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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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Lithuania

Lithuania US Consular Information Sheet
May 19, 2008
COUNTRY DESCRIPTION:
Lithuania is a stable democracy undergoing rapid economic growth. Tourist facilities in Vilnius, the capital, and to a lesser extent in Kaunas and Klaipeda, are simi
ar to those available in other European cities. In other parts of the country, however, some of the goods and services taken for granted in other countries may not be available. Read the Department of State Background Notes on Lithuania for additional information.
ENTRY/EXIT REQUIREMENTS: A valid passport is required to enter Lithuania. As there are no direct flights from the U.S. to Lithuania, U.S. citizens should be aware of passport validity requirements in transit countries. American citizens do not need a visa to travel to Lithuania for business or pleasure for up to 90 days. That 90-day period begins with entry to any of the “Schengen Group” countries: Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, Spain, and Sweden. Multiple visits to Schengen countries may not exceed 90 days in any 6 month period. Travelers remaining in Lithuania for more than 90 days within any six-month period must apply for temporary residency.

Lithuanian authorities recommend applying or a residency permit through a Lithuanian embassy or consulate before initial entry into Lithuania, as processing times can run beyond 90 days. All foreigners of non-European Union countries seeking entry into Lithuania must carry proof of a medical insurance policy contracted for payment of all costs of hospitalization and medical treatment in Lithuania. Visitors unable to demonstrate sufficient proof of medical insurance must purchase short-term insurance at the border from a Lithuanian provider for roughly $1.00 per day. The number of days will be calculated from the day of entry until the date on the return ticket. Children residing in Lithuania must have written permission to travel outside the country from at least one parent if their parents are not accompanying them on their trip. This policy is not applicable to temporary visitors. See our Foreign Entry Requirements brochure for more information on Lithuania and other countries. Visit the Embassy of Lithuania web site at www.ltembassyus.org for the most current visa information.
Note: Although European Union regulations require that non-EU visitors obtain a stamp in their passport upon initial entry to a Schengen country, many borders are not staffed with officers carrying out this function. If an American citizen wishes to ensure that his or her entry is properly documented, it may be necessary to request a stamp at an official point of entry. Under local law, travelers without a stamp in their passport may be questioned and asked to document the length of their stay in Schengen countries at the time of departure or at any other point during their visit, and could face possible fines or other repercussions if unable to do so.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information abut customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY: Civil unrest is not a problem in Lithuania, and there have been no incidents of terrorism directed toward American interests. Incidents of anti-Americanism are rare.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, 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: Lithuania is a relatively safe country. Visitors should maintain the same personal security awareness that they would in any metropolitan U.S. city. Large amounts of cash and expensive jewelry should be secured in a hotel safe or left at home. Crimes against foreigners, while usually non-violent, do occur. Pickpocketing and thefts are problems, so personal belongings should be well protected at all times. Theft from cars and car thefts occur regularly. Drivers should be wary of persons indicating they should pull over or that something is wrong with their car. Often, a second car or person is following, and when the driver of the targeted car gets out to see if there is a problem the person who has been following will either steal the driver’s belongings from the vehicle or get in and drive off with the car. Drivers should never get out of the car to check for damage without first turning off the ignition and taking the keys. Valuables should not be left in plain sight in parked vehicles, as there have been increasing reports of car windows smashed and items stolen. If possible, American citizens should avoid walking alone at night. ATMs should be avoided after dark. In any public area, one should always be alert to being surrounded by two or more people at once. Additionally, criminals have a penchant for taking advantage of drunken pedestrians. Americans have reported being robbed and/or scammed while intoxicated.
Following a trend that has spread across Eastern and Central Europe, racially motivated verbal, and sometimes physical, harassment of foreigners of non-Caucasian ethnicity has been reported in major cities. Incidents of racially motivated attacks against American citizens have been reported in Klaipeda and Vilnius.
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 these serious problems 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 find an attorney if needed. For more information about assistance for victims of crime in Lithuania, please visit the Embassy’s web site at http://vilnius.usembassy.gov/service/crime-victim-assistance.html.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in Lithuania has improved in the last 15 years, but medical facilities do not always meet Western standards. There are a few private clinics with medical supplies and services that nearly equal Western European or U.S. standards. Most medical supplies are now widely available, including disposable needles, anesthetics, antibiotics and other pharmaceuticals. However, hospitals and clinics still suffer from a lack of equipment and resources. Lithuania has highly trained medical professionals, some of whom speak English, but their availability is decreasing as they leave for employment opportunities abroad. Depending on his or her condition, a patient may not receive an appointment with a specialist for several weeks. Western-quality dental care can be obtained in major cities. Elderly travelers who require medical care may face difficulties. Most pharmaceuticals sold in Lithuania are from Europe; travelers will not necessarily find the same brands that they use in the United States. Serious medical problems requiring hospitalization and/or medical evacuation can cost thousands of dollars or more. Doctors and hospitals often expect immediate cash payment for health services, particularly if immigration status in Lithuania is unclear.

Tick-borne encephalitis and lyme disease are widespread throughout the country. Those intending to visit parks or forested areas in Lithuania are urged to speak with their health care practitioners about immunization. Rabies is also increasingly prevalent in rural areas.
The Lithuanian Government does not require HIV testing for U.S. citizens. However, sexually transmitted diseases are a growing public health problem.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747); or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith.
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. All foreigners of non-European Union countries seeking entry into Lithuania must carry proof of a medical insurance policy contracted for payment of all costs of hospitalization and medical treatment in Lithuania (please see entry/exit requirements above). 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 Lithuania is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
The Police allow Americans to drive in Lithuania with an American driver’s license for up to 90 days. Americans who reside in Lithuania for 185 days or more in one calendar year and who wish to continue driving in Lithuania must acquire a Lithuanian driver's license. The foreign license must be given to the Lithuanian Road Police to be processed by the Consular Department of the Lithuanian Ministry of Foreign Affairs, which in turn sends it to the U.S. Embassy’s Consular Section, where the owner is expected to claim it.
Roads in Lithuania range from well-maintained two- to four-lane highways connecting major cities to small dirt roads traversing the countryside. Violation of traffic rules is common. It is not unusual to be overtaken by other automobiles, traveling at high speed, even in crowded urban areas. Driving at night, especially in the countryside, can be particularly hazardous. In summer, older seasonal vehicles and inexperienced drivers are extra hazards. Driving with caution is urged at all times. Driving while intoxicated is a very serious offense and carries heavy penalties. The speed limit is 50 km/hr in town and 90 km/hr out of town unless otherwise indicated. The phone number for roadside assistance is 8-800-01414 from a regular phone and 1414 from a GSM mobile phone.
Seatbelts are mandatory for the driver and all passengers except children under the age of 12. During the winter, most major roads are cleared of snow. Winter or all-season tires are required from November 10th through April 1st. Studded tires are not allowed from April 10th through October 31st. Drivers must have at least their low beam lights on at all times while driving. Public transportation is generally safe.
Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office and national authority responsible for road safety at www.tourism.lt and at www.lra.lt/index_en.html.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Lithuania, the U.S. Federal Aviation Administration (FAA) has not assessed Lithuania’s Civil Aviation Authority for compliance with International Civil Aviation Organization ICAO aviation safety standards. For more information, travelers may visit the FAA’s web site at www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: Lithuanian customs authorities may enforce strict regulations concerning the temporary importation into or export from Lithuania of items such as firearms and antiquities. Please see our Customs Information.
Telephone connections are generally good. American 1-800 numbers can be accessed from Lithuania but not on a toll-free basis; the international long distance rate per minute will be charged. Local Internet cafes offer computer access. ATMs are widely available. Most hotels and other businesses accept major credit cards.
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 Lithuanian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Lithuania are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or possessing or disseminating child pornography in a foreign country is a crime prosecutable in the United States. For more information about arrest procedures in Lithuania, please visit the Embassy’s web site at http://vilnius.usembassy.gov/arrests.html. Please see our information on Criminal Penalties.
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues web page.
REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Lithuania 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 Lithuania. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at Akmenu Gatve 6, tel. (370) (5) 266-5500 or 266-5600; fax (370) (5) 266-5590. Consular information can also be found on the Embassy Vilnius web site at http://vilnius.usembassy.gov/.
* * *
This replaces the Consular Information Sheet dated November 5, 2007 to update sections on Crime and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed 7 Aug 2019 01:17:58 EEST
Source: Xinhua News Agency [edited]

The rate of tick-borne encephalitis in Lithuania remains the highest in Europe, announced the country's Center for Communicable Diseases and AIDS (ULAC) on [Tue 6 Aug 2019].

According to ULAC, the rate of tick-borne encephalitis cases was 16.6 cases per 100 000 population in 2017, based on the latest data provided by the European Center for Disease Prevention and Control (ECDC) in its latest annual epidemiological report.  "In Lithuania the rate of encephalitis remains the highest in Europe," said ULAC.

Lithuania was followed by the Czech Republic and Estonia with the rate of 6.4 cases per 100 000 population, according to ULAC.  ULAC notes the largest proportion of tick-borne encephalitis cases is at the age group of 45-64 years and the lowest among the children of the age of 0-4 years.  "ULAC medics remind vaccination is the most reliable protection from tick-borne encephalitis," said ULAC in the announcement, noting vaccines have a reliability rate of 98 percent.

ULAC's warning comes amid increasing number of tick-borne encephalitis cases this year [2019] in Lithuania, a Baltic country with a population of around 3 million.  More than 90 cases of tick-borne encephalitis were reported during the 1st half of the year [2019] in Lithuania, 1/3 more compared to the same period last year [2018], according to local data by ULAC.

According to the ECDC's report, the highest prevalence of tick-borne encephalitis historically is found in the Baltic countries. Tick-borne encephalitis usually reaches its seasonal peak during the warmest months -- July and August.

Tick-borne encephalitis is a human viral infectious disease of central nervous system caused by infected ticks, usually found in woodland habitats. The disease manifests itself with symptoms similar to fever, fatigue, headache, nausea, and can cause meningitis.
=====================
[Cases of tick-borne encephalitis (TBE) have been reported before (see ProMED mail archive Tick-borne encephalitis - EU (Czech Rep., Latvia, Lithuania) http://promedmail.org/post/20040624.1677). Given the high rate of TBE cases in Lithuania reported above, there doubtless have been cases occurring there annually in recent years.

A report in Eurosurveillance Weekly in 2004 stated, "Tick-borne encephalitis (TBE) is endemic in virtually all countries in Central and Eastern Europe. It is caused by several closely related but distinct flaviviruses. 3 subtypes are recognised at present: a Far-Eastern subtype, a Siberian subtype and a European subtype. The Siberian subtype is associated with Russian spring-summer encephalitis and is transmitted predominantly by the tick _Ixodes persulcatus_, whereas the European subtype causes central European encephalitis and is transmitted by _Ixodes ricinus_.

The clinical spectrum of acute TBE ranges from symptoms of mild meningitis to severe meningoencephalitis with or without myelitis. The incubation period of central European TBE is 7-14 days. Onset is generally biphasic. The 1st phase involves a non-specific influenza-like illness with fever, headache, nausea, and vomiting, lasting about a week. After a period of remission lasting a few days, the fever returns with aseptic meningitis or encephalomyelitis. The case fatality rate is 1-5 percent and about 20 percent of survivors have neurological sequelae. Residual motor defects are rare." - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Lithuania:
Date: Wed, 3 Jul 2019 15:49:43 +0200

Vilnius, July 3, 2019 (AFP) - Lithuania declared an emergency on Wednesday as a severe drought hit the Baltic EU state, threatening to slash this year's harvest by up to half.   Apart from jeopardising crops, scant rainfall has also drastically reduced water levels in some rivers, threatening fish stocks and shipping activities.

The formal declaration of an "emergency situation" will allow the government to compensate farmers for some losses as well as help them to avoid EU financial sanctions should they fail to reach production goals.   "Farmers believe their harvest can be slashed by 40 percent or 50 percent, while fish stocks are also endangered," environment minister Kestutis Mazeika told AFP.

Mazeika said "nobody has any doubt" that global climate change is behind the prolonged and more intensive dry spells and heatwaves in recent years.   He also appealed to neighbouring Belarus to increase the water level in the Neris river by allowing more water to flow from its reservoirs.   Last month was the hottest June ever recorded with soaring temperatures worldwide capped off by a record-breaking heatwave across Western Europe, satellite data showed Tuesday.   Lithuania also registered its hottest-ever June, with a peak of 35.7 degrees Celsius (96.2 degrees Fahrenheit) recorded on June 12.

Over the last week, firefighters have fought wildfires triggered by the heat in peat bogs in western Lithuania and neighbouring Latvia.   Elsewhere in Central Europe, Polish authorities said this week that varying degrees of drought have put grain crops at risk in 14 of the EU country's 16 regional districts.   The Czech Academy of Sciences said it expects drought to affect the entire country, with 80 percent of the territory facing "exceptional to extreme drought".
Date: Thu, 13 Jun 2019 15:12:32 +0200

Vilnius, June 13, 2019 (AFP) - Lithuanian temperatures have hit record June highs, meteorologists said Thursday, as a heatwave forced school closures and threatened to reduce harvests in the draught-hit Baltic region.   Kaisiadorys in central Lithuania was the hottest place at 35.7 degrees Celsius (96.2 degrees Fahrenheit) on Wednesday, the highest-ever temperature recorded for June in the country, weather forecaster Paulius Starkus told AFP.   Six people drowned in the Baltic EU state on Wednesday, the deadliest day of the year to date, while some schools put classes on hold or cut lessons short due to the heatwave.

Scientists say the extreme weather is in part a result of climate change.   "Lithuania used to have heatwaves but now they occur more often and are more intense due to climate change," Vilnius University climatologist Donatas Valiukas told AFP.   Starkus said a downpour with thunder and hail could follow in some areas on Thursday afternoon.   Agriculture Minister Giedrius Surplys told lawmakers that some areas were experiencing "a real climatic draught" threatening harvests, while hydrologists warned that river water levels posed a threat to fish.   Demand for air-conditioning has also soared in recent weeks.   Lithuania's hot weather is expected to last through the week, then temperatures may ease below 30 degrees Celsius starting Monday.   Fellow Baltic state Latvia is also experiencing unusual heat for June, with temperatures over 32 degrees Celsius.

In recent days, Latvia's western region of Kurzeme saw thunderstorms with hail damaging buildings, smashing greenhouses and tearing power lines.   Two people have been hospitalised in the northern Latvian town of Cesis after a tree fell on their camper van while they were inside.    Fellow Baltic state Estonia had a heatwave last week and is now experiencing rainy and windy weather.   Poland has also been experiencing high temperatures this month, which has resulted in increased air-conditioner use. The power transmission system operator PSE said that on Wednesday there was record electricity demand for a summer morning at nearly 24.10 gigawatts (GW).   Forty-two people have already drowned in Poland this month, according to the government security centre RCB.
Date: Sat 30 Mar 2019
Source: PM News Nigeria [abridged, edited]

Measles in Lithuania is up to 310 cases this year [2019] compared to 30 cases for 2018 in total. The number of measles cases is projected to increase further in Lithuania, as people have lost their collective immunity to this highly contagious viral disease, Director of Lithuania's Centre for Communicable Diseases and AIDS (ULAC), Saulius Caplinskas, said on Fri [29 Mar 2019].  "The collective immunity has been lost, as a 95 per cent measles vaccination coverage rate is considered as minimum to prevent an outbreak. There are new suspected cases of measles; blood samples are being examined. I have no doubt that in the nearest future, there will be new cases,'' Caplinskas was quoted as saying by local news website lrt.lt.

Recent data from ULAC shows that the proportion of children vaccinated against measles in the country has decreased from 97 per cent in 2009 to 92.2 per cent in 2018 due to parents' reluctance to vaccinate their kids.  According to ULAC, every year, some 5000 children are not vaccinated in Lithuania. "Measles outbreaks feature certain upswings and descents, yet we will have to live under the threat of measles for a while,'' Caplinskas said.

In total, 310 cases of measles have been registered as of Fri [29 Mar 2019] in Lithuania this year [2019], compared to 30 cases for the whole of 2018, ULAC data showed.  The largest number of cases, 149, was registered in Kaunas, Lithuania's 2nd largest city. In Vilnius, the capital, 39 measles cases have been registered to date. Measles is a highly contagious, serious disease caused by a virus, says the World Health Organization.
Date: Thu, 11 Oct 2018 13:38:41 +0200

Vilnius, Oct 11, 2018 (AFP) - Lithuania's parliament on Thursday passed a law that will allow doctors to prescribe marijuana-based medicine in the Baltic EU state.   The lawmakers voted 90-0 with three abstentions in favour of the legislation that will now go to President Dalia Grybauskaite to be signed into law.   "It is a historic decision to ensure that patients can receive the best possible treatment," said lawmaker Mykolas Majauskas who tabled the bill.

Other European countries have legalised cannabis for medical purposes including Austria, Britain, Croatia, Finland, France, Germany, Greece and Italy among them.   "Of course, it does not mean cannabis will be available to get at a drugstore to smoke before going to a nightclub," Majauskas said.   The law will come into force in May next year. Selling the drugs will require a licence from the state regulator.    Recreational use of marijuana remains illegal in Lithuania, a Baltic state of 2.8 million people.
More ...

Australia

Travelling to Australia
===========================
Introduction
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Travelling to Australia for business or pleasure can be a most memorable experience and each year many Europeans travel this
route to experience something of life ‘down-under’. Staying healthy and well is essential if you want to enjoy your trip to its fullest extent. Australia is a huge continent and the climatic conditions vary considerably throughout. The main southern cities have a temperate climate similar to North West Europe, Perth enjoys a Mediterranean climate while Queensland and the Northern Territories have a sub-tropical weather pattern.
Preparation
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It is important that all travellers are in good general health before undertaking any long-haul trip. Patients who tire easily on light exercise or who have a significant underlying medical condition will need to take extra care. If you are concerned about this aspect of your proposed trip arrange for a meeting with a doctor at an early stage in your preparations.
Long Haul Flights
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On these long flights you will be travelling across many time zones. You will lose or gain hours depending on the direction of your flight. Your body will take time to adjust to the new time zone and so it is important to allow this to occur naturally. If you arrive during the daylight hours try to stay out in the sun for a period of time as this will help your body release a hormone which counteracts jet lag. (Watch you don’t get sun burnt!) Don’t plan to be too energetic during the first day or two after you arrive. Be sensible. If this is a business trip try not to make any major decisions over the first 24 hours. Even the relatively short flight from South East Asia down to Australia crosses time zones and again it will be important to allow your body to settle.
Stop-Overs in SE Asia
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Frequently travellers will stop-over in Singapore, Bali, Hong Kong or Bangkok on their way to or from Australia. During these short stops it is essential that travellers take all possible precautions to ensure that they rest and are careful about what they eat or drink as contaminated food or water is more common in some of these regions.

Mosquito protection in SE Asia
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Mosquito borne diseases are present depending on the location (Malaria, Dengue Fever, Japanese B Encephalitis etc) One of particular concern is Dengue Fever, which is a viral disease transmitted by the bite of an infected mosquito. These mosquitoes tend to bite during the day time. This is in contrast to the mosquitoes which transmit malaria which mainly bite at night. Many of the main tourist destinations throughout SE Asia are malaria free and so tablets to protect against the disease are not usually required. Those going off the usual routes will need to talk this through in depth before leaving.
Road Traffic Accidents
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Frequently, cars are purchased by tourists to Australia for the duration of their stay. Often the cost is low and the maintenance and safety of the vehicle may be somewhat questionable! Long monotonous driving associated with a lack of concentration can cause serious accidents. Car breakdown in the middle of ‘nowhere’ may lead to the risk of dehydration and potential animal attack (kangaroo, dingos, snakes etc). Make sure you always have sufficient food and water and some means of communication (fully charged mobile phone) before leaving to travel across the continent. Make sure other responsible friends or relations back home know of your intended route and inform them of any changes. Get contact numbers for essential services for your journey.

Health Concerns in Australia
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Many travellers feel that Australia is the same as at home in Europe and so little care with personal health needs be taken. This is not always the case as there are many local health variations throughout the country which should be considered.
Sun Exposure
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The northern European skin is usually unaccustomed to intensity of the sun exposure experienced in many parts of Australia. Unfortunately this regularly leads to sun burn among tourists but, more seriously, it also significantly increases the risk of potentially fatal skin cancers. Always use plenty of adequate sun block, cover exposed areas of your body where possible (especially by wearing a wide brimmed hat) and drink plenty of water. (You may also need to replace salt lost through increased perspiration ~ assuming no underlying blood pressure problem)
Northern Australia
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As mentioned previously, the northern parts of Australia are sub-tropical and mosquito borne diseases are more common. Malaria transmission does not occur and many of the diseases transmitted by mosquitoes or other insects cause mild discomfort. Unfortunately some are which are much more severe and can cause long term difficulties.
Ross River Fever
This viral disease is transmitted by mosquitoes and causes a severe arthritic type condition. The disease is often short lived but in some patients the disease may continue to cause arthritis for months and even years. There is no specific treatment and travellers need to be careful about avoiding bites.
Typhus
This disease occurs in isolated parts of Northern Australia through the bite of infected ticks. The disease can cause a skin rash, fever and general unwellness. Antibiotics can help to ease the symptoms but avoiding bites is essential at all times.
Dengue
This mosquito borne disease also occurs in parts of Northern Australia usually by day-biting mosquitoes. (See Dengue leaflet - TMB)
Other Risks
********************************************
The sea waters in parts of Australia are infested by sharks and jelly fish. Always take competent local advice before undertaking any sea activities. Drowning occurs regularly each year among tourists who disregard some of the basic rules of water safety. If in desert regions, take care with disturbing rocks in case you awaken a peaceful snake or scorpion.
Medical Care for Travellers
********************************************
If travellers have stopped in South East Asia and then become ill on arrival in Australia, they should make contact with a medical centre dealing with Tropical Medicine. Details of the centres in the major cities throughout Australia are available from the Tropical Medical Bureau.
Vaccinations for Stop-Overs
********************************************
Usually travellers will have vaccination cover for Typhoid, Poliomyelitis, Tetanus and Hepatitis A. Malaria prophylaxis may not be required depending on your actual itinerary. There is a higher risk of Hepatitis B in central Australia and so this may need to be considered if the risk of contact (mainly blood following accidents) is thought to be higher than usual. Rabies risk in Australia is almost non existent though obviously contact with all warm blooded animals should be avoided at all times.

Travel News Headlines WORLD NEWS

Date: Thu, 21 Nov 2019 01:25:15 +0100 (MET)

Sydney, Nov 21, 2019 (AFP) - The fire danger was elevated across wider swathes of southern Australia on Thursday, with residents warned to avoid at-risk areas as smoke from bushfires choked Sydney and other major cities.   Devastating fires along the country's east coast have claimed six lives and destroyed more than 500 homes since mid-October, with climate change and unseasonably hot, dry conditions fuelling the unprecedented blazes.   Now the fire danger has moved into states further south, with a so-called "Code Red" -- the highest possible fire risk in Victoria -- being declared in the state's northwest for the first time in a decade.   "What that means is that if we see fires in those areas they will be fast moving, they will be unpredictable, they will be uncontrollable," emergency management commissioner Andrew Crisp told reporters.

Country Fire Authority chief Steve Warrington told people living in rural areas to leave for the safety of cities.   "We are saying, 'do not be there, do not be there when a fire occurs, because you will not survive if you are there'," he said.   "There is a good chance if a fire occurs that your home will be destroyed."   The fire danger was also elevated to "severe" in the island state of Tasmania off mainland Australia's southeastern coast,  where a total fire ban was declared.   Two bushfires in the state's northeast did not pose an immediate threat to residents, the Tasmania Fire Service said.

For the second time in two days, smoke from bushfires blanketed Sydney, Australia's biggest city and home to more than five million people, sending air quality plummeting to hazardous levels.   More than 110 fires are still burning in worst-hit New South Wales and neighbouring Queensland, while in South Australia more than 40 fires broke out during catastrophic fire conditions Wednesday.    A South Australia Country Fire Service spokeswoman said all of those blazes had been brought under control or extinguished by Thursday, with the exception of a major fire on the Yorke Peninsula that had come perilously close to a small town.

Conditions were expected to ease in the coming days in South Australia, where the state capital Adelaide was also shrouded in bushfire smoke and residents were being told to stay indoors for health reasons.   Bushfire-prone Australia has experienced a horror start to its fire season, which scientists say is beginning earlier and becoming more extreme as climate change pushes temperatures higher and saps moisture from the environment after months of severe drought.   Growing calls to curb fossil fuels and drastically cut greenhouse gas emissions are being ignored by the country's conservative government, which is eager to protect its lucrative mining industry.   The country is bracing for challenging fire conditions to continue throughout the Southern Hemisphere summer.
Date: Tue, 12 Nov 2019 13:10:01 +0100 (MET)
By Holly ROBERTSON, Andrew BEATTY, with Daniel De Cartert in Hillville

Sydney, Nov 12, 2019 (AFP) - Bushfires raging across eastern Australia singed Sydney's suburbs on Tuesday, with firefighters scrambling planes and helicopters to douse a built-up neighbourhood with water and red retardant.   Experts have described the conditions as the worst on record, as spring temperatures climbed toward 40 degrees Celsius (104 Fahrenheit) and winds topped 80 kilometres (50 miles) per hour across a zone which has been plagued by persistent drought.   Although the bushfire season is in its infancy, scientists predict it to be one of Australia's toughest ever, with climate change and unfavourable weather cycles helping created a tinderbox of strong winds, low humidity and high temperatures.

Twin blazes in the north shore suburb of Turramurra -- around 15 kilometres (nine miles) from the centre of Australia's largest city -- tore through a eucalypt forest park and sparked spot fires in homes, before eventually being brought under control.   As night fell, authorities said they were bringing another "clearly suspicious" blaze in a national park in the city's southern suburbs under control.    Throughout the day, more than 300 bushfires burned up and down Australia's east coast, fanned by gale-force winds, scorching temperatures and tinder-dry bushland that has brought some of the most dangerous conditions the country has seen.

In Turramurra, gardens smouldered, thick smoke hung heavy in the air and cars, houses and roads were caked in raspberry-red retardant as if hit by a giant paintball.   "It was the embers that floated up that actually went across and set off spot fires in the front yards" resident Nigel Lush told AFP, adding that one roof had been set alight.   Another resident, Julia Gretton-Roberts, said the blaze spread shockingly quickly.   "Next thing I know the fire was opposite our house and it was massive and the police came and grabbed our kids and took them away," she said.   "My daughter is pretty freaked out."   Firefighter Andrew Connon told AFP "a number of homes were threatened but it was contained by the aerial bombing".

- 'Catastrophic conditions' -
From early morning thousands of firefighters spread out across New South Wales in anticipation of what they called "off the scale" fire risk and "catastrophic" conditions.   They were unable to prevent several bushfires from breaching containment lines and trapping residents who had not already evacuated.   New South Wales Rural Fire Service Commissioner Shane Fitzsimmons said so far only a dozen buildings had been damaged Tuesday and a handful non-life-threatening injuries were reported, but the crisis was far from over.

Firefighters will be "working on these fires for days and weeks given the enormity of the firegrounds," he said.    Even before unfavourable weather hit, days of fires had killed three people and destroyed at least 150 homes.   "The conditions are expected to get worse," Fitzsimmons said, warning residents in adjacent areas to stay alert.   "Complacency kills," he added.   Up to 600 schools were closed, as well as many national parks, a total fire ban was introduced for the affected area and Rally Australia -- due to be held in Coffs Harbour at the weekend -- was cancelled.   The military pitched in, helping firefighters with logistics and water-dropping sorties using more than 100 aircraft.

- 'We'll fight it first' -
In the town of Hillville a fire that has ripped through an area the size of 25,000 soccer fields approached the home of Daniel Stevens.   Like many, his family -- including his mother nursing a broken leg -- have packed their bags, but have resisted leaving their house and everything they own.    "We'll fight it first," he told AFP, "but if it jumps the fence line into the paddock, we'll go."

In the nearby town of Taree, dozens of people have already moved to a showground that has become a makeshift evacuation centre.   Fifty-nine-year-old Caroline Watson arrived last night with her husband and their dog.    "The fires are just rife. They are absolutely everywhere" she told AFP. "They didn't ask us to get out, but we figured it was coming."

Further south in the Blue Mountains on the outskirts of Sydney, veteran Winmalee firefighter Alan Gardiner said locals were "terrified and on edge".    The town still bears the scars of a 2013 blaze that destroyed 200 homes, and residents are acutely aware that with few roads in and out of the mountains, a decision to leave late can be fatal.   Efforts to burn fuel in a controlled way have been limited by months of drought-like conditions that made it too dangerous.
Date: Thu 31 Oct 2019
Source: Food Safety News [edited[

The number of people ill in a salmonellosis outbreak linked to a brand of frozen microwave meals in Australia has jumped to 46. Public health investigations have found that sick people in New South Wales (NSW), Queensland, South Australia, Western Australia and the Australian Capital Territory (ACT) reported consuming the products.

15 _Salmonella [enterica_ serotype] Weltevreden infections have been recorded in NSW, 12 in Queensland, 11 in South Australia, 6 in Western Australia and 2 in ACT. Previously, 15 people were part of the outbreak from NSW, South Australia and ACT. The cause of contamination is still under investigation. Core Powerfoods is assisting authorities in an investigation to confirm the source of the outbreak and has temporarily halted production.

Salmonella will not grow in frozen meals, but it may survive the freezing temperature. If food is thawed incorrectly, such as at room temperature, it will have an opportunity to grow, and if it is not reheated to above 75 degrees C (167 degrees F), it will not be killed, according to Food Standards Australia New Zealand.

Core Ingredients had recalled 8 frozen pre-prepared meals with best before dates from [26 Aug 2020], to [4 Oct 2020]. This has now been extended to include earlier best before dates beginning [5 Mar 2020]. Items were sold at IGA's and Coles nationally, independent retailers in NSW, ACT, Queensland, Victoria, South Australia, NT and Western Australia, and a few Woolworths metro stores in Victoria.

Core Powerfoods frozen meals in a 310 or 350-gram pack size of the variety Going Nuts, Deep South Chilli, Muay Thai Meatballs, Holy Meatballs, Naked Chicken, Seismic Chicken, Old School and Smokey Mountain Meatballs are affected.

NSW Health reiterated a warning for consumers to return or dispose of Core Powerfoods frozen microwave meals. Keira Glasgow, NSW Health Enteric and Zoonotic Diseases Manager, advised consumers not to eat the products, and either throw them away or return items to the place of purchase for a refund as proof of purchase is not required for recalled food.

Glasgow said frozen food should always be cooked thoroughly following manufacturer instructions. "Microwaves are a quick and convenient way to cook food, however, if they are not used correctly, they can cook food unevenly. When using a microwave to cook food, make sure the food is heated until it is piping hot all the way through." [byline: Joe Whitworth]
===================
[Care must be taken in the cooking of microwavable meals as many times cooking is needed, not just defrosting, and the heat in a microwave is characteristic not uniform. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Thu, 31 Oct 2019 04:23:06 +0100 (MET)

Sydney, Oct 31, 2019 (AFP) - Sydney residents coughed and spluttered their way around Australia's largest metropolis Thursday, as a bank of smoke from rural bushfires enveloped the city, prompting health warnings.   Smoke from out-of-control fires to the north of the city prompted health authorities to warn Sydneysiders with respiratory problems to avoid outdoor physical activity.   "If you really want to keep out of the smoke, the best thing you can do is stay indoors, keep your doors and windows shut," said Richard Broome of the New South Wales ministry of health.   Firefighters are struggling to contain dozens of blazes, including one caused by a lightning strike far north of the city that has ravaged an area of over 2,000 hectares (4,942 acres).

Strong winds have pushed the fumes toward Sydney, shrouding landmark buildings like the Opera House and Harbour Bridge and lacing the air with an acrid taste.   "The smoke will likely persist for several days and may not clear until some stage over the weekend," said New South Wales Rural Fire Service said Thursday.   In contrast to many of Asia's major cities, Sydney's residents and visitors usually enjoy the city's beaches and woodland under crystalline skies and pleasant sea breezes.   Authorities on Thursday rated the air quality as "hazardous", with a higher concentration of particles per million than cities like Bangkok, Jakarta or Hong Kong Kong.
Date: Wed, 30 Oct 2019 06:54:41 +0100 (MET)

Sydney, Oct 30, 2019 (AFP) - Tourism operators want aerial shark patrols to be introduced in Australia's Whitsunday Islands as they try to stem falling visitor numbers following a spate of attacks along the Great Barrier Reef.    An English tourist is recovering in hospital after his foot was ripped off by a shark on Tuesday while another had his leg mauled in the same attack at a popular snorkelling spot in the region.   In the past year there have been several shark attacks in waters around the Whitsundays, a chain of islands that attracts both Australian and foreign tourists.   In two separate incidents late last year, a 12-year-old girl lost a leg and a man died of his injuries.

Tourism Whitsundays CEO Tash Wheeler said tourist numbers had fallen in the past year, partly as a result of the shark attacks.   "Looking back over the last 12 months I can certainly say that there has been some impact to our industry in terms of visitation," she told reporters.   International visitors to the region dropped more than six percent to 226,000 in the year ending March 2019, the latest available figures.   Wheeler said tourism operators were seeking government funding fo aerial patrols of the Whitsundays as an "interim measure" while research is undertaken into sharks in the area, which had been considered safe for swimming.

The latest attack comes just over a month after the Queensland state government removed dozens of unmanned shark traps, known as "drum lines", from popular swimming beaches after losing a court battle over its decades-old shark control program.    The Federal Court ruled that sharks found alive on baits in the Great Barrier Reef Marine Park had to be released -- which the government argued would be too dangerous for its workers to do.   After Tuesday's attack, the Queensland government announced it would install 32 additional drum lines just outside the protected area.

The Humane Society International, which launched the court action, denied the most recent attack was linked to the rolling back of "outdated" shark control practices.    "Installing more traditional drum lines to cull sharks is an ineffective knee jerk reaction. It doesn't work," marine campaigner Lawrence Chlebeck said in a statement.   Despite tens of millions of visits to the beach in Australia annually, shark attacks remain rare.   There were 27 attacks in the country's waters in 2018, according to data compiled by Sydney's Taronga Zoo.
More ...

Malaysia

General
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Malaysia consists of two separate components; peninsular Malaysia (which is situated between Thailand and Singapore) and Borneo (which has the states of Sabah and Sarawak.) The total population is o
er 20 million and it has a very diverse cosmopolitan culture. Bahasa Malaysia is the official language though English is very widely spoken. The entire country has an equatorial climate with rainfall throughout most of the year. However there are two distinct rainy seasons – March to May and September to November. The costal regions may also experience monsoon conditions. Info: http://www.visitmalaysia.com
Safety & Security
**************************************
Violent crime against tourists is rare though petty incidents like bag snatching, burglaries and car break-in crimes are increasing. It is wise to take special care of your personal belongings when walking through some of the crowded market places or along the curb. Credit card fraud is becoming a serious problem so don’t let your card out of your sight at any time. Travelling out from the main tourist destinations on Borneo may lead to a higher risk of personal danger. Kidnapping from Pandanan Island and Sipadan (both diving resorts) show how there is a need for increased vigilance when visiting parts of coastal Sabah near to the islands. Drug offences of any kind are treated very seriously in Malaysia and may result in disruption of travel plans or imprisonment. Never carry drugs for another individual unless you are certain that there is no risk involved whatsoever.
Climate
**************************************
All over Malaysia the climate tends to be very humid though this can vary from location to location and throughout the year. Being so close to the equator, the sun is strong and proper care against sun burn must be constantly taken. Dehydration and loss of salt through perspiration are two other common problems for the unprepared traveller. Drink plenty of fluids and replace your salt loss. Make sure you pack clothing suitable for a warm humid climate.
Long Haul Flight & Jet Lag
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On the plane make sure you exercise your calf muscles and drink plenty of fluids. Female travellers on the contraceptive pill should be aware of the higher risk of venous clotting. After your long haul flight it is essential to allow your body catch up and so try to ensure that you have sufficient time to rest on the first day after arrival. (Make sure you don’t fall asleep beside the pool after arrival and then awaken with sunburn.)
Food & Water
**************************************
Generally the level of food hygiene throughout the country is high. Nevertheless avoidance of bivalve shellfish meals is a wise precaution. Food from street vendors should also be treated with suspicion though unpeeled fresh fruit or various well-cooked foods should be fine. Adding ice to your drinks is probably unnecessary and potentially harmful and should be avoided. The menus will usually be in English so that should make meal selection somewhat easier!
Mosquitoes
**************************************
Due to the constant humid climate mosquitoes tend to be present throughout the year. In Malaysia there are a number of diseases transmitted by mosquitoes and so care to avoid their bite is to be encouraged at all times. The three most significant diseases transmitted by mosquitoes are Malaria, Dengue Fever and Japanese B Encephalitis. In the case of Dengue Fever the mosquito responsible tends to prefer to live in the towns and cities throughout both Borneo and Peninsular Malaysia. This mosquito usually bites during the day-light hours. The transmission of Japanese B is usually in the rural regions of the country seldom visited by tourists. Most cases occur in Sarawak. Both of these viral diseases can be very serious and even life threatening and so avoidance of mosquito bites is essential.
Malaria Risk
**************************************
The risk of malaria for most tourists visiting Peninsular Malaysia is extremely small. There is insignificant risk in Kuala Lumpur, Penang etc and so many tourists opt not to use prophylaxis. However in Sarawak and Sabah the risk of malaria is present throughout the year. Even in these regions the risk is mainly off the coastal plains and towards the border areas. Generally prophylaxis is recommended for those visiting Sabah or Sarawak.
Water Sports in Malaysia
**************************************
Many tourists will undertake some water sports while in Malaysia and so make sure your insurance policy will cover this eventuality. Before you agree a contract with a provider check that their equipment appears to be well maintained and that they have good safety instructions. If you are unsure do not take part. Never swim alone or after a heavy meal (or excess alcohol intake) and always listen to local advice regarding sea currents etc.
Vaccinations for Malaysia
**************************************
Travelling directly from Ireland there are no vaccines which are essential for entry into Malaysia. However for most tourists the following vaccines are recommended for personal protection.
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food & water borne disease)
*
Hepatitis A (food & water borne disease)
For those undertaking a more adventurous trip further vaccines may need to be considered such as Hepatitis B, Rabies, Japanese B Encephalitis and Meningitis. The need for Malaria prophylaxis will depend on your proposed itinerary.
Summary:
**************************************
Malaysia is becoming a more common destination for holidays and also as a stop-off for those travelling on to Australia. With commonsense and care you should be able to have a very enjoyable safe time. If you do develop any unusual health problem after your trip (skin rash, bowel disturbance, influenza symptoms etc) make sure you attend for urgent medical attention.

Travel News Headlines WORLD NEWS

Date: Thu 3 Oct 2019
Source: European Centre for Disease Prevention and Control (ECDC) News & events [edited]

[Authorities in] Denmark has reported a travel-related case of malaria caused by _Plasmodium cynomolgi_ in a Danish traveller returning from a visit to forested areas in peninsular Malaysia and Thailand during August-September 2018.

_P. cynomolgi_ is a parasite causing disease among macaque monkeys across Southeast Asia but rarely infects humans.

The traveller was admitted to hospital with the suspicion of malaria. Routine initial tests for malaria (rapid diagnostic test and microscopy) and more in-depth tests (malaria-specific loop-mediated isothermal amplification test and Sanger sequencing) were required to diagnose malaria caused by _P. cynomolgi_. After receiving treatment, symptoms resolved on the 2nd day and the patient recovered fully.

ECDC wants to raise awareness about the possibility of more human cases due to the presence of _P. cynomolgi_ in macaques across Southeast Asia and the volume of tourists visiting these areas, including national parks. Since the diagnosis is challenging, advanced detection and identification techniques should be performed when all other tests show negative results.

Travellers to the region are advised to apply preventive measures against malaria such as taking chemoprophylaxis and using mosquito nets and insect repellents, wearing long sleeved shirts and trousers, and sleeping in air-conditioned rooms.
=====================
[It is well known that _P. cynomolgi_ can be transmitted from monkeys to humans just as it is seen for _P. knowlesi_ (Eyles DE, Coatney GR, Getz ME. _Vivax_-type malaria parasite of macaques transmissible to man. Science. 1960; 131: 1812-3; Coatney GR et al. Transmission of the M strain of _Plasmodium cynomolgi_ to man. Am J Trop Med Hyg. 1961; 10: 673-8). Thus, it is not surprising that _P. cynomolgi_ is seen in humans visiting areas where the simian host is abundant and the _Anopheles_ vectors are present, as is the case for _P. knowlesi_. As far as we know, neither _P. cynomolgi_ nor _P. knowlesi_ can be transmitted between humans. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps:
Date: Tue, 17 Sep 2019 15:38:37 +0200 (METDST)

Jakarta, Sept 17, 2019 (AFP) - Massive forest fires in Indonesia that have caused a toxic haze to spread as far as Singapore and peninsular Malaysia are also seriously affecting endangered orangutans and their habitat, a rescue foundation said Tuesday.   Jakarta has deployed thousands of troops as temporary fireman and deployed dozens of water-bombing aircraft to battle blazes that are turning pristine forest into charred landscape in Sumatra and Borneo islands.   The fires -- usually started by illegal burning to clear land for farming -- have unleashed a choking haze across parts of southeast Asia.

The Borneo Orangutan Survival Foundation said Tuesday that the haze was affecting hundreds of great apes in its care at rescue centres and wildlife re-introduction shelters.   "The thick smoke does not only endanger the health of our staff... but also it affects the 355 orangutans we currently care for", the foundation said in a statement, referring to just once cetre in Kalimantan   "As many as 37 young orangutans are suspected to have contracted a mild respiratory infection," it added.   Conditions were so bad at their Samboja Lestari facility in East Kalimantan that outdoor activities for the animals had been restricted to a few hours a day.

Orangutans have been particularly vulnerable to commercial land clearances and have seen their natural habitat shrink dramatically in the last few decades.   The population of orangutan in Borneo has plummeted from about 288,500 in 1973 to about 100,000 today, according to the International Union for Conservation of Nature.   The toxic smoke caused by the forest fires is an annual problem for Indonesia and its neighbours, but has been worsened this year by particularly dry weather.   On Borneo island, which Indonesia shares with Malaysia and Brunei, pollution levels were "hazardous", according to environment ministry data.   Hundreds of schools across Indonesia and Malaysia were shut.
Date: Mon, 9 Sep 2019 11:49:46 +0200 (METDST)

Kuala Lumpur, Sept 9, 2019 (AFP) - Malaysia prepared to seed clouds after air quality in parts of the country reached unhealthy levels due to smog from forest fires in neighbouring Indonesia, an official said Monday.   Smog regularly blankets parts of Southeast Asia during the dry season when burning is used to clear Indonesian land for palm oil, paper plantations and other crops, sparking ire from regional neighbours.   In the latest outbreak, parts of Malaysia's eastern state of Sarawak on Borneo island have been blanketed over the past few days.

The pollutant index in some places has reached "very unhealthy levels", said Gary Theseira, special functions officer with the environment ministry.   "It is extremely severe in Kuching," Theseira told AFP, referring to a city of half a million people.   He said Malaysia is prepared to carry out cloud seeding to induce rain in an effort to ease the smog.   "The moment the cloud situation is right, the chemicals will be loaded and the aircraft will take off and proceed with the seeding," he said.

Some countries conduct seeding during prolonged dry spells to induce rain and clear the air by releasing certain chemicals into the clouds, although some experts have questioned its efficacy.   Boo Siang Voon, a 47 year-old engineer in Kuching described the skies as "hazy, hot with smoky smell".   "This year the smog is getting worse. Residents are using face masks. We should not pay the price of our health for the open burning. We want a solution," he told AFP.   The Malaysian capital Kuala Lumpur and neighbouring Singapore were also experiencing hazy conditions on Monday, with the air laced with the smell of burning foliage, although the pollutant index remained at moderate levels.   Some Kuala Lumpur residents complained about eye and throat irritation.

Malaysia's meteorological department Sunday warned that hot conditions will prevail for another week, and the monsoon season is only expected to arrive at the end of September or early October.   The ministry of science, technology and innovation on Friday said it would lodge a complaint with Indonesia for the haze and called for quick action to be taken to put out the fires.   Indonesian authorities have deployed thousands of extra personnel since last month to prevent a repeat of the 2015 fires, which were the worst for two decades and choked the region in haze for weeks.   Under pressure from neighbours, Indonesian leader Joko Widodo last month warned that officials would be sacked if they failed to stamp out forest fires.
Date: Tue 16 Jul 2019 3:34 PM MYT
Source: The Star [abridged, edited]

The Japanese encephalitis (JE) virus has been detected in Tambunan [Sabah], about 100 km (62 mi) from [the state capital, Kota Kinabalu], says the state agriculture and food industries minister Datuk Junz Wong on [Tue 16 Jul 2019]. He said Health Department officials in Sabah had detected the virus in a pig farm in Kampung Lubang, Tambunan on [11 Jul 2019].

On being informed, the Department of Veterinary Services started inspection at all 7 pig farms within the vicinity. "My officers are still on the ground and taking samples from the pigs in the area."

Wong's confirmation came after an internal memo from the Veterinary Department informing the department that health officials had found a [presumably human] case of JE in Tambunan.

There is no cure for JE, but vaccinations [for people] are encouraged by health officials as they provide a form of protection. JE is a type of viral brain infection that can affect both humans and animals. It can be passed on to humans by infected animals through the bite of an infected culex mosquito.

An infected person develops inflammation of the brain (encephalitis) and suffers symptoms such as sudden onset of headache, high fever, neck stiffness, convulsions and muscle weakness, and might even fall into a coma.

Last month [June 2019], the Sarawak Health Department urged public to be cautious after confirming 5 JE cases in the state.  [byline: Muguntan Vanar]
===================
[JE virus is endemic in Malaysia's Borneo, including Sabah and its neighbouring state, Sarawak. Pigs are susceptible to JE virus infection, develop high viremias that serve as infectious blood meals for culex vector mosquitoes. The report above does not indicate which tests were done to determine JE virus infection in the pigs, whether by virus isolation, PCR demonstration of JE virus genomic segments or development of antibodies. Pregnant sows may have transplacental infection of their foetal piglets with teratogenic effects. Piglets and very young pigs may develop encephalitis when infected by JE virus. Infected adult male pigs may develop orchitis with a loss of libido and reduced fertility. Since pigs are JE virus amplifying hosts, people in the areas where pigs are infected should be especially careful to avoid mosquito bites. Vaccination may be the best measure for avoiding JE. - ProMED Mod.TY]

[Maps of Malaysia:
Date: Mon 15 Jul 2019
Source: Outbreak News Today [edited]

Health officials in Malaysia are investigating a malaria cluster in Kuala Lipis, Pahang state. On [Thu 11 Jul 2019], 4 confirmed cases of malaria were reported to Kuala Lipis District Health Office (PKD) from Betau Health Clinic. All cases involve Orang Asli children aged 4-10 from 2 villages, 2 cases [each] from Kampung Pagar and Kampung Serdang. All cases have been taken to the Kuala Lipis Hospital ward and given treatment.

Kuala Lipis has not reported a malaria case for the past 8 years; the last case was reported in 2011.

The Pahang State Health Department has activated the epidemic room on [12 Jul 2019] and control activities and case detection (active case detection) conducted by Kuala Lipis PKD Team in Kampung Pagar and Kampung Serdang. A total of 393 blood slides have been taken from residents in both villages for microscopic testing. [Based on] initial examination of the slides, PKD found 11 more malaria infections in Kampung Serdang.

>From [11-15 Jul 2019], there have been 15 cases reported from these 2 villages. All cases have been diagnosed with _Plasmodium vivax_, hospitalized for treatment and are in a stable condition.

PKD has also carried out malaria control activities by conducting indoor residual spraying and distribution of mosquito nets in the affected locality. At this point, the PKD team is in the process of tracking cases and vector control activities.

Residents in the locality have been given health education to take preventive measures by wearing clothing that covers the limbs and using repellents to prevent mosquito bites. In addition, residents are advised to sleep in the mosquito nets and avoid activities that take place in or near the forest area at night.

The Ministry of Health is monitoring the occurrence of this malaria case cluster, and the collaboration of the public is very much needed to ensure that the incidence of malaria can be controlled.
=====================
[Along with China and the Republic of Korea, Malaysia is one of the 3 countries of the WHO Western Pacific Region, and it's also among 21 countries in total across the globe identified by WHO in 2016 as having the potential to eliminate malaria by 2020. The selection was based on an analysis that looked at the likelihood of elimination across key criteria. Reaching malaria-free status is a critically important public health and sustainable development goal. It is also a core objective of the WHO Global Technical Strategy for Malaria 2016-2030, which calls for the elimination of malaria in at least 10 countries by the year 2020.

It is also worth noting that the dominant local human malaria species in Malaysia is _Plasmodium vivax_ (69%) with 33 areas (foci) with active malaria transmission; the populations at greater risk are labourers, including foreign workers, in agriculture, farming, and forestry sectors in East Malaysia. There are 8666 people at risk of malaria in these areas.

As "an important aspect of the disease in the country is the presence of _P. knowlesi_ malaria, a parasite normally found in monkeys, and now accounting for the majority of local cases", the 3 main activities to keep Malaysia on the course of malaria elimination by 2020 are as follows:
- increase surveillance of _P. knowlesi_ zoonotic infections and strengthen elimination efforts;
- intensify surveillance activities to address the threat of malaria importation and better target foreign and migrant workers engaged in activities such as agriculture, forestry, and mining; and
- continue to invest in its national malaria strategy to ensure the financing of programmes targeting elimination and prevention of reintroduction. (<https://apps.who.int/iris/bitstream/handle/10665/273633/WHO-CDS-GMP-2018.13-eng.pdf>)

The resurgence of _P. vivax_ among this specific group of people (aged 4-10 years old) is worrisome, and further investigation will elucidate the specific contextual situation to support the national effort to eliminate malaria by 2020. - ProMED Mod.ST]

[_Plasmodium vivax_ are seen in 2 isoforms, one with a long incubation time of up to 8 months (White NJ. The rise and fall of long-latency _Plasmodium vivax_. Trans R Soc Trop Med Hyg. 2019 Apr 1; 113(4):  163-168. doi: 10.1093/trstmh/trz002.  <https://www.ncbi.nlm.nih.gov/pubmed/30809676>).

Outbreaks like this one is common in areas where there is a transmission potential due to the presence of anopheles mosquitoes, and a limited local transmission is started from an introduced case, usually an asymptomatic carrier from an endemic area. It is important to know which isoform is found in this outbreak to understand the transmission dynamics and when it was introduced. Thus, genotyping should be performed. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Pahang, Malaysia:
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Reunion

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Thu 2 May 2019
Source: France TV Info [trans. ProMED SB, edited]

Ti Baba nursery in Saint-Paul has been affected by cases of salmonellosis. Five babies were infected with the bacterium. They were examined by the nursery doctor following symptoms of acute gastroenteritis. For several days, symptoms of acute gastroenteritis have been occurring in the toddlers.

The analyses were carried out on the foodstuffs, the menus served to the children, and, according to the director of the SPL Ti Baba, the service providers in charge of the meals The LRA and the various health authorities are continuing the investigations to find the source of the infection.  [Byline: Rahabia Issa]
=======================
[The source of salmonellosis here is not yet known. Although a foodborne outbreak in the centre is possible, introduction of this enteric pathogen into the day care centre by a child is also possible.

Reunion, one of the overseas departments of France, is an island with a population of about 800 000 located in the Indian Ocean, about 943 km (586 mi) east of Madagascar and about 200 km (120 mi) southwest of Mauritius, the nearest island. A map showing the location of Reunion Island in the Indian Ocean and its main cities can be accessed at <http://www.nationsonline.org/oneworld/map/reunion-map.htm>.

A HealthMap/ProMED-mail interactive map of Reunion Island can be accessed at
<http://healthmap.org/promed/p/45149>. - ProMED Mod.LL]
- La Reunion. 10 Apr 2019

From 800 confirmed cases the previous week, the dengue epidemic increased to 904 cases in the week.
<https://la1ere.francetvinfo.fr/reunion/dengue-barre-900-cas-confirmes-semaine-est-depassee-698934.html> [in French, trans. ProMED Corr.SB]

- La Reunion. 12 Apr 2019. Dengue La Reunion (French overseas territory): dengue cases near 5000 in Q1 2019. New transmission zones have been identified in Saint-Andre, Saint-Denis, Sainte-Marie, and Sainte-Suzanne. In addition, the number of hospitalizations is increasing with 25-30 recorded weekly.

- La Reunion. 27 Mar 2019. The circulation of the dengue virus continues at a sustained level, say the prefecture and the ARS. From 11-17 Mar 2019, 682 cases of dengue fever were confirmed. Since the beginning of the year [2019], 153 emergency room visits have been recorded and 80 patients have been hospitalized. In addition, 5 deaths have been reported since the beginning of 2019, of which 2 have been considered, after investigation, as directly related to dengue fever. The most active households are located at: the Saint-Louis River, Saint Louis, Saint Pierre, the Etang-Sale Cabris Ravine.
- Reunion Island. Fri 24 Aug 2018

6476 dengue cases gave been confirmed since January 2018; 138 hospitalized, 20 cases of severe dengue, including 3 deaths.

[HealthMap/ProMED-mail map of Reunion Island:
Reunion Island. 23 May 2018

In the Indian Ocean, it is also serotype 2 that predominates during the dengue epidemic affecting western and southern Reunion. According to the last assessment of [22 May 2018], 3416 biologically confirmed or probable cases have been reported since [1 Jan 2018, including 387 in a single week. Among them, 75 cases were hospitalized, including 9 severe cases.

[HealthMap/ProMED-mail map of Reunion Island:
Date: Fri 25 May 2018, 5:29 PM
Source: Linfo [in French, trans. ProMED Corr.SB, edited]
<http://www.linfo.re/la-reunion/societe/leptospirose-89-cas-confirmes-depuis-le-debut-de-l-annee-a-la-reunion>

Since the beginning of the year, 89 cases of leptospirosis have been reported in Reunion (against 50 in 2017). This disease can be contracted through contact with contaminated wetland (stagnant water, mud, etc). The West and South are the most affected regions with 21 confirmed cases in Saint-Paul.

Once again, the cleaning of courtyards and gardens or bathing in fresh water [flood water that is contaminated with urine from infected animals, e.g., rats, dogs?] after heavy rains is particularly at risk. The ARS Indian Ocean [the French Regional Health Agency in charge of health administration for Mayotte and La Reunion islands] wants to sensitize the population: it is essential to apply protective measures and fight against rats.

In addition, in the context of a proven epidemic of dengue fever, it is recommended to consult your doctor in case of high fever, in order to be tested and treated appropriately if necessary. [Byline: Lucie Touza]
===================
[Leptospirosis is a zoonotic bacterial infection that is distributed widely throughout the world in warm climates and is transmitted to humans by direct contact of abraded skin or mucous membranes with the urine of infected animals or by contact with wet soil, vegetation, or water that has been contaminated with infected animal urine. _Leptospira_ bacteria shed in urine may survive in fresh water or moist soil for weeks to months.

Many species of wild and domestic animals (including dogs, cattle, swine, and especially rats) are susceptible to chronic kidney infection with pathogenic _Leptospira_. Different leptospiral serovars are prevalent in particular geographical regions. Inadequate disposal of trash and debris provides a suitable habitat for rat infestation in urban settings.

Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers. Reunion experiences seasonal outbreaks of leptospirosis probably related to the rainfall. Reunion, one of the overseas departments of France, is an island with a population of about 800,000 located in the Indian Ocean, about 943 km (586 mi) east of Madagascar and about 200 km (120 mi) south west of Mauritius, the nearest island.

A map showing the location of Reunion Island in the Indian Ocean and its main cities can be accessed at
<http://www.nationsonline.org/oneworld/map/reunion-map.htm>.

A HealthMap/ProMED-mail interactive map of Reunion Island can be accessed at
<http://healthmap.org/promed/p/45149>. - ProMED Mod.ML]
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Bangladesh

Bangladesh - US Consular Information Sheet
June 17, 2008

COUNTRY DESCRIPTION:
Bangladesh is a democratic republic with a parliamentary form of government.
On January 11, 2007, President Iajuddin Ahmed declared a state of emergenc
.
On May 12, 2008, the Chief Adviser announced that national parliamentary elections would be held in the third week of December, 2008.
Bangladesh remains a developing country with poor infrastructure.
Tourist facilities outside major cities and tourist areas are minimal.
Read the Department of State Background Notes on Bangladesh for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport, visa and onward/return ticket are required.
All travelers to Bangladesh, including American citizens, must have a valid visa in their valid passport prior to arrival.
Although airport visas (landing permits) are available upon arrival by air, the U.S. Embassy in Dhaka does not recommend this option for most categories of travelers as working hours may not coincide with flight arrival times and precise formalities can vary.
Additionally, if issued, landing permit validity is usually limited to a maximum of fifteen days.
A valid visa in an expired or cancelled U.S. passport is not acceptable to the Bangladeshi authorities; if you are issued a new U.S. passport, you will need a new visa.

If you intend to use Dhaka as a hub from which to visit other countries in the region, ensure that you obtain a multiple-entry visa before arrival.
If you intend to work for a non-governmental organization (NGO) in Bangladesh, you should ensure that your sponsor has provided you with up-to-date advice on the kind of visa you must obtain before arrival.
It is difficult and time-consuming to change your immigration status once you have arrived in Bangladesh.

Visas to Bangladesh which are expiring may be extended at the Directorate of Immigration and Passport, located at Sher-e-Bangla Nagar, Agargaon, Dhaka.
The phone numbers are (880-2) 913-1891 and 913-4011.

New visa rules, introduced in October 2006, require foreign nationals who come to Bangladesh to work or for long-term visits to have the appropriate work permits and clearances on arrival.
There are increased financial penalties for overstaying visas.
Additionally, those who overstay for more than 90 days face the possibility of being charged with violating the Foreigners Act of 1946.
For further information on these rules, please check with the nearest Bangladeshi Embassy or Consulate (U.S. addresses listed below) before traveling, or visit the Bangadeshi Immigration Police web site at www.immi.gov.bd, which provides further details on rules relating to foreigner registrations.

There are two exit requirements:
A.
When traveling by air, there is a departure tax on all foreigners except children under the age of two.
This tax is often included when air tickets are purchased.
Otherwise, it is collected at the airport at the time of departure.
The amount of the departure tax varies, depending on the destination (e.g., the departure tax for the U.S. is the most expensive, at USD $43).
There is no travel tax for transit passengers transiting Bangladesh without a visa and in country for 72 hours or fewer.
These requirements may be subject to change, and travelers are advised to check with the Embassy of Bangladesh before traveling.

B.
Departing foreign nationals are also required to comply with the income tax ordinance of 1984 and submit an income tax clearance certificate/income tax exemption certificate to local airline offices upon departure from Bangladesh.
More information can be obtained from the Bangladesh Board of Revenue web site at http://www.nbr-bd.org/.

For further information on entry requirements and possible exceptions to the exit requirements, please contact the Embassy of the People's Republic of Bangladesh, 3510 International Drive NW, Washington, DC
20008, telephone 202-244-0183, fax 202-244-5366, web site http://www.bangladoot.org, or the Bangladeshi Consulates in New York at 211 E. 43rd Street, Suite 502, New York, NY 10017, telephone 212-599-6767 or Los Angeles at 10850 Wilshire Boulevard, Suite 1250, Los Angeles, CA 90024, telephone 310-441-9399. Visit the Embassy of Bangladesh web site at http://www.bangladoot.org for the most current visa information.

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

SAFETY AND SECURITY:
Bangladesh is currently under a state of emergency.
As of May, 2008, national parliamentary elections have been scheduled for the third week of December, 2008.
The security situation in Bangladesh is fluid, and Americans are urged to check with the U.S. Embassy for the latest information.
Spontaneous demonstrations take place in Bangladesh from time to time.
American citizens are reminded that even demonstrations intended to be peaceful can turn confrontational and escalate into violence quickly and unexpectedly.
American citizens are therefore urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations.
American citizens should stay up-to-date with media coverage of local events and be aware of their surroundings at all times.
Information regarding demonstrations in Bangladesh can be found on the U.S. Embassy Dhaka’s web site at http://dhaka.usembassy.gov/.

A terrorist bombing campaign in the second half of 2005, political violence throughout the country at the end of 2006, and threats to U.S. and Western interests led to increased security around U.S. Government facilities.
On August 17, 2005, a banned Islamist terrorist group, Jamaatul Mujahideen Bangladesh (JMB), claimed responsibility for nearly 500 coordinated small bomb blasts in virtually every part of Bangladesh that killed two persons and injured several dozen.
The most recent JMB bombing occurred on December 8, 2005, and the Bangladeshi government subsequently apprehended the known senior leadership of JMB.
Six JMB leaders convicted of complicity in JMB attacks were executed on March 29, 2007.
JMB and other extremist groups are small in number but remain active and may resume violent activities.

Demonstrations, political activity, and hartals (nationwide strikes) were initially banned during the state of emergency, but the rules restricting political activity have been slightly relaxed as part of the process leading up to the planned elections in the third week of December 2008.
Prior to the state of emergency, rallies, marches, demonstrations and hartals took place frequently.
In August 2007, violent protests involving thousands of demonstrators occurred in several cities in Bangladesh, including Dhaka.
Authorities imposed a curfew to restore calm.
Protests involving workers from the large garment-manufacturing industry are not uncommon.
Visitors to Bangladesh should check with the Consular Section of the U.S. Embassy in Dhaka for updated information on the current political situation.

U.S. citizens are advised against traveling to the Khagrachari, Rangamati and Bandarban Hill Tracts districts (collectively known as the Chittagong Hill Tracts) due to kidnappings and other security incidents, including those involving foreign nationals.
Foreigners traveling in the Chittagong Hill Tracts are required to register with local authorities.
Additionally, the U.S. Embassy has in the past received reports of incidents of kidnapping, arms and narcotics smuggling and clashes between local Bangladeshis and Rohingyan refugees in areas near Rohingyan refugee camps in the Teknaf, Kutupalong, Ukhia, and Ramu areas of the Cox’s Bazar district.
The U.S. Embassy also recommends against travel to these areas.
Individuals who choose to visit these districts are urged to exercise extreme caution.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs web site at http://travel.state.gov where the current Travel Warnings and Travel Alerts, including the Worldwide Caution, can be found.
Americans traveling to or living in Bangladesh who are registered at the U.S. Embassy will receive updated security information about Bangladesh via e-mail.
All Demonstration Notices and Warden Messages are posted on the Embassy’s web site at http://dhaka.usembassy.gov/.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

CRIME:
Urban crime can be organized or opportunistic, conducted by individuals or groups, and commonly encompasses fraud, theft (larceny, pick-pocketing, snatch-and-grab), robbery (armed and unarmed), carjacking, rape, assault, and burglary (home and auto).
Incidents of crime and levels of violence are higher in low-income residential and congested commercial areas, but are on the rise in wealthier areas as well.
Visitors should avoid walking alone after dark, carrying large sums of money, or wearing expensive jewelry.
Valuables should be stored in hotel safety deposit boxes and should not be left unattended in hotel rooms.
Police are generally responsive to reports of crimes against Americans.
Crimes, however, often go unsolved.

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

The local equivalent to the “911” emergency line in Bangladesh is 999.
This connects you to the Dhaka Metro Police Exchange.
There is no guarantee that English will be spoken or understood at the Dhaka Metro Police Exchange.
The Police Exchange can only transfer calls to the appropriate police station within the Dhaka metropolitan area, and then the caller will have to speak with that police station in order to actually have any police services performed.
There is similarly no guarantee that English will be spoken or understood at the local police station.

Outside of Dhaka, the caller will need to add the city code for Dhaka, so dial 02-999.
The caller will again be connected to the Dhaka Metro Police Exchange, which should be able to provide the number of the appropriate police station within Bangladesh, but the Dhaka Metro Police Exchange is unlikely to be able to transfer the call to a police station outside Dhaka.
The caller would have to hang up and dial the number provided by the Dhaka Metro Police Exchange.
The ability to speak and/or understand English is even more unlikely at local police stations outside of Dhaka.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Bangladesh do not approach U.S. standards, even in tourist areas.
There is limited ambulance service in Bangladesh.
Several hospitals in Dhaka (e.g., Apollo Hospital and Square Hospital) have emergency rooms that are equipped at the level of a community hospital.
Hospitals in the provinces are less well equipped and supplied.
There have been reports of counterfeit medications within the country, but medication from major pharmacies and hospitals is generally reliable.
Medical evacuations to Bangkok or Singapore are often necessary for serious conditions or invasive procedures.

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

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

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

The Bangladeshi road network is in poor condition and poorly maintained.
The streets of Dhaka are extremely congested; bicycle rickshaws compete with three-wheeled mini-taxis (CNGs), cars, overloaded buses, and trucks on limited road space.
Also, driving on the left-hand side of the road may be confusing to American visitors.
Inter-city roads are narrow.
Driving at night is especially dangerous.
Streetlights are rare even in cities.
Road accidents are common in Bangladesh.
Fatal head-on collisions on inter-city roads are common.
When vehicle accidents occur, a crowd quickly gathers and violence can occur when the crowd becomes unruly.
Travelers are strongly urged not to use public transportation, including buses, rickshaws, and three-wheeled baby taxis due to their high accident rate and crime issues.
An alternative to consider is a rental car and driver.

Please refer to our Road Safety page for more information.
Visit the website of Bangladesh’s National Tourism Organization at http://www.parjatan.org, e-mail bpcho@bangla.net.

SPECIAL CIRCUMSTANCES:
Bangladesh is a country crisscrossed with rivers, and thus uses a wide network of water-based public transportation.
Ferries and other boats compete with the railroads as a major means of public transport.
Typically overloaded and top-heavy, ferries do capsize, particularly during the monsoon season from May to October or during unexpected thunderstorms or windstorms.
Every year there are dozens of fatalities resulting from ferry accidents.

Bangladeshi customs authorities may enforce strict regulations concerning temporary importation into or export from Bangladesh of items such as currency, household appliances, alcohol, cigarettes and weapons.
There is no restriction as to the amount of U.S. currency visitors may bring into Bangladesh; however, they must declare to customs authorities if they are carrying more than USD $5,000 at the time of arrival.
It is advisable to contact the Bangladeshi Embassy or Consulates for specific information regarding customs requirements.

Please see our Customs Information.

Land disputes are extremely common in Bangladesh and are extremely difficult to resolve through legal channels.
Court cases can last for months, and sometimes years, without there ever being a final and accurate determination of which party has legitimate claim to the title.

The U.S. Embassy currently has on file nearly twenty cases of American citizens who claim to be victimized in land-grabbing disputes.
Rarely are these simple cases of a legitimate property owner and an opportunistic land-grabber.
More often, it is a case of disagreement between an owner who believes he has historical ownership of the property and a new owner who has just purchased the same property.
One of them has been swindled, both of them have deeds, and it is next to impossible to determine whose deed is valid.

The dangers in becoming involved in a property dispute range from being threatened by bullies to being involved in a lengthy court dispute.
Those involved in a court dispute run the risk of having cases filed against them, and may be arrested and jailed, sometimes for months.

American Citizens wishing to purchase property in Bangladesh should be thoroughly aware of the risks they take and should only purchase property from a seller whose ownership is beyond doubt.
Additionally, they should recognize the risks associated if they are not physically present to oversee their property.
American Citizens should bear in mind that the U.S. Embassy cannot protect personal property in the absence of owners and cannot take sides in a legal dispute.

A marriage must be entered into with the full and free consent of both individuals.
The parties involved should feel that they have a choice.
If an American citizen is being forced into a marriage against his/her will, help and advice are available.
For more information, please and the U.S. Embassy in Dhaka information on forced marriage at http://dhaka.usembassy.gov/forced_marriage_home.html, or contact the American Citizens Services unit directly at DhakaACS@state.gov, or 011-88-02-885-5500 from the United States, 02-885-5500 from inside Bangladesh, or 885-5500 from anywhere in the city of Dhaka.
All travelers to Bangladesh should retain their passports and their return plane tickets to ensure independence to travel.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Bangladesh’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Bangladesh’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.

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 Bangladeshi laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in Bangladesh 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, international parental child abduction and the U.S. Embassy in Dhaka information on forced marriage at http://dhaka.usembassy.gov/forced_marriage_home.html.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Bangladesh are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Bangladesh.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Embassy is located approximately four miles south of Zia International Airport, and five miles north of downtown in the Diplomatic Enclave, Madani Avenue, Baridhara, Dhaka, telephone (88-02) 885-5500, fax number (88-02) 882-3744.
The workweek is Sunday through Thursday.
The Consular Section is open for American Citizens Services Sunday through Thursday from 1:00 p.m. to 4:00 p.m.
For emergency services and general information during business hours, please call (88-02) 882-3805.
For emergency services after hours, please call (88-02) 885-5500 and ask for the duty officer.
The Embassy's Internet home page is http://dhaka.usembassy.gov/
* * *
This replaces the Country Specific Information for Bangladesh dated November 23, 2007 to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Traffic Safety and Road Conditions, Special Circumstances, and Children’s Issues.

Travel News Headlines WORLD NEWS

Date: Sat, 9 Nov 2019 18:59:25 +0100 (MET)

MOUSOUNI ISLAND, India, Nov 9, 2019 (AFP) - Cyclone Bulbul hit India and southern Bangladesh on Saturday, leaving two dead as authorities in the countries ordered more than two million people to get out of the path of the storm.   The cyclone, packing winds of up to 120 kilometres (75 miles) per hour, has "weakened" and "started crossing" India's West Bengal and Bangladesh's Khulna coast at about 9:00 pm (1500 GMT), Dhaka's Meteorological Department said in a special bulletin.   "It is likely to move in a northeasterly direction" and "weaken gradually, and may complete crossing West Bengal-Khulna coast by midnight tonight," the department said.     Airports and ports were shut down and the deaths were reported before the full force of the cyclone had hit.   One person was killed by an uprooted tree in Kolkata and another by a wall that collapsed under the force of the winds in Odisha state, authorities said.

More than 60,000 people were moved away from the coast on the Indian side of the border.   Bangladesh disaster management secretary Shah Kamal told AFP that "2.028 million" have been evacuated and moved to more than 5,500 cyclone shelters.   He said there was no reports of casualties and rejected reports in local media that dozens of local fishermen were missing on the southern coast.    Bangladeshi troops were sent to some villages, while about 55,000 volunteers went door-to-door and making loudspeaker announcements in the streets to get people away from the danger zone in villages, many of which were below sea level.

- Ports closed, flights halted -
A storm surge up to two metres (seven feet) was predicted along the coast, Bangladesh's Meteorological Department said.   About 1,500 tourists were stranded on the southern island of Saint Martin after boat services were suspended due to bad weather.   Bangladesh's two biggest ports, Mongla and Chittagong, were closed because of the storm, and flights into Chittagong airport were halted.   In India, flights in and out of Kolkata airport were suspended for 12 hours because of the storm.   On the West Bengal island of Mousouni, which lies in the path of the storm, frightened residents took shelter in schools and government buildings because they had not been able to escape.   Military planes and ships have been put on standby to help in emergencies, Indian authorities said.

Bulbul hit the coast at the Sundarbans, the world's largest mangrove forest, which straddles Bangladesh and part of eastern India, and is home to endangered species including the Bengal tiger and the Irrawaddy dolphins.   Bangladesh's low-lying coast, home to 30 million people, is regularly battered by cyclones that leave a trail of destruction.   Hundreds of thousands of people have been killed in cyclones in recent decades.   While the frequency and intensity have increased, partly due to climate change, the death tolls have come down because of faster evacuations and the building of 4,000 cyclone shelters along the coast.   In November 2007, Cyclone Sidr killed more than 3,000 people. In May this year, Fani became the most powerful storm to hit the country in five years, but the death toll was about 12.
Date: Thu 26 Sep 2019, 12:00 AM
Source: Daily Sun [edited]

A new mosquito-borne virus, West Nile Virus (WNV), has been found in Bangladesh. However, detailed information about the virus has not been available yet as the government's concerned department didn't investigate to know its origin.

According to the experts, West Nile is a potentially life-threatening viral infection which can pass to animals and humans if they are bitten by an infected mosquito.

WNV is a virus of the _Flaviviridae_ family, which includes the viruses responsible for Japanese encephalitis and dengue fever. It mainly affects birds, but it can also infect mammals and reptiles. Between 70-80% of people have no symptoms. Up to 1% of those who become ill have serious and potentially fatal complications, they added.

"We have asked the Institute of Epidemiology Disease Control and Research (IEDCR) to investigate the West Nile virus," said Dr. Sanya Tahmina Jhora, Director of the Disease Control unit of Directorate General of Health Services (DGHS) on [Wed 25 Sep 2019].

Asked about the West Nile virus, Prof. Dr Meerjady Sabrina Flora, Director of Institute of Epidemiology of the IEDCR, said: "A report about the West Nile virus has come to us. A study of the ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh) has mentioned the detection the virus in Bangladesh. Our team will go to the spot and carry out investigation about the West Nile virus. We can give details about it after the investigation," she added.

The DGHS sources said the ICDDR,B detected the West Nile virus infected patient in an area near Dhaka city and informed the concerned authorities of the government to this end. However, talking to Daily Sun, the ICDDR,B communication department refused to comment.

According to the Centers for Disease Control and Prevention of the United States (US), West Nile virus (WNV) is the leading cause of mosquito-borne disease in the continental United States.

It is most commonly spread to people by the bite of an infected mosquito. Cases of WNV occur during mosquito season, which starts in the summer and continues through fall. There are no vaccines to prevent or medications to treat WNV in people," it said.

The report also said "most people infected with WNV do not feel sick, but about 1 in 5 people who are infected develop a fever and other symptoms. About 1 out of 150 infected people develop a serious, sometimes fatal, illness. You can reduce your risk of WNV by using insect repellent and wearing long-sleeved shirts and long pants to prevent mosquito bites."

The World Health Organization (WHO) said the West Nile virus can cause a fatal neurological disease in humans, while approximately 80% of people who are infected will not show any symptoms. "West Nile virus is mainly transmitted to people through the bites of infected mosquitoes. The virus can cause severe disease and death in horses. Vaccines are available for use in horses but not yet available for people. Birds are the natural hosts of West Nile virus," it said.

The WHO statement said WNV can cause neurological disease and death in people. "WNV is a member of the _flavivirus_ genus and belongs to the Japanese encephalitis antigenic complex of the family _Flaviviridae_. WNV is maintained in nature in a cycle involving transmission between birds and mosquitoes. Humans, horses and other mammals can be infected," it added. The WHO statement said human infection is most often the result of bites from infected mosquitoes. Mosquitoes become infected when they feed on infected birds, which circulate the virus in their blood for a few days. The virus eventually gets into the mosquito's salivary glands. During later blood meals (when mosquitoes bite), the virus may be injected into humans and animals, where it can multiply and possibly cause illness.

It said the virus may also be transmitted through contact with other infected animals, their blood, or other tissues. A very small proportion of human infections have occurred through organ transplant, blood transfusions and breast milk.

The WHO report further said infection with WNV is either asymptomatic (no symptoms) in around 80% of infected people or can lead to West Nile fever or severe West Nile disease. About 20% of people who become infected with WNV will develop West Nile fever. The report added that symptoms include fever, headache, tiredness, and body aches, nausea, vomiting, occasionally with a skin rash (on the trunk of the body) and swollen lymph glands. The symptoms of severe disease (also called neuroinvasive disease, such as West Nile encephalitis or meningitis or West Nile poliomyelitis) include headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis.

It is estimated that approximately 1 in 150 people infected with the West Nile virus will develop a more severe form of the disease. Serious illness can occur in people of any age; however, people over the age of 50 and some immunocompromised persons (for example, transplant patients) are at the highest risk for getting severely ill when infected with WNV. The incubation period is usually 3 to 14 days.

The WHO further said that treatment is supportive for patients with neuro-invasive West Nile virus disease, often involving hospitalization, intravenous fluids, respiratory support, and prevention of secondary infections. No vaccine is available for humans.  [Byline: Mohammad Al Amin]
=====================
[The news report above indicates the detection of West Nile virus (WNV) by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in a patient near Dhaka city, the Capital in Bangladesh. This is the 1st report of WNV from Bangladesh affecting humans. A further investigation from the health authority concerned in the country seems underway to obtain more information about the reported finding.

Earlier, Islam et al have reported WNV antibody prevalence of approx. 5.4 percent in resident and migratory wild birds in 2015 [Islam, Ariful & Rahman, Mohammad & Paul, Suman & Hannan, M. A. & Hossain, Mohammad Elius & Rahman, Mohammed & Hosseini, Parviez & Dey, T. & Zeidner, N.. (2015). Seroprevalence of West Nile Virus in Wild Birds in Bangladesh].
West Nile virus (WNV) was 1st isolated in a woman in the West Nile district of Uganda in 1937. It was identified in birds (crows and columbiformes) in the Nile delta region in 1953. Before 1997, WNV was not considered pathogenic for birds, but at that time in Israel, a more virulent strain caused the death of different bird species, presenting signs of encephalitis and paralysis.

The largest WNV outbreaks occurred in Greece, Israel, Romania, Russia and the USA, with outbreak sites on major bird migratory routes. In its original range, WNV was prevalent throughout Africa, parts of Europe, Middle East, West Asia, and Australia. Since its introduction in 1999 into the USA, the virus has spread and is now widely established from Canada to Venezuela.

Human infection most often results from bites of infected mosquitoes. Mosquitoes become infected when they feed on infected birds, which circulate the virus in their blood for a few days. The virus eventually gets into the mosquito's salivary glands. During later blood meals (when mosquitoes bite), the virus may be injected into humans and animals, where it can multiply and possibly cause illness. The virus may also be transmitted through contact with other infected animals, their blood, or other tissues. Rarely, human infections have occurred through organ transplant, blood transfusions and breast milk. There is one reported case of transplacental (mother-to-child) WNV transmission (<https://www.who.int/news-room/fact-sheets/detail/west-nile-virus>).

About 20 percent of people who become infected with WNV will develop West Nile fever. Symptoms include fever, headache, tiredness, and body aches, nausea, vomiting, occasionally with a skin rash (on the trunk of the body) and swollen lymph nodes.

Treatment is supportive for patients with neuro-invasive West Nile virus disease, often involving hospitalization, intravenous fluids, respiratory support, and prevention of secondary infections. No vaccine is available for humans. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
2 Aug 2019

A record 19,513 people have been infected [as of] yesterday [1 Aug 2019], including 3464 outside Dhaka, the Directorate General of Health Services (DGHS) said, adding that 1712 new dengue cases were reported at hospitals in the last 24 hours since 8:00 am on Wednesday [31 Jul 2019]. Two pregnant women die of dengue at BSMMU [Bangabandhu Sheikh Mujib Medical University]. With the latest development, the death toll in dengue disease has risen to at least 48 this year [2019], according to different hospital sources.
Date: Tue, 13 Aug 2019 13:34:30 +0200 (METDST)

Dhaka, Aug 13, 2019 (AFP) - At least 40 people have died in Bangladesh's worst-ever outbreak of dengue, officials said Tuesday, as overburdened hospitals struggled to treat thousands of patients.   Outbreaks of the mosquito-borne viral infection, which causes flu-like symptoms but can be deadly if it develops into a haemorrhagic fever, usually occur in the South Asian nation during the monsoon season between June and September -- but this year the disease has reached epidemic proportions.

More than 44,000 people have been admitted to hospitals with the illness since January, including some 2,100 on Monday alone, said health ministry official Ayesha Akhter.    "We have confirmed 40 dengue-related casualties so far to Monday," she told AFP.   Local media put the number much higher, reporting that the death toll passed 100 last week.   The week-long holiday marking the Muslim festival of Eid-al-Adha has seen hundreds of thousands of people leaving Bangladeshi cities to return to their family homes in the countryside, raising concerns that the disease will spread further.

The country's health minister said the outbreak was "gradually reducing" while inaugurating an emergency dengue ward at a public hospital in Dhaka this week.   For the first time on record, holidays for all public health workers have been cancelled to help respond to the crisis, said health ministry director general Abul Kalam Azad.   "It is getting very tough to cope up with the amount of work pressure," one medical officer told AFP.
Date: Mon, 29 Jul 2019 14:58:38 +0200

Dhaka, July 29, 2019 (AFP) - Bangladesh is in the grip of the country's worst-ever dengue fever outbreak, officials said Monday, with hospitals overflowing and social media flooded with pleas for blood donors.   Eight people have died and there have been 13,637 cases of the disease so far this year, with nearly 1,100 people -- most of them children -- diagnosed in the last 24 hours, according to official figures.   "This number is the highest since we started keeping record on dengue patients nearly two decades ago," senior health ministry official Ayesha Akter told AFP.

Local media reported that the number of victims could be much higher and the Amader Shomoy newspaper said at least 30 people had died of dengue this year.   The capital Dhaka is the worst-hit, with the city launching a fumigation drive to kill the Aedes mosquito, which is capable of spreading devastating diseases like dengue, Zika and chikungunya.

Dengue, which causes flu-like symptoms, can be deadly if it develops into a haemorrhagic fever. There is no vaccine or any specific medicine to treat dengue, according to the World Health Organisation.   An AFP correspondent visited major hospitals in Dhaka and saw patients lying on floors and in corridors as they waited for treatment.   The country's largest hospital -- Dhaka Medical College Hospital (DMCH) -- has treated some 1,858 dengue patients this month, according to director general A.K.M Nasir Uddin.   "We have opened a special corner for dengue patients," he told AFP.

Doctors have been working overtime to cope with the large volume of patients.   "Our facilities are overstretched and overwhelmed. We are struggling to cope," a medical officer at Dhaka's Mitford Hospital said.   There have been reports of blood banks struggling to meet the needs of seriously ill patients, with appeals for blood launched on social media sites such as Facebook.   One mother said she was worried about her sick daughter, aged four.   "Doctors have done all they could do. All I am doing now is calling Allah for help," Nasima Khatun told AFP.
More ...

Iraq

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

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

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://www.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.
AVIAN INFLUENZA: The WHO and Iraqi authorities have confirmed human cases of the H5NI strain of avian influenza, commonly known as the "bird flu." Travelers to Iraq and other countries affected by the virus are cautioned to avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to be contaminated with feces from poultry or other animals. In addition, the CDC and WHO recommend eating only fully cooked poultry and eggs. For the most current information and links on avian influenza, see the State Department's Avian Influenza Fact Sheet.
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation as well as whether medical evacuation would be possible from Iraq. Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Iraq is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
All vehicular travel in Iraq is extremely dangerous. There have been numerous attacks on civilian vehicles, as well as military convoys. Attacks occur throughout the day, but travel at night is exceptionally dangerous and should be avoided. There have been attacks on civilian vehicles as well as military convoys on Highways 1, 5, 10 and 15, even during daylight hours. Travelers are strongly urged to travel in convoys with at least four vehicles in daylight hours only. Travel in or through Ramadi and Fallujah, in and between al-Hillah, al-Basrah, Kirkuk, and Baghdad and between the International Zone and Baghdad International Airport, and from Baghdad to Mosul is particularly dangerous. Occasionally, U.S. Government personnel are prohibited from traveling to select areas depending on prevailing security conditions. There continues to be heavy use of Improvised Explosive Devices (IEDs) and/or mines on roads, particularly in plastic bags, soda cans, and dead animals. Grenades and explosives have been thrown into vehicles from overpasses, particularly in crowded areas. Travel should be undertaken only when absolutely necessary and with the appropriate security.
Buses run irregularly and frequently change routes. Poorly maintained city transit vehicles are often involved in accidents. Long distance buses are available, but are often in poor condition and drive at unsafe speeds. Jaywalking is common. Drivers usually do not yield to pedestrians at crosswalks and ignore traffic lights (if available), traffic rules and regulations. Roads are congested. Driving at night is extremely dangerous. Some cars do not use lights at night and urban street lights may not be functioning. Some motorists drive at excessive speeds, tailgate and force other drivers to yield the right of way. Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by air carriers registered in Iraq, the U.S. Federal Aviation Administration (FAA) has not assessed Iraq's Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
There is credible information that terrorists are targeting civil aviation. Military aircraft arriving and departing from Baghdad International Airport (ORBI) have been subjected to small arms and missile fire. Travelers choosing to utilize civilian aircraft to enter or depart Iraq should be aware that, although there have been no recent attacks on civilian aircraft, the potential threat still exists. Official U.S. Government (USG) personnel are strongly encouraged to use U.S. military or other USG aircraft when entering or departing Iraq. All personnel serving in Iraq under Chief of Mission (COM) authority are prohibited from entering or departing ORBI on commercial airlines unless they receive COM approval, which is granted on a case-by-case basis for emergency purposes only. Other personnel not under COM authority must be guided by their own agencies. Personnel under COM authority assigned to the Erbil and Sulaymaniyah areas are permitted to use commercial flights in and out of Erbil on a case-by-case basis.

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

Transporting large amounts of currency is not advisable. Almost all of the international companies working in Iraq have the capability to make payments to their employees and at least four Iraqi banks are also able to convert cash into an international wire transfer directed to a bank account outside Iraq. Branches of the Credit Bank of Iraq on Al-Sa’adoon St., Baghdad (creditbkiq@yahoo.com), Dar Es Salaam Bank (info@desiraq.com), Iraqi Middle East Investment Bank (coinvst@iraqimdlestbank.com) and Al-Warqaa Investment Bank (warkabank@hotmail.com) all have this capability. Please be aware that large wire transfers may require Central Bank of Iraq approval because of measures in place to combat money laundering. Such approvals can be obtained by the sending bank, if information on the origin of the funds and the reason for its transfer are provided. Additional information on banking in Iraq is available at the Central Bank of Iraq web site http://www.cbi.iq/.
Customs and MNF-I officers have the broad authority to search persons or vehicles at Iraq ports of entry. Officers may confiscate any goods that may pose a threat to the peace, security, health, environment, or good order of Iraq or any antiquities or cultural items suspected of being illegally exported. Goods that are not declared may be confiscated by an officer. Persons may also be ordered to return such goods, at their expense, to the jurisdiction from which they came. Please see our Customs Information.
The banking and financial infrastructure has been disrupted and is in the process of rebuilding. Hotels usually require payment in foreign currency. Automatic Teller Machines (ATMs) are extremely limited but the Trade Bank of Iraq (TBI) provides ATM services in dinars and U.S. dollars at the TBI head office in central Baghdad and two other locations (See http://www.tbiraq.com.)
Telecommunications are very poor. There is limited international phone service in Iraq at this time. Local calls are often limited to a neighborhood network. There are no public telephones in the cities; however, calls may be made from hotels, restaurants or shops. Limited cellular telephone service and Internet service are available in Iraq.
Due to security conditions, the Consular Section of the U.S. Embassy is able to provide only limited emergency services to U.S. citizens. Because police and civil structures are in the process of being rebuilt, emergency service and support will be limited.
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Iraqi laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Iraq are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

CHILDREN'S ISSUES: The U.S. and international media have occasionally reported on the difficult situation faced by Iraq's children, and it is completely understandable that some American citizens want to respond to such stories by offering to open their homes and adopt these children in need. However Iraqi law does not permit full adoptions as they are generally understood in the United States. It is not possible to adopt Iraqi children at this time. For more information on this issue, please refer to our flyer Intercountry Adoptions – Iraq.
Iraq is not party to the Hague Convention on the Civil Aspects of International Child Abduction, nor are there any international or bilateral treaties in force between Iraq and the United States dealing with international parental child abduction. The security situation in Iraq limits consular access to children. For more information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
REGISTRATION / EMBASSY LOCATION:
The Travel Warning on Iraq urges U.S. citizens to defer travel to Iraq. However, Americans living or traveling in Iraq despite that Warning are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Iraq. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. U.S. citizens may also contact the consular section of the U.S. Embassy in Baghdad, Iraq located in the International Zone via e-mail at baghdadacs@state.gov, via landline at 1-240-553-0581, extension 2413 (this number rings in Baghdad) or the U.S. Embassy's web site at http://iraq.usembassy.gov. The after-hours number in case of extreme emergency is GSM 1-914-822-1370 or Iraqna 07901-732-134.
* * * * * *
This replaces the Country Specific Information for Iraq dated January 22, 2008, to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, Aviation Safety Oversight, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

World Travel News Headlines

Date: Thu, 21 Nov 2019 22:38:09 +0100 (MET)

Bogota, Nov 21, 2019 (AFP) - Tens of thousands of Colombians took to the streets of the capital Bogota on Thursday amid a general strike to protest the policies of President Ivan Duque's right-wing government.   There were no reported outbreaks of major violence as trade unions, students, opposition parties and the South American country's indigenous organizations challenged the full gamut of Duque's economic, social and security policies.   "It is an accumulation of situations that we hope to see reviewed after today, including a great national dialogue of conciliation," Robert Gomez, president of the main workers' union, told AFP.   The protest comes amid social upheaval across South America, as a wave of unrest over the past two months has battered governments in Chile, Bolivia and Ecuador.   The popularity of Duque's right-wing government -- a key US ally -- has been on the wane since his election 18 months ago, as it deals with hosting 1.4 million refugees from neighboring Venezuela's economic meltdown as well as the complex fallout of a 2016 peace deal with FARC rebels and rampant drug trafficking.

- Troops deployed -
Troops were deployed in the capital and other cities to protect "strategic facilities," authorities said.   The Colombian office of the UN High Commissioner for Human Rights voiced concern over the deployment, saying states must limit the use of military forces "for the control of internal disturbances."   Authorities said the protests were largely peaceful, though riot police fired tear gas to break up groups of demonstrators in isolated clashes in Bogota and the western city of Cali. Blocked roads in some areas snarled transportation.

The general strike was widely followed in Bogota, and other big cities like Bucaramanga in the northeast and Medellin in the northwest.   Several separate marches converged on Bolivar Square, the historic center of the capital close to the presidency.   "We are marching because in Colombia we are tired of corruption, of impunity, that the government does nothing for the poor," Olga Canon, 55, told AFP.   Organizations that participated in the strike take issue with Duque's security policy as well as attempts to introduce a more flexible labor market, weaken public pension funds and raise the retirement age.   Students are demanding more funding for education, while indigenous communities insist on greater protection in remote areas where 134 activists have been killed since Duque came to power in August 2018.

- 'Afraid to march' -
"We are very afraid to march in the streets but we do it anyway because the state is spreading so much fear with its militarization and by closing the borders," political science student Valentina Gaitan, 21, told AFP.    Duque admitted some of the criticisms were legitimate in a televised speech on the eve of the strike, but said the campaign against his government was based on lies seeking to provoke violence.   "We recognize the value of peaceful protests, but also guarantee order," he said.   The borders with Brazil, Ecuador, Peru and Venezuela were closed until Friday to avoid any threat to "public order and security," authorities said.   Political analyst Jason Marczak said the outrage against the government, the target of several demonstrations in recent months, is part of a "considerable demonstration of discontent in the region."   "The unsatisfied claims and deep polarization are the basis for this massive event," said Marczak, of the Washington-based Atlantic Council.
Date: Thu, 21 Nov 2019 09:12:36 +0100 (MET)

Bangkok, Nov 21, 2019 (AFP) - A shallow 6.1-magnitude earthquake hit north-western Laos near the Thai border early Thursday, the United States Geological Survey reported, alarming locals who felt buildings shake as far away as Bangkok.  The quake hit at 6:50am (2350 GMT Wednesday), roughly three hours after a 5.7-magnitude earthquake in the same region triggered an immediate suspension to Laos' largest-capacity power plant located near its epicentre.    Tremors could be felt more than 700 kilometres (435 miles) away in the Thai capital, where Pope Francis is currently on a four-day visit.    "The shaking... was the main shock from a quake in Laos at 6:50 am and was felt in northern and northeastern Thailand and Bangkok and suburbs," said Sophon Chaila, an official at the Thai Meteorological Department.

The department said the quake affected nine provinces in Thailand and there were four lesser aftershocks.    It also became a top trending topic on Twitter in Thailand, as locals shared videos of swaying overhead lights and rattling window blinds in office buildings.    Residents in the Vietnamese capital Hanoi also felt buildings sway.    "The ceiling lights were shaking quite strongly. I felt dizzy and scared," said Hanoi resident Tran Hoa Phuong, who felt the earthquake in her 27-storey apartment building.    After the first quake, the 1,878-megawatt Hongsa Power Plant -- Laos' largest-capacity thermal energy generator -- immediately suspended operations according to a statement from the Thai-owned company.

No "fundamental" damages or injuries have been found so far, "merely damages to the external texture of the buildings", it said, adding that Hongsa is expected to take 24 hours to complete its inspection.    Photos shared by Thai news showed portions of the power plant's walls had collapsed, and debris littered its premises.    Nearby Xayaburi dam project, one of Laos' largest hydropower dams, has seen "no impact" so far, and is continuing to generate electricity "as normal", said a statement from CK Power.   Information is slow to trickle out of the closed communist state, and there were similarly no official reports of injuries after the twin quakes hit early Thursday.

Impoverished Laos has ploughed ahead with ambitious dam-building projects that critics say lack transparency and stringent safety measures.   The cost was laid bare last year when a massive hydropower project collapsed in southern Laos, killing dozens and leaving thousands homeless.   Pope Francis arrived in Bangkok on Wednesday and has a busy agenda Thursday meeting officials and the Thai king before he leads a mass in the evening.    There was no word from his team on whether he felt the quake.    Powerful earthquakes occasionally strike hard in Southeast Asia.   In 2016 a 6.8-magnitude quake struck Myanmar, killing at least three people and damaging temples in the ancient temple town of Bagan.
Date: Tue, 19 Nov 2019 14:25:40 +0100 (MET)

Ottawa, Nov 19, 2019 (AFP) - Train operators at Canadian National Railway went on strike on Tuesday after months of contract talks failed, effectively shutting down the largest rail network in Canada.   The union representing more than 3,000 CN workers had given a midnight (0500 GMT) deadline to reach a deal to replace an agreement that expired in July.   "Unfortunately, we were unable to reach a deal with CN," the Teamsters Canada Rail Conference said in a statement.   "The company remains unwilling to address our member's health and safety issues. As a result, members at CN will be on strike... at 00:01 Eastern Time."

The workers had expressed concerns over long hours and fatigue leading to dangerous working conditions. Wages are not in dispute.   The labour dispute follows layoffs of 1,600 staff in North America announced by CN on Friday.    Employment Minister Patty Hajdu has encouraged both sides to continue the negotiations and reach an agreement.    "We are monitoring the situation closely," she said on Saturday after the Teamsters gave a 72-hour strike notice.
Date: Tue, 19 Nov 2019 09:24:19 +0100 (MET)

Wellington, Nov 19, 2019 (AFP) - The death toll from a measles outbreak raging in the Pacific nation of Samoa has risen to 15, with most of the victims young children, UNICEF said Tuesday.   The UN children's agency said that suspected measles cases had topped 1,000 in the island nation, which has declared a state of emergency and launched a compulsory vaccination programme.   "The epidemic has claimed the lives of 14 children under-five years old and one adult," it said in a statement.   UNICEF said it was in the process of delivering more than 110,000 doses of measles vaccine to Samoa's population of about 200,000.   With the virus sweeping through the South Pacific, the agency said it had also sent vaccines to Tonga and Fiji.

Officials were also helping with preparations for potential outbreaks in Vanuatu, the Solomon Islands, Kiribati, the Cook Islands, the Marshall Islands and Micronesia.   It said Samoa, which is by far the worst affected, had low measles vaccination rates of 28-40 percent.   In Tonga and Fiji, which have vaccination rates of 99 percent and 81 percent respectively, the outbreak is more contained and there have been no fatalities.   Children are the most vulnerable to measles, which typically causes a rash and fever but can also lead to brain damage and death.   Samoa has closed all schools and kindergartens, as well as banning children from public gatherings, in a bid to halt the spread of the virus.    After initially facing criticism for its slow response, the government had opened a national emergency operations centre to roll out mass vaccinations.
Date: Mon, 18 Nov 2019 19:25:45 +0100 (MET)

Srinagar, India, Nov 18, 2019 (AFP) - An avalanche on Monday hit an Indian patrol in the world's highest militarised zone in the Himalayas, killing four soldiers and two porters, an army spokesman said.   The disaster was the latest on the Siachen Glacier at more than 5,000 metres (16,500 feet) that is claimed by India and rival Pakistan.

Hundreds of troops from both sides have died in avalanches and from the fierce climate in the region over the past three decades.   An Indian military spokesman told AFP that the avalanche engulfed eight people in the patrol at the northern end of the glacier in the Karakoram mountain range.   Rescue teams managed to dig the patrol members out of the snow, and they were taken by helicopter to hospital.   "Despite best efforts, six casualties which includes four soldiers and two civilian porters succumbed to extreme hypothermia," said the spokesman, Colonel Rajesh Kalia.

Avalanches are common on the 700-square-kilometre (270-square-mile) glacier, where temperatures regularly fall to minus 60 degrees Celsius (-76 Fahrenheit).   In 2016, 10 Indian soldiers were buried and killed.   About 900 Indian soldiers alone have died on the glacier since 1984, when Indian forces took complete control of Siachen.   The glacier is located at the northern end of the Line of Control that divides Kashmir, which India and Pakistan have fought over since 1947.
Date: Mon, 18 Nov 2019 16:10:29 +0100 (MET)

Vienna, Nov 18, 2019 (AFP) - A man died on Monday in a landslide that destroyed much of his home in southern Austria, which has been hit by heavy rainfall and snow affecting transport and electricity.   The retiree was behind his house in Carinthia state when part of the hill above it slid off, killing the 79-year-old, police said.   Earlier Monday, two women were rescued from the rubble of two houses after another landslide, this one in the spa town of Bad Gastein in Salzburg state.   Salzburg, Tyrol and Carinthia states have all seen heavy rain and snowfall since last week, leading to power cuts in thousands of homes.   Many roads and railway lines have also been cut, and several schools in these areas remained closed on Monday.
Date: Fri, 15 Nov 2019 13:19:27 +0100 (MET)

Karachi, Nov 15, 2019 (AFP) - Lightning strikes killed at least 18 people and injured several more during a deadly night in Pakistan's Thar desert, police said Friday, describing the deaths as "unprecedented".   Thunderstorms and a heavy downpour caused havoc in several villages, destroying dozens of homes, in an unusual rainfall event that a meteorologist says could be linked to climate change.

It was the lightning strikes in 18 different places which had the greatest impact.   "We have so far confirmation of 18 deaths in our district," Abdulah Ahmed, the police chief of the region -- which is located in southern Sindh province and stretches over 22,000 square kilometres (8,500 square miles)-- told AFP.   He said that officers in each village had verified that each death was caused by lightning strike.    In contrast, lightning kills an average of three people each year in the UK, according to the Royal Society for the Prevention of Accidents.

The Thar desert, straddling the Indian border and one of Pakistan's poorest areas, is dependent on monsoon rains.   But such a heavy rainfall in November is "unusual", while "lightning of that intensity is unprecedented," said Dr Syed Sarfraz, a senior meteorological officer in Karachi.   He said the causes were still being investigated but suggested hot air over the desert had met with a cold air mass entering from Iran, fuelling the storms. Climate change could also be playing a role, he added.    Dozens of tents and blankets were dispatched from Karachi in a relief effort for the families who lost their homes in the rain.
Date: Fri, 15 Nov 2019 09:41:09 +0100 (MET)

Phnom Penh, Nov 15, 2019 (AFP) - Cambodia will ban all elephant rides at the country's famed Angkor temple park by early next year, an official said Friday, a rare win for conservationists who have long decried the popular practice as cruel.   The Angkor archaeological complex in northern Siem Reap attracts the bulk of the kingdom's foreign tourists -- which topped six million in 2018 -- and many opt for elephants rides around the ancient temples.

But these rides "will end by the start of 2020", said Long Kosal, a spokesman with the Apsara Authority, which manages the park.   "Using elephants for business is not appropriate anymore," he told AFP, adding that some of the animals were "already old".   So far, five of the 14 working elephants have been transferred to a community forest about 40 kilometres (25 miles) away from the temples.   "They will live out their natural lives there," Kosal said.   The company that owns the elephants will continue to look after them, he added. 

Cambodia has long come under fire from animal rights groups for ubiquitous elephant rides on offer for tourists, also seen in neighbouring Thailand, Vietnam and Laos.    The elephants are broken in during training and rights groups have accused handlers of overworking them.   In 2016, a female elephant died by the roadside after carrying tourists around the Angkor Wat temple complex in severely hot weather.   The animal had been working for around 45 minutes before she collapsed.
Date: Fri, 15 Nov 2019 05:28:34 +0100 (MET)

Bangkok, Nov 15, 2019 (AFP) - A French tourist has died after falling from a waterfall while trying to take a selfie in Thailand, police said Friday.   The accident happened Thursday afternoon on the tropical island of Koh Samui, whose palm-fringed, white-sand beaches are a magnet for both backpackers and high-end tourists.   The 33-year-old man fell from Na Mueang 2 waterfall, the same spot where a Spanish tourist died in a fall in July, Lieutenant Phuvadol Viriyavarangkul of the island's tourist police told AFP.

"It took several hours to retrieve his body because the waterfall is slippery and steep," he said by phone, adding that the spot is roped off and there is a sign warning tourists of the danger.   "His friend said he was trying to take a selfie and then he slipped and fell."   Thailand is largely considered a safe destination for tourists and typically draws more than 35 million visitors each year.    But the industry took a hit in 2018 after a ferry carrying Chinese visitors in the country's south sank last year, killing 47 people.   The accident highlighted lax safety rules in the tourism sector and authorities have been scrambling to restore the country's image since.
Date: Fri, 15 Nov 2019 01:13:41 +0100 (MET)
By Sophie PONS

Dakhla, Western Sahara, Nov 15, 2019 (AFP) - In the heart of disputed Western Sahara, a former garrison town has become an unlikely tourist magnet after kitesurfers discovered the windswept desert coast was perfect for their sport.  In Dakhla, an Atlantic seaport town punctuated with military buildings in Morocco-administered Western Sahara, swarms of kitesurfers now sail in the lagoon daily.y    "Here there is nothing other than sun, wind and waves. We turned the adversity of the elements to our advantage: that's the very principle of kitesurfing," said Rachid Roussafi. 

After an international career in windsurfing and kitesurfing, Roussafi founded the first tourist camp at the lagoon at the start of the 2000s.    "At the time, a single flight a week landed in Dakhla," the 49-year-old Moroccan said.   Today, there are 25 a week, including direct flights to Europe.   "Dakhla has become a world destination for kitesurfing," said Mohamed Cherif, a regional politician.

Tourist numbers have jumped from 25,000 in 2010 to 100,000 today, he said, adding they hoped to reach 200,000 annual visitors.    The former Spanish garrison is booming today with the visitor influx adding to fishing and trade revenue.   Kitesurfing requires pricey gear -- including a board, harness and kite -- and the niche tourism spot attracts well-off visitors of all nationalities.    Peyo Camillade came from France "to extend the summer season", with a week's holiday costing about 1,500 euros ($1,660). 

Only the names of certain sites, like PK 25 (kilometre point 25), ruined forts in the dunes and the imposing and still in-use military buildings in Dakhla, remind tourists of the region's history of conflict.   In the 1970s, Morocco annexed Western Sahara, a former Spanish colony, and fought a war with the Algeria-backed Polisario Front from 1975 to 1991, when a ceasefire deal was agreed.   A United Nations mission was deployed to monitor the truce and prepare a referendum on Western Sahara's independence from Morocco, but it never materialized.   Without waiting for the political compromise that the UN has been negotiating for decades, hotels have sprouted from the sand along the coast, and rows of streetlights on vacant lots announce future subdivisions.

- 'Good communication' -
"The secret to success is to develop kitesurfing with good communication focused on the organisation of non-political events," said Driss Senoussi, head of the Dakhla Attitude hotel group.    Accordingly, the exploits of kitesurfing champions like Brazilian Mikaili Sol and the Cape Verdian Airton Cozzolino were widely shared online during the World Kiteboarding Championships in Dakhla last month.   The competition seemed to hold little interest for Dakhla's inhabitants however.

Only a few young people with nothing to do and strolling families found themselves on the beach for the finals.   Just as rare are the foreign tourists who venture into the town of 100,000 residents to shop.   Like her friends, Alexandra Paterek prefers to stay at her hotel, some 30 kilometres (19 miles) from downtown.    "Here is the best place in the world for learning kitesurfing," said the 31-year-old Polish stewardess.    On her understanding of the broader regional context, she said: "It's an old Spanish colony and they have good seafood, for sure."

Like many tourists, she was under the impression that the area belonged to Morocco, as the destination tends to be marketed in the travel industry as "Dakhla, Morocco".   That angers the Polisario, which wants independence for the disputed region and tried last year in vain to sue businesses it said were "accomplices to the occupying military power."   The independence movement is now focused on challenging commercial deals between Morocco and the European Union that involve Western Sahara, according to the group's French lawyer Gilles Devers.   Moroccan authorities are looking actively for investors for their development projects on the west coast, the most ambitious being the Dakhla Atlantique megaport with a budget of about $1 billion to promote fishing.

- Environmental concerns -
On the lagoon, surrounded by white sand and with its holiday bungalows, "there is a struggle between developing aquaculture and tourism," said a senior regional representative, who spoke on condition of anonymity.    "One has less impact on the environment, but the other generates more revenue and jobs," said the representative, adding that "pressure from real-estate investors is very high."

With the influx of tourists, the protection of the environment has become a major concern.   "Everything is developing so quickly... we need to recycle plastic waste and resolve the issue of wastewater," said Rachid Roussafi.    Daniel Bellocq, a retired French doctor, worries for the future of this lagoon, that was "once so wild" that he has kitesurfed in for 20 years.   "There is green algae that wasn't there before, it's becoming a septic tank," he said.   Regional councillor Cherif, though, insists the bay is clean, saying: "All the hotels are equipped with wastewater management systems."   For him, the real threat is from plastic waste, whether it is dropped by tourists or brought by sea currents.