WORLD NEWS

Getting countries ...
Select countries and read reports below or

Andorra

General
************************************
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
**************
*********************
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
***************************************
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
************************************
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
************************************
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
************************************
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
************************************
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]
=====================
[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]
More ...

Puerto Rico

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Sun, 15 Mar 2020 23:58:27 +0100 (MET)

San Juan, March 15, 2020 (AFP) - The US territory of Puerto Rico on Sunday ordered a 9:00 pm to 5:00 am curfew to stem the spread of the novel coronavirus, the strongest measure yet taken on American soil.   It took effect immediately and lasts until March 30.   "Faced with the possibility of transmission and propagation of the virus, I have ordered the imposition of a curfew for all residents of Puerto Rico," Governor Wanda Vazquez announced in a video message.   "We must take every precaution to ensure that we do not become potential carriers," Vazquez said.

The Caribbean territory of 2.9 million, whose residents are US citizens, also will close many businesses from Sunday until the end of the month, she said.   That includes malls, movie theaters, concert venues, gyms, bars and other businesses that bring together large crowds on the island popular with tourists.   The exceptions will be businesses in the food supply chain, and in the medical care system, as well as drugstores, gas stations, banks and senior citizens' group homes.

At night, only those who are providing or receiving medical care, or carrying out essential duties, will be allowed to be on Puerto Rico's streets.   Anyone defying the curfew faces a six-month jail term and a fine of up to $5,000.   The island declared a state of emergency when its first cases were reported March 12. The island has reported five cases.   On Friday, Vazquez accepted the resignation of Health Secretary Rafael Rodriguez Mercado, who was under fire for his handling the coronavirus emergency.

Recently, island residents were irate when two warehouses were found to be filled with abandoned supplies, apparently never used after Hurricanes Irma and Maria in 2017.   The storms' one-two punch left Puerto Ricans without power for months and killed nearly 3,000 people, according to the local government's official numbers.   President Donald Trump has accused the Puerto Rican government of incompetence and siphoning off hurricane relief money.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
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.
More ...

Tajikistan

Tajikistan - US Consular Information Sheet
December 9, 2008
COUNTRY DESCRIPTION: Tajikistan remains the poorest of the former Soviet republics in Central Asia.
It is a nominally constitutional, democratic, and secular republic, dominated b
President Emomali Rahmon who has been in power since 1992.
Tourist facilities are undeveloped and many goods and services usually available in other countries are unavailable.
Read the Department of State Background Notes on Tajikistan for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid passport and visa are required to enter and exit Tajikistan, as well as for registration at hotels.
The visa should be valid for the entire period of stay in country, through departure, and travelers should ideally request visas which allow for changing travel dates.
Failure to produce a valid visa will require the traveler to leave the country immediately.
Travelers planning to arrive in Tajikistan from countries that have Tajik embassies or consulates must obtain Tajik visas abroad prior to their travel.
Tajikistan is represented by embassies and consulates in the following countries:
United States of America, United Kingdom, Austria, Germany, Belgium, Turkey, China, Afghanistan (Kabul, Mazori Sharif), Iran, Pakistan, India, Russian Federation, Belarus, Kazakhstan, Kyrgyzstan, Uzbekistan, Turkmenistan, Egypt, and United Arab Emirates (Dubai).
Travelers arriving in Tajikistan from countries in which there are no Tajik embassies or consulates must have Tajik visa support, in the form of a letter from the Tajik Ministry of Foreign Affairs (MFA) confirming that a visa may be issued, in order to receive a Tajik visa at the Dushanbe International Airport upon arrival.
Travelers need to have two passport-size photos and a passport valid for at least six months longer than the duration of the planned stay in Tajikistan.
Visas issued at the Dushanbe airport are normally valid for only 45 days.
This “upon arrival” visa service does not apply to any other Tajik airports or land borders.

Travelers staying in Tajikistan three days or longer must, within three days of arrival in Tajikistan, obtain registration stamps at the MFA or the Department of Visas and Registration of the Ministry of Internal Affairs (OVIR), depending on whether the purpose of the visit to Tajikistan is for official or personal travel.
Immigration authorities may deny the departure of travelers who failed to register their visas until after they have paid a fine and obtained the registration stamps at the MFA or OVIR.

In order to receive visa support, an organization inviting a traveler to Tajikistan must submit a request to the MFA at least two weeks in advance of the planned travel date to Tajikistan.
Persons planning to arrive in Tajikistan at the invitation of a private Tajik resident (e.g., a friend or relative in Tajikistan) need to obtain a notification letter from OVIR.
According to OVIR, it may take up to 45 days to obtain the notification letter.
The MFA will issue Tajik visa support on the basis of the OVIR notification letter.
The inviting party will send a copy of visa support to the traveler.
The original MFA visa support will be sent to the Consular bureau at Dushanbe airport.
According to the Ministry of Foreign Affairs, persons traveling at the invitation of Tajik organizations or travel agencies, who are applying for visas at Tajik embassies or consulates abroad, will be able to obtain single-entry Tajik visas valid for 45 days upon direct submission of their visa request to the Tajik embassy or consulate (without a visa support letter).
With the issuance of visa support, travelers applying for visas at Tajik embassies or consulates abroad will be able to obtain multiple-entry visas valid for a maximum of three months.
Travelers who would like their visas extended need to apply for extension in advance through the MFA (official travelers) or OVIR (tourist or commercial travelers).
Entry into the Gorno-Badakhshan region, both from inside and outside of Tajikistan, requires special authorization in advance in addition to a valid Tajik visa.
Travelers can obtain this authorization at Tajik embassies and consulates abroad, or by applying to the MFA or OVIR once in Tajikistan.
Tajik authorities advise that sponsoring organizations in Tajikistan submit requests for travel authorization for the Gorno-Badakhshan Autonomous Region at least two weeks in advance of the planned travel.
The Tajik MFA or OVIR will list the names of the settlements and cities in Gorno-Badakhshan which the traveler plans on visiting in the travel authorization stamp.
The Gorno-Badakhshan travel authorization is not written on a Tajik visa sticker; it is a separate note put in a passport.

The government of Tajikistan requires visitors who remain in country for more than 90 days to present a medical certificate showing that they are HIV-free, or to submit to an HIV test in Tajikistan.
HIV is a growing health threat in Tajikistan.

Visit the Embassy of Tajikistan web site at http://www.tjus.org for the most current visa information.

Note: Departure options from Tajikistan may be limited in an emergency.
U.S. citizens, their family members, and their dependents can maximize departure options by obtaining extended visas for travel to countries with reliable connections to Tajikistan, including Kazakhstan, Kyrgyzstan, Uzbekistan and Russia.
Other destinations, notably Turkey, offer several flights a week and do not require American citizens to obtain visas in advance.
Please note, however, that in emergency situations, flights may be suspended.

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

SAFETY AND SECURITY:
Supporters of terrorist groups such as the Islamic Movement of Uzbekistan (IMU), the Islamic Jihad Union (IJU), al-Qaida, and the Eastern Turkistan Islamic Movement remain active in Central Asia, as do anti-Western, anti-Semitic extremist organizations such as Hizb’ut-Tahrir.
These groups have expressed anti-U.S. sentiments and may attempt to target U.S. Government or private interests in the region, including in Tajikistan.
Terrorist attacks involving the use of suicide bombers have previously taken place in neighboring Uzbekistan.
Taliban resurgence and successful operations in Afghanistan, including attacks in the north, could also affect the security situation in southern Tajikistan.

Minor explosions have occasionally occurred in Dushanbe in the last two years.
These explosions usually happen at night.
In June 2007, an individual threw a grenade at the Supreme Court building.
Witnesses and unofficial reports indicate that three guards were killed, although no official reports confirmed this.
In November 2007, a small explosive killed an individual outside the Kokhi Vahhdat conference center in the center of Dushanbe.
In both cases, no individual or organization claimed responsibility and authorities continue to investigate.
Also in November 2007, a small improvised explosive device destroyed the official car belonging to the Commander of the President’s National Guard.
Incursions along the Afghan border have resulted in shootings and kidnappings; however, most are believed to be related to narcotics trafficking.
None of these incidents have indicated the targeting of Americans or Westerners.

Criminal groups and terrorists do not distinguish between official and civilian targets.
Because of increased security at official U.S. facilities, terrorists are seeking softer civilian targets such as residential areas, clubs and restaurants, places of worship, hotels, outdoor recreation events, and other venues.
The limited number of facilities catering to Westerners presents a heightened risk.
American travelers should also avoid demonstrations and large crowds.
Demonstrations and mobs are rare in Tajikistan following the 1992-1997 civil war, and police reaction to such behavior is unpredictable.

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

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

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

CRIME:
The current crime rating for Dushanbe is high.
The primary concern is the inability of Tajikistan’s law enforcement entities to provide adequate and immediate assistance.
Lack of manpower, low salaries, and inadequate training all contribute to a lack of professionalism.
Tajikistan’s struggling economy and high unemployment have resulted in incidents of street crime, including pick pocketings, muggings and armed robberies.
Alcohol-related incidents such as bar fights and drunk driving are common.
Criminals are not deterred by the risk of confrontation and tend to operate in groups of two or more to decrease their chances of arrest.
When crimes do occur, they can be violent in nature.
Additionally, the lack of a free media, and the infrequent public outreach between the government and the public through the media, does not provide the average citizen current and accurate information to make informed decisions about safety.

Government statistics are typically inaccurate because many crimes are not reported to law enforcement organizations.
Often police refuse to open minor or routine cases that seem too difficult to resolve.
In 2007, the Ministry of Interior reported a number of arrests related to organized crime, although overall reported crimes saw a slight decrease.
The Ministry also reported a slight increase in firearm and drug-related offenses compared to previous years.

Crimes of opportunity can occur against anyone, and the Embassy reminds visitors to be careful and cautious in their own personal security, whether within the city limits of Dushanbe or in the more remote areas of the country.
Americans should be aware that danger increases after dark, and they are advised to use caution when traveling alone or on foot after dark.
The U.S. Embassy encourages visitors to travel in pairs and to notify colleagues of their whereabouts when not working, especially during evening hours.
Travelers are also encouraged to carry a copy of their passport (separate from their wallets) to speed up issuance of a new passport in case of theft.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products are 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 Tajikistan is: 01 - Fire, 02 - Police, 03 - Ambulance
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
The quality of Tajikistan’s medical infrastructure is significantly below Western standards, with severe shortages of basic medical supplies, including disposable needles, anesthetics, and antibiotics.
Many trained medical personnel left the country during and following the civil war.
Elderly travelers and those with pre-existing health problems may be at particular risk due to inadequate medical facilities.

Significant disease outbreaks are possible due to population shifts and a decline in some immunization coverage among the general population.
There have been outbreaks of typhoid in the Dushanbe area and in the south, and the risk of contracting malaria, cholera, and water-borne illnesses is high.
Throughout Central Asia, rates of infection of various forms of hepatitis and tuberculosis (including drug-resistant strains) are on the rise.
Tuberculosis is an increasingly serious health concern in Tajikistan.
For further information, please consult the CDC’s Travel Notice on tuberculosis at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.
It is advised to drink only bottled or thoroughly boiled water while in Tajikistan.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Tajikistan.
However, the government of Tajikistan does require visitors who remain in country for more than 90 days to present a medical certificate showing that they are HIV-free, or to submit to an HIV test in Tajikistan.
HIV is a growing health threat in Tajikistan.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

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

Travel to, from, and within Tajikistan is difficult and unreliable.
Neighboring countries may unilaterally close borders and some borders are poorly delineated.
Armed police or military checkpoints can make road travel outside of Dushanbe more difficult.
Crossing the Tajik-Uzbek border, in particular, has been known to present difficulties for drivers operating vehicles with non-Tajik government-issued plates.
Road travel should be undertaken only in daylight hours and on routes known to the traveler or a reliable escort.
Those traveling to Gorno-Badakhshan by car should do so only during daylight hours.
The roads traverse mountainous terrain along the Afghan border that is difficult to navigate, even in daylight hours.
Public transportation vehicles in the city are often overcrowded and not always safe.
If you are driving, be vigilant because pedestrians often tend to cross the street at inappropriate places or walk along the highway without paying attention to vehicular traffic.
Bus services between major cities have been severely disrupted by border closures and should not be relied upon.
The State Traffic Inspectorate (GAI, or in Tajiki, BDA), which has checkpoints in many cities and at regular intervals along all highways outside the city, frequently stops vehicles for inspection of the vehicle and the driver’s documents.

During the winter months, the potential dangers when traveling outside of Dushanbe in the mountainous areas of the country are heightened.
Every year, accidents and casualties occur on Tajikistan’s mountain roads and passes, often when drivers ignore warnings not to travel over a closed mountain pass.
Avalanches are a common occurrence in Tajikistan’s mountains during the winter months.
The tunnel bypassing the Anzob Pass is still not complete and travel via this construction project is not advised in any season.
Please exercise caution and limit winter travel to Tajikistan’s mountain regions.

In certain parts of the country, including in the Vakhsh and Rasht valleys and along the Afghan-Tajik border, land mines and cluster munitions form an additional hazard.
If an area has land mine warning signs, or is marked off with red and white plastic tape, heed the warning and do not venture off the road.
In all cases, do not pick up or handle anything that looks like unexploded munitions.

Emergency phone numbers in Tajikistan:
police – 02, ambulance – 03, state traffic control (GAI) duty officer – 235-45-45.
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 Tajikistan, the U.S. Federal Aviation Administration (FAA) has not assessed the Government of Tajikistan’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: Tajikistan has a cash-only economy.
International banking services are limited, but ATM machines have been installed in several locations.
Cash is dispensed in both U.S. and local currency.
Few establishments in the country accept credit cards and none accepts traveler's checks.
Tajikistan's national currency is the Somoni, which is convertible.

Tajik customs authorities may subject all items that are imported into or exported from Tajikistan to a high level of scrutiny.
The Government of Tajikistan may enforce strict customs regulations against those who import and export goods.
The export of antiques and cultural valuables requires special permission.
There are also currency restrictions.
Travelers must fill out a Customs Declaration Form upon arrival in Tajikistan, have it stamped by Tajik customs officials at the port of entry and retain the form until departure to demonstrate that the travelers are not leaving Tajikistan with more money than they brought into the country.
Please contact the Embassy of the Republic of Tajikistan in the United States, 1005 New Hampshire Avenue NW, Washington, DC, 20037; telephone (202) 223-6090, fax:
(202) 223-6091, e-mail: tajikistan@verizon.net, web site: http://www.tjus.org for specific information about customs requirements.

The Republic of Tajikistan does not recognize dual citizenship with most countries, including the United States (one exception is with Russia, where dual citizenship is regulated by a special interstate agreement).
Dual nationals who attempt to leave Tajikistan on U.S. passports without valid Tajik visas in them are likely to have problems with immigration authorities upon departing Tajikistan.

Travelers to Tajikistan are subject to frequent document inspections by local police.
U.S. citizens are strongly encouraged to carry copies of their U.S. passports, Tajik visas, and visa registration at all times (including while traveling within Tajikistan) so that, if questioned by local officials, proof of identity,
U.S. citizenship, and valid visa status in Tajikistan are readily available.
Always check your visa and registration validity dates so that these documents can be renewed if necessary before they expire.
Taking photographs of anything that could be perceived as being of military or security interest, including many government buildings, may result in problems with the authorities.
In accordance with the Vienna Convention on Consular Relations and certain bilateral agreements, local authorities must grant a U.S. consular officer access to any U.S. citizen who is arrested.
U.S. citizens who are arrested or detained should ask to contact the U.S. Embassy immediately.

Tajikistan is an earthquake-prone country.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.

Please see our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Tajik laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Tajikistan 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 Tajikistan are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Tajikistan.
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 109A Ismoili Somoni Avenue, Dushanbe, Tajikistan, Main Phone: 992-37-229-2000, Consular Direct Line: 992-37-229-23-00, consular e-mail dushanbeconsular@state.gov, embassy fax:
992-37-229-20-50, Duty Officer: 992-90-770-10-32, web site: http://dushanbe.usembassy.gov
* * *
This replaces the Country Specific Information for Tajikistan dated February 14, 2008, to update the sections on Entry/Exit Requirements, Crime, Aviation Safety Oversight and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon, 6 Aug 2018 06:19:37 +0200
By Akbar Borisov, with Christopher Rickleton in Almaty

Dushanbe, Tajikistan, Aug 6, 2018 (AFP) - En route to mountainous Tajikistan's "roof of the world" lies a hastily-erected memorial to four bike tourists killed in an attack claimed by the Islamic State group late last month.     Roses and tulips lie scattered at the tribute -- featuring a plaque inscribed in English -- in the foreground of a scrubby mountain landscape.    "We express sincere condolences on behalf of all Tajik people and Tajikistan to the families and relatives of the died tourists in our country tragically and cruelly," the plaque reads.

It was here, approximately 100 kilometres south of Tajikistan's capital Dushanbe, that American tourists Lauren Geoghegan and Jay Austin, Dutch citizen Rene Wokke and Swiss citizen Markus Hummel were fatally wounded in an attack initially reported as a hit-and-run road accident.    The attack comes as a deep blow to Tajikistan, which has been trying to promote the authoritarian country as a tourism hotspot, simplifying visa bureaucracy and even declaring 2018 "the year of tourism."

Police said the gang that attacked the group of seven tourists, injuring two others, had also stabbed their victims, while a video released via IS' official media channel indicated the attackers were inspired by the Islamist group.   "It was a tragedy," 32-year-old account manager and biking enthusiast Pau Ros told AFP ahead of a seven-day cycle over Tajikistan's legendary Pamir Highway with girlfriend Mariona Miranda.   "This happens around the world now. But we are not going to change our lives because that is what these bad people would want," said Ros, who is a native of Barcelona.

- IS-linked? -
Authorities have played down video evidence that appears to show five men -- four of whom they say were killed resisting arrest -- swearing an oath of allegiance to IS leader Abu Bakr al-Baghdadi.   On Friday Tajikistan's state prosecutor said the clip had been released "with the aim of deflecting suspicions from another terrorist organisation -- the Islamic Renaissance Party", a former opposition party banned by the government in 2015. 

The IRPT has refuted links to the attack, as has Iran, a country that Tajikistan has poor ties with and says provided training to a 33-year-old man called Hussein Abdusamadov, who was detained for allegedly leading the attack on the cyclists.   In a brief interview with AFP, the mother of Abdusamadov, who was shown sporting a black eye in his police photo, could not say if he had traveled to Iran but said he spoke Arabic and had worked in Russia, a migration destination for hundreds of thousands of Tajiks.   "We do not know when he came back to (Tajikistan). The police just came to our door and told us he had committed a crime," Gulchekhra Shodmonova told AFP.

Analysts have pointed to a number of reasons to doubt the official narrative linking IRPT and Iran to the attack -- chiefly a downturn in Tajikistan's relations with Iran, an intensified crackdown on the opposition since 2015 and the IS video evidence.     Mahmudjon Faizrahmon, a spokesman-in-exile for the party that has always described itself as peaceful opposition force said on Thursday that police brought his 62-year-old mother for questioning after he denied links between the party and the attack on Twitter.     In addition to Abdusamadov, Tajikistan's prosecutor says 10 people have been detained under suspicion of financing the crime and failing to supply information to police before the attack took place.

- 'Simply Cycling' -
At the US embassy in Dushanbe, Tajikistan, a simple bicycle donated by a local student provides a fitting flourish to a display honouring 29-year-old Geoghegan and Austin, whose blog Simplycycling.org was popular among other bike-the-world cyclists.   The pair whose photo stood on a table at the heart of the display described themselves as enthusiasts who fell in love with cycling in adulthood but were not above "hitching a ride when a stretch of road is dangerous or just awful."   It is uncertain how the attack from which only one tourist, a Frenchman, emerged unscathed, will affect one of the few sources of economic optimism in the poorest country to gain independence from the Soviet Union.    Tajikistan announced plans to create a "tourist police" earlier this week, but provided few details.    One representative of a Bed and Breakfast in Dushanbe told AFP that a Polish tourist who had planned on cycling the highway had flown home. 
Date: Mon, 30 Jul 2018 10:24:00 +0200

Dushanbe, Tajikistan, July 30, 2018 (AFP) - Four foreign tourists were killed in Tajikistan on Sunday by armed attackers in what was originally reported as a hit-and-run road accident, the interior minister said Monday.   "(The suspects) had knives and firearms," minister Ramazon Hamro Rahimzoda said of the attack that left tourists from the United States, Switzerland and the Netherlands dead and two others injured.
Date: Sun, 29 Jul 2018 20:22:04 +0200

Dushanbe, Tajikistan, July 29, 2018 (AFP) - Four tourists were killed and another three injured on a bike tour in southern Tajikistan on Sunday when a car hit them before fleeing the scene, authorities said.   The seven cyclists included two Americans, two Dutch nationals and three other foreigners, the interior ministry told AFP without specifying the nationalities of those who died.   However, the US embassy in Tajikistan said two of the fatalities were US citizens.

The hit-and-run accident took place in the district of Danghara, 150 kilometres (90 miles) south of the capital Dushanbe.    "Three foreigners were killed at the scene and another died in hospital," the interior ministry said, adding that three other tourists had also received medical treatment.

Authorities in the Central Asian nation announced later Sunday one arrest and the deaths of two other suspects during a special operation launched to find those responsible for the deadly hit-and-run incident.   "One person has been arrested, two others resisted arrest and have been killed," the interior ministry said, without giving further details about the suspects.   Tajikistan is the poorest of the ex-Soviet republics and has been ruled by the iron hand of President Emomali Rakhmon since 1992.
Date: Tue 7 Nov 2017
Source: UN OCHA, ReliefWeb, Int Fed of Red Cross and Red Crescent Societies (IFRC) report [edited]

Measles outbreak DREF [Disaster Relief Emergency Fund] Operation MDRTJ025 Final Report
----------------------------------------------------------------------
A. Situation analysis
Description of the disaster
The measles epidemic in Tajikistan started in April 2017 in Rudaki district, and gradually spread to the capital city of Dushanbe and the surrounding districts, as well as Khatlon oblast. In mid-April 2017, 263 registered cases of measles were reported, out of which 157 were laboratory confirmed. By 1 May 2017, the number of notified and investigated cases rose from 263 to 345, with 246 patients (71 per cent) hospitalised. There were 2 child deaths registered over the course of the epidemic -- one in Khatlon oblast and one in the Districts of Republican Subordination).

The group most affected by the epidemic were children between 1 and 9 years of age. This also corresponded to the cohort born after the last national measles and rubella (MR) immunisation campaign conducted in 2009. Normally, the immunisation centre of the Ministry of Health and Social Protection (MoHSP) carries out immunisation on an annual basis for approx. 97 per cent of this cohort. The remaining 3 per cent -- including migrants, Roma and displaced people -- however, tends to remain non-immunised.

In response to the outbreak, the MoHSP decided to conduct a nationwide MR vaccination campaign targeting children aged 1-9 years, 15-26 May 2017, with the support of the Measles and Rubella Outbreak Response Initiative (MRI) Fund. The government of Tajikistan issued a decree on National Additional Immunisation Days in the country on 28 Apr 2017. The MoHSP issued an internal order on immunisation accordingly.
=====================
[The complete IFRC report is available at

Maps of Tajikistan can be seen at
Date: Mon, 30 Jan 2017 09:06:48 +0100

Dushanbe, Tajikistan, Jan 30, 2017 (AFP) - Authorities in Tajikistan said Monday that at least seven people were killed in a series of avalanches that hit the mountainous Central Asian country over the weekend.   Avalanches killed at least five people on a highway linking the capital Dushanbe with Khujand, Tajikistan's second largest city, the emergency services committee said.

Two more died in avalanches in the remote Pamir region in the country's east, the committee said.   Authorities said a rescue operation was ongoing and the casualty toll could continue to rise.    A spokesperson for the committee told AFP around 800 people had been evacuated Sunday following the avalanches.   Mountainous and poverty-struck Tajikistan is prone to natural disasters including avalanches, landslides and earthquakes.   In February 2015, a single avalanche claimed six lives in the east of the country.
More ...

Bahamas

The Bahamas Consular Information Sheet
July 14, 2005

COUNTRY DESCRIPTION:
The Bahamas is a developed, English-speaking Caribbean nation composed of hundreds of islands covering a territory approximately the size of California.
To
rism and financial services comprise the two largest sectors of the economy. Independent from the United Kingdom since 1973, The Bahamas is a Commonwealth nation with a centuries-old democratic tradition.
The capital, Nassau, is located on New Providence Island.
Read the Department of State Background Notes on The Bahamas at http://travel.state.gov for additional information.

ENTRY/EXIT REQUIREMENTS:
On December 31, 2005, the U.S. Government will begin to phase in new passport requirements for U.S. citizens traveling in the Western Hemisphere.
By December 31, 2007, all U.S. citizens will be expected to depart and enter the United States on a valid passport or other authorized document establishing identity and U.S. citizenship.
The Department of State strongly encourages travelers to obtain passports well in advance of any planned travel.
Routine passport applications by mail take up to six weeks to be issued.
For further information, go to the State Department's Consular website: http://travel.state.gov/travel/cbpmc/cbpmc_2223.html.

U.S. citizens must present original proof of U.S. citizenship (valid U.S. passport or certified U.S. birth certificate with a government-issued photo ID) and a return ticket. A passport is recommended as it eases processing upon return to the United States.
Voter registration cards, Social Security cards, driver's licenses, affidavits, and other similar documents are not acceptable as proof of U.S. citizenship. U.S. citizens do not need to obtain visas for stays of up to one month. Travelers arriving via private watercraft are charged docking fees.
See our Foreign Entry Requirements brochure for information on entry to The Bahamas and other countries.
U.S. citizens may also contact The Embassy of The Bahamas at 2220 Massachusetts Ave., NW, Washington, DC 20008 (tel: 202-319-2660), its Consulates in Miami and New York, or by email at bahemb@aol.com.

For entry and exit requirements pertaining to dual nationality and the prevention of international child abduction, read our information at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1469.html.
For Customs Information see http://travel.state.gov/travel/cis_pa_tw/cis/cis_1468.html.

SAFETY AND SECURITY:
The water sports and scooter rental industries in The Bahamas are not carefully regulated.
Visitors should rent equipment only from reputable operators, and should insist on sufficient training before using the equipment.
Every year, people are killed or injured by the improper use of scooters, jet-skis, and personal watercraft or by the careless or reckless operation of such equipment by others.
You should insist on seeing proof that operators have sufficient medical and liability insurance. Travelers should also invest in low-cost traveler's insurance that includes medical evacuations, as most American insurance companies do not cover this.

For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site at http://travel.state.gov where the current Travel Warnings and Public Announcements, including the Worldwide Caution Public Announcement, 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 at http://travel.state.gov/travel/tips/safety/safety_1747.html.

CRIME:
While The Bahamas has a relatively low crime rate, visitors should exercise caution and good judgment. Although most criminal incidents take place in a part of Nassau not usually frequented by tourists (the "over-the-hill" area south of downtown), crime and violence has moved into more upscale tourist and residential areas.
Criminals also target restaurants and nightclubs frequented by tourists.
The most common approach for criminals is to offer victims a ride, either as a "personal favor" or by claiming to be a taxi, and then robbing and/or assaulting the passenger once they are in the car. Visitors should take care to ride only in licensed taxis, identifiable by their yellow license plates.

In the last year the U.S. Embassy has received several reports of sexual assaults, including against teen-age girls. Most assaults have been perpetrated against intoxicated young women, some of whom were reportedly drugged. To minimize the potential for sexual assault, the Embassy recommends that young women stay in groups, consume alcohol in moderation or not at all, ride only in licensed taxis, and not accept rides or drinks from strangers.
Travelers should avoid walking alone after dark or in isolated areas, and avoid placing themselves in situations where they are alone with strangers. Be cautious on deserted areas of beaches at all hours. Hotel guests should always lock their doors and should never leave valuables unattended, especially on beaches.
Visitors should store passport/identity documents, airline tickets, credit cards, and extra cash in hotel safes. Avoid wearing expensive jewelry, particularly Rolex watches, which criminals have specifically targeted. Use only clearly marked taxis with yellow license plates and make a note of the license plate number for your records.

The legal age in the Bahamas for consumption of alcoholic beverages is 18. Parents should be aware, however, that enforcement of the drinking age is weak.
It is easy for teenagers to obtain alcoholic beverages and underage drinking is prevalent.
Many of the arrests, accidents and violent crimes suffered by U.S. citizens in The Bahamas involve alcohol.

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 understand the local criminal justice process and find an attorney if needed.

See our information on Victims of Crime at http://travel.state.gov/travel/tips/emergencies/emergencies_1748.html.

MEDICAL FACILITIES AND HEALTH INFORMATION:
High quality medical care is generally available, but expensive, in Nassau and Freeport. Medical care is limited outside of Nassau and Freeport. Bahamian doctors and hospitals do not usually accept U.S. medical insurance policies and typically expect immediate cash payment for professional services. It is the patient's responsibility to seek reimbursement later from their insurance companies. Serious health problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars. Persons with serious or life-threatening conditions who wish to return to U.S. medical facilities for treatment normally must be airlifted.
There is a chronic shortage of blood at Princess Margaret Hospital in Nassau, where most emergency surgery is performed.
Travelers with rare blood types should know the names and locations of possible blood donors should the need arise.
The Lyford Cay Hospital has a hyperbaric chamber for treatment of decompression illness.
Ambulance service is available, but may not be able to respond quickly in the event of a major emergency or disaster.

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); fax 1-888-CDC-FAXX (1-888-232-3299), 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 at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1470.html.

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

Traffic in The Bahamas moves on the left side of the roadway. Roads in Nassau and Freeport are generally adequate, but traffic congestion in those cities is endemic.
Rural roads can be narrow, winding, and in poor repair.
Flooding frequently occurs on roads in low-lying areas throughout The Bahamas, including Nassau and Freeport.
Drivers should be alert for unmarked construction zones throughout The Bahamas.
Travel by moped or bicycle can be quite hazardous, especially in the heavy traffic conditions prevalent in Nassau and Freeport. Travelers should exercise appropriate caution when renting motorbikes. Accidents involving U.S. tourists on motorbikes have caused severe injuries and fatalities. Those who choose to ride a moped or bicycle should wear helmets and drive defensively.
Pedestrians need to remember that vehicular traffic comes from the right.
Pedestrians have been hit by cars after failing to check properly for oncoming traffic.

Emergency ambulance service is generally available and can be reached by dialing 911. Roadside assistance is also widely available through private towing services, listed in the phone book.

For specific information concerning driver's permits, vehicle inspection, road tax, and mandatory insurance in The Bahamas, please contact The Bahamas Tourist Board in New York at http://bahamas.com, (tel:
1-800-823-3136).

Please refer to our Road Safety page for more information at http://travel.state.gov/travel/tips/safety/safety_1179.html.
Visit the website of the country's national tourist office and national authority responsible for road safety.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of The Bahamas as being in compliance with ICAO international aviation safety standards for oversight of The Bahamas' air carrier operations.
For more information, travelers may visit the FAA's Internet web site at http://www.faa.gov/avr/iasa/index.cfm.

SPECIAL CIRCUMSTANCES:
CUSTOMS:
The Bahamas customs authorities may enforce strict regulations concerning temporary importation into or exportation from The Bahamas of firearms. It is advisable to contact the Embassy of The Commonwealth of The Bahamas in Washington or one of the Bahamian consulates in the U.S. for specific information regarding customs requirements. Tourists who arrive by private boat are required to declare firearms to Bahamian Customs and leave firearms on the boat while in The Bahamas. Please see our information on customs regulations at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1468.html.

BOATING/FISHING:
Boaters should be aware that long-line fishing in Bahamian waters is illegal. All long-line fishing gear is required to be stowed below deck while transiting through Bahamian waters. Fishermen should note that stiff penalties are imposed for catching crawfish (lobster) or other marine life out of season or in protected areas.

TIME-SHARES:
U.S. citizens should exercise caution when considering time-share investments and be aware of the aggressive tactics used by some time-share sales representatives. Bahamian law allows time-share purchasers five days to cancel the contract for full reimbursement. Disputes that arise after that period can be very time-consuming and expensive to resolve through the local legal system.
HURRICANES:
The Bahamas, like all countries in the Caribbean basin, is vulnerable to hurricanes. Hurricane season officially runs from June 1 to November 30, although hurricanes have been known to occur outside that time period. Visitors to The Bahamas during hurricane season are advised to monitor weather reports in order to be prepared for any potential threats. General information about disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating The Bahamas' laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in The Bahamas are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
For more information visit http://travel.state.gov/travel/cis_pa_tw/cis/cis_1467.html.

CHILDREN'S ISSUES:
For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website at http://www.travel.state.gov/family/family_1732.html.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in The Bahamas are encouraged to register with the nearest U.S. Embassy through the State Department's travel registration website, https://travelregistration.state.gov, and to obtain updated information on travel and security within The Bahamas.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located next to McDonald's restaurant on Queen Street in downtown Nassau; telephone (242) 322-1181, after hours: (242) 328-2206.
Consular Section hours are 1:00 p.m. - 4:00 p.m. Monday-Thursday and 10:00-12:00 on Fridays. The Embassy is closed on local and U.S. holidays.
You may wish to visit the Embassy's website at http://bahamas.usembassy.gov/ or contact the Consular Section by e-mail at acsn@state.gov .

The U.S. Embassy is also responsible for consular services in the Turks and Caicos Islands (TCIS), a United Kingdom (British) overseas territory.
U.S. citizens may obtain updated information on travel and security in TCIS from the U.S. Embassy in Nassau or the Consular Information Sheet for the Turks and Caicos.
*

*

*
This replaces the Consular Information Sheet dated October 15, 2004, to update Sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Traffic Safety and Road Conditions, Special Circumstances, and Registration/Embassy Location; to include a Section on Information For Victims of Crime; and to combine and update the Sections on Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Mon, 2 Sep 2019 11:42:27 +0200 (METDST)

Geneva, Sept 2, 2019 (AFP) - Hurricane Dorian has caused "extensive damage" across the Bahamas, the Red Cross said Monday, warning that as many as 13,000 houses may have been severely damaged or destroyed.   "We don't yet have a complete picture of what has happened," Sune Bulow, head of the International Federation of Red Cross and Red Crescent Societies' Emergency Operation Centre in Geneva, said in a statement.   "But it is clear that Hurricane Dorian has had a catastrophic impact," he said, adding that "we anticipate extensive shelter needs, alongside the need for short-term economic support, as well as for clean water and health assistance."

Hurricane Dorian battered the Bahamas with ferocious wind and rain on Sunday, the monstrous Category 5 storm wrecking towns and homes as it churned on an uncertain path toward the US coast where hundreds of thousands were ordered to evacuate.   There was no immediate word on casualties in the low-lying islands.   But IFRC said that up to 13,000 houses may have been severely impacted.

The organisation also warned that extensive flooding on the island of Abaco was believed to have contaminated wells with saltwater.   IFRC said it had released 250,000 Swiss francs ($252,000, 230,000 euros) from its Disaster Relief Emergency Fund to bolster the initial response to the crisis, and to provide some 500 families with emergency shelter assistance.   Packing sustained winds of 185 miles per hour (295 kilometre per hour), Dorian crashed onshore in the Abacos Islands, in the northwest of the Bahamas, as the strongest storm ever to hit the Caribbean chain.

After days of nerve-wracking uncertainty surrounding the storm's path, the southeastern US states of Florida, Georgia and South Carolina finally ordered coastal residents to evacuate in a mass exodus set to affect hundreds of thousands of people.    The American Red Cross estimated that some 19 million people live in areas that could be impacted by the storm, with as many as 50,000 people in Florida, Georgia and South Carolina potentially in need of emergency shelter, depending on the impact.   IFRC said that hundreds of Red Cross volunteers, emergency response vehicles and more than 30 truck loads of relief supplies were being mobilised to help people living in the path of the hurricane.
Date: Mon, 2 Sep 2019 00:55:48 +0200 (METDST)
By Leila MACOR

Riviera Beach, United States, Sept 1, 2019 (AFP) - Hurricane Dorian blasted the northern Bahamas as a monster Category 5 storm on Sunday, pummeling the low-lying island chain with torrential rains and winds of a violence unprecedented in its history.   Packing winds of 185 miles per hour (295 kilometers per hour), Dorian made landfall twice in the Bahamas' Abaco Islands, and was tied for the second most powerful hurricane ever in the Atlantic basin, the National Weather Service said.

Footage posted on social media showed major destruction. There was no immediate word on casualties.   Parts of the Abaco Islands were reported to be under water as forecasters warned it was facing a towering 18 to 23 foot storm surge. Winds were gusting over 220 mph, the National Hurricane Center in Miami said.   Video posted on the website of the Bahamian newspaper Tribune 242 showed water up to the roofs of wooden houses in what ppeared to be a coastal town. Capsized boats floated in muddy brown water dotted with wooden boards, tree branches and other debris.

In other social media footage of what appears to be an inland area, cars were smashed or turned over, telephone poles and trees were snapped like twigs and debris filled the yards of severely damaged homes. AFP could not immediately confirm the authenticity of any of this footage.   Bahamas Prime Minister Hubert Minnis broke down in tears as he addressed a news conference, calling it "probably the most sad and worst day of my life," the Nassau Guardian reported.   "We're facing a hurricane... one that we've never seen in the history of the Bahamas," he said.

Footage shot in Cooper's Town, Abaco and obtained by AFP showed waves crashing violently onshore, sending up huge clouds of spray along the coastline.   Local radio reported that people were calling for help after winds blew the roof off the Island Breezes Hotel in Marsh Harbour, a commercial hub in the Abacos.   "Things are really starting to rock and roll," a post on the Facebook page of the Hope Town Bulletin in Abacos said at 10:00 am local time.    As of 2200 GMT, the storm was 75 miles (120 kilometers) east of Freeport on the island of Grand Bahama and moving slowly west.   In Grand Bahama, thousands have evacuated to get out of Dorian's predicted path.   "It feels like we are standing in a line waiting for a beating," Yasmin Rigby, a resident of Freeport, the island's main city, told AFP.

- Strongest storm to hit Bahamas -
The NHC said Dorian had become "the strongest hurricane in modern records for the northwestern Bahamas."   Describing "catastrophic" conditions in the Abacos Islands, it said the storm was "heading with all its fury towards Grand Bahama," where it was expected Sunday night into Monday.  NHC director Ken Graham on Facebook Live said the Bahamas would be under major hurricane conditions for a punishing 30 hours or more.   "That's major hurricane winds, that's storm surge of 10 and even 20 feet in some of those areas," he said. "That's also torrential rainfall of 15 to 20 inches, isolated 30 inches."

In Washington, US President Donald Trump met with his emergency management chiefs and declared "this looks monstrous."   "We expect that much of the eastern seaboard will be ultimately impacted and some of it very, very severely," he said.   Tropical storm warnings were in effect for parts of the Florida coast, and residents up and down the Atlantic coast braced for a brush with danger.   Florida issued its first evacuation orders in parts of Palm Beach, home of Trump's Mar-a-Lago resort, and Martin Counties.

- 'Very great danger' -
Kevin McAleenan, acting homeland security secretary, said hurricane force winds could hit Florida, followed by a prolonged rain event combined with a storm surge.   "That's going to be very difficult as the storm starts to move northward, mostly like, up the coast of Florida and toward Georgia and South Carolina," he said on ABC's "This Week."   While Miami appeared likely to be largely spared, 30-year-old David Duque, picking up sandbags there on Saturday, noted that "everything could change... I know it could be a scare, but better prepare instead of doing nothing."   The Florida National Guard said roughly 2,000 service members had been mobilized, with another 2,000 poised to join them.

- 'Absolute monster' -
Trump has declared a federal state of emergency in Florida, authorizing US assistance to supplement state and local efforts.   Following a similar state order in Florida, South Carolina Governor Henry McMaster declared a state of emergency Saturday, saying, "Given the strength and unpredictability of the storm, we must prepare for every possible scenario."   Neighboring North Carolina also declared a state of emergency, and Georgia announced a state of emergency for 12 counties.   Orlando International Airport was to protectively halt commercial flights at 2:00 am (0600 GMT) Monday, and Florida's NASA Kennedy Space Center said it was moving an enormous mobile rocket launcher inside to protect it.
Date: Wed 25 Jul 2018
Source: Eyewitness News [edited]

Cases of reported conch poisoning are on the rise in the capital, according to Minister of Health Dr. Duane Sands. The health minister confirmed Tue 24 Jul 2018 that over 3 dozen persons have sought medical attention for conch poisoning since the Ministry of Health announced the new outbreak in New Providence nearly a month ago.

Luckily, there have been no reports of conch poisoning in the Family Islands. Dr. Sands confirmed that the outbreak has been isolated to New Providence. "We can now confirm 25 clinical cases with laboratory testing," he said. "There are an additional 15 clinical cases that meet the definition but are still awaiting finalization of their laboratory data, so there may be as many as 40 clinical cases that might have been presented to the hospital. There are some people who get conch poisoning but it's not severe enough for them to come to the hospital for treatment."

The health minister continued to issue warning to patrons and vendors. "I continue to say that this is a preventable problem, so to the vendors, you have to wash the conch in fresh water. To the patrons, it is a good idea to insist that [the conch] is washed in fresh water."

Conch poisoning occurs when raw conch meat is not thoroughly washed in fresh water. Bacteria that resides on the skin of conch is what leads to the treacherous poisoning. The most recent major outbreak of conch poisoning in the Bahamas dates back to the 1990s.  [Byline: Theo Sealy]
=====================
[The aetiology is _V. parahaemolyticus_, a bacterium in the same family as those that cause cholera. It lives in brackish saltwater and causes gastrointestinal illness in humans. Symptoms include watery diarrhoea, abdominal cramping, nausea, vomiting, and fever and chills. Usually these symptoms begin within 24 hours of exposure. Illness is usually self-limited and lasts approximately 3 days. Severe disease is rare and occurs more commonly in persons with weakened immune systems.

Infections with this organism, which can be normal microflora in seawater, have been associated with the consumption of raw, improperly cooked, or cooked and recontaminated fish and shellfish. A correlation exists between the probability of infection and warmer months of the year. Improper refrigeration of seafood contaminated with this organism will allow its proliferation, which increases the possibility of infection. ProMED-mail covered a large 2005 outbreak in Chile. It was impressive in its size (more than 10 000 cases), continued to spread despite early recognition, and involved clams and mussels rather than the classical oyster vehicle. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
New Providence Island, New Providence, Bahamas:
Date: 5 Jul 2018
Source: The Nassau Guardian [edited]

The Ministry of Health warned yesterday of a recent outbreak of conch poisoning. Health authorities yesterday [4 Jul 2018] confirmed 4 cases of conch poisoning stemming from Potter's Cay in the past 72 hours but said the outbreak of _Vibrio parahaemolyticus_ could easily be prevented by vendors washing their conch supplies in fresh water.

_V. parahaemolyticus_ is a bacterium found in brackish saltwater, which, when ingested, causes symptoms including abdominal cramps, vomiting, headache, diarrhea and fever. "This is a preventable illness that requires basic hygiene as it relates to conch preparation," said Minister of Health Dr. Duane Sands during a press conference at the Ministry of Health of Meeting Street. He continued, "I think there is no reason why we can't say we will ensure that every single vendor is reminded of the requirement to wash the conch with copious amounts of fresh, clean water. To those in the purchasing public, if your vendor does not have access to fresh tap water or distilled water, and is only washing the conch in seawater, until we get the all clear, don't buy from that vendor."

The 4 patients with confirmed cases of vibriosis are Bahamians. There were at least 6 more people exhibiting symptoms awaiting confirmation of conch poisoning.

Sands assured the public that health officials, who received reports of the cases yesterday morning [4 Jul 2018], have mobilized in conjunction with the Ministry of the Environment to take the necessary steps to protect the health of those affected and, through targeted interventions, prevent further cases. The minister also advised all conch vendors will be required to take a food-handling course and maintain fresh potable water at their stalls.

As it relates to the unconfirmed cases, Sands said those patients, who were admitted to the Emergency Room at Doctors Hospital and Princess Margaret Hospital in the past 24 hours with gastroenteritis, were awaiting lab results. "Bear in mind that gastroenteritis can occur for a number of reasons," he said, "And so, to ascribe a case of gastroenteritis to vibrio would require confirmatory testing."

Sands said one of the priorities of the ministry is to have the conversation with the public early and spread awareness. "The 2nd thing we would like to do and we have started to do is to ensure the environmental health teams speak directly with the vendors, but throughout New Providence [Bahamas] and anywhere else we may suspect a possibility of exposure," the minister said. "We learned back in the 1990s this is easily controlled if people practice very simple techniques of washing conch with fresh water, which minimizes, if not eliminates, the possibility of transmission. And so, we just redouble those efforts combined with public education."

Additionally, Sands advised conch purchasers to ask vendors and restaurants whether the conch has been washed in fresh water before purchasing and eating it. "If the answer is affirmative, then you ought to feel reasonably comfortable you can eat it," he said. "If the answer is no, then I wouldn't suggest you eat or purchase it." No vendor has been closed down as a result of the cases presented. Sands said that would be premature, noting that conch poisoning from _V. parahaemolyticus_ can be easily prevented.

Thousands of visitors frequent Potter's Cay and other venues to sample conch in the variety of ways it is prepared, such as conch salad, in which the conch is consumed raw with vegetables, pepper and lime. According to health officials, cooking the conch removes the chance of it being contaminated.

There were 223 cases of vibriosis in New Providence [Bahamas] in 2003. In 1991 and 1999, there were also outbreaks of conch poisoning with a combined 1100 cases, Sands said.

Regarding testing, Sands was asked whether the ministry has periodically tested random conch batches from vendors. "This is not an issue of the meat itself," he responded. "Vibrio is a bacteri[um] ordinarily living in sea water and is a part of the surface of the conch. The conch meat itself is not infected with _V. parahaemolyticus_, so you can wash it off. Testing the conch meat itself is not the issue."

Sands continued, "We have learned historically you can eliminate this problem by washing the conch in fresh water. If you are washing the conch with _Vibrio_-containing water, you are not going to solve the problem, even though the conch may appear clean on the surface." Sands said while this is a breaking matter and the ministry has a strategic plan, it has not gotten to the stage of testing batches of conch and the storage water, but "that does not mean that we won't get there."

Symptoms of conch poisoning from _V. parahaemolyticus_ can persist for 72 hours, and some patients may require hospitalization for treatment of dehydration. Those experiencing symptoms are asked to contact the ministry's surveillance unit at +1-242-502-4790 between 9 a.m. and 5 p.m. EDT.  [Byline: Torrell Glinton]
====================
[There is now confirmation the agent involved in the conch poisoning situation is the bacterium _Vibrio parahaemolyticus_. I apologize for the error regarding identification of the agent. Laboratory confirmation is always appreciated. [ProMED would like to thank Mr. Ryan Burke for bringing the laboratory confirmation to our attenttion. - ProMED Mod.JH]

_V. parahaemolyticus_ is a bacterium in the same family as those that cause cholera. It lives in brackish saltwater and causes gastrointestinal illness in humans. Symptoms include watery diarrhea, abdominal cramping, nausea, vomiting, and fever and chills. Usually these symptoms begin within 24 hours of exposure. Illness is usually self-limited and lasts approximately 3 days. Severe disease is rare and occurs more commonly in persons with weakened immune systems <http://www.health.state.mn.us/divs/idepc/diseases/vibrio/basics.html>.

Additional information regarding _V. parahaemolyticus_ may be found on the CDC fact sheet <https://www.cdc.gov/vibrio/faq.html> - ProMED Mod.TG]

[Infections with this organism, which can be normal microflora in seawater, have been associated with the consumption of raw, improperly cooked, or cooked and recontaminated fish and shellfish. A correlation exists between the probability of infection and warmer months of the year. Improper refrigeration of seafood contaminated with this organism will allow its proliferation, which increases the possibility of infection. ProMED-mail covered a large 2005 outbreak in Chile. It was impressive in its size (more than 10 000 cases), continued spread despite early recognition, and the involvement of clams and mussels rather than the classical oyster vehicle. - ProMED Mod.LL]

[HealthMap/ProMED-mail map: <http://healthmap.org/promed/p/11584>]
Date: Thu 5 Jul 2018
Source: EW News [edited]

With 4 confirmed cases of conch poisoning in New Providence, [Bahamas], the Ministry of Health cautioned Bahamians against consuming the delicacy in the wake of this latest outbreak. Health Minister Dr. Duane Sands confirmed the 4 Bahamians suffering from the illness. The earliest case, he said, dates back to [Sat 30 Jun 2018].

Dr. Sands revealed that an additional 6 persons have been hospitalized with symptoms of conch poisoning. He said even though the number of cases is considered minimal, the ministry's warning is a proactive measure to prevent future cases. The ministry, he said, is expected to begin dialogue with local vendors to ensure they are utilizing proper cleaning methods in the preparation of conch dishes.

"Conch should be washed with fresh water, and not salt water, to ensure that all bacteria is removed from the conch meat," suggested Dr. Sands. He urged Bahamians to ask local vendors about the processes they employ during the preparation of conch dishes. "If they do not wash the conch in fresh water during the process of preparing it, then do not purchase the conch," he warned.

The early onset of conch poisoning is said to be accompanied by watery diarrhoea and extreme abdominal cramps. Some cases, the health minister said, are severe and can lead to dehydration and subsequent hospitalization.

The last major outbreak of conch poisoning dates back to the 1990s, according to Dr. Sands.  [Byline: Theo Sealy]
=========================
[The group of conchs that are sometimes referred to as "true conchs" are marine gastropod molluscs in the family Strombidae, specifically in the genus _Strombus_ and other closely related genera. For example, see _Lobatus gigas_, the queen conch, and _Laevistrombus canarium_, the dog conch (<https://en.wikipedia.org/wiki/Conch>).

In ciguatera poisoning, the poisonous ingredient is ciguatoxin. This is a poison made in small amounts by certain algae and algae-like organisms called dinoflagellates. Environmental conditions are right for other organisms, mollusks, or fish to ingest the algae and dinoflagellates. Smaller organisms may be ingested by larger organisms, thus transferring the toxic agent to the larger animal.

Ciguatera is a foodborne illness (food poisoning) caused by eating fish that is contaminated by ciguatera toxin. Ciguatera toxin, a heat-stable, lipid-soluble compound produced by dinoflagellates and concentrated in fish organs, can cause nausea, pain, and cardiac and neurological symptoms in humans when ingested.

Ciguatera toxin is harmless to fish but poisonous to humans. The toxin is odorless and tasteless, and cooking does not destroy the toxin. The toxin activates voltage-dependent sodium channels, causing symptoms in gastrointestinal, cardiac, and nerve tissues of humans and other mammals.

Symptoms in people generally begin 6-8 hr after eating the contaminated fish but can occur as early as 2 or as late as 24 hr after ingestion. Symptoms include nausea, vomiting, diarrhea, muscle pain, numbness, tingling, abdominal pain, dizziness, and vertigo. There is no specific antitoxin available for ciguatera toxin.

Some investigators have suggested vomiting should be induced if the victim is awake and alert and has eaten ciguatera toxin-containing fish within the last 3-4 hr. Ipecac, a substance that causes vomiting, was suggested as the medication to use, but many investigators now think ipecac causes too much dehydration. Currently, some physicians recommend gastrointestinal decontamination with activated charcoal. Activated charcoal may absorb the toxin if administered 3-4 hr after ingestion.

Victims should maintain hydration. Intravenous fluids may be necessary for uncontrollable nausea and vomiting. Although there is no specific antidote available, supportive therapy and time usually is curative.

Portions of this comment were extracted from

[HealthMap/ProMED-mail map:
New Providence Island, New Providence, Bahamas:
More ...

United Kingdom

United Kingdom and Gibraltar (England, Wales, Scotland, Northern Ireland) US Consular Information Sheet
October 09, 2008
COUNTRY DESCRIPTION:
The United Kingdom of Great Britain and Northern Ireland is a highly developed constitutional mon
rchy composed of Great Britain (England, Scotland, and Wales) and Northern Ireland.
Read the Department of State Background Notes on the United Kingdom for additional information.
Gibraltar is a UK Overseas Territory bordering Spain, and is located at the southernmost tip of Europe at the entrance to the Mediterranean Sea.
It is one of 13 former British colonies that have elected to continue their political links with London.
Tourist facilities are widely available throughout the United Kingdom and Gibraltar.

ENTRY/EXIT REQUIREMENTS:
A UK visa/entry clearance is not required for tourist or business visits to the United Kingdom of less than six months in duration.
Visitors wishing to remain longer than one month in Gibraltar should regularize their stay with Gibraltar immigration authorities.
Those planning to visit the United Kingdom for any purpose other than tourism or business, or who intend to stay longer than six months, should consult the website of the British Embassy in the United States at http://ukinusa.fco.gov.uk/en for information about current visa/entry clearance requirements.
Those who are required to obtain a visa/entry clearance and fail to do so may be denied entry and returned to their port of origin.
The U.S. Embassy cannot intervene in UK immigration matters.

In the past year, the British government has completely restructured its immigration system, tightening visa/entry clearance regulations and enforcement at its borders.
All American travelers to the United Kingdom are urged to check the web site of the British Embassy in the United States at http://ukinusa.fco.gov.uk/en or the web site of the UK Border Agency at http://www.bia.homeoffice.gov.uk/ to determine whether they must have a visa/entry clearance before traveling to the United Kingdom.
Students should be especially alert to UK visa/entry clearance requirements.
Under no circumstances should Americans seeking to study or work in the United Kingdom attempt to enter the country without the appropriate visa/entry clearance from a British Consulate in the United States.
If you do so, you are likely to be detained by UK immigration officials at the port of entry and held in an immigration detention facility until you can be returned to the United States.
Again, the U.S. Embassy cannot intervene in UK immigration matters.

In addition to the British Embassy web site at http://ukinusa.fco.gov.uk/en, those seeking current UK visa/entry clearance information may also contact UK consular offices in the United States via their premium rate telephone service at 1-900-656-5000 (cost $3/minute) or 1-212-796-5773 ($12 flat fee).
There is also a no-fee website for visa information at www.visainfoservices.com.

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

SAFETY AND SECURITY:
The United Kingdom is politically stable, with a modern infrastructure, but shares with the rest of the world an increased threat of terrorist incidents of international origin, as well as the potential, though significantly diminished in recent years, for isolated violence related to the political situation in Northern Ireland (a part of the United Kingdom).

Like the United States, the United Kingdom shares its national threat levels with the general public to keep everyone informed and explain the context for the various increased security measures that may be encountered. UK threat levels are determined by the UK Home Office and are posted on its web site at http://www.homeoffice.gov.uk/security/current-threat-level/.

Information from the UK Security Service, commonly known as MI5, about the reasons for the increased threat level and actions the public can take is available on the MI5 web site at http://www.mi5.gov.uk/.
American citizens are advised to check with the UK Department for Transport at http://www.dft.gov.uk/transportforyou/airtravel/airportsecurity/ regarding the latest security updates and carry-on luggage restrictions.

The British Home Secretary has urged UK citizens to be alert and vigilant by, for example, keeping an eye out for suspect packages or people acting suspiciously at subway (called the Tube or Underground) and train stations, as well as at airports, and reporting anything suspicious to the appropriate authorities.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.
For more information about UK public safety initiatives, consult the UK Civil Contingencies Secretariat web site at http://www.ukresilience.gov.uk.

The political situation in Northern Ireland has improved dramatically.
The potential remains, however, for sporadic incidents of street violence and/or sectarian confrontation.
American citizens traveling to Northern Ireland should therefore remain alert to their surroundings and should be aware that if they choose to visit potential flashpoints or attend parades, sporadic violence remains a possibility.
Tensions may be heightened during the summer marching season (April to August), particularly during the month of July (around the July 12th public holiday).

The phone number for police/fire/ambulance emergency services – the equivalent of 911 in the United States – is 999 in the United Kingdom and 112 in Gibraltar.
This number should also be used for warnings about possible bombs or other immediate threats.
The UK Anti-Terrorist Hotline, at 0800-789-321, is for tips and confidential information about possible terrorist activity.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Recent communications from U.S. Embassy London to the local American citizen community, called Warden Messages, can be found on the U.S. Embassy's American Citizens Services web page at http://london.usembassy.gov/cons_new/acs/index.html.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the United States, or for callers outside the United States and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME:
The United Kingdom and Gibraltar benefit from generally low crime rates, which decreased slightly in 2007 in significant categories, including violent crime.
The crime situation in the United Kingdom is similar to that in the United States: typical incidents include pick pocketing; muggings; “snatch and grab” thefts of mobile phones, watches and jewelry; and thefts of unattended bags, especially at airports and from cars parked at restaurants, hotels, and resorts.
Pickpockets target tourists, especially at historic sites and restaurants, and on buses, trains, and the London subway (known as the Tube or Underground).
Thieves often target unattended cars parked at tourist sites and roadside restaurants, looking for laptop computers and handheld electronic equipment, especially global positioning satellite equipment.
Walking in isolated areas, including public parks, especially after dark, should be avoided, as these are advantageous venues for muggers and thieves.
At night or when there is little foot traffic, travelers should be especially careful using the underground pedestrian tunnels.
As a general rule, either walk the extra distance to use a surface crossing or wait until there are other adult pedestrians entering the tunnel.

In London, travelers should use only licensed Black Cabs or car services recommended by their hotel or tour operator.
Unlicensed taxis or private cars posing as taxis may offer low fares, but are often uninsured and may have unlicensed drivers.
In some instances, travelers have been robbed and raped while using these cars.
You can access 7,000 licensed Black Cabs using just one telephone number: 087-1871-8710.
This taxi booking service combines all six of London’s radio taxi circuits, allowing you to telephone 24 hours a day if you need a cab.
Alternatively, to find a licensed minicab, text HOME to 60835 on your mobile phone to get the telephone number to two licensed minicab companies in the area.
If you know in advance when you will be leaving for home, you can prebook your return journey.
The Safe Travel at Night partnership among the Metropolitan Police, Transport for London, and the Mayor of London maintains a web site with additional information at http://www.cabwise.com/.
Travelers should not leave drinks unattended in bars and nightclubs.
There have been some instances of drinks being spiked with illegal substances, leading to incidents of robbery and rape.

Americans should take steps to ensure the safety of their U.S. passports.
Visitors in England, Scotland, Wales, Northern Ireland, and Gibraltar are not expected to produce identity documents for police authorities and thus may secure their passports in hotel safes or residences.
Abundant ATMs that link to U.S. banking networks offer an optimal rate of exchange, and they preclude the need to carry a passport to cash travelers’ checks.
Travelers should be aware that U.S. banks might charge a higher processing fee for withdrawals made overseas.
Common-sense personal security measures taken in the United States when using ATMs should also be followed in the United Kingdom.
ATM fraud in the United Kingdom is becoming more sophisticated, incorporating technologies to surreptitiously record customer ATM card and PIN information.
Travelers should avoid using ATMs that look in any way temporary in structure or location, or are located in isolated areas.
Travelers should be aware that in busy public areas, thieves use distraction techniques, such as waiting until the PIN number has been entered and then pointing to money on the ground, or attempting to hand out a free newspaper.
When the ATM user is distracted, a colleague will quickly withdraw cash and leave.
If distracted in any way, travelers should press the cancel transaction button immediately and collect their card before speaking to the person who has distracted them.
If the person’s motives appear suspicious, travelers should not challenge them but remember the details and report the matter to police as soon as possible.
In addition, travelers should not use the ATM if there is anything stuck to the machine or if it looks unusual in any way.
If the machine does not return the card, report the incident to the issuing bank immediately.

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 at the opening of the next business day.
The U.S. Embassy or Consulate issues replacement passports only during regular business hours.
If you are the victim of a crime while overseas, report it to local police.
The nearest U.S. Embassy or Consulate will also be able to assist by helping you to find appropriate medical care, contacting family members or friends, and explaining how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

Visit the Victim Support web site, maintained by an independent UK charity to help people cope with the effects of crime: http://www.victimsupport.org.uk/.

See our information for Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
While medical services are widely available, free care under the National Health System is allowed only for UK residents and certain EU nationals.
Tourists and short-term visitors will be charged for medical treatment in the United Kingdom.
Charges may be significantly higher than those assessed in the United States.

Hiking in higher elevations can be treacherous.
Several people die each year while hiking, particularly in Scotland, often due to sudden changes in weather.
Visitors, including experienced hikers, are encouraged to discuss intended routes with local residents familiar with the area, and to adhere closely to recommendations.

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 from 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.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance companies prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
If your medical insurance policy does not provide overseas coverage, you may want to purchase a short-term policy for your trip.
The Department of State provides an online list of travel insurance companies that can provide the additional insurance needed for the duration of one’s trip abroad.

Remember also that most medical care facilities and medical care providers in the United Kingdom do not accept insurance subscription as a primary source of payment.
Rather, the beneficiary is expected to pay for the service and then seek reimbursement from the insurance company.
This may require an upfront payment in the $10,000 to $20,000 range

Please see our information on medical insurance overseas.

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

UK penalties for driving under the influence of even minimal amounts of alcohol or drugs are stiff and often result in prison sentences.
In contrast to U.S. and continental European traffic, which moves on the right side of the road, UK traffic moves on the left.

The maximum speed limit on highways/motorways in the United Kingdom is 70 mph.
Motorways generally have a hard shoulder (breakdown lane) on the far left, defined by a solid white line.
It is illegal to stop or park on a hard shoulder unless it is an emergency.
In such cases, you should activate your hazard lights, get out of your vehicle, and go onto an embankment for safety.

Emergency call boxes (orange telephone booths with SOS printed on them) may be found at half-mile intervals along the motorway.
White and blue poles placed every 100 yards along the motorway point in the direction of the nearest call box.
Emergency call boxes dial directly to a motorway center.
It is best to use these phones rather than a personal cell phone, because motorway center personnel will immediately know the location of a call received from an emergency call box.

Roadside towing services may cost approximately £125 (as of 10/08, approximately $225).
However, membership fees of automotive associations such as the RAC (Royal Automobile Club) or AA (Automobile Association) often include free roadside towing service.

Visitors uncomfortable with or intimidated by the prospect of driving on the left-hand side of the road may wish to avail themselves of the United Kingdom’s extensive bus, rail, and air transport networks.
Roads in the United Kingdom are generally excellent but are narrow and often congested in urban areas.
If you plan to drive while in the United Kingdom, you may wish to obtain a copy of the Highway Code, available at http://www.direct.gov.uk/en/TravelAndTransport/Highwaycode/index.htm.

Travelers intending to rent cars in the United Kingdom should make sure that they are adequately insured.
U.S. auto insurance is not always valid outside the United States, and travelers may wish to purchase supplemental insurance, which is generally available from most major rental agents.
A congestion charge of £8 (as of 10/08, approximately $15) is imposed on all cars entering much of central London Monday through Friday from 7:00 a.m. to 6:30 p.m.
Information on the congestion charge can be found at http://www.tfl.gov.uk/roadusers/congestioncharging/.
Public transport in the United Kingdom is excellent and extensive.
However, poor track conditions may have contributed to train derailments, resulting in some fatalities.
Repairs are under way and the overall safety record is excellent.
Information on disruptions to London transportation services can be found at http://www.tfl.gov.uk/tfl/livetravelnews/realtime/tube/default.html and information about the status of National Rail Services can be found at http://nrekb.nationalrail.co.uk/service_disruptions/today.html.
Many U.S. pedestrians are injured, some fatally, every year in the United Kingdom because they forget that oncoming traffic approaches from the opposite direction than in the United States.
Extra care should be taken when crossing streets; remember to remain alert and look both ways before stepping into the street.

Driving in Gibraltar is on the right-hand side of the road, as in the United States and continental Europe.
Persons traveling overland between Gibraltar and Spain may experience long delays in clearing Spanish border controls.
Please refer to our Road Safety Overseas page for more information.
For specific information concerning UK driving permits, vehicle inspection, road tax, and mandatory insurance, refer to the UK Department of Environment and Transport web site at http://www.dft.gov.uk/ or the Driving Standards Agency web site at http://www.dsa.gov.uk/.
The U.S. Embassy London’s web site at http://london.usembassy.gov/ also provides information.

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

Back to Top
SPECIAL CIRCUMSTANCES:
The legal drinking age in the United Kingdom is generally lower than that in the United States, and social drinking in pubs is often seen as a routine aspect of British life.
Parents, organizers of school trips, and young travelers should be aware of the impact that this environment may have when combined with the sense of adventure that comes with being abroad.
Please see our Students Abroad web site as well as Studying Abroad to help students plan a safe and enjoyable adventure.

The United Kingdom has strict gun-control laws, and importing firearms is extremely complicated.
Travelers should consider leaving all firearms in the United States.
Restrictions exist on the type and number of weapons that may be possessed by an individual.
All handguns, such as pistols and revolvers, are prohibited, with very few exceptions.
Licensing of firearms in the United Kingdom is controlled by the police.
Applicants for a license must be prepared to show “good reason” why they require each weapon.
Applicants must also provide a copy of their U.S. gun license, a letter of good conduct from their local U.S. police station, and a letter detailing any previous training, hunting, or shooting experience.
Background checks will also be carried out.
Additional information on applying for a firearm certificate and/or shotgun certificate can be found on the Metropolitan Police Firearms Enquiry Teams web site at http://www.met.police.uk/firearms-enquiries/index.htm.

A number of Americans are lured to the United Kingdom each year in the belief that they have won a lottery or have inherited from the estate from a long-lost relative.
Americans may also be contacted by persons they have “met” over the Internet who now need funds urgently to pay for hospital treatment, hotel bills, taxes, or airline security fees.
Invariably, the person contacted is the victim of fraud.
Any unsolicited invitations to travel to the United Kingdom to collect winnings or an inheritance should be viewed with skepticism.
Also, there are no licenses or fees required when transiting a UK airport, nor is emergency medical treatment withheld pending payment of fees.
Please see our information on International Financial Scams.

Please read ourCustoms Information.

Back to Top
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 British law, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the United Kingdom 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.

Many pocket knives and other blades, and mace or pepper spray canisters, although legal in the United States, are illegal in the United Kingdom and will result in arrest and confiscation if detected.
A UK Metropolitan Police guide to items that are prohibited as offensive weapons is available at http://www.met.police.uk/youngpeople/guns.htm.
A UK Customs Guide, detailing which items visitors are prohibited from bringing into the United Kingdom, is available at http://customs.hmrc.gov.uk/channelsPortalWebApp/downloadFile?contentID=HMCE_CL_001734.

Air travelers to and from the United Kingdom should be aware that penalties against alcohol-related and other in-flight crimes (“air rage”) are stiff and are being enforced with prison sentences.
Please also see our information on customs regulations that pertain when returning to the United States.

CHILDREN'S ISSUES:
Visit our web site for information on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the United Kingdom are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within the United Kingdom.
By registering, Americans make it easier for the Embassy or Consulate to contact them in case of emergency, and to relay updated information on travel and security within the United Kingdom.
The Embassy and Consulates regularly send security and other information via email to Americans who have registered.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
The Consular Section also disseminates a newsletter every month.
Those wishing to subscribe to the monthly consular newsletter in London should send a request by email to LondonACSNewsletter@state.gov.

The U.S. Embassy is located at 24 Grosvenor Square, London W1A 1AE; telephone: in country 020-7499-9000, from the United States 011-44-20-7499-9000 (24 hours). Consular Section fax: in country 020-7495-5012, from the United States 011-44-20-7495-5012, and on the web at http://london.usembassy.gov.

The U.S. Consulate General in Edinburgh, Scotland, is located at 3 Regent Terrace, Edinburgh EH7 5BW; telephone: in country 013-1556-8315, from the United States 011-44-13-1556-8315.
After hours: in country 012-2485-7097, from the United States 011-44-12-2485-7097.
Fax: in country 013-1557-6023, from the United States 011-44-13-1557-6023.
Information on the Consulate General is included on the Embassy’s web site at http://london.usembassy.gov/scotland.

The U.S. Consulate General in Belfast, Northern Ireland, is located at Danesfort House, 228 Stranmillis Road, Belfast BT9 5GR; telephone: in country 028-9038-6100, from the United States 011-44-28-9038-6100.
Fax:
in country 028-9068-1301, from the United States 011-44-28-9068-1301.
Information on the Consulate General is included on the Embassy’s web site at: http://london.usembassy.gov/nireland.

There is no U.S. consular representation in Gibraltar.
Passport questions should be directed to the U.S. Embassy in Madrid, located at Serrano 75, Madrid, Spain; telephone: 34-91-587-2200 and fax 34-91-587-2303.
The web site is http://madrid.usembassy.gov.
All other inquiries should be directed to the U.S. Embassy in London.
* * *
This replaces the Consular Information Sheet dated May 8, 2008 and updates the sections on Entry Requirements, Safety and Security, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Sat, 4 Apr 2020 16:10:44 +0200 (METDST)

London, April 4, 2020 (AFP) - Britain on Saturday reported 708 more deaths from COVID-19 in a new daily high, as the number of confirmed cases rose to nearly 42,000.   The health ministry said 4,313 people who tested positive for the virus in hospital had died as of 1600 GMT Friday while there were 41,903 confirmed cases as of 0800 GMT Saturday, up 3,735.   The toll has been steadily increasing at more than over 500 deaths a day this week and the country is bracing for an expected peak in the next week to 10 days.   Prime Minister Boris Johnson, who is in self-isolation after developing mild symptoms of the disease, ordered a three-week lockdown of the country on March 23 to try to cut infections.

But there has been concern that warmer weather forecast for this weekend could tempt people from their homes to green spaces and public parks.   "I just urge you not to do that," Johnson said in a video message on Friday. "Please, please stick with the guidance now."   Health Secretary Matt Hancock also warned against any relaxation in social distancing. "If we do, people will die," he told a daily briefing on the government's response on Friday.   A special address on the crisis by Queen Elizabeth II is to be broadcast on Sunday evening.

Imperial College London epidemiologist Neil Ferguson, who is advising the government, told BBC radio on Saturday a peak was expected around the Easter weekend.   "We still think things will plateau but we'll be at quite high levels of infection for weeks and weeks rather than seeing quite a rapid decline as the type seen in China," he said.   But he said that was dependent on people staying at home. If that happened, it could lead to less stringent measures in place "at least by the end of May", he added.

The announcement of another record rise in deaths came after 13 residents at a care home in Glasgow died in one week in a suspected outbreak of coronavirus.   The Burlington Court Care Home in the Cranhill area of the city said those who died had underlying medical conditions and two staff members were being treated for COVID-19.

Tests for coronavirus are currently carried out on the most serious cases that require hospital treatment, suggesting the true extent of confirmed cases and deaths is an under-estimate.   The government meanwhile announced that up to 4,000 low-risk prisoners near the end of their sentence could be release from jails in England and Wales to try to stop the spread of COVID-19.   A total of 88 prisoners and 15 prison staff have tested positive for the virus, and there is concern it could spread rapidly because of shared cells and overcrowding.   The justice ministry said those released would be electronically tagged and temporarily released on licence in stages. High-risk offenders will not be considered for early release.
Date: Wed, 1 Apr 2020 15:46:23 +0200 (METDST)

London, April 1, 2020 (AFP) - Britain reported 563 daily coronavirus deaths on Wednesday, the first time the national toll has exceeded 500, bringing the total fatalities to 2,352, according to official figures.   "As of 5pm (1600 GMT) on 31 March, of those hospitalised in the UK who tested positive for coronavirus, 2,352 have sadly died," the health ministry said on its official Twitter page.

Some 29,474 people have now tested positive, an increase of 4,324 over the previous day, it added.   Britain locked down last week in an attempt to combat the virus, but Prime Minister Boris Johnson, who himself has tested positive, warned that it would "get worse before it gets better".

The virus has also hit the royal family, with Prince Charles only coming out of isolation on Tuesday after displaying mild symptoms of the disease.   On Wednesday he released a video message praising the "remarkable" state-run National Health Service. "None of us can say when this will end, but end it will," he said.    "Until it does, let us all try and live with hope and, with faith in ourselves and each other, look forward to better times to come."
Date: Wed, 1 Apr 2020 00:15:13 +0200 (METDST)

London, March 31, 2020 (AFP) - A 13-year-old British boy has died days after testing positive for COVID-19, hospital officials and his family said on Tuesday, with relatives saying he had no underlying illnesses.   The boy, who died Monday at King's College Hospital in London, is believed to be Britain's youngest confirmed death in the coronavirus pandemic.

A 12-year-old girl, whose death was confirmed earlier on Tuesday in Belgium, is thought to be Europe's youngest victim.    The boy's family said Ismail Mohamed Abdulwahab "started showing symptoms and had difficulties breathing" before he was admitted to hospital.   "He was put on a ventilator and then put into an induced coma but sadly died yesterday morning," the family said through a family friend, Mark Stephenson, adding: "We are beyond devastated."

Nathalie MacDermott, a lecturer at King's College, said: "While we know it is much less likely for children to suffer severe COVID-19 infection than older adults, this case highlights the importance of us all taking the precautions we can to reduce the spread of infection in the UK and worldwide."   She urged research into deaths outside the groups expected to succumb to infection as it "may indicate an underlying genetic susceptibility."

On Tuesday, Britain announced 381 deaths from COVID-19 in the past 24 hours, the highest figure in the country since the start of the pandemic, bringing the death toll to 1,789.
Date: Fri, 27 Mar 2020 12:37:54 +0100 (MET)

London, March 27, 2020 (AFP) - British police faced criticism on Friday for using "over-the-top" methods to maintain a coronavirus lockdown, after officers armed with sweeping new powers deployed drones to detect walkers far from home.   Civil liberties group Big Brother Watch said the police must behave within the rule of law after it also emerged that road checkpoints had been set up to quiz drivers about their journeys.   "It's understandable why police are dispersing parties and barbecues but demanding drivers give journey details at road checkpoints is over-the-top," said director Silkie Carlo.     "It's critical we protect public health and critical we protect basic democratic norms too. Arbitrary policing will not help the country to fight this pandemic."

The drone incident happened in the Peak District National Park in Derbyshire, central England, while roadblocks were used in other parts of the country.   Social media users compared their actions to "the Stasi", East Germany's notorious state police.    Another civil liberties group, Liberty, said in a statement: "We need a response in terms of public health rather than a response in terms of criminal justice to this epidemic."   Britons have been told since the beginning of the week that they are only allowed to leave their homes for limited reasons such as going to work, essential food shopping, or for exercise once a day.   But they are not allowed to travel for recreational purposes.

To enforce the new rules, police were officially handed powers which prevents people leaving their home "without reasonable excuse".   Those ignoring the tougher restrictions on movement could be hit with a £60 fine doubled to £120 (133 euros,$147) for any second offence.   The measures will be in place for at least six months, with a review every three weeks.   Derbyshire police defended their actions, claiming in a tweet that "we will not be apologetic for using any legal and appropriate methods to keep people safe".   It added: "Our actions and the government's advice are there to keep you and others safe."   A total of 11,658 coronavirus cases have so far been confirmed in Britain, and 578 deaths.
Date: Thu, 26 Mar 2020 17:27:21 +0100 (MET)
By David HARDING, Phil HAZLEWOOD

London, March 26, 2020 (AFP) - Hospital bosses and doctors on Thursday warned of being swamped with a "tsunami" of COVID-19 patients in London, as Britain braced for a peak in cases and the government faced calls to urgently provide specialist kit and tests for frontline health workers.   Scientists also warned thousands of new ventilators may come too late and Prime Minister Boris Johnson was criticised for not cooperating with European countries to boost capacity.

Britain initially adopted a light-touch approach to the outbreak but has since imposed tougher measures, including a three-week lockdown, as confirmed cases and deaths climbed.   According to the latest figures, 463 people have died from the virus and more than 9,500 people have been infected, with London accounting for about one-third of all cases.   The chief executive of NHS Providers, which represents the heads of hospital trusts in the state-run National Health Service, said there had been an "explosion of demand" in the capital.

Chris Hopson told BBC radio that hospital bosses said there had been "wave after wave after wave" of admissions of seriously ill patients, with numbers predicted to surge further in the next two weeks.   "The word that's often used to me is a sort of continuous tsunami," he added.   Official statistics are thought to represent only a fraction of the real number of infections across Britain, as only those taken to hospital with severe symptoms of COVID-19 are tested.

- Mixed messages -
Johnson on Monday imposed a shut-down of non-essential shops and services, and banned gatherings of more than two people to cut close-contact transmission of the virus.   In a sign of an expected rise in cases, 500 beds will be available from next week in a new 4,000-bed field hospital set up at the giant ExCeL exhibition centre in east London.   The government is looking at creating 10 other centres around the country.

But despite urging people to stay at home, London Underground trains and platforms have been packed with people unable to work remotely, particularly non-contract construction workers.   London's Mayor Sadiq Khan, whose powers include transport in the capital, has been urged to run more services but he has said that is impossible because of staff illness and shortages.   Public transport use was down 13 percent on Thursday, Khan said.

- 'Lambs to the slaughter'  -
Britain has unveiled a raft of measures to help businesses and individuals as the economy slumps, with more expected on Thursday for the self-employed.    But frontline healthcare workers say a lack of personal protective equipment (PPE) as well as insufficient testing of staff for COVID-19 is putting them and patients at risk.   "If hospitals are to survive this, we urgently need adequate protective clothing. Otherwise we are lambs to the slaughter," one doctor wrote in the Daily Mail newspaper.

The chairman of the British Medical Association said the lack of equipment was "totally unacceptable".    The government says it has shipped 7.5 million pieces of PPE in the last 24 hours.   Hopson of NHS Providers said an "unprecedented" staff absence rate of 30 to 50 percent in some places was exacerbating the crisis in London while there was also a "real problem" with ventilator capacity.   The NHS has access to some 8,000 ventilators and the government has ordered 8,000 more. Johnson's spokesman said they were expected to arrive in the coming weeks and months.

But Imperial College epidemiology professor Neil Ferguson, a government scientific advisor, has said most would be needed "in approximately two to three weeks" time as demand peaked.   Entrepreneur James Dyson said the government had ordered 10,000 ventilators from his firm but Downing Street said that depended on the machines passing safety and regulatory checks.   Opposition political parties meanwhile criticised the government for not taking part in a European Union scheme to increase the number of ventilators.   But Johnson's spokesman told reporters: "We are no longer members of the EU... This is an area where we're making our own efforts."
More ...

Bulgaria

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

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

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Petty street crime, much of which is directed against persons who appear to have money or to be foreign, continues to be a problem.
Pocket picking and purse snatching are frequent occurrences, especially in crowded markets and on shopping streets.
Con artists operate on public transportation and in bus and train stations.
Credit cards and ATMs should be used with caution.
Be wary of people who approach you at an ATM and offer assistance.
Do not give your PIN number to anyone under any circumstances. (See the Special Circumstances section below.) Travelers should be suspicious of "instant friends" and should also require persons claiming to be government officials to show identification.
There have been incidents in which tourists have been drugged or assaulted and robbed after accepting offers of coffee or alcoholic beverages from "friendly” individuals met by “chance” at hotels, the airport, or at bus or train stations.
Travelers should be wary of unfamiliar individuals who encourage them to drink or eat products, as these may be tainted with strong tranquilizers (such as valium) that can lead rapidly to unconsciousness.
Reporting a crime immediately to the police has helped recover money and valuables on more than one occasion and is recommended.
To avoid becoming a victim of more serious crimes, one should use the same personal safety precautions that they would use in large urban areas of the United States.

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

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

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

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

Visitors may exchange cash at banks or Exchange Bureaus, but they should know that Exchange Bureaus sometimes post misleading rate quotations that confuse travelers.
People on the street who offer high rates of exchange are usually con artists intent on swindling the unwary traveler.
Damaged or very worn U.S dollar bank notes are often not accepted at banks or Exchange Bureaus.
Major branches of the following Bulgarian banks will cash travelers' cheques on the spot for Leva, the Bulgarian currency, or another desired currency:
Bulbank, Bulgarian Postbank, Biochim, First Investment Bank, and United Bulgarian Bank (UBB).
UBB also serves as a Western Union agent and provides direct transfer of money to travelers in need.
There are also many Western Union branches in major towns and cities.
Most shops, hotels, and restaurants, with the exception of the major hotels, do not accept travelers' cheques or credit cards.
Only some local banks can cash U.S. Treasury checks and the payee may need to wait up to a month to receive funds.
Corruption remains an important concern of the Government.
The Commission for Coordinating of the Activity for Combating Corruption manages the efforts of each government agency’s internal inspectorate in fighting public corruption and engages in public awareness campaigns.
Complaints of public corruption can be made to it at the Ministry of Justice, 2A Knyaz Dondukov Blvd., 1055 Sofia, Bulgaria, email: acc@government.bg, 359-2-980-9213, 359-2-923-7595, 359-2-940-3630 or to the Ministry of Finance hotline: 0800180018.
Please see our Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Bulgaria’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Bulgaria are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Bulgaria are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, and to obtain updated information on travel and security within Bulgaria.
Americans without Internet access may use a public computer at the U.S. Embassy to register.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at 16, Kozyak St., Sofia1407; tel.: (+359 2) 937-5100; fax (+359 2) 937-5209; web site: http://sofia.usembassy.gov/.
Questions regarding consular services may be directed via email to: niv_sofia@state.gov (for non-immigrant visa matters); iv_sofia@state.gov (for immigrant visa matters) and acs_sofia@state.gov (for American Citizen Services matters).
*

*

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

Travel News Headlines WORLD NEWS

Date: Fri, 6 Mar 2020 14:42:37 +0100 (MET)

Sofia, March 6, 2020 (AFP) - Bulgaria declared a nationwide influenza epidemic, closing schools and banning planned surgeries from Friday as the country -- so far spared any novel coronavirus infections -- grapples with a rise in flu cases.   Members of the national task force set up to address the new coronavirus warned hospitals were already full of flu patients, potentially jeopardising preparedness to respond to an expected virus arrival and spread.

Doctors in the EU's poorest member say the country of 7 million people has seen an unusual rapid spread of type B flu.   "Such rapid growth of type B flu has not happened in Bulgaria for the past ten years," said Todo Kantardzhiev, director of the national centre for contagious diseases.   Almost 5,000 people contracted type B flu in the last week of February, according to National Centre of Infectious and Parasitic Diseases data with babies and children aged under 14 most affected.

Schools will remain closed until March 11, the health ministry said, recommending universities cancel classes in order to contain the outbreak.   Local authorities were also advised to cancel sports or cultural events likely to draw large numbers of people.   Hospitals were meanwhile ordered to postpone all planned surgeries and ban patients' visits.

Pharmacies in the Balkan country have already run out of protective face masks and disinfectants as people rushed to stock themselves amid a coronavirus panic.   "The health system is already overburdened even before a first case of coronavirus has been detected," said health ministry official Angel Kunchev.
Date: Fri 23 Aug 2019
Source: Ekathimerini [edited]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Namibia

Namibia US Consular Information Sheet
August 16, 2007
COUNTRY DESCRIPTION: Namibia is a southern African country with a moderately developed economy.
Facilities for tourism are good and generally increasing in quality.
The capital is
indhoek.
Read the Department of State Background Notes on Namibia for additional information.
ENTRY/EXIT REQUIREMENTS: A passport and visa are normally required.
Bearers of U.S. passports who plan to visit Namibia for tourism for less than 90 days can obtain visas at the port of entry and do not need visas prior to entering the country.
Travelers coming for work or study, whether paid or voluntary, must obtain a work or study permit prior to entering Namibia.

All travelers traveling to or from Namibia via South Africa are strongly encouraged to have several unstamped visa pages left in their passports.
South Africa requires two unstamped visa pages, and Namibia usually also requires an unstamped page to stamp a visa upon arrival.
Visitors who do not have enough free visa pages in their passport risk being denied entry and returned to the U.S. at their own expense.

Travelers should obtain the latest information from the Embassy of Namibia located at 1605 New Hampshire Avenue, NW, Washington, D.C. 20009, telephone (202) 986-0540 or from the Permanent Mission of Namibia to the U.N. at 135 E. 36th St., New York, NY 10016, telephone (212) 685-2003, fax (212) 685-1561.
Overseas, inquiries should be made to the nearest Namibian embassy.
See our Foreign Entry Requirements brochure for more information on Namibia and other countries.
Visit the Embassy of Namibia's website at http://www.namibianembassyusa.org/ for the most current visa information.
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:
American citizens wishing to cross into Angola from Namibia should do so only at official border crossing areas and should consult the State Department's Consular Information Sheet for Angola.
American citizens should avoid street demonstrations.
However, such events are rare in Namibia.
American citizens traveling in Namibia are urged to contact the consular section of the U.S. Embassy in Windhoek for the latest safety and security information.
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: Crime is a serious concern in Namibia, but visitors who employ common-sense preventive measures normally enjoy an incident-free stay.
Incidents of violent crime directed specifically against Americans or other foreigners are rare, but the number of overall incidents continues to increase.
The most common crimes are property-motivated crimes of opportunity, including pick pocketing, purse snatching, vehicle theft, and vehicle break-ins.
Taxi drivers have robbed several American passengers; if taxis must be used, radio taxis that display the NABTA logo (Namibia Bus and Taxi Association) are the most reliable.
Violent crimes are less frequent than non-violent incidents.
Common sense measures such as being alert to one's surroundings, avoiding isolated areas of town, not leaving valuables in parked cars, keeping car doors locked and windows up while driving, safeguarding purses, wallets and especially cellular phones are the best deterrents against becoming a victim.
Drivers should exercise caution at rest stops outside of towns or away from gasoline stations.

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

See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Windhoek has a small number of private medical hospitals and clinics capable of providing emergency care and performing many routine procedures.
Doctors, both general practitioners and specialists, as well as dentists, generally have training and facilities that are comparable with U.S. standards.
Facilities outside the capital vary widely.
Several large towns have well-equipped facilities similar to those available in Windhoek, while smaller towns generally do not.
Malaria is prevalent only in the north of the country.
Malaria prophylaxis is not required in Windhoek but is suggested for travel to the north.
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); fax 1-888-CDC-FAXX (1-888-232-3299), 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 Namibia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
In Namibia, driving is done on the left-hand side of the road.
Many of Namibia's rural roads are gravel.
Although these roads are generally well maintained, controlling a vehicle on gravel is significantly more difficult than on pavement.
Drivers should not drive in excess of 80km per hour (45 mph) on gravel roads, should reduce speed significantly for curves or turns, and should heed all warning signs.
Hitting a sand patch or driving around a curve too fast can easily result in a rollover or spinout.
Many accidents on gravel roads occur when tourists exceed safe speeds on corners or in areas recently damaged by rains.
Visitors are reminded that motor vehicle accidents are one of the primary causes of injury and death in Namibia, and drivers are therefore strongly urged to drive with caution.

For those driving outside of the capital, distances between cities can be considerable, and often gasoline is only available at a few service stations along a route.
Fuel availability can be impacted by power outages as well.
All travelers are encouraged to plan their route to ensure a sufficient supply of fuel, and are recommended to bring five liters of water per person when traveling on dirt roads to guard against dehydration if an accident should occur.
Turning on a red traffic light is not permitted in Namibia.
Seat belts are required for all vehicle occupants.
Motorcyclists are required by law to wear protective helmets.
While child car seats are not required, they are recommended.
To drive legally while in Namibia, visitors staying more than a few weeks need an international driving permit.
International driving permits must be obtained prior to leaving the U.S. and are available from either the American Automobile Association or the American Automobile Touring Alliance.
Short-term visitors do not need an international driving permit; a valid U.S. driver's license is sufficient.
Roads in Namibia are generally well maintained.
However, few have shoulders or “pull-off” lanes for broken vehicles.
Wildlife wandering on roads is a special driving hazard in Namibia, especially at night.
An encounter at high speeds with antelope or cattle can be fatal.
The salt-surfaced roads at the coast can also be deceptively dangerous, especially when they have been made slick by morning or evening mist.
Robbery has occurred at roadside "rest stops" and motorists are advised to take rest breaks in towns and/or at gasoline stations.
Most major roads are undivided with one lane in each direction.
Drivers should remain alert for passing vehicles and exercise caution when passing slow moving vehicles.
Accidents involving drunk drivers are an increasing problem on major roads where there are high speed limits.
Driving under the influence is illegal in Namibia.
A charge of culpable homicide can be made against a driver involved in an accident resulting in death.
Roadside assistance and emergency medical services outside of Windhoek may be unreliable or non-existent.
Assistance on main roads that link Namibia's larger towns, however, is generally good due to quality cell phone networks.
Emergency services contact numbers vary from town to town.
The Namibian telephone directory has a list of emergency contact numbers at the beginning of each town listing.
It is recommended that Americans maintain a list of contact numbers for the area in which they plan to drive.
Telephone numbers may change, and 24-hour availability of these numbers is not guaranteed.
Public transportation is not widely available outside of the capital.
Taxis and municipal buses are the only forms of public transportation in Windhoek.
Schedules and routes are limited.
Car rentals or radio taxis are generally the best means of transport but may be relatively expensive.
The Embassy has received reports of foreign citizens being robbed by drivers of taxis hailed on the streets of Windhoek.
The Embassy has not received any such reports regarding radio taxis.
Flashing of high beams and similar signals could mean anything from a friendly greeting to a warning.
When encountering a motorcade, motorists are encouraged to make way immediately and follow promptly any instructions given by the officials present.
Because of the possibility of intoxicated and/or reckless drivers, the poor mechanical condition of some motor vehicles, and the high incidence of single-vehicle rollover accidents, Americans are urged to avoid hitchhiking in Namibia.
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: http://www.met.gov.na/default.htm
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service between the United States and Namibia, the U.S. Federal Aviation Administration (FAA) has not assessed Namibia'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 web site at www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES: Wild animals may pose some danger.
Travelers are advised that, even in the most serene settings, animals are wild and can pose a threat to life and safety.
Travelers are cautioned to observe all local or park regulations and heed all instructions given by tour guides.
In addition, tourists are advised that potentially dangerous areas sometimes lack fences and warning signs.
Appropriate caution should be used in all unfamiliar surroundings.

Namibia does not recognize dual citizenship for adults over the age of 18.
Therefore, despite the fact that these individuals possess U.S. citizenship, they must enter and exit Namibia bearing a Namibian passport.
Namibia recognizes dual citizenship up until the age of 18; however, such children must enter Namibia on their Namibian passport and may face questioning by an immigration officer before being permitted entry.
Please see our information on customs regulations.

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 offences.
Persons violating Namibian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Namibia 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.
Americans should avoid purchasing diamonds and other protected resources outside of licensed retail establishments.
The penalty for illegal dealing in diamonds in Namibia is stiff -- up to U.S. $20,000 in fines or five years in prison -- and the courts generally impose the maximum sentence.
The purchase and exportation of other protected resources, such as elephant ivory, may also be prohibited by Namibian, international, and/or U.S. law.
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website.
REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Namibia 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 Namibia.
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 14 Lossen Street, Ausspannplatz, Windhoek, telephone (264-61) 295-8500, fax (264-61) 295-8603.
You can reach the Consular Section at extension 8551; i.e., (264-61) 295-8551 or via e-mail consularwindho@state.gov.
The mailing address for the Embassy is Private Bag 12029, Windhoek, Namibia.
The U.S. Embassy Windhoek website is http://windhoek.usembassy.gov/.
* * *
This replaces the Consular Information Sheet dated August 1, 2006, 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: Sat 28 Mar 2020
Source: CGTN Africa [edited]

The number of reported hepatitis E cases in Namibia are on the decrease, statistics released by the Ministry of Health on Saturday [28 Mar 2020] show. A total of 74 hepatitis E (HEV) cases were reported countrywide between 24 Feb and 8 Mar 2020, compared with 102 cases reported during the previous 2 weeks.

The Ministry of Health declared an outbreak of hepatitis E on 14 Dec 2017 in the capital, Windhoek. The outbreak then spread to other regions around April 2018, eventually involving a total of 10 regions. Cases have been reported mainly from informal settlements such as Havana and Goreangab in Windhoek, DRC [Democratic Resettlement Community] in Swakopmund and similar settings in other regions where access to potable water, sanitation, and hygiene is limited.

A total of 7457 hepatitis E cases have been reported since the outbreak began with 65 deaths reported nationally, representing a case fatality rate of 0.9 per cent.

"There is a decrease in the number of HEV cases during the reporting period. (However) the outbreak continues to be protracted and cases are still being detected in areas where water and toilet facilities are limited, particularly in Khomas and in Erongo regions," a report from the health ministry said.
=====================
[Hepatitis E is found worldwide, and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, whereas genotype 3 is usually seen in developed countries and does not cause outbreaks. Acute epidemic hepatitis E is attributable to infection with hepatitis E virus genotypes 1 and 2. Many of the deaths are in pregnant women, characteristic of genotype 1.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus. - ProMed Mod.LL]

[Maps of Namibia:
Date: Fri 31 Jan 2020
Source: The New Era [edited]

Agonising back pain, fatigue, jaundice, nausea and loss of appetite are some of the symptoms that a 27 year old had to endure last year [2019] before he was diagnosed with hepatitis E.

The disease, which is commoner in areas with poor hand washing and lack of clean water, has been described as an epidemic, as more cases are reported to the authorities. The man is among 4000 Namibian men, mostly from Windhoek's informal settlements, battling the virus.

"I could not sleep at night, as my body was in intense pain. And you cannot sleep on one side for long, as the body aches. I could also not sit, as my lower back was in pain," he narrated to New Era from his home at Ehambo dhaNehale close to the Havana informal settlement. "I went to Black Chain clinic, and a nurse drew my blood and gave me feedback that I tested positive for hepatitis E virus. They injected me and gave me tablets that I took 3 times a day for a week." [There is no specific treatment for HEV. - ProMED Mod.LL]. Like many local people, he has expressed grave concern over the outbreak of the epidemic, which has since spread to other regions, including Omusati.

The outbreak of hepatitis E in the country, according to the latest report issued in December 2019, indicated that a majority of the cases are males, with 4167 men testing positive, compared with 2896 women. The least affected are children under one year, representing 0.11%. The report also shows that most of those affected are between the ages of 20 and 39. "Males are more likely to eat food from street vendors than females. Males are also less likely to wash their hands before eating," read the report.

Cumulatively, up to 29 Dec 2019, a total of 7063 hepatitis E virus cases were reported since the outbreak began. This includes 1731 laboratory confirmed, 4345 epi-linked, and 987 suspected cases. A total of 59 deaths have been reported nationally, and among those are 24 maternal deaths. The virus cases have been reported mainly from informal settlements such as Havana, Goreangab in Windhoek, DRC in Swakopmund and similar settings in other regions where access to potable water, sanitation and hygiene is a serious challenge.

Meanwhile, the latest official report on the outbreak indicated that during the period of 16-29 Dec 2019, a total of 82 hepatitis E virus cases were reported countrywide, compared to 63 cases reported during 2-15 Dec 2019. "The outbreak has become protracted and continues to spread to other regions with ongoing active transmission of the virus. Inadequate washing intervention in some informal settlements still persists." The health ministry declared the virus outbreak on 14 Dec 2017 in Khomas, and it spread to other regions around April 2018.  [byline: Selma Ikela]
================
[Hepatitis E is found worldwide, and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, whereas genotype 3 is usually seen in developed countries and does not cause outbreaks. Acute epidemic hepatitis E is attributable to infection with hepatitis E virus genotypes 1 and 2. Many of the deaths are in pregnant women, characteristic of genotype 1.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Thu 5 Nov 2019
Source: Namibia Press Agency [edited]

The Ministry of Health and Social Services and other stakeholders at Gobabis are working around the clock to curb the spread of hepatitis E in the region. Since the 1st case in the Omaheke region was reported in December 2017, about 137 other cases have been confirmed between March and November 2019. Out of the notified cases, one death has been recorded. Most of the reported cases in the region are from Gobabis, mainly from the Kanaan C informal settlement, where 123 cases were reported. This is as a result of a lack of clean drinking water, lack of sanitation facilities, and open-air defecation in the settlement.

Responding to questions emailed to him by Nampa [Namibia Press Agency], Omaheke health director Jeremiah Shikulo said regional and district health emergency committees have been activated and are in full operation, leading and coordinating the outbreak response process with other line ministries.

"The Ministry of Agriculture, Water and Forestry has provided 4 water tanks to the community of Kanaan, which the Gobabis municipality are refilling on a regular basis. Water purification tablets are also being distributed to households on a daily basis by community health workers," he added. The municipality has likewise given Kanaan C informal residents permission to build their own affordable temporary toilets.

Among other attempts to combat hepatitis E in the region, campaigns on how to properly clean water containers, screening pregnant women for the virus, and health education through community health workers have been conducted at Kanaan C. Five clean-up campaigns have also been held at the informal settlement, with another one set for tomorrow [6 Dec 2019].

Hepatitis E is a liver disease caused by the hepatitis E virus, usually as a result of poor sanitation. The disease was declared an outbreak on [14 Dec 2017] by the health ministry.  [Byline: Elvi Haihambo]
====================
[Hepatitis E is found worldwide, and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, whereas genotype 3 is usually seen in developed countries and does not cause outbreaks. Acute epidemic hepatitis E is attributable to infection with hepatitis E virus genotypes 1 and 2. Many of the deaths are in pregnant women, characteristic of genotype 1.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Mon 14 Oct 2019
Source: The Namibian [edited]

A total of 115 cases of anthrax in humans have been reported in the northern regions of the country, after they allegedly came into contact with, or consumed meat of suspected anthrax-infected carcasses.

Only 3 people have however been admitted [to hospital] with regard to the suspected anthrax outbreak, while no deaths were reported.

A joint press statement issued by agriculture ministry executive director Percy Misika and his counterpart in the health ministry, Ben Nangombe, detailed the effects of the suspected anthrax disease breakout in the Kunene and Zambezi regions.

The statement details that 104 suspected cases of human anthrax were reported at the Otjitanga village in the Kunene region after the village community had consumed and had close contact with anthrax-contaminated meat.

In the Zambezi region, the Katima Mulilo district reported suspected cases after 11 people developed lesions on different parts of their bodies after consuming meat from a hippo that died of an unknown cause, according to the statement.

A total of 68 small stock and 39 hippos have been reported dead. "Livestock deaths suspected to be caused by anthrax were detected at Otjitanga village in the Kunene region since [25 Sep 2019]," the statement said. "While in the Zambezi region, deaths of hippos at the lake of Liambezi were detected on the [29 Aug 2019].

Anthrax is a serious infectious disease that affects both animals and humans, and the bacteria can be found naturally in soil.  [Byline: Arlana Shikongo]
====================
[HealthMap/ProMED-mail map of Namibia:
Kunene is in the NW corner of Namibia; see: <https://en.wikipedia.org/wiki/Kunene_Region> while the Zambezi Region (previously Caprivi) is at the eastern end of the Caprivi Strip; see <https://en.wikipedia.org/wiki/Zambezi_Region>

Hippo die-offs from anthrax are never minor. And if people will not listen, we will see more statistics on human cases and possible deaths. - ProMED Mod.MHJ]
Date: Mon 23 Sep 2019
Source: News Ghana, via XinhuaNet [edited]

Hepatitis E cases in Namibia have risen to over 6305 cases in the entire country, health officials said Monday [23 Sep 2019]. Health Ministry director of research Phelomena Ochurus said there is a need for the country to be concerned, as cases are being reported on a weekly basis.

According to statistics Ochurus provided, there have so far been 52 fatal cases since 2017, with pregnant women topping the list of deaths.

"Pregnant women are more susceptible, because when they are pregnant, their immune system is compromised," she said. She added that males are topping the number of cases reported, with 60% of them affected in a specific age group of between 20 and 39 years old.

"In the Khomas and Erongo regions, people affected are living in areas with limited water and sanitation facilities, especially in the informal settlements where there are no proper facilities," she said. Khomas region has so far recorded 3865 cases, while Erongo region has recorded 1358 cases.

Namibia experienced the 1st hepatitis E outbreak in 1983 in Rundu, where 9 cases were confirmed, and the last outbreak was experienced in 1995-1996, also in Rundu.
========================
[Hepatitis E is found worldwide, and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, whereas genotype 3 is usually seen in developed countries and does not cause outbreaks. Acute epidemic hepatitis E is attributable to infection with hepatitis E virus genotypes 1 and 2. Many of the deaths are in pregnant women, characteristic of genotype 1.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus. - ProMED Mod.LL]

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

Tanzania

General
Nowadays there are few areas of our planet where you can really experience the timeless wonder and separation from the hum drum we face in our daily lives. Visiting Africa is fascinating and provides a new perspective on another life, another
world. The vast, untamed and primitive landscape provides a perfect glimpse into a life which many miss as they go about their daily chores. A trip which includes the majestic splendour of Africa’s tallest peak, Mt Kilimanjaro, rates high on the list of the unofficial wonders of the world and one not to be missed if the opportunity arises.
Mt Kilimanjaro
This is the highest peak in all of Africa stretching 5895m above sea level. Actually a few years ago the height of the summit was reassessed and then dropped by approximately 10m with more accurate recording by global positioning satellite. However, this minimal change will not be noticed by most travellers! There are a number of routes up to the summit and obviously which route is taken will make a significant difference to both the difficulty of the trek and any potential medical difficulties. Travelling with sufficient and well experienced guides and porters, and being part of a well organised group, are probably the most important factors in protecting your health.
Travelling to Tanzania
Mt Kilimanjaro is situated just across the border from Kenya in the northern part of Tanzania. You can approach the region by a number of different routes including buses from Nairobi, travelling from Dar es Salaam or flights straight into Moshi. How you travel for your climb of Kilimanjaro makes quite a significant difference to some of the health issues which you may face along the way.
General Health Issues
Before you leave for your trip make sure you are in good enough general health. If you can’t even run up a flight of stairs without collapsing then a trip up Kilimanjaro might not be the best choice! If you are unsure then see your doctor and ask for his or her advice at an early stage - before you commit yourself to the trip.
Long-Haul Flights
Flying to either Nairobi or Dar es Salaam takes between 9 to 10 hours from most Western European centres. This is regarded as a ‘long-haul flight’ so make sure you realise the risks associated with blood clotting in the legs and drink plenty of still fluids (water is the best), walk around the plane and use compression stockings if you are at any particular risk. (DVT in travel - TMB)
Food & Water
In Africa, as in many other areas of the world, what you eat and what you drink are essential for your well being. Being part of a large group has its advantages but you also need to stick with food and water that suits you personally. Don’t take extra risks with what you eat or drink just because others seem to be okay. Have your own sensible rules and remember to care for your stomach! Dehydration is common while climbing in a hot climate just make sure the water you drink is pure. You will also lose salt through perspiration and this will need to be replaced by increasing the amount of salt you put on your food at meal times.
What shoes to wear
Remember this is a walking holiday so prepare well in advance. Obviously increase your walking at home before you leave but remember to also include some significant hill walks to test your shoes. Blisters and corns are regularly associated with poorly fitted and substandard boots so spend that extra to get a pair that suits you and supports both the arch of your foot and also your ankles. A slightly larger pair is essential to lessen the pressure on your feet. Good thick socks will help to absorb perspiration and cushion your feet against friction.
Clothes to bring
This is one of the most difficult areas to sort out. The weather and climate along your climb will vary from a beautiful Irish-like summer day, to a roasting hot, dehydrating scorcher to a chilly or freezing night when the sun retires after about 6 pm. You must pack light cotton clothing but warm enough for the chill of the evenings at altitude. A wide brimmed hat (and sun lotion) is essential to protect against sun burn.
Problems at Altitude
High altitude is defined as over approx 3500m and as you know Kilimanjaro is a whole lot higher. The affects of altitude can hit anybody but most commonly it is the fit younger traveller who experiences the most serious consequences and even death. The doctor who discusses your vaccines and malaria prophylaxis will talk through the issues relating to Altitude sickness and may prescribe a medication to lessen the risks in certain circumstances. But remember, this disease can kill so if you develop any possible symptoms (lightheadedness, headaches, altered gait etc) please report it to your guide immediately. (Altitude sickness - TMB)

Being part of a group
The main advantage of being part of a group is that each member can help look-out for others during the trip. Never get separated from your main party and always report it if you feel one of your group is not quite right medically. This may be the first signs of altitude sickness and you could quite literally save a life by your intervention.
Mosquitoes and Malaria
Mosquitoes do not tend to live above 2000m and so the risk of malaria while climbing Kilimanjaro does not occur. However, you have to get to that altitude first and so protection against mosquito bites and malaria prophylaxis will be essential for this trip. (Malaria protection - TMB)
Rabies Risks in Tanzania
Any warm blooded animal can transmit rabies and so it is extremely important that you avoid any contact with dogs, cats, monkeys, and other animals on the slopes of Mt Kilimanjaro such as hyrats and other beaver like creatures. Report any contact immediately to your group leader.
Vaccinations for visiting Tanzania
As you travel to Tanzania from Western Europe we normally recommend that you have a number of vaccinations to cover against a range of diseases. In certain patients it may also be worth considering further vaccination cover against conditions like Rabies and Hepatitis B. These should be talked through in detail with your vaccinating doctor.
After your visit
When you return home you must remember that certain diseases can present days, weeks or even months afterwards. If you develop any peculiar symptoms (fever, headache, diarrhoea, skin rash etc) please make contact so this can be urgently assessed.
In the vast majority of cases the traveller climbing Kilimanjaro will stay perfectly healthy and well providing they follow the main common sense rules. Have a great safe trip and enjoy some of the splendours that Africa has to provide.

Travel News Headlines WORLD NEWS

Date: Tue, 31 Mar 2020 11:20:53 +0200 (METDST)

Dar es Salaam, March 31, 2020 (AFP) - Tanzania on Tuesday recorded its first death from coronavirus, a 49-year-old man who had underlying health issues, the health ministry said.   The East African nation has reported cases since March 16, including foreign travellers and those with whom they have had contacts. One person has so far recovered.   "I regret to announce the first death of coronavirus patient early this morning. The 49-year old man had other health complications," Health Minister Ummy Mwalimu said in a statement, without giving details.   Tanzania has already shut all schools and universities in a bid to curb the disease, and from Tuesday parliament cut working hours and limited the number of MPs allowed in the debating chamber.

However while neighbouring countries have imposed lockdowns and urged people to stay home, President John Magufuli has played down the seriousness of the disease.   "This is time to build our faith and continue praying to God and not depending on face masks. Don't stop going to churches and mosques for prayers. I'm sure this is just a change of wind and it will go like others have gone," Magufuli said at a church in Dodoma earlier this month.   "There are too many threats being spread about corona but this is a small disease and we will beat it in the name of Jesus. I also ask Tanzanians to continue working hard," he added.   His comment was criticised by other politicians who said Tanzania should actually consider closing churches and mosques to avoid spreading coronavirus.   "Let's not argue with science," said opposition lawmaker Zitto Kabwe on Twitter.
Date: Fri 6 Dec 2019
From: Paola De Benedictis <pdebenedictis@izsvenezie.it> [edited]

A 44-year-old man was admitted to a public hospital (ICU Bisceglie, Barletta-Andria-Trani province, Apulia region, Italy) on 8 Oct 2019 with a suspected rabies infection. At the time of admission, he presented acute respiratory distress. Due to his deteriorating clinical conditions, he was transferred to the ICU of a tertiary hospital (ICU Policlinico, Bari, Italy), where he died of rabies on 19 Nov 2019, after a hospital stay of 42 days. Antemortem laboratory diagnostic tests for rabies performed at the National and FAO Reference Centre for Rabies, IZSVe (Padova, Italy) confirmed the initial suspicion based on the patient's clinical history.

The man had been bitten on his right hand by an aggressive dog on 8 Sep 2019 on the Island of Zanzibar (Tanzania). He immediately underwent post-exposure prophylaxis, which consisted of wound washing with an antiseptic solution (Betadine and hydrogen peroxide) and rabies vaccination in absence of rabies immunoglobulin administration. However, the patient was immunocompromised due to a corticosteroid therapy prescribed to treat an autoimmune disease and, unfortunately, such an important anamnesis went unnoticed until the onset of the symptoms.

Despite the internationally coordinated efforts to achieve a global goal of zero human dog-mediated rabies deaths by 2030, rabies still reaps human victims. In most cases, appropriate post-exposure prophylaxis [PEP] can safely prevent the infection in humans. However, shortages in rabies immunoglobulin (RIG) still represent the main constraint for human death prevention. Pre-exposure prophylaxis (PrEP) makes administration of RIG unnecessary after a bite. In this particular case, PrEP and antibody titration of the victim before his travel might have saved his life. Of note, recent WHO recommendations reshape the PrEP protocol from 3 to 2 shots administered within one week (0-7). Moreover, we believe that enhanced awareness and information should be envisaged at different levels, and disseminated by travel health advisors, travel agents, and resorts or through official public health guidelines,  similarly to those recommended by the United States Centers for Disease Control (CDC-ATL, <https://wwwnc.cdc.gov/travel/destinations/traveler/none/Tanzania>, paragraph "Keep away from animals" under "Stay Healthy and Safe").
--------------------------------
Lidia Dalfino, MD, Bari hospital
Sergio Carbonara, MD, Bisceglie hospital
Paola De Benedictis, DVM, PhD, FAO RC, IZSVe
===================
[Zanzibar island is a popular tourist destination in a semi-autonomous region of Tanzania, located off the eastern coast of Africa. Its government has undertaken, with the support of NGOs, great efforts to control and eradicate canine rabies since the earlier decade of the century. This was done mainly by annual rabies vaccinations, leading to a significant decline in the number of clinically confirmed canine rabies cases. In 2015, the Zanzibar government felt close to officially declaring the island free from canine rabies but this goal was eventually not achieved. In October 2017, the Global Alliance for Rabies Control (GARC) informed that The local authorities were "working hard towards ensuring a 70% vaccination coverage across the entire island within next 2 months" and that Zanzibar "is very close to being declared the 1st region in Africa to be free from rabies." (<https://rabiesalliance.org/news/towards-freedom-canine-mediated-rabies-zanzibar-island-wide-strategic-dog-vaccination>). This end, unfortunately, has not yet been reached, as tragically demonstrated by the case described above.

According to media reports, the victim, a businessman from the city of Andria in southern Italy, was visiting Kiwengwa beach, a resort area in the northeast of the island. "The family had arrived only a day earlier in Zanzibar and was on an excursion in the area when the animal attacked him. The animal was reportedly suffering from rabies and the wound was treated by local medics, which included it being disinfected at the local hospital."

According to the report above, for which the authors, Drs De Benedictis, Dalfino, and Carbonara are gratefully acknowledged, PEP was applied in Zanzibar but did not include rabies immunoglobulin. The victim continued with his holiday before returning to Italy. "He showed no signs of ill health for 2 weeks after returning, but then towards the end of September (2019), he started to feel unwell. Speaking to a friend before he died, he said the symptoms had included high blood pressure and spasms." The friend told local media: "The rabies [pre-exposure] vaccination was not something he had because it was only recommended, and was not listed as compulsory. An absurdity. [He] was very unlucky." (<https://ananova.news/tourist-bitten-by-rabid-stray-dog-in-zanzibar-dies>.)

The US CDC website provides pre-travel vaccination advice to "all travellers", "most travelers", and "some travellers". Rabies is one of the 5 vaccines which "some travelers" to Tanzania should be vaccinated with "after consulting their doctors." It is recommended for the following groups:
- Travellers involved in outdoor and other activities (such as camping, hiking, biking, adventure travel, and caving) that put them at risk for animal bites;
- people who will be working with or around animals (such as veterinarians, wildlife professionals, and researchers);
- people who are taking long trips or moving to Tanzania;
- children, because they tend to play with animals, might not report bites, and are more likely to have animal bites on their head and neck. (<https://wwwnc.cdc.gov/travel/destinations/traveler/none/tanzania#vaccines-and-medicines>).

WHO's advice concerning pre-travel vaccination, for all destinations, fall in broad line with CDC's, while adding the following:

"Pre-exposure vaccination is also recommended for individuals travelling to isolated areas, or to areas where immediate access to appropriate medical care is limited, or to countries where modern rabies vaccines are in short supply and locally available rabies vaccines might be unsafe and/or ineffective." (<https://www.who.int/ith/vaccines/rabies/en/>).

Should immunocompromised travelers apply PrEP?
The availability of RIG at destination may influence such a decision. The advice of one's GP and/or travel medicine expert deserves to be sought in a timely fashion.

A report of previous cases of inadequate antibody response to rabies vaccine in an immunocompromised patient and a literature search revealing 15 additional immunocompromised patients, of whom 7 did not exhibit the minimum acceptable level of antibodies after a complete postexposure prophylaxis regimen, are available in ref 1 below.

Reference
---------
1. Kopel E, Oren G, Sidi Y, David D. Inadequate antibody response to rabies vaccine in immunocompromised patient. Emerg Infect Dis. 2012; 18(9): 1493-5;

[HealthMap/ProMED-mail maps:
Kiwengwa Beach, Zanzibar North, Tanzania:
Date: Sat, 28 Sep 2019 20:04:29 +0200 (METDST)

Nairobi, Sept 28, 2019 (AFP) - A Canadian tourist died Saturday while parachuting from the top of Mount Kilimanjaro, Africa's highest peak and Tanzania's top tourist attraction.   Justin Kyllo, 51, was killed after his parachute failed to open, Tanzanian National Parks spokesman Pascal Shelutete said.   Kyllo had arrived in the country on September 20, he said.   Around 50,000 people climb the nearly 6,000-metre mountain, located near the northeastern frontier with Kenya, every year.
Date: Fri 20 Sep 2019
From: Daniel R. Lucey MD, MPH [edited]

ProMED-mail reports since 14 Sep [2019] of a Tanzanian woman who died in Dar es Salaam on 8 Sep [2019] and was declared negative for Ebola by Tanzanian officials raises the question of what did cause her death. Given her travel to Uganda in August [2019], perhaps bat-associated Sosuga virus could be tested for if stored specimens exist. Similar to this young woman from Tanzania, the initial patient from the USA working in Uganda in 2012 in whom Sosuga virus was discovered had [experienced] fever, headache, rash, and diarrhoea (EID 2014; 20: 211-216). This virus was found from fruit bats in Uganda in 3 locations approximately 130 km [about 81 mi] apart (J Wildl Dis 2015; 51:774-779). An IgM and IgG test was developed at the US Centers for Disease Control and Prevention, and antiviral compounds active against this virus were reported in 2018.

Daniel R. Lucey MD, MPH
Consultant, ProMED
=======================
[The fatal case of a young Tanzanian woman studying in Uganda who died after travelling back to Tanzania for her field studies, as reported in ProMED-mail post http://promedmail.org/post/20190914.6674377, continues to elude an aetiological diagnosis. The initial concern for Ebola infection has since effectively been ruled out (see http://promedmail.org/post/20190914.6674377), but outside observers have called for greater transparency and information sharing given widespread rumours surrounding this case and its potential public health implications for neighbouring countries as well as Tanzania itself (see http://promedmail.org/post/20190918.6680252).

As discussed by ProMED Mod.LK, the Ebola-like symptoms manifested in this case can be caused by other viral haemorrhagic fevers and a variety of other pathogens (see http://promedmail.org/post/20190914.6674377). ProMED thanks Dr. Lucey for raising the intriguing possibility of Sosuga virus in his letter. We continue to seek any additional information about this case, as well as alternative etiologic diagnoses and how they could be tested for.

Citations and URLs for the articles referenced by Dr. Lucey are as follows:

Albarino CG et al.: Novel Paramyxovirus Associated with Severe Acute Febrile Disease, South Sudan and Uganda, 2012. Emerg Infect Dis. 2014; 20(2): 211-216. <https://dx.doi.org/10.3201/eid2002.131620>.

Amman BR et al.: A Recently Discovered Pathogenic Paramyxovirus, Sosuga Virus, is Present in _Rousettus aegyptiacus_ Fruit Bats at Multiple Locations in Uganda. J Wild Dis. 2015; 51(3): 774-779. <https://www.jwildlifedis.org/doi/10.7589/2015-02-044>. - ProMED Mod.LXL]

[HealthMap/ProMED-mail map:
28 Jul 2019

As many as 13 have died while 6677 have been infected across Tanzania. In Dar es Salaam region alone, 6631 cases and 11 deaths have occurred.

HealthMap/ProMED-mail map of Tanzania:
More ...

World Travel News Headlines

Date: Mon, 6 Apr 2020 13:48:38 +0200 (METDST)

Vienna, April 6, 2020 (AFP) - Austria could start easing its coronavirus lockdown measures from next week, Chancellor Sebastian Kurz said Monday, but warned that this depended on citizens abiding by social distancing rules.   "The aim is that from April 14... smaller shops up to a size of 400 square metres, as well as hardware and garden stores can open again, under strict security conditions of course," Kurz said at a press conference.

He said that as of April 14, the current obligation to cover one's mouth and nose in supermarkets will be extended to other shops and on public transport.   He added that if the government's timetable goes to plan, larger shops will reopen on May 1.   From mid-May hotels, restaurants and other services could also start to open their doors again in stages, Kurz said, adding that a decision on this would be taken at the end of April.

- 'Strongest decline in EU' -
However, he said that the restrictions on movement that Austria has introduced to fight the spread of COVID-19 remained in place.   He urged Austrians not to celebrate Easter with people outside their household, adding that he would not be seeing his own parents.   Schools will remain closed until at least mid-May and public events will remain banned until the end of June.

If trends in infection begin to worsen again, the government "always has the possibility to hit the emergency brake" and re-introduce restrictions, Kurz said.   He pointed to the example of Singapore, which initially had managed to contain the spread of the virus but was now facing a second wave of infections.   Kurz also warned that international travel would continue to be severely hampered for the foreseeable future, with discussions ongoing at an EU level as to how restrictions could be eased.   Kurz was speaking alongside several cabinet colleagues who entered wearing face masks before taking them off to speak behind specially erected screens.

- Reopening parks -
Interior Minister Karl Nehammer announced that the government also hoped to re-open public parks on April 14.   He clarified that the punishment for not adhering to mask-wearing in shops and on public transport would be 50 euros ($54).   Health Minister Rudolf Anschober said he was encouraged by the downward trend in the growth rate for infections, adding: "We have the strongest coronavirus decline in the EU".   The country of 8.8 million people currently has 12,058 confirmed infections, with 204 deaths and 2,998 recoveries.   In mid-March the increase in infections was running at around 40 percent, which unchecked would have led to two million people in Austria contracting the virus by now, Anschober said.

The daily rate of increase is now at 1.6 percent with a successful flattening of the curve, Anschober said, although he emphasised the rate must be brought down yet further.   Anschober also welcomed the fact that Austria was "well ahead" of many other countries when it comes to testing, with 111,000 tests carried out so far.   He said that great progress was being made on antibody tests and that he hoped these could be used in infection "hotspots".   Also on Monday authorities in western Tyrol, Austria's worst hit region, said that the quarantine ordered for the region's 750,000 people would be lifted on Tuesday.
Date: Mon, 6 Apr 2020 13:40:30 +0200 (METDST)

Berlin, April 6, 2020 (AFP) - Germany will put all arriving travellers in quarantine for 14 days, the interior ministry said Monday, as Berlin ramps up entry curbs to fight the coronavirus pandemic.   The measure, which will come into force on April 10, is expected to affect mostly German or EU nationals and residents, as the European Union has already banned all arrivals from outside the bloc.

Workers in the health sector living outside Germany in border regions will be exempted from the restriction, which will also not apply for business travellers entering for a short period of time.   Chancellor Angela Merkel's government had decided on the toughened rule during a cabinet meeting focus on the battle against the coronavirus pandemic.

During the same meeting, which is ongoing, ministers agreed that 100 percent of loans made by banks to small- and medium-sized firms will be guaranteed by the state.   The federal government will stand fully behind 500,000 euros ($540,000) of lending to companies with up to 50 employees and 800,000 euros for larger ones, upping its guarantee level from a previous 80 percent for large firms or 90 percent for smaller ones.
Date: Mon, 6 Apr 2020 13:26:30 +0200 (METDST)

Madrid, April 6, 2020 (AFP) - Spain declared Monday a fourth consecutive drop in the number of coronavirus-related deaths with 637 over the past 24 hours, the lowest number in nearly two weeks.   Fatalities, which were sharply down on the record 950 on Thursday, brought the total deaths in the country to 13,055, second only to Italy.   The official figures represent an increase of 5.1 percent over the last 24 hours, compared to a 4.8 percent rise on Sunday and a 32.63 percent leap as recently as March 21.

The number of new infections also slowed, rising 3.3 percent to 135,032, down from a rise of 24.8 percent on March 21.   "These figures confirm again this downwards tendency which we have been observing," said Maria Jose Sierra of the health ministry's emergencies coordination unit.   Over 40,000 coronavirus patients have been discharged from hospital, or nearly 30 percent of all confirmed cases of the disease, she added.   With deaths and new infections falling the Spanish government is studying how to gradually ease the lockdown imposed on the country of 47 million people on March 14. It has been  extended until April 25.

The government plans to ramp up testing to be able to isolate people who are infected but not showing symptoms and is mulling requiring all people to wear face masks in public to curb the spread of the disease.   Four Spanish firms are currently producing 245,000 coronavirus tests per week, Foreign Minister Arancha Gonzalez Laya said during a television interview on Monday.   "During the coming weeks we will multiply by three the capacity of our companies to supply the market" with tests, she added.   As for face masks, the minister said "we will probably all have to learn to use them as a prophylactic, at least until there is a vaccine" against COVID-19.
Date: Mon, 6 Apr 2020 12:53:51 +0200 (METDST)

Kinshasa, April 6, 2020 (AFP) - Kinshasa on Monday closed off its upmarket business district for two weeks and began a large-scale disinfection operation in a bid to clean up DR Congo's main suspected source of coronavirus.   Access to Gombe, which houses the country's main institutions and foreign embassies, was barricaded off to everyone except local residents with a pass, an AFP journalist saw.   "The choice of this district is linked to the fact that it's from Gombe that the virus is spreading little by little to other districts," the health authorities said in a daily statement.   "Massive disinfection has been scheduled during this period. The offices and main buildings in Gombe district are concerned. Once everything has been cleaned in Gombe, other areas will targeted," it said.   On Thursday, Kinshasa Governor Gentiny  Ngobila announced that Gombe, one of the capital's 26 districts, would be "placed in quarantine" from April 6-20.   The district "is considered to be the epicentre of the epidemic in the city," he said.

According to the Democratic Republic of Congo's official figures, the sprawling country has recorded 161 cases of coronavirus, 18 of them fatal.    Almost all have occurred in the capital, with a handful of other cases in the  volatile east.   During the partial lockdown, anti-coronavirus teams in Kinshasa will "look for sick people but also investigate risk contacts and asymptomatic cases" for testing and treatment, the authorities said.   People who go to work in Gombe -- drivers, gardeners and so on -- will be tested in their districts of residence and will be quarantined if they have the virus.
6th April 2020

Twinkling flames from candles and traditional lamps lit up India's night sky Sunday in a nine-minute show to mark the fight against the coronavirus pandemic, which has left the vast nation in lockdown.   Across major cities and towns in the world's second-most populous country of 1.3 billion people, many heeded the call of Prime Minister Narendra Modi to turn off their lights at 9:00 pm local time.
6th April 2020

South Korea reported fewer than 50 new coronavirus cases for the first time in more than six weeks, having once been the hardest-hit country outside China, where the virus first emerged.   The South confirmed 47 new cases on the previous day, the Korea Centers for Disease Control and Prevention said, taking its total to date to 10,284. It was the lowest increase since late February.
6th April 2020

The city-state has put nearly 20,000 migrant workers under quarantine for two weeks after a growing number of coronavirus infections were detected in their dormitories.   Authorities reported 120 new virus cases Sunday, the highest jump for the country in a single day, with many linked to foreign workers' dorms.    Many workers from less affluent countries, particularly parts of South Asia, come to Singapore to work in construction and are typically housed in large dormitory complexes.
6th April 2020

The Japanese government may declare a state of emergency this week to contain the coronavirus outbreak, media reports said.    Prime Minister Shinzo Abe is reportedly set to make the declaration for parts of Japan including Tokyo, as the number of people infected with the virus continues to increase.   The news pushed up Tokyo stocks, with investors seeing the move as positive for containing the outbreak, analysts said.
Date: Mon, 6 Apr 2020 09:16:37 +0200 (METDST)
By Philippe Carillo

Port Vila, Vanuatu, April 6, 2020 (AFP) - A deadly Pacific cyclone intensified as it hit Vanuatu on Monday, threatening a natural disaster that experts fear will undermine the impoverished nation's battle to remain coronavirus-free.   Tropical Cyclone Harold, which claimed 27 lives when it swept through the Solomon Islands last week, strengthened to a scale-topping Category 5 superstorm overnight, Vanuatu's meteorology service said.

The cyclone is now packing winds of up to 235 kilometres per hour (145 miles per hour), prompting red alerts across several provinces.   It made landfall on the remote east coast of Espiritu Santo island on Monday morning and was heading directly for Vanuatu's second-largest town Luganville, which has a population of 16,500.   The slow-moving storm is expected to pass north of the capital Port Vila early Tuesday.   "For now, we don't have any reports of injury, but lots of damage," Red Cross Vanuatu secretary general Jacqueline de Gaillande told AFP.

Another concern is the impact a large natural disaster could have on Vanuatu's attempts to remain one of the world's few countries without any reported COVID-19 infections.   The nation has sealed its international borders to avoid the virus but emergency measures including bans on public meetings have been temporarily suspended so people can gather in evacuation centres.   "There have been no confirmed cases of COVID-19 in Vanuatu, but a significant disaster at this time could present serious logistical challenges to delivering life-saving aid," Oxfam's Vanuatu director Elizabeth Faerua said.

- Widespread destruction -
A major international relief effort was needed the last time a Category 5 system, Cyclone Pam, hit Vanuatu in 2015.   If a similar operation were needed in the wake of Cyclone Harold, it would run the risk of importing the virus to a nation that lacks the health infrastructure to deal with even a mild outbreak.

New Zealand Prime Minister Jacinda Ardern raised concerns about the cyclone and said the Kiwi military was ready to deploy if needed, even though New Zealand is on COVID-19 lockdown.   "(Harold) looks like it's coming into the Pacific with considerable force," she told reporters.   "Our defence force is at the ready, that's the role they play regardless of what's going on in New Zealand."   Cyclone Pam flattened Port Vila, killed 11 people and left a swath of destruction that the World Bank estimated wiped out almost two-thirds of Vanuatu's economic capacity.

De Gaillande said Vanuatu's government could face a balancing act between helping cyclone-devastated communities and potentially importing the virus by allowing in international aid.   "We will need international aid, but we're hoping initially it will be through funding only, so we can buy supplies and help those most in need," she said.   "We have a lot of skilled people on the ground here already (to carry our disaster operations)."   Cyclone Harold has already caused widespread damage in he Solomon Islands, where an inter-island ferry ignored weather warnings and 27 people were washed off its decks.

Solomons police said Sunday that the bodies of five passengers from the MV Taimareho had been recovered and the search would resume the next day.   "I would like to thank everyone... involved in the search for the missing 27 people so far as we try as much as possible to find the bodies so their grieving relatives can give them a proper burial," chief superintendent Richard Menapi said.   The ferry set off from Honiara for Malaita island on Thursday night, packed with more than 700 people as part of a government evacuation programme in response to the virus crisis.
Date: Mon, 6 Apr 2020 01:32:44 +0200 (METDST)

Abidjan, April 5, 2020 (AFP) - Residents in a working-class district of the Ivory Coast city of Abidjan on Sunday destroyed a coronavirus testing centre that was under construction, police and health ministry officials said.   Videos posted on social media, showed several dozen people dismantling the building, some of them shouting: "We don't want it!"

The incident happened in Yopougon district of the city of five million inhabitants, which is the country's commercial capital.   Locals had demonstrated against the centre because they thought it was too close to their homes and right in the middle of a residential district, one police officer told AFP on condition of anonymity.   But the building, which was still under construction, had never been intended as a treatment centre for virus patients -- only as a testing centre, said a health ministry official, who also asked not to be named.

This was the first violent incident connected to the COVID-19 outbreak in the country, which so far appears to have been relatively untouched by the virus, at least according to official figures.   They put the number of cases at 261, with three deaths so far.

Nevertheless, the authorities are trying to increase their capacity to treat the outbreak.   President Alassane Ouattara declared a state of emergency on March 23.   Abidjan has already been placed under quarantine, effectively cut off from the rest of the country, and a nationwide overnight curfew is in force.

Schools, churches and non-essential shops have been closed and gatherings have been banned.   On Saturday, senior health officials recommended that people wear masks in public places to try to slow the spread of the virus.   So far however, the government has not ordered a full lockdown.   Last Tuesday, the government announced a 2.6-billion-euro plan ($2.8 billion) to tackle the economic and social effects of the pandemic, which is forecast to halve the country's growth rate to 3.6 percent in 2020.