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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Visit the Embassy of the Dominican Republic web site at http://www.domrep.org for the most current visa information.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Americans traveling in the Dominican Republic should be aware that Dominican hospitals often require payment at the time of service and may take legal measures to prevent patients from departing the country prior to payment. Please see our information on medical insurance overseas.

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

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

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

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

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

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

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

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

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

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

Please refer to our Road Safety page for more information.

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

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

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

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

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

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

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

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

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Dominican laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the Dominican Republic are severe, and convicted offenders can expect long jail sentences and heavy fines. For more information on the Dominican judicial system, procedures, and penalties, please visit the Consular Section’s web page at http://www.usemb.gov.do. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues web pages. The Dominican Republic is a party to the Hague Convention on the Civil Aspects of International Child Abduction. The United States formally accepted the accession of the Dominican Republic on June 1, 2007.

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

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

Travel News Headlines WORLD NEWS

Date: Mon 18 Nov 2019
Source: Pan American Health Organization (PAHO) [abridged, edited]

Between 2005 and 2014, there was an overall decreasing trend in the number of cases of malaria in the Region of the Americas; however, since 2015, there has been an increase in the number of malaria cases reported in the Region.

This overall increase is due to the increase in cases over the last 3 years in the Bolivarian Republic of Venezuela along with increased transmission in endemic areas of countries such as Brazil, Colombia, Guyana, Nicaragua, and Panama, as well as outbreaks in countries that were moving towards elimination (Costa Rica, the Dominican Republic, and Ecuador) (Figure 1 [available at the source URL above]).

Despite this, in 2018, Guatemala and Honduras reported a significant decrease in malaria cases compared to the prior year, which has continued as of November 2019. El Salvador has not reported an autochthonous case in almost 3 years, while Paraguay and Argentina were certified by the Pan American Health Organization/World Health Organization (PAHO/WHO) as malaria-free countries in July 2018 and May 2019, respectively.

In Venezuela, between 1 Jan and week 41 [ending 11 Oct] of 2019, a total of 323,392 malaria cases were reported, representing a slight decrease (1.5%) compared to the same period in 2018 (328,373 cases). In contrast, in 2017, there were 321,358 cases reported during the same period.

In Brazil, the Amazon region is characterized by high endemicity of malaria, accounting for nearly 99% of the cases reported nationally. In this region, there was a 24% overall decrease in the number of cases reported during the 1st semester of 2019 (71,549 cases) compared to the 1st semester of 2018 (93,995 cases).

In Colombia, between 1 Jan and week 42 [ending 18 Oct] of 2019, an outbreak has been occurring with 66,581 malaria cases reported, representing a 28.2% increase compared to the same period in 2018 (51,935 cases).

In Nicaragua, in 2019 as of week 41 [ending 11 Oct] of 2019, there were 9358 cases reported, representing a 15% decrease compared to the same period in 2018 (10,988 cases). This is mainly due to the decrease in cases reported in Puerto Cabezas since mid-2019.
=====================
[The complete PAHO summary can be accessed at the source URL above.  The surge of malaria in Venezuela is well known and is due to an almost entire lack of any vector control activities over the past 10 years. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps:
Date: 26 Jun 2019
Source: VOX [edited]

Tourist deaths in the Dominican Republic are sparking concern among travellers.  It's not yet clear whether the deaths of 10 Americans over the past year are connected. [Some sources report as many as 13 deaths. - ProMED Mod.TG] Ten known US tourists have died at Dominican Republic resorts, or at the hospital immediately following resort stays -- including 3 within 7 days, and 2 within 3 days -- in just over a year.

Now over a dozen more visitors who fell dangerously ill on vacation in the Dominican Republic are coming forward. Sicknesses reportedly set in quickly, marked by frequently cited symptoms of abdominal pain, nausea, and sweating; guests' descriptions of a "chemical smell" in hotel rooms; and a pattern of minibar liquor consumption before indicators of illness set in.

The Dominican Republic's Ministry of Tourism attributes these deaths to natural causes; local and US federal authorities, however, are investigating the incidents, having left some American travellers uneasy, and the future of the Dominican Republic's robust tourism industry uncertain.  The incidents occurred at a collection of resorts on the island: the Terra Linda Resort in Sousa, the Excellence Resorts in Punta Cana, the Grand Bahia Principe in Punta Cana, the Grand Bahia Principe in La Romana, and the Hard Rock Hotel & Casino in Punta Cana.

At least 3 of the people who died reportedly began experiencing symptoms after having a drink from the minibar in their rooms. The US Embassy in Santo Domingo confirmed earlier this month [June 2019] that the FBI were dispatched to the island to conduct toxicology reports, and the Dominican Republic's Ministry of Health announced samples from the minibar in the guest room of CD and NH of Maryland, who were both found dead on 30 May 2019 in their room at the Grand Bahia Principe La Romana, were undergoing testing. On Monday [24 Jun 2019], the Hard Rock Hotel & Casino announced it'd be removing liquor from minibars in its guest rooms.

As forensic scientist Lawrence Kobilinsky told the "Cut," many of the victims' symptoms might suggest methanol poisoning. Methanol is a toxic, synthetic chemical normally used in antifreeze, also used, illegally, to create counterfeit alcohol. Consuming even a small amount of pure methanol can lead to pulmonary edema, or fluid in the lungs, and respiratory distress, 2 of the official causes of death listed for CD and NH. They're also 2 of the official causes of death listed for SW of Pennsylvania, who also died at Grand Bahia Principe La Romana, after reportedly having a drink from her hotel room minibar, just 5 days before CD and NH's deaths.

The toxicology reports for CD, NH, and SW have not yet been released; the FBI said in mid-June 2019 that answers could be another 30 days coming.

Some recent travellers, however, suspect they were exposed to fumes emitted from the air conditioners in their rooms. CNN reports one Denver couple, KK and TS sued the Grand Bahia Principe La Romana -- the same resort where CD and NH stayed -- earlier this year [2019] for illnesses occurring during a trip last July 2018. KK and TS described a "chemical smell" overtaking their room, an odor similar to paint or industrial cleaner. [Earlier, reports indicated KK and SW described the smell as chemical or pesticide smell. Some of their clinical signs sound like organophosphates. This couple reported earlier a grounds worker was spraying the trees, which reportedly was over the air conditioner. - ProMED Mod.TG] Soon after, they said they experienced excruciating stomach cramps, diarrhoea, bloody stool, incessant sweats and drool, watery eyes, and dizziness. Back home in Denver, their doctors wondered whether they'd been exposed to organophosphates, chemicals most often used in pesticides.

KK said she thought back on what she had seen days earlier: A maintenance person spraying palm plants covering the air conditioning units just outside their room. "I wondered if someone sprayed our unit. They are always constantly out there taking care of the plants. We saw them out there with bug sprayers."

Other tourists told CNN they too became sick after they inhaled what they described as a chemical, or paint-like smell, at the Majestic Elegance Resort in Punta Cana in 2017, and at the Grand Bahia Principe Punta Cana going back to 2016.

As the New York Times reports, poisoning or pesticide exposure is even more likely when more than one person experiences the same outcome on the same timeline, as was the case with CD and NH. Chemicals like organophosphates, adds the Times, can "seep into a vent not adequately sealed, or be sucked inside by a hotel air conditioner." Current scientific literature indicates organophosphate poisoning can lead to respiratory failure in some cases.

Tourism drives much of the Dominican Republic's economy, employing more than 300 000 people and drawing a reported 6.6 million international travellers in 2018. A report on the Dominican Republic's economy from the Canadian Trade Commissioner Service says the Dominican government aims to draw 10 million tourists -- roughly the size of its current population -- by 2020, "generating estimated revenues of US $7.2 billion."

Preliminary autopsies conducted by Dominican authorities have been released by the resorts for several of the 10 Americans known to have died in the past year. In addition to pulmonary edema and respiratory failure, the causes of death for the tourists have included pneumonia, multiple organ failure, and an exceptionally common one: heart attack. According to Tourism Minister Javier Garcia, 5 of the deaths can be categorized as "natural causes." [While the Tourism Minister may report it as "natural causes," an investigation is necessary, including toxicology reports, to be fully certain of the cause of those individuals' deaths. - ProMED Mod.TG]

The Excellence Resorts in Punta Cana told the family of LC of New York City she died in her room on 10 Jun 2019 of a heart attack. Her son BC remains skeptical, telling WCBS, "I do not believe it was of natural causes."

It's not yet clear what caused this spate of heart attacks, respiratory failures, and food poisoning-like illnesses. And it's also not clear whether these catastrophic events, similar as they are in geographic location, presenting symptoms, and outcome, are connected. Neither the US Embassy nor the Dominican Ministry of Public Health has acknowledged the possibility of a connection; in fact, Garcia has said: "These cases are very regrettable, but isolated" [The deaths are indeed tragic and regrettable, but evidence revealed so far does not seem isolated. - ProMED Mod.TG].

The Dominican Republic's Ministry of Tourism asks the public to look at these recent deaths in context: Many millions of people travel to the Dominican Republic each year and don't fall seriously ill or die. A statement released by the ministry earlier this month [June 2019] references statistics and polls conducted by the Central Bank of the Dominican Republic. The "rate of tourist incidents" in 2018, the ministry says, fell to 1.4 per 100 000 tourists from 1.6 the previous year. It also highlights that 99 percent of American tourists told their survey they'd return to the Dominican Republic for future vacations.

Nevertheless, US travellers are concerned by recent news, to say the least. CNBC cites a survey from the American Society of Travel Advisors revealing that 2/3rds of its members have cancelled trips to the Dominican Republic for clients within one week. CBS News adds flights to the Dominican Republic from the US are down 74.3 percent from this time last year [2018], with cancelled flights up by 51.2 percent in recent weeks, according to data from flight analysis agency. The [US] State Department's most recent Travel Advisory on the Dominican Republic -- from April 2019 -- places the country as a Level 2, with the directive, "Exercise Increased Caution." The rationale: crime.  "Here we are talking about 9 people, but there are countries in the area where 10 times the number of Americans have died there," the Dominican Republic's tourism board reportedly said at a press conference on 21 Jun 2109, as covered by NBC News. (Details on the 10th death, of New York native VC on 17 Jun 2019, hadn't yet been released.) "But all eyes are on us."  [Byline: Stephie Grob Plante]
=====================
[There are several reports of individuals complaining of shortness of breath and an ill feeling after consuming products from the mini bar. There were television reports indicating some drink containers were filled by the hotel, or the pool bar and put back into the mini bar.

This is the 1st article reporting methanol. However, methanol is a common product substituted in alcoholic drinks because it is cheap and easy to make. Frequently, this type of alcohol is associated with blindness. An individual, possibly dehydrated, coming in from the sun who consumes the beverage somewhat quickly may react differently. But pulmonary oedema is certainly associated with methanol consumption.


Airway and lungs:
- Breathing difficulty
- No breathing
Eyes:
- Blindness, complete or partial, sometimes described as "snow
blindness"
- Blurred vision
- Dilation (widening) of the pupils [Organophosphates produce pin
point pupils - Mod.TG]
Heart and blood:
- Low blood pressure
Nervous system:
- Agitated behaviour
- Coma (unresponsiveness)
- Confusion
- Difficulty walking
- Dizziness
- Headache
- Seizures
Skin and nails:
- Bluish-colored lips and fingernails
Stomach and intestines:
- Abdominal pain (severe)
- Diarrhea
- Liver problems, including jaundice (yellow skin) and bleeding
- Nausea
- Pancreatitis (nausea, vomiting, and abdominal pain)
- Vomiting, sometimes bloody
Other:
- Fatigue
- Leg cramps
- Weakness

Compare the clinical signs, as listed by the same source
<https://medlineplus.gov/ency/article/002832.htm> for organophosphate poisoning:

Symptoms of organophosphate or carbamate poisoning:

Heart and Blood
- Slow heart rate
Lungs and Airways
- Breathing difficulty
- Wheezing
Nervous System
- Anxiety
- Coma (decreased level of consciousness and lack of responsiveness)
- Convulsions
- Dizziness
- Headache
- Weakness
Bladder and Kidneys
- Increased urination
Eyes, Ears, Nose, and Throat
- Drooling from increased saliva
- Increased tears in the eyes
- Small pupils
Stomach and Intestines
- Abdominal cramps
- Diarrhea
- Loss of appetite
- Nausea and vomiting
Skin
- Blue-colored lips and fingernails

Note: Serious poisoning can occur if an organophosphate gets on your bare skin or if you don't wash your skin soon after it gets on you. Large amounts of the chemical soak through the skin unless you are protected. Life-threatening paralysis and death can occur very quickly.

While the clinical signs have some differences, it could have been a combination of organophosphates and methanol intoxication. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Dominican Republic: <http://healthmap.org/promed/p/24>]
Date: Thu 27 Jun 2019
Source: USA TODAY on Yahoo News [edited]

A Denver man is the latest American tourist to die in the Dominican Republic this year [2019]. [KA] died on Tuesday [25 Jun 2019], the State Department confirmed to USA TODAY.

Denver's 9 News and Fox 31 report [KA] was on vacation with his daughter [MA] when he fell ill in the Caribbean vacation destination. [MA] told 9 News her father started to complain about a painful bump on his leg just before her flight home on Sunday [23 Jun 2019]. She said they stopped by their hotel's medical clinic, but decided against treatment unless the pain became worse.

[MA] had already returned to Denver when her father's pain worsened the following day [24 Jun 2019]. He booked an earlier return flight but was forced to disembark due to his symptoms.

His sister-in-law [MS] told Fox 31 he was dripping with sweat and vomited in the plane's lavatory. "They transferred him to Santo Domingo and (said) his breathing is really bad and his kidneys were failing," she said. [MS] noted while her brother-in-law had undergone a kidney transplant several years earlier, he was in perfect health when he left Colorado.

[KA]'s relatives said they were not even told he had died; they found out only after [MA] called the hospital repeatedly Wednesday [26 Jun 2019] morning. "It's been hard," she told 9News. "Not being able to get a hold of them, or them miscommunicating, or simply not knowing information."

Authorities are conducting an autopsy and investigation to determine the official cause of death, according to 9 News. (The family said they did not receive any diagnosis.)

Questions about safety have dogged the Dominican Republic since late May [2019], when the 1st of several Americans died in their hotel rooms and a Delaware woman claimed she was attacked there in January [2019].

Last week, tourism minister Francisco Javier Garcia held a press conference to dispel those concerns, stating, "The Dominican Republic is a safe country." Garcia also said the confirmed deaths -- 9 including [KA] -- are not out of the ordinary and the number is actually lower than in some previous years. Garcia said by this point in 2011 and 2015, 15 tourists had died in the Dominican Republic.  [Byline: Sara M. Moniuszko]
=====================
[The Dominican Republic is a small place compared with the USA, Europe, Russia, Australia, Canada, Brazil and others.  While this article says there were 9 deaths, including this victim, other sources and listed names add up to 13, with other victims being severely ill and reporting their illness and having survived to tell about it. This is a lot for a small place and even more so given that most of them are reporting the same clinical signs.

An autopsy alone is insufficient for determining a cause of death in these cases. We have been waiting weeks for the release of the toxicology report from the first 10 or more victims, which allegedly the US officials and CDC toxicologist are involved with.

If the man had no prior illness and suddenly started having these pains, sweating and vomiting, it seems quite out of the ordinary. His kidneys may well have failed from the toxins (allegedly) in his system, but it does not mean the kidney failure was the primary reason for death.

The excessive sweating, complained about by every victim prior to death, and by a few who managed to survive, as well as reports of vomiting roll together to make me think this is not a plain and simple death or a death from kidney failure.

I am still suspicious of organophosphates. I am also suspicious of the pain from a bump on his leg. This article does not address anything about the bump. I wonder if there was a bite or sting there? Or was he injected with something?

While the minister of tourism is saying it is safe, there is no indication of security being increased around the resorts to prevent others with nefarious motives from entering the area. There is no indication of an investigation from the resorts or the minister of tourism to assess what is really happening. - ProMED Mod.TG]

[It is also possible that the "bump" on his leg was an abscess either insect bit related or small entry wound related and the disease process described could also be consistent with sepsis, remembering that the individual had a history of a kidney transplant and was most likely on immunosuppressive drugs to prevent rejection of the transplanted kidney. - ProMED Mod.MPP]

[HealthMap/ProMED-mail map:
Dominican Republic: <http://healthmap.org/promed/p/24>]
Date: Sat 15 Jun 2019, 1:03 PM
Source: New York Post [edited]

A group of Jimmy Buffett-diehards from Oklahoma were incredibly sick in paradise -- the latest in an ever-growing list of tourists to be sickened during a jaunt to the Dominican Republic, a report said.

DF, a travel agent who vacationed to Punta Cana with the Buffett-loving Central Oklahoma Parrothead Association, said 4 days into their April [2019] trip, he and other members came down with a mysterious illness. "I can't even explain how sick I was," DF told Oklahoma's News 4. "I lost 14 pounds during that time and was really sick."

By the end of the vacation, 47 of the 114 Oklahomans reported becoming ill, DF said, with many of them too sick to leave their rooms at the Hotel Riu Palace Macao.

DF said it's unclear what caused the illnesses -- Punta Cana doctors suggested a parasite might be to blame. Everyone who got sick swam in the resort pool equipped with a swim-up bar, DF recalled.

Some of the sick Parrotheads, the nickname for fans of the "Why Don't We Get Drunk" singer [Jimmy Buffet], tested positive for _Salmonella_ spp, according to DF, who said he did not.

The latest report of illness comes amid a spate of unexplained deaths on the island nation since January [2019]. The death count ticked to 8 on [Fri 14 Jun 2019], when the family of a 78-year-old Ohio man revealed he died suddenly after dinner and drinks at the Dreams Punta Cana Resort & Spa. Authorities are eyeing bootleg liquor from hotel minibars as the potential killer, sources have told The Post.  "I will not be going back to the Dominican any time soon," DF said.  [Byline: Sara Dorn]
=====================
[These people may be lucky they were only sick and not dead. However, _Salmonella_ sp most often causes diarrhoea and cramps along with severe dehydration and weakness. While an individual may develop a fever and be sweating, the sweating reported in the fatal cases is extreme sweating.

There is no report of the deceased individuals testing positive for salmonellosis.

Regardless of the cause, salmonellosis, or poisoning by something other than bacteria, the resorts involved in these reports appear to have a problem. The problem may be lack of awareness of chemicals from spraying trees above air conditioning units, to someone tampering with alcohol bottles, or perhaps uncleanliness at some eating/drinking  establishment. This many illness and deaths seems quite out of the ordinary for these resorts. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Dominican Republic: <http://healthmap.org/promed/p/24>]
Date: Wed 12 Jun 2019
Source: New York Times [edited]
<https://www.nytimes.com/2019/06/12/travel/dominican-republic-deaths.html>

More than two million Americans visit the Dominican Republic every year, making up about a third of the country's tourists. Six have died in the last year during their visits. Because of the seeming similarities among their deaths, their family members have suggested that they are connected and have raised suspicions about the resorts where they died. Here's what we know, and don't know, about the circumstances.

Who has died, and how?
Yvette Monique Sport, 51, died in June 2018 of a heart attack. Her sister, Felecia Nieves, has said that Ms. Sport had a drink from the minibar in her room at a Bahia Pri­ncipe resort, one of a number on the island, then went to sleep and never woke up.

In July 2018, David Harrison, 45, died at the Hard Rock Hotel & Casino Punta Cana. Mr. Harrison died of a heart attack and The Washington Post reported that his death certificate also listed "pulmonary oedema, an accumulation of fluid in the lungs that can cause respiratory failure, and atherosclerosis" as causes of death. He and his wife were in the Dominican Republic for their wedding anniversary with their son.

In April of this year, Robert Wallace became sick at the Hard Rock Hotel & Casino Punta Cana, where he was attending a wedding and died. The 67 year old's family said that he became ill after drinking scotch from the minibar in the hotel. Miranda Schaup-Werner, 41, of Allentown, Pa., was celebrating her 10th wedding anniversary when she died at the Luxury Bahia Pri­ncipe Bouganville, on May 25 of this year of a heart attack. She had been at the resort for less than 24 hours.

A few days later, Nathaniel Edward Holmes 63, and Cynthia Ann Day, 49, from Prince George's County, Md., were found dead in their room at the Grand Bahia Pri­ncipe La Romana. The two had recently become engaged. An autopsy found that the couple had respiratory failure and pulmonary oedema.

Are the hotels connected?
Four of the dead were staying at Bahia Pri­ncipe resorts, which are part of a group of 14 hotels in the Dominican Republic that are popular among tourists because they are all-inclusive. The Luxury Bahia Pri­ncipe Bouganville, where Ms. Schaup-Werner died, is less than a five-minute walk away from the Grand Bahia Pri­ncipe La Romana, where Mr. Holmes and Ms. Day died. Both are near the town of San Pedro De Macoris.

The Hard Rock is across the island from the other two hotels in Punta Cana. It is not known which Bahia Principe resort Ms. Sport was staying in.

What are the hotels saying?
In a statement on Friday, Bahia Principe said reports of the deaths had been inaccurate and that the hotel was committed to "collaborating completely with the authorities and hope for a prompt resolution of their inquiries and actions." Hard Rock Hotels & Casinos said in a statement on Tuesday evening that it is waiting for official reports about the deaths and is, "Deeply saddened by these two unfortunate incidents, and we extend our sincerest sympathy to the families of Mr. Harrison and Mr. Wallace."

What are Dominican officials doing?
The Dominican Attorney General's office and the national police are investigating the deaths, but tourism officials have been downplaying them. The tourism minister, Francisco Javier Garci­a, said last week that in the last five years, more than 30 million tourists have visited the country, and that these deaths are "isolated incidents" and the island is safe for tourists. "These are situations that can occur in any country, in any hotel in the world," he said. "It's regrettable but sometimes it happens." The tourism ministry said last week that hotels had 60 days to install security cameras. What are U.S. officials saying?

In a statement issued Tuesday evening, the U.S. State Department said that "Dominican authorities have asked for F.B.I. assistance for further toxicology analysis," and it could take up to a month to receive the results. A spokeswoman for the Centers for Disease Control said that the organization had not received a request for assistance from the Dominican Republic relating to these deaths. Are there any theories as to what might be causing the deaths? Tom Inglesby, director of the Johns Hopkins Center for Health Security, said in a phone interview that the symptoms that have been reported, like pulmonary oedema, bleeding and vomiting blood, are "consistent with poisoning," perhaps accidental.

But until toxicology reports are available, he said, it is difficult and too soon to definitively say what caused the visitors' deaths. "It's rare for travellers to die of unknown causes like this, and to have a high number of them in a relatively short period of time is alarming, shocking, sad," Dr. Inglesby said. "It's something that investigators should be able to get to the bottom of." The fact that toxicology reports have not been released or completed is "unconscionable and inexplicable," he said. Have there been other incidents? Two couples have come forward to say they fell ill while staying at one of the Bahia Pri­ncipe resorts where tourists have died. In January 2018, Doug Hand, 40, and his wife Susie Lauterborn, 38, were staying at the Grand Bahia Pri­ncipe La Romana when, he said in a phone interview, they got sick with fevers, nausea, cold sweats, diarrhoea and fatigue. Mr. Hand said that he didn't drink alcohol on the trip, but he did notice a "mouldy, mildew smell like the A.C. or filter hadn't been cleaned."

When Mr. Hand told an employee in the hotel's lobby that his wife was sick, the employee gave him directions to a doctor, but seemed more focused on ensuring the couple attended a meeting about buying time shares, Mr. Hand said. Kaylynn Knull, 29, and Tom Schwander, 33, are suing the resort chain for $1 million, their lawyer told The Times, because the Colorado-based couple became violently ill during their stay at the Grand Bahia Pri­ncipe La Romana last summer. Ms. Knull got a persistent headache and was sweating and drooling profusely, the lawyer, David Columna, said. She also had blurry vision, nausea and diarrhoea, she told CNN, and family doctors determined the couple had been exposed to organophosphates, a class of insecticides. "The hotel did nothing," said Mr. Columna, who is representing Ms. Knull and Mr. Schwander in the Dominican Republic. The couple, he said, "spent the night inhaling the chemical and they are still having side effects of the intoxication and the hotel hasn't given us any idea of what happened." [Byline: Elisabeth Malkin, Tariro Mzezewa]
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Cambodia

Cambodia US Consular Information Sheet
June 05, 2008
COUNTRY DESCRIPTION:
Cambodia is a developing country with a constitutional monarchy and an elected government. King Norodom Sihamoni is the constitutional monarch and head of state. Ele
tions for Members of the National Assembly were last held in July 2003, and are scheduled to take place again in July 2008. Two political parties, the CPP and FUNCINPEC, have formed a coalition government, which the CPP dominates. The country has a market economy with approximately 80 percent of the population of 13.6 million engaged in subsistence farming. The government has good relations with its neighbors despite strains over residual border disputes and other historic antagonisms. The quality of tourist facilities varies widely in Cambodia with the highest standard found in Phnom Penh, Siem Reap, and Sihanoukville. Read the Department of State Background Notes on Cambodia for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid passport and a Cambodian visa are required.
Cambodia offers on-line visa processing at http://evisa.mfaic.gov.kh.
Tourist and business visas are valid for one month beginning with the date of entry into Cambodia. You may also apply in person at the Cambodian Embassy located at 4530 16th Street NW, Washington, DC
20011, tel. 202-726-7742, fax 202-726-8381. Tourists and business travelers may also obtain a Cambodian visa at the airports in Phnom Penh, Siem Reap, and at all major border crossings.
Both methods of obtaining a Cambodian visa require a passport-sized photograph and a passport that is valid for a minimum of six months beyond the date of entry into Cambodia. A departure tax is charged on all domestic and international flights. This tax must be paid in U.S. dollars.
Overseas inquiries may be made at the nearest embassy or consulate of Cambodia. Travelers should note that Cambodia regularly imposes fines of USD 5.00 per day on charges of overstay on an expired visas. Visit the Embassy of the Kingdom of Cambodia web site http://www.embassyofcambodia.org/ for the most current visa information.

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

SAFETY AND SECURITY:
The State Department is concerned that individuals and groups may be planning terrorist actions against United States citizens and interests, as well as sites frequented by Westerners, in Southeast Asia, including in Cambodia.
Extremist groups present in Southeast Asia have transnational capabilities to carry out attacks against locations where Westerners congregate.
American citizens traveling to Cambodia should therefore exercise caution in clubs, discos, bars, restaurants, hotels, places of worship, schools, outdoor recreation venues, tourist areas, beach resorts, and other places frequented by foreigners.
They should remain vigilant with regard to their personal security and avoid crowds and demonstrations.
From time to time, the U.S. Embassy places local establishments off limits to Embassy personnel due to safety and security incidents.
You can contact the Embassy for notification on the current restrictions in place for Embassy personnel.
Local commune elections in April 2007 were peaceful.
National elections are scheduled for July 27, 2008. Political tensions have eased, and the current situation is relatively stable; however, Cambodian political activities have turned violent in the past, and the possibility for politically motivated violence remains.

In November 2006, police arrested six people for allegedly plotting to conduct bomb attacks in Phnom Penh during the November Water Festival.
On July 29, 2007, three improvised explosive devices (IEDs) were planted at the Vietnam-Cambodia Friendship Monument in Phnom Penh. One of the IEDs partially exploded, but the others failed to detonate and were recovered by Cambodian authorities. No one was injured, primarily because the explosion occurred during the early morning hours. Police subsequently arrested several individuals suspected of constructing the devices and planning the bombings. While there is no indication this attack was directed at U.S. or other Western interests, the possibility remains that further attacks could be carried out, harming innocent bystanders.
The U.S. Embassy advises U.S. citizens to avoid large public gatherings and crowded public areas.
Land mines and unexploded ordnance are found in rural areas throughout Cambodia, and especially in Battambang, Banteay Meanchey, Pursat, Siem Reap, and Kampong Thom provinces. Travelers should never walk in forested areas or even in dry rice paddies without a local guide. Areas around small bridges on secondary roads are particularly dangerous.
Travelers should not touch anything that resembles a mine or unexploded ordnance; they should notify the Cambodia Mine Action Center at 023-368-841/981-083 or 084.

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

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

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

CRIME:
Cambodia has a high crime rate, including street crime. Military weapons and explosives are readily available to criminals despite authorities’ efforts to collect and destroy such weapons. Armed robberies occur frequently in Phnom Penh. Foreign residents and visitors are among the victims.
Victims of armed robberies are reminded not to resist their attackers and to surrender their valuables, since any perceived resistance may be met with physical violence, including lethal force. Local police rarely investigate reports of crime against tourists, and travelers should not expect to recover stolen items.
The U.S. Embassy advises its personnel who travel to the provinces to exercise extreme caution outside the provincial towns at all times. Many rural parts of the country remain without effective policing. Individuals should avoid walking alone after dusk anywhere in Sihanoukville, especially along the waterfront. Some of the beaches are secluded, and post has received reports that women have been attacked along the Sihanoukville waterfront during the evening hours. Take security precautions when visiting the Siem Reap (Angkor Wat) area. Travelers should be particularly vigilant during annual festivals and at tourist sites in Phnom Penh, Siem Reap and Sihanoukville, where there have been marked increases in motorcycle “snatch and grab” thefts of bags and purses. A group of young men sexually assaulted a foreigner in Phnom Penh in November 2006 while she was taking a moto-taxi from a nightclub.
Pickpockets, including some who are beggars, are present in the markets and at the tourist sites. Persons visiting Cambodia should practice sound personal security awareness by varying their routes and routines, maintaining a low profile, not carrying or displaying large amounts of cash, not wearing flashy or expensive jewelry, and not walking the streets alone after dark. In addition, we recommend that Americans travel by automobile and not use local moto-taxis or cyclos (passenger-carrying bicycles) for transportation. These vehicles are more vulnerable to armed robberies and offer no protection against injury when involved in traffic accidents.
To avoid the risk of theft or confiscation of original documents, the U.S. Embassy advises its personnel to carry photocopies of their U.S. passport, driver's license or other important documents.

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 assist you to find appropriate medical care, to contact family members or friends and explain how funds can be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities and services in Cambodia do not meet international standards.
Both Phnom Penh and Siem Reap have a limited number of international-run clinics and hospitals that can provide basic medical care and stabilization. Medical care outside these two cities is almost non-existent. Local pharmacies provide a limited supply of prescription and over-the-counter medications, but because the quality of locally obtained medications can vary greatly, travelers should bring adequate supplies of their medications for the duration of their stay in Cambodia.

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

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

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

Driving at night in Cambodia is strongly discouraged. Road maintenance is sporadic in both urban and rural areas. Roads between major areas are adequate; however, roads leading to areas that are more rural are poor. During the rainy season, both urban and rural road conditions deteriorate considerably. Roadside assistance is non-existent. The safety of road travel outside urban areas varies greatly. Cambodian drivers routinely ignore traffic laws, and vehicles are poorly maintained. Intoxicated drivers are commonplace, particularly during the evening hours, and penalties for DWI offenses vary greatly. Banditry occurs even on heavily traveled roads, so all travel should be done in daylight between the hours of 7:00 a.m. and 5.00 p.m.
Serious flooding occurs in both Phnom Penh and the rest of Cambodia starting at the end of July, early August. Heavy flooding continues into November. The unimproved highways to Prey Veng, Battambang, Pailin, Stung Treng and Poipet become more difficult and dangerous during this time of the year, and travel on unpaved or dirt roads is virtually impossible. The National Route highways are the only roads that can be traveled, with caution, this time of the year.
The U.S. Embassy advises Embassy personnel not to travel by train because of low safety standards and the high risk of banditry. Travel by boat should be avoided because boats are often overcrowded and lack adequate safety equipment.
Boat owners accept no liability for accidents.
Travelers also should exercise caution when using intercity buses, including those to popular tourist destinations such as Siem Reap and Sihanoukville.
Moto-taxis and cyclos are widely available; however, the Embassy does not recommend using them due to safety concerns and because personal belongings can be easily stolen. Organized emergency services for victims of traffic accidents are non-existent outside of major urban areas, and those available in major urban areas are inadequate. Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Cambodia, the U.S. Federal Aviation Administration (FAA) has not assessed Cambodia’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 http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

The U.S. Embassy strongly discourages its employees from using domestic air carriers due to safety incidents that have occurred in recent years.
A PMT Air flight from Siem Reap to Sihanoukville crashed in bad weather in a coastal mountain range on June 25, 2007.
There were no survivors.
Incidents at the Ratanakiri airport since 2005 have included collapsed landing gear and hard landings.
Embassy employees are permitted to use international carriers Siem Reap Airways and Bangkok Airways between Phnom Penh and Siem Reap.
SPECIAL CIRCUMSTANCES:
Cambodian customs authorities may enforce strict regulations concerning temporary importation into or export from Cambodia of items such as drugs, firearms, antiquities, or ivory. It is advisable to contact the Embassy of Cambodia in Washington for specific information regarding customs requirements. Please see our information on Customs Regulations.

Dual Nationality:
Dual nationality is not prohibited under Cambodia's 1996 nationality law. In addition to being subject to all Cambodian laws affecting U.S. citizens, individuals who possess Cambodian nationality may also be subject to laws that impose special obligations on Cambodian citizens.
Business Transactions: Some U.S. citizens have reported threats of personal injury, extortion, detention or kidnapping related to personal business disputes, in particular those involving real estate.
The Embassy urges any American citizen planning to engage in real estate deals or other significant financial transactions to proceed with caution.
U.S. citizens who do not have confidence in the ability of the local police to protect them may wish to depart the country expeditiously.

Financial Transactions:
The U.S. dollar is widely used, especially for larger transactions, and most prices are quoted in dollars. Ripped or torn U.S. bills are not accepted. The Cambodian riel can also be used, but is less favored and is mostly given to tourists as change for dollar purchases. The riel is commonly used in smaller towns and rural areas.
Credit cards are increasingly accepted within Cambodia, and a number of banks in Phnom Penh accept Visa cards for cash advances. Credit cards are often subject to a service charge. Banks and major hotels accept travelers' checks, but usually charge a service fee.
Several international banks operate ATM machines that allow travelers to obtain U.S. dollar currency in Phnom Penh, Siem Reap and other urban centers.
Personal checks are not generally accepted. Several banks serve as Western Union agents in Phnom Penh, Siem Reap, Sihanoukville and other provincial cities to which funds can be wired. Information on Western Union can be found at http://www.westernunion.com.
Photography: Taking photographs of anything that could be perceived as being of military or security interest — including government buildings, military installations, airfields, bridges — may result in problems with the authorities and confiscation of the camera.
Please see our Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Cambodian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession of, use of, or trafficking in illegal drugs in Cambodia are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Cambodia 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 Cambodia. 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 No. 1, Street 96 (near Wat Phnom), Phnom Penh, Cambodia. The telephone number is (855-23) 728-000; fax (855-23) 728-600. Additional information about American Citizen Services can be found at the U.S. Embassy in Phnom Penh at http://cambodia.usembassy.gov/
* * *
This replaces the Country Specific Information for Cambodia dated September 14, 2007, to update sections on Safety and Security, Medical Facilities and Health Information, Traffic Safety and Road Conditions, Aviation Safety Oversight and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Thu, 13 Feb 2020 13:58:41 +0100 (MET)
By Suy SE

Sihanoukville, Cambodia, Feb 13, 2020 (AFP) - A US cruise ship blocked from several Asian ports over concerns that a passenger could have been infected with the new coronavirus docked at a Cambodian pier Thursday, as frustrated holidaymakers expressed hope their ordeal may soon be over.   The Westerdam was supposed to be taking its 1,455 passengers on a dream 14-day cruise around east Asia, beginning in Hong Kong on February 1 and disembarking on Saturday in Yokohama, Japan.   But the ship was turned away from Japan, Guam, the Philippines, Taiwan and Thailand over fears of the novel coronavirus epidemic that has killed more than 1,300 people in China.

Cruise operator Holland America has insisted there are no cases of the SARS-like virus on board and Cambodia announced Wednesday that the boat would be able to dock in Sihanoukville, on its southern coast.   By evening, the ship moved into the beach town's port, moving past the small fishing vessels that usually ply the waters.   As it slowly approached the pier, people onshore snapped selfies of themselves with the massive vessel.   The mood was equally buoyant on the boat.   "Thank you Cambodia! You believed in us when no one would!" tweeted passenger Lydia Miller around 7 pm (1200 GMT). "We promise to spend lots of money in your country."

Fellow cruiser Christina Kerby -- who has been posting light-hearted updates from the Westerdam -- tweeted she was "feeling rebellious tonight so I'm wearing sneakers in the dining room".   But all passengers would have to remain onboard until flights have been arranged, said provincial governor Kuoch Chamroeun.    "The arrangement of the planes to take them from (Sihanoukville) airport to Phnom Penh airport is underway," he said, explaining that three flights were scheduled Friday morning.    Buses were lined up by the pier ready to transfer passengers to Sihanoukville's airport. Holland America has said they would foot the bill to return all guests.

- 'Disease of fear' -
Before the ship docked, doctors conducted health checks for the passengers.    The samples of 20 on board who were sick were sent to the Pasteur Institute in Phnom Penh to test for the virus, said transport minister Sun Chanthol.    Cambodian premier Hun Sen is a staunch Chinese ally and has been vocal in his support of Beijing's handling of the epidemic, even going so far as to visit China last week in a show of solidarity.   "The permission to dock is to stop the disease of fear that is happenin
around the world," he told state-affiliated media website Fresh News on Wednesday.    "We must help them when they asked us for help," he added.   Neighbouring Thailand, which blocked the Westerdam from docking in its eastern seaboard port, on Thursday received two cruise liners in holiday resort town Phuket. 

Both Seabourne Ovation and Quantum of the Seas were allowed to dock, and passengers to alight for roughly 10 hours as part of the scheduled stop.    "They were all checked by their doctors on the ship, and we also examined them when they disembarked," Phuket governor Pakapong Tawipat told AFP.    He added that the passengers and the crew members "were not Chinese", and that Phuket was part of their regular routes, unlike the Westerdam.    Japan's premier Shinzo Abe expressed worries last week over a possible infection on the Westerdam, and said measures will be taken to "reject entries" for foreigners into the country.    Cambodia, which has one confirmed case of the virus, is the recipient of billions of dollars in soft loans, infrastructure, and investment from China.
Date: Fri, 15 Nov 2019 09:41:09 +0100 (MET)

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

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

Cambodia has long come under fire from animal rights groups for ubiquitous elephant rides on offer for tourists, also seen in neighbouring Thailand, Vietnam and Laos.    The elephants are broken in during training and rights groups have accused handlers of overworking them.   In 2016, a female elephant died by the roadside after carrying tourists around the Angkor Wat temple complex in severely hot weather.   The animal had been working for around 45 minutes before she collapsed.
Date: Mon, 28 Oct 2019 08:10:36 +0100 (MET)

Phnom Penh, Oct 28, 2019 (AFP) - Cambodia deployed soldiers, police and divers to scour an island popular with backpackers after a British tourist went missing there four days ago, an official told AFP on Monday.

Nearly 200 members of the army, navy and police have fanned out across Koh Rong in southern Cambodia in an attempt to find Amelia Bambridge, who was last seen at a beach party around 3:30 am on October 24.   "Divers are searching in the sea around Koh Rong while the others are scanning the jungle," said Kheang Phearun, a spokesman for the Preah Sihanouk provincial administration.   "We have not yet found the missing British woman."

British media reports said the 21-year-old had befriended other tourists, but the alarm was raised after she failed to check out of her hostel.   The mystery deepened after authorities said they found her bag and phone where she was last seen, a late-night hangout called Police Beach.   Bambridge's family have arrived in Cambodia and headed to the closest city, Sihanoukville, on Sunday night, Phearun added.

Located in the Gulf of Thailand, Koh Rong is a two-hour boat ride from the coast and draws budget travellers with its cheap guesthouses, beachside bars and idyllic beaches.   But it has also undergone development in recent years in keeping with a construction and casino boom in nearby Sihanoukville.   Cambodia has long been a stop for tourists travelling around Southeast Asia.   Though generally safe, crimes involving foreigners have grabbed headlines in the past.

Last week a Cambodian court charged three men with gang-raping a French tourist in the coastal province of Kampot after offering her a ride in their car.   In 2013, Kampot town was rocked by the discovery of a mutilated body of a 25-year-old Frenchwoman floating in a river.    A Belgian was charged with the alleged rape and murder of the woman, but released on bail due to a lack of evidence.
31 Jul 2019

The north eastern province of Si Sa Ket, on the Cambodian border, has declared that the prevention and control of dengue fever required urgent attention throughout its area. Local health officials say they are now especially concerned about what will happen during the last 3 months of the annual wet season. At a Provincial Hall meeting it was announced that 7 people had died from dengue so far in 2019 and that 1664 people were now suffering from the mosquitoborne disease, making Si Sa Ket the country's 12th worst-hit province. They agreed the situation had worsened drastically, saying the monthly figures for those hospitalised had exploded from 81 cases in January to 618 in June and 457 in July [2019].

HealthMap/ProMED-mail map of Cambodia:
Date: Thu, 15 Aug 2019 06:14:20 +0200 (METDST)

Battambang, Cambodia, Aug 15, 2019 (AFP) - As he tears off a leg of a charcoal-grilled rat at a roadside stall in western Cambodia, Yit Sarin hails the simple joy of rodent and rice washed down with beer.   "It's delicious," he says of the snack.   Barbecued field rats are not everybody's idea of a tasty treat, but in Cambodia's rural Battambang province they are popular as a quick -- and cheap -- snack, with small skewered ones going for $0.25 each while larger rodents can cost $1.25.

Rats were commonly eaten in the 1970s, under the ultra-Maoist Khmer Rouge, when frogs, tarantulas and other small creatures were considered fair game as a means to survive.   Now they are simply an inexpensive lunch for workers and farmers -- though there is disagreement over what its meat tastes like.    Sarin tells AFP that rat is like "chicken or beef", whereas others say it's more like pork.

He is one of many customers and Cambodian tourists stopping at a stall outside of Battambang town, where rows of grilled field rats are displayed over burning coals and served with dipping sauces made from lime juice, black peppers or chillies.    Vendor Ma Lis says the snack has grown in popularity since she launched her stall more than a decade ago and sold just a few kilograms a day.   Today, she can net daily sales of around 20 kilograms, making brisk business from van-loads of travelling Cambodians and the occasional curious foreigner. 

The holiday season also spells bad news for the field rodents -- Ma Lis can sell up to 180 large rats a day on the Cambodian New Year or water festival.   Dismissing any health concerns one might have about eating her unconventional treat, Ma Lis says her rodents are caught from rice fields and are good for you.    "These rats are healthier than pork and chicken... they eat lotus roots and rice grains," she says, as she flips the barbecued bodies on the grill.    Despite the snack's enduring appeal, many people remain squeamish.     "They feel it is disgusting," she says, smiling.
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Hungary

Hungary US Consular Information Sheet
April 07, 2008
COUNTRY DESCRIPTION:
Hungary is a stable democracy with a market economy. Tourist facilities outside Budapest are widely available, if not as developed as those found in Western Europe.
isitors considering a trip are encouraged to read the Embassy’s consular web site at http://budapest.usembassy.gov/information_for_travelers.html.
Please read the Department of State Background Notes on Hungary.

ENTRY/EXIT REQUIREMENTS:
A passport is required. A visa is not required for tourist stays of up to ninety (90) days as of May 1, 2004. American citizen tourists may remain in Hungary for up to ninety days during any six-month period from the date of first entry. If you plan to reside or study in Hungary for a period of more than ninety days, a visa must be obtained from the Embassy of the Republic of Hungary at 3910 Shoemaker Street NW, Washington, DC 20008, telephone (202) 362-6730. More information can be found on the Hungarian Embassy’s web site, http://www.huembwas.org, or at the nearest Hungarian Consulate in Los Angeles or New York.

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

SAFETY AND SECURITY:
Prior police approval is required for public demonstrations in Hungary and police oversight is routinely provided to ensure adequate security for participants and passersby. Nonetheless, situations may develop which could pose a threat to public safety. This has been the case several times since 2006, as large demonstrations continue to occur in protest of various domestic political issues. While demonstrations have occurred throughout the country, demonstrations often occurred at Budapest’s Kossuth Lajos ter, outside the Hungarian Parliament Building and very close to the U.S. Embassy. On several occasions the demonstrations turned violent, resulting in local law enforcement response that included the use of water canons and tear gas. Domestic politics also appears to be the impetus behind a recent rash of Molotov cocktail and “white powder” incidents across the country. While Americans and U.S. interests are not specifically targeted by these incidents, many take place in areas popular with tourists. As a result, U.S. citizens are advised to avoid areas in which public demonstrations are taking place.

While Hungary does not appear to be experiencing the wave of race or ethnic-based violence associated with other countries in East and Central Europe, there has been an increase in the profile of a number of small groups espousing religious, ethnic and social intolerance. One such group, calling itself the Magyar Garda (Hungarian Guard), gained prominence in 2007 due to its radical nationalist message of intolerance and its efforts to intimidate opponents by adoption of imagery reminiscent of Hungary’s fascist regime of the 1940’s. Although such groups are not avowedly anti-American, their targeting of people based on their ethnicity, race or sexual orientation should be noted by Americans traveling in Hungary, and steps should be taken to avoid confrontations with the group and its members.

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

Up to date information on 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:
Hungary has a low rate of violent crime. However, street crime occasionally involving violence has been reported, especially near major hotels and restaurants and on public transportation. Theft of passports, currency, and credit cards is a frequent problem, especially in train stations and on public transportation.

The U.S. Embassy’s Consular Section offers an informational brochure for tourists in Hungary, including a section on crimes and scams that have been encountered by other tourists. To consult the advisory, please visit the Embassy’s consular web site at http://budapest.usembassy.gov/tourist_advisory.html.

Drivers should be cautious when stopping at gas stations and highway parking lots, or fixing flat tires or other mechanical problems, especially at night. There have been reports of scams perpetrated on unsuspecting victims while traveling the highways. One reported scam involves someone who attracts the driver’s attention by saying that there is something wrong with his/her car (e.g. a smoking hood or flat tire) in order to encourage the driver to pull over to the side of the road. Once pulled over, the people participating in the scam will remove purses, passports, etc., from the car and drive away. Luggage and valuables should not be left unattended inside any vehicle.

A common scam involves young women asking foreign men to buy them drinks. When the bill arrives the drinks cost hundreds of dollars each. Americans should avoid bars and restaurants promoted by cab drivers or people on the street. Every bar and restaurant should provide a menu with prices before ordering.

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

INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy or Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
Tourists who become victims of a crime in Hungary are strongly encouraged to call a 24-hour multilingual crime reporting telephone number. The number from 8 a.m. to 8 p.m. is 01-438-8080; from 8 p.m. to 8 a.m., the number is 06-8066-0044. There is also a 24-hour police Tourist Information office that provides service in English and German and is located in one of downtown Budapest’s busiest tourist area: 1051 Budapest.

For more information, see Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical treatment in Hungary is adequate, but hospital facilities and nursing support are not comparable to those in the United States. Physicians are generally well trained, but there is a lack of adequate emergency services. Some doctors, particularly in Budapest, speak English. Doctors and hospitals usually expect immediate cash payment for health services.

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

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

Please see our information on medical insurance overseas.

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

In Hungary, fatal traffic accidents number approximately 1,200 per year, with about 7,000 traffic accidents per year resulting in serious injuries. While this may seem low compared to the United States, Hungary has a much higher rate of accidents per mile driven. Americans should drive with caution and always be alert for other vehicles that may be violating traffic laws. Road travel is more dangerous during the Christmas season, summer months, and at night. Roadside assistance, including medical and other services, is generally available. English is usually spoken at the emergency numbers listed below. In case English is not spoken, dial 112.

Ambulance: 104 or 350-0388
Police: 107
Fire: 105
24-hour English speaker: 112

Bus, train and taxi services are readily available for inter-city travel.
Hungarian motorways and highways are generally in good condition.
Urban roads and road maintenance are also good although areas under construction are not always adequately marked or blockaded. In Budapest, many roads are often under construction. In rural areas, however, roads are often narrow, badly lit, and can be in a state of poor repair in some areas. Pedestrians, agricultural machinery, and farm animals often use these small rural roads. This requires increased caution on the part of drivers. Additional information on road conditions is available from “Utinform” at phone number (38) (1) 336-2400.

Hungary has a policy of zero tolerance for driving under the influence of alcohol. Police often conduct routine roadside checks where breath-analyzer tests are administered. Persons found to be driving while intoxicated face jail and/or fines. Possible penalties for a car accident involving injury or death are one to five years in prison. Police have instituted a widespread practice of stopping vehicles, particularly in Budapest, to check driver identity documents in a search for illegal aliens and residents in Hungary, and to check vehicle registration and fitness documentation. It is against the law to use a hand-held cell phone while driving anywhere in Hungary.

Hungary recognizes international driver’s permits (IDP) issued by the American Automobile Association (AAA) and the American Automobile Touring Alliance when presented in conjunction with a state driver’s license. American driver’s licenses will be accepted in Hungary for one year after arrival provided that a certified Hungarian translation has been attached to the license. Those with IDPs do not need to have the license translated, but must present both IDP and state driver’s license together. After one year in Hungary, U.S. citizens must obtain a Hungarian driver’s license. For further information on this procedure visit the embassy’s consular web site at http://budapest.usembassy.gov/information_for_travelers.html.

The speed limit for cars and motorcycles on the motorway is 130 km per hour (approximately 80 mph); on highways, the limit is 110 km per hour (approximately 65 mph);
and in town and village areas, the speed limit is 50 km per hour (approximately 30 mph). Many drivers, however, do not observe the speed limits, and extra care should be taken on two-way roads.
Special seats are required for infants. Children under age 12 may not sit in the front seat of an automobile. Seats belts are mandatory for everyone in the car. Unless another instruction sign is displayed, yielding the right of way to cars approaching from the right is the general rule. Turning right on a red light is prohibited. The police write up tickets for traffic violations and levy any applicable fine(s) on the spot. The police will give the offender a postal check (money order) on which the amount of the fine to be paid is written, and this postal check may be presented and paid at any Hungarian post office. Sometimes in disputes about fines or the offense, the police will confiscate the person’s passport and issue a receipt for the passport with an “invitation letter” to appear at the police station the ext day or day after to resolve the dispute. The passport is returned after resolution and/or the payment of the fine.

For specific information about Hungarian driver’s permits, vehicle inspection, road taxes and mandatory insurance, visit the Hungarian National Tourist Organization Office in New York web site at http://www.gotohungary.com.

Please refer to our Road Safety page for information.

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

SPECIAL CIRCUMSTANCES: The acceptance of traveler’s checks is not universal in Hungary. The presence of ATMs is increasing in Budapest and other major cities.

Hungary’s custom authorities may enforce strict regulations concerning temporary importation into or export from Hungary of items such as firearms, antiquities, and prescription medications. It is advisable to contact the Embassy of Hungary in Washington or one of Hungary’s consulates in the United States for specific information regarding customs requirements.

Please see our information on Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Hungarian laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Hungary 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 see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION/EMBASSY AND CONSULATE LOCATIONS:
Americans living in Hungary are encouraged to register with the nearest U.S. Embassy of Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov, and to obtain updated information on travel and security within Hungary.
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 in Budapest is located at 1054 Budapest 12; telephone (36) (1) 475-4703 or (36) (1) 475-4929. The Consular Section’s fax is (36) (1) 475-4188 or (36) (1) 475-4113, and the Consular Section’s web site is located at http://hungary.usembassy.gov/.
*
*

*
This replaces the Consular Information Sheet dated August 23, 2007 with updated information on Safety and Security.

Travel News Headlines WORLD NEWS

Date: Thu, 30 May 2019 08:06:11 +0200

Budapest, May 30, 2019 (AFP) - Seven South Korean tourists died and 21 others were missing after a sightseeing boat capsized and sank on the Danube in Budapest, Hungarian and South Korean officials said Thursday.   The accident happened near the parliament building in the heart of the Hungarian capital after a collision with a larger river cruise boat during torrential rain around 09:15 pm (1915 GMT) on Wednesday, according to officials.   A total of 33 South Koreans were on board, Seoul's foreign ministry said, confirming the seven dead were Korean.   The youngest was a six-year-old girl, travel agency officials said.

The 26-metre tourist boat, called the "Mermaid," was also carrying two Hungarian crew members.   "Our services have recorded the death of seven people," Pal Gyorfi, a spokesman for Hungarian emergency services, said early Thursday morning.   "Seven people have been taken to hospital in a stable condition with hypothermia and shock symptoms," Gyorfi added.   "A further 21 people are missing," a Hungarian police spokesman Kristof Gal told AFP.   "Police are searching the river throughout the entire length of the Danube in Hungary south of where the incident took place," he said.

- All night search -
Local media reported that one of the bodies was found several kilometres south of the collision location, although Gal declined to confirm.   The temperature of the river water is between 10 and 15 degrees, according to local media.   The search for the missing with the help of divers and police shining lights continued through the night, said an AFP photographer at the scene.   A film crew working from a bridge south of the accident site also used reflector lights to help light up the water through the gloom and pouring rain, reported local media.   Heavy rainfall since the beginning of May has led to high water levels and a fast-moving river current, complicating rescue efforts.

The accident happened on a popular part of the Danube river for pleasure trips, from where passengers can view the city and parliament building illuminated at night.   The boat was regularly serviced and had no apparent technical faults, Mihaly Toth, a spokesman for Panorama Deck that owned the vessel, told the Hungarian news agency MTI.     "It was a routine sightseeing trip," said Toth.   "We know nothing about how it happened, the authorities are investigating, all we know is that it sank quickly," he said. 

- Hit by bigger cruise boat -
An eye-witness told the Index.hu news-site that the Mermaid, which could hold 60 people on board, had been hit from behind by a large cruise boat.   Web camera footage from a hotel rooftop posted on local news-sites appeared to show the bigger boat colliding with the Mermaid.     The wreckage of the Mermaid was found on the riverbed after several hours of searching near the Margaret Bridge, one of the main bridges connecting the two parts of the Hungarian capital, local media said.   Access to the river has been blocked by the authorities, according to public television.

South Korea's President Moon Jae-in instructed the government to "deploy all available resources" for the rescue, the presidential office said.   Seoul planned to send a team of 18 officials to assist the authorities in Budapest, South Korea's Yonhap news agency reported.   The foreign ministry said minister Kang Kyung-wha would leave for Budapest later Thursday as head of a government taskforce.   Embassy staff have also been assisting the emergency services in the identification of victims.   The Hungarian interior and health ministers visited the scene and expressed condolences to the families of the victims.
Date: Thu, 30 Aug 2018 05:07:31 +0200
By Géza MOLNAR

Siófok, Hungary, Aug 30, 2018 (AFP) - With its inviting turquoise waters, white sandy banks, picturesque mountainous landscapes and resort towns, Hungary's Lake Balaton has plenty for tourists to write home about.   But a labour shortage exacerbated by low salaries and Hungary's
anti-immigration policies is making life difficult for the lake's tourism industry.   Already popular under communism, visitors still flock in increasing numbers to central Europe's largest lake to soak up its warm summer climate and enjoy the beaches, bars and eateries, as well as locally produced wines.

But that's proving a headache for restaurant and hotel owners, who struggle to find workers, as unemployment in Hungary is historically low at 3.6 percent, while nationalist firebrand Prime Minister Viktor Orban is strongly against immigration.   "It's impossible to find a gardener, or a waitress or a cook," said Balazs Banlaki, the owner of Kali-Kapocs, a restaurant nestled in the hills of Mindszentkalla on the northern shore of the lake, which lies about 80 kilometres (50 miles) southwest of the capital, Budapest.   Banlaki usually needs about 10 employees to run his restaurant, which he only opens during the summer months, but he has to do more and more himself.   "Before each new season, we repaint the restaurant, but even for that kind of work, it's me who takes up the brush now," he told AFP.

- 'Young people don't stay' -
With a national average salary of less than 530 euros ($610) per month and half a million people having left the country to work in western Europe over the past decade, Hungary lacks workers.   Despite having one of the lowest fertility rates in the OECD (Organisation for Economic Co-operation and Development) and a population currently of less than 10 million, its government has not heeded appeals from businesses to open its borders to qualified workers.

Banlaki recalled how last year he could only offer drinks, coffee and sandwiches because he could not find a cook.    After raising salaries, he is glad to have at least a handful of workers this year.   "But even when we find someone, there is a high chance that he or she will quit again quickly. With festivals, holiday plans with friends and other occasions, young people don't stay. I don't dare to criticise our workers for fear they will just leave," he said.   On the other side of the lake -- known also for its big beach parties and discotheques -- the high-end Plazs Siofok beach complex that can hold close to 10,000 people faces similar challenges.   "We advertise (job openings) everywhere and all the time... The lack of qualified workers is a constant problem," manager Erzsebet Mazula said.

- Online check-in? -
Due to its trendy image -- with numerous restaurants, an outdoor gym, beach bars and a concert stage drawing Hungary's best DJs and singers -- Plazs Siofok can attract student workers, Mazula said.   "They are certainly not professionals, but we train them before the season starts. Being involved and friendly and smiling is more important than knowing how to make complicated cocktails," she told AFP.   "But even with this system, you can see there are not enough waiters and waitresses to serve our clients."   At Siofok, mother-of-two Petra Lisztes, 39, said they spent several weeks at the lake every year and she had noticed that many of the small food and drinks stands had remained shut this time and that service in restaurants was slower.   The problem extends far beyond Lake Balaton.

Seen as a relatively cheap holiday destination, the number of tourists to Hungary has climbed seven percent this year so far, according to official data released by the KSH Hungarian Central Statistical Office, after already reaching a record 29.5 million hotel overnight stays last year.   To compensate for a lack of workers, several Budapest hotels have started to simplify reception services inspired by airline companies' online check-in systems.   But the problem is hard to solve for jobs that require expertise, such as cooks, head waiters and waitresses or managers.   Seeking to offer a solution, the government is trying to convince pensioners to return to work by exempting them from having to pay social contributions and capping taxes at 15 percent.    Since last year, Budapest has permitted workers from neighbouring non-EU countries Ukraine and Serbia to work in Hungary for up to 90 days without a work permit.   But, so far, the measures have failed to solve the shortage.
Date: Tue 3 Jul 2018
Source: Food Poison Journal [edited]

Frozen corn and possibly other frozen vegetables are the likely source of an outbreak of _Listeria monocytogenes_ that has been affecting Austria, Denmark, Finland, Sweden, and the United Kingdom since 2015.

Experts used whole genome sequencing to identify the food source, which initially was thought to be limited to frozen corn. As of 8 Jun 2018, 47 cases including 9 deaths had been reported.

The same strains of _L. monocytogenes_ have been detected in frozen vegetables produced by the same Hungarian company in 2016, 2017, and 2018. This suggests that the strains have persisted in the processing plant despite the cleaning and disinfection procedures that were carried out.

The available information confirms the contamination at the Hungarian plant. However, further investigations, including thorough sampling and testing, are needed to identify the exact points of environmental contamination at the Hungarian plant. The same recommendation applies to other companies belonging to the same commercial group if environmental contamination is detected.

On 29 Jun 2018, the Hungarian Food Chain Safety Office banned the marketing of all frozen vegetable and frozen mixed vegetable products produced by the affected plant between August 2016 and June 2018, and ordered their immediate withdrawal and recall. This last measure is likely to significantly reduce the risk of human infections and contain the outbreak. All freezing activity at the plant has been stopped.

New cases could still emerge due to the long incubation period of listeriosis (up to 70 days); the long shelf-life of frozen corn products; and the consumption of frozen corn bought before the recalls and eaten without being cooked properly.

To reduce the risk of infection, consumers should thoroughly cook non ready-to-eat frozen vegetables, even though these products are commonly consumed without cooking (such as in salads and smoothies). This applies especially to consumers at highest risk of contracting listeriosis -- such as the elderly, pregnant women, newborns and adults with weakened immune systems.  [Byline: Josh Fensterbush]
======================
[When last reported by ProMED-mail in March 2018 (Listeriosis - EU: fatal, ST6, frozen corn, 2015-18, recall http://promedmail.org/post/20180325.5708506), there was a total of 32 confirmed listeriosis cases, including 6 deaths, between December 2015 and 8 Mar 2018, in a multi-country outbreak in 5 EU member states (Austria, Denmark, Finland, Sweden, and the United Kingdom) linked by whole genome sequencing (genotyping) of clinical isolates of _Listeria monocytogenes_ to frozen corn that was packed in Poland and processed/produced in Hungary. As of 8 Jun 2018, there are now 47 reported cases, including 9 deaths.

Possibly other frozen vegetables produced by the Hungarian facility are also being implicated and on 29 June 2018, the Hungarian Food Chain Safety Office ordered recall and banned further the marketing of all frozen vegetable and frozen mixed vegetable products produced by the affected facility between August 2016 and June 2018. All freezing activity at the plant has been stopped.

_Listeria monocytogenes_ is widely distributed in the environment where it can form biofilms, which enables them to attach to solid surfaces and become extremely difficult to remove, especially in parts of equipment that are difficult to access. In a prior ProMED-mail report of a listeriosis outbreak in Canada, the design of a commercial meat slicer responsible for contamination of deli meat made its regular cleaning difficult and costly for the food processor (Listeriosis - South Africa (04): comment http://promedmail.org/post/20180126.5586393). The contamination occurred in parts of the machinery "well beyond the [manufacturer's] recommended sanitation process" and was "found only after the devices were completely disassembled" (<https://www.theglobeandmail.com/news/national/maple-leaf-eyes-meat-slicers-in-outbreak/article1060898/>).  Perhaps a similar situation is responsible for this prolonged multicountry EU outbreak.

Serotyping of _L. monocytogenes_ strains, based on variations in the somatic (O) and flagellar (H) antigens, has determined that only 3 (1/2a, 1/2b, and 4b) of the 12 serotypes of _L. monocytogenes_ cause 95 per cent of human cases; serotype 4b is most commonly associated with outbreaks (<https://www.cdc.gov/listeria/pdf/listeriainitiativeoverview_508.pdf>). The serotype of the strain of _L. monocytogenes_ responsible for this multi-country European outbreak is 4b, multi-locus sequence type 6 (ST6). Whole genome sequence (WGS) analysis of _L. monocytogenes_ isolates from 2 different samples of mixed frozen vegetables and an isolate from a surface where various vegetables could have been processed closely matched that of the clinical isolates (ProMED-mail post Listeriosis - EU: fatal, ST6, frozen corn, 2015-18, recall http://promedmail.org/post/20180325.5708506).

HealthMap/ProMED-mail map of Europe:
Date: Tue, 19 Dec 2017 04:32:51 +0100
By Peter MURPHY

Budapest, Dec 19, 2017 (AFP) - Bigger than Prague and some say more beautiful, Budapest's belle epoque boulevards, cafes and locals playing chess in steaming outdoor thermal spas have long attracted tourists.    But for some locals the city's tourism sector is booming too literally.   "My walls shake from music at night, it's impossible to sleep," says Dora Garai, a weary resident of the Hungarian capital's inner seventh district, these days called the "party quarter".

"In the morning I often have to clean vomit off my car," she says, the flat where she has lived all her life a beer can's throw away from a raucous 2,000-capacity all-night bar complex.   The 32-year-old now fronts a residents' group that has held marches in protest at the situation, mirroring unease in other European cities from Barcelona to Amsterdam.   The main attraction for the revellers is that Budapest gives more bang for your buck, Melanie Kay Smith, a Budapest-based academic at the Corvinus University, told AFP.

Hundreds of visitors interviewed for an upcoming report by Smith's students said they chose Budapest, within easy reach on dozens of budget flights daily, for the "cheap alcohol" and "the party".    "We get so much here for so little," a group of young Danes told AFP, beaming, on a recent night out.   Beer rarely costs more than 1.50 euros ($2.50), while a glut of Airbnb flats are on offer for under 30 euros a night.   Hedonistic thermal bath parties, and all-night opening hours add to the lure for thirsty youth, mostly hailing from expensive northern Europe, and often Brits on stag nights.   Offers on the pissup.com website, for example, include the "Killer Attila Warrior Weekend", or steaks and beers followed by a "sensational lesbian show".

- Moving out -
Annual arrivals have almost doubled since 2009 to 3.5 million last year, with Athens the only large city forecast to grow faster in 2017, according to Euromonitor.  Even in winter the neighbourhood is choked with taxis and rickshaws transporting revellers. The Corvinus study counted 800 bars and restaurants, double the number just five years ago.   "Are you ready to party?!" roared a young Hungarian through a megaphone at his foreign student pub-crawl group.    "People can always move out if it bothers them," he shrugged.   Some of the estimated 15,000 residents of the area's compact grid of 19th-century streets, traditionally called the Jewish district after its many synagogues, have done just that.

No official data exist yet but one in five people of some 300 residents told Corvinus that they were "considering moving out" due to noise, litter and public urination.    "People used to live here," reads an ominous bronze plaque put up near a party hostel in the heart of the zone.   Despite soaring property prices driven by investor demand for rental apartments many live in council accommodation and cannot sell, said Dora Garai, or, like her, refuse to budge.   "Why should I move out just because people come here for a few days to behave how they like," she said.

- Midnight closing? -
Garai's group, set up in April, now has over 1,000 members who share experiences on Facebook.    "Last night a drunk Englishman looking for his Airbnb apartment rang every doorbell in our building," one said.   Bars should shut by midnight, not the current 6:00 am, the group demands, while City Hall should create a party zone outside the downtown.

But midnight closing would put him out of business, said Abel Zsendovits, manager of the popular Szimpla Kert (a grungy "ruin bar" in a formerly derelict building), dubbed one of the world's best pubs by Lonely Planet in 2014.   "Yes, the situation outside is unsustainable now," he admitted. "So bring in fines for anti-social behaviour, more police, street cleaning and public toilets". 

At weekends his colleagues don green jackets and try to calm down street noise, part of a "Night Mayor" idea launched by an association of bars.   The residents though are unconvinced that such a business-led initiative will end their woes.    Nor would a proposed local referendum on midnight closing that would likely see low turnout given the outer part of the district is unaffected by the problems.   Ultimately, Budapest needs to upgrade from low-budget "laissez-faire" tourism, says Smith. "Prices will have to go up somehow".
Date: Wed, 19 Jul 2017 16:02:04 +0200

Budapest, July 19, 2017 (AFP) - Hungarian police on Wednesday inspected all international trains entering the country after receiving an anonymous bomb threat, sparking major travel delays.   "An unidentified male called to say that he had placed a bomb on an international train travelling through Hungary," police said in a statement.

As many as 20,000 Hungarian and international travellers were affected by the delays lasting up to three hours, according to the national railway station company (MAV).   By Wednesday afternoon, more than 18 trains had already been searched before being allowed to continue their journeys, with no explosives found so far.   The checks will be carried out until midnight, MAV said.
More ...

Cayman Islands

CAYMAN ISLANDS US Consular Information Sheet
October 02, 2008

COUNTRY DESCRIPTION:
The Cayman Islands are a British dependent territory consisting of three main islands with a total area of approximately 100 square miles and located a
out 500 miles west of Jamaica. There is an international airport located in Grand Cayman, and facilities for tourists are widely available. The U.S. Embassy in Kingston, Jamaica, has consular responsibility for the Cayman Islands. Read the Department of State Background Notes on the Cayman Islands for additional information.

ENTRY/EXIT REQUIREMENTS: All Americans traveling by air outside of the United States are required to present a passport or other valid travel document to enter or re-enter the United States. This requirement will be extended to sea travel (except closed-loop cruises), including ferry service, by the summer of 2009. Until then, U.S. citizens traveling by sea must have government-issued photo identification and a document showing their U.S. citizenship (for example, a birth certificate or certificate of nationalization), or other Western Hemisphere Travel Initiative (WHTI) compliant document such as a passport card for entry or re-entry to the U.S. Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.
Applications for the new U.S. Passport Card are now being accepted and have been in full production since July 2008.The card may not be used to travel by air and is available only to U.S. citizens. Further information on passport cards is available at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html. We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel. American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.
Visas are not required for U.S. citizens traveling to the Cayman Islands for short-term visits. U.S. citizens traveling to the Cayman Islands for work must obtain a temporary work permit from the Department of Immigration of the Cayman Islands, telephone (345) 949-8344. There is a departure tax for travelers age 12 and older, which is regularly included in airfare. For further information travelers may contact Cayman Islands Department of Tourism offices in Miami at (305) 599-9033, New York (212) 889-9009, Houston (713) 461-1317 and Chicago (630) 705-0650; or via the Internet at http://www.caymanislands.ky.

Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
The Cayman Islands are considered politically stable and enjoy a high standard of living. There have been no reported incidences of terrorism or threats made against Americans or American interests in the Cayman Islands.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Public Announcements, 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. and Canada, or for other callers, 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 pamphletA Safe Trip Abroad.
CRIME: The crime threat in Cayman Islands is generally considered low, although travelers should always take normal precautions when in unfamiliar surroundings. Petty theft, pick-pocketing and purse snatchings occur. A few cases involving sexual assault have been reported to the Embassy. Police in the Cayman Islands rigorously enforce laws against illegal drugs. The majority of arrests of American citizens in the Cayman Islands over the past two years have been for possession, consumption, or intent to sell marijuana, cocaine or other illicit drugs. American citizens should avoid buying, selling, holding or taking illegal drugs under any circumstances.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

The local equivalent to the “911” emergency line in the Cayman Islands is “911.”
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: The quality of medical care in the Cayman Islands is generally comparable to that available in the United States; however, some procedures and cases requiring critical care may require medical evacuation to the United States. Several American citizens each year drown or suffer cardiac arrest while snorkeling or scuba diving in the Cayman Islands. These deaths may be attributed in part to tourists attempting to do more than they are trained to do or to poor physical conditioning or preexisting medical conditions that are exacerbated when snorkeling or diving. A hyperbaric chamber is available for treatment of decompression illness. Doctors and hospitals often expect immediate payment for health services.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

Although there are no express HIV/AIDS entry restrictions exist for visitors to the Cayman Islands, persons suffering from HIV/AIDS can be denied permission to land if a Health Officer certifies that their entry to the Islands would be dangerous to the community pursuant to Section 82 (c) of the Cayman Immigration Law (2007 Revision), which states:

“The following persons, not being Caymanian or permanent residents, are prohibited immigrants – a person certified by a Health Officer to be suffering from a communicable disease that makes his entry into the Islands dangerous to the community.”
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning the Cayman Islands is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
As in Great Britain and its other colonies, vehicles in the Cayman Islands travel on the left-hand side of the road (the opposite side compared with driving in the United States). Due to their size, the Caymans have little highway infrastructure to maintain. Local driving standards, the risk of accidents, the availability of emergency roadside service, quality and frequency of signage, and enforcement of traffic laws, generally meet the standards of the United States. Visitors must obtain a temporary driver's license, easily granted upon presentation of a valid state driver's license and payment of a small fee, at a car rental agency or a police station. Laws against driving while intoxicated are strictly enforced, with a legal maximum blood alcohol level set at 100 milligrams per 100 milliliters of blood. Seatbelt laws are also enforced and require the driver and all passengers to wear seatbelts while in motion. Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office at www.caymanislands.ky
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the Cayman Islands’ Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the Cayman Islands’ air carrier operations. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Cayman Islands customs authorities may enforce strict regulations concerning temporary importation into or export from the Cayman Islands of items such as firearms of any kind, spear guns (or pole spears or Hawaiian slings), live plants and plant cuttings. Raw fruits and vegetables are also restricted. Visitors from the United States should be aware that products made from farmed green sea turtles at the Cayman Turtle Farm Ltd. are offered for local consumption; however, the importation of genuine sea turtle products is strictly prohibited by the United States, as well as other countries that have signed the Convention on International Trade in Endangered Species. In addition, U.S. Customs prohibits the transshipment of turtle products through the United States and any products discovered will be confiscated. It is advisable to contact the Collector of Customs (345) 949-2473 for specific information regarding customs requirements. Please see our Customs Information.

The Cayman Islands, like all Caribbean countries, can be affected by hurricanes. Hurricane season runs from June 1 to November 30 each year. The Office of Disaster Preparedness and Emergency Management (ODPEM) has put measures in place in the event of an emergency or disaster. General information is available on the subject via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.

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

CHILDREN'S ISSUES: For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the Cayman Islands are encouraged to register with the U.S. Embassy in Kingston, Jamaica through the State Department's travel registration web site, and to obtain updated information on travel and security within the Cayman Islands. Americans without Internet access may register directly with the U.S. Consular Agency in George Town, Grand Cayman or the U.S. Embassy in Kingston, Jamaica. By registering, American citizens make it easier for the Embassy or Consular Agency to contact them in case of emergency. The U.S. Consular Agency in the Cayman Islands is located at 222 Mirco Center, North Sound Road, Georgetown, Grand Cayman. Its phone number is (345) 945-8173. Office hours are Monday, Wednesday, and Friday from 08:00 a.m. to 2:00 p.m.

American citizens requiring assistance in Cayman may also contact the American Citizen Services Unit of the U.S. Embassy in Kingston, Jamaica at (876) 702-6000. The Consular Section of the U.S. Embassy is located at 142 Old Hope Road,, Kingston 6. Office hours are Monday through Friday (except Jamaican and U.S. holidays), 7:15 a.m. to 4:00 p.m., with window services 8:30 to 11:30 a.m. Both the Consular Agency and Embassy may provide updated information on travel and security within the Cayman Islands. The Embassy web site is http://kingston.usembassy.gov/
* * *
This replaces the Country Specific Information for the Cayman Islands dated December 3, 2007, to update sections on entry/exit requirements, crime, and medical facilities.

Travel News Headlines WORLD NEWS

Date: Mon 19 Feb 2018
Source: Cayman Compass [edited]

An outbreak of hand-foot-mouth disease that surfaced a few weeks ago is still affecting some schools on Grand Cayman.

The disease is not uncommon on the island and typically affects children under 10 and especially those aged 5 and younger. Children with the virus typically have a fever, sore throat, a red rash on the palms of the hands and soles of the feet, mouth sores, and loss of appetite. There is no specific treatment other than to let the illness run its course. The best prevention is practicing good sanitation and hygiene.

Tim McLaughlin, an epidemiologist with the Public Health department, said the 14 cases reported from 4-10 Feb 2018 were the most he has seen in a single week. Figures for last week [week of 12 Feb 2018] are not yet available, but Mr McLaughlin said it looked as though the spread of the disease had slowed down. Most children were out of school last week and that may be a factor, he said

"14 in a week is a lot," Mr. McLaughlin said. "It also tells me there are more cases out there."

As a consequence, he said, he is more closely monitoring the spread of the disease, which is not uncommon this time of year. If need be, he said, "We'll sound the alarm."

At the Department of Education Services, director Lyneth Monteith said she was unaware of any public schools currently being affected by the disease. But preschools are seeing the problem.

Bri Bergstrom, the owner of the Montessori School of Cayman, said 3 of her students came down with the illness 3.5 weeks ago. It was the 1st such outbreak at the school, she said, adding that no other students have since been affected.

"It seems to be going around," Ms Bergstrom said. "It's almost impossible to avoid sometimes, things coming into the school."

She and others operating schools and preschools said that they have increased their efforts to keep classrooms and play areas sanitary by cleaning more often and doing thorough deep cleaning.

"Even when the flu is going around, we always amp up the sanitation," Ms Bergstrom said.

At the Treasure Garden, a preschool with 35 students, teacher Tonie-Ann Broomfield said 6 pupils have contracted the disease over the past 2-3 weeks. Some of the students, she said, showed no outward symptoms, such as a fever, before breaking out in a rash. She said the staff is being more vigilant.

"As soon as we check their temperature and it's above 100 deg F [37.8 deg F], we call the parents and ask them to take them to the doctor," Ms Broomfield said, adding that the child is kept isolated from other children until they are picked up.  [Byline: Mark Muckenfuss]
========================
[Hand-foot-mouth disease is caused by viruses that belong to the _Enterovirus_ genus (group), which includes polioviruses, coxsackieviruses, echoviruses, and other enteroviruses. - Coxsackievirus A16 is typically the most common cause of hand-foot-mouth disease in the United States, but other coxsackieviruses can also cause the illness. - Enterovirus 71 has also been associated with cases and outbreaks (<https://www.cdc.gov/hand-foot-mouth/outbreaks.html>) of hand-foot-mouth disease, mostly in children in East and Southeast Asia. Less often, enterovirus 71 has been associated with severe disease, such as encephalitis.  - Several types of enteroviruses may be identified in outbreaks of hand-foot-mouth disease, but most of the time, only 1 or 2 enteroviruses are identified.

Generally, a person with hand-foot-mouth disease is most contagious during the 1st week of illness. People can sometimes be contagious for days or weeks after symptoms go away. Some people, especially adults, may become infected and not develop any symptoms, but they can still spread the virus to others. This is why people should always try to maintain good hygiene, such as frequent handwashing, so they can minimize their chance of spreading or getting infections. (Excerpted and edited from <https://www.cdc.gov/hand-foot-mouth/about/transmission.html>). - ProMED Mod.LK]

[HealthMap/ProMED-mail map
Grand Cayman, Cayman Islands: <http://healthmap.org/promed/p/7955>]
Date: Fri 2 Feb 2018
Source: Cayman News Service [edited]

The [Cayman Islands] Public Health Department is issuing an alert for travellers after at least 2 cases of measles were confirmed in the Caribbean and Central America that appear to have been imported from Europe. There have been no cases of measles in the Cayman Islands since 1990. Local immunisation coverage against the disease is around 90% among 15-month-old children and about 97% by the time they reach school age. But officials are urging anyone who becomes unwell after returning from the UK and Europe as well as parts of the US to visit a doctor.

People who are experiencing a sudden high fever accompanied by a rash should seek medical attention immediately and provide their travel history to the doctor for necessary investigation.

"If you are travelling to any of the affected areas where measles has been confirmed, safeguard yourself and your family by ensuring that your and your children's immunisations against measles are up to date," advised Nurse Angela Graham, manager of the Health Services Authority's Expanded Programme on Immunisation. "Unprotected children are at the greatest risk of contracting this virus, should a case be imported to the Cayman Islands. It is the responsibility of parents and guardians, alike, to ensure that their children are protected."

Dr Samuel Williams-Rodriguez, Acting Medical Officer of Health, said that while there has been great progress in the fight against measles regionally, there is a risk of spread and sustained transmission in areas with susceptible populations.

"Vaccination with at least 2 doses remains the most effective measure," he said. "I emphasise that measles can be reintroduced as we have many residents and visitors travelling to and from the Americas and European countries. We should therefore remain vigilant."

He added, "The 1st sign of measles is usually a high fever which begins about 10-12 days after exposure to the virus. A runny nose, cough, along with red and watery eyes and small white spots inside the cheeks, can develop in the initial stage followed by a rash on the face and upper neck, eventually reaching the hands and feet."

Measles is caused by a virus which grows in the cells that line the back of the throat and lungs. It is a human disease and is not known to occur in animals. Close contact with other people following the onset of rash must be avoided 7 for days.

For complete protection, children older than 12 months should have 2 doses of MMR (measles mumps and rubella) vaccine. Children between 6 and 11-months, who are travelling abroad, are recommended to have one dose of MMR vaccine.
====================
[Maps of the Caribbean and Central America can be found at
Date: Thu 17 Apr 2014
Source: cayCompass.com [edited]

More than 400 feral chickens in Bodden Town have died of botulism, according to a post-mortem examination carried out by the Department of Agriculture. The birds began dying more than 2 weeks ago, residents in the area said. Brian Crichlow of the Department of Agriculture said a post-mortem exam on one of the birds revealed botulism. The bird was also tested for avian flu, with negative results. Mr Crichlow said botulism is not spread by direct contact with affected chickens, but there is a "low potential for spreading to humans and other animals through consumption of dead chickens" contaminated with the botulism toxin.

Botulism is a micro-organism that occurs naturally in the soil and in decaying flesh. Since chickens are scavengers, they likely ate a dead animal and got sick, said Mr. Crichlow.

The Department of Environmental Health was expected to begin removing the birds from the site, near the Bodden Town Mission House, on Wednesday afternoon [16 Apr 2014], according to the department's director, Roydell Carter. "We are aware of the situation. We were notified by the Department of Agriculture about it. We went on site today [Wed 16 Apr 2014] and we will be assisting them in getting the birds removed and disinfecting the area," he said. "We're putting together the resources we need -- there are so many [dead chickens] all over the place ... We will go in and help. There could probably be public health implications as well [if the carcasses are not removed]. We don't want all these dead birds lying around ... where other animals might feed on their carcasses," he added.

On Wednesday [16 Apr 2014], many of the dead chickens could be seen around the Mission House and Harry McCoy Park, and under the home of an elderly couple nearby. Mr Crichlow advised that if the dead or dying birds are not removed and disposed of properly, other chickens will feed on the carcasses and the maggots from the dead chickens, leading to more chickens contracting botulism. Botulism is also known as "limberneck," he said, reflecting the neck paralysis typically seen in affected birds. [The son] of the couple under whose home many of the decaying carcasses were seen, said he had picked up as many as he could, but those under the house would have to stay there until he had help removing them.

"The chickens just get crippled, lie down and die," said [the man], who often fed the chickens. For the past 2 weeks, the chickens have been "dropping off like flies," he said.

The feral chickens roam the neighborhood and are considered pests by many in the area. Mr Crichlow said there had been no reports of domestic flocks of chickens owned by local farmers being affected by botulism. However, he said the department had seen similar episodes before of local wild chickens dying, adding that botulism is common in feral chickens in Cayman and elsewhere. Over the past 2 years, his department has responded to deaths of feral chickens in George Town, West Bay and Bodden Town districts, he said.

Karen Rosenthal, a St. Matthews Veterinary School veterinarian who studies birds, said, "It is not so easy for people to get botulism the same way chickens do. But you would never eat the eggs or meat from a chicken with botulism," she said. "What we should worry about is if the people are using the same water source as the dead birds."

Kiran Kumar, medical officer of health at the public health department, said botulism from dead chickens does not spread to human beings through the air, and there is also no evidence of it spreading to humans by consumption of chickens with botulism. However, he advised against eating infected chickens to "prevent any rarest possibility of such occurrence."   [Byline: Jewel Levy]
========================
[Avian botulism is much more often seen in wild ducks and other water birds. But we do have a prior report of an Australian incident which is very similar to this Cayman report. The Australians ascribed it to a buildup of the causative organism, _Clostridium botulinum_, in the soil. - ProMed Mod.MHJ]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/38613>.]
Date: Fri 17 Jan 2014
Source: Businessweek [summ., edited]

The 1st known outbreak of the chikungunya virus in the western hemisphere has Caribbean governments working to prevent the disease from spreading and damaging the region's tourism-dependent economies.

About 280 cases of chikungunya [virus infection; many more cases than this, see other reports - ProMed Mod.TY], which can cause severe joint pain, fever and headaches, have been reported since early December [2013] in Dutch and French Saint Martin, Saint Barthelemy, Martinique, Guadeloupe, Dominica, the British Virgin Islands, and French Guiana. Officials from Venezuela to the Cayman Islands have warned of the potential for the mosquitoborne virus, 1st identified from a patient in Tanzania in 1953, to spread. There is no treatment, and the illness is rarely fatal.

"The worst case scenario would be that the impact would be significant and slow down the whole economy in the Caribbean," James Hospedales, the executive director of the Caribbean Public Health Agency, said by telephone. "The Caribbean is the most tourism-dependent region in the world, so if it spreads like wildfire you could scare away tourists."   [byline: Isabella Cota and Elizabeth Lopatto]
=====================
[This report is a good illustration of potential adverse economic effects when a new disease appears in a major tourist destination. Although dengue fever poses greater health risks, the addition of a 2nd virus disease to the area increases concern on the part of the traveling public. - ProMed Mod. TY]
Date: Mon 17 Sep 2012.
Source: Cay Compass [edited]

The Cayman Islands Mosquito Research and Control Unit and Oxitec have cited an 80 per cent reduction in the numbers of _Aedes aegypti_ mosquitoes in Grand Cayman after introducing genetically modified mosquitoes into the environment as a control measure. This finding, which was officially published in a report in Nature Biotechnology, was previously reported in the 17 Jan 2012 edition of the Caymanian Compass.

One of the main reasons the report said led to the Cayman Islands "having a need the need for alternative measures of control" was the high level of resistance to insecticide shown by _Aedes aegypti_ mosquitoes in Grand Cayman. The report references research done by MRCU Entomologist Angela Harris and Hilary Ranson of the Liverpool School of Tropical Medicine, who in their findings, "Pyrethroid Resistance in Aedes Aegypti," stated: "The Grand Cayman population of _Aedes aegypti_ is highly resistant to DDT and pyrethroid insecticides."

In an interview with the Caymanian Compass, Dr. Harris said, "For our experiments regarding the issue of resistance to insecticides we used mosquitoes that have been in a secure environment for over 30 years in a colony that was bred repeatedly over time and then compared those with the mosquitoes from the Grand Cayman. The results indicated that those found here are much more resistant and could be exposed to DDT for up to 8 hours."

Ms Harris added that the _Aedes aegypti_ mosquito has only been in the Cayman Islands since 2002 and could have likely acquired its resistance from its places of origin, which have not been determined. She also surmised that their resistance level could be as a result of cross-resistance from a pyrethroid resistance. In any event, much of Dr. Harris' research going forward will be to substantiate the theory that the mosquitoes came to the Cayman Islands with the resistance as opposed to developing it here. The Cayman Islands has never used DDT in its mosquito control efforts.

However, the Mosquito Research and Control Unit of the Cayman Islands was scrutinised in the foreign press for using genetically modified _Aedes aegypti_ mosquitoes to combat the spread of dengue fever. It was the 1st time the method was being used in a real world test area.

At the time, Bill Petrie, director of MRCU, said the initiative was essentially a new spin on an old technique in which males that were made sterile were released. He added that the difference here is that the male mosquitoes' genes were altered, as opposed to their sterility being chemically induced by radiation.

"MRCU along with Oxitec of Oxford University ran the trial for 6 months," Mr. Petrie said. "We chose a small isolated area in East End. This was done in 3 blocks; one block was where the method was introduced, while nothing was done in another block and the 3rd block was used to monitor the natural population of the _Aedes aegypti_ mosquito.

"Once the team perfected the technique, monitoring was done by traps. The final statistical analysis has shown a significant reduction in the population of this potential dengue carrier," he added.

Mr. Petrie said the male _Aedes aegypti_ mosquito cannot bite and lives a short life-span and since their eggs will not survive using this new method of control, the population of the species has decreased, as did the probability of dengue fever transmission.  Since the Cayman Islands' success using the genetic modification technique, several other jurisdictions are following suit.

"Dengue is a dangerous and debilitating disease, which affects up to 100 million people each year. The incidence of dengue has grown very rapidly in recent years: it is now a serious threat to global health, and the only means of prevention is to target the mosquitoes which carry it. We need new tools in the fight against these dangerous pests, and today's publication shows that Oxitec's approach can provide that," Mr. Petrie said.   [Byline: Stuart Wilson]
======================
Reference:
Harris AF, Nimmo D., McKemey AR, Kelly N, Scaife S, Donnelly CA, Beech C, Petrie WD, Alphey L. Field performance of engineered male mosquitoes. Nat Biotechnol 2011 Oct 30;29(11):1034-7.

[This is an interesting field experiment that produced an 80 per cent reduction in the _Aedes aegypti_ population through release of genetically modified mosquitoes into a population of native mosquitoes resistant to 2 common pesticides. The release of genetically modified mosquitoes will be considered controversial and opposed by some, but alternatives such as increasing use of pesticidal chemicals have been of limited success in medium- to long-term vector population reduction efforts. It will be interesting to see how successful the release of these genetically modified mosquitoes will be in other locations. An effective, commercially available dengue virus vaccine is still several years away. Meanwhile, vector control is the only way to prevent dengue virus transmission. - ProMed Mod.TY]

[A HealthMap/ProMED-mail map showing the location of the Cayman Islands in the Caribbean can be accessed at: http://healthmap.org/r/1IG3.]
More ...

World Travel News Headlines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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