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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: Tue, 24 Sep 2019 07:27:34 +0200 (METDST)

Miami, Sept 24, 2019 (AFP) - A strong 6.0 magnitude struck off the northwest coast of Puerto Rico late Monday, the United States Geological Survey said, although no casualties or damage were reported.   The quake struck 62km northwest of San Antonio at 11:23 pm local time (03:20 GMT) at a depth of 10km, the agency said.  San Antonio is home to Rafael Hernandez Airport, a key air link to the mainland US.    In 2010 nearby Haiti was struck by a devastating 7.0 magnitude earthquake that killed more than 250,000 people and crippled the nation's infrastructure.
Date: Mon, 12 Feb 2018 05:54:19 +0100

San Juan, Feb 12, 2018 (AFP) - Most of San Juan and a strip of northern Puerto Rico municipalities were plunged into darkness Sunday night after an explosion at a power station, five months after two hurricanes destroyed the island's electricity network.

The state electric power authority (AEE) said the blast was caused by a broken-down switch in Rio Piedras, resulting in a blackout in central San Juan and Palo Seco in the north.   "We have personnel working to restore the system as soon as possible," the AEE said.   San Juan's mayor, Carmen Yulin Cruz, said on Twitter that emergency services and local officials attended the scene in the neighbourhood of Monacillos, but no injuries were reported.

Meanwhile, the Puerto Rican capital's airport said it was maintaining its schedule using emergency generators.   The blackout comes as nearly 500,000 of AEE's 1.6 million customers remain without power since Hurricanes Irma and Maria struck the US territory in September 2017.   AEE engineer Jorge Bracero warned on Twitter that the outage was "serious," and advised those affected that power would not be restored until Monday.
Date: Wed, 13 Dec 2017 03:08:12 +0100
By Leila MACOR

Fajardo, Puerto Rico, Dec 13, 2017 (AFP) - Until Hurricane Maria hit Puerto Rico, Jose Figueroa did brisk business renting kayaks to tourists itching to see a lagoon that lights up by night thanks to millions of microorganisms.   Today, things are so dire he's considering selling water to motorists stopped at red lights.   "Now we are trying to survive," the 46-year-old tour guide said.

It used to be that visitors had to reserve a month in advance to get one of his kayaks and paddle around in the dark on the enchanting, bioluminescent body of water called Laguna Grande.   But tourists are scarce these days as the Caribbean island tries to recover from the ravages of the storm back in September.   "We do not know if we will have any work tonight," Figueroa said. "Last week, we worked only one day."    He and another employee of a company called Glass Bottom PR are cleaning kayaks on the seaside promenade of Fajardo, a tourist town in eastern Puerto Rico whose main attraction is the so-called Bio Bay.

The year started off well for Puerto Rico, with the global success of the song "Despacito" by local musicians Luis Fonsi and Daddy Yankee.   The catchy tune helped promote the US commonwealth island of 3.4 million people, which is saddled with huge debts and declared bankruptcy in May.    But the hurricane turned what should be an island bustling with tourists into one with deserted beaches, shuttered restaurants and hotels full of mainland US officials working on the rebuilding of the island.   "What few tourists we have are the federal officials themselves," said Figueroa.

- Locals only -
The grim outlook spreads up and down the seaside promenade of Fajardo, where many restaurants are closed because there is no electricity.   On this particular day around noon, the only restaurant open is one called Racar Seafood. It has its own emergency generator.   "We get by on local tourists," said its 61-year-old owner, Justino Cruz.   "Our clients are local -- those who have no electricity, no generator, cold food or no food."

Puerto Rico's once-devastated power grid is now back up to 70 percent capacity, but this is mainly concentrated in the capital San Juan.   So while inland towns that depend on tourism are struggling mightily, things are getting better in San Juan as cruise ships are once again docking.   On November 30, the first cruise ship since the storm arrived with thousands of vacationers on board. They were received with great fanfare -- quite literally, with trumpet blaring and cymbals crashing.

- Pitching in to help -
The World Travel & Tourism Council, based in London, says tourism accounted for about eight percent of Puerto Rico's GDP in 2016, or $8.1 billion.   Hurricane Maria's damage has been uneven. Although some tour guides now have no work and many eateries are shut down, hotels that have their own generators are doing just fine.   Thanks to the thousands of US government officials and reconstruction crew members that came in after the storm, the hotels that are open -- about 80 percent of the total -- are pretty much full.

These people are starting to leave the island this month but hotels may receive tourists around Christmas, at least in San Juan, where power has for the most part been restored.   The hurricane "undoubtedly cost billions in lost revenue," said Jose Izquierdo, executive director of the Puerto Rico Tourism Company.    But Izquierdo nevertheless says he is "optimistic" and suggests an alternative: put tourists to work as volunteers in the gargantuan reconstruction effort that the island needs.   "We want to look for travellers who want to travel with a purpose, who might have the commitment to help rebuild," said Izquierdo.

The program, called "Meaningful Travel" and launched in mid-November, organizes trips on which residents, Puerto Ricans living abroad and tourists are invited to help the island get back on its feet.   "The plan aims to create empathy with this tourist destination," said Izquierdo.    "We want to be like New Orleans after Katrina, where 10 years after the hurricane, tourism is the driving force of its economy. We want to build that narrative of recovery," he added.   "There are different ways in which the world wants to help Puerto Rico. The best way is to visit us."
Date: Thu, 9 Nov 2017 12:39:04 +0100
By Marcos PÉREZ RAMÍREZ

San Juan, Nov 9, 2017 (AFP) - Andrea Olivero, 11, consults her classmate Ada about an exercise during their daily English class at San Juan's Sotero Figueroa Elementary School. The task: list the positive and negative aspects of Hurricane Maria's passing almost two months ago.

The girls only have to look around. There is no electricity and they "roast" in the heat, Andrea says. At the back of the room, computers and televisions collect dust.   "We would like to move past the topic of the hurricane a bit. It is already getting repetitive," Andrea told AFP.   She is one of more than 300,000 pupils in the public education system, although only half of schools are functioning. Barely 42 per cent of Puerto Ricans have electricity seven weeks after Maria struck, killing at least 51 in the American territory.

The lack of power has prompted disorienting timetable changes on the tropical island, to avoid both the hottest hours of the day and the use of dining facilities.   "The children are very anxious. We manage to make progress in lessons and they change the hours again. Everything is messed up and we fall behind," English teacher Joan Rodriguez explained.   "We can't use the computers to illustrate classes," she said. "They are reading the novel "Charlotte's Web," and we wanted to do exercises comparing it to the film version. But we cannot use the television.

- Suspicions -
From October 23, some directors reopened their schools in the western region of Mayaguez and San Juan.   But last Thursday, the Department of Education ordered their closure, insisting they must be evaluated by engineering and architectural firms, then certified by the US Army Corps of Engineers.   One of those schools was Vila Mayo, also in San Juan. The community presumed it would open, as it had been used as a shelter, its electrical infrastructure had been inspected and it had not suffered structural damage.

But Luis Orengo, the education department's director in San Juan, told protesters outside the school it was closed as inspectors' findings had not reached the central government.   "This is unacceptable! The school is ready to give classes but they don't want to open it. Our children cannot lose a year," fumed Enid Guzman, who protested with her 11-year-old son, Reanny De la Cruz.   There are suspicions the stalled reopening of schools is, in part, related to the prior closure of 240 schools over the past year during Puerto Rico's long-running financial crisis.   The fiscal difficulties have seen the island's population drop over the past decade by 14 percent, leading in turn to a fall in school enrolment.

Before the storms, 300 schools were at risk of closure -- and for the president of Puerto Rico's federation of teachers, Mercedes Martinez, the government's aim is clear.   "Secretary (Julia) Keleher seems to have an orchestrated plan to close schools," she said, referring to the education secretary. "Why do you have to wait 30 days to get a certification so a school can open?"   Keleher has announced she expects most schools to be open by the middle of November.
Date: Tue 24 Oct 2017
Source: KFOR Oklahoma News4 [edited]

Puerto Rico has reported at least 76 cases of suspected and confirmed leptospirosis, including a handful of deaths, in the month after Hurricane Maria, said Dr. Carmen Deseda, the state epidemiologist for Puerto Rico.

Two deaths involved leptospirosis confirmed through laboratory testing, and "several other" deaths are pending test results, Deseda said. The 76 cases, up from 74 last week, also include one patient with confirmed leptospirosis who is currently hospitalized.

The island typically sees between 63 and 95 cases per year, she said. Health officials had expected that there would be a jump after the hurricane. "It's neither an epidemic nor a confirmed outbreak," Public Affairs Secretary Ramon Rosario Cortes said at a news conference Sunday [22 Oct 2017]. "But obviously, we are making all the announcements as though it were a health emergency."

Leptospirosis may be treated with antibiotics, but many people recover on their own. "The majority of leptospirosis cases is a mild, subclinical disease with no complications," Deseda said. "But one out of 10 people who have leptospirosis develop severe illness." In the 1st stage of leptospirosis, symptoms vary widely from fever and headache to red eyes and rashes. Some people may have no symptoms at all. But a small number will develop dire complications: meningitis, kidney and liver damage, bleeding in the lungs and even death.

Doctors are required to report any potential leptospirosis cases to health authorities, Deseda said. Those cases must then be tested to confirm the bacteria, since the symptoms can be difficult to tell apart from other illnesses. After that, health officials may look for patterns or clusters and determine whether there is an outbreak.

The lab tests on the suspected cases have been sent to the US Centers for Disease Control and Prevention, Deseda said. The turnaround time is about 5-6 days.

Doctors on the island have expressed concerns about burgeoning health crises amid hospitals that are overwhelmed, undersupplied and sometimes burning hot. Influenza is another concern on the horizon, Deseda said. Drinking water is also hard to come by on many parts of the island.

Dr. Raul Hernandez, an internist in San Juan, told CNN that people were drinking water from whatever sources they could find, such as rivers and creeks. If that water contains urine from a [leptospirosis-infected rat], those people will be at risk, he said.

Deseda said people should be discouraged from walking barefoot, drinking or swimming in potentially leptospirosis-contaminated waters.

"These diseases are everywhere, and there's a way to prevent them," she said.
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[Leptospirosis is a zoonotic, spirochetal infection that occurs worldwide and is transmitted to humans by exposure to soil or fresh water contaminated with the urine of wild and domestic animals (including dogs, cattle, swine, and especially rodents) that are chronically infected with pathogenic _Leptospira_. _Leptospira_ may survive in contaminated fresh water or moist soil for weeks to months. Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers.

Parts of Puerto Rico saw more than 30 inches of rain and consequent flooding with recent Hurricane Maria. A map showing the estimated rainfall across Puerto Rico with this hurricane is available at <https://twitter.com/NWSSanJuan/status/910983698597777409/photo/1?ref_src=twsrc%5Etfw&ref_url>.

With continued absence of potable water, inadequate sanitation, and flooding in the streets for a large proportion of the population in Puerto Rico, food- and water-borne diseases, like leptospirosis, will be a major problem. - ProMED Mod.ML]

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

Yemen - US Consular Information Sheet
July 21, 2008
COUNTRY DESCRIPTION:
The Republic of Yemen was established in 1990 following unification of the former Yemen Arab Republic (North) and the People's Democratic Republic of Yemen (South). I
lamic and traditional ideals, beliefs, and practices provide the foundation of the country's customs and laws. Yemen is a developing country and modern tourist facilities are widely available only in major cities. Read the Department of State Background Notes on Yemen for additional information.

ENTRY/EXIT REQUIREMENTS: Passports and visas are required for travel to Yemen. Visas may be obtained at Yemeni Embassies abroad; all travelers to Yemen can also potentially obtain entry visas at ports of entry. Travelers to Yemen are no longer required to have an affiliation with and arrange their travel through a Yemeni-based individual or organization to enter Yemen. However, individuals may be asked for supporting evidence of their character, purpose of visit and length of stay. Upon arrival at ports of entry, travelers may be issued a visa valid for a maximum of three months.
Yemeni law requires that all foreigners traveling in Yemen obtain exit visas before leaving the country. In cases of travelers with valid tourist visas and without any special circumstances (like those listed below), this exit visa is obtained automatically at the port of exit as long as the traveler has not overstayed the terms of the visa.
In certain situations, however, foreigners are required to obtain exit visas from the Immigration and Passport Authority headquarters in Sanaa. These cases may include, but are not limited to, foreigners who have overstayed the validity date of their visa; U.S.-citizen children with Yemeni or Yemeni-American parents who are not exiting Yemen with them; foreigners who have lost the passport containing their entry visa; foreign residents whose residence visas are based on their employment or study in Yemen, marriage to a Yemeni citizen, or relationship to a Yemeni parent; or foreign residents who have pending legal action (including court-based "holds" on family members' travel). The loss of a passport can result in considerable delay to a traveler because Yemeni law requires that the traveler attempt to recover the passport by placing an advertisement in a newspaper and waiting a week for a response. All minor/underage U.S. citizens should be accompanied by their legal guardian(s) and/or provide a notarized letter in Arabic of parental consent when obtaining exit visas to depart Yemen. In all of these more complex cases, obtaining an exit visa requires the permission of the employing company, the sponsoring Yemeni family member, the sponsoring school or the court in which the legal action is pending. Without this permission, foreigners -- including U.S. Citizens -- may not be allowed to leave Yemen.
American women who also hold Yemeni nationality and/or are married to Yemeni or Yemeni-American men often must obtain permission from their husbands for exit visas. They also may not take their children out of Yemen without the permission of the father, regardless of who has custody (see Special Circumstances section below).
For more details, travelers can contact the Embassy of the Republic of Yemen, Suite 705, 2600 Virginia Avenue NW, Washington, DC 20037, telephone 202-965-4760; or the Yemeni (Mission to the U.N., 866 United Nations Plaza, Room 435, New York, NY 10017, telephone (212) 355-1730. Visit the Yemeni Embassy home page for more visa information at http://www.yemenembassy.org/.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY: The Department of State is concerned that al-Qa‘ida and its affiliates are actively engaged in extremist-related activities in Yemen and the Arabian Peninsula. The Department remains concerned about possible attacks by extremist individuals or groups against U.S. citizens, facilities, businesses and perceived interests.

On March 18, 2008, three mortar rounds landed in the vicinity of the U.S. Embassy in Sanaa. Yemeni students at a nearby school and Yemeni government security personnel posted outside the embassy were injured in the attack. On April 6, 2008, an expatriate residential compound in the Hadda neighborhood of southwestern Sanaa was attacked by mortar fire, and on April 30, 2008, suspected extremists fired two mortar rounds that exploded near the Yemen Customs Authority and the Italian Embassy. No injuries were reported in either incident. A group calling itself al-Qa'ida in Yemen may be responsible for all three attacks. Following the attacks against the Embassy and the residential compound, the Department of State ordered the departure of all American non-emergency embassy staff and family members on April 7, 2008.
On January 18, 2008, suspected al-Qa’ida operatives ambushed a tourist convoy in the eastern Hadramout Governorate, killing two Belgians. On July 2, 2007, suspected al-Qa’ida operatives carried out a vehicle-borne explosive device attack on tourists at the Belquis Temple in Marib, which resulted in the deaths of eight Spanish tourists and two Yemenis. The targeting of tourist sites by al-Qa’ida may represent an escalation in terror tactics in Yemen. On February 3, 2006, 23 convicts, including known affiliates of al-Qa’ida, escaped from a high-security prison in the capital city, Sanaa. Among the al-Qa’ida associates were individuals imprisoned for their roles in the 2000 bombing of the USS Cole and the 2002 attack on the French oil tanker Limburg. In the weeks following the escape, some prisoners voluntarily turned themselves in to authorities; to date, however, some escapees remain at large. Two of the escapees were killed in vehicle-based suicide attacks on oil facilities near Mukalla and Marib on September 15, 2006. Those attacks were followed by the arrest the next day in Sanaa of four suspected al-Qa’ida operatives, who had stockpiled explosives and weapons. On December 5, 2006, a lone gunman opened small arms fire outside of the Embassy compound during the early morning hours. The assailant, wounded by host-nation security personnel and subsequently arrested, was the sole casualty. It appears that, although the gunman was influenced by extremist ideology, he worked alone in planning and executing the attack.
Americans should avoid areas where demonstrations are taking place. A 2005 demonstration against an increase in the fuel price led to two days of widespread demonstrations and rioting throughout Sanaa and other cities. Those demonstrations resulted in a large amount of property damage, looting, and several roadblocks.
In late 2007 and throughout 2008, there has been an increase in anti-government demonstrations in southern Yemen, including the cities of Aden, Taizz, Ibb, and Mukalla, as well as surrounding regions. Some of these demonstrations have resulted in injuries and deaths. Americans should be aware of the potential for further demonstrations when traveling in these areas.
Throughout the country, U.S. citizens are urged to exercise particular caution at locations where large groups of expatriates have gathered. From time to time, the U.S. Embassy in Sanaa may temporarily close or suspend public services as necessary to review its security posture and ensure its adequacy.
In addition, U.S. citizens are urged to avoid contact with any suspicious, unfamiliar objects, and to report the presence of such objects to local authorities. Vehicles should not be left unattended and should be kept locked at all times. Americans in Yemen are urged to register and remain in contact with the American Embassy in Sanaa for updated security information (see section on Registration/Embassy location below).
Yemeni government security organizations have arrested and expelled foreign Muslims, including Americans, who have associated with local Muslim organizations considered to be extremist by security organs of the Yemeni government. Americans risk arrest if they engage in either political or other activities that violate the terms of their admission to Yemen.
Travel on roads between cities throughout Yemen can be dangerous. Armed carjacking, especially of four-wheel-drive vehicles, occurs in many parts of the country, including the capital. Yemeni security officials advise against casual travel to rural areas. The U.S. Embassy sometimes restricts the travel of its own personnel to rural areas, while the Government of Yemen also sometimes places restrictions on Americans traveling outside Sanaa. Please check with the Embassy for the latest restrictions.
Travel is particularly dangerous in the tribal areas north and east of Sanaa. Armed tribesmen in those areas have kidnapped a number of foreigners in attempts to resolve disputes with the Yemeni government. Hostilities between tribesmen and government security forces in the Sadah governorate north of Sanaa have flared up on several occasions since 2005. Serious fighting occurred in the city of Benni Hashish from late May through early June 2008. Americans are urged to avoid this region during periods of conflict.
Travel by boat through the Red Sea or near the Socotra Islands in the Gulf of Aden presents the risk of pirate attacks. If travel to any of these areas is necessary, travelers may reduce the risk to personal security if such travel is undertaken by air or with an armed escort provided by a local tour company.
Other potential hazards to travelers include land mines and unexploded ordnance from the 1994 civil war. This is of particular concern in areas where fighting took place in the six southern provinces. However, most minefields have been identified and cordoned off.
Americans are most vulnerable to terrorist attacks when they are in transit to and from their residences or workplaces, or visiting locations where large groups of expatriates have gathered. All Americans are reminded to vary their routes and times, remain vigilant, report suspicious incidents to the Embassy, avoid areas where large groups of expatriates have gathered, lock car windows and doors, and carry a cell phone.
Based on previous abductions of foreigners in Iraq, Afghanistan and Kuwait, the Embassy recommends that Americans with doubts about the identity of security or police personnel on the roads remain in their vehicles, roll up their windows, and contact the Embassy. For additional information on travel by road in Yemen, see the Traffic Safety and Road Conditions section below.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, including the Travel Warning for Yemen, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: The most serious crime problem affecting travelers to Yemen is carjacking. Travelers have rarely been victims of petty street crime.
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 Yemen is 199, but operators do not speak English.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Lack of modern medical facilities outside of Sanaa and Aden and a shortage of emergency ambulance services throughout the country may cause concern to some visitors. Doctors and hospitals often expect immediate cash payment for health services. An adequate supply of prescription medications for the duration of the trip is important. While many prescription drugs are available in Yemen, a particular drug needed by a visitor may not be available.
The U.S. Embassy in Sanaa strongly advises all American citizens residing in or traveling to Yemen to ensure that they have received all recommended immunizations (see below).
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/.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Yemen.

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 Yemen is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Based on previous abductions of foreigners in Iraq, Afghanistan and Kuwait, the Embassy recommends that Americans with doubts about the identity of security or police personnel on the roads remain in their vehicles, roll up their windows, and contact the Embassy. For additional information addressing security concerns for Americans in Yemen, please see the Safety and Security section above.
Travel by road in Yemen should be considered risky. Within cities, minivans and small buses ply somewhat regular routes, picking up and dropping off passengers with little notice or regard for other vehicles. Taxis and public transportation are widely available but the vehicles may lack safety standards and equipment. Embassy personnel are advised to avoid public buses for safety reasons. Despite the presence of traffic lights and traffic policemen, drivers are urged to exercise extreme caution, especially at intersections. While traffic laws exist, they are often not enforced, and/or not adhered to by motorists. Drivers sometimes drive on the left side of the road, although right-hand driving is specified by Yemeni law. No laws mandate the use of seat belts or car seats for children. The maximum speed for private cars is 100 kilometers per hour (62.5 miles per hour), but speed limits are rarely enforced. A large number of under-age drivers are on the roads. Many vehicles are in poor repair and lack basic parts such as functional turn signals, headlights and taillights. Pedestrians, especially children, and animals on the roads constitute a hazard in both rural and urban areas. Beyond the main inter-city roads, which are usually paved and in fair condition, the rural roads in general require four-wheel-drive vehicles or vehicles with high clearance.
Yemeni security officials advise against casual travel to rural areas. The U.S. Embassy sometimes restricts the travel of its own personnel to rural areas, while the Government of Yemen also sometimes places restrictions on Americans traveling outside Sanaa. Please check with the Embassy for the latest restrictions.
Travelers should take precautions to avoid minefields left over from Yemen's civil wars. Traveling off well-used tracks without an experienced guide could be extremely hazardous, particularly in parts of the south and the central highlands.
Penalties for driving under the influence of alcohol or drugs, and reckless driving which causes an accident resulting in injury, are a fine and/or prison sentence. If the accident results in death, the driver is subject to a maximum of three years in prison and/or a fine. Under traditional practice, victims' families negotiate a monetary compensation from the driver proportionate to the extent of the injuries -- higher if it is a fatality.
Please refer to our Road Safety page for more information and visit the web site of Yemen’s national tourism office at http//yementourism.com.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Yemen, the U.S. Federal Aviation Administration (FAA) has not assessed Yemen’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: Photography of military installations, including airports, equipment, or troops is forbidden. In the past, such photography has led to the arrest of U.S. citizens. Military sites are not always obvious. If in doubt, it is wise to ask specific permission from Yemeni authorities.
Travelers should be aware that automated teller machines (ATMs) are being introduced in major cities but are still not widely available in Yemen. Credit cards are not widely accepted. The Government of Yemen may not recognize the U.S. citizenship of persons who are citizens of both Yemen and the United States. This may hinder the ability of U.S. consular officials to assist persons who do not enter Yemen on a U.S. passport. Dual nationals may also be subject to national obligations, such as taxes or military service. For further information, travelers can contact the nearest embassy or consulate of Yemen.
American citizens who travel to Yemen are subject to the jurisdiction of Yemeni courts, as well as to the country's laws, customs, and regulations. This holds true for all legal matters including child custody. Women in custody disputes in Yemen may not enjoy the same rights that they do in the U.S., as Yemeni law often does not work in favor of the mother. Parents planning to travel to Yemen with their children should bear this in mind. Parents should also note that American custody orders might not be enforced in Yemen.
American women who also hold Yemeni nationality, and/or are married to Yemeni or Yemeni-American men, are advised that if they bring their children to Yemen they may not enjoy freedom of travel should they decide they want to leave Yemen. Such women often must obtain permission from their husbands for exit visas. They also may not take their children out of Yemen without the permission of the father, regardless of who has custody (See Entry/Exit Requirements section above).
American students and workers in Yemen sometimes report that the sponsors of their residence permits seize their U.S. passports as a means of controlling their domestic and international travel. While the sponsors say they seize the passports on behalf of local security services, there is no law or instruction from Yemeni passport or security offices requiring that passports be seized.
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 Yemeni laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession or use, or trafficking in illegal drugs in Yemen are severe, and convicted offenders can expect long jail sentences and heavy fines. The use of the mild stimulant "qat” or “khat" is legal and common in Yemen, but it is considered an illegal substance in many other countries, including the United States. 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 Yemen 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 Yemen. 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 Dhahr Himyar Zone, Sheraton Hotel District, PO Box 22347. The telephone number of the Consular Section is (967)(1) 755-2000, extension 2153 or 2266. The fax number is (967) (1) 303-175. The after-hours emergency number is (967) (1) 755-2000 (press 0 for extension) or (967) 733213509. The Embassy is open from Saturday through Wednesday.
* * *
This replaces the Country Specific Information for Yemen dated December 27, 2007, to update the sections on Entry/Exit Requirements, Safety and Security, Information for Victims of Crime, Criminal Penalties and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Tue 3 Dec 2019
Source: Twitter feed in Arabic [machine trans., edited]

Taiz health official: 24 laboratory-confirmed cases of West Nile virus and more than 300 suspected cases. #Republic_Yemen
===================
[Any information on the actual number of WNV cases, their lab confirmation, and public health response activities in this regard will be highly appreciated. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map of Yemen:
Date: Tue 15 Oct 2019
Source: Yemen Online [edited]

The cumulative number of suspected cholera cases reported in Yemen between October 2016 and August 2019 is 2,036,960, including 3716 related deaths (fatality rate of 0.18%). The 5 governorates with the highest attack rate per 10 000 are: Amran (1602.13), Al Mahwit (1474.79), Sana'a (1295.78), Al Bayda (1027.14) and Dahamar (957.61).

The national average attack rate is 713.99 per 10 000. The highest numbers of deaths are reported in the Hajjah (559), Ibb (486), Al Hudaydah (380) and Taizz (304) governorates. Cholera patients are often unable to afford transportation to supported health facilities, which contributes to the spread of disease and to deaths at community level.

Acute fuel shortages are causing critical disruption of water and sanitation services in Yemen given the reliance on fuel for extracting water. Limited access to water increases the risk of epidemic diseases, acute malnutrition, and triggers additional population displacement. Up to 16 million Yemenis may fall into acute need of humanitarian assistance and WASH services.
========================
[The calculated case fatality rate from this is quite low, strongly suggesting that many of the cases are not cholera. Even with that, the numbers reported in this continuing catastrophe are difficult to wrap one's head around. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Thursday 22nd August 2019
World Health Organisation

Sana’a, 21 August 2019 — A 6-day oral cholera vaccination campaign reached almost 400 000 people, including almost 65 000 children under the age of 5 in Aden, Al Dhale’e and Taiz, where high numbers of suspected cholera and acute watery diarrhoea cases have been recorded.

The first few months of 2019 saw an increase of reported acute watery diarrhoea cases in over 95% of districts across Yemen. Between January and the end of July 2019, there have been nearly 536 000 suspected cases and 773 associated deaths. Children under 5 represent one quarter of all suspected cases.

The vaccination campaign, run by local health authorities, UNICEF and WHO, was made possible thanks to GAVI, the Vaccine Alliance, and to the World Bank’s ‘Emergency Health and Nutrition Project.’

“Amid the fighting in surrounding areas, over 800 health workers, brave men and women, risked their lives to reach communities from cholera — these are the real heroes,” said Altaf Musani, WHO Representative in Yemen.

“Thanks to the extraordinary commitment and dedication of Yemen’s local health workforce, hundreds of thousands of people from these priority districts were reached with vaccination against cholera,” said Sara Beysolow Nyanti, UNICEF Country Representative in Yemen. 

Since April 2017, the cholera and acute watery diarrhoea epidemic in Yemen has caused an estimated 2 million suspected cases and 3500 associated deaths. Almost one third have been in children under 5, including 711 associated deaths. The outbreak in Yemen remains the largest cholera in the world. 

Health partners throughout Yemen joined forces to control and prevent any future cholera outbreaks. UNICEF and WHO are working closely with the relevant health authorities and other humanitarian partners to respond.

Date: Fri 2 Aug 2019
Source: Outbreak News Today [edited]

The Global Alliance to Eliminate Lymphatic Filariasis (GAELF) reported this week that Yemen has eliminated lymphatic filariasis as public health problem, making them the 2nd country in the Eastern Mediterranean Region of the World Health Organization (WHO) to achieve this.

Yemen's success comes after almost 2 decades of tremendous efforts of sustained elimination measures as recommended by WHO of the 2 pillars -- mass drug administration (MDA) and morbidity management and disease prevention (MMDP) of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) strategy. After several rounds of MDA implementation, surveys since 2011 have validated that infection has been reduced to below transmission thresholds.

Transmission assessment surveys (TAS) conducted in 2013 and 2016 confirmed that Yemen had met all criteria for achieving elimination as a public health problem while, at the same time, management of morbidity in affected patients continued. Yemen will continue to improve its morbidity management programme treating patients with clinical symptoms as well as [maintaining] the appropriate level of surveillance to ensure continued zero transmission.

Lymphatic filariasis is caused by infection with parasitic worms living in the lymphatic system. The infection impairs the lymphatic system triggering abnormal enlargement of body parts, causing pain, severe disability and social stigma.

The larval stages of the parasite (microfilaria) circulate in the blood and are transmitted from person to person by mosquitoes.

The achievements of the Yemen PELF were made possible through the generous support and funding from the World Health Organization (WHO), the integration with the national leprosy programme (NLEP), the generous drug donations from the Mectizan Donation Program and GSK and the generous technical guidance of GPELF-WHO and GAELF.
=====================
[The problem of lymphatic filariasis in Yemen was realised around 2000, and in 2002 an initial pilot mass drug administration was implemented in Wisab subdistrict, Dhamar governorate (about 12,800 inhabitants) and 2 subdistricts on Socotra island, Hadramout governorate (about 29 000 inhabitants; El Setouhy M, Ramzy RM. Lymphatic filariasis in the Eastern Mediterranean Region: current status and prospects for elimination. East Mediterr Health J 2003;9:534-41.  <http://applications.emro.who.int/emhj/0904/9_4_2003_534_541.pdf>).

The location of Dhamar governorate can be found here:
<https://en.wikipedia.org/wiki/Dhamar_Governorate>.

Thus, filariasis was limited to the Dhamar governorate in central eastern Yemen and the Socotra island. Currently the Dhamar governorate is under control of the Houthi-led government in Sanaa (see <https://www.ecfr.eu/mena/yemen>), and Socotra is controlled by the United Arab Emirates.

Onchocerciasis, which is also considered a variant of filariasis, is still found in Yemen along the coastal areas toward the Red Sea (Al-Kubati A-S, et al. Onchocerciasis in Yemen: moving forward towards an elimination program. Int Health 2018;10 Suppl 1:i89-i96. <https://academic.oup.com/inthealth/article/10/suppl_1/i89/4868662>). - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Date: Tue 25 Jun 2019
Source: Urdu Point News [edited]

A cholera outbreak in Yemen has killed 686 people since the start of 2019, the SABA news agency reported on Monday [24 Jun 2019], citing Houthi health ministry spokesman Youssef Hadri.

Over 418 000 cholera cases have been reported in the country since January 2019, in addition to hundreds of malaria, dengue, diphtheria, meningitis, and chicken pox cases, Hadri said. The WHO said the number of suspected cholera cases between 1 Jan 2018 and 9 Jun 2019 had gone up to 759 464 in Yemen, with 1163 associated deaths.

This year's [2019's] outbreak, the 3rd major flare-up since the war began in Yemen in 2015, has affected 22 of 23 regions. Children under 5 represented a fifth of suspected cholera cases.  [Byline: Mohammad Ali]
======================
[The cumulative reported cholera total in Yemen from 27 Apr 2017 to 7 Jan 2018 was 1,029,717 suspected cholera cases and 2241 associated deaths. Adding in this information, in about 27 months, the total number of reported cholera cases in this war-torn country has reached about 1 790 000 with about 3300 fatalities. The calculated case fatality rate from this is quite low, strongly suggesting that many of the cases are not cholera. Even with that, the numbers reported in this continuing catastrophe are difficult to wrap one's head around. - ProMED Mod.LL]

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

Paraguay

Paraguay - US Consular Information Sheet
September 15, 2008
COUNTRY DESCRIPTION:
Paraguay is a constitutional democracy with a developing economy.
Tourist facilities are adequate in the capital city of Asuncion, but they vary greatly
n quality and prices.
Travelers outside Asuncion should consider seeking travel agency assistance, as satisfactory or adequate tourist facilities are very limited in other major cities and almost nonexistent in remote areas.
Read the Department of State Background Notes on Paraguay for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
U.S. citizens traveling to Paraguay must submit completed visa applications in person or by secure messenger to the Paraguayan Embassy or one of the consulates and pay a fee.
Paraguay issues visas for one-entry or multiple entries up to the validity of the U.S. passport.
Applicants under 18 years of age traveling alone must appear with both of their parents or a legal guardian.
In case of a guardian, an original and one copy of proof of legal guardianship are required.
A document of authorization from parents/guardian will be accepted only if it is notarized and certified by the county clerk.
Travelers entering or departing Paraguay with regular U.S. passports will be fingerprinted.
Some airlines include the Paraguayan airport departure tax in the price of the airline ticket.
It is recommended that you check with the airline in order to determine whether or not the departure tax has been included.
If the tax is not included in the airline ticket then payment would be required upon departure in either U.S. or local currency (no credit cards or checks accepted). Visit the Embassy of Paraguay web site at http://www.embaparusa.gov.py for the most current visa information.

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

SAFETY AND SECURITY:
As stated in the Department of State's latest Worldwide Caution, U.S. citizens overseas may be targeted by extremist groups and should maintain a high level of vigilance.
The U.S. Embassy is not aware of any specific terrorist threat to Americans in Paraguay.
Individuals and organizations providing financial support to extremist groups operate in Ciudad del Este and along the tri-border area between Paraguay, Brazil and Argentina.
Small armed groups have also been reported to be operating in the San Pedro and Concepcion Departments.
Drug trafficking remains a serious concern in the Department of Amambay.
Because of concerns about the lack of security in border areas, the U.S. Embassy in Asuncion requires U.S. Government personnel and their family members to provide advance notice and a travel itinerary when traveling to Ciudad del Este or Pedro Juan Caballero.
As a general precaution, the Embassy also counsels its employees traveling outside the capital to provide an itinerary including dates, contact names, and telephone numbers where the employee may be reached.

Since January 2007, there have been numerous kidnapping incidents mainly in the Alto Parana department.
Targets have been members of the Paraguayan business community or their family members.
It is believed that the individuals responsible for the kidnappings are financially motivated and have pre-selected their targets based on the victims’ wealth.

U.S. citizens should avoid large gatherings or any other event where crowds have congregated to demonstrate or protest.
Such activities have resulted in intermittent road closures including major routes traveled by tourists and residents.
While generally nonviolent, demonstrations and/or roadblocks have turned violent in the past.
Areas where such closures and barricades exist should be avoided.
U.S. citizens who encounter demonstrations and/or roadblocks should not attempt to continue the planned travel or to confront those at the roadblock.
Instead, they should avoid areas where individuals are demonstrating and in case of roadblock, wait for the road to reopen or return to the origin of their trip.
Uniformed police often conduct roving checks of vehicles and passengers.

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the 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:
Crime has increased in recent years with criminals often targeting those thought to be wealthy.
Although most crime is nonviolent, there has been an increase in the use of weapons and there have been incidents where extreme violence has been used.
U.S. citizens have on occasion been the victims of assaults, kidnappings, robberies, and rapes.
Local authorities frequently lack the training and resources to solve these cases.
Under these circumstances, U.S. citizens traveling to or residing in Paraguay should be aware of their surroundings and security at all times.
They should take common sense precautions including refraining from displaying expensive-looking cameras and jewelry, large amounts of money, or other valuable items.
Resistance to armed assailants has often aggravated the situation and therefore is not advised.

Armed robbery, carjackings, car theft, and home invasions are a problem in both urban and rural areas.
Street crime, including pick pocketing and mugging, is prevalent in cities.
The number of pick pocketing incidents and armed assaults is also increasing on public buses and in the downtown area of Asunción.
As many incidents on public buses involve individuals snatching valuables, passengers should not wear expensive-looking jewelry or display other flashy items.
There have been incidents of pilferage from checked baggage at both airports and bus terminals.
Travelers have found it prudent to hide valuables on their person or in carry-on luggage.
Unauthorized ticket vendors also reportedly operate at the Asuncion bus terminal, badgering travelers into buying tickets for substandard or non-existent services.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime are 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.

Below are the local equivalent phone numbers to the “911” emergency line in Paraguay.
In Asuncion, the following phone numbers exist for roadside/ambulance assistance:
Emergency Services, including police and ambulances:
911.
Fire Department, including rescue of accident victims: 131, 132.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Adequate medical facilities, prescription and over-the-counter medicine, supplies, and services are available only in Asuncion.
Elsewhere, these are limited and may not exist.

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.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to Paraguay or foreign residents of the country.

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

U.S. citizens have been injured and killed in traffic accidents.
Only minimal standards must be met to obtain a Paraguayan driver's license, and driver education prior to licensing is not common.
Drivers throughout Paraguay routinely ignore traffic regulations.
No vehicle insurance is required, and many Paraguayans drive without any insurance coverage.
Persons who drive in Paraguay should be prepared to drive defensively and with their own insurance in both urban and rural areas.

Public transportation is readily available for urban and inter-city travel.
Buses vary in maintenance conditions and may not meet U.S. safety standards.
Armed robberies and pick pocketing occur on buses in cities and rural areas, sometimes with the apparent collusion of the bus driver.
Taxis are available and may be called using telephone numbers listed in the newspapers.
No passenger train service exists.
Bicycle travel may not be safe due to traffic and other road hazards.
Most urban streets consist of cobblestones over dirt.
Some roads in Asuncion and other large cities are paved.
However, these roads frequently develop potholes that often remain unrepaired.
Nearly all rural roads are unpaved, and during rainy periods and the rainy season (November-March/April), they may be impassable.
Road signs indicating hazards, such as sharp curves or major intersections, are lacking in many areas.

Driving or traveling at night is not advisable outside Asuncion because pedestrians, animals, or vehicles without proper lights are often on the roads.
In addition, assaults and other crimes against motorists traveling at night have occurred.
Extra precautions should be exercised along infrequently traveled portions of the rural roads.

Intercity highway maintenance is not equal to U.S. standards.
The privately maintained toll road between Caaguazu and Ciudad del Este and the routes between Asuncion and Encarnacion and Asuncion and Pedro Juan Caballero are in good condition.
Most other intercity routes are in good to fair condition, with brief stretches in poor condition.
The Trans-Chaco route is in fair condition except for the portion between Mariscal Estigarribia and the Bolivian border, which is unpaved and at times impassable.

The Touring and Automobile Club provides some roadside assistance to its members.
The Club may be contacted in Asuncion by visiting its offices at 25 de Mayo near Brazil, First Floor, or telephoning 210-550, 210-551, 210-552, 210-553, Monday through Friday from 8:00 a.m. to 5:00 p.m., or Saturday from 8:00 a.m. to noon, except for Paraguayan holidays.
The Touring Club also has offices in Ciudad del Este (tel. 061-512-340), Coronel Oviedo (tel. 0521-203-350), Encarnación (tel. 071-202-203), San Ignacio Misiones (tel. 082-232-080), Caaguazu Campo 9 ( tel. 0528-222-211), Santani (tel. 043-20-314), Pozo Colorado (cell phone. 0981-939-611, Villa Florida (tel. 083-240-205) and Ybyyau (tel. 039-210-206).
Towing services are scarce outside urban areas.
Twenty-four-hour tow truck services from Asuncion may be contacted by telephoning (021) 224-366, (021) 208-400, (cellular service provider) Tigo by dialing *822 or 0971-951-930.
For an extra fee, these companies may provide service outside Asuncion, but they typically demand immediate payment and may not accept credit cards.

Please refer to our Road Safety page for more information.
Visit the website of Paraguay’s national tourist office and national authority responsible for road safety at http://www.senatur.gov.py and http://www.mopc.gov.py/
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Paraguay’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Paraguay’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs%5Finitiatives/oversight/iasa/
SPECIAL CIRCUMSTANCES: Paraguay’s customs authority may enforce strict regulations concerning temporary importation into or export from Paraguay of items such as firearms, medications, toys resembling weapons, or protected species.
It is advisable to contact the Paraguayan Embassy in Washington, D.C., or one of Paraguay's consulates in the United States for specific information regarding customs requirements.

Paraguay does not recognize dual Paraguayan nationality for American citizens.
Under Article 150 of the Paraguayan Constitution, naturalized Paraguayans lose their nationality by virtue of a court ruling based on unjustified absence from the Republic for more than three years, or by voluntary adoption of another nationality.
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 Paraguay’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Paraguay 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 residing or traveling in Paraguay 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 Paraguay.
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 1776 Mariscal Lopez Avenue, Asuncion; telephone (011-595-21) 213-715, fax (011-595-21) 213-728; Internet: http://paraguay.usembassy.gov, email: paraguayconsular@state.gov.
The Consular Section is open for U.S. citizen services, including registration, Monday through Thursday from 1:00 p.m. to 4:30 p.m. and Fridays from 7:30 a.m. to 10:30 a.m., except for U.S. and Paraguayan holidays; telephone (011-595-21) 213-715, fax (011-595-21) 228-603.

Travel News Headlines WORLD NEWS

Date: Tue, 28 May 2019 03:40:13 +0200
By Hugo OLAZAR

Nanawa, Paraguay, May 28, 2019 (AFP) - Like 70,000 people living close to the broken banks of the Paraguay River, where the water level has risen seven meters (23 feet) in some places, Graciela Acosta has had to pack up her belongings and evacuate.   Piled up on a canoe are the 39-year-old housewife's bed, wardrobe, bedside table and her dog Pirulin.

Acosta is getting ready to cross the border into Argentina with her daughter to seek refuge in a reception center in the neighboring town of Clorinda.   "I've had enough! It's the third time that I've had to move everything because of the floods," said Acosta.   "I pray to God that it ends. Every time. it costs a lot of money."   However, there's no chance of Acosta leaving her home in Nanawa, a town of just 6,000 people that borders Argentina to the west and faces the capital Asuncion to the east across the Paraguay River, for good.   "As soon as the water level drops, I'll go home," she said.

- 'Greater impact' -
In Nanawa, only around 500 people were able to avoid evacuation, due to living in homes with upper floors above the flood levels.   They're used to this as the Paraguay River, one of the largest in the Americas, breaks its banks and causes havoc in the poorest Nanawa neighborhoods built on the flood plain.   The river's brown waters rise almost to the height of street signs: in some areas, there is up to one or two meters of water covering roads.

Paraguayans have seen worse, though, back in 1983, according to the assistant director of the country's meteorology and hydrology service, Nelson Perez.   "It's not the Paraguay River's worst flood, but the impact is greater because more people live close to the river," said Perez.   "These are the worst floods I've seen," said Ruben Acosta, 55, who peddles his moving services by canoe.   It's a far cry from January and February, when the river's level was so low that navigating it became difficult.   "It rained a lot in March, three times more than usual, and it also rained a lot in April and May," said Perez, who pointed to deforestation as an added problem.

- 'It's like being in Venice' -
Wading through water up to his chest, Rigoberto Nunez leaves a cemetery carrying a chandelier, a vase, some crucifixes and family portraits, all plucked from the family vault.   "I prefer to take them away to be safe," says the 47-year-old traveling salesman.    The town is without electricity or police and inhabitants are afraid of looters.   Nunez is heading to a reception center provided by Argentine authorities in a Clorinda slum where he's already stashed his furniture.   Enrique Cardozo's workshop has already been ravaged by the floods.   "I've lost my sofa, the cupboard, I had nowhere to put them," said the 51-year-old father of four.

The family has moved into the first floor of their house, which is just 15 meters from the river.   "It rained non-stop for a week. One day, the water rose one meter. It was impressive, we couldn't save everything," said Cardozo.   "There's nowhere you can put your feet on the ground. It's like being in Venice, we move about by Gondola!"

On the other side of the river, Asuncion has not been spared as several areas have also had to be evacuated.   In the Sajonia residential zone, inhabitants and shopkeepers have seen their sidewalks lined with sandbags, to keep back the floodwaters.   According to Perez, though, the problems -- and waters -- will soon subside.   The water level rose only slightly on Monday, and will continue to do so for a few more days before it drains away during the first half of June, he said.
Date: Mon, 27 May 2019 12:07:58 +0200

Asuncion, May 27, 2019 (AFP) - Heavy flooding in Paraguay has displaced 70,000 families and is threatening to further inundate the capital Asuncion in the coming weeks, the country's weather bureau said.   Water levels on the Paraguay River are rising at a rate of 4-5 centimetres (1.5-2 inches) every day and is only 46 cm (18 in) below a "disaster" level, according to official data from the Department of Meteorology and Hydrology (DMH).

Crossing that threshold would "have a very strong impact" because of the number of Asuncion residents who have moved into the city's floodplain, said DMH deputy director Nelson Perez on Sunday.   The city's water service infrastructure was clogged with garbage which was exacerbating the floods, Perez added. 

Unusually heavy downpours over May, including two days which together exceeded Asuncion's average monthly rainfall, have exacerbated the flooding, said DMH meteorologist Eduardo Mingo.    Some 40,000 people in Asuncion have already been affected by the floods, official data reported.   A further 10,000 people have been displaced in the southern town of Pilar on the Argentinian border.   The government has mobilized armed forces to help displaced residents relocate to shelters, but hundreds of families have opted to stay behind in their inundated homes.
Date: Thu, 4 Apr 2019 03:06:45 +0200

Asuncion, April 4, 2019 (AFP) - More than 20,000 families across Paraguay have been affected by severe flooding from two weeks of heavy rain that caused the country's main river to burst its banks, a senior official said Wednesday as an emergency was declared in the capital.   National Emergency Minister Joaquin Roa made the announcement as forecasters said the precipitation would continue for the rest of the week.   The Paraguay River, which runs some 1,000 kilometres north to south and splits the country in two, is expected to continue overflowing.

A 90-day emergency was declared in Asuncion on Wednesday due to the flooding. Hardest-hit are some 5,000 families living in the Banado Sur working-class neighbourhood on the city outskirts.   The people affected by flooding "need sheet metal roofing, wood, and all types of help," a municipal official told AFP.   The Paraguay River flows past Asuncion and eventually merges into the Parana River in Argentina.   "We did not expect it to swell so quickly," said Pablo Ramirez, a resident of Banado Sur, a neighbourhood in the capital, dismayed after returning to his home after he left it one month ago due to flooding.

Ramirez, who relies on crutches to get around following a car accident, said that he will not leave home this time. The flooding "will go by quickly," he said optimistically.   Pedro Velasco, the leading neighbourhood Catholic priest, said that one week ago they warned emergency officials that the river was about to overflow and asked for trucks to deliver aid and help evacuate people.   "They didn't move until Monday, but by then it was already too late and they couldn't come in" because of the flooding, Velasco said.   Roa said that his office will deliver 400,000 of food in the next days in coordination with the Paraguayan military.
Date: Thu 28 Feb 2019
Source: Hoy [in Spanish trans. Mod.TY, edited]

Patients who present with febrile symptoms and who reside in the area where the 1st positive case was reported positive request tests for hantavirus [infection]. Until now there are 5 cases, 3 were positive in initial laboratory tests and 2 are suspect cases that will be tested outside [the country] because the Central Laboratory does not do confirmatory tests.

The febrile cases of residents in Capiata [Central department], the area where the 1st cases of hantavirus occurred, are adding up and now Health Surveillance has reported 2 more suspected cases, all children between 2 and 7 years old living in the same city; community intervention continues in search of possible cases.

The 1st cases confirmed in a private laboratory remain hospitalized in intensive care and the others who have improved are now receiving ambulatory treatment, stated Dr Sandra Irala of Health Surveillance.

"The clinical picture of hantavirus [infection] is that of a patient with a temperature above 38 deg C [100.4 deg F] and respiratory difficulty is another characteristic in the endemic area such as that of Chaco. In the non-endemic area [hantavirus infection] is suspected if the patient presents with fever and other possible causes are eliminated," the doctor indicated in a press conference.

The rodents that transmit the hantavirus do not inhabit urban areas and the way in which the disease [virus] is acquired is through contact with excreta and other secretions such as saliva and urine of these [infected] rodents.

Irala pointed out that the cases that are initially positive should have a cross-section of studies for final confirmation, so the samples were sent to Argentina, where there is a reference laboratory for the detection of this type of virus.

The person acquires the virus by inhaling air contaminated with the virus that is transported through dust particles, which is why it is recommended before cleaning, especially of storage buildings, to open doors and windows to ventilate the environment and moisten the soil to before proceeding with the sweeping.

The possibility of acquiring a hantavirus [infection] is if you have a history of having visited the Chaco area or if you were in a country that registers outbreaks of hantavirus, such as southern Argentina.

The disease has a 30% mortality rate and in Paraguay every year about 20 cases are registered, all in the Chaco region.

Alerting symptoms
-----------------
The symptoms of hantavirus [infection] are similar to other infectious diseases and include fever, headache, and gastrointestinal problems and, according to the development and the seriousness of the case, the patient may present with respiratory manifestations.

Before the appearance of any of these or other symptoms [the Ministry of Health] urges the public to go to the nearest health service to make the appropriate diagnosis and appropriate treatment. Under no circumstances should self-medication be used as this could aggravate the picture and obstruct the actual diagnosis of the disease.
=====================
[The active surveillance efforts in the neighborhood of the initial case has detected more patients now with a total 3 confirmed and 2 suspected. The tests used in the private laboratory to determine that 3 cases as confirmed are not indicated, nor if samples of these 3 cases were sent to the reference laboratory in Argentina for confirmation.

Most of the previous cases of hantavirus infection in Paraguay have been diagnosed in Boqueron department in the north western part of the country. This is the 1st report of hantavirus infections in the Central department of Paraguay. The possible hantavirus involved in this suspected case is not stated. A 2011 report indicated that Leguna Negra hantavirus was responsible for hantavirus pulmonary syndrome (HPS) cases in Presidente Hayes department. In addition to Laguna Negra virus (rodent host _Calomys laucha_), other hantaviruses that can cause HPS and are found in Paraguay (and their rodent hosts) include Juquitiba (_Akodon cursor_), Ape Aime-Itapua (_Akodon montensis_), Araucaria (_A. montensis_, _Oligoryzomys nigripes_), Jabora and Jabora-like (_A. montensis_), Alto Paraguay (_Holochilus chararius_), and Lechiguanas (_Oligoryzomys nigripes_). - ProMED Mod.TY]

[Maps of Paraguay:
Date: Tue 12 Jun 2018
Source: WHO, Malaria [edited]

- What were the key elements to Paraguay's malaria elimination success that helped the country reach zero indigenous cases of the disease?
Paraguay is the 1st country in the Americas since Cuba in 1973 to be certified malaria-free, representing a significant public health achievement not only for Paraguay but for the Americas as a whole. Achieving elimination in Paraguay required substantial levels of political commitment and leadership, as well as sustained investments in its national malaria programme over a period spanning more than 50 years. Notable aspects of its approach include:

Rapid and targeted response
---------------------------
With free universal health services in Paraguay and a strong malaria surveillance system, malaria cases were detected early, investigated promptly, and classified correctly.

Dedicated elimination strategy
------------------------------
After reporting its last case of malaria in 2011, Paraguay launched a 5-year plan to consolidate the gains, prevent re-establishment of transmission, and prepare for elimination certification. Activities centred on strengthening epidemiological surveillance, robust case management, and a public information campaign on the diagnosis, treatment, and prevention of malaria to promote behaviour change among populations in at-risk areas.

Integration
-----------
During 2015 and 2016, as part of a broader health reform, malaria surveillance, diagnosis, and treatment activities were integrated within Paraguay's general health services, with the aim of expanding health coverage to at-risk populations and preventing re-establishment.

Strengthening surveillance skills
---------------------------------
A 3-year initiative to hone the skills of front-line health workers in the country's 18 health regions was launched in 2016 to keep the malaria surveillance system sustainable over the long term. Supported by The Global Fund to Fight AIDS, Tuberculosis and Malaria, the project addresses disease prevention, identification of suspected cases, accurate diagnosis and prompt treatment to respond to the on-going threat of malaria importation from endemic countries in the region and Africa.

- How has Paraguay managed to stay malaria-free since 2012? What are the systems in place that made this possible and how long will the country keep those systems operational?
As part of the WHO elimination certification process, countries must demonstrate that they have the capacity to prevent the re-establishment of malaria transmission. The availability of free universal health services in Paraguay and a strong malaria surveillance system ensure imported cases of malaria are detected and responded to in a timely manner to prevent local transmission.

The inclusion of the national malaria programme within the National Malaria Eradication Service (SENEPA, in the Spanish acronym), the institution within the ministry of health responsible for the control of vector-borne diseases, helps guarantee the programme's future existence.

Further, congressional legislation provides predictable and long-term financing for the national malaria programme: by law, 1.5 percent of annual income from Paraguay's social security programme is allocated to SENEPA. Together, these elements ensure that efforts to prevent the re-establishment of malaria transmission can be sustained in the decades to come.

- What are the benefits of malaria elimination for Paraguay?
Eliminating malaria in Paraguay means that no one will fall ill or die from local transmission of the disease, bringing about tangible health benefits at the individual and community levels, as well as broader socio-economic outcomes.

- What role did national leadership, political will, civil society and international partners play in Paraguay's success?
Eliminating malaria is a collective effort, requiring the sustained engagement of many partners at the national, regional and global levels. However, achieving elimination is a country-driven process. For elimination efforts to succeed, government stewardship is essential, together with the engagement and participation of affected communities.

- Does Paraguay coordinate cross-border surveillance activities to prevent importation of malaria cases and do they provide antimalarial treatment to visitors and migrants?
Paraguay provides free treatment to all citizens, visitors, and migrants, regardless of their nationality or residency status. The national malaria programme has identified 3 populations at greatest risk: the military, Brazilian students attending universities in Paraguay, and Paraguayans travelling to Africa. Targeted interventions include strengthening passive detection systems, promotion of health education, and providing prophylaxis to travellers heading to and returning from malaria-endemic regions in Africa.

To step up cross-border collaboration, the Pan American Health Organization (PAHO) funded a project focused on strengthening entomological surveillance and control of vector-borne diseases in the 'triple border' area of Argentina, Brazil, and Paraguay. A key outcome of the project, which ran from 2010 to 2012, was the development of an _Anopheles_ mosquito range map, a tool that shows the geographic distribution of malaria-carrying mosquitoes.

- What are the lessons learned from Paraguay's experience that can be applied in other countries looking to eliminate malaria?
Paraguay provides universal free health services to all, one of the critical elements that helps drive a country towards malaria elimination. Sustained political commitment and robust financial support are further keys to success. Continued surveillance of suspected cases, targeted community engagement and education, as well as strengthening skills of front-line health workers, are recommended strategies that WHO encourages countries to adopt as part of their national malaria elimination programmes.
 
- Is Paraguay replicating its elimination strategy with other infectious and mosquito-borne diseases?
Paraguay has an integrated approach to entomological surveillance activities, taking into account several vector-borne diseases including dengue, leishmaniasis, and Zika virus. Integration of malaria surveillance into the general health system had been a challenging task in Paraguay, but the lessons and experiences learned from other vector-borne diseases have contributed to the smooth integration and transition of the malaria programme. At the same time, the approach used to eliminate malaria is now being applied to eliminate Chagas disease and schistosomiasis.
======================
[ProMED congratulates Paraguay for this important public health achievement. It is important to demonstrate that malaria eradication is possible, and the achievement could be an inspiration for the countries in southeast Asia experiencing a decline in artemisinin susceptibility. - ProMED Mod.EP]

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

Nigeria

Nigeria US Consular Information Sheet
June 02, 2008
COUNTRY DESCRIPTION:
Nigeria is a developing country in western Africa that has experienced periods of political instability. It has the largest population on the continent, estimated at
44 million people, and its infrastructure is not fully functional or well maintained. Read the Department of State’s Background Notes on Nigeria for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. The visa must be obtained in advance from a Nigerian Embassy or Consulate. Visas cannot be obtained on arrival at the airport. Promises of entry into Nigeria without a visa are credible indicators of fraudulent commercial schemes in which the perpetrators seek to exploit the foreign traveler's illegal presence in Nigeria through threats of extortion or bodily harm. U.S. citizens cannot legally depart Nigeria unless they can prove, by presenting their entry visas, that they entered Nigeria legally. Entry information may be obtained at the Embassy of the Federal Republic of Nigeria, 3519 International Court NW, Washington, DC 20008, telephone (202) 822-1500, or at the Nigerian Consulate General in New York, telephone (212) 808-0301. Overseas, inquiries may be made at the nearest Nigerian embassy or consulate.

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

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:
The Department of State continues to caution U.S. citizens about the possible dangers of travel to some parts of Nigeria. [Please also see the Crime Section below.] In light of the risk of kidnapping, crime, militant activity, or armed attacks, the U.S. Mission restricts the travel of U.S. government personnel to the following states to official travel only: Delta, Bayelsa, Rivers and Akwa Ibom in the Niger Delta, and Edo and Imo in the south. Only essential travel by non-official Americans is recommended to these areas. In addition, the military's Joint Task Force patrols the creeks in the Niger Delta because of ongoing militant and piracy incidents, especially against oil-related facilities or infrastructure, so individuals may be questioned, detained or arrested when traveling in these sensitive areas without evidence of permission from the Nigerian government or for carrying electronic equipment such as cameras, recorders, etc. Periodically, travel by U.S. mission personnel is restricted in certain parts of Nigeria based on changing security conditions, often due to crime, general strikes, or student/political demonstrations or disturbances. See the Department of State’s Travel Warning for Nigeria for more information.

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

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

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

CRIME: Violent crime committed by individual criminals and gangs, as well as by some persons wearing police and military uniforms, is a problem, especially in Lagos, Abuja and other large cities, although it can occur anywhere. Some visitors and resident Americans have experienced armed muggings, assaults, burglary, carjacking, kidnappings and extortion, often involving violence. Home invasions are on the rise in Lagos, with armed robbers accessing even guarded compounds by following, or tailgating, residents or visitors arriving by car into the compound, subduing guards and gaining entry into homes or apartments. Armed robbers in Lagos also access waterfront compounds by boat. U.S. citizens, as well as Nigerians and other expatriates, have been victims of armed robbery on roads to airports during both daylight and evening hours. Law enforcement authorities usually respond to crimes slowly or not at all, and provide little or no investigative support to victims. U.S. citizens and other expatriates have experienced harassment and shakedowns at checkpoints and during encounters with Nigerian officials.

Nigerian-operated fraud scams, known as 419s, are noted for their cleverness and ingenuity. These scams target foreigners worldwide, posing risks of both financial loss and personal danger to their victims. Scams are often initiated through internet postings or from internet cafes, by unsolicited emails, faxes, and letters, or can involve credit card use. As anywhere else, no one should provide personal or financial information to unknown parties or via Nigerian telephone lines. The expansion of bilateral law enforcement cooperation, which has resulted in numerous raids on commercial fraud premises, has reduced the overall level of overt fraud activity, but new types of sophisticated scams are introduced daily.

American citizens are very frequently the victims of Nigerian confidence artists offering companionship through internet dating websites. These confidence artists almost always pose as American citizens visiting or living in Nigeria who unexpectedly experience a medical, legal, financial or other type of “emergency” that requires the immediate financial assistance of the American citizen in the United States. In these cases, we strongly urge the American citizen in the United States to be very cautious about sending money to any unknown person purportedly acting on their behalf, or traveling to Nigeria to meet someone with whom their sole communications have been via the internet. Other common scams involve a promise of an inheritance windfall, work contracts in Nigeria, or an overpayment for goods purchased on-line. For additional information on these types of scams, see the Department of State's publication, International Financial Scams.

Commercial scams or stings that targets foreigners, including many U.S. citizens, continue to be a problem. One needs to be alert to scams that may involve U.S. citizens in illegal activity, resulting in arrest, extortion or bodily harm. These scams generally involve phony offers of either outright money transfers or lucrative sales or contracts with promises of large commissions or up-front payments, or improperly invoke the authority of one or more ministries or offices of the Nigerian government and may cite, by name, the involvement of a Nigerian government official. In some scams, government stationery and seals are also improperly used to advance the scam. The ability of U.S. consular officers to extricate U.S. citizens from unlawful business deals or scams and their subsequent consequences is extremely limited. U.S. citizens have been arrested by police officials and held for varying periods on charges of involvement in illegal business activity or scams. Nigerian police or other law enforcement officials do not always inform the U.S. Embassy or Consulate immediately of the arrest or detention of a U.S. citizen. The U.S. Department of Commerce has advisories to the U.S. business community on a variety of issues that should be seriously reviewed with respect to doing business in Nigeria. To check on a business’s legitimacy while in the United States, contact the Nigeria Desk Officer at the International Trade Administration, Room 3317, Dept. of Commerce, Washington, D.C. 20230, telephone 1-800-USA-TRADE or (202) 482-5149, fax (202) 482-5198. If you are abroad, contact the nearest U.S. Embassy or Consulate.

The Department of State encourages all travelers abroad to register their travel. The most convenient way to do so would be through the online travel registration page. Travelers may also register in person at the U.S. Embassy in Abuja or the U.S. Consulate General in Lagos. See the section on Registration / Embassy Location below.

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, for example, can provide you with a list for appropriate medical care, or contact family members or friends and explain how funds could be transferred to you to cover unexpected costs. 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 the Department of State’s information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: While Nigeria has many well-trained doctors, medical facilities in Nigeria are in poor condition, with inadequately trained nursing staff. Diagnostic and treatment equipment is most often poorly maintained, and many medicines are unavailable. Caution should be taken as counterfeit pharmaceuticals are a common problem and may be difficult to distinguish from genuine medications. This is particularly true of generics purchased at local pharmacies or street markets. Hospitals often expect immediate cash payment for health services.

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

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their health insurance policy applies overseas and whether it will cover emergency expenses such as a medical evacuation from a foreign country to the United States or another location. Please see the our brochure 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 Nigeria is provided for general reference only and may not be totally accurate in a particular location or circumstance.

Roads in many areas are generally in poor condition, causing damage to vehicles and contributing to hazardous traffic conditions. There are few working traffic lights or stop signs. The rainy season from May to October is especially dangerous because of flooded roads and water-concealed potholes.

Excessive speed, unpredictable driving habits, and the lack of basic maintenance and safety equipment on many vehicles are additional hazards. Motorists seldom yield the right-of-way and give little consideration to pedestrians and cyclists. Gridlock is common in urban areas. Chronic fuel shortages have led to long lines at service stations, which disrupt or block traffic for extended periods.

Public transportation vehicles are unsafe due to poor maintenance, high speeds and overcrowding. Motorbikes, known in Nigeria as "okadas," are a common form of public transportation in many cities and pose particular danger to motorists, their own passengers and pedestrians. Motorbike drivers frequently weave in and out of traffic at high speeds and observe no traffic rules. Motorbikes are banned within Abuja's city limits. Passengers in local taxis have been driven to secluded locations where they were attacked and robbed. Several of the victims required hospitalization. The U.S. Mission advises that public transportation throughout Nigeria be avoided.

It is recommended that short-term visitors not drive in Nigeria. A Nigerian driver's license can take months to obtain, and to date an international driving permit is not recognized. Major hotels offer reliable car-hire services complete with drivers. Reliable car-hire services can also be obtained at the customer service centers at the airports in Lagos, Abuja, and Kano. Inter-city travelers must also consider that roadside assistance is extremely scarce, and as noted above medical facilities and emergency care are poor, meaning that being involved in a traffic incident might result in a lack of available medical facilities to treat either minor or life-threatening injuries.

All drivers and passengers are reminded to wear seat belts, lock doors, and raise windows. It is important to secure appropriate automobile insurance. It is also important to be aware that drivers and passengers of vehicles involved in accidents resulting in injury or death have experienced extra-judicial actions, i.e., mob attacks, official consequences such as fines and incarceration or involvement with the victim's family. Night driving should be done with extreme caution, but it is recommended to avoid driving between 6:00 p.m. and 6:00 a.m. as bandits and police roadblocks are more numerous at night. Streets are very poorly lit, and many vehicles are missing one or both headlights, tail lights, and reflectors.

The Government of Nigeria charges the Federal Road Safety Commission with providing maps and public information on specific road conditions. The Federal Road Safety Commission may be contacted by mail at: Ojodu-Isherri Road, PMB 21510, Ikeja, Lagos; telephone [243] (1) 802-850-5961 or [234] (1) 805-684-6911.
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 Nigeria, the U.S. Federal Aviation Administration (FAA) has not assessed Nigeria’sCivil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

The Port Harcourt International Airport, which was closed in mid-2006 for rehabilitation, resumed operations in December 2007 for domestic daylight flights. Installations and improvements needed for international flights and night operations are expected to be completed in 2008.

For additional information on aviation safety concerns, see the Department of State’s Travel Warning for Nigeria.
SPECIAL CIRCUMSTANCES:
Permission is required to take photographs or videotape any government buildings, airports, bridges, and in areas where the military is operating throughout the country. These sites include, but are not limited to, Federal buildings in the Three Arms Zone (Presidential palace area, National Assembly, Supreme Court/Judiciary) of the capital of Abuja, other government buildings around the country and foreign Embassies and Consulates. Many restricted sites are not clearly marked, and application of these restrictions is subject to interpretation by the Nigerian security services and can result in detention. Permission may be obtained from Nigeria's State Security Services, but even permission may not prevent the imposition of penalties or detention. Penalties for unauthorized photography or videography may include confiscation of the still or video camera, exposure of the film or deletion of film footage, a demand for payment of a fine or bribe, and/or detention, arrest, or physical assault. For these reasons, visitors to Nigeria should avoid taking still photos or videotaping in and around areas that are potentially restricted sites, including any government sites.

The Nigerian currency, the naira, is non-convertible. U.S. dollars are widely accepted. Nigeria is a cash economy, and it is usually necessary to carry sufficient currency to cover the expenses of a planned visit, which makes travelers an attractive target for criminals. Credit cards are rarely accepted beyond a few upscale hotels. Due to credit card fraud in Nigeria and by cohorts in the United States, credit card use should be considered carefully. While Citibank cashes some traveler’s checks, most other banks do not. American Express does not have offices in Nigeria; however, Thomas Cook does. Inter-bank transfers are often difficult to accomplish, though money transfer services such as Western Union are available. For further information, visitors may contact the U.S. Embassy or Consulate.

Please see the Department of State’s information on 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 Nigerian laws, even unknowingly, may be expelled, detained, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Nigeria 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 the Department of State’s information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Nigeria are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Nigeria and other general information.Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Embassy is located at 1075 Diplomatic Drive, Central Area, Abuja. American citizens can call [234] (9) 461-4176 during office hours (Monday through Thursday, 7:30 a.m. to 4:30 p.m.; Friday, 7:30 a.m. to 1:30 p.m.). For after-hours emergencies, call [234] (9) 461-4000. The email address for the Consular Section in Abuja is ConsularAbuja@state.gov.

The U.S. Consulate General is located at 2 Walter Carrington Crescent, Victoria Island, Lagos. American citizens can call [234] (1) 261-1215 during office hours (7:30 a.m. to 4:00 p.m.). For after-hours emergencies, call [234] (1) 261-1414, 261-0050, 261-0078, 261-0139, or 261-6477. The e-mail address for the Consular Section in Lagos is Lagoscons2@state.gov.

The Embassy and Consulate website is http://nigeria.usembassy.gov/.
* * *
This replaces the Consular Information Sheet dated April 16, 2007, to update sections on Country Description, Safety and Security, Crime, Traffic Safety and Road Conditions, Aviation Safety Oversight, Special Circumstances and Registration / Embassy Location.

Travel News Headlines WORLD NEWS

Date: Wed 4 Dec 2019
Source: UK Government, Public Health England [edited]

Public Health England (PHE) confirms an individual has been diagnosed with monkeypox [MPX] in England.

Monkeypox is a rare viral infection that does not spread easily between people, and the risk to the general public in England is very low. It is usually a self-limiting illness, and most people recover within a few weeks. However, severe illness can occur in some individuals.  The patient is believed to have contracted the infection while visiting Nigeria.

The patient was staying in southwest England prior to transfer to the specialist high-consequence infectious disease centre at Guy's and St Thomas' NHS Foundation Trust, London, where [the patient is] receiving appropriate care.

As a precautionary measure, PHE experts are working closely with NHS colleagues to implement rapid infection-control procedures, including contacting people who might have been in close contact with the individual to provide information and health advice. This includes contacting passengers who travelled in close proximity to the patient on the same flight to the UK. If passengers are not contacted, then there is no action they should take.

Dr Meera Chand, consultant microbiologist at Public Health England, said: "Monkeypox does not spread easily between people, and the overall risk to the general public is very low. We are following up with those who have had close contact with the patient to offer advice and to monitor them as necessary."

PHE and the NHS have well-established and robust infection-control procedures for dealing with cases of imported infectious disease, and these will be strictly followed to minimise the risk of transmission.

This is not the 1st time that the virus has been detected in the UK. PHE reported the 1st UK cases of monkeypox in September 2018.

Background
Monkeypox is a rare disease caused by monkeypox virus and has been reported mainly in central and west African countries. In most cases, monkeypox is a mild condition that will resolve on its own and has no long-term effects on a person's health. Most people recover within a few weeks [see comment below].

Initial symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills, and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body. The rash changes and goes through different stages before finally forming a scab, which later falls off.
====================
[Sporadic cases of monkeypox (MPX) continue to occur in Nigeria this year (2019), so it is not surprising if the individual became infected there and travelled to England during the incubation period. The USA CDC states that the incubation period (time from infection to symptoms) for monkeypox is usually 7-14 days but can range from 5-21 days, allowing adequate time for travel prior to the appearance of symptoms (see <https://www.cdc.gov/poxvirus/monkeypox/symptoms.html>).

There is no mention in the above report if the individual acquired the MPX infection from wildlife hosts or from contact with infected people. There is no mention above of the current condition of the patient. The health authorities in England are prudent to track individuals who had been in contact with the patient. Consideration of vaccination of contact individuals with the new MPX/smallpox vaccine, especially those providing care of this patient, in this type of situation may be a useful approach to prevent person-to-person transmission.

Prevention of MPX virus infections in the endemic countries in West and Central Africa will not be possible without knowing the source of infection and locality where they occurred. The question remains about the source of recent infections. Monkeys are not the reservoirs of the virus, despite the name that the virus has received. Studies of prevalence of MPX virus in populations of rodent hosts are not mentioned in this or in previous reports. The main reservoirs of MPX virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp., an arboreal rodent) and terrestrial rodents in the genera _Cricetomys_ and _Graphiurus_. Halting the bushmeat trade and consumption of wild animals to halt MPX virus exposure will be culturally and economically difficult, so continued occurrence of cases can be expected.

The MPX virus clade involved in these and previous cases is not mentioned. As noted in previous ProMED-mail posts, the monkeypox virus clade in the Congo Basin causes more severe disease in humans -- with a case fatality rate of 11-17% -- than the clade in Ghana, which causes few fatalities. The reported case fatality rate in Nigeria is low.

Similar reports of this case can be found at <https://www.theguardian.com/science/2019/dec/04/person-diagnosed-with-monkeypox-in-england-after-visiting-nigeria>, provided by ProMED Mod.MHJ, and in <https://www.bbc.com/news/uk-england-50659118>, which also shows typical MPX lesions, communicated by Mary Marshall (<mjm2020@googlemail.com>). - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
Date: Wed, 20 Nov 2019 17:17:39 +0100 (MET)

Lagos, Nov 20, 2019 (AFP) - Nigerian President Muhammadu Buhari on Wednesday announced a campaign to end defecation in public, in a country where tens of millions of people going to the toilet outside poses a major health risk.    "Nigeria has committed to end open defecation throughout the country by 2025," a statement by the presidency said a day after the United Nations marked World Toilet Day.     The decree set up a new body called the Clean Nigeria Campaign Secretariat to ensure "that all public places including schools, hotels, fuel stations, places of worship, market places, hospitals and offices have accessible toilets and latrines within their premises". 

According to the United Nations children agency, UNICEF, Nigeria has amongst the highest number of people practising open defecation in the world, estimated at over 46 million people -- almost a quarter of the population.   Around Nigeria each year 87,000 children die from diarrhoea, with more than 90 per cent of deaths caused by a lack of water, sanitation and hygiene, according to the World Bank.   The new agency will be disbanded when the goal of ending open defecation has been met, the presidency said.
Date: Sun 3 Nov 2019
Source: Nigeria Centre for Disease Control (NCDC) [edited]

Highlights
- In the reporting week 44 (28 Oct - 3 Nov 2019), 11 new confirmed** cases were reported from Ondo (6) and Edo (5) states with one new death from Edo state.
- From 1 Jan - 3 Nov 2019, a total of 4396 suspected* cases have been reported from 23 states. Of these, 754 were confirmed positive, 19 were probable, and 3623 were negative (not a case).
- Since the onset of the 2019 outbreak, there have been 158 deaths in confirmed cases. Case-fatality ratio in confirmed cases is 21%.
- A total of 23 states (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Plateau, Taraba, Adamawa, Gombe, Kaduna, Kwara, Benue, Rivers, Kogi, Enugu, Imo, Delta, Oyo, Kebbi, Cross River, Zamfara, Lagos, and Abia) have recorded at least one confirmed case across 86 local government areas [LGAs] - Figure 1.
- 93% of all confirmed cases are from Edo (38%), Ondo (31%), Ebonyi (7%), Bauchi (7%), Taraba (5%), and Plateau (5%) states - Figure 1.
- Predominant age group affected is 21-40 years (range: greater than one month to 98 years; median age: 34 years) - Figure 6.
- The male-to-female ratio for confirmed cases is 1:1 - Figure 6.
- In the reporting week 44, no new healthcare worker was affected. A total of 19 healthcare workers have been infected since the onset of the outbreak in 10 states: Edo (6), Ondo (4), Ebonyi (2), Enugu (1), Rivers (1), Bauchi (1), Benue (1), Delta (1), Plateau (1) and Kebbi (1) with 2 deaths in Enugu and Edo states.
- Nine patients are currently being managed at various treatment centres across the country: Irrua Specialist Teaching Hospital (ISTH) treatment Centre (7) and Federal Medical Centre, Owo (2).
- A total of 8400 contacts have been identified from 21 states. Of these, 356 (4.2%) are currently being followed up, 7967 (94.8%) have completed 21 days follow-up, while 12 (0.1%) were lost to follow-up. A total of 132 symptomatic contacts have been identified, of which 65 (49.2%) have tested positive.
- National Lassa fever multi-partner, multi-sectoral Technical Working Group (TWG) continues to coordinate response activities at all levels.

Figures [available at the source URL above]
-------------------------------------------
Figure 1 [map]. Randomised distribution of confirmed Lassa fever cases in Nigeria as at 3 Nov 2019.
Figure 2 [map]. LGAs with confirmed Lassa fever cases in Nigeria as at 3 Nov 2019.
Figure 3 [graph]. Epicurve of Lassa fever confirmed cases (754) in Nigeria - week 01-44, 2019.
Figure 4 [graph]. November 2019. Weekly trends of Lassa fever confirmed cases in Nigeria, 2016/week 01-2019/week 44.
Figure 5 [graph]. Confirmed Lassa fever cases in Nigeria with state-specific case-fatality rates (CFR) as at 3 Nov 2019.
Figure 6 [graph]. Age-sex distribution of confirmed Lassa fever cases in Nigeria as at 3 Nov 2019.

*Suspected case describes any individual presenting with one or more of the following: malaise, fever, headache, sore throat, cough, nausea, vomiting, diarrhoea, myalgia, chest pain, hearing loss, and either (a) history of contact with excreta or urine of rodents or (b) history of contact with a probably or confirmed Lassa fever case within a period of 21 days of onset of symptoms, or any person with inexplicable bleeding/hemorrhagia.
**Any suspected case with laboratory confirmation (positive IgM antibody, PCR, or virus isolation)
==================
[The 11 new confirmed and 4396 suspected cases indicate that Lassa fever (LF) virus transmission is continuing. Nigeria should be in the period of the year when fewer cases usually occur, as illustrated in the graph in Figure 3 (at the source URL above), but more cases are still occurring. There has been a peak in case numbers between weeks 1 and 11 (January-March) over the past 3 years and probably will be the case again next year (2020).

The number of confirmed deaths has increased by 2 to 158. Fortunately, there are no new healthcare workers infected during this reporting period, and the total number of infected healthcare workers remains at 19, a likely indication that effective barrier nursing and the use of personal protective equipment are being employed. This outbreak remains widespread so far in 2019, with confirmed cases occurring in 23 states, and the number of affected LGAs remains at 86. ProMED-mail readers may wish to see the maps and graphs (Figures 1-6) that are available at the source URL above.

Transmission of LF virus occurs when individuals are in contact with rodent reservoir host excreta or are within healthcare facilities. It would be interesting to know whether the prevalence of Lassa fever virus has been increasing in populations of rodent hosts in areas where human cases are occurring.

Images of the rodent reservoirs of Lassa fever virus:
_Mastomys natalensis_:
_Mastomys erythroleucus_ and _Hylomyscus pamfi_:

There is no mention in the plans above of public education for avoidance of contact with these rodents and their excreta. - ProMED Mod.TY]

[Maps of Nigeria:
Date: Fri 8 Nov 2019
Source: The Nigerian Voice [edited]

Between 1 Aug and 5 Nov 2019, Nigeria experienced an upsurge in cases of yellow fever, with 511 suspected cases in 3 states: 309 from Katsina, 162 from Bauchi, and 40 from Benue. Of the samples tested from these cases, 83 were confirmed positive (43 in Katsina, 34 in Bauchi, and 6 in Benue).

Since the beginning of the year [2019], the Nigeria Centre for Disease Control (NCDC) and the National Primary Health Care Development Agency (NPHCDA) have been working with development partners to support the states to prevent and reduce the number of cases and deaths.

This year [2019], Katsina state has recorded 599 suspected cases, 43 confirmed cases, and 77 deaths among suspected cases. A mass vaccination campaign was carried out in the state in September 2019. Bauchi state has been reporting suspected cases of yellow fever mostly in Alkaleri LGA [local government area]. This year [2019], the state has recorded 183 suspected cases, 34 confirmed cases, and 24 deaths among suspected cases. Following the outbreak in Alkaleri LGA, a reactive vaccination campaign was carried out. Benue state has recorded 150 suspected cases, 6 confirmed cases, and no deaths in 2019. Vaccination campaigns have been carried out in 3 LGAs of the state this year [2019]: Vandekiya LGA in January 2019 and Oju and Ado LGAs in September 2019.

In response to the increase in cases, a multi-agency yellow fever emergency operations centre (EOC) was activated on 5 Nov 2019. Three rapid response teams (RRTs) have been deployed to Katsina, Bauchi, and Benue this week [week of Mon 4 Nov 2019] to support the outbreak response.

Working together, NPHCDA, NCDC, and development partners recently implemented yellow fever mass vaccination campaigns in Alkaleri LGA of Bauchi, 2 LGAs of Benue (Oju and Ado), and all the LGAs in Katsina. All the campaigns were implemented between September and October 2019. In total, yellow fever vaccination campaigns have been implemented in 13 of the 36 states in Nigeria and in the FCT.

Since the re-emergence of yellow fever in Nigeria in 2017, NCDC, NPHCDA, and the National Arbovirus and Vector Research Centre (NAVRC) have been working together to support states to investigate each case and respond to outbreaks.

Yellow fever virus is spread through the bite of an infected mosquito. There is no human-to-human transmission of the virus. Yellow fever is a completely vaccine-preventable disease, and a single shot of the yellow fever vaccine protects for a lifetime. In Nigeria, vaccination against yellow fever is primarily through the routine childhood immunisation. Where necessary, catch-up campaigns are carried out to increase population immunity. The yellow fever vaccine is available for free in all primary healthcare centres in Nigeria as part of the routine childhood immunisation schedule. We encourage every family to ensure that children receive all their childhood vaccines.

In addition to the vaccine, the public is advised to keep their environment clean and free of stagnant water to discourage the breeding of mosquitoes and ensure the consistent use of insecticide-treated mosquito nets, screens on windows, and doors to prevent access for mosquitoes. Hikers, park visitors, and people engaged with activities in the wild especially are encouraged to be vaccinated against yellow fever. It is important to avoid self-medication; visit a health facility immediately if you feel ill.

Healthcare workers and members of the public are reminded that the symptoms of yellow fever include yellowness of the eyes, sudden fever, headache, and body pain. If you have these symptoms or notice someone in your community displaying them, please contact your nearest primary healthcare centre.  [Byline: Jeremiah Agenyi]
========================
[Yellow fever cases have been occurring in various states across Nigeria this year (2019), most recently in the 3 above states. There is no indication in the above report what proportions of the population have been vaccinated in these 3 states, but clearly it is less than the ideal of 80-90%, given these cases. One hopes that the ongoing vaccinations will bring these outbreaks to a halt. - ProMED Mod.TY]

[Maps of Nigeria:
Date: Thu 7 Nov 2019
Source: PM News [edited]

In Bauchi state, 29 people have died so far following the outbreak of yellow fever, an acute viral haemorrhagic disease transmitted by infected mosquitoes. Dr Rilwanu Mohammed, chairman, Bauchi State Primary Healthcare Development Agency (BSPHDA), gave the death toll on Thursday [7 Nov 2019].  "We discovered 224 suspected cases, and 29 were confirmed dead, with 24 in Alkaleri local government, 2 in Bauchi local government, one in Darazo council area, and 2 in Ningi local government," he said.

Mohammed explained that the virus was 1st detected in Alkaleri council area in September [2019], adding that efforts had since been stepped up to avoid further spread. He said that government was doing everything possible to ensure that the disease did not spread to the state capital.  "That is why the government has made efforts through the vaccination of people living in the prone areas. Already, 500,000 doses of vaccines had been administered in Alkaleri, and we are expecting 600 000 doses of vaccines to be administered in the Ningi community," he said.

According to the BSPHDA chairman, yellow fever is not a communicable disease; it can only be transmitted through mosquitoes. He urged communities to give early information to the authorities, especially when they notice unusual happenings around them. Mohammed also urged the residents of the state not to reject vaccines, saying that this was the only way they could be free from the dreaded disease.

The "yellow" in the name refers to the jaundice that affects some patients. Symptoms of yellow fever include fever, headache, jaundice, muscle pain, nausea, vomiting, and fatigue.
======================
[The yellow fever (YF) outbreak is continuing in Bauchi state. On 14 Oct 2019, the Bauchi State Primary Health Care Development Agency confirmed 6 new recorded deaths in the yellow fever outbreak in the state, bringing the total number of deaths to 22 for the year (2019) (see Yellow fever - Africa (19): Nigeria (BA) http://promedmail.org/post/20191016.6729323). A subsequent 3 Nov 2019 report indicated that there are at least 6 additional YF deaths, for a total of 28. Now 29 fatal YF cases are reported with 224 suspected cases. Continuation of the active vaccination campaign is prudent and the only way to bring this outbreak to an end. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Bauchi state, Nigeria: <http://healthmap.org/promed/p/3741>]
More ...

Swaziland

Swaziland US Consular Information Sheet
February 10, 2009
COUNTRY DESCRIPTION:
Swaziland is a small developing nation in Southern Africa.
Several well-developed facilities for tourism are available.
The capital is Mbabane.
R
ad the Department of State Background Notes on Swaziland for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport is required.
Visas are not required for tourists and business travelers arriving in Swaziland for short visits (less than 60 days) on standard U.S. passports.
Most travelers visiting Swaziland enter through South Africa.

PLEASE NOTE:
All travelers traveling to South Africa are strongly encouraged to have several unstamped visa pages left in their passports. South Africa requires two unstamped visa pages, excluding amendment pages, to enter the country. Visitors who do not have enough free visa pages in their passport risk being denied entry and returned to the U.S. at their own expense.

For the most current information on Swaziland’s visa requirements, contact the Embassy of the Kingdom of Swaziland, 1712 New Hampshire Avenue NW, Washington, DC 20009; phone (202) 234-5002.

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:
Public protests, demonstrations, and strikes occur from time to time in Swaziland and are mostly in response to on-going labor relations/difficulties.
When a strike is pending, armed soldiers may be called to augment the police force, and they have used force to disrupt such events.
During the course of such events, police may not distinguish between “innocent bystanders” and protesters.
Americans should avoid crowds, political rallies and street demonstrations.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, 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:
Violent crime is a concern and is the most significant threat to American citizens visiting or working in Swaziland.
Incidents of petty crime and occasionally violent crime are most prevalent in Mbabane, the capital city, and Manzini, Swaziland’s urban industrial center, but also affect most other urban and rural areas.
Criminals will resort to force if necessary, including deadly force, in order to accomplish their goal.
Gangs are not deterred by confrontations with their intended victims.
Carjacking occurs and, as with other crimes, can be potentially violent if victims do not immediately cooperate.

Congested dark urban areas are particularly dangerous at night and daytime attacks are not uncommon.
The presence of others on the street should not be misinterpreted as an indication of security.
Many victims report being robbed in the presence of large numbers of witnesses.
Pedestrians are cautioned not to wear jewelry or carry expensive or unnecessary valuables in public.
American citizens are also advised against displaying cell phones and large sums of cash, as they are targets for thieves.
Money should only be converted at authorized currency exchanges and never with street vendors.
Exercise caution with using local taxis.
Ensure the taxi you use is from a reputable company.
Never enter a taxi that is occupied by anyone else besides the driver.
It is good practice to call a friend to let them know the plate number of the taxi you are using.
Crime tends to increase during the holiday season from December to January.
Crime victims should immediately report the incident to the nearest police station.
If there is an emergency, the police can be contacted by dialing 999.

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, help you 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 Swaziland is 999.
Please see our information on Victims of Crime, including possible victim compensation programs in the United States.

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 Swazi laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Swazi 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.

SPECIAL CIRCUMSTANCES: Swaziland does not have any unusual customs/currency regulations nor any visa registration requirements.
It is illegal to photograph Swaziland’s government buildings, members of the Swazi armed forces, royal residences and official ceremonies without prior permission from government authorities. Please see our Customs Information sheet.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are limited throughout Swaziland and emergency medical response capabilities (including ambulance transport) are almost non-existent.
Although the Mbabane Clinic in the capital is small and currently undergoing building renovations, it is well equipped and well staffed for minor procedures. For advanced care, Americans often choose to go to South Africa where better facilities and specialists exist.
Most prescription drugs are available locally or can be imported from South Africa, but travelers are advised to bring sufficient quantities of their own required medication.
A doctor’s note describing the medication may be helpful if questioned by authorities.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Swaziland.
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.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site.
Further health information for travelers is available from the WHO.
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 Swaziland is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Traffic accidents in Swaziland may pose an even greater hazard than crime.
Visitors should use extreme caution when driving, given the relatively high rates of speed of drivers on major thoroughfares.
Other hazards include poor lighting and traffic signals; presence of pedestrians, animals, and slower moving vehicles; aggressive driving behavior; and erratic stopping for pedestrian and animals.
Traffic drives on the left in Swaziland, which requires U.S. drivers to exercise particular caution.
Special care should be used in driving at night and in fog, especially in rural areas.
Rural and suburban areas are poorly lit and pose additional safety hazards as pedestrians and animals cross the road.
Many vehicles are poorly maintained and lack headlights.
Extreme caution is recommended if/when using mini-bus taxis, which follow fixed routes and are flagged down by passengers almost everywhere on the streets and roads of Swaziland.
Many of these vehicles fail to meet minimal safety standards.
Drivers frequently overload the vehicles and travel at excessive speeds.
Fatal accidents involving these conveyances are very common.
The Royal Swaziland Police Service set up periodic road blocks and also uses radar to monitor your speed.
Respect the local laws.
If you are pulled over for a moving violation you will be responsible for the consequences.
Always drive with your driver’s license.
Failure to do so will result in a fine.
Please refer to our Road Safety page for more information.
Visit the web site of the country’s national authority responsible for road safety.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Swaziland’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Swaziland’s air carrier operations.
For more information, travelers may visit the FAA web site.

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 Swaziland are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Swaziland.
Americans without Internet access may register directly with the nearest U.S. embassy or consulate.
By registering, American citizens make it easier for the embassy or consulate to contact them in case of emergency.
The U.S. Embassy is located in the Central Bank Building on Mahlokohla Street in the capital city of Mbabane.
The mailing address is Box 199, Mbabane, Swaziland.
The telephone number is (268) 404-6441/5; fax (268) 404-5959. For after-hours emergencies involving American citizens, please dial 268-602-8414.
* * *
This replaces the Country Specific Information for Swaziland dated August 6, 2008, to update sections on Entry/Exit Requirements, Crime, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Wed, 2 Oct 2019 17:36:56 +0200 (METDST)

Manzini, Swaziland, Oct 2, 2019 (AFP) - Angry teachers and government workers clashed with police in the tiny kingdom of eSwatini on Wednesday as they rallied to demand better pay and lower living costs in Africa's last absolute monarchy.   Civil servants took to the streets in Manzini, the kingdom's second largest town, singing protest songs and blowing horns.   "We want cost of living adjustment not bullets," read a banner wielded by one protester.

The crowd threw stones at the police, who responded with water canons, rubber bullets and tear gas.   Civil servants launched a series of strikes across the kingdom of eSwatini -- formerly known as Swaziland -- last month.   They accuse King Mswati III of spending public money on expensive trips abroad and royal ceremonies at the expense of their salaries.   "King Mswati is not considerate of the plight of the people of the country," said a worker in Manzini, who wished to remain anonymous.   "We are told that there is no money, the economy is in bad shape but he continues to take expensive trips abroad... with his extended family and friends," he told AFP, adding that a revolution was "on the cards".

An AFP reporter at the scene said the majority of shops in Manzini were closed due to the unrest.   "Let's continue the fight for democracy," said Mbongwa Dlamini, head of the Swaziland National Association of Teachers, adding that some people had been arrested.   The authorities were not immediately available to verify that claim.   Protests are rare in eSwatini, where opposition parties and anti-government movements are effectively banned.   But undercurrents of frustration have surfaced in recent months.   Government spokesman Percy Simelane said last week that police would open an investigation into the recent demonstrations and that offenders would "face justice".   "It would be unfortunate if trade unionism could be taken as a chaos club," Simelane told local media.
Date: Wed, 25 Sep 2019 19:16:45 +0200 (METDST)

Mbabane, eSwatini, Sept 25, 2019 (AFP) - Violent clashes erupted in eSwatini on Wednesday after police cracked down on civil servants protesting against low pay and rising living costs in Africa's last absolute monarchy.

Teachers and workers went on strike last week in the four main towns of eSwatini -- a tiny southern African kingdom until recently known as Swaziland, surrounded by South Africa and Mozambique.   They accuse King Mswati III of draining public coffers at the expense of his subjects, and flocked to the capital Mbabane from Friday to discuss action with opposition pro-democracy groups.

Police fired tear gas, stun grenades and water canons on Wednesday to disperse the crowd, who responded by pelting rocks at police cars and government buildings.   "Our problem is that we have a selfish king," said Sibongile Mazibuko, who heads the Ngwane National Liberatory Congress pro-democracy group. "He loots national coffers to satisfy his personal greed."    Mazibuko blasted the king for wasting money on "expensive" royal ceremonies and trips abroad involving "huge delegations" and "shopping sprees".    "The same government says they have no money," he said.

- Growing frustrations -
Frustrations have boiled over into a series of protests around the country this week.   More than 3,500 people marched in Mbabane and the neighbouring city of Manzini on Monday, and around 3,000 protesters showed up in the capital again on Wednesday.

South Africa's trade union federation announced "border protest action" in the neighbouring province of Mpumalanga on Wednesday "in support" of the eSwatini strike.   "The workers demand only 7.8 percent salary adjustment while the Mswati regime spends millions of rands for his lavish lifestyle," said the Congress of South African Trade Unions (COSATU) in a statement.   Wandile Dludlu, national coordinator of an eSwatini pro-democracy coalition, welcomed COSATU's support.     "This is (a) fight," said Dludlu. "Protest action is not like a coffee session."

The government said earlier this month that it was unable to meet the protesters' demands.   "Government is in a challenging financial situation, hence (its) inability to award civil servants with a cost of living adjustment for the past two years," Prime Minister Ambrose Dlamini said in a statement.      King Mswati III was crowned in 1986, when he was just 18. He has come under fire for his expensive tastes, frivolous spending and prioritising his family's needs.

The king's older daughter Princess Sikhanyiso was appointed as a member of cabinet last year, stoking outrage among pro-democracy groups.   He is currently attending the UN general assembly in New York.   "It is not true that there is no money in this country," said Dludlu.   "The PM is not a problem, we know where our problem lies. We have a greedy king. The royal family impoverishes this country," he told AFP.   eSwatini ranked 144 out of 189 the UN's latest Human Development Index. Around two thirds of the country's 1.4 million inhabitants lives below the poverty line.
Date: Mon, 24 Jul 2017 12:55:52 +0200

Paris, July 24, 2017 (AFP) - Swaziland, which bears the world's heaviest HIV burden, has halved the rate of new infections in five years by boosting access to virus-suppressing drugs, researchers said Monday.   The country where about one in three adults are infected with the AIDS-causing virus, has vastly expanded public programmes to test people for HIV infection and put them on life-saving anti-retroviral treatment (ART).   "Since 2011, national HIV incidence in Swaziland dropped by almost half," a research team led by Velephi Okello of the Swazi health ministry said in a written presentation to an HIV science conference in Paris.   Incidence is the word used by epidemiologists for the rate of new infections in a population.   "Sustaining these achievements will be paramount to Swaziland's success in curbing its severe HIV epidemic," said the researchers.   In 2011, 31 percent of adults (aged 18-49) out of a total country population of just over 1.2 million, were infected with HIV, according to government data.   This made Swaziland the country with the highest national rate of new infections, said the authors of the new study, as well as the highest proportion of people living with HIV.

The latest data, based on blood tests from about 11,000 people aged 15 and over, showed that 27 percent were HIV-positive in 2016.   This translated to an infection rate of 1.39 percent among 18- to 49-year-olds, down from 2.58 percent in 2011 -- a 46-percent reduction.   "Incidence was higher among women than in men," said the report to the International AIDS Society conference. The decline was also steeper for men at 52 percent than for women at 40 percent.   The survey showed that 73 percent of people on ART had achieved suppression of the virus, compared to 35 percent in 2011.   ART not only stops HIV from replicating and attacking a patient's immune system, but also curbs its spread to sexual partners.   The gains were the fruit of a much improved HIV treatment programme, said the researchers.   The number of HIV tests conducted in Swaziland more than doubled from 176,000 in 2011 to 367,000 in 2016, and the share of infected people on ART rose from 37 percent to 74 percent.
Date: Thu, 11 Aug 2016 19:48:51 +0200

Mbabane, Swaziland, Aug 11, 2016 (AFP) - Drought-stricken Swaziland Thursday said it would begin sever water rationing in the capital Mbabane after levels in the main dam supplying the city fell to a critical low.   Swaziland Water Services Corporation (SWSC) said the restrictions would begin on Friday and probably last until the arrival of summer rains expected around October.

Under the measure, there will be no mains water for four days a week. Residents will collect water from mobile tanks instead.   "This is because of the dire drought situation which has decreased water levels at the Hawane Dam," said SWSC spokeswoman Nomahlubi Matiwane.   She said water levels in the dam had dropped from 15 percent of capacity in the last few weeks to just nine percent.

Swaziland is one of a number of countries in southern Africa that have been badly hit by El Nino -- a weather phenomenon that is centred on the countries in the Pacific but can affect other regions as well.   In February, dry conditions gripping the agricultural sector prompted the government to declare a state of emergency.   Water resources in the impoverished country of 1.2 million people have more than halved, contributing to higher food prices and poor crops.   Last month aid organisations estimated that El Nino had affected 12.3 million people across southern Africa.
Date: Sat 1 Dec 2012
Source: Observer.org (Swaziland) [edited]

A rabies outbreak has been reported in the Manzini region almost 2 months after dogs were vaccinated countrywide.  The most affected areas are Ludzeludze, Ngabezweni and Dwaleni Power Station, and the outbreak is so bad that the ministry of agriculture has decided to revaccinate canines.

The outbreak was 1st spotted at Ngabezweni when a dog from a legislator's family, a Dlamini, went berserk, chasing after people and barking at its shadow.

Because the dog was a nuisance to the community, they decided to team up against it and stoned it to death then called for veterinary assistance from Ludzeludze Rural Development Area (RDA), who took it for tests.

A few days later, another report was received from Dwaleni (Power) about a troublesome dog, whereby veterinary officers took it for tests. "The dogs tested positive to rabies, and it was then that we resolved to undertake the revaccination exercise. Our investigations also revealed that owners of both dogs did not vaccinate them when the ministry conducted the exercise in September [2012?]. One wonders why people fail to vaccinate their dogs when called to do so, because it is free," said a source from the ministry of agriculture.

It was then gathered that the revaccinating exercise began on Monday [26 Nov 2012], and areas within a radius of 7 km also have to be visited, where all the dogs will be revaccinated.

The source revealed that one of the major challenges that might compromise the revaccinating exercise was the shortage of chemicals [vaccines?].

Reached for comment, Director of Veterinary Services Dr Xolani Dlamini said he was not aware of the matter and had to investigate it further.  [Byline: Faith Vilakati]
======================
[As with the entire African continent, animal rabies is endemic in Swaziland, mainly involving dogs. According to Swaziland's annual OIE reports, the number of cases in dogs for 2011 was 26 and for humans 38 (rate per 100 000 population = 3.2371). For comparison: India, generally regarded to rank high among rabies-stricken countries, reported 162 human cases (0.015 per 100,000) during 2010 (most recent available quantitative information).

During 2011, 60 868 dogs have reportedly been vaccinated in Swaziland. - ProMed Mod.AS]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/3psa>.]
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Djibouti

Djibouti - US Consular Information Sheet
May 30, 2006

COUNTRY DESCRIPTION: Djibouti is a developing African country located on the Gulf of Aden. It is a multi-party democracy with a legal system based on French civil law (Djibouti was a Fr
nch colony until 1977), though modified by traditional practices and Islamic (Sharia) law. Although exact statistics are unavailable, unemployment is estimated in excess of 50% of the working-age population. About two-thirds of the country's 650,000 residents live in the capital, also called Djibouti. Modern tourist facilities and communications links are limited in the city of Djibouti and are virtually non-existent outside the capital. Read the Department of State Background Notes on Djibouti for additional information.

ENTRY/EXIT REQUIREMENTS: A passport, visa, and evidence of yellow fever vaccination are required. Travelers may obtain the latest information on entry requirements from the Embassy of the Republic of Djibouti, 1156 15th Street, N.W., Washington, D.C. 20005, telephone (202) 331-0270, or at the Djibouti Mission to the United Nations, 866 United Nations Plaza, Suite 4011, New York, N.Y. 10017, telephone (212) 753-3163. Overseas, inquiries may be made at the nearest Djiboutian embassy or consulate. In countries where there is no Djiboutian diplomatic representation, travelers may sometimes obtain visas at the French Embassy. See our Foreign Entry Requirements brochure for more information on Djibouti and other countries. Visit the Embassy of Djibouti web site at www.embassy.org/embassies/dj.html for the most current visa information.
American journalists or any American connected with the media must contact the U.S. Embassy's Public Affairs section prior to travel to facilitate entry into Djibouti. If you are unclear whether this applies to you, please contact the U.S. Embassy for more information.

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

SAFETY AND SECURITY: Djibouti enjoys a stable political climate. However, its international borders are porous and lightly patrolled. In particular, Somalia, Djibouti's neighbor to the south, is considered by many to be a haven for terrorists and other insurgent elements. In addition, tensions exist between neighboring Ethiopia and Eritrea due to the unsettled nature of their long-running border dispute. Civil unrest or armed conflict in neighboring countries could disrupt air travel to and from Djibouti or otherwise negatively affect its security situation.
Terrorism continues to pose a threat in East Africa. U.S. citizens should be aware of the potential for indiscriminate attacks on civilian targets in public places, including tourist sites and other sites where Westerners are known to congregate.
Travelers should exercise caution when traveling to any remote area of the country, including the borders with Eritrea, Ethiopia, and Somalia. Djiboutian security forces do not have a widespread presence in those regions. In recent years, acts of sabotage have occurred along the Djibouti-Ethiopia railway. Although Americans were not specifically targeted in any of these attacks, U.S. citizens should exercise caution.
Demonstrations have become more frequent due to the recent increase in energy prices. Americans are advised to avoid all demonstrations as they may become violent.
Americans considering seaborne travel around Djibouti's coastal waters should exercise extreme caution, as there have been several recent incidents of armed attacks and robberies at sea by unknown groups. These groups are considered armed and dangerous. When transiting in and around the Horn of Africa and/or the Red Sea near Yemen, it is strongly recommended that vessels convoy in groups and maintain good communications contact at all times. Marine channels 13 and 16 VHF-FM are international call-up and emergency channels and are commonly monitored by ships at sea. 2182 Mhz is the HF international call-up and emergency channel. In the Gulf of Aden, transit routes farther offshore reduce, but do not eliminate, the risk of contact with suspected assailants. Wherever possible, travel in trafficked sea-lanes. Avoid loitering in or transiting isolated or remote areas. In the event of an attack, consider activating the Emergency Position Indicating Radio Beacons. Due to distances involved, there may be a considerable delay before assistance arrives. Vessels may also contact the Yemeni Coast Guard 24-hour Operations Center at 967 1 562-402. Operations Center staff members speak English.
U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times for readily available proof of identity and U.S. citizenship if questioned by local officials. Police occasionally stop travelers on the main roads leading out of the capital to check identity documents.

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

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State's pamphlet A Safe Trip Abroad .
CRIME: Accurate crime statistics are not available, but crime appears to be on the rise. Petty thefts and pickpockets are common, and a few home invasions have been reported. Major crimes involving foreigners are rare, but are increasing in frequency. In the past year the number of murders has increased in Djibouti, involving mainly Djiboutian and third country nationals (TCNs). This increase in crime is possibly linked to declining economic conditions and a deepening resentment toward the increasing number of TCN workers brought in to assist with major construction projects in Djibouti.

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: Adequate medical facilities in the capital of Djibouti are limited and medicines are often unavailable. Medicines that are available are extremely expensive. Medical services in some outlying areas may be completely nonexistent. Motorists especially should be aware that in case of an accident outside the capital, emergency medical treatment would depend almost exclusively on passersby. In addition, cell phone coverage in outlying areas is often unavailable, making it impossible to summon help.
Malaria and dengue fever are prevalent in Djibouti. Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what anti-malarial drugs they have been taking.

In 2005, polio was found in all of Djibouti's neighbors (Somalia, Ethiopia, Eritrea and Yemen) and health professionals strongly suspect it is present in Djibouti. The Advisory Committee on Immunization Practices (ACIP) recommends that all infants and children in the United States should receive four doses of inactivated poliovirus vaccine (IPV) at 2, 4, and 6-18 months and 4-6 years of age. Adults who are traveling to polio-endemic and epidemic areas and who have received a primary series with either IPV or oral polio vaccine should receive another dose of IPV. For adults, available data does not indicate the need for more than a single lifetime booster dose with IPV.

In May 2006, avian influenza was confirmed in three chickens and one human in Djibouti. For more information about this illness, see the Department of State's Avian Flu Fact Sheet .

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 . For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at . Further health information for travelers is available at .

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

The Djiboutian Ministry of Defense and the national police force share responsibility for road safety in Djibouti. While Djibouti has been declared a "mine-safe" country, this indicates landmines have been identified and marked, not that they have been removed. Landmines are known to be present in the northern districts of Tadjoureh and Obock. In addition, there may be mines in the Ali Sabieh district in the south. Travelers should stay on paved roads and should check with local authorities before using unpaved roads.
The two main international routes to the capital city via Dire Dawa, Ethiopia, and Yoboki, Djibouti, are both in poor condition due to heavy truck traffic, whose presence demands that drivers remain vigilant. Major roads outside the capital are paved but lack guardrails. Railroad crossings are often not clearly marked.
Roads are often narrow, poorly maintained, and poorly lit. Drivers and pedestrians should exercise extreme caution. Excessive speed, unpredictable local driving habits, pedestrians and livestock in the roadway, and the lack of basic safety equipment on many vehicles are daily hazards. Speed limits are posted occasionally but are not enforced. The leafy narcotic khat is widely used, particularly in the afternoons, creating another traffic hazard. Travelers should be aware that police set up wire coils as roadblocks on some of the major roads, and these may be difficult to see at night.
The only means of public inter-city travel is by bus. Buses are poorly maintained and their operators often drive erratically with little regard for passenger safety.
Please refer to our Road Safety page for more information. Visit the web site of Djibouti's national tourist office and national authority responsible for road safety at .

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service between the United States and Djibouti, the U.S. Federal Aviation Administration (FAA) has not assessed Djibouti's Civil Aviation Authority for compliance with ICAO international aviation safety standards. For more information, travelers may visit the FAA's Internet website at .

SPECIAL CIRCUMSTANCES: Although the narcotic khat is legal and widely chewed in Djibouti, it is considered an illegal substance in many countries, including the United States.
Djiboutians are generally conservative in dress and manner, especially in rural areas.
Photography of public infrastructure (including, but not limited to, public buildings, seaports, the airport, bridges, military facilities or personnel) is not allowed in Djibouti. Use extreme caution when photographing anyone or anything near prohibited areas. Photographic equipment will be confiscated, and the photographer may be arrested.
Djibouti is a cash-based economy and credit cards are not widely accepted. Reliable automated teller machines (ATMs) are not available. Changing money on the street is legal, but be aware of possible scams as well as personal safety considerations if people observe you carrying large amounts of cash. The exchange rate on the street will be similar to that at a bank or hotel. It is important that the U.S. banknotes that you carry have a date of 2003 or newer because some currency exchanges will not accept U.S. paper money older than 2003.

Djiboutian customs authorities may enforce strict regulations concerning temporary importation into or export from Djibouti of firearms. It is advisable to contact the Embassy of Djibouti in Washington, D.C., for specific information regarding customs requirements.

Please see our information on 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 Djiboutian law, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Djibouti 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 Djibouti 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 Djibouti. Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Embassy is located at Plateau du Serpent, Boulevard Marechal Joffre, Djibouti City. The mailing address is Ambassade Americaine, B.P. 185, Djibouti, Republique de Djibouti. The telephone number is (253) 35-39-95. The fax number is (253) 35-39-40. Normal working hours are Sunday through Thursday, 7:30 a.m. to 4:00 p.m.
* * *
This replaces the Consular Information Sheet dated November 2, 2005, to update sections on Safety and Security, Crime, Medical Facilities and Health Information, Special Circumstances, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon, 26 Feb 2018 08:27:14 +0100

Djibouti, Feb 26, 2018 (AFP) - President Ismael Omar Guelleh's ruling party claimed a resounding victory in Friday's parliamentary elections in Djibouti, taking nearly 90 percent of seats after the opposition largely boycotted the poll.   Mohamed Abdallah Mahyoub, a senior member of Guelleh's UMP party and campaign spokesman, told AFP late Sunday the party had won 58 out of 65 parliamentary seats, an increase of three since the last vote in 2013.   There was no immediate figure for turnout among the tiny Horn of Africa nation's 194,000 registered voters.   Guelleh has ruled Djibouti since 1999 and was last re-elected in 2016 with 87 percent of the vote.

The UMP's victory has helped by the badly-divided opposition with two parties -- MRD and RADDE and a faction of a third party, ARD -- refusing to put forward any candidates, saying the elections would neither be fair nor transparent while others accused the election commission of bias.   The UMP claimed every seat outside of the capital and all but seven seats in Djibouti city with the remainder going to the UDJ party.   The law stipulates that 25 percent of seats must go to women, an increase from just 10 percent in the outgoing parliament. According to Mahyoub, this threshold was nearly met as 15 women won parliamentary seats, 14 of them from the UMP.
Date: Thu, 12 Jun 2014 16:56:37 +0200 (METDST)

GENEVA, June 12, 2014 (AFP) - Nearly a quarter of the population in drought-hit Djibouti is in desperate need of aid, with malnutrition and a dramatic lack of water causing a mass exodus from rural areas, the UN said on Thursday.   "Persistent and recurring droughts have resulted in a general lack of water for both people and livestock," said the UN's Djibouti coordinator Robert Watkins.   The crisis, which has dragged on since 2010, has left a full 190,000 of the country's 850,000 residents in need of humanitarian assistance.   They include 27,500 refugees, mainly from neighbouring Somalia, Watkins told reporters in Geneva.

Yet the crisis in Djibouti has received little international attention, with a UN appeal for aid last year reaching only a third of its target -- the lowest level of funding for any such appeal worldwide.   The appeal comes amid warnings from Britain on Thursday that Somalia's Al-Qaeda-linked Shebab insurgents were planning further attacks in the tiny and traditionally tranquil Horn of Africa country.   Shebab suicide bombers hit a crowded restaurant in Djibouti last month, killing at least one, in an attack apparently linked to the country's participation in the African Union force in Somalia.   Djibouti's port also serves as a key base for international anti-piracy operations off the Somali coast.

Watkins also said on Thursday that some 60,000 migrants -- most of them Ethiopians trying to reach the Gulf for work -- were also in need of aid inside Djibouti.   Last year alone, 100,000 passed through the country, he said. Most migrants come on foot, staggering alongside the roads in the extreme heat.   "Many die from dehydration," he said.   Foreigners are not the only ones on the move in the country, where most people still live off livestock which have been hard-hit by the drought.   "There has been a huge exodus of people living in rural areas," Watkins said, adding that the population in the capital Djibouti City had more than doubled since 2010, now home to 85 percent of the population.

Nationwide, a full 18 percent of the population is considered acutely malnourished, rising to 26 percent in some areas -- well above the 15-percent emergency threshold, Watkins said.   Sixty percent of the country's population was also suffering from diarrhoeal diseases, he said.   Watkins said he hoped the lack of interest from funders would change, pointing out that a new appeal last month for $74 million (55 million euros) was already 13 percent funded, with contributions from the United States, the EU and Japan among others.
Date: Mon, 26 Nov 2012 18:20:54 +0100 (MET)

RIYADH, Nov 26, 2012 (AFP) - The United Nations said on Monday that the number of people in Arab countries infected with HIV more than doubled to 470,000 in the eight years to 2009. "The number of adults and children living with HIV has more than doubled between 2001 and 2009 from 180,000 to 470,000," according to data from UNAIDS, the UN programme on HIV and AIDS. New HIV infections increased from 43,000 in 2001 to 59,000 in 2009, it said at a meeting in Riyadh on combatting AIDS, organised by the Arab League and the Saudi government. The number of deaths from AIDS also surged from about 8,000 in 2001 to 24,000 in 2009.

In Djibouti and Somalia, the percentage of infected people represents 2.5 percent and 0.7 percent of the countries' respective populations. "These figures are very worrying and need an immediate response," it said in an Arabic-language statement. The figures appear in contrast with the global trend. UNAIDS said last week that 25 low- and middle-income countries had managed to at least halve their rate of new HIV infections since 2001, representing a reduction of 700,000 new HIV infections. Globally, new HIV infections fell to 2.5 million last year from 2.6 million in 2010 and represented a 20-percent drop from 2001, it said.
Date: Wed 23 Nov 2011
Source: IC Publications [edited]

Authorities in Djibouti have reported a serious outbreak of a potentially fatal diarrhea infection in the capital [Djibouti], with 2 deaths since October 2011 and 127 new cases this month [November 2011], the WHO said on Tuesday [22 Nov 2011]. WHO said 5000 cases of acute watery diarrhea (AWD) have already been reported this year [2011] compared to 2000 in the Red Sea port in 2010.

Poor hygiene and sanitation along with recent rainfall in some areas had led to the contamination of already limited and unsafe water supplies, according to the UN health agency, which said the drought in the Horn of Africa had exacerbated the situation.

"The effects of the recurring drought on several parts of Djibouti and neighbouring countries have resulted in a malnourished, poorer and more vulnerable population," a WHO statement said. [WHO] is working with the Djibouti ministry of health to train health workers and set up treatment centres.
Date: Tue, 22 Nov 2011 12:16:01 +0100 (MET)

GENEVA, Nov 22, 2011 (AFP) - Authorities in Djibouti have reported a serious outbreak of a potentially fatal diarrhoea infection in the capital, with two deaths since October and 127 new cases this month, the WHO said on Tuesday. The World Health Organization said 5,000 cases of Acute Watery Diarrhoea (AWD) have already been reported this year compared to 2,000 in the Red Sea port in 2010.

Poor hygiene and sanitation along with recent rainfall in some areas had led to the contamination of already limited and unsafe water supplies, according to the UN health agency, which said the drought in the Horn of Africa had exacerbated the situation. "The effects of the recurring drought on several parts of Djibouti and neighbouring countries have resulted in a malnourished, poorer and more vulnerable population," a WHO statement said. The body is working with the Djibouti ministry of health to train health workers and set up treatment centres.

Last week the UN rights agency reported an outbreak of cholera among Somali refugees in Kenya's huge Dadaab refugee camp, with one death. The WHO said on Tuesday that all five camps were affected by AWD but no cases had been reported in Kenya outside the camps. AWD is rife in south central Somalia where more than 53,000 cases were reported this year, resulting in 795 deaths, the agency said.
More ...

World Travel News Headlines

Date: Mon, 9 Dec 2019 11:12:25 +0100 (MET)
By Clare BYRNE

Paris, Dec 9, 2019 (AFP) - France's transport chaos deepened Monday on the fifth day of a nationwide strike over pension reforms, ramping up tensions at the start of a crucial week in President Emmanuel Macron's battle with trade unions.   With only two of the Paris metro's 16 lines running as normal and suburban trains also heavily disrupted, many commuters slipped behind the wheel to try to get to work in torrential rain, causing major gridlock.

By 9 am, the tailbacks in the Paris area ran to 600 kilometres (370 miles), twice the normal level, the Sytadin monitoring website said.   Large queues formed at bus stops following an announcement that one out of two buses would be running but striking workers blocked seven out of 25 bus depots, leaving more travellers stranded.   With many having opted to work from home last week and only now returning to the workplace, this week will test public support for the strike.

A poll Sunday in the Journal du Dimanche newspaper showed 53 percent of the French supporting the strike or expressing sympathy for their demands, up six points in a week.   Unions have called a second day of mass protests for Tuesday, a day before the government unveils the full details of its plans for a single points-based pension scheme that does away with dozens of more advantageous plans enjoyed by train drivers, sailors, lawyers and other professions.

- 'A monstrosity' -
Critics argue that the shake-up will require people in both the public and private sector to work longer for a smaller retirement payout.   Teachers are expected to walk out again for the second time in a week Tuesday, leading to widespread school closures.

Firefighters, electricity workers and "yellow vest" anti-government demonstrators have also joined railway workers in the streets in recent days.   The government's pensions envoy Jean-Paul Delevoye, who drafted the reforms, and Health Minister Agnes Buzyn will meet with trade unions on Monday to try to negotiate an end to the deadlock.   But the unions have sounded an uncompromising note.   "I will not negotiate over the implementation of what I describe as a monstrosity which endangers tomorrow's pensioners," said Yves Veyrier, the head of the militant Force Ouvriere union.

The strike has squeezed retailers in the run-up to Christmas, raising the prospect of another bleak year-end after the unrest caused by the yellow vests in late 2018.   The first day of the stoppage already caused an average 30 percent drop in sales, according to the Alliance of Commerce, which represents 27,000 supermarkets and clothing and shoe stores with almost 200,000 workers.   A hotel association said reservations in the larger Paris region dropped by 30 to 40 percent on the first day of the strike.    Regional and international trains, including the Eurostar to London and Thalys to Brussels, have also been hobbled by the unrest, and several flights were cancelled on the first days of the strike.

- Fairer system for all? -
Over 800,000 people took to the streets when the strike was launched on December 5, many accusing Macron of trying to weaken France's generous social safety net.   The president, Prime Minister Edouard Philippe and senior cabinet ministers met late Sunday to discuss the changes, which they argue will ensure a fairer and more sustainable system for all.   "If we do not carry out a far-reaching, serious and progressive reform today, someone else will do a really brutal one tomorrow," Philippe told Le Journal du Dimanche.

The strike has drawn comparisons with late 1995 when three weeks of strikes forced the then centre-right government to withdraw its pension reforms.   Adrien Quatennens, a lawmaker from the far-left France Unbowed party, acknowledged on LCI radio that the strike was hard on businesses and commuters, but said: "It's better to endure a few weeks of hassle than... years of hardship" in retirement.
Date: Mon, 9 Dec 2019 10:20:33 +0100 (MET)
By Neil SANDS, with Holly Robertson in Sydney

Wellington, Dec 9, 2019 (AFP) - Five people were killed, 18 were injured and several more were left stranded after an island volcano popular with tourists erupted unexpectedly in New Zealand on Monday.   Police said some 50 people were visiting White Island when it exploded suddenly in the early afternoon -- hurling ash and rock high into the air.   Two dozen people made it off the island, five of whom have since died. The rest are being treated for injuries, including severe burns.

Nothing is yet known about a group -- now estimated to number in the double digits -- who are still trapped on the island.   "We're unsure of the exact numbers on there and we're unsure of their wellbeing," said deputy commissioner John Tims.   As night fell, he said volcanic activity made a rescue attempt too dangerous.   "The island is unstable, there's a danger of further eruptions, it is physically unsafe for us to return to the island"   "I've got to consider the safety of our people and emergency services staff."   The eruption occurred at 2:11pm (0111 GMT), thrusting a thick plume of white ash 3.6 kilometres (12,000 feet) into the sky.   Seconds before, live camera feeds showed a group of more than a half dozen people walking on the crater floor. Then the images went black.

A "considerable number" of those caught up in the disaster are believed to be Australian, according to officials in Canberra.   As many as 30 people are also believed to be cruise passengers on a day trip from the vessel Ovation of the Seas, Kevin O'Sullivan, chief executive officer of industry body the New Zealand Cruise Association told AFP.   The ship's operator Royal Caribbean -- who had billed the trip to White Island as "an unforgettable guided tour of New Zealand's most active volcano" -- said "a number of our guests were touring the island" but did not confirm that number.   The ship has a capacity of around 4,000 people and set sail from Sydney last week on a 12 day voyage.

- Scene of terror -
Tourist Michael Schade, made it off the island just in time and was able to capture footage of the devastation.   His videos showed groups of startled tourists clustered by the shoreline, waiting to be evacuated as the ground around them smouldered, the sky filled with white debris. An ash-caked helicopter lies damaged nearby.   As his ship hurtled away, the caldera became virtually invisible, shrouded by a thick bank of ash.   Volcanic Air said they had landed a helicopter on the island shortly before the eruption carrying four visitors and one pilot. All were now accounted for.   "It had landed on the island. What happened after that we don't know, but we know that all five made it back to Whakatane on one of the tourist boats," a company spokesman told AFP.

Guillaume Calmelet, the co-director of Skydive Tauranga, saw the eruption from above as he took a customer on a tandem skydive from a plane 12,000 feet above the Bay of Plenty.   "As soon as the parachute opened there was this huge cloud that was really different to whatever we've seen before," he told AFP. "I could see it coming out in freefall, so probably about 30 seconds for the whole cloud to form, if that. It was pretty quick."   The country's National Emergency Management Agency described the eruption as "moderate", although the plume of ash was clearly visible from the mainland and from satellites flying overhead.    "We have seen a steady decline in activity since the eruption. There remains significant uncertainty as to future changes but currently, there are no signs of escalation."

White Island -- - also known as Whakaari -- is about 50 kilometres (30 miles) offshore in the picturesque Bay of Plenty and is popular with adventurous tourists willing to don hard hats and gas masks.   It is New Zealand's most active volcano cone and about 70 percent of it is underwater, according to government-backed agency GeoNet.   Around 10,000 people visit the volcano every year. It has erupted frequently over the last half-century, most recently in 2016.

In August of that year the New Zealand Defence Force airlifted a 2.4-tonne shipping container onto the island to serve as an emergency shelter in case of an eruption.   "Sudden, unheralded eruptions from volcanoes such as White Island can be expected at any time," said University of Auckland volcanologist Shane Cronin.   "The hazards expected from such events are the violent ejection of hot blocks and ash, and formation of 'hurricane-like' currents of wet ash and coarse particles that radiate from the explosion vent."   "These can be deadly in terms of causing impact trauma, burns and respiratory problems. The eruptions are short-lived, but once one occurs, there are high chances for further, generally smaller ones as the system re-equilibrates."
Date: Mon, 9 Dec 2019 09:54:20 +0100 (MET)

Rome, Dec 9, 2019 (AFP) - A 4.5 magnitude earthquake hit the central Italian region of Mugello on Monday, sending panicked residents into the streets but causing minimal damage to buildings.   The quake, centred some 31 km (19 miles) northeast of Florence in Tuscany, hit at 4:37 am (0330 GMT), after a series of smaller quakes, according to the national institute for geophysics and vulcanology (INGV).

Residents fled their buildings in the rain,  congregating outside or in their cars to await authorities.    "The quake went on for awhile, especially the first one, things fell down at a supermarket but for the moment we haven't seen any damage to people or things," said Filippo Carla' Campa, mayor of the town of Vicchio.   A resident of Barberino del Mugello said his neighbours were panicking getting out of the building.    "Paintings fell off the walls, bookcases fell over," he told Rai 24.    In Barberino del Mugello, the 17th century church suffered a crack in one side, television images showed.

Schools were closed in the region and some trains through Florence were cancelled or delayed.    Italy is frequently struck by seismic activity, often devastating. Most recently, a series of strong quakes hit central Italy in late 2016 and early 2017, killing 300 people.   In 1919, the area was hit by an earthquake that killed 100 people.
Date: Mon, 9 Dec 2019 03:52:15 +0100 (MET)

Mount Hutt, New Zealand, Dec 9, 2019 (AFP) - Almost 1,000 tourists were stranded in New Zealand's South Island Monday after wild storms cut highways, washed away bridges and flooded the rugged landscape.   Meteorologists said up to 400 millimetres (16 inches) of rain was dumped on the South Island over 24 hours by a severe weather system that unleashed gale-force winds and 230,000 lightning strikes.   The main highway through the island was closed after the Rangitata river burst its banks. Townships near the popular Franz Josef glacier were isolated when landslips blocked road access.

With New Zealand entering its peak tourist season, some 970 travellers at Franz Josef were left facing the prospect of taking an expensive helicopter ride to get out or hunkering down until Friday, when the road is expected to be cleared.   "Between the community, the hotels and motels and our welfare centre we've managed to billet out most people overnight," Civil Defence spokesman Stephen Doran told TVNZ.   "We'd just ask people to stay put at the moment. We want to keep the work site clear so we can get supplies in there... and try to get the road into some sort of shape."

Another landslip on the island's west coast will take an estimated six weeks to clear.   The worst of the weather hit over the weekend and it is forecast to deteriorate again later in the week, leaving authorities scrambling during a brief respite to complete as much repair work as possible.
Date: Sun, 8 Dec 2019 17:30:45 +0100 (MET)

Kigali, Dec 8, 2019 (AFP) - Rwanda on Sunday started a voluntary Ebola vaccination programme at its border with the Democratic Republic of Congo in a bid to prevent the spread of the deadly virus from its neighbour.   All countries in high-risk areas, even if not hit by Ebola, had been advised by the WHO to use a new vaccine developed by US group Johnson & Johnson, the country's health minister, Diane Gashumba, told journalists.   The idea was "to protect those with high chances of getting in contact with people living in areas where Ebola has been reported to be active", she said.

The vaccine, Ad26-ZEBOV-GP, is an experimental drug produced by US pharmaceuticals giant, Johnson & Johnson. It was used for the first time in mid-November in Goma in DR Congo, on the other side of the border.    So far, there have no confirmed cases of Ebola in Rwanda.   The epicentre of the outbreak in DR Congo, which has killed more than 2,200 people since August 2018, is located 350 kilometres (217 miles) north of Goma, in the Beni-Butembo region.   That region sits on the DR Congo border with Uganda.   More than 250,000 people in DR Congo have already been vaccinated using another product, rVSV-ZEBOV, made by US drug company, Merck Shape and Dohme.

- Ebola in Goma -
People working in the health sector, at border crossings, police officers, and business executives who frequently travel between the two countries are being given priority in the vaccination campaign.   But all residents in the border districts can ask to be vaccinated if they wish.    The first volunteers expressed relief at the measure.    "We lived in a life of worry because of what was going on in DR Congo," Joel Ntwari Murihe, one of the first Rwandans to be vaccinated, told AFP.   "It caused a lot of border disruptions as we were restricted to buying or selling with DR Congo residents who live in Goma.    "The vaccine is an assurance to the safety for our lives and our children's lives."

The head of DR Congo's anti-Ebola efforts, Jean-Jacques Muyembe, and the WHO's representative in Rwanda, Kasonde Mwinga, were present at the campaign launch.    In August, Rwanda briefly closed its border with DR Congo and ordered its citizens not to visit the country when the first Ebola cases were recorded in Goma.   The city, which is the regional capital of the Congolese province of North Kivu, sits on the border with Rwanda.    The border has since been reopened, but strict medical checks are being enforced.
Date: Sun, 8 Dec 2019 14:43:06 +0100 (MET)

Kuala Lumpur, Dec 8, 2019 (AFP) - Malaysia has reported its first polio case in 27 years, health authorities said Sunday, announcing a three-month-old baby had been diagnosed on Borneo island.   The Malaysian health ministry's director-general, Noor Hisham Abdullah, said the baby from Tuaran in eastern Sabah state had been admitted into intensive care after experiencing fever and muscle weakness.   "The patient is currently undergoing treatment in an isolation ward and is in a stable condition but needs respiratory support," Noor Hisham said, adding that the infant was diagnosed on Friday.

Polio is a highly infectious viral disease which has no cure and can only be prevented with several doses of oral and injectable vaccines. It affects the nervous system and spinal cord and can be fatal in rare cases.   Over the past three decades the world has made great strides in the battle against polio. The World Health Organization said only 33 cases were reported worldwide last year.   Malaysia was declared polio free in 2000. The last case in the country occurred in 1992.

The diagnosis comes after the Philippines, which shares a close sea border with Sabah, was hit in September by its first polio case in nearly two decades.   Noor Hisham said test results showed that the Malaysian child was infected with a strain that shared genetic links to the virus detected in the Philippines.   Public health expert  T. Jayabalan told AFP that he was not surprised by the polio outbreak because immunisation was not mandatory in Malaysia.   "This first case probably is the tip of the iceberg. There is a very high possibility of a rising trend," he warned.   Jayabalan said there was a small group of people who refuse vaccination on account of misinformation.

In recent years, Malaysia had recorded a number of deaths among children from diphtheria, a vaccine-preventable disease, because they did not receive immunisation.   Noor Hisham said investigations found that 23 children under the age of 15 who lived close to the infected baby had also not received the polio vaccine.   "This is a frustrating situation because the spread of the disease... can only be stopped with polio immunisation."   Vaccination activities and monitoring will be carried out to try and contain the spread of the disease, he added.
Date: Sun, 8 Dec 2019 05:56:06 +0100 (MET)

Sydney, Dec 8, 2019 (AFP) - Smoke haze from bushfires raging in Australia spread to the capital Sunday, as firefighters raced to contain more than 140 blazes ahead of a heatwave forecast early this week.   Australia is experiencing a horrific start to its fire season, which scientists say began earlier and is more extreme this year due to a prolonged drought and the effects of climate change.

Residents of Canberra in the country's southeast woke up to see the capital shrouded in haze Sunday, joining those in Sydney who have endured weeks of toxic air pollution caused by bushfire smoke.   Officials said favourable weather conditions had given them a chance to bring several blazes under control before the forecast return of strong winds and high temperatures Tuesday.   Among those is a "mega fire" burning across 250,000 hectares within an hour's drive of Sydney, Australia's largest city, where ash from the fires has occasionally fallen.

Firefighters are now bracing for Tuesday, when temperatures are expected to reach above 40 Celsius in parts of New South Wales state -- worst-hit by the bushfires -- and gusting westerly winds are likely to fan the flames.   "Today (fire) crews will be doing what they can to consolidate and strengthen containment lines, which in some areas will include backburning," NSW Rural Fire Service spokesman Greg Allan told AFP.   But the state's Bureau of Meteorology warned that the massive fires are "in some cases just too big to put out at the moment".   "They're pumping out vast amounts of smoke which is filling the air, turning the sky orange & even appearing like significant rain on our radars," the department tweeted.

Nearly 50 reinforcements from the United States and Canada have been flown in to support fatigued firefighters in recent days, with the international contingent tasked with providing logistical assistance.   In neighbouring Queensland, the focus was also on managing fatigue among frontline firefighters -- who in both states are almost all volunteers -- as weather there provided a brief reprieve from weeks of battling blazes.   "We're just looking to wind down and recover and prepare for the next round, whenever that may be," a Queensland Fire and Emergency Service spokesman told AFP.

Since the crisis began in September, six people have been killed, more than 700 homes destroyed and an estimated two million hectares (almost five million acres) scorched.   Though the human toll has been far lower than the deadliest fire season in 2009 -- when almost 200 people died -- the scale of this year's devastation has been widely described as unprecedented, as Australians grapple with the impacts of a changing climate.   Official data shows 2019 is on track to be one of the hottest and driest years on record in Australia.
Date: Sat, 7 Dec 2019 15:58:56 +0100 (MET)

Kampala, Dec 7, 2019 (AFP) - Twelve people have been swept to their deaths by floods in western Uganda, the Red Cross said on Saturday, as the East African country is battered by torrential rain.   "We have recovered 12 bodies from the water and one person has been rushed to hospital with serious injuries," said Diana Tumuhimbise, Red Cross branch manager in the Bundibugyo district.   "The rain started last night and continued until 9:00 am (0600 GMT)," she told AFP on Saturday.   "Several houses have been swept away, roads have been blocked and some washed away completely."

The Red Cross has launched a search and rescue operation with the police, military and community members in 12 affected areas but it is not yet clear how many people are missing.    Rain is hampering communication in the remote location, on the border with DR Congo and separated from the rest of Uganda by the Rwenzori mountains.   At least 20 people have been killed as a result of floods and mudslides in the last week in Uganda.

The extreme weather has been blamed on the Indian Ocean Dipole -- a climate system defined by the difference in sea surface temperature between western and eastern areas of the ocean.   At the moment, the ocean around East Africa is far warmer than usual, resulting in higher evaporation and moist air flowing inwards over the continent as rain: the hallmarks of a "positive" dipole.   Scientists warn that as ocean temperatures rise because of climate change, Indian Ocean dipoles will become more frequent and severe.
Date: 8 Dec 2019
Source: The Star [edited]

A polio case has been confirmed in the country, the 1st in Malaysia in 27 years.  The Health Ministry confirmed that a 3-month-old Malaysian boy from Tuaran, Sabah had been admitted into a hospital's Intensive Care Unit after experiencing fever and weakness of limbs. Health director-general Datuk Dr Noor Hisham Abdullah said the last polio case in Malaysia occurred in 1992, and in 2000, the country was declared as being polio-free.

In the recent case, the child was confirmed to be infected with the vaccine-derived poliovirus type 1 (VDPV1) on [6 Dec 2019] this year.  "The patient is currently undergoing treatment in an isolation ward and is in stable condition but needs respiratory support," he said in a statement Sunday [8 Dec 2019]. He added that the VDPV1 is classified as a circulating vaccine-derived poliovirus (cVDPV) type 1.

"The cVDPV originates from a poliovirus that has been weakened by the orally-administered polio vaccine. Those who have been vaccinated will be protected from infection. The weakened virus has been excreted from the body through the faeces. However, in unsanitary environments, the virus can infect others who have not been immunised against polio and will thus spread in communities whose polio immunisation rates are less than 95%. The longer the virus spreads in the community, it will undergo genetic mutation until it once again becomes an active virus," he said.

Dr Noor Hisham said test results showed that the virus has genetic links to the polio virus that was detected in a recent outbreak in the Philippines. The Philippines in September this year [2019] declared an outbreak of polio, caused by VDPV1.

He added that up until [5 Dec 2019], investigations at the vicinity of the polio-infected child's residence found that 23 out of 199 people aged between 2 months to 15 years have not received the polio vaccine.  "This is a frustrating situation because the circulation of a cVDPV can only end with a polio immunisation. "After explaining the importance of polio immunisation, the parents of the children have agreed to have them vaccinated," he said.

He added that surveillance for acute flaccid paralysis (AFP) -- a clinical syndrome which is characterised by weakness of the muscles of respiration and swallowing -- will be conducted in the area. "As of [5 Dec 2019], as many as 646 people have been checked, and symptoms of AFP have not been detected. "To ensure that the polio virus does not continue to spread in Malaysia and infect those who are not immunised, vaccination activities will be continued in the area of this case and will be expanded to other risk areas," he said.

He urged members of the public to immediately seek treatment if they have AFP symptoms or to inform the Health Ministry if they know of other cases.  "The success in eradicating the disease previously was due to prevention efforts through the polio vaccination, which was introduced in the National Immunisation Programme in 1972. The programme was made even more effective when the vaccine was changed from being administered orally to being administered through injection," he said.

Polio, or poliomyelitis, is a potentially deadly infectious disease caused by the poliovirus and can cause paralysis by invading a person's brain and spinal cord. The disease has no cure and can only be prevented through vaccination.  [Byline: Clarissa Chung]
===================
[As the media report states, this is the 1st case of polio reported from Malaysia since 1992, 27 years ago. According to the genetic profile of the isolated cVDPV1, it is related to the cVDPV1 identified in the Philippines. It is not mentioned whether this is related to the cVDPV1 identified from environmental samples in the Manila metropolitan region or whether it is related to the paralytic case confirmed with VDPV1 in the Mindinao region (see below for details).

It is curious that cVDPV1 seems to be affecting mostly countries in Eastern Asia (Myanmar, Malaysia) and Western Pacific (Papua New Guinea and Indonesia) this year (2019). Since 2015, the countries reporting cVDPV1 associated AFP cases include Philippines, Myanmar, Indonesia, Papua New Guinea, Laos, Madagascar and Ukraine  (<http://polioeradication.org/polio-today/polio-now/this-week/circulating-vaccine-derived-poliovirus/>).

This now brings the total number of cVDPV associated acute flaccid paralysis (AFP) cases in the past 2 years to 24.

Tuaran, Sabah state is located on the northwest coast of Borneo island (<https://www.mapsofworld.com/malaysia/malaysia-political-map.html>). Of interest is that Basilan island, where the VDPV1 case has been reported, is one of the southernmost islands of the Philippines.

The HealthMap/ProMED map of Malaysia:
Date: Tue 3 Dec 2019
Source: Liberian Observer [edited]

A report reaching the Daily Observer from the Nimba County Health Team said that Lassa fever is becoming alarming, with 9 cases confirmed, out of which 3 persons have died.

The county health surveillance officer, Isaac Cole, told reporters in Nimba that 3 districts, including Sanniquellie Mahn, Saclepea, and Tappita have been declared as the "epicenters" of the deadly disease.

Of the 3 districts, Cole said Sanniquellie Mahn is the worst-affected area, where over 30 cases of suspected Lassa cases were registered and 9 confirmed, and from where the 3 deaths are recorded.

He has meanwhile warned locals to avoid rodents (rats) by thoroughly cleaning their surroundings to stop the flow of rats in their homes. The county health team is therefore calling on residents to report any suspected case, particularly people who may have developed prolonged fever, to any of the nearest health facilities. Residents are also advised not to bury the dead (suspected Lassa fever patients) without referencing trained medical practitioners.

"Protect your food from rats, and also avoid touching them at all times should you encounter one," he added.

Lassa fever, also known as Lassa hemorrhagic fever (LHF), is a type of viral hemorrhagic fever caused by the Lassa virus. Many of those infected by the virus do not show symptoms early on. When symptoms do occur, they typically include fever, weakness, headaches, vomiting, and muscle pains.  [Byline: Ishmael F. Menkor]
===================
[The occurrence of Lassa fever cases in Liberia is continuing with the confirmation of 9 new cases. The previous ProMED-mail post reported that according to MoH data, a total of 92 suspected cases between 1 Jan-25 Aug 2019, including 21 deaths, have been reported. Of these, 25 cases have been confirmed by RT-PCR (Nimba (9), Bong (10), Grand Bassa (5), and Grand Kru (1)), while 9 remain suspected cases, the release recorded. The case-fatality rate among confirmed cases in that report was stated as 36% (9 deaths out of 25 confirmed cases). Males are mostly affected by the disease (56%) of confirmed cases as compared to females.

Occurrence of Lassa fever cases in areas outside the usual "Lassa fever belt" is of concern, and the Ministry of Health is wise to increase public information and advise citizens about measures that should be taken to avoid infection with the virus. Occurrence of Lassa fever in Liberia is not new, and cases have occurred there sporadically for several years. Between 1 Jan and 27 Jun 2018, 20 cases were laboratory confirmed (see archive no. http://promedmail.org/post/20180711.5898495). Apparently, all those Lassa fever virus infections were acquired by contact with infected rodents or their excretions. Lassa fever virus can be acquired from infected rodents or patients in the hospital. Transmission can occur in health facilities when personal protective equipment is not employed or barrier-nursing practices or biocontainment facilities in the laboratory are not adequate to protect staff from blood and secretions of infected patients.

As mentioned in previous posts, Lassa fever virus transmission to humans occurs when people are in contact with the reservoir rodent host, the multimammate mouse (_Mastomys natalensis_ and _M. erythroleucus_) and the African wood mouse (_Hylomycus pamfi_) or their excreta, as was likely the situation in many of these cases. Rodent control has to be undertaken at the village level with individual households employing the preventive measures listed above. This requires an extensive and continuous public education effort.

Images of the _Mastomys natalensis_ mouse, the rodent reservoir of Lassa fever virus, can be seen at <https://www.inaturalist.org/taxa/45326-Mastomys-natalensis> and of _M. erythroleucus_ and _Hylomycus pamfi_ at <http://punchng.com/nigerias-large-rat-population-threatens-lassa-fever-war/>. - ProMED Mod.TY]