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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Libya

Libya - US Consular Information Sheet
August 13, 2008
COUNTRY DESCRIPTION:
Officially known as the Great Socialist People's Libyan Arab Jamahiriya, Libya has a developing economy. Islamic ideals and beliefs provide the conservative foundat
on of the country's customs, laws, and practices. Tourist facilities are not widely available. Read the Department of State Background Notes on Libya for more information.

ENTRY/EXIT REQUIREMENTS:
Passports and visas are required. The restrictions on the use of U.S. passports for travel to, in, or through Libya were lifted in February 2004. Please see the section below on Special Circumstances.
Without prior notice, the Libyan government on November 11, 2007 “reinstated” a requirement that all foreign travelers must have an Arabic translation of their personal biographic data added to their passport in order to apply for a Libyan visa, or to enter Libya. This requirement includes foreigners who already received visas before the requirement was put into place, including those foreigners currently resident in Libya. Since that date, foreign travelers whose passports do not have Arabic translations have been denied entry into Libya or refused boarding by airlines on flights into Libya.
The U.S. passport is a U.S. travel document that meets all generally recognized international standards. While the Libyan government has the right to impose its own requirements for travelers in connection with obtaining a Libyan visa, it also has the responsibility to give travelers information on where and how to meet these requirements. Travelers should be aware that in some cases, Libyan officials may ask that U.S. citizens obtain translations from U.S. Government-approved translation services. However, U.S. consular officers have no authority to designate or certify private translations; nor do they have authority to place a consular authentication stamp over a privately-obtained translation.

American citizens who hold Libyan visas or who intend to apply for a visa are advised to contact the nearest Libyan embassy or consulate for information on how to obtain an acceptable translation. Information from Libyan embassies and consulates may differ from country to country. American citizens may also contact the Consular Section at the U.S. embassy or consulate for additional information.
The Government of Libya does not allow persons with passports bearing an Israeli visa or entry/exit stamps to enter the country. At this time, neither Libya nor the U.S. provides visa services to the general public in each other’s countries; U.S. visitors to Libya should therefore plan to obtain a visa via a third country. Libyan visas require an invitation or sponsor, can take up to several months to process, and should be obtained prior to travel. All visas are vetted and approved by immigration departments in Tripoli and only issued by the appropriate Libyan Embassy upon receipt of that approval. There may be another wait for actual visa issuance once approval has been received. For tourists, the visa application procedure in most cases requires a letter of invitation from an accredited tour company in Libya; for business travelers, a letter of invitation is needed from the Libyan business entity. Americans who apply for Libyan visas are experiencing significant delays, often waiting several weeks or months if their applications are approved at all. Inconsistent Libyan visa practice is subject to change without notice and visa service to American citizens is often blocked without warning. With few exceptions, Libya has stopped issuing tourist visas to Americans. It is recommended that Americans always obtain individual Libyan visas prior to travel, rather than group visas. Americans who expected to enter on group tour visas or individual airport visas arranged by Libyan sponsors have routinely been denied entry at the air and sea ports and have been forced to turn back at the airport or remain onboard ship at the port while other nationals disembark. The U.S. Embassy in Tripoli cannot provide assistance to American citizens seeking Libyan visas.
Inquiries about obtaining a Libyan visa may be made through the Libyan Embassy in Washington, D.C. The Embassy is located at 2600 Virginia Avenue NW – Suite 705, Washington, DC 20037, phone number 202-944-9601, fax number 202-944-9606, website www.libyanbureau-dc.org. Neither the Libyan Mission to the UN in New York nor the Libyan Embassy in Washington, DC accepts visa applications from the general public. The closest Libyan visa-issuing office to the continental United States is the Libyan People’s Bureau in Ottawa, Canada; however, that office frequently declines to accept visa applications from American citizens. The land borders with Egypt and Tunisia are subject to periodic closures even to travelers with valid Libyan visas. Short-term closures of other land borders may occur with little notice. Within three days of arrival, visitors must register at the police station closest to where they are residing or they may encounter problems during their stay or upon departure.
Women and children in Libya are often subject to strict family controls.
This can be a particular problem for young single women of marriageable age. Although a woman does not need her father’s or husband's explicit consent every time she wishes to leave Libya, a Libyan husband may take legal action to prevent his wife from leaving the country, regardless of her nationality. While not illegal, it is unusual for women and children to travel alone. Children under 18 whose fathers are Libyan must have the father's permission to depart Libya, even if the mother has been granted full custody by a Libyan court.
The Libyan Government requires all its citizens, including dual nationals of Libyan descent, to enter and depart Libya on Libyan documents. In some cases American citizens of Libyan descent have entered Libya on old or expired Libyan identity document and then discovered that they cannot depart Libya without obtaining a valid Libyan passport, which can be a cumbersome process.
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: As Libya has taken steps to cooperate in the global war on terrorism, the Libyan Government’s designation as a state sponsor of terrorism was rescinded on June 30, 2006. Recent worldwide terrorist alerts have stated that extremist groups continue to plan terrorist attacks against U.S. interests in the region. Therefore, any American citizen who decides to travel to Libya should maintain a strong security posture by being aware of surroundings, avoiding crowds and demonstrations, keeping a low profile, and varying times and routes for all required travel.
Security personnel may at times place foreign visitors under observation. Hotel rooms, telephones, and fax machines may be monitored, and personal possessions in hotel rooms may be inspected. Taking photographs of anything that could be perceived as being of military or security interest may result in problems with the authorities.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ website 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: Crime against foreigners is a growing problem in Libya. The most common types of crime are property crimes of opportunity, to include vehicle burglaries. Pick-pocketing and residential burglaries are also on the increase. Women routinely face verbal harassment. While physical violence is not common, there have been instances of assault against women. These assaults can range from sexual groping or assault/battery, to attempted rape.

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/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 Libya is: 193.
This number is generally monitored only in Arabic.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
While some health care providers have been trained in the United States or Europe, basic modern medical care and/or medicines may not be available in Libya. Many Libyan citizens prefer to be treated outside of Libya for ailments such as heart disease and diabetes. A representative list of healthcare providers is available at the U.S. Embassy Tripoli’s web site at http://libya.usembassy.gov/medical_information.html.

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 website at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) website at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.
Some HIV/AIDS entry restrictions exist for visitors to and foreign residents of Libya.
All positive HIV/AIDS tests made in country must be reported to the government.

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 Libya is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Paved roads in rural areas are satisfactory; however, many rural roads are unpaved (i.e. dirt roads). Also, major highways along the seacoast and leading south merge into single-lane highways once they are outside the cities. These roads are heavily trafficked and precarious to navigate, especially at night and during the winter rainy season. The presence of sand deposits, and domestic and wild animals that frequently cross these highways and rural roads, makes them even more hazardous.

Availability of roadside assistance is extremely limited and offered only in Arabic. In urban areas and near the outskirts of major cities there is a greater possibility of assistance by police and emergency ambulance services, although they are usually ill equipped to deal with serious injuries or accidents.

Driving in Libya may be hazardous, and there is a high accident rate. Police enforcement of traffic signs and laws is rare. As a result, it is often difficult to anticipate the actions of other drivers on Libyan streets and highways. Wind-blown sand can reduce visibility without warning. Road conditions are poor, and public transportation, which is limited to occasional bus service, is poor. Taxis are available, but many taxi drivers are reckless and untrained, and English-speaking drivers are extremely rare.
The sidewalks in urban areas are often in bad condition and cluttered, but pedestrians are able to use them.

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 Libya, the U.S. Federal Aviation Administration (FAA) has not assessed Libya’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES: Libya's economy operates on a “cash-only" basis for most transactions, even though U.S. law now permits the use in Libya of credit cards and checks drawn on U.S. banks. Some hotels, restaurants, and major airlines are the only businesses known to accept credit cards (Visa more often than MasterCard). It is recommended that travelers consult their credit card entity prior to travel to ensure that transactions from Libya can be accepted by that entity. A very limited number of ATM machines are being put into service at a few large hotels, major office complexes, the airport, and one or two markets. Service is sporadic and sometimes unreliable. Foreign visitors should be aware that the penalties for use of unauthorized currency dealers are severe. Foreign visitors should also be aware that their passports might be confiscated in business disputes and/or they may not be permitted to depart Libya until the dispute has been settled. The workweek is Sunday-Thursday. Most U.S. economic sanctions against Libya were terminated effective September 21, 2004. For further information, please contact the Office of Foreign Assets Control at http://www.treas.gov/offices/enforcement/ofac/.
On June 30, 2006, the U.S. Department of State officially rescinded Libya’s designation as a State Sponsor of Terrorism. On August 31, 2006, the U.S. Commerce Department’s Bureau of Industry and Security (BIS) published an amendment to the Export Administration Regulations (EAR) in the Federal Register. This amendment updated BIS’ license requirements for Libya under the EAR due to its removal from the State Sponsors’ List. For further information specific to Libya, contact BIS’ Office of Nonproliferation and Treaty Compliance/Foreign Policy Controls Division at (202) 482-4252. Libya-related information is also found on the BIS web site: http://www.bis.doc.gov/PoliciesAndRegulations/regionalconsiderations.htm.
Libyan customs authorities enforce strict regulations concerning the introduction into Libya or removal from Libya of firearms, religious materials, antiquities, medications, and currency. Importation of pornographic materials is illegal. The importation and consumption of alcohol and pork products are illegal in Libya. At times, passengers arriving in Libya have been required to bring varying amounts of convertible currency into Libya.
This requirement is subject to a border check, and the passenger faces possible deportation if this requirement is not met. It is advisable to contact any Libyan Embassy abroad for specific information regarding customs requirements. Please see our Customs Information.
In addition to being subject to all Libyan laws, U.S. citizens of Libyan origin may also be subject to other laws that impose special obligations on Libyan citizens.
The Government of Libya considers all children born to Libyan fathers to be Libyan citizens even if they were not issued a Libyan birth certificate or a passport. Dual Libyan-American nationals may not enter and leave Libya on their U.S. passports, and must obtain a Libyan travel document before traveling to Libya.
Persons with dual nationality who travel to Libya on their Libyan passports are normally treated as Libyan citizens by the local government.
The ability to provide U.S. consular assistance to those traveling on Libyan passports is extremely limited.
For additional information, please see our dual nationality flyer.

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 Libyan laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Libya 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 Libya are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Libya.
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 U.S. Embassy is located in the Seraj District of Tripoli.
Their phone number is (+218) 91-220-0125.
This number may also be used for emergencies after-hours by American citizens. General information, including forms, is available on the U.S. Embassy’s web site at http://libya.usembassy.gov/.
*

*

*
This replaces the Country Specific Information for Libya dated January 16, 2008, to update the sections on Entry/Exit Requirements, Crime, Medical Facilities and Health Information, Traffic Safety and Road Conditions, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Thu, 15 Aug 2019 15:36:40 +0200 (METDST)

Tripoli, Aug 15, 2019 (AFP) - Flights at the Libyan capital's sole functioning airport were suspended Thursday after deadly overnight rocket fire, a spokesman for the country's unity government said.   Wednesday night's rocket fire "killed a guard and wounded several security agents tasked with protecting the airport," said Moustafa al-Mejii, spokesman for the Tripoli-based Government of National Accord (GNA).   He blamed the attack on "the militias of (Khalifa) Haftar" whose forces launched an offensive on the Libyan capital in April.   Arrivals and departures at Mitiga airport were suspended as a result, Mejii said.   Located east of Tripoli, Mitiga is a former military airbase that has been used by civilian traffic since Tripoli international airport suffered severe damage during fighting in 2014.

Mitiga is in a zone under the control of forces loyal to the GNA and has often been targeted, leading to repeated suspensions of flights.   United Nations envoy Ghassan Salame, in a report to the UN Security Council last month, urged "authorities in Tripoli to cease using the (Mitiga) airport for military purposes and for the attacking forces to halt immediately their targeting of it."   The GNA protested at what it said were "untruths" in the envoy's report.   Haftar's self-styled Libyan National Army (LNA) has encountered fierce resistance from pro-government forces in the battle for Tripoli.   A stalemate on the ground in the capital's southern outskirts has led to a greater reliance on air strikes by both sides.

The fighting since April has killed 1,093 people and wounded 5,752 others, according to the World Health Organization.   More than 120,000 people have been displaced.   The LNA said Thursday its air force carried out a strike against an airfield in Zuwara, a town west of Tripoli, and destroyed two hangars allegedly used to house Turkish drones.   "The runway and terminals were spared" at the airfield, which is not open to commercial flights, LNA spokesman General Ahmed al-Mesmari wrote on Facebook.   The GNA, however, posted pictures of a huge crater and debris on the tarmac.   Libya has been mired in chaos since a NATO-backed uprising that toppled and killed dictator Moamer Kadhafi in 2011.
Date: Wed, 3 Jul 2019 21:54:46 +0200

Tripoli, July 3, 2019 (AFP) - The Libyan capital's only functioning airport suspended flights on Wednesday after an air raid claimed by strongman Khalifa Haftar's forces, airport authorities said in a statement.   The attack did not cause casualties or damage, a security source at Mitiga airport said.   But Ahmad al-Mesmari, a spokesman for Haftar's self-styled Libyan National Army, said that a "command centre for drones at Mitiga" was destroyed in the raid.

Haftar launched an offensive in early April to take the capital Tripoli, seat of the rival Government of National Accord.   The GNA is recognised by the international community.   Over the past three months his self-styled Libyan National Army (LNA) has repeatedly targeted Mitiga airport.   It says it is targeting "Turkish drones" which it claims take off from Mitiga to carry out strikes on LNA forces south of Tripoli.

On Sunday the LNA said it had destroyed a Turkish drone in a strike on Mitiga, which prompted aviation authorities to temporarily suspend flights there.   Haftar's forces, which hold much of eastern and southern Libya, last month lost a key town to forces loyal to the unity government in an operation the strongman has accused Ankara of backing.   Afterwards Haftar ordered his forces to target Turkish companies, ban flights and arrest Turkish nationals in Libya, his spokesman said Friday.
WorldHealthOrganizationNews@who.int
Thu 09/05/2019 12:26
http://www.emro.who.int/lby/libya-news/who-denounces-attack-on-health-workers-and-ambulance-in-libyan-capital.html

Tripoli, 9 May – The World Health Organization today condemned in the strongest terms an attack on an ambulance in Tripoli, Libya, on Wednesday 8 May, that left 3 health workers injured, one severely.

“This attack on an ambulance with visible logos is a shocking and intolerable violation of international humanitarian law,” said Dr Syed Jaffar Hussain, WHO Representative in Libya. “Not only did this attack injure key personnel, but the ambulance itself was taken away, thereby depriving patients of future care.”

Since the conflict in Libya escalated in early April, 11 additional ambulances have been impacted or suffered collateral damage. In April, 3 health workers were killed in Tripoli, and numerous first-line responders have struggled to reach the wounded without being injured themselves. As the conflict continues into its second month, more than 400 people have died and over 2000 have been wounded.

WHO has been supporting field hospitals and field ambulance teams in Libya since the beginning of the conflict. The Organization has also deployed emergency medical teams to key referral hospitals to perform surgeries in hospitals in and around Tripoli. WHO is also providing health facilities with medical supplies, including trauma kits with medicines for war injuries.

“This flagrant breach of the basic rules of warfare could jeopardize the operations of field hospitals and ambulance teams, and deter dedicated health staff from performing their life-saving duties,” said Dr Ahmed Al-Mandhari, WHO’s Regional Director for the Eastern Mediterranean. “WHO cannot accept any actions that put health workers in harm’s way. Health staff in Libya are working to save lives and must be allowed to work without additional risk to their safety or well-being.”
Date: Tue, 16 Apr 2019 11:53:34 +0200

Tripoli, April 16, 2019 (AFP) - At least 174 people have been killed and 758 wounded in the battle for control over the Libyan capital Tripoli, the World Health Organization said Tuesday.   Fighting broke out on April 4 when military strongman Khalifa Haftar launched an offensive to take Tripoli, the seat of the UN-backed Government of National Accord (GNA).

At least 14 civilians are among those killed and 36 have been wounded, WHO spokesman Tarik Jasarevic told journalists citing local health facilities.   "WHO has deployed additional surgical staff to support hospitals receiving trauma cases," the United Nations agency wrote on Twitter.   Both pro-government forces and Haftar's self-styled Libyan National Army (LNA) accuse each other of targeting civilians, with each launching daily air raids in addition to clashes on the ground.

Fighting in the southern outskirts of the capital has displaced more than 18,000 people, the UN office for the coordination of humanitarian affairs reported Monday.   Urgent medical supplies were being delivered to Libya's health ministry to support those in the worst-hit areas, the UN's refugee agency said.    "Health facilities are in critical need of assistance as the situation on the ground continues deteriorating and number of casualties soaring," UNHCR tweeted.
Date: Sun, 14 Apr 2019 10:57:50 +0200

Tripoli, April 14, 2019 (AFP) - Fighting near Tripoli has killed 121 people and wounded 561 since strongman Khalifa Haftar launched an offensive earlier this month to take the Libyan capital, the World Health Organization said Sunday.   WHO's Libya account said on Twitter the organisation was sending medical supplies and more staff to Tripoli, and denounced "repeated attacks on health care workers, vehicles" during the fighting which erupted on April 4.   Haftar's forces, which control swathes of the country's east, have defied international calls to halt their battle against fighters loyal to the UN-backed Government of National Accord based in Tripoli.

The United Nations' office for humanitarian affairs said more than 13,500 people had been displaced by the clashes, while more than 900 residents are living in shelters.   "Three medical personnel have been killed and five ambulances have been incapacitated by shrapnel," OCHA said in a Saturday statement.   As well as fighting on the ground, the two sides have launched daily air raids and accuse each other of targeting civilians.   The north African country has been in turmoil since the NATO-backed overthrow of dictator Moamer Kadhafi in 2011, which has led to the creation of a bewildering array of militias all seeking to take control.   Haftar backs a rival administration based in eastern Libya that refuses to recognise the UN-backed unity government led by Fayez al-Sarraj.
More ...

American Samoa

Samoa US Consular Information Sheet
January 23, 2008
COUNTRY DESCRIPTION:
Samoa consists of the two large islands of Upolu and Savai’i and seven small islets. The country has a stable parliamentary democracy with a developing economy. To
rist facilities are accessible by bus, taxi and car and are within walking distance of access roads. Infrastructure is adequate in Apia, the capital, but it is limited in other areas. Nearly all Internet connections use a relatively slow dial-up method. Samoa has two digital telephone service providers, and visitors can easily purchase prepaid phones that cover virtually the entire country. The Samoa Tourism Authority, at http://www.visitsamoa.ws/, provides a wide range of information of interest to travelers. Read the Department of State Background Notes on Samoa for additional information.

ENTRY/EXIT REQUIREMENTS:
U.S. nationals who are not U.S. citizens, and who are resident in American Samoa, must obtain a visitor permit prior to all travel to Samoa. U.S. nationals have not been permitted to travel to Samoa on certificates of identity since May 2005 except on a case by case basis. (U.S. law distinguishes between individuals who are citizens and those who are nationals. The U.S. passport bio-page shows one’s status as either a citizen or a non-citizen national.) As of March 22, 2006, visitor permits to travel to Samoa can be applied for at the new Samoa Consulate General office in Pago Pago, American Samoa. A valid passport and an onward/return ticket are required for all Americans (both citizens and nationals) to travel to Samoa. Visitor permits are not required for U.S. citizens (only for U.S. nationals) seeking to stay in Samoa for up to 60 days. All visitors are required to pay a departure tax of 40 Tala (approximately 17.50 USD) upon leaving the country. Further information about entry requirements and the departure tax may be obtained from the Samoa Mission to the United Nations at 800-2nd Avenue, Suite 400J, New York, NY 10017, telephone (212) 599-6196, fax (212) 599-0797. Visit the Embassy ofSamoa web site at http://www2.un.int/public/Samoa/ 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:
In Apia and many villages, stray dogs wander the streets. Visitors should not approach or feed them; they can become aggressive in the presence of food or if they feel threatened.

Although there have been no major accidents involving the ferry service linking Upolu and Savai’i, vessels are sometimes overloaded. One of the ferries, a multi-deck automobile ferry, sometimes transports passengers on its automobile deck. Americans who choose to use this ferry are encouraged not to remain in the automobile deck during the crossing and to ride only in the passenger compartment in order to avoid injury from shifting vehicles.

Samoa has numerous “blowholes” (lava tubes open to the sea where wave action produces, often spectacular, geysers). These blowholes are popular tourist attractions. The footing around the mouths of most blowholes is very slippery. To avoid being swept in, visitors should not approach too closely and should never stand between the opening of the blowhole and the sea.

Snorkeling and diving in ocean lagoons is a popular activity for many visitors to Samoa. Tide changes can produce powerful currents in these lagoons. Visitors are encouraged to consult local residents and tour operators about hazards and conditions at a particular location before venturing into the water.

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:
Overall, Samoa is considered a low threat environment. Nevertheless, visitors should remain aware of their surroundings, lock their doors at night, and not leave their belongings unattended. Incidents of petty theft/robberies of personal effects are common. Some such incidents have involved residential break-ins. While rare, violent assaults, including sexual assaults have occurred in Samoa. No specific groups have been targeted, nor have there been any racially motivated or hate crimes against Americans. Police responsiveness in Apia is generally good. Because of the very limited police presence elsewhere in Samoa (where order is maintained primarily by local village authorities), police responsiveness elsewhere is problematic.

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Health care facilities in Samoa are adequate for routine medical treatment, but are limited in range and availability; complex illnesses and life-threatening emergencies generally need to be treated elsewhere. Dental facilities do not meet U.S. standards, but good dental treatment and some emergency care can be obtained nearby at the LBJ Tropical Medical Center in Pago Pago, American Samoa. The national hospital and a small private hospital are located in Apia, and there are several small district hospitals on Savai'i and in outlying areas of Upolu. There are no hyperbaric chambers on any of the islands for the treatment of scuba diving related injuries. Serious cases of decompression sickness are evacuated to the nearest treatment center in Suva, Fiji, or Auckland, New Zealand. Serious medical conditions and treatments that require hospitalization and/or medical evacuation to the United States can cost thousands of dollars. Travelers should carry emergency evacuation insurance. Doctors and hospitals often expect immediate cash payment for health services. There is no reported incidence of malaria or rabies in Samoa. Occasional outbreaks of typhoid and non-hemorrhagic dengue do occur.

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 Samoa is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Safety of public transportation and rural road conditions in Samoa, are considered fair, while urban road conditions/maintenance is considered good. Taxis in particular are widely available and used by Samoans and visitors alike; buses are slow, generally crowded and uncomfortable, and rarely utilized by visitors. Rental cars can also be obtained. No roadside assistance is available. Most major roads are tar-sealed, but secondary roads are predominantly dirt and gravel and may be overgrown with vegetation. A four-wheel drive vehicle is recommended for travel on these roads. Travelers should be aware that vehicle safety regulations are rarely enforced and traffic violations occur routinely. Roads outside Apia are often narrow, winding, relatively steep, with narrow or no shoulders, and poorly lighted. Pedestrians as well as vehicles and livestock regularly travel these roads. Due to poor and deteriorating road conditions, night driving on unlit rural roads can be dangerous and should be avoided if possible. Roads in Samoa often traverse small streams. Drivers are urged to exercise extreme caution when fording these streams, which can become swollen and dangerous with little warning. Vehicles should never enter a stream if the roadbed is not visible or if the water’s depth exceeds the vehicle’s clearance.

Speed limits in Samoa are 25 miles per hour in the Apia area and 35 miles per hour outside Apia, with certain exceptions. At unmarked intersections, traffic on the left has the right of way. As in the United States, vehicular traffic moves on the right side of the road; although right-hand-drive vehicles (mainly from New Zealand) do exist in Samoa. Importing right hand drive vehicles to Samoa is currently legally forbidden.

Please refer to our Road Safety page for more information. Visit the web site of the country’s national tourist office at Samoa Tourism Authority at http://www.visitsamoa.ws/.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government ofSamoa’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Samoa’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:
Some overseas treatment centers, known as Behavior Modification Facilities, operate in Samoa. Though these facilities may be operated and staffed by U.S. citizens, the Samoan government is solely responsible for compliance with local safety, health, sanitation and educational laws and regulations, including all licensing requirements of the staff in country. These standards, if any, may not be strictly enforced or meet the standards of similar facilities in the U.S. Parents should be aware that U.S. citizens and non-citizen nationals 14 years of age and older have a right to apply for a passport and to request repatriation assistance from the U.S. government, both without parental consent. Any U.S. citizen or non-citizen enrollee has the right to contact a representative from the U.S. Embassy. For further information, consult the Department of State's Fact Sheet on Behavior Modification Facilities, available via the Bureau of Consular Affairs home page. Parents may also contact the U.S. Embassy in Apia or the country officer in the Office of American Citizens Services, Bureau of Consular Affairs at 202-647-5226.

Financial Transactions:
Although some businesses (especially those in Apia or those frequented by tourists) do accept credit cards, many (including gas stations) do not. Major credit cards (Visa, Master Card, and American Express) are accepted at major hotels and some restaurants and stores. Samoan currency can be obtained from ATMs, which are located in Faleolo Airport and in many locations in Apia. For more information on ATM locations and banking services see ANZ web site at http://www.anz.com/samoa/overview.asp and WESTPAC web site at http://www.westpac.com.ws/pacific/publish.nsf/Content/PFSA+HomePage.

Disaster Preparedness: Samoa is located in an area of high seismic activity. Although the probability that a major earthquake would occur during an individual trip is remote, earthquakes can and will continue to happen. Major cyclones have occurred in the past and are always a concern. Strong winds and very heavy rains are common, especially during the rainy season from November to April. During this period, Samoa receives most of its annual average of over 130 inches of rain. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency’s (FEMA) web site at http://www.fema.gov/.

Customs: Samoa customs authorities may enforce strict regulations concerning temporary importation into or export from Samoa of items such as firearms, fruits, pets and other animals, and drugs. It is advisable to contact the Samoan Mission to the United Nations at 800 2nd Avenue, Suite 400J, New York, NY 10017, telephone (212) 599-6196 for specific information regarding customs requirements. 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 Samoa’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Samoa 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:
Samoa is not a member of the Hague Convention on the Civil Aspects of International Child Abduction. 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 Samoa are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security withinSamoa. 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 in the Accident Compensation Board (ACB) Building, Fifth Floor, Apia. The Embassy is open to the public from 8:15 a.m. to 5:00 p.m. Monday - Friday. The Embassy's mailing address is U.S. Embassy, P.O. Box 3430, Apia, Samoa 0815. The telephone numbers are (685) 21436/21631/22696 and 21452. The fax number is (685) 22030. An Embassy officer can be reached after hours in an emergency involving the welfare of a U.S. citizen or non-citizen national at (685) 21514 or (685) 777-1776. Visit the U.S. Embassy’s web site at http://samoa.usembassy.gov/.
* * *
This replaces the Consular Information Sheet (now known as Country Specific Information) dated May 21, 2007, to update sections on Country Description and Crime.

Travel News Headlines WORLD NEWS

American Samoa. 8 Mar 2017.
(susp) as of mid-February 30 cases of Dengue.

A HealthMap/ProMED-mail map showing the location of American Samoa in the Pacific can be accessed at <http://healthmap.org/promed/p/380>
and a map of the island at <http://www.nationsonline.org/maps/tutuila-island-map.jpg>. - ProMED Mod.TY
Date: Sat 20 Sep 2014
Source: Radio New Zealand [edited]

Latest figures from Samoa's Ministry of Health show an increase of suspected and confirmed cases of chikungunya [virus infections] from 400 to 626 since the outbreak of the acute fever, rash and joint pain disease was reported in July [2014].

However, the ministry says so far presentation of the main signs and symptoms of those affected have largely been mild.

The highest number of people affected is recorded in the districts of Vaimauga west in the urban area with 151 cases; Faleata east, 139 cases; and 113 in Faleata west.  The majority of patients is young.

In American Samoa, the chikungunya outbreak is on the wane. Health officials say there are now 823 probable cases of the mosquito-borne illness, with 15 people requiring hospital care.
===========
[The chikungunya outbreak continues to grow in Samoa, from 269 cases reported on 25 Aug 2014 to 433 reported on 8 Sep 2014 and now to 626 cases. One hopes that a prompt and aggressive clean up of breeding sites will reduce the vector mosquito population enough to halt, or at least reduce, transmission.

On 26 Jul 2014, it was reported that American Samoa had about 100 cases, with 3 laboratory confirmed as chikungunya virus infections (see ProMED-mail archive no. 20140727.2638925). This is a sharp outbreak, with over 700 cases in a little over one month, apparently peaking at 823 probable cases reported above. Once introduced into American Samoa, spread of the virus is not surprising, because it has had dengue virus transmission in the past, and the same mosquitoes that transmit dengue viruses can transmit chikungunya virus as well.

A map showing the location of Samoa in the Pacific Ocean can be accessed at <http://www.worldatlas.com/webimage/countrys/oceania/wsnewz.gif>. A HealthMap/ProMED-mail map showing the location of both Samoa and American Samoa in the Pacific Ocean can be accessed at <http://healthmap.org/promed/p/380>. - ProMed Mod.TY]
Date: Mon 9 Sep 2014
Source: Radio New Zealand [edited]
<http://www.radionz.co.nz/international/pacific-news/253977/chikungunya-related-cases-reach-over-700-in-american-samoa

The latest reports from American Samoa reveal that chikungunya-related [febrile] cases have now reached over 700, and there is now one probable case in Ofu, Manua. The virus was discovered in the territory in July 2014, but there have been no reported cases in Manua until now.

Health officials are urging residents not to travel to Manua if they have chikungunya, and testing is being done to determine whether the case in Ofu is due to the virus. Since July 2014, there have been 11 hospitalisations with the virus but no deaths.

Health officials continue to urge those with symptoms to drink plenty of fluids, get a lot of rest, and visit the emergency department if symptoms become serious.
=======================
[On 26 Jul 2014, it was reported that American Samoa had about 100 cases, with 3 laboratory confirmed as chikungunya virus infections (see ProMED-mail archive no. 20140727.2638925). This is a sharp outbreak, with over 700 cases in a little over one month. Once introduced into American Samoa, spread of the virus is not surprising, because it has had dengue virus transmission in the past, and the same mosquitoes that transmit dengue viruses can transmit chikungunya virus as well.

A HealthMap/ProMED-mail map showing the location of American Samoa in the Pacific Ocean can be accessed at
Date: Tue 5 Aug 2014
Source: Radio New Zealand International [edited]

The American Samoan Department of Health says there are now more than 300 confirmed cases of chikungunya or 'chik' virus in the territory.

The Health Director Motusa Tuileama Nua says his department and LBJ hospital have confirmed the outbreak of fever, rashes, and joint pains among people on the main island of Tutuila is due to chikungunya.

He says there have been 343 recorded cases, with 6 patients hospitalised and no deaths, since the beginning of July [2014].

He recommends those who are ill with fever and body aches do not travel off island.
--------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
===============
[CHIKV has been circulating in Pacific islands this year (2014).

Maps showing the location of American Samoa in the Pacific Ocean can be accessed at
<http://healthmap.org/promed/p/380>. - ProMed Mod.TY]
****************************
American Samoa: confirmed
Date: Fri 8 Aug 2014
Source: Samoa News [edited]

The American Samoa Department of Health and the LBJ hospital have created a 24 hour a day hotline for the CHIK virus. The CHIK hotline number is 731-7511.

The Health Alert issued yesterday [7 Aug 2014] confirms chikungunya (CHIK) virus as the cause of fever, rash, and joint pains outbreak on Tutuila and there have been more than 390 recorded cases, with 7 patients hospitalized and no deaths since 1 Jul 2014.

According to the health alert, there is no cure for CHIK virus [infection, and] it can usually be treated at home by drinking lots of fluids, taking pain medicine like Tylenol, ibuprofen, or Aleve as needed but only as much and with cautions as recommended on the package.

The health alert urges not to work while your joints are painful, let them rest and apply ice or cold packs on the joints and this may protect against prolonged joint pain.

DOH notes you should go to the Emergency Room to see a doctor if symptoms persist more than 10 days, or if you have bleeding from any part of the body or bruised skin. Call the hotline "or come to the ER or clinic if you are worried about your condition getting worse."

The alert once again urges that people stay indoors in air-con, behind screens, or under bed nets while you are ill, because if you are bitten by mosquitoes while you are ill, you can spread the disease to your family and neighbors.

For travelers, the DOH urges those who are ill not to travel off island, including to Manu'a. "If you travel and become ill when you arrive, tell the doctor who sees you that you may have been exposed to the CHIK virus."  [Byline: B. Chen]
----------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
-----------------------------------
[Interestingly, the 5 Aug 2014 report above indicated that there were 343 reported cases, and in the subsequent report of 8 Aug 2014 above, that number has increased to 390 cases, indicating that transmission of CHIK virus is continuing. - ProMed Mod.TY]
******
Samoa: suspected cases
Date: Fri 8 Aug 2014
Source: Island Business [edited]

Samoa's Ministry of Health has reported 2 deaths from acute fever and rash, saying it is now an outbreak. A press statement from the Director General, Leausa Toleafoa Dr Take Naseri, says there have been 21 recorded cases as of earlier this week with 4 people hospitalised.

The cases are suspected to be chikungunya virus, similar to dengue fever, but results are yet to be confirmed and 3 children and one man have been admitted to the intensive care unit.

The ministry says collaboration with other government agencies, and media campaigns, aim to raise awareness of the outbreak and help its containment.

Samoa has also sought assistance from the Ministry of Health's development partners including the Secretariat of the Pacific Community and the World Health Organisation.

In neighbouring American Samoa, there have been more than 300 confirmed cases of chikungunya.
======================
[This is the 1st ever ProMED-mail report of a chikungunya outbreak in Samoa. Concerning the current outbreak, it would be unusual to have 2 deaths from chikungunya virus infections of a total of 21 recorded cases. One explanation for the high proportion of fatal cases could be significant underreporting of non-fatal cases. No mention is made indicating that there were contributory underlying medical conditions in these 2 fatal cases. ProMED-mail will be interested in receiving results of the laboratory tests when they become available.

Maps showing the location of Samoa in the Pacific Ocean can be accessed at
at <http://healthmap.org/promed/p/2>. - ProMed Mod.TY]
Date: Wed 14 May 2014
Source: Radio New Zealand International [edited]

Health officials in American Samoa are warning the public about an amoebic dysentery outbreak which has so far affected 26 people, half of which have been admitted to the LBJ hospital. A Pacific Island Health Officers' Association Epidemiologist, Mark Duran, says the department of health is leading an investigation into the source of the parasite.

Dr Duran says amoebic dysentery is spread through contamination of human waste. "It especially attacks the intestines and invades its way into the wall of the intestines; it causes abdominal pain, it causes bloody diarrhoea, fever." Dr Duran says in serious cases the parasite can travel through the body and cause abscesses especially in the liver.
===================
[Maps of American Samoa can be seen at
<http://healthmap.org/promed/p/380>. - ProMed Sr.Tech.Ed.MJ]
More ...

World Travel News Headlines

Date: Fri, 16 Aug 2019 03:38:45 +0200 (METDST)
By Paulina ABRAMOVICH

Santiago, Aug 16, 2019 (AFP) - Once deep in powder this time of year, Chile's ski stations are fighting the ravages of climate change and pollution that have brought less and less snow to the central Andes.   Just a few decades ago, the Andes mountain range could be buried under four meters of snow, forcing the closure of access roads and requiring the use of tractors to get around.

But this year, it's snowed only three times in the Chilean Andes, and never more than 30 centimetres.   It's not just Chile affected, but the whole of the Andes where the area of snow cover in the central zone has diminished by five to 10 percent each decade, according to Raul Cordero, an academic at the University of Santiago.   "But it's not just snow cover that's decreasing, the thickness of the snow cover is also reducing," he said.   "So when we talk about a decrease of the cover of five to 10 percent, this probably signifies a much greater reduction in the volume of available snow over the Andes."

Rising temperatures mean the snow line -- above which snow never melts all year round -- keeps creeping upwards.   The snow melt is even more pronounced in the central zone due to pollution from the Chilean capital, one of the most contaminated urban areas in the region.   A recent study led by Cordero found that soot, or black carbon, from Santiago was settling in the Andes and accelerating the snow melt.   As it's black, it absorbs more solar radiation and heats up quicker.   "When this pollution is over the cities it poisons people and when the wind blows, this pollution goes and is deposited on the mountains and contributes to the snow melt," said Cordero.

- Essential snow cannons -
The upshot is that Chile's ski stations have had a difficult season.    But thanks to the snow cannons, the erection of fences and a tailored piste management policy, the resorts have managed to stay open throughout a winter in which there has been almost no snow.   "All the ski centers in the central zone are without natural snow. However, thanks to the fabrication of snow we've been able to keep open pistes that without this fabrication would not have been able to stay open," Fernando Montenegro, the operations director at Andacor, which operates the El Colorado and Parque Farellones ski stations, told AFP.

El Colorado is 50 kilometers from Santiago and sits at 2,800-meters. It pumps out snow whenever the conditions allow it.   Low temperatures and high humidity is what's needed for the snow cannons to chug into gear and churn out snowflakes from water.   This technology has been around since 1994, but it's never before been in use as much as it is now -- and even then the ski station is only operating at 70 percent capacity.   But even if the situation gets worse, the ski stations will manage, according to Montenegro.   "There's no risk. However, we need to manage the snow and manage the water in the mountain range in a good way."   El Colorado has already invested almost $4 million in buying snow cannons and hopes to increase that to $10 million over the coming years.

- 'Variety so important' -
Last weekend, some 7,000 people descended on El Colorado where ski and snowboard national teams come to train -- although, they're not necessarily happy.   "If there's not enough snow, there's not as many hills. We don't get the variety, we don't get steepness, (or) different slopes: it's so important for us to have that variety," Megan Farrell, a member of the Canadian snowboard team, told AFP.   Amateur skiers also noticed the difference from previous years.   "You can see that the snow is harder. It's not very deep, there are a lot of stones and snow made by the cannons, which makes it feel like you're skiing on a different type of snow," said Chilean Rado Milosevic, 24.
Date: Thu, 15 Aug 2019 20:21:28 +0200 (METDST)

Tokyo, Aug 15, 2019 (AFP) - A powerful tropical storm lashed Japan on Thursday, bringing strong winds and torrential rain that claimed at least one life, prompted warnings of landslides and flooding, and sparked evacuation advisories and travel chaos at a peak holiday period.   Severe Tropical Storm Krosa -- one notch below a typhoon -- slammed into the southern Hiroshima region, packing wind gusts of up to 126 kilometres (78 miles) per hour.   Dramatic television footage showed violent winds uprooting trees, snapping lampposts and spinning pods on a Ferris wheel.

Meanwhile, high waves smashed into a breakwater, engulfing a 10-metre lighthouse, while swollen rivers broke their banks and swamped nearby roads.  Authorities issued a voluntary evacuation advisory to around 430,000 people in the storm's path, although few appeared to have heeded the warning.

A 82-year-old man was confirmed dead after he fell in the sea in Hiroshima while trying to moor his boat, a local government spokesman said.    Japanese news agency Kyodo reported that a total of 49 people were injured from Wednesday to Thursday.   "We still have intermittent downpours," said Takayoshi Sugimoto, a disaster management official in the southwestern province of Tokushima.   "We will remain vigilant," he told AFP.

The national disaster management agency said a party of 18 people, including children, were stranded during a barbeque in a valley when a river rose rapidly on Wednesday. They were rescued Thursday morning.   Krosa also sparked travel chaos as people battled to return to major cities following the Obon holiday.   More than 800 domestic flights were cancelled to and from cities in western Japan, and bullet train services were either scrapped or sharply reduced.   Ferries connecting the southern Shikoku island and other parts of Japan were also cancelled as high waves lashed the coast.

The storm brought strong winds and downpours to the capital Tokyo.   Several ceremonies commemorating the end of World War II were cancelled in western Japan due to bad weather.    Krosa weakened significantly from earlier in the week as it stalled in the Pacific Ocean but it boasts an unusually large eye, meaning it is likely to dump rain over a wide area.   It was moving north at 35 kilometres (22 miles) per hour and the rain was expected to last for an extended period.   The storm crossed Japan's mainland and hit the Sea of Japan late Thursday.
Date: Thu, 15 Aug 2019 15:36:40 +0200 (METDST)

Tripoli, Aug 15, 2019 (AFP) - Flights at the Libyan capital's sole functioning airport were suspended Thursday after deadly overnight rocket fire, a spokesman for the country's unity government said.   Wednesday night's rocket fire "killed a guard and wounded several security agents tasked with protecting the airport," said Moustafa al-Mejii, spokesman for the Tripoli-based Government of National Accord (GNA).   He blamed the attack on "the militias of (Khalifa) Haftar" whose forces launched an offensive on the Libyan capital in April.   Arrivals and departures at Mitiga airport were suspended as a result, Mejii said.   Located east of Tripoli, Mitiga is a former military airbase that has been used by civilian traffic since Tripoli international airport suffered severe damage during fighting in 2014.

Mitiga is in a zone under the control of forces loyal to the GNA and has often been targeted, leading to repeated suspensions of flights.   United Nations envoy Ghassan Salame, in a report to the UN Security Council last month, urged "authorities in Tripoli to cease using the (Mitiga) airport for military purposes and for the attacking forces to halt immediately their targeting of it."   The GNA protested at what it said were "untruths" in the envoy's report.   Haftar's self-styled Libyan National Army (LNA) has encountered fierce resistance from pro-government forces in the battle for Tripoli.   A stalemate on the ground in the capital's southern outskirts has led to a greater reliance on air strikes by both sides.

The fighting since April has killed 1,093 people and wounded 5,752 others, according to the World Health Organization.   More than 120,000 people have been displaced.   The LNA said Thursday its air force carried out a strike against an airfield in Zuwara, a town west of Tripoli, and destroyed two hangars allegedly used to house Turkish drones.   "The runway and terminals were spared" at the airfield, which is not open to commercial flights, LNA spokesman General Ahmed al-Mesmari wrote on Facebook.   The GNA, however, posted pictures of a huge crater and debris on the tarmac.   Libya has been mired in chaos since a NATO-backed uprising that toppled and killed dictator Moamer Kadhafi in 2011.
Date: Thu, 15 Aug 2019 14:11:31 +0200 (METDST)

Hong Kong, Aug 15, 2019 (AFP) - Hong Kong's government unveiled HK$19.1 billion (US$2.44 billion) worth of economic relief measures and downgraded its growth forecasts on Thursday as the international hub reels from simmering pro-democracy protests and the US-China trade war.   Last week city leader Carrie Lam warned that 10-weeks of anti-government protests were hitting businesses like a "tsunami".    On Thursday, financial chief Paul Chan predicted the city's economy would grow by a miserly zero to one percent this year, the worst rate since 2009 after the global crash hit.

But as he announced a raft of sweeteners in a surprise "mini-budget", he denied the move was linked to the roiling unrest.   "The measures that we have just announced... trying to tackle the current economic difficulties and the coming economic headwinds, is not related to the political difficulties that we are facing," Chan told reporters.   Instead, he said, the primary headwinds remained ongoing trade tensions between Washington and Beijing -- two major markets for Hong Kong -- and the possible impact of Brexit.    "Based on the latest developments and assessments on the outlook, the Hong Kong economy will continue to face an austere environment for the rest of the year," he said.

Nonetheless, the sweeteners seemed to be aimed at winning over support from moderate Hong Kongers as the city reels from the protests.    The measures included financial breaks for small businesses, more generous student subsidies and goodies for low-income households.  Ten weeks of unprecedented rallies, demonstrations and occupations in Hong Kong have seen millions of people take to the streets in the biggest challenge to China's rule of the semi-autonomous city since its 1997 handover from Britain.   The social and political unrest was triggered by a controversial bill which would have allowed extraditions to mainland China, but has evolved into a call for wider democratic reforms and a halt to sliding freedoms.

The retail and tourism sectors have been especially hit by the drop in arriving visitors to the city, but the property market remains strong.   At a "citizens press conference" on Thursday, one protest group blamed the city's economic woes on the local leaders who they accused of undermining the city's business appeal by kowtowing to Beijing.
Date: Thu, 15 Aug 2019 11:07:44 +0200 (METDST)

Johannesburg, Aug 15, 2019 (AFP) - South Africa on Thursday announced visa waivers for four countries in a bid to boost tourism amid an economic crisis and falling visitor numbers.   Visitors from Qatar, Saudi Arabia, United Arab Emirates and New Zealand will no longer require a visa to visit for holiday, conferencing and business purposes, Home Affairs Minister Dr Aaron Motsoaledi said.

The unilateral decision comes as official tourism figures released in May reflected a dip in the overall number of visitors to South Africa from Europe and the Middle East in the first financial quarter of the year, normally one of the most popular times to visit.   Foreign traveller arrivals decreased by more than 10 percent between April and May 2019 alone.   Motsoaledi said the South African government was engaging with Qatar, Saudi Arabia, United Arab Emirates and New Zealand about a similar relaxation of entry requirements for SA citizens.   He argued the move by his department would boost tourism "and by extension growing the economy and creating jobs".

South Africa's economy has hit trouble, with gross domestic product (GDP) contracting by 3.2 percent in the first three months of 2019 and unemployment at a record high of 29 percent.   The government estimates there is potential to create 2.1 million jobs in the tourism sector by 2028.   South Africa is in talks to extend the visa waiver to Ghana, Cuba and Principe and Sao Tome.    The country has already waived the visa requirement for 82 of the 193 countries who are UN members.
Date: Tue 13 Aug 2019, 18:22 PM
Source: The News Minute (TNM) [edited]

In early July [2019], 2 children from Sathyamangalam in Tamil Nadu's Erode district succumbed to diphtheria. Around this time, several other cases of diphtheria were being reported from the state. The latest information shows that at least 50 people have been admitted to the Coimbatore Medical College and Hospital with diphtheria.

Health officials in the state have begun stepping up measures to ensure that the spread of the disease is contained and that more people are vaccinated. The Directorate of Public Health (DPH) even issued an alert to doctors in Chennai to treat all children presenting with sore throat with an antibiotic used to treat the disease, without waiting for the confirmation of a diagnosis.

Despite several campaigns to raise awareness about the importance of vaccination and ensuring that children are vaccinated according to the immunisation schedule, officials note that discrepancies in immunisation have played a large role in the current outbreak of diphtheria.

Tamil Nadu's Deputy Director of Public Health, Dr. K Kolandaswamy, had earlier told TNM that the current spike in the number of cases had to do with lack of immunisation. While several parents had skipped vaccinating their children at a young age, many others had not ensured that the booster dose was taken at a later age. However, in light of the recent outbreak in which both young people and adults have been affected, preventive measures have been stepped up. Not only are children being given the vaccine and booster doses (as deemed necessary), but so are adults.

Diphtheria is a disease caused by the organism _Corynebacterium diphtheriae_ and is highly contagious. Symptoms of diphtheria are often very similar to that of a common cold or any mild respiratory infection, which makes it difficult to differentiate between diphtheria and a more generic infection.

An infected individual may begin to present with symptoms anywhere from 2 to 10 days after exposure to the bacteria. The infected person usually develops a sore throat, which aggravates and will generally develop other respiratory issues as well, if left untreated. While the treatment for diphtheria consists of antibiotics and supportive measures as necessary (painkillers, fluids, etc), it has been determined that the best course of action is to take preventive measures.

The vaccine against diphtheria is given as a pentavalent vaccine (offers immunisation against 5 diseases: diphtheria, pertussis, tetanus, hepatitis B and Hib-Haemophilus influenza type b). It is given at 1.5, 2.5 and 3.5 months of age. The DPT vaccine (trivalent, covers 3 diseases: diphtheria, pertussis and tetanus) is given between 16 to 24 months of age. When the child is around 6 years old, another booster dose is required. In addition, the Centre has also advised that children be given the Td vaccine (covers tetanus and diphtheria) at age 10 and age 15.  [Byline: Dr Nimeshika Jayachandran]
========================
[Erode, with a population of about 2.25 million residents in 2011, is the largest district in the Indian state of Tamil Nadu, located in the state's westernmost region; its headquarters is the city of Erode (<https://en.wikipedia.org/wiki/Erode_district>).

A map showing the location of Erode District in south-central India can be found at
<https://www.google.com/maps/place/Erode,+Tamil+Nadu,+India>.

Diphtheria is caused by toxin-producing strains of _Corynebacterium diphtheriae_, an aerobic Gram positive bacillus. _C. diphtheriae_ causes respiratory tract or cutaneous diphtheria. Toxin production occurs only when the bacillus is infected (lysogenized) by a specific bacteriophage that carries the gene encoding the toxin. The most common sites of diphtheria infection are the pharynx and the tonsils, where an adherent pseudomembrane forms, which may result in respiratory obstruction. The toxin is responsible for the major complications, myocarditis (such as cardiac arrhythmias and heart failure) and neuritis (such as paralysis of the soft palate, eye muscles, limbs, and diaphragm). The overall case fatality rate for diphtheria is 5-10% but is higher (up to 20%) among persons younger than 5 and older than 40 years of age.

Close contacts, especially household contacts, should receive a diphtheria booster, appropriate for age, and antibiotics, such as benzathine penicillin G or a 7-10-day course of oral erythromycin. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of India:
Date: Tue 13 Aug 2019 2:21 AM CDT
Source: MPR [Minnesota Public Radio] News [edited]

[Minnesota] state health officials said [Tue 13 Aug 2019], 3 children are sick from _E. coli_ bacteria after swimming in a Minneapolis lake. The children have tested positive for the same strain of _E. coli_ after swimming at Lake Nokomis beaches between [26 Jul and 2 Aug 2019]. 2 beaches of the lake are closed until further notice, the Minnesota Department of Health said. The children, all under the age of 10, were not hospitalized.

Minneapolis Park Board Superintendent Al Bangoura said it's the 1st time someone has fallen ill after swimming in a Minneapolis lake in more than 20 years. "We take this very seriously and are working closely with the Minnesota Department of Health as they conduct their investigation," Bangoura said in a news release.

Symptoms of illness caused by _E. coli_ bacteria include stomach cramps and diarrhea, with mild or no fever. People typically become ill 1 to 8 days after exposure. It's rare, but the infections sometimes lead to a serious complication involving kidney failure. Health officials say children younger than 10 years old, the elderly, and those with weakened immune systems have a higher chance of developing complications from _E. coli_ infections.

"This is also an important reminder that anyone who is experiencing diarrhoea should not go swimming while they are sick," said Trisha Robinson, waterborne disease supervisor at the Health Department.

Officials also want to hear from anyone else who may have become ill after swimming in Lake Nokomis.

"If there are other people who have gone swimming and are concerned about their symptoms of illness, we very much encourage them to contact their health care providers," Robinson said.
===================
[It is important to understand that there are many different kinds of _E coli_. The organism is an important component of the human intestinal tract and can perform important functions helpful to its host. These strains can cause human infections if they "escape" from the usual location into the urinary tract, gall bladder, or abdominal cavity. They are also what are mentioned when a beach is closed for _E. coli_ contamination. In this circumstance, officials are measuring the organism or "coliforms" in the water to reflect human sewage contamination.

Additionally, there are some strains of _E. coli_ that can produce toxins that can produce diarrhea, and much of so-called travellers' diarrhoea is caused by these strains. All of these strains are human bacteria, not zoonotic organisms, that is, not spread from animal hosts. One _E. coli_ group called Shiga toxin producing or enterohemorrhagic _E. coli_ (EHEC) is the organism likely to be involved here, are zoonotic. Spread in a number of ways, including via undercooked ground beef, contaminated vegetables, and direct or direct contact with farm animals including contaminated water, EHEC can cause significant disease and even death.

In the spring of 2000, in Walkerton, a town of 5000 in southern Ontario, an outbreak of _E. coli_ O157:H7 infection claimed 7 lives -- 6 adults and a child -- and over 200 were seen at local area hospitals.

Swimming-associated transmission is illustrated in the following references:

1. Keene WE, McAnulty JM, Hoesly FC, et al. A swimming-associated outbreak of hemorrhagic colitis caused by _Escherichia coli_ O157:H7 and _Shigella sonnei_. N Engl J Med. 1994; 331(9): 579-84; available at <http://www.nejm.org/doi/full/10.1056/NEJM199409013310904>.
2. CDC. Lake-associated outbreak of _E. coli_ O157:H7 - Illinois. MMWR 1996; 45(21): 437-9; available at <https://www.cdc.gov/mmwr/preview/mmwrhtml/00042070.htm>.
3. Ackman D, Marks S, Mack P, et al. Swimming-associated hemorrhagic colitis due to _Escherichia coli_ O157:H7 infection: evidence of prolonged contamination of a fresh water lake. Epidemiol Infect. 1997;119:1-8; available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808815/>. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Minnesota, United States:
Date: 13 Aug 2019
Source: RFI France [edited]

38 children in France, including babies, living near what was once Europe's largest gold mine have tested positive for arsenic poisoning.

Children in the Orbiel Valley, in the southern department of Aude, were examined when families became concerned that flooding in October last year [2018] had carried arsenic and heavy metals from the nearby Salsigne mine.

After testing 103 children aged under 11 years, the Occitanie Regional Health Agency confirmed on Tue [13 Aug 2019] that 38 of them had returned positive test results for above-average levels of arsenic.

Salsigne, the world's largest arsenic mine, had been operating for almost a century when it closed in 2004. Millions of tons of toxic waste, which local NGOs say have not been properly sealed, are in storage at 5 nearby sites.

In October 2018, 14 people were killed when the Aude was hit by violent floods. Media reports say the Orbiel river and its tributaries have spread pollutants from the old mine.  [Byline: Eric Cabanis]
=========================
[There are a number of ways products can enter the body: inhalation, absorption, ingestion, and injection. Absorption is often thought of as products being absorbed through the GI tract, but it is also most significantly through the skin (such as a bath if arsenic is in the water). The integument (skin) is one of the largest organs of the body.

There are different forms of arsenic. There are 2 forms of inorganic arsenic: the reduced or trivalent arsenic (+3) or arsenite, and the oxidized or pentavalent (+5) form known as arsenate. Both of these forms can be absorbed and accumulated in tissues and body fluids.

There are also organic arsenics, but these are generally regarded as less harmful, by orders of magnitude.

Arsenic is a known carcinogen. The article does not tell us whether the exposure was to organic or inorganic arsenic. The form of arsenic is important with regard to toxicity. We are not told the specific ages of the children or babies. However, children, babies, and even pregnant women metabolize arsenic differently than non-pregnant adults.

Exposure to higher than average levels of arsenic occur mostly in the workplace, near hazardous waste sites, or in areas with high natural levels. At high levels, inorganic arsenic can cause death. Exposure to lower levels for a long time can cause a discoloration of the skin and the appearance of small corns or warts. In the United States, arsenic has been found in at least 1149 of the 1684 National Priority List sites identified by the Environmental Protection Agency (EPA).

Arsenic is a naturally occurring element widely distributed in the earth's crust. In the environment, arsenic is combined with oxygen, chlorine, and sulfur to form inorganic arsenic compounds. Arsenic in animals and plants combines with carbon and hydrogen to form organic arsenic compounds.

Inorganic arsenic compounds are mainly used to preserve wood. Copper chromated arsenate (CCA) is used to make "pressure-treated" lumber. CCA is no longer used in the U.S. for residential uses; it is still used in industrial applications. Organic arsenic compounds are used as pesticides, primarily on cotton fields and orchards.

What happens to arsenic when it enters the environment?
- Arsenic occurs naturally in soil and minerals and may enter the air, water, and land from wind-blown dust and may get into water from runoff and leaching.
- Arsenic cannot be destroyed in the environment. It can only change its form.
- Rain and snow remove arsenic dust particles from the air.
- Many common arsenic compounds can dissolve in water. Most of the arsenic in water will ultimately end up in soil or sediment.
- Fish and shellfish can accumulate arsenic; most of this arsenic is in an organic form called arsenobetaine that is much less harmful.

How might I be exposed to arsenic?
- Ingesting small amounts present in your food and water or breathing air containing arsenic.
- Breathing sawdust or burning smoke from wood treated with arsenic.
- Living in areas with unusually high natural levels of arsenic in rock.
- Working in a job that involves arsenic production or use, such as copper or lead smelting, wood treating, or pesticide application.

How can arsenic affect my health?
Breathing high levels of inorganic arsenic can give you a sore throat or irritated lungs.

Ingesting very high levels of arsenic can result in death. Exposure to lower levels can cause nausea and vomiting, decreased production of red and white blood cells, abnormal heart rhythm, damage to blood vessels, and a sensation of "pins and needles" in hands and feet.

Ingesting or breathing low levels of inorganic arsenic for a long time can cause a darkening of the skin and the appearance of small "corns" or "warts" on the palms, soles, and torso. Skin contact with inorganic arsenic may cause redness and swelling.

Almost nothing is known regarding health effects of organic arsenic compounds in humans. Studies in animals show that some simple organic arsenic compounds are less toxic than inorganic forms. Ingestion of methyl and dimethyl compounds can cause diarrhea and damage to the kidneys.

Several studies have shown that ingestion of inorganic arsenic can increase the risk of skin cancer and cancer in the liver, bladder, and lungs. Inhalation of inorganic arsenic can cause increased risk of lung cancer. The Department of Health and Human Services (DHHS) and the EPA have determined that inorganic arsenic is a known human carcinogen. The International Agency for Research on Cancer (IARC) has determined that inorganic arsenic is carcinogenic to humans.

There is some evidence that long-term exposure to arsenic in children may result in lower IQ scores. There is also some evidence that exposure to arsenic in the womb and early childhood may increase mortality in young adults.

There is some evidence that inhaled or ingested arsenic can injure pregnant women or their unborn babies, although the studies are not definitive. Studies in animals show that large doses of arsenic that cause illness in pregnant females, can also cause low birth weight, fetal malformations, and even fetal death. Arsenic can cross the placenta and has been found in fetal tissues. Arsenic is found at low levels in breast milk.

How can families reduce their risk for exposure to arsenic?
- If you use arsenic-treated wood in home projects, you should wear dust masks, gloves, and protective clothing to decrease exposure to sawdust.
- If you live in an area with high levels of arsenic in water or soil, you should use cleaner sources of water and limit contact with soil. - If you work in a job that may expose you to arsenic, be aware that you may carry arsenic home on your clothing, skin, hair, or tools. Be sure to shower and change clothes before going home.

There are tests available to measure arsenic in your blood, urine, hair, and fingernails. The urine test is the most reliable test for arsenic exposure within the last few days. Tests on hair and fingernails can measure exposure to high levels of arsenic over the past 6-12 months. These tests can determine if you have been exposed to above-average levels of arsenic. They cannot predict whether the arsenic levels in your body will affect your health.

The EPA has set limits on the amount of arsenic that industrial sources can release to the environment and has restricted or cancelled many of the uses of arsenic in pesticides. EPA has set a limit of 0.01 parts per million (ppm) for arsenic in drinking water.

The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit (PEL) of 10 micrograms of arsenic per cubic meter of workplace air (10 ug/m3) for 8 hour shifts and 40 hour work weeks.

Reference:
Agency for Toxic Substances and Disease Registry (ATSDR). 2007. Toxicological Profile for Arsenic (Update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Portions extracted from Agency for Toxic Substance and Disease Registry;
<https://www.atsdr.cdc.gov/toxfaqs/tf.asp?id=19&tid=3>. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Date: Sat 10 Aug 2019
Source: Nigeria CDC [edited]

The Nigeria Centre for Disease Control (NCDC) is aware of a suspected outbreak of yellow fever in Ebonyi state and has had a rapid response team supporting Ebonyi state's response since [Tue 30 Jul 2019], in partnership with the World Health Organization (WHO).

Following a report of cases and deaths from fever of unknown origin in Izzi local government area (LGA) in Ebonyi state, the state public health team commenced an investigation. As at [Wed 31 Jul 2019], 3 cases had tested positive for yellow fever at NCDC's national reference laboratory, which triggered an immediate response.

The Ebonyi State Epidemiology Team is leading the response with support from the Nigeria Centre for Disease Control (NCDC), the National Primary Health Care Development Agency (NPHCDA), and the World Health Organisation (WHO). In the course of investigation, it was discovered that between 1 May-7 Aug 2019, there had been cases that fit into the case definition for yellow fever and 20 deaths in Izzi LGA, Ebonyi state, indicating that the outbreak may have been going on for a few months, undetected by local health authorities. It was too late to collect samples for confirmation from these cases.

Immediately [after] it was notified, NCDC deployed a rapid response team to support Ebonyi state with contact tracing, case finding, risk communications, and the management of cases. Detailed analysis and plans are in advanced stages to apply to the international vaccine stockpile to enable a reactive vaccination campaign in Ebonyi state, in response to the cluster of cases.

Yellow fever virus is spread through bites of an infected mosquito. There is no human-to-human transmission of the virus. Yellow fever is a completely vaccine-preventable disease, and a single shot provides immunity for a lifetime. The yellow fever vaccine is available for free in primary health care centres in Nigeria as part of the routine immunisation schedule. Every child is protected for life if vaccinated. We encourage every family to ensure that children receive all their childhood vaccines.

In addition to the vaccine, the public is advised to keep their environments clean and free of stagnant water to discourage the breeding of mosquitoes and to use insecticide-treated mosquito nets as well as screens on windows and doors to prevent mosquito bites. It is important to avoid self-medication. Visit a health facility immediately if you feel ill.

Since September 2017, Nigeria has recorded suspected cases of yellow fever in all states in the country. As at [Wed 31 Jul 2019], 78 cases have been laboratory confirmed in Nigeria in 2019 alone. A multi-agency yellow fever technical working group coordinated by NCDC has been leading the investigation and response to yellow fever cases. The National Primary Health Care [Development] Agency is leading efforts to provide an additional opportunity of vaccination through preventive vaccination campaigns across the country.

Healthcare workers are reminded that the symptoms of yellow fever include yellowness of the eyes, sudden fever, headache, and body pain. If you have these symptoms or notice someone in your community displaying them, please contact your nearest health centre.
=====================
[The yellow fever [YF] virus is endemic in Nigeria, and cases occur there sporadically. This has been an active year (2019) for YF in Nigeria. The previous ProMED-mail post indicated that 930 suspected cases have been reported this year from 1 Jan-30 Apr 2019. There are 332 suspected cases during the April 2019 reporting period, up from 254 suspected cases on 19 Feb 2019. There are 3 new presumptive and 3 new confirmed yellow fever cases during the April 2019 reporting period.

The current focus of transmission is in Ebonyi state. The above report indicates that YF vaccine is available without cost in primary healthcare centers but does not mention if an organized vaccination campaign is underway or being planned, nor the proportion of the Ebonyi state population that is unvaccinated and, hence, at risk for YF. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Ebonyi state, Nigeria: <http://healthmap.org/promed/p/1306>]
Source: Arutz Sheva 7 [edited]
Date: Tue 13 Aug 2019

A stewardess of Israel's El Al airline died Tuesday [13 Aug 2019], following a months-long battle with measles. The 43-year-old stewardess was infected with the measles virus during a flight from New York to Israel 5 months ago.

After she was infected, the stewardess was hospitalized in serious condition at Meir Medical Center in Kfar Saba in central Israel after she was found unconscious and struggling to breathe. During her hospitalization, the stewardess' condition deteriorated, and she was transferred to the quarantine section of the hospital's intensive care wing.

On Tuesday [13 Aug 2019], doctors at Meir hospital declared her death, following the 5-month struggle.  [Byline: Orly Harari]
===========================
[This is a very sad outcome, and our condolences go out to the family of the flight attendant, who worked for El Al, the Israeli national airline. It is not clear whether she contracted the virus in New York, in Israel, or on a flight between the two locations. The flight attendant received only one dose of the measles vaccine when she was a child. It wasn't discovered until later that one dose is only about 93% effective. More recently -- in the USA, starting in 1989 -- children have been given 2 doses, which is about 97% effective, according to the CDC. See Measles update (27) http://promedmail.org/post/20190418.6429834 for an earlier report on the flight attendant. - ProMED Mod.LK]