sun 24 Sep 2017] the spread of plague and called for a national campaign against rodents that are causing the disease.

The deputy head of the Parliamentary Health and Environment Committee, Fares Al-Barefkani, told Alghad Press that "new cases of plague have been identified, and the causes of the disease are known and are related to the poor municipal, disease control, sewage, and landfill services, in addition to widespread residential slums."

Al-Barefkani indicated that "there are a lot of residential slums that have emerged and are not under the control of Baghdad municipality and lack health services." He called for "a serious national campaign to combat rodents in the residential neighbourhoods that cause plague and provide medicines that help to eliminate the disease" and stressed that "there is a need to support Baghdad municipality and the health and the environment directorates to educate people on how to combat plague."

Al-Barefkani added that "the Parliamentary Health and Environment Committee does not have accurate data on the number of cases because we are in the process of follow-up in all the governorates."

On Tuesday [12 Sep 2017], the Ministry of Health denied some social media and other media reports about the occurrence of plague cases.
===================
[ProMED would again appreciate more information regarding whether plague cases have occurred in Iraq as it had been previously denied. If plague is present there, a program to eradicate rodents alone will not be effective in preventing human cases as the infected flea vector will seek other blood sources, such as humans.

This publication regarding the history of _Yersinia pestis_ in Iran also reviews the history of plague in other countries in the Middle East including Iraq:

Hashemi Shahraki A, Carniel E, Mostafavi E: Plague in Iran: its history and current status. Epidemiol Health. 2016 Jul 24; 38: e2016033; available at

"Throughout its history, Iraq has experienced multiple epidemics of plague. In 716 and 717 CE, a large outbreak known as al-Ashraf (the Notables) was recorded in Iraq and Syria. In an epidemic of bubonic plague in 1772 and 1773, many victims died in cities such as Basra (with 250 000 deaths) and Mosul. In 1801 CE, a large plague epidemic occurred in Mosul and Baghdad. A plague epidemic occurred again in Baghdad in 1908. From 1923 to 1924, approximately 90 cases of pneumonic plague were reported in Baghdad, and some plague outbreaks were reported in Basra." - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Tue 12 Sep 2017
Source: Alghad Press [in Arabic, trans. ProMED Mod.NS, edited]

The Ministry of Health denied on [Tue 12 Sep 2017] what has been circulated in some social media sites and other media sources about the occurrence of plague cases. The spokesman for the Ministry of Health, Saif Al-Bader, said in a statement that "after communicating with the relevant authorities and departments, it has been found that no deaths due to plague have occurred." He indicated that "this disease was eliminated from Iraq a long time ago and the health departments, whether in Baghdad or the other governorates, have not registered any cases in the whole country."

"The Ministry of Health is carrying out intensive campaigns to combat vectors of diseases, under the supervision and follow-up of the Communicable Diseases Control Center," Al-Bader added.

The director of the Communicable Diseases Control Center, Sabah Abdul-A'ayma, said that "the center continues to supervise all the teams from the different units of the center that are involved in the ongoing campaigns to fight disease carriers, especially in the areas that were mentioned in the rumors such as Al-Rusafa, Al-Saadoun, and Al-Batawin."

Abdul-A'ayma added that "the last campaign was carried out today [Tue 12 Sep 2017] as a team from the Communicable Diseases Control Center conducted an intensive rodent control campaign in the area of Al-Batawin, through the distribution of toxic baits and carrying out fumigation of rodent burrows in the region."

Abdul-A'ayma stressed that "these measures taken by the Communicable Diseases Control Center are aimed to reduce the spread of rodents, which are hard to control due to rapid reproduction as well as the presence of a poor environment from the accumulation of wastes and sewage that contributes to the spread of rodents."

Al-Bader pointed out that "the ministry calls on people not to believe these rumors that are aimed at spreading panic in society." He called on the media to adhere to the scientific standards and accuracy in the dissemination of any information affecting the health of the country, without reference to specialists particularly under the circumstances of the country's fight against terrorism.
========================
[ProMED would appreciate more information regarding whether plague cases have occurred in Iraq. If plague is present there, a program to eradicate rodents alone will not be effective in preventing human cases as the infected flea vector will seek other blood sources such as humans.

This publication regarding the history of _Y. pestis_ in Iran also reviews the history of plague in other countries in the Middle East including Iraq:

Hashemi Shahraki A, Carniel E, Mostafavi E: Plague in Iran: its history and current status. Epidemiol Health. 2016 Jul 24; 38: e2016033; available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037359/>

"Throughout its history, Iraq has experienced multiple epidemics of plague. In 716 and 717 CE, a large outbreak known as al-Ashraf (the Notables) was recorded in Iraq and Syria. In an epidemic of bubonic plague in 1772 and 1773, many victims died in cities such as Basra (with 250 000 deaths) and Mosul. In 1801 CE, a large plague epidemic occurred in Mosul and Baghdad. A plague epidemic occurred again in Baghdad in 1908. From 1923 to 1924, approximately 90 cases of pneumonic plague were reported in Baghdad, and some plague outbreaks were reported in Basra." - ProMED Mod.LL]

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

World Travel News Headlines

Date: Fri, 6 Dec 2019 10:30:54 +0100 (MET)

Moscow, Dec 6, 2019 (AFP) - More than 50 polar bears have gathered on the edge of a village in Russia's far north, environmentalists and residents said, as weak Arctic ice leaves them unable to roam.   The Russian branch of the World Wildlife Fund said climate change was to blame, as unusually warm temperatures prevented coastal ice from forming.   The WWF said 56 polar bears had gathered in a one-square-kilometre (0.4-square-mile) area near the village of Ryrkaipy in Chukotka on the north-eastern tip of Russia.

There were concerns they could enter the village, home to fewer than 1,000 people, and patrols had been set up to monitor their movements.   "The number of human and predator encounters in the Arctic is increasing," the WWF said in statement.    "The main reason is the decline of sea ice area due to the changing climate. In the absence of ice cover, animals are forced to go ashore in search of food."

Residents had gathered walrus carcasses in the area to try to keep the bears from wandering into the village.   "We have created a feeding point with walrus carcasses that we gathered along the coast," Tatyana Minenko of the local "Bear Patrol" told news agency RIA Novosti.   "As long as there is no big freeze, the sea ice will not form and the bears will stay on the coast," she said.

Russia's weather service said temperatures in the region should fall from Saturday and that coastal ice should freeze by December 11.    Polar bears regularly visit areas inhabited by humans in Arctic Russia to search for food, often in rubbish tips.   But the number of visits has been growing as the melting of Arctic ice from climate change forces the bears to spend more time on land where they compete for food.
Date: Fri, 6 Dec 2019 10:28:26 +0100 (MET)
By Joseph Schmid

Paris, Dec 6, 2019 (AFP) - Travellers across France endured a second day of chaos on Friday as unions vowed to keep up their strike until President Emmanuel Macron backs down on controversial pension overhauls.   Rail operator SNCF said 90 percent of high-speed TGV trains were again cancelled, and several airlines dropped flights including Air France, EasyJet and Ryanair.

Nine of the capital's 16 metro lines were shut and most others severely disrupted, sparking some 350 kilometres (220 miles) of traffic jams in the Paris region, well above the usual 200 km, the traffic website Sytadin reported.   Many employees were unable to get to work and several schools again provided only daycare, though fewer teachers were on strike compared with Thursday when some 800,000 people demonstrated across the country according to the interior ministry.   Bike paths were crowded with bikes and electric scooters, with metro operator RATP sponsoring special deals for commuters with a range of ride-hailing companies and other transportation alternatives.

The walkout is the latest test for Macron after months of protests from teachers, hospital workers, police and firefighters as well as the "yellow vest" movement demanding improved living standards.   Unions say his "universal" pension system, which would eliminate dozens of separate plans for public workers, forces millions of people in both public and private sectors to work well beyond the legal retirement age of 62.   Health Minister Agnes Buzyn said Friday that the government had "heard" the protesters' anger and would meet with union leaders to discuss the reform on Monday.   The government has yet to lay out the details of its plan, and Buzyn told Europe 1 radio that "there is indeed a discussion going on about who will be affected, what age it kicks in, which generations will be concerned -- all that is still on the table".

- Macron 'determined' -
Yves Veyrier, head of the hardline FO union, warned Thursday the strike could last at least until Monday if the government did not take the right action.   But it remains to be seen if the protests will match the magnitude of the 1995 strikes against pension overhauls, when France was paralysed for three weeks from November to December in an action that forced the government to back down.

Macron, a former investment banker, has largely succeeded in pushing through a series of controversial reforms, including loosening labour laws and tightening access to unemployment benefits.   But this is the first time the various disgruntled groups have come together in protest.   So far Macron has not spoken publicly on the stoppages though a presidential official, who asked not to be named, said Thursday that the president was "calm" and "determined to carry out this reform" in a mood of "listening and consultation".

While most of Thursday's rallies were peaceful, police fired tear gas to disperse dozens of black-clad protesters smashing windows and throwing stones during the Paris march, with one construction trailer set on fire. Sporadic clashes were also reported in some other cities.   Many people were bracing for further disruptions over the weekend, including the prospect of fuel shortages as unions blocked most of the country's eight oil refineries.

The minimum pension age in France is 62, one of the lowest among developed countries, but there are 42 "special regimes" for railway workers, lawyers, opera employees and others offering earlier retirements and other benefits.   The government says a single system will be fairer for everyone while ensuring its financial viability while acknowledging that people will gradually have to work longer.
Date: Fri, 6 Dec 2019 04:23:51 +0100 (MET)

Sydney, Dec 6, 2019 (AFP) - Three hundred animals have been evacuated from a wildlife park north of Sydney as massive bushfires encircled Australia's largest city and foreign firefighters arrived to relieve beleaguered local forces.   Walkabout Wildlife Park said it had shipped out lizards, dingoes, peacocks and marsupials, as firefighters battled more than 100 fires up and down the eastern seaboard.   "This fire has been doing some crazy things, so we have to be prepared," general manager Tassin Barnard told AFP.

Prolonged drought has left much of eastern Australia tinder dry and spot fires have raged every day for the past three months, leaving firefighters struggling to cope.   New South Wales rural fire chief Shane Fitzsimmons said Friday that some US and Canadian firefighters had arrived to help out, easing the strain on the exhausted largely volunteer Australian force.

The incident-management and aviation specialists will help ease "fatigue and crew rotations" he said.   "We are not only appreciative of their presence here today, but of their sacrifice," said Fitzsimmons -- who has become a fixture on Australian television screens for weeks, updating the public on blazes in towns, national parks and backwaters.    "They are volunteering to sacrifice time from loved ones, from families, to give up that special time of the year around Christmas and New Year to come down here and lend us a hand," he said.

More than 600 homes have been destroyed and six people have died since the crisis began in September. That is many fewer than Australia's deadliest recent fire season in 2009 when almost 200 people died, but 2019's toll belies the scale of devastation.    Millions of hectares have burned -- the size of some small countries -- across a region spanning hundreds of kilometres (miles).   Bushfires are common in Australia but scientists say this year's season has come earlier and with more intensity due to a prolonged drought and climatic conditions fuelled by global warming.

The fires have taken a toll in Sydney and other major cities, which have been blanketed in toxic smoke for weeks and occasionally sprinkled with snow-like embers.   Fitzsimmons said he could not "overstate the effect that this profound drought is having" as he warned of a long, painful summer ahead.   "There is an absolute lack of moisture in the soil, a lack of moisture in the vegetation... you are seeing fires started very easily and they are spreading extremely quickly, and they are burning ridiculously intensely."
Date: Fri, 6 Dec 2019 03:03:18 +0100 (MET)
By Pierre-Henry DESHAYES

Half Moon Island, Antarctica, Dec 6, 2019 (AFP) - The swimsuit-clad tourists leap into the icy water, gasping at the shock, and startling a gaggle of penguins.   They are spectators at the end of the world, luxury visitors experiencing a vulnerable ecosystem close-up.   And their very presence might accelerate its demise.   Antarctica, a vast territory belonging to no one nation, is a continent of extremes: the coldest place on Earth, the windiest, the driest, the most desolate and the most inhospitable.   Now, it's also a choice destination for tourists.

All around Half Moon Island, off the Antarctic Peninsula, blocks of ice of all sizes float by on a calm sea, their varying forms resembling weightless origami shapes.    On this strip of land, that juts out of the Antarctic Polar and towards South America, visitors can see wildlife normally only viewed in zoos or nature documentaries along with spectacular icy landscapes.   The ethereal shades of white that play across the pillowy peaks change with the light, acquiring pastel hues at dawn and dusk.   "Purity, grandeur, a scale that's out of this world," says Helene Brunet, an awestruck 63-year-old French pensioner, enjoying the scene.    "It's unbelievable, totally unbelievable. It's amazing just to be here, like a small speck of dust."

AFP joined the 430 passengers on board the Roald Amundsen, the world's first hybrid electric cruise ship, on its maiden voyage in the Southern Ocean.    "It's not your typical beach, but it's awesome to do it," says a numb Even Carlsen, 58, from Norway, emerging from his polar plunge in the three-degree C (37.4 F) water.   When tourists go ashore, bundled up in neon-coloured windbreakers and slathered in SPF50 sunscreen, they have to follow strict rules: clean your personal effects so you don't introduce invasive species, keep a respectful distance from wildlife to avoid distressing them, don't stray from the marked paths and don't pick up anything.   "We mucked up the rest of the world. We don't want to muck up Antarctica too," says an English tourist, as she vacuums cat hair off her clothes before going ashore.

- 'Heart of the Earth' -
The Antarctic peninsula is one of the regions on Earth that is warming the fastest, by almost three degrees Celsius in the past 50 years, according to the World Meteorological Organization -- three times faster than the global average.    In March 2015, an Argentinian research station registered a balmy 17.5 degrees Celsius, a record.    "Every year you can observe and record the melting of glaciers, the disappearance of sea ice... (and) in areas without ice, the recolonisation of plants and other organisms that were not present in Antarctica before," said Marcelo Leppe, director of the Chilean Antarctic Institute.

Antarctica is "like the heart of the Earth," he added, saying that it expands and contracts like a heart beating, while the mighty current which revolves around the continent is like a circulatory system as it absorbs warm currents from other oceans and redistributes cold water.   The Antarctic Treaty, signed 60 years ago by 12 countries -- it now has 54 signatories -- declared the area a continent dedicated to peace and science, but tourism has gradually increased, with a sharp rise in the past few years.   Tourism is the only commercial activity allowed, apart from fishing -- the subject of international disputes over marine sanctuaries -- and is concentrated mainly around the peninsula, which has a milder climate than the rest of the continent and is easier to access.

Cruise ships have roamed the region for around 50 years, but their numbers only started to increase from 1990, as Soviet ice-breakers found new purposes in the post-Cold War era.   Some 78,500 people are expected to visit the region between November and March, according to the International Association of Antarctica Tour Operators (IAATO).   That's a 40-percent increase from last year, due in part to short visits by a few new cruise ships carrying more than 500 passengers, too many to disembark under IAATO regulations.     "Some might say 'Well, 80,000 people, that doesn't even fill a national stadium'... (and that it) is nothing like Galapagos which welcomes 275,000 a year," says IAATO spokeswoman Amanda Lynnes.    "But Antarctica is a special place and you need to manage it accordingly."

- 'Leave Antarctica to the penguins' -
It is Antarctica's very vulnerability that is attracting more and more visitors.   "We want to see this fantastic nature in Antarctica before it's gone," Guido Hofken, a 52-year-old IT sales director travelling with his wife Martina, says.    They said they had paid a supplement to climate compensate for their flight from Germany.

But some question whether tourists should be going to the region at all.   "The continent probably would be better off being left to penguins and researchers, but the reality is, that is probably never going to happen," said Michael Hall, professor and expert on polar regions at the University of Canterbury in New Zealand.   "Vicarious appreciation never seems to be enough for humans. So with that being the case, it needs to be made as low risk to the Antarctic environment and as low carbon as possible," said Hall.    "However, when the average tourist trip to Antarctica is over five tonnes of CO2 emissions per passenger (including flights), that is a serious ask."

Soot or black carbon in the exhaust gases of the scientific and cruise ships going to the region is also of concern, said Soenke Diesener, transport policy officer at German conservation NGO Nabu.   "These particles will deposit on snow and ice surfaces and accelerate the melting of the ice because the ice gets darker and will absorb the heat from the sun and will melt much faster," he told AFP.   "So the people who go there to observe or preserve the landscape are bringing danger to the area, and leave it less pristine than it was," he added.

- Responsible tourism -
Antarctic tour operators insist they are promoting responsible tourism.   The trend is for more intimate, so-called expedition cruises, in contrast to popular giant cruise liners elsewhere which are criticised for being invasive and polluting.   With greener ships -- heavy fuel, the most commonly used for marine vessels, has been banned in Antarctica since 2011 -- cruise companies have sought to make environmental awareness a selling point, occasionally earning them accusations of greenwashing.

Global warming, pollution and microplastics are the result of human activities on other, faraway continents, say tour operators.   Here, their motto is "Take nothing but photographs, leave nothing but footprints, keep nothing but memories".   But before they've even set foot on the cruise ships departing from South America -- the most common itinerary -- visitors to Antarctica will already have flown across the world, causing emissions that harm the very nature they have come so far to admire.

Most visitors hail from the Northern Hemisphere, and almost half are from the United States and China, IAATO says.   "I'm a tourist who feels a little guilty about taking a flight to come here," admits Francoise Lapeyre, a 58-year-old globetrotter om France.   "But then again, there are priorities. There are some trips I just won't take, because they leave a big footprint and they're not worth it.   "Crisscrossing the planet to go to a beach for example," she says.

- Don't mention climate change -
Like other expedition cruises where accessible science is part of their trademark, the Roald Amundsen, owned by the Hurtigruten company, has no dance floor or casino.  Instead, there are microscopes, science events and lectures about whales and explorers like Charles Darwin.   But they steer clear of climate change, which is only mentioned indirectly.   That's a deliberate decision as the subject has proven "quite controversial", said Verena Meraldi, Hurtigruten's science coordinator.   "We held several lectures dedicated specifically to climate change but it leads to conflicts. There are people who accept it as a fact, others who don't," she said.   Onboard, "passengers" are referred to as "guests" and "explorers" rather than "cruisers".   "Explorers" are typically older, well-heeled, often highly travelled pensioners who are handed walking sticks as they step ashore.   "My 107th country," says a Dane, stepping ashore onto Antarctica.

The Roald Amundsen "guests" choose between three restaurants, from street food to fine dining -- a far cry from the conditions endured by the Norwegian adventurer for whom the ship is named, who had to eat his sled dogs to survive his quest to reach the South Pole in 1911.   They have paid at least 7,000 euros ($7,700) each for an 18-day cruise in a standard cabin, and up to 25,000 euros ($27,500) for a suite with a balcony and private jacuzzi.   Other cruises are banking on ultra-luxury, with James Bond-like ships equipped with helicopters and submarines, suites of more than 200 square metres (2,153 square feet) and butler services.   With a seaplane to boot, the mega-yacht SeaDream Innovation will offer 88-day cruises "from Pole to Pole" starting in 2021. The two most expensive suites, with a price tag of 135,000 euros per person, are already booked.
 
- Worlds collide -
Outside, in the deafening silence, wildlife abounds.   All around are penguins, as awkward on land as they are agile in water. Massive and majestic whales slip through the waves, and sea lions and seals laze in the sun.   On Half Moon Island, chinstrap penguins -- so called because of a black stripe on their chin -- strut about in this spring breeding season, raising their beaks and screeching from their rocky nests.   "This is to tell other males 'This is my space' and also, maybe, 'This is my female'," ornithologist Rebecca Hodgkiss, a member of the Hurtigruten's scientific team, explains, as a group of tourists stroll around ashore.   The colony of 2,500 penguins has been gradually declining over the years, but it's not known if that is man's fault or they have just moved away, according to Karin Strand, Hurtigruten's vice president for expeditions.   Invisible to the naked eye, traces of humankind are however to be found in the pristine landscape.   Not a single piece of rubbish is in sight but microplastics are everywhere, swept in on ocean currents.   "We've detected them in the eggs of penguins for example," Leppe told AFP.

- Venice under water -
The Antarctic, which holds the world's largest reserve of freshwater, is a ticking time bomb, warn experts and studies.   They say that the future of millions of people and species in coastal areas around the world depends on what is happening here.   As a result of global warming, the melting ice sheet -- especially in the western part of the continent -- will increasingly contribute to rising sea levels, radically re-drawing the map of the world, says climate scientist Anders Levermann, of the Potsdam Institute for Climate Impact Research.   This meltwater will contribute 50 centimetres (almost 20 inches) to the global sea level rise by 2100, and much more after that, he said.   "For every degree of warming, we get 2.5 metres of sea level rise. Not in this century, but in the long run," he said.

Even if the international community meets its obligations under the Paris Agreement to limit global warming to under two degrees Celsius, sea levels will still rise by at least five metres.   "Which means that Venice is under water, Hamburg is under water, New York, Shanghai, Calcutta," he said.   It's impossible to predict when, but the scenario appears unavoidable, says Levermann.   In the same way that a cruise ship powering ahead at full speed can't immediately stop, sea levels will continue to rise even if all greenhouse gas emissions were to cease immediately, a study has said.

- Changing the world? -
The tourism industry says it hopes to make "ambassadors" out of Antarctica visitors.   "It's good for the animal life and for the protection of Antarctica that people see how beautiful this area is, because you cherish what you know and understand," said Hurtigruten chief executive Daniel Skjeldam.   Texan tourist Mark Halvorson, 72, says he is convinced.   "Having seen it, I am that much more committed to having a very high priority in my politics, in my own inner core convictions to being as environmentally friendly in my life as I can," he said.   So, do Guido and Martina Hofken see themselves as future "ambassadors of Antarctica"?    "Just a little bit, probably. But I don't think I will change the world," Guido Hofken concedes.    "The best thing would be for nobody to travel to Antarctica."
Date: Thu, 5 Dec 2019 16:37:37 +0100 (MET)

Paris, Dec 5, 2019 (AFP) - French rail operator SNCF said Thursday that it had cancelled 90 percent of all high-speed TGV trains and 70 percent of regional trains for Friday due to a strike over the government's pension reforms.   SNCF said that services would "still be very disrupted" on the second day of the biggest transport strike in the country in years, with the Eurostar service to Britain and the Thalys service to northern Europe set to be "very heavily disrupted".   In Paris, where only two of 16 metro lines were operating normally Thursday, public transport workers voted to remain on strike until Monday.

France's civil aviation authority meanwhile told airlines to cut 20 percent of their flights in and out of airports in Paris, Beauvais, Lyon, Marseille, Toulouse and Bordeaux on Friday, the same proportion as on Thursday.   Striking transport workers, air traffic controllers, teachers, fire fighters, lawyers and other groups all fear they will have to work longer or receive reduced pensions under the government's proposal to scrap 42 special pension schemes and replace them with a single plan.   Anticipating the worst travel chaos in years, many employees opted to work from home on Thursday. Those who did venture out travelled mainly by car, bicycle, electric scooter or on foot.
Date: Thu, 5 Dec 2019 12:19:45 +0100 (MET)
By Sofia CHRISTENSEN

Johannesburg, Dec 5, 2019 (AFP) - South African Airways was placed under a state-approved rescue plan on Thursday to avoid the embattled airline's collapse following a costly week-long strike last month.   Thousands of South African Airways (SAA) staff walked out on November 15 after the flag carrier failed to meet a string of demands, including higher wages and job in-sourcing.   The strike was called off the following week after SAA management and unions eventually clinched a deal.

But the walkout dealt a severe blow to the debt-ridden airline, which has failed to make a profit since 2011 and survives on government bailouts.   "The Board of SAA has adopted a resolution to place the company into business rescue," said a statement by South Africa's Public Enterprises Minister Pravin Gordhan, adding that the decision was also supported by the government.   "It must be clear that this is not a bailout," said Gordhan. "This is the provision of financial assistance in order to facilitate a radical restructure of the airline."   The business rescue process will be directed by an independent practitioner. It is meant to prevent a "disorderly collapse of the airline", he added.   Gordhan said the government would provide 2 billion rand ($136 million) to SAA in "a fiscally neutral manner".   Existing lenders will also provide a 2 billion rand loan guaranteed by the government.

- 'Financial challenges' -
South Africa is struggling to get state-owned companies back on track after nine years of corruption and mismanagement under former president Jacob Zuma.   Its national airline -- which employs more than 5,000 workers and is Africa's second largest airline after Ethiopian Airlines -- had been losing 52 million rand ($3.5 million) a day during the strike.   SAA's board said the business rescue, scheduled to start immediately, was decided after consultations with shareholders and the public enterprises department "to find a solution to our company's well-documented financial challenges".

"The considered and unanimous conclusion has been to place the company into business rescue in order to create a better return for the company's creditors and shareholders," said the SAA board of directors in a statement.   The rescue plan will include a "new provisional timetable" and ensure "selected activities... continue operating successfully".   With a fleet of more than 50 aircraft, SAA flies to over 35 domestic and international destinations.   "SAA understand that this decision presents many challenges and uncertainties for its staff," said the board.   "The company will engage in targeted communication and support for all its employee groups at this difficult time.

- 'Lesser evil' -
Unions told AFP they would comment later on Thursday.   They have agreed to a 5.9-percent wage increase backdated to April, but which would only start to be paid out next March depending on funding.   SAA had initially refused any pay rise.    The cash-strapped airline needs two billion rand ($136 million) to fund operations through the end of March. But it was unable to cover all of its staff salaries last month.    "Business rescue allows for the airline to continue to operate while it is being restructured, as opposed to liquidation," analyst Daniel Silke told AFP.   He said the rescue was a "lesser evil for SAA" and would save more jobs than a "shutdown".

But Silke still expected jobs to be cut as SAA attempted to reduce costs.   "Various divisions that make of SAA could be privatised," he said. "There will be a review of SAA aircraft and routes covered by SAA."   Unions had already demanded a three-year guarantee of job security following an announcement last month that almost 1,000 SAA employees could lose their jobs as part of another restructuring plan.   SAA pledged to defer that process to the end of January as part of the deal that ended the strike.
Date: Wed 4 Dec 2019
Source: Stock Daily Dish [edited]

Bihar Health Minister Mangal Pandey on [Sat 30 Nov 2019] said the state government is doing its best to save children, as the death toll due to acute encephalitis syndrome [AES] in Muzaffarpur mounted to 73.

Pandey said doctors and nurses are being called in from Patna for additional help. "We are trying everything and anything that can save children's lives. Everything is being made available from medicines to doctors. We have even called doctors and nurses from AIIMS in Patna," he said. "There is a protocol regarding what kind of medicines and facilities should be given and we are doing the same. We are monitoring things regularly and trying to save our children."

Recalling the situation that prevailed 5 years ago, Pandey said a team that was formed to ascertain the cause of this disease concluded that sleeping empty stomach at night, dehydration due to humidity and eating lychee on empty stomach were some of the causes of encephalitis.

"Our government has tried to spread awareness which will be beneficial as well. Advertisement in newspapers, radio jingles, pamphlets and mic [microphone] announcements are going to spread awareness regarding the disease. Health ministry is also working on it," he said.

On being asked about spread of ASE in Gorakhpur last year [2018], he said, "From Gorakhpur to Muzaffarpur region, this disease had spread last year and the Union government had worked on this and we will continue to fight it now."

"This incident in Muzaffarpur is very saddening and we also feel bad when children of our nation die like this. Not the whole district is affected but a large part is suffering from it," he added.

From [1 Jan 2019], until now [5 Dec 2019], 220 children were admitted in Sri Krishna Medical College and Hospital in Muzaffarpur due to AES, out of which 62 lost their lives.

As per the data of SKMCH hospital, 235 children were admitted, of which 89 died; in 2013 - 90 children were admitted, of which 35 died; in 2014 - 334 children were admitted, of which 117 died; in 2015 - 37 children were admitted, of which 15 died; in 2016 - 31 children were admitted, of which 6 died; in 2017 - 44 children were admitted, of which 18 died; and in 2018 - 43 children were admitted, of which 12 died.

Meanwhile, Minister of State for Union ministry for home affairs, Nityanand Rai, visited Sri Krishna Medical College and Hospital to review the situation after the outbreak of AES.

Encephalitis is a viral disease, which causes mild flu-like symptoms such as high fever, convulsions and headaches and has been claiming lives in the district for the past few weeks.
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[The dates within which these AES cases have occurred is not stated. The urgency that has prompted Behar health officials to request the aid of physicians and nurses from adjoining Patna suggests that the AES outbreak is going on currently. The uncertainty about the etiology of AES continues. It is curious that the above report makes no mention of negative or positive tests for Japanese encephalitis among the AES patients, although that virus is endemic in northeastern India, including Bihar state. Neighboring Uttar Pradesh state has had JE cases as well this summer (2019) but has intensified its JE vaccination program.

The issue of the aetiology of AES has been under discussion for a long time. Lychee fruit contain toxins. Encephalopathy and hypoglycaemia have been associated with consumption of lychee fruit contains phytotoxins, specifically alpha-(methylenecyclopropyl)glycine (see ProMED-mail archive no. http://promedmail.org/post/20150201.3132842). However, the current cases cannot be due to lychee consumption, since the season for that fruit has passed.

AES has continued to be attributed to a variety of aetiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_). A recent publication (reference below) states that dengue virus is one of the 3 most common agents identified in AES, but existing surveillance for AES does not include routine testing for dengue. Until the etiology (or etiologies) of these AES cases is determined, effective and efficient prevention of these cases will not be possible.

Reference:
Ravi V, Hameed SKS, Desai A, et al. Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): results from a 4-year AES surveillance study of Japanese encephalitis in selected states of India. Int J Infect Dis 2019;84 Suppl:19-24. <https://doi.org/10.1016/j.ijid.2019.01.008>.

Available at:

[Maps of India:
HealthMap/ProMED maps available
at:<http://healthmap.org/promed/p/364>, and Bihar, India:
Date: Thu 5 Dec 2019 6:11 PM EET
Source: Enab Baladi [edited]

[Leishmaniasis] is spreading widely among residents of Deir ez-Zor, and especially children. Some of the areas affected are controlled by the Kurdish self-administration while others are under the control of the Syrian regime. Medical sources counted hundreds of infected civilians and confirmed the disease's rapid spread.

According to Atef al-Tawil, a manager of the Leishmania & Environmental Health Programme at the Syrian regime's Ministry of Health, most infections in eastern Deir ez-Zor are spread among school children.

In a Facebook comment on a post by Twasol agency, al-Tawil claimed that cases of leishmaniasis were detected, at the end of November [2019], in primary schools in eastern Deir ez-Zor and its surrounding villages (al-Jalaa, al-Salihiyah, al-Tawtha, al-Abbas, al-Mujawdeh, al-Hasarat, al-Saial, al-Ghabrah).

According to al-Tawil, 455 infections of children were detected. A treatment team of 10 members was formed in the affected locations, to help control the disease to aid in early detection.

The Syrian Ministry of Health acted after several appeals by civilians residing in the area as they noticed the disease spreading among their children. Al-Tawil said that this rapid spread was due to the fact that all the infected people have lately returned to their original areas which lack medical centers.

Autonomous administration areas
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According to Euphrates Post network, leishmaniasis is also widely spread in areas controlled by the Syrian Democratic Forces (SDF). In its post on [Sun 1 Dec 2019], the network claimed that the spread of leishmaniasis is mostly concentrated in the eastern countryside of Deir ez-Zor.

According to the network, unofficial statistics by the SDF-affiliated local council shows more than 7000 leishmaniasis infections among children in al-Baghouz, Hajin, Diban, al-Sha'afa, al-Kishkiye, Abu Hamam, and Gharanij. The local councils' attempts of controlling the disease are still substandard, according to the Euphrates Post.

The network also quoted doctors and nurses calling for international organizations to interfere and provide hospitals and clinics with the required vaccine [there is no vaccine for leishmaniasis; ed.], and to train specialized medical staff in each clinic to deal with the disease.

The autonomous-administration-affiliated media center in Deir ez-Zor also confirmed the spread of leishmaniasis and pointed out that the authorities took actions, by the end of November [2019], to provide treatments.

According to the media center, special medical teams and cadres were distributed among the clinics to provide 12,000 ampoules of the required [medicine] to treat leishmaniasis with the support of the World Health Organization.

Leishmaniasis is a parasitic disease transmitted by the bite of infected female phlebotomine sandflies -- a very small yellow fly that is active at night and makes no sound when it bites -- and the main cause for its spread is dirt and lack of hygiene.  [Byline: Enab Baladi]
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[Deir ez-Zor is east and south of the locations in the previous ProMED reports (see below), indicating further increase in cases of cutaneous leishmaniasis beyond its historical concentration in western Syria (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861536/>) and beyond the area of the MENTOR initiative in northern Syria (<https://wwwnc.cdc.gov/eid/article/24/11/17-2146_article>).

Cutaneous leishmaniasis is endemic in Syria with its reservoir in rodents. It has been a problem throughout the Syrian civil war and in ISIS controlled areas during the war due to a breakdown in rodent and vector control. - ProMED Mod.EP]

[Maps of Syria:
Date: Tue 3 Dec 2019
Source: Twitter feed in Arabic [machine trans., edited]

Taiz health official: 24 laboratory-confirmed cases of West Nile virus and more than 300 suspected cases. #Republic_Yemen
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[Any information on the actual number of WNV cases, their lab confirmation, and public health response activities in this regard will be highly appreciated. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map of Yemen:
Date: Tue 3 Dec 2019
Source: Cordoba Epidemiology Report and Los Tiempos news article [in Spanish, trans., edited]
<http://www.reporteepidemiologico.com/wp-content/uploads/2019/12/REC-2264.pdf>

Los Tiempos, Bolivia, 2 Dec 2019 Confirmation of the 1st case of the year (2019) of human rabies in Cochabamba After confirming the death of rabies of a 7-year-old girl in the southern area of Cochabamba, the Departmental Health Service (SEDES) and the Zoonosis Unit of the Mayor's Office intensified prevention actions to prevent the proliferation of the virus. This would be the 1st case confirmed so far this year [2019].

The head of the Epidemiology Unit of SEDES, Arturo Fernando Quiaones Lapez, reported that in the last rabies vaccination campaign for dogs more 1000 doses were given. "We suspected rabies in the case of this minor. She tested positive by laboratory both in cerebrospinal fluid as well as in brain tissue," according to lab results obtained on 2 Dec 2019. The victim died on 26 Nov 2019 after being hospitalized in intensive care of the Children's Hospital for 2 days with signs of rabies," said Dr Manuel Ascencio Villarroel.

The patient's relatives reported the girl had contact with a puppy which died a month ago. The dog did not receive rabies vaccines and belonged to someone the family knows. Quiñones mentioned the family members of the girl and the owners of the animal are receiving preventive treatment. Meanwhile, the head of Zoonosis of the Mayor's Office, Javier Humberto Rodraguez Herrera, stated on 2 Dec 2019 a "massive focus blockade" will be held with the participation of 8 health centers to prevent the circulation of the virus in the area.

He commented that, to date, 11 cases of canine rabies have been recorded in the municipality. In more than 11 months of 2019, SEDES identified 25 positive cases of canine rabies, the majority in the metropolitan region. Quiaones asked the population to report the death of their pets with signs of rabies at health centers for follow-up to fight the disease. Meanwhile, from the City Hall, the owners of dogs were urged to have their dogs vaccinated. Javier Rodra­guez added another risk factor is when animals are collected from the street and they are not vaccinated.
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[The rabies virus attacks the nervous system in animals.  When a rabid animal bites a human being, it can transfer the virus, contained in saliva, to that individual. "After inoculation, rabies virus may enter the peripheral nervous system directly and migrates to the brain or may replicate in muscle tissue, remaining sequestered at or near the entry site during incubation, prior to central nervous system invasion and replication. It then spreads centrifugally to numerous other organs. The case-fatality ratio approaches unity [100%], but exact pathogenic mechanisms are not fully understood. "Susceptibility to lethal infection is related to the animal species, viral variant, inoculum concentration, location and severity of exposure, and host immune status.

Both virus-neutralizing antibodies and cell-mediated immunity are important in host defense. "Early diagnosis is difficult. Rabies should be suspected in human cases of unexplained viral encephalitis with a history of animal bite. Unvaccinated persons are often negative for virus-neutralizing antibodies until late in the course of disease. Virus isolation from saliva, positive immunofluorescent skin biopsies or virus neutralizing antibody (from cerebrospinal fluid, or serum of a non-vaccinated patient), establish a diagnosis. "Five general stages of rabies are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death (or, very rarely, recovery).

No specific anti-rabies agents are useful once clinical signs or symptoms develop. The incubation period in rabies, usually 30 to 90 days but ranging from as few as 5 days to longer than 2 years after initial exposure, is more variable than in any other acute infection. Incubation periods may be somewhat shorter in children and in individuals bitten close to the central nervous system (such as the head).

Clinical symptoms are first noted during the prodromal period, which usually lasts from 2 to 10 days. These symptoms are often nonspecific (general malaise, fever, and fatigue) or suggest involvement of the respiratory system (sore throat, cough, and dyspnoea), gastrointestinal system (anorexia, dysphagia, nausea, vomiting, abdominal pain, and diarrhoea), or central nervous systems (headache, vertigo, anxiety, apprehension, irritability, and nervousness).

More remarkable abnormalities (agitation, photophobia, priapism, increased libido, insomnia, nightmares, and depression) may also occur, suggesting encephalitis, psychiatric disturbances, or brain conditions. Pain or paraesthesia at the site of virus inoculation, combined with a history of recent animal bite, should suggest a consideration of rabies. "The acute neurologic period begins with objective signs of central nervous system dysfunction.

The disease may be classified as furious rabies if hyperactivity (that is, hydrophobia) predominates and as dumb rabies if paralysis dominates the clinical picture. Fever, paraesthesia, nuchal rigidity, muscle fasciculations, focal and generalized convulsions, hyperventilation, and hypersalivation may occur in both forms of the disease. "At the end of the acute neurologic phase, periods of rapid, irregular breathing may begin; paralysis and coma soon follow. Respiratory arrest may occur thereafter, unless the patient is receiving ventilatory assistance, which may prolong survival for days, weeks, or longer, with death due to other complications.

"Although life support measures can prolong the clinical course of rabies, rarely will they affect the outcome of disease. The possibility of recovery, however, must be recognized, and when resources permit, every effort should be made to support the patient. At least 7 cases of human "recovery" have been documented." (<https://www.ncbi.nlm.nih.gov/books/NBK8618/>)

A very sad situation which could have been prevented if the animal had been vaccinated. Responsible owners vaccinate their animals. Condolences to the family. - ProMED Mod.TG]

[HealthMap/ProMED-mail map of Bolivia: <http://healthmap.org/promed/p/55162>]