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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 ...

Sierra Leone

Sierra Leone - US Consular Information Sheet
June 11, 2007
COUNTRY DESCRIPTION: Sierra Leone is a developing country in western Africa still recovering from a ten-year civil war that ended in 2002.
English is the official language, but Kri
, an English-based language, is widely used.
Tourist facilities in the capital, Freetown, are limited; elsewhere, they are rudimentary or nonexistent.
Read the Department of State Background Notes on Sierra Leone for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
Visitors are strongly encouraged to obtain visas in advance of travel to Sierra Leone.
Visitors to Sierra Leone are required to show International Certificates of Vaccination (yellow card) upon arrival at the airport with a record of vaccination against yellow fever. See our Foreign Entry Requirements brochure for more information on Sierra Leone and other countries.
The Embassy of Sierra Leone is located at 1701 19th Street NW, Washington, DC 20009; telephone (202) 939-9261.
The Embassy also maintains a website at www.embassyofsierraleone.org.
Information may also be obtained from the Sierra Leonean Mission to the United Nations, 245 East 49th St., New York, NY 10017; telephone (212) 688-1656 and from the website of the Sierra Leonean High Commission in London at http://www.slhc-uk.org.uk/.
Overseas, inquiries should be made at the nearest Sierra Leonean embassy or consulate.

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

SAFETY AND SECURITY:
Security in Sierra Leone has improved significantly since the end of the civil war in 2002.
The United Nations Peacekeeping Mission in Sierra Leone (UNAMSIL) withdrew in December 2005 and Sierra Leone resumed responsibilities for its own security. The Sierra Leonean police are working to improve their professionalism and capabilities, but fall short of American standards in response time, communications, and specialty skills.

Areas outside Freetown lack most basic services. Embassy employees are free to travel throughout Sierra Leone.
Travelers are urged to exercise caution, however, especially when traveling beyond the capital.
Road conditions are hazardous and serious vehicle accidents are common.
Emergency response to vehicular and other accidents ranges from slow to nonexistent.

There are occasional unauthorized, possibly armed, roadblocks outside Freetown, where travelers might be asked to pay a small amount of money to the personnel manning the roadblock.
Because many Sierra Leoneans do not speak English, especially outside of Freetown, it can be difficult for foreigners to communicate their identity.
Public demonstrations are rare but can turn violent.
U.S. citizens should are advised to avoid large crowds, political rallies, and street demonstrations, and maintain security awareness at all times.

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., 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:
Entrenched poverty in Sierra Leone has led to criminality.
There has been an increase in homicide, armed robbery, and residential burglary.
Petty crime and pick pocketing of wallets, cell phones, and passports are very common.
Law enforcement authorities usually respond to crimes slowly, if at all.
Police investigative response are often incomplete and don’t provide support to victims.
Inefficiency is a serious problem at all levels within the government of Sierra Leone.
Americans traveling to or residing in Sierra Leone should maintain a heightened sense of awareness of their surroundings to help avoid becoming the victims of crime.

Business fraud is rampant and the perpetrators often target foreigners, including Americans.
Schemes previously associated with Nigeria are now prevalent throughout West Africa, including Sierra Leone, and pose a danger of grave financial loss.
Typically these scams begin with unsolicited communication (usually e-mails) from strangers who promise quick financial gain, often by transferring large sums of money or valuables out of the country, but then require a series of "advance fees" to be paid, such as fees for legal documents or taxes.
Of course, the final payoff does not exist; the purpose of the scam is simply to collect the advance fees.
A common variation is the scammer’s claim to be a refugee or émigré of a prominent West African family, or a relative of a present or former political leader who needs assistance in transferring large sums of cash.
Still other variations appear to be legitimate business deals that require advance payments on contracts.
Sometimes victims are convinced to provide bank account and credit card information and financial authorization that drains their accounts, incurs large debts against their credit, and takes their life savings.

The best way to avoid becoming a victim of advance-fee fraud is common sense – if a proposition looks too good to be true, it probably is.
You should carefully check and research any unsolicited business proposal before committing any funds, providing any goods or services, or undertaking any travel.
It is virtually impossible to recover money lost through these scams. Please see the Department of State’s brochures on Advance Fee Business Scams and on International Financial Scams for more information.

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Quality and comprehensive medical services are very limited in Freetown, and are almost nonexistent for all but most minor treatment outside of the capital.
Persons with unstable chronic medical conditions that require on-going medical treatment or medications are discouraged from traveling to Sierra Leone.
Medicines are in short supply and due to inadequate diagnostic equipment, lack of medical resources and limited medical specialty personnel, complex diagnosis and treatment are unavailable.
The quality of medications in Sierra Leone is inconsistent and counterfeit drugs remain a problem.
Local pharmacies are generally unreliable. In the event medications are needed, such as over-the-counter medication, antibiotics, allergy remedies, or malaria prophylaxis, travelers may contact U.S. Embassy Health Unit personnel to receive general information about reliable pharmacies.

Medical facilities in Sierra Leone are scarce and for the most part sub-standard; outside the capital, standards are even lower.
There is no ambulance service in Sierra Leone, trauma care is extremely limited, and local hospitals should only be used in the event of an extreme medical emergency.
Many primary health care workers, especially in rural areas, lack adequate professional training.
Instances of misdiagnosis, improper treatment, and the administration of improper drugs have been reported.
Life-threatening emergencies often require evacuation by air ambulance at the patient's expense.
For a list of hospitals, visit our website at http://freetown.usembassy.gov/ .

Gastrointestinal diseases and malaria pose serious risk to travelers in Sierra Leone.
For additional information on malaria, including protective measures, see the CDC Travelers’ Health web site at http://www.cdc.gov/malaria/.

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

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
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 Sierra Leone is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Most main roads in Freetown are narrow and paved but have potholes; extremely narrow unpaved side streets are generally navigable.
Most roads outside Freetown are unpaved and are generally passable with a 4-wheel drive vehicle.
However, certain stretches of mapped road are often impassable during the rainy season, which usually lasts from May to September.
During the rainy season, add several hours to travel time between Freetown and outlying areas.
There is a major road repair and resurfacing program going on throughout the country that is slowly improving the quality of roads.
Public transport (bus or group taxi) is erratic, unsafe, and not recommended.
U.S. government employees are prohibited from using public transportation except for taxis that operate in conjunction with an approved hotel and that are rented on a daily basis.

Many vehicles on the road in Sierra Leone are unsafe and accidents resulting from the poor condition of these vehicles, including multi-vehicle accidents, are common.
Many drivers on the road in Sierra Leone are inexperienced and often drive without proper license or training.
Serious accidents are common, especially outside of Freetown, where the relative lack of traffic allows for greater speeds.
The chance of being involved in an accident increases greatly when traveling at night, and Embassy officials are not authorized to travel outside of major cities after dark.

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service between the United States and Sierra Leone, the U.S. Federal Aviation Administration (FAA) has not assessed Sierra Leone’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.

Passengers departing Freetown on certain airlines should expect to pay an airport tax of $40.00 (payable in U.S. Dollars).
Several regional airlines service Freetown’s Lungi International Airport; however, it is not uncommon for them to alter scheduled stops, cancel or postpone flights on short notice, and overbook flights.
Travelers may experience unexpected delays even after checking in and must be prepared to handle alternate ticketing and/or increased food and lodging expenses.
European carriers are typically more reliable.
American citizens departing Lungi Airport have reported incidents of attempted extortion by officials claiming that travel documents were not in order.
Luggage can often be lost or pilfered.

Lungi Airport is located across a large body of water from Freetown.
There are helicopter and ferry services in connection with most major flights to transport passengers to the capital; however, the ferry service has frequent delays.
It should be noted that the ferry terminal is located in East Freetown, which has a higher crime rate than other parts of the capital.
Embassy personnel use available helicopter services, which usually cost $50 each way, to transit from Freetown to the airport.


SPECIAL CIRCUMSTANCES:
Sierra Leone is a cash economy; however, an anti-money laundering law passed in July 2005 prohibits importing more than $10,000 in cash except through a financial institution.
Travelers are advised not to use credit cards in Sierra Leone because very few facilities accept them and there is a serious risk that using a card will lead to the number being stolen for use in fraudulent transactions.
There are no ATMs connected to international networks.
Travelers' checks are not usually accepted as payment; however, travelers’ checks can be cashed at some banks including Sierra Leone Commercial Bank, Standard Chartered Bank and Rokel Commercial Bank.
The traveler must, however, have proof of identification and a signed receipt by the institution where the travelers’ checks were purchased.
Currency exchanges should be handled through a bank or established foreign exchange bureau.
Exchanging money with street vendors is dangerous because criminals may "mark" such people for future attack and there is the risk of receiving counterfeit currency.

Sierra Leone's customs authorities enforce strict regulations concerning the export of gems and precious minerals, such as diamonds and gold.
All mineral resources, including gold and diamonds, belong to the State and only the government of Sierra Leone can issue mining and export licenses.
The legal authority for the issuance of licenses is vested in the Ministry of Mines and Mineral Resources.
Failure to comply with relevant legislation can lead to serious criminal penalties.
For further information on mining activities in Sierra Leone, contact the Ministry of Mines and Mineral Resources:
The Director of Mines, Ministry of Mines and Mineral Resources, Fifth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone; tel. (232-22) 240-420 or 240-176; fax (232-22) 240-574.

Corruption is a problem in Sierra Leone.
Travelers requesting service from government officials at any level may be asked for bribes.
You should report corrupt government officials to the Anti-Corruption Commission at one of the following locations:
The Sierra Leone Anti-Corruption Commission, 3 Gloucester Street, Freetown; 14a Lightfoot Boston Street, Freetown; 37 Kissy Town Road, Bo, Southern Province; Independence Square, Rogbaneh Road, Makeni; tel. (232- 22) 229-984 or 227-100 or 221-701; fax (232-22) 221-900; email: acc@sierratel.sl or info@anticorruption.sl;
and websites www.anticorruptionsl.org/anonymous.html and www.anticorruptionsl.org.

You must obtain official permission to photograph government buildings, airports, bridges, or official facilities including the Special Court for Sierra Leone and the American Embassy.
Areas where photography is prohibited may not be clearly marked or defined.
People sometimes do not want to be photographed for religious reasons or may want to be paid for posing.
Photographers should ask permission before taking someone’s picture.

U.S. citizens who are also Sierra Leonean nationals must provide proof of payment of taxes on revenues earned in Sierra Leone before being granted clearance to depart the country.
The Government of Sierra Leone now recognizes dual U.S.-Sierra Leonean citizenship; however; the U.S. Embassy may have difficulty assisting American citizens involved in legal or criminal proceedings if they entered the country on a Sierra Leonean passport.


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.
Sierra Leone’s judiciary is under-funded and overburdened, and offenders often must endure lengthy pre-trial or pre-hearing delays and detention.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Sierra Leone laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Sierra Leone 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.

Travelers should carefully check their passport to see the length of time they are permitted to remain in the country and the validity of their visa.
Travelers leaving the country with an expired visa may incur additional charges.
Any Sierra Leonean visa issues can be regulated at the immigration office at Rawdon Street in Freetown.

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

A significant number of American prospective adoptive parents have found that Sierra Leonean children offered for adoption are not orphans under U.S. immigration law, which has ultimately resulted in denials of U.S. immigrant visas for children they adopt in Sierra Leonean courts.
Please refer to the Sierra Leone adoption flyer for more information.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Sierra Leone are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website and to obtain updated information on travel and security within Sierra Leone.
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 Leicester Square, Regent; tel. (232) (22) 515 000 or (232) (76) 515 000; fax (232) (22) 515 355.
The Embassy maintains a home page on the Internet at http://freetown.usembassy.gov/.
*

*

*
This replaces the consular information sheet dated October 31, 2006, to update sections on Entry/Exit Requirement; Crime; Medical Facilities and Health Information; Aviation Safety Oversight; Special Circumstances; Criminal Penalties; and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu 28 Nov 2019
Source: World Health Organization Disease Outbreak News [edited]

Sierra Leone health officials, supported by WHO, the US Centers for Disease Control and Prevention (CDC), and other partners, are responding to an outbreak of Lassa fever. On 20 Nov 2019, WHO was informed by the Netherlands' International Health Regulations (IHR) National Focal Point of one imported case of Lassa fever from Sierra Leone. The patient was a male doctor, a Dutch national who worked in a rural Masanga hospital in Tonkolili district, Northern province in Sierra Leone.

The probable route of transmission is believed to be through exposures during a surgical procedure he performed on 2 patients in Masanga hospital on 4 Nov 2019. Both patients died following surgical interventions; one died on 4 Nov [2019] and the 2nd on 19 Nov 2019. Both surgical patients are considered probable cases, and the patient who died on 4 Nov [2019] is believed to be the index case for this outbreak, likely the source of infection of the Dutch doctor.

The doctor's symptoms started on 11 Nov [2019], a week after performing the surgery, and included malaise and headache, followed by fever, diarrhoea, vomiting, and cough. While symptomatic, he attended a surgical training event in Freetown, Sierra Leone, on 11-12 Nov [2019]. This event was also attended by several international participants from the Netherlands and United Kingdom in addition to 35 local participants. On 19 Nov [2019], the symptomatic doctor was medically evacuated to the Netherlands after he did not respond to treatment with antimalarials and antibiotics. The evacuation was managed by a dedicated ambulance plane with 4 staff from a German organization. During the journey, the plane stopped in Morocco (Agadir Airport). As the illness was initially thought to be malaria or typhoid fever, personal protective equipment, other than gloves, were not used, and no specific containment procedures were used during the medical evacuation.

Laboratory specimens from the patient tested positive for Lassa fever by polymerase chain reaction (PCR) and sequencing at Erasmus University Medical Centre in Rotterdam on 20 Nov 2019.

The patient died on the night of 23 Nov 2019.

On 22 Nov 2019, WHO was informed of a 2nd laboratory-confirmed case of Lassa fever in another Dutch healthcare worker, who also worked in the Masanga hospital. Samples from this 2nd case were sent to the Erasmus University Medical Centre in Rotterdam and tested positive for Lassa fever by PCR. The 2nd case also participated in one of the surgical procedures performed by the medically evacuated Dutch doctor. The date of onset of symptoms of the 2nd case was 11 Nov [2019]. This case was subsequently medically evacuated in high containment isolation to the Netherlands and is currently under treatment. Isolation precautions have been implemented.

The Masanga hospital in Sierra Leone where the Dutch doctor worked is supported by several non-governmental organizations with international healthcare workers including staff from countries including Denmark, the Netherlands, and the United Kingdom, alongside national healthcare workers.

Contact tracing and monitoring activities have been initiated in these countries as required.

Sierra Leone
An outbreak investigation and response is ongoing under leadership of the Ministry of Health (MoH), supported by CDC and WHO. As of 24 Nov 2019, in addition to the 2 Dutch cases, 2 further cases among national healthcare workers, one confirmed and another suspected, have been reported from Masanga hospital. Both healthcare workers were involved in the management of the 2 surgical patients operated by the Dutch doctor on 4 Nov [2019]. All high-risk contacts in Masanga hospital are being monitored.

The Netherlands
Several high- and low-risk contacts have been identified among personal contacts and healthcare workers. According to Dutch protocols, they will be monitored until 21 days after the last potential exposure. Five high-risk Dutch contacts who were in Sierra Leone have been repatriated through a dedicated flight and are now under monitoring. Dutch low-risk contacts in Sierra Leone have been advised to perform self-monitoring in situ.

Germany
The 4 medical evacuation flight staff (2 pilots and 2 healthcare workers) spent 8 flight hours in a confined space in the ambulance plane without any barrier between the cockpit and cabin. They have been assessed as moderate-risk contacts. According to German recommendations, they are being monitored for 21 days following the last potential exposure on 19 Nov (until 10 Dec 2019).

United Kingdom (UK)
UK authorities have identified 18 UK nationals as contacts of the 1st Dutch case. Of these 18, 8 are high-risk contacts and were exposed in Masanga hospital while working alongside the doctor or may have been exposed to the 2 patients he operated on 4 Nov [2019]. Of these 8 high-risk contacts, 7 returned to the UK and one went to Uganda. In addition, 13 UK nationals attended a surgical training event in Freetown, Sierra Leone, on 11-12 Nov [2019], which was also attended by the 1st Dutch case while already symptomatic. Of these 13 participants, 3 came from Masanga hospital and belong to the above group of 8 high-risk contacts. The remaining 10 participants were possibly exposed during the training and are considered low-risk contacts. Of these 18 contacts identified (8 high-risk and 10 low-risk contacts), 17 have returned to the UK and are under public health follow-up for 21 days; one high-risk contact went to Uganda. There were also several Dutch and 35 local participants who attended this event. UK authorities are in contact with the organizers, and the names of participants from Sierra Leone and the Netherlands have been shared with respective National IHR Focal Points.

Uganda
One contact, a UK national, who may have been exposed in Masanga hospital on 15 Nov [2019] and subsequently travelled to Uganda on 16 Nov [2019], is now being followed up by the Uganda authorities, and the UK authorities are providing support remotely though public health and consular channels.

The National IHR Focal Point of the Netherlands has also informed their counterpart in Morocco about the potential risk of exposure at the Agadir Airport. Morocco National IHR Focal Point confirmed that the investigation is conducted, and control measures have been implemented to ensure there was no transmission in Agadir.

Sierra Leone is endemic for Lassa fever. Previously, sporadic cases have been exported to Europe from endemic countries in Africa, such as Togo, Liberia and Nigeria. In 2018, a total of 23 confirmed Lassa fever cases with 14 deaths (case fatality rate 61%) were reported from 2 districts of Sierra Leone: Bo district (2 cases; 2 deaths) and Kenema district (21 cases; 12 deaths).

From 1 Jan-17 Nov 2019, of the 182 suspected cases, 10 cases with 6 deaths (case fatality ratio 60%) have been confirmed for Lassa virus infection. All confirmed cases during this period were reported from Kenema district, which has been reporting cases of Lassa fever every year.

Public health response
The International Health Regulations Focal Points and Health Authorities in Denmark, Germany, Morocco, the Netherlands, Sierra Leone, Uganda, and the UK have been collaborating to share information about this event, together with the WHO and US CDC. Contact tracing and monitoring activities for 21 days following the last potential exposure have been initiated in Sierra Leone, Germany, the Netherlands, Uganda, and the UK. Investigations are ongoing in Sierra Leone in Masanga hospital and surrounding areas in Tonkolili district with a deployment of a national rapid-response team, supported by US CDC and WHO.

WHO risk assessment
Lassa fever is an acute viral haemorrhagic fever illness that is transmitted to humans via contact with food or household items contaminated with rodent urine or faeces. Human-to-human infections and laboratory transmission can also occur through direct contact with the blood, urine, faeces, or other bodily secretions of a person with Lassa fever. The overall case fatality rate is 1%; it is 15% among patients hospitalized with severe illness.

Sierra Leone is endemic for Lassa fever, and sporadic cases have been exported to Europe from endemic countries in Africa, such as Togo, Liberia and Nigeria in recent years. However, in general, the secondary transmission of Lassa fever through human contacts is rare.

Data from recent imported cases show that secondary transmission of Lassa fever is rare when standard infection-control precautions are observed. Further, epidemiological investigations are ongoing: human-to-human transmission occurs in both community and healthcare settings, where the virus may spread by contaminated medical equipment. Healthcare workers are at risk if caring for Lassa fever patients in the absence of appropriate infection prevention and control measures. Considering the seasonal flare-ups of cases in humid zones between December and March, countries in West Africa that are endemic for Lassa fever are encouraged to strengthen their related surveillance systems.

WHO advice
Prevention of Lassa fever relies on community engagement and promoting hygienic conditions to discourage rodents from entering homes.  There is currently no approved vaccine. Early supportive care with rehydration and symptomatic treatment improves survival. Family members and healthcare workers should always be careful to avoid contact with blood and body fluids while caring for sick persons.

According to WHO guidance for viral haemorrhagic fever, healthcare staff should consistently implement standard precautions when caring for all patients to prevent infections acquired in a healthcare setting and strictly apply contact precautions, including isolation, when caring for suspected or confirmed Lassa fever patients or handling their clinical specimens or body fluids. Standard precautions are meant to reduce the risk of transmission of bloodborne and other pathogens from both recognized and unrecognized sources. Standard precautions are recommended in the care and treatment of all patients regardless of their perceived or confirmed infectious status. They represent the basic fundamental level of infection prevention and control and include hand hygiene, use of personal protective equipment to avoid direct contact with blood and body fluids, prevention of needle stick and injuries from other sharp instruments, and a set of environmental controls. Sterilization and environmental cleaning should also be particularly strengthened and undergo quality control assessments.

In order to avoid any direct contact with blood and body fluids and/or splashes onto facial mucosa (eyes, nose, mouth) when providing direct care for a patient with suspected or confirmed Lassa virus, personal protective equipment should include
1) clean non-sterile gloves,
2) a clean, non-sterile fluid-resistant gown, and
3) protection of facial mucosa against splashes (mask and eye protection, or a face shield).

Given the nonspecific presentation of viral haemorrhagic fevers, isolation of ill travellers and consistent implementation of standard precautions are key to preventing secondary transmission. When consistently applied, these measures can prevent secondary transmission even if travel history information is not obtained, not immediately available, or the diagnosis of a viral haemorrhagic fever is delayed.

WHO continues to advise all countries in the Lassa fever belt due to the need to enhance early detection and treatment of cases to reduce the case fatality rate as well as strengthen cross-border collaboration. WHO advises against any restrictions on travel or trade to or from Sierra Leone based on the current available information.
======================
[The above report provides the details and timelines related to the 2 confirmed cases of the Dutch physicians and the many suspected contacts. The 2 confirmed cases illustrate the difficulty in identifying Lassa fever cases when the infected individuals are early in the course of the disease so that barriers to transmission of the virus can be implemented. The 1st Dutch physician initially was thought to have malaria or typhoid fever, diseases more common in the area than Lassa fever. It will be interesting to learn if any of the contact individuals in the UK, Germany, or Uganda become infected. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Sierra Leone:
Date: Sun, 24 Nov 2019 12:56:47 +0100 (MET)

The Hague, Nov 24, 2019 (AFP) - A Dutch doctor who contracted Lassa haemorrhagic fever in Sierra Leone after treating patients has died in hospital, while a second doctor is undergoing treatment, the top Dutch health official said Sunday.

The unnamed doctor was flown back to the Netherlands on Tuesday and had been treated at a special isolation ward at a hospital in Leiden near Schiphol airport.   "The patient... which has been treated in strict isolation, has died last night," Dutch Health Minister Bruno Bruins said.   "A second doctor also has Lassa fever and has been repatriated to the Netherlands. Both doctors were infected in Sierra Leone, most likely during medical treatment," the minister said.

The second patient has been admitted to a hospital in the central Dutch city of Utrecht in an isolation unit which was also used to treat a patient who contracted Ebola in 2014.   In a statement, the Sierra Leonean Health Ministry said the deceased Dutch doctor developed Lassa fever symptoms after performing a cesarean section on a pregnant woman at the Masanga Hospital in central Sierra Leone.

The doctor also helped with the evacuation of a second woman who suffered from a septic wound after an abortion.   Both the women died shortly afterwards.    "He developed signs of fever, headache, and general malaise... and was treated for typhoid, malaria and influenza but symptoms persisted."   He was then flown back to the Netherlands where he tested "positive for Lassa fever on the same day."   The second doctor helped in both the cases and tested positive for the disease. 

Dutch minister Bruins said the Netherlands "is in close contact with those involved in Sierra Leone" and that Dutch nurses who had been in contact with the two Sierra Leonean patients are being flown back.   Lassa fever -- named after the place in Nigeria where it was first discovered in 1969 -- is caused by a haemorrhagic virus which belongs to the same family as Marburg and Ebola, according to the Centres for Disease Control (CDC).    It is mainly spread by rodents and is endemic to parts of West Africa including Sierra Leone, Guinea, Liberia and Nigeria.
Date: 24 Nov 2019
Source: BBC [edited]

A Dutch doctor who was evacuated from Sierra Leone after contracting Lassa fever has died in hospital. The medic was flown home on Tuesday [19 Nov 2019] after being infected in the northern town of Masanga, an area not previously known to have been affected.  He reportedly developed symptoms of the viral haemorrhagic illness after operating on a pregnant woman.  A 2nd Dutch doctor who was also evacuated is being treated for the disease.

Described as a cousin of Ebola [a very distant one virologically - ProMED Mod.TY], Lassa fever is endemic in eastern Sierra Leone, but cases have also been reported in northern and southern parts of the country in the last 5 years. It is also endemic in neighbouring Liberia, Guinea and several other West African states.

The doctor died while being treated in "strict isolation" at a hospital in the city of Leiden, Dutch Health Minister Bruno Bruins was quoted by AFP news agency as saying.

The minister confirmed that a 2nd doctor was in an isolation ward in hospital in the central city of Utrecht after being infected with the virus.

The doctors, who have not been named, were linked to a medical charity and had been working at a hospital in Masanga. In a statement, Sierra Leone's Health Ministry said the deceased doctor showed symptoms of Lassa fever after performing a Caesarean section.  "He developed signs of fever, headache, and general malaise ... and was treated for typhoid, malaria, and influenza but symptoms persisted," it said. He was then airlifted to the Netherlands where he was diagnosed with the disease.

The doctor had also helped with the evacuation of a 2nd woman who suffered from a septic wound after an abortion, AFP reports. Both women died shortly afterwards.
======================
[Lassa fever virus is endemic in Sierra Leone, and cases occur there sporadically. It is unfortunate that these physicians became infected while attending to Lassa fever virus-infected patients. Nosocomial transmission of Lassa fever virus in healthcare facilities, especially hospitals, is not unusual.

It is curious that the BBC report says nothing about the other 5 Dutch nationals and the 3 British doctors who were evacuated also who were mentioned in the tweet. - ProMED Mod.TY]

[ProMED also acknowledges a reader who prefers to remain anonymous for submitting this information from a Dutch news media report.  - ProMED Mod.LM]

[HealthMap/ProMED map available at:
Date: Wed, 7 Aug 2019 21:56:59 +0200 (METDST)

Freetown, Aug 7, 2019 (AFP) - Seven people have died and more than 8,000 have been made homeless after torrential rain in Sierra Leone caused massive floods, officials said.   "We can confirm the death of seven people, with 8,000 people severely affected by the flooding in Freetown and other parts of the country since last Friday," John Vandy, director of the Disaster Management Office in the National Security Office told AFP on Wednesday.   "The majority of the flood victims are from slum communities and swampy areas," Vandy said.   The government is working with development partners to assess the damage and offer relief, with more heavy rain forecast.   The authorities have urged people to leave flood-prone areas in Freetown after reports of a minor mudslide in an area where more than 1,100 people died in a landslip in 2017.
Date: Sat 11 May 2019
Source: Today [edited]

A 5-year-old girl was brought to the emergency room at Evelina London Children's Hospital [UK] with itchy, rather unsightly sores on both legs. She had recently returned from a weeks-long trip to Sierra Leone, and the lesions, which 1st appeared 3 weeks into her stay there, had become larger and ulcerated.

Diagnosis: cutaneous diphtheria, a disease rarely seen in many industrialised countries, including Britain and the United States, where most children are protected by the diphtheria toxoid vaccine, DTaP, and a booster shot of the tetanus-diphtheria-pertussis vaccine, Tdap.

Still, as more and more Americans of all ages travel abroad, often to less developed areas, travellers and doctors in this country need to be alert to unusual and often perplexing skin infections.

Even though cutaneous diphtheria is not a notifiable disease here [the U.S.], from September 2015 to March 2018, 4 cases were reported to the Centers for Disease Control and Prevention [1]. The patients, 2 from Minnesota and 1 each from Washington and New Mexico, had recently returned from Somalia, Ethiopia and the Philippines. The CDC noted in a weekly report in March [2019] [1] that reported cases of this highly contagious infection had recently increased 10-fold, from an average of only 3 a year during the period 1998 to 2011, to 33 a year during 2012 to 2017.

Still, the agency said, these numbers underestimate the true incidence of such infections. Although the 4 new cases were confined to the skin, the lesions can be a source of a life-threatening respiratory infection in people not adequately immunised against diphtheria. Thus, people who might have had close contact with the patients needed to be checked, perhaps treated with antibiotics, and if they lacked immunity to diphtheria, immunised with diphtheria toxoid-containing vaccine.

Before travelling to developing countries, people often check with the CDC or a travel health clinic to determine what immunisations they may need to update and which health precautions -- like drinking only bottled water -- are recommended. But having visited some pretty wild areas in the last 5 decades, I know that many people neglect to consult travel health experts in advance of their trips and are lax about updating needed vaccines.

Upon returning home with a health complaint, they often consult physicians who may have never seen the condition before or even heard of it since medical school, if then.

While emerging diseases like SARS and Ebola rightly garner widespread attention, Dr Jay S. Keystone of the Toronto Medisys Travel Health Clinic has noted that "skin problems are among the most frequent medical problems in returned travellers."

In a large series of traveller-related skin problems analysed by the GeoSentinel Surveillance Network, Dr Keystone reported that among ill travellers who sought medical care, cutaneous larva migrans, insect bites and bacterial infections were the most common disorders, making up 30 per cent of 4742 cases [<https://wwwnc.cdc.gov/travel/yellowbook/2018/post-travel-evaluation/skin-soft-tissue-infections-in-returned-travelers#5024>]. He added that the reported cases did not include those that were easily treated during travel or that cleared up on their own, probably many more.

=====================
[The rest of the news article mostly concerns infections acquired by travellers, such as cutaneous larva migrans (a parasitic skin disease) and infections transmitted by the bites of insects, like malaria, dengue fever, filariasis, and leishmaniasis. The full article can be found at the source URL. - ProMED Mod.ML]

[1. Griffith J, Bozio CH, Poel AJ, et al. Imported Toxin-Producing Cutaneous Diphtheria -- Minnesota, Washington, and New Mexico, 2015-2018. MMWR Morb Mortal Wkly Rep 2019;68:281-284. DOI: <http://dx.doi.org/10.15585/mmwr.mm6812a2External>.]
=====================
[The following has been extracted from my moderator comments in a prior ProMED-mail post, Diphtheria - Norway ex Mozambique: cutaneous, traveler; archive number:  http://promedmail.org/post/20140621.2556752.

"Either toxigenic or nontoxigenic strains of _C. diphtheriae_ can cause cutaneous diphtheria. Cutaneous diphtheria due to toxigenic strains is endemic in tropical countries and has been responsible for infections in travelers to these countries, even in those who are vaccinated. In the United States, cutaneous diphtheria has been most often associated with homeless persons [poor sanitation, poverty, and crowded living conditions] and the organisms isolated from recent cases were nontoxigenic (<http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/dip.pdf>). Cutaneous diphtheria is characterized by skin ulcers, which are usually chronic and may become coinfected with other pathogens such as _Staphylococcus aureus_ and _Streptococcus pyogenes_. Cutaneous diphtheria is uncommonly complicated by toxic cardiac or neurologic manifestations.

Humans are the only reservoir of _C. diphtheriae_. Transmission of _C. diphtheriae_ can occur through respiratory droplets, direct contact with cutaneous infections, and articles soiled with discharges from the respiratory tract or skin lesions. Organisms can be shed for up to 4 weeks without antibiotics, but chronic carriers may shed organisms for 6 months or more. Effective antibiotic therapy promptly terminates shedding. The organisms can survive in dust and clothing for up to 6 months (<http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/dip.pdf>). Shedding from cutaneous lesions can cause respiratory and cutaneous infections in contacts.

Cutaneous diphtheria is treated with erythromycin or penicillin for 14 days. The disease is usually not contagious 48 hours after starting antibiotics. Elimination of the organism should be documented by 2 consecutive negative cultures after therapy is completed. Management of contacts of cutaneous diphtheria should include screening for possible respiratory or cutaneous diphtheria and obtaining nasopharyngeal cultures for _C. diphtheriae_. For close contacts, especially household contacts, a diphtheria booster, appropriate for age, is given. Contacts should also receive antibiotics -- benzathine penicillin G or a 7- to 10-day course of oral erythromycin. Identified carriers in the community should also receive antibiotics. However, if the strain is shown to be nontoxigenic, the CDC recommends that investigation of contacts can be discontinued (<http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/dip.pdf>). Since 1980, cutaneous diphtheria is not a nationally reportable disease in the U.S.  (<http://www.cdc.gov/vaccines/pubs/surv-manual/chpt01-dip.html>)." - ProMED Mod.ML]
More ...

Mexico

General Information
************************************
Mexico is becoming a very popular destination for Irish travellers. The country has many well known tourist destinations including the idyllic resort of Acapulco on the Pacific Ocean and t
e Yucatan Peninsula stretching out between the Caribbean and the Gulf of Mexico. There is a rapidly developing economy and luxury hotels are widely available throughout the country. Tourist facilities in the more remote regions (seldom visited by tourists) may be very limited.
Climate
************************************
The country experiences a wide temperature profile with cool to cold temperatures on the mountainous ranges to a hot sub-tropical climate on the sea coasts. There is a rainy season from June to October and a dry season from November to May each year. Temperatures in April May and June tend to be in the mid 20’s centigrade. The southern and eastern regions tend to experience the heaviest rainfall.
Food & Water
************************************
Some tourists visiting Mexico will undertake a trekking holiday for part of their time in the country. This will bring them out from the major cities into many of the poorer regions of the country. In these areas the level of food and water hygiene may be poor and travellers need to exercise continuous caution in this regard. Typically great care should be taken with the consumption of any cold foods. Lettuce would be a common cause of illness and should be avoided. Undercooked shellfish (prawns, oysters, mussels etc.) should be avoided at any time. The risk of contamination with a variety of diseases is just too high.
Street Vendors
************************************
Many of the larger towns have a number of street vendors selling their produce on the side of the road. In general purchases of food from these vendors should be avoided. This is especially true with regard to buying ‘freshly squeezed’ fruit juice drinks. In some cases potentially contaminated tap water may have been used to supplement the supply. Another particular risk in Mexico involves the purchase of water melons from the market place. These are usually sold by their weight and it is reported that certain vendors may inject them with tap water to increase their value. Be sensible and take care.
Rabies
************************************
This is another viral disease that occurs throughout Mexico. 69 cases of human Rabies were reported in 1990 but this figure has dropped to 24 in 1995. The disease is transmitted through the bite of any infected warm blooded animal (dog, cats, monkey etc.). Animals should be avoided at all costs and any bite (lick or scratch) should be immediately washed out with water and then have a strong antiseptic applied. The individual should then always seek urgent competent medical attention. Cycling in the early morning is a high risk time. Dogs may become agitated and run out at the bicycle.
Protection against Mosquitoes & Sandflys
************************************
Travellers will need to exercise care against mosquito bites throughout the year and this has become particularly important due to regular outbreaks of Dengue Fever. This viral disease has swept through the Caribbean region over the past decade and Mexico has also been involved. There were approx. 4,500 cases during 1995 with about 16 deaths. More recently (Oct ‘99) the disease has been reported close to the US border with over 5000 patients affected. The disease seldom kills travellers but causes a severe flu like illness and pronounced skin rash in many of those infected. It is an unpleasant disease and can leave an individual ill for many weeks after infection. The mosquitoes can bite during the day or night. Most tourists should take care against mosquitoes by;
*
Using adequate Insect Repellent
*
Covering up well with pale coloured clothing
*
Refraining from using Perfumes or Aftershaves at the risk times for bites.
Malaria
************************************
For many tourists to Mexico the chance of contracting malaria is negligible. The disease does occur in some of the country and those planning to trek through the rural areas may be advised to consider prophylaxis. The states most affected are Oaxaca, Hiapas, Sinaloa, Campeche, Quintana Roo, Nayarit, Tabasco, Michoacán, Chihuahua and Hidalgo. The risk extends throughout the year and visitors to these regions always should consider adequate malaria prophylaxis.

Larva Migrans
************************************
Walking on the beach above the high tide mark in many of the hotter countries without shoe covering may expose the traveller to infection with the Larva Migrans parasite. Mexico is no exception. This minute worm penetrates through the skin and causes a significant irritation just under the skin in those infected. The rash moves and becomes very itchy. Treatment is straightforward once a diagnosis is reached. Travellers walking along the beaches (above the high tide mark) should always wear shoe covering and avoid sitting straight on the sand.
Vaccinations
************************************
No vaccines are essential for entry to Mexico however, in most cases, short term travellers will be advised to consider vaccination cover for;
*
Tetanus (childhood booster)
*
Typhoid (food & water borne)
*
Hepatitis A (food & water borne)
For those undertaking a trekking holiday (or those who will live in the region for some months) vaccination cover against Rabies (animal bites), Meningococcal Meningitis (air borne) and Hepatitis B (accidents) may need to be considered.
General Health
************************************
Further information on staying healthy while abroad may be obtained from the Tropical Medical Bureau.

Travel News Headlines WORLD NEWS

Date: Thu, 9 Jan 2020 17:49:58 +0100 (MET)

Mexico City, Jan 9, 2020 (AFP) - Mexico's Popocatepetl volcano dramatically spewed a fiery cloud of ash and rock into the sky Thursday, though it did not prompt authorities to raise their eruption alert level.   "Popo," as the volcano is known, exploded early in the morning, belching "a moderate amount of ash and incandescent material" from its crater, the National Disaster Prevention Center wrote on Twitter.   The explosion created a cloud of ash that reached 3,000 meters (1.9 miles) into the air.

The authorities, however, left the volcano's alert level at "Yellow Phase Two," which instructs people to remain at least 12 kilometres (7.5 miles) from the crater and be prepared for a possible evacuation.   Popocatepetl, which means "smoking mountain" in the indigenous Nahuatl language, has not had a massive eruption in more than a millennium, but has shown increased activity in the past 26 years.   It is considered one of the world's most dangerous volcanoes, because some 25 million people live within a 100-kilometer (60-mile) radius.
Date: Mon, 30 Dec 2019 02:39:19 +0100 (MET)

San Cristóbal de las Casas, Mexico, Dec 30, 2019 (AFP) - At least 11 people died and seven were injured on Sunday when a car and a van carrying tourists crashed on a highway in Mexico's southern Chiapas state, local prosecutors said.   "Eleven people were killed and seven more were injured," the prosecutor's office said in a statement, adding an investigation had been opened into the accident's cause.

According to reports from local authorities, the victims included tourists traveling in the van to San Cristobal de las Casas, one of the most visited cities in Chiapas state.   During the Christmas and New Year's holiday season, traffic is heavier on Mexico's roads and accidents occur more frequently.
Date: Sat, 21 Dec 2019 00:03:55 +0100 (MET)

Mexico City, Dec 20, 2019 (AFP) - Six people were injured Friday when two enormous cruise ships operated by US-based Carnival collided off Mexico's Caribbean coast, the company said.   "Oh my God!" a man can be heard saying in a dramatic video of the Carnival Glory crashing into the Carnival Legend as it docked at the popular island resort of Cozumel.   "Someone could have died!" he said.

Videos posted online show the 290-meter (952-foot) Glory slowly arcing through the azure water off Cozumel toward the 294-meter (963-foot) Legend, then making impact with a loud boom.   The Legend's massive bow then scraped along the back of the Glory, leaving the tip of the other ship's stern a mangled jumble of wreckage.   "Carnival Glory was in the process of docking when it made contact with Carnival Legend which was already docked," the company said in a statement.   "Six guests with minor injuries have presented themselves to the Carnival Glory medical centre for evaluation."

Carnival said it was still assessing the damage, but insisted there was no impact on the seaworthiness of either ship or their itineraries.   "We have advised guests from both ships to enjoy their day ashore in Cozumel," it said.   According to Carnival, the Glory weighs 110,000 tons and has capacity for 2,980 guests and 1,150 crew. The Legend weighs 88,500 tons and has capacity for 2,124 guests and 930 crew.
Date: Mon 11 Nov 2019
Source: Pan American Health Organization (PAHO)

Mexico has become the 1st country in the world to receive validation from the World Health Organization (WHO) for eliminating dog-transmitted rabies as a public health problem. "Eliminating [dog-transmitted] rabies doesn't happen by accident," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "It takes political resolve, careful planning, and meticulous execution. I congratulate the Government of Mexico on this wonderful achievement and hope many other countries will follow its example."

Rabies causes 60,000 deaths each year, mainly in Asia and Africa. In Latin America and the Caribbean, new cases of rabies were reduced by more than 95 percent in humans and 98 percent in dogs since 1983.

"By eliminating human rabies transmitted by dogs, Mexico is showing the world that ending infectious diseases for the next generation is possible and is the right way forward," said PAHO Director, Carissa F Etienne.

Mexico's achievement
--------------------
In order to achieve elimination, the country has implemented a national strategy for the control and elimination of rabies. This includes free, mass vaccination campaigns for dogs, that have taken place since the 1990's with more than 80 percent coverage; continuous and effective surveillance; public awareness-raising campaigns; timely diagnosis; and the availability of post-exposure prophylaxis in the country's public health services.

As a result, the country went from registering 60 cases of human rabies transmitted by dogs in 1990, to 3 cases in 1999, and zero cases in 2006. The last 2 cases occurred in 2 people from the State of Mexico, who were attacked in 2005 and presented symptoms in 2006.

The validation process
----------------------
WHO considers a country to be free of rabies after registering 2 years of zero transmission of rabies to humans. However, there was previously no process to verify the achievement of this goal, until this was developed by PAHO/WHO. Mexico became the 1st country in the world to begin this in December 2016.

The validation process was extensive and included the creation of a group of independent international experts established by PAHO/WHO. It also included the preparation, by Mexico, of an almost 300-page file containing all historical information about the situation of rabies in the country. PAHO and its specialized center in veterinary public health, PANAFTOSA, accompanied and supervised the implementation of the validation process throughout.

The group of experts carried out a mission to Mexico in September 2018 to review the file and verify the country complied with all WHO requirements. In September 2019, the group recommended the Director General of WHO and PAHO validate the elimination.

Moving forward
--------------
In order to sustain elimination, PAHO/WHO recommends continuing all rabies prevention, surveillance and control actions, particularly as rabies virus continues to circulate among wild animals such as bats.

PAHO collaborated with the countries of the Americas to eliminate rabies through technical cooperation, staff training, periodic meetings between those responsible for the issue in-country, and through the provision of recommendations on international standards. As of September 2019, there have been zero cases of rabies transmitted by dogs in humans in the Americas.

In addition to rabies, Mexico eliminated onchocerciasis in 2015 and trachoma in 2017, 3 of the more than 30 infectious diseases and related conditions that PAHO's new Communicable Disease Elimination Initiative in the Region of the Americas has set as a goal for elimination from the continent by 2030.
===================
[This is certainly an outstanding achievement and should be celebrated by all. It is also an example to other countries.  Of course, someone acquiring rabies from a bat would be outside of this situation. This WHO/PAHO validation specifically refers to rabies acquired from dog bites. This is a great milestone. Congratulations Mexico! - ProMED Mod.TG]

[HealthMap/ProMED-mail map of Mexico:
Date: Sat, 21 Sep 2019 00:59:40 +0200 (METDST)

Mexico City, Sept 20, 2019 (AFP) - Lorena made landfall Friday as a Category 1 hurricane, lashing the turquoise waters of popular beach destination Los Cabos on Mexico's Baja California peninsula.   "The eye of Hurricane Lorena is now passing over the coast of Los Cabos," Mexico's hurricane monitor, CONAGUA, wrote on Twitter.

The hurricane, which has been churning up the Pacific coast, first made landfall Thursday in west-central Mexico, then was briefly downgraded to a tropical storm before moving back over the water and regaining strength.   According to CONAGUA, Lorena was packing sustained winds of 140 kilometres (87 miles) per hour as it battered Los Cabos, making it a Category One hurricane on the scale of one to five.   After moving slowly northwest throughout the morning, it ground to a halt 70 kilometres from the beach town of Cabo San Lucas, dumping torrential rain on the area.

The US National Hurricane Center said the storm was expected to pour up to 20 centimetres (eight inches) of rain on the region, which "may result in flash flooding."   It warned that the storm's trajectory was "highly uncertain."   "Some weakening is forecast during the next 48 hours if Lorena moves inland. If the hurricane moves over the Gulf of California, it could strengthen instead," it said in its 2100 GMT update.

Lorena already buffeted west-central Mexico with strong winds, torrential rain and high waves, leading officials to cancel school in the affected areas.   Authorities suspended classes in Los Cabos for Friday, and ordered all boats and ships to remain docked.   The army said it had deployed troops to set up 14 emergency shelters in case they were needed.
More ...

World Travel News Headlines

Date: Thu, 23 Jan 2020 17:57:34 +0100 (MET)
By Eva XIAO

Beijing, Jan 23, 2020 (AFP) - The first fatality of China's new virus would come to represent a common set of traits for those who died to the disease: he was over the age of 60 and in poor health.   Since China reported the emergence of a new coronavirus at the end of December, the SARS-like virus has infected more than 500 and killed 17.   So far, the majority of the victims were elderly individuals with pre-existing health conditions, such as diabetes and liver cirrhosis.   All hailed from central Hubei province, where a local seafood market in the capital city of Wuhan is believed to be the epicentre of the epidemic.   But while older individuals have died from the Wuhan virus, some younger patients -- including a 10-year-old boy -- have since been released from the hospital.   Here's what we know so far about the deaths:

Most victims were over 60
According to details released by China's National Health Commission (NHC) on Thursday, the 17 victims of the virus were between 48 and 89 years old.   Only two were under the age of 60, while the average age of the victims was 73.   Most of them died this week, according to the NHC.   Among those who have been discharged from the hospital were younger patients, including a 35-year-old man from Shenzhen, a bustling tech hub in southern Guangdong province.   He was released from the hospital on Thursday, according to the local health commission, as well as the 10-year-old boy who had visited relatives in Wuhan before falling ill.

Many had pre-existing health conditions
Many of those who died from the virus also had pre-existing health issues before contracting the Wuhan disease, such as diabetes and hypertension.   One man, an 86-year-old who was hospitalised on January 9, had surgery for colon cancer four years prior, on top of suffering from high blood pressure and diabetes.   Another, an 80-year-old woman surnamed Hu, had Parkinson's Disease and more than 20 years of high blood pressure and diabetes in her medical history.

Some were hospitalised for weeks before dying
Several of the 17 victims were hospitalised for weeks before dying -- raising questions on the preparedness of hospitals that may have to treat patients for long periods of time.   The youngest victim of the Wuhan virus, a woman surnamed Yin, was hospitalised for more than a month before succumbing to the virus.   On December 10, the 48-year-old woman reported a fever, coughing, body soreness, and fatigue, and underwent anti-infection treatment for two weeks, according to the NHC.   Later in the end of the month, Yin suffered shortness of breath and chest tightness, and she passed away on January 20.

Not all of them had a fever
Currently, Wuhan authorities are screening passengers for fever at the airport, railway stations, and bus terminals.   At four airports in Thailand, authorities introduced mandatory thermal scans of passengers arriving from high-risk areas of China.   But not all those who died after being infected reported a fever before being hospitalised, according to the NHC.   A 66-year-old man surnamed Luo reported a "mainly dry cough" but no fever on December 22 before suffering from shortness of breath more than a week later.

By mid-January, Luo required a ventilator to help him breathe.   "A major concern is the range of severity of symptoms this virus is causing," said Dr Jeremy Farrar, Director of the Wellcome Trust.   "It is clear some people are being affected and are infectious while experiencing only very mild symptoms or possibly without experiencing symptoms at all," he said in an emailed statement.   "This may be masking the true numbers infected and the extent of person to person transmission," he added.
Date: Thu, 23 Jan 2020 16:05:30 +0100 (MET)

Singapore, Jan 23, 2020 (AFP) - Singapore Thursday confirmed its first case of the new SARS-like virus which has killed 17 people in China and spread to multiple countries including the United States.   The Ministry of Health (MOH) said the patient was a 66-year-old man from Wuhan who arrived in Singapore with his family on Monday.    He was immediately isolated after arriving at a hospital with a fever and cough, and test results later confirmed he was infected with the coronavirus.   One of his travelling companions, a 37-year-old man from Wuhan, has also been admitted to hospital as a suspect case.

Prior to admission, they had stayed at a hotel on the resort island of Sentosa, the ministry said.   It added that Singapore was expecting more cases and alarms "given the high volume of international travel".   Singapore's Changi Airport started screening flights from Wuhan at the beginning of the month, and on Wednesday extended the checks to all flights from China.   The travel hub receives over 430 flights from China every week.   The virus has caused alarm in China and abroad because of its genetic similarities to Severe Acute Respiratory Syndrome (SARS), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.

Singapore was among the hardest hit by SARS with 33 deaths.   Prime Minister Lee Hsien Loong, who is in Davos for the World Economic Forum, said there was "no need to panic".   Speaking to reporters travelling with him, Lee said Singapore has beefed up its hospital facilities and laid out response measures since the SARS epidemic.   "I think we are much better prepared now," he said in remarks carried by the Straits Times newspaper.
Date: Thu, 23 Jan 2020 14:43:33 +0100 (MET)

Barcelona, Jan 23, 2020 (AFP) - The death toll from a violent storm which has wrought havoc on huge swathes of Spain's eastern and southern coastline rose to nine on Thursday as rescuers pressed the hunt for at least five missing people.    The latest death was that of a man whose body was found in a flooded river near Jorba, some 70 kilometres (45 miles) northwest of Barcelona, the emergency services said.    Rescuers in Catalonia had been searching for a missing person in the same area but said it was too early to confirm if it was him.

Catalan rescuers had late on Wednesday found another body of a man who died after falling into the water in Palamos, a port town about 100 kilometres up the coast from Barcelona.    They are also searching for a man who went missing from a merchant ship in the same area, as well as a person in Cadaques near the French border.   Earlier on Thursday, regional officials confirmed the death of a 75-year-old woman whose house collapsed because of heavy rain in Alcoi, a town in the eastern Alicante region.

Storm Gloria hit the region on Sunday, bringing strong winds, torrential rains and heavy snow, battering Spain's southern and eastern flanks before moving north.   Gale-force winds and huge waves smashed into seafront towns, with dramatic images showing massive flooding that has damaged shops, houses and restaurants.   National weather agency Aemet had on Wednesday said the storm was starting to abate although it kept Catalonia and the Balearic Islands on alert.   As the storm eased, Prime Minister Pedro Sanchez was on Thursday visiting some of the worst-hit areas, overflying parts of Catalonia before heading to the Balearic Islands which on Tuesday were hit by record waves, the port authority said.

Rescuers on the islands are still searching for three people, including a 25-year-old Briton who went missing on a beach in northern Ibiza, and a 27-year-old Spaniard who disappeared in Mallorca while practising canyoning -- a mix of rappelling, climbing and watersliding through deep gorges.   Rescuers had found three other bodies on Wednesday, including that of a 67-year-old man who went missing in his car near the southeastern resort town of Benidom.    They also found two bodies in the southern Andalusia region, one of a 77-year-old man who died when a greenhouse collapsed on him in a hailstorm in Nijar as well as that of a homeless man who died of hypothermia.
Date: Wed 22 Jan 2020 1:04 PM EAT
Source: Uganda Red Cross Twitter [edited]

One confirmed case of Crimean-Congo haemorrhagic fever, 4 others suspected, in Kagadi [western Uganda]

A district Task Force has been formed to manage and coordinate the cases across the district @MinofHealthUG @robert_kwesiga @inakasiita1
========================
[Crimean-Congo haemorrhagic fever (CCHF) can cause serious disease in humans, with a case fatality rate of 10-40%. It can be responsible for severe outbreaks in humans, but it is not pathogenic for ruminants, their amplifying hosts. WHO states that the onset of symptoms in humans is sudden, with fever, myalgia, (muscle ache), dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). There may be nausea, vomiting, diarrhoea, abdominal pain, and sore throat early on, followed by sharp mood swings and confusion. After 2-4 days, the agitation may be replaced by sleepiness, depression, and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly (liver enlargement). Other clinical signs include tachycardia (fast heart rate), lymphadenopathy (enlarged lymph nodes), and a petechial rash (a rash caused by bleeding into the skin) on internal mucosal surfaces, such as in the mouth and throat, and on the skin.

Public education, especially among individuals in contact with livestock or their products, is needed to prevent cases of CCHF infection. A One Health approach is needed for effective surveillance, with effective communication between animal health and human health professionals.

The information in the tweet above indicates that there is one confirmed and at least 4 suspected cases of CCHF in Kagadi district, in the western region of Uganda.  Any updates on the epidemiology of these cases, occupational exposure, and public health response measures to control the transmission will be highly appreciated. - ProMED Mod.UBA]

[Maps of Uganda:
Date: Mon 20 Jan 2020
Source: Global News [edited]

A doctor working with Indigenous Services Canada (ISC) in Saskatchewan is urging caution to residents in and around Onion Lake First Nation following 2 people contracting a rare, deadly bacterial infection. Medical health officer Dr. Ibrahim Khan wrote a letter to the chief of the Onion Lake First Nation that said both patients were admitted to medical facilities shortly after New Years Day with diphtheria. He said one patient is under 18, while the other is an adult and was suffering from skin abrasions [? cutaneous diphtheria], which Khan said is rare for that disease.

In the letter, he said the disease is very uncommon in the province and can lead to "severe complications like breathing problems, heart failure, and paralysis, and without appropriate treatment can result in death." He applauded the medical team in Onion Lake, saying they contained the infection and made sure everyone in the community was aware of the risk and vaccinated.

"Everybody gets that vaccination, and they have that protection. That's why we don't see it. We don't see that many measles cases. We don't see that many prostatitis [pertussis?] cases, and we do not see any tetanus cases, because there is a good immunization for it. A good vaccination for it (and) people are aware of it," he told Global News. He said other local agencies, like pharmacies, made sure those on the front lines were supplied if they came across someone who wasn't vaccinated.

The letter to Chief Henry Louis said vaccination is the best method for preventing diphtheria and that the disease could virtually be eradicated if everyone who could be vaccinated received the shot. He said the target is for 97% of the population to receive the vaccination to prevent further spread in the community and noted the rates in Onion Lake are below that benchmark.  [Byline: Kyle Benning]
=====================
[Although the news report above says that one of the 2 patients with diphtheria was an adult "suffering from skin abrasions, which is rare for that disease," perhaps implying that this patient had cutaneous diphtheria, we are not told specifically the patients' clinical manifestations, i.e., whether they had respiratory diphtheria, cutaneous diphtheria, or both; if the strains of _Corynebacterium diphtheriae_ were toxin-producers; or if the patients were vaccinated against diphtheria.

Diphtheria became nationally notifiable in Canada in 1924, and that year 9057 cases were reported, the highest annual number of cases ever recorded in Canada  (<https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/diphtheria/health-professionals.html>).

The diphtheria vaccine was 1st introduced in 1926, and routine immunization in infancy and childhood has been widely practiced since 1930 in Canada. By the mid-1950s, routine immunization had resulted in a remarkable decline in the morbidity and mortality of the disease. Another steep decline in cases occurred in 1980, which has been attributed, in part, to a change in case definition to exclude carriers from reported cases in all provinces and territories. Since 1993, a total of 19 cases have been reported with a range of 0-4 cases annually  (<https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/diphtheria/health-professionals.html>).

In the USA, the case definition for reporting to the National Notifiable Diseases Surveillance System includes only respiratory diphtheria
(<https://wwwn.cdc.gov/nndss/conditions/diphtheria/case-definition/2010/>).

Similarly, the WHO case definition for reporting diphtheria only includes clinical respiratory diphtheria. Although no longer reportable, cutaneous diphtheria still occurs in the USA and has been most often associated with homelessness, poor sanitation, poverty, and crowded living conditions  (<https://www.cdc.gov/vaccines/pubs/pinkbook/dip.html>).

However, the Canadian case definition includes both respiratory diphtheria and infection at another site (e.g., wound, cutaneous)
(<https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/diphtheria/health-professionals/national-case-definition.html>).

Cutaneous diphtheria is contagious and can be a source of both respiratory and cutaneous infections in contacts. Acquisition of _Corynebacterium diphtheriae_, the cause of diphtheria, can occur even in vaccinated contacts, as vaccine-induced immunity is anti-toxin. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Saskatchewan province, Canada: <http://healthmap.org/promed/p/262>]
Date: Wed, 22 Jan 2020 17:37:27 +0100 (MET)
By Helen ROXBURGH

Beijing, Jan 22, 2020 (AFP) - A new SARS-like virus has killed 17 people in China, infected hundreds and reached as far as the United States, with fears mounting about its spread as hundreds of millions travel for Lunar New Year celebrations, which start Friday.   Many countries have stepped up screening of passengers from Wuhan, the Chinese city identified as the epicentre, and the World Health Organization has called an emergency meeting.   Here's what we know so far about the virus:

- It's entirely new -
The pathogen appears to be a never-before-seen strain of coronavirus -- a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS), which killed 349 people in mainland China and another 299 in Hong Kong between 2002 and 2003.   Arnaud Fontanet, head of the department of epidemiology at the Institut Pasteur in Paris, told AFP the current virus strain was 80 percent genetically identical to SARS.   China has already shared the genome sequencing of this novel coronavirus with the international scientific community.   It has been named "2019-nCoV".

- It's being passed between humans -
The WHO said Monday it believed an animal source was the "primary source" of the outbreak, and Wuhan authorities identified a seafood market as the centre of the epidemic.   But China has since confirmed that there was evidence the virus is now passing from person to person, without any contact with the now-closed market.

The virus has infected more than 400 people across the country, with most cases in Wuhan, according to officials. Li Bin of China's National Health Commission on Wednesday said 1,394 people were still under medical observation.   Doctor Nathalie MacDermott of King's College London said it seems likely that the virus is spread through droplets in the air from sneezing or coughing.   Doctors at the University of Hong Kong published an initial paper on Tuesday modelling the spread of the virus which estimated that there have been some 1,343 cases in Wuhan -- similar to a projection of 1,700 last week by scientists at Imperial College, London.   Both are much higher than official figures.

- It is milder than SARS -
Compared with SARS, the symptoms appear to be less aggressive, and experts say the death toll is still relatively low.   "It's difficult to compare this disease with SARS," said Zhong Nanshan, a renowned scientist at China's National Health Commission at a press conference this week. "It's mild. The condition of the lung is not like SARS."   However, the milder nature of the virus can also cause alarm.

The outbreak comes as China prepares for the Lunar New Year Holiday, with hundreds of millions travelling across the country to see family.   Professor Antoine Flahault, director of the Institute of Global Health at the University of Geneva, told AFP that the fact that the virus seems milder in the majority of people is "paradoxically more worrying" as it allows people to travel further before their symptoms are detected.   "Wuhan is a major hub and with travel being a huge part of the fast approaching Chinese New Year, the concern level must remain high," said Jeremy Farrar, Director of the Wellcome Trust.

- International public health emergency? -
The WHO will hold a meeting on Wednesday to determine whether the outbreak constitutes a "public health emergency of international concern" and if so, what should be done to manage it.   Cases have so far been confirmed in Thailand, Japan, Taiwan, South Korea, Macau and the United States.

The WHO has only used the rare label a handful of times, including during the H1N1 -- or swine flu -- pandemic of 2009 and the Ebola epidemic that devastated parts of West Africa from 2014 to 2016.   The Chinese government announced Tuesday it was classifying the outbreak in the same category as the SARS outbreak, meaning compulsory isolation for those diagnosed with the disease and the potential to implement quarantine measures on travel.   But if the WHO decides to take this step, it would put the Wuhan virus in the same category as a handful of very serious epidemics.

- Global precautions -
As the number of confirmed deaths and infections has risen, so has concern worldwide about the disease spreading to other countries.   In Thailand, authorities have introduced mandatory thermal scans of passengers arriving at airports in Bangkok, Chiang Mai, Phuket and Krabi from high-risk areas in China.

In Hong Kong, where hundreds died during the SARS outbreak of 2002-2003, authorities have said they are on high alert, carrying out scans at the city's airport -- one of the world's busiest -- and at other international land and sea crossing points.

The United States also ordered the screening of passengers arriving on direct or connecting flights from Wuhan, including at airports in New York, San Francisco and Los Angeles.   Taiwan has issued travel advisories, and went to its second-highest alert level for those travelling to or from Wuhan. Vietnam has also ordered more border checks on its border with China.
Date: Wed, 22 Jan 2020 16:53:32 +0100 (MET)
By Beiyi SEOW

Beijing, Jan 22, 2020 (AFP) - The death toll from a new SARS-like virus that has infected hundreds in China rose to 17 on Wednesday, as authorities urged people to steer clear of the city at the centre of the outbreak.   The coronavirus has caused alarm because of its similarity to SARS (Severe Acute Respiratory Syndrome), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.   With hundreds of millions of people travelling across China this week for the Lunar New Year holiday, the National Health Commission announced measures to contain the disease -- including sterilisation and ventilation at airports and bus stations, as well as inside planes and trains.

In Wuhan, the epicentre of the epidemic, large public events were cancelled and international football matches were moved to a new location. Visitors were urged to stay away, while residents were advised to not to leave the central city, which is home to 11 million people.   "If it's not necessary we suggest that people don't come to Wuhan," Wuhan Mayor Zhou Xianwang told state broadcaster CCTV.    The illness is mainly transmitted via the respiratory tract and there "is the possibility of viral mutation and further spread of the disease", health commission vice minister Li Bin told a news conference in Beijing.   More than 500 cases have now been reported, with the majority in Wuhan, capital of Hubei province.

The virus has now infected at least 444 people in Hubei province alone, said provincial officials at a press conference, adding that the death toll had risen from nine to 17.   Major cities, including Beijing, Shanghai, and Chongqing have also reported cases, as well as provinces in northeastern, central, and southern China.   The World Health Organization started an emergency meeting Wednesday to decide whether or not to declare a rare global public health emergency over the disease, which has now been detected in the United States, Taiwan, Thailand, Japan, South Korea and Macau.

The Chinese government has classified the outbreak in the same category as the SARS epidemic, meaning compulsory isolation for those diagnosed with the illness and the potential to implement quarantine measures.   But they still have not been able to confirm the exact source of the virus.   "We will step up research efforts to identify the source and transmission of the disease," Li said, adding that "the cases are mostly linked to Wuhan".   Countries have intensified efforts to stop the spread of the pathogen -- known by its technical name 2019 Novel Coronavirus (2019-nCoV).   Passengers are facing screening measures at five US airports and a host of transport hubs across Asia. Britain and Italy on Wednesday also announced enhanced monitoring of passengers from Wuhan.

- Virus source -
A prominent expert from China's National Health Commission confirmed this week that the virus can be passed between people.   However, animals are suspected to be the primary source of the outbreak.   A Wuhan market is believed to be the epicentre of the outbreak.

A price list circulating online in China for a business there lists a menagerie of animals or animal-based products including live foxes, crocodiles, wolf puppies and rats. It also offered civets, the animal linked to SARS.   "We already know that the disease originated from a market which conducted illegal transaction of wild animals," said Gao Fu, director of the Chinese centre for disease control and prevention.   He said it was clear "this virus is adapting and mutating".   Hong Kong and British scientists have estimated that between 1,300 and 1,700 people in Wuhan may have been infected.

- Containment -
Health authorities are urging people to wash their hands regularly, avoid crowded places, get plenty of fresh air and wear a mask if they have a cough.   Anyone with a cough or fever was urged to go to hospital.   In Wuhan, city authorities made it mandatory to wear a mask in public places on Wednesday, according to state-run People's Daily.

In response to skyrocketing demand for masks -- which were starting to sell out at pharmacies and on some popular websites -- China's industry and information technology ministry said it would "spare no effort in increasing supply", state media reported.   "These days, I wear masks even in places that are not too crowded, although I wouldn't have done so in the past," said Wang Suping, 50, who works at a Beijing arts school.   At the capital's main international airport, the majority of people were wearing masks.

Hong Kong flag carrier Cathay Pacific said it had agreed to allow staff to wear surgical masks on mainland China flights, and that passengers from Wuhan would be offered masks and antiseptic wipes.   In Wuhan, police were conducting vehicle spot checks for live poultry or wild animals leaving and entering the city, state media said.   Officials also screened people on roads, the airport and the train station for fever.   The local government has cancelled major public activities and banned tour groups from heading out of the city.   Women's Olympics football qualifiers scheduled for February 3-9 in Wuhan have been moved to the eastern city of Nanjing.
Date: Wed, 22 Jan 2020 15:49:25 +0100 (MET)

Montreal, Jan 22, 2020 (AFP) - A Canadian guide died and five French tourists were missing after at least one snowmobile plunged through ice in northern Quebec, police said Tuesday.   The group were riding close to where a river exits the Saint-Jean lake, and were outside the approved area for snowmobiles, police spokesman Hugues Beaulieu told AFP.   Nine people, including the guide, were on the trip on Tuesday evening when the ice broke underneath them.   Police said they were alerted by two of the tourists who had rescued a third tourist from the freezing water.

The 42-year-old guide was pulled out by emergency response teams and taken to hospital, but he died overnight, Beaulieu said, adding "five French tourists are still missing."   The police and army were searching the area on Wednesday, assisted by divers.   "This sector was not part of a marked trail, they were off-piste," said the spokesman.
Date: Wed, 22 Jan 2020 04:55:57 +0100 (MET)

Hong Kong, Jan 22, 2020 (AFP) - Macau on Wednesday reported its first confirmed case of the new SARS-like coronavirus as authorities announced all staff in the city's bustling casinos had been ordered to wear face masks.   The former Portuguese colony is a huge draw for mainland tourists as the only place in China that allows gambling.

With the Lunar New Year approaching this weekend, a huge influx of mainland tourists is expected in the city.   Asian countries have ramped up measures to block the spread of the new virus, which emerged in the Chinese city of Wuhan and has so far killed at least nine people.

On Wednesday, Macau announced its first confirmed case -- a 52-year-old businesswoman from Wuhan who arrived in the city by high-speed rail on Sunday, via the neighbouring city of Zhuhai.    "A series of tests found that she was positive for the coronavirus and had symptoms of pneumonia," Lei Chin-lon, the head of Macau's health bureau, told reporters.    The woman had been staying at the New Orient Landmark Hotel with two friends who were being monitored since her admission to hospital on Tuesday.

Ao Ieong Iu, Macau's Secretary for Social Affairs and Culture, said staff in all casinos would be required to wear masks while anyone arriving at entry ports along the city's border with the mainland would need to fill out health declaration forms.    "We have not banned tourism groups from Wuhan but we are not encouraging them," Ao Ieong said.    "We will stay in close contact with tourism agencies and require them to notify us of all groups going to and coming from Wuhan," she added.
Date: Tue, 21 Jan 2020 22:23:22 +0100 (MET)
By Issam Ahmed with Helen Roxburgh

Washington/Beijing, Jan 21, 2020 (AFP) - The United States on Tuesday announced its first case of a new virus that has claimed six lives in China and sickened hundreds, joining countries around the world in ramping up measures to block its spread.   The man, a US resident in his 30s who lives near Seattle, is in good condition, according to federal and state officials, and approached authorities himself after reading about the SARS-like virus in news reports.   He is "currently hospitalized out of an abundance of precaution, and for short term monitoring, not because there was severe illness," said Chris Spitters, a Washington state health official.  "This is an evolving situation and again, we do expect additional patients in the United States and globally," added Nancy Messonier, a senior official at the Centers for Disease Control and Prevention (CDC), but stressed that the overall risk to Americans remained low.

The man entered the country on January 15 after traveling to Wuhan, two days before the US began deploying health officials at major airports to screen passengers arriving from that central Chinese city which is at the heart of the outbreak. The efforts are to be extended now to a total of five US airports.   It came as countries ramped up measures to block the spread of the virus -- known by its technical name 2019 Novel Coronavirus or 2019-nCoV -- as the number of cases surpassed 300, raising concerns in the middle of a major Chinese holiday travel rush.

Fears of a bigger outbreak rose after a prominent expert from China's National Health Commission confirmed late Monday that the virus can be passed between people.   That conclusion is shared by the CDC, which said "person-to-person spread is occurring, although it's unclear how easily the virus spreads between people," even as the World Health Organization (WHO) adopted a more cautious approach, saying it is still investigating.   The UN agency will hold an emergency meeting Wednesday to determine whether to declare a rare global public health emergency over the disease, which has also been detected in Thailand, Japan and South Korea and Taiwan.

- Holiday rush -
Authorities previously said there was no obvious evidence of person-to-person transmission and animals were suspected to be the source, as a seafood market where live animals were sold in Wuhan was identified as the center of the outbreak.   Hundreds of millions of people are criss-crossing China this week in packed buses, trains and planes to celebrate the Lunar New Year with relatives.

More than 80 new cases have been confirmed, bringing the total number of people hit by the virus in China to 315, with the vast majority in Hubei, the province where Wuhan lies, according to officials.   But cases have also been confirmed around the country, including Beijing and Shanghai.   The first case on the self-ruled island of Taiwan was also confirmed Tuesday, with a woman taken to hospital on arrival at the airport from Wuhan.   Wuhan mayor Zhou Xianwang told state broadcaster CCTV Tuesday that the death toll had risen from four to six.   The coronavirus has caused alarm because of its genetic similarities to Severe Acute Respiratory Syndrome (SARS), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.

- Fever checks -
At four airports in Thailand, authorities introduced mandatory thermal scans of passengers arriving from high-risk areas of China.   In Hong Kong, authorities said they were on "extreme high alert," with passengers from Wuhan required to fill out health declarations and face possible jail time if they do not declare symptoms.   Enhanced screening measures have also been set up at airports in Australia, Bangladesh, Nepal, Singapore and Russia, Malaysia and Vietnam.   A man showing symptoms of the disease who had travelled to Wuhan has been put in isolation in Australia as health officials await test results, authorities said Tuesday.   In China, the government announced it was classifying the outbreak in the same category as SARS, meaning compulsory isolation for those diagnosed ith the disease and the potential to implement quarantine measures on travel.

In Wuhan, authorities banned tour groups and police were conducting spot checks for animals in vehicles leaving and entering the city, state media said.   It added that city health authorities had scheduled 800 beds to be made available in three hospitals and 1,200 more would soon be ready, and passengers were being screened for fever at the airport, railway stations and bus terminals.   Doctors at the University of Hong Kong released a study on Tuesday estimating that there have been 1,343 cases of the new virus in Wuhan.   The WHO has only called a global public health emergency a handful of times, including during the H1N1 -- or swine flu -- pandemic of 2009 and the Ebola epidemic that devastated parts of West Africa from 2014 to 2016.