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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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Rwanda

Rwanda US Consular Information Sheet
May 19, 2008
COUNTRY DESCRIPTION:
Rwanda is a landlocked developing country in central Africa which has made considerable progress in rebuilding its infrastructure and establishing security since the 19
4 civil war and genocide in which at least 800,000 people were killed. Economic activity and tourism are on the rise in Rwanda. Hotels and guesthouses are adequate in Kigali, the capital, and in major towns, but are limited in remote areas. Read the Department of State Background Notes on Rwanda for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and evidence of yellow fever immunization are required. Visas are not required for American citizens entering Rwanda for less than 90 days. U.S. citizens planning on working in Rwanda should apply for a work permit at the Directorate of Immigration as soon as possible after arrival in Rwanda. Detailed entry information may be obtained from Rwanda’s Directorate of Immigration at: http://www.migration.gov.rw/ or from the Embassy of the Republic of Rwanda, 1714 New Hampshire Avenue NW, Washington DC 20009, telephone 202-232-2882, fax 202-232-4544, web site http://www.rwandaembassy.org. Overseas, inquiries may be made at the nearest Rwandan Embassy or Consulate.
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:
There are currently no travel restrictions in place within Rwanda, but travelers should use caution when traveling near or crossing the border into Burundi, eastern Democratic Republic of the Congo (DRC), and Uganda.

In March 2005, the Congo-based Democratic Forces for the Liberation of Rwanda (FDLR), comprising ex-Rwandese Armed Forces, Interahamwe, and other extremists, announced it would end its armed struggle against the Government of Rwanda, but thousands of combatants are estimated to remain in eastern Congo. The combatants currently are not well-organized or funded, nor do they pose a serious threat to Rwandan security. However, in early March 2007, in Gisenyi Province (near the Volcanoes National Park in northwestern Rwanda) they launched a mortar round and rocket into Rwandan territory. There were no casualties, and it appears to have been an isolated incident. While visitors may travel freely to Volcanoes National Park, they are not permitted to visit the park without permission from Rwanda's Office of Tourism and National Parks (ORTPN). ORTPN stipulates that the park can only be used for gorilla tours and nature walks. Since December 2006, all restrictions have been lifted in the Nyungwe Forest near the Burundian border in southwestern Rwanda. In the past, the FDLR infiltrated Rwanda from Burundi through the Nyungwe Forest, but the last reported incident in the park was in November 2003. However, FDLR rebel factions are known to operate in northeastern DRC, Burundi, Tanzania, and Uganda, including near the popular tourist area of Bwindi Impenetrable Forest National Park. For information on travel to those and other countries, and for the latest security information, American citizens traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
From time to time, travel by U.S. Embassy personnel may be restricted based on changing security conditions. Visitors are encouraged to contact the appropriate U.S. Embassy Regional Security Office or Consular Section for the latest security information, including developments in eastern Congo, Uganda and Burundi. (See Registration/Embassy Location section below.)

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: Pick-pocketing in crowded public places is common, as is petty theft from cars and hotel rooms. Although violent crimes such as carjacking, robbery, and home invasion occur in Kigali, they are rarely committed against foreigners. Americans are advised to remain alert, exercise caution, and follow appropriate personal security measures. Although many parts of Kigali are safe at night, walking alone after dark is not recommended since foreigners, including Americans, have occasionally been the targets of robbery.

INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime. The U.S. Embassy provides some information on its web site about criminal justice in Rwanda at http://rwanda.usembassy.gov/criminal_justice_in_rwanda.html.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical and dental facilities are limited, and some medicines are in short supply or unavailable. Travelers should bring their own supplies of prescription drugs and preventive medicines. In Kigali, Americans may go to King Faisal Hospital, a private facility that offers limited services and dental facilities. There is also a missionary dental clinic and a few private dentists. American-operated charitable hospitals with some surgical facilities can be found in Kibagora, in southwestern Rwanda, in Ruhengeri, near the gorilla trekking area, and in Rwinkavu, near the entrance to Akagera National Park. The U.S. Embassy maintains on its website a current list of healthcare providers and facilities in Rwanda at http://rwanda.usembassy.gov/medical_information.html; this list is also included in the Consular Section’s welcome packets for American citizens. There are periodic outbreaks of meningitis in Rwanda. Yellow fever can cause serious medical problems, but the vaccine, required for entry, is very effective in preventing the disease. Malaria is endemic to Rwanda. All visitors are strongly encouraged to take prophylactic medications to prevent malaria. These should be initiated prior to entry into the endemic area. Because of possible counterfeit of antimalarial medications, these should be obtained from a reliable pharmaceutical source. Multiple outbreaks of ebola have been reported in neighboring Democratic Republic of Congo and Uganda in the past year, but none within Rwanda.
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 website at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Rwanda is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Due to safety concerns, the use of motorbikes or van taxis for transportation is not recommended. Regulated orange-striped (along the base of the vehicle) sedan auto taxis are safer, but be sure to agree on a fare before beginning the trip. Public transportation can be dangerous due to overloading, inadequate maintenance, and careless drivers.
While the main roads in Rwanda are in relatively good condition, during the rainy season many side roads are passable only with four-wheel drive vehicles. Nighttime driving, particularly outside major cities, is hazardous and is discouraged. Often, roadways are not marked and lack streetlights and shoulders. Many sections have deteriorated surfaces. Due to possible language barriers and lack of roadside assistance, receiving help may be difficult. Travelers may be stopped at police roadblocks throughout the country, where their vehicles and luggage may be searched. Service stations are available along main roads.
In Rwanda, as in the U.S., traffic moves on the right-hand side of the road. Cars already in a traffic circle have the right of way. Until 2004, cars entering traffic circles had the right-of-way. Drivers should exercise caution at traffic circles, since some drivers might forget this change. Excessive speed, careless driving, and the lack of basic safety equipment on many vehicles are hazards on Rwanda's roads. Many vehicles are not well maintained, and headlights are either extremely dim or not used. Drivers also tend to speed and pass other cars with little discretion. Some streets in Kigali have sidewalks or sufficient space for pedestrian traffic; others do not, and pedestrians are forced to walk along the roadway. With the limited street lighting, drivers often have difficulty seeing pedestrians. Drivers frequently have unexpected encounters with cyclists, pedestrians and livestock.
Third-party insurance is required and will cover any damages from involvement in an accident resulting in injuries, if one is found not to have been at fault. The driver’s license of individuals determined to have caused an accident may be confiscated for three months. Causing a fatal accident could result in three to six months' imprisonment. Drunk drivers are jailed for 24 hours and fined Rwandan Francs 20,000 (approximately $35). In the city of Kigali, contact the following numbers for police assistance in the event of an accident: Kigali Center, 08311112; Nyamirambo, 08311113; Kacyiru, 08311114; Kicukiro, 08311115; Remera, 08311116. Ambulance assistance is very limited. Wear seat belts and drive with care and patience at all times. In case of an emergency, American citizens can contact the Embassy duty officer at 0830-0345.
For specific information concerning Rwandan driving permits, vehicle inspection, road tax, and mandatory insurance, please contact the Rwandan Office of Tourism and National Parks, B.P. 905, Kigali, Rwanda, telephone 250-76514, fax 250-76512.
Please refer to our Road Safety page for more information. Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://www.gov.rw/.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Rwanda, the U.S. Federal Aviation Administration (FAA) has not assessed Rwanda’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.

In recent months, Rwandair, which charters aircraft to fly its routes, has had difficulties maintaining its schedule, resulting in delayed and cancelled flights which have left passengers stranded for extended periods.

SPECIAL CIRCUMSTANCES:
Telephone communication to and from Rwanda is generally reliable. Cellular telephones and Internet connections are available in Kigali and large towns.
Non-biodegradable plastic bags have been banned in Rwanda, and travelers carrying them upon arrival at the Kayibanda International airport may have them confiscated and have to pay approximately $4 for a reusable cloth replacement.
International ATMs are not available in Rwanda. The Rwandan franc is freely exchangeable for hard currencies in banks and the Bureaux de Change. Several Kigali banks can handle wire transfers from U.S. banks, including Western Union. Credit cards are accepted at only a few hotels in Kigali and only to settle hotel bills. Hotels currently accepting credit cards for payment include the Kigali Serena (formerly Intercontinental) Hotel, the Hotel des Mille Collines, the Novotel Umubano, Stipp Hotel and the Kivu Sun Hotel. Note that there may be an added fee for using a credit card. Travelers should expect to handle most expenses, including air tickets, in cash.

Traveler's checks can be cashed only at commercial banks. Because some travelers have had difficulty using U.S. currency printed before the year 2000, the Embassy recommends traveling with newer U.S. currency notes.
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 Rwandan laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Rwanda 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.
The U.S. Embassy provides some information on its website about criminal justice in Rwanda.

CHILDREN'S ISSUES: For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction. Both foreigners and Rwandans taking Rwandan children to live outside Rwanda, e.g., after adoption, must obtain an exit permission letter from the Ministry of Family and Gender located within the Primature complex at P.O. Box 969, Kigali, Rwanda; Tel: 011-250-587-128; Fax: 011-250-587-127.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Rwanda 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 Rwanda. 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 2657 Avenue de la Gendarmerie; the mailing address is B.P. 28, Kigali, Rwanda; tel. (250) 596-400,; fax: (250) 596-591. The Consular Section’s email address is consularkigali@state.gov. The Embassy's web site is http://rwanda.usembassy.gov/. American Citizen Services hours are Tuesdays from 9:00 -17:00 and Fridays from 9:00 - 12:00 except on U.S. and Rwandan holidays.
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This replaces the Country Specific Information for Rwanda dated October 4, 2007, to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Information for Victims of Crime, Medical Facilities and Health Information, Traffic Safety and Road Conditions, Aviation Safety Oversight, Criminal Penalties, Children’s Issues, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Sun, 8 Dec 2019 17:30:45 +0100 (MET)

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

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

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

The head of DR Congo's anti-Ebola efforts, Jean-Jacques Muyembe, and the WHO's representative in Rwanda, Kasonde Mwinga, were present at the campaign launch.    In August, Rwanda briefly closed its border with DR Congo and ordered its citizens not to visit the country when the first Ebola cases were recorded in Goma.   The city, which is the regional capital of the Congolese province of North Kivu, sits on the border with Rwanda.    The border has since been reopened, but strict medical checks are being enforced.
Date: Tue 6 Aug 2018
Source: New Times (Kigali, Rwanda) [summ., edited]
<https://www.newtimes.co.rw/news/livestock-vaccinations>

Livestock farmers have appealed to the government to ensure that cows get timely vaccination in order to effectively control deadly epidemics in cattle. The appeal comes after an outbreak of Rift Valley Fever [RVF] -- a deadly and infectious viral disease -- killed 154 cows countrywide since May [2018], according to figures from Rwanda Agricultural Board (RAB). Gahiga Gashumba, the chairman of Rwanda National Dairy Farmers' Federation, told The New Times that in their performance contracts, districts set themselves targets to inoculate cows, which leaves a gap in achieving effective vaccination.

Efforts to contain the recent outbreak of RVF included vaccinating 257 902 cows countrywide of which 119 520 were from Ngoma, Kirehe, and Kayonza -- the hardest hit by the disease. "All cows should be vaccinated at least in areas prone to given diseases," Gashumba said adding, "We need a clear vaccination calendar detailing the cows that should be immunised in a given period of time. When there are heavy rains, we should be prepared of [immunising cows against] East Coast fever."

Also known as theileriosis, East Coast fever is a deadly tickborne disease in cattle. Ngoma district vice mayor for Finance and Economic Development, Jean Marie Vianney Rwiririza, said that this year [2018], they want many cows to get vaccines against different diseases, including RVF and foot and mouth disease [FMD]. "With using funds from the district's budget alone, we cannot manage to give vaccines to all cows.

We request farmers' cooperatives and the farmers themselves to partake in the activity so that all the cows can be inoculated," he told The New Times. In Kirehe district, there are over 52 000 cows and over 30 000 of them were vaccinated against different diseases, including Rift Valley fever in the 2017/2018 financial year, according to Jean Damascane Nsengiyumva, Kirehe district vice mayor for Finance and Economic Development. "We have increased funding for the vaccination activity so that we inject all cows which we should vaccinate because we do not want the recurrence of such a problem," he said referring to RVF.

Rwanda Agriculture Board (RAB) said that they do not vaccinate all the cows because it can be wastage of resources or poor management when vaccination is done in areas where a disease has not been reported while it can be contained by vaccinating livestock in the risk zone. Instead of spending money on vaccinating all cows, currently estimated at over a million countrywide, appropriate strategies are devised to control the spread of outbreaks, said RAB director general Dr Patrick Karangwa. "We give more attention to diseases that spread faster than others. We do impact assessment based on spread pattern of a disease.

If a disease can be transmitted through air, measures taken to prevent its spreading should be different from the disease that cows or people catch through contact," Karangwa said. He cited FMD which often affects cattle on areas bordering Tanzania, such as Gatsibo, Kayonza, and Nyagatare, observing that when the disease has been checked in those areas, it dose spread elsewhere, pointing out that if all cows in the country are vaccinated, all the funds used [for the development of the livestock] sector might be consumed by such a single activity. Some vaccines are given free of charge, while others have to be paid for by farmers with government subsidy. [byline: Emmanuel Ntirenganya]
=======================
[RVF has become, according to local media, active in Rwanda in April 2018, as reported from the districts of Ngoma, Kirehe, and Kayonza, in the south west of the Eastern province. It was expressed mainly by cattle death and abortions. Later, Kamonyi, a southern province was added. The Rwandan Ministry of Agriculture and Animal Resources announced on [Mon 30 Jul 2018] the lifting of the ban imposed since mid-June [2018] on the movement of cattle in several parts of Eastern province. According to the ministry, 99 of the 147 604 cows in the affected districts died, and 452 aborted. This differs from other statistics from various sources, including the 154 deaths in cattle, as mentioned in the above media report, quoting the Rwanda Agricultural Board.

Official statistics are expected to be included in Rwanda's RVF report to the OIE, which all member countries are obliged to submit. In the absence of data on the number of susceptible animals on the affected holdings, the mortality rate in cattle is not known. Based on accumulated field observations and experimental RVF infection trials, the mortality in adult cattle would, generally, not exceed 10 per cent. No human cases have been reported in Rwanda during the recent event. Vaccination of livestock against RVF can be applied either with a live attenuated (Smithburn) vaccine (relatively cheap, several years immunity rendered, but may cause foetal abnormalities or abortion in pregnant animals).

Alternatively, particularly in pregnant animals, an inactivated (formalin-killed) RVF vaccine can be selected (more costly, safer in all breeds/ages/reproductive stages of cattle, sheep, and goats, but requires a booster 3-6 months after the initial vaccination, then followed by yearly boosters). For the considerations related to vaccine policies, vaccines to be selected, and other tools for the prevention and control of RVF under various epidemiological situations, please refer to references 1-3.

References
------------------------------
1. Consultative Group for RVF Decision Support. Decision-support tool for prevention and control of Rift Valley fever epizootics in the Greater Horn of Africa. Am J Trop Med Hyg. 2010. 83(2 Suppl): 75-85. DOI: 10.4269/ajtmh.2010.83s2a03; <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913494/>.

2. Anonymous. Risk-based decision-support framework for prevention and control of Rift Valley fever epidemics in eastern Africa. EU Collaborative Project, Seventh Framework Programme. 2015. (Grant Agreement no. 266327); <http://www.healthyfutures.eu/images/healthy/deliverables/d5.4%20risk-based%20decision-support%20framework.pdf>.

3. Mariner J. Rift Valley fever surveillance. FAO animal production and health manual no. 21. Rome: FAO. 80 pages; <http://www.fao.org/3/i8475en/I8475EN.pdf>. - ProMED Mod.AS]

[Maps of Rwanda: <http://www.geographicguide.com/pictures/map-rwanda.jpg>
and <http://healthmap.org/promed/p/173>.]
Date: Mon 30 Jul 2018
Source: Journalducameroun.com, APA News report [summ., edited]
<https://www.journalducameroun.com/en/rift-valley-fever-rwanda-lifts-quarantine-on-cattle-movement/>

The Rwandan Ministry of Agriculture and Animal Resources, on [Mon 30 Jul 2018] announced it was lifting the quarantine on the movement of cattle that was imposed to control the deadly Rift Valley fever [RVF] in several parts of Eastern province. A quarantine on cattle in the country's 4 affected eastern districts has been imposed since mid-June [2018] after about 100 heads of cattle were killed by the virus. In a notice issued [Mon 30 Jul 2018], the minister Ministry of Agriculture and Animal Resources, Gérardine Mukeshimana, said the quarantine is no longer serving the purpose of slowing the spread of the deadly Rift Valley fever.

Reports indicate that the outbreak was first detected on 18 May 2018 in 4 districts in Eastern Rwanda including Ngoma, Kirehe, Rwamagana, and Kayonza. Of the 147 604 cows in the affected districts, the ministry says 99 died while 452 aborted. The ministry says it has treated 1638 cows, with 36 930 sheep and 245 goats vaccinated against the disease. To combat further deaths among animals, the ministry says it has dispatched veterinary doctors across the affected districts. Official reports indicate that no human case has been reported so far in Rwanda, yet the number of affected livestock is thought to be much higher.

According to the Director General of Rwanda Agriculture Board (RAB), Dr Patrick Karangwa, the cause of the outbreak is unusually heavy rains, which have created ponds and lakes where mosquitoes can breed, in this region which is normally dry. "Most human infections result from contact with the blood or organs of infected animals", Dr Karangwa said.
========================
[RVF, expressed mainly by cattle death and abortions, became active in Rwanda in April 2018, in the districts of Ngoma, Kirehe and Kayonza, in the southwest of the Eastern Province. Later, Kamonyi, a southern province was added.

An administrative map of Rwanda and detailed districts maps are available at
<https://en.wikipedia.org/wiki/Districts_of_Rwanda#Eastern_Province>.

In the absence of data on the number of susceptible animals on the affected holdings, the mortality rate in cattle is not known. Based on accumulated field observations and experimental RVF infection trials, the mortality in adult cattle would, generally, not exceed 10 percent. No human cases have been reported in Rwanda during the recent event. The tests upon which RVF, an OIE-listed disease, has been confirmed and statistics pertaining to the number, locations, morbidity, and mortality rates in Rwanda's animal population, are expected to be included in an official report to the OIE, as anticipated from all OIE member countries. - ProMED Mod.AS]

[HealthMap/ProMED-mail map of Eastern Province, Rwanda:
<http://healthmap.org/promed/p/15277>]
Date: Sun, 11 Mar 2018 11:43:19 +0100

Kigali, March 11, 2018 (AFP) - At least 16 people were killed and dozens more injured after lightning struck a Seventh-Day Adventist church in Rwanda, a local official said Sunday.   Fourteen victims were killed on the spot as lightning hit the church in the Nyaruguru district in the Southern Province on Saturday, local mayor Habitegeko Francois told AFP over the phone.

Two others died later from their injuries, he said.   He added that 140 people involved in the incident had been rushed to hospital and district health centres, but that many had already been discharged.   "Doctors say that only three of them are in critical condition but they are getting better," he said.   According to the mayor, a similar accident took place on Friday when lightning struck a group of 18 students, killing one of them.
Date: Wed, 26 Jul 2017 11:31:06 +0200
By Fran BLANDY

Volcanoes National Park, Rwanda, July 26, 2017 (AFP) - Nicaraguan singer Hernaldo Zuniga brought his entire family to trek through the lush forests and mist-shrouded volcanoes of northwestern Rwanda in search of mountain gorillas.   He described their encounter with the critically endangered primates as "an almost spiritual" experience, and said it was the only reason they made Rwanda a stop on a trip taking in a safari in Kenya, and a tour of South Africa.

But Rwanda is no longer content with being a whirlwind stop on a tourist's itinerary, and is working hard to broaden its appeal beyond its world-famous mountain gorillas while narrowing its niche market to the wealthiest of visitors.   Zuniga counts himself lucky that his family of five scored their permits to see the gorillas before Rwanda's eyebrow-raising move to double the cost to $1,500 (1,300 euros) per person in May.   "I think that is going to be a drawback for many people. It is just going to be an elite group of people who can pay that," said Zuniga, a well-known star in Latin America.

For Rwanda however, the price hike is part of a careful strategy to boost conservation efforts while positioning itself as a luxury tourist destination.   "The idea behind (the increase) is that it is an exclusive experience which also needs to be limited in numbers. Our tourism is very much based on natural resources and we are very serious about conservation," said Clare Akamanzi, the chief executive of the Rwanda Development Board.   It is a high-value, low-impact strategy that has worked well for countries such as Botswana and Bhutan.

- Safe and clean -
The remote, mountainous border area straddling Rwanda, the Democratic Republic of Congo and Uganda is the only place in the world where one can see the gorillas, whose numbers have slowly increased to nearly 900 due to conservation efforts.   Permits in the DRC ($400) and Uganda ($600) are far cheaper, but Rwandan officials are not concerned that they will lose tourists to their neighbours, arguing the country offers an experience that is rare in the region.   Ever since the devastating 1994 genocide in which 800,000 mainly Tutsis were killed, the country has been praised for a swift economic turnaround.   "When you come to Rwanda it is a clean, organised, safe country with zero tolerance for corruption. We have concentrated on creating a good experience," said Akamanzi, also highlighting a quick visa process.

The challenge is getting tourists to make Rwanda their main destination, and spend more than the usual four days it takes to visit the gorillas and maybe the genocide museum before heading elsewhere.   "We want to keep it high-end as an anchor for tourism but provide other offerings," said Akamanzi. She said tourism is already the country's top foreign exchange earner, but believes they "have only scratched the surface".   So the country, known as the Land of a Thousand Hills is looking into sports tourism such as cycling, cultural tourism and becoming a Big Five safari destination in its own right.   In the past two years Rwanda has re-introduced both lions and rhino to its Akagera National Park -- which had gone extinct due to poor conservation -- and visitor numbers to the reserve have doubled, said Akamanzi.

- 'There will be an impact' -
However gorillas remain the main lure, and industry players are concerned about the impact the price increase could have on the whole tourism chain.   "We risk losing substantial revenue for the industry and government as a whole. Currently a number of gorilla permits are already not sold in the low season," the Rwanda Tours and Travel Association (RTTA) said in a statement after the decision was announced.   Mid-range hotels around the Volcanoes National Park say it is too soon to tell what the fallout will be, but several managers expressed concerns they would lose their main clientele.   "Either way there will be an impact," said Fulgence Nkwenprana, who runs the La Palme hotel.

Aloys Kamanzi, a guide with Individual Tours, acknowledged there has been an initial slowdown in reservations, but is convinced people will keep coming, adding his clients are mostly "retired tourists who have saved their whole lives", some of whom come three or four times.   The singer Zuniga said coming to Rwanda was a hard decision, as he had not heard much about what the country was like today from Mexico, where he lives with his family.   "Rwanda has a lot of sensitive echoes in my generation, the genocide ... we had to cross over all these personal obstacles to make the decision to come here," he said.   "They have to do better in promoting their tourism. Once you are here it is amazing, the people are unique, the country is beautiful. I would like to stay longer."
More ...

Costa Rica

Costa Rica - US Consular Information Sheet
June 05, 2008
COUNTRY DESCRIPTION:
Costa Rica is a middle-income, developing country with a strong democratic tradition.
Tourist facilities are extensive and generally adequate.
The capi
al is San Jose.
English is a second language for many Costa Ricans.
Read the Department of State Background Notes on Costa Rica for additional information.

ENTRY/EXIT REQUIREMENTS:
For entry into Costa Rica, U.S. citizens must present valid passports that will not expire for at least thirty days after arrival, and a roundtrip/outbound ticket.
Some U.S. airlines may not permit passengers to board flights to Costa Rica without such a ticket.
Passports should be in good condition; Costa Rican immigration will deny entry if the passport is damaged in any way.
Costa Rican authorities generally permit U.S. citizens to stay up to ninety days; to stay beyond the period granted, travelers must submit an application for an extension to the Office of Temporary Permits in the Costa Rican Department of Immigration.
Tourist visas are usually not extended except under special circumstances, and extension requests are evaluated on a case-by-case basis.
There is a departure tax for short-term visitors.
Tourists who stay over ninety days may experience a delay at the airport when departing.
Persons who overstayed previously may be denied entry to Costa Rica.
Persons traveling to Costa Rica from some countries in South America and Sub-Saharan Africa must provide evidence of a valid yellow fever vaccination prior to entry.
The South American countries include Bolivia, Brazil, Colombia, Ecuador and Venezuela.
See “SPECIAL CIRCUMSTANCES” for information on requirements to carry documentation within Costa Rica and on travel by dual national minors.


The most authoritative and up-to-date information on Costa Rican entry and exit requirements may be obtained from the Consular Section of the Embassy of Costa Rica at 2114 “S” Street NW, Washington, DC 20008, telephone (202) 234-2945/46 , fax (202) 265-4795 , e-mail consulate@costarica-embassy.org, web site http://www.costarica-embassy.org, or from the Costa Rican consulates in Atlanta, Chicago, Houston, Los Angeles, Miami, New Orleans, New York, San Juan (Puerto Rico), San Francisco, and Tampa.
The Costa Rican immigration agency web site is http://www.migracion.go.cr.
It is advisable to contact the Embassy of Costa Rica in Washington or one of Costa Rica's consulates in the United States for specific information regarding customs requirements before shipping any items.
Visit the Embassy of Costa Rica web site at http://www.costarica-embassy.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:
There have been no recent acts of terrorism in Costa Rica.
Visitors to Costa Rica may experience the effects of civil disturbances such as work stoppages and strikes.
Although infrequent, these acts can create inconveniences for visitors.
On both the Caribbean and Pacific coasts, currents are swift and dangerous, and there are few lifeguards or signs warning of dangerous beaches.
Every year eight to twelve American citizens drown in Costa Rica due to riptides or sudden drop-offs while in shallow water.
Extreme caution is advised.

Adventure tourism is popular in Costa Rica, and many companies offer white-water rafting, bungee jumping, jungle canopy tours, deep sea diving, and other outdoor attractions.
Americans are urged to use caution in selecting adventure tourism companies.
The government of Costa Rica regulates and monitors the safety of adventure tourism companies; enforcement of safety laws is overseen by the Ministry of Health.
Registered tourism companies with operating permits must meet safety standards and have insurance coverage.
The safety regulations enforced in Costa Rica are not the same as safety regulations enforced in the United States.

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

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

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

CRIME:
Over one and a half million foreign tourists, the majority American, visit Costa Rica annually.
All are potential targets for criminals, primarily thieves looking for cash, jewelry, credit cards, electronic items and passports.
U.S. citizens are encouraged to exercise the same level of caution they would in major cities or tourist areas throughout the world.
Local law enforcement agencies have limited capabilities and do not act according to U.S. standards.
Travelers should minimize driving at night, especially outside urban areas.

Americans should avoid areas with high concentrations of bars and nightclubs, especially at night, and steer clear of deserted properties or undeveloped land.
For safety reasons, the Embassy does not place its official visitors in hotels in the San Jose city center, but instead puts them at the larger hotels in the outlying suburbs.
Americans should walk or exercise with a companion, bearing in mind that crowded tourist attractions and resort areas popular with foreign tourists are common venues for criminal activities.
Travelers should ignore any verbal harassment, and avoid carrying passports, large amounts of cash, jewelry or expensive photographic equipment.
Tourists are encouraged to carry photocopies of the passport data page and Costa Rican entry stamp on their persons, and leave the original passport in a hotel safe or other secure place.
Costa Rican immigration authorities conduct routine immigration checks at locations, such as bars in downtown San Jose and beach communities, frequented by illegal immigrants.
American citizens detained during one of these checks who have only a copy of the passport will be required to provide the original passport with appropriate stamps.



Travelers should purchase an adequate level of locally valid theft insurance when renting vehicles, park in secured lots whenever possible, and never leave valuables in the vehicle.
The U.S. Embassy receives several reports daily of valuables, identity documents, and other items stolen from locked vehicles, primarily rental cars.
Thefts from parked cars occur in downtown San Jose, at beaches, in the airport and bus station parking lots, and at national parks and other tourist attractions.
Travelers should use licensed taxis, which are red with medallions (yellow triangles containing numbers) painted on the side.
Licensed taxis at the airport are painted orange.
All licensed taxis should have working door handles, locks, seatbelts and meters (called "marias"); passengers are required to use seatbelts.
When traveling by bus, avoid putting bags or other personal belongings in the storage bins.
At all times have your belongings in your line of sight or in your possession.

Thieves usually work in groups of two to four.
A common scam has one person drop change in a crowded area, such as on a bus, and when the victim tries to assist, a wallet or other item is taken.
The most prevalent
scam involves the surreptitious puncturing of tires of rental cars, often near restaurants, tourist attractions, airports, or close to the car rental agencies themselves.
When the travelers pull over, "good Samaritans" quickly appear to change the tire - and just as quickly remove valuables from the car, sometimes brandishing weapons.
Drivers with flat tires are advised to drive, if at all possible, to the nearest service station or other public area, and change the tire themselves, watching valuables at all times.
In late 2006, the government of Costa Rica established a Tourist Police force, and units were established in popular tourist areas throughout the country.
The Tourist Police can assist with the reporting of a crime, which can be difficult for victims due to language barriers and the requirement that only investigative police can accept crime reports.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care in San Jose is adequate, but is limited in areas outside of San Jose.
Most prescription and over-the-counter medications are available throughout Costa Rica.
Doctors and hospitals often expect immediate cash payment for health services, and U.S. medical insurance is not always valid outside the United States.
A list of local doctors and medical facilities can be found at the website of the U.S. Embassy in San Jose, at http://sanjose.usembassy.gov.
An ambulance may be summoned by calling 911.
Most ambulances provide transportation but little or no medical assistance.
The best-equipped ambulances are called “unidad avanzada.”
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

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

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

Costa Rica has one of the highest vehicle accident rates in the world.
The fatality rate for pedestrians and those riding bicycles and motorcycles is disproportionately high.
Traffic laws and speed limits are often ignored, turns across one or two lanes of traffic are common, turn signals are rarely used, passing on dangerous stretches of highway is common, and pedestrians are not given the right of way.
Roads are often in poor condition, and large potholes with the potential to cause significant damage to vehicles are common.
Pedestrians, cyclists, and farm animals may use the main roads.
Traffic signs, even on major highways, are inadequate and few roads are lined.
Shoulders are narrow or consist of drainage ditches.
All of the above, in addition to poor visibility due to heavy fog or rain, makes driving at night especially treacherous.
Landslides are common in the rainy season.
All types of motor vehicles are appropriate for the main highways and principal roads in the major cities.
However, some roads to beaches and other rural locations are not paved, and many destinations are accessible only with high clearance, rugged suspension four-wheel drive vehicles.
Travelers are advised to call ahead to their hotels to ask about the current status of access roads.
Costa Rica has a 911 system for reporting emergencies.
In the event of a traffic accident, vehicles must/must be left where they are.
Both the Transito (Traffic Police) and the Insurance Investigator must make accident reports before the vehicles are moved.

Please refer to our Road Safety page for more information.
Visit the website of Costa Rica’s national tourist office and national authority responsible for road safety at http://www.mopt.go.cr and www.visitecostarica.com.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Costa Rica’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Costa Rica’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Land Ownership and Shoreline Property: U.S. citizens are urged to use caution when making real estate purchases, and consult reputable legal counsel and investigate thoroughly all aspects before entering into a contract.
Coastal land within fifty meters of the high tide line is open to the public and therefore closed to development, and construction on the next one hundred fifty meters inland is possible only with the approval of the local municipality.

Squatters: Organized squatter groups have invaded properties in various parts of the country.
These squatter groups, often supported by politically active persons and non-governmental organizations, take advantage of legal provisions that allow people without land to gain title to unused agricultural property.
Local courts may show considerable sympathy for the squatters.
Victims of squatters have reported threats, harassment, and violence.
Documentation Requirements: Visitors are required to carry appropriate documentation at all times.
However, due to the high incidence of passport theft, tourists are permitted and encouraged to carry photocopies of the datapage and entry stamp from the passport, leaving the passport in a hotel safe or other secure place.
However, as noted under CRIME, Costa Rican immigration authorities conduct routine checks for illegal immigrants, especially in bars located in downtown San Jose and in beach communities.
An American citizen detained during one of these checks and carrying only the copy of the passport will be required to produce the original passport.
Tourists should consider carrying their passports when traveling overnight or a considerable distance from their hotel.
Tourists who carry passports are urged to place them securely in an inside pocket.

Exit Procedures for Costa Rican Citizens: Costa Rican children may only depart the country upon presentation of an exit permit issued by immigration authorities.
This policy, designed to prevent international child abduction, applies to dual national U.S./Costa Rican citizens.
Parents of minors who obtained Costa Rican citizenship through a parent or through birth in Costa Rica are advised to consult with appropriate Costa Rican authorities prior to travel to Costa Rica, especially if one (or both) parent(s) is not accompanying the child.



Disaster Preparedness: Costa Rica is located in an earthquake and volcanic zone.
Serious flooding occurs annually on the Caribbean side near the port city of Limon, but flooding occurs in other parts of Costa Rica as well, depending on the time of year and rainfall.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Costa Rica’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Costa Rica are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Costa Rica 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 Costa Rica.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located in Pavas, San Jose, and may be reached at (506) 2519-2000; the extension for the Consular Section is 2453.
The Embassy is open Monday through Friday, and is closed on Costa Rican and U.S. holidays.
Those seeking information are strongly encouraged to utilize the embassy web site http://sanjose.usembassy.gov/, and can email consularsanjose@state.gov with any questions/concerns.
For emergencies arising outside normal business hours, U.S. citizens may call (506) 2220-3127 and ask for the duty officer.
*

*

*
This replaces the Country Specific Information for Costa Rica dated August 15, 2007, to update sections on Registration/Embassy Location and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Fri 25 Oct 2019
From: Donald J. Brightsmith <dbrightsmith@cvm.tamu.edu> [edited]

There have been 37 cases of autochthonous transmission of malaria in 2019 as reported by the Costa Rican Ministry of Health (<https://www.ministeriodesalud.go.cr/index.php/vigilancia-de-la-salud/analisis-de-situacion-de-salud>). The ministry also reports 39 cases of malaria in country that were likely contracted in foreign countries, mostly in Nicaragua.

The autochthonous cases came mostly from the northern part of the country in the district of Crucitas, but cases were also reported from other areas of the country.
---------------------------------------------------
Donald J. Brightsmith
University College of Veterinary Medicine & Biomedical Sciences
Texas A&M University
College Station, TX
=============================
[ProMed thanks Dr. Donald J. Brightsmith for communicating this to us.

This is a comment from the WHO website, "Costa Rica: 'Ripe' for malaria elimination?"

"Costa Rica is one of 21 countries identified by WHO as having the potential to eliminate malaria by 2020. Its success in bringing down cases of indigenous malaria -- that is, transmission of the malaria parasite within a country's own borders -- has been commendable, so much so that it has received an award from the Pan American Health Organization in recognition of the strides made. Notably, no one has died from malaria since 2009.

"However, after recording 3 consecutive years of zero indigenous cases between 2013 and 2015, local transmission of the disease has slowly been creeping upwards: 4 cases in 2016 and 12 in 2017. Of equal concern is imported malaria: To date, 21 such cases have been detected in 2018, up from 5 for all of 2017.

"In June 2018, the Costa Rican Ministry of Health issued a public health alert following the reporting of 10 imported malaria cases in just one week in the country's northern region bordering malaria-endemic Nicaragua. The Ministry is working to quickly identify and treat imported cases to prevent onward transmission to local communities in high-risk zones of the country. The areas of concern are mainly agricultural sites, like banana plantations.

"One such area is the canton of Matina, home to some of Costa Rica's largest plantations that grow the yellow fruit. Situated next to a major port on the Caribbean Sea, the canton's agricultural produce is shipped to markets worldwide, making Matina an important economic hub.

"Although Matina is far from the area of the recent alert, and no cases of malaria have been reported this year, all 4 indigenous cases reported in 2016 originated from the canton, as well as 2 of the 12 indigenous cases in 2017. Health authorities are not taking any chances and are working with the canton's fincas bananeras (banana plantations) to step up malaria surveillance activities, particularly among plantation workers and nearby communities." - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Date: Sun, 21 Jul 2019 00:04:32 +0200

San José, July 20, 2019 (AFP) - Alcohol tainted with potentially toxic levels of methanol has killed 19 people in Costa Rica, where authorities issued an alert against drinking some half-dozen brands.   The Ministry of Health issued the national warning Friday while also updating the death toll.   Of 34 people who have been poisoned, 14 men and five women, age 32 to 72, have died since the first week of June, the ministry said.   Authorities warned that it was not known how much alcohol had been adulterated, but have confiscated some 30,000 bottles and are carrying out a countrywide investigation.

The doctored alcohol contained between 30 to 50 percent methanol, according to Donald Corella, head of emergency services at Calderon Guardia Hospital in San Jose, who was quoted in the daily La Nacion.   He said six people who were treated at his hospital had died, while four others survived but suffered "very serious after-effects" ranging from irreversible total blindness to brain lesions that cause tremors similar to Parkinson's disease.   If ingested in large quantities, methanol can cause blindness, liver damage and death.   According to authorities, the majority of the 19 deaths occurred among homeless and alcoholic individuals.
Date: Wed, 26 Jun 2019 10:01:43 +0200

San José, June 26, 2019 (AFP) - A 6.2 magnitude earthquake hit the Panama-Costa Rica border around midnight on Tuesday, the US Geological Survey said, revising earlier warnings of "significant damage", as the tremor cut power supplies near the epicentre.   The quake struck at a depth of 26 kilometres (16 miles), about two kilometres from the nearest town of Progreso in Panama, USGS said, updating a previous alert that estimated the depth at 10 kilometres.

There were no immediate reports of casualties, and USGS said "the impact should be relatively localized", reversing an earlier advisory that "past events with this alert level have required a regional or national level response."   "Estimated economic losses are less than 1 percent of GDP of Panama," the website said.   According to the National Seismological Network (RSN) in Costa Rica, the quake struck at 0523 GMT Wednesday (11.23 pm Tuesday) with its epicentre located 11 kilometres east of the Panamanian border town of Puerto Armuelles.

The tremor was felt in Costa Rica's capital San Jose and in many parts of the Central American country, according to initial reports, but the national tsunami warning system said there was no risk of a tsunami.   Villagers in the south of Costa Rica fled their homes, fearing aftershocks. Two houses in the region were damaged by the quake, said Alexander Solis, president of the country's National Emergency Commission.

Costa Rica's President Carlos Alvarado said there were power cuts in several communities in the southwest of the country, near the epicentre.   In November 2017 a 6.5-magnitude quake on the Pacific coast of Costa Rica caused buildings to sway in San Jose and contributed to the deaths of two people who had heart attacks.   Further north, two months earlier a 7.1-magnitude earthquake killed more than 300 people in Mexico.
Date: Mon 20 Jan 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/costa-rica-health-officials-investigate-hepatitis-surge-puntarenas-28003/>

Health officials in Costa Rica continue to investigate the hepatitis A outbreak reported in the province of Puntarenas where 33 cases have been reported during the 1st 11 days of 2019, according to the [health ministry] (computer translated). Cases have been primarily reported in the following districts: Barranca (10), Oak (8), and Chacarita (7). Officials announced last week [week of 14 Jan 2019] that contaminated water has been ruled out by laboratory analysis and the epidemiologists now aim to confirm as a source of contamination the poor hygiene in the preparation of food products and the presence of faecal coliforms (faeces) in the food.

After confirmation of the cases, the Ministry of Health issued a health alert to intervene and activate the health protocols in the active surveillance of new cases, both in the health services and in the population close to the suspects. In addition, urgent actions are taken in health services, protection of water sources for consumption, and dissemination of prevention measures for the population. The Regional Directorates of the CCSS [Caja Costarricense de Seguro Social/Costa Rican Social Security Fund] and the Ministry of Health intensified health promotion and prevention activities, using all local means of communication to inform the population about the disease, existing cases, hygiene measures in preparation and handling of food, and personal hygiene measures for the prevention of Hepatitis A.

The Director of Health Surveillance, Dr Rodrigo Mara­n, vehemently calls the people of Barranca, Chacarita, and El Roble to take measures to prevent and avoid new cases: "Self-care and food safety are the more effective measures to combat hepatitis A. Self-care refers, in this case, to proper personal hygiene practices such as proper and regular hand washing," said Mara­n.
=====================
[The cases are not broken down in regard to age. In children, most cases of HAV infection are subclinical so it is likely that the cases reported were in adults. In the developing world, HAV is not reported much in adults as most children have been infected, and therefore immune to subsequent infection, by the age of 10. That outbreaks are occurring in the area suggests improvement in potable water so less children are infected and therefore still susceptible to HAV as adults. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Costa Rica: <http://healthmap.org/promed/p/43112>]
Date: Wed, 5 Dec 2018 18:04:53 +0100

San José, Dec 5, 2018 (AFP) - A fingerprint test has confirmed the murder of a Venezuelan-born American tourist who had been missing for over a week, police said Wednesday.   The body found in the mountainous area of San Antonio de Escazu, southwest of the capital, where the tourist was staying, "is that of Carla Lucia Stefaniak, 36, who had been reported missing," the Judicial Investigation Agency (OIJ) said.   The body, exhibiting stab wounds and a severe blow to the head, was found on Monday near Stefaniak's hotel, OIJ chief Walter Espinoza said.   Her identity was confirmed after the US Federal Bureau of Investigation sent fingerprints that were compared to those of the body.

Nicaraguan national Bismarck Espinoza Martinez, 32, was arrested as a suspect in the homicide. He will be held in preventive detention for three months while the case is being investigated, prosecutors said.    "Words cannot express the devastation within her family and friends. We want the world to know that we will never forget Carla," the victim's family said on a dedicated Facebook page, "Finding Carla."    "We will never forget the joy she brought into our lives, how much she made us laugh. We will always be with her and we know she will always be with us."   Stefaniak's father, Carlos Caicedo, was able to view the body late Tuesday, when he identified it as his daughter's.   The murder was a fresh blow to Costa Rica's image as a tourist destination, after a Mexican tourist and one from Spain were killed in separate incidents in August.
More ...

Zambia

Zambia US Consular Information Sheet
June 02, 2008
COUNTRY DESCRIPTION:
Zambia is a developing country in southern Africa. Tourist facilities outside of the capital, Lusaka, Livingstone (Victoria Falls), and well-known game parks are not f
lly developed. Read the Department of State Background Notes on Zambia for additional information.
ENTRY/EXIT REQUIREMENTS: A passport and visa are required. A visa may be obtained in advance at a Zambian Embassy or Consulate or at the port of entry. Zambia raised the visa fee for American passport holders to $135 as of January 26, 2008. American citizens should bring exact change, whenever practical. Visas are valid for 3 years, and for multiple entries. At the time of entry, the immigration officer will stamp your passport with the permitted length of stay. This is normally 30 days and can ordinarily be extended twice (for a total time of 90 days) by visiting the immigration home office in Lusaka. All Americans, except resident diplomats, must pay an airport departure tax which is collected in U.S. dollars. Airlines include this tax in the cost of the ticket. However, passengers will need to verify that this tax has been paid at the airport. The passenger will receive a “no-fee” receipt reflecting this payment.

Travelers transiting through South Africa should ensure that they have at least two blank (unstamped) visa pages in their passports. South African immigration authorities routinely turn away visitors who do not have enough blank visa pages in their passports. Zambian Immigration officials insist visitors carry the original or a certified copy of their passport and their immigration permit at all times. Certified copies must be obtained from the immigration office that issued the permit. American citizens should closely follow immigration guidelines, including visa requirements for travel to Zambia.
NOTE: Some tour operators were previously able to obtain visas at reduced rates using a special tourism waiver. Zambia announced that they were ending this waiver program as of January 26, 2008 and that all American tourists would be required to pay the new $135 fee. Travelers with outstanding reservations with tour operators should be prepared to pay the difference upon arrival in Zambia.
Additional information on entry requirements may be obtained from the Embassy of the Republic of Zambia, 2419 Massachusetts Avenue NW, Washington, DC 20008, telephone (202) 265-9717 or 19 or online at http://www.zambiaembassy.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:
U.S. citizens are advised to exercise caution when traveling in northern Luapula Province and in areas of the Northern Province adjacent to the Democratic Republic of Congo (DRC). Although a cease-fire is currently in effect, the DRC is not yet stable and uncontrolled militias operate in the eastern DRC. In the past, armed gunmen have occasionally attacked vehicles near the DRC-Zambian border. Land mines and unexploded ordnance along the western, southern, and eastern borders make off-road travel to those areas potentially hazardous. For these reasons, the U.S. Embassy discourages travelers from driving off-road or on remote little-used tracks near the borders with DRC and Angola. American citizens who must drive in these areas are encouraged to drive in convoy and to carry satellite telephones.

U.S. citizens should avoid political rallies and street demonstrations and maintain security awareness at all times. For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

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

CRIME: Travel in many sections of Lusaka, Livingstone and most other major cities as well as in the major game parks, is generally safe during daylight hours. Travelers using public transportation or visiting high pedestrian traffic areas are advised to be vigilant against robbery and pick-pocketing.

Vehicle thefts, burglaries, and armed robbery occur throughout the country. Carjacking remains an ongoing problem, especially in Lusaka and other major cities. Carjackers generally employ a strategy of blocking the back of one’s car when the car is waiting to pass through a security gate into a residence or other facility. It is recommended to drive with doors locked and windows closed at all times and remain vigilant when entering or exiting one’s residence.
Foreign tourists have frequently been the target of small-scale financial scams involving bogus “fees” to be paid to various Zambian officials and groups. The embassy cautions travelers to make sure that they receive an official, Government of Zambia receipt for any fines and duties paid. Often, travelers will be told that the official does not have a receipt book or that this type of fine is not receipted. Polite, but firm insistence on a Zambian Government receipt will often result in these fines disappearing.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Government hospitals and clinics are often understaffed and lack supplies. Private medical clinics in major cities can provide reasonable care in many cases, but major medical emergencies usually require medical evacuation to South Africa, Europe, or the United States. Basic medical care outside of major cities is extremely limited. Doctors and hospitals often expect immediate cash payment for health services. Travelers should carry their prescription drugs and medications in original labeled containers, as well as the written prescription from their physician. (See “Criminal Penalties” section.)
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

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

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Zambia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Traffic circulates on the left side of the road, and there are many British-style roundabouts rather than intersections with traffic lights. There is no left turn on red. Seat belts are mandatory, as are helmets for motorcyclists. A child's seat is not mandatory by law, but is essential for safeguarding children. The speed limit is 50 km/30 mph in Lusaka and 100 km/60 mph outside of city limits. However, speed limits are rarely respected, and most cars drive 80 km/50 mph in the city and 120 km/75 mph outside town. Most vehicles operate at even faster speeds on the road from Lusaka to Livingstone. Drivers under the influence of alcohol who are involved in accidents are tested at Lusaka's University Teaching Hospital (UTH) and then taken to court.

Driving on Zambian roads can be hazardous. Most roads do not have shoulders or sidewalks; pedestrians and livestock use the roadways both day and night. While the main roads in Lusaka as well as the principal highways linking Lusaka with the major provincial capital are generally maintained, many secondary roads are in poor repair. During the rainy season (end of October to mid-March), travelers who do not have a four-wheel drive vehicle will encounter problems driving on rural roads. Even in daylight, passing another vehicle can be particularly dangerous given the general condition of roads. Driving at night can be hazardous and is discouraged. When breakdowns occur, local drivers place a few branches behind the car to indicate trouble, but this is hardly visible at night. As a result, many drivers use their high beams at night to detect stopped vehicles and pedestrians.
Since 2000, Americans have been involved in a number of series car accidents. There are no emergency services for injured or stranded drivers. Car accident victims are vulnerable to theft by those who pretend to be “helpful.” It is advisable to have a cell phone when undertaking a trip outside of town, although many parts of the country do not yet have cell phone service.

City traffic is comprised mostly of cars and minibuses; motorcycles are rare. Minibuses serve as the primary means of inter-city travel in Zambia. They are often overcrowded and seldom punctual. Drivers often use pass using road shoulders or opposing traffic lanes. Often they will stop with little or no warning, in order to pick up or drop off passengers. Some luxury buses do ply the routes between Lusaka and Livingstone and the Copperbelt. Please refer to our Road Safety page for more information. Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://www.zambiatourism.com/.
AVIATION SAFETY OVERSIGHT:As there is no direct commercial air service to the United States by carriers registered in Zambia, the U.S. Federal Aviation Administration (FAA) has not assessed Zambia’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:
Perpetrators of business fraud often target foreigners, including Americans. While such fraud schemes in the past have been largely associated with Nigeria, they are now prevalent throughout Africa, including Zambia. For additional information, please consult The Department of State's publication "International Financial Scams." In addition, Americans are advised to exercise caution when approached with unsolicited offers to purchase gemstones or precious metals for export as the Embassy has received multiple recent complaints from Americans who have been victimized as a result of their involvement in these deals.
U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times, so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available. Zambian police do not provide the U.S. Embassy with timely notification of the arrest of American citizens. If you are detained, you should insist on your right to contact a U.S. consular officer.
MasterCard and Visa cards are accepted in major supermarkets, restaurants, stores, and hotels in Lusaka and Livingstone (Victoria Falls). Credit card fraud is increasing in Zambia and there have been several cases involving fraudulent charges, including some at major hotels catering primarily to foreign visitors. Many businesses use carbonized paper documents to process payment. These documents are not secure and can pose a threat to cardholders. The Embassy urges caution when using debit or credit cards at any point of purchase, especially if the transaction is not processed electronically. Normally, American travelers can withdraw money (in local currency) from ATMs in major cities in Zambia using their ATM cards or credit cards from the United States. However, from time to time, the banks lose their connections with the credit card exchanges, thus making withdrawals impossible. Zambian banks and bureaux de change will not accept dollar-denominated notes issued before 1990.
Travel to military areas and photographing military facilities, airports, bridges, and other facilities deemed to be of security relevance, are prohibited. Often these sites are not clearly marked and the first notification that a tourist would receive is a police officer demanding their film and/or camera. Authorities may also challenge photography of areas other than tourist attractions. Service providers in Zambia, including the tourism sector, are not subject to the same standards of safety oversight that exist in the United States; visitors should evaluate risks carefully.

Travelers are cautioned to observe local or park regulations and heed all instruction given by tour guides. Even in the most serene settings, wild animals can pose a threat to life and safety.

Large numbers of travelers visit tourist destinations, including South Luangwa National Park and Livingstone (Victoria Falls), without incident. However, American citizens are advised to avoid rafting and other whitewater boating activities on the Zambezi River below Victoria Falls during the high-water season, February through June. During periods of high water, the Batoka Gorge section of the river becomes unpredictable and several tourists have been involved in fatal accidents.
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 Zambian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Zambia 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.

It is against both Zambian and U.S. law to buy, possess or transport animals or animal products, such as tortoise shell, rhino horn, elephant ivory, tusks of any animal or any items made out of these materials. In Zambia, penalties range from large fines to mandatory 5-year prison sentences. The Zambian Wildlife Authority has screeners at international ports of entry/exit and WILL prosecute offenders to the fullest extent of the law.

While many of these items are sold in open markets particularly aimed at foreign tourists, it remains the responsibility of the customer to ensure that he/she is not purchasing a prohibited item.

Further instructions on the importation of items to the U.S. may be found on the U.S. Customs and Border Protection web site at
http://www.customs.gov/xp/cgov/travel/vacation/kbyg/prohibited_restricted.xml.

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 Zambia 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 Zambia. 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 the corner of Independence and United Nations Avenues. The mailing address is P.O. Box 31617, Lusaka, Zambia. Telephone exchanges have recently changed within Zambia. When calling from the United States, please contact the American Embassy during regular work hours, Monday through Thursday from 7:30 a.m. to 5:00 p.m., and on Friday from 7:30 a.m. to 12:30 p.m. by dialing 011-260-21-125-0955. For after-hours emergencies involving American citizens, please dial 011-260-21-125-0955 extension 1. The fax number is 260-21-125-2225. The web site is http://zambia.usembassy.gov.
* * *
This replaces the Country Specific Information for Zambia dated February 14, 2008, to update sections on Entry/Exit Requirements and Crime.

Travel News Headlines WORLD NEWS

Date: Tue, 29 Oct 2019 20:07:03 +0100 (MET)

Lusaka, Oct 29, 2019 (AFP) - More than two million Zambians are facing "severe" food insecurity after drought and flooding reduced harvests, the Red Cross said Tuesday.   Southern Africa is grappling with one of the worst droughts in decades after months of erratic rainfall and record-high temperatures.   Zambia Red Cross warned the drought had left an estimated 2.3 million people facing "severe food insecurity", up from 1.7 million a month ago.   "The successive mixture of drought and flooding has been catastrophic for many communities," said Zambia Red Cross head Kaitano Chungu in a statement.

While rainfall hit a record low in southern and western Zambia, flash floods and  waterlogging occurred in the north and east of the country.   The Red Cross said that combination resulted in "poor harvests", with families in the worst-affected areas surviving on wild fruit and roots -- posing a serious risk to their health.   "In most of the affected areas there isn't enough drinking water, which means that people and animals-both livestock and wildlife-are having to use the same water points," said Chungu.    "This is unacceptable as it exposes people to diseases and creates a heightened risk of animal attacks," he added.

Zambia's regional neighbours have also felt the impact.   More than five million rural Zimbabweans -- nearly a third of the population -- could face food shortages before the next harvest in 2020, according to the United Nations.   And wildlife has been affected as well.   At least 55 elephants died in Zimbabwe and 100 in Botswana over the past two months due to lack of food and water.
Date: 21 Oct 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/polio-cases-reported-in-zambia-chad-and-togo-73820/>

Circulating vaccine-derived polio virus (cVDPV) type cases have been confirmed in 10 African countries through [16 Oct 2019] this year [2019]. Now, the World Health Organization (WHO) is reporting 3 additional countries from the continent that more recently reported circulating vaccine-derived polio virus type 2 (cVDPV2) cases: Zambia, Chad and Togo.

Zambia
The Ministry of Health of Zambia reported last week on a confirmed case of circulating vaccine-derived polio virus type 2 (cVDPV2) in a 2-year-old child in Chienge district, Luapula province on the border with Democratic Republic of the Congo. This is the 1st case of cVDPV2 reported from Zambia in 2019. [Date of onset of paralysis reported to be 16 Jul 2019 according to another media report <https://www.lusakatimes.com/2019/10/21/polio-case-has-been-recorded-in-zambias-luapula-province/>.

In addition to the initial case-patient, 34 stool samples were collected from healthy contacts, and 2 samples tested positive for VDPV2, which were genetically linked to the case-patient. No established links have so far been found with the ongoing outbreak of cVDPV2 in Democratic Republic of the Congo, where 37 cases have been reported in 2019. The last recorded case of indigenous polio in Zambia was in 1995, while between 2001 and 2002, 5 cases of wild polio virus were identified among Angolan refugees in the Western province of the country.

Chad
Last week, WHO was informed about cVDPV2 in Chad. A cVDPV2 was isolated from a 13-month-old case of acute flaccid paralysis (AFP), with onset of paralysis on [9 Sep 2019] in Chari Baguirmi province, bordering Cameroon. The isolated virus has 32 nucleotide changes from Sabin 2, and is genetically linked to a cVDPV2 detected in Borno, Nigeria and is part of the Jigawa emergence. The last indigenous wild poliovirus cases were reported in 2000 in Chad.

Togo
In addition, last week WHO was informed about cVDPV2 in Togo. A cVDPV2 was isolated from a 30-month-old case of AFP with onset of paralysis on [13 Sep 2019] in Plateaux province, bordering Benin and Ghana. The isolated virus has 32 nucleotide changes from Sabin 2 and is genetically linked to a cVDPV2 detected in Irewole state, Nigeria and is part of the Jigawa emergence as well. The last indigenous wild poliovirus case was reported in 1999 in Togo.
======================
[Three more countries are joining the list of cVDPV outbreak countries, all with cVDPV2 isolates. Two of the 3 countries (Togo and Chad) have viruses related to the Jigawa, Nigeria cVDPV2 outbreak. The case in Zambia is suspected to be associated with the ongoing cVDPV2 transmission in the Democratic Republic of the Congo (DR Congo), but genetic testing is presumably still pending or has been negative. See my comments below after the following section, as they are relevant to what is ongoing globally with respect to cVDPVs.

Below are the HealthMap/ProMED map links to countries where cVDPV cases/outbreaks have occurred in the past 12 months, a total of 20 countries.

Angola: <http://healthmap.org/promed/p/165>
Benin: <http://healthmap.org/promed/p/59>
Cameroon: <http://healthmap.org/promed/p/65>
Central African Republic: <http://healthmap.org/promed/p/66>
Chad: <http://healthmap.org/promed/p/57>
China: <http://healthmap.org/promed/p/155>
Democratic Republic of the Congo: <http://healthmap.org/promed/p/194>
Ethiopia: <http://healthmap.org/promed/p/95>
Ghana: <http://healthmap.org/promed/p/53>
Indonesia: <http://healthmap.org/promed/p/184>
Kenya: <http://healthmap.org/promed/p/174>
Mozambique: <http://healthmap.org/promed/p/177>
Myanmar: <http://healthmap.org/promed/p/148>
Niger: <http://healthmap.org/promed/p/58>
Nigeria: <http://healthmap.org/promed/p/62>
Papua New Guinea: <http://healthmap.org/promed/p/188>
Philippines: <http://healthmap.org/promed/p/158>
Somalia: <http://healthmap.org/promed/p/125>
Togo: <http://healthmap.org/promed/p/64>
Zambia: <http://healthmap.org/promed/p/170> - ProMED Mod.MPP]
Date: Fri, 23 Aug 2019 15:08:04 +0200 (METDST)
By Obert SIMWANZA

Lusaka, Aug 23, 2019 (AFP) - Children living in a central Zambian mining town are still exposed to high levels of toxic lead 25 years after the mine closed, Human Rights Watch said Friday, as lawyers announced plans to take legal action.   Decades of lead mining have left Kabwe, around 150 kilometres (95 miles) north of Lusaka, severely polluted, with serious health implications for residents.   The mine, which operated from the early 1900s until its closure in 1994, was at one time the world's largest lead mine. It was run by the Zambian government from the early 1970s when the mining industry was nationalised.     In a report published Friday, HRW said the town in the Copperbelt area still has extreme levels of contamination and children continue to be exposed to high levels of toxic lead in soil and dust around their homes, schools and play areas.

HRW's children's rights fellow and report author Joanna Naples-Mitchell described the situation in Kabwe as "a public health emergency" and said the government was "not responding with the sense of urgency that is warranted".    "The Zambian government is aware that Kabwe has been severely contaminated... since the 1990s and efforts to clean up have been inadequate," she told AFP.   A class action suit is being prepared to demand compensation for poisoning from Anglo American South Africa, a former investor in the mine, London-based law firm Leigh Day announced Friday. The law firm deals in human rights issues.   The case will be brought in courts in South Africa, where the mining firm is based, said the lawyers, who are acting on behalf of some 200 children who have been treated for lead poisoning.   Anglo American on Friday said in a statement it did not believe it was "in any way responsible for the current situation" in Kabwe.    "We were concerned to learn of the situation at Kabwe as reported by the press," it said, adding "the nationalisation more than 40 years ago effectively placed these issues under the control of the Zambian Government".

- 'Severely contaminated' -
The HRW report said that although lead and zinc mining have stopped in the town, various medical studies conducted over the past seven years show children there still had elevated levels of lead in their blood.   Between 2003 and 2011, the World Bank funded a government project to decontaminate Kabwe's affected townships, and to test and treat children. But some 76,000 people, or a third of the town's population, still live in contaminated areas.   One recent study published last year and cited by HRW estimated that more than 95 percent of children in the townships surrounding the lead mine have elevated blood lead levels and that about half of them require medical intervention.   "This is the worst environmental disaster I have seen in 30 years of practice," said lawyer Richard Meeran of Leigh Day.    Johannesburg-based collaborating lawyer Zanele Mbuyisa said they will argue that "the environmental damage created has potentially contaminated almost three generations of men, women and children".

- Insufficient resources -
Three years ago, the government launched another five-year World Bank-funded project to get rid of the lead and carry out new rounds of testing and treatment.   The project targets around 10,000 people including children, pregnant women and mothers.   "We think this a very important opportunity for the Zambian government to find a lasting solution to this problem," said Naples-Mitchell.   She urged Zambia to find new and effective methods to clean up the lead, adding that their 2018 study indicated that pollution levels were "as high they had been in the 1970s".    In a letter last month, the government indicated to HRW that it does not have enough resources to address the full scale of the contamination.   The government did not immediately comment on the report.   Children are more vulnerable to lead poisoning since they absorb four to five times as much as an adult and this can retard their growth and IQ, while in worst cases it can result in brain damage or even death.
Date: Sat 6 Jul 2019
From: Johannes Jochum <j.jochum@uke.de> [edited]

A 19-year-old German woman was diagnosed with East African trypanosomiasis (due to _Trypanosoma brucei rhodesiense_) during a stay in Zambia.

The patient had been working since August 2018 in a school project close to Kabwe. From 29 May to 4 Jun [2019] she visited South Luangwa National Park. On 31 May [2019], she received a mildly painful insect bite on her calf during an afternoon game-viewing drive from Kafunta River Lodge.

She recalled seeing numerous tsetse flies during this drive but was told there had not been any cases of trypanosomiasis for years in this area. The bite initially healed well and she returned to Kabwe.

On the evening of 11 Jun [2019], she developed high fever, rigors, and severe headache. The site of the insect bite on her calf was swollen and showed livid discoloration. Several point-of-care tests for malaria were negative.

Antibiotic treatment at a local hospital led to no improvement of her symptoms. On 16 Jun [2019] she was admitted to Lusaka Coptic Hospital where African trypanosomiasis was diagnosed by blood microscopy. Central nervous system involvement was ruled out by spinal tap, and treatment with suramin was started on 17 Jun [2019]. The patient returned in stable condition to Germany on 2 Jul [2019] where she sought further treatment and follow-up at our institution.

South Luangwa National Park is known to be endemic for East African trypanosomiasis with several cases in recent years; the most recent report in ProMED-mail is in March 2019:  <http://www.promedmail.org/post/http://promedmail.org/post/20190320.6377064>.

Game animals and livestock are the main reservoir of this zoonotic disease in south-eastern Africa. Tourists acquire the disease occasionally during game safaris in Zambia, Malawi, Zimbabwe, Uganda, and Tanzania. West African trypanosomiasis (_Trypanosoma brucei gambiense_) accounts for substantially more cases in total, affecting local populations mostly in remote rural areas of the Democratic Republic of Congo, Angola, and Central African Republic  (<https://www.who.int/trypanosomiasis_african/country/en/>).
---------------------------------------------
Communicated by:
Dr. Johannes Jochum
Department of Tropical Medicine
Bernhard Nocht Institute for Tropical Medicine
Department of Medicine
University Medical Center Hamburg-Eppendorf
Hamburg, Germany
==========================
[This is the website of the national park:

Trypanosomiasis is endemic in the national parks in southern Africa, where there are tsetse flies and a reservoir of the trypanosomes in the wildlife. It is important to consider trypanosomiasis in febrile travellers to these national parks with negative tests for malaria. - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Date: Tue 14 May 2019
Source: Lusaka Times [edited]

Government has revealed that about 17 people are admitted to Mpulungu urban clinic for suspected cholera. Mpulungu District Commissioner Dennis Sikazwe has confirmed the development to ZANIS [Zambia News and Information Services] in Mpulungu today [14 May 2019].

Mr. Sikazwe said the Ministry of Health has since recommended that schools be closed for the period of one week to ensure that the situation is contained. He added that all operations of ferrying people from Mpulungu to Nsumbu in Nsama district by boats has been suspended for the period of one week. Mr. Sikazwe has also revealed that the ministry has put up measures to sensitize people on the need to maintain high levels of hygiene during this period.

The District Commissioner has also urged people to work with the medical staff at the health facility in order to control a further spread of the disease. He has also urged people to report all suspected cholera cases to the nearest health centres.

In Mbala, 5 people have been admitted at Tulemane clinic for suspected cholera. Sources from Tulemane clinic, who sought anonymity, confirmed the development to ZANIS in Mbala yesterday [13 May 2019]. Mbala District Commissioner Kedrick Sikombe, who could not confirm the matter, has promised to give a detailed report once he gets details from the Ministry of Health in the area.
==================
[The mortality from cholera and most diarrheal illnesses is related to non-replacement of fluid and electrolytes from the diarrheal illness.

As stated by Lutwick and colleagues (Lutwick LI, Preis J, Choi P. Cholera. In Chronic illness and disability: the paediatric gastrointestinal tract. Greydanus DE, Atay O, Merrick J, editors. New York: Nova Bioscience; 2018:113-127), oral rehydration therapy can be life-saving in outbreaks of cholera and other forms of diarrhoea: "As reviewed by Richard Guerrant et al. (1), it was in 1831 that cholera treatment could be accomplished by intravenous replacement, and, although this therapy could produce dramatic improvements, not until 1960 was it 1st recognized that there was no true destruction of the intestinal mucosa, and gastrointestinal rehydration therapy could be effective, and the therapy could dramatically reduce the intravenous needs for rehydration. Indeed, that this rehydration could be just as effective given orally as through an orogastric tube (for example, refs 2 and 3) made it possible for oral rehydration therapy (ORT) to be used in rural remote areas and truly impact the morbidity and mortality of cholera. Indeed, Guerrant et al. (1) highlight the use of oral glucose-salt packets in war-torn Bangladeshi refugees, which reduced the mortality rate from 30% to 3.6% (4) and quotes sources referring to ORT as "potentially the most important medical advance" of the 20th century. A variety of formulations of ORT exist, generally glucose or rice powder-based, which contain a variety of micronutrients, especially zinc (5).

"The assessment of the degree of volume loss in those with diarrhoea to approximate volume and fluid losses can be found in ref 6 below. Those with severe hypovolemia should be initially rehydrated intravenously with a fluid bolus of normal saline or Ringer's lactate solution of 20-30 mL/kg followed by 100 mL/kg in the 1st 4 hours and 100 mL/kg over the next 18 hours with regular reassessment. Those with lesser degrees of hypovolemia can be rehydrated orally with a glucose or rice-derived formula with up to 4 L [4.2 qt] in the 1st 4 hours, and those with no hypovolemia can be given ORT after each liquid stool with frequent reevaluation."

References
1. Guerrant RL, Carneiro-Filho BA, Dillingham RA: Cholera, diarrhoea, and oral rehydration therapy: triumph and indictment. Clin Infect Dis 2003;37(3):398-405; available at <http://cid.oxfordjournals.org/content/37/3/398.long>.
2. Gregorio GV, Gonzales ML, Dans LF, Martinez EG: Polymer-based oral rehydration solution for treating acute watery diarrhoea. Cochrane Database Syst Rev 2009;(2):CD006519; available at <http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006519.pub3/full>.
3. Gore SM, Fontaine O, Pierce NF: Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials. BMJ 1992;304(6822):287-291; available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1881081/>.
4. Mahalanabis D, Choudhuri AB, Bagchi NG, et al: Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med 1973;132(4):197-205; available at <http://www.searo.who.int/publications/journals/seajph/media/2012/seajph_v1n1/whoseajphv1i1p105.pdf>.
5. Atia AN, Buchman AL: Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol 2009;104(10):2596-2604; abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/19550407>.
6. WHO. The treatment of diarrhea, a manual for physicians and other senior health workers. 4th ed. 2005; available at <http://whqlibdoc.who.int/publications/2005/9241593180.pdf>. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Zambia:
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Chile

Chile US Consular Information Sheet
August 20, 2008
COUNTRY DESCRIPTION:
Chile is a rapidly developing country with a large, educated middle class and a robust free-market economy.
Tourist facilities are generally good and are continu
usly improving.
Read the Department of State’s Background Notes on Chile for additional information.
ENTRY/EXIT REQUIREMENTS:
U.S. citizens entering Chile must have a valid passport.
U.S. visitors will be charged a reciprocity fee at the port of entry, and a small receipt for the fee will be stapled in the last page of the passport.
This visa is valid for multiple entries and remains valid until the expiration of the passport.
In addition, visitors will be issued a tourist visa consisting of a single sheet of paper placed in the passport. This visa is valid for a stay of up to 90 days.
An extension of stay for an additional 90 days is possible, but requires payment of an extension fee.
The visa document must be surrendered to immigration authorities upon departure.

Chilean entry and exit control laws require that a minor child under age 18 traveling unaccompanied must have permission from the parents or legal guardians.
The document must be notarized and, if issued in the United States, authenticated by a Chilean consul in the United States.

If the child is traveling in the company of only one parent or guardian, the non-traveling parent or guardian will also be required to grant permission for travel.
In this case, the document will also need to be notarized and authenticated by a Chilean consul.
The permission to travel may also be notarized by a Chilean notary in Chile.

Parents are required to have documentary evidence of their relationship to the child.
An original birth certificate or certified copy of an original birth certificate is required.
This requirement applies to all foreigners as well as Chileans.
This requirement is increasingly being enforced by Chilean immigration officers.
When traveling with a minor child in Chile on a tourist visa, having such documentation on hand will facilitate entry and departure.

Visit the Embassy of Chile web site www.chile-usa.org for the most current visa information and entry/exit requirements.
Visitors should be aware of the severe Chilean restrictions on the importation of fruit, vegetables & agricultural products.
Check the Ministry of Agriculture web site www.sag.gob.cl for current requirements.

Information about dual nationality and the prevention of international child abduction can be found on our website.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
The potential for terrorist activity is low.
There has been some politically-motivated violence among indigenous communities in southern Chile, none of which has affected Americans.
Potential for civil disturbance is low, although demonstrations, sometimes violent, do occur.
Particularly violent days are March 29, the Day of the Young Combatant, and the anniversary of the September 11, 1973, coup against the government of President Salvador Allende.

For the latest security information, Americans traveling abroad should regularly monitor the Department's web site where the current Worldwide Caution, Travel Warnings and Travel Alerts can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Crime rates are low to moderate throughout Chile and are moderate in Santiago, Valparaiso, and other major cities.
American citizens visiting Chile should be as careful in cities as they would be in any city in the United States.
There have been few violent crimes committed against Americans.
However, American tourists are at a heightened risk for pick-pocketing, purse or camera snatching, and theft from backpacks and rental cars.
Such crimes have been reported in all areas of Chile frequented by tourists.
In Santiago, visitors should be especially alert to the possibility of crime at the Plaza de Armas and the Mercado Central; at major hotels and restaurants in the Las Condes, Vitacura, and Providencia areas, and in the Suecia and Bellavista entertainment districts.
In Valparaiso, visitors should be especially alert in the port and adjoining tourist areas.
Tourists using taxis in Santiago should be alert to possible scams involving currency switching.
Tourists should also be especially alert while using public transportation, such as the Santiago Metro Subway and public buses and while in the vicinity of Metro stations and bus terminals. The emergency number for the police (Carabineros) is 133.

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 www.cybercrime.gov/18usc2320.htm.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. You will find information about the Chilean legal system at the following website www.ministeriopublico.cl.
Women that are victims of domestic violence will find helpful information at the website www.sernam.cl.

The local equivalent to the “911” emergency line in Chile is:
131 – AMBULANCE (SAMU)
132 – FIRE DEPARTMENT (BOMBEROS)
133 – POL
ICE DEPARTMENT (CARABINEROS)
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care, though generally good, may not meet U.S. standards, especially in remote areas.
Although emergency rooms in some major hospitals accept credit cards, many doctors and hospitals in Chile expect immediate payment in cash.
Prescriptions written by local doctors and over-the-counter medicines are widely available.
Air pollution is a major source of health concern in Santiago, resulting in severe bronchial ailments affecting infants, small children and the elderly.
The most severe air pollution occurs during the winter (May through August). Additional information on air quality levels is available at the National Air Quality Information Service (SINCA) web site - www.sinca.conama.cl.

The ozone layer is especially thin at the bottom of the world.
Travelers should take proper precautions to protect themselves from ultraviolet radiation.

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-TRI (1-877-394-8747) or from the CDC’s web site 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 www.who.int/en.
Further health information for travelers is available at www.who.int/countries/chl/en/.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Chile.

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 Chile is provided for general reference only, and may not be totally accurate in a particular location or circumstance
Driving in Chile is on the right-hand side of the road.
Traffic laws in Chile differ from traffic laws in the United States in some respects.
Right-hand turns are generally prohibited at red lights unless otherwise posted.
Seat belts are mandatory. Several modern toll highways have recently been opened in and around Santiago, dramatically improving transit into and through the city.
Major roads are generally in good condition throughout the country.
Some secondary roads, however, may be poorly maintained.
At night, occasional heavy fog in rural areas may lead to vehicle accidents with occasional deaths and injuries.
Care should be taken while driving in the mountains because the roads tend to have many tight switchbacks and may not have guardrails.
Chains are often required and should be used on mountain roads during the winter.
Many major highways in Chile are toll roads; drivers should carry a sufficient amount of local currency to cover the tolls.
The new major highways in and around Santiago generally collect tolls through use of an electronic transmitter issued by the concessionaire and placed on the vehicle.
“Day passes” may be purchased separately.
Vehicles rented at Santiago airport generally are equipped with the electronic transmitter and the rental car companies charge a surcharge for its use.
Some major arteries remain under construction in Santiago and drivers should be alert for detours and delays. Information on the major highways in the Metropolitan Region requiring an electronic transmitter is found at www.concesiones.cl.
Throughout Chile, care should be exercised when changing lanes or merging because many drivers do not signal lane changes and rarely yield to merging traffic.
Many Chilean drivers exceed posted speed limits, do not maintain safe distances, and do not observe posted road signs.
Buses are especially aggressive in moving between lanes.
Speeding is common, including in urban areas.
Traffic jams and detours in Santiago and other areas are common.
Taxis are plentiful and relatively inexpensive.
Drivers should drive with car doors locked at all times, especially in the southern parts of the city and near the airport, as there have been reports of thieves entering cars stopped at traffic lights or moving in slow traffic.
In Santiago, certain major arteries switch directions during morning and evening rush hours.
Visitors to Santiago should obtain up-to-date information on these changes from their auto rental company or the Chilean Automobile Association (please see below).
Visitors that wish to use the public bus and subway system in Santiago should visit the following websites for information on purchasing a “BIP” card, a prepaid ticket required for public buses, routes and other helpful information regarding the public transportation systems: www.transantiagoinforma.cl; www.metrosantiago.cl and www.micros.cl.
Driving under the influence of alcohol in Chile is severely punished, and can result in incarceration if the driver is involved in an accident. In accidents involving injuries or death, police may detain both drivers for many hours.
Visitors must have an international driver’s permit in order to drive legally in Chile. The international driver’s license must be obtained in the United States before traveling to Chile.
Although car rental firms may rent to customers with only a U.S. driver’s license, the police fine foreigners for driving without a valid international permit.

Please refer to our Road Safety page for more information.
Visit the website of Chile’s national tourist office at www.sernatur.cl and national authority responsible for road safety at www.vialidad.cl.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Chile’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Chile’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Visitors should take care to use only the services of government licensed tour operators throughout Chile as the Embassy is aware of at least one accident involving American fatalities with an unauthorized tour operator.
Special care should be taken by arriving cruise ship passengers if arranging land tours not authorized by the cruise line.
Chile is an earthquake-prone country.
Information on Chilean earthquake preparedness is available from the Oficina Nacional de Emergencia de Chile (ONEMI) at www.onemi.cl.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at www.fema.gov.
Information about emergency preparedness is also available on the Embassy web site at http://santiago.usembassy.gov/.
The U.S. Geological Survey provides earthquake information on Chile at http://earthquake.usgs.gov/regional/world/index.php?regionID=8.
Minefields are found in Chile’s northern border with Peru and Bolivia and on the southern border with Argentina in Patagonia.
Minefields are generally marked, but markers may have been shifted, become obscured or been vandalized.
Travelers should pay attention to markers and follow clearly identified roads and trails when traveling in minefield areas.
Border crossings should only be made at authorized locations.
Persons visiting wilderness areas in the border regions mentioned above should check with park or other local officials concerning minefields and other potential hazards.
Chile is a popular destination for outdoors and adventure sports.
Much of the country is mountain, forest, desert, or glacier.
Despite the best efforts of local authorities, assisting persons lost or injured in such areas can be problematic.
American citizens have been killed in recent years in mountain climbing and whitewater rafting accidents, and seriously injured while skiing.
Persons planning to travel in isolated and wilderness areas should first learn about local hazards and weather conditions.
Information about parks and wilderness areas can be obtained from the Chilean Forestry Service at www.conaf.cl.
Information about mountain climbing in Chile can be obtained from the Federacion de Andinismo de Chile at www.feach.cl.
Current weather forecasts are available from the Chilean Meteorological Service at www.meteochile.cl.
Reports of missing or injured persons should be made immediately to the police so that a search can be mounted or assistance rendered.
Travelers in isolated areas should always inform park rangers, police, or other local authorities of their itinerary before starting off.
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 Chilean laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Chile 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.
Just as in the United States, foreigners in Chile must have proper immigration status and pay taxes on income earned in Chile.
Recently, Americans have been deported for working in Chile without authorization.
Please see our information on Criminal Penalties and ensure compliance with all Chilean immigration regulations; consult the web site of the U.S. Embassy in Chile for more information at http://santiago.usembassy.gov/
CHILDREN'S ISSUES:
See our Office of Children’s Issues web pages for information on intercountry adoption and international parental child abduction.
Chile has demonstrated patterns of noncompliance with the Hague Child Abduction Convention. Chile’s patterns of noncompliance fall in its judicial performance. The courts continue to demonstrate a clear bias toward Chilean mothers.

REGISTRATION/ EMBASSY LOCATION:
Americans living or traveling in Chile are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Chile.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located at Avenida Andres Bello 2800, Las Condes, Santiago, Chile.
The telephone number is (56) (2) 330-3000.
The Embassy web site is http://santiago.usembassy.gov, and the email address for the American Citizen Services Unit is SantiagoAMCIT@state.gov.
The Consular Section fax number is (56) (2) 330-3005.
The American Citizen Services Unit is open to the public from 8:30am-11:30am, Monday through Friday, except U.S. and Chilean holidays and the first Friday of each month.
* * *
This replaces the Country Specific Information dated October 23, 2007 to update all sections except Aviation Safety Oversight.

Travel News Headlines WORLD NEWS

Date: Sat 30 Nov 2019
Source: 24 Horas [in Spanish trans. ProMED Mod.TY, edited]

The ISP [Public Health Institute] confirmed the 1st hantavirus [infection] case in the O'Higgins region [of 2019]. The affected individual is a 32-year-old woman, resident of San Vicente. Moreover, the Health SEREMI [Regional Health Ministerial Secretariat] stated that they are studying a suspected case in a minor.

"Chile is an endemic country for hantaviruses in the Coquimbo y Aysen regions. Because of this, the inhabitants of our region must always observe preventive measures," stated the Health SEREMI Dr. Daniela Zavando. The chief of this agency added, "Sadly, the ISP confirmed the 1st case of hantavirus [infection] in our region."

Dr. Zavando added that, "there is a suspected hantavirus [infection] case in a minor, and we await the confirmation or elimination of the case. People who visit the countryside, rivers, mountains, among other sites, must follow the recommendations to walk along established trails, ventilate sheds or cabins before entering them, do not gather and eat wild fruit, protect food materials adequately, and do not kill natural predators of the long-tailed mouse such as owls, foxes etc.," stated the regional sanitary authority.

The SEREMI added that, "Our Epidemiological and Sanitary Action team is currently carrying out monitoring and investigation of the case with the object of preventing new cases in the areas visited by the patient in rural localities in San Vicente."
==================
[An additional report of 1 Dec 2019 indicated that the patient was taken to the intensive care unit in the Hospital del Torax in metropolitan Santiago

A 3rd report of 1 Dec 2019 indicates that although in serious condition, the patient is progressing well

As noted in previous comments, much of central and southern Chile is endemic for Andes hantavirus. The report above provides no information about the circumstances under which the woman acquired her hantavirus infection, but it may have been due to exposure to rodent reservoir hosts of the virus or to virus-contaminated rodent excreta while in contact with the environment where rodents were present. Cases of human hantavirus infections occur fairly frequently in the endemic region.

Although not specified in this or previous reports from the region, the hantavirus involved in these cases no doubt is Andes virus. This virus is endemic in Chile, and cases of hantavirus pulmonary syndrome occur every year. In Chile, Andes virus can be transmitted directly person-to-person but only with very close physical proximity, usually within the family.

Images of the long-tailed pygmy rice rat (_Oligoryzomys longicaudatus_), the sigmodontine rodent host of Andes hantavirus, can be seen at

[HealthMap/ProMED map available at:
Date: Sat 23 Nov 2019
Source: Outbreak News Today [edited]

A salmonellosis outbreak in Maipu commune in Santiago Province has now affected 80 people, according to the Chile news source, T13 (computer translated). This is up from 45 cases reported ill at the El Carmen Hospital with symptoms of salmonella infection on [Tue 19 Nov 2019].

Health officials have linked to outbreak to the consumption of sushi at a Bokado sushi store. "This is an important call for the preparation of these products, they must be cooked. They must not use salmon or raw seafood, they must use cooked products," said health SEREMI [Secretaria Regional Ministerial de Salud; regional ministerial secretariat of health], Rosa Oyarce.
=======================
[Fish are not considered to be reservoirs for salmonellosis but can certainly be contaminated after harvesting. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Chile:
Date: Mon, 4 Nov 2019 23:47:26 +0100 (MET)

Santiago, Nov 4, 2019 (AFP) - A strong 6.0-magnitude earthquake shook Chile on Monday, rattling buildings in the capital while a big anti-government demonstration was under way.   The quake struck at 6:53 pm (2153 GMT) with its epicentre near the northern town of Illapel, the US Geological Survey said.   A strong and prolonged shaking was felt in the capital.   Chile's National Seismological Center measured the quake at magnitude 6.1, revising down an earlier estimate of 6.3.   There were no immediate reports of damage or casualties.   "There have been no reports of damage to people, disruption of basic services or infrastructure," the National Emergency Office said.   The Army Hydrographic and Oceanographic Service said the quake was unlikely to cause a tsunami on Chile's Pacific coast.

When the quake hit, police in Santiago were dispersing protesters at the start of the third week of anti-austerity protests targeting the conservative government.   Chile is one of the world's most earthquake-prone countries.   The 9.5-magnitude 1960 Valdivia earthquake was the strongest ever recorded on the magnitude scale, according to the USGS.   In 2010 an 8.8-magnitude followed by a tsunami killed more than 500 people.   Chile lies on the Ring of Fire -- an arc of fault lines that circles the Pacific Basin and is prone to frequent earthquakes and volcanic eruptions.
Date: Thu, 24 Oct 2019 02:27:37 +0200 (METDST)
By Miguel SANCHEZ

Santiago, Oct 24, 2019 (AFP) - Thousands of Chileans flooded the streets of Santiago and other cities in a general strike on Wednesday, upping the pressure on beleaguered President Sebastien Pinera after days of social unrest that left 18 dead.   Students, professors and state workers walked off the job at the urging of the country's largest union, ignoring a package of measures announced by Pinera aimed at quelling the violence.   "THE STRIKE IS ON! We say it loud and clear: enough of the increases and abuses," said the Workers' United Center of Chile, which organized the two-day action alongside about 20 other groups.   In the capital Santiago, police used water cannons to disperse protesters.   "Chile has awakened," read the sign of one protester -- a slogan that has been popular since the protests against social and economic woes, and a yawning gap between rich and poor, began last week.

The country, usually one of the most stable in Latin America, has experienced its worst violence in decades since protests against a now-scrapped hike in metro fares escalated dramatically on Friday.   A four-year-old child and a man were killed on Tuesday when a drunk driver rammed into a crowd of demonstrators, Interior Undersecretary Rodrigo Ubilla said.   A third person died after being beaten by police, according to the victim's family.   The armed forces announced a nighttime curfew for the fifth day running, although at just six hours, Wednesday night's is the shortest yet.   In an address to the nation late on Tuesday, Pinera apologized for failing to anticipate the outbreak of social unrest.   "I recognize this lack of vision," Pinera said after a meeting with some of Chile's opposition leaders.   Beyond the dead, another 269 people have been injured and about 1,900 have been arrested, according to the National Institute for Human Rights.

- Pinera's proposals -
Having initially taken a confrontational line -- declaring that Chile was "at war" and imposing a state of emergency in Santiago and most of Chile's 16 regions --  Pinera has rapidly changed tack and sought cross-party support to find a solution.   He says he will increase the universal basic pension by 20 percent, cancel a recent 9.2 percent increase in electricity bills and propose a law that would see the state cover the costs of expensive medical treatment.   He also pledged a state subsidy to increase the minimum wage from 301,000 to 350,000 pesos ($482) a month and said the government would introduce health insurance for medications, which is among the most expensive in the region.

Chileans were unconvinced by the promises.   "It seems like a joke to me. Does he think with this the people will calm down?" protester Ximena Gutierrez told AFP.   "No, they won't calm down, this will continue because we won't be silenced!"   After widespread scenes of violence, destruction, arson and looting last week, protests have become more peaceful this week, particularly in Santiago.   But it's the worst violence to hit Chile since the country returned to democracy after the 1973-1990 right-wing dictatorship led by General Augusto Pinochet.   Some 20,000 police and troops have been deployed.   Strike organizers issued a statement demanding that the government end the state of emergency and send troops back to their barracks.   The country's powerful copper mine workers' unions joined the strike movement, but the state copper company insisted that operations continued nonetheless. 

Chile is the largest producer of copper in the world, much of which is sold to China.   Despite 2.5 percent growth, ordinary Chileans are deeply unhappy.    In a poll by Ipsos, two thirds of respondents said their economic, health and pensions situation was "unequal and unfair."    "Pinera has always been a liar and now... he is asking for forgiveness," said 23-year-old Carlos Morales.   Before Pinera's announcement, one of Chile's largest conglomerates, Quinenco, promised to increase its minimum salaries to 500,000 pesos a month from January 1 -- 60 percent more than the current minimum wage.   Chile's big business conglomerates are one of the major factors in the huge wealth disparity that has angered protesters.

- Back to normal -
Life in the capital has been returning to normal, with three of seven metro lines open on Wednesday.   More than half of Santiago's 136 metro stations suffered heavy damage during last week's protests and remained guarded by soldiers.   Shops and businesses -- even banks -- appeared to be reopening, but some Santiago-area schools were still closed.   LATAM, South America's largest airline, said more than 98 percent of its flights to and from Santiago's international airport took off following dozens of cancelations during days of chaos caused by the curfews.   Chile's Central Bank dropped interest rates from 2.0 percent to 1.75 percent and said the crisis would affect the country's economy.
Date: Mon, 21 Oct 2019 13:34:35 +0200 (METDST)

Santiago, Oct 21, 2019 (AFP) - Chile, reeling from its worst social unrest in decades, has since the 1990s been considered a Latin American hub of political stability and economic growth after 17 years of dictatorship.   Here is some background.

- From dictatorship to democracy -
In 1973 General Augusto Pinochet toppled Socialist President Salvador Allende in a military coup. Allende committed suicide in the presidential palace as troops closed in.   Pinochet imposed a right-wing dictatorship that lasted for 17 years, during which at least 3,200 people were killed or disappeared as a result of political repression. Around 38,000 were tortured.   In 1988 he lost a plebiscite on remaining in power and handed over to democratically elected Patricio Aylwin in 1990, remaining head of the armed forces until 1998.    Pinochet died in 2006 without standing trial for atrocities under his regime.   In 2006 Socialist Michelle Bachelet became Chile's first female president. Re-elected in 2013, she was barred constitutionally from standing again immediately and appointed UN right commissioner in 2018.   The 2017 elections were won by conservative billionaire Sebastian Pinera, who had already been president in 2010-2014.

- Model economy -
Pinochet applied neo-liberal free-market methods, privatising healthcare, education and pensions.   Chile turned to exports and in the 1980s became the preferred Latin American host for foreign investors.   With this economic model still largely in place, growth reached a strong 4% in 2018. The country of 18 million people also has the highest per capita income of Latin America at $20,000.   GDP, however, fell to 1.8% in the first half of 2019 -- due to a challenging external context, adverse climatic conditions and a delay in reforms -- and is expected at 2.5 percent for the year.   Despite slashing poverty from 30% in 2000 to 8.6% in 2019, the country has high social inequalities including in healthcare, education and pensions.   It is the world's biggest producer of copper, with lithium, timber, fisheries, gold, silver, avocados and oil also driving exports.

- Paedophile priests scandal -
The staunchly Roman Catholic country has been rocked by allegations of sexual abuse within the church going back decades.   In May 2018 Pope Francis summoned all 34 Chilean bishops to Rome over the crisis and all tendered their resignations, although only a handful have been accepted.   Since 2000 about 80 priests have been reported to authorities in Chile for alleged sexual abuse, including of children and adolescents.   Prosecutors said in August 2018 they were investigating 158 members of the church, both priests and lay people.   Ultra-conservative Chile allowed divorce only from 2004 and legalised abortion in certain cases in 2017.

- World's most seismic -
Bordered by the Pacific Ocean to the west and the Andes mountain range to the east, long and narrow Chile is the world's most seismic country.   In 1960 it was struck by the most powerful earthquake ever registered which measured 9.5 and struck at Valdivia. More than 5,700 people were killed.   In 2010 a 8.8-magnitude quake in the south and centre unleashed a tsunami that swept away entire villages, leaving around 520 people dead.

- Astronomy heaven -
Benefitting from a totally clear sky for most of the year, northern Chile is home to some of the world's most powerful telescopes.   The construction of the planet's biggest telescope was launched in May 2017 in the Atacama desert by ESO, the European Organisation for Astronomical Research in the Southern Hemisphere.
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Marshall Islands

Introduction
 
After almost four decades under US administration as the easternmost part of the UN Trust Territory of the Pacific Islands, the Mar
hall Islands attained independence in 1986 under a Compact of Free Association. Compensation claims continue as a result of US nuclear testing on some of the atolls between 1947 and 1962. The Marshall Islands hosts the US Army Kwajalein Atoll (USAKA) Reagan Missile Test Site, a key installation in the US missile defense network.
 
Geography
 
Located in the Oceania region its consists of two archipelagic island chains of 29 atolls, each made up of many small islets, and five single islands in the North Pacific Ocean, about half way between Hawaii and Australia
 
Climate
 
tropical; hot and humid; wet season May to November; islands border typhoon belt

Travel News Headlines WORLD NEWS

Date: Fri, 29 Nov 2019 03:01:21 +0100 (MET)

Majuro, Marshall Islands, Nov 29, 2019 (AFP) - More than 200 people have been forced to flee their homes, after they were inundated by freak waves in the Marshall Islands capital Majuro.   Swells averaging five metres (16 feet) washed rocks and debris onto roads, temporarily cutting access to the international airport at the peak of the flooding on Wednesday.   The Red Cross set up evacuation centres at two schools, with local churches and Majuro's mosque also offering help to fleeing residents.

The Marshall Islands are one of the Pacific nations on the front line of climate change, causing increasingly intense weather phenomena and storm surges linked to rising seas.   Climate researcher Murray Ford said such factors may have played a role in this week's flooding but were not the main cause.   "The key driver of this current inundation appears to be a large swell which has arrived from a more northerly direction than the typical trade wind swell," he said.   "This particular event would be best described as a large swell, meeting a high, but not unusually high tide."   Disaster response officials were expected to complete a damage assessment on Friday.
8 Aug 2019

The Republic of the Marshall Islands declares dengue emergency, restricts travel. 1st case of DEN-3 confirmed on Ebeye Island; 21 cases probable.

HealthMap/ProMED-mail map of Marshall Islands:
Date: Mon, 28 May 2018 01:20:00 +0200

Majuro, Marshall Islands, May 27, 2018 (AFP) - Haze from the Kilauea volcano eruption in Hawaii blanketed the Marshall Islands 3,700 kilometres (2,300 miles) away on Sunday, as officials warned it would continue moving west.   The haze, a phenomenon known as "vog" or volcanic smog, "is spreading across Micronesia," the US National Weather Service based in Guam said.

The volcano on Hawaii's Big Island is now in its fourth week of eruptions.   Meteorologists advised residents on the Marshall Islands with respiratory problems to stay indoors while airlines and shipping companies were warned to be aware of "lower visibilities".

The Guam weather office said haze produced by Kilauea would spread farther westward and reach Kosrae, Pohnpei and possibly Chuuk in the Federated States of Micronesia over the next few days.   Kilauea is the world's most active volcano and one of five on Hawaii's Big Island.   It started erupting on May 3, prompting about 2,000 people to flee from their mountainside homes.   Scientists believe the volcanic activity may be a precursor to a major eruption similar to the one that shook the island in the mid-1920s.
Date: Fri 4 May 2018
Source: CDC. MMWR Morb Mortal Wkly Rep 2018; 67(17):504-5 [edited]

ref: Hofmeister MG, McCready JA, Link-Gelles R, et al. Notes from the field: Increase in hepatitis A virus infections -- Marshall Islands, 2016-2017. MMWR Morb Mortal Wkly Rep 2018; 67:504-5. doi: 10.15585/mmwr.mm6717a5
------------------------------------------------------------------------
In mid-September 2016, a case of hepatitis A virus (HAV) infection was reported to the Marshall Islands Ministry of Health and Human Services (MOHHS). On 4 Nov 2016, MOHHS received laboratory confirmation of 4 additional cases, prompting activation of an outbreak investigation by the MOHHS Exposure Prevention Information Network (EPINet) team and solicitation of technical assistance from the Pacific Island Health Officers' Association, the WHO, and CDC. CDC began participating in the investigation by providing technical assistance remotely at that time. CDC provided remote assistance throughout the course of the investigation. In April 2017, the CDC-affiliated coauthors traveled to the Marshall Islands to provide in-person technical assistance.

To characterize the outbreak, the MOHHS EPINet Team, with assistance from CDC, conducted an investigation through in-person interviews and medical chart abstractions. A probable HAV outbreak case was defined as an acute illness with onset of any signs or symptoms consistent with acute viral hepatitis (such as fever, anorexia, nausea, vomiting, diarrhoea, fatigue, dark urine, clay-colored stool, or abdominal pain) on or after 1 Sep 2016, and either jaundice or elevated serum aminotransferase levels; a confirmed case met the probable case definition and also had either a positive immunoglobulin M (IgM) antibody to HAV on laboratory testing or an epidemiologic link to a confirmed case.

>From September 2016 (epidemiologic week 37) through July 2017 (epidemiologic week 28), 194 outbreak-associated hepatitis A cases (168 confirmed and 26 probable) were reported by MOHHS (Figure [available at the source URL above. - ProMED Mod.LL]). Illness onset dates ranged from 12 Sep 2016 through 11 Jul 2017. The median age of infected persons was 8 years (range equal to 2-76 years), 57 percent of patients were male, 91 percent were Marshallese, and 11 percent were hospitalized. No deaths were reported. Persons younger than 25 years accounted for 90 percent of cases, and 92 percent of patients were residents of the capital, Majuro. The most commonly reported signs and symptoms were jaundice (92 percent), nausea (76 percent), anorexia (75 percent), and dark urine (68 percent). Clay-colored stool (10 percent) was less commonly reported.

Complete contact information was available for 102 (53 percent) patients. A total of 1143 contacts were identified, with a mean of 11 contacts identified per patient (range equal to 2-60). Among the identified contacts, 902 (79 percent) received post-exposure prophylaxis (PEP) with hepatitis A vaccine. Some contacts were identified outside the recommended PEP window of 14 days after exposure, and 14 contacts were infants who were too young to be vaccinated (1). 7 contacts refused vaccination.

The EPINet team disseminated public information about the outbreak and recommendations on hygiene and vaccination through radio shows, mass text messages, posters, and school presentations; developed standardized case reporting and interview tools; and expanded case finding through investigation of contacts. Hepatitis A vaccine is not currently included in the Marshall Islands routine childhood immunization schedule. Marshall Islands began immunization of contacts of patients with hepatitis A in January 2017 and then launched a comprehensive immunization campaign targeting school-aged children on Majuro in February 2017, which ultimately covered approximately 70 percent of the total kindergarten through 8th grade student population. Once the vaccine supply was replenished in April 2017, a 2nd immunization campaign was directed at high school students aged 14-19 years on Majuro. In total, approximately 12,500 doses of hepatitis A vaccine were administered to school-aged children and adult contacts of patients in response to the outbreak. No additional cases were reported as of 30 Aug 2017.

Before this outbreak, the last HAV outbreak in the Marshall Islands occurred approximately 25 years ago. Since then, approximately 5 hepatitis A cases per year have been reported (MOHHS, unpublished data, 2017). HAV infection is typically acquired through faecal-oral transmission, either from direct person-to-person contact or consumption of contaminated food or water. In this outbreak, transmission occurred primarily through direct person-to-person contact, and despite extensive measures, the initial source of HAV infection was not identified.

HAV infection occurs in 3 distinct epidemiologic patterns (high, intermediate, and low endemicity) associated with hygiene and sanitation, access to clean drinking water, household crowding, and socioeconomic conditions (2). As socioeconomic conditions and sanitation improve, areas transition from high to intermediate endemicity, which is associated with an increased incidence of symptomatic clinical disease and potential for outbreaks. Hepatitis A-related hospitalizations and mortality also increase as the age of infection shifts from early childhood, when disease is typically asymptomatic or mild, to adolescence and adulthood, when illness is more likely to be severe (2).

Before this outbreak, HAV was thought to be endemic in the Marshall Islands; however, this outbreak demonstrates that the country might be undergoing an epidemiologic transition toward intermediate endemicity (3). Health officials are evaluating the potential costs and benefits of incorporating routine hepatitis A vaccination in Marshall Islands as a means of reducing ongoing transmission and preventing outbreaks.

References
-----------------
1. Advisory Committee on Immunization Practices, CDC: Update: prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR Morb Mortal Wkly Rep 2007; 56(41): 1080-84; available at
2. Wasley A, Fiore A, Bell BP: Hepatitis A in the era of vaccination. Epidemiol Rev 2006; 28: 101-11; available at
3. Jacobsen KH: The global prevalence of hepatitis A virus infection and susceptibility: a systematic review. Geneva, Switzerland: World Health Organization; 2009; available at
===================
[This posting underscores the importance of the kind of epidemiologic pattern of HAV in an area and certainly suggests that this island nation has improved hygiene and sanitation to transition to intermediate endemicity where routine childhood HAV vaccination bears consideration. The current outbreaks in a variety of areas in the USA (including parts of Michigan, Utah, and Kentucky) affecting certain cohorts of adults (who were old enough not to be immunized as children) underscore immunization.

The Marshall Islands (<https://en.wikipedia.org/wiki/Marshall_Islands>), officially the Republic of the Marshall Islands, is an island country located near the equator in the Pacific Ocean, slightly west of the International Date Line. Geographically, the country is part of the larger island group of Micronesia. The country is spread out over 29 coral atolls, comprising 1156 individual islands and islets. Politically, the Marshall Islands is a presidential republic in free association with the United States, with the USA providing defense, subsidies, and access to USA-based agencies such as the Federal Communications Commission and the United States Postal Service. - ProMED Mod.LL]

[HealthMap/ProMED-mail map
Date: Sat, 3 Feb 2018 05:50:34 +0100

Majuro, Marshall Islands, Feb 3, 2018 (AFP) - Emergency services were put on standby Saturday in Majuro, as rising king tides threatened to flood the capital of the low-lying Marshall Islands.

The national weather service warned "major inundation" was possible from Saturday evening through to Tuesday at peak tide periods in the Pacific island nation, highlighting its vulnerability to rising sea levels.   "We're on stand-by through Tuesday," Public Works Minister Tony Muller said Saturday as the 30,000 population of Majuro Atoll braced for the expected floods.    Heavy equipment, including bulldozers, was being positioned at critical locations around Majuro so emergency crews can respond quickly in the event of flooding, he said.

Majuro is barely a metre above sea level and the single road along the 30-mile (50-kilometre) length of the coral atoll is often blocked during serious flooding by coral, rocks, sand and garbage tossed up by waves.   The National Disaster Management Office has been placed on high alert and used its mass text messaging system for the first time Friday to issue a high tide advisory.

The US National Weather Service in nearby Guam issued an advisory Saturday morning warning "major inundation of one to two feet is possible, especially during high tides inside the lagoon".   King tides, which are extremely high tides, are a natural phenomenon early in the year in the Marshall Islands caused by the strong gravitational pull from a new or full moon when the moon is at its closest to the earth.
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Norfolk Island

General:
**********************************
Cuba is an independent island country situated in the Caribbean. It is the largest of the islands and covers 42,000sq miles. The climate is sub tropical throughout the year with most of the rainfall in
the northern parts of the country. Temperatures of between 20C to 35C are fairly standard throughout the year. Generally the winter effects of the American continent only last for short periods.
Safety & Security:
**********************************
The majority of tourists visiting Cuba will have no difficulty but bag snatching and other street crime appears to be increasing. The old Havana area and other major tourist resorts may be particular areas of concern in this regard. On arrival be careful to only use your recognised tour operator. If you are taking a taxi at any stage make sure it is a registered one and not a private vehicle. It is unwise to carry large quantities of money or jewellery away from your hotel and try not to flaunt wealth with your belongings. Pickpockets are too common an occurrence on buses and trains and at train stations so be careful with your essential documents and credit cards. Valuables should not be stored in suitcases when arriving in or departing from Havana as there have been a number of thefts from cases during the time the cases are coming through baggage handling. There is an airport shrink-wrap facility for those departing Havana which reduces the risk of tampering. Remember to carry a photocopy of your main documents (passport, flight tickets etc).
Road Safety:
**********************************
Following a number of serious road accidents involving tourists, you are advised not to use mopeds for travelling around Cuba or in Havana. Also, if you are involved in any accident a police investigation will be required to clear you and this may significantly delay your travel plans. On unlit roads at night there have been a number of accidents associated with roaming cattle (sounds like Ireland!). The traffic moves on the right side of the roads. There is a main highway running the length of the country but many of the country roads are in poor repair.
Local Laws & Customs:
**********************************
When arriving into Cuba make sure you are not carrying any items which could be considered offensive. Any illicit drug offense is treated very seriously and Cuban law allows for the death penalty to be used under these circumstances. If you require personal medication for your health, make sure it is in original packing and carry a letter from your doctor describing the medication. Never agree to carry any item for another individual and always secure your cases once they are packed. Taking photographs of military or police installations or around harbours, rail and airport facilities is strictly forbidden.

Currency:
**********************************
Since 1993 it is now possible to use US dollars for all transactions within Cuba. Remember, there is a 20$ airport departure tax. Certain travellers cheques and credit cards may not be acceptable within Cuba. This is particularly true of American Express cheques and cards but check your situation with the travel operator before departure.
Health Facilities:
**********************************
Generally healthcare facilities outside of Havana are limited and many standard medications may not be available. It is important to carry sufficient quantities of any medications which may be required for the duration of your time in Cuba.
Food & Water:
**********************************
The level of food and water hygiene varies throughout the country and between resorts. On arrival check the hotel cold water supply for the smell of chlorine. If it is not present then use sealed bottled water for both drinking and brushing your teeth throughout your stay. Cans and bottles of drinks are safe but take care to avoid pre-cut fruit. Peel it yourself to make sure it is not contaminated. Food from street vendors should be avoided in most cases. Bivalve shellfish are also a high risk food in many countries and Cuba is no exception in this regard. (Eg Mussels, Oysters, Clams etc)
Malaria & Mosquito Borne Diseases:
***********************************************
Malaria transmission does not occur within Cuba and so prophylaxis is not required. However, a different mosquito borne disease called Dengue has begun to reoccur in the country over the past few years. This viral disease can be very sickening and even progress to death. It is rare for tourists to become infected but avoiding mosquito bites is a wise precaution.
Swimming, Sun & Dehydration:
************************************
The extent of the Cuban sun (particular during the summer months (April to October) can be very excessive so make sure your head and shoulders are covered at all times when exposed. Watch children carefully as they will be a significant risk. Drink plenty of fluids to replace what will be lost through perspiration and, unless there is a reason not to,
take extra salt either on your food or in crisps, peanuts etc. Take care if swimming in the Caribbean to stay with others and to listen to local advice. Never swim after a heavy meal or alcohol.
Rabies Risk in Cuba:
**********************************
This viral disease does occur throughout Cuba and it is essential that you avoid any contact with all warm blooded animals. Dogs, cats and monkeys are the most commonly involved in spreading the disease to humans. Don't pick up a monkey for a photograph! If bitten, wash out the wound, apply an antiseptic and seek urgent medical attention.
Vaccinations for Cuba:
**********************************
There are no essential vaccines for entry / exit if coming from Ireland. However, for your own personal protection travellers are advised to have cover against the following;
*
Tetanus (childhood booster)
*
Typhoid (food & water borne disease)
*
Hepatitis A (food & water borne disease)
For those planning a longer or more rural trip vaccine cover against conditions like Hepatitis B and Rabies may also need to be considered.
Summary:
**********************************
Cuba is becoming a popular destination for tourists and generally most will stay very healthy. However commonsense care against food and water borne disease is essential at all times. Also take care with regard to sun exposure, dehydration and mosquito bites.

Travel News Headlines WORLD NEWS

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Bulgaria

Bulgaria US Consular Information Sheet
September 20, 2007
COUNTRY DESCRIPTION: Bulgaria is a quickly developing European nation undergoing significant economic changes.
Tourist facilities are widely available, although conditions vary and
ome facilities may not be up to Western standards.
Goods and services taken for granted in other European countries may not be available in many areas of Bulgaria.
Read the Department of State Background Notes on Bulgaria for additional information.
ENTRY/EXIT REQUIREMENTS:
A United States passport is required for U.S. citizens who are not also Bulgarian nationals.
As of September 1, 2006, U.S. citizens who enter the country without a Bulgarian visa are authorized to stay for a total of 90 days within a six-month period.
This law is strictly enforced.
An application to extend one’s stay beyond the original 90 days can be filed for urgent or humanitarian reasons, but must be submitted to regional police authorities no later than five days prior to the end of the original 90-day period.
Travelers who have been in the country for 90 days, and then leave, will not be able to reenter Bulgaria before the six-month period expires.
Travelers using official or diplomatic passports must secure visas prior to arrival.
Upon entering the country, Bulgarian immigration authorities request that all foreigners declare the purpose of their visit and provide their intended address.
U.S. citizens intending to live or work in Bulgaria for more than 90 days within six months (or more than six months within a year) must obtain a “D” visa prior to arrival.
The practice of switching from tourist status to long-term status when already in Bulgaria is no longer allowed.
Those wanting to do so must leave Bulgaria and apply for a “D” visa at a Bulgarian embassy or consulate.
This procedure takes from two to four weeks.
American citizens who marry Bulgarian nationals and want to switch to long-term status must also leave the country, present their marriage license at a Bulgarian embassy or consulate in a neighboring country, and apply for a “D” visa.

The Bulgarian authorities do not consider presentation of a copy of the passport sufficient for identification purposes.
Visitors should carry their original passports with them at all times.
For further information concerning entry requirements, travelers should contact the Embassy of the Republic of Bulgaria at 1621 22nd St. N.W., Washington, D.C. 20008; http://www.bulgaria-embassy.org; tel. (202) 387-7969 (main switchboard (202) 387-0174), or the Bulgarian Consulate in New York City at 121 East 62nd Street, New York, NY 10021; http://www.consulbulgaria-ny.org; tel. (212) 935-4646.
See our Foreign Entry Requirements brochure for more information on Bulgaria and other countries.
Visit the Embassy of Bulgaria web site at http://www.bulgaria-embassy.org for the most current visa information.
Traveling with Bulgarian minors: Bulgarian authorities are particularly strict in matters involving the travel of Bulgarian children.
Adults, other than a child’s parents, departing Bulgaria with a Bulgarian national (including dual or multi-national Bulgarian) child, must present to authorities a certified/legalized declaration signed by the child’s parents authorizing custody for travel purposes.
This holds true even if the adult is otherwise related to the child.
If the declaration is signed in Bulgaria, certification by a Bulgarian notary public is required.
If signed in the U.S., the declaration must be certified by a notary public and the court in the jurisdiction where the notary is licensed.
The declaration must then be legalized with an apostille issued by the individual state's Department of State or the Governor’s office.
Please note Bulgarian authorities do not require such documentation for minors who are not Bulgarian.
Find more information about dual nationality and the prevention of international child abduction on our web site. For further information about customs regulations, please read our Customs Information.

SAFETY AND SECURITY:
Bulgaria’s accession to the European Union has enhanced the overall security environment for tourist and business travelers.
However, the country still suffers from many of the ills of a former Eastern Bloc country in transition.
Organized crime groups and criminals who specialize in petty crimes and credit card fraud are highly prevalent in Bulgaria’s largely cash economy.
Petty criminals such as pick-pockets and purse snatchers operate in crowded public areas and on public transportation.
Also, technology exists in Bulgaria to clone credit cards and trap ATM cards for later retrieval.
Suspected organized crime members often travel in convoys of late-model SUVs and luxury sedans, accompanied by armed men, and frequent expensive restaurants, hotels, and nightclubs.
For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site at http://travel.state.gov, where the current Worldwide Caution Public Announcement, Travel Warnings and Public Announcements can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. 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:
Petty street crime, much of which is directed against persons who appear to have money or to be foreign, continues to be a problem.
Pocket picking and purse snatching are frequent occurrences, especially in crowded markets and on shopping streets.
Con artists operate on public transportation and in bus and train stations.
Credit cards and ATMs should be used with caution.
Be wary of people who approach you at an ATM and offer assistance.
Do not give your PIN number to anyone under any circumstances. (See the Special Circumstances section below.) Travelers should be suspicious of "instant friends" and should also require persons claiming to be government officials to show identification.
There have been incidents in which tourists have been drugged or assaulted and robbed after accepting offers of coffee or alcoholic beverages from "friendly” individuals met by “chance” at hotels, the airport, or at bus or train stations.
Travelers should be wary of unfamiliar individuals who encourage them to drink or eat products, as these may be tainted with strong tranquilizers (such as valium) that can lead rapidly to unconsciousness.
Reporting a crime immediately to the police has helped recover money and valuables on more than one occasion and is recommended.
To avoid becoming a victim of more serious crimes, one should use the same personal safety precautions that they would use in large urban areas of the United States.

Travelers should pay special attention to the drink prices at high-end bars and nightclubs.
There have been instances of travelers being charged exorbitant prices, especially for champagne and hard alcohol.
Bills have been as high as several thousand dollars for drinks, and in some establishments the management may use force to assure payment.

On occasion, taxi drivers overcharge unwary travelers, particularly at Sofia Airport and the Central Train Station.
We recommend travelers use taxis with meters and clearly marked rates displayed on a sticker on the passenger side of the windshield.
Travelers should be aware that there is no official commission that sets taxi cab rates.
Taxi drivers are within their full rights to charge passengers any price they want, provided that it corresponds with the price shown on the windshield sticker.
At the airport, there is a clearly marked booth within the arrivals terminal, which arranges for metered taxis at a fair rate.
Finding reputable taxis at the Central Train Station is more difficult.
It is recommended to inquire about the fare first, to avoid excessive payment if a metered taxi cannot be found.
Always ensure that you have and account for all luggage, packages and hand-carried items before you pay and release a taxi.
The likelihood of retrieving articles left behind in a taxi is remote.
Because pilferage of checked baggage may occur at Sofia Airport, travelers should not include items of value in checked luggage.
Automobile theft is a concern, with four-wheel-drive vehicles and late model European sedans the most popular targets.
Very few vehicles are recovered.
Thieves smash vehicle windows to steal valuables left in sight.
Break-ins at residential apartments occur as frequently as in major cities everywhere.
Persons who plan to reside in Bulgaria on a long-term basis should take measures to protect their dwellings.
Long-term residents should consider installation of window grilles, steel doors with well-functioning locks, and an alarm system that alerts an armed response team.

Travelers should also be cautious about making credit card charges over the Internet to unfamiliar websites.
As recent experience has shown, offers for merchandise and services may be scam artists posing as legitimate businesses.
A recent example involves Internet credit card payments to alleged tour operators via Bulgaria-based web sites.
In several cases, the corresponding businesses did not actually exist.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
While Bulgarian physicians are trained to a very high standard, most hospitals and clinics, especially in village areas, are generally not equipped and maintained to meet U.S. or Western European standards.
Basic medical supplies and over-the-counter and prescription medications are widely available, but highly specialized treatment may not be obtainable.
Pediatric facilities are in need of funding and lack equipment.
Serious medical problems requiring hospitalization and/or medical evacuation to the United States may cost thousands of dollars.
Doctors and 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 Internet site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.
All foreign citizens traveling to Bulgaria should be prepared to present valid evidence of health insurance to the Bulgarian border authorities in order to be admitted into the country.
The insurance should be valid for the duration of the traveler’s stay in Bulgaria.
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 Bulgaria is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
The Bulgarian road system is largely underdeveloped.
There are few sections of limited-access divided highway.
Some roads are in poor repair and full of potholes.
Rockslides and landslides may be encountered on roads in mountainous areas.
Livestock and animal-drawn carts present road hazards throughout the country, especially during the agricultural season.
Travel conditions deteriorate during the winter as roads become icy and potholes proliferate.
The U.S. Embassy in Sofia advises against driving at night because road conditions are more dangerous in the dark.
Some roads lack pavement markings and lights, and motorists often drive with dim or missing headlights.
Driving in Bulgaria is extremely dangerous.
Aggressive driving habits, the lack of safe infrastructure, and a mixture of late model and old model cars on the country’s highways contribute to a high fatality rate for road accidents.
Heavy traffic conditions have led to a significant increase in “road-rage” accidents.
Motorists should avoid confrontations with aggressive drivers in Bulgaria.
In particular, drivers of late-model sedans (BMW, Mercedes, Audi) are known to speed and drive dangerously.
Motorists should exercise caution and avoid altercations with the drivers of such vehicles, which may be driven by armed organized crime figures.
In some cities traffic lights late at night blink yellow in all directions, leaving rights-of-way unclear and contributing to frequent accidents.
Heavy truck traffic along the two-lane routes from the Greek border at Kulata to Sofia and from the Turkish border at Kapitan Andre to Plovdiv creates numerous hazards.
Motorists should expect long delays at border crossings.
A U.S. state driver's license is valid in Bulgaria only when used in conjunction with an International Driving Permit.
For information on how to obtain a permit, please see our road safety information.
If pulled over by a police officer, motorists should remember that, under Bulgarian law, police officers may not collect fines on the spot; they may only issue a ticket with the fine to be paid at the motorist’s local regional tax office.
Buses, trams, and trolleys are inexpensive, but they are often crowded and of widely varying quality.
Passengers on the busiest lines have reported pick pocketing, purse slashing, and pinching. The use of seat belts is mandatory in Bulgaria for all passengers, except pregnant women.
Children under 10 years of age may ride in the front seat only if seated in a child car seat.
In practice, these rules are often not followed.
Speed limits are 50 km/h in the cities/towns, 90 km/h out of town, and 130 km/h on the highways.
For motorcycles, speed limits are 50 km/h in the cities/towns, 80 km/h out of town, and 100 km/h on the highways.
Motorcyclists must drive with helmets and with lights on at all times.
At crossings that are not regulated, the driver who is on the right has the right-of-way, but this rule, too, is frequently ignored.
Drivers may be charged with driving under the influence of alcohol with a blood level as low as 0.05 percent.
Right turns on red lights are not permitted unless specifically authorized.
The penalties for drivers involved in an accident resulting in injury or death range from a 25 U.S. Dollar fine up to imprisonment for life.
A new law requires the use of headlights day and night from November 1st through March 31st.
The most generally encountered local traffic custom is a driver flashing high beams, which usually means that a traffic police post is ahead.
In case of emergency, drivers should contact the police at telephone number 166 and/or Roadside Assistance at telephone number 146.
For an ambulance, please call 150.
The fire department can be reached at 160.
For specific information concerning Bulgarian driving permits, vehicle inspection, road tax, and mandatory insurance, please contact the Bulgarian Embassy via the Internet at http://www.bulgaria-embassy.org.
Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office at http://www.bulgariatravel.org/eng/index.php and the web site of the Bulgarian national authority responsible for road safety at http://www.kat.mvr.bg.
[Note: the latter web site is available in the Bulgarian language only.]
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Bulgaria’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Bulgaria’s air carrier operations.
For more information, travelers may visit the FAA’s Internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Bulgaria is still largely a cash economy.
Due to the potential for fraud and other criminal activity, credit cards should be used sparingly and with extreme caution.
There have been reports of false ATM fronts on bona fide machines that capture cards and PINs for later criminal use, including unauthorized charges or withdrawals.
In connection with such scams, travelers should be extremely wary of friendly bystanders near ATMs who offer assistance.
Any time a card is not returned the traveler should immediately report the card as lost/stolen to the card-issuing company.

Visitors may exchange cash at banks or Exchange Bureaus, but they should know that Exchange Bureaus sometimes post misleading rate quotations that confuse travelers.
People on the street who offer high rates of exchange are usually con artists intent on swindling the unwary traveler.
Damaged or very worn U.S dollar bank notes are often not accepted at banks or Exchange Bureaus.
Major branches of the following Bulgarian banks will cash travelers' cheques on the spot for Leva, the Bulgarian currency, or another desired currency:
Bulbank, Bulgarian Postbank, Biochim, First Investment Bank, and United Bulgarian Bank (UBB).
UBB also serves as a Western Union agent and provides direct transfer of money to travelers in need.
There are also many Western Union branches in major towns and cities.
Most shops, hotels, and restaurants, with the exception of the major hotels, do not accept travelers' cheques or credit cards.
Only some local banks can cash U.S. Treasury checks and the payee may need to wait up to a month to receive funds.
Corruption remains an important concern of the Government.
The Commission for Coordinating of the Activity for Combating Corruption manages the efforts of each government agency’s internal inspectorate in fighting public corruption and engages in public awareness campaigns.
Complaints of public corruption can be made to it at the Ministry of Justice, 2A Knyaz Dondukov Blvd., 1055 Sofia, Bulgaria, email: acc@government.bg, 359-2-980-9213, 359-2-923-7595, 359-2-940-3630 or to the Ministry of Finance hotline: 0800180018.
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 Bulgaria’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Bulgaria are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Bulgaria are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, and to obtain updated information on travel and security within Bulgaria.
Americans without Internet access may use a public computer at the U.S. Embassy to register.
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 16, Kozyak St., Sofia1407; tel.: (+359 2) 937-5100; fax (+359 2) 937-5209; web site: http://sofia.usembassy.gov/.
Questions regarding consular services may be directed via email to: niv_sofia@state.gov (for non-immigrant visa matters); iv_sofia@state.gov (for immigrant visa matters) and acs_sofia@state.gov (for American Citizen Services matters).
*

*

*
This replaces the Consular Information Sheet dated March 28, 2007, to update the sections on Entry and Exit
Requirements, Safety and Security, Crime, Traffic Safety and Road Conditions, Children’s Issues, and Registration/Embassy.

Travel News Headlines WORLD NEWS

Date: Fri 23 Aug 2019
Source: Ekathimerini [edited]

Two cases of the West Nile Virus [WNV] have been confirmed in Bulgaria, with one of the patients said to have lived in Cyprus during a part of the summer.

The Ministry of Foreign Affairs in Bulgaria has not issued an update as of [Thu 22 Aug 2019] morning, but according to Philenews, the health ministry in Bulgaria had issued a statement regarding a 48-year-old Bulgarian man who was diagnosed with WNV [infection]. The man, said to be from Pazardzhik in southern Bulgaria, is a construction worker who had been living for the last 2 months in Cyprus.

Upon his return to his country, according to Bulgarian officials, the worker started running a fever and generally feeling unwell. He was then immediately admitted to hospital with a known WNV infection.

Other towns were also on alert in Bulgaria, with an official statement saying clinics for infectious diseases in Belgrade and Nis have reported infected people. Most cases were associated with summer flu symptoms while the nervous system was affected in a number of other cases.

Based on additional media reports, there were other places besides Cyprus on the radar of Bulgarian officials regarding possible WNV infections.

According to State Medical Services of the Republic of Cyprus, 9 WNV cases have been confirmed in the south this year up until [16 Aug 2019]. All cases involved the neuroinvasive disease of the virus, with 2 patients remaining critical and 4 others being discharged from hospital.

Earlier this week, one confirmed WNV death was recorded in greater Nicosia with officials saying the patient was very senior.
Date: Mon 5 Aug 2019, 11:33 AM
Source: Novinite.com [edited]

Mosquitoes carry viral meningitis in Bulgaria. There are nearly 1/3 more cases of meningitis since the beginning of the year [2019] than the previous year [2018]. The state has allocated another BGN 2 million [USD 1 783 680] to deal with mosquitoes.

The disease is not typical for Bulgaria's latitudes, but has started to manifest itself with climate change, said Prof. Dr. Tatyana Chervenyakova of the Infectious Diseases Hospital in Bulgaria. The infection is transmitted through mosquitoes, and if there are complications, hospitalisation may be needed. However, the complications are only about 1% of the cases, said Prof. Chervenyakova.

Most of the cases pass the disease slightly - with fever and general malaise. It usually goes away after 2-3 days.

"It is very difficult to control the mosquitoes in these rainfalls. After every rainfall it must be sprayed. We shouldn't think that all mosquitoes are infected with the virus. The individual protection is the availability of repellents, the other is within the reach of the state " Dr. Tatiana Chervenyakova, said in an interview for Bulgaria ON ON AIR.
=======================
[This report deals with mosquito-borne virus infections, but does not indicate which one, nor is the number of cases to date given. There are 2 possible arboviruses involved as the etiological agents of these cases: West Nile virus or Usutu virus. Both have been found in Central Europe. As noted in a previous ProMED-mail post, "West Nile virus (WNV) and Usutu virus (USUV) are phylogenetically closely related mosquito-borne members of the family _Flaviviridae_, and belong to the Japanese encephalitis antigenic complex of the _Flavivirus genus_ (1,2). Both viruses have been isolated from numerous ornithophilic mosquito species, mainly _Culex_ spp. (1,2). In the enzootic cycle of WNV and USUV, avian species are also involved and serve as amplifying hosts. Mosquitoes facilitate virus transmission to humans and equids which then remain incidental hosts as they are not able to produce a level of viraemia sufficient for further virus transmission by mosquito bites (2)." (see  <https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2019.24.28.1900038>  for complete reference list, including those cited here).

ProMED-mail would appreciate a response indicating which virus or viruses are involved in these cases in Bulgaria. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: 30 Aug 2018
Source: Euro Surveillance [summarized, edited]

In June 2018, Crimean-Congo haemorrhagic fever (CCHF) was diagnosed in a Greek construction worker who returned home after becoming ill with fever and haemorrhagic symptoms in south-western Bulgaria. Here, we describe the case along with the epidemiological investigation and phylogenetic analysis.

On 30 May 2018, a Greek male in his late 40s returned to Greece after spending 23 days in a forested area in Blagoevgrad province, south-western Bulgaria, where he was working in bridge construction. Three days earlier (27 May 2018, day 1), while in Bulgaria, he developed fever, severe headache, myalgia (mainly in the lower extremities), malaise and loss of appetite; on 28 May 2018 he visited a local hospital and received symptomatic treatment as an outpatient. As his condition deteriorated (onset of photophobia and abdominal pain) he returned to his permanent residence in northern Greece. On 31 May 2018 (day 5), the patient was admitted to a local hospital.

He was transferred to the university hospital in Alexandroupolis the next day because he presented severe thrombocytopenia and leukopenia; elevated levels of liver enzymes, creatine phosphokinase (CPK) and lactate dehydrogenase (LDH); and prolonged activated partial thromboplastin time (aPTT) (Table). On day 6, his headache was resolved, but his fever (38.2 C [101 F]), malaise and myalgia were ongoing. The main laboratory findings were thrombocytopenia, prolonged aPTT (82 s) and increased level of aminotransferases. His laboratory parameters indicated rhabdomyolysis (CPK 1739 U/L) and slightly elevated urea and creatinine levels (Table). A bone marrow biopsy showed haemophagocytosis. ...

Based on the patient's clinical presentation, and as he was bitten by a tick in an area of Bulgaria where CCHF cases have been reported previously, CCHF was highly suspected. Typically, the incubation period of CCHF after a tick bite is short (1-3 days), but the exact date of the bite was unknown in this case. The treating physician contacted the National Reference Centre for Arboviruses and Haemorrhagic Fever Viruses in Thessaloniki, and the suspected case was immediately notified to the Hellenic Center for Disease Control and Prevention (HCDCP). ...

The HCDCP investigated the case immediately after the diagnosis of CCHF (through telephone interviews with a close family member and with the patient, after recovery, to confirm the dates) and his contacts while he was ill (household members, co-workers, roommates in Bulgaria and relatives who visited him in the hospitals). Close contacts were tested for CCHF and monitored for 14 days for any symptom development. The risk for further transmission was also assessed. The HCDCP promptly informed the Bulgarian health authorities about the case; they also informed the patient's Greek co-workers in Bulgaria about prevention and proper management of tick bites (informative material in Greek was sent to them) advising them to seek medical care in case they develop symptoms.

No other cases were reported among the patient's co-workers in Bulgaria, up to the end of July 2018. The regional and local public health authorities were also informed about the case, and they performed further contact investigation in Greece. No secondary cases were detected. The HCDCP raised awareness for CCHF among health professionals working in local health centres and hospitals in northern Greece, especially in areas with populations travelling to Bulgaria for occupational reasons.

The patient and his laboratory samples, apparel, waste and cleaning procedures were managed in accordance with the national guidelines for viral haemorrhagic fevers (available in Greek from HCDCP website: <http://www.keelpno.gr/>). In particular, upon the suspicion of CCHF (day 8), the patient was immediately isolated, and strict barrier precautions were utilised (waterproof gowns, gloves, FFP3 respiratory masks, goggles), and personal protective equipment was used by healthcare workers (HCWs) and visitors; however, visitors were discouraged from entering the isolation room. The HCDCP sent guidelines for contact tracing and active surveillance of symptoms in HCWs possibly exposed to CCHFV. Patients who were hospitalised in the same room with the patient before the suspicion of CCHF (2 patients in the 1st hospital (days 5-6), and 3 patients in the 2nd hospital (days 6-8)), were also monitored for symptoms for 14 days after their last contact with the patient. No secondary cases were observed. ...

Discussion
---------
CCHF was 1st recognised in Bulgaria in 1952; since then, several cases have been reported. Genetic characterisation of the Bulgarian strains showed that they cluster into the clade Europe 1. Our patient was infected in an area that was considered at low risk for CCHF outbreaks up to 2008, when a cluster of cases was observed in the region. Although the seroprevalence in the human population in Blagoevgrad province is low (1 percent), a seroprevalence of 41.9 percent in livestock was reported recently. Since CCHFV is transmitted mainly by bites of infected Ixodid ticks, persons living in rural areas are at increased risk for acquiring the infection. This was the reason that information about preventive measures was sent to our patient's Greek co-workers in Bulgaria, and all related public health authorities were informed about the case.

Regarding Greece, no other imported cases have been reported so far, and the only autochthonous CCHF case was observed in 2008. A review of travel-associated CCHF cases published during 1960-2016 reported 21 cases; 2 imported cases have been reported within Europe: Bulgaria to Germany in 2001 and Bulgaria to the United Kingdom in 2014.

Due to the high pathogenicity of CCHFV, the absence of a specific drug treatment or vaccine, and the risk of person-to-person transmission, rapid diagnosis is crucial to ensure that appropriate infection control measures (e.g. isolation of patient and barrier precautions) can be implemented in a timely manner. A detailed medical history of the patient, including travel history and possible risk factors, is important for the timely diagnosis of the disease. In our case, information regarding the tick bite was not provided immediately, and this, in combination with the non-specific initial symptoms, meant that CCHF was 1st suspected on day 8 of illness. Despite this delay, the patient fully recovered, and no secondary cases of CCHF have been reported. Since the northern part of Greece is close to CCHF-endemic countries, HCWs in this region should be made aware of CCHF, including the provision of training to better help them address questions from patients about travel history (to identify potential risk of exposure). Physicians should include CCHF in the differential diagnosis for patients with haemorrhagic syndromes, especially if patients report a tick bite, outdoor activities, or occupation in rural areas and recent travel to an endemic area.
=======================
[The above report provides an excellent example of CCHF transmission in a case with no history of conventional professional contact with infected cattle, such as cattle rearing or butchering. History of travel to a location that has reported human cases, presence of the vector, and the clinical picture should raise suspicions in health care providers, with appropriate diagnostic tests conducted as soon as possible. - ProMED Mod.UBA]

[HealthMap/ProMED maps available at:
Date: Thu, 8 Mar 2018 12:10:48 +0100
By Diana SIMEONOVA

Bansko, Bulgaria, March 8, 2018 (AFP) - "Unlimited Ski and Fun!" promises a pamphlet touting the Bansko ski resort, a magnet for bargain-hunting holidaymakers in southwest Bulgaria.   But nature lovers are demanding limits to the growth of the bustling resort carved into the majestic pine forests of Pirin National Park, a UNESCO World Heritage site since 1983.

The clearance of more than 160 hectares (400 acres) of centuries-old forest to build the ski zone already prompted UNESCO in 2010 to remove the area from the World Heritage designation, labelling it a "buffer zone".   Now a much larger area could come under threat after a government decision in December opened 48 percent of the park's 40,000 hectares for construction, sparking weekly protests attended by thousands across the country.

Protestors accuse the government of favouring business interests in a country ranked by watchdog Transparency International as the EU's most graft-prone, with one huge banner at a recent rally in the capital Sofia reading: "Corruption! Save Pirin".   But the resort is the area's biggest employer and locals have responded with their own demonstrations in favour of expansion.   At issue in particular is a plan to build a second ski lift to ease persistent queues at the sole six-person lift, which currently takes 2,200 skiers per hour up to the 75 kilometres (46 miles) of runs.

- 'Horrific' queue -
British holidaymaker Carolyn Bennett, 30, is among the skiers who come in droves to Bansko from Britain, Russia and Bulgaria's Balkan neighbours, attracted by the cheap food and lift passes as well as budget flights.   But even on a supposedly quiet day, she was among scores of people at the foot of the ski lift, where queues form from early morning and waits can last up to three hours.

"Another gondola is going to have a huge impact environmentally but I imagine coming here in peak season, that queue would probably be horrific," she shrugged in the crammed gondola cabin.    "With a daily lift pass costing 28 euros ($34), Bansko is the cheapest resort of its capacity in Europe, and even if our queues have become notorious, people keep pouring in," Bansko's marketing chief Ivan Obreykov told AFP.   Daily lift passes at ski resorts in France and Austria typically cost twice as much.

Bansko hosts some 35,000 to 40,000 visitors per month during the winter season. On a busy day, up to 7,000 people could hit the ski lift at the same time in the mornings.   Booming construction in the once quiet town of 9,500 inhabitants has seen its two-storey houses and cobbled streets surrounded by hotels and luxury apartments with space for 18,000 guests.   While ugly concrete skeletons of a number of hotel projects abandoned after the 2008 financial crisis mar the landscape, pressure is mounting to expand both the town and the ski zone.

- Trojan horse claim -
Obreykov praised the government's green light for the second ski lift, adding that its construction was the resort's "first and most pressing task".   But those opposed to the plan say it is a Trojan horse to cover up previous unauthorised building and encourage even more expansion.   "If they wanted to do just a second gondola, they would not have opened almost half of the territory of Pirin National Park for construction," WWF's Konstantin Ivanov said at a rally in Sofia.   "We don't buy their promises that nothing more will be built there," he added.   WWF claims the ski zone has already grown to cover 60 percent more territory than initially agreed and points to as yet unapproved plans for huge expansion of the resort.    Obreykov denied the charge, adding that new ski runs could be built only within the current area of the ski zone.

A recent study for the WWF concluded that the resort has already inflicted "irreparable damage" on the reserve, calling for UNESCO to inscribe Pirin on its List of World Heritage in Danger if new construction begins.    A report by the International Union for Conservation of Nature (IUCN) in November also said the conservation outlook for Pirin National Park -- home to bears, chamois and wolves -- was of "significant concern" and just one step away from the final "critical" stage.   IUCN also underlined the "threats of disturbance and fragmentation of the site associated with the exclusion of the skiing areas as incompatible with its World Heritage status."

- 'Deepening mistrust' -
For economist Petar Ganev, of the Sofia-based Institute for Market Economics, the row is an example of "deepening mistrust in Bulgaria's institutions".   On the one hand, Ganev said Bansko is "a positive example of a very poor place which grew into a prosperous resort" and that building a second ski lift could be justified for that reason.   But, he added, suspicions that development is not being regulated fairly will "continue to bring people out on the streets".   "The problem is not the second gondola but the corruption in the country," Ganev said.
Date: Fri 1 Dec 2017 15:26
Source: Focus News Agency [edited]

The hepatitis A outbreak in the Kosharnik, an all-Roma neighbourhood of Montana, is spreading, the number of people infected has reached 15, Dr. Mariya Kamenova, Deputy Director of Montana Regional Health Inspectorate (RHI) told FOCUS Radio . Another 8 cases were registered for the period from [Fri 27 Oct 2017] until the end of November 2017, adding up to the 7 cases registered by [Thu 26 Oct 2017]. Those 1st 7 cases were children under 14, while the newly infected are 4 children under 4 years of age, 2 children aged 5 to 9, and 2 children aged 15 to 19.

A 51-year-old male from the neighborhood is also probably hepatitis A infected, but his tests are pending. The Montana municipality has taken measures and the streets in Kosharnik and the yards of the infected families have been disinfected every month. The RHI has said that they will continue to monitor the situation.
=====================
[The location of Montana in Bulgaria is north and west of Plovdiv where HAV is being reported in the Roma community there. Montana's location can be seen on a map at <https://en.wikipedia.org/wiki/Montana,_Bulgaria>. Since most ca es of
HAV in children are unrecognized, being either asymptomatic or anicteric (without jaundice), the total number of cases are likely to be much higher. - ProMED Mod.LL]

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

World Travel News Headlines

Date: Tue, 10 Dec 2019 10:50:09 +0100 (MET)

Sydney, Dec 10, 2019 (AFP) - The death toll from New Zealand's White Island volcano eruption rose to six late Tuesday, after an injured person died in an Auckland hospital, police said.   "Police can confirm a further person has died following the eruption on Whakaari/White Island, bringing the official toll to six," a police statement said.   Eight more people who remain missing are presumed dead after the volcano erupted Monday.
Date: Tue, 10 Dec 2019 09:27:57 +0100 (MET)
By Andrew BEATTY, with Daniel de Carteret in Gosford

Sydney, Dec 10, 2019 (AFP) - Toxic haze blanketed Sydney Tuesday triggering a chorus of smoke alarms to ring across the city and forcing school children inside, as "severe" weather conditions fuelled deadly bush blazes along Australia's east coast.   Fire engines raced office-to-office in the city centre with sirens blaring, as inland bushfires poured smoke laden with toxic particles into commercial buildings.   Emergency services responded to an "unprecedented" 500 automatic call-outs inside a few hours according to New South Wales Fire and Rescue's Roger Mentha.

A regional fire headquarters miles from the nearest blazes was itself evacuated while throngs of mask-wearing commuters choked their way through thick acrid air and the organisers of a harbour yacht race declared it was unsafe to proceed.   "The smoke from all the fires is just so severe here on the harbour that you just can't see anything, so it's just too dangerous," said spokeswoman Di Pearson of an event that normally foreshadows the famed Sydney-Hobart yacht race. "The vision is just so poor."   Some of the city's commuter ferries were also cancelled "due to thick smoke" and school kids were kept inside at breaktime and sent home early as pollution levels soared far above "hazardous" levels.

For weeks the east of the country has been smothered in smoke as drought and climate-fuelled bushfires have burned. But the scale of the problem on Tuesday shocked even hardened residents.   Bruce Baker -- an 82-year-old who lives in Gosford, north of Sydney -- said he was skipping his daily morning walk because of the smoke.   "This is the worst it's been, for sure," he told AFP. "It dries your throat. Even if you're not asthmatic, you feel it."   Authorities recommended that the vulnerable cease outdoor activity altogether and that everyone stay inside as much as possible, although one couple braved the toxic air to get married on the waterfront in front of Sydney Harbour Bridge shrouded in smog.

A cricket match between New South Wales and Queensland also went ahead, despite a barely visible ball.   Tuesday had been expected to bring strong winds and high temperatures that made for "severe conditions where embers can be blown ahead of the fire into suburbs and threaten properties."   But New South Wales Rural Fire Service said "deteriorating fire conditions have been delayed by a thick blanket of smoke" over the east of the state.   As the day developed there were nearly 100 bushfire incidents in the state of New South Wales alone and dozens more in Queensland.   Total fire bans were put in place across much of the east of the country and in large parts of western Australia.   Temperatures in some inland areas eased past 44 degrees Celsius (111 Fahrenheit).

- The 'big dry' -
To the northwest of Sydney, several fires already burning for weeks have combined to create a "megafire" that has already destroyed 319,000 hectares (788,000 acres) of land, mostly inside national parks.   Prime Minister Scott Morrison  -- who for weeks has not commented on the smoke haze -- defended his government's handling of the fires and said there were no plans to professionalise the countryside's largely volunteer force.    "Our policy is sensible when it comes to addressing and taking action on climate change. Our actions on climate change are getting the results they're intended to get," he said.   Morrison's conservative coalition has been criticised by former fire chiefs for failing to heed warnings about climate change.   The crisis has been propelled by a prolonged drought that has made vegetation tinder dry.

The Bureau of Meteorology has reported that Australia experienced its driest November on record this year.   The "big dry" has left farmers desperate and small towns facing the prospect of running out of water completely.   A swathe of the east of the country has seen "rainfall deficiencies" since early 2017 -- almost three years.   Many dams in New South Wales are empty and almost all are well below capacity.   Firefighters south of Brisbane recently reported 1,000 litres of water were stolen from tanks at their station.   Amid the shortage, Tuesday also saw the toughest water restrictions in a decade being introduced for Sydney -- with curbs on everything from hosepipe use to washing cars.
Date: Tue, 10 Dec 2019 03:09:17 +0100 (MET)
By Allison JACKSON

Sao Paulo, Dec 10, 2019 (AFP) - Gripping the deadly snake behind its jaws, Fabiola de Souza massages its venom glands to squeeze out drops that will save lives around Brazil where thousands of people are bitten every year.   De Souza and her colleagues at the Butantan Institute in Sao Paulo harvest the toxin from hundreds of snakes kept in captivity to produce antivenom.    It is distributed by the health ministry to medical facilities across the country.

Dozens of poisonous snake species, including the jararaca, thrive in Brazil's hot and humid climate.    Nearly 29,000 people were bitten in 2018 and more than 100 died, official figures show.   States with the highest rates of snakebite were in the vast and remote Amazon basin where it can take hours to reach a hospital stocked with antivenom.   Venom is extracted from each snake once a month in a delicate and potentially dangerous process.

Using a hooked stick, de Souza carefully lifts one of the slithering creatures out of its plastic box and maneuvers it into a drum of carbon dioxide.    Within minutes the reptile is asleep.    "It's less stress for the animal," de Souza explains.    The snake is then placed on a stainless steel bench in the room where the temperature hovers around 27 degrees Celsius (80 degrees Fahrenheit).    De Souza has a few minutes to safely extract venom before the snake begins to stir.      "It's important to have fear because when people have fear they are careful," she says.

- Antivenom 'crisis' -
The snakes are fed a diet of rats and mice that are raised at the leafy institute and killed before being served up once a month.   After milking the snake, de Souza records its weight and length before placing it back in its container.    The antivenom is made by injecting small amounts of the poison into horses -- kept by Butantan on a farm -- to trigger an immune response that produces toxin-attacking antibodies.

Blood is later extracted from the hoofed animals and the antibodies harvested to create a serum that will be administered to snakebite victims who might otherwise die.   Butantan project manager Fan Hui Wen, a Brazilian, says the institute currently makes all of the country's antivenom -- around 250,000 10-15 millilitre vials per year.

Brazil also donates small quantities of antivenom to several countries in Latin America.    There are now plans to sell the life-saving serum abroad to help relieve a global shortage, particularly in Africa.    About 5.4 million people are estimated to be bitten by snakes every year, according to the World Health Organization (WHO). 

Between 81,000 and 138,000 die, while many more suffer amputations and other permanent disabilities as a result of the toxin.   To cut the number of deaths and injuries, WHO unveiled a plan earlier this year that includes boosting production of quality antivenoms.   Brazil is part of the strategy. It could begin to export antivenom as early as next year, Wen says.   "There is interest for Butantan to also supply other countries due to the global crisis of antivenom production," she says.
Date: Mon, 9 Dec 2019 14:14:15 +0100 (MET)

Dec 9, 2019 (AFP) - New Zealand, struck by a deadly volcanic eruption Monday, lies in a zone where Earth's tectonic plates collide, making it a hotspot for earthquakes and volcanic activity.   In one of its worst natural disasters, a huge mass of volcanic debris from the eruption of Mount Ruapehu triggered a mudslide in 1953 that washed away a bridge and caused a passenger train to plunge into a river with the loss of 151 lives.  After Monday's eruption on New Zealand's White Island, here is a recap of some of the deadliest volcanic eruptions around the world in the past 25 years.

- 2018: Indonesia -
In December the Anak Krakatoa volcano, a small island in the Sunda Strait between Java and Sumatra, erupts and a section of its crater collapses, sliding into the ocean and generating a tsunami. More than 420 people are killed and 7,200 wounded.

- 2018: Guatemala -
The June eruption of the Fuego volcano, about 35 kilometres (22 miles) from the capital, unleashes a torrent of mud and ash that wipes the village of San Miguel Los Lotes from the map. More than 200 people are killed.

- 2014: Japan -
The sudden eruption in September of Mount Ontake, in the central Nagano region, kills more than 60 people in Japan's worst volcanic disaster in nearly 90 years. The mountain is packed with hikers at the time. In 1991 an eruption of the southwestern Unzen volcano kills 43.

- 2014: Indonesia -
At least 16 people are killed on the island of Sumatra in February by a spectacular eruption of Mount Sinabung, which had lain dormant for 400 years before roaring back to life five months earlier. In 2016 villages are scorched and farmland devastated after another eruption kills seven.

- 2010: Indonesia -
Indonesia's most active volcano, Mount Merapi on Java island, starts a series of explosions in October, eventually killing more than 320 people. An 1930 eruption of the volcano killed 1,300 people and one in 1994 claimed more than 60 lives.

- 2002: DR Congo -
The eruption in July of Mount Nyiragongo in the eastern Democratic Republic of Congo destroys the centre of Goma town, along with several residential areas, and kills more than 100 people.

- 1997: Montserrat -
The capital of the small British colony, Plymouth, is wiped off the map and 20 are killed or left missing in avalanches of hot rock and ash clouds when its volcano erupts in June.

- 1995: The Philippines -
At least 70 are killed and another 30 missing after the crater of the Parker volcano in the south of the island of Mindanao collapses. Five years earlier the eruption of Mount Pinatubo, 80 kilometres north of the capital Manila, kills more than 800 people.

- Worst ever -
The explosion of Indonesia's Krakatoa volcano in 1883 is considered the worst ever seen. The eruption sent a jet of ash, stones and smoke shooting more than 20 kilometres (12 miles) into the sky, plunging the region into darkness, and sparking a huge tsunami that was felt around the world. The disaster killed more than 36,000 people.

The most famous eruption in history is that of Mount Vesuvius in modern-day Italy in 79 AD, which destroyed the towns of Herculaneum, Stabiae and Pompeii, wiping out an estimated 10 percent of the population of the three cities.
Date: Mon 9 Dec 2019
Source: Fox 29 Philadelphia [edited]

A total of 31 people have been sickened by salmonellosis at 4 health care facilities in south-eastern Pennsylvania. A majority of those cases occurred after individuals ate pre-cut fruit from New Jersey-based Tailor Cut Produce. The Food and Drug Administration (FDA) announced the salmonellosis outbreak in conjunction with the Pennsylvania Department of Health (DOH) on [Fri 6 Dec 2019]. The North Brunswick distributor has recalled its fruit mix with cantaloupe, honeydew, pineapple and grapes as a result.

Tailor Cut Produce reports that its products may be found in restaurants, banquet facilities, hotels, schools and institutional food service establishments in Pennsylvania, New Jersey and New York. "We recommend that any facility who use Tailor Cut Produce pre-cut fruit to immediately stop and throw it away," Pennsylvania Secretary of Health Dr. Rachel Levine said.

Salmonellosis is an infection caused by _Salmonella_ bacteria that generally affects the intestinal tract. People usually become infected by either eating or drinking contaminated food or water, by contact with infected people or animals, or through contact with contaminated environmental sources.
Date: Mon 9 Dec 2019
Source: Sixth Tone [edited]

Dozens of researchers in northwestern China's Gansu province have been infected with brucellosis, an animal-borne disease that causes flu-like symptoms and, potentially, lingering problems. In a statement [Fri 6 Dec 2019], the Lanzhou Veterinary Research Institute, an affiliated institute of the Chinese Academy of Agricultural Sciences, said that the 1st few grad students from the institute's foot-and-mouth disease prevention team tested positive for brucellosis antibodies on [28 Nov 2019]. The labs affected have been closed, the institute said, and national and local health authorities have assembled a team to investigate the outbreak.

Li Hui, an official at the health commission in Lanzhou, the provincial capital, told Sixth Tone on [Mon 9 Dec 2019] that the total number of brucellosis cases at the institute had climbed to 96. None have shown clinical symptoms, according to domestic media, and it remains unclear how they were exposed to the bacteria.

Brucellosis -- also known as Malta, Mediterranean, or undulant fever -- is a zoonotic disease that mainly affects animals, including livestock and dogs, which can in turn transmit the bacteria to humans through direct contact. Symptoms include fever, chills, sweating, lethargy, and aches and pains, according to the WHO. In the absence of early diagnosis and treatment, brucellosis can become a chronic condition that is difficult to cure.

In China, brucellosis is a Class B disease, ranking below a more serious category that includes cholera and plague. Human-to-human transmission has only been known to occur between lactating mothers and their babies. According to state broadcaster China National Radio, the brucellosis outbreak at the Gansu veterinary institute has prompted health checks among local students and staff who fear that they may have come into contact with infected animals.

One of the last brucellosis outbreaks in China occurred in 2011, when an agricultural university in the northeastern Heilongjiang province reported 28 cases stemming from infected goats being used in lab research. The school publicly apologized, fired 2 administrators, and offered each of the students' affected monetary compensation.

Scientific labs are subject to different experimental standards depending on their biosafety level, according to a researcher surnamed Yang at the Shanghai Institutes for Biological Sciences, an affiliate of the Chinese Academy of Sciences.

"If the protection levels don't keep pace (with biosafety levels), there will be a risk of infection," Yang, who studies viruses and works in a Biosafety Level 2+ lab, told Sixth Tone. As a result, labs generally require researchers to undergo safety training or even pass an exam to earn a certification, said Yang, who only used her surname because she was not authorized by her employer to speak to media.

The Lanzhou Veterinary Research Institute describes itself as "China's only authorized research center for working with the live virus that causes foot-and-mouth disease," a highly contagious disease affecting livestock. The institute is reportedly also one of the few in China with Biosafety Level 3 labs, which are required for _brucella_ pathogen studies, according to the National Health Commission.

As the local agriculture department tries to ascertain the source of the recent infections, Lanzhou's health commission said [Fri 6 Dec 2019], it is implementing precautionary measures so that brucellosis does not pose a threat to neighbouring communities. [Byline: Yuan Ye]
=================
[An earlier report suggested that 4 persons were clinically ill but this is not confirmed here.  Brucellosis (<http://www.medicinenet.com/brucellosis/article.htm>) is a disease that is thought to have existed since ancient times, as it was 1st described more than 2000 years ago by the Romans and Hippocrates. It was not until 1887 that a British physician, Dr. David Bruce, isolated the organism that causes brucellosis from several deceased patients from the island of Malta. This disease has had several names throughout its history, including Mediterranean fever, Malta fever, Crimean fever, Bang's disease, and undulant fever (because of the relapsing nature of the fever associated with the disease).

The symptoms and signs of brucellosis may develop from days to months after the initial exposure to the organism. While some individuals may develop mild symptoms, others may go on to develop long-term chronic symptoms. The signs and symptoms of brucellosis are extensive, and they can be similar to many other febrile illnesses, so recognition of potential exposure -- from ingestion of unpasteurized milk or cheese, employment as a veterinarian or veterinary student, in a slaughter house or meat processing plant, or working in a microbiology lab -- is vital. In this outbreak, it is not clear what symptoms the students had or whether they were just seropositive. ProMED would like more information about this episode. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Gansu Province, China: <http://healthmap.org/promed/p/333>]
Date: Tue 3 Dec 2019
Source: Outbreak News Today [edited]

In late November [2019], Uganda health authorities notified the World Health Organization of a fatal Rift Valley fever (RVF) case from Obongi district.  The case was a 35-year-old man from South Sudan who was living in the Palorinya Refugee camp in Obongi district, Uganda. The case had travel history to South Sudan between 12 and 19 Nov 2019 to harvest cassava. While in his home country, he developed fever and other symptoms and was treated for malaria; however, his condition got worse.  He later returned to the refugee camp in Uganda and his symptoms progressed and he was hospitalized. Viral hemorrhagic fever was suspected. Samples were collected and sent to the Uganda Virus Research Institute; however, the patient died. A safe and dignified burial was performed on 22 Nov 2019. As of 24 Nov 2019, a total of 19 contacts were recorded during the active case search including 10 healthcare workers.
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[The circumstances and specific location under which the man became infected with Rift Valley fever (RVF) virus in South Sudan is not mentioned. It is worth noting that there was an RVF outbreak in the Eastern Lakes region of South Sudan during the 1st 3 months of last year (2018). At the end of that outbreak, the OIE's follow-up report no. 3 reported: "The event cannot be considered resolved, but the situation is sufficiently stable. No more follow-up reports will be sent. Information about this disease will be included in the next 6-monthly reports."

There were more human cases than animal ones in that outbreak, prompting Mod.AS to comment: "Unfortunately, during the recent South Sudan RVF event, as in most -- if not all -- previous RVF events in other African countries, humans served as sentinels. Improved surveillance in animals is desperately needed in Africa, to allow timely measures applied, predominantly preventive vaccination, before the development of a full-blown epizootic involving secondary infection in humans." Intensified surveillance is needed in South Sudan in those localities where the affected man had been prior to his return to Uganda.

It is likely that RVF virus has persisted in this area in transovarially infected eggs of _Aedes_ mosquito vectors. These eggs can remain viable for long periods of time and hatch when flooded during future rain events, with the subsequent emergence of infected females ready to transmit the virus. This risk provides justification for maintaining livestock of the area well vaccinated into the future. This may have accounted for the reappearance of RVF in South Sudan in 2018, after nearly 2 years without additional reported cases in humans or livestock and again with this human case in 2019. - ProMED Mod.TY]

Obongi district, Uganda is located approximately 50 km (30 mi) from the South Sudan border.
HealthMap/ProMED-mail maps:

According to OIE's data, a total of 2 outbreaks of RVF affecting animals have been reported from Sudan during the event. The 1st outbreak started in the Arabaata dam area, Red Sea state, on 25 Sep 2019, affecting goats. The 2nd (and, so far, last) outbreak started 10 Oct 2019 in the River Nile state, affecting sheep and goats. Both outbreaks have been declared as 'resolved' on 14 Nov 2019.

Outbreak summary:
Total outbreaks = 2 (Submitted)
Species / Susceptible / Cases / Deaths / Killed and disposed of / Slaughtered
Goats / 1700 / 37 / 7 / 0 / 0
Sheep / 1550 / 37 / 5 / 0 / 0

According to the recent (5 Dec 2019) OCHA (UN Office for the Coordination of Humanitarian Affairs) update, the (human) RVF situation in Sudan, as of 26 Oct 2019, was the following: "a total of 345 suspected RVF cases -- including 11 related deaths -- reported in the states of Red Sea (128), River Nile (212), Khartoum (1), White Nile (1), Kassala (2), and Gedaref (1). The most affected age group is 15 to 45 years, which accounts for 83% of the total suspected cases. The male to female ratio is 2.6, with a high proportion of the cases being farmers (37.5 per cent). RVF is endemic in Sudan and 3 outbreaks affecting people have been documented in 1973, 1976, and 2008. During the outbreak in 2008, a total of 747 laboratory-confirmed cases were reported, including 230 deaths."

Egypt suffered its 1st RVF outbreak in 1977/78 with serious human disease and death as well as severe losses in livestock; several additional events have been recorded since. A recent historical review paper [1] concluded: "due to the availability and abundance of the potential vectors, the suitability of environmental conditions, continuous importation of livestock's from Sudan, and the close association of susceptible domestic animals with humans, the RVF virus could possibly occur and circulate in Egypt."   (https://tinyurl.com/whz3pz5)

Reference
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1. Kenawy MA, Abdel-Hamid YM, Beier JC. Rift Valley fever in Egypt and other African countries: Historical review, recent outbreaks, and possibility of disease occurrence in Egypt. Acta Trop. 2018; 181: 40-49; <https://doi.org/10.1016/j.actatropica.2018.01.015>  - ProMED Mods.AS/TY]
Date: Fri 6 Dec 2019 5:53 PM MST
Source: CTV News [edited]

A syphilis outbreak is worsening in Alberta [Canada], and the majority of new cases are in the Edmonton zone. Edmonton saw 1186 of the 1753 infectious syphilis [primary, secondary and early latent syphilis] cases reported in Alberta in 2019, a total of 68 per cent.

Alberta Health Services [AHS] declared an outbreak in July 2019, saying cases had 'increased dramatically' in the province since 2014. The number increased again in July [2019]  [<https://edmonton.ctvnews.ca/alberta-declares-province-wide-syphilis-outbreak-1.4510737>].

AHS sent a new public health alert to doctors on [27 Nov 2019], asking for their help to control the outbreak [<https://www.albertahealthservices.ca/assets/info/hp/phys/if-hp-phys-moh-ez-syphilis-outbreak.pdf>]. "It's very significant," said Dr Ameeta Singh, a clinical professor in infectious diseases. "That's an alarming rise in new syphilis cases in Alberta." She said it's the highest number of cases the province has seen since the 1940s.

According to Dr Singh, the increase in cases being reported is partially due to a greater number of people getting tested. "We know more people are coming in to get tested, but if we look a bit closer at the data we have, we do see there's, in fact, a [bigger] rise in the number of cases than we would expect to see," said Singh.

Another factor could be the rise in methamphetamine use in Edmonton. "I believe this is a major factor. Meth also stimulates risky sexual behaviour and increases the chance people will engage in multiple, usually casual or anonymous partners as well and not use precautions such as condoms to protect themselves during sex," she said.

What's also alarming, Singh said, is the spike in cases of congenital syphilis, where the disease is passed on to newborns. According to AHS, there have been 38 cases of congenital syphilis in 2019, 31 of which were in the Edmonton area. That accounts for more than half of the 61 cases of congenital syphilis reported since 2014.

"Those are not numbers we should be talking about in Canada ever...in a country that has universal access to health care, in a major city in Canada where syphilis testing is offered to all pregnant women who access prenatal care," she said. "What we're seeing with the congenital syphilis cases is many of the women are not accessing prenatal care until they come into the hospital to deliver and then the tests are being done."
===================
[A recent ProMED-mail post (Syphilis - Canada (04): (AB) RFI http://promedmail.org/post/20190718.6574300) reported a rise in "infectious syphilis" cases over a 4-year period: from 2014 to 2018 but made no mentioned of contributing factors. As illicit drug use has been cited as a contributing factor to recent increases in syphilis cases in the Canadian provinces of Ontario and Manitoba, I questioned in this prior ProMED-mail post if use of illicit drugs, in particular, methamphetamine, could similarly be contributing to the rise of syphilis cases in Alberta. The news article above reports that the rise in methamphetamine use in Edmonton, as well as increased testing for syphilis, are thought to be contributing factors in Alberta.

Methamphetamine can be swallowed, snorted, smoked or injected by needle and syringe

When methamphetamine is injected, transmission of syphilis may occur as a consequence of sharing a needle/syringe contaminated with infected blood from somebody who has primary or secondary syphilis (<https://ucsdnews.ucsd.edu/archive/newsrel/health/04-28TransmissionSyphilis.asp>); but syphilis can also be acquired by direct contact with an infected lesion during oral, vaginal, or anal sex when the drug is taken by any route of administration. Methamphetamine use is associated with sexual behaviors that increase the risk for acquiring syphilis and other sexually transmitted diseases, including having multiple sex partners, inconsistent condom use, and exchange of sex for drugs or money (<https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a4.htm>).

The linkage of methamphetamine use and syphilis transmission is reminiscent of the increase in syphilis among heterosexuals during the crack cocaine epidemic of the 1980s and 1990s, when the practice of trading sex with multiple partners for drugs, especially crack cocaine, played a major role in the transmission of syphilis. Under these circumstances, the identities of sex partners are often unknown, which weakens the traditional syphilis-control strategy of partner notification.

Bacteremia due to _Treponema pallidum_, the cause of syphilis, which occurs during primary, secondary, and latent syphilis, can result in transplacental transmission of this organism to the fetus during pregnancy and cause congenital syphilis. An increase in the incidence of syphilis in women in the population is commonly accompanied by increasing rates of congenital syphilis.

Edmonton, with a population of 932 546 residents in 2016, is the capital of the Canadian province of Alberta
(<https://en.wikipedia.org/wiki/Edmonton>).

A map showing the location of Edmonton can be found at
<https://goo.gl/maps/Rfq6XC2vvwi19ypb6>. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Alberta, Canada:
9 December 2019
https://www.who.int/bangladesh/news/detail/09-12-2019-cholera-vaccination-campaign-launched-to-protect-635-000-people-in-cox-s-bazar

Cox’s Bazar, Bangladesh

Over 635,000 Rohingya refugees and Bangladeshi host community will be vaccinated against cholera in a 3-week-long campaign beginning today at the refugee camps in Cox’s Bazar and nearby areas, to protect vulnerable population against the deadly disease amidst increasing number of cases of acute watery diarrhoea (AWD).


The Oral Cholera Vaccination (OCV) campaign will be implemented in the refugee camps from 8-14 December to reach 139,888 Rohingya aged 1 year and less than 5 years. In the host community, the campaign will take place from 8-31 December and aims to reach any person older than 1 year (495,197). In total, 635,085 people are expected to be reached.

Led by the Ministry of Health and Family Welfare, with support of the World Health Organization (WHO), UNICEF and other partners, the campaign aims to reach people who missed some or all previous cholera vaccination opportunities. The campaign, including operational costs, is funded by Gavi, the Vaccine Alliance.

“We want to equip these populations with more protection against diarrheal diseases. Despite the progresses made to ensure access to quality water and sanitation, such diseases remain an issue of concern: approximately 80% of host community living near the camps have not been targeted in previous OCV campaigns and are still vulnerable”, says Dr Bardan Jung Rana, WHO Representative in Bangladesh.

Earlier rounds of cholera vaccination, which have taken place since the beginning of the emergency response in 2017, have helped prevent outbreaks of the disease. To this date, over 1 million people were vaccinated against cholera.
6th December 2019
https://www.theguardian.com/world/2019/dec/06/flooding-hits-new-zealand-tourist-hubs-of-wanaka-and-queenstown

Heavy rain has led to rivers bursting their banks, forcing the closure of shops and restaurants

Streets in the South Island tourist towns of Wanaka and Queenstown were slowly going under water on Friday, after Lake Wanaka and Lake Wakatipu burst their banks earlier in the week, flooding businesses and sewerage systems.

Water and large debris closed the main street of Wanaka, a popular spot with Instagrammers thanks to its famous tree that appears to have grown out of the lake. On Friday businesses were sandbagging as heavy rain continued to fall.

Sewerage systems in the town were also at risk of contaminating the lake, with the Queenstown Lakes District council taking the precautionary measure of shutting down the sewer connection to a handful of premises.

Wanaka residents were told to be on “high alert” with heavy rain predicted all weekend.

The streets of the usually bustling tourist town were largely empty, and the popular cafes and restaurants on the lake shore were closed.