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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: Mon, 12 Feb 2018 05:54:19 +0100

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu, 19 Oct 2017 16:37:27 +0200
By Ricardo ARDUENGO, con Nelson DEL CASTILLO en San Juan y Leila MACOR en Miami

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

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

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

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

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

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

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

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

Making things worse, people are leaving the island for the mainland US. Forecasts are that the population now at 3.4 million will go down to 3.1 million or even less by 2026, said Villamil.   The government of Florida estimates that since October 3 -- the day a state of emergency to deal with an influx of Puerto Ricans was declared -- more than 36,000 people from the island have poured in.
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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: 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.
Date: Tue, 29 Aug 2017 11:52:52 +0200
By Marielle VITUREAU

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

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

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

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

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

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

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

The average Lithuanian over the age of 15 consumed the equivalent of 13.2 litres of pure alcohol last year, the country's statistics agency reported this week, down by nearly a litre per person compared with a year ago.   But Gauden Galea, a senior World Health Organization official, last month pegged average annual consumption at 16 litres per person, making Lithuanians the world's "top" drinkers, according to the Baltic News Service.   Critics said the measures were unlikely to be effective.   "We're preventing adults from buying alcohol and we think that this will solve all social ills. This is a short-sighted approach," said liberal lawmaker Ausrine Armonaite.
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: Fri, 14 Jun 2019 18:27:56 +0200
By Rosa SULLEIRO

Sao Paulo, June 14, 2019 (AFP) - A nationwide strike called by Brazil's trade unions disrupted public transport and triggered road blocks in parts of the country Friday, ahead of protests against far-right President Jair Bolsonaro's pension reform.   Hours before the opening match of the Copa America in Sao Paulo, some metro lines in the country's biggest city were paralyzed as professors and students also prepared to take to the streets over the government's planned education spending cuts.    It will be the latest mass demonstration against Bolsonaro since he took office in January, but the timing could not be worse for the embattled president as Brazil prepares to play Bolivia in South America's showcase football tournament.

Bolsonaro was expected to attend the opener at Morumbi stadium where police sharpshooters will be deployed as part of increased security for the competition.    One of Brazil's main trade unions estimated 45 million workers had taken part in the strike.   Some 63 cities had been affected by the stoppage, with more than 80 cities recording demonstrations, G1 news site said.   The number of protesters is expected to balloon in the afternoon with demonstrations planned in Brazil's major cities.   Protesters have already blocked some roads in several cities, including Rio de Janeiro and Sao Paulo, where G1 said police had used tear gas to disperse demonstrators and clear the streets.   Brazilians were divided over the partial strike.   "This current government wants to destroy everything that we built decades ago so that's why I'm in favor (of the strike) and I am fighting against social inequality," Vania Santos, 49, told AFP in Rio.    In Sao Paulo, Flavio Moreira opposed the stoppage, however, saying it "hurts the commercial part" of the city.

- Pension savings cut -
Bolsonaro's proposed overhaul of Brazil's pension system -- which he has warned will bankrupt the country if his plan is not approved -- is seen as key to getting a series of economic reforms through Congress.    But the changes, including an increase in the retirement age and workers' contributions, have faced resistance from trade unions and in the lower house of Congress, where Bolsonaro's ultraconservative Social Liberal Party has only around 10 percent of the seats.    A pared-back draft of the reform presented to Congress on Thursday -- which reduces expected savings from 1.2 trillion reais ($300 billion) in 10 years to around 900 billion reais -- did little to appease union leaders, who vowed to go ahead with the shutdown.   Such savings are seen as vital to repairing Brazil's finances and economy, which were devastated by a 2015-2016 crisis.

Economy minister Paulo Guedes, who is spearheading the government's reform agenda, has threatened to resign if the bill is not passed or is watered down significantly.   It caps a tumultuous six months for Bolsonaro, who has seen his popularity nosedive as he struggles to push his signature reform through a hostile Congress and keep Latin America's biggest economy from sliding back into recession.   More than 13 million people are unemployed, the latest data shows, with a record number giving up looking for a job.     Fighting between military and far-right factions of Bolsonaro's government has fueled chaos in his administration where his sons and right-wing writer and polemicist Olavo de Carvalho wield enormous influence.   Bolsonaro sacked his third minister on Thursday -- retired general Carlos Alberto dos Santos Cruz, who had been the government secretary and seen as a moderate voice.   That came on the same day Bolsonaro broke his silence to defend Justice Minister Sergio Moro, who has been accused of wrongdoing while serving as a judge in the sprawling Car Wash anticorruption investigation.
Date: Mon 3 Jun 2019
Source: Fit for Travel [edited]

According to the Brazilian Ministry of Health, there have been 81 cases of yellow fever, including 14 deaths, in the country between 1 Jan and 14 May 2019. Most cases have been confirmed in Sao Paulo (68), with Parana (12) and Santa Catarina (1) also reporting cases.

Nearly all of Brazil is at risk of yellow fever transmission.

Advice to travellers:
- There is a widespread risk of yellow fever in Brazil.

- The World Health Organisation recommends the yellow fever vaccine for travellers to areas at risk of yellow fever (including all of Sao Paulo state and Sao Paulo city) unless contraindicated. Vaccination is advised for all of Parana, Santa Catarina, and Rio Grande do Sul.

- The most recent yellow fever risk map of Brazil is shown here:

- A traveller's risk of yellow fever is determined by their general risk assessment (e.g., country visited, length of stay, city or rural, activities, etc.).

- Mosquito-bite-avoidance rules should be adhered to at all times; the mosquito that spreads yellow fever bites predominantly during the day.
====================
[As has been noted frequently in previous ProMED-mail posts, yellow fever virus is endemic in Brazil and several other South American countries that have tropical forests where the sylvan (forest) transmission cycle is maintained. So far, in Brazil, the sylvan cycle has not spilled over to urban and suburban areas where _Aedes aegypti_ populations are abundant. Currently, vaccination is the best preventive measure available. The risk of adverse effects due to the vaccine is small, approximately one in 1 million. Yellow fever is a serious disease with a case fatality rate of approximately 30% and a potential for rapid spread in an urban situation with a population with low vaccination coverage and abundant mosquito vectors. - ProMED Mod.TY]

[Maps of Brazil:
Date: Fri 31 May 2019
Source: G1 [in Portuguese, trans. ProMED Corr.SB, abridged, edited]

The epidemiology department of the Santarem public health network in western Para is investigating a case of suspected human rabies in a patient who arrived in the city on Thursday night [30 May 2019) from Ruropolis, in Para state.

The patient, a boy only 9 years old, who came from Ruropolis with a referral to TOD (treatment out of domicile) is hospitalized at the Municipal Hospital Dr Alberto Tolentino Sotelo (HMS/Santarem Municipal Hospital). Due to the suspicion of human rabies, the child was placed in an isolation room, where he is receiving medication and going through collection of material for [laboratory] examination.

Through a notice, the Municipal Hospital reported that the epidemiology team at HMS, led by 2 infectious diseases experts, is monitoring the case. Among possible diseases, human rabies is suspected.

Blood, and saliva tests are in the process of being collected and will be sent to the authorized laboratory in Belem. The results should arrive the next week [week of 3 Jun 2019].

Also according to the notice, the clinical picture of the patient is serious. He is intubated in the unit's isolation room.
=======================
[As my ProMED-Port colleague RNA commented this account lacks any information on how this boy might have been exposed and when, when did his symptoms start, and whether he is receiving the appropriate post-exposure immune serum and vaccine. Treatment of human rabies cases once symptoms have started is difficult and rarely successful though latterly, with better knowledge, there have been successes.

HealthMap/ProMED-mail map of Brazil:

Ruropolis is a municipality in the state of Para in the northern region of Brazil. The municipality contains part of the Trairao National Forest, in which logging is permitted subject to a management plan. It also holds part of the Tapajos National Forest, a 549,067 hectares (1 356 770 acres) sustainable use conservation unit created in 1974 (<https://en.wikipedia.org/wiki/Rur%C3%B3polis>). This amount of woodland raises the possibility that this boy, if he has rabies, was infected by a bat. Bat rabies is common in Brazil. Of course it could have been from a rabid dog. - ProMED Mod.MHJ]

[More information on the results of testing and epidemiologic information such as route of transmission and location of exposure would be greatly appreciated. - ProMED Mod.MPP]
Date: Fri 24 May 2019
Source: Virologica Sinica [edited]

[Concern about yellow fever (YF) vaccine availability has been increasing following the large outbreak in Angola and the Democratic Republic of the Congo and more recently in Brazil. Because YF vaccine supplies were not adequate to provide full 0.5 ml doses during those outbreaks, a 1/5th fractional dose was used. The abridged report below reviews the situation and proposes measures to be taken. - ProMED Mod.TY]

Daniel R Lucey, Kristen R Kent. Boosting global yellow fever vaccine supply for epidemic preparedness: 3 actions for China and the USA. Virol Sin. (2019). <https://doi.org/10.1007/s12250-019-00129-w>

In 2016, 2 unprecedented events occurred regarding yellow fever flavivirus infection and vaccine. 1st, in China, 11 persons were diagnosed with yellow fever virus after being infected while working in Angola and returning to China in March-April 2016 (WHO 2016a; Wang et al, 2016; Chen et al, 2016). No transmission within China occurred (Chen and Lu 2016). These were the 1st persons anywhere in Asia known to have laboratory-documented yellow fever infection. 2nd, a global shortage of yellow fever vaccine resulted in the 1st-ever use of a fractional (1/5th) normal dose of yellow fever vaccine anywhere in the world when it was given to 7.5 million people in Kinshasa, Democratic Republic of the Congo (DRC) in August 2016 (Monath et al. 2016; WHO 2016b).
 
These 2 events catalyzed multiple reports about the potential risk and implications of yellow fever epidemics occurring for the 1st-time ever in China or anywhere else in Asia where the _Aedes aegypti_ vector for yellow fever and dengue exists - for example, India, Pakistan, Thailand, Indonesia and beyond (Wasserman et al, 2016: Baumgaertner 2016; The Economist 2016; Schlagenhauf and Chen 2017; Wilder-Smith and Leong 2017; Lucey and Donaldson 2017; Brey et al, 2018; Shearer et al, 2018; Musso et al, 2018; Wilder-Smith and Massad 2018; Brent et al, 2018). Moreover, this fractional dosing of vaccine in Kinshasa in 2016 signified that if additional outbreaks occurred soon after anywhere in the world - for example, Africa, Latin America or Asia, then shortages of full-dose vaccine would likely occur as well.

WHO created the 1st-ever "Global strategy for eliminating yellow fever epidemics (EYE) 2017-2026" program in September 2016 (WHO 2016d). This program estimated that 1.38 billion doses of yellow fever vaccine would be required to eliminate yellow fever epidemics from endemic areas in sub-Saharan Africa and in Latin America and the Caribbean (WHO 2016d). This projected 1.38 billion doses of vaccine did not include any doses for Asia, a continent with no prior yellow fever transmission or vaccination campaigns, and, therefore, immunologically-susceptible to yellow fever epidemics.

Of concern, in Brazil throughout 2018 and into 2019, a YF vaccine shortage required use of the fractional (1/5th) dose involving at least 21 million persons (PAHO 2018, 2019). Due to their national vaccine shortage, Brazil was no longer able to export YF vaccine, as they had done for use in Angola and DRC in 2016. Of note, only the Brazilian vaccine has been used for fractional dosing. Thus, vaccine being used outside of Brazil - for example, sub-Saharan Africa, in 2018 was full-dose vaccine.

Actions to boost YF vaccine supply by China and the USA:

We advocate for 3 actions to be taken by the USA and China to help boost global supply of YF vaccine and increase epidemic preparedness and response. 1st, both nations would work with the WHO to have their YF vaccines prequalified. Thus, their vaccines could be used outside their own borders as part of the international stockpile of YF vaccine as traditionally administrated by the WHO, UNICEF and other members of the multi-partner International Coordinating Group (ICG). 2nd, production of this vaccine would be sharply scaled up by both countries. These vaccines could be made available nationally, regionally, and globally through the ICG - for example, to help stop and prevent epidemics anywhere in the world. 3rd, clinical studies would be coordinated with the WHO to assess the efficacy and safety of fractional dosing using 1/5th normal dose and, if needed, even a 1/10th dose.
=====================
[Readers interested in the YF vaccine situation are encouraged to read the full report available at the above URL. Unfortunately, it is available only through subscription or purchase. - ProMED Mod.TY]
Date: Fri 17 May 2019
Source: The Rio Times [edited]

A new threat to public health haunts the state of Rio de Janeiro: Scientists at the Federal University of Rio de Janeiro (UFRJ) have discovered that a virus with symptoms similar to those of the chikungunya virus [infection] may precipitate an epidemic in the Southeast.

Both have similar characteristics, such as disabling intense joint pains that last for months. There is no vaccine or any specific treatment.

Laboratory tests have shown that the Mayaro virus can be transmitted by both the _Aedes_ mosquito and the common mosquito (_Culex_). According to Amilcar Tanuri, coordinator of the Laboratory of Molecular Virology at UFRJ, where the study was carried out, this increases the risk of an epidemic.

Mistaken for chikungunya [virus], Mayaro [virus] has been present in Rio since 2016. Additionally, the gravity of the discovery lies in the fact that the cases are autochthonous, meaning the victims were infected here, rather than in other locations. To date, 3 cases are known, all from Niteroi.
=======================
[Mayaro virus (MAYV) has been found to cause human disease in other areas in Brazil. This is the 1st report of Mayaro virus infection in Rio de Janeiro state that ProMED-mail has posted. The 1st report of Mayaro virus cases was in 1955, in an outbreak in Para state, Brazil. In 2011, thousands of cases of Mayaro fever were reported an outbreak occurred in Manaus, Amazonas, Brazil.

As ProMED Mod.JT noted in an early ProMED-mail post, MAYV, of the _Alphavirus_ genus, Togaviridae family, is endemic in tropical areas of South America (Trinidad, Suriname, French Guyana, Brazil, Peru, Bolivia and Venezuela). The transmission cycle is very similar to yellow fever virus, utilizing primates as reservoirs and _Haemagogus_ mosquitoes as vectors.

MAYV has been associated with a variety of mosquitoes that are possible vectors that can transmit it humans. MAYV has been isolated from _Aedes aegypti_ and _Culex quinquefasciatus_ captured in the field in Brazil. _Anopheles_ mosquitoes have been implicated as important virus vectors (see references below).

References
Brustolin M, Pujhari S, Henderson CA, Rasgon JL. _Anopheles_ mosquitoes may drive invasion and transmission of Mayaro virus across geographically diverse regions. PLoS Negl Trop Dis 2018;12(11):e0006895. <https://doi.org/10.1371/journal.pntd.0006895> Serra OP, Cardoso BF, Ribeiro AL, et al. Mayaro virus and dengue virus 1 and 4 natural infection in culicids from Cuiaba, state of Mato Grosso, Brazil. Mem Inst Oswaldo Cruz 2016;111(1):20-9.  <http://dx.doi.org/10.1590/0074-02760150270>

Several public health experts have expressed concern that MAYV could become a significant problem in the tropical Americas. - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
Rio de Janeiro State, Brazil: <http://healthmap.org/promed/p/1650>]
More ...

Netherlands

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

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

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

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

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

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

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

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

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

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

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

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
In the Netherlands, the U.S. Consulate General in Amsterdam provides all passport and American citizen services.
A lost or stolen passport can usually be replaced within a few hours during normal working hours for those with immediate travel plans.
If you are the victim of a crime while in the Netherlands, in addition to reporting to local police, please contact the U.S. Consulate General for assistance.
It is a good idea to make a photocopy of the "biographic page" of your passport, to bring extra passport photos, and to keep these separate from your actual passport just in case it is lost or stolen.
Consulate staff can, for example, help you find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
Contact information is provided at the bottom of this document.

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

See our information on Victims of Crime.

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

Vaccinations are not required for travel to the Netherlands.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention's hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC's Internet site at http://www.cdc.gov/travel.
For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Medical evacuations cost thousands of dollars and are not always covered by travel insurance.
Foreign doctors and hospitals usually require payment at the time service is rendered, and this too may not be covered by a traveler's policy.
Please see our information on medical insurance overseas.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

Date: Tue, 28 May 2019 11:27:14 +0200

The Hague, May 28, 2019 (AFP) - A strike by public transport workers in the Netherlands forced the cancellation of dozens of flights at the country's main airport on Tuesday as passengers faced difficulties reaching the airport.   "Several airlines cancelled their flights," said Willemeike Koster, spokeswoman of Amsterdam's Schiphol airport.

Dutch carrier KLM, along with budget airlines Ryanair and EasyJet, were among the airlines cancelling some 80 flights overall. Several other flights were delayed.   "It's busy on the roads to the airport due to the strike because there is very limited train traffic between Schiphol and Amsterdam," she said. "There are four trains per hour today instead of the usual 25."

Once passengers reach the airport, services are functioning normally, she added.   Dutch trade unions called the strike to secure better pension benefits and to call for the country's retirement age to be fixed at 66 years.   The FNV, the largest trade union in the Netherlands, also plans for brief strike actions among security and cleaning staff at Schiphol airport on Wednesday.
Date: Sun, 26 May 2019 18:19:48 +0200

The Hague, May 26, 2019 (AFP) - A Dutch judge Sunday ruled against plans by the country's largest trade union to allow train drivers serving Amsterdam's busy Schiphol airport to join a country-wide strike.   Thousands of bus, train and tram drivers are expected strike on Tuesday in
protest at government plans to raise the retirement age from 66 and to demand higher pension payments.

"Our right to call a 24-hour strike remains, with the exception of a limited number of trains running to and from Schiphol," the FNV union said in a statement.   "There will be four trains an hour between Schiphol and Amsterdam Central station... in order to guarantee public order at the airport," the FNV said.   Last year, Schiphol was Europe's third-busiest airport with 71.5 million passengers, behind London Heathrow and Paris-Charles de Gaulle, according to figures by the Airports Council International Europe (ACI).   Apart from being the gateway to Amsterdam, Schiphol is also a major transit hub for flights from all around the globe.

The decision by the judge comes after negotiations between Schiphol Airport's management and the FNV broke down earlier on Sunday "despite intensive talks," the FNV said.   Schiphol, in a statement, warned of "traffic congestion, limited train access and no buses" during Tuesday's strike.   "If you're travelling to or from Schiphol Airport on 28 May, please note that travelling by train is limited and trains and stations will be crowded," the airport said.   Although no figures re available, FNV spokeswoman Mariette van Dijk told AFP that "thousands of bus, train and tram drivers, as well as ferry boat captains" were expected to join the strike.

Tuesday's day-long strike follows similar industrial action in March, when public transport was shut down for 66 minutes -- symbolic of the current retirement age.   But the government led by business-friendly Dutch Prime Minister Mark Rutte's Liberal VVD party accelerated plans to increase the retirement age to 67 years in 2021 and 67 years and three months in 2022.   "People are healthier and they live longer," the Dutch government said on its pensions website.   "The higher life expectancy makes working for longer and a gradual increase in the state pension age possible," the Dutch government said.
Date: Tue 2 Apr 2019
Source: Dutch News.nl [abridged, edited]

Three children at a creche in The Hague have come down with measles, and a 4th child may have the disease, public broadcaster NOS reports. The children involved had not been vaccinated, and one of them may have caught the disease when on holiday, the broadcaster said. One of the children is over the age of 14 months, when it should have been vaccinated against the disease, but the others are younger.

The children in The Hague bring the total measles cases in the Netherlands to 12 so far this year [2019], compared with an average annual infection rate of 10-20.

The RIVM public health institute said that at the moment no link can be made between The Hague cases and the drop in the number of children being vaccinated in the Netherlands. Currently, 90.2% of Dutch children are vaccinated against potentially serious illnesses such as measles, polio, and whooping cough. This is below the level of 95% the World Health Organisation considers safe.

Vaccine uptake has been declining, prompting a government information campaign, while daycare centres have been demanding the right to refuse children who have not been vaccinated. At the moment this is not yet legally possible.

The last measles epidemic in the Netherlands hit the Dutch Bible belt in 2013. In total, 2600 people were diagnosed with measles, and the outbreak was concentrated in families with young children who had not been vaccinated for religious reasons. One girl, who had not been vaccinated, died.
====================
[HealthMap/ProMED map of Netherlands:
Date: Sun, 10 Mar 2019 20:42:44 +0100

Amsterdam, March 10, 2019 (AFP) - Tens of thousands of people marched through the heavy rain in Amsterdam Sunday, calling on the Dutch government to act to counter the effects of climate change.   The organisers, including Greenpeace and a number of Dutch groups, said around 40,000 turned out for the demonstration, the first of its kind in the Netherlands.   "The high turnout is the proof that people now want a decisive policy on climate from the government," they said in a statement.

The Netherlands is particularly vulnerable to the consequences of climate change, as part of the country lies below sea level and some of its land has been reclaimed from the sea.   "We are under sea level, so we really need to do something about it," said one demonstrator, Esther Leverstein, a 21-yer-old climate studies student at Amsterdam University.   "We're great with water (management) but we need to step up our game."

Gert van Rees, a 72-year-old pensioner, said she was concerned for future generations.   "We have seven grand-children and sometimes we are really worried. So that's why we are here, it really should change."   In February, around 15,000 school students skipped school to march for action on climate change, following the example of their fellow students across the border in Belgium.   A second youth march for the climate is scheduled for Thursday in Amsterdam.
Date: Tue, 6 Nov 2018 16:28:42 +0100

The Hague, Nov 6, 2018 (AFP) - Irish budget airline Ryanair announced Tuesday it had shut down its Eindhoven base for winter, despite a Dutch court decision stopping it from forcing pilots there to transfer abroad.   "The Ryanair base at Eindhoven closed yesterday (Monday), as planned," said a statement from the company.  "All pilots and cabin crew have already been offered base transfers, which protects their seniority and earnings, but if any crew members wish to choose redundancies over base transfers then we will respect that choice," it added.   On Thursday, a Dutch court ruling forbade Ryanair from imposing the transfer of Dutch pilots elsewhere in Europe.   The airline had "abused its power" in deciding to close its Eindhoven base, said the court.

Sixteen pilots brought the case to the Dutch court after Ryanair announced in October it was closing its base at Eindhoven, where four of its planes are based.   Joost van Doesburg, spokesman for the Dutch pilots union VNV, told AFP, the pilots were currently at home and would stay home refusing any transfer.   The Dutch court ordered Ryanair to continue paying the Dutch pilots who are refusing the imposed transfer, threatening a 250,000-euro ($286,000) fine per pilot should they fail to do so.

In recent months, the airline has had to contend with a wave of industrial action in several European countries as its pilots and cabin staff press for better working conditions.   It announced it was cutting back this winter by closing three European bases: Eindhoven and two others in Germany. It said it planned to transfer staff to other bases to limit job losses.   The largest trades union in the Netherlands, the FNV, said Tuesday it was launching an action against the company in the name of Ryanair cabin staff, demanding that the company respect Dutch labour laws.   On Friday, employment ministers from Belgium, Germany, Italy, Luxembourg and the Netherlands urged the company to respect labour laws across Europe.   The European Commission has already warned Ryanair's chief executive Michael O'Leary that he must apply local regulations in each country in which he has employees.
More ...

World Travel News Headlines

Date: Mon, 24 Jun 2019 16:11:10 +0200

Kinshasa, June 24, 2019 (AFP) - More than 1,500 people have died in a nearly 10-month-old outbreak of Ebola in the Democratic Republic of Congo, the health ministry said Monday.   As of Sunday, 1,506 people have died out of 2,239 recorded cases, it said.   Earlier this month, the virus claimed two lives in neighbouring Uganda among a family who had travelled to the DRC.   Nearly 141,000 people have been vaccinated in the affected eastern DRC provinces of Ituri and North Kivu, the epicentre of the outbreak.

Ebola spreads among humans through close contact with the blood, body fluids, secretions or organs of an infected person, or objects contaminated by such fluids.   The current outbreak in the DRC is the worst on record after an epidemic that struck mainly in Liberia, Guinea and Sierra Leone between 2014-2016, killing more than 11,300 people.   Chronic violence and militia activity in Ituri and North Kivu as well as hostility to medical teams among locals have hampered the response.

On Monday, a crowd of people opposed to the burial of two Ebola victims in the Beni area burnt the vehicle of a health team, local police chief Colonel Safari Kazingufu told AFP.   He said a member of the medical team had been injured in the attack and taken to hospital.    The United Nations in May nominated an emergency coordinator to deal with the crisis. However, the World Health Organization (WHO) said this month the outbreak currently did not represent a global threat.
Date: Mon, 24 Jun 2019 20:27:21 +0200

Ouagadougou, June 24, 2019 (AFP) - Hundreds of doctors and nurses demonstrated Monday in the Burkina Faso capital Ouagadougou to protest against declining health facilities and to demand better working conditions.   The main doctors' union also warned it would stage a general strike from June 30 to July 7 to demand "concrete responses" to their grievances.

Health professionals staged a series of strikes at the end of May, seriously disrupting work at health centres in the poor West African country.   "We are... asking health authorities not to underestimate the health crisis," said Alfred Ouedraogo, general secretary of the Union of Burkina Doctors.   "For several months, there have been recurring breakdowns in laboratories," he said. "In most health centres, there are no X-ray films."    The protesters marched to the health ministry and submitted their demands.

Health worker Idrissa Compaore said that ever since the introduction of free medical care for children under five and pregnant women, "basic goods were regularly lacking" at health facilities.   "The situation is the same in health centres," he said.   The doctors also want the implementation of an accord signed with the government in 2017 promising better working conditions which they say remains only on paper.   If their demands are not met, the health workers could launch an open-ended strike which would affect consultations and surgeries, Ouedraogo said.
Date: Wed 19 Jun 2019
Source: InSight crime [edited]

Disease outbreaks show desperate Venezuelans have migrated to illegal gold mining areas for work.

Outbreaks of malaria and diphtheria in a region of Venezuela where these diseases are rare has revealed how armed groups are organizing a vast migration to illegal mines.

The outbreaks show that criminals operating in the state of Miranda found a way to make money amid the country's worsening crisis by moving into the illegal gold mines of Bolivar state, in the south of Venezuela.

In the middle of 2017, doctors witnessed an unusual, sustained, and inexplicable malaria outbreak in Valles del Tuy, a region in the state of Miranda located between the coast and the center of Venezuela where the mosquito-borne disease is seldom seen, Efecto Cocuyo reported.

The startling epidemic offered the 1st clue to the changing criminal dynamics in the region.

"Malaria was not a disease native to states in the center of the country, so this caught our attention. We started to ask patients about it to find out how they contracted it. The surprise came when one of the patients told me that he had caught it in the mining region in the state of Bolivar, where they went to work in gold mining," explained a doctor whose practice is in Charallave, the municipal seat in Cristobal Rojas municipality in Miranda state. The doctor asked to remain anonymous for security reasons.

Pressured by the economic situation and massive inflation, residents of the Valles del Tuy region began working during their vacations in the illegal mines in Bolivar, more than 500 kilometers [about 311 mi] away. The doctor said that they were recruited by 'pranes', or prison gang bosses, who had previously been the leaders of local 'megabandas' in Valles del Tuy.

The megabandas' grip on Valles del Tuy began in 2013, when various sites were converted into so-called peace zones, areas where security forces could not enter.

Later, when kidnappings and extortion stopped being profitable in the poor areas where they operated, members of the same megabandas migrated to the mining region in search of other sources of income, and to escape police and military raids.

InSight crime analysis
----------------------
Criminals are not immune to the effects of Venezuela's current economic, political, and social crisis.

Many criminals, primarily pranes and leaders of megabandas, have been forced to abandon their former strongholds and change the pattern of their criminal activities, according to investigations conducted by InSight Crime.

Criminals are trading robbery, petty theft, and kidnappings for drug trafficking and illegal mining. Additionally, they are migrating to states where these illicit economies are strongest: Sucre, Zulia, Tachira, and Bolivar. In the south of Venezuela, Bolivar has become the principal destination for the pranes of Valles del Tuy.

Ramon Teran Rico, alias "Monchi," for example, was the leader of one of the largest criminal organizations in the state of Miranda. Community representatives told InSight Crime that he fled to Bolivar's mines 2 years ago.

Monchi was the 1st crime boss to try his luck at the Orinoco Mining Arc, a transnational mining project created in 2016. He gradually moved his henchmen there from the Valles del Tuy. Sources in his circle of friends say that he even purchased his own dredge to extract gold.

Leaders of other criminal structures operating in the Valles del Tuy have also had to reinvent themselves in order to survive, and have moved into southern Venezuelan states where they operate comfortably.

Hundreds of residents of the towns in Valles del Tuy have migrated to the mining region. "All of the families here have at least one person that has gone to work in the mines," said a resident of Ocumare del Tuy in Miranda state, who reports seeing his neighbors' children and relatives head for the mines.

In November 2016, a case of diphtheria, an acute infectious disease [that most commonly affects the throat and the tonsils], was detected in the Sucuta sector of Ocumare del Tuy, alerting health authorities to the re-emergence of a disease rarely seen in the center of the country.

Follow-up with the patient found that he had contracted the infection in the Bolivar mines.

Health authorities developed prevention plans targeted at the neighborhoods where criminal groups operate. Investigations conducted by health authorities demonstrated that the men that go to work in the mines, as well sex workers or women who work in the kitchens there, carried these diseases back to the Valles del Tuy.

The public health problem shed light on the fact that an illegal gold mining fever had emerged -- an economic lifeline that is now strengthening organized crime.  [Byline: Venezuela Investigative Unit]
=======================
[Malaria has surged in Venezuela over the past 9 years (see ProMED reports below). Control measures have ceased to exist and drugs for treatment have become difficult to find. The association with illegal haphazard mining was reported from Bolivar state in 2012, and the present report underlines that such activities constitute high risk for malaria and other diseases.

The diphtheria outbreak that began in July 2016 remains ongoing. Through February 2019, Venezuela has seen a total of 2726 suspected cases (1612 confirmed), including 164 in 2019 to date (<http://outbreaknewstoday.com/diphtheria-update-venezuela-60872/>). - ProMED Mod.EP]

[Maps of Venezuela:
Date: 23 Jun 2019
Source: Outbreak News [edited]

The Malaysia Ministry of Health is reporting a methanol poisoning cluster believed linked to counterfeit alcohol.

For the period of 11-21 Jun 2019, 3 methanol poisoning clusters were reported to the National Crisis Preparedness and Response Center (CPRC). The incidents involved 19 cases from the following states:
Penang (8), Johor (6) and Negeri Sembilan (5). The cause of the methanol poisoning was believed to be due to the counterfeit liquor branded by Myanmar Whiskey, Miludeer Beer, Whiskey 99 and Martens Extra Strong.

The cluster of methanol poisoning cases in Penang began on 11 Jun 2019 and involved 8 Myanmar citizens. Two of the cases have died. They had been drinking Myanmar branded whiskey. The drink was purchased from the same seller who sells directly at the premises where these poisoning victims work. On 21 Jun 2019, one methanol poisoning case was still being treated at a Penang hospital in critical condition, while 5 others were discharged.

In the state of Johor, reporting of methanol poisoning cases has been received since 18 Jun 2019. It involves 6 cases, 3 Malaysians and one Pakistani, Nepalese and Indian, respectively. Three of the cases involved were found to have consumed a drink believed to be counterfeit branded Miludeer Beer. Four of the cases of methanol poisoning have died. On 21 Jun 2019, one case was still being treated at the Sultanah Aminah Hospital (HSA) in critical condition, and one more reported case of blurred vision was being treated in a regular ward at Sultan Ismail Hospital, Johor Bahru, Johor.

The Negeri Sembilan Health Department (JKNNS) reported one methanol poisoning cluster on 20 Jun 2019 involving 5 cases from the Port Dickson district including 2 deaths. It involves 3 Malaysians, one Indian citizen and one Myanmar citizen. Investigations found cases involved drinking alcoholic beverages allegedly branded Miludeer Beer (2 cases), Whisky 99 (1 case) and Martens Extra Strong (1 case), while one case had no brand information. On 21 Jun 2019, 3 cases were being treated at Port Dickson Hospital, 2 critical cases, and one case in a regular ward.

Clinical samples were taken from all 19 cases for methanol test analysis. The results showed 5 positive cases of methanol and one negative case of methanol but showed symptoms and clinical signs of methanol poisoning. Laboratory results for the remaining 13 cases are still pending.

The Penang State Health Department, Negeri Sembilan and the State of Johor have collaborated with the Royal Malaysian Police and Royal Malaysian Customs in an investigation to identify the sources of the counterfeit alcoholic drink.

The MOH continues to monitor the situation and take preventative and control measures to address these methanol poisoning incidents. Consumers are advised to ensure each purchased alcohol product has a label containing complete manufacturer, importer, agent and listing information.

Consumers are also advised to avoid consuming home-brewed alcoholic beverages or alcohol being sold at low prices.

If individuals have symptoms of methanol intoxication such as stomach-ache, nausea, vomiting, headache, and vision loss within 5 days of consuming an alcoholic drink, MOH advises them to seek immediate treatment at any clinic or the closest hospital.
===========================
[Methanol toxicity initially lacks severe toxic manifestations. Its pathophysiology represents a classic example of lethal synthesis in which toxic metabolites cause fatality after a characteristic latent period. In other words, these people may not realize they are sick or ill until some time after consumption.

Methanol is sometimes used as an ethanol substitute for alcohol. Foods such as fresh fruits and vegetables, fruit juices, fermented beverages, and diet soft drinks containing aspartame are the primary sources of methanol in the human body, but [they contain] minute quantities.

Wood alcohol is also known as methanol. It is a commonly used toxic organic solvent causing metabolic acidosis, neurologic issues, and death when ingested. It is a part of many commercial industrial solvents and of adulterated alcoholic beverages or is mistaken as being the same as alcohol for ingestion. Methanol toxicity remains a common problem in many parts of the developing world, especially among members of lower socioeconomic classes.

Neurological complications are recognized more frequently due to advanced technologies and because of early recognition of the toxicity and advances in supportive care. Hemodialysis and better management of acid-base disturbances remain the most important therapeutic improvements.

Serum methanol levels of greater than 20 mg/dL correlate with ocular injury. Funduscopic changes are notable within only a few hours after methanol ingestion. The mechanism by which the methanol causes toxicity to the visual system is not well understood. Formic acid, the toxic metabolite of methanol, is regarded as being responsible for ocular toxicity, and blindness can occur in humans.

The prognosis in methanol poisoning correlates with the amount of methanol consumed and the subsequent degree of metabolic acidosis; more severe acidosis confers a poorer prognosis. Methanol has a relatively low toxicity. The adverse effects are thought to be from the accumulation of formic acid, a metabolite of methanol metabolism. The prognosis is further dependent on the amount of formic acid that has accumulated in the blood, with a direct correlation existing between the formic acid concentration and morbidity and mortality. Little long-term improvement can be expected in patients with neurologic complications.

The minimal lethal dose of methanol in adults is believed to be 1 mg/kg of body weight. The exact rates of morbidity and mortality from methanol intoxication are not available.

Rapid, early treatment is necessary for survival, but sequelae such as blindness may be permanent.

Metabolic acidosis in methanol poisoning may necessitate the administration of bicarbonate and assisted ventilation. Bicarbonate potentially may reverse visual deficits. In addition, bicarbonate may help to decrease the amount of active formic acid.

Antidote therapy, often using ethanol or fomepizole, is directed towards delaying methanol metabolism until the methanol is eliminated from the patient's system either naturally or via dialysis. Like methanol, ethanol is metabolized by ADH, but the enzyme's affinity for ethanol is 10-20 times higher than it is for methanol. Fomepizole is also metabolized by ADH; however, its use is limited because of high cost and lack of availability.

Hemodialysis can easily remove methanol and formic acid. Indications for this procedure include (1) greater than 30 mL [1 oz] of methanol ingested, (2) serum methanol level greater than 20 mg/dL, (3) observation of visual complications, and (4) no improvement in acidosis despite repeated sodium bicarbonate infusions.

Intravenous administration of ethanol in a 10 percent dextrose solution may be helpful. As ethanol prolongs the elimination half-life of methanol, the treatment may take several days, and the patient should be hospitalized. Dialysis may be necessary to prevent kidney failure as well. Hemodialysis remains an effective treatment.

Portions of this comment were extracted from:

[HealthMap/ProMED map available at:
Date: Fri 21 Jun 2019
Source: WHO/EMRO (Regional Office for the Eastern Mediterranean) [edited]

Situation reports on Al-Hol camp, Al-Hasakah
--------------------------------------------
- Over the past 2 weeks, a total of 633 people have left the camp. This number includes 107 people who returned to their homes in north-east Syria. There were no new arrivals during the reporting period.
- 9 medical points are reporting regularly to the disease Early Warning And Response System (EWARS). Leishmaniasis, acute diarrhoea, bloody diarrhoea, and severe acute malnutrition (SAM) remain the most commonly reported diseases.
- 38 new cases of leishmaniasis were detected. All patients are being treated by a WHO-supported mobile team in coordination with the Al-Hasakeh Directorate of Health.
- 7 suspected cases of measles were reported. No new cases of tuberculosis were detected during the reporting period.
- 30 children with severe acute malnutrition with medical complications were admitted to Al-Hikmah hospital during the reporting period, of whom 22 were discharged, one died, and the remainder are still under treatment. Mortality rates related to severe acute malnutrition remain below the emergency threshold.
- 2 new static health care points have been established, bringing the total number to 12. There is still an acute shortage of health care points in the Foreign Annex.
- 35 water sources were tested for microbial contamination in Al-Hasakeh water national laboratory during the reporting period. All 35 samples tested negative for contamination. WHO continues to test the quality of water from different sources in the camp.
- Stool samples from patients with diarrhoea were tested for
_Salmonella_, _E. coli_, and cholera, with all samples testing negative. Blood samples from patients with suspected measles were also sent for testing, and all samples tested negative.
- Following intensive negotiations by WHO, the local authorities have given their approval in principle to evacuate a patient requiring advanced mental health treatment
===================
[Leishmaniasis has surged throughout Syria during the civil war on all sides and continues to be a health problem in the refugee population. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Syria:
Date: Mon, 24 Jun 2019 05:38:33 +0200

Jakarta, June 24, 2019 (AFP) - A powerful magnitude 7.3 quake struck eastern Indonesia on Monday, US seismologists said, but no tsunami warning was issued and there were no immediate reports of major damage or casualties.   The quake hit at a depth of 208 kilometres (129 miles) south of Ambon island in the Banda Sea at 11:53 local time, the US Geological Survey said.

The Pacific Tsunami Warning Center said there was no threat of a tsunami as the quake was too deep.   The strong temblor came hours after a 6.1-magnitude earthquake hit Papua, also in the eastern part of the Southeast Asian archipelago.   That quake hit about 240 kilometres (150 miles) west of the town of Abepura in Papua province, at a relatively shallow depth of 21 kilometres, according to the USGS.

There were also no immediate reports of casualties after the earthquake.   A shallower 6.3-magnitude hit the area last week, but the damage was not extensive.   Indonesia experiences frequent seismic and volcanic activity due to its position on the Pacific "Ring of Fire", where tectonic plates collide.   Last year, a 7.5-magnitude quake and a subsequent tsunami in Palu on Sulawesi island killed more than 2,200 with a thousand more declared missing.   On December 26, 2004, a 9.1-magnitude earthquake struck Aceh province, causing a tsunami and killing more than 170,000.
Date: Sat, 22 Jun 2019 21:45:46 +0200
By Anna SMOLCHENKO with Irakli METREVELI in Tbilisi

Moscow, June 22, 2019 (AFP) - Russia's government on Saturday banned Georgian airlines from flying into its territory, extending restrictions imposed by President Vladimir Putin as part of growing tensions between Moscow and its ex-Soviet neighbour.   Putin had signed a decree late Friday banning Russian airlines from flying to pro-Western Georgia from July 8 in response to anti-Moscow rallies in the Georgian capital Tbilisi.

The protests broke out after a Russian lawmaker addressed parliament from the speaker's seat earlier this week, a hugely sensitive move for two countries whose relations remain tense after a brief war in 2008.   The rallies have morphed into a broader movement against the Georgian authorities while the Kremlin has branded them a "Russophobic provocation".   On Saturday, protesters took to the streets of the Georgian capital for a third day of rallies, with some 3,000 demanding snap elections and electoral reform.   The crowd sang a profanity-laced, anti-Putin chant and some of the demonstrators held up placards insulting the Russian president.   Demonstrators also shot paper airplanes into the sky in response to the Russian bans.

Russia's transportation ministry said that from July 8 two Georgian airlines would be banned from flying to Russia, citing the need to ensure "aviation safety" and debt owned by the Georgian companies.   The Kremlin has said the ban against travel to Georgia was to "ensure Russia's national security and protect Russian nationals from criminal and other unlawful activities."

Authorities recommended travel companies stop selling holiday packages to Georgia and advised Russian tourists to return home.   Russia's travel industry and ordinary Russians hit out at the decision by the Kremlin, saying it was a politically motivated move that has little to do with safety concerns.   "Tourism in Georgia is on the rise, and the decision has shocked the whole industry," Aleksan Mkrtchyan, head of Pink Elephant, a chain of travel agencies, said in a statement.

- 'This is politics' -
The ban during high season is expected to hit the travel industry in both countries hard and become a major nuisance for Russian holidaymakers.   Russia and Georgia fought a brief but bloody war in 2008 and tensions between the two governments remain high.   But Georgia -- known for its picturesque Black Sea resorts, rich national cuisine and generous hospitality -- has emerged as one of the most popular destinations for Russian tourists over the past few years, with more than 1.3 million visiting last year.

Irina Tyurina, a spokeswoman for the Russian Tourism Union, said that most in the industry believed that Georgia was not a dangerous destination.   "Georgians have traditionally treated Russians well," Tyurina told AFP.    It was too early to estimate potential industry losses from the ban, she said.   More than 7,000 people have signed a petition calling on Moscow to resume flights.

Russian tourists in Tbilisi expressed regret at the restrictions.   "We are against the ban," Nina Guseva told AFP in the Georgian capital. "We are not guilty and we do not have to suffer."   Fellow traveller Mikhail Strelkov added: "This is politics and has nothing to do with people on holidays."   In Russia, many struck a similar note.   Elena Chekalova, a prominent chef and culinary blogger, said the latest Kremlin move "shocked" her.   "Why are they deciding for us what we cannot eat, where we cannot fly, who we cannot be friends with?" she wrote on Facebook.

- Simmering discontent -
Moscow has suspended flights to Georgia before -- during a spike in tensions in October 2006 and in August 2008 following the outbreak of the five-day war over the breakaway regions of Abkhazia and South Ossetia.   "Putin decided to punish Georgia because there are street protests there," opposition leader Alexei Navalny said on Twitter.   A senior government official in Tbilisi said the Kremlin ban was politically motivated.   "Putin's decision is of course political and has nothing to do with safety concerns," the official told AFP on condition of anonymity.

Analysts say the latest restrictions may further fuel simmering discontent with Kremlin policies.   Since 2014, Russians have been chafing under numerous rounds of Western sanctions over Moscow's role in Ukraine and other crises, with real incomes falling for the fifth year in a row.    During an annual phone-in with Russians this week, Putin dismissed calls to "reconcile" with the West to alleviate economic hardship, saying Moscow needed to protect its interests and "nothing" would change anyway.
Date: Sat, 22 Jun 2019 04:35:24 +0200
By Alexandre MARCHAND

Chennai, India, June 22, 2019 (AFP) - Angry residents fight in queues at water taps, lakes have been turned into barren moonscapes and restaurants are cutting back on meals as the worst drought in living memory grips India's Chennai.   The hunt for water in south India's main city has become an increasingly desperate obsession for its 10 million residents after months with virtually no rain.   The bustling capital of Tamil Nadu state usually receives 825 million litres of water a day, but authorities are currently only able to supply 60 percent of that.   With temperatures regularly hitting 40 degrees Celsius (104 Fahrenheit), reservoirs have run dry and other water sources are dwindling each day.

A rainstorm on Thursday night, the first for about six months, brought people out onto the streets to celebrate, but provided only temporary relief.   "We don't sleep at night because we worry that this well will run out," said Srinivasan V., a 39-year-old electrician who starts queueing for water before dawn in his home district near Chennai airport.   The 70 families who use the well are allowed three 25-litre pots each day. Most pay high prices to private companies to get the extra water they need to survive.   Local officials organise a lottery to determine who gets to the front of the queue. The lucky first-comers get clear, fresh water. Those at the end get an earth-coloured liquid.

- Long, hot wait -
Srinivasan said he waits about five hours each day in water queues and spends around 2,000 rupees ($28) a month on bottled water or paying for a tanker truck to deliver water.   It is a big chunk of his 15,000-rupee monthly salary. "I have loans, including for the house, and I can't repay them now," he said.

The desperation has spilled over into clashes in Chennai. One woman who was involved in a water dispute with neighbours was stabbed in the neck.   In another suffering Tamil Nadu city, Thanjavur, an activist was beaten to death by a neighbouring family after he accused them of hoarding water.   Many in Chennai do not have the money to pay for extra supplies, and arguments in queues for free water often turn violent.   The hunt for H2O dominates daily life.   Some Chennai restaurants now serve meals in banana leaves so that they do not have to wash plates. Others have stopped serving lunch altogether to save water.

- Isolated showers -
Families have had to reorganise daily life, setting up schedules for showers and devoting up to six hours a day to line up for water -- three in the morning, three in the afternoon.   Most of those queuing are women, including housewife Nagammal Mani, who said looking for water was like "a full time job".   "You need one person at home just to find and fill up the water while the other person goes to work," she said.   Chennai gets most of its water from four lakes around the city. But it had a poor monsoon last year and levels have not recovered since.   The bones of dead fish now lie on the cracked bottoms of the lakes.   While weak rainfall is a key cause of Chennai's crisis, experts say India's poor record at collecting water does not help, particularly as the country of 1.3 billion people becomes increasingly urbanised.   The drought is seen as a symbol of the growing threat faced in many of India's highly vulnerable states, which have been hit by longer periods each year of sweltering heat that has devastated food production.

Hundreds of villages have already emptied in the summer heat this year because their wells have run dry.   Pradeep John, a local weather expert known online as "Tamil Nadu Weatherman", said if families in the area had spent their money on rain-collection equipment instead of truckloads of water they would be "self-sufficient" now.   "We've got almost 1,300-1,400 millimetres of rainfall every year. So that is a very significant amount of rainfall," he told AFP.   "So we have to find out where the problem lies, where the problem of urbanisation lies -- whether we are encroaching into the (rain) catchment areas -- improve these catchment areas, and then find a long-term solution."   John said there is no immediate hope for rains to end the crisis, with the monsoon not expected before October.   "If the water doesn't come, people will be shedding blood instead of tears," said housewife Parvathy Ramesh, 34, as she endured her daily queue in Chennai's stifling heat.
Date: Fri, 21 Jun 2019 22:49:46 +0200
By Laure FILLON

Paris, June 21, 2019 (AFP) - Forecasters say Europeans will feel sizzling heat next week with temperatures soaring as high as 40 degrees Celsius (104 degrees Fahrenheit) in an "unprecedented" June heatwave hitting much of Western Europe.   From Great Britain to Belgium to Greece, a wave of hot air coming from the Maghreb in North Africa and Spain will push up temperatures starting this weekend and hitting a peak around mid-week.    Spain's meteorological agency (Aemet) has issued a "yellow alert" for severely bad weather for Sunday and says it expects the country to see a "hotter than usual" summer, like last year.

In Germany, forecasters are predicting temperatures up to 37 degrees C on Tuesday and 38 C on Wednesday, with similar hot weather also expected in Belgium and Switzerland.   The British MetOffice said it was particularly concerned that the heatwave could trigger "violent storms" and warned Britons to expect "hot, humid and unstable" weather.   Greece will be one of the countries most affected by the heatwave with temperatures hitting 39 degrees C at the weekend.

In France, meteorologist Francois Gourand said the heatwave is "unprecedented for the month of June" and will no doubt beat previous heat records.    Back in the summer of 2003, France suffered an intense heatwave that led to the deaths of nearly 15,000 mostly elderly people.   Starting on Tuesday, France will see temperatures from 35 to 40 degrees C, which will remain high at night offering little respite from the heat, forecasters predicted.   "Since 1947, only the heatwave of 18 to 28 June, 2005, was as intense," said Meteo France, adding the scorching weather would probably last a minimum of six days.   This latest intense heatwave again shows the impact of global warming on the planet, and such weather conditions are likely to become more frequent, meteorologists said.
Date: Thu, 20 Jun 2019 13:08:42 +0200

Berlin, June 20, 2019 (AFP) - German cabin crew union UFO called Thursday for a strike against airline giant Lufthansa in July, threatening travel chaos during the busy summer holiday season over a wage dispute.   Employees of Lufthansa's subsidiaries Eurowings and Germanwings are expected to vote next week on whether to take action.   Depending on the ballot, dates for the walkout are to be announced for July.   In the coming weeks, UFO union members will also decide whether to go on strike at main company Lufthansa.   "Lufthansa has deliberately managed to escalate wage disputes with its employees," said UFO vice-president Daniel Flohr in a statement.

Lufthansa called off talks with UFO last week and Flohr warned that strike action could cause "flight attendants, passengers and shareholders an additional worry this summer".   With most German schools shut for summer holidays in July, the industrial action could seriously disrupt travel plans in the peak season.   However, a Lufthansa spokesman insisted "there can be no strike, as currently there are neither wage agreements still open nor concrete demands".  The German airline reacted angrily with spokesman Boris Ogursky telling AFP it wants a "reliable collective bargaining partner" to be able to "jointly  develop solutions in the interest of employees and the company.  "At present we cannot see when and how UFO can once again fulfil its role  as a predictable, constructive bargaining partner.    "Therefore, no talks are currently taking place."