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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 ...

Ukraine

Ukraine - US Consular Information Sheet
March 28, 2008
COUNTRY DESCRIPTION:
Ukraine is undergoing profound political and economic change as it moves from its Soviet past toward a market economy, multi-party democracy, and integration into
uro-Atlantic and other international institutions.
In recent years, the availability of goods and services has increased along with increased rates of growth in Ukraine's economy, and facilities for travelers have improved somewhat.
Nonetheless, the availability of travel and tourist services remains uneven throughout the country, and Ukraine still lacks the abundance of many of the goods and services taken for granted in other countries.
Read the Department of State Background Notes on Ukraine for additional information.

ENTRY/EXIT REQUIREMENTS: Depending on the length and purpose of travel, U.S. citizens may or may not be required to get a Ukrainian visa prior to coming to Ukraine.
A passport valid for six months beyond the planned date of travel is required.
According to Ukrainian Presidential Decree #1008, dated June 30, 2005, U.S. citizens are exempt from the requirement to have a Ukrainian visa as long as the duration of their stay in Ukraine does not exceed 90 days and the purpose of their travel is tourism, private travel, or business. U.S. citizens whose planned stay in Ukraine exceeds 90 days, and so consequently bears the characteristics of a long-term stay, must have visas authorizing their entry into Ukraine. If the purpose of their visit is other than tourism, private travel, or business, an appropriate visa must be obtained. U.S. citizens may apply for all types of visas through Ukrainian Embassies and Consulates overseas. A list of required documents for the visa application will be determined based on the purpose and length of travel on a case-by-case basis. Contact details for Ukrainian Embassies and Consulates are available on the Ministry of Foreign Affairs of Ukraine web site at http://www.mfa.gov.ua/mfa/en/305.htm.

Visas may be obtained from the Consular Office of the Embassy of Ukraine in Washington, DC, or from Ukrainian Consulates General in New York, Chicago, or San Francisco.
For additional information about Ukrainian visas and related policy, please contact the Ukrainian Embassy or Consulate nearest you.

Embassy of Ukraine
3350 M Street, NW
Washington, D.C. 20007
Tel: (202) 333-0606
Fax: (202) 333-0817
Web site: http://www.mfa.gov.ua/usa/en/
Consulate General of Ukraine in New York
240 East 49th Street
New York, NY 10017
Tel: (212) 371-5690
Fax: (212) 371-5547
Web site: http://www.ukrconsul.org/
Consulate General of Ukraine in San Francisco
530 Bush Street, Suite 402
San Francisco, CA 94108
Tel: (415) 398-0240
Fax: (415) 398-5039
Web site: http://www.ukrainesf.com/
Consulate General of Ukraine in Chicago
10 East Huron St.
Chicago, IL 60611
Tel: (312) 642 4388
Fax: (312) 642 4385
Web site: http://www.ukrchicago.com/
The Government of Ukraine does not issue visas at the point of entry into Ukraine.
Travelers whose purpose of travel puts them in a category that requires a visa must obtain the correct Ukrainian visa prior to arrival; otherwise they will be turned back to the United States or will have to travel to another country to obtain a visa.

Please check your visa carefully upon receipt and pay careful attention to validity dates.
Each traveler is responsible for understanding the type of visa issued and the provisions of the visa.
Frequently, American citizens are refused entry to Ukraine because they thought they possessed a multiple entry visa, but in fact their visa was valid for only a single entry; Americans occasionally try to reenter Ukraine after using their single-entry visa, believing they have unlimited travel for six months.
In some cases, Americans attempt to enter Ukraine before their visa becomes valid.
This is a common mistake, since in Ukraine the date is written day-month-year, not month-day-year.
Thus, a visa issued on 01/05/07 is valid from May 1, 2007 and NOT from January 5, 2007.
Such travelers can be detained at the port of entry, refused admission and sent back to the country from which they traveled.
The U.S. Embassy in Kyiv is unable to assist travelers in these situations.

All foreigners entering or staying in Ukraine must be registered with Ukrainian authorities. American Citizens traveling to or staying in Ukraine are reminded that recent changes to Ukrainian immigration law change the registration procedures for short-term stays. The registration for short-term visits of up to 90 days is completed at the border by the customs offices.
Such registration is valid for 90 days out of each period of 180 days; the calculation of the 90-day period begins from the date of first entry into Ukrainian territory.

The initial registration for both short- and long-term visits to Ukraine, with or without a visa, is accomplished at the border when entering Ukraine.
Future extensions for stays exceeding 90 days are completed through the Ukrainian Ministry of Internal Affairs’ Office of Citizenship, Immigration and Registration (OVIR).
Most cities will have several OVIR offices.
Extensions are not automatic, however, and are valid only for continued presence in the country.
It is not possible to depart Ukraine and return on the extension, nor can an adjustment to visa status be made from within Ukraine. Applications for extension of registration should be submitted at least three days before the current registration expires.

Travelers who intend to visit Russia from Ukraine must also have a Russian visa.
The Consular Section of the Russian Embassy in Ukraine is located at Prospekt Kutuzova 8, tel.: (380-44) 284-6816, fax 284-7936, e-mail: general@rucons.kiev.ua, http://www.embrus.org.ua.

Visitors to Ukraine should also note that Ukrainian law requires them to obtain mandatory health insurance.
For more information see the section on Medical Insurance below.

Visit the Embassy of Ukraine’s web site at http://www.mfa.gov.ua/usa/en/1609.htm for the most current visa information.
Also, see the Ukrainian Ministry of Foreign Affairs’ web site at http://www.mfa.gov.ua/usa/en or http://www.ukraineinfo.org/.

Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Regulations sheet and visit the Ukrainian State Customs Service web site at http://www.customs.gov.ua/dmsu/control/en/index.

SAFETY AND SECURITY:
Ukraine is largely free of significant civil unrest or any organized anti-American domestic political movements.
However, occasionally, mass demonstrations occur in larger cities, such as Kyiv, and are usually sponsored by individual political forces.
In 2008, there has been an upsurge in the number of pro-Russian anti-NATO protests.
These protests are likely to increase in size and frequency as Ukraine pursues closer ties to the alliance.
While the majority of these protests are small and peaceful, they can still result in violence and it is best to avoid such gatherings.

There also have been increasing incidents of racially-motivated violence; groups of “skinheads” and neo-Nazis target people of Asian, African, or other non-European descent, as well as religious minorities, in Kyiv and throughout Ukraine (see the section on Crime below).

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the 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:
Ukraine is undergoing a significant economic, political, and social transformation, and income disparities have grown sharply.
As a result, foreign visitors may be perceived as wealthy targets for criminals.
Americans often stand out in Ukraine, and are therefore more likely to be targeted than in Western European countries, where incomes are higher and Americans may blend in better.

Most street crime ranges from various scams, simple pocket picking, purse snatching, and theft of personal items from parked cars, to mugging, armed robbery, or the drugging of unsuspecting victims at nightspots and bars (where they are then robbed).
Cases of assaults in apartment building corridors, elevators, and stairwells, as well as armed break-ins and crimes involving small caliber firearms have also been reported.
Please see the Embassy’s web site for additional security information for Americans at http://kyiv.usembassy.gov/amcit_security_eng.html.

A commonly reported scam in Kyiv is”The Wallet Scam”, which involves a person dropping a wallet or a packet of money near a potential victim. After the victim picks up the wallet and attempts to return it to the individual who “dropped” it, the perpetrator then claims that the wallet is missing money which the victim stole.
The perpetrator either threatens to call the police if the victim does not pay, or asks the victim to show his or her wallet to the perpetrator to ensure that the victim did not take any money.
When the victim produces his or her wallet, the perpetrator grabs the money and flees.
Another variant involves a second person who claims to be a police officer – who is of course involved in the crime – who approaches the victim after the wallet has been picked-up.
This second person also asks to see the wallet, grabbing the money and fleeing or, through sleight-of-hand, stealing the victim’s money.

While most travelers do not encounter problems with crime in Ukraine, there has been an increase in the number of hate crimes directed at ethnic and religious minorities over the past few years. Many of these incidents are conducted by “skinheads” or neo-Nazis in Kyiv, but similar crimes have also been reported throughout the country. In Kyiv, these incidents have occurred without provocation in prominent downtown areas commonly frequented by tourists.
While the majority of people targeted have been of Asian, African, or other non-European descent, all travelers should exercise caution.
In addition to incidents of assault, racial minorities may be subject to various types of harassment, such as being stopped on the street by both civilians and law enforcement officials. Individuals belonging to religious minorities have also been harassed and assaulted in Kyiv and throughout Ukraine.

The police and government’s slow response to hate crimes is a continuing concern.
Although senior Government of Ukraine officials (including the President and Prime Minister) have publicly deplored these hate crimes and groups, Ukrainian street level law enforcement activities are unable to effectively deter hate crimes or adequately protect racial minorities.
The Embassy has received numerous reports from victims of violent hate crimes, as well as from bystanders, stating that uniformed police officers observed the assaults and did nothing to prevent the attacks, to assist the victims afterward, or to investigate and apprehend the attackers.
The Government of Ukraine took initial steps to address the problem in the final months of 2007 with the establishment of special law enforcement units to prevent and investigate hate crimes in Ukraine.
It remains to be seen if these units will be effective.

Credit card and ATM fraud is widespread.
Ukraine operates as a cash economy, and money scams are widespread.
Although credit card and ATM use among Ukrainians is increasingly common, it is nevertheless strongly recommended that visitors and permanent residents of Ukraine refrain from using credit cards or ATM cards except at major international establishments.

Burglaries of apartments and vehicles represent a significant threat to long-term residents.
Although few cars are actually stolen, primarily because of increased use of alarm systems and security wheel locks, vehicular break-ins and vehicular vandalism are common.

Ukraine lacks reliable tourist and travel services for foreign victims of crime.
Transferring funds from the United States, replacing stolen traveler’s checks or airline tickets, or canceling credit cards can be difficult and time consuming.
There are few safe low-cost lodgings, such as youth hostels.
Public facilities in Ukraine are generally not equipped to accommodate persons with physical disabilities.

Over the past several years, the Embassy has received a number of reports of harassment and intimidation directed against foreign businesspersons and interests.
While these reports have become much less frequent in recent years, they have not ended entirely.
Reported incidents range from physical threats (possibly motivated by rival commercial interests tied to organized crime), to local government entities engaging in such practices as arbitrary termination or amendment of business licenses, dilution of corporate stock to diminish U.S. investor interest, delays of payment or delivery of goods, and arbitrary “inspections” by tax, safety or other officials that appear designed to harm the business rather than a genuine attempt at good governance. American business entities are encouraged to read the Corruption, Money Laundering and Organized Crime section of the 2007 Crime Report for Ukraine at http://kyiv.usembassy.gov/amcit_crimereport_eng.html.
American businesses and other private sector organizations are also encouraged to read the most recent Overseas Security Advisory Council (OSAC) Annual Crime and Safety Report for Ukraine at https://www.osac.gov/Regions/country.cfm?country=42.

Computer fraud is also becoming more common in Ukraine.
Internet scams appear to be on the rise.
The Embassy suggests refraining from wiring money unless the recipient is well-known and the purpose of business is clear.
American citizens have reported transferring money to Ukraine to pay for goods purchased from residents of Ukraine via online auction sites, but never receiving the goods in return.
The Embassy regularly receives complaints from Americans regarding scams involving marriage and dating services.
Numerous Americans have lost money to agencies and individuals that claimed they could arrange for student or fiancée visas to the U.S.
Additional information is available on our web site in a document titled “Marriage Brokers” at http://kyiv.usembassy.gov/amcit_marriage_eng.html and on the Department of State’s web site under Ukraine: Internet and Other Fraud Schemes.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm.

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
In December 2005, Ukraine reported the first cases of H5N1 (“avian influenza,” "avian flu," "bird flu," "chicken flu") among birds in Crimea.
Further outbreaks followed in 2006.
On January 18, 2008, another outbreak of the H5N1 avian influenza virus was detected at a poultry farm in the Krasnogvardiyskyi Rayon in Crimea. There are no registered human cases of H5N1 in Ukraine.
For detailed information on H5N1, please review the Avian Influenza Fact Sheet.

The U.S. Embassy maintains a list of hospitals and clinics with some English-speaking staff.
Many facilities have only limited English speakers.
There are no hospitals in Ukraine that provide a level of medical care equal to that found in American hospitals, or which accept American health insurance plans for payment (see the section on Medical Insurance below).
Some facilities are adequate for basic services.
Basic medical supplies are available; however, travelers requiring prescription medicine should bring their own.
Elderly travelers and those with existing health problems may be at risk due to inadequate medical facilities.
When a patient is hospitalized, the patient, relative, or acquaintance must supply bandages, medication, and food.
The Embassy recommends that ill or infirm persons not travel to Ukraine.
The Embassy also recommends that travelers obtain private medical evacuation insurance prior to traveling to Ukraine.

Medical evacuation remains the best way to secure western medical care.
This option, however, is very expensive and could take at least several hours to arrange.
Travelers may wish to purchase medical evacuation insurance prior to travel, or have access to substantial lines of credit to cover the cost of medical evacuation.
The Consular Section of the U.S. Embassy has information on various air ambulance companies that perform medical evacuations to Europe or to the U.S.
Serious medical problems requiring hospitalization and/or medical evacuation to other European countries can cost from $25,000 to $50,000, and to the U.S. as much as $70,000 or more.
More information can be found on the U.S. Embassy's web site in the document “Medical Services in Kyiv” at http://usembassy.kiev.ua/amcit_medical_serv_eng.html.

Please note that while the Embassy can help American travelers and their families make contact with a medical evacuation service, the U.S. Government cannot pay for medical evacuation.
Travelers should make sure they have medical evacuation insurance, which is available from many private companies, or have funds available for evacuation, should the need arise.

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, http://wwwn.cdc.gov/travel/default.aspx.
Tuberculosis is an increasingly serious health concern in Ukraine.
For further information, please consult the CDC’s Travel Notice on TB at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.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.

RADIATION AND NUCLEAR SAFETY:
In 1986, the Chornobyl incident resulted in the largest short-term, unintentional, accidental release of radioactive materials to the atmosphere ever recorded.
The highest areas of radioactive ground contamination occurred within thirty kilometers of the Chornobyl nuclear power station.
The city of Kyiv was not badly affected because of the wind direction, but it was not completely spared.
The last operating reactor at the Chornobyl Nuclear Power Plant site closed officially on December 15, 2000. All identified stabilization measures on the existing sarcophagus are complete, and preparatory work to start construction of the new shelter is almost nearing completion. The contract for the new Chornobyl shelter was awarded in September 2007 and its construction is projected to be completed in 2012.

The Ukrainian government has an effective program of monitoring fresh foods and meats sold in local markets.
Street purchase of produce should be avoided.
Wild berries, mushrooms, and wild fowl and game should be avoided, as these have been found to retain higher than average levels of radiation.
Background levels of radiation are monitored regularly by the Embassy and, to date, have not exceeded the level found on the Eastern seaboard of the United States. If external radiation levels are high enough to require evacuation, the U.S. Embassy will notify the American community through the Embassy warden e-mail and text messaging system.

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.

The Ukrainian parliament passed a law in 1997 whereby all visitors to Ukraine are required to obtain mandatory health insurance. According to information from the Ukrainian authorities, the cost of this medical insurance depends on the anticipated length of a foreigner's stay in Ukraine.
The cost for the insurance is approximately 25 cents per day (more for short stays).
This required insurance can be purchased after arrival and covers only the costs of basic medical care inside Ukraine; it does not cover medical evacuation.
Failure to purchase mandatory health insurance often results in refusal of treatment at Ukrainian public hospitals and clinics.
Private clinics do not require Ukrainian public health insurance, but can be as expensive as similar clinics in the United States and may require payment in advance
More information can be found online in Ukrainian at http://www.pro100.com.ua, or by calling +38 (044) 206 2885 from abroad or 8-800-500-1080 from within Ukraine.

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

Generally, roads in Ukraine outside major urban areas are in poor condition and are poorly lit.
Visitors should drive defensively at all times, since local drivers often disregard traffic rules.
Drivers are often poorly trained or drive without a valid driver's license.
Drivers can also be very aggressive, and they normally do not respect the rights of pedestrians, even at clearly marked pedestrian crossings.
Pedestrians should also be aware of cars driving or attempting to park on sidewalks.
Many cars do not meet the safety standards common in America.

Due to heavy traffic and congested roads, vehicle accidents are a common occurrence in larger Ukrainian cities, especially in Kyiv. In Ukraine, it is mandatory for motorists involved in vehicle accidents not to remove the vehicle from the site of the accident, unless it presents a clear safety concern. Local police must be notified and will report to the scene to conduct an investigation. Persons should be prepared to wait until the police arrive and complete their report. Due to traffic and slow response, it may take up to several hours for police to arrive. When police arrive, they will ascertain responsibility, take the drivers’ personal information, and file a report of the accident.

Cross-country travel at night and in winter can be particularly dangerous.
The Embassy strongly recommends that visitors and permanent residents of Ukraine refrain from driving their private vehicles after dark outside of major cities.
However, major roads are drivable during daylight hours.
Roadside services such as gas stations and repair facilities are becoming more common, particularly on the main national and regional overland highways and in large and mid-size cities.

Nonetheless, such services are far from American standards, and travelers should plan accordingly.
There have been isolated reports of carjackings of western-made or foreign-registered cars.
There has also been an increase in the number of documented reports of criminal acts (primarily theft) occurring on trains and other modes of public transport.

Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Ukraine’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Ukraine’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Ukraine does not recognize dual nationality.
American citizens entering Ukraine with a Ukrainian passport will be treated as Ukrainian citizens by the local authorities.
This may include being required to perform mandatory military service.
Also, Ukrainians who have immigrated to the U.S. without obtaining the proper exit visa from Ukrainian authorities may be subject to civil or criminal penalties, and will be required to obtain an exit visa before returning to the U.S.
For additional information, see the Consular Affairs web site at http://travel.state.gov/index.html for our Dual Nationality flyer.

Ukraine is a cash economy.
Traveler’s checks and credit cards are gaining wider acceptance in larger cities.
Even in Kyiv, however, acceptance of credit cards is not nearly as widespread as in the U.S. or in Western European countries.
Expect credit card use to be limited to major hotels, upscale restaurants, international airlines, and the rapidly growing, but still select number of up-market stores.

Exchanging U.S. dollars into the national Ukrainian currency, hryvnya, is simple and unproblematic, as licensed exchange booths are widespread, and exchange rates are normally clearly advertised.
Currency exchange is only legal at such licensed exchange booths, banks, and currency exchange desks at hotels; anyone caught dealing on the black market can expect to be detained by the local militia.

There are many banks and licensed currency exchange booths located in major cities.
ATMs (a.k.a. bankomats) are becoming more common throughout Ukraine, particularly in Kyiv and in other larger cities.
In smaller cities and towns, ATMs are still virtually non-existent.
Most ATMs disperse cash only in the local currency, hryvnya. The difficulties of a currency shortage can be avoided by coming to Ukraine with a sufficient supply of hard currency to cover necessary obligations during travel.
Funds may be transferred by wire, advances may be drawn on credit cards, and traveler’s checks may be cashed at many locations.
Again, the Embassy emphasizes that the incidence of credit card and ATM bankcard fraud is high, and strongly recommends that visitors and permanent residents of Ukraine refrain from using local ATMs.

Customs regulations prohibit sending cash, traveler’s checks, personal checks, credit cards, passports, or other forms of identification through the international mail system, as well as via courier mail (FedEx, DHL, etc.).
Customs authorities regularly confiscate these items as contraband.
Ukrainian customs authorities may also enforce strict regulations concerning temporary importation into or export from Ukraine of items such as firearms, antiquities, currency, etc.
It is advisable to contact the Embassy of Ukraine in Washington, or one of Ukraine's consulates in the United States for specific information regarding customs requirements.
As in many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines.

Ukrainian law requires that travelers declare all cash and jewelry, regardless of value, upon entering Ukraine.
Travelers should fill out a customs declaration and ask customs officials to stamp it.
According to Ukrainian law, foreign citizens may bring up to $15,000 in cash, or up to $30,000 in traveler’s checks, into Ukraine without a special license.
A traveler must declare the imported currency.
If customs officials determine that a traveler entering or exiting the country is carrying undeclared currency, they can and often do confiscate the undeclared funds.
When leaving the country, foreign travelers are only allowed to take out a maximum of $3,000 in cash, or as much cash as they declared upon their entry into Ukraine.
If a traveler wants to take out more than $3,000, the traveler must have a customs declaration proving that he or she in fact brought the corresponding sum of money into the country.

Travelers desiring to bring more than $15,000 into Ukraine must obtain a special license AFTER entering the country.
Details for obtaining this license are available on the Embassy's web site in the document “Ukrainian Customs: Procedures for Transporting Currencies, Monetary Instruments, or Precious Metals” at http://kyiv.usembassy.gov/amcit_travel_ukrcustoms_eng.html.
Ukraine has strict limitations for the export of antiques and other goods and artifacts deemed to be of particularly important historical or cultural value.
This includes any items produced before 1950.

Ukraine is a developing democratic nation undergoing significant political, economic, and governmental reform.
This includes reform of police and emergency services.
Visitors should be aware that although Ukrainian police and emergency services have made much progress, they still generally remain below Western European and U.S. standards in terms of training, responsiveness, and effectiveness.
American citizens have reported waiting sometimes hours for Ukrainian police and ambulance services to respond to calls for emergency assistance.
Although this may generally be atypical, it does nevertheless occur.

It is advisable to contact the Embassy of Ukraine in Washington, or one of Ukraine's consulates in the United States, for specific information regarding customs requirements.
Please see our information on Customs Regulations.

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 Ukraine’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Ukraine are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Ukraine 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 Ukraine.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The Consular Section of the U.S. Embassy is located at #6 Mykoly Pymonenka St., 01901 Kyiv, Ukraine. Telephone: (38-044) 490-4422, fax 486-3393. The American Citizen Services unit is located at the same address and can be reached at (38-044) 490-4445
The Embassy is located at #10 Yuriy Kotsyubynsky St. 01901 Kyiv, Ukraine. Tel.: (38-044) 490-4000.
* * *
This replaces the Country Specific Information Sheet dated February 15, 2008 to update the sections on Safety and Security and Crime.

Travel News Headlines WORLD NEWS

Date: Mon 18 Nov 2019
Source: 112.UA [edited]

Eight school classes in Odesa [Odessa] have been closed for quarantine. More than 30% of school students in these classes are sick with Coxsackie virus, a highly contagious respiratory disease, said Olena Buynevych, the director of the city hall's department for science and education, as quoted by UNN news agency.

"More than 30% of students in these classes are sick wi h acute
respiratory diseases, which include cases of cases and Coxsackievirus," the official said. She urged the parents to keep the children away from schools in case they have any symptoms of acute respiratory diseases.

The symptoms are basically the same as flu; the key difference is the rash on the palms, in case of the Coxsackievirus.

Coxsackievirus is a member of a family of viruses called enteroviruses. Enteroviruses are made up of a single strand of ribonucleic acid (RNA). The enteroviruses are also referred to as picornaviruses ("pico" means "small," so, "small RNA viruses"). They are present all over the world and spread by fecal-oral route. About 90% of infections don't cause symptoms or present with a fever only. Infants and young kids are particularly susceptible to symptomatic coxsackie.
======================
[Coxsackievirus belongs to a family of nonenveloped, linear, positive-sense, single-stranded RNA viruses, Picornaviridae and the genus _Enterovirus_, which also includes poliovirus and echovirus. Enteroviruses are among the most common and important human pathogens, and ordinarily its members are transmitted by the fecal-oral route. Coxsackieviruses share many characteristics with poliovirus. With control of poliovirus infections in much of the world, more attention has been focused on understanding the nonpolio enteroviruses such as coxsackievirus.

Coxsackieviruses are divided into group A and group B viruses based on early observations of their pathogenicity in neonatal mice. In general, group A coxsackieviruses tend to infect the skin and mucous membranes, causing herpangina, acute hemorrhagic conjunctivitis, and hand, foot, and mouth (HFM) disease. Both group A and group B coxsackieviruses can cause nonspecific febrile illnesses, rashes, upper respiratory tract disease, and aseptic meningitis.

Group B coxsackieviruses tend to infect the heart, pleura, pancreas, and liver, causing pleurodynia, myocarditis, pericarditis, and hepatitis (inflammation of the liver not related to the hepatotropic viruses). Coxsackie B infection of the heart can lead to pericardial effusion.

The development of insulin-dependent diabetes (IDDM) has recently been associated with recent enteroviral infection, particularly coxsackievirus B pancreatitis.

It is common for the coxsackievirus to cause a febrile upper respiratory tract infection with sore throat and/or a runny nose. Some patients have a cough resembling bronchitis. Less commonly, coxsackievirus may cause pneumonia. Some people with coxsackievirus have a rash. In many, this is a nonspecific generalized red rash or clusters of fine red spots. The rash may not appear until the infection has started to get better.

Coxsackievirus is spread from person to person. The virus is present in the secretions and bodily fluids of infected people. The virus may be spread by coming into contact with respiratory secretions from infected patients. If infected people rub their runny noses and then touch a surface, that surface can harbor the virus and become a source of infection. People who have infected eyes (conjunctivitis) can spread the virus by touching their eyes and touching other people or surfaces. Conjunctivitis may spread rapidly and appear within one day of exposure to the virus. Coxsackieviruses are also shed in stool, which may be a source of transmission among young children. The virus can be spread if unwashed hands get contaminated with fecal matter and then touch the face. This is particularly important for spread within  day-care centers or nurseries where diapers are handled. Diarrhoea is the most common sign of coxsackievirus intestinal infection.

Most infections are self-limiting, and no specific treatment is required or available. Some options include intravenous immune globulin (IVIG), which contains antibodies and may be somewhat effective.

HealthMap/ProMED-mail map:
Odesa oblast, Ukraine: <http://healthmap.org/promed/p/51897>]
Date: Mon 28 Oct 2019, 12:41 PM
Source: 112 International [edited]

"A total of 15 students of the secondary school No. 7 in Chernihiv were hospitalized with suspicion of hepatitis A on [28 Oct 2019]," the press service of Ukraine's State Emergency Service reports. It is noted that at the moment a complex of epidemic prevention measures are being carried out.

Besides, a 2018 hepatitis outbreak was spotted in Mykolaiv -- 47 people were hospitalized with a confirmed diagnosis.
========================
[With this number of cases admitted with the suspicion of acute hepatitis A on the same day, it is likely that a point-source outbreak related to a food or water source occurred. The definitive test for the disease is the finding of IgM anti-HAV in the blood.

Chernihiv, also known as Chernigov, is a historic city in northern Ukraine, which serves as the administrative centre of the Chernihiv Oblast (province), as well as of the surrounding Chernihiv Raion (district) within the oblast. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Thu 24 Oct 2019 (accessed Mon 28 Oct 2019)
Source: Ministry of Health, Ukraine, press release [in Ukrainian, machine trans., edited]

In Ukraine, the 1st confirmed case of vaccine-associated paralytic polio has occurred in a 2 year old child from Volyn Oblast. The parents deliberately refused the vaccinations provided by medical standards. Recent cases of illness in Ukraine were recorded in 2015 and 2017.

Pathogenesis of the disease
---------------------------
Sources of the disease: a person who is ill or a carrier that carries the virus asymptomatically. Fecal-oral routes (dirty hands, water, contaminated food, excrement) and airborne droplets are considered as transmission routes.

Symptoms: In most cases, the disease first goes unnoticed, which worsens the patient's chances of recovery; then there are signs that are different in nature, depending on the form of the virus. You can learn more about the symptoms on the website of the Public Health Center at <https://old.phc.org.ua/pages/diseases/other_social_diseases/poliomyelitis>  [in Ukrainian]

The incubation period of the disease is 2-35 days, more often 7-14 days. The following types of disease are classified: with and without lesions of the central nervous system (CNS). It should be noted that even atypical poliomyelitis (without lesion of the CNS) is capable of seriously harming the patient. They all pose a significant threat to the unvaccinated person and cause irreversible processes that can lead to death.

Myths and refutations
---------------------
On World Polio Day [24 October], the Ministry of Health of Ukraine dispels myths that provoke refusal of immunization. Common among parents is talk about the dangers of vaccination and the side effects of vaccination. You can read more about refuting these stereotypes at <https://moz.gov.ua/article/health/9-mifiv-pro-vakcinaciju> [in Ukrainian].

Why are vaccines safe?
----------------------
The Global Polio Eradication Initiative is using several vaccines to combat the disease. In Ukraine, there are 2 types -- the inactivated polio vaccine (IPV) and the oral polio vaccine (OPV). Both vaccines are purchased through the United Nations Children's Fund (UNICEF) and have a World Health Organization  ualification that guarantees quality and ongoing monitoring of manufacturers. For more information on vaccine production standards, go to: <https://moz.gov.ua/article/news/nichogo-krim-pravdi-5-faktiv-pro-vakcini>  [in Ukrainian]

The WHO website explains:
- OPV is one of the safest vaccines invented by humanity and used to immunize newborns;
- it is so safe that it can be used even when the baby is sick;
- OPV is used several times to achieve the maximum immunity of the vaccine, but the increase in the number of vaccinations does not increase the risk of side effects.

Where, when, and who should be vaccinated?
------------------------------------------
Polio vaccination is required from the birth of a baby. Vaccination must be carried out in a comprehensive manner, without missing any dose, to increase the body's resistance to the disease.
1st dose - at 2 months of baby's life;
2nd dose - at 4 months;
3rd dose - at 6 months;
4th dose - at 18 months;
5th dose - at 6 years;
6th dose - at 14 years.

Free polio vaccination is available from your family doctor or pediatrician at public health facilities, as well as from private contractors with the National Health Service of Ukraine. More information is available at <https://moz.gov.ua/article/immunization/chomu-v-aptekah-i-privatnih-klinikah-mozhe-ne-buti-vakcin-ta-de-zrobiti-scheplennja-bezoplatno> [in Ukrainian].

The only way to protect yourself and your children from the effects of this disease is vaccination, as there is no specific treatment. The Ministry of Health of Ukraine recommends that you consult the calendar of preventive vaccinations at <https://moz.gov.ua/article/immunization/kalendar-profilaktichnih-scheplen>  [in Ukrainian]
--------------------------------------
communicated by:
Viki Hansen-Landis, RN, MPH
Medical Information and Analysis team, International SOS
======================
[According to information from the Global Polio Eradication Initiative, Ukraine had 2 cases of cVDPV1 confirmed in 2015 (see <http://polioeradication.org/polio-today/polio-now/this-week/circulating-vaccine-derived-poliovirus/> for table of cVDPVs by type and year, and see Poliomyelitis update (05): Ukraine, vaccine-derived, WHO http://promedmail.org/post/20150901.3616558 and Poliomyelitis update (04): Ukraine, 2 cases, RFI http://promedmail.org/post/20150901.3616015 for details on these cases). No additional cases of cVDPV were reported by the Ukraine to WHO in 2017. If there is additional information on case(s) reported in 2017, ProMED-mail would greatly appreciate receiving it, as well as information on the serotype of cVDPV associated with this current case.

The addition of this case will bring the total number of cVDPV associated cases confirmed with date of onset in 2019 to 103, and the number of countries reporting cVDPV associated paralytic cases to 20.

Maps of Ukraine can be seen at
and <http://healthmap.org/promed/p/123>.
Volyn oblast is located in the north west of Ukraine, sharing a border with Poland to the west and Belarus to the north. - ProMED Mod.MPP]
Date: Thu, 22 Aug 2019 19:34:04 +0200 (METDST)

Kiev, Aug 22, 2019 (AFP) - Around 200 anti-vaccine protesters rallied in central Kiev Thursday after authorities threatened to ban unvaccinated children from schools in Ukraine, which has been hit by a deadly measles outbreak.   Ukraine has one of the lowest vaccination rates in Europe and has recorded more than 57,000 measles cases since the start of the year, including 18 deaths.

This is a record number of cases since the country gained independence from the Soviet Union in 1991.    "I came here with my child to protect her right for education without vaccination, without injecting poison into her blood," said 29-year-old Iryna Lazutkina, who was at the protest with her young daughter.   "Vaccination is a ticking time bomb," she said, suggesting that it could lead to allergies, autoimmune diseases and even cancer -- claims which are not backed up by medical research.    Authorities blame distrust of vaccines among a section of the population, as well as an earlier shortage of medical supplies, for the current outbreak.   In mid-August, the government threatened to ban unvaccinated children from schools.    This year the health ministry organised mass vaccinations in schools in areas most affected by the crisis.

Acting health minister Ulyana Suprun last week warned of the likelihood of diphtheria and tetanus outbreaks because of low vaccination rates.   But the protesters, many of them young parents with children, insisted they had the right to refuse vaccinations.    "I am for free choice and against discrimination," said Alla Fedorchuk, a 25-year-old who travelled to the capital from the western city of Lutsk.    Her three-year-old son has not been vaccinated. Fedorchuk said a relative suffered side effects after vaccination.

Some protesters carried banners that read "Forced medical intervention is a crime."    Kateryna Bulavinova, a consultant with the UN children's agency UNICEF, said local doctors' lack of knowledge about vaccines was a reason why many missed out on them.   Bulavinova said that doctors and nurses must explain to patients in detail how the vaccine works and what kind of reactions are normal.    "When there is this understanding, the fear goes away," she said.   According to the UNICEF survey, Ukrainians were most likely to be put off vaccines because of fears of side effects or a distrust of the manufacturers.   There is growing concern over global public resistance to vaccinations.

Measles cases nearly tripled globally during the first seven months of the year compared to the same period in 2018, the World Health Organization (WHO) said this month.    Measles, which is highly contagious, can be entirely prevented through a two-dose vaccine, but the WHO has in recent months sounded the alarm over vaccination rates.    The airborne infection causing fever, coughing and rashes can be deadly in rare cases and had been officially eliminated in many countries with advanced healthcare systems.
Date: Wed 14 Aug 2019
Source: Unian [abridged, edited]

Director of the Department of Health of Kyiv Valentyna Hinzburh has said that an outbreak of measles in Kyiv has become the largest since the independence of Ukraine.

According to her, over 5000 people fell ill with measles in Kyiv in 6 months of 2019, of which almost 3000 were adults. This is 3 times the figure recorded in the same period of 2018. About 50% of patients required hospitalization due to the severe course of the disease. This year [2019], 2 adults died from measles, as they were not vaccinated and reported to the doctor too late.

Ukraine is among the countries that have reported the highest numbers of measles cases in 2019.

"Today, nothing but vaccines will protect Kyiv from outbreaks and epidemics of vaccine-preventable infectious diseases," Hinzburh said. She said the current situation in the capital and Ukraine as a whole was a result of reduced collective immunity. "Here are just a few figures that are staggering. In 2015, 5 people got measles in Kyiv, 3 in 2016, 87 in 2017, 3045 in 2018, and over 5000 for 6 months in 2019!" she said.
More ...

Virgin Islands

British Virgin Islands US Consular Information Sheet
April 03, 2006
COUNTRY DESCRIPTION: The British Virgin Islands (BVI) are a British overseas territory, part of the British West Indies, lying about 60 miles east of Puerto Rico. There are abo
t 50 islands in the BVI, many of them uninhabited. Tortola is the main island; other islands include Virgin Gorda, Jost Van Dyke, and Anegada. Tourist facilities are widely available.
ENTRY/EXIT REQUIREMENTS: For tourist stays of up to six months, U.S. citizens need a valid U.S. passport or other proof of U.S. citizenship (original or certified birth certificate, Certificate of Naturalization or Certificate of Citizenship as well as photo identification), onward or return tickets, and sufficient funds for their stay. Upon initial entry, no more than 60 days will be granted. At the end of 60 days, visitors must report to the Immigration Department's main office in Road Town for an extension. Extensions of up to 90 days are issued at the discretion of the Immigration Officer subsequent to an interview. For further information on travel to the British Virgin Islands, travelers should contact the BVI Department of Immigration at 1-284-494-3471. Visit the Embassy of the British Government web site at for the most current visa information.
See Entry and Exit Requirements for more information pertaining to dual nationality and the international child abduction . Please refer to our Customs Information to learn more about customs regulations.

SAFETY AND SECURITY 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: Thefts and armed robberies do occur in the BVI. Visitors should take common-sense precautions against petty crime. Avoid carrying large amounts of cash and use hotel safety deposit facilities to safeguard valuables and travel documents. Do not leave valuables unattended on the beach or in cars. Always lock up boats when going ashore.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
See our information on Victims of Crime .
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in the British Virgin Islands consists of a small general hospital with an emergency room staffed 24-hrs/day by physicians, several clinics on Tortola, and one clinic in Virgin Gorda. Ambulances staffed with paramedics serve both islands. There are no medical facilities on the other islands. A volunteer organization, Virgin Islands Search and Rescue (VISAR), responds 24-hrs/day to medical emergencies at sea or on outer islands. VISAR transports casualties to the nearest point for transfer to ambulance. To reach VISAR, dial SOS (767) or call on Marine Channel 16.
There is no hyperbaric chamber in the BVI. Patients requiring treatment for decompression illness are transferred to St. John, U.S. Virgin Islands. Most sensitive medical cases are transferred to San Juan, Puerto Rico.
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 . For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at . Further health information for travelers is available at .
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 the British Virgin Islands is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Vehicles drive on the left (the British side) with most steering wheels on the left (the "American" side). Road signs are limited and seatbelts are required by law. Drivers often fail to yield the right-of-way to pedestrians, even at painted crosswalks. Speeding and reckless driving are fairly common in the BVI. Drivers can encounter nighttime drag racing on main thoroughfares and livestock on roads. Roads in Tortola's interior can be steep and extremely slippery when wet. Travelers planning to drive across the island should consider requesting four-wheel drive vehicles and should ensure that tires and brakes are in good operating condition on any rental vehicle. Please refer to our Road Safety page for more information, as well as the website of the BVI's national tourist office and national authority responsible for road safety at
.
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the British Virgin Islands as being in compliance with ICAO international aviation safety standards for oversight of BVI's air carrier operations. For more information, travelers may visit the FAA's Internet web site at .
CUSTOMS REGULATIONS: BVI customs authorities may enforce strict regulations concerning temporary importation into or export from the British Virgin Islands of items such as drugs and firearms. Visitors to BVI carrying firearms must declare them upon entry into any port in the territory. Firearms must be bonded and are held by the proper authorities until time of departure. Contact BVI Customs & Immigration at 1-284-494-3475, the Embassy of the United Kingdom in Washington, D.C. or one of the UK's consulates in the United States for specific information regarding customs requirements. Please see our information on 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 Virgin Island laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the BVI 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 .
DISASTER PREPAREDNESS: All Caribbean countries can be affected by hurricanes. The hurricane season normally runs from June to the end of November, but there have been hurricanes in December in recent years. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA).
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 AND CONSULATE LOCATIONS: Americans living or traveling in the British Virgin Islands are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website , and to obtain updated information on travel and security within the BVI. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The nearest U.S. Embassy to the BVI is located in Bridgetown, Barbados. The Consular Section is located in the American Life Insurance Company (ALICO) Building, Cheapside, telephone 1-246-431-0225 or fax 1-246-431-0179, email ConsularBridge2@state.gov , or . The U.S. Consular Agent in Antigua, located at Jasmine court, St. John's, tel. 1-268-463-6531, is closer to the BVI and can also assist in some limited non-emergency cases, by previous appointment only.
****
This replaces the British Virgin Islands Consular Information Sheet dated April 26, 2005 to update all sections.

Travel News Headlines WORLD NEWS

Date: Thu 19 Sep 2019
Source: Emerg Infect Dis [edited]

Citation:
Guendel I, Ekpo LL, Hinkle MK, Harrison CJ, Blaney DD, et al.: Melioidosis after Hurricanes Irma and Maria, St. Thomas/St. John District, US Virgin Islands, October 2017. Emerg Infect Dis. 2019; 25(10): 1952-1955. doi: 10.3201/eid2510.180959.

Melioidosis is caused by _Burkholderia pseudomallei_, a saprophytic, gram-negative bacillus endemic to tropical regions worldwide (1). Diagnosis is difficult because of wide-ranging clinical manifestations (2), and this bacterium is innately resistant to many antimicrobial drugs, making treatment options limited, complex, and lengthy (3). Infection occurs by percutaneous exposure, inhalation, or ingestion.

Melioidosis is rare in the USA, and cases are usually travel related (4,5). However, regional endemicity has been documented in Puerto Rico (6), and sporadic human cases have been reported in the Caribbean (5,7). In September 2017, the US Virgin Islands were affected by 2 category 5 hurricanes, Irma and Maria; widespread flooding continued for weeks. We describe the clinical manifestations, management, and outcome of post-hurricane melioidosis cases in 2 women in St. Thomas and St. John, US Virgin Islands.

The study
Despite major damage to the 2 hospitals in the territory during the 2 hurricanes, the Virgin Islands Department of Health (VIDOH) maintained surveillance at both emergency departments. Two isolates were recovered from each patient. Local specimen analysis for organism identification was performed by using the MicroScan WalkAway System (Siemens Healthcare Diagnostics, <https://www.siemens-healthineers.com>). All isolates were confirmed as _B. pseudomallei_ at the CDC. Whole-genome sequencing and single-nucleotide polymorphism analysis were performed (National Center for Biotechnology Information, <https://www.ncbi.nlm.nih.gov>. Genomes from a given patient were clonal to each other. However, representative genomes from both patients had differences (greater than 5600 single-nucleotide polymorphisms), indicating the presence of different strains in these infections. Genomic comparison with a reference panel indicated that the isolates were within the previously described Western Hemisphere clade and subclade associated with the Caribbean (8).

Patient 1 was an 80-year-old female resident of St. Thomas who had a history of cardiomyopathy and type II diabetes mellitus. She came to the emergency department (ED) at Schneider Regional Medical Center (St. Thomas, US Virgin Islands) because of shortness of breath (symptom onset 28 days after Hurricane Irma and 9 days after Hurricane Maria). Her symptoms were worsened orthopnea, increased abdominal girth, and edema, consistent with her symptoms at previous admissions. The patient was admitted for management of acute decompensated heart failure.

The patient had a temperature of 98.5 deg F [36.9 deg C]; diffuse pulmonary crackles; jugular venous distension; normal heart sounds; and bilateral, lower extremity pitting edema. Examination showed a focal area on the anterior left thigh that had a central, firm, warm, erythematous, tender, subcutaneous nodule about 2 cm [approximately 0.8 in] in diameter with a central fluctuant area and a small pinhole. Incision and drainage was performed, and a swab specimen of purulent drainage was sent for culture.

The patient was given intravenous clindamycin (600 mg every 8 h for 5 d) and was discharged while receiving oral clindamycin, but the treatment course was not completed. Cultured wound showed growth of _B. pseudomallei_ at 5 days. However, culture growth was not yet positive before patient discharge. The isolate was susceptible to trimethoprim/sulfamethoxazole (Table 1 [for Tables and Figure, see original URL - ProMED Mod.LL]).

Patient 1 returned to the ED 2 weeks later because of manifestations similar to those at the 1st visit. She was afebrile and admitted for diuresis. The left thigh lesion had progressed into a 2 cm [about 0.8 in], tender, shallow ulcer productive of purulent material surrounded by erythema and a focal area of induration (Figure). Laboratory data reflected a leukocyte count within reference ranges and mild renal insufficiency with estimated glomerular filtration rate of 40.47 mL/min (Table 2). A 2nd wound culture was collected, and the patient was given intravenous meropenem (1 g every 8 h). Culture was presumptively positive for _B. pseudomallei_ and _Serratia marcescens_ after 48 hours, confirmed after 8 days. Both isolates showed the same resistance pattern and were susceptible to meropenem and trimethoprim/sulfamethoxazole: the MIC for meropenem was <1 microgram/mL (Table 2). Meropenem was continued for 8 days, and ulcer improvement was observed. The patient was discharged while receiving oral trimethoprim/sulfamethoxazole (800 mg/160 mg 2x/d) to complete maintenance therapy. The patient completed a 3-month course of trimethoprim/sulfamethoxazole and achieved resolution.

Patient 2 was a 60-year-old female who had diabetes and was a resident of St. John. She was referred to the ED at Schneider Regional Medical Center by her primary care physician because of hyperglycemia, productive cough, and malaise for one week (symptom onset 46 days after Hurricane Irma and 33 days after Hurricane Maria). The patient was admitted to the intensive care unit because of community-acquired pneumonia.

The patient was lethargic and had a temperature of 101 deg F [38.3 deg C]; heart rate was 99 beats/min, respiratory rate 22 breaths/min, and blood pressure 142/81 mm Hg. Blood gas testing showed pO2 of 47.6 mm Hg with an oxygen saturation of 87.2% on 2-liter nasal cannula. A chest radiograph showed a left-sided mild infiltrate, and her leukocyte count was markedly increased (28 300 cells/mm3) (Table 2).

The patient was given intravenous ceftriaxone (1 g/d) and azithromycin (500 mg/d) after blood and sputum cultures were prepared. She required bilevel positive airway pressure but eventually required mechanical ventilation. The patient then became hypotensive and required norepinephrine to maintain a main arterial pressure greater than 65 mm Hg. Ceftriaxone was discontinued, and she was given intravenous piperacillin/tazobactam (3.375 g every 6 h). Trimethoprim/sulfamethoxazole- and ceftazidime-sensitive _B. pseudomallei_ were identified from sputum culture after 72 hours (Table 1). Methicillin-sensitive _Staphylococcus aureus_ and _Candida glabrata_ were also identified. One of 2 blood cultures was positive for gram-negative rods. Piperacillin/tazobactam was discontinued, and the patient was given meropenem (1 g every 8 h).

The patient remained critically ill and was transferred to a tertiary-care hospital in the continental USA. She died in a long-term care facility during October 2018 without showing signs of neurologic improvement.

Isolates from both patients showed susceptibility to routinely tested antimicrobial drugs (10,11). Isolates from patient 1 showed resistance to ceftazidime during preliminary analysis (Table 1). However, broth microdilution confirmatory testing performed at CDC indicated ceftazidime susceptibility, highlighting the need for additional antimicrobial resistance confirmation.

Both patients were interviewed to determine travel history and possible exposure sources. Patient 1 traveled occasionally to the southeastern USA; her last travel date was 3 months before her illness. This patient reported flooding and water damage to her home from the hurricanes but did not report contact with flood waters. Patient 2 reported no travel history before the hurricanes.

VIDOH has investigated and confirmed a subsequent case-patient with pulmonary melioidosis in St. Thomas during December 2018 (I. Guendel et al., unpub. data). This case-patient reported no recent travel and might have had occupational exposure as a professional gardener. This person had 2 risk factors (type II diabetes mellitus and heavy use of alcohol).

Conclusions
Given regional occurrence, detection of melioidosis in the US Virgin Islands is not surprising. Furthermore, emergence of melioidosis after extreme weather events has been well documented, and cases were likely acquired locally from storm-related exposure to flooded soil, surface water runoff, or generation of coarse aerosols (12,13). Although detection of _B. pseudomallei_ has yet to be confirmed in the environment, it might be endemic to the US Virgin Islands, as in Puerto Rico.

In January 2018, melioidosis was listed as a reportable disease in the US Virgin Islands. Future actions include disease education efforts for physicians and laboratory staff because misdiagnosis is common (14). Awareness campaigns highlighting preventive measures for the public are necessary because risk factors are prevalent in the local population (e.g., diabetes and other chronic disease) and might be exacerbated under disaster settings (e.g., respiratory effects and open wounds). VIDOH has implemented rapid diagnostic testing by using Active Melioidosis Detect (InBios International, <https://inbios.com>) on suspected specimens for prompt on-island case identification while routine ED diagnostic cultures are performed (5). All confirmatory testing is conducted at CDC.

References
-------
On Request
======================
[This infection is found primarily in southeast Asia and the Northern Territory of Australia. Despite this, cases of melioidosis have been acquired in other parts of the world including the Americas. Flooding from the increasing number of severe tropical storms related to climate change is increasing.

Melioidosis is a disease of the rainy season in its endemic areas. It mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (most common risk factor), renal disease, cirrhosis, thalassemia, alcohol dependence, immunosuppressive therapy, chronic obstructive lung disease, cystic fibrosis, and excess kava consumption (kava is an herbal member of the pepper family that can be associated with chronic liver disease).

Melioidosis may present at any age but peaks in the 4th and 5th decades of life, affecting men more than women. In addition, although severe fulminating infection can and does occur in healthy individuals, severe disease and fatalities are much less common in those without risk factors.

The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, and chest pain, and -- although the cough can be nonproductive -- respiratory secretions can be purulent, significant in quantity, and associated with on-and-off bright red blood. The lung infection can be rapidly fatal -- with bacteremia and shock -- or somewhat more indolent.

Acute melioidosis septicaemia is the most severe complication of the infection. It presents as a typical sepsis syndrome with hypotension, high cardiac output, and low systemic vascular resistance. In many cases, a primary focus in the soft tissues or lung can be found. The syndrome, usually in patients with risk factor comorbidities, is characteristically associated with multiple abscesses involving the cutaneous tissues, lung, liver, and spleen, and a very high mortality rate of 80-95%. With prompt optimal therapy, the case fatality rate can be decreased to 40-50%.

The melioidosis bacillus is intrinsically insensitive to many antimicrobials, and in fact, bioterrorism strains may be engineered to be even more resistant. _Burkholderia pseudomallei_ is usually inhibited by tetracyclines, chloramphenicol, trimethoprim-sulfamethoxazole (SXT), antipseudomonal penicillins, carbapenems, ceftazidime, and amoxicillin/clavulanate or ampicillin/sulbactam. Ceftriaxone and cefotaxime have good in vitro activity but poor efficacy, and cefepime did not appear, as well, to be equivalent to ceftazidime in a mouse model. The unusual antimicrobial profile of resistance to colistin and polymyxin B and the aminoglycosides but sensitivity to amoxicillin/clavulanate is a useful tool to consider in treatment of infection with the organism.

The randomized and quasi-randomized trials comparing melioidosis treatment have been reviewed, and it was found that the formerly standard therapy of chloramphenicol, doxycycline, and SXT combination had a higher mortality rate than therapy with ceftazidime, imipenem/cilastatin, or amoxicillin/clavulanate (or ampicillin/sulbactam). The betalactam-betalactamase inhibitor therapy, however, seemed to have a higher failure rate.

Source: Tolaney P, Lutwick LI: Melioidosis. In: Lutwick LI, Lutwick SM (eds). Bioterror: the Weaponization of Infectious Diseases. Totowa NJ: Humana Press, 2008. pp 145-58. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
US Virgin Islands: <http://healthmap.org/promed/p/479>]
Date: Fri 31 Jan 2014
Source NBC News [edited]

The Explorer of the Seas outbreak was caused by norovirus, one of the worst outbreaks in 20 years, the Centers for Disease Control and Prevention (CDC) said. The Explorer of the Seas cruise ship returned to port after hundreds of passengers became ill. Federal health officials confirmed on Friday [31 Jan 2014] that norovirus was the culprit that sickened nearly 700 people on a cruise ship this week, and said it was one of the biggest norovirus outbreaks in 20 years. But the source of the outbreak on the Royal Caribbean ship Explorer of the Seas, which returned early to New Jersey on Wednesday [29 Jan 2014], may never be known, CDC said: "CDC has been investigating the outbreak since last Sunday [26 Jan 2014] but no particular source has been identified and it's quite possible a source won't be identified."

The report comes after passengers streamed off the Caribbean Princess on Friday morning [31 Jan 2014], the 2nd cruise cut short this week amid reports of illness on board. The ship, operated by Princess Cruises, returned to Houston [Texas] a day early with a confirmed outbreak of norovirus. "The ship was forced to return to Houston one day early because we were informed that dense fog was expected to close the port for much of the weekend," the company said in a statement. "The ship did not return early because of the increased incidence of norovirus on board, despite some media reports."

At least 178 people on board became ill during the cruise, according to the cruise line and CDC. Sick patients were quarantined to their rooms, and other passengers said they no longer had access to buffet tongs as crew members handed out hand sanitiser. CDC health officials met the Caribbean Princess at the Bayport Cruise Terminal in Pasadena, Texas. The vessel launched on a 7-day cruise to the western Caribbean on [25 Jan 2014] and had been scheduled to return on Saturday [1 Feb 2014]. Princess Cruises said the outbreak was over by the time the ship returned to Houston. "As a result of our actions, case numbers declined significantly and by the end of the cruise there were no passengers with active symptoms," the company said. "Over the course of the cruise 178 passengers (5.7 per cent) and 11 crew (1 per cent) reported ill to the Medical Center."

CDC officials also helped Royal Caribbean clean up the Explorer of the Seas, and said it had been approved to go back out again with a new batch of passengers Friday afternoon [31 Jan 2014]. Royal Caribbean officials say they cleaned the ship, which carried more than 3000 passengers, 3 times. It's the 3rd cruise ship outbreak to occur this year [2014]. A Norwegian Cruise Line ship, the Norwegian Star, reported that 130 passengers and 12 crew members became ill on 2-week cruise that launched [5 Jan 2014] from Miami.

About 20 million passengers take cruises in the US each year, fuelling a USD 37.8 billion annual industry, according to the American Association of Port Authorities. There were 9 vessel outbreaks in 2013 and 16 in 2012, according to the CDC. Norovirus is a common culprit in outbreaks on cruise ships, in nursing homes, and other confined places. It is a fast-moving gut bug typically spread by infected people or contaminated food or water. Norovirus is the most common cause of acute gastroenteritis in the US, resulting in about 21 million illnesses, between 56 000 and 71 000 hospitalizations and as many as 800 deaths, CDC says.

The virus lingers on surfaces and spreads very easily. Thorough hand washing with hot water and soap and meticulous environmental cleaning can help stop the spread. CDC says it's the season for norovirus. "Norovirus outbreaks wit high attack rates are common during this time of year," the agency said. "Most outbreaks occur between January and April."   [byline: Maggie Fox]
*****
Date: Wed 29 Jan 2014
Source: NBC News [edited]

Beleaguered passengers finally fled a Royal Caribbean cruise ship on Wednesday [29 Jan 2014] after a 10-day vacation cut short by a nasty gut bug that sickened nearly 700 people. One woman aboard the Explorer of the Seas yelled, "We made it!" as the ship docked in Bayonne [New Jersey], 2 days ahead of schedule. Other passengers stood on deck wrapped in blankets to watch the ship pull in. One person was removed from the Explorer of the Seas on a stretcher and taken away by ambulance. Others walked under their own power after the vessel arrived. Several passengers recounted a week full of tension and drama, but also professionalism and care from the cruise line crew.

Still, the ordeal on the 1020-foot ship -- whose relaxing voyage to the US Virgin Islands was thwarted by suspected norovirus -- may linger a little longer for people still showing signs of the fast-moving infection, health officials said. "We have passengers who are still exhibiting active disease," said Burnadette Burden, a spokeswoman for the Centers for Disease Control and Prevention. People who are still sick may be too ill to travel home -- and too contagious to use public transportation like trains and buses, health experts say. Royal Caribbean officials said Wednesday [29 Jan 2014] that they'd pay for hotels or make sure that ill passengers get additional medical care. "Should a guest feel sick enough that they want to go to the hospital, we will arrange for transportation," Royal Caribbean spokeswoman Cynthia Martinez said in an email. "We will work with the small number of guests that still feel ill to make them as comfortable as possible."

At least 630 of the ship's 3071 passengers and at least 54 of the 1166 crew members came down with diarrhea and vomiting -- classic signs of norovirus. Most of the cases occurred early in the cruise, which left New Jersey on [21 Jan 2014], and many passengers had already recovered. It's hard to say that the outbreak was the worst on record because of inconsistencies in record-keeping. But it's a bad one, Burden said. "It would be fair to say this is one of the largest numbers in the last 20 years or so," she said. One of the closest outbreaks to compare occurred in 2006, when a Carnival Cruise ship, the Carnival Liberty, was hit with an outbreak of norovirus that sickened 679 passengers and crew on a November trip to the US Virgin Islands.

CDC officials have not confirmed that norovirus is the culprit on the Explorer of the Seas, though it's a common cause of illness on cruise ships. Officials said testing was delayed by a treacherous winter snowstorm that closed the agency's Atlanta headquarters and results aren't expected until Friday [31 Jan 2014]. But if it is the germ, it's highly contagious for the one to 2 days when people are actively sick -- and for a few days afterward. The virus actually lingers in people's stool for 2 weeks or more, according to the CDC. That means that anyone who fell ill -- and those who were around them -- should pay extra attention to washing their hands and other kinds of cleanliness, said Dr Ruth Lynfield, outgoing head of the public health committee of the Infectious Diseases Society of America.

Cleanliness will be the key for the cruise line, too. Officials said they plan another scrub, a so-called "barrier sanitation" program to ensure that any remaining traces of illness are removed from the ship. Norovirus is a notoriously difficult bug to eradicate, health experts say. "It will be the 3rd aggressive sanitizing procedure the ship has undertaken since we became aware of the issue, and will additionally provide a window of more than 24 hours where there are no persons aboard the ship," officials said in a statement.   [byline: JoNel Aleccia]
******
Date: Fri 31 Jan 2014
Source: CDC, National Center for Environmental Health, Division of
Emergency and Environmental Health Services, Vessel Sanitation Program (VSP) [edited]

Cruise ship: Explorer of the Seas -- voyage dates: 21-31 Jan 2014
-----------------------------------------------------------------
- number of passengers who reported being ill during the voyage out of total number of passengers onboard: 634 of 3071 (20.6 per cent)
- number of crew who reported being ill during the voyage out of total number of crew onboard: 55 of 1166 (4.7 per cent)
- predominant symptoms: vomiting, diarrhea
- Causative agent: Norovirus

Actions: in response to the outbreak, Royal Caribbean Cruise Line and the crew aboard the ship took the following actions:
- increasing cleaning and disinfection procedures according to their outbreak prevention and response plan;
- making announcements to both notify onboard passengers of the outbreak and encourage case reporting;
- collecting stool specimens from ill passengers and crew for submission to the CDC lab;
- making multiple daily reports of gastrointestinal illness cases to the VSP [Vessel Sanitation Program];
- preparing additional crew members to join the ship mid-voyage to assist with case management and intensified sanitation procedures;
- consulting with CDC on plans for: passenger notification procedures and the planned delayed embarkation schedule in Bayonne, NJ on [31 Jan 2014], and disembarkation plans for active cases, terminal, and transport infection control procedures.

One CDC Vessel Sanitation Program epidemiologist, one contract epidemiologist, and one VSP environmental health officer boarded the ship in St Thomas, [US Virgin Islands] and are sailing on the ship as it travels back to port in New Jersey. This team is conducting an epidemiologic investigation, environmental health assessment, and evaluating the outbreak and response activities on board. One additional CDC Vessel Sanitation Program environmental health officer will board the ship upon arrival on [29 Jan 2014] to assist with the evaluation of the disinfection process. The team will continue the investigation and evaluation on the ship thru the boarding of new passengers for the next voyage. 5 clinical specimens were shipped to the CDC lab for testing on [26 Jan 2014].
**************************
Date: Fri 31 Jan 2014
Source: CDC, National Center for Environmental Health, Division of
Emergency and Environmental Health Services, Vessel Sanitation Program (VSP) [edited]

Cruise ship: Caribbean Princess -- voyage dates: 25 Jan-1 Feb 2014
------------------------------------------------------------------
- number of passengers who reported being ill during the voyage out of total number of passengers onboard: 181 of 3102 (5.8 per cent)
- number of crew who reported being ill during the voyage out of total number of crew onboard: 11 of 1148 (0.96 per cent)
- predominant symptoms: vomiting, diarrhea
- causative agent: Norovirus

Actions: in response to the outbreak, Princess Cruise Lines and the crew aboard the ship took the following actions:
- increasing cleaning and disinfection procedures according to their outbreak prevention and response plan;
- making announcements to both notify onboard passengers of the outbreak and encourage case reporting;
- collecting stool specimens from ill passengers and crew for submission to the CDC lab. Samples tested with the vessel's onboard rapid norovirus test were positive for norovirus. The specimens will be sent to the CDC lab for confirmatory analysis;
- making multiple daily reports of gastrointestinal illness cases to the VSP;
- consulting with CDC on plans for: passenger notification procedures and the planned delayed embarkation schedule in Houston, TX on [1 Feb 2014], and disembarkation plans for active cases, and terminal and transport infection control procedures.

Two CDC Vessel Sanitation Program environmental health officers will board the ship in Houston, TX on [31 Jan and 1 Feb 2014] to conduct an epidemiologic investigation, environmental health assessment, and evaluate the outbreak and response activities. Specimens are being collected and will be sent to the CDC lab for testing.
=====================
[ProMED-mail does not normally report outbreaks of norovirus-related gastroenteritis because of their ubiquity during the winter months. (Hence the alternate designation 'winter vomiting bug'). Norovirus infection is very contagious and can be contracted from an infected person, contaminated food or water, or by touching contaminated surfaces. The virus causes acute gastroenteritis with stomach pain, nausea, and diarrhea and vomiting. Anyone can be infected with norovirus and acquire norovirus illness repeatedly throughout life. Norovirus is the commonest cause of acute gastroenteritis in the United States. Each year, it causes 19-21 million cases and contributes to 56 000-71 000 hospitalizations and 570-800 deaths. Norovirus is also the commonest cause of foodborne disease outbreaks in the United States. There's no vaccine to prevent norovirus infection and no drug to treat it.

Norovirus illness is usually not serious. Most people get better in 1 to 3 days. But norovirus illness can be serious in young children, the elderly, and people with other health conditions. It can lead to severe dehydration, hospitalisation but rarely death. Most outbreaks of norovirus illness happen when infected people spread the virus to others. But, norovirus can also spread by consumption of contaminated food or water and by touching contaminated surfaces.

Health care facilities, including nursing homes and hospitals, are the most commonly reported places for norovirus outbreaks in the United States. Over half of all norovirus outbreaks reported in the United States occur in long-term care facilities. Outbreaks of norovirus illness appear to be occurring more frequently in cruise ships and similar environments. - ProMed Mod.CP]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/8vcv>.]
Date: Tue 13 Dec 2011
Source: Virgin Islands Daily News [edited]

The Centers for Disease Control and Prevention [CDC] has linked 5 past cases of Legionnaires' disease -- reported between March 2010 and August 2011 -- with stays at Marriott's Frenchman's Reef and Morning Star Beach Resort and Marriott's Frenchman's Cove [in Saint Thomas], prompting remediation work to the resorts' water systems. The VI [Virgin Islands] Health Department has been "working closely" with a team of CDC specialists to monitor the remediation efforts at the resorts, after an investigation into the 5 past cases, according to a statement the Health Department released Monday [12 Dec 2012].

The illness was found in stateside residents who had been guests at the resorts, said Health Department spokeswoman Eunice Bedminster. They required hospitalization but have since recovered, she said. There have been no reports of employees affected at either site, according to the Health Department statement.

The statement indicates that Frenchman's Reef and Morningstar Beach Resort has hired a consultant who led a cleaning project of the affected areas and treated the water system. Test results show no existence of _Legionella_ bacteria, although the Health Department statement said the test results have not yet been evaluated independently by the CDC.

The Health [Department] had asked the resorts to notify those who could potentially be affected by the bacteria: guests and employees, Bedminster said. The properties asked for an extension on a deadline that had been set, and it was granted, but the deadlines passed last week [week of 5 Dec 2011] without the notification to guests and employees going out, Bedminster said. She did not know if, after the deadline, the properties had made the requested notifications, she said.

The hotel provided The Daily News with a written statement that did not address guest notification: "Marriott takes hotel hygiene and cleanliness very seriously. As soon as we were notified of the possibility of the presence of _Legionella_ bacteria we immediately began to work with the USVI Department of Health (DOH) to address the situation. The Frenchman's Reef and Morning Star Beach Resorts hired a consultant who led a cleaning project of affected areas and the treatment of the water system. The latest test results taken after the implementation of these measures show no existence of _Legionella_ bacteria in the samples tested. We have complied with the recommendations provided by the DOH, and we have successfully addressed the issue at the resort. The DOH has allowed the hotel to remain fully open for business and welcome our guests."

The Daily News spoke with Marriott Frenchman's Reef and Morning Star Beach Resort General Manager Jose Gonzalez Espinosa by phone and asked for comment on the Health Department's assertion that the resort did not make the notifications it was supposed to make by the deadline. Gonzalez would not answer the questions unless they were in writing. The Daily News has a policy against submitting questions in writing because written Q and A stifles and slows follow-up and response. The resort underwent a major renovation during the summer, closing 3 May 2011 and reopening on 6 Oct 2011.

Legionnaires' disease is a pneumonia caused by the _Legionella_ bacteria, which live in warm water supplies, said Dr Lauri Hicks, a medical epidemiologist with the CDC. The bacteria that cause the disease do not pass from person to person. "It really requires exposure to water aerosol that contains _Legionella_," she said, Exposure may occur from showering or with time spent in a whirlpool or hot tub where the bacteria that lead to Legionnaires' disease are present, Hicks said.

Only a fraction of people -- typically those with certain risk factors, such as compromised immune systems -- exposed to the bacteria become ill, she said.

According to the Health Department statement, from 2000 through 2009, a total of 22 418 cases of legionellosis were reported to CDC from the 50 states and the District of Columbia. The CDC informed the Health Department in October [2011] of the 5 Legionnaires' disease cases among past guests at the resorts, and the Health Department asked for the agency's help in investigating. From 18 to 22 Oct 2011, CDC specialists conducted testing, and the properties were alerted about the possible _Legionella_ contamination, Bedminster said. On 3 Nov 2011, the Health Department notified each property of the CDC's conclusive findings and ordered them to immediately work on their water systems, including cleansing, superheating, chlorinating, and hiring a private consultant experienced in eliminating _Legionella_ from building water systems, according to the release. More than 6 weeks later, the Health Department notified the public with the statement it released Monday [12 Dec 2011].

Bedminster said that there had been no delay -- and that remediation work began immediately. "We have worked in good faith with both the resorts during what I have said was a monitoring process. We had some agreed-upon deadlines that had not been met, so we had to let the public know," she said.

Bedminster said that Health Department officials had discussed the possibility of enforcement actions with the Department of Labor and the Department of Planning and Natural Resources to get those deadlines met, but she did not know the outcome of the discussions. "Safeguarding the public's health, including that of employees and guests, from exposure and threats are of the utmost importance to the Department of Health," acting Health Commissioner Mercedes Dullum said in the prepared statement. "DOH will continue to monitor this situation with assistance from the CDC. People should not be discouraged from traveling to or within the US Virgin Islands."  [Byline: Joy Blackburn]
---------------------------------------------
Communicated by:
Denis Green
denis@gatesit.com.au
=======================
[The following has been extracted from the US CDC document Travel-Associated Legionnaires' Disease (<http://www.cdc.gov/legionella/faq.htm>):

"About 20-25 percent of all Legionnaires' disease reported to CDC is travel-associated. Legionnaires' disease is important to diagnose and to report because its identification implies the presence of an environmental source to which other susceptible individuals are likely to be exposed. Clusters of Legionnaires' disease associated with travel to hotels or aboard cruise ships are rarely detected by individual clinicians or health departments; travelers typically disperse from the source of infection before developing symptoms. Therefore, a travel history should be actively sought from patients with community-acquired pneumonia and _Legionella_ testing should be performed for those who have traveled in the 2 weeks before onset of symptoms.

"_Because of the multi-state nature of travel in the US, national-level surveillance is necessary to detect outbreaks of travel-associated Legionnaires' disease. CDC relies upon state and local health departments to conduct this surveillance. Surveillance through the National Notifiable Diseases Surveillance System (NNDSS) is still important for monitoring national trends; all cases should be reported through NNDSS."

"Because of the public health importance of timely reporting, inform CDC of travel-associated cases by emailing about the patient's movements in the 2-10 days before onset."

"Environmental sampling/testing should only be conducted after careful consideration of the epidemiologic evidence linking a case(s) to a particular location."

The following article is linked to the CDC document: Barbaree JM, et al: Protocol for Sampling Environmental Sites for Legionellae. Applied Environmental Microbiol 1987; 53(7): 1454-8 (<http://www.cdc.gov/legionella/files/sampling_protocol1987.pdf>): "Since legionellae not related to disease may be found in many of the sites sampled, an epidemiologic association with the probable source should be established before intervention methods, such as disinfection, are undertaken."

"Random sampling without an epidemiologic evaluation and comparing isolates from the environment and from patients could lead to false conclusions about sources of epidemic strains."

Potential environmental sampling sites for _Legionella_ spp that the CDC document suggests include: internal surfaces of faucets, aerators, and shower heads; and water from incoming water main, holding tanks and cisterns, water heater tanks, decorative fountains, irrigation equipment, fire sprinkler system (if recently used), whirlpools, and spas. Because _Legionella_ may be found in water supplies without linkage to any cases, the actual causative source should be demonstrated by matching the genotype of the environmental isolates with that of any clinical isolates to assure frequently costly corrective measures are carried out on the actual source (<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC86783/>; and <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730281/>).

The Virgin Islands are located in the Leeward Islands of the Lesser Antilles, which form the border between the Caribbean Sea and the Atlantic Ocean. Politically, the eastern islands form the British Virgin Islands and the western ones form the United States Virgin Islands. The US Virgin Islands consist of the main islands of Saint Croix, Saint John, and Saint Thomas (<http://en.wikipedia.org/wiki/United_States_Virgin_Islands >). They can be seen on the HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/1xng>. - ProMed Mod.ML]
Date: Sat 18 Sep 2010
Source: Virgin Islands Daily News [edited]
<http://virginislandsdailynews.com/dengue-outbreak-confirmed-in-1.1018284>

After 19 cases of suspected dengue fever -- and at least one death -- reported in the St Thomas-St John District, the VI Health Department issued a statement Friday [17 Sep 2010] saying that the district is experiencing a dengue fever outbreak. According to the Health Department statement released [Fri 17 Sep 2010], 9 of the 19 suspected cases have been laboratory-confirmed as dengue fever in the St Thomas-St John District since June [2010]. On St Croix, there have been 4 suspected cases with no confirmed cases. There is no requirement in the territory that people with suspected dengue fever undergo testing to confirm whether or not they have the mosquito-borne virus, said Health Department epidemiologist Eugene Tull.

His experience with a 2005 outbreak on St Croix leads him to believe that the number of dengue cases this year [2010] is higher than reported, Tull said, adding that he is now receiving anecdotal information about more cases in the community. According to the release, the strain causing the current outbreak is [dengue virus] type 2, which was responsible for the 2005 outbreak on St Croix.
================
[An interactive HealthMap/ProMED-mail map showing the location of the Virgin Islands in the Caribbean can be accessed at
<http://healthmap.org/r/01tp>. - ProMed Mod.TY]
Date: Fri 27 Aug 2010
Source: Virgin Islands Daily News [edited]
<http://virginislandsdailynews.com/news/dengue-fever-possible-cause-of-death-of-st-john-woman-1.977556>

A St John woman who was transferred last week [week of 16 Aug 2010] to a Miami hospital with possible dengue fever symptoms died there 20 Aug [2010] from complications, her husband said. VI [Virgin Islands] Health Department epidemiologist Eugene Tull said earlier this week [week of 23 Aug 2010] that he had no information about a possible death from dengue fever.

Health Department spokeswoman Eunice Bedminster said Thursday [26 Aug 2010] that the department was not aware of any deaths from the territory's dengue fever cases but had been investigating since receiving inquiries from reporters Monday [23 Aug 2010].

Tull said earlier this week that so far this year [2010], there have been 8 confirmed, laboratory positive cases of dengue fever in the territory, 3 probable cases with lab results pending, and 15 suspected cases. All of those were in the St Thomas/St John District, except for 2 of the suspected cases, which were on St Croix, he said. [Byline: Joy Blackburn]
=====================
[The attribution of the woman's death to dengue virus infection is speculative. ProMED-mail awaits confirmation (or not) as further information becomes available. It is clear, however, that locally acquired dengue virus infections are occurring there.

Maps showing the location of the US Virgin Islands can be accessed at <http://www.worldatlas.com/webimage/countrys/carib.htm>. and the HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/01tp> - ProMed Mod.TY]
More ...

World Travel News Headlines

Date: Fri, 13 Dec 2019 16:41:23 +0100 (MET)
By Mariëtte Le Roux and Joseph Schmid

Paris, Dec 13, 2019 (AFP) - French commuters gritted their teeth for a ninth day of public transport strikes Friday, with unions vowing to keep up their protest against a pension overhaul through the holidays unless the government backs down.   Officials have said they are ready to negotiate, with Education Minister Jean-Michel Blanquer meeting teachers' representatives on Friday to try and stave off another day of class shutdowns.   "It was an intense and frank meeting... but we still need details, and maintain our call to strike on Tuesday," Stephane Crochet of the SE-Unsa union said.

Unions are hoping for a repeat of 1995, when they forced a rightwing government to back down on pension reforms after three weeks of metro and rail strikes just before Christmas.   The prospect of a protracted standoff has businesses fearing big losses during the crucial year-end festivities, and travellers worried that their Christmas plans may be compromised.   "Right now it's a catastrophe here, but we're hoping there will be a solution before Christmas," Frederic Masse, a foie gras producer at the huge Rungis wholesale food market south of Paris, told AFP on Friday.

The capital city was again choked by huge traffic jams as most metro lines remained shut, only a handful of buses and trams were running, and one in four TGV trains were cancelled.   "I'm sick of this, and I won't be able to keep working if it goes on," Zigo Makango, a 57-year-old security agent, told AFP onboard a bus in the Bobigny suburb northeast of Paris.   To get home at night Makango said he has to use taxis, but "my boss doesn't reimburse me for that".

- 'Historic reform' -
President Emmanuel Macron on Friday expressed his "solidarity" with people impacted by the strike, "but I want the government to continue its work" in forging a single pension system, a key campaign promise.   "It's a historic reform for the country," he told journalists at an EU summit in Brussels. 

The overhaul unveiled by Prime Minister Edouard Philippe would do away with 42 separate regimes, some of which offer early retirement and other benefits to public-sector employees such as train drivers, dockers and even Paris Opera employees.   But Philippe angered unions further by proposing a reduced payout for people who retire at the legal age of 62 instead of a new, so-called "pivot age" of 64.

They have called for new mass demonstrations for next Tuesday, the third since the action started on December 5 in the biggest show of strength in years by France's notoriously militant unions.   Philippe insisted on Twitter that "My door is open and my hand outstretched".   But Laurent Brun of the hard-line CGT union, the largest among public-sector workers including those at rail operator SNCF, has already warned "There won't be any Christmas truce" unless the government drops the plan entirely.

- France divided -
A poll released Thursday by the Elabe institute found France evenly divided on Philippe's plan, with 50 percent for and 49 percent against.  But 54 percent rejected the mooted 64-year cutoff for a full pension, and 54 percent supported the protest.

Staff at four of France's eight oil refineries were on strike Friday, affecting output and raising fears of shortages down the line.   And both Paris operas, the Garnier and the Bastille, again cancelled Friday performances and others through the weekend.   Macron's government insists the changes will make for a fairer system and help erase pension system deficits forecast to reach as much as 17 billion euros ($19 billion) by 2025.   The average French person retires at just over 60, years earlier than most in Europe or other rich OECD countries.
Date: Fri, 13 Dec 2019 14:05:22 +0100 (MET)

Milan, Dec 13, 2019 (AFP) - More than 300 flights were cancelled Friday in Italy due to a planned one-day strike by workers from Alitalia and Air Italy.   Alitalia said in a statement that 315 flights were cancelled on Friday, with another 40 cancelled Thursday night and Saturday morning. It was not immediately clear how many flights were cancelled at Air Italy.   The 24-hours strike, which involves pilots, flight attendants and ground personnel, was called by three unions to draw attention to what they called "the ongoing crisis at Alitalia and Air Italy."

The strike was felt most in Sardinia, with about 30 flights cancelled.    Money-losing Alitalia has been under special administration since 2017 when employees rejected a restructuring plan that would have laid off 1,700 workers out of an approximately 11,000.   The government has so far looked for buyers without success.    Unions plan to meet on Tuesday with Economy Minister Stefano Patuanelli.    A potential consortium of buyers for the ailing carrier fell apart last month after Atlantia, which operates Rome's airports, pulled out.
Date: Fri, 13 Dec 2019 05:24:44 +0100 (MET)
By Neil SANDS

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

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

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

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

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

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

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

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

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

Neither Roberts nor Lueck expected the White Island eruption to hit international arrivals in New Zealand, which have continued to climb despite major earthquakes in 2011 and 2016.   The nature of any review arising from White Island remains uncertain, but Lueck said at the very least tourists needed to be better informed about any risks.   "Operators and tourism boards should have tourists understand what these risks are, and not brush over quickly signing a waiver," he said.   "Only then can tourists make an informed decision and decide whether or not they want to take that particular risk."
Date: Thu, 12 Dec 2019 21:25:36 +0100 (MET)

Kinshasa, Dec 12, 2019 (AFP) - Twenty-three cases of Ebola have been recorded in four days in eastern Democratic Republic of Congo, where deadly violence is hampering efforts to end the 16-month-old epidemic, authorities said on Thursday.   Ten cases were recorded on Tuesday alone in Mabalako in North Kivu province, after six on Monday, according to the Multisectoral Committee for Epidemic Response (CMRE).   Three out of the six were practitioners of traditional medicine, it said.

On Wednesday, three cases were recorded in North Kivu, including one in the Biena neighbourhood -- which has had no new Ebola cases for the last 85 days.   More than 2,200 people have died since the epidemic was declared on August 1, 2018.   As of November 22, the rate of new cases had fallen to 10 per week.   CMRE said "security reasons" -- attacks on Ebola health workers and sites by armed groups and angry youths -- had "paralysed" work in the key zones of Beni, Biakato and Mangina.   The attacks led to a pullout of locally-employed Ebola workers in Biakato by the UN's World Health Organization (WHO) and Doctors Without Borders (MSF).
Date: Thu, 12 Dec 2019 15:59:23 +0100 (MET)

Juba, Dec 12, 2019 (AFP) - Devastating flooding in South Sudan following a fierce drought could tip parts of the country into famine in the next few months, the World Food Programme (WFP) warned on Thursday.   According to the UN refugee agency nearly one million people were affected by floodwaters that submerged entire towns, compounding an already dire humanitarian situation after six years of war.

The WFP said that 5.5 million people are expected to be going hungry in early 2020 -- the time at which the population is generally benefiting from their harvest in October and November of the previous year.   An earlier harvest failed due to drought. This time crops have been washed away.    "The number of people in need is likely to increase because of the catastrophic level of destruction caused by floods since October following a drought that hammered parts of the country earlier in the year," the agency said in a statement.

The floods wiped out 73,000 metric tons of potential harvests as well as tens of thousands of cattle and goats, said the WFP.   "We know the problems that we've been having in South Sudan, but the rains and the floods have led to a national disaster and are much worse than anyone could have anticipated," said WFP Executive Director David Beasley.    "In fact, if we don't get funding in the next few weeks and months, we are literally talking about famine. We need support, we need help and we need it now."   The agency estimated its needs at $270 million (242 million euros) for the first half of 2020.   South Sudan declared a "man-made" famine affecting around 100,000 people in 2017. 

The term "famine" is used according to a scientific system agreed upon by global agencies, when at least 20 percent of the population in a specific area has extremely limited access to basic food; acute malnutrition exceeds 30 percent; and the death rate exceeds two per 10,000 people per day for the entire population.   "Famine in South Sudan was defeated after four months in 2017 by a concerted large-scale humanitarian response," said the WFP.   "Experts now say the country's food security outlook has never been so dire."   Political instability is also high as President Salva Kiir and his rival Riek Machar have again delayed their formation of a power-sharing government, this time by 100 days until February 2020.
Date: Wed, 11 Dec 2019 09:33:13 +0100 (MET)
By Holly ROBERTSON

Sydney, Dec 11, 2019 (AFP) - Up to 20,000 protesters rallied in Sydney on Wednesday demanding urgent climate action from Australia's government, as bushfire smoke choking the city caused health problems to spike.   Sydney has endured weeks bathed in toxic smoke as hundreds of blazes have raged across the countryside, with hospitals recording a 25 percent increase in the number of people visiting emergency departments last week.   On Tuesday smoke alarms rang out across Australia's biggest city, with thick haze triggering smoke alarms and forcing buildings to be evacuated, school children to be kept indoors, and ferries to be cancelled.   The devastating fires have focused attention on climate change, with scientists saying the blazes have come earlier and with more intensity than usual due to global warming and a prolonged drought.   Police estimated the crowd size at 15,000, organisers put the figure at 20,000.

Many of the protestors voiced anger at the government's silence in the face of the crisis.   "The country is on fire" said 26-year-old Samuel Wilkie attending his first climate protest. He described politicians' response as "pathetic".    "Our government is not doing anything about it," said 29-year-old landscape gardener Zara Zoe. "No one is listening, no one is doing anything."   Prime Minister Scott Morrison -- a staunch backer of Australia's vast coal industry -- has said little about the smoke since the crisis began, preferring to focus on fire-hit rural communities.   Organiser Chloe Rafferty said that had created anger at the conservative government's inaction.   "I think the wider public can see that we are not expecting the climate crisis in the future but we are facing the climate crisis now," she told AFP.   "People are experiencing it in their day-to-day lives."   As well as a rise in people visiting hospitals with smoke-related health symptoms, the number of emergency calls for ambulances spiked 30 percent last week.    "For most people, smoke causes mild symptoms like sore eyes, nose and throat," top health department official Richard Broome said.   "However, people with conditions like asthma, emphysema and angina are at greater risk because the smoke can trigger their symptoms."

Smoke from bushfires is one of the biggest contributors to air pollution in Australia, releasing fine particles that can lodge deep within people's lungs and cause "severe" health impacts over time, according to scientist Mick Meyer from government-funded scientific research agency CSIRO.   "The impact of smoke on people remote from the fires may, on occasion, substantially exceed the direct injury to people within the fire zone," he wrote in The Conversation.   "But we currently lack the operational tools to understand the extent of these impacts or to manage them."   Six people have been killed and more than 700 houses destroyed in bushfires this fire season.   Though the human toll has been far lower than the deadliest fire season in 2009 -- when almost 200 people died -- the scale of this year's devastation has been widely described as unprecedented.   Three million hectares (7.4 million acres) of land has been burnt -- the size of some small countries -- and vast swathes of koala habitat scorched.   Official data shows 2019 is on track to be one of the hottest and driest years on record in Australia.
Date: Tue 3 Dec 2019
Source: Trinidad Express [abridged, edited]

The number of local deaths from the influenza virus has risen to 24. At the Health Ministry's update last week, 16 fatalities were reported from the flu, with Health Minister Terrence Deyalsingh appealing to citizens -- especially those considered at-risk -- to get vaccinated.
Date: Sat 30 Nov 2019
Source: The New Indian Express, Express News Service [edited]

According to official data, 14 swine flu [influenza A/H1N1] deaths across the state were recorded this year [2019] till [17 Nov 2019]. The figure is slightly less than the previous year's [2018] toll of 17. The total number of H1N1 swine flu-positive cases [has] also come down this year [2019] compared with 2018 from 402 to 325. Health officials are setting up isolation wards in hospitals as a preventive measure.

As the winter season has set in and the minimum temperatures are coming down, health officials are instructing the public to take precautions in order to stay away from being infected by swine flu. The health department has initiated steps to set up district-[wide] swine flu testing facilities and isolation wards in every district hospital, area hospital, and community health centre.

As per the requirement of treatment procedure, the government has to set up special isolation wards in all government hospitals and provide protection kits to the healthcare staff, especially to those who will attend to the patients suffering from the flu. Across the state, Visakhapatnam registered the highest number of positive swine flu cases and deaths. Out of 325 positive cases, 180 alone were reported from Visakhapatnam, of which 8 died. West Godavari district registered 3 deaths, and Anantapur, East Godavari, and Srikakulam registered one death case each.

All the district health officials have been instructed to intensify awareness camps and screening centres. As part of the action plan, isolation wards with 5-10 beds are to be set up in every teaching, district, and area hospital. A sufficient stock of drugs, masks, and PPE [personal protective equipment] kits are to be made available. Currently, there are 18 labs eligible for conducting confirmation test in the state. "We are creating awareness by distributing pamphlets and putting up screening centres at bus stops and railway stations," DMHO [district medical and health officer] Dr. TSR Murthy said.

Symptoms of swine flu are generally similar to that of seasonal flu. These include cough, fever, sore throat, stuffiness, runny nose, body aches, headache, chills, fatigue, diarrhoea, and vomiting. Later on, breathlessness, chest pain, drowsiness, low blood pressure, sputum mixed with blood, and bluish discoloration of nails also develops.
Date: Thu 28 Nov 2019
Source: GDN Online [edited]

Two expatriates living in Oman died after contracting the seasonal influenza (H1N1) or swine flu in the governorate of Dhofar -- the 1st in July and the 2nd in August [2019]. They were among 78 confirmed cases of swine flu registered at the Sultan Qaboos Hospital over the first 9 months of 2019 in the governorate.

The hospital authorities reported a total of 599 registered suspected cases of H1N1 between January and last September [2019]. Doctors working at Sultan Qaboos Hospital dealt overall with 1779 cases of respiratory infections during the same period.

Patients most vulnerable to the respiratory viruses are those over 18 years, particularly pregnant women; those suffering from chronic illnesses, kidney and heart diseases, liver problems, diabetes, asthma, blood disorders, and HIV/AIDS; and even health workers, according to Muscat Daily.
Date: Wed 11 Dec 2019
Source: UNICEF/WHO Situation report 11 Dec 2019 [edited]

Highlights
- 5 new human cases reported in the past week
- In response to 1st human vaccine-derived poliovirus type 1 (VDPV1) case from the island province of Basilan, in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), outbreak immunization was conducted
in Maluso, Basilan, with bivalent oral polio vaccine (bOPV) against polio type 1, vaccinating 13 547 children under 10 years old (102% of the target).
- Currently 9 human cases confirmed with circulating VDPV type 2 (cVDPV2), 1 case with VDPV1, 1 case with cVDPV1, and 1 case with immunodeficiency-related VDPV type 2 (iVDPV2).
- A case with VDPV1 from Sultan Kudarat is pending genetic analysis; 1 case of cVDPV1 from Malaysia was confirmed as genetically linked to the Basilan case.
- Synchronized polio vaccination campaign conducted on [25 Nov 2019 - 10 Dec 2019] (including 2 days of extension) vaccinated 4 309 566 children under 5, which is 98% of the target total of 4.4 million children under 5. A total of 1 395 365 children under 5 were vaccinated in National Capital Region (NCR), which is 109% of the target, and 2 914 201 (94%) in Mindanao.
- DOH planning to conduct outbreak immunization with bOPV targeting 710,296 children under 10 in the Sulu Archipelago, Zamboanga City, and Lambayong, Sultan Kudarat, on [6-12 Jan 2020].
- Current polio outbreak resulting from persistently low routine immunization coverage, and poor sanitation and hygiene.
- Philippines is affected by both cVDPV1 and cVDPV2. cVDPV is considered a public health emergency of international concern (PHEIC).

cVDPV1
---------
- In response to the 1st human case confirmed with VDPV1 from Maluso, Basilan (BARMM), outbreak immunization was conducted in the area with bOPV for children under 10 years old, vaccinating 13,547 children under 10 years of age (102% of the target).
- A cVDPV1 case in Sabah state, Malaysia, was confirmed to be genetically linked to the Basilan case by the Victorian Infectious Diseases Reference Laboratory (VIDRL) in Australia. Since the 2 viruses are genetically linked, they are both classified as circulating.
- A new VDPV1 case from Sultan Kudarat (Region XII) was confirmed on [6 Dec 2019] and is pending further genetic analysis.
- All 13 cVDPV1 environmental samples found in Manila are genetically linked.

cVDPV2
---------
- All 9 human cases and 17 environmental samples confirmed with cVDPV2 are genetically linked. All human cases were reported from Mindanao (BARMM and Region XII), whereas environmental samples were found in NCR and Davao.
- All samples were tested by the National Polio Laboratory at the Research Institute for Tropical Medicine (RITM), whereas sequencing and genetic analysis is done at the NIID in Japan, and additional genetic characterization is provided by the United States Centers for Disease Control and Prevention (CDC).
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[Given the identification of the cVDPV1 case in Malaysia that is genetically related to the VDPV1 case in Basilan, it is now clear there are at least 2 separate cVDPV outbreaks in the Mindinao region of the Philippines: one of the outbreaks is associated with cVDPV2, and the other with cVDPV1 and one outbreak of cVDPV1 in the Manila Metropolitan area (although only environmental samples have been positive without AFP (acute flaccid paralysis) cases as yet.) What all these areas have in common is pockets of populations with suboptimal vaccination coverages. Clearly, we await further information on the genetic profiling of the newly identified VDPV1 case in Sultan Kudarat, also located in southern Philippines. Note that Basilan Island, Sultan Kudarat, and Sabah state in Malaysia, while all in the same general area, are not contiguous, each being on a different island. In. total, there are 11 cases of AFP in the Philippines that are attributable to infection with a VDPV.

A map showing the provinces in the Philippines can be found at

HealthMap/ProMED-mail map of the Philippines: