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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Some 250,000 customers were hit by electric power outages after the quake, which struck at 6:32 am local time (1032GMT).   Images posted on social media showed houses tumbled from their supporting pillars, cracks in walls, cars crushed under collapsed houses and small scale landslides.   The quake was the strongest of a series that have rippled through the island since December 28, and it was followed by at least eight aftershocks, officials said.   No tsunami alerts were issued.
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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, 14 Jan 2020 12:29:02 +0100 (MET)

Dubai, Jan 14, 2020 (AFP) - At least 78 children in war-torn Yemen have died from dengue-related illnesses, Save the Children said Tuesday, warning of an epidemic.    "Seventy-eight children under 16 have already died in the outbreak of dengue-related illness in Yemen, with more than 52,000 suspected cases being recorded across the country," the aid group said in a statement.    It added this "could signal the start of an epidemic".

Save the Children said that a total of 192 people have died in Yemen last year from dengue-related illnesses -- most cases reported in the port cities of Hodeida and Aden.    "Hodeida has the second highest death rate in the country with 62 adult and children deaths in 2019. We have never seen anything like this before," said Save the Children's field coordinator in Yemen, Mariam Aldogani, herself recovering from dengue fever.   "More than 40 of our staff including their families have been affected by the fever." 

According to the Red Cross in November, Yemen was already grappling with an epidemic of the viral disease, which is transmitted by several species of mosquito that breed in stagnant water.   Tens of thousands of people, mostly civilians, have been killed and millions pushed to the brink of famine since a Saudi-led military coalition intervened against Iran-aligned Shiite rebels in 2015.   It has generated what the United Nations has termed the world's worst humanitarian crisis.
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:
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: Thu, 20 Feb 2020 10:28:16 +0100 (MET)

Lagos, Feb 20, 2020 (AFP) - An outbreak of Lassa in Nigeria has killed 103 people this year, health authorities said, as the first confirmed case was reported in the economic hub Lagos.    "Cumulatively from week 1 to week 07, 2020, 103 deaths have been reported with a case fatality rate of 17.6%," said the Nigeria Centre for Disease Control (NCDC) in its latest statistics on the virus released on Wednesday.    The overall number of confirmed cases rose by 115 last week to a total of 586 across the country.

Separately, health authorities in Lagos, Nigeria's most populous city with 20 million inhabitants, said an infected person was diagnosed there on February 17 and being treated in isolation in hospital.    "Sixty-three people that may have been in contact with the patient and who may have been infected in the process have been identified and are being monitored," the state government wrote on Twitter on Thursday.

Endemic to Nigeria, Lassa fever belongs to the same family as the Ebola and Marburg viruses, but is much less deadly.   The disease is spread by contact with rat faeces or urine or the bodily fluids of an infected person.    The majority of those infected do not show symptoms but the disease can go on to cause severe bleeding and organ failure in about 20 percent of cases.

An outbreak of Lassa fever killed some 170 people around Nigeria last year.     The number of cases usually climbs around the start of the year linked to the dry season.   While the overall number of confirmed cases and deaths is up this year on the same period in 2019, the mortality rate is lower.    Twenty health workers across the country have been confirmed as contracting the disease so far in 2020.    The virus takes its name from the town of Lassa in northern Nigeria, where it was first identified in 1969.
Date: Fri 31 Jan 2020
Source: Nigeria CDC Situation report, yellow fever [edited]

Highlights
----------
In this reporting period:
- A total of 139 suspected cases were reported in 90 LGAs across 27 states
- All 139 suspected cases had blood samples collected
- 2 presumptive positive and 1 inconclusive case were reported; the inconclusive case was reported from Katsina State
- No confirmed case was recorded from Institute Pasteur Dakar
- No death was recorded from all the cases reported

Yellow fever response activities are being coordinated by the multi-agency yellow fever Technical Working Group (YF TWG).

Off-site support is being provided to all states.

Yellow fever preventive mass vaccination (PMVC) campaigns are planned for implementation in Oyo, Delta, Benue, Osun, Bauchi and Borno in the 3rd and 4th quarters.

Graphs and a map accessible at the above URL;
Figure 1 [graph]: Epidemic Curve of All Cases of Yellow Fever in Nigeria from Week 1 - Week 5, 31 Jan 2020
Figure 2 [graph]: Trends of Confirmed Cases in Nigeria - 2018, 2019 and January 2020
Figure 3 [graph]: Yellow fever Attack rate by State in Nigeria from Week 1 - Week 5, 31 Jan 2020
Figure 4: Map of Nigeria Showing States with Suspected and Presumptive confirmed Cases from Week 1 - Week 5, 31 Jan 2020
====================
[This report is not clear about the number of confirmed yellow fever (YF) cases that there have been in Nigeria this year (2020). The above report indicates that there are 139 suspected cases and all have had blood samples taken but does not state if all samples have been tested for YF by the Institute Pasteur in Dakar. The report does state that no confirmed case was recorded by the Institute Pasteur Dakar. The report states that 2 cases are presumptive and 1 is inconclusive. The graph in Figure 2 shows no confirmed cases in 2020.

It is curious that a 19 Jan 2020 report indicated that there were 141 suspected yellow fever cases in Jos North, Wase, Bassa, Kanam and Riyom Local Governments of Plateau State, of which 25 cases had been confirmed (see Yellow fever - Africa (02): Nigeria (PL) http://promedmail.org/post/20200121.6903167). A 29 Dec 2019 The World Health Organization (WHO) report confirmed 13 cases of yellow fever (YF), with 3 deaths in 4 local government areas of Plateau State (see Yellow fever - Africa (01): Nigeria (PL) http://promedmail.org/post/20200101.6862783). It is possible that all of these Plateau state cases occurred in 2019 and, hence, are not included in the above 2020 report which does not mention any cases in Plateau state. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Wed 29 Jan 2020
Source: Daily Trust [edited]

An unknown illness has reportedly claimed the lives of 4 persons in the rural community of Oye-Obi in Obi local government area of Benue state. The president-elect, Igede National Youths Council, Andyson Iji Egbodo, who raised the alarm on Wednesday night [29 Jan 2020] on behalf of the villagers, told our correspondent by telephone that 15 more people with the same symptoms are already hospitalised in the affected community.

"The sickness has so far killed 4 persons in 2 weeks. The 4 victims developed the same symptoms -- headache, fever, diarrhoea, vomiting, stomach-ache, weakness of the body, and swollen stomach -- and died alike," he said. Egbodo added that about 6 more persons who as at Wednesday [29 Jan 2020] were developing the same symptoms have been moved to the General Hospital in Oju, while the remaining 9 that made up the total of 15 on admission are kept at a private dispensary.

The youth leader who suspected the illness to be Lassa fever has appealed as a matter of urgency to the state government as well as relevant health authorities to come to the aid of the boundary settlement people before the illness causes further harm.

When contacted, the state's epidemiologist, Dr. Sam Ngishe, confirmed the death of the 4 people, adding that the health authorities were alerted to the situation a few hours ago.

Ngishe said an emergency response team from the state's Ministry of Health had been immediately sent to the area to contain the situation, while 3 of the patients are expected to be moved to Makurdi on Thursday [30 Jan 2020] for further investigation. The epidemiologist added that until investigation on the matter is completed, he cannot immediately confirm the nature of the illness, as there were already 2 sides to the rumour of possible causes of the deaths. He explained that there were reports that the community's source of drinking water was poisoned with Gamalin, and those affected may have consumed fish taken from the pond, while another side of the story suggested that the people who died presented symptoms of fever. "We can't base our findings yet on these rumours. We'll have to investigate it, and by tomorrow [Thu 30 Jan 2020], we will able to tell the press what exactly the challenge might be," Ngishe said.  [Byline: Hope Abah Emmanuel, Makurdi]
=======================
[It is difficult to speculate on the etiology of the illnesses that these individuals were suffering. Although no hemorrhaging was reported, the other reported symptoms are compatible with Lassa fever, and this is the season when Lassa fever virus transmission is highest (see <Lassa fever - West Africa (07): Nigeria http://promedmail.org/post/20200129.6930926>). The epidemiological investigations may provide additional information. Laboratory testing of samples from the affected individuals should provide information that may indicate the etiology involved. - ProMED Mod.TY]

[This article mentions "..community's source of drinking water was poisoned with Gamalin and those affected may have consumed fish taken from the pond.."

Gamalin, more often spelled Gammallin is also known as Lindane, which is a gamma-hexachlorocyclohexane, also called gammaxene. It is an organochlorine chemical and has been used as an insecticide and as a treatment for lice and scabies.

Lindane, a neurotoxin, interfering with nervous system, and can also affect the function of the liver and/or kidneys. It may be a carcinogen but has not specifically been designated as such. It has been classified as moderately hazardous by the World health Organization.

Being exposed to large amounts of lindane may be harmful to the neurological system. Clinical signs may include headache, dizziness, and seizures/convulsions, but rarely does it cause death.

Many of the organochlorines are banned in many areas because of the neurological effects, with the exception of the specific use of treating scabies.

Although the article specifically mentions lindane (organochlorine) the clinical signs mentioned in the article (headache, fever, diarrhoea, vomiting, stomach ache, weakness of the body and swollen stomach and death) do not mention the overwhelming clinical sign of most organochlorines, which is over-stimulation of the CNS, with seizures beginning approximately 1 hour post ingestion.

We look with interest to the outcome of the investigation and learning what affected these individuals. - ProMED Mod.TG]

[Maps of Nigeria:
Date: Thu 30 Jan 2020
Source: All Africa [edited]

An epidemiologist in Ondo state, Dr. Stephen Fagbemi, on Wednesday [29 Jan 2020] said the death toll from Lassa fever has risen to 20. The casualty figure was also corroborated by the state commissioner for health, Dr. Wahab Adegbenro.

A total of 112 confirmed cases were said to have been recorded in the state so far just as 5 local government areas [LGAs] of the state were said to have been hit by the disease.

The affected council areas include Akoko South West, Ose, Owo, Akure South, and Ondo West LGAs, while the victims were transferred to the Federal Medical Centre, Owo, and a treatment centre in Akure.

The state government last week revealed that 16 deaths had been recorded from the disease out of the 100 cases that were confirmed.

Adegbenro said the figure of the victims rose as a result of the influx of some victims from the neighbouring states to Ondo due to free treatment in the state.

"We are having the high figure because Ondo state is the only state that the treatment of Lassa fever is free of charge. I think we are having people coming from other areas to access the free treatment," he said.

The commissioner, who addressed journalists on World Neglected Tropical Diseases [NTD] Day, held on 20 Jan [2020], said the state has been mapped for the various neglected tropical diseases [NTDs]. Some of these, he said, include onchocerciasis, lymphatic filariasis, leishmaniasis, soil-transmitted helminths, schistosomiasis, and human African trypanosomiasis.

He explained that the "mapping result indicates that the state has overlapping endemicity for 4 preventive chemotherapy NTDs: the onchocerciasis, lymphatic filariasis, schistosomiasis, and schistosomiasis."

He said the government was being proactive in tacking the diseases as the government had begun the distribution of the preventive chemotherapy for the NTD, adding that the distribution varies across the communities and LGAs in the state.

"The scourge of NTDs were also being addressed through mass awareness created through different print and electronic media along with specific mass administration of medicines in the endemic areas," he stated.

The commissioner also noted that the World Health Organisation had targeted most of the preventive chemotherapy of the NTDs for elimination by 2030 "in line with the Millennium Development Goal 3."  [Byline: James Sowole]
===========================
[The number of Lassa fever cases in Ondo state is increasing, although not all may have originated in that state, as mentioned above. The most recent Nigeria CDC Lassa fever update indicates that Ondo and Edo states have the majority of cases (see Lassa fever - West Africa (07): Nigeria http://promedmail.org/post/20200129.6930926). Nigeria is now well into the period of the year when more cases usually occur, as illustrated in the graph in Figure 6 (at the source URL in above-mentioned post). There has been a peak in case numbers between weeks 1 and 11 (January-March) over the past 3 years, and it appears that this will be the case again this year (2020).
Transmission of LF virus occurs when individuals are in contact with rodent reservoir host excreta or are within healthcare facilities. The above report does not mention the circumstances under which the individuals acquired their infections. Presumably, it was from contact with the rodent reservoir or their excreta. Public education at the village level about the risks these rodents present and ways to avoid exposure is the best way to prevent most cases.

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

Maps of Nigeria:
Date: Wed, 29 Jan 2020 09:43:38 +0100 (MET)

Lagos, Jan 29, 2020 (AFP) - The death toll from Lassa fever in Nigeria since the beginning of January has risen to 41 as cases were confirmed in more regions, Nigeria's disease control agency said.  The Nigeria Centre for Disease Control (NCDC) said Tuesday that from January 1 to January 26 a total of 258 confirmed cases, including five health workers, were reported across 19 states.   The latest figures marked an increase from 29 deaths and 195 confirmed cases given by the authorities for the period up to January 24.

Endemic to Nigeria, Lassa fever belongs to the same family as the Ebola and Marburg viruses, but is much less deadly.   The virus is spread by contact with rat faeces or urine. It starts with fever and can, in worst case scenarios, lead to severe bleeding and organ failure.   Nigeria declared an outbreak of Lassa fever a year ago and around 170 people died from the virus in 2019.   The number of cases usually climbs in January due to weather conditions during the dry season.

The NCDC said that the fatality rate was down to 15.9 percent from 19.7 percent during the same period last year.    The agency said although there has been a spike in the number of deaths reported for the week, the figure is still lower than the 42 deaths reported in January 2019.    The NCDC said at the weekend that it had activated a national emergency operations centre to coordinate the response "to the increasing number of Lassa fever cases" across the country.  The name of the virus comes from the town of Lassa in northern Nigeria where it was first identified in 1969.
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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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Croatia

Croatia US Consular Information Sheet
January 16, 2008
COUNTRY DESCRIPTION:
Croatia is an increasingly well-developed nation in the process of accession to the EU. Facilities for tourism are available throughout the country, and the Adriat
c coast is an increasingly popular tourist destination. Read the Department of State Background Notes on Croatia for additional information or go to http://www.hr/english.

ENTRY/EXIT REQUIREMENTS:
A passport is required for travel to Croatia. A visa is not required for U.S. passport holders for tourist or business trips of fewer than 90 days within a six-month period. All foreign citizens must register with the local police within 24 hours of arrival and inform the office about any change in their address. Registration of foreign visitors staying in hotels or accommodations rented through an accommodation company is done automatically by the hotelier or accommodation company. Failure to register is a misdemeanor offense; some Americans have been fined as a result of their failure to register. U.S. citizens already in Croatia who wish to remain in Croatia for more than 90 days must obtain a temporary residence permit from the local police having jurisdiction over their place of residence in Croatia. With their residency application, applicants will need to provide a copy of their birth and marriage certificates (obtained within 90 days before application) and a police report authenticated for use abroad from their state of residence in the U.S. or from the country where they permanently reside. All documents should have an “apostille” stamp certifying their authenticity. Information regarding apostilles and authentication of documents is available at http://travel.state.gov/law/info/judicial/judicial_701.html.

For information on obtaining FBI or local police reports, please see http://travel.state.gov/tips/emergencies/emergencies_1201.html.
If an extension of the approved temporary stay is needed, the request should be submitted no later than 30 days in advance of the last day of authorized stay. For more information on obtaining residence or work permits, please see http://www.usembassy.hr/acs/entry.htm.

For further information on entry requirements for Croatia, including information regarding requirements for residency and work permits, travelers may contact the Embassy of Croatia at 2343 Massachusetts Avenue NW, Washington, DC 20008, tel. (202) 588-5899, the Croatian Consulates in New York City, Chicago, and Los Angeles or the Croatian Ministry of Internal Affairs/Office for Foreigners, tel. (385) (1) 4563-111 or http://www.mup.hr and http://www.mvpei.hr/MVP.asp?pcpid=1123. Visit the Embassy of Croatia web site at www.croatiaemb.org for the most current 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 or visit www.carina.hr for specific information about Croatian customs regulations.

SAFETY AND SECURITY:
Although hostilities in all parts of the country ended in 1995, de-mining of areas along former confrontation lines is not complete. It is estimated that de-mining operations will continue at least until 2010. Mine-affected areas are well-marked with the Croatian-language warning signs using the international symbol for mines. Travelers in former conflict areas, including Eastern Slavonija, Brodsko-Posavska county, Karlovac county, areas around Zadar, and in more remote areas of the Plitvice Lakes National Park should exercise caution and not stray from known safe roads and areas.
Mine clearance work may lead to the closure of roads in former conflict areas. For more information about mine-affected areas and de-mining operations in Croatia, please see the Croatian Mine Action Center’s web site at www.hcr.hr/en/minskaSituacija.asp.

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., 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:
Croatia has a relatively low crime rate, and violent crime is rare. Foreigners do not appear to be singled out. However, in tandem with increased numbers of American tourists visiting Croatia, the Embassy is receiving increased reports of thefts. Travelers are advised to safeguard their belongings in public areas, especially in bus or railroad stations, airports and on public transportation. As in many countries, outward displays of wealth may increase a traveler’s chances of being targeted by thieves.

While violent crime is rare, there have been isolated attacks targeted at specific persons or property, which may have been racially motivated or prompted by lingering ethnic tensions from Croatia’s war for independence.

Additionally, American citizens are cautioned to be mindful that Croatia is predominantly Catholic and, in some regions, quite conservative. Behavior that may be generally acceptable by American standards may offend local sensitivities and be met with hostility and, in a few cases, even violence.

American citizens are urged to be cautious when frequenting so called "gentlemen's clubs." A few such establishments have presented foreign patrons with grossly inflated bar bills, sometimes in the thousands of dollars, and threatened those customers who refuse to pay.

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:
Health facilities in Croatia, although generally of western caliber, are under severe budgetary strains. Some medicines are in short supply in public hospitals and clinics. The number of private medical and dental practitioners is substantial, and private pharmacies stock a variety of medicines not readily available through public health facilities. Croatian health care facilities, doctors and hospitals may expect immediate cash payment for health services and generally will not accept credit cards. Tick-borne encephalitis, a disease preventable with a three-shot vaccination series, is found throughout inland Croatia but is not prevalent along the coast. Travelers to Croatia may obtain a list of English-speaking physicians and dentists at the Embassy’s web site at www.usembassy.hr/acs/medical.htm or by calling: (385) (1) 661-2376 during working hours, or (385) (1) 661-2400 after working hours. Ambulance services can be reached by dialing 94. Ambulance services are effective; however, response times may be longer to more isolated areas.

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. Americans who plan to stay in Croatia for more than 90 days may be required by Croatian authorities to pay into the Croatian health insurance system for the period of their stay in Croatia, regardless of whether they hold private American insurance or not.

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

Road conditions and maintenance in Croatia vary widely. Two modern highways linking Zagreb with Rijeka and Split opened in 2004. Construction is complete between Zagreb and Split and Zagreb and Rijeka, but work is still ongoing between Split and Dubrovnik; This work may cause delays and road closures. Additionally, there are stretches of highway, with average travel speeds up to 130km/hour, which are still only one lane in each direction. Opposing traffic may not be separated by a divider. Highway tolls are higher than in the United States. Primary roads, including roads along the coast, are generally adequate, but most have only one lane in each direction. Coastal roads are narrow and congested, and tend to be slippery when wet. Rock slides are also possible on roads along the coast as well as through the mountain regions of Lika and Gorski Kotar. There is heavy congestion on major routes on weekends (towards the coast, for example) and in major cities during rush hours. Congestion on coastal routes, at border crossings and at tunnels is especially heavy in the summer months. Drivers should be prepared for sudden slowdowns when approaching tunnels at any time of year. Drivers tend to be aggressive in Croatia. Passing on curves or in oncoming lanes is common on highways and poses a higher risk of accidents. Drivers traveling though former conflict areas should stay on paved roads to reduce the risk of encountering unmarked mines and unexploded ordnance left over from the 1991-1995 war. In Zagreb, motorists and pedestrians alike should also pay special attention to trams (streetcars), which in downtown areas may travel at a high rate of speed through the narrow, congested streets.

Right turns on red lights are strictly forbidden in Croatia, unless an additional green light (in the shape of an arrow) allows it. At unmarked intersections, right of way is always to the vehicle entering from the right. The use of front seat belts is obligatory and passengers in vehicles equipped with rear seat belts are required to use them. Special seats are required for infants, and children under age 12 may not sit in the front seat of an automobile. The use of a cellular phone while operating a motor vehicle is prohibited unless the driver is using a hands-free device. Cars must have headlights on while in operation.

Croatia has adopted a policy of zero tolerance to driving under the influence of alcohol. It is illegal for a driver to have blood alcohol level greater than 0.00. Police routinely spot-check motorists for drinking and driving and will administer breath-analyzer tests at even the most minor accident. Drivers who refuse to submit to a breath-analyzer are automatically presumed to have admitted to driving while intoxicated. In case of accidents resulting in death or serious injury, Croatian law requires police to take blood samples to test blood alcohol levels.

Within Croatia, emergency road help and information may be reached by dialing 987, a service of the Croatian Automobile Association (HAK), staffed by English speaking operators. The police can be reached by dialing 92 and the ambulance service by dialing 94. Additional road condition and safety information may be obtained from HAK at tel. (385-1) 464-0800 ext. 0 (English speaking operators available 24 hours), or (385-1) 455-4433 or (385-1) 661-1999, or via their web site, www.hak.hr. During the tourist season, traffic information in English is also available at 98.5 FM on Croatian radio thirty minutes past the hour between 6:30 a.m. and 8:30 p.m.

According to Croatian law, U.S. citizens in Croatia for tourism or business may use a U.S. driver’s license for up to three months. U.S. citizens in Croatia with an approved extended tourist visa or permit for permanent residence may continue to use a U.S. driver’s license for up to twelve months, after which a Croatian driver’s license must be obtained. Please see http://www.usembassy.hr/acs/driver_license.htm for more information on obtaining a Croatian driver’s license. For specific information concerning Croatian driver’s permits, vehicle inspection, road tax and mandatory insurance, please contact the Croatian National Tourist Office, 350 Fifth Avenue, Suite 4003, New York, NY 10118; phone 1-800-829-4416 or 212-278-8672; fax 212-279-8683.

In cases of traffic accidents involving a foreign-registered vehicle, the investigating police officer on the scene is required to issue a vehicle damage certificate to the owner of the foreign-registered vehicle. This certificate is necessary to cross the state border. Upon written request, the police station in the area where the accident occurred will issue a Traffic Accident Investigation Record. For further information, please visit http://www.mup.hr/1266.aspx.

Please refer to our Road Safety page for more information.

For travelers arriving by private marine craft, please refer to the nautical information and regulations available at www.mmtpr.hr.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by Croatian carriers, the U.S. Federal Aviation Administration (FAA) has not assessed the Government of Croatia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Croatia’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:
With numerous automated teller machines and ever-wider acceptance of credit cards in Croatia, traveler’s checks are accepted less frequently or exchanged at an unfavorable rate. Western Union money transfer is available. For information on money transfers, call (385)(1) 4839-166 or fax (385)(1) 4839-122.

Recreational Boating:
The Government of Croatia adopted a law (effective January 1, 2006) requiring all recreational skippers chartering Croatian flagged vessels to have a certificate of competence. Under the law, the Ministry of Sea, Tourism and Transport will only recognize licenses issued by national authorities of other states. As no such national licensing regime exists in the U.S., Americans wishing to charter and pilot a Croatian-flagged vessel may be required to pass a certification test at the Ministry in Zagreb or a designated harbormaster's office on the coast.

Tourists can be certified in Croatia at harbormasters' offices in Pula, Rijeka, Senj, Zadar, Sibenik, Split, Ploce and Dubrovnik, as well as at the Ministry in Zagreb. Candidates need to contact the harbormaster's office or the Ministry to schedule the test. Please note that the test will be administered only to groups, so individuals may need to wait until a sufficient number of interested applicants apply. The certification costs 850 kuna (roughly $165) and is valid indefinitely. A study guide is available and the test can be taken in Croatian, English, German, and Italian.

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 Croatian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Croatia 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 also 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 Croatia 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 Croatia.Americans withoutInternet access may register directly with the U.S. Embassy. By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy in Zagreb is located at ul. Thomasa Jeffersona 2, 10010 Zagreb, tel. (385) (1) 661-2200. The Embassy is located in the southern outskirts of Zagreb near the airport. For emergencies on weekends, holidays and after hours, an embassy duty officer can be reached at tel. (385) (1) 661-2400 or (385) (91) 455-2247.
* * *
This replaces the Consular Information Sheet dated July 6, 2007, to update sections on Traffic and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Tue, 16 Jul 2019 10:44:51 +0200

Zagreb, July 16, 2019 (AFP) - Some 10,000 tourists were evacuated from a popular party beach on a Croatian island after a forest fire erupted early Tuesday, police said.

Police ordered visitors to night clubs on Zrce beach on the northern island of Pag to leave after the blaze erupted in a pine forest at around 1:00 am (2300 GMT Monday), a police statement said.   No one was injured in the fire which was brought under control, the mayor of the nearby town of Novalja, Ante Dabo, told national radio.  The cause was not immediately known.   Three firefighting planes were rushed to the scene to help extinguish the blaze which spread to a local road that had to be closed.

The island of Pag and its Zrce beach are popular with young tourists, notably British, who party there.  Tourism is a pillar of Croatia's economy, with visitors flocking to hundreds of islands and islets along its stunning Adriatic coast.   Last year the country of 4.2 million people welcomed more than 19 million tourists.
Date: Tue, 25 Sep 2018 19:50:04 +0200

Zagreb, Sept 25, 2018 (AFP) - A forest fire erupted Tuesday in Croatia's southern Peljesac peninsula, prompting the evacuation of dozens of villagers and tourists and destroying four houses, officials said.   The blaze broke out near the town of Orebic. It threatened the hamlet of Mokalo whose 40 inhabitants were evacuated, the national rescue and protection directorate (DZUS) said.   Tourists from two nearby camps were also evacuated, it added.

Meanwhile, strong winds hampered firefighting efforts and prevented the use of two water-bombing planes, they said.   "The situation in the Orebic area is pretty serious," national firefighting commander Slavko Tucakovic told state-run television.   "Unfortunately four houses were burned down but there are no casualties," he said.   This summer Croatia did not see major forest fires which mainly namely threaten its Adriatic coast.   But in 2017, summer fires were among the worst in several years, with 83,000 hectares (205,000) of forests damaged.
Date: Mon 3 Sep 2018, 11:43 PM
Source: Xinhua [edited]

A total of 26 people in Croatia have been diagnosed with the West Nile virus (WNV) this year [2018] and one has died, the Croatian Institute of Public Health announced on [Mon 3 Sep 2018].

Since last week, the institute has received 10 new reports of the disease, which is most often transmitted by infected mosquitoes and birds. The victims all came from the northwest and eastern parts of the country.

According to the European Center for Disease Prevention and Control, by [30 Aug 2018] there were 710 cases of WNV infections in Europe. Most of them in were in Italy (327), Serbia (243) and Greece (147).

Croatian news portal index.hr reported on [Mon 3 Sep 2018] that at least 20 people in Croatia who have been diagnosed with the virus were infected in Croatia.

WNV can cause neurological disease and death. The virus 1st appeared in Croatia in 2012 and since then 38 people have been infected. However, only a small percentage of the infected has been recorded, as the disease is usually mild and goes without any symptoms.

It is estimated that 80 percent of infected people have no symptoms while others develop a disease with flu-like symptoms such as high temperature, headache, sickness, and vomiting. Only 1 percent of infected people are hit by a heavy fever that usually leads to meningitis or encephalitis.  [Byline: Mu Xuequan]
======================
[In 2012, the 1st outbreak of human WNV neuroinvasive disease was reported in Croatia with 7 confirmed cases in 3 north-eastern counties [1]. In addition, acute asymptomatic infections in horses were noted in the same counties where human cases occurred [2].

All the cases of the West Nile virus infection in 2018 have been reported in the north-western and eastern regions of the country [3]

Vector surveillance and control measures can be helpful in reducing the burden of WNV and other vector borne diseases such as Dengue and Chikungunya.

References
1. Pem-Novosel, Vilibic-Cavlek T, Gjenero-Margan I, et al. First outbreak of West Nile virus neuroinvasive disease in humans, Croatia, 2012. Vector Borne Zoonotic Dis. 2014 Jan;14(1):82-4. doi: 10.1089/vbz.2012.1295, available at:

[HealthMap/ProMED map available at:
Date: Thu, 28 Jun 2018 12:57:23 +0200

Zagreb, June 28, 2018 (AFP) - Croatian authorities arrested a young British man Thursday on suspicion of stabbing to death another Briton on a popular party island in the Adriatic, in what local media said was a drug-related brawl between British gangs.   "We have identified the person suspected of committing the killing ... and the suspect was arrested this morning at the airport in Split", on the central Adriatic coast, Interior Minister Davor Bozinovic told reporters.   A police statement identified the suspect as a 25-year-old British man.   The victim was a 26-year-old British tourist who was killed at dawn Wednesday on the resort island of Pag.   Two other Britons were hurt in the alleged brawl on a beach, famous for parties. One of them suffered life-threatening stab wounds and was hospitalised while a third British tourist sustained minor injuries, hospital sources said.

The Jutarnji List paper -- which identified the victim as Ugo W. and said surveillance cameras recorded the fight -- reported Thursday that the "young men clashed over an area where they were selling drugs."   Croatia's northern island of Pag, particularly the town of Novalja and Zrce beach, is well known as a summer party destination for young tourists, many of them British.   Tourism is a major industry for Croatia where visitors flock to its stunning Adriatic coast, with more than 1,000 islands and islets.   Last year the country of 4.2 million people welcomed more than 17 million tourists. Among them were more than 750,000 British visitors.
Date: Wed, 27 Jun 2018 18:12:03 +0200

Zagreb, June 27, 2018 (AFP) - A British tourist was stabbed to death outside a nightclub on a popular Croatian party island at dawn on Wednesday in what the local media said was a brawl between British gangs.

Two other Britons were hurt in the fight on a beach on the Adriatic resort island of Pag, one of them suffering life threatening injuries.   Police said they were questioning several people over the incident, which occurred on Zrce beach at around 05:35 am (0335 GMT).   Surveillance cameras recorded the "fight between two British gangs" and police have identified those involved, the Jutarnji List paper reported online.

Police did not give further details about the brawl or the British tourists, although the state-run HINA news agency reported that the dead man was 26 years old.   "Unofficially, it was a fight between a group of young Brits," it said.   Another 26-year-old Briton suffered several stab wounds.   "He is stable now but his life is still in danger," said Edi Karuc, deputy head of a hospital in the coastal town of Zadar, quoted by HINA.    A third British tourist sustained minor injuries.

The northern island of Pag, particularly the town of Novalja and Zrce beach, is well known as a summer party destination for young tourists, many of them British.   Tourism is a major industry for Croatia where visitors flock to its stunning Adriatic coast, with more than 1,000 islands and islets.   Last year the country of 4.2 million people welcomed more than 17 million tourists. Among them were more than 750,000 British visitors.
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World Travel News Headlines

Date: Sun 23 Feb 2020
Source: Q Costa Rica News [edited]
<https://qcostarica.com/costa-rica-is-the-first-country-in-america-where-very-resistant-antibiotic-bacteria-for-meningitis-is-isolated/>

A 50-year-old man and a senior became the 1st 2 people in Costa Rica -- and in the Americas -- found to be infected with the bacteria most resistant to antibiotics used in the treatment of meningitis and meningococcal septicaemia that cause serious brain damage and even death. The Centro Nacional de Referencia en Bacteriolog­a (CNRB) -- National Center of Reference in Bacteriology, of the Instituto Costarricense de Investigacian y Enseaanza en Nutricin y Salud (Inciensa) -- Costa Rican Institute for Research and Education in Nutrition and Health (Incense), issued an alert, in early February [2020], after documenting the circulation of _Neisseria meningitidis_ (_N. meningitidis_) serogroup Y, resistant to penicillin and not sensitive to cefotaxime [and ceftriaxone?], two 3rd generation antibiotics, reports La Nation.
====================
[Invasive meningococcal disease (meningococcaemia and meningitis) is a life-threatening infection caused by _Neisseria meningitidis_ that evolves rapidly, often even when appropriate treatment has been started promptly. Because antimicrobial treatment for invasive meningococcal disease with a 3rd-generation cephalosporin (cefotaxime and ceftriaxone) is the widely accepted standard recommendation (<https://academic.oup.com/cid/article/39/9/1267/402080>), resistance of _N. meningitidis_ to cefotaxime and ceftriaxone is very worrisome.

The news report above says that 2 patients in Costa Rica were infected with _N. meningitidis_ serogroup Y resistant to penicillin and 2 3rd generation cephalosporins, one of which was cefotaxime. The other 3rd generation cephalosporin is not specified, but is perhaps ceftriaxone, the other 3rd generation cephalosporin usually used to treat this disease. We are also not told in the news report above if the 2 patients were epidemiologically linked, nor are we told the extent (that is, MICs [minimum inhibitory concentration] of penicillin or cefotaxime), the mechanisms of resistance, or resistance to any of the other antimicrobial drugs used to prevent or treat this disease.

More information would be appreciated from knowledgeable sources. Reduced susceptibility of _N. meningitidis_ to penicillin has been reported in the past in many countries, including the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>), usually due to decreased affinity of target penicillin-binding proteins for penicillin and less commonly to beta-lactamase production (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC89938/>, <https://pubmed.ncbi.nlm.nih.gov/3134848-relative-penicillin-g-resistance-in-neisseria-meningitidis-and-reduced-affinity-of-penicillin-binding-protein-3/>, and <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC162989/pdf/392577.pdf>).

Meningococcal isolates with reduced susceptibility to penicillin G usually were reported susceptible to 3rd-generation cephalosporins (cefotaxime and ceftriaxone). For example, despite the decrease in susceptibility to penicillin G in 33% of 2888 isolates of _N. meningitidis_, all isolates were susceptible to ceftriaxone in Brazil from 2009 to 2016 (<https://pubmed.ncbi.nlm.nih.gov/29717974-surveillance-of-antimicrobial-resistance-in-neisseria-meningitidis-strains-isolated-from-invasive-cases-in-brazil-from-2009-to-2016/>). Similar data have been reported for the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>).

However, one previous study reported 8 clinical isolates _N. meningitidis_ in Delhi, India in 2006 that were resistant to ceftriaxone and cefotaxime, with most also resistant to penicillin, ciprofloxacin, and chloramphenicol (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698303/>). All of the isolates were identified as serogroup A _N. meningitidis_, but no further details concerning these isolates were given in this report (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1865813/>).

Resistance to other antimicrobial agents that may be used for therapy of meningococcal infections or for prophylaxis of case contacts has been reported in several countries. This includes resistance to chloramphenicol, fluoroquinolones, and rifampin. Horizontal exchange of genes that encode resistance for penicillin, rifampin, and the fluoroquinolones from other _Neisseria_ species that share a common ecological niche with _N. meningitidis_ in the nasopharynx has been proposed as one possible mechanism of acquisition of meningococcal antibiotic resistance (<http://jac.oxfordjournals.org/cgi/content/full/49/3/545>). - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Costa Rica: <http://healthmap.org/promed/p/17>]
Date: Tue 25 Feb 2020
From: Anne Laudisoit, PhD [edited]
<laudisoit@ecohealthalliance.org>

A suspect plague outbreak cluster has been noted in the the Godjoka health area as of 19 Feb 2020. The chief medical officer of the Rethy Health zone, the head nurse and the laboratory team from the Rethy General reference hospital investigated the outbreak site. The Godjoka village is located in the Linga health zone, Djugu territory, Ituri province, in the Congo DR (N 02.01'47.9'' and E030.44'56.6'', 1940m) in the plague endemic area.
 
There have been 6 suspected cases of plague, including 5 deaths and 1 recovering patient. The index case is a young boy who died on 19 Feb 2020. His mother, the neighbour and her child all died on 21 Feb 2020 and were buried the night of 24 Feb 2020, under pressure from the villagers. Finally the traditional healer ["tradipraticien"] who took care of the mother (who was the 2nd case) died in turn on 25 Feb 2020, and samples were taken that same day. The rapid diagnostic test was positive for plague.  Because of their rapidly fatal course, pneumonic plague is suspected for one or more of the 5 fatal cases. 

The only survivor has been under treatment at the Godjoka Health center since 22 Feb; he is the 20 year-old brother of the index case. The test on the sputum of this patient was negative.
-------------------------------------
Francoise Ngave Nyisi, Rethy General Reference Hospital, DR Congo
Mandro Michel, Provincial Division of Health, Bunia, DR Congo
Adroba Pascal, Provincial Division of Health, Bunia, DR Congo
Laudisoit Anne, Ecohealth Alliance, New York, USA
=====================
[ProMED thanks Dr Laudisoit and her hardworking Congolese colleagues for this important report.  Thus far the diagnosis of plague rests on the single positive diagnostic test obtained from the traditional healer, as it appears that the first 4 fatal cases were buried before diagnostic tests could be obtained. Following this logic, It is possible that the sole survivor thus far has the bubonic form of the disease, and thus a negative sputum result.  We seek and hope to obtain further information on all of these cases, including age, nature and duration of symptoms, presence or absence of buboes, etc.

This putative plague cluster is in a known historic plague-endemic region, where there were 31 cases and 8 deaths between Jan - Oct 2019, as previously reported by ProMED (Plague - Congo DR (02): (IT) fatal http://promedmail.org/post/20191016.6731137).  The Ituri district, of course, has also been affected by the still smouldering North Kivu-Ituri Ebola outbreak that began in July 2018.  This district has also been, and continues to be, a region of great civil unrest, with multiple armed insurgency groups operating near and across the Ugandan border.

The following background information on plague by Mod.LL is copied from our most recent ProMED post on plague [see below under See Also]:

"The bacterium that causes plague is _Yersinia pestis_. Most cases of plague are due to bubonic plague following the bite of an infected rodent flea causing a swollen and very tender lymph gland. The swollen gland is called a "bubo." Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2-6 days after being bitten. At this point in the illness, there is no risk of person-to-person spread, so if this was indeed a case of bubonic plague, no isolation or quarantine is necessary.

When bubonic plague is left untreated, plague bacteria invade the bloodstream. As the plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition. Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The infected person may experience high fever, chills, cough, and breathing difficulty and may expel bloody sputum. If plague patients are not given specific antimicrobial therapy, the disease can progress rapidly to death. At this stage, as appears to have happened in this case, person-to-person spread can occur, causing other cases of "primary" plague pneumonia. - ProMED Mod.LL]

[A ProMED/HealthMap of DR Congo is available at: DR Congo:
Date: Thu, 27 Feb 2020 09:14:05 +0100 (MET)
By Anuj Chopra and Haitham El-Tabei

Riyadh, Feb 27, 2020 (AFP) - Saudi Arabia on Thursday suspended visas for visits to Islam's holiest sites for the "umrah" pilgrimage, an unprecedented move triggered by coronavirus fears that raises questions over the annual hajj.   The kingdom, which hosts millions of pilgrims every year in the cities of Mecca and Medina, also suspended visas for tourists from countries with reported infections as fears of a pandemic deepen.

Saudi Arabia, which so far has reported no cases of the virus but has expressed alarm over its spread in neighbouring countries, said the suspensions were temporary. It provided no timeframe for when they will be lifted.   "The kingdom's government has decided to take the following precautions: suspending entry to the kingdom for the purpose of umrah and visit to the Prophet's mosque temporarily," the foreign ministry said in a statement.   "Suspending entry into the kingdom with tourist visas for those coming from countries, in which the spread of the new coronavirus (COVID-19) is a danger."

The move comes as Gulf countries implement a raft of measures, including flight suspensions and school closures, to curb the spread of the disease from people returning from pilgrimages to Iran.  Even as the number of fresh coronavirus cases declines at the epicentre of the disease in China, there has been a sudden increase across the Middle East.

Since its outbreak, the United Arab Emirates has reported 13 coronavirus cases, Kuwait has recorded 43, Bahrain has 33 and Oman is at four cases.   Iran has emerged as a major hotspot in the region, with 19 fatalities from 139 infections -- the highest death toll outside China, where COVID-19 originated.   While no cases have been reported in Saudi Arabia, one citizen is reported to be infected in Kuwait along with four Saudi women in Bahrain -- all of whom had returned from Iran.

- 'Unprecedented' move -
The umrah, which refers to the Islamic pilgrimage to Mecca that can be undertaken at any time of year, attracts millions of devout Muslims from all over the globe each year.    There was no clarity over how the move would affect the annual hajj pilgrimage due to start in late July.   Some 2.5 million faithful travelled to Saudi Arabia from across the world to take part in last year's hajj -- one of the five pillars of Islam.

The event is a key rite of passage for Muslims and a massive logistical challenge for Saudi authorities, with colossal crowds cramming into relatively small holy sites.   "This move by Saudi Arabia is unprecedented," Ghanem Nuseibeh, founder of London-based risk consultancy Cornerstone Global Associates, told AFP.   "The concern for Saudi authorities would be Ramadan, which starts at the end of April, and hajj afterwards, should the coronavirus become a pandemic."

The holy fasting month of Ramadan is considered a favourable period by Muslim pilgrims to perform the Umrah.   Saudi Arabia's custodianship of Mecca and Medina -- Islam's two holiest sites -- is seen as the kingdom's most powerful source of political legitimacy.     But a series of deadly disasters over the years has prompted criticism of the Sunni kingdom's management of the pilgrimage.

In September 2015, a stampede killed up to 2,300 worshippers -- including hundreds of Iranians -- in the worst disaster ever to strike the pilgrimage.   The pilgrimage forms a crucial source of revenue for the government, which hopes to welcome 30 million pilgrims annually to the kingdom by 2030.   De facto ruler Crown Prince Mohammed bin Salman's Vision 2030 reform plan seeks to shift the economy of Saudi Arabia -- the world's top crude exporter -- away from oil dependency towards other sources of revenue, including religious tourism.
Date: Thu, 27 Feb 2020 05:04:04 +0100 (MET)

Kuala Lumpur, Feb 27, 2020 (AFP) - Badminton's German Open will not go ahead next week and the Polish Open has been postponed, officials said as two more Olympic qualifying events fell victim to the coronavirus.   It hasn't yet been decided whether the German Open, originally scheduled for March 3-8, will be postponed or cancelled entirely, the Badminton World Federation said late Wednesday.   New dates are being sought for the Polish Open, which was meant to take place on March 26-29, but it will not now fall in the qualifying period for the Tokyo Olympics.

Both events were in the same month as the All England Open, one of the biggest events in the badminton calendar, although that tournament is currently still set to go ahead.   "The BWF is continuing to monitor all official updates on COVID-19 with no change to the intention to stage other HSBC BWF World Tour or BWF-sanctioned tournaments," said a statement.   This week the Vietnam International Challenge, which also carried rankings points for the Olympics, was shifted from late March to early June.

The loss of qualifying tournaments will pose a problem for many players including two-time Olympic champion Lin Dan, who needs a rapid rise up the rankings to win a place on the Chinese team.   Many of China's players are currently in Britain and have been cleared to play during what is a "critical period" of Olympic qualifying, the Chinese Badminton Association said last weekend.   China have been the dominant force in badminton at recent Olympics, sweeping all five titles at London 2012 and winning the men's singles and doubles gold medals four years ago in Rio.
Date: Thu, 27 Feb 2020 09:58:42 +0100 (MET)

Tallinn, Feb 27, 2020 (AFP) - Estonia reported its first coronavirus case on Thursday, a day after the man returned to the Baltic nation of just 1.3 million people from his homeland Iran.    "The person, a permanent resident of Estonia who is not a citizen, arrived in Estonia on Wednesday evening," Social Affairs Minister Tanel Kiik told public broadcaster ERR.   He said the Iranian citizen is currently hospitalised.

Local media said the man arrived in Tallinn by bus from the Latvian capital Riga.   "For now, there are no plans of putting cities in quarantine following this one case," Kiik said.    "The patient is isolated, there is no risk of the disease spreading, now we have to identify all the people the patient was in contact with."   Iran has announced a total of 19 deaths and more than 130 infections, including the country's deputy health minister.   Iran's coronavirus death toll is the highest after that of China, where more than 2,700 people have died from the disease.
Date: Wed, 26 Feb 2020 19:27:33 +0100 (MET)

Vynnyky, Ukraine, Feb 26, 2020 (AFP) - Ukrainian authorities began the task of destroying 37,000 bottles of illicit adulterated vodka on Wednesday, a national "record" in a country where consumption of illegal alcohol regularly poisons and even kills.    Minister of Justice Denys Malyuska launched the operation in the city of Vynnyky in the central Lviv region where the bottles, holding 14 tonnes of alcohol, have been stored since their seizure in 2014.   "It is difficult to say what is in there but consumption is strictly not recommended," said the minister.    "This adulterated alcohol poses a huge threat to people's health and their lives."    In front of the media, the contents of several bottles were poured into plastic tanks or blue dye was added, to rule out any illegal re-sale of the beverage.

The procedure should last about a week, after which the liquid will be poured into the sewers at a secret location, according to the minister.   "This is the first time this procedure has been used so that everyone can see that the alcohol that has been seized is really destroyed," said Maliouska.   The minister said that in the past there had been "complaints" from the business community that because of corruption within the police, the illicit alcohol had often turned up in shops after being seized.   Cases of poisoning from adulterated drinks are a regular occurence in Ukraine, where the consumption of alcohol, especially spirits, remains high. And they are often fatal.

In 2016, 73 people died from a total of 150 people who were poisoned by adulterated alcohol.    The following year, six poisoning cases killed three people and, according to Ukrainian media, ten poisonings recorded by the authorities in 2018 led to nine deaths.   The tax department of the Lviv region told AFP on Wednesday that the most adulterated alcohol was vodka, which is then sold in shops in small towns or cafes located along the roads.
Date: Thu, 27 Feb 2020 07:21:09 +0100 (MET)

Copenhagen, Feb 27, 2020 (AFP) - Denmark reported its first coronavirus case Thursday, a man who had returned from a skiing holiday in northern Italy which has become a hotspot for the disease.   "The man who came back from a skiing trip with his wife and son on February 24 has been suffering since then from a cough and a temperature," Denmark's public health agency said in a statement.   "The man tested positive, but the results of his wife and son are negative," it said.   The man is relatively well and has returned to his home, where he remains in isolation with his family, it added.   According to public TV station TV2, the man is one of its employees.   Italy has reported 400 coronavirus cases, mostly in the north, and 12 deaths.
Date: Wed, 26 Feb 2020 23:18:10 +0100 (MET)

Bucharest, Feb 26, 2020 (AFP) - Romania reported its first confirmed case of the novel coronavirus on Wednesday -- a man who was in contact with an Italian who visited the country last week.    "The patient, who is in good health and is showing no symptoms, will be transferred to Bucharest's hospital of infectious diseases," Health Minister Victor Costache told a press conference.

Seven other people who live at the same address as the man in the south-eastern Gorj county have all tested negative but will be quarantined for 14 days as a precaution, emergency department official Raed Arafat said.   The Italian believed to be the source of Romania's first diagnosis tested positive for the deadly virus upon returning to Italy after a four-day visit to Gorj.

New cases have been emerging across Europe, many linked to the continent's coronavirus hotspot in northern Italy.    Several governments have advised against travel to Italy, which has now recorded 400 cases and 12 deaths.   The COVID-19 outbreak has killed over 2,700 people and infected more than 80,000 in 34 countries, although the vast majority of cases remain in China, according to the World Health Organization.
Date: Wed, 26 Feb 2020 21:33:56 +0100 (MET)

Oslo, Feb 26, 2020 (AFP) - Norwegian health authorities on Wednesday announced the first case of coronavirus in the Nordic nation in someone who returned from China last week, but said the patient was not "in danger".   "The person is not ill, they are in good health and do not present any symptoms," Line Vold, an official at the Norwegian Institute of Public Health, told reporters. "We think it is very unlikely that they have infected" others.   Routine tests had given a "weekly positive result" and detected traces of the new coronavirus, the institute said.
Date: Wed, 26 Feb 2020 20:03:47 +0100 (MET)

Tbilisi, Feb 26, 2020 (AFP) - Georgia on Wednesday announced its first confirmed case of the novel coronavirus in the South Caucasus region.   "A Georgian national has tested positive for the novel coronavirus," Health Minister Ekaterine Tikaradze told a news conference, adding that the infected man has been placed in isolation in a Tbilisi hospital.   "Three different tests of the 50-year-old man's nasopharyngeal smear gave positive results, but he is doing well, he is clinically healthy," head of Georgia's national centre for disease control, Amiran Gamkrelidze told journalists.

The man had arrived in Georgia from Iran via Azerbaijan, Gamkrelidze said.   Tikaradze said Georgia would introduce a two-week ban on Iranian nationals entering Georgia, but flatly dismissed fears of a coronavirus epidemic in the ex-Soviet country "at this point".   On Sunday, Georgia's neighbour Armenia closed its border with Iran and suspended flights as fears over an outbreak of coronavirus in Iran sent neighbouring countries scrambling to contain the outbreak.