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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tick-borne encephalitis and lyme disease are widespread throughout the country. Those intending to visit parks or forested areas in Lithuania are urged to speak with their health care practitioners about immunization. Rabies is also increasingly prevalent in rural areas.
The Lithuanian Government does not require HIV testing for U.S. citizens. However, sexually transmitted diseases are a growing public health problem.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747); or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith.
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. All foreigners of non-European Union countries seeking entry into Lithuania must carry proof of a medical insurance policy contracted for payment of all costs of hospitalization and medical treatment in Lithuania (please see entry/exit requirements above). Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Lithuania is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
The Police allow Americans to drive in Lithuania with an American driver’s license for up to 90 days. Americans who reside in Lithuania for 185 days or more in one calendar year and who wish to continue driving in Lithuania must acquire a Lithuanian driver's license. The foreign license must be given to the Lithuanian Road Police to be processed by the Consular Department of the Lithuanian Ministry of Foreign Affairs, which in turn sends it to the U.S. Embassy’s Consular Section, where the owner is expected to claim it.
Roads in Lithuania range from well-maintained two- to four-lane highways connecting major cities to small dirt roads traversing the countryside. Violation of traffic rules is common. It is not unusual to be overtaken by other automobiles, traveling at high speed, even in crowded urban areas. Driving at night, especially in the countryside, can be particularly hazardous. In summer, older seasonal vehicles and inexperienced drivers are extra hazards. Driving with caution is urged at all times. Driving while intoxicated is a very serious offense and carries heavy penalties. The speed limit is 50 km/hr in town and 90 km/hr out of town unless otherwise indicated. The phone number for roadside assistance is 8-800-01414 from a regular phone and 1414 from a GSM mobile phone.
Seatbelts are mandatory for the driver and all passengers except children under the age of 12. During the winter, most major roads are cleared of snow. Winter or all-season tires are required from November 10th through April 1st. Studded tires are not allowed from April 10th through October 31st. Drivers must have at least their low beam lights on at all times while driving. Public transportation is generally safe.
Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office and national authority responsible for road safety at www.tourism.lt and at www.lra.lt/index_en.html.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Lithuania, the U.S. Federal Aviation Administration (FAA) has not assessed Lithuania’s Civil Aviation Authority for compliance with International Civil Aviation Organization ICAO aviation safety standards. For more information, travelers may visit the FAA’s web site at www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: Lithuanian customs authorities may enforce strict regulations concerning the temporary importation into or export from Lithuania of items such as firearms and antiquities. Please see our Customs Information.
Telephone connections are generally good. American 1-800 numbers can be accessed from Lithuania but not on a toll-free basis; the international long distance rate per minute will be charged. Local Internet cafes offer computer access. ATMs are widely available. Most hotels and other businesses accept major credit cards.
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Lithuanian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Lithuania are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or possessing or disseminating child pornography in a foreign country is a crime prosecutable in the United States. For more information about arrest procedures in Lithuania, please visit the Embassy’s web site at http://vilnius.usembassy.gov/arrests.html. Please see our information on Criminal Penalties.
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues web page.
REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Lithuania are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within Lithuania. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at Akmenu Gatve 6, tel. (370) (5) 266-5500 or 266-5600; fax (370) (5) 266-5590. Consular information can also be found on the Embassy Vilnius web site at http://vilnius.usembassy.gov/.
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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/.
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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, 26 Dec 2019 20:35:51 +0100 (MET)

Tripoli, Dec 26, 2019 (AFP) - An air strike Thursday on a shopping area during rush hour near Libya's capital killed at least two civilians and wounded 20 others, a local official said.   The air strike on the town of Zawiya, 45 kilometres (30 miles) west of Tripoli, hit a pharmacy, a bakery and cars parked on the street, the mayor of the town, Jamal Baher, told AFP.   "Two people were killed and 20 others were wounded," he said.   The air strike took place as the area was busy with shoppers ahead of the weekend, which starts Friday in the North African country.   It comes amid fighting between the Tripoli-based, UN-recognised Government of National Accord (GNA) and rival forces answering to strongman Khalifa Haftar, who is based in the country's east.

Tensions have further spiked in recent weeks as Turkey said it could deploy troops in Libya to support the GNA.   Earlier on Thursday, GNA Interior Minister, Fathi Bashaga, said his government may officially seek Turkish military support to counter an offensive on Tripoli launched by Haftar in April.   Haftar has "provided foreign forces with military bases in Libya," Bashagha told journalists in the Tunisian capital Tunis.   "If this position continues, we have the right to defend Tripoli and we will officially ask the Turkish government for its military support," he added.   Turkish President Recep Tayyip Erdogan, who is in Tunisia to discuss the conflict in Libya, said his country's parliament will vote in January on a motion to send troops to Libya to support the GNA.   "God willing, we will pass it in parliament on January 8-9 and thus respond to an invitation" from the GNA, said Erdogan.

His comments come after the Turkish parliament on Saturday ratified a security and military cooperation deal with the GNA.   Libya was plunged into chaos with the toppling and killing of longtime dictator Moamer Kadhafi in a 2011 NATO-backed uprising.    It has since become divided between two main camps: the GNA and a rival administration in the country's east, backed by Haftar.   The GNA on Thursday accused Haftar's forces of carrying out the deadly air strike on Zawiya.   There was no immediate comment from Haftar's self-styled Libyan National Army.   At least 284 civilians have been killed and 363 wounded since Haftar launched his offensive to seize Tripoli, according to UN figures. Tens of thousands have been displaced from their homes.
Date: Sun 13 Oct 2019
Source: Libya Observer [edited]

150 persons with leishmaniasis disease arrived in Tawergha hospital on Friday [11 Oct 2019], and the number of affected people is increasing, the hospital said.

On Facebook, the hospital called on all medical staffers from all across Libya to provide assistance to the hospital in Tawergha to treat the patients with leishmaniasis.

Member of Tawergha local council Abdelnabi Abu Araba said Saturday [12 Oct 2019] that 500 leishmaniasis cases have been registered in the city since last July [2019]. He told reporters that the leishmaniasis cases started after the people of Tawergha returned to their city in July 2018, saying 410 cases were registered since last year [2018] and 500 from July to October 2019, adding that sewage water across the city is behind the disease.

Abu Araba called on the residents not to take heed of media reports that urge them to leave the city, saying fighting this disease needs the people to remain in their locations to get treatment.

He indicated that public service companies are removing garbage to terminate the rodents that cause leishmaniasis, calling on the Health Ministry to speed up repairing the hospitals in Tawergha so people can receive medical care.

Last Sunday, the Anti-Disease National Center said it had started distributing medical treatment for leishmaniasis across Libya.  [Byline: Abdulkader Assad]
==================
[We assume that these are cases of cutaneous leishmaniasis [CL].  CL is caused by the protozoan leishmania parasite, which is transmitted by sandflies. Outbreaks occur when vector and reservoir control activities break down, as is the case in Tawergha (see sections below).

Zoonotic CL is endemic in Libya, with sporadic outbreaks. In 2006, over 7000 cases were recorded in 8 districts, with an outbreak of 3961 cases in Misratah, and the disease spread to non-endemic areas (el-Buni AA et al. (2000). "Cutaneous leishmaniasis in the Libyan Arab Jamahiriya: a study of the Yafran area. East Mediterr Health J 2000;6:884-7).

In 2009, the prevalence of CL was 7.1 per 10,000 population. There is a vector control program that involves insecticide spraying, and regular rodent control is performed (Alvar J. et al. Leishmaniasis Worldwide and Global Estimates of Its Incidence. PLoS One. 2012; 7(5): e35671, supporting file S54).

From other reports about the Tawergha displaced populations, it appears that the residents have been returning only sporadically to Tawergha since 2018 due to a blockade and intimidation by Misratah militias and that the local infrastructure has been destroyed (<https://www.hrw.org/news/2019/01/24/libya-displaced-population-cant-go-home>).

Tawargha is, as of August 2011, a ghost town in Libya that is under administrative jurisdiction of the city of Misratah, which is 38 km away. It was the site of intense fighting during the Libyan Civil War before its capture and ethnic cleansing by anti-Gaddafi forces in August 2011. By the end of the war in October 2011, the town was largely cleared of its population by NTC militias (<https://en.wikipedia.org/wiki/Tawergha>). - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Misratah District, Libya: <http://healthmap.org/promed/p/5116>]
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.”
More ...

Bulgaria

Bulgaria US Consular Information Sheet
September 20, 2007
COUNTRY DESCRIPTION: Bulgaria is a quickly developing European nation undergoing significant economic changes.
Tourist facilities are widely available, although conditions vary and
ome facilities may not be up to Western standards.
Goods and services taken for granted in other European countries may not be available in many areas of Bulgaria.
Read the Department of State Background Notes on Bulgaria for additional information.
ENTRY/EXIT REQUIREMENTS:
A United States passport is required for U.S. citizens who are not also Bulgarian nationals.
As of September 1, 2006, U.S. citizens who enter the country without a Bulgarian visa are authorized to stay for a total of 90 days within a six-month period.
This law is strictly enforced.
An application to extend one’s stay beyond the original 90 days can be filed for urgent or humanitarian reasons, but must be submitted to regional police authorities no later than five days prior to the end of the original 90-day period.
Travelers who have been in the country for 90 days, and then leave, will not be able to reenter Bulgaria before the six-month period expires.
Travelers using official or diplomatic passports must secure visas prior to arrival.
Upon entering the country, Bulgarian immigration authorities request that all foreigners declare the purpose of their visit and provide their intended address.
U.S. citizens intending to live or work in Bulgaria for more than 90 days within six months (or more than six months within a year) must obtain a “D” visa prior to arrival.
The practice of switching from tourist status to long-term status when already in Bulgaria is no longer allowed.
Those wanting to do so must leave Bulgaria and apply for a “D” visa at a Bulgarian embassy or consulate.
This procedure takes from two to four weeks.
American citizens who marry Bulgarian nationals and want to switch to long-term status must also leave the country, present their marriage license at a Bulgarian embassy or consulate in a neighboring country, and apply for a “D” visa.

The Bulgarian authorities do not consider presentation of a copy of the passport sufficient for identification purposes.
Visitors should carry their original passports with them at all times.
For further information concerning entry requirements, travelers should contact the Embassy of the Republic of Bulgaria at 1621 22nd St. N.W., Washington, D.C. 20008; http://www.bulgaria-embassy.org; tel. (202) 387-7969 (main switchboard (202) 387-0174), or the Bulgarian Consulate in New York City at 121 East 62nd Street, New York, NY 10021; http://www.consulbulgaria-ny.org; tel. (212) 935-4646.
See our Foreign Entry Requirements brochure for more information on Bulgaria and other countries.
Visit the Embassy of Bulgaria web site at http://www.bulgaria-embassy.org for the most current visa information.
Traveling with Bulgarian minors: Bulgarian authorities are particularly strict in matters involving the travel of Bulgarian children.
Adults, other than a child’s parents, departing Bulgaria with a Bulgarian national (including dual or multi-national Bulgarian) child, must present to authorities a certified/legalized declaration signed by the child’s parents authorizing custody for travel purposes.
This holds true even if the adult is otherwise related to the child.
If the declaration is signed in Bulgaria, certification by a Bulgarian notary public is required.
If signed in the U.S., the declaration must be certified by a notary public and the court in the jurisdiction where the notary is licensed.
The declaration must then be legalized with an apostille issued by the individual state's Department of State or the Governor’s office.
Please note Bulgarian authorities do not require such documentation for minors who are not Bulgarian.
Find more information about dual nationality and the prevention of international child abduction on our web site. For further information about customs regulations, please read our Customs Information.

SAFETY AND SECURITY:
Bulgaria’s accession to the European Union has enhanced the overall security environment for tourist and business travelers.
However, the country still suffers from many of the ills of a former Eastern Bloc country in transition.
Organized crime groups and criminals who specialize in petty crimes and credit card fraud are highly prevalent in Bulgaria’s largely cash economy.
Petty criminals such as pick-pockets and purse snatchers operate in crowded public areas and on public transportation.
Also, technology exists in Bulgaria to clone credit cards and trap ATM cards for later retrieval.
Suspected organized crime members often travel in convoys of late-model SUVs and luxury sedans, accompanied by armed men, and frequent expensive restaurants, hotels, and nightclubs.
For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site at http://travel.state.gov, where the current Worldwide Caution Public Announcement, Travel Warnings and Public Announcements can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. 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:
Petty street crime, much of which is directed against persons who appear to have money or to be foreign, continues to be a problem.
Pocket picking and purse snatching are frequent occurrences, especially in crowded markets and on shopping streets.
Con artists operate on public transportation and in bus and train stations.
Credit cards and ATMs should be used with caution.
Be wary of people who approach you at an ATM and offer assistance.
Do not give your PIN number to anyone under any circumstances. (See the Special Circumstances section below.) Travelers should be suspicious of "instant friends" and should also require persons claiming to be government officials to show identification.
There have been incidents in which tourists have been drugged or assaulted and robbed after accepting offers of coffee or alcoholic beverages from "friendly” individuals met by “chance” at hotels, the airport, or at bus or train stations.
Travelers should be wary of unfamiliar individuals who encourage them to drink or eat products, as these may be tainted with strong tranquilizers (such as valium) that can lead rapidly to unconsciousness.
Reporting a crime immediately to the police has helped recover money and valuables on more than one occasion and is recommended.
To avoid becoming a victim of more serious crimes, one should use the same personal safety precautions that they would use in large urban areas of the United States.

Travelers should pay special attention to the drink prices at high-end bars and nightclubs.
There have been instances of travelers being charged exorbitant prices, especially for champagne and hard alcohol.
Bills have been as high as several thousand dollars for drinks, and in some establishments the management may use force to assure payment.

On occasion, taxi drivers overcharge unwary travelers, particularly at Sofia Airport and the Central Train Station.
We recommend travelers use taxis with meters and clearly marked rates displayed on a sticker on the passenger side of the windshield.
Travelers should be aware that there is no official commission that sets taxi cab rates.
Taxi drivers are within their full rights to charge passengers any price they want, provided that it corresponds with the price shown on the windshield sticker.
At the airport, there is a clearly marked booth within the arrivals terminal, which arranges for metered taxis at a fair rate.
Finding reputable taxis at the Central Train Station is more difficult.
It is recommended to inquire about the fare first, to avoid excessive payment if a metered taxi cannot be found.
Always ensure that you have and account for all luggage, packages and hand-carried items before you pay and release a taxi.
The likelihood of retrieving articles left behind in a taxi is remote.
Because pilferage of checked baggage may occur at Sofia Airport, travelers should not include items of value in checked luggage.
Automobile theft is a concern, with four-wheel-drive vehicles and late model European sedans the most popular targets.
Very few vehicles are recovered.
Thieves smash vehicle windows to steal valuables left in sight.
Break-ins at residential apartments occur as frequently as in major cities everywhere.
Persons who plan to reside in Bulgaria on a long-term basis should take measures to protect their dwellings.
Long-term residents should consider installation of window grilles, steel doors with well-functioning locks, and an alarm system that alerts an armed response team.

Travelers should also be cautious about making credit card charges over the Internet to unfamiliar websites.
As recent experience has shown, offers for merchandise and services may be scam artists posing as legitimate businesses.
A recent example involves Internet credit card payments to alleged tour operators via Bulgaria-based web sites.
In several cases, the corresponding businesses did not actually exist.
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:
While Bulgarian physicians are trained to a very high standard, most hospitals and clinics, especially in village areas, are generally not equipped and maintained to meet U.S. or Western European standards.
Basic medical supplies and over-the-counter and prescription medications are widely available, but highly specialized treatment may not be obtainable.
Pediatric facilities are in need of funding and lack equipment.
Serious medical problems requiring hospitalization and/or medical evacuation to the United States may cost thousands of dollars.
Doctors and hospitals often expect immediate cash payment for health services.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s Internet 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.
All foreign citizens traveling to Bulgaria should be prepared to present valid evidence of health insurance to the Bulgarian border authorities in order to be admitted into the country.
The insurance should be valid for the duration of the traveler’s stay in Bulgaria.
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 Bulgaria is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
The Bulgarian road system is largely underdeveloped.
There are few sections of limited-access divided highway.
Some roads are in poor repair and full of potholes.
Rockslides and landslides may be encountered on roads in mountainous areas.
Livestock and animal-drawn carts present road hazards throughout the country, especially during the agricultural season.
Travel conditions deteriorate during the winter as roads become icy and potholes proliferate.
The U.S. Embassy in Sofia advises against driving at night because road conditions are more dangerous in the dark.
Some roads lack pavement markings and lights, and motorists often drive with dim or missing headlights.
Driving in Bulgaria is extremely dangerous.
Aggressive driving habits, the lack of safe infrastructure, and a mixture of late model and old model cars on the country’s highways contribute to a high fatality rate for road accidents.
Heavy traffic conditions have led to a significant increase in “road-rage” accidents.
Motorists should avoid confrontations with aggressive drivers in Bulgaria.
In particular, drivers of late-model sedans (BMW, Mercedes, Audi) are known to speed and drive dangerously.
Motorists should exercise caution and avoid altercations with the drivers of such vehicles, which may be driven by armed organized crime figures.
In some cities traffic lights late at night blink yellow in all directions, leaving rights-of-way unclear and contributing to frequent accidents.
Heavy truck traffic along the two-lane routes from the Greek border at Kulata to Sofia and from the Turkish border at Kapitan Andre to Plovdiv creates numerous hazards.
Motorists should expect long delays at border crossings.
A U.S. state driver's license is valid in Bulgaria only when used in conjunction with an International Driving Permit.
For information on how to obtain a permit, please see our road safety information.
If pulled over by a police officer, motorists should remember that, under Bulgarian law, police officers may not collect fines on the spot; they may only issue a ticket with the fine to be paid at the motorist’s local regional tax office.
Buses, trams, and trolleys are inexpensive, but they are often crowded and of widely varying quality.
Passengers on the busiest lines have reported pick pocketing, purse slashing, and pinching. The use of seat belts is mandatory in Bulgaria for all passengers, except pregnant women.
Children under 10 years of age may ride in the front seat only if seated in a child car seat.
In practice, these rules are often not followed.
Speed limits are 50 km/h in the cities/towns, 90 km/h out of town, and 130 km/h on the highways.
For motorcycles, speed limits are 50 km/h in the cities/towns, 80 km/h out of town, and 100 km/h on the highways.
Motorcyclists must drive with helmets and with lights on at all times.
At crossings that are not regulated, the driver who is on the right has the right-of-way, but this rule, too, is frequently ignored.
Drivers may be charged with driving under the influence of alcohol with a blood level as low as 0.05 percent.
Right turns on red lights are not permitted unless specifically authorized.
The penalties for drivers involved in an accident resulting in injury or death range from a 25 U.S. Dollar fine up to imprisonment for life.
A new law requires the use of headlights day and night from November 1st through March 31st.
The most generally encountered local traffic custom is a driver flashing high beams, which usually means that a traffic police post is ahead.
In case of emergency, drivers should contact the police at telephone number 166 and/or Roadside Assistance at telephone number 146.
For an ambulance, please call 150.
The fire department can be reached at 160.
For specific information concerning Bulgarian driving permits, vehicle inspection, road tax, and mandatory insurance, please contact the Bulgarian Embassy via the Internet at http://www.bulgaria-embassy.org.
Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office at http://www.bulgariatravel.org/eng/index.php and the web site of the Bulgarian national authority responsible for road safety at http://www.kat.mvr.bg.
[Note: the latter web site is available in the Bulgarian language only.]
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Bulgaria’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Bulgaria’s air carrier operations.
For more information, travelers may visit the FAA’s Internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Bulgaria is still largely a cash economy.
Due to the potential for fraud and other criminal activity, credit cards should be used sparingly and with extreme caution.
There have been reports of false ATM fronts on bona fide machines that capture cards and PINs for later criminal use, including unauthorized charges or withdrawals.
In connection with such scams, travelers should be extremely wary of friendly bystanders near ATMs who offer assistance.
Any time a card is not returned the traveler should immediately report the card as lost/stolen to the card-issuing company.

Visitors may exchange cash at banks or Exchange Bureaus, but they should know that Exchange Bureaus sometimes post misleading rate quotations that confuse travelers.
People on the street who offer high rates of exchange are usually con artists intent on swindling the unwary traveler.
Damaged or very worn U.S dollar bank notes are often not accepted at banks or Exchange Bureaus.
Major branches of the following Bulgarian banks will cash travelers' cheques on the spot for Leva, the Bulgarian currency, or another desired currency:
Bulbank, Bulgarian Postbank, Biochim, First Investment Bank, and United Bulgarian Bank (UBB).
UBB also serves as a Western Union agent and provides direct transfer of money to travelers in need.
There are also many Western Union branches in major towns and cities.
Most shops, hotels, and restaurants, with the exception of the major hotels, do not accept travelers' cheques or credit cards.
Only some local banks can cash U.S. Treasury checks and the payee may need to wait up to a month to receive funds.
Corruption remains an important concern of the Government.
The Commission for Coordinating of the Activity for Combating Corruption manages the efforts of each government agency’s internal inspectorate in fighting public corruption and engages in public awareness campaigns.
Complaints of public corruption can be made to it at the Ministry of Justice, 2A Knyaz Dondukov Blvd., 1055 Sofia, Bulgaria, email: acc@government.bg, 359-2-980-9213, 359-2-923-7595, 359-2-940-3630 or to the Ministry of Finance hotline: 0800180018.
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 Bulgaria’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Bulgaria 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 Bulgaria are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, and to obtain updated information on travel and security within Bulgaria.
Americans without Internet access may use a public computer at the U.S. Embassy to register.
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 16, Kozyak St., Sofia1407; tel.: (+359 2) 937-5100; fax (+359 2) 937-5209; web site: http://sofia.usembassy.gov/.
Questions regarding consular services may be directed via email to: niv_sofia@state.gov (for non-immigrant visa matters); iv_sofia@state.gov (for immigrant visa matters) and acs_sofia@state.gov (for American Citizen Services matters).
*

*

*
This replaces the Consular Information Sheet dated March 28, 2007, to update the sections on Entry and Exit
Requirements, Safety and Security, Crime, Traffic Safety and Road Conditions, Children’s Issues, and Registration/Embassy.

Travel News Headlines WORLD NEWS

Date: Fri 23 Aug 2019
Source: Ekathimerini [edited]

Two cases of the West Nile Virus [WNV] have been confirmed in Bulgaria, with one of the patients said to have lived in Cyprus during a part of the summer.

The Ministry of Foreign Affairs in Bulgaria has not issued an update as of [Thu 22 Aug 2019] morning, but according to Philenews, the health ministry in Bulgaria had issued a statement regarding a 48-year-old Bulgarian man who was diagnosed with WNV [infection]. The man, said to be from Pazardzhik in southern Bulgaria, is a construction worker who had been living for the last 2 months in Cyprus.

Upon his return to his country, according to Bulgarian officials, the worker started running a fever and generally feeling unwell. He was then immediately admitted to hospital with a known WNV infection.

Other towns were also on alert in Bulgaria, with an official statement saying clinics for infectious diseases in Belgrade and Nis have reported infected people. Most cases were associated with summer flu symptoms while the nervous system was affected in a number of other cases.

Based on additional media reports, there were other places besides Cyprus on the radar of Bulgarian officials regarding possible WNV infections.

According to State Medical Services of the Republic of Cyprus, 9 WNV cases have been confirmed in the south this year up until [16 Aug 2019]. All cases involved the neuroinvasive disease of the virus, with 2 patients remaining critical and 4 others being discharged from hospital.

Earlier this week, one confirmed WNV death was recorded in greater Nicosia with officials saying the patient was very senior.
Date: Mon 5 Aug 2019, 11:33 AM
Source: Novinite.com [edited]

Mosquitoes carry viral meningitis in Bulgaria. There are nearly 1/3 more cases of meningitis since the beginning of the year [2019] than the previous year [2018]. The state has allocated another BGN 2 million [USD 1 783 680] to deal with mosquitoes.

The disease is not typical for Bulgaria's latitudes, but has started to manifest itself with climate change, said Prof. Dr. Tatyana Chervenyakova of the Infectious Diseases Hospital in Bulgaria. The infection is transmitted through mosquitoes, and if there are complications, hospitalisation may be needed. However, the complications are only about 1% of the cases, said Prof. Chervenyakova.

Most of the cases pass the disease slightly - with fever and general malaise. It usually goes away after 2-3 days.

"It is very difficult to control the mosquitoes in these rainfalls. After every rainfall it must be sprayed. We shouldn't think that all mosquitoes are infected with the virus. The individual protection is the availability of repellents, the other is within the reach of the state " Dr. Tatiana Chervenyakova, said in an interview for Bulgaria ON ON AIR.
=======================
[This report deals with mosquito-borne virus infections, but does not indicate which one, nor is the number of cases to date given. There are 2 possible arboviruses involved as the etiological agents of these cases: West Nile virus or Usutu virus. Both have been found in Central Europe. As noted in a previous ProMED-mail post, "West Nile virus (WNV) and Usutu virus (USUV) are phylogenetically closely related mosquito-borne members of the family _Flaviviridae_, and belong to the Japanese encephalitis antigenic complex of the _Flavivirus genus_ (1,2). Both viruses have been isolated from numerous ornithophilic mosquito species, mainly _Culex_ spp. (1,2). In the enzootic cycle of WNV and USUV, avian species are also involved and serve as amplifying hosts. Mosquitoes facilitate virus transmission to humans and equids which then remain incidental hosts as they are not able to produce a level of viraemia sufficient for further virus transmission by mosquito bites (2)." (see  <https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2019.24.28.1900038>  for complete reference list, including those cited here).

ProMED-mail would appreciate a response indicating which virus or viruses are involved in these cases in Bulgaria. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: 30 Aug 2018
Source: Euro Surveillance [summarized, edited]

In June 2018, Crimean-Congo haemorrhagic fever (CCHF) was diagnosed in a Greek construction worker who returned home after becoming ill with fever and haemorrhagic symptoms in south-western Bulgaria. Here, we describe the case along with the epidemiological investigation and phylogenetic analysis.

On 30 May 2018, a Greek male in his late 40s returned to Greece after spending 23 days in a forested area in Blagoevgrad province, south-western Bulgaria, where he was working in bridge construction. Three days earlier (27 May 2018, day 1), while in Bulgaria, he developed fever, severe headache, myalgia (mainly in the lower extremities), malaise and loss of appetite; on 28 May 2018 he visited a local hospital and received symptomatic treatment as an outpatient. As his condition deteriorated (onset of photophobia and abdominal pain) he returned to his permanent residence in northern Greece. On 31 May 2018 (day 5), the patient was admitted to a local hospital.

He was transferred to the university hospital in Alexandroupolis the next day because he presented severe thrombocytopenia and leukopenia; elevated levels of liver enzymes, creatine phosphokinase (CPK) and lactate dehydrogenase (LDH); and prolonged activated partial thromboplastin time (aPTT) (Table). On day 6, his headache was resolved, but his fever (38.2 C [101 F]), malaise and myalgia were ongoing. The main laboratory findings were thrombocytopenia, prolonged aPTT (82 s) and increased level of aminotransferases. His laboratory parameters indicated rhabdomyolysis (CPK 1739 U/L) and slightly elevated urea and creatinine levels (Table). A bone marrow biopsy showed haemophagocytosis. ...

Based on the patient's clinical presentation, and as he was bitten by a tick in an area of Bulgaria where CCHF cases have been reported previously, CCHF was highly suspected. Typically, the incubation period of CCHF after a tick bite is short (1-3 days), but the exact date of the bite was unknown in this case. The treating physician contacted the National Reference Centre for Arboviruses and Haemorrhagic Fever Viruses in Thessaloniki, and the suspected case was immediately notified to the Hellenic Center for Disease Control and Prevention (HCDCP). ...

The HCDCP investigated the case immediately after the diagnosis of CCHF (through telephone interviews with a close family member and with the patient, after recovery, to confirm the dates) and his contacts while he was ill (household members, co-workers, roommates in Bulgaria and relatives who visited him in the hospitals). Close contacts were tested for CCHF and monitored for 14 days for any symptom development. The risk for further transmission was also assessed. The HCDCP promptly informed the Bulgarian health authorities about the case; they also informed the patient's Greek co-workers in Bulgaria about prevention and proper management of tick bites (informative material in Greek was sent to them) advising them to seek medical care in case they develop symptoms.

No other cases were reported among the patient's co-workers in Bulgaria, up to the end of July 2018. The regional and local public health authorities were also informed about the case, and they performed further contact investigation in Greece. No secondary cases were detected. The HCDCP raised awareness for CCHF among health professionals working in local health centres and hospitals in northern Greece, especially in areas with populations travelling to Bulgaria for occupational reasons.

The patient and his laboratory samples, apparel, waste and cleaning procedures were managed in accordance with the national guidelines for viral haemorrhagic fevers (available in Greek from HCDCP website: <http://www.keelpno.gr/>). In particular, upon the suspicion of CCHF (day 8), the patient was immediately isolated, and strict barrier precautions were utilised (waterproof gowns, gloves, FFP3 respiratory masks, goggles), and personal protective equipment was used by healthcare workers (HCWs) and visitors; however, visitors were discouraged from entering the isolation room. The HCDCP sent guidelines for contact tracing and active surveillance of symptoms in HCWs possibly exposed to CCHFV. Patients who were hospitalised in the same room with the patient before the suspicion of CCHF (2 patients in the 1st hospital (days 5-6), and 3 patients in the 2nd hospital (days 6-8)), were also monitored for symptoms for 14 days after their last contact with the patient. No secondary cases were observed. ...

Discussion
---------
CCHF was 1st recognised in Bulgaria in 1952; since then, several cases have been reported. Genetic characterisation of the Bulgarian strains showed that they cluster into the clade Europe 1. Our patient was infected in an area that was considered at low risk for CCHF outbreaks up to 2008, when a cluster of cases was observed in the region. Although the seroprevalence in the human population in Blagoevgrad province is low (1 percent), a seroprevalence of 41.9 percent in livestock was reported recently. Since CCHFV is transmitted mainly by bites of infected Ixodid ticks, persons living in rural areas are at increased risk for acquiring the infection. This was the reason that information about preventive measures was sent to our patient's Greek co-workers in Bulgaria, and all related public health authorities were informed about the case.

Regarding Greece, no other imported cases have been reported so far, and the only autochthonous CCHF case was observed in 2008. A review of travel-associated CCHF cases published during 1960-2016 reported 21 cases; 2 imported cases have been reported within Europe: Bulgaria to Germany in 2001 and Bulgaria to the United Kingdom in 2014.

Due to the high pathogenicity of CCHFV, the absence of a specific drug treatment or vaccine, and the risk of person-to-person transmission, rapid diagnosis is crucial to ensure that appropriate infection control measures (e.g. isolation of patient and barrier precautions) can be implemented in a timely manner. A detailed medical history of the patient, including travel history and possible risk factors, is important for the timely diagnosis of the disease. In our case, information regarding the tick bite was not provided immediately, and this, in combination with the non-specific initial symptoms, meant that CCHF was 1st suspected on day 8 of illness. Despite this delay, the patient fully recovered, and no secondary cases of CCHF have been reported. Since the northern part of Greece is close to CCHF-endemic countries, HCWs in this region should be made aware of CCHF, including the provision of training to better help them address questions from patients about travel history (to identify potential risk of exposure). Physicians should include CCHF in the differential diagnosis for patients with haemorrhagic syndromes, especially if patients report a tick bite, outdoor activities, or occupation in rural areas and recent travel to an endemic area.
=======================
[The above report provides an excellent example of CCHF transmission in a case with no history of conventional professional contact with infected cattle, such as cattle rearing or butchering. History of travel to a location that has reported human cases, presence of the vector, and the clinical picture should raise suspicions in health care providers, with appropriate diagnostic tests conducted as soon as possible. - ProMED Mod.UBA]

[HealthMap/ProMED maps available at:
Date: Thu, 8 Mar 2018 12:10:48 +0100
By Diana SIMEONOVA

Bansko, Bulgaria, March 8, 2018 (AFP) - "Unlimited Ski and Fun!" promises a pamphlet touting the Bansko ski resort, a magnet for bargain-hunting holidaymakers in southwest Bulgaria.   But nature lovers are demanding limits to the growth of the bustling resort carved into the majestic pine forests of Pirin National Park, a UNESCO World Heritage site since 1983.

The clearance of more than 160 hectares (400 acres) of centuries-old forest to build the ski zone already prompted UNESCO in 2010 to remove the area from the World Heritage designation, labelling it a "buffer zone".   Now a much larger area could come under threat after a government decision in December opened 48 percent of the park's 40,000 hectares for construction, sparking weekly protests attended by thousands across the country.

Protestors accuse the government of favouring business interests in a country ranked by watchdog Transparency International as the EU's most graft-prone, with one huge banner at a recent rally in the capital Sofia reading: "Corruption! Save Pirin".   But the resort is the area's biggest employer and locals have responded with their own demonstrations in favour of expansion.   At issue in particular is a plan to build a second ski lift to ease persistent queues at the sole six-person lift, which currently takes 2,200 skiers per hour up to the 75 kilometres (46 miles) of runs.

- 'Horrific' queue -
British holidaymaker Carolyn Bennett, 30, is among the skiers who come in droves to Bansko from Britain, Russia and Bulgaria's Balkan neighbours, attracted by the cheap food and lift passes as well as budget flights.   But even on a supposedly quiet day, she was among scores of people at the foot of the ski lift, where queues form from early morning and waits can last up to three hours.

"Another gondola is going to have a huge impact environmentally but I imagine coming here in peak season, that queue would probably be horrific," she shrugged in the crammed gondola cabin.    "With a daily lift pass costing 28 euros ($34), Bansko is the cheapest resort of its capacity in Europe, and even if our queues have become notorious, people keep pouring in," Bansko's marketing chief Ivan Obreykov told AFP.   Daily lift passes at ski resorts in France and Austria typically cost twice as much.

Bansko hosts some 35,000 to 40,000 visitors per month during the winter season. On a busy day, up to 7,000 people could hit the ski lift at the same time in the mornings.   Booming construction in the once quiet town of 9,500 inhabitants has seen its two-storey houses and cobbled streets surrounded by hotels and luxury apartments with space for 18,000 guests.   While ugly concrete skeletons of a number of hotel projects abandoned after the 2008 financial crisis mar the landscape, pressure is mounting to expand both the town and the ski zone.

- Trojan horse claim -
Obreykov praised the government's green light for the second ski lift, adding that its construction was the resort's "first and most pressing task".   But those opposed to the plan say it is a Trojan horse to cover up previous unauthorised building and encourage even more expansion.   "If they wanted to do just a second gondola, they would not have opened almost half of the territory of Pirin National Park for construction," WWF's Konstantin Ivanov said at a rally in Sofia.   "We don't buy their promises that nothing more will be built there," he added.   WWF claims the ski zone has already grown to cover 60 percent more territory than initially agreed and points to as yet unapproved plans for huge expansion of the resort.    Obreykov denied the charge, adding that new ski runs could be built only within the current area of the ski zone.

A recent study for the WWF concluded that the resort has already inflicted "irreparable damage" on the reserve, calling for UNESCO to inscribe Pirin on its List of World Heritage in Danger if new construction begins.    A report by the International Union for Conservation of Nature (IUCN) in November also said the conservation outlook for Pirin National Park -- home to bears, chamois and wolves -- was of "significant concern" and just one step away from the final "critical" stage.   IUCN also underlined the "threats of disturbance and fragmentation of the site associated with the exclusion of the skiing areas as incompatible with its World Heritage status."

- 'Deepening mistrust' -
For economist Petar Ganev, of the Sofia-based Institute for Market Economics, the row is an example of "deepening mistrust in Bulgaria's institutions".   On the one hand, Ganev said Bansko is "a positive example of a very poor place which grew into a prosperous resort" and that building a second ski lift could be justified for that reason.   But, he added, suspicions that development is not being regulated fairly will "continue to bring people out on the streets".   "The problem is not the second gondola but the corruption in the country," Ganev said.
Date: Fri 1 Dec 2017 15:26
Source: Focus News Agency [edited]

The hepatitis A outbreak in the Kosharnik, an all-Roma neighbourhood of Montana, is spreading, the number of people infected has reached 15, Dr. Mariya Kamenova, Deputy Director of Montana Regional Health Inspectorate (RHI) told FOCUS Radio . Another 8 cases were registered for the period from [Fri 27 Oct 2017] until the end of November 2017, adding up to the 7 cases registered by [Thu 26 Oct 2017]. Those 1st 7 cases were children under 14, while the newly infected are 4 children under 4 years of age, 2 children aged 5 to 9, and 2 children aged 15 to 19.

A 51-year-old male from the neighborhood is also probably hepatitis A infected, but his tests are pending. The Montana municipality has taken measures and the streets in Kosharnik and the yards of the infected families have been disinfected every month. The RHI has said that they will continue to monitor the situation.
=====================
[The location of Montana in Bulgaria is north and west of Plovdiv where HAV is being reported in the Roma community there. Montana's location can be seen on a map at <https://en.wikipedia.org/wiki/Montana,_Bulgaria>. Since most ca es of
HAV in children are unrecognized, being either asymptomatic or anicteric (without jaundice), the total number of cases are likely to be much higher. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
More ...

Botswana

Botswana - US Consular Information Sheet
August 29, 2008
COUNTRY DESCRIPTION:
Botswana is a country in southern Africa with a stable democratic government and a growing economy. Facilities for tourism are widely available. Read the Departm
nt of State Background Notes on Botswana for additional information.

ENTRY/EXIT REQUIREMENTS: A passport with at least six months of validity remaining is required. U.S. citizens are permitted stays up to 90 days without a visa. For additional information on entry requirements, travelers may contact the Embassy of the Republic of Botswana, 1531-1533 New Hampshire Avenue NW, Washington, DC 20036, telephone (202) 244-4990/1, fax (202) 244-4164 or the Permanent Mission of the Republic of Botswana to the United Nations, 103 E. 37th St., New York, NY, 10016, telephone (212) 889-2277, fax (212) 725-5061. There are also honorary consuls in Los Angeles, San Francisco and Houston. Visit the Embassy of Botswana’s web site at http://www.botswanaembassy.org/ for the most current visa information. As a general precaution, all travelers are advised to carry a photocopy of the photo/bio information page of their passport and keep it in a location separate from the passport.

Visitors to Botswana who also intend to visit South Africa should be advised that the passports of all travelers to South Africa must contain at least two blank (unstamped) visa pages each time entry to South Africa is sought; these pages are in addition to the endorsement/amendment pages at the back of the passport. Otherwise, the traveler, even when in possession of a valid South African visa, may be refused entry into South Africa, fined, and returned to their point of origin at the traveler’s expense.

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:
Civil unrest and disorder are rare. U.S. citizens should avoid crowds, political rallies, and street demonstrations and maintain security awareness at all times.

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 pamphletA Safe Trip Abroad.

CRIME: Crime is a serious concern in Botswana. Visitors must be vigilant and take common-sense security precautions. The criminal threat is very similar to that of any large urban area. Petty street crime and crimes of opportunity, primarily the theft of money and personal property, are not uncommon. Home invasions ‘smash and grabs’ from vehicles, and cell phone thefts, often at knife point, are routinely reported to the police. Visitors should use care when talking on a cell phone while walking. Urban areas are particularly dangerous at night; pedestrians are advised to avoid walking in Gaborone and other urban areas in Botswana at night. Except for visits to the Gaborone Yacht Club during daylight hours, U.S. Embassy personnel are prohibited from traveling to the area surrounding the Gaborone Dam and to the Kgale Hill area, a popular Gaborone hiking venue, because of multiple incidents of violent crime. American citizens are urged to avoid these areas.

Travelers arriving in Botswana via South Africa should be aware that there is a serious baggage pilferage problem at OR Tambo (Johannesburg) and Cape Town International Airports. Travelers are encouraged to use an airport plastic wrapping service and to avoid placing electronics, jewelry, cameras, designer athletic gear, or other valuables in checked luggage. Also, make an inventory of items in checked baggage to aid in claims processing if theft does occur.

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.

Botswana has three numbers equivalent to the “911” emergency line. For police assistance, dial “999.” For an ambulance, dial “997.” In the event of a fire, dial “998.”

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities in Gaborone are adequate for simple medical problems, but facilities outside of Gaborone are limited. Adequately equipped emergency rooms and trained physicians are available in the capital but services are rudimentary elsewhere. Professional private emergency rescue services operate air and ground ambulances throughout the country, but care is rendered only after a patient’s ability to pay is established. Response times are often slow in less populated areas. Outside of Gaborone, most airports are either not equipped or have frequently malfunctioning night lighting capability, so airborne medical evacuations can usually only be conducted during daylight hours. Malaria is prevalent only in the north of the country, particularly around the Chobe and Okavango National Parks. Malaria prophylaxis is not required in Gaborone but is suggested for travel to the north. For advanced care Americans often choose to travel to South Africa. Many South African manufactured prescription drugs are available in Gaborone.

Approximately one-quarter of the population of Botswana is infected with HIV, the virus that causes AIDS. Travelers are advised to exercise appropriate precautions if engaging in sexual activity, or if exposed to blood products through injuries or rendering assistance to accident victims. Tuberculosis is also endemic to Botswana. Two cases of extensively drug resistant tuberculosis (XDR-TB) have been identified in Botswana since January 2008 when Botswana first obtained the ability to test for this form of TB. Individuals who plan to reside or stay in Botswana for extended periods are advised to obtain a tuberculosis skin test (PPD test) prior to arrival and again upon departure from Botswana.

There are occasional diarrhea outbreaks in areas affected by heavy rains. Travelers are encouraged to take necessary precautions when handling food and drinking water.

The Department of Immigration of Botswana does not impose any HIV/AIDS entry restrictions for visitors to or foreign residents of Botswana.

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

Driving in Botswana is challenging and motorists must drive defensively. Traffic circulates on the left in Botswana, as elsewhere in the region. While the roads in major population centers in Botswana are generally good, many roads have been damaged by heavy rains in December and January. Travel by automobile outside of large towns may be dangerous. The combination of long, tedious stretches of two-lane highways without shoulders, high speed limits, and poor lighting make driving at night on rural highways particularly hazardous. Recent rolling power outages mean that many traffic lights and street lamps do not work properly. Free-range domestic animals, even in urban centers, and large numbers of pedestrians and hitchhikers in the roadways make fatal accidents a frequent occurrence.

‘Smash and grab’ robberies from vehicles are not uncommon in Botswana, particularly in urban areas at traffic lights. Motorists should avoid carrying anything of value (hand bags, briefcases, purses, cell phones, etc.) in the passenger compartment that could attract potential assailants.

Please refer to our Road Safety page for more information. Visit the web site of Botswana’s national tourist office and national authority responsible for road safety at http://www.botswana-tourism.gov.bw.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Botswana, the U.S. Federal Aviation Administration (FAA) has not assessed Botswana’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Since February 2008, rolling electric power outages have left many areas without power for several hours each week. This situation is likely to continue. Visitors are urged to carry flashlights. American citizens are also urged to be aware of how power outages might affect home security systems, garage doors and gates, and kitchen equipment, such as stoves and refrigerators. The power fluctuations could cause power surges that might harm computers, televisions, or other electrical appliances.

Botswana strictly enforces its laws controlling the trade in animal products. The hunting of lions is explicitly prohibited and leopards and elephants are covered under a strict quota regime. Botswana's Wildlife Conservation and National Parks Act makes it illegal to possess or remove from Botswana without a government permit any living or dead animal or animal trophy. A trophy is any horn, ivory, tooth, tusk, bone, claw, hoof, hide, skin, hair, feather, egg, or other durable portion of an animal, whether the item has been processed or not. Curio shops and vendors throughout the country sell items such as animal skins, plain and decorated ostrich eggs and eggshells, and carved bones or teeth of animals protected by this law. All of the souvenirs, although widely sold, are subject to this act. Travelers departing the country with a trophy must have a receipt from a store licensed to sell such items. Ivory and endangered rhinoceros horn products obtained in Botswana may not be removed from the country under any circumstances; elephant hair jewelry may be removed only with the appropriate license from the Department of Wildlife and National Parks. Trophies may not be taken from the wild without a permit. Violators are subject to arrest and may face a penalty of up to five years imprisonment and a substantial fine.

Wild animals may pose a danger to tourists. Tourists should bear in mind that, even in the most serene settings, the animals are wild and can pose a threat to life and safety. Tourists should use common sense when approaching wildlife, observe all local or park regulations, and heed all instructions given by tour guides. In addition, tourists are advised that potentially dangerous areas sometimes lack fences and warning signs. Exercise appropriate caution in all unfamiliar surroundings. 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 Botswana’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Botswana 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 Botswana 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 within Botswana. Americans withoutInternet 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 Gaborone on Embassy Drive in the Government Enclave. The mailing address is P.O. Box 90, Gaborone, telephone +267 395-3982; fax +267 318-0232; email consulargaborone@state.gov, and the after-hours emergency telephone is +267 395-7111.
* * *
This replaces the Country Specific Information for Botswana dated March 5, 2008, to update the sections on Information for Victims of Crime and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Fri, 17 Jan 2020 19:10:08 +0100 (MET)

Tutume, Botswana, Jan 17, 2020 (AFP) - Packed with protein and calcium, mopane worms are a delicacy in Botswana, where they are stirred into chunky tomato and peanut stews.    In the north and centre of the country, the spiky black and green caterpillars are harvested to make relish and sold at markets.

But a regional drought has decimated the mopane population, sapping an important source of income for rural communities.   "(The mopane worm) is not in abundance just like in the past during the times of good rainfalls," said Onalethata Mbakile, a single mother of two in the central village of Goshwe, near the border with Zimbabwe.

Mbakile, 40, has been picking caterpillars off the branches of Mopane trees -- where they are usually found -- for more than two decades.   She travelled more than 440 kilometres (273 miles) to Botswana's capital Gaborone, where she charges 10 pula (80 euros cents) for small sachet of dried mopane -- a popular road-side snack.   "The rains are unreliable and unpredictable," Mbakile said. "We used to harvest it around December and April but it is no longer the case."

Southern Africa is grappling with one of its worst droughts in history, badly affected by a prolonged period of low rainfall and scorching temperatures.   The UN has warned that 45 million people in the region are in urgent need of food aid due to drought, flooding and economic hardship.   The harvest period for mopane worms has shrunk and sachets have doubled in price.
Date: Tue, 22 Oct 2019 18:42:15 +0200 (METDST)

Gaborone, Botswana, Oct 22, 2019 (AFP) - More than 100 elephants have died in two months in Botswana's Chobe National Park due to drought, which has also affected wildlife in other countries in the region, the government said Tuesday.   Several southern African countries are enduring one of the worst droughts in decades, caused by months of over-average temperatures and erratic rainfall.   The drought has wilted grasslands and dried up water holes, making it increasingly difficult for animals to survive.    Botswana's environment ministry said it has recorded a spike in the number of elephant and other animal deaths since May.    "More than one hundred elephants are estimated to have died naturally in the past two months," the ministry said in a statement, adding that 13 deaths were recorded just this week.

In neighbouring Zimbabwe, Its wildlife agency has recorded at least 55 elephant deaths over the past month due to lack of food and water.  Preliminary investigations in Botswana have also suggested some of the elephants may have died from anthrax.   "Due to the severe drought, elephants end up ingesting soil while grazing and get exposed to the anthrax bacteria spore," the ministry said in a statement.   "The animals are also travelling long distances in search of food which leaves some highly emaciated, ending in death."   Anthrax is an infectious disease found naturally in soil. It is generally contracted by herbivores and is a common cause of death for both wild and domestic animals around the world.      The environment ministry said it would be burning "anthrax related carcasses" to prevent the disease from spreading to other animals.   It warned the public not to touch any animal carcasses they might find and report them to the authorities.
Date: Tue 22 Oct 2019 9:28 PM CAT
Source: Reuters [edited]

More than 100 elephants have died in Botswana in the past 2 months partly because of a suspected anthrax outbreak, the government said on [Tue 22 Oct 2019]. "Preliminary investigations suggest the elephants are dying from anthrax whilst some died from drought effects," a Department of Wildlife and National Parks statement said. "Due to the severe drought, elephants end up ingesting soil while grazing and get exposed to the anthrax bacteria spore," it said.

Elephants Without Borders said an aerial survey showed fresh elephant carcasses increased by 593% between 2014 to 2018, mostly from poaching and illegal hunting, with drought also a contributing factor. The wildlife authority said the latest deaths were in the Chobe River front and Nantanga areas in northern Botswana, where 14 dead elephants were found this week. It said it would be burning the carcasses to prevent the anthrax infection from spreading to other animals.

According to the Centers for Disease Control and Prevention in the United States, anthrax is a bacterium found naturally in soil and commonly affects domestic and wild animals when they breathe in or ingest spores in contaminated soil, plants, or water. Anthrax is not contagious and humans can only get infected by ingesting the bacteria. It can be prevented in animals via regular vaccination.

Botswana is home to almost 1/3 of Africa's elephants, around 130,000.  Botswana has lifted a ban on big-game hunting to combat a growing conflict between humans and wildlife. Botswana and its neighbors in southern Africa are experiencing a severe drought because of below-average rainfall since an El Nino weather system struck in 2015.  [Byline: Brian Benza, writing: Mfuneko Toyana; editing: Grant McCool)
====================
[Check CBC
which has a nice picture of 2 Okavango Delta bull elephants.

Elephants can graze, although they are usually browsers of branches and vegetation off trees. They are attracted to water. So the source is presently uncertain but might have been a secondary spread from a prior wildlife case that resulted in contaminated browse from blow flies or water from a contaminating carcass. Until a cheap and effective wildlife oral vaccine can be developed, these cases in Chobe will be a constant sporadic event. As elsewhere, the best control is to burn any carcasses and disinfect any contaminated soil. -

Chobe is on the northern border of Botswana abutting the Caprivi Strip of Namibia; see

[HealthMap/ProMED-mail map of Botswana:
Date: Fri, 30 Aug 2019 11:13:54 +0200 (METDST)

Maun, Botswana, Aug 30, 2019 (AFP) - A calf struggles neck-high in the stew-like mud, kicking frantically to make its way across the mire.   Around 38,000 livestock depend on the waters of Lake Ngami in northern Botswana, but the animals -- like the lake itself -- have been stricken by a crippling drought.   Grazers have to walk long distances in hopes of finding anything to eat. Some succumb to the heat and vultures can be seen feasting on their corpses in the sludge of the lake bed.

In May, President Mokgweetsi Masisi officially declared Botswana to be in drought after months of unevenly distributed rains, heat waves and dry spells.   Rural households have been especially hit, and are looking to the government for help.   Southern Africa has been hard hit by intensifying extreme weather conditions such as drought and floods, leaving millions in need of food aid.

Zambia is in the throes of a drought which has affected the 2018/19 farming season. Around 2.5 million people are facing food shortages, according to official figures.

In Zimbabwe, nearly a third of the 16 million population are in need of aid and at least half of these face acute hunger, according to the World Food Programme (WFP).   Lake Ngami is also home to around 100 hippos, half of whom have cannily migrated to parts where life is easier.   "Only the livestock is trapped in the muddy waters," the acting director of wildlife and national parks,  Moeti Batshabang, told AFP.
Date: Wed 15 Nov 2017 20:00 pm (GMT +2)
Source: MMEGI online [edited]

Dozens of Nthompe Koma Primary School pupils on Monday night [13 Nov 2017] thronged Mahalapye health facilities following a food poisoning incident allegedly caused by rape they ate at school.

Classes came to a halt yesterday [14 Nov 2017] as more students showed signs of food poisoning while health workers were present at the school and hospital to establish what could have caused the incident that led to at least 26 pupils being admitted at Mahalapye Hospital. According to a source, it is suspected that the students were fed rape, which was recently sprayed with pesticides.

"The students started vomiting and having diarrhoea at their homes after school. A huge number of them were rushed to the hospital and it was said that the newly treated vegetable was given to them," the source said.

Mahalapye Hospital Superintendent, Dr Kumal Bose said they are yet to establish the cause of diarrhoea and vomiting, whether it is the food they ate or not. "We attended to a total of 82 students of whom 26 were admitted and others discharged. More students were coming in this morning [15 Nov 2017].

We have sent our public health team to the school to investigate all possible causes," he said. Mahalapye chief education officer,

Maria Dikeme [Principal Education Officer] confirmed the incident. "It is true that a lot of students from the school were taken to various health facilities yesterday [14 Nov 2017].

The students were fed sorghum and rape at break time and the sorghum has been taken for tests by the public health team. All of the rape was cooked yesterday. We will, however, go to the source if there is still any left so that it can be tested," she said.

Dikeme said more students were taken to the hospital the following day as some developed signs late.

"We do not have a certain number currently, but we have recorded over 100 cases with 11 pupils still admitted at the hospital," she said.

She said they kept the pupils within the school so they could monitor them rather than sending them home while parents are at work.

Dikeme said there were some pupils who were in school yesterday [14 Nov 2017] who were not affected and that there was no report of any adult person having been diagnosed with the same problem.  [Byline: Innocent Selatlhwa]
===================
[Rape seed and soybeans are both grains. This article says a possible pesticide. The class of chemicals causing these clinical signs would be organophosphates. Grains are often treated with chemicals to prevent insect infestation and ruination of the crop. Therefore it is possible an organophosphate was used on the grain, and not washed or cleaned before being put into human consumption, could produce vomiting and diarrhoea. These could be signs associated with organophosphates. There are likely other crop chemicals capable of producing this, but the organophosphate class is large with numerous chemicals.

The article does not tell us if the pupils are being treated or if they are, what they are being treated with.

Consequently, the results of the testing is very important. Hopefully the testing will reveal the cause of this situation. - ProMED Mod.TG]

[A HealthMap/ProMED-mail map can be accessed at:
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Gambia

General
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The Gambia is situated on the coast of West Africa and is a common tourist destination. It enjoys a tropical climate with a rainy season between May to October each year. Harmattan winds can be experienced
during the dry season.
Stability throughout the country has been in question since a coup in 1994 but generally tourists remain unaware of any particular difficulty in this regard. Civilian rule has been in place since 1996. There is a successful tourist industry and the majority of travellers will remain in the resort regions along the coast.
Safety & Security
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It is uncommon to hear of attacks against tourists but it is considered unwise to flaunt personal wealth. Thus wearing valuable jewellery or watches should be avoided. Use the hotel safety deposit boxes for storing items of value and keep an eye on personal belongings while on the beach, on ferries or walking through market places. Many of the main tourist beaches have police or hotel security but there would be a risk if visiting some of the more isolated areas along the coast.

Road Transport
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In the main tourist regions road transport is perfectly reasonable but travelling throughout the country, particularly during the rainy season, is much more difficult. Paved roads exist in the capital, Banjul, but pedestrians still need to take care while out walking. If leaving the main tourists resorts it is essential to travel with a recognised guide. If driving, take care to stop at all check points and never reverse to avoid a road checkpoint. It is safer to use a taxi where possible (green ones for tourists). Avoid travelling to the Casamance region in Senegal (close to Gambia border), as this area is quite unstable at present. The region around Ziguinchor has also unexploded mines and armed bandits and so it would be wise to avoid.
Ferry Risks
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Taking the Banjul to Barra ferry may involve safety risks as the boat is frequently overcrowded and does not carry enough life belts etc for the number of passengers. All the engines for the ferry do not always work and it may be wiser to consider travelling 150km upriver and use the Yelitenda to Bambatenda ferry.
Health Facilities
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The level of medical facilities varies greatly throughout the country. The Medical Research Council facility in Banjul offers excellent healthcare but travellers are advised to carry sufficient supplies of any personal medication they may require while abroad.
Food & Water Facilities
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The main tourist resorts offer a good standard of food for tourists. However, it is wise to ensure that all food is fresh and well cooked. Avoiding bivalve shell fish (oysters, mussels, clams etc) is essential as these foods are frequently associated with illness among those who partake. The tap water supply may not always be regularly maintained and so it is safer to use sealed mineral water for both drinking and brushing your teeth while in The Gambia. Ice in drinks will be made from tap water and so best avoided. Food and fluids should not be purchased from street vendors except in the case of fruit, which you will then peel yourself. Tinned drinks may be safe but be careful to clean the lip before drinking straight from the can.
Malaria & Mosquitoes
*******************************
The risk of malaria in The Gambia is generally between June to December each year. Tourists have seldom been at significant risk up until recently when there has been a significant increase in the numbers of cases returning to Europe with the disease. Malaria prophylaxis should be used throughout the year. Mosquitoes mainly bite between dusk and dawn but other species can bite at any time of the day.
Rabies Risk
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There is an ever-present risk of Rabies in Africa and The Gambia is no exception. The disease is mainly transmitted to humans through the bite of an infected dog but other animals also pose a risk including cats and monkeys. The disease can also be transmitted through licks and scratches’ so avoiding all contact with animals is a wise precaution.
Sun Exposure & Dehydration
************************************
The heat and radiation from sunlight in The Gambia can be very significant especially for fair skinned Irish travellers. Make sure you use a wide brimmed hat and keep covered from the suns rays. Dehydration and salt depletion are also common and you will need to increase the amount of fluid (and salt, unless there is a contraindication) while in this climate.
Local Laws & Customs
*******************************
The Gambian authorities take strong action against those involved in any drug trade and so take care not to carry any item for another person at any time. It is a predominantly Muslim country and so care should be taken to respect their customs for example by dressing modestly particularly when away from the main tourist regions. Never take photographs or videos of any police or military installations.
Vaccinations
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If travelling to The Gambia you are advised to consider vaccination cover against the following;
*
Yellow Fever (mosquito borne viral disease)
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food & water borne disease)
*
Hepatitis A (food & water borne disease)
Occasionally travellers are advised to also consider protection against diseases like Hepatitis B, Rabies and Meningitis.
Malaria prophylaxis is essential at all times of the year for your personal protection.
Summary
*******************************
Tourist holidays to The Gambia are increasing after a lull following the unrest of the mid 90’s. However, the recent increase in malaria during December 2000 among European tourists shows how travel to tropical Africa must be treated with the respect it deserves. The majority of travellers who follow sensible guidelines will travel healthy and well.

Travel News Headlines WORLD NEWS

Date: Thu 22 Nov 2018
From: Vanessa Field vanessa.field@nhs.net

Dr. Bram Goorhuis and Dr Martin Grobusch of the GeoSentinel Surveillance Network site, Center for Tropical & Travel Medicine, AMC, Amsterdam, have reported a patient with confirmed yellow fever (YF) after travel to the Gambia and Senegal. The patient is a 26-year-old male, with no significant medical history, and previously unvaccinated against YF, who had travelled, together with his girlfriend, to the Gambian coastal region, Mansa Konko (14 days) and the Niokolo Park game reserve, Senegal (3 days). He had exposure to insect bites, but not tick bites, and did not have contact with fresh water or animals. He did not take malaria chemoprophylaxis.

On 17 Nov [2018], whilst on his flight home to Amsterdam, Netherlands, he developed a fever, chills, photophobia, and some transient gastrointestinal complaints (frequent liquid stools and abdominal discomfort). On 20 Nov [2018], he was transferred to the Center for Tropical and Travel Medicine, Amsterdam, from a peripheral hospital, with fulminant hepatitis (AST 22,000 U/L; ALT 12,500 U/L) and signs of liver failure. He tested negative for malaria and dengue; yellow fever PCR showed a very high viral load of 3.82 x 109/L. Due to an evolving encephalopathy, and a potential need for liver transplantation, the patient has now been transferred to the Erasmus Medical Center, a GeoSentinel site (Dr. Jan Nouwen and Dr. Perry van Genderen), Rotterdam, Netherlands. More follow-up is pending.

The last reported case of yellow fever in a traveller from the Gambia was in 2001 in a 47-year-old unvaccinated Belgian woman, who acquired yellow fever during a one-week vacation and subsequently died. Ref. Colebunders R et al.: A Belgian Traveler Who Acquired Yellow Fever in the Gambia. Clinical Infectious Diseases. 2002. 35(10): e113-e116. doi: <https://doi.org/10.1086/344180>.

The Ministry of Health in Senegal last notified the WHO in 2001 of 3 cases of yellow fever in K'dougou and Saraya Health districts, near the border with Mali and Guinea Conakry. A mass vaccination campaign followed. There have been no official reports to the WHO from the Gambia.

Ref: WHO Disease Outbreak News

In 2017, there were major yellow fever (YF) outbreaks in Brazil and Nigeria. These outbreaks were not marked by the rapid urban spread seen in 2016 in Angola and the Democratic Republic of the Congo (DRC), yet they illustrate the increased risk of YF and urban outbreaks with international spread. The "Eliminate Yellow Fever Epidemics" (EYE1) strategy was developed with the goal to reduce the risk of YF through a continuum ranging from outbreak detection and response to prevention. The YF surveillance network also identified suspected cases in several other high-risk countries including Congo, DRC, and Liberia.
Ref: World Health Organization (WHO) Weekly epidemiological record, 10 Aug 2018, No. 32, 2018, 93, 409-416; Yellow fever in Africa and the Americas, 2017.
<http://apps.who.int/iris/bitstream/handle/10665/273782/WER9332.pdf?ua=1>.

World Health Organization (WHO) data suggest that the rate of yellow fever transmission is increasing, especially in sub-Saharan Africa. The WHO estimates that, after adjustment for underreporting, about 200 000 cases of yellow fever occur each year. In most of west Africa, with the exception of the Gambia, yellow fever vaccination coverage is low, and there are regular epidemics of yellow fever that fluctuate according to the sylvatic cycle. Since the mid-1990s, epidemics have been reported from Ghana, Gabon, Liberia, Senegal, Benin, and Ivory Coast.

Yellow fever remains endemic in west Africa. Even urban yellow fever has recently been detected in Abidjan, Ivory Coast. Many countries in areas of endemicity in Africa (such as the Gambia) and South America (such as Venezuela) do not require travelers to undergo yellow fever vaccination. International guidelines for travellers recommend vaccination against yellow fever for persons traveling to these countries, but vaccination is not required by the countries themselves.
-----------------------------------------
Communicated by:
Davidson Hamer, MD (GeoSentinel PI)
Professor of Global Health and Medicine
Boston University School of Public Health and School of Medicine
Boston, MA USA
and
Vanessa Field, MD
Chair, GeoSentinel Tracking and Communication Working Group
International Society of Travel Medicine
=======================
[Drs. Hamer and Field are thanked for this report of the Netherlands case and the overview of the YF situation in endemic countries. The Netherlands case is another example of failure of travellers to receive YF vaccination at least 10 days prior to arrival in an endemic country. Although the Netherlands case presents no risk of initiation of ongoing YF virus transmission, it does illustrate the fact that viremic individuals can travel long distances and, should their destination be an area that could support transmission, such as Central America or south/southeast Asia, can initiate an outbreak in a population that is overwhelmingly unvaccinated. - ProMED Mod.TY]

[Map of the Netherlands:

Maps of Senegal and the Gambia:
Date: Wed, 18 Jan 2017 17:50:39 +0100

Banjul, Gambia, Jan 18, 2017 (AFP) - Gambian President Yahya Jammeh looked determined to cling to power on Wednesday as his mandate came to an end, prompting neighbouring Senegal asking the UN to back regional actions against him.   Jammeh has announced a state of emergency which he said was necessary due to interference of foreign powers in the West African country's December 1 election, which the president of 22 years lost to opponent Adama Barrow.

Barrow, who is currently sheltering in Senegal, maintains his inauguration will go ahead on Thursday on Gambian soil, putting the country on a collision course.   Senegal on Wednesday presented a draft resolution to the UN Security Council seeking support for west African efforts to press Jammeh to step down, diplomats said in New York.   But the text does not explicitly seek council authorisation to deploy troops to The Gambia, they added.   Jammeh's declaration immediately triggered travel advisory warnings by Britain and the Netherlands, with around 1,000 British tourists expected to leave on special flights on Wednesday alone.   The 15-nation Economic Community Of West African States (ECOWAS) has repeatedly urged Jammeh to respect the outcome of the vote and step aside, a call backed unanimously by the international community.

The exact location of the inauguration was "in the hands of ECOWAS," said James Gomez, the inauguration's head organiser who said he had spoken with Barrow twice on Tuesday.   Gomez said that plans for the transfer of power in a huge stadium outside the capital Banjul were now cancelled, but added "there will be a big celebration" despite the state of emergency.   A source at Nigeria's military HQ told AFP a deployment to Senegal, whose territory surrounds The Gambia, would happen "very soon", ramping up expectations of a possible military intervention.   Under the Gambian constitution a state of emergency lasts up to 90 days if the national assembly confirms it -- which the legislature did late Tuesday.   The country's vice-president Isatou Njie-Saidy resigned Wednesday, family sources said, along with environment minister Pa Ousman Jarju, the latest in a mass string of cabinet members deserting Jammeh's government.

- Tourist disappointment -
Tourists were streaming out of the country, leaving the small airport near Banjul struggling to handle extra flights.   Brian and Yvonne Souch, a couple from Witney in southern England, told AFP they were unaware of the potential risk of flying to the country 10 days ago and felt tour company Thomas Cook should have kept them better informed.   "We didn't know anything until we came down for breakfast,"  Brian Souch said, sitting in shorts and sleeveless T-shirt in the lobby of a hotel in the Kololi tourist strip as he awaited a bus to the airport.

Thomas Cook said in a statement Wednesday a programme of additional flights into Banjul airport would bring home the 1,000 package holidaymakers it has in The Gambia, followed by up 2,500 more at the "earliest possible flight availability".   Holidaymakers were told that Thomas Cook flights would stop completely in a few days time, leaving them at risk of being stranded.   The Dutch travel firm TUI Nederland told AFP Tuesday it would repatriate "about 800" clients.   Some tourists were unfazed by the news as the state of emergency, however, as their countries have not issued travel alerts.   "We have over two weeks left and we are staying," said Mariann Lundvall, who flew into Banjul to escape Finland's freezing winter.   "If the Finnish government decides we go, then we go," she added, but with a pained face added "the climate in Helsinki... it is so cold now!"   The panic caused by the state of emergency could prove devastating for the country's economy, which experts say relies on tourism for up to 20 percent of the economy.

- Stockpiling -
Gambians were taking precautions and stocking up on food and supplies in the few shops that remained open in districts near the capital, with roads quiet and street hawkers notably absent.   A source told AFP that patients at Banjul's Edward Francis Small Teaching Hospital, which sits opposite Jammeh's seat of power, were removed for security reasons. Only those in intensive care remained.   Fatou Sarr, a resident of the fishing community of Old Jeshwang, said: "Only a few shops had bread this morning and they ran out of stock very early. If this stalemate drags on for a week or two, the country will run out."   Citizens continue to pack their bags and stream out of Gambia -- a small, narrow enclave of Senegal except for its coast -- by road and ferry heading for Senegal, Guinea-Bissau and Guinea, taking as many possessions as they could carry.   "My two children and I are staying with my aunt. We don't know what will happen tomorrow," said a 50-year-old woman who recently took shelter in Senegal, adding that she hoped to return home soon.
Date: Wed, 18 Jan 2017 04:45:54 +0100

Banjul, Gambia, Jan 18, 2017 (AFP) - Gambia's Yahya Jammeh declared a state of emergency just days before he was due to step down, with British and Dutch travel agencies scrambling to evacuate thousands of tourists Wednesday.   Jammeh, who has ruled The Gambia with an iron fist for 22 years, initially acknowledged opponent Adama Barrow as the victor in December elections, but later rejected the ballot count as flawed and lodged a complaint with the country's Supreme Court.   He declared a state of emergency on Tuesday due to the "unprecedented and extraordinary amount of foreign interference in the December 1 presidential elections and also in the internal affairs of The Gambia," Jammeh announced on state TV.

Citizens were henceforth "banned from any acts of disobedience to the laws of The Gambia, incitement to violence and acts intended to disturb public order and peace," Jammeh said, asking security forces to maintain law and order.   Under the Gambian constitution a state of emergency lasts up to 90 days if the national assembly confirms it -- which the legislature did late Tuesday, a parliamentary source told AFP.   In Washington, the US State Department urged Jammeh to "peacefully hand over power" to Barrow -- who is in Senegal, where he plans to remain until his planned inauguration Thursday.   "Doing so would allow him to leave office with his head held high and to protect the Gambian people from potential chaos," spokesman John Kirby said. "Failure to do so will put his legacy, and more importantly The Gambia, in peril."

The 15-nation Economic Community Of West African States (ECOWAS) has also repeatedly urged Jammeh to respect the outcome of the vote and step aside, a call backed by the UN Security Council, African Union and others.   Jammeh has rebuffed two high-level delegations by west African leaders pleading with him to go.   "The potential for military intervention and civil disturbance is high," the British foreign ministry said on its website, a warning echoed on social media by its Dutch counterpart, who both urged citizens to avoid all but essential travel.   British travel agency Thomas Cook said it had "implemented our contingency plans to bring all our UK customers home," and was trying to arrange evacuation of up to 3,500 tourists from Banjul airport as soon as possible.    "We will operate a programme of additional flights into Banjul airport over the next 48 hours," the company said in a statement, adding this included four extra flights on Wednesday.   The Dutch travel firm TUI Nederland told AFP it would repatriate "about 800" clients.

- String of resignations -
Four more cabinet ministers in Jammeh's government defected, a source close to the regime told AFP on Tuesday.   Foreign minister Neneh Macdouall-Gaye, finance minister Abdou Kolley, trade minister Abdou Jobe and tourism minister Benjamin Roberts all resigned, the source said, requesting anonymity for safety reasons.   They follow the high-profile defection last week of information minister Sheriff Bojang, who is now in neighbouring Senegal.   Citizens continued to pack their bags and stream out of Gambia -- a small, narrow enclave of Senegal except for its coast -- by road and ferry heading for Senegal, Guinea-Bissau and Guinea, taking as many possessions as they could carry.   One traveller told AFP that those arriving at 10:00 am would have to wait until the following day to board a ferry at Banjul port to cross the river headed for Senegal, unless they bribed officials, due to huge numbers exiting the city.

- Military deployment? -
Military intervention in The Gambia seems closer than ever, following declarations by the UN and African Union that boots on the ground could get the green light without a rapid resolution to the crisis.   In Nigeria -- the regional power of west Africa -- a source at the country's military HQ said, "We are deploying to Dakar, Senegal, very soon."   "We are deploying platforms, a few personnel, pilots, technicians and the maintenance crew," said the source, speaking on condition of anonymity.   "You already know that this deployment is in connection with the unfolding development in The Gambia."   In Rabat, it was reported that Morocco had offered Jammeh asylum for accepting the election defeat and stepping down "in return for a golden retirement", but Banjul sources were reluctant to confirm the claim.   Seven journalists -- from Sweden and Senegal, plus four from Kenya and South Africa who were working for a Chinese TV channel -- were expelled late Monday soon after they arrived at Banjul airport to cover the ongoing crisis.
Date: Tue, 13 Dec 2016 05:39:37 +0100
By Jennifer O'MAHONY

Banjul, Gambia, Dec 13, 2016 (AFP) - The cocktails keep flowing by the pool on the tourist strip, but in The Gambia's markets many African migrant traders are packing up their businesses and heading home.   The international community is piling pressure on President Yahya Jammeh to leave power after 22 years and hand over to opposition leader Adama Barrow, who won an election two weeks ago only for Jammeh to later reverse his original concession of defeat.

Of the economy's two main sources of investment from abroad, tourism appears to be weathering the country's political storm far better than the thousands of petty traders who move to The Gambia from the rest of west Africa.   President-elect Barrow told AFP on Monday claims that tourist numbers could be hit were "exaggerated", and with hotels and restaurants full, for the moment he appears to be right.   Flights from Brussels and London are still arriving like clockwork for the peak winter sun season, with many holidaymakers telling AFP they return to the country year after year -- and aren't changing their minds.

"I did think there were more checkpoints," said Elly Preston, a returning retired schoolteacher spending three and a half months in Kololi, the Gambian heartland of full English breakfasts and karaoke bars stuffed with crooning pensioners.   Preston had seen alarming posts on the Tripadvisor tourism website, but with hotel prices as low as £40 a night (48 euros) she stuck with her instinct and left behind the cold and rain of Cleckheaton in northern England.   "I feel safe here. I know everybody and we come together," she said from her sunlounger, waving at a friend she met while on holiday here a few years ago.

Reading a thriller while taking in some rays in the late afternoon, Joseph Fowlis from Liverpool is well aware that Jammeh has refused to stand down, and supports Barrow's fight for change.   "Taxi drivers told me they want a democracy," he told AFP. "And why shouldn't they have one?"   But that hasn't affected his budget break. Apart from a higher than usual level of political conversation in the back of cabs, he said, little had changed from the previous years he has been here.   "If you didn't know about it you wouldn't think anything of it," he said.   Hotel owners are slightly more nervous, but as long as the tour operators keep the flights up, business will boom, they told AFP.

- Trader panic -
The tiny west African state relies on largely British and Scandinavian tourists for 20 percent of its GDP.   Meanwhile Guineans, Mauritanians and Senegalese are well known for importing goods and selling them to the local population.   In a recent speech, Jammeh said 100,000 foreigners were working in The Gambia's markets, but did not specify a source for that figure.   Fifteen minutes down the road from Kololi, the hawkers and fruit sellers of Serekunda market have a very different interpretation of the events unfolding.

Amadou Wurri Jallow, a Guinean shopkeeper, spoke of his fear of soldiers being stationed on the streets of his neighbourhood.   "I do not understand why soldiers armed with machine guns would be deployed every night in built-up areas of Serekunda," Jallow said.   "This is really frightening and disturbing. I am leaving for my country until this political stalemate is resolved peacefully."   Fallou Diop, a Senegalese hawker who has lived and worked in The Gambia for the past few years, told AFP shortly before his departure to the city of Touba in central Senegal that the uncertainty was too much.   "Since no one can tell how this problem would come to an end, I am going back to Touba until the dust settles," he said.
Date: Fri 14 Nov 2014
Source: StarAfrica, APA (Agence Africaine de Presse) report [edited]

The head of disease control in the Gambia, Sanna Sambou, has confirmed the reopening of the country's border to countries affected by the deadly Ebola virus, APA reported on Friday [14 Nov 2014]. Mr Sambou noted that border closure was not the best solution to contain the virus, hence the need to reopen borders to allow in and out movement of people between the Gambia and countries affected by Ebola. According to media reports, the issue of border closure, as a result of the outbreak of the disease, was deemed discriminatory and unworthy by the World Health Organisation (WHO), adding that it should be considered a global pandemic.

Despite the restoration of the border crossing, however, Sambou said the health authorities are poised to continue on the thorough screening of people moving into the country from Ebola hit nations. It could be recalled the Gambia in September [2014] announced that it would no longer be granting entrance to Guineans, Liberians, Nigerians or Sierra Leoneans, due to fear of the disease getting into the country.
More ...

World Travel News Headlines

Date: Wed, 19 Feb 2020 11:20:59 +0100 (MET)

Dhaka, Feb 19, 2020 (AFP) - Bangladesh on Wednesday kicked off a drive to vaccinate more than a million people against cholera, which infects tens of thousands a year, as part of an international campaign to eliminate transmission by 2030.   The delta nation has sought to reduce the impact of the disease -- which causes acute diarrhoea and spreads through contaminated food and water -- through vaccines and by setting up a dedicated treatment hospital.   "We have brought down the mortality rate in cholera to almost zero in Bangladesh," said senior scientist Firdausi Qadri at the Dhaka-based International Centre for Diarrhoeal Disease Research.   But she admitted that the number of infections was still very high.   According to the World Health Organisation, cholera infects about 1.3 to five million people every year, and kills an estimated 21,000 to 143,000.

Bangladesh has an estimated 100,000 cases a year, according to authorities, but plans to immunise half its 168 million people in the next decade.   Daisy Akter, who lost two sisters and a brother to cholera in the 1970s, was one of the first recipients of the oral vaccine at a Dhaka neighbourhood on Wednesday.   "No villager came to offer funeral prayers for them fearing they might get the disease," she told AFP.   "We had to bury them in the front yard of our home."   UN agencies and Bangladesh authorities have already carried out a massive cholera vaccination drive in the country's southeast, where nearly one million Rohingya refugees have lived in overcrowded camps since 2017.   Some 800,000 Rohingya and 600,000 locals were vaccinated in that campaign.
Date: Tue, 18 Feb 2020 17:16:35 +0100 (MET)

Juba, Feb 18, 2020 (AFP) - Swarms of locusts which are wreaking havoc across East Africa have now arrived in South Sudan, the government said Tuesday, threatening more misery in one of the world's most vulnerable nations.   Billions of desert locusts, some in swarms the size of Moscow, have already chomped their way through Ethiopia, Somalia, Kenya, Djibouti, Eritrea, Tanzania, Sudan and Uganda.   Their breeding has been spurred by one of the wettest rainy seasons in the region in four decades.

Experts have warned the main March-to-May cropping season is at risk. Eggs laid along the locusts' path are due to hatch and create a second wave of the insects in key agricultural areas.    The arrival of the locusts could be catastrophic in South Sudan, where war  followed by drought and floods has already left six million people -- 60 percent of the population -- facing severe hunger.   Agriculture Minister Onyoti Adigo Nyikiwec said the locusts had crossed the eastern border with Uganda on Monday.   "The report came that these are matured. As you know locusts are like human beings, they send their reconnaissance ahead of time to make sure that whether there is food or not and if the area is good for breeding."

Meshack Malo, the Food and Agriculture Organization (FAO) representative in South Sudan, said about 2,000 locusts had been spotted so far, and if not controlled quickly, could have a devastating impact.   "These are deep yellow which means that they will be here mostly looking at areas in which they will lay eggs."    He said the FAO was training locals and acquiring sprayers and chemicals to try and combat the locusts. It is the first locust invasion in 70 years in the country.   Other countries have employed aircraft to spray the swarms, while desperate locals have employed tactics like banging pots and pans or shooting at them.    Nyikiwec said the government had prepared a contingency plan.   "We are training people who will be involved in spraying and also we need chemicals for spraying and also sprayers. You will also need cars to move while spraying and then later if it becomes worse, we will need aircraft."

Earlier this month Somalia declared a national emergency over the invasion.   The FAO says the current invasion is known as an "upsurge," the term for when an entire region is affected.   However, if the invasion cannot be rolled back and spreads, it becomes known as a "plague" of locusts.   There have been six major desert locust plagues in the 1900s, the last of which was in 1987-89. The last major upsurge was in 2003-05.
Date: Tue, 18 Feb 2020 15:26:41 +0100 (MET)
By Ismail BELLAOUALI

AIT-BEN-HADDOU, Morocco, Feb 18, 2020 (AFP) - Millions worldwide may have seen the desert fortress in the hit fantasy series "Game of Thrones", but fewer know they can visit the Moroccan village of Ait-Ben-Haddou.   The fortified old settlement at the foot of the majestic Atlas mountains enchanted audiences in the HBO series and also served as a dusty backdrop in Ridley Scott's epic swords-and-sandals film "Gladiator".

But unlike other famous locations from movie and television history, this UNESCO World Heritage Site has so far missed out on a mass influx of tourism -- something some of its inhabitants are eager to change.    "Several people have told me that they came here to see the filming location of 'Game of Thrones'," said Ahmed Baabouz, a local tour guide. "There is tourism linked to cinema here but frankly we have not developed it to the extent it could be."   Ait-Ben-Haddou is southern Morocco's most famous fortress. Time seems to have stopped at the site overlooking a valley some 30 kilometres (18.6 miles) from the town of Ouarzazate.

After passing through the imposing entrance way, visitors navigate a labyrinth of winding alleys that eventually lead onto a public square where the settlement's inhabitants once gathered.    There is a mosque and two cemeteries -- one for Muslims and one for Jews. Most inhabitants have long since departed though, with a few homes converted into stalls selling handicrafts.    The fortress is an ideal film setting, located a short distance from the studios of Ouarzazate, the "Mecca" of Moroccan cinema. Productions ranging from "Lawrence of Arabia" to "The Mummy" have been filmed here.

More recently, scenes from the cult series "Game of Thrones" were shot at Ait-Ben-Haddou, with the site standing in for the fictional Yellow City of Yunkai which is conquered by Daenerys Targaryen, a key character in the "GOT" universe.   Hammadi, 61, is a privileged witness to the location's cinematic history.   "All of these productions have contributed to the reputation of the region," he said, grinning widely.    Hammadi himself has appeared as an extra in a number of films. And while like most people he lives in a more modern home in a village on the other side of the valley, he continues to return to Ait-Ben-Haddou to welcome tourists.

-'House of the Dragon' -
On a wall at the entrance to Hammadi's former home, photos bear witness to the projects he has worked on.    One shows him dressed as an ancient Roman with director Ridley Scott on the set of "Gladiator".    "We have a very rich cinematic heritage that we hope to use to attract tourists," said tour guide Baabouz, who is 29.   But "nothing indicates that 'Game of Thrones' was shot here," he added.    On Morocco's Atlantic coast, the city of Essaouira also formed the backdrop to scenes from the series.    But there too, Moroccan tourism promoters are yet to capitalise on the connection.

In comparison, Northern Ireland, Malta and Dubrovnik in Croatia have attracted hordes of fans from around the world, drawn by their links to the franchise.    To remedy this, Baabouz and other young people in the village are pooling their limited resources towards an ambitious project: a museum in the fortress, gathering photography from the productions that have been filmed here.    US channel HBO has commissioned a prequel to "GOT", called "House of the Dragon". George R.R. Martin, the author of the books on which the series is based, wrote on his blog that shooting would also take place in Morocco.
Date: Tue, 18 Feb 2020 09:44:12 +0100 (MET)

Macau, Feb 18, 2020 (AFP) - Macau's casinos will reopen Thursday after authorities lifted a city-wide two-week closure aimed at stopping the spread of the deadly new coronavirus.    The resumption of the lynchpin industry comes after the city reported no new infections in the last two weeks, with the number confirmed cases at just ten people.

The former Portuguese colony took the unprecedented step of shutting down almost all of its lucrative entertainment sector earlier in the month, including casinos, nightclubs and many bars.   The vast majority of Macau's tourists are mainland Chinese travellers, drawn to the city's casinos.

As the only place in China where casinos are allowed, Macau's gambling houses account for about 80 percent of government revenue.   But arrivals tanked as the epidemic spread.   Authorities said casinos that don't want to reopen because of low tourist numbers could apply to extend the closure, but they must be up and running within 30 days.

Macau's government has been keen to ensure the casinos keep employing staff through the downturn and are trying to avoid lay-offs.   Officials said all gamblers and casino staff must wear face masks.   First found in the city of Wuhan in central China, the new coronavirus has infected over 72,000 people on the mainland and 60 in Hong Kong.    It has also taken over 1,800 lives on the mainland and one in Hong Kong.
Date: Tue, 18 Feb 2020 09:07:42 +0100 (MET)

Athens, Feb 18, 2020 (AFP) - Greece was hit with a 24-hour strike Tuesday over a pension reform encouraging people to stay longer in the workforce.   The labour action paralysed public transport in Athens, intercity trains and ferry ship services.   Civil servants are also walking off the job and journalists will stage a three-hour work stoppage against the pension reform.   "This bill is practically the continuation of (austerity) laws introduced in 2010-2019," civil servants' union ADEDY said.

Unions will hold street protests in Athens, Thessaloniki and other major cities later in the day.   The new conservative government says the reform, to be voted by Friday, will make the troubled Greek pension system viable to 2070.   The labour ministry says the overhaul -- the third major revamp in a decade -- will contain pension increases and reduce penalties for pensioners still working.

Successive governments have attempted to reform the pension system, whose previously generous handouts are seen as one of the causes of the decade-long Greek debt crisis.   Chronic overspending and the inaccurate reporting of the budget deficit spooked creditors in 2010, and required three successive bailouts by the European Union and the International Monetary Fund to avert a Greek bankruptcy.   In return for billions of euros in rescue funds, Greece had to adopt unpopular austerity reforms and pension cuts.
Date: Tue, 18 Feb 2020 08:50:55 +0100 (MET)

Peshawar, Pakistan, Feb 18, 2020 (AFP) - A policeman was killed and two others wounded Tuesday by a roadside bomb aimed at polio vaccination workers in Pakistan's restive northwest, officials said.    The attack came a day after Islamabad launched a nationwide anti-polio drive, aiming to immunise tens of millions of children in Pakistan -- one of only three countries, along with Afghanistan and Nigeria, where the crippling disease remains endemic.

Opposition to inoculations grew after the CIA organised a fake vaccination drive to help track down Al-Qaeda's former leader Osama Bin Laden in the Pakistani city of Abbottabad.   According to Captain Wahid Mehmood, a district police chief, a police van monitoring the polio team was hit on the outskirts of the north-western city of Dera Ismail Khan.   "It was an IED (improvised explosive device) explosion in which one of our policemen got martyred while two others were wounded", Mehmood told AFP.   Sadaqat Khan, a local police official, confirmed the toll.   There was no immediate claim of responsibility, but the Pakistani Taliban and other militants have targeted polio vaccinators in the past.

The nationwide polio vaccination campaign aims to vaccinate some 39 million children.  Tuesday's attack follows a devastating year in Pakistan's long fight against polio, with at least 17 cases reported in 2020 so far.   In 2019, the number of polio cases jumped to 144 from just 12 in 2018.

Even as Pakistan has tried to eliminate polio, a new challenge has emerged in the form of a growing global movement against vaccinations.   The phenomenon has attracted adherents worldwide, fuelled by medically baseless claims and proliferated on social media resulting in a resurgence of once-eradicated, highly contagious diseases.
Date: Mon, 17 Feb 2020 21:19:05 +0100 (MET)
By Joe JACKSON

London, Feb 17, 2020 (AFP) - Britain on Monday battled the fallout from Storm Dennis after the second severe storm in seven days left one woman dead over the weekend.   Winds of more than 90 miles (140 kilometres) an hour, along with more than a month's worth of rain in 48 hours in some places, led officials to issue rare "danger to life" warnings.   A 55-year-old woman was found dead after being swept away by near the flood-prone town of Tenbury Wells in western England.   "We are all devastated," her family said in a statement after a body was discovered.

James Bevan, chief executive of the Environment Agency, which is responsible for flood protection, said more than 400 homes in England had been flooded while at least 1,000 agency staff were working "to protect and support those communities which have been hit".   "This is not yet over," he told BBC radio.   "We still have many flood warnings in force and we may still see significant flooding in the middle of this week from larger rivers."   The storm also pummelled much of France, with some 20,000 people without electricity on Monday after suffering power cuts in the northwest.

- 'More extreme' -
In Britain, more than 600 warnings and alerts -- a record number -- were issued on Sunday, extending from the River Tweed on the border of England and Scotland to Cornwall in the southwest.   After a day of torrential rain, major flooding incidents were declared in south Wales and parts of west central England.  In northern England, the defence ministry deployed troops in West Yorkshire, which had also been hit by flooding from last weekend's Storm Ciara.   There were fears that rivers there could burst their banks.

Newly appointed environment secretary George Eustice said the government had done "everything that we can do with a significant sum of money" to combat increased flooding.    "We'll never be able to protect every single household just because of the nature of climate change and the fact that these weather events are becoming more extreme," he said.   Youth climate activists gathering for a national conference in Staffordshire, west central England, were forced to cancel the event because of the storm.   "There's a bleak irony in our being beaten back by climate change," 15-year-old attendee Sophia said in a statement released by organisers.

- 'Supercomputer' announced -
Two rivers in south Wales burst their banks on Sunday, prompting rescue workers to launch operations to evacuate hundreds of people and their pets trapped in their homes.   Police said a man in his 60s died after entering the River Tawe, north of the Welsh city of Swansea, but later clarified that the death was not "linked to the adverse weather".

Meanwhile the bodies of two men were pulled from rough seas off the south coast of England on Saturday as the storm barrelled in.   Britain's Coastguard said it had sent a helicopter and rescue team to join navy and other search vessels after receiving reports of a man overboard in the sea near Margate, Kent.   "After many hours of searching, a body was sadly found in the water... and was brought to shore," it added.

Around the same time in nearby Herne Bay, emergency responders discovered another dead man following reports a person had been pulled from the sea, according to Kent police.   In a timely announcement the Met Office, Britain's national weather service, said Monday it would invest £1.2 billion ($1.6 billion) in a state-of-the-art supercomputer to improve forecasting.   The government claims it is the world's "most powerful weather and climate supercomputer".
Date: Sun 16 Feb 2020, 5:00 PM
Source: WHO, Weekly Bulletin on Outbreaks and Other Emergencies, page 9 [abridged, edited]

During week 4 [week ending 26 Jan 2020], a total of 73 suspected cases including one death were reported across the country, compared to 46 suspected cases and no deaths in the previous week. The majority of cases in week 4 were reported from Sankuru province (78%).

In the past 4 weeks (weeks 1 to 4 of 2020) a total of 222 suspected cases with 4 deaths (CFR: 1.8%) were notified in the country, with the majority of cases being reported from the provinces of Sankuru (31%), Bas-Uele (18%), Equateur (15%) and Mai-Ndombe (9%). There has been an increase in the weekly case incidence since week 2 of 2020.

Between weeks 1 and 52 of 2019 a cumulative total of 5288 monkeypox cases, including 107 deaths (CFR 2%) were reported from 133 health zones in 19 provinces.
======================
[Monkeypox (MPX) virus is endemic and widespread geographically in the DR Congo, with cases occurring sporadically in several provinces. January 2020 is off to a similar start with 222 suspected cases and 4 deaths reported in 4 provinces. The 2% CFR is relatively low for the clade of MPX that occurs in the DRC, which can reach 10% or more. The 222 cases are suspected, and there is the possibility that without laboratory confirmation some of them may be varicella cases misdiagnosed as MPX. There is no additional information about the circumstances under which these cases acquired their infection. Monkeys are not the reservoirs of the virus, despite the name that the virus has received. Studies of prevalence of MPX virus in populations of rodent hosts are not mentioned in this or previous reports. The main reservoirs of MPX virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp., an arboreal rodent) and terrestrial rodents in the genera _Cricetomys_ and _Graphiurus_. Halting the bushmeat trade and consumption of wild animals to halt MPX virus exposure will be culturally and economically difficult, so continued occurrence of cases can be expected. MPX virus can be transmitted between people but not readily. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Fri 31 Jan 2020
Source: Nigeria CDC Situation report, yellow fever [edited]

Highlights
----------
In this reporting period:
- A total of 139 suspected cases were reported in 90 LGAs across 27 states
- All 139 suspected cases had blood samples collected
- 2 presumptive positive and 1 inconclusive case were reported; the inconclusive case was reported from Katsina State
- No confirmed case was recorded from Institute Pasteur Dakar
- No death was recorded from all the cases reported

Yellow fever response activities are being coordinated by the multi-agency yellow fever Technical Working Group (YF TWG).

Off-site support is being provided to all states.

Yellow fever preventive mass vaccination (PMVC) campaigns are planned for implementation in Oyo, Delta, Benue, Osun, Bauchi and Borno in the 3rd and 4th quarters.

Graphs and a map accessible at the above URL;
Figure 1 [graph]: Epidemic Curve of All Cases of Yellow Fever in Nigeria from Week 1 - Week 5, 31 Jan 2020
Figure 2 [graph]: Trends of Confirmed Cases in Nigeria - 2018, 2019 and January 2020
Figure 3 [graph]: Yellow fever Attack rate by State in Nigeria from Week 1 - Week 5, 31 Jan 2020
Figure 4: Map of Nigeria Showing States with Suspected and Presumptive confirmed Cases from Week 1 - Week 5, 31 Jan 2020
====================
[This report is not clear about the number of confirmed yellow fever (YF) cases that there have been in Nigeria this year (2020). The above report indicates that there are 139 suspected cases and all have had blood samples taken but does not state if all samples have been tested for YF by the Institute Pasteur in Dakar. The report does state that no confirmed case was recorded by the Institute Pasteur Dakar. The report states that 2 cases are presumptive and 1 is inconclusive. The graph in Figure 2 shows no confirmed cases in 2020.

It is curious that a 19 Jan 2020 report indicated that there were 141 suspected yellow fever cases in Jos North, Wase, Bassa, Kanam and Riyom Local Governments of Plateau State, of which 25 cases had been confirmed (see Yellow fever - Africa (02): Nigeria (PL) http://promedmail.org/post/20200121.6903167). A 29 Dec 2019 The World Health Organization (WHO) report confirmed 13 cases of yellow fever (YF), with 3 deaths in 4 local government areas of Plateau State (see Yellow fever - Africa (01): Nigeria (PL) http://promedmail.org/post/20200101.6862783). It is possible that all of these Plateau state cases occurred in 2019 and, hence, are not included in the above 2020 report which does not mention any cases in Plateau state. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Sat 15 Feb 2020 2:34:10 PM AFT
Source: MENAFN, Afghanistan Times News report [edited]

At least 35 people including women and children have died in the past few weeks due to pneumonia outbreak in Badakhshan Province in the north-western mountainous area, the provincial health department confirmed.

Dr Noor Khawari, head of the provincial public health department, said [Sat 15 Feb 2020] that the people had died in the Wakhan district, a remote area surrounded by high and impassable mountains.

He said that 15 of the dead were children, calling malnutrition and cold weather as the main reasons for the fatalities. A medical team had been dispatched to Wakhan to prevent further outbreak of the disease, according to Dr Khawari.

The provincial council had earlier said that at least 10 people had lost their lives since an unknown disease had broken out in the Yomgan district [Badakhshan Province].

The report caused panic and concerns among the residents as coronavirus [infection, COVID-19] in China that borders Badakhshan takes the lives of people every day.

But the ministry of public health denied outbreak of any unknown disease in Badakhshan, saying that the recent deaths happened only due to pneumonia and pertussis (whooping cough) as well as malnutrition. Badakhshan is one of the provinces where seasonal diseases like pneumonia and whooping cough break out during winter. The diseases claim the lives of people in the remote areas behind high mountains as the roads connecting them to the provincial capital are blocked by heavy snowfalls.

The provincial health department has deployed medical teams to the borders with China and Tajikistan to examine those entering from the neighbouring states and to prevent coronavirus [infection, COVID-9].
===========================
[We are told in the news report above that at least 35 people, including 15 children, died in the past few weeks due to a "pneumonia" outbreak in Wakhan district, a remote area surrounded by high and impassable mountains, with a population of about 14 000 residents. Wakhan is a narrow strip about 350 km (220 mi) long and 13-65 km (8-40 mi) wide that extends from Badakhshan Province in Afghanistan in the west to Xinjiang Autonomous Region in China in the east, separating the Pamir Mountains and Tajikistan to the north and the Karakoram Mountains and Pakistan to the south  (<https://en.wikipedia.org/wiki/Wakhan_Corridor>).

A trade route through this valley has been used by travellers since antiquity
(<https://caravanistan.com/afghanistan/wakhan-corridor/>).

A map of this region can be found at

The local residents are concerned that the novel coronavirus infection, COVID-19, may be the cause of the outbreak of pneumonia in Wakhan district. There are about 70 500 total cases of COVID-19 in China, mainly concentrated in Hubei Province in Central China.

Although Xinjiang in Western China has reportedly 75 confirmed cases of COVID-19 and 1 death (assessed 16 Feb 2020 at 9:43 PM EST) (<https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6>), spread of COVID-19 to this very remote region in Afghanistan, that is easily cut off from the rest of the world especially in winter, seems unlikely. Also, 43% of deaths (15/35) occurred in children, which would be unusual for COVID-19. However, we are not told the clinical presentation of the illness, nor how a diagnosis of "pneumonia" was made in this undeveloped region. Other diagnoses, such as influenza, are also possible. More information from knowledgeable sources would be appreciated. - ProMED Mod.ML]

[Maps of Afghanistan: