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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Thu, 16 Jan 2020 02:45:27 +0100 (MET)
By Ivelisse RIVERA, con Leila MACOR en Miami

Yauco, Puerto Rico, Jan 16, 2020 (AFP) - Living out in the open, their nerves on edge after a series of earthquakes that have shaken Puerto Rico, some 5,000 people are hoping that their president, Donald Trump, will heed the island's plea to be designated a disaster zone and free up much-needed aid.   Since December 28, more than 1,000 tremors have rattled the US island territory in the Caribbean, which just two years ago was devastated by two powerful hurricanes in quick succession.

In Yauco, one of the areas worst hit by the earthquakes, dozens of people were sitting on cot beds Wednesday in the parking lot of a municipal stadium, sheltered from the sun by white tents and blue tarps handed out by the federal disaster management agency, known as FEMA.  "The most difficult thing is the psychological aspect," said Wilfredo Rodriguez, 31. His house had been fractured by the seismic movement and he has spent a week living with his kids, aged six and 10, under an awning.    "We are living in constant fear of another powerful tremor," he said.

He only returns to his house to wash, then hurries back to the shelter. "We worry that there'll be a more powerful tremor while we are inside the house," he said.   Throughout the day, volunteers arrive to hand out food and toys for the children who fill the shelters: schools have been suspended because the buildings are not sturdy enough to withstand another quake.    The island's earthquake detection system has registered 1,104 tremors in the past two weeks alone, of which 186 could be felt by the population. By comparison, during the whole of 2019 there were 6,442 tremors, of which just 62 could be felt by people on the island.

Further south, in Guanico, Juan Santiago decided to move into a shelter on Saturday after a tremor of 5.9 on the Richter scale hit the island. "The mountain shook and rocks and earth started to come down," said the 30-year-old.  "My house has a crack in it and is about to fall down," he added. His home had weathered the Category Five winds of Hurricane Maria in September 2017 and of Hurricane Irma which followed it just two weeks later.   "It's different to a hurricane. What is happening now is much nastier," he said.

As he was talking the earth shook again, a tremor of 5.2 magnitude. Vehicles rocked like hammocks in the wind, but the quake-hardened victims barely reacted.   The houses in this part of the island are mostly rudimentary constructions built by the people who live in them with scant resources available in the mountains, where no regulations stipulate that buildings should be earthquake resistant.    The government of Puerto Rico said that as of Monday, there were 4,924 people living in 28 shelters in 14 municipalities. There were no figures on how many buildings had been damaged or destroyed.

- Seeking disaster designation -
Puerto Rico's governor Wanda Vazquez Garced called on Trump to declare the earthquake a disaster and clear the way for desperately needed aid. Trump had declared an emergency days before, but the governor wanted more.   The declaration of an emergency frees up to $5 million dollars in aid for the island, although Congress can bump that figure up. But if the situation is designated a disaster, there is no ceiling on funding, a FEMA spokesman said.   On Wednesday, the government said it would release $8.2 billion in delayed hurricane relief that had been stalled after the president threatened to divert Puerto Rico's emergency funds to help pay for his wall on the US-Mexico border.

In the past few days there have been growing calls among Democratic lawmakers for Trump to declare the situation in Puerto Rico a disaster.   It is a delicate subject, as Trump has accused the government of Puerto Rico of incompetence and of siphoning off hurricane relief money, triggering a public spat between the president and the mayor of San Juan, Carmen Yulin Cruz, as well as the former governor Ricardo Rossello, who was forced to step down last summer amid massive protests.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
Date: Sat, 11 Jan 2020 15:43:12 +0100 (MET)

Washington, Jan 11, 2020 (AFP) - A 5.9 magnitude earthquake rocked Puerto Rico Saturday, the latest in a series of powerful tremors that have shaken the US territory in recent days, the US Geological Survey reported.

The latest quake occurred at 8:54 am local time (1254 GMT) around 13 kilometres (eight miles) southeast of Guanica, a town on the island's southern Caribbean coastline that was hard hit by earlier quakes.   The USGS revised its initial report of a 6.0 magnitude quake to 5.9.   It follows a 6.4 magnitude quake Tuesday that killed one person, knocked
out electric power and caused widespread damage.

Puerto Rico Governor Wanda Vazquez declared a state of emergency after Tuesday's quake, which forced an automatic shutdown of the power grid.    Puerto Rico's electric power authority reported outages in the towns of Ponce, Lares, Adjuntas and San German after the latest quake.   The Pacific Tsunami Information Center in Hawaii issued a statement saying there was "no significant tsunami threat" but a small possibility of tsunami waves along coasts nearest the epicentre.

The island is still recovering from Hurricane Maria, which came ashore more than two years ago as a devastating Category 4 storm.   Starting December 28, a wave of tremors have swept the island, putting residents on edge.   The 6.4 quake on January 7 came a day after a 5.8 magnitude quake; it was followed by major aftershocks.   Saturday's quakes were also preceded by a string of smaller tremors.
Date: Tue, 7 Jan 2020 23:44:45 +0100 (MET)
By Ricardo Arduengo

Guayanilla, Puerto Rico, Jan 7, 2020 (AFP) - Puerto Rico's governor declared a state of emergency on Tuesday after a powerful 6.4 magnitude earthquake killed at least one person in the south of the island and caused widespread damage.   Governor Wanda Vazquez said the declaration would allow for the activation of National Guard troops in the US territory still recovering from a devastating 2017 hurricane.   The US Geological Survey said the quake struck at 4:24 am (0824 GMT) with the epicenter off the coast of the southern city of Ponce, and was followed by more than a dozen aftershocks.

Tuesday's quake was the most powerful in a series of tremors that have shaken the island since December 28.   Scientists initially sent out an alert about a potential tsunami but it was later canceled.   The island's electricity authority said the quake had forced an automatic shutdown of the power grid, already severely damaged by Hurricane Maria more than two years ago.   The worst damage appeared to be in towns on the southwest coast, including Ponce, Guayanilla and Guanica.   El Nuevo Dia newspaper said a 73-year-old man died after a wall fell in his home in Ponce. Eight others there were reported injured.

Two power plants in Guayanilla sustained major damage, the Puerto Rico Electric Power Authority said. The city could be without power for two weeks, its mayor Nelson Torres Yordan said.   Celebrity chef Jose Andres announced that a charity he runs, World Central Kitchen, had started serving meals and distributing solar-powered lamps in quake-hit areas.   Vazquez announced that $130 million in emergency aid funding will be disbursed.   On social media, people wrote of being shaken awake by the force of the quake.   One woman on Twitter said she had been "wrenched from sleep."   "Everybody is awake & scared all over," she posted.   In Guayanilla, the Inmaculada Concepcion church, built in 1841, was heavily damaged.   Volunteers salvaged statues and other valuable items from the ruins as a priest consoled distraught parishioners.

- 'Be safe' -
A 5.8 magnitude quake on Monday toppled some structures, caused power outages and small landslides, but did not result in any casualties.   It also destroyed a popular tourist landmark, Punta Ventana, a natural stone arch that crumbled on the island's southern coast.   Vazquez, the governor, said government employees were being given the day off on Tuesday to take care of their families.   "We want everyone to be safe," she said.   She said ports were undamaged and there are several weeks' supply of gasoline, diesel and natural gas stored so people need not worry about shortages.

The White House said President Donald Trump had been briefed and Pete Gaynor, head of the Federal Emergency Management Agency (FEMA), had been in touch with the governor.   Trump's administration came under severe criticism for its response to Hurricane Maria.   The Category 4 storm destroyed the island's already shaky power grid, overwhelmed public services, left many residents homeless and claimed several thousand lives, according to government estimates.
Date: Tue, 7 Jan 2020 12:52:34 +0100 (MET)

Washington, Jan 7, 2020 (AFP) - A strong earthquake struck south of Puerto Rico early Tuesday, the US Geological Survey said, the latest in a series of tremors that have shaken the island since December 28.   The shallow 6.5 magnitude quake struck 13.6 kilometres (8.5 miles) south of the city of Ponce, the USGS said, revising down its initial reading of 6.6.   The quake struck just off the US territory's southern Caribbean coastline at 4:24 am local time (0824 GMT).   "The whole island is without power," the director of Puerto Rico Electric Power Authority, Jose Ortiz, told local media.

Puerto Rico's governor Wanda Vazquez Garced posted on Twitter that the government's security protocols had been activated.   She said government employees were not expected at work, adding: "We want everyone to be safe."   On social media, people wrote of being shaken awake by the force of the quake.   One woman on Twitter said she had been "wrenched from sleep", adding "Everybody is awake & scared all over."

Dramatic images also shared on social media appeared to show widespread damage in the town of Guayanilla, home to around 20,000 people, as well as nearby Guanica.   The mayor of Guayanilla told local news channel NotiUno that the town's church had collapsed in the incident.

An alert issued by the Tsunami Warning Center immediately following the earthquake was later cancelled.   Tuesday's quake was the strongest of a series of tremors that have shaken the island since December 28, topping Monday's 5.8 quake.   That earthquake toppled houses and caused power outages, but there were no reports of casualties.
Date: Mon, 6 Jan 2020 18:04:21 +0100 (MET)

Miami, Jan 6, 2020 (AFP) - A 5.8-magnitude earthquake shook Puerto Rico Monday, toppling houses and causing power outages and small landslides but there were no reports of casualties, the US Geological Survey said.   The quake, just off the US territory's southern Caribbean coastline, was felt throughout much of the island, including the capital San Juan.

Some 250,000 customers were hit by electric power outages after the quake, which struck at 6:32 am local time (1032GMT).   Images posted on social media showed houses tumbled from their supporting pillars, cracks in walls, cars crushed under collapsed houses and small scale landslides.   The quake was the strongest of a series that have rippled through the island since December 28, and it was followed by at least eight aftershocks, officials said.   No tsunami alerts were issued.
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Lithuania

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

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

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, including the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: Lithuania is a relatively safe country. Visitors should maintain the same personal security awareness that they would in any metropolitan U.S. city. Large amounts of cash and expensive jewelry should be secured in a hotel safe or left at home. Crimes against foreigners, while usually non-violent, do occur. Pickpocketing and thefts are problems, so personal belongings should be well protected at all times. Theft from cars and car thefts occur regularly. Drivers should be wary of persons indicating they should pull over or that something is wrong with their car. Often, a second car or person is following, and when the driver of the targeted car gets out to see if there is a problem the person who has been following will either steal the driver’s belongings from the vehicle or get in and drive off with the car. Drivers should never get out of the car to check for damage without first turning off the ignition and taking the keys. Valuables should not be left in plain sight in parked vehicles, as there have been increasing reports of car windows smashed and items stolen. If possible, American citizens should avoid walking alone at night. ATMs should be avoided after dark. In any public area, one should always be alert to being surrounded by two or more people at once. Additionally, criminals have a penchant for taking advantage of drunken pedestrians. Americans have reported being robbed and/or scammed while intoxicated.
Following a trend that has spread across Eastern and Central Europe, racially motivated verbal, and sometimes physical, harassment of foreigners of non-Caucasian ethnicity has been reported in major cities. Incidents of racially motivated attacks against American citizens have been reported in Klaipeda and Vilnius.
In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. More information on these serious problems is available at http://www.cybercrime.gov/18usc2320.htm.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. For more information about assistance for victims of crime in Lithuania, please visit the Embassy’s web site at http://vilnius.usembassy.gov/service/crime-victim-assistance.html.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in Lithuania has improved in the last 15 years, but medical facilities do not always meet Western standards. There are a few private clinics with medical supplies and services that nearly equal Western European or U.S. standards. Most medical supplies are now widely available, including disposable needles, anesthetics, antibiotics and other pharmaceuticals. However, hospitals and clinics still suffer from a lack of equipment and resources. Lithuania has highly trained medical professionals, some of whom speak English, but their availability is decreasing as they leave for employment opportunities abroad. Depending on his or her condition, a patient may not receive an appointment with a specialist for several weeks. Western-quality dental care can be obtained in major cities. Elderly travelers who require medical care may face difficulties. Most pharmaceuticals sold in Lithuania are from Europe; travelers will not necessarily find the same brands that they use in the United States. Serious medical problems requiring hospitalization and/or medical evacuation can cost thousands of dollars or more. Doctors and hospitals often expect immediate cash payment for health services, particularly if immigration status in Lithuania is unclear.

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Brazil

General

 Brazil is the largest country in South America and extends from the Atlantic Ocean to the Caribbean to the depths of the Amazon basin. The climate varies throughout the country but generally it experiences a humid

tropical climate.

Safety & Security

The level of crime in many of the main urban centres is certainly rising and tourists need to be aware of the risks involved in travelling particularly in the evening hours. It is wise to use an official taxi for any journeys after dark. It is sensible not to flaunt any personal wealth and to use the hotel safety boxes for any valuables and your travel documents. The amount of crime against tourists tends to be greater in areas surrounding hotels, discotheques, bars, nightclubs and other similar establishments that cater to visitors, especially at dusk and during the evening hours. There are frequent reports of theft on city buses and such transportation should be avoided. A number of the main cities have established specialised tourist police units to patrol areas frequented by tourists. Rio de Janeiro, Sao Paulo and Brasilia all continue to experience a high incidence of crime.

Road Safety

Throughout this huge country the state of the roads varies greatly. In many regions the roads are dirt tracks and assistance would be hard to obtain for those travelling off from the main tourists routes. Bag snatching from traffic lights occurs in the main cities. If considering hiring a car make certain that your travel insurance is sufficient.

Jet Lag

After your flight you will experience a degree of jet lag. Travelling from Europe this will be less than when you travel home but nevertheless it will still cause your body to complain for 24 to 48 hours. Try to have a more relaxing time for the first few days (and also after returning home if possible!). Be careful not to fall asleep by the pool and then awaken with sunburn which could ruin your time abroad.

Medical Facilities

In any country of this size the level of medical care will vary greatly. This is particular true out side the main tourist resorts. English speaking doctors should be available but the level of hospital care can be worrisome. Make certain you carry sufficient supplies of any medication you may require for your entire holiday. Essential drugs (asthma, diabetes, epilepsy etc) should be divided for security.

Sun Exposure and Dehydration

The hot humid tropical climate often leads to quite significant problems for the Irish traveller. Make sure you cover your head when out in the sunlight and drink plenty of fluids to replenish that lost through perspiration. Replace the salt you loose by eating crisps etc orby putting salt on your meal (providing there is no contraindication).

Visiting the Iguassu Falls

These huge waterfalls border Argentina, Brazil and Paraguay. There is only minimal risk of malaria and so malaria prophylaxis is not generally recommended. Also, Yellow fever is not transmitted in this area but mosquitoes can abound. Sensible insect bite precautions should be followed at all times.

Food & Water

Many tourists who visit Brazil stay in the main resorts along the southern coast. The food and water preparation in the hotels is normally excellent but eating food from street vendors is generally unwise. Shell fish (bivalve oysters, mussels, clams etc) are unwise even in a five star hotel. Check the water from the cold water tap in your room. If you can’t easily smell chlorine (swimming pool style) don’t use it even for brushing your teeth. If travelling around the country (Caribbean coast or into the Amazon regions) take significantly more care.

Rabies 

This viral disease occurs throughout Brazil and it is usually transmitted through the bite from an infected warm-blooded animal (eg dogs, cats & monkeys). Any contact should be avoided but if it occurs treat it very seriously and seek competent medical attention immediately after you wash out the area and apply an antiseptic.

Malaria

The risk of malaria is significant all year throughout the Amazon regions. There is insignificant risk for those staying along the coast up as far as Fortaleza and for those remaining in this region prophylaxis is not usually recommended. The risk in the region of Brasilia is also thought to be minimal though this is an area which has unusually experience an outbreak of Yellow Fever recently, and so the situation will require review.

Mosquito Borne Diseases  Apart from malaria the other two main diseases transmitted by mosquitoes which cause problems in Brazil are Dengue Fever (mainly along Caribbean Coast but has been reported much further south) and Yellow Fever (mainly in the Amazon Basin but thought to be spreading to other regions). Avoidance techniques are important at all times throughout the day. Swimming **************************************** Most of the main tourist swimming pools will be well maintained and the smell of chlorine will be evident. If sea swimming is on your agenda make sure you go where there are plenty of others and never swim alone. Look for warning signs and pay attention to local advice. Be very careful of local currents which can be dangerous. Vaccinations **************************************** The Brazilian Embassy is advising all travellers to Brazil to have vaccination cover against Yellow Fever. Also for your personal protection it is wise to consider some further vaccines. Generally we would recommend the following vaccination cover; * Yellow Fever (mosquito borne) * Tetanus (childhood booster) * Typhoid (food & water borne) * Hepatitis A (food & water borne) For those travelling more extensively or staying in the country for longer periods we would usually suggest that further vaccines are considered including Hepatitis B, Meningitis and Rabies. Summary **************************************** Many travellers to Brazil will remain perfectly healthy and well providing they follow some sensible precautions. Further information is available from either of our centres regarding any recent disease outbreaks.

Travel News Headlines WORLD NEWS

Date: Wed 12 Feb 2020
Source: Teresina Municipal Health Foundation [in Portuguese, machine trans., edited]

Health Surveillance Directorate - Epidemiology Management
---------------------------------------------------------
Given the laboratory confirmation of 5 human cases of melioidosis (ICD-10 A24.4) that occurred in the state of Piaui in 2019 (including one death), the FMS Health Surveillance Directorate recommends Hospital Infection Control Commissions, to the Hospital Surveillance Centers, public and private microbiology laboratories, infectious disease specialists, pulmonologists, microbiologists, biochemists and physicians in general who are attentive, immediately report any case with a result of a culture of biological material (blood culture, urine culture, wound culture, tracheal secretion, cerebrospinal fluid, bronchial lavage, ascitic fluid, abscess, tissues, etc.) positive for the bacterium _Burkholderia pseudomallei_ (or _Burkholderia_ sp.). The notification must be made through the individual notification form of SINAN (available at <http://portalsinan.saude.gov.br/images/documentos/Agravos/NINDIV/Notificacao_Individual_v5.pdf>) and sent to the FMS, with the code appended ICD10: A24.4.

The positive bacterial isolate should be sent to the Central Public Health Laboratory, Dr. Costa Alvarenga (LACEN - PI) for confirmatory examination (Nested - PCR), upon registration in the GAL system (research: _Burkholderia pseudomallei_ sample: swab), in swab with Stuart's medium, at room temperature, along with a copy of the notification form.
======================
[This 2016 article (Limmathurotsakul D, Golding N, Dance DA, et al., Predicted global distribution of _Burkholderia pseudomallei_ and burden of melioidosis. Nat Microbiol. 2016;1:15008. <https://doi.org/10.1038/nmicrobiol.2015.8>; article available at <http://www.nature.com/articles/nmicrobiol20158.pdf>) for 2015 estimates the burden of melioidosis for the areas of major and some risk as follows:

Area / Population at risk in millions / Melioidosis cases in thousands / Melioidosis deaths in thousands
South Asia / 1525 / 73 / 42
East Asia and Pacific / 858 / 65 / 31
Sub-Saharan Africa / 602 / 24 / 15
Latin America and Caribbean / 246 / 2 / 1
Middle East and North Africa / 49 / less than 1 / less than 1

Although a classical infection in eastern Asia and northern Australia, cases have been acquired in Africa, the Caribbean basin, Central America, and, as in this case, South America. - ProMED Mod.LL]

Date: Wed, 5 Feb 2020 22:30:14 +0100 (MET)

Rio de Janeiro, Feb 5, 2020 (AFP) - A tourist who was robbed while vacationing in Rio de Janeiro posted a disgusted message online... only to have Brazil's national tourism board post it to its official Instagram account by mistake.   "Rio is such a beautiful city," begins the message posted by Instagram user @withlai -- and that is perhaps as far as the Brazilian Tourist Board's social media department read before clicking "share."   But the message continues: "Beautiful is not enough."   During a three-day stay in Rio, @withlai wrote, "my family and I were robbed and my nine-year-old sister witnessed a violent robbery. I can't recommend a visit to a city where I felt afraid of even leaving the apartment."

Embratur, as the tourism board is known, shared the message on its own Instagram account Tuesday evening, leaving it up long enough for the gaffe to go viral before deleting the post.  "This message was shared by mistake," Embratur said in a red-faced statement, adding that it was in fact working to "publicize the drop in violent crime (in Brazil) in 2019."   Rio, the port of entry for many of the millions of tourists who visit Brazil each year, is known for the breath-taking beauty of its sun-soaked beaches and emerald mountains, but also its violent crime.   Rio de Janeiro state, of which the city is the capital, registered nearly 4,000 murders and 120,500 muggings last year -- though that was a drop of 19 percent and eight percent, respectively.
Date: Mon 3 Feb 2020
Source: NSC Total [in Portuguese, trans. ProMED Mod.TY, edited]

Santa Catarina has another confirmed case [the 2nd] of yellow fever [YF] in humans. The information was confirmed by the secretary of state for health (SES) this Mon 3 Feb 2020. The patient is admitted to the Nereu Ramos Hospital, in Florianopolis, a reference infectious disease unit in Santa Catarina.

The diagnosis of the disease [as yellow fever] was confirmed by the Central Laboratory of Public Health (LACEN/SC)on Sunday [2 Feb 2020]. The 40 year old man, resident of Jaragua do Sul, in Planalto Norte of Santa Catarina, was not registered for the [YF] vaccination in the Information System of the National Program of Immunizations (SIPNI).

This is the 2nd case of human infection in the state and the 4th since 2019, when there was the 1st diagnosis in the state. Last year [2019], SC registered 2 deaths on account of the disease.

The 1st case of 2020:
The patient whose diagnosis was confirmed on 24 Jan [2020] remains hospitalized at Nereu Ramos Hospital, in Florianopolis. He is 47 years old and is a resident of the municipality of Sao Bento do Sul, also in Planalto Norte, and with no vaccine registration in the system.

Transmission:
Yellow fever is a serious disease, transmitted by mosquitoes in wildland areas and close to forests. Vaccination is the best way to protect oneself from the disease. The dose is free. To date, the state's vaccination coverage is 84%, below what the Ministry of Health recommends, which is to vaccinate at least 95% of the target population.

Symptoms:
Yellow fever is a rapidly progressive disease. The infection results
in the following symptoms:
- fever of up to 6 days duration;
- intense headache;
- abdominal pain;
- haemorrhagic manifestations;
- jaundice.

Monkey deaths:
On Mon 3 Feb 2020, SES also confirmed 2 more monkeys dead of yellow fever. The howlers were located in Corupa on 26 Dec 2019 and in Blumenau on 7 Jan of this year [2020].

In total, 9 monkeys dead of yellow fever were counted in 2019 (in Garuva, Joinville, Indaial, Jaragua do Sul, Sao Bento do Sul, and Corupa) and the 2 animals diagnosed with the disease in 2020 (Blumenau e Pomerode).  [byline: Clarissa Battistella]
====================
[The 2 human cases this year (2020) are due to YF virus spill-over from the sylvan (forest) transmission cycle. The dead monkeys indicate that the virus has been circulating in the state for over a year. It is important that the human population YF vaccination coverage reach the 95% goal set by the Ministry of Health. Vaccination is the only way to avoid these sylvan cases, since elimination of the forest YF virus transmission cycle is not feasible. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Santa Catarina, Brazil: <http://healthmap.org/promed/p/2975>]
Date: Wed 29 Jan 2020
Source: Globo.com [in Portuguese, trans. ProMED Mod.PMB, edited]
<https://g1.globo.com/pr/parana/noticia/2020/01/29/mortes-de-macacos-por-febre-amarela-aumentam-para-46-no-parana-indica-boletim.ghtml> [edited]

Monkey deaths due to yellow fever (YF) in Parana state have increased to 46 from 40 the previous week. According to a report issued by the state secretary of health, no case has been confirmed in humans so far, although 16 suspected cases are being investigated. Five of the new confirmed monkey cases were from Lapa, in the metropolitan region of Curitiba. This municipality had no previous record of dead monkeys due to YF. Another monkey death due to YF was in Antonio Olinto, in Southern Parana state. That city already had reported a confirmed case in monkeys.

The previous list of localities with records of monkey deaths due to YF is as follows: Castro: 11 Ponta Grossa: 8 Lapa: 5 Candido de Abreu, Sapopema, Teixeira Soares, Antonio Olinto, Ipiranga and Piraí do Sul: 2 Balsa Nova, Mandirituba, Quatro Barros, Rio Negro, Palmeira, Sao Joao do Triunfo, Imbituva, Mallet, Prudentópolis and Sao Mateus do Sul: 1. "The weekly newsletter is useful to monitor the outbreaks and alert on the presence of the virus in these localities", said the secretary of health, Beto Preto. Citizens of Parana state are being summoned to local units of health to receive vaccination against YF.

The vaccine is indicated for adults of up to 59 years old, and children from 9 months of age, with a booster at the age of 4 years. Pregnant and breastfeeding women, children up to 9 months of age and adults over 60, people with severe egg allergy or immunocompromised people should be vaccinated only after medical assessment.
===================
[The current expansion of YF in South America raises concern for public health and also about potential conservation problems for susceptible non-human primate species in the continent. The virus is endemic in much of central and northern South America, and makes sporadic incursions to southern areas of the continent, like the states of Santa Catarina, Parano and Rio Grande do Sul in Brazil, Misiones in Argentina, or Paraguay.

The YF virus was introduced into the Americas about 400 years ago, yet the complex interactions that were established after its introduction are far from being elucidated. There is need for more research on the eco-epidemiology of the disease in the continent, specifically on the role of each non-human primate species, and especially in the presence of the persistent anthropogenic global environmental change. - ProMED Mod.PMB]

[HealthMap/ProMED map available at: Brazil:
<http://healthmap.org/promed/p/6>]
Date: Tue 21 Jan 2020
Source: Outbreak News Today [edited]

For the 1st time in 20 years, Brazil health authorities are reporting a confirmed case of Brazilian haemorrhagic fever.  During this 20-year period, there were 4 cases in humans, 3 cases acquired in a sylvan environment in the state of Sao Paulo, and one due to infection in a laboratory environment in Para. The disease is considered to be extremely rare and highly lethal, and treatment is according to the patient's clinical condition and symptoms.

The disease incubation period is long (on average 7 to 21 days) and begins with fever, malaise, muscle pain, a rash on the body, sore throat, stomachache, and soreness behind the eyes, headache, dizziness, sensitivity to light, constipation, and bleeding from mucous membranes such as mouth and nose. As the disease progresses, there may be neurological impairment (drowsiness, mental confusion, changes in behavior and convulsion).

Between the onset of symptoms (30 Dec 2019) and death (11 Jan 2020), the current patient passed through 3 different hospitals in the municipalities of Eldorado, Pariquera-Acu and Sao Paulo, the last being the Hospital das Clinicas of the Faculty of Medicine of the University of Sao Paulo (HCFM USP). There was no history of international travel.

During his hospitalization, tests were carried out to identify diseases such as yellow fever, viral hepatitis, leptospirosis, dengue and Zika. However, the results were negative for these diseases. Complementary tests were carried out at the Special Techniques Laboratory of the Albert Einstein Hospital, which identified an arenavirus which causes Brazilian hemorrhagic fever. This result was confirmed by the Medical Research Laboratory of the Institute of Tropical Medicine, Hospital das Clinicas, USP Medical School, and Adolfo Lutz Institute.

In addition, SVS/MS has already communicated the fact to the World Health Organization and the Pan American Health Organization (WHO/PAHO), in accordance with established international protocols.

At this time, the source of the patient's infection has not been confirmed. What is known is that people contract the disease possibly through the inhalation of particles formed from the urine, feces and saliva of infected rodents. Transmission of arenaviruses from person to person can occur when there is very close and prolonged contact or in hospital environments, when personal protective equipment is not used, through contact with blood, urine, feces, saliva, vomit, semen and other secretions or excretions.

The employees of the hospitals through which the patient passed are being monitored and evaluated, as well as the family members of the confirmed case in Sao Paulo.

On Mon 20 Jan 2020, the Ministry of Health convened a meeting with representatives of all parties involved in the case: Secretariat of Sao Paulo, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo, Hospital Israelita Albert Einstein and the National Councils and State Health (Conass and Conasems). The purpose of the meeting was to verify the current scenario and the search and monitoring actions of people who had direct contact with the patient.

The Ministry of Health also offered support to the Sao Paulo Department of Health by sending a team of technicians to actively search for people who had contact with the patient and for environmental investigation.
--------------------------------
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
and
Barry Atkinson <Barry.Atkinson@phe.gov.uk>
via Mary Marshall
==================
[These are the 1st documented cases of Sabia virus infection in a long time. This confirmed case was an adult who lived in Sorocaba, Sao Paulo state.

The genome of the virus responsible for the disease was about 90% similar to the Sabia arenavirus according to Epidemiological Bulletin 03 (see below). One hopes that the environmental investigation will provide information about the circumstances under which the infection was acquired. A rodent reservoir was doubtless the direct or indirect source of the virus, as it is for other arenaviruses such as Machupo virus that causes Bolivian hemorrhagic fever. The rodent reservoir of the virus has not been identified.

The above report is a machine translation of an official report from the Brazil Ministry of Health

The Brazil Ministry of Health in its Epidemiological Bulletin No. 03 published an extensive overview of Sabia virus with a helpful epidemiological diagram (<http://portalarquivos2.saude.gov.br/images/pdf/2020/janeiro/20/Boletim-epidemiologico-SVS-03.pdf> in Portuguese). The bulletin provided the following references that report the original Sabia virus cases:

References:
Coimbra, Terezinha Lisieux M. et al. New arenavirus isolated in Brazil. The Lancet, v. 343, n. 8894, p. 391-392, 1994.
Gonzalez, Jean Paul J. et al. Genetic characterization and phylogeny of Sabia virus, an emergent pathogen in Brazil. Virology, v.221, n.2, p. 318-324, 1996. - Mod.TY

HealthMap/ProMED map available at:
More ...

Haiti

Haiti US Consular Information Sheet
June 02, 2008
COUNTRY DESCRIPTION:
Haiti is one of the least developed and least stable countries in the Western Hemisphere. The availability of consumer goods and services is barely adequate in the capi
al, Port-au-Prince, but other parts of the country experience chronic shortages. Most consumer products are imported and expensive. Some tourism facilities in the large cities and resort areas are satisfactory, but many are rudimentary at best, and are difficult to find in most rural areas and small towns. Read the Department of State Background Notes on Haiti 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. Haitian law requires U.S. citizens to have a passport to enter and exit Haiti. Once in Haiti, an undocumented U.S. citizen can experience delays of several weeks for the issuance of a passport, as it is often more difficult to establish identity and citizenship overseas than in the United States. The Haitian government requires foreigners to pay a departure fee. U.S. citizens are encouraged to contact the Embassy of the Republic of Haiti for more details regarding current entry, departure and customs requirements for Haiti. The Embassy of the Republic of Haiti is located at 2311 Massachusetts Avenue NW, Washington, DC 20008; the telephone number is (202) 332-4090, and the Internet address is http://www.haiti.org/. There are Haitian consulates in Miami and Orlando, Florida; Boston, Massachusetts; New York, NY; Chicago, Illinois and San Juan, Puerto Rico.

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:
U.S. citizens should exercise extreme caution and are strongly encouraged to register online at https://travelregistration.state.gov prior to travel.
Travel in Haiti can be dangerous and all visitors are urged to exercise vigilance and caution. In some cities and towns ordinary services such as water, electricity, police protection and government services are either very limited or unavailable. While U.N. personnel from several countries have been in Haiti since 2004, their presence does not guarantee absolute security for residents or visitors.
During 2007 and early April 2008, the Embassy issued several security related messages warning U.S. citizens in Haiti of violent or unstable conditions. On occasion, the U.S. mission in Haiti was forced to suspend service to the public or close because of security concerns. These concerns have also prevented Embassy personnel from traveling to or through some areas. Since October 2004 Embassy personnel have been prohibited from entering central Port-au-Prince after dark due to security concerns. The Embassy has also imposed a curfew on its officers from time to time. If situations occur where the Embassy must suspend operations or when officers are unable to travel freely, the Embassy will continue to be available by telephone to offer emergency services to U.S. citizens.
In early April 2008, there were violent demonstrations, looting, transportation disruptions, and up to seven reported deaths in Les Cayes and Port-au-Prince. Some American citizens were temporarily stranded in isolated locations and could not safely travel until calm was restored. Because political and economic conditions precipitating the civil unrest have not been entirely resolved, American citizens should defer non-essential travel to Haiti.
U.S. citizens in Haiti should avoid all large gatherings, as crowd behavior can be unpredictable. Visitors encountering roadblocks, demonstrations, or large crowds should remain calm and depart the area quickly and without confrontation. Assistance from Haitian officials, such as the police, is often unavailable. Overseas visitors must be particularly cautious on the days of planned political activities. U.S. citizens are urged to take common-sense precautions and avoid any event where crowds may congregate.

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

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

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

CRIME: There are no "safe areas" in Haiti. Crime, a chronic problem over the years, has increased in recent years and can be subject to periodic surges sometimes not obviously explained by other events or conditions. The U.S. estimates that up to 8% of the cocaine entering the United States passes through Haiti. The state of law and order has steadily deteriorated as a result. Reports of kidnapping, death threats, murders, drug-related shootouts, armed robberies, break-ins or carjackings are common. These crimes are primarily Haitian against Haitian, though several foreigners and U.S. citizens have been victimized. In 2007, there were 29 reported kidnappings of American citizens, including two victims who were killed. Many American citizens reported that they were beaten and or raped by their hostage takers. Kidnapping remains the most critical security concern; kidnappers frequently target children.
U.S. citizens who travel to Haiti should exercise extreme caution throughout the country. Travelers should keep valuables well hidden, ensure possessions are not left in parked vehicles, use private transportation, alternate travel routes, and keep doors and windows in homes and vehicles closed and locked. U.S. citizens should avoid all night-time travel due to poor road conditions and increased criminal activity after dark. They should be alert for suspicious onlookers when entering and exiting banks, as criminals often watch and subsequently attack bank customers. Withdrawals of large amounts of cash should be avoided.
Criminal perpetrators often operate in groups of two to four individuals, and are disposed occasionally to be confrontational and gratuitously violent. Criminals sometimes will seriously injure or kill those who resist their attempts to commit crime. In robberies or home invasions, it is not uncommon for the assailants to beat or shoot the victim in order to limit the victim's ability to resist. If an armed individual demands the surrender of a vehicle or other valuables, the U.S. Embassy recommends compliance without resistance. This recommendation also applies in the event of a kidnapping. Visitors to Haiti should exercise caution at all times and review basic personal security procedures frequently.
U.S. citizens in Haiti must be particularly alert when arriving from overseas at the Port-au-Prince airport, as criminals have often targeted arriving passengers for later assaults and robberies. Some recent incidents have resulted in death. The use of public transportation, including "tap-taps" (private transportation used for commercial purposes), is not recommended. Visitors to Haiti should arrange for someone known to them to meet them at the airport.
U.S. citizens should decline all requests to carry items for others to or from Haiti. Traffickers of illegal drugs have duped unsuspecting travelers into helping transport narcotics aboard commercial airlines.
Certain high-crime zones in the Port-au-Prince area should be avoided, including Croix-des-Bouquets, Carrefour, Martissant, the port road (Boulevard La Saline), urban route Nationale #1, the airport road (Boulevard Toussaint L'Ouverture) and its adjoining connectors to the New ("American") Road via Route Nationale #1 (which should also be avoided). This latter area in particular has been the scene of numerous robberies, carjackings, and murders. Embassy employees are prohibited from remaining in the downtown area after dark or entering Cite Soleil and La Saline and their surrounding environs due to significant criminal activity. Neighborhoods in Port-au-Prince once considered relatively safe, such as the Delmas road area and Petionville, have been the scenes of an increasing number of violent crimes.
Cameras and video cameras should only be used with the permission of the subjects; violent incidents have followed unwelcome photography. Their use should be avoided altogether in high-crime areas.
Holiday periods, especially Christmas and Carnival, often bring a significant increase in criminal activity. Haiti's Carnival season is marked by street celebrations in the days leading up to Ash Wednesday. In recent years, Carnival has been accompanied by civil disturbances, altercations and severe traffic disruptions. People attending Carnival events or simply caught in the resulting celebrations have been injured and killed. Random stabbings during Carnival season are frequent. Roving musical bands called “rah-rahs” operate during the period from New Year's Day through Carnival. Being caught in a rah-rah event may begin as an enjoyable experience, but the potential for injury and the destruction of property is high. A mob mentality can develop unexpectedly leaving people and cars engulfed and at risk. During Carnival, rah-rahs continuously form without warning; some rah-rahs have identified themselves with political entities, lending further potential for violence.
The Haitian police are understaffed, poorly equipped and unable to respond to most calls for assistance. There are continued allegations of police complicity in criminal activity. The unsatisfactory response and enforcement capabilities of the Haitian national police and the weakness of the judiciary frustrate many victims of crime in Haiti. In the past, U.S. citizens involved in business and property disputes in Haiti have been arrested and detained without charge, and have been released only after intervention at high levels of the Haitian Government.

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

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities in Haiti are scarce and for the most part sub-standard; outside the capital standards are even lower. Medical care in Port-au-Prince is limited, and the level of community sanitation is extremely low. Life-threatening emergencies often require evacuation by air ambulance at the patient's expense. Doctors and hospitals often expect immediate cash payment for health services.

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

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

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Haiti is provided for general reference only, and may not be totally accurate in a particular location or circumstance. Cars are supposed to be driven on the right side of the road in Haiti, but few roads have lane indicators and drivers use whatever part of the road is open to them, even if it is not the correct side of the road. Traffic is extremely congested in urban areas, and hours-long traffic jams develop throughout the country.
Driving in Haiti must be undertaken with extreme caution. The situation on the roads can be described as chaotic at best, and it is advisable for those with no knowledge of Haitian roads and traffic customs to hire a driver through a local hotel. Roads are generally unmarked, and detailed and accurate maps are not widely available. Lanes are not marked and signs indicating the direction of traffic flow seldom exist. This lack of organization, along with huge potholes that occur without warning, may cause drivers to execute unpredictable and dangerous maneuvers in heavy traffic. The Haitian government lacks adequate resources to assist drivers in distress or to clear the road of accidents or broken-down vehicles blocking the flow of traffic. Drinking and driving is illegal in Haiti, but people frequently drive after drinking, especially at night.
Public transportation as it is usually defined does not exist in Haiti. While Haitians use buses, "tap-taps" and taxis, which may observe regular routes, much like public transportation, none of these should be considered reliable. The Embassy strongly discourages their use.
Those who drive in Haiti should do so defensively and conservatively, avoid confrontations such as jockeying for position, and remain aware of the vehicles around them. Drivers should carry the phone numbers of people to call for assistance in an emergency, as Haitian authorities are unlikely to respond to requests for assistance. When traveling outside of Port-au-Prince, drivers should caravan with other vehicles to avoid being stranded in the event of an accident or breakdown.
Although written and driving tests are required to qualify for driver's licenses, road laws are not generally known or applied. Signaling imminent actions is not widely practiced, and not all drivers use turn indicators or international hand signals properly. For instance, many drivers use their left blinker for all actions, including turning right and stopping in the road, and others flap their left arm out the window to indicate that they will be taking an unspecified action. Drivers do not always verify that the road is clear before switching lanes, turning, or merging.
Speed limits are seldom posted and are generally ignored. Speeding is the cause of many of the fatal traffic accidents in Haiti, as are overloaded vehicles on winding, mountainous roads and vehicles without brakes. Poor maintenance and mechanical failures often cause accidents as well. Drivers should be particularly cautious at night, as unlighted vehicles can appear without warning.
Right of way is not widely observed in Haiti, and there are few operational traffic lights or traffic signs. It is advisable at most intersections to stop and verify that there is no oncoming traffic even if it appears that you have the right of way. Drivers can be quite aggressive and will seldom yield. Walls built to the edge of roads frequently make it impossible to see around corners, forcing drivers to edge their cars into the road at intersections to check for oncoming traffic.
In addition to vehicles, a variety of other objects may appear on the road in Haiti, such as wooden carts dragged by people, small ice cream carts, animals, mechanics working on vehicles parked on the street, and even vendors and their wares. Vehicles are often abandoned in the road or by the side of the road. There are few marked crosswalks and sidewalks, and pedestrians often wend their way through traffic in urban areas. 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 Haiti’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Haiti'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:
The official currency of Haiti is the gourde, which has a variable exchange rate. Visitors will notice that most establishments in Haiti price items in an unofficial currency known as the “Haitian dollar.” (One Haitian dollar is equivalent to five gourdes.) Others give prices in gourdes or even in U.S. dollars. It is always a good idea to clarify with vendors which currency -- the gourde, Haitian dollar, or U.S. dollar -- is being used in a given transaction, as price tags often bear a number without indicating currency. The currency itself shows a value in gourdes. U.S. dollars are the currency of choice at the Labadee Beach cruise ship port-of-call.
Travelers' checks are often difficult to change in Haiti, but credit cards are widely accepted and some establishments accept or cash personal checks. At least one local bank chain has ATMs around Port-au-Prince that are compatible with some U.S. ATM cards. These ATMs are frequently out-of-order, and there have been reports of over-charging accounts.
Haiti, like most Caribbean countries, can be affected by hurricanes and other storms. Hurricane season runs from approximately June 1 - November 30 each year. Extensive flooding as a result of heavy rainfall has occurred in the past. Daily weather information in Haiti is available from national and international media. The Haitian meteorological service provides hurricane warnings via national radio. Both media and government information is only in Kreyol and/or French. Warnings are also available on the internet from many sources among which is the National Oceanic and Atmospheric Administration (NOAA) at hurricanes.noaa.gov. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.
Please see our Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offences. Persons violating Haiti's laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Haiti are severe, and convicted offenders can expect long jail sentences and heavy fines. The judicial process in Haiti can be extremely long; progress is often dependent on considerations not related to the specific case. Detainees may wait months or years for their cases to be heard before a judge or to have legal decisions acted upon by the authorities. Bond is not usually available to those arrested for serious crimes with the result that often suspects remain in custody for many months before formal indictment. Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Haiti are encouraged to register with the nearest U.S. Embassy or Consulate through the State Departments travel registration web site so that they can obtain updated information on travel and security within Haiti. 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 Boulevard du 15 October, Tabarre 41, Tabarre, Haiti. The main Embassy switchboard number is: (509) (2) 229-8000. The America Citizens Services (ACS) Unit fax number is (509) (2) 229-8027, the email address is acspap@hotmail.com. Web site: http://haiti.usembassy.gov/. ACS Unit office hours are 7:00 a.m. to 3:30 p.m., Monday through Friday. The Consular Section is closed on U.S. and local holidays.
* * *
This replaces the Country Specific Information for Haiti dated April 27, 2007 to update sections on Exit/Entry Requirements, Safety and Security, Crime, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu, 4 Jul 2019 01:08:12 +0200

Port-au-Prince, July 3, 2019 (AFP) - At least five people were killed and three are missing in Haiti after a torrential downpour buffeted the capital of Port-au-Prince, the country's civil protection agency said Wednesday.   Three people were found dead in the city's impoverished Cite Soleil neighbourhood, while two others were killed elsewhere in Port-au-Prince.   In the busy hillside neighbourhood of Petionville, three people went missing and five were seriously injured when a wall collapsed under the weight of the downpour.

On Wednesday, heavy equipment was rolled out across the capital to clear mud and debris, while officials warned residents in flood-prone areas to remain on alert.   "There are unstable weather conditions prevailing in the Caribbean basin, and rain and thunderstorm activity could hit the country over the next two days," Haiti's civil protection agency said.

Heavy rain causes unusual damage in Haiti's main cities due to a lack of proper drainage infrastructure.   Some of the country's poorest residents also build flimsy homes along canals and gullies that easily become clogged with waste when it rains.   Every year Haiti has to prepare for potentially catastrophic storms during the Atlantic hurricane season, which runs from June 1 through November 30. However due to a complete lack of urban planning, even heavy rain is enough to threaten lives across the country.
Date: Wed, 22 May 2019 02:06:35 +0200
By Amelie BARON

Port-au-Prince, May 22, 2019 (AFP) - With no oxygen in intensive care or gloves in the emergency room, residents at Haiti's largest hospital have gone on strike to protest the filthy environment and demand six months of back pay.   "We have almost nothing when we talk about emergency services," said Emmanuel Desrosiers, 24, one of the doctors-in-training at the State University of Haiti Hospital (HUEH) that began the work stoppage Monday.    "When a patient arrives, when we should immediately take charge, we start by listing the things they or their family need to go buy."   The HUEH, known as the "general hospital," is where the most disadvantaged families in this impoverished Caribbean country crowd. Buying the medical supplies themselves is a financial headache, but private clinics are far too expensive.   In crumbling buildings in the center of Port-au-Prince, male and female patients are crowded together in tiny rooms, while trash cans overflow.   "We feel ridiculous when we give hygienic advice to patients," one resident said of the situation.

The residents' selflessness as they work in an unsanitary environment is compounded by the fact that they have not been paid since the start of their residency, nearly six months ago.   After five years of medical studies, the state is required to pay them 9,000 Haitian gourdes (HTG) per month -- only about $100, due to the devaluation of the national currency.   Nothing is being done about the hospital's disrepair, with those in charge waiting for a new building to be completed, according to resident Yveline Michel.   The new HUEH will have two floors and more than 530 beds once it's finished -- but it's unclear when that will be.   The project began after the January 2010 earthquake, which destroyed more than half the hospital. The United States, France and Haiti invested $83 million in a new hospital, which should have been completed by 2016.   Instead, there is little visible activity on the construction site, which can be seen through the windows of the current building.

Due to the heat, the windows are always open, letting in noise and dust from the street. There are only a few fans in the hospital rooms, which do little to combat the humidity or the flies.   "At any moment we could lose patients, but the state isn't doing anything to save their lives," said Michel, 25.   "We're striking for the population, since it should make these demands."   But some locals question the residents' position because the strike prevents the already struggling hospital from functioning.   Since the strike began, the poorest families in the area no longer know where to go for medical emergencies, as the residents are in charge of admitting patients.   "Due to the lack of resources and the unsanitary environment, there are always people dying in the hospital, so it's not the strike causing that," said Michel in response.
Date: Thu, 21 Feb 2019 07:52:47 +0100
By Amelie BARON

Port-au-Prince, Feb 21, 2019 (AFP) - With flaming barricades and widespread looting, 10 days of street violence in Haiti have all but buried a tourism industry that managed to resurrect itself after a devastating earthquake in 2010.   Ugly, violent footage beamed around the world has again sent the message that this impoverished Caribbean country is politically unstable and no place to go on vacation.

The final straw was the helicopter evacuation last week of 100-odd Canadian tourists trapped as angry protesters demanded the resignation of the president, whom they accuse of corruption.   "We have been through 12 days of hell. We managed the crisis but today we are suffering from the aftershocks," said Tourism Minister Marie-Christine Stephenson.

- Blacklist -
Beside the direct effects of the demonstrations, the United States delivered another crushing blow on February 14 when it urged its citizens not to travel to Haiti, which thus joined a no-go list with war-torn countries like Syria, Yemen and Afghanistan.

The minister said the US travel alert for Haiti was too harsh, calling the riots something that flared up unexpectedly and are now over.   "OK, they lasted 12 days but I am not sure that other Caribbean countries, which have had riots of their own, have been punished as severely and quickly as we have," said Stephenson.   Overnight, the decision by the US State Department hit the tourism industry hard. Travel web sites simply stopped offering flights to Haiti's two international airports.   Hotels are reporting cancellation of reservations and many empty rooms.

Officials in the industry have yet to tally up the damage but say that for the second time in less than a year, they will have to lay off workers.   In July of last year, three days of riots over a government attempt to raise fuel prices ruined the summer vacation season for Haiti's tourism industry.   It is not just hotels that will suffer again, said Beatrice Nadal-Mevs, president of the Haitian Tourism Association.   "This is going to affect everyday people because these are direct jobs that are going to be lost and supply chains will be threatened: farming, fishing, crafts, transport," Nadal-Mevs said.

- Mardi Gras cancelled -
With the opposition planning more demonstrations to seek the resignation of President Jovenel Moise, the sector got yet more bad news with word that Carnival celebrations have been called off in the Haitian capital, Port-au-Prince.   City Hall said it could not guarantee revelers' safety.   The festivities, which this year were planned for March 3-5, usually draw many Haitians living abroad and fleeing the winter cold in Canada and the eastern US.

Another major Carnival celebration is scheduled to take place in the city of Gonaives, but the government has not said if it will go ahead.   As grim as things are, some foreign tourists have gone ahead with visits to Haiti.   On Wednesday, a group of Australians under police escort visited a square featuring statues of heros of Haiti's independence from France. Days ago, demonstrators at the same plaza were throwing rocks at police, who responded with volleys of tear gas grenades.

A woman named Carole, who did not want to give her last name, said, "I trust the company we're traveling with. They not only want to take us but they want to bring us back."   Kevin McCue, another of the people in the group of 20, said he was glad that their tour operator had not opted for Plan B, which would have meant skipping Haiti and spending the whole week in the neighboring Dominican Republic.   "Tourism is alive and well here. People should come. The more they come, the better they spread some money among people who need it and the better for Haiti," said McCue.
Date: Sun, 17 Feb 2019 23:37:22 +0100

Ottawa, Feb 17, 2019 (AFP) - A group of 25 school students from Quebec and three chaperones were able to leave Haiti on Sunday, where they had been stuck due to violent anti-government protests.   "We are on the plane" back to Montreal, one of the chaperones confirmed in a message to AFP.   Canadian tour operator Transat also confirmed that the group of students was aboard flight TS663, which departed at 3:59 pm (2059 GMT) from Port-au-Prince.   In addition to the students, employees of Canada's temporarily-shuttered embassy were also heading home aboard the aircraft.   The day before, a group of 131 Canadian tourists were evacuated via helicopter from their beachside resort in Haiti after being trapped for one week at the site due to the ongoing unrest.   The tourists were ferried in shifts to the Port-au-Prince international airport, where they boarded a flight to Canada, Transat said.

On Friday, Canada officially warned its citizens against all travel to Haiti, an advisory issued after the temporary closure of its embassy in Port-au-Prince.   Since February 7, at least seven people have died as Haiti has been plunged into political crisis, with everyday life paralyzed by protests and barricades in the largest towns.   The protesters, angry at soaring inflation and the alleged theft of nearly $2 billion in Venezuelan oil relief, are demanding President Jovenel Moise's resignation.   Canada is one of Haiti's largest international donors and is home to a large Haitian diaspora, located mostly in French-speaking Quebec.
Date: Thu, 14 Feb 2019 20:37:05 +0100

Ottawa, Feb 14, 2019 (AFP) - Canada on Thursday temporarily closed its embassy in Haiti as violent protests against President Jovenel Moise's government trapped hundreds of Canadian tourists in the Caribbean island nation.   "Due to the current volatility, the Port-au-Prince embassy is closed today and we will continue to assess the situation in the coming days to ensure that our diplomats and their families are safe," Canada's foreign ministry said in a statement.   Clashes between police and protesters left at least one dead on Wednesday in Port-au-Prince, bringing to at least seven the number of people killed since protests began a week earlier.   The protesters, angry about skyrocketing inflation and the alleged theft of nearly $2 billion in Venezuelan oil relief to the island, are demanding Moise's resignation.

Gun violence and blocked roads prevented about 100 Canadian tourists staying at the all-inclusive Royal Decameron Indigo Beach resort to get to the airport on Sunday.   "At present, it is not safe to organize a trip to the airport, so for the moment our customers are at the hotel, they are perfectly safe," said Christophe Hennebelle, vice president of tour operator Transat.   "We are in constant contact with the Canadian embassy in Haiti and with the government authorities to assess the situation," he said, adding that he hoped that "in the coming days" the Canadians would be repatriated. An airplane remains on standby in Canada to go pick them up.   Ottawa, meanwhile, is urging Canadians to avoid all non-essential travel to Haiti.
More ...

Nicaragua

Nicaragua - US Consular Information Sheet
December 22, 2008
COUNTRY DESCRIPTION:
Nicaragua’s fragile democracy remains under stress.
Following municipal elections in November 2008, in which opposition leaders have charged massive fr
ud took place, political tensions have increased significantly.
The economy remains among the poorest in the hemisphere.
Crime has increased significantly in recent months.

The national language is Spanish, although many residents of the Caribbean coastal areas also speak English and indigenous languages.
The climate is hot and humid, with the “summer” dry season running mid-November through mid-May and the “winter” rainy season running from mid-May through mid-November.
Terrain ranges from the hilly and volcanic to coastal beaches and tropical jungles.
Geological faults run throughout the country, along which active volcanoes are situated.
Earthquakes are common, but the last major earthquake, which destroyed the city of Managua, occurred in 1972.

Nicaragua lacks tourist infrastructure.
Except in the cities and major thoroughfares, most roads are unpaved.
Public transportation is unsafe and there are no sidewalks.
Most essential services are sporadic.
Most hospitals are substandard.
Hotels in Managua are adequate, but primarily are oriented to serve a business or government clientele.
Potential tourists may want to obtain information from the National Tourism Institute (INTUR), the governmental agency responsible for developing, regulating, and promoting tourism in Nicaragua at http://www.intur.gob.ni/.
Read the Department of State Background Notes on Nicaragua for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid U.S. passport is required to enter Nicaragua.
Although there is a bilateral agreement that waives the six-month validity passport requirement, U.S. citizens are urged to ensure that their passports are valid for the length of their projected stay in the country before traveling.
U.S. citizens must have an onward or return ticket and evidence of sufficient funds to support themselves during their stay.
A visa is not required for U.S. citizens; however, a tourist card must be purchased for $5 upon arrival.
Tourist cards are typically issued for 30 to 90 days.

A valid entry stamp is required to exit Nicaragua.
Pay attention to the authorized stay that will be written into your entry stamp by the immigration inspector.
Visitors remaining more than the authorized time must obtain an extension from Nicaraguan Immigration at http://www.migracion.gob.ni/.
Failure to do so will prevent departure until a fine is paid.

There is also a $32 departure tax.
Many airlines include this tax in the price of the ticket.
If the tax is not included in the ticket, payment can be made at the airline counter upon departure.

Per Nicaraguan law, individuals should exit Nicaragua with the same passport with which they entered the country.
Dual national minors who entered Nicaragua on their Nicaraguan passports will be subject to departure requirements specific to Nicaraguan children under the age of 18, even though they may also be citizens of other countries.
More information on these requirements can be found on the U.S. Embassy web site at http://nicaragua.usembassy.gov/dual_nationality.html.

According to Nicaragua’s Laws for Foreigners, foreigners must be in possession of a valid identity document at all times while in Nicaragua and may be required to show it to Nicaraguan authorities upon request.
Acceptable identity documents are: (1) a permanent residency card, (2) temporary residency card, or (3) valid passport or travel document accompanied by an entry stamp.

In June 2006, Nicaragua entered a “Central America-4 (CA-4) Border Control Agreement” with Guatemala, Honduras, and El Salvador.
Under the terms of the agreement, citizens of the four countries may travel freely across land borders from one of the countries to any of the others without completing entry and exit formalities at Immigration checkpoints.
U.S. citizens and other eligible foreign nationals, who legally enter any of the four countries, may similarly travel among the four without obtaining additional visas or tourist entry permits for the other three countries.
Immigration officials at the first port of entry determine the length of stay, up to a maximum period of 90 days.
Foreign tourists who wish to remain in the four-country region beyond the period initially granted for their visit are required to request a one-time extension of stay from local Immigration authorities in the country where the traveler is physically present, or travel outside the CA-4 countries and reapply for admission to the region.
Foreigners “expelled” from any of the four countries are excluded from the entire “CA-4” region.
In isolated cases, the lack of clarity in the implementing details of the CA-4 Border Control Agreement has caused temporary inconvenience to some travelers and has resulted in others being fined more than one hundred dollars or detained in custody for 72 hours or longer.

For the most current information about visas to visit Nicaragua, visit the Embassy of Nicaragua web site at http://www.cancilleria.gob.ni.

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

SAFETY AND SECURITY:
Municipal elections took place across Nicaragua on November 9, 2008.
Violent demonstrations followed as opposition groups questioned the authenticity of the results.
Activities observed during protests included but were not limited to tear gas, rubber bullets, setting off fireworks, rock-throwing, tire burning, road blocks, bus and vehicle burning, and physical violence between law enforcement and protestors and between political rivals.
Political demonstrations and strikes continue to occur sporadically, are usually limited to urban areas, and occasionally become violent.
U.S. citizens are advised to monitor local media reports, to avoid crowds and blockades during such occurrences and to exercise caution when in the vicinity of any large gathering.

U.S. citizens are cautioned that strong currents and undertows off sections of Nicaragua's Pacific coast have resulted in a number of incidents of drowning.
Powerful waves have also resulted in broken bones, and injuries caused by sting rays are not uncommon in popular resort bathing areas.
Warning signs are not posted, and lifeguards and rescue equipment are not readily available.
U.S. citizens contemplating beach activities in Nicaragua's Pacific waters should exercise appropriate caution.

Hiking in volcanic or other remote areas can be dangerous and travelers should take appropriate precautions.
Hikers should have appropriate dress, footwear, and sufficient consumables for any trek undertaken.
Individuals who travel to remote tourist or other areas for hiking activities are encouraged to hire a local guide familiar with the terrain and area.
In particular, there have been instances of hikers perishing or losing their way on the volcanoes at Ometepe Island.
While they may look like easy climbs, the terrain is treacherous and heavily overgrown.

Although extensive de-mining operations have been conducted to clear rural areas of northern Nicaragua of landmines left from the civil war in the 1980s, visitors venturing off the main roads in these areas are cautioned that the possibility of encountering landmines still exists.
Domestic travel within Nicaragua by land and air, particularly to the Atlantic side can be dangerous.
Domestic airlines use small airstrips with minimal safety equipment and little boarding security.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

CRIME:
Violent crime in Managua is increasing and petty street crimes are very common.
Gang activity also is increasing, though not at levels found in neighboring Central American countries.
Pick-pocketing and occasional armed robberies occur on crowded buses, at bus stops and in open markets like the Oriental and Huembes Markets.
Gang violence, drive-by shootings, robbery, assault and stabbings are most frequently encountered in poorer neighborhoods, including the Ticabus area, a major arrival and departure point for tourist buses.
However, in recent months it spread to more upscale neighborhoods and near major hotels, including the Zona Hippos.
In 2008, a U.S. citizen was critically injured in a gang-motivated drive-by shooting that occurred in the San Judas area.
Another U.S. citizen was kidnapped and left for dead in the Villa Fontana area of Managua.

U.S. citizens are increasingly targeted shortly after arriving in the country by criminals posing as Nicaraguan police officers who pull their vehicles – including those operated by reputable hotels -- over for inspection.
In each case, the incidents happened after dark and involved gun-wielding assailants who robbed passengers of all valuables and drove them to remote locations where they were left to fend for themselves.
Some assailants employed threats of physical violence.
While the traditional scene of these attacks has been the Tipitapa-Masaya Highway, this activity has recently spread to the Managua-Leon Highway.
The U.S. Embassy warns U.S. citizens to exercise extreme caution when driving at night from Managua’s International Airport and to avoid traveling the Tipitapa-Masaya Highway at night.
U.S. citizens should exercise caution when approached by strangers offering assistance.
Several U.S. citizens traveling by bus from San Juan del Sur to Managua have reported being victimized by fellow women travelers who offered to assist them in locating and/or sharing a taxi upon arrival in Managua.
In all cases, upon entering the taxi, the U.S. citizens have been held at knife-point, robbed of their valuables, and driven around to ATM machines to withdraw funds from their accounts.

Violent criminal activities and petty crime are also increasing in the tourist destination of San Juan del Sur.
In 2008, a U.S. citizen family was violently assaulted and kidnapped by several armed men.
Other American citizens have been the victims of armed robberies by assailants wielding machetes, knives, and/or guns along the beaches in and around San Juan del Sur.
U.S. citizens should exercise particular caution when visiting the following beaches: Maderas, Marsella, Yankee, Coco, and Remanso.

Police coverage is extremely sparse outside major urban areas, particularly in Nicaragua’s Atlantic coast autonomous regions.
Lack of adequate police coverage has resulted in these areas being used by drug traffickers and other criminal elements.
Street crime and petty theft are a common problem in Puerto Cabezas, Bluefields, and the Corn Islands along the Atlantic coast.
For security reasons, the Embassy has limited travel by its staff to the North and South Atlantic Autonomous Regions (RAAN and RAAS), including the Corn Islands.
Given the area’s geographical isolation, the Embassy’s ability to provide emergency services to U.S. citizens who choose to travel in the Caribbean costal area is constrained.
Police presence on Little Corn Island is made up of volunteers with little to no formal training, and is minimal on Corn Island and other remote areas.
In late 2007, a U.S. citizen was assaulted and violently raped while on vacation in Little Corn Island.
U.S. citizens have previously been the victims of sexual assault on this island and other beaches in the country.
The Embassy recommends traveling in groups when in isolated areas.
Single travelers should exercise special caution while traveling in the Corn Islands and other remote areas of the country.
Throughout the country, U.S. travelers should utilize hotels and guest houses that have strong security elements in place, including but not limited to rooms equipped with safes for securing valuables and travel documents and adequate access control precautions.

Visitors should avoid walking and instead use officially registered taxicabs.
Radio-dispatched taxis are recommended and can be found at the International Airport and at the larger hotels.
Robbery, kidnapping, and assault on passengers in taxis in Managua are increasing in frequency and violence, with passengers subjected to beating, sexual assault, stabbings, and even murder.
Several U.S. citizens reported brutal attacks in taxis during 2008, particularly around the International Airport area.

Before taking a taxi, make sure that it has a red license plate and that the number is legible.
Select taxis carefully and note the driver's name and license number.
Instruct the driver not to pick up other passengers, agree on the fare before departing, and have small bills available for payment, as taxi drivers often do not make change.
Also, check that the taxi is properly labeled with the cooperativa (company) name and logo.
Purse and jewelry snatchings sometimes occur at stoplights.
While riding in a vehicle, windows should be closed, car doors locked, and valuables placed out of sight.

Do not resist a robbery attempt.
Many criminals have weapons, and most injuries and deaths have resulted when victims have resisted.
Do not hitchhike or go home with strangers, particularly from nightspots.
Travel in groups of two or more persons whenever possible.
Use the same common sense while traveling in Nicaragua that you would in any high-crime area of a major U.S. city.
Do not wear excessive jewelry in downtown or rural areas.
Do not carry large sums of money, ATM, or credit cards that are not needed, or other valuables.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members, or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime are 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 is very limited, particularly outside Managua.
Basic medical services are available in Managua and in many of the smaller towns and villages.
However, treatment for many serious medical problems is either unavailable or available only in Managua.
Emergency ambulance services, as well as certain types of medical equipment, medications and treatments, are not available in Nicaragua.
Physicians and hospital personnel frequently do not speak English, and medical reports are written in Spanish.
Patients must have good understand and an ability to speak Spanish in order to navigate the local medical resources.

In an emergency, individuals are taken to the nearest hospital that will accept a patient.
This is usually a public hospital unless the individual or someone acting on their behalf indicates that they can pay for a private hospital.
Payment for medical services is typically done on a cash basis, although the few private hospitals will accept major credit cards for payment.
U.S. health insurance plans are not accepted in Nicaragua.

Dengue fever is endemic in Nicaragua.
Currently, no vaccine or specific medication is available to prevent or treat Dengue fever.
Malaria is endemic in the Atlantic coast region and anti-malarial medication should be taken before and after travel to this region.
Travelers are advised to take a prophylactic regimen best suited to their health profile.
No prophylaxis anti-malarial medication is required for Managua and the western, Pacific coast region.
For both Dengue fever and malaria, the best prevention is the use of DEET insect repellant, as well as the wearing of protective clothing and bed-nets to prevent mosquito bites.

Tap water is not considered safe in Nicaragua.
All persons should drink only bottled water.
Individuals traveling to Nicaragua should ensure that all their routine vaccinations are up to date.
Vaccination against Hepatitis A, Hepatitis B, rabies and typhoid is strongly recommended.
A yellow fever vaccination is not required to enter Nicaragua unless the traveler has recently visited a country where yellow fever is endemic.
Travelers taking prescription medications should bring an adequate supply with them when coming to Nicaragua.
Many newer combination medications are not available in local pharmacies.

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

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

TRAFFIC SAFETY AND ROAD CONDITIONS:
Driving in Nicaragua poses many difficulties and risks, including mandatory arrest for drivers involved in accidents that result in death or serious injury until police are able to determine who is at fault.

Driving is on the right side of the road in Nicaragua.
Motorists driving to Nicaragua should use the principal highways and official border crossings at Guasaule, El Espino, and Las Manos between Nicaragua and Honduras and Penas Blancas between Nicaragua and Costa Rica.
Although some of the principal highways connecting the major cities are in generally good condition, drivers should be aware that seasonal, torrential rains take a heavy toll on road beds.
With few exceptions, secondary roads are in poor repair, potholed, poorly lit, frequently narrow, and lack shoulders.
Road travel after dark is especially hazardous in all areas of the country.
Motorists are encouraged to prepare accordingly and may want to carry a cellular phone in case of an emergency.

Some of the major highways and roads are undergoing major repair, repaving, and upgrading.
Be on the lookout for detours and slow traffic on these roads.
In general, road signs are poor to non-existent.
Bicycles, oxcarts, dogs, horses, and vehicles without lights are at times encountered even on main thoroughfares in Nicaragua.
Motorcycles, often carrying passengers, dart in and out of traffic with little or no warning.
Many vehicles are in poor condition, travel very slowly, and break down without warning.
Drivers should be especially careful on curves and hills, as many drivers will pass on blind spots.
Speed limits vary depending on the type of road, but because the government lacks the resources, traffic rules are rarely enforced.
Due to the age and disrepair of many vehicles, many drivers will not signal their intentions using turn indicators.
Rather, it is common for a vehicle operator to stick his hand out the window to signal a turn.
If you do drive in Nicaragua, you need to exercise the utmost caution, drive defensively, and make sure you have insurance.

Nicaraguan law requires that a driver be taken into custody for driving under the influence or being involved in an accident that caused 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 Nicaragua might want to consider hiring a professional driver during their stay.
Licensed drivers who are familiar with local roads can be hired through local car rental agencies.
In case of accident, only the driver will be taken into custody.

The Embassy has received an increasing number of complaints from U.S. citizens who have been stopped by transit police authorities demanding bribes in order to avoid paying fines.
Motorists in rental cars and those whose cars have foreign license plates are more likely to be stopped by transit police.
Transit police have seized driver licenses and car registration documents from motorists who refuse to or are unable to pay.
Subsequently, these drivers have reported difficulties in recovering the seized documents.
U.S. citizens are urged to ensure that their vehicles comply fully with Nicaraguan transit regulations, including being in possession of an emergency triangle and fire extinguisher, and that the vehicle is properly registered.
If transit police authorities demand an on-the-spot payment, drivers should ask for the officer's name and badge number, as well as a receipt, and inform the Embassy of when/where the event took place.
(Reports should be sent via email to ACS.Managua@state.gov.)
Rental car agencies should also be advised if their vehicles have been deemed negligent in meeting Nicaraguan transit regulations.

As noted in the “Crime” section above, several groups of U.S. citizens driving from Managua’s International Airport at night have been robbed and kidnapped by men dressed as Nicaraguan police officers.
While the majority of these crimes have occurred on the Tipitapa-Masaya Highway, recent reports indicate similar activity along the Managua-Leon Highway.
The U.S. Embassy warns U.S. citizens to exercise extreme caution when driving at night from Managua’s International Airport and to avoid traveling the Tipitapa-Masaya Highway at night.

Avoid taking public transportation buses.
They are overcrowded, unsafe, and often are used by pickpockets.
Because of the conditions discussed above, traffic accidents often result in serious injury or death.
This is most often true when heavy vehicles, such as buses or trucks, are involved.
Traditionally, vehicles involved in accidents in Nicaragua 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.

Regulations governing transit are administered by the National Police.
For specific information concerning Nicaraguan driver’s permits, vehicle inspection, road tax, and mandatory insurance, you may wish to refer to the National Police web site at http://www.policia.gob.ni.
You may also contact the Embassy of Nicaragua or a Consulate for further information.
Please refer to our Road Safety page for more information.
Visit the website of the country’s national tourist office and national authority responsible for road safety at http://www.mti.gob.ni
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Nicaragua’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Nicaragua’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:
Purchasing Property: U.S. citizens should be aware of the risks of purchasing real estate in Nicaragua and should exercise caution before committing to invest in property.
The U.S. Embassy has seen an increase in property disputes over the last several years.
The 1979-90 Sandinista government expropriated approximately 28,000 real properties, many of which are still involved in disputes or claims.
Land title remains unclear in many cases.
Although the government has resolved several thousand claims by U.S. citizens for compensation or return of properties, there remain hundreds of unresolved claims registered with the Embassy.
Potential investors should engage competent local legal representation and investigate their purchases thoroughly in order to reduce the possibility of property disputes.

The Nicaraguan judicial system offers little relief when the purchase of a property winds up in court.
The Embassy is aware of numerous cases in which buyers purchase property supported by what appear to be legal titles only to see themselves subsequently embroiled in legal battles when the titles are contested by an affected or otherwise interested third party.
Once a property dispute enters the judicial arena, the outcome may be subject to corruption, political pressure, and influence peddling.
Many coastal properties have been tied up in courts recently, leaving the ”buyer” unable to proceed with the intended development pending lengthy and uncertain litigation.
In other cases squatters have simply invaded the land while the police or judicial authorities are unable (or unwilling) to remove the trespassers.
Again, the Embassy advises that those interested in purchasing Nicaraguan property exercise extreme caution.
Please note that Nicaraguan law currently prohibits any individual from buying beach-front property (including islands) unless the original land title was registered before the 1917 Nicaraguan Agrarian Reform Law.
Coastal properties with titles pre-dating 1917 are not risk-free, however.
In 1987 the Nicaraguan Constitution established the property rights of indigenous communities over territory they have traditionally occupied.
The Embassy advises extreme caution when considering the purchase of coastal property in Nicaragua.

Currency and Credit Cards: U.S. dollars are widely accepted throughout the country, and major credit cards are also typically accepted in hotels, restaurants, stores, and other businesses in urban and tourist areas.
Visitors who need to change dollars are encouraged to do this at their hotel since this is typically the safest place.
ATM machines are available at banks in addition to some shopping centers and gas stations in urban and tourist areas.
However, individuals should exercise caution when using an automaticteller machine since they are typically in or near uncontrolled areas and criminal elements can easily see them withdrawing cash.
Traveler’s checks are accepted at a few major hotels and may also be exchanged for local currency at authorized exchange facilities ("casas de cambio").
Visitors will also find enterprising individuals - ”Cambistas” - waving wads of cash in the street.
Changing money in this fashion can be dangerous and is not recommended.

The U.S. Embassy has noted an increase in credit card fraud.
Although local police authorities have made several arrests in conjunction with credit card scam operations, the danger for abuse continues.
Illegal use can include “skimming” or making a copy of the magnetic strip on the credit card or simply copying the number for later use.
U.S. citizens who do continue to use credit cards in Nicaragua are advised to check statements frequently to monitor for abuse and/or to ask banks to email them when transactions exceed a certain number or size.

Disaster Preparedness: Nicaragua is prone to a wide variety of natural disasters, including earthquakes, hurricanes, and volcanic eruptions.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov
Boundary Disputes:
On the Atlantic side, nautical travelers should be aware that there is an ongoing boundary dispute with Colombia over the San Andres Island archipelago and the surrounding waters, specifically the area east of the 82nd and up to the 79th meridian.
Furthermore, the Government of Nicaragua has also begun to exercise sovereignty over territorial waters that were formerly controlled by Honduras but recently awarded to Nicaragua by the International Court of Justice.
Since October 2007, the Nicaraguan Navy has impounded about a dozen vessels, including two U.S.-owned vessels, for allegedly fishing without a Nicaraguan permit in theses zones.
Maritime boundary disputes also exist on the Pacific side.
In late-2007, the governments of Nicaragua, Honduras, and El Salvador reached an accord regarding shared fishing rights in the Gulf of Fonseca; however, questions remain regarding boundary demarcations in the Gulf of Fonseca.
Commercial fishing vessels should always ensure that they are properly licensed as problems have been reported in the areas off Cabo Gracias a Dios.
As a result of these disputes, in June 2008, the U.S. Coast Guard published a Special Warning on Nicaragua in the U.S. Notice to Mariners, which can be found at http://www.navcen.uscg.gov/Lnm/d1/lnm01242008.pdf (p. 6).

Travelers should also be aware that narcotics traffickers often use both the Caribbean and the Pacific coastal waters.
Customs Regulations: Before excavating archaeological materials, or agreeing to buy artifacts of historical value, all persons are strongly urged to consult with the National Patrimony Directorate of the Nicaraguan Institute of Culture.
Nicaraguan law and a bilateral accord limit the acquisition, importation into the United States and commercialization of said goods.
Severe criminal penalties may apply.
U.S. citizens planning to stay in Nicaragua for an extended period of time with the intention of bringing vehicles or household goods into the country should consult Nicaraguan customs officials prior to shipment.
Please see our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Nicaraguan laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Nicaragua are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans residing or traveling in Nicaragua are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Nicaragua.
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 Kilometer 5 1/2 (5.5) Carretera Sur, Managua; telephone (505) 252-7100 or 252-7888; after hours telephone (505) 252-7634; Consular Section fax (505) 252-7304; Email: consularmanagua@state.gov or ACS.Managua@state.gov; web page: http://nicaragua.usembassy.gov/
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This replaces the Country Specific Information for Nicaragua dated June 3, 2008, to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Medical Facilities and Health Information, Traffic Safety and Road Conditions, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Thu, 25 Oct 2018 22:17:34 +0200

Montreal, Oct 25, 2018 (AFP) - Canadian tour operator Transat has cancelled all flights to Nicaragua this coming winter over the crisis that has left more than 320 dead in the Central American country, the company said Thursday.   This decision was made "because of the ongoing civil unrest and (the) weak demand that arises," Air Transat spokeswoman Debbie Cabana told AFP.   Air Transat would have offered three direct flights weekly form Toronto or Montreal to Managua from December 20 until the end of March.   "Customers who have reservations at the destination can change their booking or get a full refund," Cabana said.

Protests that began in April against a pension reform in Nicaragua grew into a movement demanding the departure of President Daniel Ortega and his wife, Vice President Rosario Murillo, who are accused of authoritarianism.    The protests have been severely repressed by police and paramilitaries, and the government proclaimed the situation normalized.   Canada continues to advise its nationals "to avoid any non-essential travel to Nicaragua."
Date: Fri, 7 Sep 2018 19:57:24 +0200

Managua, Sept 7, 2018 (AFP) - Many shops, banks and gas stations were closed Friday in a 24-hour strike in Nicaragua called by the opposition in protest at "political prisoners" and the rule of President Daniel Ortega's government.   In Mercado Oriental, one of the capital Managua's main trade districts, most of the 20,000 shops and businesses were shut, while few people were out on the streets.   "It's an excellent strike, this is how we are supporting those who were taken, who are being tortured, who have no business being in jail just for protesting," shopkeeper Geidy Areas, 38, told AFP.   The normally busy road south from Managua to Masaya, where many shops operate, appeared more desolate than normal.   Friday's strike, the first since July, was called by the opposition Civil Alliance for Justice and Democracy.   More than 300 Nicaraguans have been charged with crimes for taking part in protests, including 85 who are accused of terrorism.   The Alliance is demanding dialogue with Ortega's government after months of turmoil that left more than 300 people dead, according to rights groups.

In Managua, most banks, gas stations, shopping malls and book shops were closed but there were more buses and public transport vehicles running than during previous strikes in June and July.   In an important economic zone north of Managua, many hardware stores, shops and cafes remained open.   "People have to keep struggling because they've got bank debts and need to feed their children," food vendor Johana Blandon, who works in a busy free trade zone to the east of Managua, told AFP.   Government offices were operating as normal.   Nicaragua's descent into chaos was triggered on April 18 when relatively small protests against now-scrapped social security reforms were met with a government crackdown, backed by armed paramilitaries.

Catholic church-brokered peace talks broke down in June after Ortega rejected a key opposition demand to step down and bring forward presidential elections.   Last week, Ortega expelled the United Nations human rights mission after it published a report criticizing the "climate of fear" in the Central American country, one of the poorest in the region.   The UN denounced a wide range of serious violations, including disproportionate use of force by police, which in some cases resulted in extrajudicial killings, enforced disappearances, arbitrary detention and torture.   Ortega, a former guerrilla leader who has been in power for the last 11 years, denied the claims and described the UN as "an instrument of the policies of terror, lies and infamy."
Date: Thu, 6 Sep 2018 18:06:28 +0200

Managua, Sept 6, 2018 (AFP) - Nicaragua's opposition called a 24-hour strike on Thursday, due to start the next day, in protest against President Daniel Ortega and to demand the release of "political prisoners."   The strike is due to begin at midnight on Thursday, the Civil Alliance for Justice and Democracy, made up of students, businesses and civil service groups, said in a statement.

The opposition is demanding dialogue with Ortega's government after months of turmoil that left more than 300 people dead, according to rights groups.   It called on supporters to "join this national effort from your homes."   "Nicaragua needs an urgent and peaceful solution through dialogue," said the opposition.   "We need to live in security, without kidnappings, without political prisoners, without persecution and without the stigmatization of those who think differently."   Last week, Ortega expelled the United Nations human rights mission after it published a report criticizing the "climate of fear" in the Central American country, one of the poorest in the region.   The UN denounced a wide range of serious violations, including disproportionate use of force by police, which in some cases resulted in extrajudicial killings, enforced disappearances, arbitrary detention and torture.

Ortega, a former guerrilla leader who has been in power for the last 11 years, refuted the claims and described the UN as "an instrument of the policies of terror, lies and infamy."   In addition to the dead and 2,000 people injured in clashes between anti-government protesters and regime forces back by paramilitaries, more than 300 Nicaraguans have been charged with crimes for taking part in the protests, of which 85 are accused of terrorism.   Two Alliance leaders, Medardo Mairena and Edwin Carcache, are amongst those to have been charged.   The opposition says "dialogue is the only path" to overcome the current political crisis.

Nicaragua's descent into chaos was triggered on April 18 when relatively small protests against now-scrapped social security reforms were met with a government crackdown, backed by armed paramilitaries.   Catholic church-brokered peace talks broke down in June after Ortega rejected a key opposition demand to step down and bring forward presidential elections.   Opposition supporters claimed the last strike in mid-July was 90 percent respected, although government media said businesses had remained open in several trade zones.
Date: Fri, 27 Jul 2018 23:17:00 +0200

Managua, July 27, 2018 (AFP) - More than a dozen doctors, nurses and technical staff in a public hospital in Nicaragua have been sacked because they treated wounded anti-government protesters and were seen backing their cause, medical sources said Friday.

Those fired "without any legal justification" worked at the Oscar Danilo Rosales Hospital in the northwestern city of Leon, surgery and endoscopy department chief Javier Pastora told AFP.   The hospital is run by the health ministry.   The allegation bolstered reports that those perceived to back protest claims calling for the ouster of President Daniel Ortega were being persecuted by his government and sympathizers.

Nicaragua has seen more than three months of unrest as those protests were brutally countered by police and armed pro-government paramilitaries.   More than 300 people have been killed and thousands have fled to neighboring Costa Rica for safety, according to rights groups.   Pastora, who has worked in Nicaragua's public health system for 33 years, said the staff members were fired because they were deemed to support the protesters by treating them.   "They said we were people showing solidarity and support for the people's fight," he said.   Pastora said at least nine medical specialists were among those fired.

- Dismissed in surgery -
"I was in surgery when they came from human resources to tell me I could no longer stay because I was fired," said one of the dismissed medics, cancer surgeon Aaron Delgado.   A dismissed pediatrician, Edgar Zuniga, called the axings "arbitrary."   They were fired "for thinking differently, for saying Nicaragua needs democracy, freedom, that the repression and killings must stop and there has to be dialogue," he said.

The staff and residents in Leon held a protest in front of the hospital demanding the sackings be reversed.   Leon used to be a bastion of support for the Sandinista movement Ortega leads, but as the unrest took hold, there too paramilitaries and anti-riot police have stormed the city several times to crush protests.   Rights groups say more than 2,000 people have been hurt across the country since the clashes erupted mid-April.   Many of them sought medical attention for their wounds from volunteers outside the state health system, which was said to have received orders to turn them away.
Date: Wed, 11 Jul 2018 22:06:35 +0200

Washington, July 11, 2018 (AFP) - The known death toll from a four-month crackdown on anti-government protests in Nicaragua has risen to 264, the Inter-American Commission on Human Rights said Wednesday.

"As recorded by the IACHR since the start of the repression against social protests, to date, 264 people have lost their lives and more than 1,800 have been injured," the commission's chief Paulo Abrao told reporters.   He was speaking at a meeting of the Organization of American States -- of which the IACHR is part -- about the situation in the violence-wracked Central American country, where protesters are seeking the ouster of President Daniel Ortega.   The rights body had previously given a toll of 212 dead, although local estimates recently put the toll at about 250.

The influential Roman Catholic church has been mediating between Ortega's government and the opposition to end the unrest, but the process has become bogged down amid continuing violence.   In the latest outburst, at least 14 people died in a weekend raid by a pro-government mob near the opposition bastion of Masaya, in the country's southwest.   The opposition is planning to crank up the pressure on Ortega starting on Thursday with an anti-government protest and general strike.

A former leftist guerrilla, Ortega will next week commemorate the 1979 popular uprising that brought him to power with an annual July 19 march due to start in Masaya.   Once the hero of left-wing revolutionaries, Ortega is now widely viewed as an oppressor.   Having lost a presidential vote in 1990, he was re-elected in 2007 but opponents have accused him -- together with his wife Vice President Rosario Murillo -- of establishing a dictatorship characterized by nepotism and brutal repression.
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World Travel News Headlines

Date: Thu, 20 Feb 2020 16:20:39 +0100 (MET)

Damascus, Feb 20, 2020 (AFP) - A bomb explosion wounded two people in Damascus Thursday, the state news agency reported, the latest of several such attacks in the Syrian capital.   "An explosive device planted on a pickup truck went off in the Marjeh area" in central Damascus, SANA said, adding that two civilians were wounded by the blast.

The Syrian Observatory for Human Rights war monitor said the device was a "sticky bomb" planted on a military vehicle, although it was not immediately clear what the target was.   There was no immediate claim of responsibility for the blast, nor for a similar explosion that wounded five people in another neighbourhood of Damascus on Tuesday. The Syrian capital was routinely targeted by major car bomb attacks in the course of the nine-year-old conflict but blasts have been less frequent since regime forces reclaimed full control of the Damascus region in 2018.
Date: Thu, 20 Feb 2020 15:40:35 +0100 (MET)
By Laurent Thomet, with Miwa Suzuki in Tokyo

Beijing, Feb 20, 2020 (AFP) - China on Thursday touted a big drop in new virus infections as proof its epidemic control efforts are working, but the toll grew abroad with deaths in Japan and South Korea.   Fatalities in China hit 2,118 as 114 more people died, but health officials reported the lowest number of new cases in nearly a month, including in hardest-hit Hubei province.

More than 74,000 people have been infected by the new coronavirus in China, and hundreds more in over 25 countries.   The number of deaths outside mainland China climbed to 11.   Japan's toll rose to three as a man and a woman in their 80s who had been aboard a quarantined cruise ship died, while fears there mounted about other passengers who disembarked the Diamond Princess after testing negative.

South Korea reported its first death, and the number of infections in the country nearly doubled Thursday to 104 -- including 15 at a hospital in Cheongdo county.   The mayor of Daegu -- South Korea's fourth-largest, with 2.5 million people -- advised residents to stay indoors, while commanders at a major US military base in the area restricted access.   Iran reported two deaths on Wednesday, the first in the Middle East. Deaths have previously been confirmed in France, the Philippines, Taiwan and Hong Kong.

Chinese officials say their drastic containment efforts, including quarantining tens of millions of people in Hubei and restricting movements in cities nationwide, have started to pay off.   "Results show that our control efforts are working," Foreign Minister Wang Yi said at a special meeting on the virus with Southeast Asian counterparts in Laos, citing the latest data.   Wang said the situation was "significantly improving" in Hubei and Wuhan, but an official in a central government team dealing with the epidemic said it was still "very severe".

- 'Not turning point' -
Although more than 600 new infections were reported in Hubei's capital Wuhan, it was the lowest daily tally since late January and well down from the 1,749 new cases the day before.   The national figure has now fallen for three straight days.   Chinese authorities placed the city of 11 million under quarantine on January 23 and quickly locked down the rest of the province in the days that followed.

Wuhan authorities this week carried out a three-day, door-to-door check on residents, with the local Communist Party chief warning that officials would be "held accountable" if any infections were missed.   Cities far from the epicentre have limited the number of people who can leave their homes for groceries, while rural villages have sealed off access to outsiders.   Richard Brennan, a World Health Organization official, said in Cairo that China was making "tremendous progress" and "trends are very encouraging, but we are not at a turning point yet".

- 'Chaotic' cruise quarantine -
While China has boasted progress in its fight against the COVID-19 epidemic, Japan's government has been criticised for the quarantine measures it placed on the Diamond Princess.   The huge vessel moored in Yokohama is easily the biggest coronavirus cluster outside the Chinese epicentre, with 634 cases confirmed among passengers and crew.   Another 13 people on board the ship were diagnosed with the virus Thursday, Japan's health ministry said.   Still, passengers were disembarking after negative tests and having completed a 14-day quarantine period -- packing into yellow buses and leaving for stations and airports.

Questions were asked over the wisdom of allowing them to mingle in Japan's crowded cities.   "Is it really safe to get off?" screamed a headline in the Nikkan Sports tabloid.   The paper quoted one passenger who said he was tested on February 15, but only left four days later.   "I thought I could be infected during the four days. I thought 'Is it really OK'?"

A specialist in infectious diseases at Kobe University slammed as "completely chaotic" the quarantine procedures on board in rare criticism from a Japanese academic.   "The cruise ship was completely inadequate in terms of infection control," said Kentaro Iwata in videos he has since deleted.

South Korea, meanwhile, announced 51 new cases, with more than 40 in a cluster centred on the Shincheonji Church of Jesus, an entity often accused of being a cult.  The infections apparently came from a 61-year-old woman who first developed a fever on February 10 and attended at least four services before being diagnosed.   Local media said she had twice refused to be tested for the coronavirus on the grounds she had not recently travelled abroad.   Authorities were investigating whether she might have visited the hospital where a long-term patient contracted the virus and later died.

Some 15 other patients have now been found to have the virus.   Shincheonji claims its founder, Lee Man-hee, has donned the mantle of Jesus Christ and will take 144,000 people with him to heaven on the day of judgement.   A man in his 60s tested positive for the coronavirus after dying Wednesday following symptoms of pneumonia, South Korean authorities said.
Date: Thu, 20 Feb 2020 10:28:16 +0100 (MET)

Lagos, Feb 20, 2020 (AFP) - An outbreak of Lassa in Nigeria has killed 103 people this year, health authorities said, as the first confirmed case was reported in the economic hub Lagos.    "Cumulatively from week 1 to week 07, 2020, 103 deaths have been reported with a case fatality rate of 17.6%," said the Nigeria Centre for Disease Control (NCDC) in its latest statistics on the virus released on Wednesday.    The overall number of confirmed cases rose by 115 last week to a total of 586 across the country.

Separately, health authorities in Lagos, Nigeria's most populous city with 20 million inhabitants, said an infected person was diagnosed there on February 17 and being treated in isolation in hospital.    "Sixty-three people that may have been in contact with the patient and who may have been infected in the process have been identified and are being monitored," the state government wrote on Twitter on Thursday.

Endemic to Nigeria, Lassa fever belongs to the same family as the Ebola and Marburg viruses, but is much less deadly.   The disease is spread by contact with rat faeces or urine or the bodily fluids of an infected person.    The majority of those infected do not show symptoms but the disease can go on to cause severe bleeding and organ failure in about 20 percent of cases.

An outbreak of Lassa fever killed some 170 people around Nigeria last year.     The number of cases usually climbs around the start of the year linked to the dry season.   While the overall number of confirmed cases and deaths is up this year on the same period in 2019, the mortality rate is lower.    Twenty health workers across the country have been confirmed as contracting the disease so far in 2020.    The virus takes its name from the town of Lassa in northern Nigeria, where it was first identified in 1969.
Date: Thu, 20 Feb 2020 09:58:17 +0100 (MET)
By Nicolas DELAUNAY

Les Mamelles, Seychelles, Feb 20, 2020 (AFP) - On a plain suburban street in Seychelles, far from the idyllic coastline and luxury resorts pampering honeymooners and paradise-seekers, heroin addicts queue anxiously for their daily dose of methadone.   It is a scene few outsiders would associate with the tropical nirvana adrift in the Indian Ocean, and one rarely, if ever, glimpsed by tourists as they shuttle from the airport to five-star luxury on white-sand beaches.

But life for many Seychellois is far from picture perfect: the tiny archipelago nation is battling what officials say are the world's highest rates of heroin addiction.   Nearly 5,000 people are hooked, government figures show, equivalent to nearly 0 percent of the national workforce -- a statistic that has startled the government into action.

In comparison, 0.4 percent of the global population consumed opioids in 2016, half of them in Asia, according to a United Nations report that puts Seychelles among the top consumers alongside producing countries such as Afghanistan.   The Seychelles' heroin boom, which took off over the past decade, gripped young and old alike and cut across class lines.   Among those queueing in the town of Les Mamelles for methadone -- a substitute narcotic used to wean users off heroin -- are parents with young children, an old man leaning on a cane and a taxi driver between shifts.

Graham Moustache, a 29-year-old father of two, described how the arrival of affordable and high-quality heroin in Seychelles swept up his entire family.   "I have four brothers and two sisters, and we have all been heroin addicts at one point," he told AFP, tracing his fingers over the needle scars on his arms.   "I've been to prison twice," he said, adding his mother had turned him in as "she didn't know what to do any more".   "Sometimes, I didn't have enough to eat and I had to choose between eating and buying heroin. I chose heroin."

- Soaring addiction -
The rise of new trafficking routes through East Africa in the late 2000s, coupled with porous borders and relatively high purchasing power among Seychellois, flooded the paradisal islands with heroin.   The average salary in the archipelago is $420 (390) -- high compared to other African nations.   The World Bank considers the Seychelles the only high-income country on the continent, thanks to the growing tourism industry.    But around 40 percent of the population still lives in poverty.

By 2011, around 1,200 people were addicted, prompting a punitive crackdown.   "We did not make a difference between the victim and the trafficker," said Patrick Herminie, director of the state-run Agency for Drug Abuse Prevention and Rehabilitation (APDAR).   By 2017, addiction had risen four-fold, placing Seychelles among the world's most drug-dependent nations.   The government, realising its war on drugs had failed, changed tack and declared a public health emergency.   "The magnitude of the problem is simply because we reacted a bit late," Herminie said.

Money has poured into combating the scourge, with state funds for drug prevention and rehabilitation programmes soaring to 75 million Seychelles rupees ($5.5 million) in 2020 -- almost 10 times the 2016 budget.    APDAR, a specialist drug agency created in 2017 to tackle the problem, employs four times as many staff as the body that preceded it.   A state-run methadone programme has reached 2,500 people, with medical follow-ups helping to track their progress.    But the free availability of methadone has also prompted drug dealers to lower their prices.

Mobile clinics drive around offering methadone to addicts and providing free health checks and advice.    "I've been clean for more than a year. I found a job as a fisherman, and I can see my two kids," said Moustache proudly, as he queued at the white methadone van staffed with healthcare workers.   Others have struggled to stay the course.   "Methadone helps me a lot, but it's difficult not to take heroin at all," said Gisele Moumou, an emaciated 32-year-old addict, drawing ragged breaths and sweating as she waits for her small cup of methadone.

- Stopping the scourge  -
Schoolchildren are being taught about the damage done by drugs through awareness campaigns and billboards in classrooms.    But there is much work to be done, especially among children from families affected by drug use, says Noellie Gonthier from CARE, a local harm-reduction charity.   "Sometimes, four- or five-year-olds at school mimic injecting heroin," she said.   "Our challenge is to make them understand that what they consider normal -- because of their family context -- actually isn't at all."   On Mahe, a small, mountainous island with lush vegetation, most of the population lives near the water. Life is quiet here, without traffic, and the streets are mostly clean.

Poverty is largely hidden, concentrated in a few neighbourhoods behind faded walls or in the hills.   So why do so many Seychellois take drugs? The authorities admit they haven't quite figured it out, but say it appears that while poverty does not quite allow people to live well, it allows them enough money to buy drugs to forget their woes.   "The root of the cause, we're still working on it," said Herminie.   Early studies show that health and social problems associated with heroin use have declined since the government switched its response from punishment to prevention, officials say.

Crime has nearly halved and annual cases of new hepatitis C infections have fallen 60 percent.    Youth unemployment, meanwhile, has shrunk from 6.5 percent to 2.1 percent in recent years.   One recovering addict, a taxi driver who did not want to be named, offered a bleak assessment as he waited for his daily methadone in an empty car park in Les Mamelles.    "We're a small island in the middle of the ocean. What else is there to do here?" he said.
Date: Wed, 19 Feb 2020 16:12:54 +0100 (MET)
By Michael O'HAGAN

Otuke, Uganda, Feb 19, 2020 (AFP) - Under a warm morning sun scores of weary soldiers stare as millions of yellow locusts rise into the northern Ugandan sky, despite hours spent spraying vegetation with chemicals in an attempt to kill them.   From the tops of shea trees, fields of pea plants and tall grass savanna, the insects rise in a hypnotic murmuration, disappearing quickly to wreak devastation elsewhere.   The soldiers and agricultural officers will now have to hunt the elusive fast-moving swarms -- a sign of the challenge facing nine east African countries now battling huge swarms of hungry desert locusts.

They arrived in conflict-torn South Sudan this week, with concerns already high of a humanitarian crisis in a region where 12 million are going hungry, according to the UN's Food and Agriculture Organization (FAO).    "One swarm of 40 to 80 million can consume food" for over 35,000 people in a day, Priya Gujadhur, a senior FAO official in Uganda, told AFP.

In Atira -- a remote village of grass-thatched huts in northern Uganda -- some 160 soldiers wearing protective plastic overalls, masks and goggles sprayed trees and plants with pesticide from before dawn in a bid to kill the resting insects.   But even after hours of work they were mostly able to reach only lower parts of the vegetation.   Major General Kavuma sits in the shade of a Neem Tree alongside civilian officials as locusts sprayed with pesticide earlier that morning fall around them, convulsing as they die.   An intense chemical smell hangs in the air.

- 'They surrounded me' -
Zakaria Sagal, a 73-year-old subsistence farmer was weeding his field in Lopei village some 120 kilometres (75 miles) away, preparing to plant maize and sorghum, when without warning a swarm of locusts descended around him.   "From this side and this side and this side, they surrounded me," Sagal said, waving his arms in every direction.    "We have not yet planted our crops but if they return at harvest time they will destroy everything. We are not at all prepared."

East Africa's regional expert group, the Climate Prediction and Applications Centre (ICPAC), warned Tuesday that eggs laid across the migratory path will hatch in the next two months, and will continue breeding as the rainy season arrives in the region.   This will coincide with the main cropping season and could cause "significant crop losses... and could potentially worsen the food security situation", ICPAC said in a statement.

- 'Panic mode' -
Since 2018 a long period of dry weather followed by a series of cyclones that dumped water on the region created "excessively ideal conditions" for locusts to breed, says Gujadhur.    Nevertheless, governments in East Africa have been caught off guard and are currently in "panic mode" Gujadhur said.   The locusts arrived in South Sudan this week after hitting Ethiopia, Somalia, Kenya, Djibouti, Eritrea, Tanzania, Sudan and Uganda.   Desert locusts take over on a dizzying scale.

One swarm in Kenya reached around 2,400 square kilometres (about 930 square miles) -- an area almost the size of Moscow -- meaning it could contain up to 200 billion locusts.   "A swarm that size can consume food for 85 million people per day," said Gujadhur.   Ugandan authorities are aware that subsequent waves of locusts may pose problems in the weeks to come, but in the meantime they are attempting to control the current generation.

Gujadhur is quick to praise the "quite strong and very quick" response from the Ugandan government but is concerned that while the army can provide valuable personnel, a military-led response may not be as effective as is necessary.    "It needs to be the scientists and (agriculture officials) who take the lead about where the control operations need to be and how and when and what time," she said.

- 'They eat anything green' -
The soldiers have been working non-stop for two days, criss-crossing the plains on the few navigable roads, trying to keep up with the unpredictable swarms.    Major General Kavuma recognises that the biggest threat is from the eggs which are yet to hatch but is confident the army will be able to control this enemy.   "We have the chemicals to spray them, all we need is to map the places they have been landing and sleeping," he said.   "In two weeks time we will come back and by that time they will have hatched and that will be the time to destroy them by praying."

Back in Lopei village, Elizabeth Namoe, 40, a shopkeeper in nearby Moroto had been visiting family when the swarm arrived.   "When the locusts settle they eat anything green, the animals will die because they have nothing to feed on, then even the people (will suffer)," she said.   "The children will be affected by hunger and famine since all life comes from all that is green. I fear so much."
Date: Wed, 19 Feb 2020 12:55:06 +0100 (MET)

Beijing, Feb 19, 2020 (AFP) - China's President Xi Jinping called Wednesday for greater protection of medical staff fighting the new coronavirus after the deaths of prominent doctors sparked national anger at the government's handling of the outbreak.   At least seven medical workers have died from the virus, while 1,716 have been confirmed as infected, most at the epicentre of the epidemic in central Hubei province where hospitals have dealt with a huge influx of patients.

Staff have faced shortages of masks and protective bodysuits, with some even wearing makeshift suits and continuing to work despite showing respiratory symptoms, health workers have told AFP.   Xi said China must "strengthen efforts to relieve the stress of medical workers, provide them with daily necessities, arrange time for their rest and give them encouragement", the official Xinhua news agency reported.   Liu Zhiming, the director of Wuchang Hospital in Hubei's capital Wuhan, died Tuesday, more than a week after the death of whistleblowing ophthalmologist Li Wenliang in the same city prompted nationwide mourning and calls for political reforms.

- 'Majestic spirit' -
A paper published by China's Center for Disease Control and Prevention said an additional 1,300 health workers may have been infected but have yet to receive a diagnosis.   Xi said China must ensure medical teams in Hubei and Wuhan "carry out work in a safe, orderly, coordinated, effective and swift manner", Xinhua reported.   The deaths of frontline medical workers "reflected doctors' humane and majestic spirit", Xi said.   The death toll from the virus jumped past 2,000 on Wednesday, while 74,185 cases of infection have been confirmed in mainland China.
Date: Wed, 19 Feb 2020 12:19:59 +0100 (MET)

Tehran, Feb 19, 2020 (AFP) - Two people in Iran tested positive Wednesday for the deadly new coronavirus, the health ministry said, in the Islamic republic's first cases of the disease.   Kianoush Jahanpour, a ministry spokesman, said the cases were detected in the holy city of Qom, south of the Iranian capital.   "In the past two days, some suspect cases of the new coronavirus were observed in Qom city," he said, quoted by state news agency IRNA.

"Teams were dispatched after receiving the reports, and based on the existing protocols the suspect cases were isolated and tested," said Jahanpour.   "Out of the samples sent, a laboratory tested two of them as positive for coronavirus just minutes ago and some of the other samples were type B influenza."

The health ministry spokesman said additional tests were being done on the two cases and final results would be announced "as soon as possible".   The new coronavirus epidemic has killed more than 2,000 people in China and infected more than 74,000. It has spread to at least two dozen countries.   The United Arab Emirates was the first country in the Middle East to report cases of coronavirus last month.
Date: Tue 18 Feb 2020
Source: CIDRAP (Center for Infectious Disease Research & Policy) News [edited]

The WHO's African regional office said that both Chad and the Central African Republic (CAR) are in the midst of measles outbreaks, with both countries reporting increasing case counts since [1 Jan 2020].

In Chad, 1276 cases, including 14 deaths have been reported since 1 Jan 2020, with 352 suspected measles cases and 4 deaths reported in the week ending on 9 Feb 2020.  "Most, 78%, of the investigated cases never received any vaccination against measles," the WHO said. "60% of the investigated cases were under 5 years of age while 19% were between 5 and 14 years and 14% were 15 years and above."

In CAR, a total of 1498 suspected measles cases, including 15 deaths, have been recorded since [1 Jan 2020]. The outbreak has been ongoing since early 2019. From 1 Jan 2019, through 9 Feb 2020, a total of 5724 suspected measles cases, including 83 deaths (case fatality rate, 1.45%) have been reported in 13 health districts.  Almost 3/4 of the cases (72%) are in children under the age of 5.
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[HealthMap/ProMED-mail maps
Central African Republic: <http://healthmap.org/promed/p/6>]
Date: Wed 19 Feb 2020
Source: Circular/News, Veterinary Services, Israel's Ministry of Agriculture [in Hebrew, trans. Mod.AS, edited]

Rabies, Case No. 6 for 2020, dog, Ramot Naftali, Upper Galilee. Reference: Kimron Vet Institute [KVI] Laboratory Test No. A00373420, dated 19 Feb 2020
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On 17 Feb 2020, a dead dog was brought for examination to the KVI [at Beit-Dagan]. The dog died while being transported to a rabies observation kennel since, as reported, it had attacked grazing cattle and attempted to attack people.  It was also reported that the dog had bitten itself. The tested animal has been diagnosed rabies positive.  [Byline: Dr. Avi Wasserman Head, Field Veterinary Services (acting)]
====================
[The above and 5 earlier rabies cases in Israel since 1 Jan 2020 are located within a small region along the Lebanese border, facing Lebanon's governorate A-Nabatieh. See the rabies map (2020) at <https://moag.maps.arcgis.com/apps/webappviewer/index.html?id=a6d8aae5cbc04c958d5efefd2724318f>.

The 2019 map, presenting a total of 17 cases, is available at

The 6 cases during 2020 are: 3 jackals, 2 dogs, 1 cow. Most likely, rabies is currently circulating within the Lebanese side of the border.

It would be interesting to note whether the rabid dog was owned and, in case affirmative, whether and when this dog was last vaccinated against rabies, as prescribed by law. Israel's owned dogs are included in the national dog registry, currently counting more than 400,000 dogs. - ProMED Mod.AS]
Date: Tue 18 Feb 2020
Source: Qatari Ministry of Public Health [edited]

The Ministry of Public Health (MOPH) declared that a case of Middle East respiratory syndrome (MERS) has been confirmed. The case is a male citizen aged 65 years who has been suffering from several chronic diseases. The patient has been admitted to the hospital to receive the necessary medical care in accordance with the national protocol to deal with confirmed or suspected cases of the disease.

The Ministry of Public Health, in cooperation with the Ministry of Municipality and Environment, is taking all necessary preventive and precautionary measures to control the disease and prevent it from spreading.

MERS is a viral respiratory disease that is caused by one of the coronaviruses (MERS-CoV), but it differs from the novel coronavirus, known as COVID-19, which has recently spread in several countries. Both viruses differ in terms of the source of infection, mode of transmission, and the disease severity. The Ministry of Public Health confirms that no cases of the novel coronavirus (COVID-19) have been diagnosed in Qatar so far.

Only 3 cases of MERS-CoV were registered in Qatar during the past 2 years. The Ministry of Public Health calls on all members of public, and especially people with chronic diseases or those with immunodeficiency disorders, to adhere to public hygiene measures. This includes washing the hands regularly with water and soap, using hand sanitizers, as well as avoiding close contact with camels and seeking medical advice when experiencing symptoms of fever, cough, sore throat, or shortness of breath.

The Rapid Response Team of the Health Protection and Communicable Disease Control is available round-the-clock to receive notifications or inquiries related to communicable diseases on its hotline numbers 66740948 or 66740951.
======================
[In early December 2019, Qatar reported 3 cases of MERS-CoV infection, a fatal case and 2 asymptomatic contacts of the fatal case. The fatal case denied a history of contact with camels or recent travel. She did have a history of underlying medical conditions (which may have led to contact with the health sector in the 2 weeks prior to onset of illness). Prior to these cases, the most recent report of a case of MERS-CoV infection in Qatar was in 2017 when there were 3 cases reported (see prior ProMED-mail posts listed below.)

The location of residence of this patient was not available, nor were other epidemiological variables, including possible high risk exposures.

The HealthMap/ProMED-mail map of Qatar is available at