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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Guatemala

Guatemala - US Consular Information Sheet
October 13, 2006
COUNTRY DESCRIPTION:
Guatemala has a developing economy, characterized by wide income disparities.
Hotels and other tourist facilities in the principal tourist sites most freq
ented by visitors from the United States are generally good to excellent.
A peace accord, signed in 1996, ended a 36-year armed conflict.
Violent crime, however, is a serious concern due to endemic poverty, an abundance of weapons, a legacy of societal violence, and dysfunctional law enforcement and judicial systems.
Read the Department of State Background Notes on Guatemala for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid U.S. passport is required for all U.S. citizens, regardless of age, to enter Guatemala and to depart Guatemala for return to the U.S.
Even if dual nationals are permitted to enter Guatemala on a second nationality passport, U.S. citizens returning to the United States from Guatemala are not allowed to board their flights without a valid U.S. passport.
Guatemalan authorities do not accept Certificates of Naturalization, birth certificates, driver's licenses, and photocopies as alternative travel documents.
While in Guatemala, U.S. citizens should carry their passports, or a photocopy of their passports, with them at all times.

An exit tax must be paid when departing Guatemala by air.
The exit tax (currently $30) is generally included in an airline ticket price, but may be charged separately.
There is an additional airport security fee (20 Quetzales, approximately $2.50) that all travelers must pay at the airport.

Minors under 18 traveling with a valid U.S. passport need no special permission from their parents to enter or leave Guatemala.
U.S. citizens do not need a visa for a stay of 90 days or less (that period can be extended for an additional 180 days upon application to Guatemalan immigration).

A U.S. citizen whose passport is lost or stolen in Guatemala must obtain a new passport at the U.S. Embassy as soon as possible and present it, together with a police report of the loss or theft, to the Dirección de Migración (Guatemalan immigration agency), Sub-director de Control Migratorio (Sub-director for Migratory Control), to obtain permission to depart Guatemala.
The agency is located in Guatemala City at 6 Avenida 3-11, Zone 4, Guatemala City.
Office hours are weekdays from 8:00 a.m. to 4:00 p.m.; telephone 2411-2411.
No fee is charged by Guatemalan immigration for this service.

In June 2006, Guatemala entered a "Central America-4 (CA-4) Border Control Agreement" with El Salvador, Honduras, and Nicaragua.
Under the terms of the agreement, citizens of the four countries may travel freely across land borders from one of the countries to any of the others without completing entry and exit formalities at Immigration checkpoints.
U.S. citizens and other eligible foreign nationals, who legally enter any of the four countries, may similarly travel among the four without obtaining additional visas or tourist entry permits for the other three countries.
Immigration officials at the first port of entry determine the length of stay, up to a maximum period of 90 days.
Foreign tourists who wish to remain in the four country region beyond the period initially granted for their visit are required to request a one-time extension of stay from local Immigration authorities in the country where the traveler is physically present, or travel outside the CA-4 countries and reapply for admission to the region.
Foreigners "expelled" from any of the four countries are excluded from the entire "CA-4" region.
In isolated cases, the lack of clarity in the implementing details of the CA-4 Border Control Agreement has caused temporary inconvenience to some travelers and has resulted in others being fined more than one hundred dollars or detained in custody for 72 hours or longer.

See our Foreign Entry Requirements brochure for more information on Guatemala and other countries.

For further information regarding entry, exit and customs requirements, travelers should contact the Guatemalan Embassy at 2220 R Street, NW, Washington, DC 20008; telephone (202) 745-4952, extension 102; fax (202) 745-1908; e-mail at info@guatemala-embassy.org; Internet web site - http://www.guatemala-embassy.org or contact the nearest Guatemalan consulate (Chicago, Denver, Houston, Los Angeles, Miami, New York, or San Francisco).

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:
Violent criminal activity has been a problem in all parts of Guatemala for years, including murder, rape, and armed assaults against foreigners.
The police force is inexperienced and under-funded, and the judicial system is weak, overworked, and inefficient.
Well-armed criminals know that there is little chance they will be caught and punished.
Traditionally, Guatemala experiences increases in crime before and during the Christmas and Easter holiday seasons.
Large demonstrations occur throughout Guatemala, often with little or no notice, and they can cause serious traffic disruptions.
Although most demonstrations are peaceful, they can turn violent, and travelers should avoid areas where demonstrations are taking place.
The use of roadblocks and/or blocking of public facilities, including the international airport, has increased and demonstrators may prevent tourists caught behind the blockades from leaving.

Due to uncontrolled drug and alien smuggling, the Guatemalan border with Mexico is a relatively high-risk area, in particular in the northern most Peten Department.
The most dangerous area in that region is on the northwestern border of the Peten, in the area including the Sierra de Lacandon and Laguna del Tigre National Parks.
Extra precautions are required when travel by U.S. Government personnel to the region is required.

In October 2005 Hurricane Stan caused widespread flooding and landslides on Guatemala's Pacific coast and in many parts of the Highlands, affecting a number of tourist destinations frequented by foreign travelers.
All major highways and tourist destinations reopened by the end of the month, and most secondary routes are also fully open.
Temporary repairs are still in place; some have already been washed out and others will likely fail during the current rainy season (May through October).
The following recommendations will help residents and visitors alike to increase their safety:

Avoid gatherings of agitated people.
Guatemalan citizen frustration with crime and a lack of appropriate judicial remedies has led to violent incidents of vigilantism, including lynching, especially in more isolated, rural areas.
Attempting to intervene may put you at risk of attacks from mobs.

Avoid close contact with children, including taking photographs, especially in rural areas.
Such contact can be viewed with deep alarm and may provoke panic and violence.
Rumors of foreigners stealing children surface periodically and can provoke a violent response towards strangers.
Foreign tourists have been attacked by mobs and some years ago one was killed while photographing children.

Keep informed of possible demonstrations by following the local news and consulting hotel personnel and tour guides.
Avoid areas where demonstrations are occurring.

Strong currents, riptides, and undertow along Guatemala's Pacific Coast beaches pose a serious threat to even the strongest swimmers.
Signs warning of treacherous surf are rare and confined mostly to private beaches owned by hotels.
Lifeguards are rarely present on beaches.

Tourists planning to climb Pacaya and Agua volcanoes during Guatemala's rainy season (May through October) should plan their climb for the morning hours, when it is less likely that thunderstorms will occur.
Climbers should monitor the weather situation and return to the base of the volcano as quickly as safely possible if thunderstorms gather.
In 2003, a Canadian tourist was killed by lightning while climbing Pacaya.
INGUAT, the Guatemalan Tourist Institute, has organized an active community-based tourism program in San Vicente Pacaya to minimize the risk of armed robbery on Pacaya.
Climbing in groups is still highly advisable for any volcano climb to reduce the risk of assault.

Security escorts for tourist groups and security information are available from the Tourist Assistance Office of INGUAT (the Guatemalan Tourist Institute) at 7a Avenida 1-17, Zona 4 Centro Cívico, Ciudad de Guatemala.
INGUAT's 24 hour/seven days per week direct telephone numbers for tourist assistance and emergencies are (502) 2421-2810 and (502) 5578-9836 and the fax is (502) 2421-2891.
INGUAT may be reached by its toll free number within the United States at 1-888- 464-8281.
You may also simply dial 1500 in Guatemala to reach INGUAT Tourist Assistance.
The e-mail address is asistur@inguat.gob.gt.
Travelers may also wish to visit INGUAT's website, http://visitguatemala.com.
Tourist groups are advised to request security escorts from INGUAT, Attention: Coordinator of the National Tourist Assistance Program.
There have been no incidents of armed robbery of groups escorted through the Tourist Protection Program.
The request should be submitted by mail, fax or e-mail and should arrive at INGUAT at least three business days in advance of the proposed travel, giving the itinerary, names of travelers, and model and color of vehicle in which they will be traveling.
Travelers should be aware that INGUAT might not be able to accommodate all requests.

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.
CRIME:
The number of violent crimes reported by U.S. citizens and other foreigners has remained high in recent years.
Incidents include, but are not limited to, assault, theft, armed robbery, carjacking, rape, kidnapping, and murder.
Criminals often operate in groups of four or more and are confrontational and violent.
Gangs are a growing concern in Guatemala City and rural Guatemala.
Gang members are often well armed with sophisticated weaponry and they sometimes use massive amounts of force.
Emboldened armed robbers have attacked vehicles on main roads in broad daylight.
Travel on rural roads always increases the risk of a criminal roadblock or ambush.
Widespread narcotics and alien smuggling activities can make remote areas especially dangerous.
Though there is no evidence that Americans are particularly targeted, criminals look for every opportunity to attack, so all travelers should remain constantly vigilant.

Most tourists and visitors travel throughout Guatemala without mishap.
However, violent criminal activity on the highways continues, and tourists, among others, have been targeted.
Many of the robbery attempts have occurred in daylight hours on main highways.
Carjacking incidents and highway robberies are often violent.
Four Americans were killed in highway robbery attempts in 2002 and three killed and one wounded in 2003.
In 2004 one American tourist was murdered, and women and children were raped in highway assaults.
Several highway assaults of American citizens also took place in 2005, but without serious injury to the victims.
In some cases, assailants have been wearing full or partial police uniforms and have used vehicles that resemble police vehicles, indicating that some elements of the police might be involved.
Armed robberies have occurred within minutes of the tourist's vehicle being stopped by the police.
U.S. Embassy personnel continue to observe heightened security precautions in Guatemala City and on the roads outside the capital city.
U.S. tourists are urged to be especially aware of safety and security concerns when traveling on the roads in Guatemala.
Rather than traveling alone, use a reputable tour organization.
Stay in groups; travel in a caravan consisting of two or more vehicles; and, stay on the main roads.
Ensure that someone not traveling with you is aware of your itinerary.
Resist the temptation to stay in hotels that do not have adequate security.
Travel after dark anywhere in Guatemala is extremely dangerous.
It is preferable to stay in the main tourist destinations.
Do not explore back roads or isolated paths near tourist sites.
Pay close attention to your surroundings, especially when walking or when driving in Guatemala City.
Refrain from displaying expensive-looking jewelry, large amounts of money, or other valuable items.
Finally, if confronted by criminals, be aware that resistance may provoke a more violent response.

Additional information:
In recent months there has been an increasing number of carjacking incidents and armed robberies near the airport, most frequently between 6:00 and 10:00 am (see list of Recent Crime Incidents Involving Foreigners on the Embassy website for more specifics).
In the most common scenario tourists or business travelers who land at the airport around 7:00 am are held up by armed men as their vehicle departs the airport.
Private vehicles, taxis and shuttle buses have been attacked.
Typically, the assailants steal money, passports, and luggage, and in some but not all cases, the assailants steal the vehicle as well.
Victims who did not resist the attackers were not physically injured.
The Embassy advises its own employees to seek alternative routes for exiting the airport.

Pickpockets and purse-snatchers are active in all major cities and tourist sites, especially the central market and other parts of Zone 1 in Guatemala City and the city of Antigua.
In a common scenario, an accomplice distracts the victim, while an assailant slashes or simply steals a bag or backpack while the victim's attention is diverted.

As in other countries, criminals also use a number of scams to steal money and possessions from tourists in Guatemala.
In one popular scam, robbers place a nail in a parked vehicle's tire.
The vehicle is then followed by the robbers who pose as "good Samaritans" when the tire becomes flat and the victims pull to the side of the road.
While "help" is being rendered, the contents of the car are stolen, often without the knowledge of the victims.
However, in some cases, the robbers have threatened the tourists with weapons.
Parking areas in and around the Guatemala City International Airport are particularly prone to this crime.
In another scam, victims are approached in a hotel, restaurant or other public place by an individual claiming there is some sort of problem with his or the would-be victim's automobile in the parking lot.
On the way to investigate the "problem," usually in a remote or concealed area near the parking lot, the robber pulls a gun on the victim demanding cash, credit cards and other valuables.
A third popular scam involves various attempts to acquire a victim's ATM card and PIN number.
Some sophisticated criminals have even placed boxes outside ATM kiosks that record PIN numbers when unsuspecting victims believe they must enter their PIN number to gain entry to the ATM foyer.
After recording PIN numbers, robbers then steal the owner's ATM card to complete their crime.
There are dozens of techniques scammers can use to rob victims of money and possessions.
While most people mean no harm, always be cautious when strangers approach you for any reason or make unusual requests.

Parents adopting children in Guatemala have also been victimized in public places and at their hotels by police (or individuals dressed as police) who have threatened to arrest foster mothers and turn adoptive children over to orphanages, but released them in exchange for significant payments, often approaching $1000.
Such threats have no basis in Guatemalan law, and should be immediately reported to the Embassy.

For security reasons, the Embassy does not allow U.S. government employees to stay in hotels in Zone 1 in Guatemala City and urges private travelers to avoid staying in this area.

Avoid low-priced intra- and inter-city buses (recycled U.S. school buses); they are often attacked by armed robbers and are poorly maintained and dangerously driven.
The use of modern inter-city buses somewhat improves security and safety.
There have been, however, several attacks on travelers on first-class buses on highway CA-2 near the border areas with both Mexico and El Salvador and on highways CA-1 and CA-9 near the El Salvador border and in the highlands between Quetzaltenango and Solola.
Be cautious with personal items such as backpacks and fanny packs while riding buses, because tourists' possessions are a favorite target of thieves.

Do not hail taxis on the street in Guatemala City.
Use radio-dispatched taxis or taxis from major hotels instead.
The main road to Lake Atitlan via the Inter-American Highway (CA-1) and Solola is safer than the alternatives, though attacks in recent years have made traveling in a caravan highly recommended, even on the Inter-American Highway.
Robbery and assault have been frequently reported on secondary roads near the lake with the highest number of incidents occurring on the RN-11 (Las Trampas road) parallel to the east side of the lake.
Robbers have used mountain roads advantageously to stop buses, vans and cars in a variety of ways.

Armed attacks have occurred on roads from Guatemala City to the Peten.
Visitors to the Mayan ruins at Tikal are urged to fly to nearby Flores and then travel by bus or tour van to the site.

Violent attacks have occurred in the Mayan ruins in the Peten, including in the Cerro Cahui Conservation Park, Yaxha, the road to and inside Tikal Park, and in the Tikal ruins.
Tourist police (POLITUR) patrols inside the park have significantly reduced the violent crime incidents inside the park, but travelers should nevertheless remain in groups and on the principal trails leading to the Central Plaza and the Temple IV complex, and avoid remote areas of the park.

POLITUR (a joint police/Guatemalan Tourism Institute initiative) is present in all major tourist destinations.
They should be contacted in case of any criminal incident in such areas, even if minor.

Foreign residents of Guatemala have special concerns.
Twenty American citizen residents and five American citizen tourists have been murdered since December 1999, and suspects have been convicted in only two cases.
There have been "express" kidnappings in recent years, primarily in Guatemala City, in which a relatively small ransom that can be quickly gathered is demanded.
U.S. citizens have been kidnapped in recent years.
At least one incident of a random kidnapping, in which the victim was grabbed off the street in an affluent neighborhood of the city, occurred in December 2003 and resulted in a physical and sexual assault.

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: A full range of medical care is available in Guatemala City, but medical care outside the city is limited.
Guatemala's public hospitals frequently experience serious shortages of basic medicines and equipment.
Care in private hospitals is generally adequate for most common illnesses and injuries, and many of the medical specialists working in them are U.S. trained and certified.

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

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

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

Driving in Guatemala requires one's full attention, and safe drivers must take extraordinary efforts to drive defensively to avoid dangerous situations.

Traffic rules are only casually observed.
Many drivers do not use their turn signals to alert other drivers.
Instead, a common custom is for a driver or passenger to stick a hand out the window and wave it to indicate that they will be taking an unspecified action.
Speed limits, lane markings and stop signs are frequently ignored.
Passing blindly on winding and/or steep mountain roads, poorly designed surfaces, and unmarked hazards, including frequent landslides and precarious temporary highway repairs, present additional risks to motorists.

Common public transportation is by local recycled school busses, which serve every town in the country.
Criminal activity and frequent fatal accidents, however, make the low-priced inter-city buses particularly dangerous.
Modern inter-city buses offer some security from highway violence, but armed attacks are increasing, showing that all buses are vulnerable.
(See additional information in the CRIME section.)

Although city streets are lit, secondary and rural roads have little to no illumination.
Driving outside of urban areas at night is dangerous and not recommended.
The Inter-American Highway (CA-1) and the road from Guatemala City to the Caribbean coast (CA-9) are especially dangerous due to heavy traffic, including large trucks and trailers.
There are no roadside assistance clubs, however a roadside assistance force (PROVIAL) patrols most of the major highways in the country.
PROVIAL can be contacted by calling 2422-7878.
Their vehicles are equipped with basic tools and first aid supplies, and their services are free.
Police patrol the major roadways and may assist travelers, but the patrols are sporadic and may be suspended due to budget restraints.
For roadside assistance, travelers may call the police by dialing 120 or the fire department by dialing 122 or 123.
Cellular telephone service covers most areas frequented by tourists.

Valid U.S. driver's licenses are accepted for the first 30 days of a visit, and international driving permits are accepted in Guatemala for extended stays.
Guatemala's road safety authorities are the Department of Transit and the Joint Operations Center of the National Police.
Drivers use the right-hand side of the road in Guatemala, and speed limits are posted (in kilometers) depending on the condition of the road.
Speed limits are different in rural and urban areas, but are rarely enforced.
Drivers often drive at the absolute maximum speed possible for the particular vehicle at the time.
These drivers share the road with slow vehicles, some barely able to manage 20 miles per hour, creating a hazardous mix of velocities.
Turning right on red is not permitted unless otherwise posted, and drivers must yield when entering a traffic circle.
Seat belts must be worn in Guatemala, but there are no laws regarding the use of child safety seats.
It is against the law for drivers to operate cellular phones while driving.

People found driving under the influence of alcohol or other drugs are arrested and may serve jail time.
In an accident resulting in injury or death, every driver involved is taken into custody and the vehicle(s) impounded until a judge determines responsibility in a re-enactment of the accident.

Please refer to our Road Safety page for more information.
Visit the website of Guatemala's national tourist office and national authority responsible for road safety at http://www.inguat.gob.gt or via e-mail at asistur@inguat.gob.gt or info@inguat.gob.gt.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Guatemala's Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Guatemala's air carrier operations.
For more information, travelers may visit the FAA's Internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
A major renovation of the international terminal at La Aurora International Airport in Guatemala City is currently under way.
Until completion in late 2006 or early 2007, there is a temporary reconfiguration of arrival and departure vehicle traffic and major construction works inside the terminal.

Guatemalan customs authorities may enforce strict regulations concerning temporary importation into or export from Guatemala of items such as antiquities and other cultural property.
It is advisable to contact the Embassy of Guatemala in Washington or one of Guatemala's consulates in the United States for specific information regarding customs requirements.
In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines.

Please see our Customs Information.

Non-Guatemalan citizens who wish to marry in Guatemala are required to provide proof of identity and civil status (indicating whether they are single or divorced).
Prior notice of the marriage must be given in the Diario de Centro America (Guatemala's Official Record) and any large circulation daily newspaper for fifteen days.
The marriage must take place within six months of the publication of the notice.

DISASTER PREPAREDNESS:
Guatemala is a geologically active country.
Visitors should be aware of the possibility of earthquakes at any time and the need for contingency plans.
There are also four active volcanoes.
Volcanic activity, such as that of Fuego Volcano near Antigua in January 2003, and again in January 2006, has on occasion forced evacuations of nearby villages; the January-February 2000 activity of Pacaya Volcano near Guatemala City also briefly closed Guatemala City's international airport.
Both the Caribbean and Pacific coasts of Guatemala are also vulnerable to hurricanes and tropical storms from June through November.
Mudslides and flooding during the May to November rainy season often kill dozens of people and close roads.
In October 2005 Hurricane Stan caused widespread flooding and landslides on Guatemala's Pacific coast and in many parts of the Highlands.
Over 1000 Guatemalans died, and many highways across the affected regions were closed for days.
All highways have now reopened.
Temporary repairs are still in place; some have already been washed out and others will likely fail during the current rainy season.
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/.

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 Guatemalan laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Guatemala 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 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 Guatemala 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 Guatemala.
Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The latest security information is available from the Embassy, including its website, http://guatemala.usembassy.gov
The Consular Section is open for citizen services, including registration, from 7:30 a.m. to 12:00 noon and 1:00 p.m. to 3:30 p.m. Monday through Thursdays and 7:30 a.m. to 11:30 a.m. Fridays, excluding U.S. and Guatemalan holidays.
The second and last Friday of each month are reserved for administrative matters; therefore, routine citizen services are not provided.
Emergency services are available at all times.
The U.S. Embassy is located in Guatemala City at Avenida La Reforma 7-01, Zone 10; telephone (502) 2-326-4000 during Embassy business hours (8:00 a.m. to 5:00 p.m.), or (502) 2-331-2354 for emergencies during non-business hours; fax (502) 2-332-4353; Internet web site - http://guatemala.usembassy.gov.
* * *
This replaces the Consular Information Sheet dated June 13, 2006 to update the Entry and Exit requirements section.

Travel News Headlines WORLD NEWS

Date: Sat, 9 Mar 2019 23:07:09 +0100

Guatemala City, March 9, 2019 (AFP) - The parents of a British tourist who has been missing in Guatemala for the past five days launched an emotional appeal for her return Saturday as authorities continued their investigation.   Catherine Shaw, 23, was last seen Monday at a hotel in San Juan La Laguna near the country's fabled Lake Atitlan, about 75 kilometres (45 miles) west of the capital Guatemala City.   The area is famous for its lakes beneath towering volcanoes. Lake Atitlan is one of Guatemala's main tourist attractions.

Her parents put up a video appeal on the Twitter account of the Lucie Blackman Trust, a British charity that provides support to the families who have relatives missing, murdered or in a crisis abroad.   "Hello Catherine, we've been out of touch for five days and we, your family and your friends, need to know you're happy and that you're well. So please get in touch, get in touch with us, and we really you home," said her mother, who did not provide her name on the video.   "We need you, please come home, sweetheart," added her father.

Shaw was described as being five feet seven inches tall (170 centimetres) and of slim build, with blonde hair, blue eyes and piercings in her nose, lip and ears.   She had been traveling in Guatemala for two weeks having previously been in Mexico and California, leaving home in England in September 2018, according to the charity.   Eduardo Smith, the British embassy spokesman, told Prensa Libre that embassy staff were working with Guatemalan police on the case.
Date: Tue, 20 Nov 2018 02:54:29 +0100

Guatemala City, Nov 20, 2018 (AFP) - Guatemalan authorities declared a red alert and evacuated around 4,000 people Monday after the Fuego volcano erupted for the fifth time this year, sending bursts of ash and lava down the mountain before its activity decreased and then stopped.   Memories are still painfully fresh of the volcano's eruption in June, which swept away villages and left nearly 200 people dead and 235 missing.   The Institute of Volcanology's director Pablo Oliva said the volcano's activity level had dropped significantly by late Monday.

A spokesman for Guatemala's disaster management agency CONRED had earlier said it decided to evacuate the municipality of Escuintla and two other districts. Some 4,000 people were taken to temporary shelters as a precaution.   The spokesman, David de Leon, said the eruption became increasingly violent after it began Sunday morning, leading to fears for the safety of the thousands of people who live on the slopes of the 3,763 meter-high (12,246 feet) mountain.

A column of ash rose about 1,000 meters above the crater and areas west of the volcano -- 35 kilometers (22 miles) from Guatemala City -- were under a barrage of gas ash and fiery rocks, CONRED said.   As the volcano's activity fell back to normal parameters, evacuees were asked for the sake of cautiousness to return home on Tuesday by bus.

A previous eruption on October 12-13 was characterized by increasingly loud booms and lava flow. On that occasion, 62 people were evacuated from their homes as a precaution and a highway around the mountain was closed.   Many of those evacuated on Monday said they had feared a repeat of the deadly June eruption.   "We were scared and that's why we evacuated," said Miriam Garcia, from the village of El Rodeo which was largely spared the deadly eruption.

Oscar Juarez from El Rodeo said: "You have to get out as soon as possible because when that (volcanic material) comes close, you no longer have time to leave, even if you run, because it comes very fast."   Activity inside Guatemala's two other volcanoes, Pacaya and Santiaguito, has increased in recent months but they have not entered the eruptive phase.
Date: Mon, 19 Nov 2018 11:28:44 +0100

Guatemala City, Nov 19, 2018 (AFP) - Guatemalan authorities on Monday declared a red alert after the Fuego volcano erupted again, forcing about 200 residents to flee.   A fiery glow rose from the crater of Fuego which is erupting for the fifth time this year, one month after the last one and following a June 3 rain of rocks, ash and toxic gases that left almost 200 people dead and 235 missing.   A spokesman for Guatemala's disaster management agency CONRED, David de Leon, said 214 residents who live on the slopes of Fuego, mostly in the southern municipality of Escuintla, were moved to safe zones and more will follow.

He said about 2,000 people in total have been asked to leave the area of the 3,763-meter (12,246-foot) volcano, 35 kilometres (22 miles) from Guatemala City.   Since the eruption began Sunday morning, lava rises 500 meters above Fuego's crater, while the ash column exceeds one kilometre above the volcanic cone and is causing a rain of particles, the Institute of Volcanology said.   The previous eruption lasted from October 12-13 with loud booms and lava flow. It caused the evacuation of 62 people and closed a highway.
Date: Fri, 12 Oct 2018 18:54:16 +0200

Guatemala City, Oct 12, 2018 (AFP) - Guatemala's deadly Fuego volcano erupted anew early Friday, unleashing a 600-meter flow of lava and sending clouds of ash spiralling into the sky.   Increased volcanic activity over the last 24 hours could release tons of fiery volcanic material and force evacuations of mountain villages, warned Guatemala's disaster management agency CONRED.

A powerful June 3 eruption of the Fuego volcano -- located 35 kilometres (22 miles) southwest of the capital -- rained rocks, ash and toxic gases on several villages and left 190 people dead and 235 missing.   CONRED had yet to issue evacuation orders for mountain communities early Friday, but spokesman David de Leon said: "Considering how the volcano is behaving some communities could make decisions to evacuate to safe areas."

Authorities shut down a nearby highway as a precaution and vulcanologists warned the civil aviation agency of an ash cloud to the west and southwest of the volcano.   Scientists monitoring the 3,763-meter (12,346-foot) volcano reported increased activity from late Thursday. However, activity intensified on Friday with loud booms and lava flows, the Institute of Vulcanology said.   Some 2,900 displaced victims of the earlier disaster remain in temporary shelters as government promises to build a 1,000 permanent homes on a state farm have been held up by irregularities.
Date: Tue 6 Feb 2018
Source: Cooperativa.cl [in Spanish, machine trans., edited]

The Ministry of Public Health and Social Welfare of Guatemala reported [Tue 6 Feb 2018], that the number of people intoxicated by an outbreak of salmonellosis detected in a bakery in the country's capital has risen to 115. A source from the portfolio confirmed that, although initially reported of 54 affected, the number has risen to 115 and added that no further details of this case can be given as it is under investigation.

Health Minister Carlos Soto had previously indicated that the 1st 54 people infected after eating at this establishment, located in zone one of the capital, had already received medical discharge. In addition to _Salmonella_, the authorities detected in the establishment the bacterium _E. coli_ and during the investigations they verified that the workers did not have sanitary cards.

The bakery had until last [Fri 2 Feb 2018], to present the proof of release in this case, but asked for an extension at which time theHealth portfolio will make the decision to close or sanction the establishment.
====================
[The source of the salmonellosis outbreak linked to the bakery is not clear.

A map of (Guatemala): <http://healthmap.org/promed/p/13>. - ProMED Mod.LL]
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Albania

Albania US Consular Information Sheet November 04, 2008

 COUNTRY DESCRIPTION

Albania is a parliamentary democracy that is transforming its economy into a market-oriented system. Albania's per capita income is among the lowest in Eu

ope, but economic conditions in the country are steadily improving. Tourist facilities are not highly developed in much of the country, and though Albania's economic integration into European Union markets is slowly underway, many of the goods and services taken for granted in other European countries are not yet available. Hotel accommodations are limited outside of major cities. Read the Department of State Background Notes on Albania for additional information.

ENTRY/EXIT REQUIREMENTS

 A passport is required. All travelers entering or exiting Albania must have six months or more validity on their passport. Customs officers strictly enforce this law. U.S. citizens do not require a visa prior to entering Albania, but those traveling without a visa will be charged a fee for an entry stamp at the point of entry, which is valid for a stay of up to 90 days. This fee is currently 10 Euros, or the equivalent in any easily convertible currency, including U.S. dollars. Travelers without a visa who intend to stay in Albania for more than 90 days should be aware that Albanian law allows a traveler without a visa to remain in Albania for 90 days only within a specific 180-day period. That 180-day period is defined from the first day of entry. For example, a traveler entering without a visa on January 1 may remain in Albania for 90 days total during the period of time between January 1 and June 28. Departing Albania during this time period does not "restart the clock." Travelers attempting to reenter Albania without a visa and within 180 days of a previous entry and after an aggregate stay of 90 days may be denied entry. For stays exceeding 90 days within a 180-day period, those interested must apply for a Residency Permit at the police station with jurisdiction over the city of residence. Information on how to apply for a residency permit is available on the Embassy of Albania web site at http://www.embassyofalbania.org/. There is also a departure fee of ten Euros, or the equivalent in any easily convertible currency, including U.S. dollars. Visit the Embassy of Albania web site at http://www.embassyofalbania.org/consular.html#visa for the most current visa information. Dual Nationality: The Albanian government considers any person in Albania of Albanian parents to be an Albanian citizen. In addition to being subject to all Albanian laws affecting U.S. citizens, dual nationals may be subject to Albanian laws that impose special obligations. Male Albanian citizens are subject to compulsory military service regulations. If such persons are found guilty of draft evasion in Albania, they are subject to prosecution by the Albanian court. Those who might be affected should inquire at an Albanian Embassy or Consulate outside Albania regarding their status before traveling. In some instances, dual nationality may hamper U.S. Government efforts to provide protection abroad. Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY

Although the overall security situation in Albania has improved in recent years, organized criminal activity continues to operate in all regions, and corruption is pervasive. US Government employees need permission to travel to the northern administrative districts of Shkoder, Malesi E Madhe and Tropoje (with the exception of the route along the national road to Montenegro and the city of Shkoder) and to the southern town of Lazarat, with such travel restricted to secure vehicles with escort. Travel restrictions for U.S. Government employees have been lifted for overnight stays in the city of Shkoder. In most cases, police assistance and protection is limited. A high level of security awareness should be maintained at all times. Photographing anything that authorities regard as being of military or security interest may cause travelers problems. All gatherings of large crowds should be avoided, particularly those involving political causes or striking workers. For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found. Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.

CRIME

In the latest State Department assessment, Albania’s crime rating is “medium.” Crime against foreigners is rare in Albania, as targeting foreigners is often viewed as too risky. Visitors should maintain the same personal security awareness that they would in any metropolitan U.S. city. Caution should be exercised in bars in Tirana where violent incidents, some involving the use of firearms, have occurred in the past, particularly in the early morning hours. Within the last years there have been fewer cases of carjacking compared with previous years. Anyone who is carjacked should surrender the vehicle without resistance. Armed crime continues to be more common in northern and northwestern Albania than in the rest of the country. Street crime is fairly common in Albania, particularly at night. Criminals do not seem to deliberately target U.S. citizens or other foreigners, but do seek targets of opportunity, and select those who appear to have anything of value. Vehicle theft is still one of the biggest problems in Albania. Pick-pocketing is widespread; U.S. citizens have reported the theft of their passports by pick-pockets. 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 is 129, though coverage is inconsistent at best. See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION

Medical facilities and capabilities in Albania are limited beyond rudimentary first aid treatment. Emergency and major medical care requiring surgery and hospital care is inadequate due to lack of specialists, diagnostic aids, medical supplies, and prescription drugs. Travelers with previously diagnosed medical conditions may wish to consult their physicians before travel. As prescription drugs may be unavailable locally, travelers may also wish to bring extra supplies of required medications. Recent electricity shortages have resulted in sporadic blackouts throughout the country, which can affect food storage capabilities of restaurants and shops. While some restaurants and food stores have generators to properly store food, travelers should take care that food is cooked thoroughly to reduce the risk of food-borne illness. Water in Albania is not potable. Visitors should plan to purchase bottled water or drinks while in country. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Albania. Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s 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 Albania is provided for general reference only, and may not be totally accurate in a particular location or circumstance. Major roads in Albania are often in very poor condition. Traveling by road throughout Albania is the most dangerous activity for locals and tourists. Vehicle accidents are the major cause of death, according to police statistics. Electricity shortages have resulted in sporadic blackouts throughout the country that can happen any hour of the day or night. Such outages affect traffic signals and street lights, making driving increasingly treacherous at any time of day. Travel at night outside the main urban areas is dangerous and should be avoided due to deplorable road conditions. During the winter months, travelers may encounter dangerous snow and icy conditions on the roads throughout mountainous regions in northern Albania. Buses travel between most major cities almost exclusively during the day, but they are often unreliable and uncomfortable. Many travelers looking for public transport prefer to use privately owned vans, which function as an alternate system of bus routes and operate almost entirely without schedules or set fares. Please note that many of these privately owned vans may not have official permission to operate a bus service and may not adhere to accepted safety and maintenance standards. Persons wishing to use privately owned vans should exercise caution. There are no commercial domestic flights and few rail connections. Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office at www.albaniantourism.com.

AVIATION SAFETY OVERSIGHT

As there is no direct commercial air service to the United States by carriers registered in Albania, the U.S. Federal Aviation Administration (FAA) has not assessed Albania's Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For further information, travelers may visit the FAA's web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa SPECIAL CIRCUMSTANCES: Albania's customs authorities may enforce strict regulations concerning temporary importation into or export from Albania of some items. It is advisable to contact the Embassy of Albania in Washington, D.C. or one of Albania's Consulates in the United States for specific information regarding customs requirements. As noted previously, the Albanian government considers any person in Albania of Albanian parents to be an Albanian citizen. In addition to being subject to all Albanian laws affecting U.S. citizens, dual nationals may be subject to Albanian laws that impose special obligations. Male Albanian citizens are subject to compulsory military service regulations. See our information pertaining to dual nationality. Albania is a cash economy. Credit cards and travelers checks are not generally accepted, except at the major new hotels in Tirana and some international airline offices. Travelers' checks can be changed at banks in larger towns. Automated Teller Machines (ATMs) are available in most cities. 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 Albania’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Albania 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. Under Albanian law, police can detain any individual for up to 10 hours without filing formal charges. U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times to show proof of identity and U.S. citizenship if questioned by local officials.

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 Albania 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 Albania. 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 Rruga Elbasanit 103, tel. (355)(4) 2247285; fax (355)(4) 2232222. The U.S. Embassy web site is http://tirana.usembassy.gov/ * * * This replaces the Consular Information Sheet dated June 10, 2008, to update sections on Entry and Exit Requirements, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Tue, 26 Nov 2019 09:28:12 +0100 (MET)
By Briseida MEMA

Tirana, Nov 26, 2019 (AFP) - Six people died and some 150 were injured in Albania after the strongest earthquake in decades rocked the Balkan country early Tuesday, destroying buildings and burying victims in rubble.

The epicentre of the 6.4 magnitude quake was about 34 kilometres (about 20 miles) northwest of the capital Tirana, at a depth of 10 km, according to the European-Mediterranean Seismological Centre.   "We have victims," Prime Minister Edi Rama wrote on Twitter. "We are working to do everything possible in the affected areas."   The quake struck at 3:54 am local time (0254 GMT) and sent panicked residents running out onto the streets of Tirana, with people huddling in the open, an AFP correspondent said.

The worst damage appeared to be around the coastal town of Durres. The quake was the strongest to hit this region since 1926, Albanian seismologist Rrapo Ormeni told local television.   Three bodies were pulled from the ruins of damaged buildings in the port town, where a three-story hotel collapsed and other buildings were damaged, according to the defence ministry.   The bodies of a man and a woman were uncovered in rubble in the nearby town of Thumane, the ministry said.

A man in his fifties died after he jumped out of his building in panic in the town of Kurbin, the defence ministry said.   Some 300 armed forces personnel have rushed to Durres and Thumane for rescue operations, where "there are people trapped under the ruins", defence ministry spokeswoman Albana Qahajaj said.

In Thumane, around a dozen rescuers used an excavator to dig through a mountain of debris in search of possible victims.   At least 150 people with injuries have sought first aid in Tirana and Durres, Health Minister Ogerta Manasterliu said.

- Trapped under rubble -
In Thumane, soldiers, rescuers and families were sifting through the rubble of a collapsed five-storey building as cries of people trapped under debris were heard, an AFP reporter said.   Thoma Nika, a 58-year-old who lived in the building, said there were at least six people under rubble.    Another man, Arben Allushi said with tears in his eyes, that his wife and niece missing after the building collapsed.

A man in Durres told local television that his daughter and niece were trapped in the rubble of a collapsed apartment building.    "I talked with my daughter and niece on the phone. They said they are well and are waiting for the rescue. I could not talk to my wife. There are other families, but I could not talk to them," the man said.

The tremors were felt across the Balkan region, from Sarajevo to Bosnia and even in the Serbian city of Novi Sad almost 700 kilometres away, according to reports in local media and on social networks.   It was followed by several aftershocks, including one of 5.3 magnitude, the European-Mediterranean Seismological Centre said. It was described by authorities as the strongest earthquake in the last 20-30 years.   The Balkans is an area prone to seismic activity and earthquakes are frequent.
Date: Sat, 21 Sep 2019 20:39:17 +0200 (METDST)

Tirana, Sept 21, 2019 (AFP) - Albania was rattled by its strongest earthquake in decades Saturday, officials said, sending people fleeing into the streets in several cities, damaging buildings and triggering power cuts in the capital.   The epicentre of the shallow 5.6-magnitude quake, was near Durres, less than 40 kilometres (25 miles) west of the capital Tirana, according to the US Geological Survey.

Albania's defence ministry said it was the "strongest earthquake in the country in the last 20 to 30 years".   "There are no deaths," defence ministry spokeswoman Albana Qajaj said.   Some 80 people sought medical help in both Tirana and Durres, 21 of whom were hospitalised due to injuries caused by falling objects or parts of walls as well as for panic attacks, Health Minister Ogerta Manasterilu said.   Qajaj told AFP that houses and buildings in Tirana had been damaged but were still standing and that the ministry was accessing damage in other towns and villages.   Prime Minister Edi Rama cancelled his scheduled trip to the United States following the quake, which cut electricity and telephone lines in Tirana and a number of other towns and villages.

Many people remained outside their homes for several hours in the capital, fearful of aftershocks.   "I fear to return because such a strong earthquake could be followed with others," Drita Lohja, a resident in her fifties, told AFP.    Falling debris pulverised parked cars in parts of the city.   AFP reporters and witnesses saw windows broken and deep fissures in the facades of buildings in Durres, as well as in the capital.   Media reported that a large building in Tirana was seriously damaged and that residents were being evacuated.   A University of Tirana building was also damaged, witnesses said.

According to local media reports, at least two people were lightly injured and a dozen houses collapsed in the village of Helmes, 10 kilometres from Tirana.   Two other earthquakes followed the strong one that occurred at around 4:00 pm (1400 GMT) and was felt in neighbouring Montenegro and Italy, but also on the Greek island of Corfu according to some Twitter users.
Date: Fri, 9 Mar 2018 16:28:50 +0100

Tirana, March 9, 2018 (AFP) - The military has been deployed in northern Albania to help hundreds of people trapped by floods following heavy rainfall, authorities said on Friday.   More than 9,230 hectares (22,800 acres) of agricultural land is underwater in the Shkodra region, including villages where the only means of transport is by boat, the defence ministry said.

Army personnel are evacuating residents and securing food supplies in the affected areas, 100 kilometres (60 miles) north of the capital, Tirana.   The torrential rain in recent days has caused landslides damaging dozens of homes and flooding roads, said the transport ministry.   The rain has also forced the Albanian authorities to release excess water from a hydroelectric plant, which has added to the flooding in northern areas of the country.   Weather forecasters say the rain is likely to ease from Saturday.
Date: Sun, 3 Dec 2017 12:29:40 +0100

Tirana, Dec 3, 2017 (AFP) - Thousands of police and soldiers have been deployed in Albania to rescue stranded residents after heavy rainfall triggered major flooding, and caused the death of a utility worker, officials and the power company said Sunday.   The victim, Sabri Vlinga, died while he was working on a electricity pole at Roskovec in the flooded south of the country, the power company said in statement.   Two other people were injured in similar accidents. it added.   Some 6,400 police and soldiers have been sent to help rescue people stranded by the floods, Prime MInister Edi Rama said Saturday, calling the situation "very critical".

Around 1,500 people in the affected areas have been rescued, while several thousand homes were without electricity as many utility poles have been swept away by mudslides, said Shemsi Prenci, head of civil protection.   More than 7,874 hectares (19,450 acres) of farm land as well as 3,193 homes are under water and several roads in the south remained impassable.

Army forces have built a temporary bridge at Darezeze, about 70 kilometres (44 miles) from the capital Tirana, to come to the aid of 2,000 residents stranded by the floods, the defence ministry said.    In neighbouring Macedonia, the heavy rains have also caused flooding as several rivers include the main Vardar river have burst their banks, the MIA news agency reported.
Date: Sat 5 Aug 2017
From: Edmond Puca <edmond_puca@yahoo.com> [edited]

Here in Albania, we have 2 imported cases of haemorrhagic fever with renal syndrome (HFRS), one imported from the north of Greece and another from Macedonia in a village near the border with Albania.

The patient from Macedonia is 25 years old. He presented in the emergency room on 31 Jul [2017]. Right now, he is in good condition and will survive. He presented with fever, nausea and vomiting, abdominal pain, and lower back pain.

The other patient from Greece had been in our service for the previous 2 weeks and now is at home in good condition.

The disease is caused by Dobrava-Belgrade virus infection.
---------------------------------
Dr Edmond Puca
Infectologue
Department of Infectious Disease
UHC "Mother Teresa"
Tirana, Albania
===================
[ProMED-mail thanks Dr Edmond Puca for sending in this report.  This and the previous report are the 1st reports of hantavirus infections in Macedonia that ProMED-mail has posted. There is also evidence of HFRS in Greece, although ProMED-mail has not posted reports previously. Sero-epidemiological investigations conducted in several Balkan countries revealed an overall seroprevalence of 4 per cent in Greece (<http://www.sciencedirect.com/science/article/pii/S0168170213004887#>). There doubtless have been Dobrava-Belgrade virus infections in Greece and the Balkans over the years, given that this virus is known to circulate widely in the Balkans.

The yellow-necked field mouse (_Apodemus flavicollis_) is the principle vertebrate host for Dobrava-Belgrade virus. - ProMED Mod.TY]

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

World Travel News Headlines

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

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

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

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

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

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

One guide said that some tourists, bothered by the island's ubiquitous mosquitos, would "leave the paths, move away from the group and walk where they are not supposed to", putting fragile habitats at risk.   Shah said that if they wanted to increase the number of tourists, it would require hiring more wardens and guides who live on the island, which would also have a negative impact on nature.   "Our absolute priority is nature, and it comes before tourists. If we have to take more steps to protect it and reduce the number of tourists, we will," he said.
Date: Thu, 16 Jan 2020 02:45:27 +0100 (MET)
By Ivelisse RIVERA, con Leila MACOR en Miami

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

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

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

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

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

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

In the past few days there have been growing calls among Democratic lawmakers for Trump to declare the situation in Puerto Rico a disaster.   It is a delicate subject, as Trump has accused the government of Puerto Rico of incompetence and of siphoning off hurricane relief money, triggering a public spat between the president and the mayor of San Juan, Carmen Yulin Cruz, as well as the former governor Ricardo Rossello, who was forced to step down last summer amid massive protests.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
Date: Wed, 15 Jan 2020 23:16:11 +0100 (MET)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[HealthMap/ProMED-mail map of Argentina: