WORLD NEWS

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

Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Puerto Rico

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: 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.
=====================
[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:
Date: Thu, 19 Oct 2017 16:37:27 +0200
By Ricardo ARDUENGO, con Nelson DEL CASTILLO en San Juan y Leila MACOR en Miami

Utuado, Puerto Rico, Oct 19, 2017 (AFP) - It's been a month since Hurricane Maria ripped through Puerto Rico and Samuel de Jesus still can't drive out of his isolated, blacked-out town.   In fact, much of the US territory in the Caribbean is still a crippled mess four weeks after that fierce Category Four storm.

The bridge connecting Rio Abajo to the rest of the island was swept away when Maria slammed the island on September 20. For two weeks Rio Abajo, located in a mountainous region in central-western Puerto Rico, was cut off and forgotten, without power or phone service.   "We didn't know what to do. We were literally going crazy," said de Jesus, 35.   "Those were difficult, desperate days. We could not find a way out, and the hurricane caused extensive damage," he told AFP.

During the two long weeks following Maria, the 27 families living in Rio Abajo saw their supplies quickly deplete.   De Jesus, who has diabetes, needed to keep his insulin refrigerated. The storm blew away the island's already decrepit power grid, so people resorted to emergency generators.   "But I was running out of gasoline to run the generator," he said.   A helicopter now makes regular deliveries of food, water and medicine because with the bridge washed out, there is no other way in or out of town.

People can't wade across the river because it is contaminated with human waste after a pipe broke when the bridge went.   Some brave souls use a precarious ladder rigged to get across the water, but for most people it is too dangerous.   We need a bridge "to take out our vehicles and leave in case of emergency, or if there is a landslide," he said.   Where the bridge once stood, residents set up a system of ropes, pulleys and buckets to move supplies over the river, which has been contaminated with sewer water since the hurricane.   Over the remains of the bridge locals hung the single-star, red, white and blue flag of Puerto Rico and a sign that reads "the campsite of the forgotten."

- Desperate need for electricity -
Puerto Rico Governor Ricardo Rossello visited the surrounding municipality of Utuado on Wednesday to deliver supplies, but he did not stop in Rio Abajo.   "Utuado is certainly one of the most severely affected municipalities in all of Puerto Rico," Rossello said.   "Our commitment is to give it support and aid during the whole road to recovery."   Eighty-one percent of Puerto Rico remains blacked out one month after Maria struck. Clean water for drinking, cooking and bathing is scarce, too.

Puerto Ricans' main obstacle to getting back to some semblance of normality is the slowness of the Puerto Rico Electric Power Authority in getting the power grid back up and running.   The lack of power has paralyzed a key industry -- pharmaceutical production -- and most businesses including restaurants are closed or operating at great cost through the use of diesel powered generators.

This nightmare comes about a year after the US government established an external fiscal control board for the island after it declared bankruptcy because of 73 billion dollars in debt.   Economist Joaquin Villamil told AFP that damage from Hurricane Maria is estimated at 20 billion dollars -- four times that of Hurricane Georges in 1998, when measured in 2016 dollars.

Villamil said reconstruction money provided by the Federal Emergency Management Agency and from insurance companies will have a positive impact on the island's economy in the second half of fiscal 2018 and in fiscal 2019, but this boost will just be temporary.   "From an economic point of view there is not much net gain," said Villamil, who works for a consulting firm called Estudios Tecnicos.   He said the economy has been shrinking since 2006 and Maria will delay any prospect of recovery.   It will take at least until 2026 to get back to the GDP level of 2006, he added.

Making things worse, people are leaving the island for the mainland US. Forecasts are that the population now at 3.4 million will go down to 3.1 million or even less by 2026, said Villamil.   The government of Florida estimates that since October 3 -- the day a state of emergency to deal with an influx of Puerto Ricans was declared -- more than 36,000 people from the island have poured in.
More ...

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: 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.
Date: Tue, 29 Aug 2017 11:52:52 +0200
By Marielle VITUREAU

Vilnius, Aug 29, 2017 (AFP) - Behind a heavy wooden door next to a Vilnius church, a couple of dozen Lithuanian men are talking about their dependence on alcohol. The moderator is Kestutis Dvareckas, a priest and a decade sober.   The World Health Organization ranks Lithuanians as the world's heaviest drinkers.   WHO estimates published in May pegged average annual consumption at 18.2 litres (4.8 gallons) of pure alcohol per person in 2016, putting the small EU Baltic state ahead of Belarus, Moldova and Russia.   "Drinking on the job had been tolerated on various occasions since the Soviet era. Today, you still see alcohol at baptisms and burials," Father Dvareckas, 37, told AFP.

Rather than being social, drinking on these occasions is often excessive to the point of passing out.   Poor mental health and coping skills play a role, especially among Lithuanian men. WHO statistics from 2014 show that 16.7 percent of them abused alcohol or were dependent on it.    Largely at fault is "Lithuanian pessimism", according to Visvaldas Legkauskas, a psychologist at Vytautas Magnus University in the central city of Kaunas.   "Life isn't too bad here, but we have this character trait and we drown our sorrows in alcohol or we commit suicide," he told AFP.

- Curbing consumption -
Dvareckas says he managed to quit drinking and get his life back thanks to a 12-step programme similar to the one used by Alcoholics Anonymous and the support of friends and family.    Wanting to pass on what he learnt, he created the free programme As Esu ("I am" in Lithuanian) in 2009, whose combination of group meetings, prayer, therapy and work opportunities help alcoholics get back on their feet.    An association created this year forged a network allowing 20 such communities to share resources. Other initiatives such as Alcoholics Anonymous are also afoot.

Burdened by the high social costs of heavy drinking, the government is taking action to curb consumption, including tax hikes and a blanket ban on alcohol advertising.   Fighting alcoholism was among the key campaign promises that gave the Lithuanian Peasants and Greens Union (LPGU) a surprise victory in 2016 elections. Its leader has been organising a booze-free cultural festival in his village for a decade.     Although parliament raised the tax on alcohol in March, consumption did not fall in the eurozone state of nearly three million residents.    Lawmakers then voted by a large margin in June to raise the legal drinking age to 20 from 18 and introduce a blanket ban on alcohol ads next year.    Whether these measures will work is another matter.   "Already back in 1998, Lithuania had adopted a strategy to curb consumption by 25 percent. But the reality is that it went up by 130 percent instead," Health Minister Aurelijus Veryga told AFP.

- Medical care -
For Father Dvareckas, the new legislation is not enough: "Why do I still have to pass the alcohol shelf at stores before reaching the one with dairy products?"   At a local store in the village of Semeliskes, located 20 kilometres (12 miles) from Vilnius, a saleswoman named Ona is sceptical.    "Prices may have gone up, but no one really cares. People will continue to buy as long as they have money, and they'll buy five bottles instead of one to make sure they're stocked," she told AFP.    Many believe that to really be effective, the restrictions affecting sales must be coupled with other forms of help.    Medical treatment of alcoholics is still spotty in Lithuania, where the necessary medication is not paid for by the state, according to the national health insurance fund.    There are only five state-run alcohol rehab centres across Lithuania.    For Veryga, the health minister, it is critical "to ensure equal access to everyone concerned in the various regions".
Date: Thu, 1 Jun 2017 20:28:08 +0200

Vilnius, June 1, 2017 (AFP) - Lithuania on Thursday banned alcohol advertising and raised the legal drinking age to 20 from 18 as part of efforts to curb consumption in one of the world's hardest-drinking nations.    The measures, which also include a ban on alcohol sales between 8pm to 10am, were approved by 101 lawmakers in the 141-seat parliament. Ten MPs were opposed, and another ten abstained.

The blanket ban on alcohol ads, which includes billboards, TV, radio, the printed press and the internet, will come into force on January 1, 2018.    Fighting alcoholism was among the key campaign promises that gave the Lithuanian Peasants and Greens Union (LPGU) a surprise victory in elections last October.   LPGU party chairman Ramunas Karbauskis said the EU nation of some 2.8 million people was taking its cue from several Nordic countries that have strict rules on alcohol sales.   "We need changes so that fewer people become dependent on alcohol and kids are not affected by this industry," Karbauskis said Thursday.

The average Lithuanian over the age of 15 consumed the equivalent of 13.2 litres of pure alcohol last year, the country's statistics agency reported this week, down by nearly a litre per person compared with a year ago.   But Gauden Galea, a senior World Health Organization official, last month pegged average annual consumption at 16 litres per person, making Lithuanians the world's "top" drinkers, according to the Baltic News Service.   Critics said the measures were unlikely to be effective.   "We're preventing adults from buying alcohol and we think that this will solve all social ills. This is a short-sighted approach," said liberal lawmaker Ausrine Armonaite.
Date: Sun 12 Mar 2017
Source: The Baltic Times [edited]
<http://m.baltictimes.com/article/jcms/id/138566/>

An emergency has been declared in Vilnius [Lithuania] after _Legionella_ bacteria were found in the water systems of several apartment buildings in the Lithuanian capital. The Emergency Commission at the Vilnius local authority stated on [Fri 10 Mar 2017] that the situation met the criteria for an emergency, Arvydas Darulis, acting director of the city's administration, told BNS [Baltic News Service].

"We have 2 deaths and a 3rd incident is still under investigation. This affects over 500 people because there are 3 buildings and it takes more than 24 hours to eliminate (the emergency situation). Based on these criteria, an emergency situation has been declared," he said. According to the official, the commission has activated an emergency operations centre to handle the emergency.

The National Public Health Service said that samples from 2 apartment blocks in the Zirmunai neighborhood, at Tuskulenu 5, and Ladygos 3, had tested positive for the bacteria that cause legionnaires' disease and samples from an apartment block in the Lazdynai neighborhood were still being tested. To date, 2 residents of these buildings have died of legionnaires' disease and a 3rd is being treated. [Byline: Donata Motuzaite]
==================
[ProMED-mail thanks Denis Green for his continued contributions. Genotyping clinical and environmental _Legionella_ isolates will help establish transmission pathways: a common source would be presumed for cases that have matching of _Legionella_ genotypes; and a source for these cases with matching genotypes would be confirmed if the clinical genotype matches an environmental genotype.

Vilnius is the capital of Lithuania and its largest city, with a population of 542,664 residents as of 2015
(<https://en.wikipedia.org/wiki/Vilnius>).

Zirmunai, where 2 apartment blocks tested positive for _Legionella_, is Vilnius's most populous administrative division, located north of central Vilnius
(<https://en.wikipedia.org/wiki/ŽirmÅ«nai>).

Lazdynai, where buildings are still being tested, is another neighbourhood located southwest of central Vilnius
(<https://www.google.com/maps/place/Lazdynai,+Vilnius,+Lithuania>). - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at: <http://healthmap.org/promed/p/57955>.]
More ...

Bolivia

Bolivia US Consular Information Sheet
July 19, 2006

COUNTRY DESCRIPTION: Bolivia is a constitutional democracy and one of the least-developed countries in South America. Tourist facilities are generally adequate, but vary greatly in qualit
. The capital is La Paz, accessible by Bolivia's international airport in El Alto. Read the Department of State Background Notes on Bolivia for additional information.

ENTRY/EXIT REQUIREMENTS: A U.S. passport valid for at least six months from the date of proposed entry into Bolivia is required to enter and depart Bolivia. U.S. citizen tourists do not need a visa for a stay of one month or less (that period can be extended up to 90 days upon application to the Bolivian immigration authorities). Visitors for other purposes must obtain a visa in advance. U.S. citizens whose passports are lost or stolen in Bolivia must obtain a replacement passport and present it, together with a police report of the loss or theft, to a Bolivian government immigration office in order to obtain permission to depart. For more information on replacement passport procedures, please consult the U.S. Embassy's Web site at . An exit tax is charged when departing Bolivia by air. Travelers with Bolivian citizenship or residency pay an additional fee upon departure. While the Bolivian Government does not require travelers to purchase round-trip air tickets in order to enter the country, some airlines have required travelers to purchase round-trip tickets prior to boarding aircraft bound for Bolivia. Some tourists arriving by land report that immigration officials did not place entry stamps in their passports, causing problems at checkpoints and upon departure. See our Foreign Entry Requirements brochure for more information on Bolivia and other countries. Visit the Embassy of Bolivia web site at for the most current visa information (please note that the web site is primarily in Spanish).

Bolivian consulates are located in Houston, Los Angeles, Miami, Oklahoma City, New York, San Francisco, and Seattle. For information on in-country visa procedures and requirements, please consult the Bolivian Immigration Service at (please note that the web site is in Spanish), fax/telephone (591-2) 211-0960, street address Avenida Camacho entre Loayza y Bueno, La Paz, Bolivia. See Entry and Exit Requirements for more information pertaining to dual nationality and the international child abduction . Please refer to our Customs Information to learn more about customs regulations.

ADDITIONAL REQUIREMENTS FOR MINORS: In an effort to prevent international child abduction, the Bolivian Government has initiated procedures at entry/exit points. Minors (under 18) who are citizens or residents of Bolivia and who are traveling alone, with one parent or with a third party, must present a copy of their birth certificate and written authorization from the absent parent(s) or legal guardian, specifically granting permission to travel alone, with one parent or with a third party. When a parent is deceased, a notarized copy of the death certificate is required in lieu of the written authorization. If documents are prepared in the United States, the authorization and the birth certificate must be translated into Spanish, notarized, and authenticated by the Bolivian Embassy or a Bolivian consulate within the United States. If documents are prepared in Bolivia, only notarization by a Bolivian notary is required. Using these documents, a t ravel permit may be obtained from the Juzgado del Menor. This requirement does not apply to children who enter the country with a U.S. passport as tourists, unless they hold dual U.S./Bolivian citizenship or have been in Bolivia for more than 90 consecutive days.

SAFETY AND SECURITY: The countrywide emergency number for the police, including highway patrol, is 110. The corresponding number for the fire department is 119. The National Tourism Police has an office in La Paz, with plans to expand to Cochabamba and Santa Cruz, providing free assistance to tourists 24 hours a day. These services include English-speaking officials who may assist tourists in filing police reports of lost/stolen documents or other valuables. The La Paz office is located at Plaza del Stadium, Edificio Olympia, planta baja, Miraflores, telephone number 222-0516.

Protests, strikes, and other civic actions can occur at any time and disrupt transportation on a local and national level. This is particularly true before, during and after elections or other changes in government. While protest actions generally begin peacefully, they have the potential to become violent. The police have used tear gas to break up protests. In addition to rallies and street demonstrations, protesters sometimes block roads; they sometimes react with force when travelers attempt to pass through or go around roadblocks and occasionally have used the threat of explosives to press their point.

U.S. citizens should avoid roadblocks and demonstrations. Demonstrations protesting government or private company policies occur frequently, even in otherwise peaceful times. Roadblocks and demonstrations in June 2005 led to the closure of the El Alto airport in La Paz, resulting in cancellation and diversion of flights and other inconveniences to travelers. U.S. citizens planning travel to or from Bolivia should take into consideration the possibility of disruptions to air service in and out of La Paz and other airports. Americans should monitor Bolivian media reports for updates. The Embassy strongly recommends that U.S. citizens avoid areas where roadblocks or public demonstrations are occurring or planned. Political rallies should similarly be avoided in light of press reports of violence at some rallies in various parts of Bolivia.

U.S. citizens who find themselves in a roadblock should not attempt to "run" a roadblock, as this may aggravate the situation and lead to physical harm. Taking alternative, safe routes, or returning to where the travel started may be the safest courses of action under these circumstances. U.S. citizens embarking on road trips should monitor news reports and may contact the American Citizen Services Unit of the U.S. Embassy in La Paz at (591)(2)(216-8297 or the U.S. consular agencies in Cochabamba at (591)(4)425-6714 and/or Santa Cruz at (591) (3) 351-3477 for updates. Given that roadblocks may occur without warning and have stranded travelers for several days, travelers should take extra food and water. The U.S. Embassy also advises its employees to maintain at least one week's supply of drinking water and canned food in case roadblocks affect supplies, as occurred in June 2005. For more information on emergency preparedness, please consult the Federal Emergency Management Authority (FEMA) Web site at . That Web site includes a Spanish language version.

Americans living or traveling in Bolivia are encouraged to register and update their contact information at the U.S. Embassy in La Paz and/or the U.S. consular agencies in Cochabamba and Santa Cruz, Bolivia. Registration may be done online and in advance of travel. Information on registering may be found at the Department of State's Consular Affairs website .

In February and October 2003, approximately one hundred people died during violent demonstrations and protests in downtown La Paz and the nearby city of El Alto. These demonstrations also affected Cochabamba and other towns and villages in the Altiplano. While the protests and demonstrations subsided, many of the underlying social, political, and economic causes remain, and in March 2005, several intercity roads, including Bolivia's major east-west highway, were closed by blockades for several weeks.

Since 2000 the resort town of Sorata, located seventy miles north of La Paz, has been cut off by blockades on three occasions, ranging from one week to one month. Visitors contemplating travel to Sorata should contact the Consular Section in La Paz prior to travel.

In the Chapare region between Santa Cruz and Cochabamba and the Yungas region northeast of La Paz violence and civil unrest, primarily associated with anti-narcotics activities, periodically create a risk for travelers to those regions.

Confrontations between area residents and government authorities over coca eradication have resulted in the use of tear gas and stronger force by government authorities to quell disturbances. Pro-coca groups have expressed anti-U.S. sentiments and may attempt to target U.S. Government or private interests. U.S. citizen visitors to the Chapare or Yungas regions are encouraged to check with the Consular Section of the U.S. Embassy prior to travel. Violence has also erupted recently between squatters unlawfully invading private land and security forces attempting to remove them.

For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site , where the current Worldwide Caution Public Announcement , Travel Warnings and Public Announcements 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: The U.S. Department of State currently classifies Bolivia as a medium to high crime threat country. Street crime, such as pick pocketing and theft from parked vehicles, occurs with some frequency in Bolivia. Theft of cars and car parts, particularly late-model four-wheel-drive vehicles, is common. Hijacking of vehicles has occurred, and travelers should take appropriate precautions to avoid being victimized. In November 2003, an American citizen was murdered during an attempted carjacking in Santa Cruz.

Bolivian police state that there are currently eight organized criminal groups operating in the La Paz area. The techniques employed by these groups vary, but there are a few major patterns that can be identified.

There have been reports of "false police" -- persons using police uniforms, identification, and even buildings modified to resemble police stations -- intercepting and robbing foreign tourists. Under Bolivian law, police need a warrant from the "fiscal" or prosecutor to detain a suspect. Any searches or seizures must occur at a bona fide police station in the presence of the fiscal. The warrant requirement also applies to suspected drug trafficking cases, although such searches and seizures may occur without a fiscal present. If detained, U.S. citizens should request to see the warrant and demand immediate contact with the nearest U.S. Consular Office (in La Paz, Cochabamba or Santa Cruz).

According to press reports, criminals using the "false police" method focus on foreigners in areas frequented by tourists including bus terminals and tourist markets such as Sagarnaga Street in La Paz. The perpetrators will identify a potential victim and have an accomplice typically driving a white taxi offer taxi services to the potential victim. They focus on European/American tourists who are not wearing a traditional "trekker" backpack and are traveling without a large number of bags. A few blocks after the potential victim boards the taxi another accomplice, pretending to be a recently arrived tourist, boards the taxi with the potential victim. With all the accomplices then in place, the "false police" stop the taxi, "search" the passengers, and rob the victim. As part of this scam, the false police may take the victim to a "false police" station.

A similar variation also introduces a "tourist" to the victims. This introduction can take place on a bus, taxi, train, or just walking down the street. The "tourist" will befriend the victims and might seek assistance in some manner. After a period of time, the "police" intercept the victims and the "tourist." At this point, the "police" discover some sort of contraband (usually drugs) on the "tourist." The entire group is then taken to the "police station." At this point, the "police" seize the documents, credit cards, and ATM cards of the victims. The perpetrators obtain pin numbers, sometimes by threat of violence, and the scam is complete.

Another technique again introduces a "tourist" to the victims. This "tourist" can be any race or gender and will probably be able to speak the language of the victims. This meeting can happen anywhere and the goal of the "tourist" is to build the trust of the victims. Once a certain level of trust is obtained, the "tourist" suggests a particular mode of transportation to a location (usually a taxi). The "taxi" picks up the victims and the "tourist" and delivers the group to a safe house in the area. At this point the victims are informed that they are now kidnapped and are forced to give up their credit cards and ATM cards with pin numbers.

Bolivian police sources state that two Austrian citizens fell victim to this scam and had their bank accounts emptied through use of their ATM card. The perpetrators then suffocated the victims and buried them in clandestine graves, where police found their bodies on April 3, 2006. During that timeframe, a Spanish citizen also purportedly fell prey to this scam, and his body was found nearby.

In most instances, the victims are released, but the murder of the victims is still a possibility. The techniques and the perpetrators are convincing. Authentic uniforms, badges, and props help persuade the victims that the situation is real and valid. All tourists visiting Bolivia should exercise extreme caution. Visitors should be suspicious of all "coincidences" that can happen on a trip. If the tourist has doubts about a situation, the tourist should immediately remove him/herself from the scene.

Thefts of bags, wallets, and backpacks are a problem throughout Bolivia, but especially in the tourist areas of downtown La Paz and the Altiplano. Most thefts involve two or three people who spot a potential victim and wait until the bag or backpack is placed on the ground, often at a restaurant, bus terminal, Internet café, etc. In other cases, the thief places a disagreeable substance on the clothes or backpack of the intended victim, and then offers to assist the victim with the removal of the substance. While the person is distracted, the thief or an accomplice grabs the bag or backpack and flees. In such a situation, the visitor should decline assistance, secure the bag/backpack, and walk briskly from the area. To steal wallets and bags, thieves may spray water on the victim's neck, and while the person is distracted, an accomplice takes the wallet or bag. At times the thief poses as a policeman, and requests that the person accompany him to the police station, using a nearby taxi. The visitor should indicate a desire to contact the U.S. Embassy and not enter the taxi. Under no circumstances should you surrender ATM or credit cards, or release a PIN number. While most thefts do not involve violence, in some instances the victim has been physically harmed and forcibly searched for hidden valuables. Visitors should avoid being alone on the streets, especially at night and in isolated areas.

Five years ago female tourists reported being drugged and raped by a tourist guide in the city of Rurrenabaque in the Beni region. Visitors should be careful when choosing a tour operator and should not accept any type of medication or drugs from unreliable sources. The Embassy has received reports of sexual assaults against female hikers in the Yungas Valley, near the town of Coroico. Visitors to Coroico are advised to avoid hiking alone or in small groups.

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

See our information on Victims of Crime .
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in large cities is adequate for most purposes but of varying quality. Ambulance services are limited-to-non-existent. Medical facilities are generally not adequate to handle serious medical conditions. Pharmacies are located throughout Bolivia, and prescription and over the counter medications are widely available. Western Bolivia, dominated by the Andes and high plains (Altiplano), is largely insect-free. However, altitude sickness (see below) is a major problem. Eastern Bolivia is tropical, and visitors to that area are subject to related illnesses. In March 2005, several cases of yellow fever were reported in the Chapare region. News media periodically report outbreaks of rabies, particularly in the larger cities.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention's hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC's Internet site at . For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at . Further health information for travelers is available at .

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Most medical evacuation flights cannot land at the airport serving La Paz due to the altitude; instead flights may need to use the international airport in Santa Cruz, Bolivia. Please see our information on medical insurance overseas .

HIGH-ALTITUDE HEALTH RISKS: Official U.S. Government travelers to La Paz are provided with the following information: The altitude of La Paz ranges from 10,600 feet to over 13,000 feet (3,400 to 4,000 meters) above sea level. Much of Western Bolivia is at the same altitude or higher, including Lake Titicaca, the Salar de Uyuni, and the cities of Oruro and Potosi. The altitude alone poses a serious risk of illness, hospitalization, and even death, if you have a medical condition that affects blood circulation or breathing.

Prior to departing the U.S. for high-altitude locations (over 10,000 feet above sea level), travelers should discuss the trip with their personal physician and request information on specific recommendations concerning medication and lifestyle tips at high altitudes. Coca-leaf tea is a popular beverage and folk remedy for altitude sickness in Bolivia. Possession of this tea, which is sold in bags in most Bolivian grocery stores, is illegal in the United States.

The State Department's Office of Medical Services does not allow official U.S. Government travelers to visit La Paz if they have any of the following:

Sickle cell anemia or sickle cell trait: 30 percent of persons with sickle cell trait are likely to have a crisis at elevations of more than 8,000 feet.
Heart disease: A man 45 years or older, or a woman 55 years or older, who has two of the following risk factors (hypertension, angina, diabetes, cigarette smoking, or elevated cholesterol) should have a stress EKG and a cardiological evaluation before the trip.
Lung disease: Anyone with asthma and on maximum dosage of medication for daily maintenance, or anyone who has been hospitalized for asthma within the last year should not come to La Paz and surrounding areas.
Given potential complications from altitude sickness, pregnant women should consult their doctor before travel to La Paz and other high-altitude areas of Bolivia.
All people, even healthy and fit persons, will feel symptoms of hypoxia (lack of oxygen) upon arrival at high altitude. Most people will have increased respiration and increased heart rate. Many people will have headaches, difficulty sleeping, lack of appetite, minor gastric and intestinal upsets, and mood changes. Many travelers limit physical activity for the first 36 to 48 hours after arrival and avoid alcohol and smoking for at least one week after arrival.

For additional information, travelers should visit the World Health Organization's website at as well as the CDC's travel warning on high altitude sickness at .

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 Bolivia is provided for general reference only, and may not be totally accurate in a particular location or circumstance. U.S. citizens planning on driving in Bolivia, despite the hazards described below, should obtain an international driver's license through their local automobile club before coming to Bolivia.

Road conditions in Bolivia are hazardous. Although La Paz, Santa Cruz, and Cochabamba are connected by improved highways, the vast majority of roads in Bolivia are unpaved. Few highways have shoulders, fencing or barriers, and highway markings are minimal. Yielding for pedestrians in the cities is not the norm. For trips outside the major cities, especially in mountainous areas, a four-wheel-drive vehicle is highly recommended. Travel during the rainy season (November through March) is difficult, as most routes are potholed, and some roads and bridges are washed out. Added dangers are the absence of formal training for most drivers, poor maintenance and overloaded vehicles, lack of lights on some vehicles at night, and intoxicated or overly tired drivers, including commercial bus and truck drivers.

The majority of intercity travel in Bolivia is by bus, with varying levels of safety and service. In recent years there have been major bus crashes on the highway between La Paz and Oruro, and on the Yungas road. The old Yungas road is considered one of the most dangerous routes in the world. Taxis, vans, and buses dominate intracity transportation. From a crime perspective, public transportation is relatively safe and violent assaults are rare. However, petty theft of unattended backpacks and other personal items does occur. For reasons of safety, visitors are advised to use radio taxis whenever possible.

Drivers of vehicles involved in traffic accidents are expected to remain at the scene until the arrival of local police authorities. Any attempt to leave the scene is in violation of Bolivian law. The Embassy believes any attempt to flee the scene of an accident would place the driver and passengers at greater risk of harm than remaining at the scene until the arrival of local police. Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Bolivia as being in compliance with ICAO international aviation safety standards for oversight of Bolivia's air carrier operations. For more information, travelers may visit the FAA's Internet web site at www.faa.gov/avr/iasa/index.cfm . There are limited flights within Bolivia and to neighboring countries. Flight delays and cancellations are common. In February and March 2006, strikes at national carrier Lloyd Aereo Boliviano led to the cancellation of both national and international flights with resultant delays and other inconveniences for travelers.

SPECIAL CIRCUMSTANCES: In the run-up to the July 2006 Constituent Assembly elections, President Morales accused the United States military of infiltrating Bolivia with operatives disguised as "students and tourists." As an apparent result of these comments, some U.S. citizens have reported harassment by Bolivian officials and been subjected to unwanted media attention. In one case, a local Bolivian newspaper wrongly identified an American citizen as an operative for the Central Intelligence Agency. Americans planning on traveling to Bolivia should be aware of the political atmosphere and the possibility of unwanted attention from pro-governmental groups and other Bolivian officials.

For information on in-country visa procedures and requirements, please consult the Bolivian Immigration Service at (please note that the Web site is in Spanish), fax/telephone (591-2) 211-0960, street address Avenida Camacho entre Loayza y Bueno, La Paz, Bolivia. In emergency cases, the Immigration Service may permit temporary residency applicants to retrieve their passports from those applications. However, under current regulations in such cases the applicant would need to commence the application anew, including paying the corresponding fees. Any U.S. documents, such as birth, marriage, divorce or death certificates, to be presented in Bolivia must first be authenticated in the U.S. at the nearest Bolivian Embassy or consulate. For information on those procedures, please consult the Department of State Office of Authentications web site, www.state.gov/m/a/auth , and the nearest Bolivian Embassy or consulate.

Please see our information on customs regulations .
MARRIAGE: Please see our information on marriage in Bolivia , available on the Embassy's Web site at
MOUNTAIN TREKKING AND CLIMBING SAFETY: U.S. citizens are advised to exercise extreme care when trekking or climbing in Bolivia. Since June 2002, four American citizens have died in falls while mountain climbing in Bolivia. Three of the deaths occurred on Illimani, a 6,402-meter peak located southeast of La Paz. Many popular trekking routes in the Bolivian Andes cross passes as high as 16,000 feet. Trekkers must have adequate clothing and equipment, not always available locally, and should be experienced mountain travelers. It is not prudent to trek alone. Solo trekking is the most significant factor contributing to injuries and robberies. The safest option is to join an organized group and/or use a reputable firm to provide an experienced guide and porter who can communicate in both Spanish and English. If you develop any of the following symptoms while climbing at altitude - severe headache, weakness, vomiting, shortness of breath at rest, cough, chest tightness, unsteadiness - descend to a lower altitude immediately. Trekkers and climbers are strongly encouraged to purchase adequate insurance to cover expenses in case of injury or death.

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 Bolivian laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Bolivia 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 .

It often takes years to reach a decision in Bolivian legal cases, whether involving property disputes, civil, or criminal matters. Depending on the circumstances of the case, the court can order a defendant held in jail for the duration of the case. Prison conditions are primitive, and prisoners are expected to pay for food and lodging. For further information, please see the Annual Human Rights Report for Bolivia at . Lists of local Bolivian attorneys and their specialties are available from the Consular Section of the U.S. Embassy in La Paz and the Consular Agencies in Santa Cruz and Cochabamba, and may also be found on our Web site at .

CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website . Pending U.S. implementation of the Hague Convention on International Adoptions, under Bolivian law U.S. citizens who are not resident in Bolivia are not permitted to adopt Bolivian children./p>

REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Bolivia are encouraged to register with the nearest U.S. Embassy or Consular Agency through the State Department's travel registration website, and to obtain updated information on travel and security within Bolivia. Americans without Internet access may register directly with the nearest U.S. Embassy or Consular Agencies in Cochabamba and Santa Cruz. By registering, American citizens make it easier for the Embassy or Consular Agency to contact them in case of emergency.

The U.S. Embassy is located at 2780 Avenida Arce in La Paz, between calles Cordero and Campos; telephone (591-2) 216-8297 during business hours 8:30 a.m.-5:30 p.m., or (591-2) 216-8000 for after-hours emergencies; fax (591-2) 216-8808; Internet . The U.S. Embassy in La Paz is open for American Citizen Services Monday through Thursday from 1:30PM to 5:00PM and Fridays from 08:30 to12:30 and from 2:00PM to 4:00PM, except U.S. and Bolivian holidays. Questions should be directed to the email address USCit.Services.Bolivia@gmail.com or consularlapaz@state.gov .

There are two consular agencies in Bolivia, which provide limited services to American citizens, but are not authorized to issue passports. Anyone requesting service at one of the consular agencies should call ahead to verify that the service requested would be available on the day you expect to visit the agency.

Santa Cruz: The Consular Agency in Santa Cruz is located at 146 Avenida Roque Aguilera (Tercer Anillo); telephone (591-3) 351-3477, 351-3479, or 351-3480; fax (591-3) 351-3478. The U.S. Consular Agency in Santa Cruz is open to the public Mondays from 09:00 to 12:30 and from 2:00PM to 5:00PM and on Tuesday through Friday from 09:00 to 12:30, except U.S. and Bolivian holidays.

Cochabamba: The Consular Agency in Cochabamba is located at Avenida Oquendo 654, Torres Sofer, room 601; telephone (591-4) 411-6313; fax (591-4) 425 -6714. The U.S. Consular Agency in Cochabamba is open Monday through Friday from 9:00 a.m. - 12:00 noon, excluding U.S. and Bolivian holidays.
* * *
This replaces the Consular Information Sheet dated April 4, 2006 to update Entry/Exit Requirements, Safety and Security, Crime, Marriage, Special Circumstances and web links.

Travel News Headlines WORLD NEWS

Date: Mon 20 May 2019
Source: El Pais [in Spanish, trans. Mod.TY, edited]

Tarija Departmental Health Services (SEDES) reported a new case of hantavirus [infection] in Padcaya municipality. The number of patients with this illness is within what is expected, because this season is when more people acquire the disease. Epidemiological surveillance is continuing in Arce province. The person who acquired this illness is male and is under medical care until his recuperation.

The head of the Epidemiological Unit of SEDES, Claudia Montenegro, stated that the patient is hospitalized in the San Juan de Dios Regional Hospital in Tarija awaiting his recuperation. The physician said that in Bermejo and Padcaya municipalities, the harvest of citrus fruit and sugar cane for production of sugar has begun, so there is a trend for the cases of this illness to increase. This is due to the large number of families that move to the countryside where the rodent (long tail) is present that transmits this disease [virus].

"In contrast to previous seasons, this year [2019], there were positives for this disease in Gran Chaco province, including fatalities," Montenegro commented. "Epidemiological surveillance there is being implemented, as well as in areas such as Padcaya and Bermejo."

The official explained that in these localities, the rodent that transmits the disease [virus] to families is present, and with agricultural activities, [people] move into places where this animal lives, and so new cases of patients with hantavirus [infections] are registered every year.

In order to prevent this illness, it is recommended that rodent control campaigns be done to reduce their populations, openings in houses be sealed, and that residents reduce the possibility for rodents to make nests within a radius of 30 meters [100 ft] around the house, and eliminate items that could attract these animals near the house (food, grain, garbage). Workers should employ protective measures during agricultural tasks and cleaning work.

Initial symptoms include fatigue, fever and muscle pain, especially in the thighs, hips and back. Also, patients may present with headache, dizziness, chills, nausea, vomiting, diarrhea and abdominal pain. [These symptoms may progress rapidly to respiratory difficulty requiring mechanical ventilation (hantavirus cardio pulmonary syndrome). Death can occur. - ProMED Mod.TY]
=====================
[The hantavirus involved in the above cases is not mentioned. Cases of hantavirus infections in Tarija department are not new. Tarija department is endemic for hantaviruses, and cases occur there sporadically. Last year (2018), there were 11 cases. The previouslyreported 2015 cases of hantavirus pulmonary syndrome (HPS) that occurred in Tarija department were confirmed. As noted in the previous comments, earlier cases of hantavirus pulmonary syndrome have been reported from tropical, lowland areas of Bolivia, including 7 cases in Tarija during 2014. The specific hantaviruses involved in these or previous cases in Bolivia were not given.

In the lowland Amazon Basin of Bolivia, the rodent hosts of the hantavirus that might be involved in these hantavirus pulmonary syndrome (HPS) cases, with their images, include the following: - Laguna Negra virus (_Calomys laucha_ <http://www.faunaparaguay.com/images/Calomys%20laucha%20enciso%2031aug2011.jpg> and _C. callosus_ <https://eee.uci.edu/clients/bjbecker/PlaguesandPeople/Calomyscallosusb.jpg>); - Bermejo (Chaco rice rat _Oligoryzomys chacoensis_ <http://www.faunaparaguay.com/oligorizomyschacoensis.html>); and - Oran (_O. longicaudatus_ <http://calphotos.berkeley.edu/imgs/512x768/0000_0000/0711/1203.jpeg>).

Since previous cases in Tarija department have occurred in Bermejo, perhaps Bermejo hantavirus was involved.

Dr. Jan Clement commented that there is a need to be able to differentiate Seoul (SEOV) as a causative agent, but that is hampered by the fact that most current commercial ELISA or WB formats do not contain (anymore) a SEOV antigen, so that a preliminary presumption of a hantavirus infection can even be missed in non-research laboratories (ibidem, and: Reynes J-M, Carli D, Bour J-B, Boudjeltia S, Dewilde A, Gerbier G, et al. Seoul virus infection in humans, France, 2014-2016. Emerg Infect Dis. 2017;23:973-7;  <https://wwwnc.cdc.gov/eid/article/23/6/16-0927_article>.

SEOV is widely distributed around the world in the brown rat and is likely found in Tarija department. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Tarija, Tarija, Bolivia: <http://healthmap.org/promed/p/12643>]
Date: Mon 29 Apr 2019
Source: El Deber [in Spanish, trans., ProMED Mod.TY, edited]
<https://www.eldeber.com.bo/santacruz/Reportan-un-caso-de-hantavirus-en-Postrervalle-20190428-9511.html>

A suspected case of [a] hantavirus [infection] in Postrervalle last week mobilized personnel of the medical centre of this municipality and the Office of Health of Vallegrande. The ill individual, a 17 year old, who works as a cowboy in the Mosqueras area, went to the [health] center, presenting with symptoms of [a] hantavirus [infection]. He was taken to Vallegrande where a corresponding chart was initiated and related tests were done that confirmed the 1st case of [a] hantavirus [infection] in the area. Due to the seriousness of the case, on [Fri 26 Apr 2019] the patient was transferred to Santa Cruz where he received treatment. It is believed that the patient was infected when he was in a rural property in Moroco, close to Mosqueras.

The Moroco - Mosqueras area is forested with high humidity due to the constant rains. There are several cattle ranches in the area. Rodrigo García, Chief of Health in Vallegrande, stated that they went immediately to the areas and established an [epidemiological] focal blockade and began to train people about management of the disease. Today [Mon 29 Apr 2019] a new team went into the place in order to verify the presence of long-tail rats that transmit the virus. A hantavirus outbreak was reported recently in [nearby] Tarija [department]. [Byline: Juan Carlos Aguilar F.]
========================
[The condition of the patient is reported as serious, prompting his transfer to Santa Cruz city where more advanced facilities are available. The seriousness of the case suggests that he may have developed hantavirus cardiopulmonary syndrome although no mention is made of the use of mechanical ventilation. The hantavirus involved in this case is not specified. The Moroco - Mosqueras area is an inter-Andean valley.

The report above indicates that it is forested area but the presence of cattle ranches indicates that extensive open areas of pasture must be present as well; making it difficult to determine which of several hantaviruses may be involved. Andes hantavirus has not been reported present in Bolivia.

In the lowland Amazon Basin of Bolivia, the rodent hosts of the hantavirus that might be involved in these cases, with their images, include the following:
- Laguna Negra virus (_Calomys laucha_ <http://www.faunaparaguay.com/images/Calomys%20laucha%20enciso%2031aug2011.jpg>
and _C. callosus_ <http://www.faunaparaguay.com/calomyscallosus.html>);
- Bermejo (Chaco rice rat _Oligoryzomys chacoensis_ <http://www.faunaparaguay.com/oligorizomyschacoensis.html>); and
- Oran (_O. longicaudatus_ <http://calphotos.berkeley.edu/imgs/512x768/0000_0000/0711/1203.jpeg>).

As Dr. Jan Clement pointed out previously, a battery of hantavirus diagnostic agents, including SEOV antigens is required to reach a definitive diagnosis. - ProMED Mod.TY]

[HealthMap/ProMED map available at: Bolivia: <http://healthmap.org/promed/p/5>]
Date: Thu 4 Apr 2019
Source: EJU TV [in Spanish, trans. Mod.TY, edited]

An 18-year-old young man died due to a hantavirus [infection], regional chief of Epidemiological Surveillance Ruben Castillo stated on Thursday [4 Apr 2019].  "We have registered on week 13 the death of a patient, an 18-year-old young man. Regrettably, this would be the 1st fatal hantavirus [infection] case notified for this year [2019]," he told the reporters, without giving the name of the victim.

According to Castillo, the patient went to a government health centre in the Villa Tunari municipality with symptoms of a febrile situation, apparently in a terminal state. He said that the preliminary information about the case determined that the youth had experienced a health problem for nearly a month. Also, he mentioned that the central Cochabamba department registered 7 laboratory-confirmed cases of hantavirus [infections]. "Of these, the 7 have emerged without any problems. Many had acquired the disease in their 'chaco' [the area around their village], as they call it, while working in an endemic area," he said.

The authority stated that the register of hantavirus [infection] cases in the Cochabamba tropics is related to an outbreak "that has us worried," so preventive tasks are being done for control.
=========================
[Unfortunately, the specific circumstances under which this youth or the previous 2019 cases acquired their infections is not mentioned. Presumably they were in contact with excreta from infected rodent hosts. Infected rodents shed the virus in faeces, urine, and saliva. Sporadic cases of hantavirus pulmonary syndrome occur in the Bolivian tropics, including Cochabamba department. The specific hantavirus involved in these or previous cases in 2013 or those in 2012, in Bolivia, is not given. In the lowland Amazon basin of Bolivia, the hantaviruses that are likely to be in tropical Cochabamba department that might be involved in these hantavirus pulmonary syndrome cases are Laguna Negra viruses with its rodent hosts, _Calomys laucha_, the small vesper mouse (<https://www.flickr.com/photos/cdtimm/4367939127/in/photolist-otqNuS-EwTizo-7DYQ8i-278Fjfq-owyXyD-osEZQs>), and _C. callosus_, the large vesper mouse (<http://www.faunaparaguay.com/calomyscallosus.html>), and Rio Mamore virus with _C. laucha_ and _Oligoryzomys microtis_, the small-eared pygmy rice rat (<https://www.reservacostanera.com.ar/wp-content/uploads/2011/02/colilargo-menor-oligoryzomys-flavescens2-JGV-e1298896507790.jpg>). - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Cochabamba, Bolivia: <http://healthmap.org/promed/p/55162>]
Date: Mon, 4 Feb 2019 21:12:01 +0100

La Paz, Feb 4, 2019 (AFP) - Two landslides in Bolivia left 14 people dead and seven missing, national police chief Romulo Delgado said on Monday.   Torrential rain caused the landslides on Saturday and Sunday on the road linking the capital La Paz to the northern town of Caranavi, the gateway to the Amazon rainforest.   President Evo Morales said on his Twitter account that helicopters were being used to transport 34 people who were injured to ocal hospitals.   He also posted pictures of himself at the scene alongside rescue teams.

Morales advised people to stay clear of the area and said humanitarian flights would be organized for emergency cases.   Saturday's landslide left 13 people dead, Delgado told the Panamericana private radio station, with Sunday's killing one person.   Pupils were due to return from their holidays on Monday but the local education authority in Caranavi postponed the start of the new school year by a week.   Bolivia's rainy season generally lasts from November to March with January and February often the wettest months.
Date: Wed, 2 Jan 2019 22:17:29 +0100

La Paz, Jan 2, 2019 (AFP) - Public sector doctors in Bolivia announced a 48-hour strike on Wednesday in response to a government move to make healthcare free for all.   "Our goal is to register 5.8 million people in Bolivia," said Adolfo Zarate, the program's spokesman, in a statement sent to AFP.   Doctors working in public hospitals responded by announcing they would down tools on Thursday and Friday.   According to the health ministry, some 5.8 million of Bolivia's 11 million population do not have health insurance but will be given access to free services once the registration period is completed in the next three months.

Diseases and illnesses covered by the universal healthcare system will include Parkinson's, child cancer, diabetes, pneumonia, flu and dental problems.   The health ministry said the program will have a budget of around 1.6 million bolivianos (about $230 million) but Erwin Viruez, president of Bolivia's professional medical college, said that won't be enough.   "We're going to need one billion dollars, at least, but this won't be enough to guarantee universal health care," he said.   "We don't have any supplies, there aren't enough beds."   President Evo Morales has called on striking doctors to engage in dialogue.
More ...

Dominican Republic

Dominican Republic US Consular Information Sheet
March 13, 2008
COUNTRY DESCRIPTION: The Dominican Republic covers the eastern two-thirds of the Caribbean island of Hispaniola. The capital city is Santo Domingo, located on the south coast of th
island. Tourist facilities vary according to price and location. Spanish is the official language. Though English is widely spoken in major cities and tourist areas, it is much less common outside these areas. Read the Department of State Background Notes on the Dominican Republic for additional information.

ENTRY/EXIT REQUIREMENTS: All Americans traveling by air outside of the United States are required to present a passport or other valid travel document to enter or re-enter the United States. This requirement will be extended to sea travel (except closed loop cruises), including ferry service, by the summer of 2009. Until then, U.S. citizens traveling by sea must have government-issued photo identification and a document showing their U.S. citizenship (for example, a birth certificate or certificate of nationalization), or other WHTI compliant document such as a passport card for entry or re-entry to the U.S. Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.

Applications for the new U.S. Passport Card are now being accepted. We expect cards will be available and mailed to applicants in spring 2008. The card may not be used to travel by air and is available only to U.S. citizens. Further information is available on our U.S. Passport Card page at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html. We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel. American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

For information concerning entry and exit requirements, travelers may contact the Embassy of the Dominican Republic at 1715 22nd Street NW, Washington, DC 20008, tel. (202) 332-6280. There are also Dominican consulates in Boston, Chicago (Northfield, IL), Mayaguez, Miami, New Orleans, New York, and San Juan. Visit the Embassy of the Dominican Republic web site at http://www.domrep.org for the most current visa information.

Visas: Visitors who do not obtain a Dominican visa prior to entry must purchase a tourist card upon arrival to enter the country. Tourist cards cost ten U.S. dollars, which must be paid in U.S. currency. Tourist cards may be purchased at the Dominican Embassy in Washington or Dominican Consulates prior to arrival, as well as at Dominican airports at the time of entry. Tourist cards normally permit a legal stay of up to 60 days. Visitors who would like to extend their time in the Dominican Republic should visit the Migration Department in Santo Domingo and request an extension. Failure to request an extension will subject the visitor to a surcharge at the airport upon departure.

Travel of children and EXIT requirements: Strict exit requirements apply to minors under 18 years of age (of any nationality) who are residents in the Dominican Republic. Such children traveling alone, without one parent, or with anyone other than the parent(s), must present written authorization from a parent or legal guardian. This authorization must be in Spanish, and it must be notarized at a Dominican consulate in the United States or notarized and then certified at the Dominican Attorney General’s office (Procuraduria de la Republica) if done in the Dominican Republic. Though not a requirement for non-resident minors (in the Dominican Republic), the U.S. Embassy recommends that any minor traveling to the Dominican Republic without one or both parents have a notarized document from the parent(s). In addition to clarifying the reason for travel, this will facilitate departure from the Dominican Republic.

The specific guidelines on the Dominican regulations governing the travel of children in the Dominican Republic can be found (in Spanish) at http://www.migracion.gov.do.

Visit the Embassy of the Dominican Republic web site at http://www.domrep.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:
American citizens should be aware that foreign tourists are often considered attractive targets for criminal activity, and should maintain a low profile to avoid becoming victims of violence or crime. In dealing with local police, U.S. citizens should be aware that the standard of professionalism might vary. Police attempts to solicit bribes have been reported, as have incidents of police using excessive force.

Protests, demonstrations, and general strikes occur periodically. Previous political demonstrations have sometimes turned violent, with participants rioting and erecting roadblocks, and police sometimes using deadly force in response. Political demonstrations do not generally occur in areas frequented by tourists and are generally not targeted at foreigners. However, it is advisable to exercise caution when traveling throughout the country. Street crowds should be avoided. In urban areas, travel should be conducted on main routes whenever possible. Power outages occur frequently throughout the Dominican Republic, and travelers should remain alert during blackout periods, as crime rates often increase during these outages.

U.S. citizens considering overland travel between the Dominican Republic and Haiti should first consult the Country Specific Information Sheet for Haiti as well as the Internet site of the U.S. Embassy in Port-au-Prince for information about travel conditions in Haiti. Santo Domingo and the majority of tourist destinations within the Dominican Republic are located several hours from the Haitian border, and recent events in Haiti have generally not directly affected these areas.

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

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

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

CRIME: Crime continues to be a problem throughout the Dominican Republic. Street crime and petty theft involving U.S. tourists does occur, and precautions should be taken to avoid becoming a target. While pick pocketing and mugging are the most common crimes against tourists, reports of violence against both foreigners and locals are growing. Criminals can be dangerous and visitors walking the streets should always be aware of their surroundings. Valuables left unattended in parked automobiles, on beaches and in other public places are vulnerable to theft, and reports of car theft have increased. Cellular telephones should be carried in a pocket rather than on a belt or in a purse. One common method of street robbery is for at least one person on a moped (often coasting with the engine turned off so as not to draw attention) to approach a pedestrian, grab his or her cell phone, purse or backpack, and then speed away. This type of robbery is particularly dangerous because the motorcyclist reaches the intended victim at 15–20 miles per hour and often knocks the victim to the ground.

Many criminals have weapons and are likely to use them if they meet resistance. Be wary of strangers, especially those who seek you out at celebrations or nightspots. Traveling and moving about in a group is advisable. The dangers present in the Dominican Republic, even in resort areas, are similar to those of many major U.S. cities. Expensive jewelry attracts attention and could prompt a robbery attempt. Limiting the cash and credit cards carried on your person and storing valuables, wallet items, and passports in a safe place is recommended.

Burglaries of private residences continue to be reported as well as crimes of violence. Criminals may also misrepresent themselves in an effort to gain access to your residence or hotel room. In one 2005 homicide, a U.S. citizen was murdered by two men who posed as repairmen to gain access to the apartment. In another, the Dominican police arrested the building’s actual maintenance man and an accomplice for the crime.

The U.S. Embassy continues to receive reports from Americans who have been stopped while driving and asked for “donations” by someone who may appear to be a police officer before they would be allowed to continue on their way. Usually, the person(s) stopping the American drivers had approached from behind on a motorcycle; several of these motorcyclists pulled up alongside the driver's window and indicated that they were carrying a firearm. In some cases, the perpetrators were dressed in the light green uniform of “AMET,” the Dominican traffic police; however, they often seemed too young to be police officers or wore ill-fitting uniforms that might have been stolen. In another incident, individuals dressed in military fatigues told the victim they were police and requested the victim to follow them to the police station prior to robbing him. Such incidents should be reported to the police and the Consular Section. If Dominican police stop an American driver for a traffic violation, the driver should request a traffic ticket rather than paying an on-the-spot fine. The driver also has the right to ask police for identification. New regulations require police to wear a nametag with their last name. While everyone driving in the Dominican Republic should abide by traffic laws and the instructions of legitimate authorities, Americans finding themselves in the aforementioned scenarios should exercise caution. In general, drivers should keep their doors locked and windows closed at all times and leave themselves an escape route when stopping in traffic in the event of an accident or other threat. Incidents involving police may be reported to the Internal Affairs Department of the National Police at 809 688-1777 or 809 688-0777.

In 2006, the U.S. Embassy received reports of Americans and others who were victims of vehicular-armed robberies in the northern provinces of the Dominican Republic. At least three of the reports indicate the victims were intercepted during the morning hours, when there was little other traffic, while driving on rural highways connecting Santiago and Puerto Plata. Drivers should exercise extreme caution when driving at night and use major highways when possible.

Although kidnappings are not common in the Dominican Republic, in 2007, two American citizens were kidnapped and held for ransom, in separate instances.

Many public transportation vehicles are unsafe, especially the route taxis or “carros publicos” in urban areas. These are privately owned vehicles that run along certain routes, can take up to six or more passengers, and are inexpensive. Passengers in “carros publicos” are frequently the victims of pick pocketing, and passengers have on occasion been robbed by “carro publico” drivers. Urban buses (“guaguas”) are only marginally better. The U.S. Embassy is also aware of at least one incident in which the driver of a “motoconcho” (motorcycle taxi) robbed an American passenger. The U.S. Embassy cautions its staff not to use these modes of transportation. As an alternative, some scheduled interurban bus services use modern buses and run on reliable timetables. These are generally the safest means of intercity travel. With respect to taxis, visitors to the Dominican Republic are strongly advised to take only hotel taxis or taxis operated by services whose cabs are arranged in advance by phone and can subsequently be identified and tracked.

Credit card fraud is common and recent reports indicate that its incidence has increased significantly. The U.S. Embassy strongly advises Americans to restrict severely the use of credit/debit cards in the Dominican Republic. The increase in credit card fraud is particularly pronounced in the eastern resort areas of the Dominican Republic. According to reports, store workers, restaurant service staff and hotel employees may conceal devices that can instantly record the credit card information. Often, this device appears to be a normal card reader used by businesses. Credit or debit cards should be carefully protected and never allowed out of the owner’s sight. Stolen cards are often used to the maximum amount before the victims are able to contact the bank. Victims of credit card fraud should contact the bank that issued the credit card immediately. It is advisable to pay close attention to credit card bills following time spent in the Dominican Republic. There have been reports of fraudulent charges appearing months after card usage in the Dominican Republic.

Automated Teller Machines (ATMs) are present throughout Santo Domingo and other major cities. However, as with credit cards, the use of ATMs should be minimized as a means of avoiding theft or misuse. One local ATM fraud scheme involves sticking photographic film or pieces of paper in the card feeder of the ATM so that an inserted card becomes jammed. Once the card owner has concluded the card is irretrievable, the thieves extract both the jamming material and the card, which they then use. There are other ATM scams as well. Exercise caution and be aware of your surroundings when using an ATM card.

The overall level of crime tends to rise during the Christmas season, and visitors to the Dominican Republic should take extra precautions when visiting the country between November and January.

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

Beaches and Resorts: The Embassy occasionally receives reports of individuals who have become victims of crime, and particularly sexual assault, while at the beach. Vigilance is recommended. The numerous “all-inclusive” resorts serve abundant quantities of alcohol, a practice that encourages inattention and may be a factor in crime or sexual assault.

Tourist Police: The Dominican Republic does have police that are specially trained to assist tourists who require assistance. This public institution is called Politur and represents a cooperative effort between the National Police, Secretary of the Armed Forces, and the Secretary of Tourism. Politur typically has personnel in tourist areas to provide first responder type assistance to tourists. If you are the victim of a crime, Politur can help you get to a police station so that you may file a police report and seek further assistance. For more information on Politur and contact information, use the following link: http://www.politur.gov.do/. Politur is located at the corner of 30 de Marzo and Mexico, Bloque D, Governmental Building, Santo Domingo. The general phone number is 809-686-8639.

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 system and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is limited, especially outside Santo Domingo, and the quality of care varies widely among facilities. There is an emergency 911 service within Santo Domingo, but its reliability is questionable. Outside the capital, emergency services range from extremely limited to nonexistent. Blood supplies at both public and private hospitals are often limited, and not all facilities have blood on hand even for emergencies. Many medical facilities throughout the country do not have staff members who speak or understand English. A private nationwide ambulance service, ProMed, operates in Santo Domingo, Santiago, Puerto Plata and La Romana; Telephone number is 809-548-7200. ProMed expects full payment at the time of transport. The U.S. Embassy maintains a non-comprehensive list of providers of medical care in the Dominican Republic, which can be found at the following link: http://www.usemb.gov.do/Consular/ACS/medical_assistance-e.htm.

Tap water is unsafe to drink and should be avoided. Bottled water and beverages are safe.
Dengue: Dengue is endemic to the Dominican Republic. To reduce the risk of contracting dengue, the U.S. Center for Disease Control (CDC) recommends wearing clothing that exposes as little skin as possible and applying a repellent containing the insecticide DEET (concentration 30 to 35 percent) or Picaridin (concentration 20 percent or greater for tropical travelers). Because of the increased risk of dengue fever and the ongoing risk of malaria in the Dominican Republic (see below), practicing preventative measures is recommended by the CDC. For further information on dengue fever, please visit the CDC web site at http://www.cdc.gov/ncidod/dvbid/dengue.

Malaria: There are occasional reports of cases of malaria in areas frequented by U.S. and European tourists including La Altagracia Province, the easternmost province in which many beach resorts are located. Malaria risk is significantly higher for travelers who go on some of the excursions to the countryside offered by many resorts. Prior to coming to the Dominican Republic, travelers should consult the CDC web site at http://www.cdc.gov/malaria/index.htm for more information and recommendations on malarial prophylaxis.

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.

The U.S. Embassy in Santo Domingo and the CDC are aware of several cases in which U.S. citizens experienced serious complications or died following elective (cosmetic) surgery in the Dominican Republic. The CDC’s web site at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5323a4.htm contains a report on patients who suffered postoperative infections following cosmetic surgery in the Dominican Republic. Patients considering travel to the Dominican Republic for cosmetic surgery may also wish to contact the Dominican Society of Plastic Surgeons (tel. 809-688-8451) to verify the training, qualifications, and reputation of specific doctors.

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. Americans traveling in the Dominican Republic should be aware that Dominican hospitals often require payment at the time of service and may take legal measures to prevent patients from departing the country prior to payment. Please see our information on medical insurance overseas.

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

Traffic in the Dominican Republic moves on the right side of the road. Speed limits vary from 25 mph in the city to 50 mph on rural roads, but they are generally not enforced. Drivers are required to carry liability insurance.

If you do drive in the Dominican Republic, you should be aware that the utmost caution and defensive driving are necessary. Traffic laws are similar to those in the United States, but undisciplined driving is common, due to a lack of adequate traffic controls. Many drivers will not use turn indicators. Rather, it is common for a vehicle operator to stick his hand out the window to signal a turn. Drivers can also be aggressive and erratic, often failing to yield the right-of-way even when road signs or signals indicate that they should. Travel at night on intercity highways and in rural areas should be avoided, due to animals on the road, poor road conditions, and other vehicles being driven at excessive speeds, often with malfunctioning headlights or taillights. Blackouts also increase the danger of night travel. Turning right on red lights is permitted, but should be done with caution.

Traffic accidents often result in serious injury or death. This is often the case when heavy vehicles, such as buses or trucks, are involved. Traditionally, vehicles involved in accidents in the Dominican Republic are not moved (even to clear traffic), until authorized by a police officer. Drivers who violate this norm may be held legally liable for the accident.

Dominican law requires that a driver be taken into custody for driving under the influence or being involved in an accident that causes serious injury or death, even if the driver is insured and appears not to have been at fault. The minimum detention period is 48 hours; however, detentions frequently last until a judicial decision is reached (often weeks or months), or until a waiver is signed by the injured party (usually as the result of a cash settlement).

Visitors to the Dominican Republic might want to consider hiring a professional driver during their stay in lieu of driving themselves. Licensed drivers who are familiar with local roads can be hired through local car rental agencies. In case of accidents, only the driver will be taken into custody.

Pedestrians tend to step out into traffic without regard to corners, crosswalks, or traffic signals. Many pedestrians die every year crossing the street (including major, multi-lane highways) at seemingly random locations. Pedestrians do not have the right-of-way, and walking along or crossing busy streets – even at intersections with traffic lights or traffic police present – can be very dangerous.

Seat belts are required by law, and those caught not wearing them will be fined. There are no child car seat laws. The law also requires the use of hands-free cellular devices while driving. Police stop drivers using cell phones without the benefit of these devices. Penalties for those driving under the influence and those involved in accidents resulting in injury or death can be severe.

Motorcycles and motor scooters are common in the Dominican Republic, and they are often driven erratically. Dominican law requires that motorcyclists wear helmets, but local authorities rarely enforce this law. As noted previously in this report, public transportation vehicles such as the route taxis (“carros publicos”) and urban buses (“guaguas”) are unsafe.

Please see the Crime section of this information sheet for more information regarding crimes involving road safety.

Please refer to our Road Safety page for more information.

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

SPECIAL CIRCUMSTANCES:
Currency Regulations: It is legal to exchange currency at commercial banks, exchange booths in hotels and exchange houses. The exchange rate is set by the Central Bank, based on prevailing market conditions. The market determines the exchange rate. No more than USD $10,000 or its equivalent in another currency, including Dominican pesos, may be taken out of the Dominican Republic at the time of departure.

Real Estate: Real estate investments require a high level of caution, as property rights are irregularly enforced. Investors often encounter problems in receiving clear title to land, and title insurance is not available. Real estate investments by U.S. citizens have been the subject of both legal and physical takeover attempts. Absentee landlords and absentee owners of undeveloped land are particularly vulnerable. Investors should seek solid property title and not just a “carta de constancia,” which is often confused by foreigners with a title. An official land registry measurement (also known as 'deslinde' or 'mensura catastral') is also desirable for the cautious overseas investor. Squatters, sometimes supported by governmental or non-governmental organizations, have invaded properties belonging to U.S. citizens, threatening violence and blocking the owners from entering their property. In at least one instance, the U.S. citizen landowner was physically assaulted. Several U.S. citizens with long-standing expropriation disputes with the Dominican Government have not received compensation.

Gambling: Many Americans have reported losing large amounts of money at Dominican casinos by playing a game (or variations thereof) known as “Super Keno,” “Caribbean Keno,” “Progressive Keno,” or “Progressive Roulette.” Players have complained that the game’s rules are unclear and/or misleading. Any complaints arising from a casino should be directed to the Office of Casinos at the Secretary of Finance. To register a complaint with this office, call 809-687-5131, ext. 2120.

Divorce: In recent years, there have been a number of businesses, primarily on the Internet, which advertise “Quickie Dominican Divorces.” The services of these businesses should be used with caution, as they may misrepresent the process of obtaining a divorce in the Dominican Republic. While it is relatively simple for foreigners to obtain a divorce in the Dominican Republic, such divorces are only valid if specific steps are taken. Those seeking information regarding divorce should first consult with an attorney in their home state. Additional information is available via the U.S. Embassy's flyer on Divorce in the Dominican Republic at http://www.usemb.gov.do/Consular/ACS/divorce_DR-e.htm.

Alien Smuggling: Dominican authorities may prosecute anyone arrested for organizing the smuggling of aliens into or out of the Dominican Republic. This is in addition to any charges individuals may face in the other country involved, including the United States.

Hurricanes: The Dominican Republic is situated in an area of the Caribbean prone to hurricanes. In the event of a hurricane alert, a notice will be posted on the U.S. Embassy in Santo Domingo's web page at http://www.usemb.gov.do/index.htm. Further information can be obtained by visiting the National Weather Service's web site at http://www.nhc.noaa.gov. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency at http://www.fema.gov.

Water Sports: Visitors to the Dominican Republic, including to local resort areas, should carefully assess the potential risk of recreational activities. Some of the swimming areas at popular beaches around the Dominican Republic are subject to dangerous undertows. Many beaches lack life guards and/or warnings of unsafe conditions. Resort managers usually offer current information on local swimming & surf conditions. Americans are cautioned not to swim alone, particularly at isolated beaches.

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 Dominican laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the Dominican Republic are severe, and convicted offenders can expect long jail sentences and heavy fines. For more information on the Dominican judicial system, procedures, and penalties, please visit the Consular Section’s web page at http://www.usemb.gov.do. 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 on international adoption of children and international parental child abduction, see the Office of Children’s Issues web pages. The Dominican Republic is a party to the Hague Convention on the Civil Aspects of International Child Abduction. The United States formally accepted the accession of the Dominican Republic on June 1, 2007.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the Dominican Republic are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within the Dominican Republic. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The Consular Section of the U.S. Embassy is located at the corner of Calle César Nicolás Penson and Avenida Máximo Gómez. The American Citizens Services (ACS) Unit can be reached by telephone at 809-731-4294, or via email at acssantodom@state.gov. ACS Unit office hours are 7:30 a.m. to 4:30 p.m., Monday through Thursday, Friday 7:30-12:15, except on U.S. and Dominican holidays. The Chancery of the U.S. Embassy is located a half-mile away from the Consular Section, at the corner of Calle César Nicolás Penson and Calle Leopoldo Navarro. The telephone number is 809-221-2171.

There is a Consular Agency in the north coast city of Puerto Plata at Calle Villanueva esq. Avenida John F. Kennedy, Edificio Abraxa Libraria, 2nd floor, telephone 809-586-4204, 809-586-8017, 809-586-8023; office hours are 9:00 a.m. to 12:00 p.m., and 2:30 p.m. to 5:00 p.m., Monday through Friday, except holidays.
* * *
This replaces the Country Specific Information dated May 09, 2007 to update Safety and Security, Crime, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: 6 Jun 2019
Source: Washington Post [edited]

Dominican government officials released more-detailed autopsy results on Thursday [6 Jun 2019] for 3 American tourists who died at adjacent beach resorts owned by the same hotel company during the last week of May 2019.

All 3 victims experienced eerily similar symptoms and internal trauma before their deaths, according to a news release from Dominican authorities. Pathologists said autopsies showed the 3 had internal haemorrhaging, pulmonary oedema, and enlarged hearts.

Toxicology reports are pending [These are likely to be the most interesting. - ProMED Mod.TG].

A U.S. State Department official said authorities have not yet established a connection between the 30 May 2019 deaths of 49-year-old CAD, and 63-year-old NEH, both of Prince George's County, MD, and the death on 25 May 2019 of 41-year-old MSW of Pennsylvania.

The FBI is providing Dominican law enforcement with "technical assistance with the toxicology reports," the State Department official said.

MSW had just checked into the Luxury Bahia Principe Bouganville, in the town of San Pedro de Macoris, and was taking pictures from her room balcony when she started to feel ill.

Less than 2 hours later, she was dead, local authorities said.

The bodies of CAD and HEH were found inside their room at the Grand Bahia Principe La Romana after relatives grew concerned because they had not checked out of the resort.

The hotels are located next to each other on the island's southern coast, about 60 miles from the tourist-heavy Punta Cana area.

Dominican authorities initially did not run toxicology tests for MSW because there were no signs of violence, said Ramon Brito, a spokesman for the National Police's special tourism unit. After the Maryland couple was found, investigators ordered a set of tests to determine whether anything the 3 Americans consumed may have led to their deaths, Brito said.  [Byline: Arelis R. Hernandez]
Dominican Republic
18 Mar 2019

(Probable and conf.) 624 cases. Municipalities most affected: Santo Domingo Este, Santo Domingo de Guzman, Barahona, and Santo Domingo Norte.
Date: Mon 31 Dec 2018
Source: Outbreak News [edited]

A 5-year-old boy died Saturday [29 Dec 2018] in a Santo Domingo hospital from rabies, the 4th such case of the year [2018] in the Dominican Republic, according to an El Comercio report (computer translated).

The child, who entered the Robert Reid Cabral Children's Hospital 10 days ago, remained in an induced coma, and yesterday his condition began to worsen, presenting respiratory, cerebral, and cardiac failures, according to a hospital spokesman.

The boy was bitten by a dog on 19 Nov 2018 in Pedernales, in the southwest of the Dominican Republic, and 10 days later he was subjected to an anti-rabies vaccination scheme, receiving 4 doses.

This death follows a 6-year-old child who died on 14 Dec 2018.
====================
[We do not know what kind of wound care this child received prior to getting the post exposure prophylaxis (PEP). Neither does this article tell us the location of the bite on the body. This article also does not mention rabies immunoglobulin (RIG).

We are sorry for the family and the loss of this child. Sadly, this is an example of the urgency and necessity to get medical attention very quickly.

According to the US Center for Disease Control (CDC),

- The rabies virus is transmitted through saliva or brain/nervous system tissue. You can only get rabies by coming in contact with these specific bodily excretions and tissues.

- It's important to remember that rabies is a medical urgency but not an emergency. Decisions should not be delayed.

- Wash any wounds immediately. One of the most effective ways to decrease the chance for infection is to wash the wound thoroughly with soap and water.

- See your doctor for attention for any trauma due to an animal attack before considering the need for rabies vaccination.

- Your doctor, possibly in consultation with your state or local health department, will decide if you need a rabies vaccination. Decisions to start vaccination, known as post exposure prophylaxis (PEP), will be based on your type of exposure and the animal you were exposed to, as well as laboratory and surveillance information for the geographic area where the exposure occurred.

- In the USA, post exposure prophylaxis consists of a regimen of one dose of immune globulin and 4 doses of rabies vaccine over a 14-day period. Rabies immune globulin and the 1st dose of rabies vaccine should be given by your healthcare provider as soon as possible after exposure. Additional doses or rabies vaccine should be given on days 3, 7, and 14 after the 1st vaccination. Current vaccines are relatively painless and are given in your arm, like a flu or tetanus vaccine (<https://www.cdc.gov/rabies/exposure/index.html>). - ProMED Mod.TG]

[HealthMap/ProMED-mail map:
Pedernales, Pedernales, Dominican Republic:
Date: Sat 1 Dec 2018

Health officials in the Dominican Republic are reporting an increase in malaria cases in 2018.

According to a Diario Salud report [computer translated], 438 cases have been reported year to date compared to just 360 during the same period in 2017.

92 percent of the malaria cases were due to _Plasmodium falciparum_ and the remainder were _P. vivax_ or mixed infections.

One death has been reported.

In the last month, 31 cases of malaria have been reported, of these, 27 are indigenous and 4 are imported, 3 from Venezuela and one from Guyana.
========================
[Autochthonous malaria has been reported from the Dominican Republic over the past 15 years, documented especially by malaria in returning visitors. The main problem is the proximity to Haiti, where malaria is endemic, and asymptomatic carriers from Haiti start local transmission in the Dominican Republic. One solution could be screening upon arrival, or if that is not possible, a course of treatment for instance with artemether/lumefantrine upon arrival, ending with a single dose of primaquine to inactivate gametocytes, as recommended by WHO (Policy brief on single-dose primaquine as a gametocytocide in _Plasmodium falciparum_ malaria. WHO, Geneva January 2015; <https://www.who.int/malaria/publications/atoz/policy-brief-single-dose-primaquine-pf/en/>). - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Dominican Republic: <http://healthmap.org/promed/p/24>]
Date: Sun 16 Sep 2018
Source: Listin Diario, Republica Dominicana [in Spanish, trans. ProMED Mod.MPP, edited]

At least 63 confirmed cases of malaria have been reported through the surveillance system in the last 4 weeks, with 75% corresponding to the localized focus in the neighbourhoods of Santa Domingo West.

Until the beginning of September 2018, 294 cases were reported in the entire country, with the neighbourhoods of La Cienaga, Hato Nuevo, Caballona, and Manoguayabo, in Santo Domingo Oeste, and Las Mercedes in Los Alcarrizos presenting the highest incidence of this febrile disease, transmitted by the bite of the _Anopheles_ mosquito, which breeds in standing and dirty water, especially where there is vegetation.

In the past week, the surveillance system detected 25 confirmed cases, all autochthonous, including 17 men and 8 women with ages ranging from 13 to 62 years, according to the data contained in the epidemiologic bulletin for week 35.  [Communicated by:  Jaime R. Torres torresj@email.com]
=======================
[This is a large outbreak of introduced malaria with an increasing number of local cases. It is important to apply vector control and early case detection and treatment. Treatment should include a single dose of primaquine to block transmission.

An outbreak of introduced _Plasmodium vivax_ malaria in Greece in 2011 to 2012 was terminated by applying mass drug administration to the migrant worker population from _P. vivax_ endemic countries (Tseroni M, Baka A, Kapizioni C, et al. Prevention of malaria resurgence in Greece through the association of mass drug administration (MDA) to immigrants from malaria-endemic regions and standard control measures. PLoS Negl Trop Dis. 2015; 9(11): e0004215. doi: 10.1371/journal.pntd.0004215;  <https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004215>).

The malaria in this outbreak is almost certainly introduced by migrants from Haiti, and a mass drug administration program similar to the program used in Greece would eliminate a reservoir of malaria in semi-immune and asymptomatic individuals. - ProMed Mod.EP]

[HealthMap/ProMED map available at:
Santo Domingo, Distrito Nacional, Dominican Republic:
More ...

World Travel News Headlines

31st May 2019

A volcano on the Indonesian island of Bali erupted Friday, spewing a plume of ash and smoke more than 2,000 metres (6,500 feet) into the sky. Mount Agung, about 70 kilometres from the tourist hub of Kuta, has been erupting periodically since it rumbled back to life in 2017, sometimes grounding flights and forcing residents to flee their homes.
Mount Agung is about 70 kilometres from the tourist hub of Kuta

The latest shortly before noon on Friday shot a cloud of volcanic ash high into the sky, but caused no disruption to flights, Indonesia's geological agency said.  Agung remained at the second highest danger warning level, and there is a four-kilometre no-go zone around the crater.

Last summer, dozens of flights were cancelled after Agung erupted, while tens of thousands of locals fled to evacuation centres after an eruption in 2017.

The last major eruption of Agung in 1963 killed around 1,600 people.

Indonesia is situated on the Pacific "Ring of Fire", a vast zone of geological instability where the collision of tectonic plates causes frequent quakes and major volcanic activity.

31st May 2019

Heatwaves across India have exacted heavy casualties this year, including dozens of deaths by sunstroke and other heat-related causes. The deaths have been mainly reported from states like Maharashtra (particularly Vidarbha), Andhra Pradesh (mainly Rayalseema) and Telangana, due to the temperature extremes in these regions. What's worrying is, a study suggests that the heatwave conditions are likely to increase from next year and continue till 2064 because of El Niño Modoki and depletion in soil moisture. Here's how the heatwave is taking a toll in the above states.

Maharashtra

Parts of Maharashtra have been reeling under high temperatures accompanied by severe heatwave condition during this summer. According to a report in The Times Of India, a 50-year old man in Beed succumbed to death because of heatstroke recently, taking the overall number to 8. Reports show a total of 456 cases of heat-related illnesses in Maharashtra this summer. Last year, the number of cases reported was 568. However, the death toll this year is more than last year's figure of 2 victims.

Regions like Nagpur and Akola show the most number of deaths and illnesses in the Vidarbha region. About 163 cases of heat-related illness were reported in Nagpur and 76 ailments were reported in Latur region. Recently, Chandrapur in Maharashtra (which lies 150km south of Nagpur) registered a day temperature of 48°C, the highest recorded in India this summer.

Andhra Pradesh

Parts of Andhra Pradesh have been experiencing temperatures of 45°C and more since the last few days. These conditions have persisted in the state after the heavy rains caused by Cyclone Fani.

Two women going on a two-wheeler and covered themselves with scarfs to protect themselves from the heat wave, in Vijayawada
(Mahesh G, TOI, BCCL, Vijayawada.)

Three people have died in Andhra Pradesh due to heat-related causes this year. Also, 433 people have been diagnosed with heatstroke. Earlier this month, electrical transformers had blown up in many parts of Krishna and Guntur districts, disrupting power supply for more than five hours and intensifying the effects of heatwave conditions and the severe temperatures.

In 2015, Andhra Pradesh experienced the most number of heat deaths in the country: 1,369 people died that year from heat-related illnesses.

Telangana

Seventeen people have succumbed in Telangana over the last 22 days. However, the number of unconfirmed deaths is expected to be higher. The region saw 541 heat-related deaths in 2015, and 27 in 2018. The farmers and those who work in the sun are usually the ones to be affected the most by high temperatures and heatwave conditions.

As heat blankets the country, make sure you stay protected. Follow official guidelines and do not step out in the Sun, especially in the afternoon hours, unless absolutely necessary.

(With inputs from The Times Of India.)

11th June 2019
https://afro.who.int/news/confirmation-case-ebola-virus-disease-uganda

Kampala, 11 June 2019 - The Ministry of Health and the World Health Organization (WHO) have confirmed a case of Ebola Virus Disease in Uganda. Although there have been numerous previous alerts, this is the first confirmed case in Uganda during the Ebola outbreak on-going in neighbouring Democratic Republic of the Congo.

The confirmed case is a 5-year-old child from the Democratic Republic of the Congo who travelled with his family on 9th June 2019. The child and his family entered the country through Bwera Border post and sought medical care at Kagando hospital where health workers identified Ebola as a possible cause of illness. The child was transferred to Bwera Ebola Treatment Unit for management. The confirmation was made today by the Uganda Virus Institute (UVRI). The child is under care and receiving supportive treatment at Bwera ETU, and contacts are being monitored.

The Ministry of Health and WHO have dispatched a Rapid Response Team to Kasese to identify other people who may be at risk, and ensure they are monitored and provided with care if they also become ill. Uganda has previous experience managing Ebola outbreaks. In preparation for a possible imported case during the current outbreak in DRC, Uganda has vaccinated nearly 4700 health workers in 165 health facilities (including in the facility where the child is being cared for); disease monitoring has been intensified; and health workers trained on recognizing symptoms of the disease. Ebola Treatment Units are in place.

In response to this case, the Ministry is intensifying community education, psychosocial support and will undertake vaccination for those who have come into contact with the patient and at-risk health workers who were not previously vaccinated.  

Ebola virus disease is a severe illness that is spread through contact with the body fluids of a person sick with the disease (fluids such as vomit, faeces or blood). First symptoms are similar to other diseases and thus require vigilant health and community workers, especially in areas where there is Ebola transmission, to help make diagnosis. Symptoms can be sudden and include:
  • Fever
  • Fatigue
  • Muscle pain
  • Headache
  • Sore throat
People who have been in contact with someone with the disease are offered vaccine and asked to monitor their health for 21 days to ensure they do not become ill as well.

The investigational vaccine being used in DRC and by health and frontline workers in Uganda has so far been effective in protecting people from developing the disease, and has helped those who do develop the disease to have a better chance of survival. The Ministry strongly urges those who are identified as contacts to take this protective measure.

Investigational therapeutics and advanced supportive care, along with patients seeking care early once they have symptoms, increase chances of survival.

The Ministry of Health has taken the following actions to contain spread of the disease in the country:
  • The District administration and local councils in the affected area have been directed to ensure that any person with Ebola signs and symptoms in the community is reported to the health workers immediately and provided with advice and testing.
  • The Ministry of Health is setting up units in the affected district and at referral hospitals to handle cases if they occur.
  • •Social mobilization activities are being intensified and education materials are being disseminated.

There are no confirmed cases in any other parts of the country.

The Ministry is working with international partners coordinated by the World Health Organization.

The Ministry of Health appeals to the general public and health workers to work together closely, to be vigilant and support each other in helping anyone with symptoms to receive care quickly. The Ministry will continue to update the general public on progress and new developments.
Date: Mon, 10 Jun 2019 14:24:43 +0200

Lima, June 10, 2019 (AFP) - Peru has declared a health emergency in five regions, including Lima, after the deaths of at least four people linked to Guillain-Barre syndrome, an autoimmune disorder that attacks the nervous system.   Health Minister Zulema Tomas said Sunday that in addition to the deaths there were currently 206 cases of the disease.   "We have an outbreak, there has been a brusque increase" since June 5, Tomas said on state-run TV Peru, adding that health authorities were taking steps to control and contain the disease.

While the syndrome is not contagious, a 90-day health emergency was declared because the current cases "have unusual and atypical characteristics that require rapid or immediate initial treatment," Peru's Institute of Neurological Sciences said.   The precise cause of the disorder is unknown, but most cases develop after a person has been sick with diarrhoea or a respiratory infection.

The Centers for Disease Control and Prevention in the US says its research suggests that the syndrome is "strongly associated" with the Zika virus, a mosquito-borne illness.   The regions affected by GBS include three on the country's northern coast -- Piura, Lambayeque, La Libertad -- tourist destinations known for their archaeological sites and beaches.   Also included was the central region of Junin and Lima, which has nine million inhabitants.   Two deaths were reported in Piura, one in La Libertad and another in Junin.
Date: Mon, 10 Jun 2019 16:39:03 +0200

Madrid, June 10, 2019 (AFP) - Three tourists have fallen from their hotel balconies in Spain's Balearic Islands in recent days, one of them dying on impact, police said Monday as the summer season in the party archipelago begins.   The incidents came as Britain's foreign office warned holidaymakers heading to Spain against "balcony falls" and asked them not to "take unnecessary risks... particularly if you're under the influence of drink or drugs."   On Friday in Magaluf, a party resort notorious for its booze-fuelled tourism, a 19-year-old British man fell to his death from the second floor of his hotel, Spain's Civil Guard police force said.

A spokesman said police were looking at two theories -- either "he threw himself off voluntarily, or he fell by accident."   He did not know whether the victim had consumed drugs or alcohol.   On Thursday, a 35-year-old German man fell from the second floor of his hotel too, this time in Palma de Majorca, and was seriously injured, police said.   A source close to the probe, who declined to be named, said the man had drunk, dozed off, woken up and subsequently fallen from the balcony, possibly disorientated.   And on Monday, an Australian man in his early thirties fell from the second floor of his hotel in Ibiza and was seriously hurt, police said, without giving further details.

Balcony falls happen every year in the Balearic Islands and other party resorts in Spain, most of them due to excessive drinking or drug-taking/   Some are accidental slips, while others happen when tourists miss while trying to jump into pools or onto another balcony -- a practice known as "balconing."   The British foreign office's online travel advice for Spain has an entire section warning against "balcony falls".   "There have been a number of very serious accidents (some fatal) as a result of falls from balconies," says the website.    "Many of these incidents have involved British nationals and have had a devastating impact on those involved and their loved ones."
Date: Mon, 10 Jun 2019 06:44:54 +0200

Sydney, June 10, 2019 (AFP) - Australian police said Monday they were scouring bushland for a Belgian teenage tourist missing in a popular surf town for more than a week.   Theo Hayez, an 18-year-old backpacker, was last seen on May 31 at a hotel in the coastal tourist town of Byron Bay -- some 750 kilometres (470 miles) north of Sydney -- New South Wales state police said.   "We have a large amount of resources searching... in bushland that is towards the east and northeast of the town," police Chief Inspector Matthew Kehoe said in a statement.   "We are advised that this disappearance is completely out of character for him."   Police said they were alerted to his disappearance on Thursday after he failed to return to a hostel he was staying in.   Hayez's passport and personal belongings were all left at the hostel, and police believe he had not made any financial transactions since his disappearance or used his mobile phone.
Date: Sat 8 Jun 2019
Source: New Jersey 101.5 [edited]

The potentially deadly Powassan tick-borne virus has been confirmed in 2 Sussex county residents, one of whom died last month [May 2019], state health officials confirmed [Sat 8 Jun 2019].

The Powassan virus is spread by the deer tick [_Ixodes scapularis_]. The illness is rarer than Lyme disease, which is also spread by the tick, but 10% of people who contract the [Powassan virus] illness die from it.

A Department of Health official on [Sat 8 Jun 2019] said that the department had not determined the cause of death for the patient who died last month [May 2019] but said that lab results this week [week of 3 Jun 2019] confirmed that he had the virus.

A 2nd victim continues to recover at home.

Symptoms of the virus include brain swelling, meningitis, fever, headache, vomiting, weakness, confusion, loss of coordination, trouble speaking, and memory loss. Symptoms can appear a week to a month after a tick bite, although some people show no symptoms and do not require treatment.

There is no vaccine or cure for the disease. Treatment includes hospitalization, support for breathing, and intravenous fluids.

Prevention involves the same precautions that should be taken to avoid Lyme disease: avoid wooded areas with tall grasses, use insect repellent while outdoors, and check for ticks after being outdoors.

Powassan [virus] -- first discovered in Powassan, Ontario, in 1958 -- has been confirmed in recent years in New Jersey, with one case each in 2013, 2014, and 2015, and 4 cases in 2017, the most recent year for which data is available. The cases were reported in Sussex, Warren, Morris, and Essex counties.

Between 2008 and 2017, there were 125 confirmed cases in the entire country and 9 deaths.

A person who said they were close to the man who died last month [May 2019] posted on Facebook that the man was bitten in the arm by a tick while gardening and fell ill about 2 weeks later. The Facebook post said that there was no bull's-eye mark around the bite -- a known tell-tale sign for Lyme infection. About a day before he was hospitalized, the man reported feeling like he was coming down with a cold and had a high fever.

State health department's tip sheet for preventing Powassan [virus infection]:
- avoid contact with ticks by avoiding wooded areas with high grass;
- when hiking, stay on the center of the trail;
- picnic in areas away from wooded and bushy areas;
- keep children on playground equipment and away from tall grass and shrubs;
- when outdoors, apply insect repellents;
- wear light-colored clothes so it is easy to see and remove ticks;
- wear long-sleeve shirts and pants;
- tuck long pants into socks so ticks cannot crawl under pants;
- do tick checks every couple hours while outdoors and before coming indoors;
- if you see a tick during tick checks, remove it right away;
- keep grass mowed short;
- keep children's toys, playground equipment, pools, and lawn furniture at least 15 feet [4.6 m] from wooded areas;
- create a woodchip or mulch border between your yard and wooded areas;
- keep areas under bird feeders and pet dishes clean, so they do not attract animals that may carry ticks;
- keep trash in closed containers or areas so it does not attract animals that may carry ticks.  [Byline: Sergio Bichao]
=======================
[Powassan virus is endemic in New Jersey, and cases occur there sporadically. The tick vector is the deer tick, _Ixodes scapularis_. Humans become infected with POWV during spillover transmission from the natural transmission cycles. In humans, POWV can be a causative agent of a severe neuroinvasive illness, with 50% of survivors displaying long-term neurological sequelae. Individuals living or visiting areas where the deer tick occurs, should follow the above recommendations to avoid tick bites. If a tick is found feeding, it should be removed with forceps or tweezers grasping the tick at skin level and then gentle, constant force applied. The tick should never be removed by grasping it with thumb and forefinger, as squeezing the tick may cause inoculation of contents containing the pathogenic agent into the feeding site.

POWV was recognized as a human pathogen in 1958, when a young boy died of severe encephalitis in Powassan, Ontario, Canada. In that case, POWV was isolated from the brain autopsy. There are 2 distinct genetic lineages now recognized: POWV (lineage I) and deer tick virus (lineage II). Since the index case in 1958, over 100 human cases of POWV have been reported, with an apparent rise in disease incidence in the past 16 years. This recent increase in cases may represent a true emergence of POWV in regions where the tick vector species are prevalent, or it could represent an increase in POWV surveillance and diagnosis. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of New Jersey, United States:
New Jersey county map:
Date: 6 Jun 2019
Source: Washington Post [edited]

Dominican government officials released more-detailed autopsy results on Thursday [6 Jun 2019] for 3 American tourists who died at adjacent beach resorts owned by the same hotel company during the last week of May 2019.

All 3 victims experienced eerily similar symptoms and internal trauma before their deaths, according to a news release from Dominican authorities. Pathologists said autopsies showed the 3 had internal haemorrhaging, pulmonary oedema, and enlarged hearts.

Toxicology reports are pending [These are likely to be the most interesting. - ProMED Mod.TG].

A U.S. State Department official said authorities have not yet established a connection between the 30 May 2019 deaths of 49-year-old CAD, and 63-year-old NEH, both of Prince George's County, MD, and the death on 25 May 2019 of 41-year-old MSW of Pennsylvania.

The FBI is providing Dominican law enforcement with "technical assistance with the toxicology reports," the State Department official said.

MSW had just checked into the Luxury Bahia Principe Bouganville, in the town of San Pedro de Macoris, and was taking pictures from her room balcony when she started to feel ill.

Less than 2 hours later, she was dead, local authorities said.

The bodies of CAD and HEH were found inside their room at the Grand Bahia Principe La Romana after relatives grew concerned because they had not checked out of the resort.

The hotels are located next to each other on the island's southern coast, about 60 miles from the tourist-heavy Punta Cana area.

Dominican authorities initially did not run toxicology tests for MSW because there were no signs of violence, said Ramon Brito, a spokesman for the National Police's special tourism unit. After the Maryland couple was found, investigators ordered a set of tests to determine whether anything the 3 Americans consumed may have led to their deaths, Brito said.  [Byline: Arelis R. Hernandez]
Date: 31 May 2019
Source: 4 News [edited]

The Alachua County Health Department is warning residents that there are 12 confirmed cases of mumps, primarily from college students at the University of Florida.  "This is a little more than usual," says Steve Orlando, University of Florida spokesman.

Alachua County normally receives around 2 reported cases a year, and UF believes more students could be infected.  "So, it's curious because these are individuals who are vaccinated, and that's what we are seeing nationwide," says Paul Myers, Alachua County Health Department administrator.

Officials say it is still unclear why there has been an uptick with the virus. So far, the CDC shows 736 people have contracted mumps nationwide in 2019.

"The sharing of the utensils, sharing of the cups, sharing of the water bottles, you know it is a very common thing for students to share those things, and that's exactly the kind of thing that could lead to transmission," says Orlando.
Date: Sat 8 Jun 2019
Source: Business Standard [edited]

As many as 14 children have died due to acute encephalitis syndrome (AES) in the district, while over a dozen are admitted in hospitals with high fever and other symptoms of the infection.

Sunil Shahi, Superintendent of Shri Krishna Medical College and Hospital (SKMCH), told ANI, "We have received 38 patients so far; most of them have a deficiency of glucose in their blood. Of these, 2 have also tested JE [Japanese encephalitis] positive; the overall casualty till now is 14."

Dr Gopal Sahni, head of Critical Care Unit, said, "When heat and humidity rise, the body's sweat cannot evaporate. The humidity level is over 50 per cent in the last few days. We have about 15 such children admitted in the hospital currently, and 89 such cases come regularly."

Encephalitis is a viral infection, which causes mild flu-like symptoms such as a fever or a headache.
=======================
[Again, this year (2019), cases of AES and JE are appearing in north-western India. Of the 14 AES cases, 2 tested positive for JE. The aetiology of the remaining cases is not stated, but the majority are reported as hypoglycaemic. As noted previously, frequently, in reports of JE cases in India, acute encephalitis syndrome (AES) of undefined aetiology is often mentioned with JE cases that are a minority of those hospitalized.

The determination of the aetiology or aetiologies of AES has been confusing and elusive. Various etiological agents have been proposed in recent years as responsible for AES cases. AES has continued to be attributed to a variety of aetiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_). Recently, scrub typhus has been implicated in many AES cases. A recent publication (reference below) states that dengue virus is one of the 3 most common agents identified in acute encephalitis syndrome (AES). Unfortunately, existing surveillance for AES does not include routine testing for dengue. Dengue accounts for 5% of AES cases in India, especially in the absence of laboratory evidence for other pathogens tested. Dengue should be added to the list of possible AES etiological agents.

Reference:
Vasanthapuram Ravi, Shafeeq Keeran Shahul Hameed, Anita Desai, Reeta Subramaniam Mani, Vijayalakshmi Reddy, et al.: Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): Results from a 4-year AES surveillance study of Japanese encephalitis in selected states of India. International Journal of Infectious Diseases. 2019. doi: <https://doi.org/10.1016/j.ijid.2019.01.008>.

Maps of India:

[HealthMap/ProMED map available at: