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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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Guam

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Tue 19 Mar 2019
Source: Daily Post [edited]

The Department of Public Health and Social Services is monitoring an outbreak of shigellosis on Guam. Shigellosis is an infectious disease caused by a group of bacteria called _Shigella_. Most who are infected with _Shigella_ develop diarrhoea, fever, and stomach cramps starting a day or 2 after they are exposed to the bacteria.

So far in 2019, a total of 10 cases have been reported, 9 have been confirmed. In 2018, a total of 29 cases of shigellosis were reported; 23 were confirmed.

Shigellosis usually resolves in 5 to 7 days. However some people who are infected may have no symptoms at all, but may still pass the _Shigella_ bacterium to others. The spread of shigellosis can be stopped by frequent and careful hand washing with soap and taking other hygiene measures.
=========================
[_Shigella_ was discovered more than 100 years ago by the Japanese microbiologist Kiyoshi Shiga, for whom the genus is named. There are 4 species: _S. boydii_, _S. dysenteriae_, _S. flexneri_, and _S. sonnei_. _Shigella_ organisms can survive transit through the stomach because they are less susceptible to acid than other bacteria; for this reason, as few as 10 to 100 organisms can cause disease. Ingested bacteria pass into the small intestine where they multiply; large numbers of bacteria then pass into the colon, where they enter the colonic cells. Given its relatively low infectious dose, transmission can occur via contaminated food and water or via direct person-to-person spread, including sexual practices more common in MSM (men who have sex with men). Humans are the only natural reservoir for the disease.

The bacterium is the classical cause of bacterial dysentery (formerly known as flux or the bloody flux) is an inflammatory disorder of the colon, which results in severe diarrhoea containing mucus and/or blood in the faeces with fever, abdominal pain, and rectal tenesmus (pain while passing the diarrhoea).

Guam (<https://en.wikipedia.org/wiki/Guam>) is an unincorporated and organized territory of the United States in Micronesia in the western Pacific Ocean. It is the easternmost point and territory of the USA, along with the Northern Mariana Islands. The inhabitants of Guam are called Guamanians, and they are American citizens by birth. Indigenous Guamanians are the Chamorros, who are related to other Austronesian natives of Eastern Indonesia and Philippines and Taiwan.  - ProMED Mod. LL]

[HealthMap/ProMED map available at:
Date: Wed, 23 Aug 2017 10:40:35 +0200

Tokyo, Aug 23, 2017 (AFP) - Guam's number two politican Wednesday rolled out the welcome mat to tourists, promising his sun-kissed tropical island is safe -- despite North Korea's threat to launch missiles toward the Pacific US territory.   Lieutenant Governor Raymond Tenorio made the comments in Tokyo where he was joined by Guam's tourism boss Jon Nathan Denight, amid fears that Pyongyang's sabre-rattling will hammer the key tourism industry.

Last year, Japanese tourists made up about half of the 1.5 million visitors to the island, which is about a four-hour flight from Tokyo.   "We're one of the most protected and safe islands you'll find in the world," Tenorio told reporters at the Foreign Correspondents' Club of Japan.   He added there was a big US military presence on Guam, a strategic outpost in the Pacific with its own missile defence system.

Added Denight: "Guam's brand image was built as a very safe and family-friendly destination. I want to reassure people of Japan that there has been no change and Guam is safe for travel."   The unusual appeal to tourists comes several weeks after Pyongyang said it was considering firing a salvo of missiles toward the island -- prompting an angry reaction from US President Donald Trump.

Unlike Trump, however, Guam's 162,000-odd residents seem to be taking it all in stride, including Tenorio.   "By and large, 99 percent of our population just go about their lives every single day. Things are normal on Guam," he said.   "I have to admit sometimes it's really hard to do my job in my office. If you look outside...(from) where I'm sitting at my desk many times you'll see dolphins chasing the fish."
Date: Fri, 11 Aug 2017 12:10:33 +0200

Hagatna, Guam, Aug 11, 2017 (AFP) - Tourism-dependent Guam is looking to cash in on its new-found fame as a North Korean missile target, tapping an unlikely promotional opportunity to attract visitors to the idyllic island and prove that all publicity is good publicity.   Pyongyang's threats to launch four missile strikes near the US territory has stirred global curiosity in the remote Pacific destination, with it trending heavily on search engines as social media users wondered, "what is Guam?"

Although Guam hosts two US military installations and 6,000 US soldiers, making it the target of North Korea's wrath, tourism authorities are keen to dispel any impression of danger to the tranquil island and its secluded beaches.   "The circumstances are unfortunate but this is a good opportunity for us to educate the world about Guam and our culture, about where we are, and who we are," said Josh Tyquiengco, marketing director at Guam Visitors Bureau, the official agency for the island.

"Guam is more than a military base. We are a safe family destination. We reassure potential visitors that we continue to be a safe... place to visit," Tyquiengco told AFP.   Despite North Korea's threats to prepare plans within days that would surround Guam with "enveloping fire", fears of a potential attack have not deterred tourists from visiting Guam, he said.   "We heard about a few booking cancellations from South Korea, but it's too minimal to affect the industry," he said. 

Governor Eddie Calvo, in a briefing late Friday, said any attack on Guam "would be met with overwhelming force", pointing out that the biggest threat facing the island was the looming typhoon season.   "With that, everybody should conduct their lives like business as usual. It's the weekend. Go out, have a good time, enjoy the beaches tomorrow and live your lives.   "At this point, there are thousands of tourists coming in on a daily basis... from Japan, (South) Korea, Taiwan and China and other areas. It is our belief that they should enjoy themselves here."

As aircraft after aircraft -- packed with tourists -- landed Friday at Guam's international airport, the latest visitors to the island appeared untroubled by the prospect of missile strikes.   Sun Doojin, who arrived with her husband and two-year-old daughter on a flight from Seoul, responded with an emphatic "no" when asked if she was concerned about an attack during her visit.

- 'A hidden gem' -
The Guam Daily Post, in an editorial, said the spotlight on the territory offered an opportunity to show the world why an island of 162,000 people draws more than 1.5 million tourists a year.    "The beach waters are crystal clear, beaches aren't overrun, and nature hiking trails are very accessible.   "The different cultures that are showcased on the island through food make Guam a hidden gem, a tropical vacation getaway but with the amenities and comforts of some of the small cities stateside."

Guam's history of earthquakes and typhoons mean its infrastructure is built to robust standards and authorities insist that the island is prepared for any emergency, including a North Korean strike.   Homeland Security spokeswoman Jenna Gaminde told the Guam Daily News that in the event of an attack, residents would be immediately notified by sirens from the All-Hazards Alert Warning System located throughout the island.   "If you hear the sirens, tune into local media -- radio, print, television -- for further instructions," she said. 

Pyongyang has said it would take less than 18 minutes for a missile to cross the 3,400-kilometre (2,100-mile) distance to the US territory.   In addition to the US military bases, Guam is also equipped with the sophisticated THAAD weapons system which is capable of destroying intermediate-range missiles in the final phase of flight.

Officials, however, have sought to brush off fears and say there has been no change in the threat level for now.   "I don't think there's anything to worry about. No missile is going to land on Guam," said Carl Peterson, who serves on the Guam Chamber of Commerce's armed forces committee.   "We've got defense mechanisms in place... they have the ability to seek out the missiles with kinetic energy and destroy it."
Date: Thu, 8 Jun 2017 21:02:05 +0200

Miami, June 8, 2017 (AFP) - Five percent of women in the US territories who were infected with the Zika virus while pregnant had fetus or babies with defects, including microcephaly, government health data said Thursday.   The report by the US Centers for Disease Control and Prevention covered the US territories of Guam, American Samoa, the US Virgin Islands, Micronesia, the Republic of Marshall Islands and Puerto Rico.   The report is the first based on data from the US territories and the largest study of its kind to date.

CDC experts said the findings are consistent with previous findings about Zika cases in the mainland United States.   "Women in the US territories and elsewhere who have continued exposure to mosquitoes carrying Zika are at risk of infection," said CDC acting director Anne Schuchat.    "We must remain vigilant and committed to preventing new Zika infections."   The rate of birth defects was slightly higher -- eight percent, or one in 12 -- in women whose infections were confirmed early in the pregnancy, during the first trimester, said the report.

The findings were based on the cases of 2,549 women with possible Zika virus infection who completed their pregnancies.   Among these women, 1,508 had confirmed Zika virus infection from January 1, 2016 to April 25, 2017.   Over 120 pregnancies resulted in Zika-associated birth defects, including infants born with unusually small heads, an irreversible condition known as microcephaly.   Other complications in babies included seizures and problems with movement, coordination, eating and near constant crying.

Zika can be spread by the bite of infected mosquito or via sexual contact.  Pregnant women are urged to avoid areas where Zika is spreading.   Since Zika erupted on a large scale in mid-2015, more than 1.5 million people have been infected, mostly in Brazil and other countries in South America.    Some 70 countries have been impacted.   Zika may lead to an itchy rash and although it is dangerous for pregnant women and their fetuses, it often causes no symptoms in adults.   In November 2016, the World Health Organization announced that the Zika virus outbreak no longer poses a world public health emergency, though it warned the epidemic remains a challenge.
Date: Fri 27 Mar 2015
Source: Outbreak News Today [edited]

Health authorities on the Pacific Island of Guam say the pertussis, or whooping cough outbreak has reached 11 cases to date. This comes after the Department of Public Health and Social Services (DPHSS) received 3 additional laboratory confirmed cases of the vaccine-preventable disease in a 9 month old child, 3 year old child, and 41 year old adult. Investigation into the newest cases show no epidemiological linkage with each other or previous reported cases.  [Byline: Robert Herriman]
=======================
[Guam is an organized, unincorporated territory of the United States in the western Pacific Ocean. A map of the island can be found at <http://www.lib.utexas.edu/maps/islands_oceans_poles/guam.gif>.

There are likely a number of reasons for the upswing of pertussis in the USA and elsewhere, which include the well-recognized normal swings in incidence, the increase in the number of unvaccinated individuals whose parents chose not to vaccinate them, and waning immunity which has caused public health officials to advise boosters for all adults and especially pregnant women. However, research by both Dr Frits R Mooi from the Netherlands (Pertussis - Australia (04): newly emerging clones, discussion 20120322.1078115) and Dr Lyn Gilbert from Australia (Pertussis - Australia (03): newly emerging clones 20120321.1076103) have been previously highlighted in ProMED-mail, reflecting antigenic changes in circulating clones of _Bordetella pertussis_ which may be causing the increased number of pertussis cases throughout the world. These changes may result in a need for modifications of the currently used acellular pertussis vaccines. - ProMED Mod.LL]
More ...

Belize

Belize US Consular Information Sheet
November 05, 2008
COUNTRY DESCRIPTION:
Belize is a developing country.
Tourism facilities vary in quality, from a limited number of business class hotels in Belize City and resorts on the cayes to
range of ecotourism lodges and very basic accommodations in the countryside.
Crime is a growing concern. Read the Department of State Background Notes on Belize for additional information.

ENTRY/EXIT REQUIREMENTS :
All U.S. citizens must have a U.S. passport valid for the duration of their visit to Belize.
U.S. citizens do not need visas for tourist visits of up to thirty days, but they must have onward or return air tickets and proof of sufficient funds to maintain themselves while in Belize.
Visitors for purposes other than tourism, or who wish to stay longer than 30 days, must obtain visas from the government of Belize.
All tourists and non-Belizean nationalities are required to pay an exit fee of U.S. $35 (payable in U.S. dollars only) when leaving Belize. Additional information on entry and customs requirements may be obtained from the Embassy of Belize at 2535 Massachusetts Avenue NW, Washington, DC
20008, Tel. (202) 332-9636 or at their web site:
http://www.embassyofbelize.org.

Information is also available at the Belizean Consular offices in Miami, and Los Angeles, or at the Belizean Mission to the UN in New York.
Visit the Embassy of Belize web site at http://belize.usembassy.gov 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:
Visitors should exercise caution and good judgment when visiting Belize.
Crime can be a serious problem (see Crime), particularly in Belize City and remote areas.
Road accidents are common (see Traffic Safety and Road Conditions) and traffic fatalities have included Americans.
Public buses and taxis are frequently in poor condition and lack safety equipment.
Medical care is limited and emergency response services such as ambulances or paramedics may be either unavailable or limited in capability or equipment (See Medical Facilities and Health Information).

Boats serving the public, especially water taxis, often do not carry sufficient safety equipment, may carry an excess number of passengers and may sail in inclement weather.
Rental diving equipment may not always be properly maintained or inspected, and some local dive masters fail to consider the skill levels of individual tourists when organizing dives to some of Belize’s more challenging sites. Deaths and serious mishaps have occurred as a result of negligent diving tour operators and the lack of strict enforcement of tour regulations. The Embassy strongly recommends that anyone interested in scuba diving and snorkeling while in Belize check the references, licenses and equipment of tour operators before agreeing to or paying for a tour.
Both tour guides and boat captains are now required to be licensed by the Government of Belize. Safety precautions and emergency response capabilities may not be up to U.S. standards.

Following a fatal accident at the Cave Branch Archeological Park in September 2008, the Belize Tourism Board (BTB) is implementing new regulations, effective and legally enforced beginning October 15, 2008, to improve safety at cave tubing attractions.
Those policies will include an enhanced, mandatory guest-to-guide ratio of eight-to-one for all operating cave tubing tour companies in Belize.
Additional signage will be posted in each cave tubing excursion site, informing participants of park rules and current water conditions and/or warnings.
Mandatory specialty training for each cave tubing guide will continue and include education on new regulations.

Helmets will also be required for each cave tubing participant starting January 1, 2009.
Furthermore, the National Institute of Culture and History (NICH), which manages the Cave Branch Archeological Park, will be installing additional monitoring equipment for cave tubing excursions which measure currents and other factors needing to be taken into considerations to ensure participant safety,

Cave tubing participants are urged to exercise due caution and their own best judgment regarding safety and river conditions at the time of their tour, particularly during the rainy/hurricane season from June 1 through November 30.
Rainfall upstream from tour sites, sometimes miles away, can cause rapid changes in current strength and water level conditions without notice.

The border between Belize and Guatemala is in dispute, but the dispute thus far has not affected travel between the two countries.
There have not been any terrorist activities in Belize.

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

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad .
CRIME:
The incidence of crime, including violent crimes such as armed robbery, shooting, stabbing, murder, and rape, is on the rise.
The Embassy has noted an increase in recent years in reports of crimes against tourists at resorts and on the roadways and river ways.
The incidence of crimes such as theft, burglary, purse snatching and pick pocketing rises around the winter holidays and spring break.
Several victims who resisted when confronted by criminals have received serious personal injuries, including gunshot wounds.
Although the majority of reported incidents are in Belize City, crime occurs in all districts including tourist spots such as San Pedro, Caye Caulker, and Placencia.

Sexual harassment and/or assault of females traveling alone or in small groups have occurred this past year.
Several American travelers have been the victims of sexual assaults in recent years. One of these occurred after the victim accepted a lift from an acquaintance, while others have occurred during armed robberies in resort areas.
One of these assaults has resulted in the death of the victim.

The Embassy recommends that visitors travel in groups and only in daylight hours, stay off the streets after dark, in urban and rural areas, and avoid wearing jewelry, or carrying valuable or expensive items.
As a general rule, valuables should not be left unattended, including in hotel rooms and on the beach.
Care should be taken when carrying high value items such as cameras, or when wearing expensive jewelry on the street.
Women’s handbags should be zipped and held close to the body.
Men should carry wallets in their front pants pocket.
Large amounts of cash should always be handled discreetly.

If traveling by taxi, use only vehicles with green license plates, do not get in a taxi that is occupied by more than the driver, and do not let the driver pick up additional fares.

Armed robberies of American tourist groups occurred during the summer of 2006 in the Mountain Pine Ridge and Caracol regions of the western district of Belize.
Due to increased police patrols, coordinated tours among resort security managers, and the arrest of two of the "highway bandits," there have not been any additional robberies since June, 2006. In the past, criminals have targeted popular Mayan archeological sites in that region.
Visitors should travel in groups and should stick to the main plazas and tourist sites.
Although there are armed guards posted at some of the archeological sites, armed criminals have been known to prey on persons walking from one site to another.
Victims who resist when confronted by these armed assailants frequently suffer personal injury.

Travel on rural roads, especially at night, increases the risk of encountering criminal activities.
Widespread narcotics and alien smuggling activities can make remote areas especially dangerous.
Though there is no evidence that Americans in particular are targeted, criminals look for every opportunity to attack, so all travelers should be vigilant.

Rather than traveling alone, use a reputable tour organization.
It is best to stay in groups, travel in a caravan consisting of two or more vehicles, and stay on the main roads.
Ensure that someone not traveling with you is aware of your itinerary.
Travelers should resist the temptation to stay in budget hotels, which are generally more susceptible to crime, and stay in the main tourist destinations.
Do not explore back roads or isolated paths near tourist sites.
And remember always to pay close attention to your surroundings.

Americans visiting the Belize-Guatemala border area should consider carefully their security situation and should travel only during daylight hours. Vehicles should be in good operating condition, adequately fueled, and carry communications equipment.
Persons traveling into Guatemala from Belize should check the Country Specific Information for Guatemala and the U.S. Embassy web site at http://guatemala.usembassy.gov for the latest information about crime and security in Guatemala.

A lack of resources and training impedes the ability of the police to investigate crimes effectively and to apprehend serious offenders. As a result, a number of crimes against Americans in Belize remain unresolved.
Nonetheless, victims of crime should report immediately to the police all incidents of assault, robbery, theft or other crimes as well as notifying the U.S. Embassy in Belmopan, telephone 822-4011(after hours and weekends 610-5030).
Tourists may contact the Belizean tourist police unit in addition to the main police office for assistance.

In addition to reporting crimes to local police, American citizens should report all criminal incidents to the U.S. Embassy in Belmopan, telephone 822-4011 (after hours and weekends 610-5030).
The embassy staff can assist an American with finding appropriate medical care, contacting family members or friends, and having funds transferred, as well as in determining whether any assistance is available from the victim’s home state.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help explain the local criminal justice process and assist in finding an attorney if needed.

Drug use is common in some tourist areas.
American citizens should avoid buying, selling, holding, or taking illegal drugs under any circumstances.
Penalties for possession of drugs or drug paraphernalia are generally more severe than in the U.S.

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.

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:
Medical care for minor conditions is generally available in urban areas.
Trauma or advanced medical care is limited even in Belize City; it is extremely limited or unavailable in rural areas.
Serious injuries or illnesses often necessitate evacuation to another country.
The Government of Belize reported an outbreak of dengue fever in April, May and June of 2005.

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

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas .
TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Belize is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Valid U.S. driver's licenses and international driving permits are accepted in Belize for a period of three months after entry.
Driving is on the right-hand side of the road.
Buses and private vehicles are the main mode of transportation in Belize; no trains operate in the country.
Roadside assistance can be difficult to summon, as there are very few public telephones along the road and emergency telephone numbers do not always function properly.
The Belizean Department of Transportation is responsible for road safety.

Roads in Belize vary from two-lane paved roads to dirt tracks.
The few paved roads are high-crowned roads, which can contribute to cars overturning, and have few markings or reflectors.
Even in urban areas, few streets have lane markings, leading many motorists to create as many lanes as possible in any given stretch of street or road.
Bridges on the major highways are often only single lanes.
The Manatee Road, leading from the Western Highway to Dangriga, is unpaved, easily flooded after storms and without services.
The Southern Highway from Dangriga to Punta Gorda is mostly completed and in good condition, except for a short portion that is under construction.
Service stations are plentiful along the major roads, although there are some significant gaps in the rural areas.

During Tropical Storm Alma/Arthur in May-June 2008, the Southern Highway bridge over the Sittee River, north of Kendall, Stann Creek District, was destroyed.
In the interim, a temporary causeway has been constructed pending permanent replacement of the Kendall bridge but at times the causeway may not be passable due to conditions on the Sittee River.
The causeway itself has had to be replaced several times following major rainfall and flooding.

Poor road and/or vehicle maintenance causes many fatal accidents on Belizean roads.
Speed limits are 55 miles per hour on most highways and 25 miles per hour on most other roads, but they are seldom obeyed or even posted.
Many vehicles on the road do not have functioning safety equipment such as turn signals, flashers, or brake lights.
Seatbelts for drivers and front-seat passengers are mandatory, but child car seats are not required.
Driving while intoxicated is punishable by a fine; if an alcohol-related accident results in a fatality, the driver may face manslaughter charges. Moreover, Americans can and have been imprisoned in Belize for accidents, even where alcohol is not involved.

Unusual local traffic customs include: pulling to the right before making a left turn; passing on the right of someone who is signaling a right-hand turn; stopping in the middle of the road to talk to someone while blocking traffic; carrying passengers, including small children, in the open beds of trucks; and tailgating at high speeds.

Bicycles are numerous and constitute a traffic hazard at all times.
Bicyclists often ride against traffic and do not obey even basic traffic laws such as red lights or stop signs.
Few bicycles have lights at night. It is common to see bicyclists carrying heavy loads or passengers, including balancing small children on their laps or across the handlebars.
The driver of a vehicle that strikes a bicyclist or pedestrian is almost always considered to be at fault, regardless of circumstances.
Americans who have struck cyclists in Belize have faced significant financial penalty or even prison time.

Driving at night is not recommended, due to poor signage and road markings, a tendency not to dim the lights when approaching other vehicles, and drunk driving.
Pedestrians, motorcyclists and bicyclists without lights, reflectors, or reflective clothing also constitute a very serious after-dark hazard.
Local wildlife and cattle also are road hazards in rural areas.
For safety reasons, travelers should not stop to offer assistance to others whose vehicles apparently have broken down.

Please refer to our Road Safety page for more information.

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

SPECIAL CIRCUMSTANCES:
Belize is vulnerable to tropical storms, especially from June 1 until November 30 of each year. General information on weather conditions may be obtained from the National Hurricane Center at http://www.nhc.noaa.gov.

It is not possible to access most U.S. bank accounts through automated teller machines (ATMs) in Belize.
However, travelers can usually obtain cash advances from local banks, Monday through Friday, using major international credit cards.

Special Notice for Dual Nationals:
A person who is a citizen of both the U.S. and Belize is able to enter Belize with only a Belizean passport; such a dual national should be aware, however, that he/she must have a U.S. passport in order to board a flight to the U.S. from Belize, and that average processing time for a passport at the U.S. Embassy in Belize is approximately 10 working days.

Belize customs authorities may enforce strict regulations concerning temporary importation into or export from Belize of firearms.
It is advisable to contact the Embassy of Belize in Washington or one of Belize’s Consulates in the U.S. for specific information regarding customs requirements.
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 Belize laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Belize 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.
Belize has strict laws making possession of a firearm or ammunition illegal unless a valid permit is obtained.
Penalties for firearms violations are severe.
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 Belize are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site in order to obtain updated information on travel and security within Belize.
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 in the capital city of Belmopan, approximately 50 miles west of Belize City.
The U.S. Embassy is on Floral Park Road, Belmopan, Cayo District, and the telephone number is 822-4011.
The American Citizen Services section fax number is 822-4050.
In the event of an after hours emergency, the embassy duty officer may be reached at 610-5030. The Embassy is open from 8:00 a.m. to 5:00 p.m., Monday through Friday, except for the 12:00 noon to 1:00 p.m. lunch hour, and on U.S. and Belizean holidays.
The Embassy web site is http://belize.usembassy.gov/; the e-mail address is embbelize@state.gov

Travel News Headlines WORLD NEWS

Date: Wed 2 May 2018, 3:30 PM CST.
Source: Breaking Belize News [edited]

Ministry of Health staff from the Western Health Region are currently in Benque Viejo and surrounding areas monitoring a developing situation due to confirmed cases of hepatitis A in Arenal and Benque. According to a statement from the Ministry, there have been 3 confirmed cases in Benque Viejo and 11 suspected cases in Arenal.

Part of the plan includes sensitization of school staff and students about hepatitis A, its transmission and risk factors. Food handlers in Benque and Arenal will also be visited and informed of the risks of hepatitis A and the importance of following established protocols.

The relevant departments in health have been made aware and are working closely with the region to minimize ongoing cases including a sensitization session on the local radio station in Benque.
===================
[No information is given about the age of those affected. In much of the developing world where hepatitis A is quite endemic, the population is almost all seropositive for HAV by the age of 10. I would wonder if the infection was confirmed by a specific IgM anti-HAV antibody. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Cayo District, Belize: <http://healthmap.org/promed/p/6149>]
Date: Mon 8 Oct 2017
Source: Outbreak News Today [edited]

The summer of 2017 appears to be "pink eye", or conjunctivitis season in the Americas with a number of countries in Central and South America and the Caribbean reporting increases of the eye infection.

Now joining the Bahamas, Brazil, Costa Rica, Dominica, the Dominican Republic, Guadeloupe, Martinique, Mexico, Panama, Saint Lucia, Saint Martin, Suriname, and the Turks and Caicos Islands is Belize where health officials report an increase in the number of reported conjunctivitis cases, particularly in the northern and central health regions.

The Belize Health Ministry says the symptoms of pink eye include:
- redness in the white of the eye or inner eyelid;
- watery eyes;
- thick yellow discharge that crusts over the eyelashes, especially after sleep; and
- itchy eyes, blurred vision and increased sensitivity to light

They offer the following measures to prevent the spread of this contagious infection:
- wash your hands often with soap and warm water. Wash them especially before and after cleaning, or applying eye drops or ointment to your infected eye;
- avoid touching or rubbing your eyes. This can worsen the condition or spread the infection;
- with clean hands, wash any discharge from around your eye(s) several times a day using a clean wet washcloth. Wash the used washcloth with hot water and soap, and then wash your hands again with soap and warm water;
- wash pillowcases, sheets, washcloths, and towels often with hot water and soap; wash your hands after handling such items;
- do not wear contact lenses until your eye doctor says it's okay to start wearing them again;
- do not share personal items such as pillows, washcloths, towels, eye drops, eye and face makeup, makeup brushes, contact lenses and contact lens containers, or eyeglasses;
- avoid shaking hands with others;
- persons suffering pink eye should stay away from work, school and public places until the infection clears.  [Byline: Robert Herriman]
==================
[Viral conjunctivitis, also called pinkeye, is a common, self-limiting condition that is typically caused by adenovirus. Other viruses that can be responsible for conjunctival infection include herpes simplex virus (HSV), varicella-zoster virus (VZV), picornavirus (enterovirus 70, Coxsackie A24), poxvirus (molluscum contagiosum, vaccinia), and human immunodeficiency virus (HIV) (<http://emedicine.medscape.com/article/1191370-overview>). But bacteria and allergens also can cause conjunctivitis.

There is no known specific treatment for this disease, and containment includes increased attention to hygiene.

According to <https://www.garda.com/crisis24/news-alerts/73151/belize-conjunctivitis-outbreak>, in the [3 weeks leading up to 26 Sep 2017], 1108 cases have been reported [in Belize] in what government officials are calling the worst such outbreak since 2005. Cases have been reported in Belize City, Corozal, Cayo, Chetumal, and Orange Walk, among other places.

See ProMED Conjunctivitis - Americas (10): Panama, Grenada, Mexico http://promedmail.org/post/20170929.5348507 for further discussion regarding the conjunctivitis outbreak in the Americas.

A HealthMap/ProMED-mail map of Belize can be found at
Date: Sat 26 Aug 2017
Source: Amandala [edited]
<http://amandala.com.bz/news/ciguatera-poisoning-linked-turneffe-barracudas/>

Each year, between 10,000 and 50,000 people who live in or visit tropical and subtropical areas suffer from Ciguatera Fish Poisoning (CFP), which is said to be one of the most frequently reported seafood-toxin illness in the world. Ciguatera poisoning, which causes symptoms such as tingling and numbness in fingers and toes, around lips, tongue, mouth and throat; nausea, vomiting, diarrhoea and/or abdominal cramps; joint pains and headache; and breathing difficulty, has also been reported in Belize, and over the past 4 days, 2 alerts have been issued by the Ministry of Health in Belize, following reports of cases cropping up, which have been linked to the consumption of barracuda fish. In the 1st alert, issued on [Fri 18 Aug 2017], the Ministry of Health reported that "suspected fish poisoning (Ciguatera poisoning) was detected in people that had eaten fish bought from a fish vendor in Ladyville, Belize District."

In the 2nd alert, issued on [Tue 23 Aug 2017], the Ministry said that 2 further cases of suspected Ciguatera poisoning, linked to the consumption of the large predatory fish, had been identified. "Investigations conducted so far reveal that the barracuda fish from the Turneffe Islands area has been the sole carrier of the ciguaxtoin or poison," the alert said. It warned that toxic fish does not have any odor or taste and cooking and freezing does not eliminate the toxin. According to the US Center for Disease Control and Prevention (CDC), ciguatera fish poisoning (or ciguatera) is an illness caused by eating fish that contain toxins produced by a marine microalgae called _Gambierdiscus toxicus_, associated with corals.

Whereas the barracuda is believed to be the culprit for the most recent bouts of illness caused by the toxin, other fish may also carry the toxin, including coral trout, red snapper, donu, parrot fish, grouper, Spanish mackerel, red emperor, wrasse, reef cod, sturgeon fish, trevally and moray eel. The CDC also lists blackfin snapper, cubera snapper, dog snapper, greater amberjack, hogfish, horse-eye jack, and king mackerel among the fish which have been known to carry ciguatoxins. "Anyone who consumes fish contaminated with the ciguatera toxin will become ill," the Ministry's alert said, adding that, "The gastrointestinal or stomach symptoms normally appear within 24 hours of exposure and those of the nervous system can appear 1 to 2 days later."

Although some symptoms may last only a few days, in some cases, the toxin can continue to affect those who ingest it for months. The CDC says people who have ciguatera may find that cold things feel hot and hot things feel cold. The Belize Ministry of Health has shared some guidelines for reducing the risk of CFP.

It advises the following:
- Avoid eating larger reef fish that have a greater likelihood of carrying ciguatoxins, especially the barracuda.
- Limit the weight of a fish to less than 11 pounds, as ciguatera fish poisoning occurs more frequently in larger fish.
- Eat other types of fish not listed above.
- Avoid eating the head, roe or fish egg, liver, or other organs of the fish, as it is where the highest level of toxin is present. [Byline: Adele Ramos]
=========================
[A recent open access review of ciguatera fish poisoning (CFP) has been published in Marine Drugs: Friedman MA , Fernandez M, Backer LC, et al: An updated review of Ciguatera Fish Poisoning: Clinical, epidemiological, environmental, and public health management. Mar Drugs 2017, 15(3): pii: E72; doi:10.3390/md15030072; available at: <http://www.mdpi.com/1660-3397/15/3/72/htm.

The publication does not say that the intoxication occurs related to fish from European waters. The description of the acute illness with the citations intact (the citations can be found at the original URL) has been extracted below: "CFP is characterized by gastrointestinal, neurological, and cardiovascular symptoms. In addition, after the initial or acute illness, neuropsychological symptoms may be reported.

Clinical features can vary depending on elapsed time since eating the toxic meal, and whether the geographic source of the implicated fish was the Caribbean Sea, Pacific, or Indian Ocean [17,36,52-58]. Gastrointestinal symptoms and signs usually begin within 6-12 hours of fish consumption and resolve spontaneously within 1-4 days.

Gastrointestinal symptoms may include nausea, vomiting, abdominal pain, and diarrhoea. The neurologic symptoms usually present within the 1st 2 days of illness. They often become prominent after the gastrointestinal symptoms (particularly in CFP events from Caribbean fish), although they may present concurrently with gastrointestinal symptoms (K Schrank, written communication, April 2016) [59].

The neurologic symptoms vary among patients and include paresthesias (that is, numbness or tingling) in the hands and feet or oral region, metallic taste, sensation of loose teeth, generalized pruritus (itching), myalgia (muscle pain), arthralgia (joint pain), headache, and dizziness. A distinctive neurologic symptom is cold allodynia, sometimes referred to as "hot-cold reversal," an alteration of temperature perception in which touching cold surfaces produces a burning sensation or a dysesthesia (that is, unpleasant, abnormal sensation) [60]. One study revealed that intra-cutaneous injection of CTX in humans elicited this sensation [61].

Cold allodynia is considered pathognomonic of CFP, although not all patients report experiencing it and it can be seen with other human seafood poisoning syndromes (such as neurotoxic shellfish poisoning). Less commonly, severe central nervous system symptoms, such as coma or hallucinations, have been reported [54,62,63].

Neuropsychological symptoms, which often become apparent in the days or weeks after the initial or acute illness, include subjectively reported cognitive complaints such as confusion, reduced memory, and difficulty concentrating [64-67], depression or irritability [64,65,68], and anxiety [65]. Fatigue or malaise have been reported and may be debilitating [6,62,69,70].

Cardiac symptoms and signs may manifest, generally in the early stage of the illness. When present, they usually occur in combination with gastrointestinal and/or neurologic signs and symptoms [71,72]. Cardiac signs often include hypotension and bradycardia which may necessitate emergency medical care." - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at: <http://healthmap.org/promed/p/19>.]
Date: Thu 2 Feb 2017 10:41 AM CST
Source: Breaking Belize News [edited]

Yesterday [1 Feb 2017] the Belize Agricultural Health Authority (BAHA) announced that bovine rabies has been confirmed in 3 districts in Belize: Orange Walk, Cayo, and Toledo.

Bovine rabies is a specific type of rabies that affects cattle; however, it can be transmitted to humans and as a result, farmers are advised by BAHA to vaccinate their livestock as well as sheep, cattle and horses.

Bovine rabies is a fatal disease that can be prevented through vaccination of animals.

Affected animals will show aggressive behavior and may salivate more than normal.

If [bovine] rabies is suspected in your district, please contact BAHA immediately at phone number 822-0818.
===================
[Rabies is a viral infection caused by viruses belonging to the Lyssavirus genus. It is a zoonosis -- an animal disease that can spread to humans -- transmitted through saliva from bites, and even scratches of infected animals.

In Belize, as urban rabies is well controlled, most cases of rabies occur as bovine paralytic rabies transmitted by the vampire bat. Rabies in cattle has been reported in all 6 districts. According to the OIE vaccinating 70 percent of dogs allows rabies to be eradicated from a given endemic area.

Generally in Belize the rabies is of vampire bat origin. Cases of human rabies, including deaths, have been reported in Belize. There, several strains of the rabid virus circulate in the vampire bat, _Desmodus rotundus_.

The hairy-legged vampire bat, _Diphylla ecaudata_, is naturally infected by rabies virus (same variant as one infecting _D. rotundus_), so this vampire species is definitely a source for rabies cases in humans.

This vampire species ranges from Southern Tamaulipas (Mexico) to Colombia, Venezuela, Ecuador, Peru, Bolivia, Belize, and Brazil (except the central Amazon basin); a single vagrant individual has also been reported from Southern Texas, USA. (For a picture go to  <https://naturalhistory.si.edu/mna/images/images/831032911523015.jpg>).

Predators and parasites can be plastic when it comes to selecting their preys/hosts, and this confers to them the ability to adapt to environmental changes, and a phenomenon of special interest for public health, as it is associated with the link between human-driven change and emerging diseases.

Notifications of suspect rabies cases are investigated by BAHA, the MoH and the Ministry of Agriculture (MNRA) at no cost to the animal owner. A history of the animal determines the steps to be taken, I.e., whether it is isolated and kept for observation or euthanatized and the brain sent to the veterinary services laboratory in Panama. The MoH will determine human exposure to the virus. If warranted (bite, scratch, saliva) a post exposure regimen will be initiated which consists of 5 vaccines. Laboratory-confirmed cases in cattle trigger control response which includes vaccination of herd, vaccination of susceptible animals in protection zone and vampire bat control at farm and roosts (caves).

If you believe your animal, regardless of whether it is bovine, dog or other animal has rabies or is acting differently than normal, please call your veterinarian. Remember that thinking a bovine is choking and putting your hand in the mouth to remove the blockage may expose you to rabies.

Portions of this comment were extracted from

[Maps of Belize can be seen at
<http://healthmap.org/promed/p/19>. - ProMED Sr.Tech.Ed.MJ]
Date: Thu, 4 Aug 2016 08:41:33 +0200
By Henry MORALES

Puerto Barrios, Guatemala, Aug 4, 2016 (AFP) - A hurricane packing 130 kilometre (80 mile) per hour winds and heavy rain made landfall in Central America near Belize's capital, where officials warned of likely flooding and damage to homes Thursday.   Hurricane Earl swept in from the Caribbean to strike just south of Belize City, population 60,000, around midnight Wednesday (0600 GMT Thursday), according to the US National Hurricane Center (NHC).

Along the way, it had gathered strength and dumped rain on northern Honduras as it brushed past at sea.     The hurricane's heavy rains "could cause flash floods and mudslides especially over higher terrain," Belize's National Emergency Management Organization said in a bulletin just before it arrived.   "For coastal areas, there is also a risk for flooding, especially in low-lying areas."   Nearby Guatemala, Honduras and southern Mexico also issued alerts. Airports in the area were closed.

- Evacuations -
Earl was expected to weaken as it continued west from Belize City, farther inland, toward northern Guatemala and southeastern Mexico.   The Mexican authorities took no chances, evacuating 300 families living close to a river along the border with Belize in the southeastern state of Quinta Roo for fear of flooding.   More than 750 shelters were readied in the state in preparation for expected high winds and fierce gusts.

Other southern Mexican states likely to be affected were Campeche, Tabasco and Yucatan.   In the northern Guatemala town of Puerto Barrios, a military commander, Colonel Nelson Tun, told AFP that "patrols in vulnerable areas" were being carried out.   "We have identified high areas to where the population can evacuate before possible flooding," he said.

Guatemala in particular is prone to rainy season flooding and mudslides that often prove fatal.   Guatemala's population, at 16 million, is much bigger than the 330,000 in Belize, Central America's only English speaking country.   Guatemala's president, Jimmy Morales, late Wednesday offered Belize humanitarian aid and shelters along the border if needed.   That gesture was significant after months of tensions between the two countries following a shooting death of a Guatemalan boy by a Belizean border patrol in April.

- Category 1 hurricane -
The fifth named tropical storm of the 2016 season, Earl strengthened to a Category 1 hurricane on Wednesday, according to the NHC. Winds initially measured at 120 kilometers per hour picked up just before landfall.   Category 1, the lowest of five grades on the hurricane scale, is described as having dangerous winds of between 119 and 153 kilometers per hour that can rip off roofs, bring down trees and cause extensive damage to power lines.   Belizean public and private sector workers were permitted to go to their homes Wednesday to secure property.   Officials warned that people living on the ground floor "will experience flooding" and some older wooden buildings would likely be destroyed.   The authorities have opened 29 shelters.
More ...

Vietnam

General:
************************************
Viet Nam is becoming a more popular tourist destination with Irish travellers each year. In many cases these will be those who have no defined itinerary and so their travel plans may change at short
otice. Facilities for tourists vary greatly throughout the country and this needs to be borne in mind when considering some of the serious health issues which can occur throughout the country. The climate is cooler in the north and more tropical further south. There is a monsoon season from May to November each year and the Mekong Delta is prone to significant flooding. Transport during this time can be very difficult and there will be a higher incidence of various diseases during and soon after times of flooding.
Further local information on health issues in Viet Nam is available at http://www.doctorkot.com/index.htm
Safety & Security:
************************************
The majority of those visiting Viet Nam will have no particular difficulty though street crime can be a problem in the main cities of Hanoi and Ho Chi Ming. Generally this is in the form of pick-pocketing, or snatch and grab incidents. Take care of your personal belongings at all times and tourists should not flaunt their relative wealth. Be careful while walking along the footpaths as occasionally a motorcyclist may grab at your bag or camera. Use the hotel safe to store belongings. Attacks against ships in the South China Sea are reported and it is sensible to be vigilant at all times.
Local Laws & Customs:
************************************
Drug smuggling offences carry the death penalty. Don’t take photographs of any military or police installation and avoid any large gathering as the mood can suddenly change. Travel to some of the border areas of the country can be very restricted and so should be avoided. Religious freedom in Viet Nam is quite restricted and those attending gatherings may be detained and fined. Police may occasionally raid hotel rooms without notice. Seizure of documents, pornographic material, compact disks and other goods have lead to high fines and detention.
Road Transport:
************************************
Traffic accidents are becoming more common throughout the country and tourists are occasionally involved with serious consequences. Hiring your own means of transport (car, motorbike etc) is generally unwise. International driving licences are not valid and those wishing to drive will need to obtain a Vietnamese licence. The streets are crowded and many road users will stop suddenly to make purchases from roadside vendors. Traffic laws are often unobserved and horns and gesticulations are used to indicate right of way! Outside the cities, buses and trucks often travel at high speed and accidents are a regular occurrence.
Food & Water:
************************************
The level of food and water hygiene varies greatly throughout the country. Many tourists become ill following consumption of food from both street vendors and also from good quality hotels. Care should be taken at all times. Undercooked or reheated food should be avoided and tap water must be checked for the smell of chlorine. Make sure that a sealed bottle of water is brought to your table during meals. Carbonated water is safer. Bivalve shellfish meals are high risk and previously peeled fruit should not be eaten. Typhoid is reported as a particular problem in the Mekong Delta.
Malaria Risks:
************************************
Viet Nam is endemic for malaria and the risk of transmission occurs in many regions of the country. However, the risk is highest during the monsoon season (May to November) and in the southernmost provinces of Ca Mau and Bac Lieu. The urban areas of Hanoi, Ho Chi Minh City, the Red River Delta and the coastal plain north of Nha Trang are regarded as low risk regions throughout the year.
Mosquito Borne Diseases:
************************************
The other two main mosquito borne diseases are Dengue Fever and Japanese B Encephalitis. Both of these viral conditions can cause serious disease and it is essential that all travellers continually take special care to avoid mosquitoes. The mosquitoes which transmit Dengue tend to bite in the main urban areas while the ones that transmit Japanese B (and malaria) are more common out of the large cities.
Sun Exposure:
************************************
The direct sunlight in Viet Nam can be very intense and both burn and dehydration can easily occur. After a long-haul flight this is a particular concern as many travellers will sleep beside the hotel pool to recover from their journey. After just a short while they may have become significantly burnt. Those trekking should increase their fluids and also take more salt in their diet if possible.
Entertainment Problems:
************************************
Viet Nam has a reputation of a location where it is too easy to obtain sexual exposure for those unaware of the risks. This is particularly true following the consumption of alcohol. The risk of AIDS and other serious STD’s is very high and so contact should be avoided at all costs. A number of otherwise healthy male travellers have suddenly died during the past few years following what is thought to have been laced alcoholic drinks.
Rabies Risk:
************************************
Rabies occurs throughout Viet Nam and any contact with warm-blooded animals should be avoided at all times. Dogs, Cats and Monkeys are most commonly involved in transmitting the disease to humans. Treat any exposure very seriously and wash out the wound, apply an antiseptic and seek urgent medical attention immediately.
Vaccinations for Viet Nam:
************************************
There are no essential vaccines for entry to Viet Nam from Western Europe. However, for personal health, it is advised that all travellers consider cover against;
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food and water borne disease)
*
Hepatitis A (food & water borne disease)
For those trekking within the country there are a number of other vaccines which should be considered including Hepatitis B, Rabies, Japanese B and Meningitis.
Summary:
************************************
The biggest risks within Viet Nam tend to be associated with food and water borne diseases, mosquito bites and the traffic. Commonsense and care is needed at all times to ensure a good safe holiday.

Travel News Headlines WORLD NEWS

Date: Thu, 10 Oct 2019 13:13:57 +0200 (METDST)

Hanoi, Oct 10, 2019 (AFP) - Selfie-snapping tourists railed against the closure of Hanoi's 'train street' on Thursday after police blocked off the Instragram-famous tracks for safety reasons.   The narrow railway corridor in central Hanoi has become a hotspot among visitors seeking the perfect holiday snap on the tracks -- often dodging trains that rumble through daily.    But Hanoi authorities said this week they would block people from the tracks to avoid accidents, and police on Thursday erected barricades to keep out disappointed visitors.    "I'm very frustrated because today I can't go in and take a picture," Malaysian tourist Mustaza bin Mustapha told AFP, vowing to come back later.

Dozens of other tourists were turned away, though some managed to get onto still-open sections of the railway, moving out of the way as an afternoon train chugged past.    Built by former colonial rulers, the railway once shipped goods and people across France's former Indochina colony and remains in use today by communist Vietnam's state-run railway company.    The stretch of the tracks was once known as a rough part of town, occupied by drug users and squatters until their recent discovery by camera-wielding holidaymakers who have splashed images of the area across social media.

Cafe owners complained that business would be hurt thanks to the new regulations, and that tourists always moved out of the way for oncoming trains.   "There has never been any regretful accidents here," said Le Tuan Anh, who runs a cafe from his home along the tracks.   "Compared to traffic density elsewhere in the city, this is much safer," he said, referring to Hanoi's chaotic, motorbike-clogged streets.   New signs were installed in the area Thursday, warning passersby not to take photos or videos in the "dangerous area", much to the chagrin of British tourist Harriet Hayes.   "People come from all over the world to Hanoi just to see the train go past," she told AFP.   "It's such a shame that we come and have been told that we have to leave."
Date: Wed 11 Sep 2019
Source: Saigon Giai Phong [edited]

The Hanoi-based Bach Mai Hospital yesterday [Tue 10 Sep 2019] warned of a high possibility of death from rare Whitmore's disease [melioidosis], as the disease re-occurred and killed 4 people in August [2019].

Moreover, the fatal disease infected 12 patients including a woman suffering from a severe abscess on her nose. The case was very rare, and the hospital treated such cases for the 1st time, said Director of the hospitals' Tropical Disease Center Dr. Do Duy Cuong. The patient was misdiagnosed as having sepsis caused by a staphylococcal infection at a local hospital. However, tests from her wound carried out at the center were positive for the Whitmore bacterium, _Burkholderia pseudomallei_.

The doctors had to change the treatment regimen; otherwise the patient could have died, as Dr. Cuong said. After 2 weeks of treatment, her wound had improved. However, she will still be undergoing treatment for at least 3 months under the close watch of doctors to avoid disease recurrence.

Dr. Cuong added that there have been around 20 cases of melioidosis in the past 5 to 10 years, but since the beginning of the year [2019], the center has admitted 20 cases, mostly from the northern and central provinces.

Melioidosis is an infectious disease caused by the bacterium _Burkholderia pseudomallei_. that can affect humans or animals. It is predominately a disease of tropical climates, especially in Southeast Asia and northern Australia where it is widespread.

The bacteria causing melioidosis are found in contaminated water and soil. It is spread to humans and animals through direct contact with the contaminated source. Patients developing the disease may die without proper treatment.  [Byline: Minh Khang - Translated by Uyen Phuong]
=======================
[Melioidosis is a disease of the rainy season in its endemic areas. It mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (most common risk factor), renal disease, cirrhosis, thalassemia, alcohol dependence, immunosuppressive therapy, chronic obstructive lung disease, cystic fibrosis, and excess kava consumption (kava is an herbal member of the pepper family that can be associated with chronic liver disease).

Melioidosis may present at any age but peaks in the 4th and 5th decades of life, affecting men more than women. In addition, although severe fulminating infection can and does occur in healthy individuals, severe disease and fatalities are much less common in those without risk factors.

The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, and chest pain, and -- although the cough can be nonproductive -- respiratory secretions can be purulent, significant in quantity, and associated with on-and-off bright red blood. The lung infection can be rapidly fatal -- with bacteremia and shock -- or somewhat more indolent.

Acute melioidosis septicemia is the most severe complication of the infection. It presents as a typical sepsis syndrome with hypotension, high cardiac output, and low systemic vascular resistance. In many cases, a primary focus in the soft tissues or lung can be found. The syndrome, usually in patients with risk factor comorbidities, is characteristically associated with multiple abscesses involving the cutaneous tissues, lung, liver, and spleen, and a very high mortality rate of 80-95%. With prompt optimal therapy, the case fatality rate can be decreased to 40-50%.

The melioidosis bacillus is intrinsically insensitive to many antimicrobials, and in fact bioterrorism strains may be engineered to be even more resistant. _Burkholderia pseudomallei_ is usually inhibited by tetracyclines, chloramphenicol, trimethoprim-sulfamethoxazole (SXT), antipseudomonal penicillins, carbapenems, ceftazidime, and amoxicillin/clavulanate or ampicillin/sulbactam. Ceftriaxone and cefotaxime have good in vitro activity but poor efficacy; and cefepime did not appear, as well, to be equivalent to ceftazidime in a mouse model. The unusual antimicrobial profile of resistance to colistin and polymyxin B and the aminoglycosides but sensitivity to amoxicillin/clavulanate is a useful tool to consider in treatment of infection with the organism.

The randomized and quasi-randomized trials comparing melioidosis treatment have been reviewed, and it was found that the formerly standard therapy of chloramphenicol, doxycycline, and SXT combination had a higher mortality rate than therapy with ceftazidime, imipenem/cilastatin, or amoxicillin/clavulanate (or ampicillin/sulbactam). The betalactam-betalactamase inhibitor therapy, however, seemed to have a higher failure rate.

Source: Tolaney P, Lutwick LI: Melioidosis. In: Lutwick LI, Lutwick SM (eds). Bioterror: the Weaponization of Infectious Diseases. Totowa NJ: Humana Press, 2008 pp 145-58. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Fri, 10 May 2019 11:12:19 +0200

Ha Long Bay, Vietnam, May 10, 2019 (AFP) - Most visitors to Vietnam's famed Ha Long Bay opt for cruise views of the UNESCO heritage site but from Friday tourists can hop on a helicopter to see the area's famous karst rock formations from the skies.    Nervous flyers beware.   A pair of five-seater helicopters soared up to 300 metres (1,000 feet) to offer passengers aerial views of the limestone towers, cruise ships and the odd houseboat dotting Ha Long's green waters for the maiden flights on Friday.

Helicopter manufacturer Bell said the trips, which start at $125 for 12 minutes, were aimed at tapping into a growing number of tourists to Vietnam -- many from the world's second biggest economy.    "With the Chinese economy growing, you're seeing more tourists come here," said David Sale, Bell's managing director for Asia-Pacific.

The number of visitors to Vietnam grew nearly 20 percent last year, with one-third of the total coming from its powerful communist neighbour to the north.    Domestic tourism is also booming among Vietnam's fast-growing middle class with expanding appetites -- and budgets -- for travel.   Ha Long Bay is one of the country's top draws, with as many as 500 cruise ships in the bay every day and a newly-opened airport helping to funnel visitors into the area.

But the tourist boom has also prompted environmental concerns in the once-pristine bay in Quang Ninh province, also home to home to rapid industrialisation.    "We're under pressure from the coal industry, the urbanisation process, the arrival of more tourists and the population increase," said Le Minh Tan, deputy director of Quang Ninh's tourism department.    He added that a waste-water management system is set to be rolled out soon to deal with sewage spewed out by cruise ships daily.   "We're launching many programs in the area to ensure the environment of Ha Long is green and clean."
Date: Tue, 9 Apr 2019 13:43:38 +0200

Hanoi, April 9, 2019 (AFP) - Three divers who helped rescue a Thai football team last year have made a fresh discovery in Vietnam where they explored a tunnel that could expand the footprint of the world's largest cave.   The team was invited to descend into a waterlogged pit in the Son Doong cave in central Vietnam that has never been explored and is believed to connect to nearby chambers.    They were forced back at 77 meters (252 feet) because they did not have enough oxygen to push further, but they think the tunnels could be 120 meters deep.   If the tunnel connects to another cave, it would make Son Doong "easily the largest cave in the world and it would never be overtaken," British cave expert Howard Limbert, who helped organise the dive, said Tuesday at a press conference announcing the find.

The three divers -- Rick Stanton, Jason Mallinson and Chris Jewell -- were part of the daring rescue to save 12 Thai footballers and their coach who were trapped in a cave for eighteen days last year.    Stanton -- who found the boys on a ledge -- said the painstaking task of safely leading the group out of the tunnel alive helped to prepare for the mission in Vietnam.    "Our planning and preparation is without parallel," he said.   The team plans to return to Vietnam next year to try to link the tunnel to another cave near Son Doong, which is so big that it has its own ecosystem and weather patterns.

The cave in central Quang Binh province was first found by a local forager in 1991, but was not re-discovered for another 19 years because its entrance was hidden by thick surrounding jungle.   Only 30 percent of Vietnam's Phong Nha national park -- where Son Doong and a network of adjacent caves are located -- has so far been explored.     Son Doong is the world's largest cave by volume, big enough to house a New York city block -- including 40-storey skyscrapers -- according to Oxalis, which runs tours into the caves. 

Proposed plans to build a cable car in the area have sparked anger among the Vietnamese public who fear it will harm the area's wildlife and pristine views.      An official said Tuesday there were no plans to move ahead with the project despite offers from several companies.   "That is only in theory, in truth, to build a cable car there is no such project yet," the vice chairman of Quang Binh province Tran Thien Dung said Tuesday.       Vietnam's tourism industry is booming among domestic and foreign travellers alike, but the communist country has come under fire for failing to preserve landscapes as it rapidly expands the sector.
Date: Fri, 25 Jan 2019 12:21:09 +0100
By Jenny VAUGHAN

Vu Thu, Vietnam, Jan 25, 2019 (AFP) - Tran Huu Hoa was scared, desperate and on the verge of suicide after his leprosy diagnosis in 1958, fearing he'd never work or marry in an age when lepers were completely shunned from Vietnamese society.   He could not imagine he would find new life at the leprosy hospice where he has been living for 61 years, a walled off compound in northern Thai Binh province where he met his wife, worked as a union boss and took in needy children.    "There were about 2,000 people here then, mostly young people. It was fun because we started a teen union," the 80-year-old told AFP, sitting on his bed with his wife Teo of 54 years. 

Today there are only 190 patients at the hospital, all cured but living with disabilities caused by leprosy.    Many walk with prosthetic legs. Others like Hoa have lost fingers. Some are so severely disabled they spend the day bent over in bed, covered with thick blankets to keep the cold at bay.    Founded in 1900, Van Mon is the oldest leprosy hospital in northern Vietnam.    At its peak it treated 4,000 patients a year -- a number that has dwindled as leprosy cases have dropped across Vietnam thanks to improved healthcare, hygiene and greater awareness of the disease.   World Leprosy Day is January 27.

There were 248 people being treated for leprosy in 2017 in Vietnam, down by more than half from a decade earlier, according to data from the World Health Organization.    But as numbers have decreased so have the live-in patients at the Van Mon centre.   Meandering days are punctuated with a morning and midday meal. Some pass the time worshipping at the on-site chapel or pagoda, while most watch TV or listen to the radio during the day when they are not sleeping.    "I have no one to count on, I'm so lonely, so I just follow God. When I die I will follow God then too," said Pham Van Bac, 83, who has been at the centre since 1960. 

His daughter no longer visits and his grandchildren come only once a year, so he has little to look forward to most days, he says.    But many like Bac chose to stay, fearing they will be a burden on their families, or lose the care and small stipend provided at the government-run hospital.   Some, like Hoa, have found companions in the centre.   "It's a source of encouragement and motivation and they can have a happier and better life," said Nguyen Thi Thai, deputy director of the hospital where both her parents were once treated for leprosy.    And even though stigma against leprosy sufferers has largely faded outside the walls of the hospice, many prefer to remain at Van Mon.    Hoa said: "This is my second home, I will live here until my death."
More ...

World Travel News Headlines

Date: Fri, 13 Dec 2019 16:41:23 +0100 (MET)
By Mariëtte Le Roux and Joseph Schmid

Paris, Dec 13, 2019 (AFP) - French commuters gritted their teeth for a ninth day of public transport strikes Friday, with unions vowing to keep up their protest against a pension overhaul through the holidays unless the government backs down.   Officials have said they are ready to negotiate, with Education Minister Jean-Michel Blanquer meeting teachers' representatives on Friday to try and stave off another day of class shutdowns.   "It was an intense and frank meeting... but we still need details, and maintain our call to strike on Tuesday," Stephane Crochet of the SE-Unsa union said.

Unions are hoping for a repeat of 1995, when they forced a rightwing government to back down on pension reforms after three weeks of metro and rail strikes just before Christmas.   The prospect of a protracted standoff has businesses fearing big losses during the crucial year-end festivities, and travellers worried that their Christmas plans may be compromised.   "Right now it's a catastrophe here, but we're hoping there will be a solution before Christmas," Frederic Masse, a foie gras producer at the huge Rungis wholesale food market south of Paris, told AFP on Friday.

The capital city was again choked by huge traffic jams as most metro lines remained shut, only a handful of buses and trams were running, and one in four TGV trains were cancelled.   "I'm sick of this, and I won't be able to keep working if it goes on," Zigo Makango, a 57-year-old security agent, told AFP onboard a bus in the Bobigny suburb northeast of Paris.   To get home at night Makango said he has to use taxis, but "my boss doesn't reimburse me for that".

- 'Historic reform' -
President Emmanuel Macron on Friday expressed his "solidarity" with people impacted by the strike, "but I want the government to continue its work" in forging a single pension system, a key campaign promise.   "It's a historic reform for the country," he told journalists at an EU summit in Brussels. 

The overhaul unveiled by Prime Minister Edouard Philippe would do away with 42 separate regimes, some of which offer early retirement and other benefits to public-sector employees such as train drivers, dockers and even Paris Opera employees.   But Philippe angered unions further by proposing a reduced payout for people who retire at the legal age of 62 instead of a new, so-called "pivot age" of 64.

They have called for new mass demonstrations for next Tuesday, the third since the action started on December 5 in the biggest show of strength in years by France's notoriously militant unions.   Philippe insisted on Twitter that "My door is open and my hand outstretched".   But Laurent Brun of the hard-line CGT union, the largest among public-sector workers including those at rail operator SNCF, has already warned "There won't be any Christmas truce" unless the government drops the plan entirely.

- France divided -
A poll released Thursday by the Elabe institute found France evenly divided on Philippe's plan, with 50 percent for and 49 percent against.  But 54 percent rejected the mooted 64-year cutoff for a full pension, and 54 percent supported the protest.

Staff at four of France's eight oil refineries were on strike Friday, affecting output and raising fears of shortages down the line.   And both Paris operas, the Garnier and the Bastille, again cancelled Friday performances and others through the weekend.   Macron's government insists the changes will make for a fairer system and help erase pension system deficits forecast to reach as much as 17 billion euros ($19 billion) by 2025.   The average French person retires at just over 60, years earlier than most in Europe or other rich OECD countries.
Date: Fri, 13 Dec 2019 14:05:22 +0100 (MET)

Milan, Dec 13, 2019 (AFP) - More than 300 flights were cancelled Friday in Italy due to a planned one-day strike by workers from Alitalia and Air Italy.   Alitalia said in a statement that 315 flights were cancelled on Friday, with another 40 cancelled Thursday night and Saturday morning. It was not immediately clear how many flights were cancelled at Air Italy.   The 24-hours strike, which involves pilots, flight attendants and ground personnel, was called by three unions to draw attention to what they called "the ongoing crisis at Alitalia and Air Italy."

The strike was felt most in Sardinia, with about 30 flights cancelled.    Money-losing Alitalia has been under special administration since 2017 when employees rejected a restructuring plan that would have laid off 1,700 workers out of an approximately 11,000.   The government has so far looked for buyers without success.    Unions plan to meet on Tuesday with Economy Minister Stefano Patuanelli.    A potential consortium of buyers for the ailing carrier fell apart last month after Atlantia, which operates Rome's airports, pulled out.
Date: Fri, 13 Dec 2019 05:24:44 +0100 (MET)
By Neil SANDS

Wellington, Dec 13, 2019 (AFP) - Adventure tourism is a key part of New Zealand's international appeal but the White Island volcano eruption is a tragic reminder that such activities carry genuine risk that must be better explained to travellers, experts say.   The South Pacific nation offers a wealth of adrenaline-fuelled pursuits, from heli-skiiing on snow-capped mountains to ballooning and blackwater rafting through caves.

Some, such as bungee-jumping, jet-boating and zorbing -- where you hurl yourself down a hill inside an inflatable ball -- were invented or popularised in a country that prides itself on catering to intrepid visitors.   The tourism industry as a whole is among New Zealand's biggest earners, generating about NZ$16.2 billion ($10.7 billion) and attracting 3.8 million international visitors annually.     "Adventure tourism is a massive sector in New Zealand. We are promoting ourselves as the adventure capital of the world," professor Michael Lueck, a tourism expert at Auckland University of Technology, told AFP.

New Zealand is also renowned for its rugged landscapes, which feature prominently films such as Kiwi director Peter Jackson's "Lord of the Rings".   Day-trips to White Island combined both, taking tourists including cruise ship passengers to a desolately beautiful island off the North Island coast where they could experience the thrill of standing on an active volcano.   Instead, at least 16 people are believed to have died and dozens suffered horrific burns when 47 tourists and guides were caught on the island during Monday's eruption.

The disaster has raised questions about why tourists were allowed on a volcano where experts had recently raised threat levels, as well as broader issues about the regulation of risky activities in the tourism sector.   "There will be bigger questions in relation to this event," Prime Minister Jacinda Ardern told parliament after the eruption.   "These questions must be asked, and they must be answered."

- 'Slapdash' or world's best? -
The disaster on White Island -- also known as Whakaari -- is not the first mass-fatality accident to affect tourists in New Zealand.   In 2015, seven people were killed when a scenic helicopter flight crashed into Fox Glacier. Two years earlier, a hot-air balloon claimed 11 lives and in 2010 nine died when a plane carrying skydivers plunged into a paddock.

Briton Chris Coker's son Brad, 24, died in the skydive plane crash and since then he has campaigned from afar for tighter regulations in New Zealand's adventure tourism sector.   "In my opinion, the New Zealand authorities... are still slapdash about tourist safety," Coker told news website stuff.co.nz after the White Island eruption.   "To run tourists there is insane. I know they signed a waiver and so on, but it's not really taking care of people."

Trade body Tourism Industry Aotearoa disputes such assessments, saying operators are "working within a world's best regulatory framework", but could not eliminate risk completely.   "Operators put safety first, but adventure activity inherently carries some risk and it's critical that 'adventure' remains in adventure tourism," TIA chief executive Chris Roberts told AFP.   "Operators take all practical actions to minimise the risks and the safety culture of individual operators remains the key factor in preventing accidents."

Roberts said the issue was not tourism operators, but the alert system they relied on at volcanic destinations such as White Island, which attracts about 17,000 visitors a year.   The GeoNet monitoring agency raised White Island's threat level in the week before the eruption but also advised current activity "does not pose a direct hazard to visitors".   "The reviews need to look at the science and specifically the guidance provided about volcanic activity, and whether the operating practices followed for the past 30 years need to change," Roberts said.

- 'Understand the risks' -
Travel companies such as White Island Tours brief customers before setting off and require them to sign a waiver declaring they understand the risk, as well as supplying equipment such as hard-hats and gas masks.   However, some relatives of those affected by the eruption have expressed scepticism that their loved ones truly appreciated the potential danger they faced.   Options for legal redress are limited under New Zealand's Accident Compensation Commission scheme, which covers victims' medical bills and provides modest compensation but does not allow civil suits for damages.

Neither Roberts nor Lueck expected the White Island eruption to hit international arrivals in New Zealand, which have continued to climb despite major earthquakes in 2011 and 2016.   The nature of any review arising from White Island remains uncertain, but Lueck said at the very least tourists needed to be better informed about any risks.   "Operators and tourism boards should have tourists understand what these risks are, and not brush over quickly signing a waiver," he said.   "Only then can tourists make an informed decision and decide whether or not they want to take that particular risk."
Date: Thu, 12 Dec 2019 21:25:36 +0100 (MET)

Kinshasa, Dec 12, 2019 (AFP) - Twenty-three cases of Ebola have been recorded in four days in eastern Democratic Republic of Congo, where deadly violence is hampering efforts to end the 16-month-old epidemic, authorities said on Thursday.   Ten cases were recorded on Tuesday alone in Mabalako in North Kivu province, after six on Monday, according to the Multisectoral Committee for Epidemic Response (CMRE).   Three out of the six were practitioners of traditional medicine, it said.

On Wednesday, three cases were recorded in North Kivu, including one in the Biena neighbourhood -- which has had no new Ebola cases for the last 85 days.   More than 2,200 people have died since the epidemic was declared on August 1, 2018.   As of November 22, the rate of new cases had fallen to 10 per week.   CMRE said "security reasons" -- attacks on Ebola health workers and sites by armed groups and angry youths -- had "paralysed" work in the key zones of Beni, Biakato and Mangina.   The attacks led to a pullout of locally-employed Ebola workers in Biakato by the UN's World Health Organization (WHO) and Doctors Without Borders (MSF).
Date: Thu, 12 Dec 2019 15:59:23 +0100 (MET)

Juba, Dec 12, 2019 (AFP) - Devastating flooding in South Sudan following a fierce drought could tip parts of the country into famine in the next few months, the World Food Programme (WFP) warned on Thursday.   According to the UN refugee agency nearly one million people were affected by floodwaters that submerged entire towns, compounding an already dire humanitarian situation after six years of war.

The WFP said that 5.5 million people are expected to be going hungry in early 2020 -- the time at which the population is generally benefiting from their harvest in October and November of the previous year.   An earlier harvest failed due to drought. This time crops have been washed away.    "The number of people in need is likely to increase because of the catastrophic level of destruction caused by floods since October following a drought that hammered parts of the country earlier in the year," the agency said in a statement.

The floods wiped out 73,000 metric tons of potential harvests as well as tens of thousands of cattle and goats, said the WFP.   "We know the problems that we've been having in South Sudan, but the rains and the floods have led to a national disaster and are much worse than anyone could have anticipated," said WFP Executive Director David Beasley.    "In fact, if we don't get funding in the next few weeks and months, we are literally talking about famine. We need support, we need help and we need it now."   The agency estimated its needs at $270 million (242 million euros) for the first half of 2020.   South Sudan declared a "man-made" famine affecting around 100,000 people in 2017. 

The term "famine" is used according to a scientific system agreed upon by global agencies, when at least 20 percent of the population in a specific area has extremely limited access to basic food; acute malnutrition exceeds 30 percent; and the death rate exceeds two per 10,000 people per day for the entire population.   "Famine in South Sudan was defeated after four months in 2017 by a concerted large-scale humanitarian response," said the WFP.   "Experts now say the country's food security outlook has never been so dire."   Political instability is also high as President Salva Kiir and his rival Riek Machar have again delayed their formation of a power-sharing government, this time by 100 days until February 2020.
Date: Wed, 11 Dec 2019 09:33:13 +0100 (MET)
By Holly ROBERTSON

Sydney, Dec 11, 2019 (AFP) - Up to 20,000 protesters rallied in Sydney on Wednesday demanding urgent climate action from Australia's government, as bushfire smoke choking the city caused health problems to spike.   Sydney has endured weeks bathed in toxic smoke as hundreds of blazes have raged across the countryside, with hospitals recording a 25 percent increase in the number of people visiting emergency departments last week.   On Tuesday smoke alarms rang out across Australia's biggest city, with thick haze triggering smoke alarms and forcing buildings to be evacuated, school children to be kept indoors, and ferries to be cancelled.   The devastating fires have focused attention on climate change, with scientists saying the blazes have come earlier and with more intensity than usual due to global warming and a prolonged drought.   Police estimated the crowd size at 15,000, organisers put the figure at 20,000.

Many of the protestors voiced anger at the government's silence in the face of the crisis.   "The country is on fire" said 26-year-old Samuel Wilkie attending his first climate protest. He described politicians' response as "pathetic".    "Our government is not doing anything about it," said 29-year-old landscape gardener Zara Zoe. "No one is listening, no one is doing anything."   Prime Minister Scott Morrison -- a staunch backer of Australia's vast coal industry -- has said little about the smoke since the crisis began, preferring to focus on fire-hit rural communities.   Organiser Chloe Rafferty said that had created anger at the conservative government's inaction.   "I think the wider public can see that we are not expecting the climate crisis in the future but we are facing the climate crisis now," she told AFP.   "People are experiencing it in their day-to-day lives."   As well as a rise in people visiting hospitals with smoke-related health symptoms, the number of emergency calls for ambulances spiked 30 percent last week.    "For most people, smoke causes mild symptoms like sore eyes, nose and throat," top health department official Richard Broome said.   "However, people with conditions like asthma, emphysema and angina are at greater risk because the smoke can trigger their symptoms."

Smoke from bushfires is one of the biggest contributors to air pollution in Australia, releasing fine particles that can lodge deep within people's lungs and cause "severe" health impacts over time, according to scientist Mick Meyer from government-funded scientific research agency CSIRO.   "The impact of smoke on people remote from the fires may, on occasion, substantially exceed the direct injury to people within the fire zone," he wrote in The Conversation.   "But we currently lack the operational tools to understand the extent of these impacts or to manage them."   Six people have been killed and more than 700 houses destroyed in bushfires this fire season.   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.   Three million hectares (7.4 million acres) of land has been burnt -- the size of some small countries -- and vast swathes of koala habitat scorched.   Official data shows 2019 is on track to be one of the hottest and driest years on record in Australia.
Date: Tue 3 Dec 2019
Source: Trinidad Express [abridged, edited]

The number of local deaths from the influenza virus has risen to 24. At the Health Ministry's update last week, 16 fatalities were reported from the flu, with Health Minister Terrence Deyalsingh appealing to citizens -- especially those considered at-risk -- to get vaccinated.
Date: Sat 30 Nov 2019
Source: The New Indian Express, Express News Service [edited]

According to official data, 14 swine flu [influenza A/H1N1] deaths across the state were recorded this year [2019] till [17 Nov 2019]. The figure is slightly less than the previous year's [2018] toll of 17. The total number of H1N1 swine flu-positive cases [has] also come down this year [2019] compared with 2018 from 402 to 325. Health officials are setting up isolation wards in hospitals as a preventive measure.

As the winter season has set in and the minimum temperatures are coming down, health officials are instructing the public to take precautions in order to stay away from being infected by swine flu. The health department has initiated steps to set up district-[wide] swine flu testing facilities and isolation wards in every district hospital, area hospital, and community health centre.

As per the requirement of treatment procedure, the government has to set up special isolation wards in all government hospitals and provide protection kits to the healthcare staff, especially to those who will attend to the patients suffering from the flu. Across the state, Visakhapatnam registered the highest number of positive swine flu cases and deaths. Out of 325 positive cases, 180 alone were reported from Visakhapatnam, of which 8 died. West Godavari district registered 3 deaths, and Anantapur, East Godavari, and Srikakulam registered one death case each.

All the district health officials have been instructed to intensify awareness camps and screening centres. As part of the action plan, isolation wards with 5-10 beds are to be set up in every teaching, district, and area hospital. A sufficient stock of drugs, masks, and PPE [personal protective equipment] kits are to be made available. Currently, there are 18 labs eligible for conducting confirmation test in the state. "We are creating awareness by distributing pamphlets and putting up screening centres at bus stops and railway stations," DMHO [district medical and health officer] Dr. TSR Murthy said.

Symptoms of swine flu are generally similar to that of seasonal flu. These include cough, fever, sore throat, stuffiness, runny nose, body aches, headache, chills, fatigue, diarrhoea, and vomiting. Later on, breathlessness, chest pain, drowsiness, low blood pressure, sputum mixed with blood, and bluish discoloration of nails also develops.
Date: Thu 28 Nov 2019
Source: GDN Online [edited]

Two expatriates living in Oman died after contracting the seasonal influenza (H1N1) or swine flu in the governorate of Dhofar -- the 1st in July and the 2nd in August [2019]. They were among 78 confirmed cases of swine flu registered at the Sultan Qaboos Hospital over the first 9 months of 2019 in the governorate.

The hospital authorities reported a total of 599 registered suspected cases of H1N1 between January and last September [2019]. Doctors working at Sultan Qaboos Hospital dealt overall with 1779 cases of respiratory infections during the same period.

Patients most vulnerable to the respiratory viruses are those over 18 years, particularly pregnant women; those suffering from chronic illnesses, kidney and heart diseases, liver problems, diabetes, asthma, blood disorders, and HIV/AIDS; and even health workers, according to Muscat Daily.
Date: Wed 11 Dec 2019
Source: UNICEF/WHO Situation report 11 Dec 2019 [edited]

Highlights
- 5 new human cases reported in the past week
- In response to 1st human vaccine-derived poliovirus type 1 (VDPV1) case from the island province of Basilan, in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), outbreak immunization was conducted
in Maluso, Basilan, with bivalent oral polio vaccine (bOPV) against polio type 1, vaccinating 13 547 children under 10 years old (102% of the target).
- Currently 9 human cases confirmed with circulating VDPV type 2 (cVDPV2), 1 case with VDPV1, 1 case with cVDPV1, and 1 case with immunodeficiency-related VDPV type 2 (iVDPV2).
- A case with VDPV1 from Sultan Kudarat is pending genetic analysis; 1 case of cVDPV1 from Malaysia was confirmed as genetically linked to the Basilan case.
- Synchronized polio vaccination campaign conducted on [25 Nov 2019 - 10 Dec 2019] (including 2 days of extension) vaccinated 4 309 566 children under 5, which is 98% of the target total of 4.4 million children under 5. A total of 1 395 365 children under 5 were vaccinated in National Capital Region (NCR), which is 109% of the target, and 2 914 201 (94%) in Mindanao.
- DOH planning to conduct outbreak immunization with bOPV targeting 710,296 children under 10 in the Sulu Archipelago, Zamboanga City, and Lambayong, Sultan Kudarat, on [6-12 Jan 2020].
- Current polio outbreak resulting from persistently low routine immunization coverage, and poor sanitation and hygiene.
- Philippines is affected by both cVDPV1 and cVDPV2. cVDPV is considered a public health emergency of international concern (PHEIC).

cVDPV1
---------
- In response to the 1st human case confirmed with VDPV1 from Maluso, Basilan (BARMM), outbreak immunization was conducted in the area with bOPV for children under 10 years old, vaccinating 13,547 children under 10 years of age (102% of the target).
- A cVDPV1 case in Sabah state, Malaysia, was confirmed to be genetically linked to the Basilan case by the Victorian Infectious Diseases Reference Laboratory (VIDRL) in Australia. Since the 2 viruses are genetically linked, they are both classified as circulating.
- A new VDPV1 case from Sultan Kudarat (Region XII) was confirmed on [6 Dec 2019] and is pending further genetic analysis.
- All 13 cVDPV1 environmental samples found in Manila are genetically linked.

cVDPV2
---------
- All 9 human cases and 17 environmental samples confirmed with cVDPV2 are genetically linked. All human cases were reported from Mindanao (BARMM and Region XII), whereas environmental samples were found in NCR and Davao.
- All samples were tested by the National Polio Laboratory at the Research Institute for Tropical Medicine (RITM), whereas sequencing and genetic analysis is done at the NIID in Japan, and additional genetic characterization is provided by the United States Centers for Disease Control and Prevention (CDC).
=======================
[Given the identification of the cVDPV1 case in Malaysia that is genetically related to the VDPV1 case in Basilan, it is now clear there are at least 2 separate cVDPV outbreaks in the Mindinao region of the Philippines: one of the outbreaks is associated with cVDPV2, and the other with cVDPV1 and one outbreak of cVDPV1 in the Manila Metropolitan area (although only environmental samples have been positive without AFP (acute flaccid paralysis) cases as yet.) What all these areas have in common is pockets of populations with suboptimal vaccination coverages. Clearly, we await further information on the genetic profiling of the newly identified VDPV1 case in Sultan Kudarat, also located in southern Philippines. Note that Basilan Island, Sultan Kudarat, and Sabah state in Malaysia, while all in the same general area, are not contiguous, each being on a different island. In. total, there are 11 cases of AFP in the Philippines that are attributable to infection with a VDPV.

A map showing the provinces in the Philippines can be found at

HealthMap/ProMED-mail map of the Philippines: