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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 ...

Denmark

Denmark, Greenland and the Faeroe Islands US Consular Information Sheet
March 05, 2008
COUNTRY DESCRIPTION:
Denmark is a highly developed stable democracy with a modern economy.
Greenland is a self-governing dependency of Denmark.
>The Faroe Islands are a self-governing overseas administrative division of Denmark.
For additional information, visit the State Department page http://www.state.gov/p/eur/ci/da.

ENTRY REQUIREMENTS:
Passport and visa regulations are similar for Denmark, Greenland, and the Faroes.
A valid passport is required.
U.S. citizen tourist and business travelers do not need visas for visits of up to 90 days.
That period begins when entering any of the following countries which are parties to the Schengen agreement: Austria, Belgium, The Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, and Sweden.
Contact the Royal Danish Embassy at 3200 Whitehaven Street NW, Washington, DC
20008, telephone (202) 234-4300 or visit its web site at http://www.ambwashington.um.dk/en for the most current visa information.

Note:
Although European Union regulations require that non-EU visitors obtain a stamp in their passports 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 passports 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 about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
Denmark remains largely free of terrorist incidents, however, the country shares, with the rest of Western Europe, an increased threat of Islamic terrorism.
Like other countries in the Schengen area, Denmark’s open borders with its Western European neighbors allow the possibility of terrorist groups entering and exiting the country with anonymity.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

Public demonstrations occasionally occur in Copenhagen and other Danish cities and are generally peaceful events.
Prior police approval is required for public demonstrations, and police oversight is routinely provided to ensure adequate security for participants and passers-by.
Nonetheless, as with any large crowd comprised of diverse groups, situations may develop which could pose a threat to public safety.
U.S. citizens are advised to avoid areas where public demonstrations are taking place.

From time to time Copenhagen may experience protest activities from young people in their attempt to defend their self-proclaimed rights to either property (club activity buildings) or other privileges provided by Danish public means.
American citizens should be aware that participation in illegal demonstrations or street riots may result in immediate imprisonment and long term bans on re-entering Denmark.

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, 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 United States, or, for callers outside the United States 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:
Denmark, Greenland, and the Faroes all have relatively low violent crime rates, however, non-violent crimes of opportunity have increased over the last few years, especially in Copenhagen and other major Danish cities, where tourists can become targets for pickpockets and sophisticated thieves.
Criminals frequent airports, train stations, and cruise ship quays to take advantage of weary, luggage-burdened travelers.
Thieves also operate at popular tourist attractions, shopping streets, and restaurants.
In hotel lobbies and breakfast areas, thieves take advantage of even a brief lapse in attention to snatch jackets, purses, and backpacks.
Women’s purses placed either on the backs of chairs or on the floor are typical targets for thieves.
Due to the increase of crimes of opportunity, Embassy Copenhagen has experienced a high rise in passport thefts during the summer of 2007.
Car and home break-ins are also on the rise.

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

Denmark has a program to provide financial compensation to victims who suffer serious criminal injuries.
According to existing regulations, the victim must report the incident to the police within 24 hours.
Danish police routinely inform victims of serious crime of their rights to seek compensation.
The relevant forms can be obtained from the police or the Danish Victims’ Compensation Board:
Civilstyrelsen, Erstatningsnaevnet, Gyldenløvesgade 11, 1600 Copenhagen V, TEL:
(45) 33-92- 3334; FAX:
(45) 39-20-45-05; www.erstatningsnaevnet.dk; email: erstatningsnaevnet@erstatningsnaevnet.dk.
Claim processing time is a minimum of 3 months.
There is no maximum award limit.

See our information for Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Excellent medical facilities are widely available in Denmark.
In Greenland and the Faroe Islands, medical facilities are limited and evacuation is required for serious illness or injury.
Although emergency medical treatment is free of charge, the patient is charged for follow-up care.

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

A valid U.S. driver's license may be used while visiting Denmark, but the driver must be at least 18 years old.
Driving in Denmark is on the right side of the road.
Road signs use standard international symbols.
Many urban streets have traffic lanes reserved for public transport only.
Unless otherwise noted on traffic signs, the speed limit is 50 km/h in urban areas, 80 km/h on open roads, and 130 km/h on expressways.

Use of seat belts is mandatory for drivers and all passengers.
Children under three years of age must be secured with approved safety equipment appropriate to the child's age, size, and weight.
Children from three to six years of age may use approved child or booster seats instead of seat belts.

Driving under the influence of alcohol or drugs is considered a very serious offense.
The rules are stringently enforced, and violations can result in stiff fines and possible jail sentences.

Copenhagen, the capital and largest city in Denmark, has an extensive and efficient public transportation system.
Trains and buses connect Copenhagen with other major cities in Denmark and to Norway, Sweden, and Germany.
Bicycles are also a common mode of transportation in Denmark.
Passengers exiting public or tourist buses, as well as tourists driving rental cars, should watch for bicycles on their designated paths, which are usually located between the pedestrian sidewalks and the traffic lanes.

Danish expressways, highways, and secondary roads are of high quality and connect all areas of the country.
It is possible to drive from the northern tip of Denmark to the German border in the south in just four hours.
Greenland has no established road system, and domestic travel is performed by foot, boat, or by air.
The majority of the Faroe Islands are connected by bridges or serviced by boat.
Although the largest islands have roads, most domestic travel is done on foot, horseback, boat, or by air.

The emergency telephone number for police/fire/ambulance in Denmark and the Faroe Islands is 112.
In Greenland contact the local police.

Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://www.denmark.org.
See also additional information on driving in Denmark at http://www.trafikken.dk/trafikken.asp?page=company&objno=7.

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

SPECIAL CIRCUMSTANCES:
The official unit of currency in Denmark is the Danish krone.
ATM machines are widely available throughout Denmark.
Please see our information on customs regulations.

For information concerning the importation of pets into Denmark, please visit the following website:
http://www.foedevarestyrelsen.dk.

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

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Denmark are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov, and to obtain updated information on travel and security within Denmark.
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 Dag Hammarskjolds Alle 24; 2100 Copenhagen, telephone: (45) 33-41-71-00; Embassy fax: (45) 35-43-02-23; Consular Section fax: (45) 35-38-96-16; After-hours emergency telephone: (45) 35-55-92-70.
Information is also available via the U.S. Embassy’s web site at http://denmark.usembassy.gov/.
The United States has no consular presence in Greenland or the Faroe Islands.
* * *
This replaces the Consular Information Sheet dated August 23, 2007 to update the sections on Entry Requirements and Information for Victims of Crime.

Travel News Headlines WORLD NEWS

Date: Sat 5 Jan 2020
Source: Food Safety News [edited]

Several people part of a _Salmonella_ outbreak in Denmark tasted or ate raw or undercooked sausage, according to a recently published study. In November 2018, an outbreak of monophasic _Salmonella_ Typhimurium was detected. It sickened at least 49 people across the country.

A traditional form of raw Danish pork sausage called medister sausage was believed to be the source of illnesses. Product samples were negative for _Salmonella_, and investigations at the production site did not reveal the source of contamination. Medister sausage is often served in the late autumn months and Christmas season. It is a long, thick sausage made from ground pork, seasoned and stuffed into casings. Due to a control program, _Salmonella_ Enteritidis is all but eliminated in Danish broiler poultry and egg production, but _Salmonella_ Typhimurium still exists in pigs and pork.

In mid-November 2018, Statens Serum Institut (SSI) noted 8 cases of monophasic _Salmonella_ Typhimurium belonging to the same WGS cluster. The sequence type (ST) 5296 had not been detected before but was closely related to ST 34, which is often found in pork products.

In 8 initial hypothesis-generating interviews, 7 people said they had eaten a certain type of classic Danish raw pork sausage known as medister sausage, according to a study published in the journal Epidemiology and Infection. The median age was 65 years with a range from 11 months to 97 years, and 53 percent were male. Seven of 49 cases were children less than 18 years of age. 30 people were hospitalized, and 13 reported bloody diarrhea as one of the symptoms. There were no deaths. The onset date of illness was known for 38 of 49 patients and was between 14 Oct 2018, and 17 Jan 2019.

Almost all interviewed patients had eaten fresh pork, and 28 of them ate medister sausage in the week prior to becoming ill with Salmonella. Six patients said they had partly eaten the medister sausage raw or undercooked. Five people said they had failed to boil it prior to frying as is normally recommended on packages and by the Danish Veterinary and Food Administration (DVFA). In one family, a child had eaten medister sausage that was not thoroughly cooked.

"Consumers have to make sure that pork is handled correctly, in particular when it comes to raw products that need to be thoroughly cooked before consumption. Tasting raw meat or eating undercooked pork meat should be discouraged," said researchers.

Traceback investigations pointed to one manufacturer of minced meat and prepared meat products. A total of 90 batches of ground meat and of prepared meat, including 9 batches of medister sausage, were analyzed for _Salmonella_. Only one sample from a batch of minced pork patty sampled in January 2019 found _Salmonella_, but it was not related to the outbreak strain. Medister sausages were packed at the production site, and no handling of the sausage took place at supermarket level.

"No breaches in procedures or obvious incidents that could explain the presence of a specific type of _Salmonella_ in multiple batches of medister sausage in a prolonged period of several weeks were identified," according to researchers. The DVFA also investigated results of routine sampling at the slaughterhouse providing meat to the manufacturer. As part of mandatory sampling, one of every 1000 carcasses were swap sampled and analyzed for _Salmonella_. It was detected 8 times in these samples, but none were identical to the outbreak strain.

Because shelf life of medister sausage is short, and fresh meat is used for production, none of the raw material meat used to produce the batches suspected of having caused illness was available from the manufacturer by the time the outbreak was detected and investigation started. Researchers said it was likely the bacteria might be present in low numbers and unevenly distributed in the raw material, so the chance of detecting it at sampling might be limited. High fat content may also increase thermal resistance of bacteria so they are not fully eliminated by heating. "It is also likely that only a low _Salmonella_ dose is sufficient for patients to become ill, as medister sausage is a product with a high content of fat (10 to 20 percent) that protects the bacteria past the barrier of the gastric acid."

Samples of medister sausage from more manufacturers, as part of routine surveillance and companies own checks, were positive for Salmonella during the outbreak period. This includes finding the serovars Mbandaka, Typhimurium, and its monophasic variant, which was different from the outbreak strain.  [Byline: Joe Whitworth]
===================
[By monophasic, it is meant that the organism does not have the
complete set of flagellar serotypes. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Thu 24 Oct 2019
Source: Eurosurveillance 2019, 24(43) [edited]

[ref: Agergaard CN, Rosenstierne MW, Boedker R, et al. New tick-borne encephalitis virus hot spot in Northern Zealand, Denmark, October 2019. Euro Surveill. 2019; 24(43): pii=1900639]
---------------------------------------------------------------------
Abstract
--------
Tickborne encephalitis virus (TBEV), a member of the family Flaviviridae, genus _Flavivirus_, causes tickborne encephalitis (TBE). In Denmark, TBE is endemic only on the island of Bornholm, with an incidence of 4 per 100 000 inhabitants per year [1,2]. Here we report 3 clinical cases of TBE in patients hospitalised within a month [June/July 2019] and all residing at the boundary of the same forest, Tisvilde Hegn [Capital Region], in Northern Zealand.

Discussion
----------
The incidence of TBE has been increasing in Denmark, in its neighbouring countries as well and in the rest of Europe in recent years, which mirrors the increased abundance of ticks, the increased geographic spread and potentially climate changes [8-11]. The vector for the European virus subtype, TBEV-Eu, is _Ixodes ricinus_, which is prevalent in most of Europe and the dominant tick species in Denmark (greater than 90%) [12]. In 2009, 2 clinical cases of TBE were reported outside Bornholm and TBEV was detected in Northern Zealand in ticks collected in the forest of Tokkekebb Hegn, which is 40 km [25 mi] south east of Tisvilde Hegn, in 2009, 2010, and 2011 [4,5]. Surprisingly, TBEV was no longer detected in the same area in Tokkekoeb Hegn during 2016 and 2017 [13]. In 2018, another 2 human cases of TBE outside Bornholm were identified on the Island of Funen and in Jutland, respectively, but no new micro foci of TBEV has been localized [14], (data not shown).

All 3 patients presented here live close to Tisvilde Hegn in Northern Zealand, and had typical biphasic disease starting with fever, gastrointestinal or influenza-like symptoms and fatigue, followed by a few days of recovery before clinical meningitis/meningoencephalitis at hospitalisation and neurologic sequelae in terms of primarily fatigue and dizziness.

Subsequent collection of _I. ricinus_ ticks from a part of Tisvilde Hegn surrounding a well-visited forest playground, where Case 3 recalled a tick bite, identified a specific area adjacent to the playground to be an acute, new, high-risk TBEV micro-focus in Northern Zealand. The estimated high prevalence of TBEV is 8% at the centre of the focus which exceeds recent prevalence estimates of 0.6% from endemic Bornholm, as well as Denmark's neighbouring countries and most European countries [4,5,8,10,11,13,15]. The presence of the virus in nymphs, but not adult ticks, and the molecular evolutionary analyses of the homogeneous TBEV sequences suggests a single TBEV introduction in 2019, probably by migrating birds from Norway. Tisvilde Hegn and the forest playground is well-visited by Danish and international tourists, and containment measures such as fencing, grass cutting and signage along the playground's eastern side have been made in order to minimise the risk of further infections and spreading.
====================
[The complete article including figures, tables, and references is available at the source URL above.  There were previous reports of human cases TBE virus infection in Denmark in 2009 and again in 2018. The authors note that TBE virus was not found in ticks in the area in 2016 and 2018, nor were any human cases identified there then. They speculate that the virus was introduced by ticks on migratory birds.

TBE is caused by 3 different subtypes of tick borne encephalitis virus: Western European TBE virus, Far Eastern TBE virus, and Siberian TBE virus. Western European TBE (also known as Central European encephalitis) is endemic in western and central European countries and is expanding its range. - ProMED Mod.TY]

Date: Fri 26 Jul 2019
Source: Food Safety News [edited]
<https://www.foodsafetynews.com/2019/07/wgs-project-helps-denmark-uncover-campylobacter-outbreak/>

Fifty people are ill in Denmark from campylobacteriosis after eating chicken meat but authorities believe the actual number of patients may be much higher. Statens Serum Institut (SSI), Danish Veterinary and Food Administration (Fødevarestyrelsen) and DTU Food -- National Food Institute are investigating the _Campylobacter jejuni_ outbreak. _Campylobacter_ is the main cause of bacterial intestinal infections in Denmark and more than 4500 cases were registered in 2018. The same type of _Campylobacter_, sequence type 122, identified in patients by whole genome sequencing has also been found in chicken meat from one slaughterhouse, named as HKScan in Vinderup, a town in North-western Jutland.

HKScan is a Nordic meat and meals company employing more than 600 people in Denmark at production units in Vinderup and Skovsgaard. The Danish Veterinary and Food Administration is continuing to investigate and officials have been sent to help the company track and eliminate the source of infection. Those sick are 20 women and 30 men aged 14 to 87 with a median age of 49 years. As part of a project this year [2019] involving the Clinical Microbiology Department (KMA) in Aalborg, the Danish Veterinary and Food Administration and SSI; _Campylobacter_ isolates from patients diagnosed in Aalborg since March 2019 have been collected, sent to SSI and whole genome sequenced. _Campylobacter_ isolates are not routinely submitted and sequenced so the outbreak has been detected due to the project and may otherwise have gone unnoticed. In the past it has been difficult to detect and solve such outbreaks.

Some isolates also come from other KMA's as part of the Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP) project. Steen Ethelberg, a senior scientist at SSI, said patients have fallen sick over a couple of months and are still being reported. "The most recent estimate for how many more cases are in the population relative to the diagnosed laboratory controlled cases is a factor of 12 so there would be more cases that are actually ill in any outbreak," he told Food Safety News. "The reason we know about this outbreak is because we are running a project in one part of the country where all the patient isolates are being collected and subjected to whole genome sequencing.

Since the outbreak is mainly based on one of the 10 labs only you would expect patients all over the country. It seems likely that there could be more cases and we also have some smaller clusters detected in the project." Ethelberg said the project is trying to see how WGS may be helpful in understanding _Campylobacter_. "It is about collecting patient isolates from one lab and at the same time analysing chicken meat and subjecting the _Campylobacter_ isolates in chicken meat to WGS and then comparing the sequences. In the project we are learning about the aetiology of _Campylobacter_ but we also see outbreaks in real time.

This outbreak is big enough that we thought it should be reported to the public but in a sense it is not so different because we know many people are ill from _Campylobacter_ from poultry products." The Danish Veterinary and Food Administration has been taking samples for _Campylobacter_ of various cuts of chicken from different stores and these have been sequenced. Annette Perge, from the agency, told Food Safety News that it was still too early to conclude the outbreak was over. "The slaughterhouse produces both fresh and frozen products hence we can't rule out that products may still be on the market or bought and stored frozen at private households.

Based on patient interviews it has not been possible to point out specific products, places of purchase, or periods of purchase," she said. "Furthermore there is no legal requirements stating that _Campylobacter_ is prohibited in poultry meat. However even without legal requirements foods used as intended should not result in illness. The slaughterhouse is a large establishment and their products are sold at all the major Danish retail chains." The agency does not yet know if a link was limited to one farm or establishment, according to Perge. "The link between food isolates and routine samples taken at the slaughterhouse, samples of thigh skin from chickens taken routinely for analyses, and the patient isolates was seen when comparing whole genome sequencing results.

However it has not been possible to verify the link through interview with patients. We have no indication that this outbreak is due to a contamination persisting in the slaughterhouse. They have been allowed to continue production. They are assisting us in any way possible to solve the case." Perge said samples from chickens from a specific farm showed a close resemblance to the patients. "The farm has been visited by the audit team from the slaughterhouse and corrections to practices have been made. At the moment no chickens are delivered for slaughter as they are not yet old enough. Meat from chickens slaughtered from that farm will be tested for _Campylobacter_ and eventual isolates will be sequenced and compared to the outbreak strain. If the meat contains larger numbers of _Campylobacter_, the use of the meat will be restricted." [Byline: Joe Whitworth]
========================
[The source of the outbreak may we'll be chicken, a common vehicle for this enteric pathogen. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Denmark:
<http://healthmap.org/promed/p/111>]
Date: Tue 28 May 2019
Source: Food Safety News [edited]
<https://www.foodsafetynews.com/2019/05/ongoing-yersinia-outbreak-traced-to-fresh-spinach-more-than-50-sick/>

An outbreak of yersiniosis in Denmark and Sweden with more than 50 cases has been linked to fresh spinach. Statens Serum Institut, a public health research institute in Denmark, reports 20 people have been infected in the country. One person needed hospital treatment. The Public Health Agency of Sweden has recorded 37 confirmed cases. In March 2019, 20 cases of _Yersinia enterocolitica_ [infection] were found in Denmark. There were 11 women and 9 men aged 2 to 74 years old, with most cases aged 20 to 30. Patients were distributed throughout Denmark in Hovedstaden, Sjaelland, Syddanmark, Midtjylland, and Nordjylland.

The link to spinach was based on a case control study and the traceback investigation, which indicated spinach from Italy was responsible. In March 2019, most fresh spinach in Denmark comes from Spain or Italy. No specific batch of product was found to be the source of the outbreak and no product testing was conducted. After interviews with patients, Statens Serum Institut did a study in which healthy people of the same gender and age, and who lived in the same municipality as those sick, were asked if they had eaten certain foods that many of the yersiniosis patients ate. The study showed patients had consumed fresh spinach to a far greater extent than the control people.

The investigation found spinach was bought in Netto and a supermarket chain in Sweden. Danish officials said the implicated product is no longer on the market because the country had not seen any cases since March 2019 and given duration of the outbreak it was likely only one batch that was contaminated. The cause of the outbreak was _Yersinia enterocolitica_ serotype O3, biotype 4. Whole genome sequencing found all patients were infected with the same bacterial strain. "Although the outbreak is over, we can use this knowledge to prevent it from happening again. It is also a good reason to remind consumers that leafy greens always must be washed thoroughly before eating," said Luise Müller, an epidemiologist from Statens Serum Institut.

Denmark sees about 400 _Yersinia enterocolitica_ cases a year, with 366 having been reported in 2018. In Sweden, the increase in _Yersinia_ infections started in March [2019] and the 37 cases were from across the country. 7 men and 20 women with an age range from 6 to 62 years fell ill. Swedish officials said they were not able to analyse food samples since no case had spinach left at home and their case-control study did not identify a specific food item. Infection with yersinia is relatively rare in Sweden, with between 200 to 300 cases reported annually. Previous outbreaks have been caused by raw or undercooked meat consumption and contaminated ready-to-eat vegetables.

After an incubation period of 3 to 7 days, symptoms includes fever, diarrhoea, and abdominal pain in the right lower part of the abdomen. [byline: Joe Whitworth]
========================
[It is not specifically stated whether the strains in Denmark and Sweden are genetically related. The 2 species of _Yersinia_ associated with foodborne disease are _pseudotuberculosis_ and _enterocolitica_. The latter species can be associated with abdominal pain as a hallmark symptom. As a mesenteric lymphadenitis, yersiniosis can mimic appendicitis but may also cause infections of other sites, such as wounds, joints, and the urinary tract.

As noted in the FDA "Bad Bug Book" (<https://wayback.archive-it.org/7993/20170406190140/https://www.fda.gov/Food/FoodborneIllnessContaminants/CausesOfIllnessBadBugBook/ucm070040.htm>, "Strains of _Y. enterocolitica_ can be found in meats (pork, beef, lamb, etc.), oysters, fish, and raw milk.

The exact cause of the food contamination is unknown. However, the prevalence of this organism in soil, water, and animals, such as beavers, pigs, and squirrels, offers ample opportunities for it to enter our food supply. Poor sanitation and improper sterilization techniques by food handlers, including improper storage, cannot be overlooked as contributing to contamination." In addition, some strains of these organisms can be associated with blood transfusion-associated illnesses due to an ability to grow at refrigerator temperatures. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps:
Denmark: <http://healthmap.org/promed/p/111>
Sweden: <http://healthmap.org/promed/p/108>]
Date: Wed 2 May 2019
Source: CPH Post [edited]

A bacterial infection found in the intestines of many animals and common in pigs, _Yersinia enterocolitica_, has been found in 18 Danes since 30 Mar 2019. So far, 10 women and 8 men aged 2-74 from all over Denmark have been diagnosed with the rare infection, reported BT.  "Right now, we have an outbreak of the bacterium _Yersinia enterocolitica_. It is a disease like salmonella that typically infects people via food," said Luise Muller from the State Serum Institute (SSI).

The disease is not common in Denmark. Over the last 5 years, there have only been 3 outbreaks. SSI is trying to localise the source of the infection by looking for common threads in the infected people's diet.

Typical symptoms are generally feeling under the weather, violent stomach pains, fever, and diarrhoea. The incubation period is usually 3-7 days. "The best advice we can give people is to cook meat thoroughly and wash fruit and vegetables carefully," said Muller.

Sweden has seen a similar outbreak, and the Danish and Swedish authorities are working together to map the infection.

In the 1980s, the infection used to be just as common as salmonellosis and campylobacteriosis, but it has become rarer nowadays. In 2014 there were 414 registered cases.  [Byline: Stephen Gadd]
==========================
[The 2 species of _Yersinia_ associated with food-borne disease are _pseudotuberculosis_ and _enterocolitica_. The latter species can be associated with abdominal pain as a hallmark symptom. As a mesenteric lymphadenitis, yersiniosis can mimic appendicitis but may also cause infections of other sites, such as wounds, joints, and the urinary tract.

As noted in the FDA "Bad Bug Book" (<https://wayback.archive-it.org/7993/20170406190140/https://www.fda.gov/Food/FoodborneIllnessContaminants/CausesOfIllnessBadBugBook/ucm070040.htm>), "Strains of _Y. enterocolitica_ can be found in meats (pork, beef, lamb, etc.), oysters, fish, and raw milk. The exact cause of the food contamination is unknown. However, the prevalence of this organism in soil, water, and animals, such as beavers, pigs, and squirrels, offers ample opportunities for it to enter our food supply. Poor sanitation and improper sterilization techniques by food handlers, including improper storage, cannot be overlooked as contributing to contamination."

Additionally, some strains of these organisms can be associated with blood transfusion-associated illnesses due to an ability to grow at refrigerator temperatures. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
More ...

Belarus

Belarus - US Consular Information Sheet
November 25, 2008
COUNTRY DESCRIPTION:
Belarus became an independent republic in 1991, after the breakup of the Soviet Union.
In 1996, a constitutional referendum, not recognized by the internat
onal community, centralized power in the executive branch (president), headed by Alyaksandr Lukashenka.
Economic and political reform in Belarus has stalled or is being reversed under his authoritarian government.
The Belarusian Government’s human rights record remains very poor.
President Lukashenka gained a third five-year term as president in March 2006, in an election that international observers judged to be seriously flawed.
Democratic nations, including the United States and the members of the European Union, condemned the subsequent governmental crackdown on peaceful protests in Minsk, and imposed visa restrictions and other sanctions on senior Belarusian officials. As a result of the release of political prisoners in August 2008, the EU lifted its visa restrictions, but those of the United States remain in effect.
Both Belarusian and Russian are official languages, and Russian is widely spoken throughout the country, particularly in the cities.
Tourist facilities are not highly developed, but food and lodging in the capital and some regional centers are adequate.
Read the Department of State Background Notes on Belarus for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
Travelers must obtain a visa in advance to visit or transit through Belarus.
Travelers who do not have a visa cannot register at hotels.
U.S. citizens visiting or residing in Belarus are required to register with the local office of the Citizenship and Migration Department of the Ministry of Interior (formerly OVIR) within three business days after arrival.
The registration fee is one National Minimum Tariff Unit (currently about $17).
Failure to register can result in fines and difficulties when departing.
U.S. citizens staying in hotels are automatically registered at check-in.
Visa validity dates are strictly enforced; travelers should request visas of sufficient length to allow for changes in arrival and departure plans, and should carefully review the beginning and ending dates of their visas before traveling.
A valid exit visa is necessary to depart Belarus.
Generally, the visa issued by a Belarusian Embassy or Consulate is valid for both entry and exit.
Photocopies of visas may be helpful in the event of loss, but note that a copy of a visa will not be sufficient for entry or departure, as Belarusian border officials always require original travel documents.

Travelers who overstay their visa’s validity -- even for one day -- will be prevented from leaving until they have been granted an extension by the Department of Citizenship and Migration.
United States citizens without valid visas face delays in leaving Belarus and may have trouble finding adequate accommodation.
By Belarusian law, travelers with an expired visa may not check in at any hotel or other lodging establishment.

U.S. citizens traveling through Belarus to other countries are strongly advised that there is a transit visa requirement for entering and leaving Belarus.
Transit visas are required even for travelers transiting on direct overnight trains with no stops or transfers on Belarusian territory. Transit visas should be obtained prior to any journey that requires travel through Belarus.
Commonwealth of Independent States (CIS) and Russian visas are no substitute for this transit visa.
Most travel agencies, including those in Russia and CIS countries, as well as train ticket sales personnel, are often not aware of this visa requirement and may not seek a transit visa for a traveler unless instructed by the traveler to do so.

U.S. citizens attempting to transit Belarus without a valid Belarusian transit visa have been denied entry into the country and forcibly removed from trains.
In some instances, local border and railway authorities have threatened passengers who did not possess a valid transit visa with jail or extorted “fines.”
American citizens are advised not to pay any border or railway officials for transit visas or “transit visa fines,” as these officials are not authorized to issue such visas.
Americans finding themselves in Belarus without transit visas, if confronted by border or train personnel, should request to be put in contact with consular officials at the U.S. Embassy in Minsk.
U.S. citizens traveling to Belarus via Russia are reminded that they must possess a Russian transit visa in addition to their Belarusian visa. Russian Embassies outside of the United States, including the Russian Embassy in Belarus, generally do not issue transit or tourist visas to Americans.
Russian transit visas are not normally obtainable at Russian airports.

The Law on the Legal Status of Foreign Citizens and Stateless Persons in the Republic of Belarus states that all foreign citizens may be granted permission for a temporary stay (up to 90 days within a chronological year), temporary residence (up to one year), or permanent residence.
Belarusian Embassies and Consulates will issue visas for temporary stays.
A temporary stay visa will allow the bearer to be present physically in Belarus for a maximum of 90 days within the 365-day period for which the visa is issued.
Once an individual has spent 90 days in Belarus, at one time or through a combination of visits, he or she will not be eligible to receive another visa until the original 365-day period has passed.

Individuals who receive visas for a temporary stay, but wish to remain in Belarus for longer than 90 days, must apply for temporary or permanent residence with the Ministry of Interior.
Individuals must make the application in Belarus within the 90 days allotted for a temporary stay.
Permission for temporary residence can be granted to students, spouses, or close relatives of Belarusian citizens, or for “work, business, or other activities.”
Travelers may contact the Consular Section at the U.S. Embassy in Minsk for information about application procedures for temporary or permanent residence.
Every foreigner entering Belarus is required to fill out a migration card.
This card should be retained for the whole period of stay and should be presented to the border authorities when exiting Belarus.

Foreign citizens without a valid Belarusian visa, migration card, or proper registration with the Department of Citizenship and Migration as a temporary visitor or resident can be subject to sanctions up to and including deportation under the provisions of the Code of Administrative Violations.
Depending on the circumstances, deportees also can be banned from returning to Belarus for a period from one to ten years.

Foreign citizens visiting and transiting Belarus also should be prepared to demonstrate sufficient financial means to support their stay.
For individuals staying in Belarus for less than one month, this amount is equal to approximately $15/day/person.
For those staying for longer than one month, the requirements call for $375/month/person.
Belarusian officials may request this proof of funds at the time of visa application, at the border, or during registration.
According to the Ministry of Interior, cash, credit cards, paid hotel reservations, or a letter from an inviting party pledging full financial support are sufficient means to demonstrate financial wherewithal.

Belarus requires all foreign nationals (other than accredited diplomats) entering the country to purchase medical insurance at the port-of-entry, regardless of any other insurance they might have.
Costs for this insurance will vary according to the length of stay.
(Subject to change, current information puts costs at approximately $1 for a one or two day stay, $15 for a stay of up to 31 days, and $85 for a stay of one year.)

Travelers entering Belarus by air with more than 35 kilograms of luggage (77 pounds) will be charged 2 Euros per kilogram in excess of that limit.
The fee must be paid in dollars or Euros.
In accordance with current customs regulations, foreigners may enter Belarus with up to $10,000 and exit the country with up to $3,000 without submitting a written declaration.
For additional information on customs rules for Belarus please see the Belarusian State Customs Committee official web site.
The Belarusian Government enforces a requirement for special permits to travel in “protected border zones.”
The Government of Belarus has not provided information defining the parameters of those zones.
Travelers should be alert for warning signs, road barriers, and/or border guard posts, and are advised not to cross into such areas without permission.

Foreign missionaries may not engage in religious activities outside the institutions that invited them unless they have a religious worker visa.
One-year validity, multiple-entry, "spiritual activities" visas, which are required of foreign missionaries, can be difficult to get, even for faiths that are registered with the government and have a long history in the country.
Approval often involves a difficult bureaucratic process.

A law enacted in 2002 required all religious groups and organizations, including recognized “traditional” religions such as Russian Orthodoxy, Roman Catholicism, Orthodox Judaism, Sunni Islam, and Lutheranism, to re-register; most organizations have done so.
Unregistered religious groups may not legally gather for religious purposes.
Many unregistered groups continue to meet, however, leaving them vulnerable to selective implementation of the law by authorities.
The law also stipulates that only Belarusian citizens can head religious organizations in Belarus.
In recent years, authorities have harassed, warned, fined, and briefly detained members of some unregistered and so-called "non-traditional" faiths for engaging in unsanctioned worship or proselytism. The U.S. Embassy strongly recommends that any U.S. citizen who chooses to attend a religious service of an unregistered religious group do so only after consulting with members of the group about the risk of harassment or possible arrest by local law enforcement authorities.
U.S. citizens are also urged to contact the U.S. Embassy should they encounter any problems with authorities due to their participation in such services or events.

Naturalized U.S. citizens originally from Belarus do not automatically lose Belarusian citizenship upon naturalization.
Such individuals retain Belarusian citizenship unless they take specific steps to renounce it.
The Belarusian authorities will allow naturalized U.S. citizens from Belarus to enter the country without a valid Belarusian passport on a “certificate of return” issued by Belarusian Embassies and Consulates, but please note that a valid Belarusian passport will be required to leave the country.
It can take two to four weeks to receive a new Belarusian passport.
For additional information please consult with the Embassy of Belarus at http://www.belarusembassy.org.
Belarusian citizens, including dual nationals, are subject to Belarusian laws requiring service in Belarus’ armed forces, as well as other laws pertaining to passports and nationality.
American-Belarusian dual nationals of military age who do not wish to serve in the Belarusian armed forces should contact the Embassy of Belarus in Washington, D.C. to learn more about an exemption or deferment from Belarusian military service before going to Belarus.
Without this exemption or deferment document, they may not be able to leave Belarus without completing military service, or may be subject to criminal penalties for failure to serve.

Children born to Belarusian parent(s) before August 15, 2002, even if born in the United States and in possession of a U.S. passport, may not be issued a Belarusian visa for travel to Belarus.
The Belarusian government considers these children to be Belarusian citizens until age 16, when they may choose to accept or reject that claim to citizenship.
Instead of a visa, a "certificate of return" is issued that will allow the child to enter Belarus.
It is imperative that parents of such children understand that, in order to leave the country, the child will be required to have a Belarusian passport if he/she does not already have one.
It can take anywhere from two to four weeks to complete the application procedures and receive a new Belarusian passport.
(Note: if the parent left Belarus on a series PP passport, given to Belarusians who reside abroad and have cancelled their local registration, then Belarus would not require the child to reject his/her claim to citizenship).
For children born to one Belarusian parent and one foreign parent after 2002, the parents must by mutual consent agree to Belarusian citizenship for the child, regardless of the place of birth.
If the parents cannot reach consensus, Belarus would only force Belarusian citizenship on a child in cases where the child would be left stateless.
Visit the Embassy of Belarus web site at http://www.belarusembassy.org/ for the most current visa information, or contact the Embassy of Belarus at 1619 New Hampshire Avenue, NW, Washington, DC 20009, tel: 202-986-1606, fax: 202-986-1805, consul@belarusembassy.org.
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:
Both organized and spontaneous demonstrations occur in Belarus.
Localized street disturbances relating to political events occur most frequently in Minsk or larger cities.
In some instances, authorities may use force to disperse protesters; bystanders, including foreign nationals, may face the possibility of arrest, beating, or detention.
Even demonstrations intended to be peaceful can sometimes become confrontational and escalate into violence.
For this reason, it is recommended that American citizens avoid all demonstrations and protest gatherings.

Security personnel may at times place foreign visitors under surveillance.
Hotel rooms, telephones, and fax machines may be monitored, and personal possessions in hotel rooms may be searched.
Taking photographs of anything that could be perceived as being of military or security interest may result in problems with authorities.
These sites are not always clearly marked and application of these restrictions is subject to interpretation.

For the latest security information, Americans living or traveling abroad should regularly monitor the Department of State’s 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 A Safe Trip Abroad.
CRIME:
Belarus has a moderate incidence of street crime. Though violent crime against foreigners is rare, criminals have been known to use force if met with resistance from victims.
Common street crime, such as mugging and pocket picking, occurs most frequently near public transportation venues, near hotels frequented by foreigners, and/or at night in poorly lit areas.

American citizens and other foreigners in Belarus have also been the victims of car theft, car vandalism, and hotel and residential break-ins.
Foreigners visiting nightclubs should pay particular attention to their surroundings, as criminal elements may rob unsuspecting patrons after surreptitiously drugging their drinks.
Travelers should keep a copy of their passport in a separate location from their original passport.

As in many countries around the world, counterfeit and pirated goods are widely available in Belarus. 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 in finding appropriate medical care, contacting family members or friends and explaining 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.
To see if you can be compensated in the U.S. as a victim of violent crime overseas, see our information on Victims of Crime.

The local equivalents to the “911” emergency line in Belarus are: 111 Fire and Rescue Squad, 102 Police, 103 Ambulance (Medical Emergency)
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care in Belarus is limited.
There is a severe shortage of basic medical supplies, including anesthetics, vaccines and antibiotics.
Elderly travelers and those with existing health problems may be at risk due to inadequate medical facilities. Travelers are encouraged to ensure that they bring an adequate supply of prescription medications in the event that there are delays in departing Belarus.
Tuberculosis is an increasingly serious health concern in Belarus.
For further information, please consult the CDC's Travel Notice on TB at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to Belarus on a 30 day visit.
Long-term residents or students must obtain an HIV/AIDS test in Belarus and submit the results to the Department of Citizenship and Migration.
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 (CDC) 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) website 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 Belarus is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
American citizens on short-term visits to Belarus (up to 90 days) are permitted to drive with a valid U.S. state driver’s license.
U.S. citizens should, therefore, always carry their passports with them to prove date of entry into the country in the event that police stop them.
If residing in Belarus for more than 90 days, one should apply for a Belarusian driver’s license.
Drivers will be required to successfully complete a two-part test in Russian; the first part is a computer-based multiple-choice test on local driving rules, and the second part is a driving test.
To receive a local driver’s license, drivers will also need to complete a medical exam at a special medical clinic, which will include a general physical, a chest x-ray, and an eye exam.

Radar traps and road construction sites, often unlit at night, are widespread.
Except for a stretch of the main east-west highway, where the speed limit is 100 km/h (60 mph), the maximum speed limit on divided highways or main roads outside village, town or city limits is 90 km/h (55 mph).
Speed limits in cities are 60 km/h unless marked and will usually range between 40 km/h and 70 km/h, with frequent radar traps.
Visible and hidden dangers exist, including potholes, unlit or poorly lit streets, inattentive and dark-clothed pedestrians walking on unlit roads, drivers and pedestrians under the influence of alcohol, and disregard for traffic rules.
Driving in winter is especially dangerous because of ice and snow.
Driving with caution is urged at all times.

Radio-dispatched taxi services are generally reliable, arrive promptly once called and usually offer the lowest fare.
Most radio-dispatched taxis are metered, although fares can vary greatly and are considerably higher in the late evening and overnight hours.
The use of informal taxis or "gypsy cabs" is not recommended.

Minsk has a clean, safe, and efficient subway system that easily reaches most of the city center. Service is stopped briefly during the early morning hours, but otherwise runs regularly throughout the day.
Ticket prices are extremely low by western standards.
Though their routes are extensive, buses and trolleys lack heating or cooling capabilities and are usually crowded.

Travelers on all public transportation should be wary of pickpockets and other petty crime.
For travelers interested in car rental, only one major western rental agency currently operates in Minsk.
In general, rental car networks in Belarus are not well developed.

Travelers may experience significant delays (of several hours) in crossing the border by road into neighboring countries.

Please refer to our Road Safety page for more information.
Also visit the website of the country’s national tourist office and national authority responsible for road safety at: http://siteks.com/sites/touragency/.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Belarus, the U.S. Federal Aviation Administration (FAA) has not assessed Belarus’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:
Traveler's checks are normally not accepted in Belarus as a means of payment, but can be freely exchanged for cash at any bank.
Most hotels, restaurants, and stores accept major credit cards.
All Belarusian banks provide cash from major credit cards.
All payments in Belarus are made in Belarusian rubles.
Authorized currency exchange centers are widely available throughout major cities.


ATMs are also available for use, and it has become easier to use credit cards and debit cards in Belarus, especially in Minsk; however, this does not mean that it is safer to do so.
There have been reports of instances in which U.S. citizens have had their card numbers “skimmed” and the money in their debit accounts stolen or their credit cards fraudulently charged.
(“Skimming” is the theft of credit card information by an employee of a legitimate merchant or bank, manually copying down numbers or using a magnetic stripe reader.)
In addition to skimming, the risk of physical theft of credit or debit cards also exists.
To prevent such theft, the Embassy recommends that travelers keep close track of their personal belongings and only carry what is needed when out.
If travelers choose to use credit cards, they should regularly check their account status to ensure its integrity.
Persons seeking to marry in Belarus should consult the information located on the Embassy web site at http://minsk.usembassy.gov/marriage.html.
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 Belarusian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Belarus 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.
Access for U.S. consular officers to U.S. citizens in detention is often limited and/or delayed.
Although U.S. citizens are able to obtain legal representation, there has been at least one case of delayed notification, hindered consular access, limited medical treatment, and trial behind closed doors. 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 Belarus 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 Belarus.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located in Minsk at 46 Starovilenskaya Ulitsa; telephone (375 17) 210-1283 or after hours (375 29) 676-0134, fax (375 17) 334-7853 or (375 17) 17-217-7160 (consular section).
The Consular Section may also be reached by email at ConsularMinsk@state.gov
*

*

*
This replaces the Country Specific Information for Belarus dated December 7, 2007, and updates the sections on Exit/Entry Requirements, Safety and Security, Information for Victims of Crime, Medical Facilities and Health Information, and Criminal Penalties.

Travel News Headlines WORLD NEWS

Date: Thu, 2 Aug 2018 06:04:14 +0200
By Tatiana Kalinovskaya

Minsk, Aug 2, 2018 (AFP) - A massive corruption scandal has rocked the health service of ex-Soviet Belarus, leading even officials in the country dubbed "Europe's last dictatorship" to call for an overhaul of the system.   Authorities have arrested dozens of medics, drug company representatives and bureaucrats on suspicion of siphoning off millions of dollars in state funding.   Valery Vakulchik, head of the powerful KGB state security service, in televised comments last month denounced what he called a vast system of procurement of drugs and medical equipment at inflated prices.   Prices were habitually hiked by up to 60 percent and in some cases even doubled, he said.   Following his announcement, 37 top health officials were arrested and criminal investigations were opened involving 60 people including local representatives of international pharmaceutical companies.

The KGB chief acknowledged that the Soviet-style bureaucracy in the country bordering the European Union, ruled by strongman Alexander Lukashenko, helped promote corruption.   "The existing system of procuring medical equipment and drugs created the conditions for corrupt practices," he said.    "Bona fide suppliers could not rely on a positive outcome," he added, while procurements were made not directly from producers but "via numerous middlemen (and) finance companies."   Those detained in the scandal include deputy health minister Igor Lositsky, doctors at reputed clinics and leading business figures involved in producing and importing medicines.   One of the arrested businessmen is Sergei Shakutin, director of Iskamed group, who is the brother of one of Lukashenko's close associates.   Belta state news agency has published photos of searches at the home of a medical centre director that uncovered $500,000 in cash.   Officers also found $620,000 in the garage of the director of a public enterprise that imported medical equipment.

The KGB chief said bribes paid to corrupt officials amounted to millions of dollars.   "There will be further arrests since the people detained so far are just the perpetrators," Sergei Satsuk, editor of news site Yezhednevnik, who is familiar with the case, told AFP.   The chief beneficiaries in such schemes were retired law enforcement officials who set up companies to enter the lucrative medical equipment market, Satsuk said.   "In 10 years they drained all the juice out of the country's medical system," he said.   He said this involved supplying equipment that was not just over-priced but also often lacked the necessary certification or came with faked documentation.    Some equipment was imported as second-hand but re-sold as new.

- Powerful temptation -
This is one of the biggest corruption scandals in the history of Belarus, which is wedged between Russia and Poland and has been led by Lukashenko since 1994.   "Bureaucracy has privatised the state. We need to reform the whole system of state management, otherwise corruption schemes will spring up wherever budget funds are being spent," independent economist Yaroslav Romanchuk told AFP.

Other smaller corruption scandals have in recent years hit the sports, forestry and energy ministries as well as large companies, factories and banks.   Three ministers have been sacked and senior bureaucrats and regional officials have been arrested.   "Even if you clean out the state structures of bribe-takers, corruption won't die in Belarus for a single day," said Romanchuk.   "The very next day new people in old posts in the old system will relaunch the old corruption schemes."   The system "creates the most powerful temptation to set up schemes with kickbacks, bribes, swindling and abuses of office," Romanchuk said.
Date: Tue, 24 Jul 2018 18:11:12 +0200

Minsk, July 24, 2018 (AFP) - Belarus on Tuesday announced that it is extending visa-free travel for tourists from five days to 30 days in a move that could attract more visitors to the ex-Soviet state on the European Union's doorstep.

Strongman ruler Alexander Lukashenko signed a decree allowing visitors from 80 countries including 39 in Europe, as well as the United States, Australia and Japan to stay for 30 days.   The ruling will enter force when the decree is published in one or two days.   The decree says the move is aimed at "promoting further development of the Belarusian tourism sector" as well as making the country more attractive as a host for sports events and festivals and improving its connectedness to the global economy.

Belarus said it is keen to promote itself as a medical tourism venue and for people keen to recuperate and undergo spa procedures at its sanatoriums.   The visa-free rule requires visitors to fly in and out of Minsk's main airport.    As before, the visa exemption does not apply to foreigners arriving or leaving from Russia because of a lack of border controls betweeen the neighbours.

Minsk has close ties to former Soviet master Moscow, with Belarus part of an economic union with Russia.   Chinese people will also be covered by a separate visa agreement that comes into force in August.   Ties between Belarus and the European Union have improved since the 28-nation bloc began lifting most of its sanctions on the country in 2015 after Lukashenko released high-profile political prisoners.
Date: Tue, 17 May 2016 07:34:10 +0200

Belmopan, Belize, May 17, 2016 (AFP) - Belize has joined the growing number of Latin American nations grappling with the Zika virus, after the health ministry confirmed the country's first known case.    Authorities said Monday the infected person resides in Belize City, adding that efforts would be taken to prevent the virus from spreading.

"An immediate investigation was launched and several actions were simultaneously initiated to minimize and contain a potential outbreak," a health ministry statement said.   The mosquito-borne Zika virus can cause the birth defect microcephaly, which can cause babies to be born with unusually small heads and deformed brains.
Date: Fri 17 Jul 2015
Source: Rusnovosti [in Russian, trans. ProMED Mod.NP, edited]

The deceased patient was infected in Belarus
-----------------------------------------------
Rospotrebnadzor [Federal Service for Consumer Protection and Human Welfare] reported that the 1st death from tick-borne encephalitis has been registered in Moscow. The tick-borne disease was imported.

Rospotrebnadzor reports, "Infections in the capital are not registered this year [2015] and have never been registered previously. The patient was infected in Belarus."

According to Infectious clinical hospital No. 1 of the Department of Health of Moscow, 10 imported cases of viral encephalitis were identified in the 1st half of 2015; 2 cases of infection occurred in the Altai region and in the Republic of Karelia. One [imported] case was brought from the Kostroma region, the Yaroslavl region, the Volgograd region and the Republic of Udmurtia, as well as from Belarus and Mongolia.

Rospotrebnadzor also reports that the rise of the biological activity of _Ixodes_ ticks was noted. These ticks are considered the main vectors of infections such as tick-borne spring-summer encephalitis, tick-borne borreliosis (Lyme disease), granulocytic anaplasmosis, and monocytic ehrlichiosis.
=====================
[Nearly 10,000 people sought medical aid after tick bites in Moscow for the period April-June of this year (2015), among them there are more than 1900 children up to 17 years. Last year (2014) for the same period it was recorded that around 8000 people sought medical aid after tick bites. The ticks attacked people mainly in the territory of the Moscow region.

This is the season of tickborne encephalitis virus (TBEV) transmission in Russia and neighboring countries. Russia, especially western Siberia, has the largest number of reported TBE cases. For additional details on TBE, see Mod.LL's extensive comments drawn from the US CDC (<http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/tickborne-encephalitis>). The CDC information notes that in Russia, 2 inactivated TBE vaccines are available: TBE-Moscow (Chumakov Institute, Russia) and EnceVir (Microgen, Russia). The European and Russian vaccines should provide cross-protection against all 3 TBEV subtypes. Vaccine failures have been reported, particularly in people aged over 50 years.

In the previous post on TBE, ProMED Corr.BA noted, "According to weekly monitoring, from 1 Apr-15 Jul [2015] in Russia, more than 412,000 cases of tick bites were registered, including 94,270 children. Compared with the same period of last year (2014), the number of people affected by the tick bites increased by 19 per cent. In 2015, 947 cases of tick-borne encephalitis have registered in Russia. The largest number of cases was reported in the Krasnoyarsk region, followed by Novosibirsk [Siberia], Irkutsk, Tyumen, Kirov, Sverdlovsk, Vologda, Leningrad, Kemerovo, Pskov, and Kostroma regions, the Republic of Khakassia, the Perm and Primorye regions, St Petersburg [city], Moscow (importations from Yaroslavl, Vologda, Karelia, Altai, and Mongolia, Belarus)." - ProMED Mod.TY]

[The locations mentioned in this posting can be seen on the map at

[A HealthMap/ProMED-mail map can be accessed at:
Date: 15 Jul 2015
Source: Evening Brest [machine translation & edited]

Belarus has 1 imported case of measles. The Ministry of Health of Belarus does not rule out the possibility of other imported cases of measles. This is especially true during the summer holidays and vacations.

According to the deputy chief doctor of the "National Center for Hygiene, Epidemiology and Public Health," Lyudmila Naroychik, other European countries often record measles. In 2014 Belarus recorded 5 imported cases of measles. So far in 2015, Belorus has already record 1 imported case. The infections have been from Russia, Israel, Spain, Turkey, according to BelTA  [unclear whether this refers just to 2014, or other years as well].

Measles is included in the national immunization schedule, and if vaccination is carried out, even in adulthood the person retains immunity. In this regard, it is important to get vaccinated before traveling abroad.
==================
[The HealthMap/ProMED map of Belarus can be found at:
More ...

World Travel News Headlines

Date: Thu, 16 Jan 2020 02:59:31 +0100 (MET)
By Nicolas DELAUNAY

Cousin Island, Seychelles, Jan 16, 2020 (AFP) - Giant tortoises amble across Cousin Island as rare birds flit above.   The scene attests to a stunning success for BirdLife International, a conservation group that bought the tiny Seychelles isle in 1968 to save a songbird from extinction.   Thick vegetation smothers ruins that are the only reminder of the coconut and cinnamon plantations that covered the island when the group stepped in to protect the Seychelles Warbler.

Now teeming with flora and fauna and boasting white beaches, Cousin Island is firmly on the tourist map, with managers scrambling to contain visitor numbers and soften their negative environmental impact.    More than 16,000 people visited the island in 2018, compared with 12,000 a decade earlier.   "Tourism is important for Cousin. That's what allows us to finance the conservation projects we run here.    "But 16,000 tourists... that was too much," said Nirmal Shah, director of Nature Seychelles, which is charged with running the special reserve.

Before the island was in private hands, the population of Seychelles Warblers was thought to have shrunk to just 26, barely hanging on in a mangrove swamp after much of their native habitat had been destroyed.    Now, they number more than 3,000 and the greenish-brown bird has been reintroduced to four other islands in the archipelago.   The former plantations have transformed into native forests, teeming with lizards, hermit crabs and seabirds, and the island is the most important nesting site for hawksbill turtles in the western Indian Ocean.   The International Union for Conservation of Nature (IUCN) waxes lyrical about the "unique biodiversity and conservation achievements" of Cousin, "the first island purchased for species conservation", a model since replicated around the world.

- Nature first -
Tourists have been allowed onto the island since 1972, but the message is clear: nature comes first.   In a well-oiled routine, every morning a handful of luxury sailboats and small motorboats anchor off the island, where their occupants wait for Nature Seychelles to skipper them ashore on their boats.   "Tourist boats cannot land directly on the island, the biohazard risk is too big," Shah said.   "Non-indigenous animals who may accidently be on board could come to the island and threaten its (ecological) balance."   Too many tourists can also upset this balance.

Nature Seychelles in July increased the price of visits from 33 to 40 euros ($36 to $44) and removed a free pass for children under 15, resulting in a welcome 10-percent reduction in visitor numbers.   "Something had to be done, there was too much pressure on the environment," said Dailus Laurence, the chief warden of the island.   "When there are too many tourists it can bother nesting birds and turtles who want to come and lay their eggs on the island."

One guide said that some tourists, bothered by the island's ubiquitous mosquitos, would "leave the paths, move away from the group and walk where they are not supposed to", putting fragile habitats at risk.   Shah said that if they wanted to increase the number of tourists, it would require hiring more wardens and guides who live on the island, which would also have a negative impact on nature.   "Our absolute priority is nature, and it comes before tourists. If we have to take more steps to protect it and reduce the number of tourists, we will," he said.
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: Wed, 15 Jan 2020 23:16:11 +0100 (MET)

Malabo, Equatorial Guinea, Jan 15, 2020 (AFP) - Firefighters battled to bring a blaze at Malabo's cathedral under control on Wednesday, as flames engulfed parts of the historic building, considered the most important Christian church in Equatorial Guinea.     Dozens of people gathered in silence near the cathedral in the early evening as the fire service sprayed water jets onto the century-old structure.

It was not immediately known whether anyone was hurt in the fire, in which huge flames consumed part of the facade of the building.       "We have just extinguished the fire, it's finished. The roof is gone, it is a catastrophe," firefighter Alfredo Abeso told AFP.   Another firefighter at the scene said: "The whole roof is gone, the interior is burned."   The cause of the fire is not known but the cathedral has been closed to the public since January 7 for restoration work.    Built in a neo-gothic style between 1897 and 1916, the cathedral is one of the central African country's main tourist attractions.

The blaze brought comparisons to the devastating fire that ravaged the 13th century Notre-Dame cathedral in Paris in April 2019.     The French Embassy in Malabo said the fire was a "cruel reminder" of the fire at Notre Dame.    "We share the emotion of our friends in Malabo and Equatorial Guinea and hope that the fire can be brought under control quickly," it said on Twitter.      Paris engineers are still working to stabilise the 13th century cathedral in the French capital after fire tore through its roof and dramatically toppled its spire last year.
Date: Wed, 15 Jan 2020 21:55:41 +0100 (MET)

Rio de Janeiro, Jan 15, 2020 (AFP) - Widespread complaints over foul-smelling drinking water in Rio de Janeiro have triggered a run on supermarket bottled water, though the public utility denied any health risk Wednesday.   Rio governor Wilson Witzel set alarm bells ringing in a Twitter post on Tuesday, saying the situation -- fuelled by social media rumours -- was "unacceptable" and calling for a "rigorous investigation."

Moving to calm growing fears, public water utility Cedae attributed the problems to the presence of geosmin, a harmless organic compound, insisting the resulting earthy-tasting tap water was safe to drink.   "The results of the analyses show the presence of geosmin, at a rate sufficient to change the taste. But there is no risk to health," Sergio Marques, the official in charge of water quality, told a press conference.   Cedae later said it had fired the head of the Guandu treatment plant, which supplies nearly 80 percent of Rio's drinking water.   It said the supply from Guandu would be treated with carbon in the coming days to get rid of the geosmin.

According to O Globo newspaper, nearly 70 districts of the capital have been affected.   It reported that more than 1,300 cases of gastroenteritis were recorded over the last 15 days in Santa Cruz in the west of Rio, where water quality complaints were rife.   Cedae's president Helio Cabral apologized "to the whole population for the problems in the water supply," which began earlier this month.

The problem has been exacerbated by false rumours circulating on social media that the water was toxic.   Despite assurances, many Rio citizens were taking no chances. In supermarkets, mineral water stocks have been selling out and long queues are formed as soon as they are replenished.   Geosmin is also responsible for the earthy taste in some vegetables.
Date: Wed, 15 Jan 2020 21:25:04 +0100 (MET)

Lima, Jan 15, 2020 (AFP) - Five tourists arrested for damaging Peru's iconic Machu Picchu site will be deported to Bolivia later on Wednesday, police said.   A sixth was released from custody and ordered to remain in Machu Picchu pending trial after paying bail of $910.   The six tourists -- four men and two women -- were arrested for damaging Peru's "cultural heritage" after being found in a restricted area of the Temple of the Sun on Sunday.   They were also suspected of defecating inside the 600-year-old temple, an important edifice in the Inca sanctuary.   "We've got the order. Today the five foreign tourists will be expelled," Cusco police official Edward Delgado told AFP.   "We're going to take them by road to the city of Desaguadero, on the border with Bolivia."   The border town, a nine-hour drive away, is the nearest frontier point to the southern Cusco region where Machu Picchu is located.

The sixth tourist, 28-year-old Nahuel Gomez, must sign at a local court every 10 days while awaiting trial.   He admitted to removing a stone slab from a temple wall that was chipped when it fell to the ground, causing a crack in the floor.   He could face four years in prison if found guilty of damaging Peru's cultural heritage.   Several parts of the semicircular Temple of the Sun are off limits to tourists for preservation reasons.   Worshipers at the temple would make offerings to the sun, which was considered the most important deity in the Inca empire as well as other pre-Inca civilizations in the Andean region.   The group -- made up of a Chilean, two Argentines, two Brazilians, including one of the women, and a French woman -- allegedly entered the Inca sanctuary on Saturday and hid on site so they could spend the night there -- which is prohibited.

A source with the public prosecutor's office told AFP that Nahuel admitted to the damage but said "it wasn't intentional, he only leant against the wall."   The Machu Picchu complex -- which includes three distinct areas for agriculture, housing and religious ceremonies -- is the most iconic site from the Inca empire, which ruled over a large swath of western South America for 100 years before the Spanish conquest in the 16th century.   Machu Picchu, which means "old mountain" in the Quechua language indigenous to the area, is at the top of a lush mountain and was built during the reign of the Inca emperor Pachacuti (1438-1471).
Date: Wed, 15 Jan 2020 20:53:05 +0100 (MET)

Alicante, Spain, Jan 15, 2020 (AFP) - A fire broke out Wednesday on the roof of the airport in Alicante, a city on the eastern Mediterranean coast which is a tourism hotspot, forcing its closure to air traffic.   "The fire is under control but it has not been extinguished. Firefighters are continuing to work," a spokesman for Spanish airport operator Aena told AFP, adding the airport will remain closed to air traffic until noon on Thursday.

Ten flights which were due to land at Alicante were cancelled, as were 12 which were supposed to depart from the airport, he said.    Another four flights which were due to land at Alicante were diverted to other Spanish airports.   The flames were visible from inside the terminal, according to an AFP photographer at the scene.   Passengers and workers stood outside as dense smoke rose from the terminal building.   No one was injured and the authorities are still not sure what caused the fire.

The airport serves the eastern region of Valencia, which is home to several popular resorts such as Benidorm. It handled just under 14 million passengers last year, making it Spain's fifth busiest airport.   Aena recommended in a tweet that passengers contact their airline before heading to Alicante airport to see what the status of their flight was.   "We are coordinating with airlines. Consult your company to know if your flight is cancelled or will operate from an alternative airport," it said.
Date: Wed, 15 Jan 2020 11:12:40 +0100 (MET)

Beijing, Jan 15, 2020 (AFP) - A new virus from the same family as the deadly SARS pathogen could have been spread between family members in the Chinese city of Wuhan, local authorities said Wednesday.   The outbreak, which has killed one person, has caused alarm because of the link with SARS (Sudden Acute Respiratory Syndrome), which killed 349 people in mainland China and another 299 in Hong Kong in 2002-2003.   One of the 41 patients reported in the city could have been infected by her husband, Wuhan's health commission said in a statement on Wednesday.   The announcement follows news that a Chinese woman had been diagnosed with the novel coronavirus in Thailand after travelling there from Wuhan.

No human-to-human transmission of the virus behind the Wuhan outbreak has been confirmed so far, but the health commission said the possibility "cannot be excluded".   The commission said that one man who had been diagnosed worked at Huanan Seafood Wholesale Market, which has been identified as the centre of the outbreak, but his wife had been diagnosed with the illness despite reporting "no history of exposure" at the market.   At a press conference on Wednesday following a fact-finding trip to Wuhan, Hong Kong health officials also said that the possibility of human-to-human transmission could not be ruled out despite no "definitive evidence".

Dr Chuang Shuk-kwan, from Hong Kong's Centre for Health Protection, said there were two family group cases among the recorded cases in Wuhan, including the husband and wife and a separate case of a father, son and nephew living together.   However, he said mainland doctors believed the three men were most likely to have been exposed to the same virus in the market.   The market has been closed since January 1.   The woman diagnosed in Thailand, who is currently in a stable condition, had not reported visiting the seafood market, the World Health Organization (WHO) said on Tuesday.

WHO doctor Maria Van Kerkhove said Tuesday that they "wouldn't be surprised if there was some limited human-to-human transmission, especially among families who have close contact with one another".   The US Centers for Disease Control and Prevention issued a Level 1 "Watch" alert for travellers to Wuhan after the patient was diagnosed in Thailand, saying they should practice normal precautions and avoid contact with animals and sick people.

Wuhan's health commission said on Wednesday that most of the patients diagnosed with the virus were male, and many were middle-aged or elderly.   In Hong Kong, hospitals have raised their alert level to "serious" and stepped up detection measures including temperature checkpoints for inbound travellers.   Hong Kong authorities said on Tuesday that the number of people hospitalised with fever or respiratory symptoms in recent days after travelling to Wuhan had grown to 71, including seven new cases since Friday.   Sixty of that total, however, have already been discharged. None have yet been diagnosed with the new coronavirus.
Date: Wed, 15 Jan 2020 03:48:17 +0100 (MET)
By Emile Kouton with Celia Lebur in Lagos

Lome, Jan 15, 2020 (AFP) - After he was struck down by malaria and typhoid, Togolese tailor Ayawo Hievi thought he was set to recover when he started taking drugs prescribed by his doctor.   But far from curing him, the medication he was given at the neighbourhood clinic made him far worse -- eventually costing him one of his kidneys.    The drugs were fake.   "After four days of care, there was no improvement, but I started to feel pain in my belly," Hievi, 52, told AFP.

After two weeks of suffering he became unable to walk and was rushed into the university hospital in the West African nation's capital Lome.    "The doctors told me that my kidneys had been damaged... the quinine and the antibiotics used to treat me in the medical office were fake drugs."   Now, over four years later, he remains crippled by chronic kidney failure and has to go to hospital for dialysis regularly.    Hievi's horror story is far from unique in a continent awash with counterfeit medicines.    The World Health Organization (WHO) estimates that every year some 100,000 people across Africa die from taking "falsified or substandard" medication.

The American Society of Tropical Medicine and Hygiene estimated in 2015 that 122,000 children under five died due to taking poor quality anti-malaria drugs in sub-Saharan Africa.   Weak legislation, poor healthcare systems and widespread poverty have encouraged the growth of this parallel -- and deadly -- market. Since 2013, Africa has made up 42 percent of the fake medicine seized worldwide.    The two drugs most likely to be out-of-date or poor, ineffective copies are antibiotics and anti-malarials, say experts.    And bogus drugs not only pose a risk to the patient -- they also play a worrying part in building resistance to vital frontline medications.

- 'Difficult to trace' -
In a bid to tackle the scourge, presidents from seven countries -- the Republic of Congo, Gambia, Ghana, Niger, Senegal, Togo and Uganda -- meet Friday in Lome to sign an agreement for criminalising trafficking in fake drugs.    The goal is to bolster cooperation between governments and encourage other African nations to join the initiative.   But even if leaders put pen to paper, the task of stamping out the flows of counterfeit medication is huge.    Medicines spread out on plastic sheets or offered at ramshackle stalls are for sale at markets across West Africa.

Those hawked on the streets are often a fraction of the price of what's available in more reputable pharmacies where controls are stricter and supplies often have to come through official channels.    "It is very difficult to trace where the fake medicines come from," said Dr Innocent Kounde Kpeto, the president of Togo's pharmacist association.    "The countries which are mentioned on the boxes are often not the countries of origin or manufacture of these drugs. The manufacturers cover their tracks so as not to be identified".

It is estimated that between 30 and 60 percent of medicine sold in Africa is fake and Kpeto said most of it comes from China or India.    Efforts to staunch the deadly torrents of counterfeits have made some headway.    Some trafficking hubs have been dismantled, such as Adjegounle market in Cotonou that served as a key gateway for fakes heading to giant neighbour Nigeria.   In mid-November, the police in Ivory Coast made a record seizure of 200 tonnes in Abidjan and arrested four suspects including a Chinese national.

Togo is one of the pioneer countries trying to stop the flow.    It changed the law in 2015 and now traffickers can face 20 years in jail and a fine of some $85,000 (75,000 euros).   In a show of force in July the authorities burnt over 67 tonnes of counterfeit pharmaceuticals discovered between     But even given these recent successes, those in the industry like Dr Kpeto insist that the threat is still grave and involves "highly organised criminal networks".    "The phenomenon remains major," he said.    Traffickers can turn an investment of just $1,000 (900 euros) into a profit of $500,000, he claimed.   The fake medicines are smuggled in the same way as guns or narcotics and often bring higher returns.

- 'Die for nothing' -
Nigeria, Africa's most populous country with a market of 200 million people, is the number one destination on the continent for fake drugs and a showcase of difficulties being faced.    In September 2016 the World Customs Organization seized tens of millions of fake pills and medicines at 16 ports around Africa: 35 percent were intended for Nigeria.    Across the vast nation there are tens of thousands of vendors selling the counterfeits.   Competition between traffickers is fierce and the official agency meant to combat the problem is overwhelmed.

In a bid to improve the situation, Vivian Nwakah founded in 2017 start-up Medsaf and raised $1.4 million to help Nigerians track their medication from producer to user.    "The country doesn't have a reliable and centralised distribution network," she said.    "A hospital sometimes has to deal with 30 or 40 distributors for all the medications it needs. How can you have quality control with so many suppliers?"   As a result, fake or faulty medicine has not just flooded markets but also pharmacies and hospitals -- both state and private.    Sometimes, without hospital administrators even being aware, that means the drugs that reach the patients can be expired, poorly stored or the wrong doses. 

Medsaf works to ensure the quality control of thousands of products at over 130 hospitals and pharmacies in Nigeria. It looks forward to expanding deeper into Nigeria as well as Ivory Coast and Senegal.   The company uses technology, database management and analytics to monitor the movement of medications and verifies their official registration number, the expiry dates and storage conditions.   "Technology we use can help to solve most of the issues related to fake drugs," Nwakah said. "People die for nothing. We can change that."
Date: Mon 13 Jan 2020, 00.45 IST
Source: The Hindu [edited]

A 58-year-old woman from Seegemakki village in Tumari Gram Panchayat limits in Sagar taluk died due to Kyasanur Forest Disease (KFD), also known as monkey fever, at a private hospital in Manipal in Udupi district on [Sat 11 Jan 2020].

The deceased, H, who had complained of high fever and aches in joints was admitted to government sub-divisional hospital in Sagar city for treatment on [Tue 7 Jan 2020]. Her blood tested positive for KFD.

Rajesh Suragihalli, District Health Officer, told The Hindu that as her health condition had worsened, she was shifted to a private hospital in Manipal on [Thu 9 Jan 2020] for advanced treatment. She failed to respond to the treatment and breathed her last on [Sat 11 Jan 2020], he said.

Following the death, the Department of Health and Family Welfare has sounded an alert in Sagar and Tirthahalli taluks from where 7 positive cases have been reported since [1 Jan 2020]. The vaccination drive has been stepped up in the villages from where positive cases are reported. Three advanced life support ambulances have been stationed in government sub-divisional hospital in Sagar to shift KFD patients with health complications to private hospitals in Shivamogga city or Manipal for additional treatment, he said.
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[Kyasanur Forest disease (KFD) is an acute febrile illness caused by Kyasanur Forest disease virus (KFDV), a member of the family _Flaviviridae_, characterized by severe muscle pain, gastrointestinal symptoms, and bleeding manifestations. The virus was 1st identified in 1957 after it was isolated from a sick monkey from the Kyasanur Forest in Karnataka state of India. The disease is transmitted to humans following a tick bite or contact with an infected animal, especially a sick or recently dead monkey. There is no evidence of person-to-person transmission (<https://www.cdc.gov/vhf/kyasanur/index.html>).

The case fatality of Kyasanur Forest disease (KFD) is 2-10% and mortality is higher in the elderly and in individuals with comorbid conditions. There is no specific treatment for KFD. Prompt symptomatic and supportive treatment can reduce morbidity and mortality. Surveillance (human, monkey, and tick), personal protection against tick bites, and vaccination are the key measures for prevention and control of KFD (<https://idsp.nic.in/WriteReadData/l892s/60398414361527247979.pdf>).

As per the media report above, 7 confirmed KFD cases have been reported from Sagar and Tirthahalli taluks in Karnataka state so far in 2020. KFD typically occurs during the dry season from November through May, which correlates with the increased activity of the nymphs of ticks. Exposure to adult ticks and nymphs in rural or outdoor settings increases the risk of infection; herders, forest workers, farmers, and hunters are particularly at increased risk of contracting the disease. Vaccination and personal protective measures against tick bites are keys to prevent KFD.

The recommended preventive measures include using tick repellents, walking along clear trails, avoiding contact with weeds, and wearing full sleeved clothes and long pants to reduce exposed skin to reduce contact with ticks and subsequent tick bites. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Karnataka State, India: <http://healthmap.org/promed/p/307>]
Date: Mon 13 Jan 2020
Source: Food Safety News [edited]

An emergency committee to control the sale of food has been created in a city in northwest Argentina after a spike in _Salmonella_ cases in early 2020. There have been 51 confirmed cases of salmonellosis in Salta so far in 2020. At least 5 people have been hospitalized but recovered after treatment.

The committee will be responsible for controlling food sold on public roads at street stalls and at commercial premises. It includes experts from the National University of Salta (UNSA) and Catholic University of Salta (Ucasal). Officials hope by increasing controls they can bring the rise in infections under control and minimize the risk to the public. The group, created by the Mayor of Salta Bettina Romero and Undersecretary of Health and Human Environment Monica Torfe, held a meeting with Juan Jose Esteban, manager of the Hospital Senor del Milagro, and teams from the department of epidemiology of the province on preventive measures to tackle the salmonellosis rise this past week.

Norma Sponton, head of the microbiology sector; Teresita Cruz, of the epidemiological surveillance program of the province; Paula Herrera, from the Ministry of Health, and Jose Herrera, from the hospital also participated. Experts from the 2 universities are involved in training the inspectors who will be in charge of carrying out the control tasks.

Food contaminated with _Salmonella_ bacteria does not usually look, smell, or taste spoiled. Symptoms of salmonellosis infection can include diarrhoea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for 4 to 7 days. In some cases, however, diarrhoea may be so severe that patients require hospitalization.
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[The serotype of _S. enterica_ is not stated and it is not clear what the food reservoir for this ongoing outbreak is. A food diary of affected persons may be helpful.

The city of Salta is located in north-western Argentina in the province of the same name which can be found on a map at

[HealthMap/ProMED-mail map of Argentina: