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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.
More ...

South Africa

General Introduction: The Republic of South Africa lies at the Southern tip of the African continent, flanked between the Indian and Atlantic oceans. Although it lies close to the tropic of Capricorn, the inland areas are tempered by the relatively high a
titudes. Summers and winters are opposite to that found in Ireland. In South Africa the summer extents from October to March. Although South Africa is basically a developed country, much of its population, particularly in rural parts, live in poverty. However facilities for tourists in urban areas and game parks are generally excellent. Despite all the well documented reports overall violence against tourists is usually low but obviously care should always be taken. Travelling late at night is usually unwise and take particular care if visiting nightclubs etc.
Climate: There is generally a moderate climate with sunny days and cool nights. The Cape Town region has a mean yearly temperature of 170C while Johannesburg has an annual mean temperature of 160C. This is mainly because Johannesburg is at 5,700 feet altitude. Throughout South Africa, summer extends between October and March and winter is between June and September. In Johannesburg the winter months tend to be dry and cool while the rainy season tends to occur during the warmer summer months.
Health Facilities: In the larger cities of Johannesburg, Cape Town, Durban & Pretoria and many others there will be no difficulty in receiving excellent medical attention. However when travelling throughout the more isolated rural regions the same situation does not occur. Travellers should always ensure that they are up-to-date in their routine travel vaccinations. World Travel Medicine Consultants (WTMC) in South Africa offer excellent medical facilities in many of the main centres. Contact by email their head office at for further information.
Jet Lag: Even though the hour changes from Ireland are not great after flying for approximately 13 hours you will arrive tired. On the plane journey take some exercise by walking around and occasionally stretching your calf muscles to lessen any risk of blood clots. If you are on the contraceptive pill (women only!) this will increase your risk on a long haul flight and you should talk this through with the doctor looking after your health care advice and vaccines. On arrival, try and rest for the first 24 hours to allow your body to catch up with itself. If lying by the pool remember not to fall asleep and wake some hours later with significant sunburn!
Mosquito-Borne Disease: Mosquitoes are most often associated with Malaria, however it is not the only disease which the insect may carry. Insect repellents which contain more than 30% DEET are effective for keeping mosquitoes away but remember to cover your arms and legs when they are biting. This is mainly in the hours between dusk and dawn. The risk of malaria can be reduced by taking malarial prophylaxis on a regular basis if you are planning to visit the risk areas. Anti malaria tablets are advised for those visiting low altitude areas especially areas around the Kruger National Park, north, east and western Transvaal, and the costal lowlands of Natal. Large towns and cities and high altitudes are more likely to be free of mosquitoes.
Effects of Heat: Extreme climate conditions can also lead to gastrointestinal difficulties but don't forget that when you perspire you will loose both water and salt. Replacing the lost water is easy but many travellers forget to replace the salt in their diet. This can lead to muscular cramps, tiredness and lethargy, a dull headache and generally feeling cross and out of sorts. Replacing depleted salt is most easily achieved by sprinkling it on your meals. Salt tablets can be dangerous and are best avoided except in expert hands. If you have any blood pressure difficulties then it will be important to talk this whole issue through with your doctor before leaving Ireland.
Waterborne diseases: Water sources in well developed urban areas of South Africa are generally safe. Outside the main cities caution must always be exercised with regard to drinking water. Safe water should be well chlorinated and so will have a distinct chlorine odour. Sealed bottled water is more preferable especially in less developed areas. Avoid ice in your drinks as its source may be unknown and don't brush your teeth in water you wouldn't want to drink. If unsure be careful and use sealed bottled water from one of the hotels.
Food-Borne Disease: Again, in the larger cities and tourist resorts, the food and its preparation is generally of an excellent standard and you should experience no problems. It is advised however to avoid eating shellfish and cold/rare meats. In particular, Capetown is famous for its various shellfish meals. Personally I would strongly encourage travellers to avoid them even in the best hotels and restaurants. It is just not worth the risk. As in any hot climate it is also wise to choose only the type of fruit you can peel yourself. Above all avoid buying or consuming food from roadside stalls or street vendors.
Rabies in South Africa: Travellers need to be aware that this potentially fatal viral condition occurs throughout Africa. The risk to any tourist or business traveller is very small but common sense needs to be maintained at all times. The disease is mainly transmitted through the bite of an infected warm blooded animal. Usually dogs and cats are involved but also be very careful of monkeys. If bitten by any potentially at risk animal wash out the wound immediately, apply a strong antiseptic and seek medical attention urgently
Yellow Fever: A yellow fever vaccination certificate is only required for travellers coming from endemic zones in Africa and the Americas. Travellers on scheduled airlines whose flights have originated outside the areas regarded as infected (or who are only in transit through these areas) are NOT required to possess a certificate.
If the flight originated from within a Yellow fever endemic area a certificate is then required.

Vaccination Schedule: Apart from Yellow Fever vaccine in certain circumstances, as mentioned above, there are no other vaccinations required for entry into South Africa from Ireland. Nevertheless there are a number of recommended vaccines for most travellers which need to be discussed. For trekking holidays or extended visits Rabies and Hepatitis B may need to be considered. Most travellers should start their vaccines at least 4 to 6 weeks before departure.
Further Information: South Africa is a beautiful destination with much to offer. Further general health information on staying healthy while travelling abroad may be obtained from the Tropical Medical Bureau. www.tmb.ie

Travel News Headlines WORLD NEWS

Date: Tue 11 Feb 2020
Source: SABC News [edited]

A 56-year-old was admitted at the Klerksdorp Tshepong Hospital on Saturday [8 Feb 2020] with a history of tick bite followed by flulike symptoms including headaches and fatigue.

The North West Health Department says while no active bleeding was noted, treatment was started immediately.

Crimean-Congo fever, also known as Congo fever/haemorrhagic fever, is a disease caused by a tick-borne virus with a case fatality rate of 10% to 40%.

Transmission to humans occurs through contact with infected animal blood or ticks. It can be transmitted from one infected human to another by contact with infectious blood or body fluids.

Symptoms include high fever, vomiting and abdominal pain, but as the illness progresses, large areas of severe bruising and severe nosebleeds are also common.

Clinical Manager at the Klerksdorp Hospital Dr. David Leburu says: "Crimean-Congo fever can make a person bleed. It can make people bleed just like Ebola but not as aggressive as Ebola."
===================
[Occupational groups such as herders, farmers, abattoir workers, veterinarians/animal health workers, hunters and persons informally slaughtering domestic/wild animals are at higher risk of infection. These persons often have exposure to ticks on the animals and in the animal environment, and also often have exposure to animal blood/tissues (e.g., during castration of calves, vaccination, notching/tagging of ears, slaughtering).

Humans can become infected in the following ways:
- Being bitten by infected ticks;
- Squashing infected ticks (if fluid from the ticks enters into cuts/grazes on the skin, or splashes onto mucous membranes, including the eyes, nose and mouth);
- If blood/tissue from infected animals (during the short period that the animals have virus in circulation) comes into contact with cuts/grazes on the skin, or splashes onto mucous membranes, including the eyes, nose and mouth;
- Needle-stick/sharps injuries in healthcare workers from infected patients.

The patient in the above report had a history of tick bite, but no other epidemiological information is available.

Human CCHF cases have been reported annually from South Africa since 1981, when it was first recognized in the country; between 0 and 20 cases of CCHF are reported each year. Through nearly 30 years of passive surveillance, more than 180 cases have been laboratory-confirmed. Although cases have been reported from all 9 provinces in the past 30 years, more than half of the cases originate from the semi-arid areas of Northern Cape Province (31.5% of cases) and Free State Province (23% of cases) (<http://www.nicd.ac.za/assets/files/CCHF_FAQ-General_Public.pdf>). - ProMED Mod.UBA]

[HealthMap/ProMED-mail maps:
North West Province, South Africa:
Date: Tue, 21 Jan 2020 17:28:23 +0100 (MET)

Johannesburg, Jan 21, 2020 (AFP) - Beleaguered national airline South African Airways (SAA) announced on Tuesday it was cancelling 10 domestic and one international flight in an effort to streamline services and save cash.   The cash-strapped airline was last month placed under a state-approved business rescue plan to avoid total collapse following a costly week-long strike by thousands of its workers.   SAA said in was dropping 10 domestic flights between Johannesburg, Cape Town and Durban, while canning its direct route between Johannesburg and Munich.

Passengers on cancelled domestic flights will be accommodated on its budget sister airline, Mango, while international travellers would be re-routed via its flights between Johannesburg and Frankfurt, and London Heathrow.   "These decisions are in line with SAA's usual policy of reviewing flights and consolidating services with low demand," it said in a statement.   "Furthermore, during the current process of business rescue, these cancellations represent a responsible strategy to conserve cash and optimise the airline's position ahead of any further capital investment."

The company said there might be further flight schedule changes over the coming days.   Aviation analyst Phuthego Mojapele said a spate of cancellations by clients were exacerbating problems for SAA.   "At the moment SAA's perception out there ... it's not really looking good because there is negative news that is being perpetuated on the wires every single day," Mojapele told local television station, eNCA.   "However, SAA's records in terms of safety, in terms of the service has always been excellent," he added.

The debt-ridden carrier, which has failed to make a profit since 2011 and survives on government bailouts, has been awaiting a two-billion rand ($138 million) payout from the Treasury to fund a rescue plan announced in December.   Finance Minister Tito Mboweni last week told journalists that the government was still trying to "find a solution to finance the airline".    Local media have reported that SAA is selling nine older aircraft to make way for new planes, part of a separate plan to rid itself of its most costly aircraft.   SAA, Africa's second largest airline after Ethiopian Airlines, employs more than 5,000 workers. It has a fleet of more than 50 aircraft flying to more than more 35 domestic and international destinations.
Date: 13 Jan 2020
Source: Times Live [edited]

Six people collapsed and were taken to hospital -- 5 of them in a critical condition -- after apparently ingesting an unknown substance in the Cape Town suburb of Wetton on Monday [13 Jan 2020].

ER24 spokesperson Russell Meiring said the ambulance service was initially alerted to several people in desperate need of help.  "It is believed to have been some sort of poisoning incident. All those affected had ingested some sort of substance which is not yet known," he told TimesLIVE. It is not known whether the victims were related or knew one another.

Cape Town law enforcement spokesperson Wayne Dyason said: "City law enforcement officers on patrol in Wetton were alerted to an incident in which 3 males and a female had collapsed at a bus stop." He said the victims received medical attention. As the paramedics were treating them, another person was reported lying on the pavement in nearby Walnut Road, and a 6th had collapsed on the corner of St Joseph's Road and Wetton Road. "The patients were treated for their injuries and provided with several advanced life support interventions before they were transported to nearby hospitals for further care," said Meiring.  [Byline: Tanya Farber]
***************************************
Date: 13 Jan 2020
Source: Arrive Alive [edited]

Six people were transported to the hospital this afternoon [13 Jan 2020], 5 in a critical condition, after they collapsed on Wetton Road in Wetton, Western Cape.  ER24 paramedics, Life Healthcare and the Western Cape Metor Services, arrived on the scene to find 6 people had collapsed along Wetton Road.

Medics assessed the patients and found 5 people were in a critical condition, while the 6th patient was found in a serious condition. It was understood that the men had ingested an unknown substance, causing them to collapse.  Local authorities were on the scene for further investigations.
====================
[Neither of these articles give us much information regarding what the substance was or how quickly these individuals collapsed, or whether there were other specifics.

We are not told whether the substance was inhaled or ingested. If they were given life-saving procedures, then perhaps their heartbeat was irregular or had stopped, or breathing had stopped, or perhaps the unknown substance resulted in the patients being unable to breath, or perhaps they were blue and gasping for breath.

We could speculate some more, but there are few clues here. We wish these individuals a speedy recovery. - ProMED Mod.TG]

[We would appreciate any additional information on these cases including the cause of poisoning if/when it is determined. - ProMED Mod.JH]

[HealthMap/ProMED map available at:
Date: Sat, 14 Dec 2019 04:27:07 +0100 (MET)
By Béatrice DEBUT

Adelaide, Afrique du Sud, Dec 14, 2019 (AFP) - South African farmer Steve Bothma heaved a sigh of relief when the weatherman finally predicted rain.   His excitement was short-lived. Just a few days later, the forecast changed. It was back to cloudless sunshine.   In South Africa's Eastern Cape province, no one can remember the last proper downpour. Some say it was five years ago, others six. "This is a disaster," said Bothma, 51, who in his three decades working the land has never seen such dry weather.     "Older people who are 70 or 80 years old would tell you exactly the same thing," he added.

Southern Africa is grappling with one of the worst droughts in decades -- the outcome of years of absent or erratic rainfall, and temperatures that have reached record highs.   Millions are facing hunger due to poor harvests and dwindling livestock.    "It is usually beautifully green at this time of the year," said Bothma, as a hot gust of wind swept through his sheep pen.   "But now even the pine trees are dying."

South Africa is one of the world's driest countries at the best of times.   Rapid urbanisation and growing water consumption have placed a strain on water reserves and caused the coastal city of Cape Town to almost run dry in 2018.   But the ongoing drought has compounded the situation.    Dam levels dropped dangerously low in October, prompting President Cyril Ramaphosa to call for "drastic measures".   South Africa is in "a dire situation", said Ramaphosa in October, highlighting that five out of nine provinces were badly hit.

- To the slaughterhouse -
Bothma has had to cull around 60 percent of his merino sheep, including lambs.   Because of the drought, he could only afford to keep 2,000 as "breeding stock".   "Usually I keep them until they are five or six years old," Bothma explained, as his staff selected animals for the next trip to the slaughterhouse.

The price he gets for his merino wool has plunged by around 40 percent over the past year due to the drought and a foot-and-mouth disease outbreak in the north of the country.      "The wool is full of dust and not very strong," said Bothma.   Years of dry weather have left scars in the landscape.   Arid fields flanked the windy gravel road leading to the nearest town of Adelaide, tucked at the bottom of a mountain range.    Cows chewed pieces of wood and sheep ambled in search of food.   In town, livestock roamed the streets and nibbled at scorched grass on the golf course.   The nearest dam dried up at the start of the year.

- 'Can't wash' -
Some of Adelaide's 15,000 inhabitants had been without running water for seven months.  A South African aid group, Gift of the Givers, has been helping by delivering water to the area since April.     On a recent water mission, hundreds of people In the township of Bezuidenhoutville rushed up with an array of empty bottles, buckets, iceboxes and even paint cans.      "We are keeping it for food and drink," said Rodney Douglas, 59, pushing a wheelbarrow piled high with plastic jerrycans.

Assanda Sais, 38, complained that she could only spare enough water to bathe once a week and that her house was "smelling".    "We keep dirty water to flush," she explained.   Bezuidenhoutville's local middle school has had to shorten its week by half a day due to the lack of water.    Many children were missing class altogether.   "Kids have to help parents to carry water," said teacher Zeenat Gangat, sweltering as the sun beat down on the container walls of a classroom.   "They can't wash," she added. "They complain about stomach issues."

- Poor infrastructure -
Local authorities have tried to ease the situation by connecting sections of the town to a reservoir fed by Fish River, around 50 kilometres (30 miles) away.   The water is allocated on a rotational basis, but even then the pipeline to the river is way too narrow.   Adelaide deputy mayor Bornboy Ndyebi said the town's pipelines were in poor shape, and Thandekile Mnyimba, who heads the regional district of Amathole, told AFP that water trucks supplied by the government had broken down.

South Africa's main opposition, the Democratic Alliance (DA), has accused the ruling party of acting too late.   "It is only when the dam reached a very low level - around four percent -- that they woke up," said DA councillor Ernie Lombard.   Ramaphosa has sought to pin the blame on years of poor governance under former president Jacob Zuma, whom he succeeded in 2018.   "Corruption in the water sector has in no small part contributed to the situation we currently face," he declared.

- 'Can't sleep at night' -
Water insecurity could become "the biggest developmental and economic challenge facing this country," Ramaphosa added.   Adelaide is already suffering from South Africa's ailing economy, marked by low growth and chronic unemployment.    Close to 70 percent of the small town's inhabitants are out of work. When houses go up for sale, they stay on the market.

The manager of Adelaide's only hotel said she was worried if too many rooms were booked at the same time, as "it takes two weeks to do the washing".   On nearby farms, high-yielding avocado trees now barely produce 10, low-grade fruit instead of 50.   Helpless farmers watch their animals succumb to thirst and hunger. Alton Snaer has lost nine of his 15 cows.   "I can't sleep at night," said the retired farmer.   Bothma feared that more months without rain would force him "to close the books".   "Farmers are taking their life," he said, eyes reddened by the dust. 
Date: Thu, 5 Dec 2019 12:19:45 +0100 (MET)
By Sofia CHRISTENSEN

Johannesburg, Dec 5, 2019 (AFP) - South African Airways was placed under a state-approved rescue plan on Thursday to avoid the embattled airline's collapse following a costly week-long strike last month.   Thousands of South African Airways (SAA) staff walked out on November 15 after the flag carrier failed to meet a string of demands, including higher wages and job in-sourcing.   The strike was called off the following week after SAA management and unions eventually clinched a deal.

But the walkout dealt a severe blow to the debt-ridden airline, which has failed to make a profit since 2011 and survives on government bailouts.   "The Board of SAA has adopted a resolution to place the company into business rescue," said a statement by South Africa's Public Enterprises Minister Pravin Gordhan, adding that the decision was also supported by the government.   "It must be clear that this is not a bailout," said Gordhan. "This is the provision of financial assistance in order to facilitate a radical restructure of the airline."   The business rescue process will be directed by an independent practitioner. It is meant to prevent a "disorderly collapse of the airline", he added.   Gordhan said the government would provide 2 billion rand ($136 million) to SAA in "a fiscally neutral manner".   Existing lenders will also provide a 2 billion rand loan guaranteed by the government.

- 'Financial challenges' -
South Africa is struggling to get state-owned companies back on track after nine years of corruption and mismanagement under former president Jacob Zuma.   Its national airline -- which employs more than 5,000 workers and is Africa's second largest airline after Ethiopian Airlines -- had been losing 52 million rand ($3.5 million) a day during the strike.   SAA's board said the business rescue, scheduled to start immediately, was decided after consultations with shareholders and the public enterprises department "to find a solution to our company's well-documented financial challenges".

"The considered and unanimous conclusion has been to place the company into business rescue in order to create a better return for the company's creditors and shareholders," said the SAA board of directors in a statement.   The rescue plan will include a "new provisional timetable" and ensure "selected activities... continue operating successfully".   With a fleet of more than 50 aircraft, SAA flies to over 35 domestic and international destinations.   "SAA understand that this decision presents many challenges and uncertainties for its staff," said the board.   "The company will engage in targeted communication and support for all its employee groups at this difficult time.

- 'Lesser evil' -
Unions told AFP they would comment later on Thursday.   They have agreed to a 5.9-percent wage increase backdated to April, but which would only start to be paid out next March depending on funding.   SAA had initially refused any pay rise.    The cash-strapped airline needs two billion rand ($136 million) to fund operations through the end of March. But it was unable to cover all of its staff salaries last month.    "Business rescue allows for the airline to continue to operate while it is being restructured, as opposed to liquidation," analyst Daniel Silke told AFP.   He said the rescue was a "lesser evil for SAA" and would save more jobs than a "shutdown".

But Silke still expected jobs to be cut as SAA attempted to reduce costs.   "Various divisions that make of SAA could be privatised," he said. "There will be a review of SAA aircraft and routes covered by SAA."   Unions had already demanded a three-year guarantee of job security following an announcement last month that almost 1,000 SAA employees could lose their jobs as part of another restructuring plan.   SAA pledged to defer that process to the end of January as part of the deal that ended the strike.
More ...

World Travel News Headlines

Date: Tue, 25 Feb 2020
13:15:00 +0100 (MET)
By Ella IDE and Jastinder KHERA

Rome, Feb 25, 2020 (AFP) - Italy's new coronavirus spread south on Tuesday to Tuscany and Sicily, as the civil protection agency reported a surge in the number of infected people and Rome convened emergency talks.    Prime Minister Giuseppe Conte has blamed poor management in a hospital in the country's north for the outbreak, which has caused seven deaths in Italy so far and infected the largest number of people in Europe.    Tuscany reported its first two cases, including one in the tourist destination of Florence, while Sicily marked one: a tourist from the worst-hit Lombardy region, where 212 people have tested positive. The female tourist in Sicily, who had been staying in a hotel in Palermo, tested positive on the first swab but was awaiting the definitive result from Italy's institute of infectious diseases, civil protection agency chief Angelo Borrelli said.

Health ministers from neighbouring countries were to meet in Rome as the 
number of confirmed infections jumped to 283, with over 50 new cases reported since Monday.    The EU's health commissioner and other international health officials were also expected in the Italian capital Tuesday.    Hundreds of people were confined to their rooms at a Tenerife hotel after an Italian tourist was hospitalised with a suspected case of coronavirus, health officials in the Canary Islands said.  While no neighbouring country has closed its borders with Italy, several governments have announced additional measures for travellers arriving from Italy, in particular from the two northern regions of Lombardy and Veneto.  They range from medical screening to recommendations to self-isolate.

- 'Mission Impossible' -
Several upcoming matches in Italian Serie A and the Europa League will be played behind closed doors to combat the spread of the disease.    Production of the latest "Mission: Impossible" film starring Tom Cruise in Venice has been stopped following the outbreak.    The main centre of infection in Italy has been the town of Codogno, a town of some 15,000 people around 60 kilometres (35 miles) to the south of Milan. Codogno and several others in northern Italy have been put under isolation in an attempt to stem the spread of the virus.

The 38-year-old man dubbed "Patient One" by Italian media was admitted to 
hospital last Wednesday in Codogno, and it is thought a large number of the cases in the worst-hit region of Lombardy can be traced back to him.    His heavily pregnant wife, several doctors, staff and patients at the hospital are thought to have caught the virus from him.    As well as the towns placed under quarantine, further wide-ranging measures have affected tens of millions of inhabitants in the north of Italy, with schools closed and cultural and sporting events cancelled.    Elsewhere in the country officials have also been recommending precautionary measures.  In Calabria in the south, bishops have asked their worshippers not to make the sign of peace during mass, media reported.    All seven of those who have died so far in Italy were either elderly or had pre-existing medical conditions.
Date: Tue, 25 Feb 2020 11:48:12 +0100 (MET)

Madrid, Feb 25, 2020 (AFP) - Hundreds of people were confined to their rooms at a Tenerife hotel Tuesday after an Italian tourist was hospitalised with a suspected case of coronavirus, health officials in the Canary Islands said.   "Hundreds of hotel clients are being monitored for health reasons and the degree of supervision will be assessed during the day, but so far, we're not talking about quarantine," health authority spokeswoman Veronica Martin told AFP, confirming that the Italian tourist "was staying at this hotel while on holiday in Tenerife".
Date: Tue, 25 Feb 2020 11:40:20 +0100 (MET)
By Laurent Thomet with Dario Thuburn in Geneva

Beijing, Feb 25, 2020 (AFP) - Fresh deaths and a surge in new coronavirus cases in Iran, Japan and South Korea on Tuesday fuelled fears of a pandemic, as the disease took root in some of the world's poorest -- and worst-equipped -- countries.  The rapid spread abroad came as the World Health Organization announced that the epidemic had peaked at its epicentre in China, where it has killed more than 2,600 people and infected over 77,000 others.

But the situation has worsened elsewhere with nearly 2,700 other cases and more than 40 deaths globally, prompting restrictions on travellers from infected nations, the cancellation of football matches and national efforts to isolate suspected patients.    South Korea, Italy and Iran have each logged sharp increases in infections and deaths, while several Middle Eastern countries also reported their first confirmed COVID-19 cases.

WHO chief Tedros Adhanom Ghebreyesus insisted the virus could still be contained, praising China's drastic quarantine measures in several cities for helping to prevent an even bigger spread.   "For the moment we are not witnessing the uncontained global spread of this virus and we are not witnessing large-scale deaths," Tedros told reporters in Geneva on Monday.   He added, however, that countries should do everything they can to "prepare for a potential pandemic" -- a term is used to describe an illness that spreads across numerous communities.   The White House plans to spend $2.5 billion to combat the epidemic, according to US media. There are 53 cases in the United States so far.

- Iran hotspot -
Iran has emerged as a major hotspot with the death toll rising to 15 on Tuesday as three more people succumbed to the disease.   The country has been scrambling to contain the epidemic since last week when it announced its first two deaths in Qom, a centre for Islamic studies and pilgrims that attracts scholars from abroad.

Iran has confirmed 61 cases so far, making its mortality rate exponentially higher than anywhere else in the world and raising suspicion that many more people have contracted the disease there.   A WHO team was due in Iran on Tuesday.   Several neighbours have enacted measures to block arrivals from Iran but the virus has already spread to Afghanistan and elsewhere in the Middle East.   The WHO has warned that poorer countries with weak health care systems are the most at risk.

- Games off -
South Korean President Moon Jae-in warned that the outbreak was "very grave" as the country's death toll rose to 10 and the number of confirmed infections approached 1,000 -- the largest total outside China.   Scores of events have been cancelled or postponed as the outbreak has spread in the world's 12th-largest economy, from K-pop concerts to the World Team Table Tennis championship.   Parliament closed for cleaning Tuesday after confirmation a person with the coronavirus had attended a meeting last week.   More than 80 percent of the infections have been in and around Daegu, South Korea's fourth-largest city.

Streets there have been largely deserted for days, apart from long queues at the few shops with masks for sale.   Most of the country's infections are linked to the Shincheonji Church of Jesus, an entity often accused of being a cult.   The US Centers for Disease Control warned Americans against "all nonessential travel to South Korea".   In Japan, a fourth former passenger of the coronavirus-stricken Diamond Princess cruise ship died, according to local media. The man was in his 80s.   Nearly 700 people from the quarantined ship have tested positive for the illness so far.

Infections have also spiked inside Japan, with at least 160 cases including one death.   The government has expanded the number of hospitals that can receive suspected patients and asked people with moderate symptoms to stay home.   Businesses were asked to "let people stay away from offices, to avoid rush hour commuting hours, and to encourage telecommuting," Health Minister Katsunobu Kato said.   Italy -- which has reported seven deaths and over 200 cases -- has locked down 11 towns, while upcoming football matches in its Serie A and the Europa League will be played behind closed doors.    Prime Minister Giuseppe Conte has said that residents could face weeks of lockdown.

- China cases slow -
In China, 508 new cases were reported, with all but nine at the outbreak's epicentre in central Hubei province.   The death toll nationwide reached 2,663 on Tuesday after 71 more people died, the lowest rise in almost three weeks.   Reassured by the official numbers, the country is gingerly returning to business.   Beijing is seeing more cars on the street, factories are resuming work, Apple is reopening several stores, and some regions are relaxing traffic restrictions.   But schools remain closed, the capital has a mandatory 14-day quarantine for returning residents, and authorities are keeping some 56 million people in Hubei under lockdown.
Date: Sun 23 Feb 2020
Source: ZBC News [edited]

Mbire, Mashonaland Central Province has been affected by an outbreak of anthrax prompting the Veterinary Services Department to place an embargo on the movement of cattle from the province.

The acting provincial coordinator, Richard Chipfuwa, said 34 beasts had so far succumbed to the disease in the remote district, which sits on the border with Mozambique and Zambia. "These (the 34) are the reported cases, but we suspect there could be many more that were not reported. We have since mobilized vaccines to the district's 5 dip tanks: Nyatsengwa, Masomo, Tengu, Bonga and Sapa, so that farmers can have the remaining herd saved," he said.

But a poor road network in the district is making it difficult for veterinary officials to access some of the dip tanks, a situation made worse by the ongoing rains. The officials, in addition to treating infected animals, are also educating communities against consuming meat from dead animals, because this could pose health risks to people.

The anthrax outbreak in Mbire, an arid district rich in an assortment of wildlife, is suspected to have been passed on to livestock by infected wild animals such buffaloes, which are typical carriers of the disease. Last year [2019], the province lost nearly 1300 cattle due to anthrax and other livestock diseases.
=====================
[For a description of Mashonaland, go to: <https://en.wikipedia.org/wiki/Mashonaland>. It is in northern Zimbabwe and is made up of 3 provinces, East, West, and Central. For a map showing the location of Mashonaland Central Province go to: <https://en.wikipedia.org/wiki/Mashonaland_Central_Province>.

In these hard to reach areas, it is a constant concern knowing what is happening where. And this goes a long way as to why some 34 animals are reported affected and probably more. And why it is so important to get the necessary volumes of vaccine out to these communities as soon as possible. We wish the provincial veterinary service well and all the luck that they enjoy. - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Mashonaland Central Province, Zimbabwe:
Date: Mon, 24 Feb 2020 16:22:59 +0100 (MET)

Dubai, Feb 24, 2020 (AFP) - The new coronavirus hit four more Middle Eastern states on Monday, with Bahrain, Iraq, Kuwait and Oman reporting new cases and the UAE calling on its citizens not to travel to Iran and Thailand.   Oman also halted flights to and from Iran  -- which is battling the deadliest outbreak outside China --with immediate effect.   The move came shortly after two Omani women who had returned from Iran were diagnosed with the disease.

The three cases in Kuwait and the one in Bahrain were also in individuals who had returned from Iran, where the virus has claimed the lives of 12 people.   Bahrain also shut three schools after a man who had transported children to the institutions tested positive after returning from Iran on February 21 via Dubai airport, the health ministry said.

In Kuwait, a 53-year-old Kuwaiti, a 61-year-old Saudi national and a 21-year-old stateless Arab who tested positive had all returned from Iran's holy city of Mashhad, the Kuwaiti health ministry said.   In Iraq, the virus was confirmed in an Iranian national studying in the southern shrine city of Najaf, health officials said.   All seven bourses in the oil-rich Gulf states were down on Monday as fears of a pandemic hit crude prices. The Saudi stock exchange led the slide, shedding 2.95 percent.

- Travel bans -
Iran's confirmed death toll rose to 12 on Monday, with the government vowing to be transparent and dismissing a lawmaker's claim the toll could be as high as 50.   The outbreak has prompted travel bans from nearby countries.

Last week, Kuwait banned entry of all ships from the Islamic republic and suspended flights to and from the country.   Kuwait also banned non-citizens coming from Iran from entering the Gulf state and operated chartered flights to bring back hundreds of Kuwaiti Shiite pilgrims from the Islamic republic.

Around a third of Kuwait's 1.4 million citizens are Shiite Muslims, who travel regularly to Iran to visit religious shrines. Kuwait also hosts roughly 50,000 Iranian workers.   Over half of Bahrain's population of under one million are Shiites, who also travel frequently to Iran.   The United Arab Emirates has already announced 13 cases of the novel coronavirus, all of them foreigners. The latest were a 70-year-old Iranian man, whose condition is unstable, and his 64-year-old wife.

On Monday, Abu Dhabi authorities called on all UAE citizens "to not travel to Iran and Thailand at present and up until further notice" as part of its efforts to monitor and contain the spread of the disease.   UAE airlines have suspended most flights to China -- where the virus first emerged in December -- except to the capital Beijing, but have not yet taken any measures to restrict travel to and from Iran. Around half a million Iranians live and work in the UAE.

Two Gulf states -- Saudi Arabia and Qatar -- remain free of the virus, but all have suspended flights to China.   Qatar Airways said on Monday that people arriving from Iran and South Korea would be asked to stay in home isolation or a quarantine facility for 14 days.   China's death toll from COVID-19 rose to nearly 2,600 on Monday, while the virus has now spread to more than 30 countries.
Date: Mon, 24 Feb 2020 17:49:00 +0100 (MET)

Kolkata, Feb 24, 2020 (AFP) - Rangers have suspended safari rides in a popular nature reserve in eastern India after five one-horned female rhinoceroses died from a suspected infectious disease, officials said Monday.  The animals were found dead over four days last week in Jaldapara National Park, nearly 700 kilometres (434 miles) north of West Bengal state's capital Kolkata.

India is home to two-thirds of the world's remaining one-horned rhinos, a vulnerable species on the IUCN red list   "Blood smears from carcasses have been sent to a laboratory in Kolkata," the reserve's chief conservator Ujjal Ghosh told AFP.   "All the five dead rhinos were adult females. We have put our staff on alert."

The park -- spread over 200 square kilometres (77 square miles) in the foothills of the eastern Himalayas -- is home to 204 rhinos according to the last official count in 2015.  More than 70 captive elephants used for safaris and patrolling also live in the reserve. The safari rides are carried out on elephants.   Activists said the animals may have died from anthrax, a communicable disease that attacks herbivores.

Humans can contract anthrax directly or indirectly from animals or animal products.  "We suspect that the animals died from a communicable disease like anthrax. Jaldapara forest has the odd case of anthrax which killed animals earlier," wildlife activist Animesh Bose told AFP.   Rangers were riding on elephants to reach the rhinos and vaccinate them using dart guns, the Hindustan Times reported.   Drones would try to find out if other animals have died or fallen ill, the newspaper said.
Date: Tue, 25 Feb 2020 04:50:33 +0100 (MET)

Jakarta, Feb 25, 2020 (AFP) - Dozens of Jakarta neighbourhoods were flooded Tuesday after torrential rains pounded Indonesia's capital, less than two months after nearly 70 people were killed in some of the megacity's worst flooding in years.   There were no immediate reports of casualties after the latest deluge, but parts of the city ground to a halt as whole neighbourhoods were swamped in muddy water, while power outages hit some districts.   At least 81 neighbourhoods were inundated with a dozen toll roads closed and some commuter train lines shuttered, according to an announcement by Indonesia's Disaster Mitigation Agency.

More torrential rains were expected later in the day.    "So the flooding will likely spread," agency spokesperson Agus Wibowo said on Twitter.   Floodwaters in some districts were as high as 127 centimetres (4 feet).   The low-lying city is prone to flooding during the wet season which starts around November.   Torrential rain in January triggered flooding and landslides that killed nearly 70 people in and around Jakarta while thousands more were forced to evacuate to shelters.
Date: Mon 24 Feb 2020
Source: Dhaka Tribune [edited]

In Baliadanga upazila of Thakurgaon district, 2 members of a family have died and 3 other members fell sick of an unknown disease. The deceased are MB 35, wife of HI, and her sister in law PB, wife of H from Songaon village of the upazila.

Quoting family members, local schoolteacher SPL said: "MB fell sick and died on Friday [21 Feb 2020] and on Saturday [22 Feb 2020], PB fell sick. "She came back home after undergoing primary treatment at Baliadanga Health Complex; however, she died early Sunday [23 Feb 2020]."

Soon afterwards, 3 other members of the family -- TA, HK and AA -- fell sick and were taken to Adhunik Sadar Hospital, she added.

Thakurgaon Civil Surgeon Dr MD Mahfuzar Rahman Sarker said a representative team of the health department has visited the village to investigate the cause of deaths.

The reasons of the deaths are yet to be known; however, the ones who fell sick are in better condition now, he added.

In 2019, 4 members of a family died due to Nipah virus in the same upazila. Locals are assuming the current deaths are occurring for the same reason.
===================
[With these cases described only as fatal or ill without mention of symptoms, it is not possible to speculate on what the etiology of thisdisease might be. The above report does mention that 4 fatal Nipah virus infections occurred in the same locality last year (2019). Nipah virus must surely be on the list of rule-outs in these current cases. This is the season when Nipah virus is circulating in Bangladesh in giant fruit bats (_Pteropus_ species) with spill-over of the virus by the bats' contamination of fruit or of palm sap juice in collecting pots on the palms. Person-to-person transmission of the virus can also occur. The transmission season is usually January to April.

As noted earlier, it is unfortunate that the public awareness efforts have not prevented these cases from occurring. Perhaps because cases are sporadic and geographically scattered there is little public perception of risk of infection and serious disease. Until effective public education to prevent infection by avoiding eating contaminated fruit or date palm sap is implemented, sporadic cases will continue to occur.

An image of a Pteropus fruit bat can be found at

HealthMap/ProMED map available at:
A map showing the location of the area where the cases occurred can be accessed at the above URL. - ProMED Mod.TY]

24-02-2020 -- Italy has reported a rapid increase in cases of laboratory-confirmed coronavirus (COVID-19) since 21 February 2020. An initial investigation by Italian authorities has found several clusters of cases in different regions of northern Italy, with evidence of local transmission of COVID-19.

A WHO-led team of experts from WHO and the European Centre for Disease Prevention and Control (ECDC) arrived in Italy on Monday 24 February to support Italian authorities in understanding the situation. WHO experts are providing support in the areas of clinical management, infection prevention and control, surveillance and risk communication. At this stage the focus is on limiting further human-to-human transmission.

While limited local person-to-person transmission of COVID-19 in countries outside of China was expected, the rapid increase in reported cases in Italy over the past two days is of concern. However, it should also be noted that based on current data, in the majority of cases (4 out of every 5) people experience mild or no symptoms.

“COVID-19 is a new virus that we need to take very seriously. This mission to Italy is one of the ways in which WHO/Europe is supporting countries across the Region. We are working hard with our Member States to ensure that they are ready for COVID-19, preparing for the arrival of cases and possible localized spread. It is vital that we treat patients with dignity and compassion, put measures in place to prevent onward transmission, and protect health workers,” commented Dr Hans Kluge, WHO Regional Director for Europe.

Health authorities in Italy are implementing measures to prevent onward transmission, including closing of schools and bars and cancelling of sports events and other mass gatherings in the areas affected. This aligns with the containment strategy currently being implemented globally in an effort to stop the spread of COVID-19. “WHO stands by the Government of Italy in its efforts and commitment to mitigate this outbreak and manage the cases effectively. Now is the time for solidarity and cooperation, to work together to protect everyone’s health,” added Dr Kluge.

Countries across the European Region continue to prepare for and respond to cases of COVID-19. This includes establishing how to promptly detect sick people, testing samples from suspect cases, ensuring appropriate infection control and case management to minimize the risk of the virus spreading, and maintaining communication with the public.

Best Regards,
WHO Media Team

Date: Mon, 24 Feb 2020 12:29:01 +0100 (MET)
By David Vujanovic

Tehran, Feb 24, 2020 (AFP) - Iran's government vowed Monday to be transparent after being accused of covering up the deadliest coronavirus outbreak outside China, dismissing claims the toll could be as high as 50.

The authorities in the Islamic republic have come under mounting public pressure since it took days for them to admit to "accidentally" shooting down a Ukrainian airliner last month, killing 176 people.   The government said on Monday that Iran's coronavirus death toll had jumped by four to 12 -- by far the highest outside China -- as its neighbours closed their borders and imposed strict quarantine measures.

But Ahmad Amirabadi Farahani, a lawmaker from the holy city of Qom, south of Tehran, alleged the government was "lying" about the full extent of the outbreak.   The ILNA news agency, which is close to reformists, said the lawmaker spoke of "50 deaths" in Qom alone.   "The rest of the media have not published this figure, but we prefer not to censor what concerns the coronavirus because people's lives are in danger," ILNA editor Fatemeh Mahdiani told AFP.

Farahani was wearing a face mask during the closed session of parliament but left after speaking, as he felt unwell, state news agency IRNA reported, adding sanitary workers then cleaned his seat.   Iran's government rejected his claim that the virus had killed 50 in Qom.   "I categorically deny this information," Deputy Health Minister Iraj Harirchi said in a news conference aired live on state television.   "This is not the time for political confrontations. The coronavirus is a national problem," he added.

- Transparency pledge -
The government pledged transparency over the outbreak.   "We will announce any figures (we have) on the number of deaths throughout the country. We pledge to be transparent about the reporting of figures," its spokesman Ali Rabiei said.   Iran has been scrambling to contain the COVID-19 outbreak since it announced the first two deaths in the holy city of Qom on Wednesday last week.   Authorities have since ordered the closure of schools, universities and other educational centres across the country as a "preventive measure".

A spokesman for Iran's parliament, Assadollah Abbassi, announced the latest four deaths among more than 60 infections after Monday's closed-door gathering of lawmakers.   Citing Health Minister Said Namaki, he said that "the cause of coronavirus infections in Iran are people who have entered the country illegally from Pakistan, Afghanistan and China".   Iran has yet to give a breakdown of where the other deaths occurred.   The worst-hit province for infections is Qom, with 34 cases, according to health ministry figures.

The others are in Tehran with 13 infections, Gilan with six, Markazi with four, Isfahan with two and one each for Hamedan and Mazandaran.   But the health minister said that one person who died of coronavirus in Qom, south of Tehran, was a businessman who had made several trips to China.   Namaki had unsuccessfully pleaded in January for Iran's government to order the suspension of all commercial flights between Iran and China.   In his remarks to state television on Sunday, the minister said direct flights between Iran and China were now suspended, but the Qom businessman had travelled there "on a connecting flight".

- Border closures -
Since it emerged in December, the new coronavirus has killed more than 2,500 people in China.   Iran now accounts for nearly half of the deaths elsewhere in the world, which currently stand at 30.   Many of Iran's neighbours have reported cases of coronavirus in people who had travelled to the Islamic republic.   Afghanistan on Monday reported its first case in a person who had travelled to Qom.   Baghdad also reported its first case on Monday -- an elderly Iranian citizen living in the southern Iraqi city of Najaf.

Iraq has shut its border with the Islamic republic and imposed a travel ban.   Similar preventive measures were imposed by Afghanistan, Armenia, Pakistan and Turkey.    Qom is a centre for Islamic studies and pilgrims, attracting scholars from Iran and beyond.   Kuwait and Bahrain also confirmed their first novel coronavirus cases, all of whom had come from Iran.