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United Arab Emirates

United Arab Emirates US Consular Information Sheet
28th February 2008
COUNTRY DESCRIPTION: The United Arab Emirates (UAE) is a federation of seven independent emirates, each with its own ruler.
The federal government is a constitutional re
ublic, headed by a president and council of ministers.
Islamic ideals and beliefs provide the conservative foundation of the country's customs, laws and practices. The UAE is a modern, developed country, and tourist facilities are widely available. Read the Department of State Background Notes on the United Arab Emirates for additional information.

ENTRY/EXIT REQUIREMENTS: A passport is required. For stays of less than 60 days, U.S. citizens holding valid passports may obtain visitor visas at the port of entry for no fee. For a longer stay, a traveler must obtain a visa before arrival in the UAE. In addition, an AIDS test is required for work or residence permits; testing must be performed after arrival. A U.S. AIDS test is not accepted. For further information, travelers can contact the Embassy of the United Arab Emirates, 3522 International Court NW, Washington, DC 20037, telephone (202) 243-2400.
Visit the web site of the UAE's Ministry of Information regarding tourism, business, and residence in the UAE at http://www.uaeinteract.org.

Unlike other countries in the region that accept U.S. military ID cards as valid travel documents, the UAE requires U.S. military personnel to present a valid passport for entry/exit.

UAE authorities will confiscate any weapons, weapon parts, ammunition, body armor, handcuffs, and/or other military/police equipment transported to or through a civilian airport.
Americans have been arrested and jailed for transporting such weapons and equipment without the express written authorization of the UAE government, even though airline and U.S. authorities allowed shipment on a US-originating flight.

U.S. citizens and citizens of other countries that are not members of the Gulf Cooperation Council (GCC), who depart the UAE via land are required to pay a departure fee. This fee is 20 UAE dirhams and is payable only in the local UAE dirham currency.

Visit the Embassy of the United Arab Emirates web site at http://uae-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: Americans in the United Arab Emirates should exercise a high level of security awareness. The Department of State remains concerned about the possibility of terrorist attacks against U.S. citizens and interests throughout the world. Americans should maintain a low profile, vary routes and times for all required travel, and treat mail and packages from unfamiliar sources with caution. In addition, U.S. citizens are urged to avoid contact with any suspicious, unfamiliar objects, and to report the presence of the objects to local authorities.
U.S. Government personnel overseas have been advised to take the same precautions. In addition, U.S. Government facilities may temporarily close or suspend public services from time to time as necessary to review their security posture and ensure its adequacy.

Taking photographs of potentially-sensitive UAE military and civilian sites, or foreign diplomatic missions, including the U.S. Embassy, may result in arrest, detention and/or prosecution by local authorities.
In addition, engaging in mapping activities, especially mapping which includes the use of GPS equipment, without coordination with UAE authorities, may have the same consequences.

On several occasions in the past three years, small groups of expatriate recreational boaters were detained by the Iranian Coast Guard for alleged violation of Iranian territorial waters while fishing near the island of Abu Musa, approximately 20 miles from Dubai.
The UAE and Iran have had a long-standing dispute concerning jurisdiction of Abu Musa.
Fishing or sailing in these waters may result in seizure of vessels and detention of passengers and crew in Iran.
Obtaining consular assistance in Iran is difficult and can only be done through the Swiss Embassy in Tehran, which acts as a Protecting Power, providing limited U.S. consular services.

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 overseas, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME: Crime generally is not a problem for travelers in the UAE. However, the U.S. Embassy advises U.S. citizens to take normal precautions against theft, such as not leaving a wallet, purse, or credit card unattended. Although vehicle break-ins in the UAE are rare, U.S. citizens are encouraged to ensure that unattended vehicles are locked and that valuables are not left out in plain sight.

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, to 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: Basic modern medical care and medicines are available in the principal cities of the UAE, but not necessarily in outlying areas.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention's hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747); fax 1-888-CDC-FAXX (1-888-232-3299), or via the CDC's web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their 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 the United Arab Emirates is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

The police emergency number and ambulance number is 999. Mobile phones are widely used throughout the UAE, so passers-by usually request emergency police and medical services quickly. Response time by emergency services is adequate. However, medical personnel emphasize transport of the injured to the hospital rather than treatment on site. Traffic accidents are a leading cause of death in the UAE because drivers often drive at high speeds. Unsafe driving practices are common, especially on inter-city highways. On highways, unmarked speed bumps and drifting sand create additional hazards.

Country-wide traffic laws impose stringent penalties for certain violations, particularly driving under the influence of alcohol.
In the UAE, there is zero tolerance for driving after consumption of alcohol.
Penalties may include hefty jail sentences and fines over $6,000 and, for Muslims (even those holding U.S. citizenship), lashings. Persons involved in an accident in which another party is injured automatically go to jail, until the injured person is released from the hospital. Should a person die in a traffic accident, the driver of the other vehicle is liable for payment of compensation for the death (known as "dhiyya"), usually the equivalent of 55,000 U.S. dollars. Even relatively minor accidents may result in lengthy proceedings, during which both drivers may be prohibited from leaving the country.

In order to drive, UAE residents must obtain a UAE driver's license. Foreign driver's licenses are not recognized. However, a non-resident visitor to the UAE can drive if he/she obtains a valid international driver's license issued by the motor vehicle authority of the country whose passport the traveler holds. The UAE recognizes driver's licenses issued by other Gulf Cooperation Council (GCC) states only if the bearer is driving a vehicle registered to the same GCC state. Under no circumstances should anyone drive without a valid license.

Please refer to our Road Safety page for more information.
You may also visit the web site of the UAE’s national tourist office and national authority responsible for road safety at http://www.uaeinteract.org.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Arab Emirates’ Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the United Arab Emirates' 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: The UAE government does not recognize dual nationality.
Children of UAE fathers automatically acquire UAE citizenship at birth and must enter the UAE on UAE passports. UAE authorities have confiscated U.S. passports of UAE/U.S. dual nationals in the past. This act does not constitute loss of U.S. citizenship, but should be reported to the U.S. Embassy in Abu Dhabi or the U.S. Consulate General in Dubai. In addition to being subject to all UAE laws, U.S. citizens who also hold UAE citizenship may also be subject to other laws that impose special obligations on citizens of the UAE.
For additional information, please refer to our Dual Nationality flyer.

U.S. citizens have at times become involved in disputes of a commercial nature that have prompted local firms or courts to take possession of the U.S. citizen's passport. Travel bans may also be enforced against U.S. citizens involved in financial disputes with a local sponsor or firm. Such travel bans, which are rigidly enforced, effectively prevent the individual from leaving the UAE for any reason until the dispute is resolved. Although it is customary for a local sponsor to hold an employee's passport, it is illegal to do so under UAE law. Most contractual/labor disputes can be avoided by clearly establishing all terms and conditions of employment or sponsorship in the labor contract at the beginning of any employment. Should a dispute arise, the UAE Ministry of Labor has established a special department to review and arbitrate labor claims. A list of local attorneys capable of representing Americans in such matters is available from the Consular and Commercial sections of the U.S. Embassy in Abu Dhabi and the U.S. Consulate General in Dubai.

Codes of behavior and dress in the UAE reflect the country's Islamic traditions and are more conservative than those of the United States. Visitors to the UAE should be respectful of this conservative heritage, especially in the Emirate of Sharjah where rules of decency and public conduct are strictly enforced. Female travelers should keep in mind the cultural differences among the many people who coexist in the UAE and should be cognizant that unwitting actions may invite unwanted attention to them. Isolated incidents of verbal and physical harassment of Western women have occurred. Victims of harassment are encouraged to report such incidents to the U.S. Embassy in Abu Dhabi or the Consulate General in Dubai.

American citizens intending to reside and work in the UAE may have to present personal documents authenticated by the Department of State's Office of Authentications in Washington, D.C. before traveling to the UAE. This can be a complex process involving local, state and federal offices and requiring several weeks to complete.
For procedural information, the Office of Authentications may be contacted by telephone from within the United States at 800-688-9889 or 202-647-5002, by fax at 202-663-3636, or by e-mail at aoprgsmauth@state.gov.
In order to meet UAE government requirements for school registrations and residency sponsorship for family members, Americans intending to bring their families to reside with them in the UAE will need to have their marriage certificate and children's birth certificates, or custody/adoption decrees, if appropriate, authenticated by the Department of State in Washington, DC.
The U.S. Embassy and Consulate General cannot authenticate U.S. local- and state-issued personal, academic or professional documents; they will only be able to authenticate the final authentication document from the Department of State.
Additional information on authentication of documents can be found at http://www.state.gov/m/a/auth/.
In terms of employment, a recent change to UAE labor law requires local sponsors to have employees' diplomas, academic and/or occupational/professional certificates validated through a “Degree Verification” process established in the UAE.
Prospective employees will be required to submit photocopies of such documents for verification to a firm under contract to the Ministry of Labor.

In addition, persons in the education and health professions reportedly have to meet two requirements for validation of their educational credentials at this time – the formal “chain” authentication of academic/professional credentials in the U.S. and the “Degree Verification” process in the UAE.
Different UAE Ministries have different requirements in this regard.
Determining these requirements with one’s prospective employer is strongly recommended before arrival in the UAE.

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

Legislation enacted in January 1996 imposes the death sentence for convicted drug traffickers. Since January 2006, possession of even trace amounts of illegal drugs has resulted in sentences of four years imprisonment for foreign citizens transiting the UAE. American citizens transiting and entering the UAE’s airports and in possession of illegal drugs have been discovered, arrested and prosecuted by UAE authorities.
As mentioned, in such cases the minimum penalty is four years imprisonment.

Some drugs normally taken under a doctor's supervision in the United States, and even some over-the-counter U.S. drugs and medications, are classified as narcotics in the UAE and are illegal to possess.
A doctor's prescription should be carried along with any medication that is brought into the country.
A person may be subject to arrest and prosecution if possession of prescribed medicines (especially those containing codeine and similar narcotic-like ingredients) comes to the attention of local authorities.
The U.S. Embassy’s web site includes an unofficial list of such medicines, obtained from the UAE Ministry of Health.
Most medications available in the U.S. are also available by doctors’ prescription through hospitals and pharmacies in the UAE.

In addition, the UAE's tough anti-narcotics program also includes poppy seeds, widely used in other cultures, including the U.S., for culinary purposes, on its list of controlled substances. The importation and possession of poppy seeds in any and all forms is strictly prohibited. Persons found to possess even very small quantities of controlled substances listed by the UAE are subject to prosecution by the authorities and may be given lengthy prison terms of up to 15 years. Travelers with questions regarding the items on the list of controlled substances should contact the U.S. Embassy in Abu Dhabi or the U.S. Consulate General in Dubai. If suspected of being under the influence of drugs or alcohol, individuals may be required to submit to blood and/or urine tests and may be subject to prosecution.

Crimes of fraud, including passing bad checks and non-payment of bills (including hotel bills), are regarded seriously in the UAE and can result in imprisonment and/or fines. Bail generally is not available to non-residents of the UAE who are arrested for crimes involving fraud.

Drinking or possession of alcohol without a Ministry of Interior liquor permit is illegal and could result in arrest and/or fines and imprisonment. Alcohol is served at bars in most major hotels but is intended for guests of the hotel. Persons who are not guests of the hotel, and who consume alcohol in the restaurants and bars, technically are required to have their own personal liquor licenses. Liquor licenses are issued only to non-Muslim persons who possess UAE residency permits. Drinking and driving is considered a serious offense. Penalties generally are assessed according to religious law.

While individuals are free to worship as they choose, and facilities are available for that purpose, religious proselytizing is not permitted in the UAE.
Persons violating this law, even unknowingly, may be imprisoned or deported.

If arrested, U.S. citizens should contact the U.S. Embassy or Consulate General for assistance. The U.S. Consul will provide information on the local judicial system and a list of local attorneys. In Dubai, the U.S. Consul can also arrange for U.S. citizen detainees to meet with an ombudsman from the Human Rights Department of the Dubai police headquarters, if the detainee believes he or she is not being treated fairly.

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

REGISTRATION/EMBASSY AND CONSULATE LOCATION:
Americans living or traveling in the United Arab Emirates are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and to obtain updated information on travel and security within the United Arab Emirates. 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 in Abu Dhabi is located at Embassies District, Plot 38, Sector W59-02, Street No. 4, P.O. Box 4009. The telephone number is (971) (2) 414-2200, and the Consular Section fax number is (971) (2) 414-2241. The email address for American Citizens Services inquiries, including passport questions, is abudhabiacs@state.gov. The after-hours telephone number is (971) (2) 414-2500. The Embassy Internet web site is http://uae.usembassy.gov.

The U.S. Consulate General in Dubai is located on the 21st floor of the Dubai World Trade Center, P.O. Box 9343. The telephone number is (971) (4) 311-6000 (for after-hours emergencies, contact the Embassy at (971)(2) 414-2200 for the Dubai Duty Officer, and the Consular Section fax number is (971) (4) 311-6213. The email address for American Citizens Services inquiries, including passport questions, is dubaiwarden@state.gov. The web site for the U.S. Consulate General in Dubai is http://dubai.usconsulate.gov.

The workweek for both the Embassy in Abu Dhabi and the Consulate General in Dubai is Sunday through Thursday.
* * *
This replaces the Country Specific Information for the UAE dated July 06, 2007, to update the sections on Traffic Safety and Road Conditions and Criminal Penalties.

Travel News Headlines WORLD NEWS

Date: Mon, 6 Jan 2020 17:38:26 +0100 (MET)

Dubai, Jan 6, 2020 (AFP) - The United Arab Emirates on Monday introduced a multiple-entry visa scheme valid for five years for all nationalities, with the aim of turning the Gulf state into a tourism hub.   "#UAE Cabinet chaired by @HHShkMohd, approves new amendment for tourist visas in #UAE," the government of Dubai Media Office tweeted, referring to Sheikh Mohammed bin Rashid Al Maktoum, the UAE prime minister and ruler of Dubai.   "The new tourist visa will be valid for 5 years and can be used for multiple entries and is open for all nationalities," the Dubai Media Office wrote.

Sheikh Maktoum said on Twitter that the UAE currently attracts 21 million tourists a year.   Travellers from Africa, some South American countries, Arab states outside the Gulf, and European states from outside the European Union and former Soviet Union previously needed visas.   In October, Dubai is to host Expo 2020, a big-budget global trade fair.
Date: Thu 26 Sep 2019
Source: Gulf Business [edited]

Dubai Municipality has shut down a restaurant in Jumeirah after 15 people fell ill following an outbreak of _Salmonella_ infection, local media reported. An initial investigation revealed that the outbreak was likely caused by raw eggs served in a hollandaise sauce.

Officials received a report that several people, including a child, fell sick with symptoms such as diarrhoea, fever, and vomiting after eating at the restaurant. They collected samples and conducted tests, following which they found that the chef had used raw eggs in violation of the food safety rules.

The chef and person-in-charge (PIC) of food safety have been held, the municipality said. The food safety department has also downgraded the rating of the outlet and revoked its PIC certificate, Gulf News reported. The unnamed American outlet will be under "strict monitoring" for the next 6 months once it is allowed to reopen.

The municipality banned the use of raw eggs in ready-to-eat products in 2012 after authorities found them to be a cause for _Salmonella_ infections. Following the recent incident, the department has issued a fresh alert to restaurants reminding them about the ban.
=======================
[Salmonellosis is often thought to be associated with cracked eggs or eggs dirty with fecal matter, a problem controlled by cleaning procedures implemented in the egg industry. It is clearly the case, however, that most of the salmonellosis outbreaks linked to eggs were associated with uncracked, disinfected grade A eggs, or foods containing such eggs. The undamaged eggs become contaminated during ovulation, and thus were contaminated with the bacteria before the eggshell was formed. To avoid this, uncooked eggs should only be used as an ingredient if pasteurized. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Dubai, United Arab Emirates: <http://healthmap.org/promed/p/3442>]
Date: Sat 24 Aug 2019 3:39:38 PM PKT
Source: Mena FN[edited]

A resident of Swabi district has succumbed to Congo fever in Sharjah hospital and was laid to rest there on [Sat 24 Aug 2019].

According to details, the man was cutting meat on Eid day, when he accidentally cut one of his fingers. He didn't take it seriously, but after few days, he felt unwell and was taken to the hospital in Sharjah where he was told that he is suffering from a lethal infection known as Crimean-Congo haemorrhagic fever.

Doctors have told him that while he was cutting meat, the deadly Congo virus entered into his body. He was unaware of it while the virus was gradually spreading in his veins, killing him a slow death.

And finally, the virus shattered his body to an extent that he was unable to recover. He was admitted to a hospital in Sharjah in an isolated ward and was kept away from his relatives so that they may not contract the virus. His dead body was laid to rest in Sharjah and was not allowed to be taken to his home town in Swabi due to the fear of virus spread. The man was a resident of Cham village in Daghai, in District Swabi and was living with his family in Sharjah.
=======================
[The report above does not signify how the case was confirmed, and whether any contact follow up was done post confirmation, since there is an incubation period between possible exposure and appearance of symptoms.

CCHF virus has the greatest geographic range of any tick-borne virus and there are reports of viral isolation and/or disease from more than 30 countries in Africa, Asia, Eastern and Southern Europe, and the Middle East. Numerous domestic and wild animals, such as cattle, goats, and sheep, and small mammals, such as hares and rodents, serve as asymptomatic hosts for amplification of the virus, which is transmitted through _Ixodid_ ticks, especially _Hyalomma_ spp that act as both reservoirs and vectors  (<https://www.biorxiv.org/content/biorxiv/early/2018/12/20/502641.full.pdf>).

CCHF was first reported in the United Arab Emirates (UAE; Sharjah is one Emirate) in 1979, when 6 cases were reported among the staff of a hospital in Dubai. An outbreak of CCHF occurred during 1994-1995 with 35 human infections. In 1994, 35 clinical CCHF cases were reported in 1994,and between January 1998 and October 2013, 5 more cases and 2 deaths were reported from the UAE (Ince Y, Yasa C, Metin M, et al. Crimean-Congo hemorrhagic fever infections reported by ProMED. Int J Infect Dis 2014; 26: 44-6;  <https://www.ijidonline.com/article/S1201-9712(14)01499-4/fulltext>).

As the vector is widely distributed and impending climatic changes are likely to widen this spectrum, there is need for the development and implementation of a strategic framework for the prevention and control of CCHF through a coordinated 'One Health' approach. - ProMED Mod.UBA]

[Maps of United Arab Emirates:
Date: Fri, 8 Mar 2019 11:58:53 +0100
By Shatha Yaish

Hatta, United Arab Emirates, March 8, 2019 (AFP) - Just over 100 kilometres (62 miles) from Dubai's skyscrapers, Mohammed al-Kaabi strolls through the tranquil desert with his friends as the sun sets.   Kaabi, 27, hails from a long line of Emiratis, a people with a centuries-old bedouin history tied inextricably to the local desert.    Today, he is among a fast-growing group drawn to a new wave of a tradition of desert camping but with all the trappings of comfort, style and modernity.   With "glamping", short for "glamorous camping", Dubai aims to expand on its renown for luxurious city living and its tradition of camping.

Betting on tourism at a time of low oil prices, Dubai is now offering stays in chic desert trailers, in plush mountainside lodgings and beach camps, as it seeks to put its own mark on the glamping trend that has swept world tourism destinations.   "This place is far from the cities and the high-rises," said Kaabi, sporting the traditional full-length white Emirati robe worn by men.   "Camping is very popular in the UAE, but when you want to bring the family it becomes more complicated," he added, at a campsite in Hatta, near the Omani border.   "But here, safety and comfort are provided for."

- A room with... a bed -
Camping is still a beloved way of life for many Emiratis, who take their equipment and head for the desert from the fall months onwards, when the scorching summer heat has faded.    Tourists and expat residents also increasingly opt to escape the hustle and bustle of the city.

Dubai welcomed a record 15.9 million visitors in 2018, many of whom were drawn to its mega malls, luxurious hotels and pristine beaches.   It hopes to push the figure up to 20 million visitors annually by next year, when it hosts the six-month global trade fair, Expo 2020.    The mountainous eastern Hatta desert has lots to offer "glampers" with a taste for adventure but also for their home comforts.   Near the Hatta dam, campers have a choice between a trailer, caravan or five-star lodge fully equipped with TVs and power points for charging a smartphone.

Seated outside a trailer, Jamil Fahmy, a Dubai resident from Saudi Arabia, said glamping was the perfect way to escape the city without compromising on hygiene.    "It's fun, with the fire and hanging with friends and all that, but I personally prefer to sleep in a room with a bed and a private bathroom, and that's what we get here," he told AFP.    "It's great to be an adventurer and explore and cook fireside, and that's what we did.   "But when the time came, we retreated into the beautiful room and slept on a bed."

- 'Five-star camping' -
Rooms with modern amenities, including bathrooms and beds, start from 400 dirhams (about $110, 100 euros) per night at the Hatta site, which opened in October.    The Hatta camping project, part of Dubai's plan to use tourism to diversify revenues, is also home to a 350-metre zip wire.   Last year, Dubai faced a downturn in the real-estate market due to a supply glut, while oil prices also dropped, affecting the UAE as a whole.    Several glamping sites, some on the beach, have popped up across the UAE in recent years, with options to participate in yoga classes, star gazing or kayaking.

For Jay, a 37-year-old Briton, glamping offers a new experience after a decade in the UAE.    "We're fairly outdoorsy, we came here kayaking before, we did the big zip line," he told AFP, referring to the Hatta zip wire.    But, he added with a laugh that with the usual no-frills style of camping "you haven't got a shower or all the facilities" so glamping is a welcome step-up.   "You get the outdoors and all of that, and nature, and you can barbeque -- but you can also have a shower and get clean!   "It's not five-star hoteling, but five-star camping."
Date: 30 Jan 2019
From: Taiichiro Kobayashi <tkobayashi@cick.jp> [edited]

Two women who returned to Japan from the United Arab Emirates (UAE) were diagnosed with dengue fever (DF). They could be the 1st reported cases of DF infected in the UAE. They live in Japan and travelled together to the UAE from 29 Dec 2018 to 4 Jan 2019. During their stay in the UAE, they mostly stayed in Dubai and were bitten by mosquitoes several times.

They came to Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital on 16 Jan 2019. A 32-year-old woman and a 29-year-old woman complained of high fever for 6 and 4 days, respectively. One revealed an erythematous rash on her trunk, face and extremities, and their tourniquet test results were positive. Their blood examinations revealed leukocytopenia, thrombocytopenia and mild liver dysfunction.

Although the UAE is not known as an endemic country of DF, we suspected the women of having DF because of their history, physical examination and laboratory test results. We performed a rapid diagnostic test of DF (SD BIOLINE Dengue DUO), and their results of non-structural protein 1 (NS1) antigen were positive. Furthermore, dengue virus serotype 3 (DENV-3) genotype III genome was detected from both of their sera with real-time RT-PCR and following viral genome sequence analysis at the Laboratory of Arboviruses, National Institute of Infectious Diseases (NIID), Japan.

These 2 cases may be a signal of the emergence of DF in the UAE, where urbanization progresses and many travellers and immigrants from DF-endemic countries are being accepted.
===============================
Taiichiro Kobayashi
Department of Infectious Diseases
Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome
Hospital
Tokyo, Japan
<tkobayashi@cick.jp>

Yuya Atsuta, Masaru Tanaka, Kazuaki Fukushima, Keishiro Yajima and Akifumi Imamura
Department of Infectious Diseases
Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo, Japan

Takahiro Maeki, Shigeru Tajima, Satoshi Taniguchi, Masayuki Saijo and Chang-Kweng Lim
Department of Virology I, National Institute of Infectious Diseases Tokyo, Japan

[ProMED thanks the colleagues from Japan for sharing this important update on imported dengue fever cases, which were serotyped as DENV-3, from the UAE into Japan.

The worldwide distribution of dengue is expanding, in part due to globalized traffic and trade. _Aedes albopictus_ is a competent vector for dengue viruses (DENV) and is now established in numerous regions of the world. Travellers with viraemia arriving in any country from dengue-affected areas of the world can become proponents of local outbreaks. The above report also highlights the importance of considering dengue in differential diagnosis of fever with suggestive blood picture even in cases presenting in nonendemic areas. - ProMED Mod.UBA]

[HealthMap/ProMED-mail maps:
United Arab Emirates: <http://healthmap.org/promed/p/132]
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Paraguay

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

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

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

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

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

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the United States and Canada, or for callers outside the United States and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Paraguay does not recognize dual Paraguayan nationality for American citizens.
Under Article 150 of the Paraguayan Constitution, naturalized Paraguayans lose their nationality by virtue of a court ruling based on unjustified absence from the Republic for more than three years, or by voluntary adoption of another nationality.
Please see our Customs Information.

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

Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION: Americans residing or traveling in Paraguay are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Paraguay.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at 1776 Mariscal Lopez Avenue, Asuncion; telephone (011-595-21) 213-715, fax (011-595-21) 213-728; Internet: http://paraguay.usembassy.gov, email: paraguayconsular@state.gov.
The Consular Section is open for U.S. citizen services, including registration, Monday through Thursday from 1:00 p.m. to 4:30 p.m. and Fridays from 7:30 a.m. to 10:30 a.m., except for U.S. and Paraguayan holidays; telephone (011-595-21) 213-715, fax (011-595-21) 228-603.

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cyprus

Cyprus US Consular Information Sheet
December 30, 2009

Since 1974, Cyprus, a Mediterranean island nation, has been divided de facto into a government-controlled area comprising the southern two-thirds of the island, and a northern third (t
e self-declared “Turkish Republic of Northern Cyprus"), administered by Turkish Cypriots. The United States does not recognize the “Turkish Republic of Northern Cyprus” nor does any country other than Turkey. Facilities for tourism in Cyprus are highly developed. Cyprus joined the European Union in 2004. Read the Department of State Background Notes on Cyprus for additional information.
ENTRY/EXIT REQUIREMENTS: A passport is required for travel to Cyprus. A visa is not required for a stay of up to 90 days. For longer stays, a visa or residence permit is required. U.S. citizens should be mindful that the Government of Cyprus does not recognize the residence permits issued by Turkish Cypriot authorities for the portions of the island under Turkish Cypriot administration. The Government of Cyprus does not issue residency permits to individuals who live in the areas outside government control.
On occasion, Americans who resided in the area administered by Turkish Cypriots for more than 90 days without a Republic of Cyprus residence permit have been detained by officials at Larnaca airport and denied entry into the government-controlled area. They also may be subject to prosecution.

The U.S. Embassy encourages travelers to read the “Special Circumstances” section of this fact sheet for important additional information about entry requirements into the Turkish Cypriot-administered areas.
For further information on entry requirements for Cyprus, travelers can contact the Embassy of the Republic of Cyprus at 2211 R Street NW, Washington, DC 20008-4082, tel. (202) 462-5772, or the Cypriot Consulate in New York at 13 East 40th St., 5th Floor, New York, NY 10016, tel. (212) 686-6016/17. Visit the Embassy of Cyprus’ web site at http://www.cyprusembassy.net 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: Do not, under any circumstances, attempt to enter the U.N. buffer zone at any place other than a designated crossing point. This area is mined and militarized.
Never photograph military installations or anything that could be perceived as being of security interest (especially in the area administered by Turkish Cypriots). Pay particular attention to areas marked with “no photography” signs. Police on both sides strictly enforce these restrictions.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State’s 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 A Safe Trip Abroad.
CRIME: The crime rate in Cyprus is low. Visitors in urban areas should take the normal precautions they would take in any large city. Americans frequenting bars should avoid so-called “cabarets,” which sometimes employ women brought to Cyprus for sexual exploitation. These establishments can also present foreign patrons with grossly inflated bar tabs, threatening those customers who refuse to pay.

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

The local equivalent to the “911” emergency line in the Republic of Cyprus is 199 or 112.

Emergency assistance is available in the area administered by Turkish Cypriots by calling 155.
Also see our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is available at both government hospitals and private clinics. Emergency rooms offer adequate care to stabilize patients, most of whom are then transferred to private hospitals. Many of the private-sector doctors have been trained in the United Kingdom or the United States. While fees are generally lower than those in the United States, medical supplies are often more expensive. Paramedics do not staff ambulances. The standard of medical care in the area administered by Turkish Cypriots is improving but still falls below that found in the government-controlled area. The World Health Organization considers Cyprus to be one of the healthiest areas of the Mediterranean. Water supplies are potable, and the refuse collection/sewage disposal system is adequate. Communicable diseases such as typhoid are rare. Respiratory ailments and allergies are sometimes exacerbated by the dry and dusty climate.

Some HIV/AIDS entry restrictions exist for visitors to and foreign residents of Cyprus.
Legislation mandates that aliens known to have certain communicable diseases and HIV be denied entry into the country.
American citizens who think they may be included in this restriction are encouraged to check with the Embassy of Cyprus at http://www.cyprusembassy.net before they travel.
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 (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s 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 Cyprus is provided for general reference only, and it may not be totally accurate in a particular location or circumstance.
In recent years, Cyprus ranked among the top three countries in Europe, on a per capita basis, in traffic fatalities. Speeding, tailgating, overtaking, and the running of caution lights are commonplace and major causes of accidents. Emergency assistance is available in the Republic of Cyprus by calling 112 or 199.
Emergency assistance is available in the area administered by Turkish Cypriots by calling 155.
There are few public buses and no rail lines. Taxis are widely available. Traffic moves on the left side of the road, British style, and modern motorways link the major cities. Secondary roads, especially in mountainous areas, tend to be narrow and winding, and they are not as well maintained as major highways. Traffic laws, signs and speed limits are consistent with the standards used throughout Europe. Traffic circles (roundabouts) are often utilized at major intersections.

The use of seat belts (in front seats) and child car seats is required. Motorcyclists are required to wear helmets and the use of cellular phones while driving is prohibited unless used with some form of hands-free kit. Liability insurance is mandatory.

Road safety conditions in the area administered by Turkish Cypriots are similar to conditions in the south, except that the road network is less developed. Insurance purchased in the government-controlled area is not valid in the area administered by Turkish Cypriots, but insurance for that area may be purchased near the U.N. "buffer zone" checkpoints.
Please refer to our Road Safety page for more information. For specific information concerning driving permits, vehicle inspection, road tax and mandatory insurance in Cyprus, contact the Cyprus Tourism Organization at 13 East 40th Street, New York, NY 10016, tel. (212) 683-5280, email: gocyprus@aol.com, web site: http://www.visitcyprus.com/wps/portal.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Cyprus, the U.S. Federal Aviation Administration (FAA) has not assessed Cyprus’ 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: Since 1974, the Republic of Cyprus has designated Larnaca and Paphos international airports, and the seaports of Limassol, Larnaca, and Paphos, as the only legal points of entry into and exit from Cyprus. These ports are all in the government-controlled southern part of the island. Entry or exit via any other air or seaport is considered an illegal act by the Republic of Cyprus. Formerly, visitors choosing to arrive at non-designated airports and seaports in the area administered by Turkish Cypriots were not allowed to cross the U.N.-patrolled “buffer zone” to the government-controlled area in the south. Since 2004, when the Republic of Cyprus implemented new EU-related crossing regulations, Americans (and citizens of other non-EU countries not requiring visas) have been able to cross regardless of their port of entry into Cyprus.

Most American visitors to Cyprus are able to cross the “buffer zone” without hindrance, although on occasion difficulties are encountered at both the government and Turkish Cypriot checkpoints. Cypriot officials at the “buffer zone” checkpoints or at airports and seaports in the government-controlled area may detain and prosecute Americans who have been present for more than 90 days in the area administered by Turkish Cypriots if they do not possess a residency permit issued by the Government of Cyprus.

For visits of less than 90 days, American citizens may enter the Turkish Cypriot-administered area by displaying a valid U.S. passport.
Stays for 90 days or longer require a “temporary residency visa” issued by Turkish Cypriot authorities.
Turkish Cypriot authorities have deported foreigners who violate this law.
Turkish Cypriot authorities emphasize that the requirement to obtain a temporary residency visa within 90 days of arriving in the Turkish Cypriot-administered area cannot be avoided by periodically visiting the southern part of the island controlled by the Republic of Cyprus.
Policy and procedures regarding travel across the “buffer zone” are subject to change. More information on current procedures may be obtained at the U.N. “buffer zone” Ledra Palace checkpoint in Nicosia.
In an effort to prevent international child abduction, many governments have initiated strict identification procedures at entry/exit points. These often include requiring documentary evidence of relationship and permission for the child's travel from the parent(s) or legal guardian, if not present. Having such documentation on hand, even if not required, may facilitate entry and departure. Although Cyprus is party to the Hague Convention on the Civil Aspects of International Child Abduction, the Convention cannot be used effectively to recover a child abducted to the area administered by Turkish Cypriots.

Cyprus customs authorities enforce strict regulations concerning temporary importation into or export from Cyprus of items such as firearms. There are no restrictions on contemporary religious materials and medication for personal use; however, Cyprus does restrict the export of Byzantine era ecclesiastical material.
It is advisable to contact the Embassy of the Republic of Cyprus in Washington, DC for specific information regarding customs requirements or visit http://www.mof.gov.cy/mof/customs/ced.nsf/DMLindex_en/DMLindex_en?OpenDocument.
In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines. Cyprus restricts the export of Byzantine period ecclesiastical material and all archaeological material, including ancient coins. The U.S. Customs Service may impose corresponding import restrictions in accordance with the Convention on Cultural Property Implementation Act. Also see our Customs Information.

In addition to being subject to all Cypriot laws affecting American citizens, individuals who also possess Cypriot nationality may be subject to laws that impose special obligations on citizens of Cyprus. For example, American citizens whom the Republic of Cyprus considers to be Cypriot citizens may be subject to compulsory military service and other aspects of Cypriot law while in Cyprus. American citizen males between the ages of 16 and 26 years who reside in the United States and whose parents or grandfather were Greek Cypriots or have Greek Cypriot names are advised to obtain a written confirmation that they reside permanently outside of Cyprus from the Cypriot Embassy in Washington, D.C. before they travel to Cyprus.
After their arrival in Cyprus, the young men should present their foreign residency confirmation statement to the Cypriot National Guard Registration office to obtain an exit permit. Those who believe they may be affected should inquire at the Embassy of the Republic of Cyprus regarding their status. American citizens whom the Turkish Cypriot authorities consider to be "citizens" may also be subject to compulsory military service in the area administered by Turkish Cypriots. The U.S. Embassy is unable to exempt dual nationals from such service.
For additional information, please see our dual nationality flyer.

American Citizens who buy or lease property, particularly in the area administered by Turkish Cypriots, may find their ownership challenged by people displaced as a result of the 1974 conflict. Prospective property buyers should always seek legal advice before buying. On October 20, 2006, the government of the Republic of Cyprus passed Article 303A of the Criminal Code which makes it a felony to buy, rent or sell property in Cyprus without the consent of the registered owner. Cypriot courts have used the law to prosecute people involved in the sale or purchase of property in the area administered by the Turkish Cypriots. The government of Cyprus has also attempted to enforce Cypriot legal judgments in property matters in other EU countries. Cypriot customs authorities routinely detain anyone arriving in Cyprus or crossing the buffer zone found to be in possession of documents relating to property purchases in the area administered by Turkish Cypriots.

In June 2006 the "Turkish Republic of Northern Cyprus" amended the laws governing its "Immovable Property Commission" to enable the Commission to accept claims for compensation or restitution from Greek Cypriots for property in the north.
The Government of the Republic of Cyprus does not recognize the legitimacy of the "Immovable Property Commission."
Some Greek Cypriots who have filed claims with the Commission have been subjected to intensive governmental and public pressure to withdraw their claims.
CRIMINAL PENALTIES: While in a foreign country, American citizens are 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 under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Cypriot laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Cyprus are strict, and convicted offenders can expect 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 Cyprus are encouraged to register with the U.S. Embassy through the State Department's travel registration web site
in order to obtain updated information on travel and security within Cyprus. 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 Metochiou and Ploutarchou Streets, Engomi, Nicosia, tel. 357-22-39-3939; fax 357-22-39-3344; e-mail consularnicosia@state.gov; web site http://cyprus.usembassy.gov/
The U.S. Government also maintains an office in the area administered by Turkish Cypriots. The office is located at 6 Serif Arzik Street, Koskluciftlik, Nicosia.
The telephone number when calling from the United States or the Republic of Cyprus is 0090-392-227-3930. When calling within the area administered by Turkish Cypriots, please dial 227-3930.
* * * * * *
This replaces the Country Specific Information dated June 27, 2008
to update sections on Entry and Exit Requirements, Information for Victims of Crime,
Special Circumstances, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu, 18 Oct 2018 07:16:17 +0200

Larnaca, Cyprus, Oct 18, 2018 (AFP) - Cypriot low-cost carrier Cobalt Air announced it was cancelling all flights from Thursday after just two years in operation, leaving passengers stranded and scrambling to get their money back.   The airline warned customers its offices would no longer be staffed and urged them to seek refunds through their travel agent or credit card company.   In a brief announcement issued on its website without prior warning late on Wednesday, the airline said it was cancelling all flights from 23:50 pm (2050 GMT) "due to indefinite suspension of Cobalt's operations".   "As a result, future flights or services provided by Cobalt will be cancelled and will no longer operate," it added without elaborating on the reasons.

The airline advised passengers who have tickets not to go to the Mediterranean holiday island's main airport at Larnaca on Thursday or attempt to contact its offices "as no Cobalt flights will operate and no Cobalt staff will be present".   "For refunds, please contact your credit card provider or travel agent," its statement said.   "We sincerely apologise once again and would like to thank our very loyal customers for their support over the last two years of Cobalt operations."   Cobalt, the largest Cypriot airline since the collapse of the state-owned flag carrier, ceased operations after reports that it had failed to reach a deal with a potential European investor.   It is not yet clear how many passengers have been affected by the sudden shutdown.   But the Cypriot transport ministry said passengers expecting to fly with Cobalt on Thursday should secure one-way tickets in economy class from another airline and keep their receipt to be reimbursed.

Nine flights had been scheduled to arrive and nine to depart from Larnaca airport on Thursday.   Transport Minister Vasiliki Anastasiadou said that any stranded passengers in Cyprus would be helped.   Reportedly, the company has only 15 million euros in its accounts, which it needed to pay its 200 staff.   There was speculation that the budget airline was facing cash flow problems after two of its aircraft were grounded for two days.   Although Cobalt refused to comment on the rumours, sources within the company reportedly attributed the liquidity problems to difficulties faced by Chinese investors in exporting capital due to Chinese government restrictions.   The airline's largest shareholder is AJ Cyprus, with 49 per cent of the shares. AJ Cyprus is owned by China's AVIC Joy Air.   Cobalt stepped in to replace bankrupt state-owned Cyprus Airways, which shut down in January 2015.   Cobalt started flight operations in 2016 and acquired six aircraft -- two Airbus 319s and four Airbus 320s -- flying to 23 destinations.
Date: Tue, 17 Jul 2018 16:48:37 +0200

Nicosia, July 17, 2018 (AFP) - More than 1.6 million tourists visited Cyprus in the six months to June, the largest number ever for the first half of the year, the island's statistics office said Tuesday.   Tourist arrivals in January-June rose 12.4 percent to 1.64 million from 1.46 million in the same period last year, according to the Cyprus Statistical Service (Cystat).   "This also outnumbers the total of arrivals ever recorded in Cyprus during the first six months of the year," it said.

An influx of tourists from main market Britain and an upswing from Sweden helped Cyprus mark another record as arrivals in June broke the 500,000 barrier, Cystat said.   "June 2018 had the highest volume of tourist arrivals ever recorded in Cyprus during the specific month," it said.   Arrivals reached 511,073 in June, an increase of 8.2 percent from last year's 472,450.   The statistical department noted however a 5.1 percent drop in the number of Russian tourists, as well as a 15.1 percent decrease in arrivals from Israel and a 11.3 percent decline from Germany.   Year-on-year tourist arrivals from number one market the United Kingdom rose by 9.9 percent in June to 164,477 while there was a 20.2 percent increase in tourists from Sweden.

Sweden has now become the island's third largest tourist market, with Russia still holding second place.   Industry officials argue that arrivals from Russia are down due to fluctuations of the ruble and the renewed popularity of Turkey -- a destination made more attractive by a weak Turkish lira.   The tourism boom has helped Cyprus return to growth following a 10-billion-euro bailout in March 2013 to rescue its crumbling economy and insolvent banks.   Income from tourism now accounts for about 15 percent of the eastern Mediterranean island's gross domestic product and is credited with underpinning a quick recovery.   A record 3.65 million tourists took holidays in Cyprus last year, spending an unprecedented 2.6 billion euros.
Date: Sun, 24 Jun 2018 22:13:43 +0200

Nicosia, June 24, 2018 (AFP) - A British tourist was killed in a hit-and-run incident on Sunday near the Cypriot resort city of Paphos, police said.    The 39-year-old man was found dead at the scene after police responded to reports of an incident in the south-western coastal resort of Peyia at around 2:30 am (1130 GMT on Saturday).   The car was later found by police after being dumped in the sea.   Police arrested a man and woman in connection to the man's death.

A Paphos court on Sunday extended their detention for eight days on suspicion of pre-meditated murder.    Police said a 32-year-old British man also hit by the car was being treated at hospital, describing his condition as "out of danger".   According to local media reports, the two suspects and the tourists were involved in an argument at a pub in Peyia earlier in the evening.   Neither the identity of the dead tourist nor the two suspects have been released.
Date: Mon, 5 Mar 2018 15:30:54 +0100

Nicosia, March 5, 2018 (AFP) - Cyprus saw its best ever receipts from tourism in 2017, official data showed on Monday, in a record year for the eastern Mediterranean holiday island considered a regional safe haven.   Tourism income last year reached 2.63 billion euros ($3.23 billion) beating the 2.36 billion record set in 2016, an 11.7 percent increase, according to the Cyprus statistical service.   The surge in tourist spending coincides with another record year in arrivals, with more than 3.65 million people visiting the island last year -- 14.6 percent up from the 3.18 million visitors in 2016.

The expenditure per person, per day for the period January to December 2017 recorded a decrease of 2.6 percent (from 78.07 euros to 76.07).   In December the Lebanese were the biggest spenders on an average 147.88 euros per day and the most frugal were the Norwegians on 25.81 euros per day.   The island has benefited from a surge in arrivals from its largest markets Britain and Russia as well as a revival in those coming from Germany, Sweden and Israel.

Cyprus is seen as a safe haven for tourists, with other traditionally popular destinations in the eastern Mediterranean having been hit by political upheaval and security fears.   The surge has helped Cyprus return to growth following a 10-billion-euro package to rescue its crumbling economy and insolvent banks in March 2013.   Income from tourism accounts for about 12 percent of the eurozone member's gross domestic product and is credited with ensuring a relatively quick recovery.
Date: Fri, 17 Nov 2017 13:08:25 +0100

Nicosia, Nov 17, 2017 (AFP) - Cyprus has smashed its record for annual tourist arrivals with two months to spare, with the total reaching 3.4 million at the end of October, official figures showed on Friday.   The eastern Mediterranean island has benefited from its reputation as a regional safe haven as unrest has hit the tourism sectors of its traditional competitors Egypt, Tunisia and Turkey.   Arrivals in the first 10 months already comfortably exceeded the record 3.18 million registered in the whole of 2016.

Cyprus has benefited from a boom in visitors from its largest market, Britain -- up nearly eight percent for January-October -- along with a revival in those coming from Germany (up 60 percent), second largest market Russia (up 5.2 percent) and Israel (up 80.8 percent).   The surge has helped Cyprus return to growth following a 10-billion-euro bailout to rescue its crumbling economy and insolvent banks in March 2013.   Income from tourism accounts for about 12% of the country's gross domestic product and is credited with underpinning a quick recovery.
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Switzerland

Switzerland US Consular Information Sheet
December 01, 2008
COUNTRY DESCRIPTION:
Switzerland is a highly developed democracy.
Liechtenstein is a democratically run constitutional monarchy.
Read the Department of State Background
otes on Switzerland for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport is required for travel to both Switzerland and Liechtenstein.
A visa is not required for stays up to 90 days in either country.
For more information on entry requirements for both countries, travelers may contact the Embassy of Switzerland at 2900 Cathedral Avenue, NW, Washington, DC 20008, telephone (202) 745-7900, or the nearest Swiss Consulate General in Atlanta, Chicago, Los Angeles, New York, or San Francisco.
Visit the Embassy of Switzerland’s web site at http://www.swissemb.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:
Although there have been no recent terrorist attacks in Switzerland, violence by anti-globalization, anti-Semitic, and anti-establishment (anarchist) groups does occur from time to time.
This violence is typically in the form of property damage and clashes between these groups and the police.
The potential for specific threats of violence involving American citizens in Switzerland is remote.
Nevertheless, the Consular Agencies in Zurich and Geneva may close periodically to assess their security situation.
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:
Switzerland has a low rate of violent crime.
However, pick-pocketing and purse snatching do occur in the vicinity of train and bus stations, airports, and some public parks, especially during peak tourist periods (such as summer and Christmas) and when conferences, shows, or exhibits are scheduled in major cities.
Liechtenstein has a low crime rate.
Travelers may wish to exercise caution on trains, especially on overnight trains to neighboring countries.
Thieves, who steal from passengers while they sleep, can enter even locked sleeping compartments.
Thieves have been known to work in pairs to target train passengers; while one member of the pair creates a diversion at a train window or on a platform, the other steals items left briefly unattended.

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.

Switzerland, through its 26 cantons (states), has programs to assist victims of crime and their immediate relatives.
Medical, psychological, social, financial, and legal assistance are available throughout the country.
These programs also protect the rights of the victim during criminal proceedings.
The victim may receive compensation for some damages, if requested during the criminal procedure.
Information is available at the Swiss Department of Justice located on Bundesrain 20, 3003 Bern, telephone: 41-31-322-4750, as well as on the Internet at http://www.bj.admin.ch/bj/en/home.html
The local equivalent to the “911” emergency line in Switzerland is fire 118; police 117; medical 144.
For additional assistance, including possible U.S. compensation, see our information for Victims of Crime.

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

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Switzerland.
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 Switzerland is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Although many roads are mountainous and winding, road safety standards are high.
In some mountain areas, vehicle snow chains are required in winter.
Road travel can be more dangerous during summer, winter holidays, the Easter break, and Whitsunday weekend (late spring) because of increased traffic.
Travel on expressways (indicated by green signs with a white expressway symbol) requires purchase of a sticker or “vignette,” which must be affixed to the car’s windshield.
Vignettes can be purchased at most border crossings points, gas stations and at Swiss post offices.
Drivers using the highway system without a vignette are subject to hefty fines levied on the spot.
Public transportation in Switzerland and Liechtenstein is excellent.

Please refer to our Road Safety page for more information.
Visit the website of Switzerland’s national tourist office at http://www.myswitzerland.com/en.cfm/home.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Switzerland’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Switzerland’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:
Travelers who plan to participate in mountain activities (summer and winter) are strongly encouraged to buy mountain search and rescue insurance. Costs of search and rescue operations are the responsibility of the victim. Search and rescue insurance is available inexpensively in Switzerland and may be purchased at many Swiss post offices.
Information can be obtained from the Swiss National Tourist Office, at http://www.myswitzerland.com, at most tourist information offices or with the Swiss Air Rescue Organization at http://www.rega.ch/en/start_en.aspx .
Such insurance has proved useful as uninsured rescues can easily cost $25,000.

Switzerland’s customs authorities encourage the use of an ATA (Admission Temporaire/Admission) Carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes.
ATA Carnet Headquarters located at the U.S. Council for International Business, 1212 Avenue of the Americas, New York, N.Y. 10036, and issues and guarantees the ATA Carnet in the United States.
For additional information call (212) 354-4480, send an email to atacarnet@uscib.org, or visit http://www.uscib.org for details.
Please see our information on Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Switzerland’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Switzerland 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 Switzerland are encouraged to register with the U.S. Embassy in Bern, with the Consular Agencies in Geneva or Zurich, or through the State Department’s travel registration web site, and to obtain updated information on travel and security within Switzerland and Liechtenstein.
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, Consulate, or Consular Agent to contact them in case of emergency.
The U.S. Embassy is located at Sulgeneckstrasse 19, 3007 Bern; Tel. (41)(31) 357-7011 (2 p.m. – 5 p.m.); fax (41)(31) 357-7280.
The Embassy’s email address is bernacs@state.gov.
The U.S. Embassy website at http://bern.usembassy.gov answers many questions of interest to Americans visiting and residing in Switzerland.

The U.S. Consular Agency in Zurich is located at the American Center of Zurich, Dufourstrasse 101, 8008 Zurich; Tel: (41)(43) 499-2960 (10 a.m. – 1 p.m.), fax (41)(43) 499-2961.
The U.S. Consular Agency in Geneva is located at rue Versonnex 7, CH-1207 Geneva, Tel: 022-840-51 60 (10 a.m. – 1 p.m.); fax 022-840-51 62.
There is no U.S. Embassy or Consulate in Liechtenstein.
For assistance and information on travel and security in Liechtenstein, U.S. citizens may contact or register at the U.S. Embassy in Bern at the address above.
*
*
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This replaces the Consular Information Sheet dated March 3, 2008 with changes to the sections on Crime and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon 11 Nov 2019 14:31 CET
Source: SWI (swissinfo.ch) [edited]

Over 250 cases of the tick-borne early summer meningoencephalitis (ESME) disease have been recorded in Switzerland so far in 2019, the 2nd-highest number since the year 2000.

In its weekly bulletin published [Mon 11 Nov 2019], the Federal Office for Public Health (FOPH) wrote that 251 cases of the disease had been reported up to the end of October [2019]. The government urged a nationwide vaccination against the disease at the start of the year.

The figure is 2nd-only to the record 353 of last year [2018]. The 3rd-most cases reported in a single year came in 2017, with 250. Overall, since the year 2000, annual cases have fluctuated, with some years seeing less than 100 incidences, but with a steady rise in the past 5 years.

ESME, which attacks the nervous system and may result in paralysis, permanent sequelae or death, according to the World Health Organisation (WHO), is transmitted by tick bites, and most cases are reported in the summer months. In 2019, the peak came in July.

However, the FOPH also noted that general consultations by patients suffering from tick bites, as well as patients showing signs of Lyme disease -- another tick-borne disease -- were both within the normal range in 2019, at 18 000 and 9300 respectively.

The WHO says that the risk of contracting ESME is highest when hiking or camping in forested areas up to an altitude of about 1500 metres [about 4920 ft].

Advice for avoiding tick-borne diseases are mainly practical precautions such as wearing long trousers and closed footwear when hiking or camping in nature. The WHO also says that "the whole body should be inspected daily and attached ticks removed as soon as possible."

Ticks have to be properly removed with tweezers. If mouth parts of the tick remain under the skin for longer than around 36-48 hours, there is a risk of becoming ill.
=====================
[This has, indeed, been an active year for tick-borne encephalitis (TBE) cases in Switzerland. The Swiss government has had a proactive tick-borne encephalitis (TBE) vaccination program this year (2019), beginning early in the year. In a press release (<https://www.admin.ch/gov/fr/accueil/documentation/communiques.msg-id-73873.html> in German, French, Italian), the office repeated the call for anybody who may be exposed to ticks -- for example walkers, especially in forests -- to be vaccinated. Residents of Geneva or Ticino travelling outside their canton for such activities should also get the jab, it said. The optimum time for vaccination is in winter, the office wrote, so that walkers and hikers are protected once the good weather and riskiest period (from April to October) rolls around.

As cited earlier, according to government information, the most widespread TBE vector tick species in Switzerland is the wood tick (_Ixodes ricinus_, commonly known as the castor bean tick or sheep tick). It prefers deciduous woods with abundant undergrowth, the edge of the forest, and forest paths and waits on low-growing plants until a warm-blooded host (a person or animal) brushes against the plant.

In a previous comment in 2017 concerning TBE in Switzerland, Dr Ivo M Foppa indicated that the incidence of TBE in Switzerland has increased markedly, roughly about 50%, since 2000. The reason for the increase in TBE incidence in Central/Western/Northern Europe is unknown.

TBE is a virus infection caused by one of 3 TBE virus subtypes belonging to the Flaviviridae family: Central European, Siberian, and Far Eastern (formerly known as Russian spring-summer encephalitis). It is transmitted to humans through the bite of infected _Ixodes_ ticks. - ProMED Mod.TY]

[Maps of Switzerland:
<https://www.mapsofworld.com/switzerland/switzerland-political-map.html>
and <http://healthmap.org/promed/p/105>]
Date: Mon 21 Oct 2019
Source: Swiss Info [in French, trans. Corr.SB, abridged, edited]

Measles can still be deadly, even in Europe, says the FOPH [Federal Office of Public Health]. Thus 2 deaths related to the virus have been recorded so far in 2019.

A total of 214 cases of measles have been reported in Switzerland since January [2019], 6 times more than in 2018 (34 cases), and 2 deaths. The outbreaks of the disease could nevertheless be controlled.

The incidence of measles during the 1st 9 months of the year increased from 4 cases per million inhabitants in 2018 to 25.1 cases in 2019, says the Bulletin of the FOPH broadcast Monday [21 Oct 2019]; 19% were isolated cases spread over 13 cantons, of which 83 were in the canton of Bern alone.

Of these 214 cases, 58% were endemic, with no known foreign link; 17% were imported; and 9% were related to an imported case. In 16% of cases, the origin of the infection could not be established. Of the cases, 9% were fully vaccinated.

According to the FOPH, 20% of those infected were under 10 years of age, 23% were aged 10-19, and 57% were 20 or older; 91% of the 172 people with known vaccination status were not vaccinated or were incompletely vaccinated, while 9% were fully vaccinated.

The majority of cases in 2019 in Switzerland belonged to one of the 30 outbreaks recorded from January to May, which could be stopped at the end of May [2019]. These outbreaks occurred in total in 12 cantons. The most affected were Geneva, St. Gallen, Zurich, Neuchatel, and Bern.

One of the [deaths] was a young adult who was previously healthy and unvaccinated. Post-exposure vaccination took place too late to save him.

The other case was an elderly man, immunosuppressed due to cancer. He died of measles pneumonia, despite intensive care in the hospital. A total of 45 people (21% of the reported cases) had to be hospitalized.

In 2010, Switzerland set itself the goal of eradicating this disease. At the end of July 2019, the World Health Organization (WHO) declared for the 1st time that endemic measles had been eliminated from Switzerland between 2016 and 2018. Like Austria, it is one of 35 countries (out of 53 WHO European Region countries) in which this disease was eliminated between 2016 and 2018.

According to WHO indicators, the virus is considered eliminated when no transmission chain of more than 12 months is observed for 3 consecutive years. Cases imported from abroad are not taken into account.

Despite the outbreaks of early 2019, Switzerland still fulfils WHO's elimination criteria, as no chain of transmission has been observed since June [2019].

For the FOPH, this success is mainly due to vaccination coverage, particularly for infants, which has been steadily increasing in recent years. But efforts must be kept up.
Date: Mon 22 Jul 2019
Source: Swissinfo [edited]

Cases of tick-borne diseases, including encephalitis and Lyme disease, almost halved in Switzerland in the 1st 6 months of 2019 compared with the same period last year [2018].

Figures for 2019 so far show 127 cases of meningoencephalitis [the graph shows approximately 75 cases - ProMED Mod.TY], compared with 218 for the 1st half of 2018. Those showing symptoms of Lyme disease fell from 10 000 to 3600.

But Daniel Koch, head of communicable diseases at the Federal Office for Public Health (FOPH), told the Keystone-SDA news agency that while the numbers mark a big fall from 2018, they are closer to the average over a longer time period. Indeed, since 2000, numbers of tick-borne encephalitis declared in the 1st 6 months of the year varied between 24 and 120, FOPH figures show. In 2018, the number was 206.

If the cause of last year's [2018's] peak remains unclear, the subsequent drop in 2019 is also difficult to explain, though it has coincided with a concerted campaign by authorities to encourage vaccination among the population. Tick-borne encephalitis, a debilitating and potentially fatal disease that attacks the nervous system, is preventable through a jab.

To reduce the risk of picking up tick-borne diseases, authorities recommend avoiding particularly at-risk areas -- for example, bushes and tall grass -- as well as using an insect repellent and wearing clothing that covers the arms, legs, and feet.  [Byline: Laurent Gillieron]
===================
[The Swiss government has had a proactive tick-borne encephalitis (TBE) vaccination program this year (2019), beginning early in the year. In a press release [<https://www.admin.ch/gov/fr/accueil/documentation/communiques.msg-id-73873.html>], the office repeated the call for anybody who may be exposed to ticks -- for example walkers, especially in forests -- to be vaccinated. Residents of Geneva or Ticino travelling outside their canton for such activities should also get the jab, it said. The optimum time for vaccination is in winter, the office wrote, so that walkers and hikers are protected once the good weather and riskiest period (from April to October) rolls around.

As cited earlier, according to government information, the most widespread TBE vector tick species in Switzerland is the wood tick (_Ixodes ricinus_, commonly known as the castor bean tick or sheep tick). It prefers deciduous woods with abundant undergrowth, the edge of the forest, and forest paths and waits on low-growing plants until a warm-blooded host (a person or animal) brushes against the plant.

In a previous comment in 2017 concerning TBE in Switzerland, Dr Ivo M Foppa indicated that the incidence of TBE in Switzerland has increased markedly, roughly about 50%, since 2000. The reason for the increase of TBE incidence in Central/Western/Northern Europe is unknown.

TBE is a virus infection caused by one of 3 TBE virus subtypes belonging to the Flaviviridae family: Central European, Siberian, and Far Eastern (formerly known as Russian spring-summer encephalitis). It is transmitted to humans through the bite of infected _Ixodes_ ticks. - ProMED Mod.TY]

[Maps of Switzerland:
Date: Sun, 16 Jun 2019 00:19:43 +0200

Geneva, June 15, 2019 (AFP) - A woman has drowned in Lake Geneva when her sightseeing boat sank as a violent storm battered parts of Switzerland on Saturday, police said.   A man who was in the same boat was able to swim to another vessel from where he fired "two flares", Joanna Matta, police spokeswoman for the canton (region) of Geneva, told AFP.   The man told officers that the woman had been "passing through Geneva" and that the storm had taken them "by surprise", Matta said.   Three police boats and emergency services rushed to the scene. Police divers later retrieved the woman's body from the lake.

The victim, whose nationality remains unknown, was then taken to a hospital in Geneva where she was declared dead.   In a separate incident, the storm also damaged some of the 465 boats taking part in the 81st edition of the Bol d'Or, an annual regatta on Lake Geneva, the event's press service said.   Heavy rain and strong winds lashed the participants on Saturday afternoon, causing boats to capsize although nobody was injured.

However, the storm broke the mast of the ultra-fast "Real Team" catamaran, which had been in the lead and was forced to pull out of the race.   The bad weather struck western Switzerland on Saturday afternoon, bringing hail and winds reaching up to 110 kilometres (70 miles) per hour, according to the national forecaster MeteoSwiss.   In the neighbouring French region of Haute-Savoie the storm also caused damage and left a 51-year-old German tourist dead after a tree came down at a campsite.
diDate: Mon 3 Jun 2019
Source: FM1 Today [in German, machine trans., edited]

Several cases of pneumonia have occurred in the Ticino Maggia Valley in recent weeks. Those affected have been infected with Q fever. The situation is, however, under the control of the health authorities.

Q fever is transmitted by a bacterium found in goats. The Ticino health authorities have therefore ordered the vaccination of exposed animals. In addition, the transport of the animals from one farm to another was prohibited.

Infection with goat milk is considered very unlikely. Even from person to person, the disease is not transmitted. Q fever manifests itself with flu-like illnesses, but without a cold or sore throat. In 1-2 percent of cases there are complications.

Q fever is a notifiable disease in Switzerland. Since the beginning of the year [2019] around 50 cases have been reported, 20 of them from Ticino, said Daniel Koch of the Federal Office of Public Health (FOPH).

Therefore, there will be an increase this year [2019] compared to the approximately 40 cases that have occurred on average per year since 2012. In 2012, the disease was again declared as notifiable after 17 cases of illness occurred in the canton of Vaud.

According to Koch, the situation is under control, despite the increased occurrence of illnesses in Ticino. The established monitoring system proved its effectiveness. The last time a major epidemic of Q fever occurred in 1983. At that time, more than 400 people fell ill in Valais.
More ...

Andorra

General
************************************
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
**************
*********************
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
***************************************
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
************************************
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
************************************
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
************************************
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
************************************
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]
=====================
[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]
More ...

Venezuela

Venezuela US Consular Information Sheet
May 05, 2008
COUNTRY DESCRIPTION:

Venezuela is a medium income country whose economy is dominated by a substantial oil industry.
The political climate in Venezuela is highly polarized and
olatile.
Violent crime is a continuing problem.
Assaults, robberies, and kidnappings occur throughout the country.
Scheduled air service and all-weather roads connect major cities and most regions of the country.
Venezuela’s tourism infrastructure varies in quality according to location and price.
For an in depth country description of Venezuela, please read the Department of State Background Notes on Venezuela.
ENTRY/EXIT REQUIREMENTS:
A valid passport and a visa or tourist card are required.
Tourist cards are issued on flights from the U.S. to Venezuela for persons staying less than ninety days.
Persons traveling for reasons other than tourism, however, should consult the Venezuelan Embassy or nearest Venezuelan consulate regarding possible visa requirements for their specific purpose of travel.
Venezuelan immigration authorities may require that U.S. passports have at least six months validity remaining from the date of arrival in Venezuela.
Some U.S. citizens have been turned back to the United States if their passports will expire in less than six months. Passports should also be in good condition, as some U.S. citizens have been delayed or detained overnight for having otherwise valid passports in poor condition.
U.S. citizens residing in Venezuela should be careful to obtain legitimate Venezuelan documentation appropriate to their status.
There have been numerous cases in the last several months of U.S. citizens who, having employed intermediaries, received what they believed to be valid Venezuelan resident visas and work permits.
They were subsequently arrested and charged with possessing fraudulent Venezuelan documentation.
ONIDEX, the Venezuelan government agency responsible for immigration documents, has informed the Embassy that the only valid resident visas are those for which the bearer has personally signed at ONIDEX headquarters in Caracas.

Venezuelan law requires Venezuelan citizens to enter and depart Venezuela using Venezuelan passports and Venezuelan immigration authorities are increasingly enforcing this requirement.
In order to comply with U.S. and Venezuelan law, persons who hold dual American-Venezuelan nationality must plan to travel between Venezuela and the United States with valid U.S. and Venezuelan passports.
Please see our information on dual nationality for entry and exit requirements pertaining to dual nationals.
Venezuela's child protection law mandates that minors (under 18) who are citizens or non-citizen residents of Venezuela and who are traveling alone, with only one parent, or with a third party, must present a copy of their birth certificate and written, notarized authorization from the absent parent(s) or legal guardian, specifically granting permission to travel alone, with one parent, or with a third party.
This authorization must reflect the precise date and time of the travel, including flight and/or other pertinent information.
Without this authorization, immigration authorities will prevent the child's departure from Venezuela.
The Venezuelan Government no longer recognizes blanket or non-specific travel authorizations.
When a parent is deceased, a notarized copy of the death certificate is required in lieu of the written authorization.
If documents are prepared in the United States, the authorization and the birth certificate must be translated into Spanish, notarized, and authenticated by the Venezuela Embassy or a Venezuelan consulate in the United States.
If documents are prepared in Venezuela, only notarization by a Venezuelan notary is required.
A permission letter prepared outside Venezuela is valid for 90 days.
A permission letter prepared in Venezuela is valid for 60 days.
Travelers entering Venezuela from certain countries are required to have a current yellow fever vaccination certificate.
The Venezuelan government recommends that all travelers, regardless of their country of departure, be vaccinated for yellow fever before entering Venezuela.
Mosquito-borne diseases such as malaria and dengue fever are also common in some areas and travelers should take precautions to prevent infection.

An exit tax and airport fee must be paid when departing Venezuela by airline.
The exit tax is currently 46 Bolívares Fuertes, and the airport fee is currently 115 Bolívares Fuertes (a total of approximately 75 USD calculated at the official exchange rate). In many instances, especially with non-U.S. airlines, the exit tax and airport fee are not included in the airline ticket price and must be paid separately at the airport upon departure.
Authorities usually require that payment be made in local currency.
Both the departure tax and the airport fee are subject to change with little notice.
Travelers should check with their airlines for the latest information.
For current information concerning entry, tax, and customs requirements for Venezuela, travelers may contact the Venezuelan Embassy at 1099 30th Street, NW, Washington DC
20007, tel: (202) 342-2214, or visit the Embassy of Venezuela web site at http://www.embavenez-us.org/.
Travelers may also contact the Venezuelan consulates in New York, Miami, Chicago, New Orleans, Boston, Houston, San Francisco, or San Juan.
Additional information about vaccination requirements for travel to Venezuela, as well as to other international destinations, 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); fax 1-888-CDC-FAXX (1-888-232-3299), or via CDC's Internet site at http://wwwn.cdc.gov/travel/default.aspx.

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:
Violent crime in Venezuela is pervasive, both in the capital, Caracas, and in the interior.
The country has one of the highest per-capita murder rates in the world.
Armed robberies take place in broad daylight throughout the city, including areas generally presumed safe and frequented by tourists.
A common technique is to choke the victim into unconsciousness and then rob them of all they are carrying.
Well-armed criminal gangs operate with impunity, often setting up fake police checkpoints.
Kidnapping is a particularly serious problem, with more than 1,000 reported during the past year alone.
Investigation of all crime is haphazard and ineffective.
In the case of high-profile killings, the authorities quickly round up suspects, but rarely produce evidence linking these individuals to the crime.
Only a very small percentage of criminals are tried and convicted.

Travel to and from Maiquetía Airport, the international airport serving Caracas, can be dangerous and corruption at the airport itself is rampant.
Travelers at the airport have been victims of personal property theft, as well as mugging and “express kidnapping” in which individuals are taken to make purchases or to withdraw as much money as possible from ATMs, often at gunpoint.
The Embassy has received multiple, credible reports that individuals with what appear to be official uniforms or other credentials are involved in facilitating or perpetrating these crimes.
For this reason, American citizen travelers should be wary of all strangers, even those in official uniform or carrying official identification.
There are also known drug trafficking groups working from the airport.
Travelers should not accept packages from anyone and should keep their luggage with them at all times.

Because of the frequency of robberies at gunpoint, travelers are encouraged to arrive during daylight hours.
If not, travelers should use extra care both within and outside the airport.
The Embassy strongly advises that all arriving passengers make advance plans for transportation from the airport to their place of lodging.
If possible, travelers should arrange to be picked up at the airport by someone who is known to them.
The Embassy has received frequent reports of armed robberies in taxicabs going to and from the airport at Maiquetía.
There is no foolproof method of knowing whether a taxi driver at the airport is reliable.
The fact that a taxi driver presents a credential or drives an automobile with official taxi license plates marked “libre” is no longer an indication of reliability.
Incidents of taxi drivers in Caracas overcharging, robbing, and injuring passengers are common.
Travelers should take care to use radio-dispatched taxis or those from reputable hotels.
Travelers should call a 24-hour radio-dispatched taxi service from a public phone lobby or ask hotel, restaurant, or airline representatives to contact a licensed cab company for them.
A list of transportation services used by members of the U.S. Embassy community is available on the U.S. Embassy web site at http://venezuela.usembassy.gov/.
The Embassy does not vouch for the professional ability or integrity of any specific provider.
The list is not meant to be an endorsement by the Department of State or the Embassy.
Likewise, the absence of any individual or company does not imply lack of competence.
While visiting Venezuela, Americans are encouraged to carry as little U.S. currency on them as possible and to avoid wearing expensive or flashy watches and jewelry.
Due to the poor security situation, the Embassy does not recommend changing money at the international airport.
Visitors should bring a major credit card, but should be aware of widespread pilfering of credit card data to make unauthorized transactions.
Travelers’ checks are not recommended as they are honored in only a few locations.
It is possible to exchange U.S. currency at approved exchange offices near major hotel chains in Caracas (personal checks are not accepted) and at commercial banks with some restrictions.
Due to currency regulations, hotels cannot provide currency exchange.
There are ATM machines throughout Venezuela.
Malfunctions are common, however, and travelers should be careful to use only those in well-lit public places.
ATM data has also been hacked and used to make unauthorized withdrawals from user’s accounts.
Popular tourist attractions, such as the Avila National Park, are increasingly associated with violent crime.
Americans planning to participate in outdoor activities in potentially isolated areas are strongly urged to travel in groups of five or more and to provide family or friends with their itineraries prior to departure.
Cross-border violence, kidnapping, drug trafficking, smuggling, and cattle-rustling occur frequently in areas along the 1,000-mile long border between Venezuela and Colombia.
Some kidnap victims have been released after ransom payments, while others have been murdered.
In many cases, Colombian terrorists are believed to be the perpetrators.
Colombia's National Liberation Army (ELN) has had a long history of kidnapping for ransom, and the Revolutionary Armed Forces of Colombia (FARC) are active in the kidnapping trade.
Common criminals are also increasingly involved in kidnappings, either dealing with victim's families directly or selling the victim to terrorist groups.

In-country travel by U.S. Embassy employees, both official and private, within a 50-mile area along the entire Venezuela/Colombia border, is prohibited.
The State Department warns American citizens not to travel within a 50-mile area along the entire Venezuela/Colombia border.
U.S. citizens who elect to visit areas along the border region with Colombia despite this warning, apart from the Colombian terrorist threat, could encounter Venezuelan military-controlled areas and may be subject to search and arrest.
The U.S. Embassy must approve in advance the official travel to Venezuela of all U.S. Government personnel.
Private travel by U.S. military personnel to Venezuela requires advance approval by the U.S. Embassy.
Please consult the Department of Defense Foreign Clearance Guide at https://www.fcg.pentagon.mil/ for further information.
Non-military employees of the U.S. Government do not need Embassy approval for private travel.
Political marches and demonstrations are frequent in Caracas and often pass without incident.
Nevertheless, travelers should be aware that violence, including exchanges of gunfire, has occurred at political demonstrations in the past.
Demonstrations tend to occur at or near university campuses, business centers, and gathering places such as public squares and plazas.
Marches generally occur on busy thoroughfares, significantly impacting traffic.
Most major tourist destinations, including coastal beach resorts and Margarita Island, have not in the past been generally affected by protest actions.
The city of Merida, however, a major tourist destination in the Andes, has been the scene of frequent student demonstrations, some of them violent, including the use of firearms.
Travelers should keep informed of local developments by following the local press, radio and television.
Visitors should also consult their local hosts, including U.S. and Venezuelan business contacts, hotels, tour guides, and travel organizers.
As circumstances warrant, the Embassy sends out messages to U.S. citizens who have registered on-line.
These messages are also posted on the U.S. Citizens page of the Embassy’s web site at http://venezuela.usembassy.gov/.
U.S. citizens traveling or residing in Venezuela are advised to take common-sense precautions and avoid large gatherings and demonstrations, no matter where they occur.
Harassment of U.S. citizens by pro-government groups, Venezuelan airport authorities, and some segments of the police occurs but is quite limited. Venezuela’s most senior leaders, including President Chavez, regularly express anti-American sentiment.
The Venezuelan government’s rhetoric against the U.S. government, its American culture and institutions, has affected attitudes in what used to be one of the most pro-American countries in the hemisphere.

Venezuela is an earthquake-prone country and is occasionally subject to torrential rains, which can cause major disasters such as the one in Vargas State in 1999.
Travelers who intend to rent or purchase long-term housing in Venezuela should choose structures designed for earthquake resistance.
Such individuals may wish to seek professional assistance from an architect or civil/structural engineer, as does the Embassy, when renting or purchasing a house or apartment in Venezuela.
Americans already housed in such premises are also encouraged to seek a professional structural assessment of their housing.

For further information on seismic activity, you may wish to visit:

1. The Multidisciplinary Center for Earthquake Engineering Research (MCEER) web site at http://mceer.buffalo.edu/infoservice/Quakeline_Database/default.asp
2. The Global Seismic Hazard Assessment Program web site at www.seismo.ethz.ch/GSHAP
3. The Caribbean Disaster Mitigation Project web site at www.oas.org/CDMP
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts including 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: Venezuela and its capital, Caracas, have one of the highest per capita murder rates in the world.
Virtually all murders go unsolved.
The poor neighborhoods that cover the hills around Caracas are extremely dangerous.
These areas are seldom patrolled by police and should be avoided.
Armed robberies are common in urban and tourist areas throughout Venezuela, even areas presumed safe and visited by tourists.
Crimes committed against travelers are usually money-oriented crimes, such as theft and armed robbery.
Incidents occur during daylight hours as well as at night.
Many criminals are armed with guns or knives and will use force.
Jewelry attracts the attention of thieves.
Travelers are advised to leave jewelry items, especially expensive-looking wristwatches, at home.
Gangs of thieves will often surround their victims and use a chokehold to disable them, even in crowded market areas where there is little or no police presence.
Theft from hotel rooms and safe deposit boxes is a problem, and theft of unattended valuables on the beach and from rental cars parked near isolated areas or on city streets is a common occurrence.
A guarded garage or locked trunk is not a guarantee against theft.
Pickpockets concentrate in and around crowded bus and subway stations in downtown Caracas.
Subway escalators are favored sites for "bump and rob" petty thefts by roving bands of young criminals.
Many of these criminals are well dressed to allay suspicion and to blend in with crowds using the subways during rush hour.
Travelers should not display money or valuables.
"Express kidnappings," in which victims are seized in an attempt to get quick cash in exchange for their release, are a problem.
Kidnapping of U.S. citizens and other foreign nationals, from homes, hotels, unauthorized taxis and the airport terminal has occurred.
U.S. citizens should be alert to their surroundings and take necessary precautions.
The Department has received reports of robberies during nighttime and early morning hours on the highways around and leading to Caracas.
Reports have specifically involved cars being forced off the La Guaira highway leading from Caracas to the Maquetía International Airport, and the "Regional del Centro" highway leading from Caracas to Maracay/Valencia, at which point the victims are robbed.
The Department recommends avoiding driving at night and in the early morning where possible.
Drivers traveling on highways during nighttime and early morning hours should exercise caution.
Police responsiveness and effectiveness in Venezuela vary drastically but generally do not meet U.S. expectations.
U.S. travelers have reported robberies and other crimes committed against them by individuals wearing uniforms and purporting to be police officers or National Guard members.
Incidents of piracy off the coast of Venezuela remain a concern.
Some of these incidents have been especially violent, including the severe beating of a U.S. citizen in 2002, the fatal shooting of an Italian citizen in January 2004, and a machete attack on a U.S. citizen in 2005.
U.S. citizen yachters should exercise a heightened level of caution in Venezuelan waters.
Please consult the U.S. Coast Guard web site at http://www.uscg.mil/hq/g-o/g-opr/g-opr.htm for additional information on sailing in Venezuela.

Rules governing the sale of fuel to foreign sailors in Venezuela vary by state.
U.S. citizen yachters should inquire about specific state procedures prior to attempting to purchase fuel in any given location.
Failure to comply with a state’s particular requirements can result in arrest and criminal charges.

The Embassy is aware of several instances where women lured American men to Venezuela after establishing “relationships” with them over the Internet.
Some of these men were robbed shortly after they arrived in Venezuela.
Others were recruited to act as narcotics couriers or “drug mules.”
In three instances, the Americans were arrested at the airport with narcotics in their possession and served extended jail terms in Venezuela.
In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime are solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care at private hospitals and clinics in Caracas and other major cities is generally good.
Public hospitals and clinics generally provide a lower level of care and basic supplies at public facilities may be in short supply or unavailable.
Cash payment is usually required in advance of the provision of medical services at private facilities, although some facilities will accept credit cards.
Patients who cannot provide advance payment may be referred to a public hospital for treatment.
Private companies that require the patient to be a subscriber to the service or provide cash payment in advance generally provide the most effective ambulance services.
Public ambulance service is unreliable.
U.S. citizens should be aware that due to the currency restrictions in effect in Venezuela they might find it difficult to receive wire transfers from abroad, whether through a bank or Western Union.
Such wire transfers cannot be used reliably as a source of emergency funds.
U.S. citizens traveling to Venezuela may also find it difficult to obtain certain prescription drugs, particularly name brands, and should ensure that they have sufficient quantities of all medications for the duration of their stay.
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 Venezuela is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving regulations in Venezuela are similar to those in the United States, although many drivers do not obey them.
Defensive driving is a necessity.
Child car seats and seatbelts are not required and are seldom available in rental cars and taxis.
Outside the major cities, night driving can be dangerous because of unmarked road damage or repairs in progress, unlighted vehicles, and livestock.
Even in urban areas, road damage is often marked by a pile of rocks or sticks left by passersby near or in the pothole or crevice, without flares or other devices to highlight the danger.
Traffic jams are common within Caracas during most of the day and are frequently exploited by criminals. Stops at National Guard and local police checkpoints are mandatory.
Drivers should follow all National Guard instructions and be prepared to show vehicle and insurance papers and passports.
Vehicles may be searched.
Inexpensive bus service is available to most destinations throughout the country, but the high incidence of criminal activity on public transportation makes bus travel inadvisable.
Peak holiday travel occurs during summer and winter school breaks and major civil and religious holidays, including Carnival, Easter, Christmas and New Year's holidays.
Lengthy delays due to road congestion are common during these peak periods.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Venezuela’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Venezuela’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: In February 2007, the National Assembly granted President Chavez the authority to rule by decree in 11 general areas for 18 months.
Laws issued by President Chavez under this authority become effective immediately after their publication in the government legislative gazette.
As a result, laws directly impacting U.S. Citizens or their interests in Venezuela may come into force with little or no warning.
U.S. Citizens are advised to carefully monitor changes in Venezuelan law. Venezuela is also slated to hold gubernatorial and mayoral elections nation-wide in late 2008.
These electoral races are expected to generate extensive political campaigning from pro-government and opposition parties.
The government of Venezuela implemented rigid foreign exchange controls in 2003, including a fixed official rate of exchange.
Foreign exchange transactions must take place through exchange houses or commercial banks at the official rate.
As of October 2005 it is no longer possible to exchange money at hotels.
Currency exchange for tourists can be arranged at "casas de cambio" (exchange houses).
There are exchange houses located near most major hotels.
It is also possible to exchange money at commercial banks; however, visitors should be aware that the exchange would not be immediate.
Exchanges through commercial banks must first be approved by the Commission for Administration of Foreign Currencies (CADIVI).
This requires a registration process, which delays the exchange.
The exchange control mechanisms also require the exchange houses and commercial banks to obtain authorization from CADIVI to trade Bolívares Fuertes (the local currency) into U.S. dollars.
Outside the major cities, a good supply of Venezuelan currency is necessary, as it may be difficult to find exchange houses.
The Embassy cannot provide currency exchange services.
Travelers will likely encounter individuals in Venezuela who are willing to exchange Bolívares Fuertes for U.S. dollars at a rate significantly higher than the official rate of exchange.
These "parallel market" currency exchanges are prohibited under the Venezuelan foreign exchange controls.
Travelers engaging in such activity may be detained by the Venezuelan authorities.
Additionally, in accordance with an October 2005 law, any person who exchanges more than 10,000 U.S. dollars in the course of a year through unofficial means is subject to a fine of double the amount exchanged.
If the amount exceeds 20,000 U.S. dollars the penalty is two to six years imprisonment.
Any person who transports more than 10,000 U.S. dollars into or out of Venezuela by any means must declare this amount to customs officials.
Credit cards are generally accepted at most upscale tourist establishments, but foreign exchange controls have made credit card acceptance less common than in the past.
Visa, MasterCard, and American Express have representatives in Venezuela.
Due to the prevalence of credit card fraud in Venezuela, travelers should exercise caution in using their credit cards and should check statements regularly to ensure that no unauthorized charges have been made.
Most major cities have ATMs with 24-hour service where users may withdraw local currency, but many of these ATMs will not accept U.S.-issued debit cards.
Venezuelan customs authorities may enforce strict regulations concerning temporary importation into or export from Venezuela of items such as plant and animal products, firearms, medications, archaeological or "cultural heritage" items, and pirated copies of copyrighted articles.
It is advisable to contact the Embassy of Venezuela in Washington or one of Venezuela's consulates in the United States for specific information regarding customs requirements.
Please see our Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Venezuela’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Venezuela 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 Venezuela are encouraged to register with the U.S. Embassy in Caracas through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Venezuela.
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 to contact them in case of emergency.
The Consular Section is open for American Citizen Services from 8:00 a.m. to 10:30 a.m. Monday through Friday, excluding U.S. and Venezuelan holidays.
The U.S. Embassy is located at Calle Suapure and Calle F, Colinas de Valle Arriba, Caracas.
The telephone number during regular business hours (8:00 a.m. to 5:00 p.m.) is (58) (212) 975-6411.
In case of an after-hours emergency, callers should dial (58) (212) 907-8400.
The Embassy’s web site, http://venezuela.usembassy.gov/ , contains complete information about services provided and hours of operation.
A part-time consular agent in Maracaibo provides services for U.S. citizens in western Venezuela.
The agent is available to the public every Monday from 8:15 am to 12:15 pm, at the Centro Venezolano Americano del Zulia (CEVAZ), Calle 63 No. 3E-60, Maracaibo; telephone 58)(0261) 793-2101 or 793-3488.
*

*

*
This replaces the Consular Information Sheet dated November 1, 2007, and updates all sections.

Travel News Headlines WORLD NEWS

Date: Thu 21 Nov 2019
Source: WHO Emergencies preparedness [edited]

On 13 Nov 2019, the Venezuela International Health Regulations (IHR) National Focal Point (NFP) and the Venezuela PAHO/WHO Country Office shared information about a confirmed case of yellow fever in Bolivar State. The case-patient is a 46-year-old male resident of the municipality of Gran Sabana, Bolivar State. He was in the locality of Uriman municipality of Gran Sabana within the 19 days prior to the onset of symptoms. Symptom onset was on 14 Sep 2019, and included fever, chills, nausea, vomiting, epistaxis, petechiae, and diarrhoea. On 26 Sep 2019, he visited a public  hospital in the municipality of Heres where his condition deteriorated, with moderate dehydration, bleeding from the gums, jaundice, choluria, abdominal pain, and hepatomegaly. As of 13 Nov 2019, the patient remains hospitalized with chronic renal failure and moderate anaemia.

On 26 Sep 2019, the 1st serum sample was sent to the National Reference Laboratory, the National Institute of Hygiene "Rafael Rangel" per its acronym in Spanish, IHRR, in Caracas. On 13 Nov 2019, the sample tested positive for yellow fever by reverse-transcriptase polymerase chain reaction (RT-PCR), and negative for dengue on 14 Nov 2019 by RT-PCR. On 10 Oct 2019, a 2nd serum sample was taken and sent to the IHRR, for which the results are still pending.

Most of the territory of Venezuela is considered as at risk for sylvatic yellow fever, and this case marks the 1st confirmed autochthonous case of yellow fever diagnosed in Venezuela since 2005.

Public health response
-----------------------
A joint investigation team (WHO Country Office and the Venezuela Ministry of Health) was deployed on 12 Nov [2019] to characterize the risk and develop the response plan. PAHO Immunizations (IM) Unit along with the Revolving Fund have secured a donation of 571 000 doses of yellow fever vaccine from UNICEF that arrived in the country at the end of October [2019].

The local public health authorities have strengthened the active and passive epidemiological surveillance activities in humans and non-human primates. Additionally, strategic vaccination activities have been planned.

WHO risk assessment
-----------------------
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes and has the potential to spread rapidly and cause serious public health impact. There is no specific treatment, although the disease is preventable using a single dose of yellow fever vaccine, which provides immunity for life. Supportive care is required to treat dehydration, respiratory failure, and fever; antibiotics are recommended to treat associated bacterial infections.

The origin of the infection of this case is likely to be sylvatic, in an area determined as at risk for yellow fever. Venezuela is considered at risk for yellow fever transmission.

WHO advice
-------------
This yellow fever case report illustrates the importance of maintaining awareness and strong surveillance systems (including laboratory capacity) and high coverage of yellow fever vaccination, especially in areas with a favourable ecosystem for yellow fever transmission and indigenous groups.

Advice to travelers planning to visit, or reside in, areas at risk for yellow fever transmission includes:
- Vaccination against yellow fever at least 10 days prior to the travel is recommended for all travelers aged 9 months or above traveling to Venezuela, except for travelers whose itineraries are limited to the following areas:
-- the entire states of Aragua, Carabobo, Miranda, Vargas and Yaracuy, and the Distrito Federal.
- It is not recommended for travelers whose itineraries are limited to the following areas:
-- all areas above 2300 m in the states of Merida, Trujillo and Tachira;
-- the states of Falcon and Lara; Margarita Island;
-- the capital city of Caracas and the city of Valencia (please see the map here:
- The vaccine is contraindicated in children aged under 6 months and is not recommended for those aged between 6 and 8 months, except during epidemics when the risk of infection with yellow fever virus may be very high.
- Caution is recommended before vaccinating people aged 60 years or more against yellow fever, and a risk-benefit assessment should be performed for any person 60 years or more of age who has not been vaccinated and for whom the vaccine is normally recommended.
- A single dose of WHO-approved yellow fever vaccine is sufficient to confer life-long protection against yellow fever disease. A booster dose of the vaccine is not needed.
- Yellow fever virus may be transmitted not only in areas of high endemicity but also in areas of low endemicity if a traveller's itinerary results in heavy exposure to mosquitoes (e.g., during prolonged travel in rural areas). WHO recommends as a general precaution to avoid mosquito bites; the highest risk for transmission of yellow fever virus is during the day and early evening.
- A yellow fever vaccination certificate is required for travellers aged one year of age or older, arriving from Brazil, and for travellers having transited for more than 12 hours through an airport in Brazil. Travelers should be aware that the absence of a requirement for vaccination does not imply that there is no risk of exposure to yellow fever in the country. Vaccination coverage in some populations might be suboptimal, particularly among indigenous communities.
- International certificates of vaccination against yellow fever become valid 10 days after primary vaccination and remain valid for the duration of the life of the person vaccinated. A booster dose after 10 years is not necessary for protection and can no longer be required for international travelers as a condition of entry into a country.
- Awareness of symptoms and signs of yellow fever.
- Promotion of healthcare-seeking advice while traveling and upon return from an area at risk for yellow fever transmission, especially to a country where the establishment of a local cycle of transmission is possible (i.e., where the competent vector is present).

WHO encourages Member States to take all actions necessary to keep travelers well informed of risks and of preventive measures including vaccination. Travelers should also be made aware of yellow fever signs and symptoms and be instructed to seek rapid medical advice when presenting signs after possible exposure.

WHO reminds Members States to strengthen the control checks of immunization status of travelers to all potentially endemic areas. Viraemic returning travelers infected in endemic areas may pose a risk for the establishment of local cycles of yellow fever transmission in areas where a competent vector is present. If there are medical grounds for not getting vaccinated, this must be certified by the appropriate authorities.

WHO does not recommend any general travel or trade restrictions be applied to Venezuela based on the information available for this event.

For more information on yellow fever, please see:
PAHO/WHO Yellow Fever Fact Sheet
WHO Yellow Fever Health Topics
WHO Yellow Fever Risk Mapping and Recommended Vaccination for Travellers
PAHO/WHO Guidance on Laboratory Diagnosis of Yellow Fever Virus Infection
Country list - Vaccination requirements and recommendations for international travellers; and malaria situation per country - 2019 edition
Global Strategy to Eliminate Yellow Fever Epidemics (EYE) 2017-2026
WHO International Travel and Health Website
=====================
[This report provides additional information that was unavailable in the initial report. The case is now confirmed as yellow fever (YF), and the locality in Bolivar state where the man was infected is now identified as the municipality of Gran Sabana. The likelihood that this is a case of sylvan (forest) transmission is stated. The arrival of a substantial lot of YF vaccine is reported. One hopes that the plans for a vaccination campaign are completed and put into action quickly to prevent ongoing transmission in an urban cycle involving _Aedes aegypti_ that are doubtless abundant in this locality. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Date: Tue 19 Nov 2019
Source: Caracas Chronicles [edited]

The Venezuelan Public Health Society and the Let's Defend The National Epidemiology Network issued an alert after a case of yellow fever was confirmed in the state of Bolivar, after 14 years without the disease. The Health Ministry hasn't published information about the case or issued an alert, but Venezuela must formally report it to international institutions, due to the risk to a population that isn't vaccinated, having the vector (mosquitoes) in all of the territory (increasing the odds of an epidemic), and the poor access to an epidemiologic report [about the case]. Doctor Julio Castro wrote about the case for Prodavinci.  [Byline: Naky Soto]
======================
[There is little information about this case: where and when it occurred in Bolivar state, tests used to diagnose the case, condition of the patient, and any follow-up measures taken by public health authorities. Yellow fever (YF) virus is endemic in Venezuela as it is in many South American countries.

The most recent ProMED-mail report of YF in Venezuela was in 2010, in Anzoategui state, where there were 3 probable YF cases in monkeys. This outbreak was enzootic, as determined by the Ministry of Health (see Yellow fever - South America: Venezuela (AN) monkey, susp http://promedmail.org/post/20101112.4114).

Presumably, this current case is one of spill-over from the sylvan (forest) transmission cycle. Maintenance of a high level (80-90%) of coverage is essential to prevent cases and avoid outbreaks involving the urban cycle with _Aedes aegypti_ transmission. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Venezuela:
Date: Tue, 8 Oct 2019 04:13:25 +0200 (METDST)
By Margioni BERMÚDEZ

Caracas, Oct 8, 2019 (AFP) - The small waiting room at the home of self-styled healer "Brother Guayanes" in Caracas' rundown Petare district fills up quickly with patients -- business has never been better.   With Venezuela's chronic medicine shortages and hyperinflation, more and more people are turning to alternative medicine to treat common ailments in the crisis-wracked South American country.   "We go to the hospital and there's nothing there. They don't have medicines, or they're too expensive, what are we to do?" said Rosa Saez, 77, who has come to get treatment for a painful arm.   Carlos Rosales -- he uses the more ceremonious "Brother Guayanes" for his business -- is finishing up a "spiritual intervention" on a patient in what passes for his surgery.   The patient lies, eyes closed, on a cot as, in a series of swishes and clicks, the healer waves five pairs of scissors one after another over his prone body.    The healer says he performs 200 such interventions a week in a dim, candle-lit room that features two camp beds and an array of plaster statues that Rosales says represent "spiritual entities".   A regular visitor to the spiritual center, Saez says she has faith in Rosales' methods: "He healed my kidneys."

- Natural healing -
All across Venezuela, but particularly in poor areas like Petare, patients cannot hope to afford the price of medicines that due to the economic crisis, have become exceedingly rare.  Venezuela's pharmacists' federation say pharmacies and hospitals have on average only about 20 percent of the medicine stock needed.   Rosales' clinic is muggy with the smell of tobacco. A crucifix suspended from a chain around his neck, he practices a seeming mixture of smoke-blowing shamanism, plant-based medicine and mainstream religion.    Posters hung near the entrance remind clients to arrive with a candle and tobacco and "Don't forget that payment is in cash".   Much like a general practitioner, Rosales spends time consulting with his patients, examining them with a stethoscope, before offering a diagnosis. Often he prescribes potions based on plants and fruit, such as pineapple and a type of local squash known as chayote.   "We know medicines are necessary," he says. "I'm not against medicine, but my medicine is botany."

- Plants replace drugs -
At her stall in a downtown Caracas market, 72-year-old Lilia Reyes says she has seen her trade in medicinal plants flourish.   "I can't keep up with the demand," she said at her stall, bathed in the aroma of camomile, one of the 150 plants she sells.   Careless consumption of some herbs can be deadly, warns Grismery Morillo. A doctor at a Caracas public hospital, she says she has seen many cases of acute liver failure in people who have eaten certain roots.   According to Venezuela's opposition parties, some 300,000 chronically ill people are in danger of dying from the shortages of medicines.

But despite the risks, people like Carmen Teresa say they have no alternative.    In the kitchen of her restaurant which closed down three years ago as the economic crisis took hold, the 58-year-old Colombian prepares an infusion of fig leaves to treat "diabetic neuropathy".   The painkillers needed for the condition are "too expensive" and prices are going up due to hyperinflation, so she is cutting back on the pills and supplementing her treatment with herbal infusions.   She needs at least four tablets a day to keep her diabetes at bay. Her mother, bedridden since breaking a leg a year ago, suffers from Alzheimer's disease and needs five pills a day for hypertension.   "I'm still taking my pills, but I reduced the dose," says Teresa, who is also replacing cholesterol pills with lemon juice.
Date: Sat 20 Jul 2019
Source: El Pitazo [in Spanish, trans. ProMED KS, edited]

More than 10 cases of malaria have been reported in the Boyaca III sector of Barcelona (Anzoategui, Venezuela) in the past 2 weeks. Of these cases, 2 are young children aged 1 and 2 years old, infected after the bite of the _Aedes aegypti_ mosquito.

Maria Febres, a nurse and resident of the community, states that the malaria outbreak is due to the lack of weeding and cleaning in the channel that crosses the Boyaca III sector, where more than 500 families reside.  "We have 12 cases of malaria in the sector. We need them to come clean the canal, which has not received adequate maintenance for 2 years, putting many families at risk of contracting malaria due to the proliferation of mosquitoes," she said.

The nurse told the infociudadano [city correspondent] of El Pitazo [local media company], Eduardo Mora, that the sector has not been fumigated since 2018, and called on Public Health and Malariology officials to visit the area and verify what is happening.  "The most affected area is Boyaca III sector II, because we have a Simoncito [children's centre -- so-called in honour of Simon Bolivar] there and the children who go every day are the ones most at risk of being bitten by an infected mosquito and, thus, getting malaria," said Maria.  [Byline: Giovanna Pellicani]
===================
[Over the past 5 years, the malaria control programme in Venezuela has not be functioning, and malaria has resurged in most of the country, which is well illustrated by this report. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps:
Anzoategui, Venezuela: <http://healthmap.org/promed/p/40477>]
Date: Sun, 7 Jul 2019 14:05:22 +0200
By Guillaume DECAMME

El Tucuco, Venezuela, July 7, 2019 (AFP) - The sweltering heat of the Venezuelan forest makes no difference to Jose Gregorio, who trembles with a cold chill. "I have pain everywhere, fever," he stammers.    Gregorio has the classic symptoms of malaria, a disease eradicated years ago among his Yukpa indigenous people, but it's back with a vengeance all across crisis-struck Venezuela.   "He had sore joints and then started vomiting, and it's been four or five days since he's eaten anything," says his worried wife Marisol.   Their four-month-old baby babbles beside his father on the bed.   "The baby and I also had malaria," says Marisol. "Before, that was not the case here, there was only chikungunya and dengue, malaria came back here last year."

She doesn't bat an eyelid at the mention of either of the other mosquito-borne viruses, whose spread has been fueled by the collapse of Venezuela's health system.   "Here" is El Tucuco, a small village at the foot of the mountains that form the border with Colombia, a three-hour drive from Maracaibo in Venezuela's western Zulia state.   With 3,700 people, El Tucuco is the Yukpas' "capital" and malaria is rapidly making its presence felt here as in the rest of Venezuela -- a country that could once boast of being the first to have eradicated the disease in 1961.

- 'Pandemic' -
There are no official statistics on malaria's reach into El Tucuco, nor on the number of deaths it causes.    But from his consulting room at the Catholic Mission, Dr Carlos Polanco is seeing a developing crisis.    "Out of 10 people who are tested for malaria in the village laboratory, four to five come out with a positive test. This is an alarming figure."   Brother Nelson Sandoval, a Capuchin friar who presides over the mission, adds: "Before entering the order, I already knew this community and I had never seen a case of malaria. Today we are in the middle of a pandemic."   El Tucuco is affected by Plasmodium vivax, the most geographically widespread malarial species. The more lethal Plasmodium falciparum strain is prevalent in the Amazonian regions of southeastern Venezuela.

According to Sandoval and Polanco, the reason for malaria's sudden virulence in El Tucuco is simple: once-regular fumigation missions by the Venezuelan government stopped.   "And as the population of mosquitos increased, cases exploded," said Polanco.   Added to this is the malnutrition that weakens resistance to the disease, a new phenomenon since the economic crisis took hold at the end of 2015.    "Before, it was possible to vary one's diet, but with inflation the Yukpa cannot afford it," instead making do with what they can grow, like cassava and plantain, according to Polanco.   Rosa, 67, knows all about malnutrition. Lying on the floor of her house, she is battling malaria for the third time. "The doctor weighed me yesterday -- 37 kilograms. I was 83 kilos before."

A report published in British medical journal The Lancet in February warned of an epidemic of malaria and dengue fever as a result of the continuing crisis in Venezuela.   Between 2016 and 2017 alone, the number of malaria cases in the nation jumped 70 per cent.    "The situation is catastrophic," said Dr Huniades Urbina, secretary of the national Academy of Medicine. In 2018, "there were 600,000 cases of malaria and we, the scientific organizations, estimate that in 2019 we could reach a million cases" -- one in every 30 people.   But these figures are only estimates, "because the government conceals the statistics."

-'Nobody answers us'-
The malaria explosion has gone hand in hand with the worsening economic crisis. According to Nicolas Maduro's government, inflation reached a staggering 130,000 percent in 2018 and GDP halved between 2013 and 2018.    In the oil-rich state of Zulia, service stations have been dry for more than a month. Electricity blackouts are commonplace and residents flee abroad in their thousands.   Despite a poster of late president Hugo Chavez at the entry to the clinic, there is little sign of government presence in El Tucuco. Dr Luisana Hernandez despairs of ever seeing any state help.   "Every day, everything is deteriorating a bit more," she says, exasperated. Refrigerators intended to keep vaccines cold do not work "because we have no gasoline to run the generator," and both the clinic's broken-down ambulances are gathering rust in the garden.   "We've knocked on every door. But nobody answers us," said Hernandez.

Without fuel to bring drugs from the city, without resources to prevent illnesses, eradicating malaria in an almost impossible task.   Brother Nelson does what he can, with help from the Catholic charity Caritas and the Pan American Health Organization. His mission distributes the antimalarial drugs chloroquine and primaquine to sick Yukpa people.   Maria Jose Romero, 22, was able to benefit from treatment. "Repeated seizures are due to the fact that many people cannot follow the treatment," for lack of drugs, she said.   Romero now lives across the border in Colombia, having fled Venezuela. She is visiting El Tucuco to see her family. Soon she will return to the other side of the mountain, on foot.   "It's three days' walk," she says.
More ...

World Travel News Headlines

Date: Thu, 16 Jan 2020 02:59:31 +0100 (MET)
By Nicolas DELAUNAY

Cousin Island, Seychelles, Jan 16, 2020 (AFP) - Giant tortoises amble across Cousin Island as rare birds flit above.   The scene attests to a stunning success for BirdLife International, a conservation group that bought the tiny Seychelles isle in 1968 to save a songbird from extinction.   Thick vegetation smothers ruins that are the only reminder of the coconut and cinnamon plantations that covered the island when the group stepped in to protect the Seychelles Warbler.

Now teeming with flora and fauna and boasting white beaches, Cousin Island is firmly on the tourist map, with managers scrambling to contain visitor numbers and soften their negative environmental impact.    More than 16,000 people visited the island in 2018, compared with 12,000 a decade earlier.   "Tourism is important for Cousin. That's what allows us to finance the conservation projects we run here.    "But 16,000 tourists... that was too much," said Nirmal Shah, director of Nature Seychelles, which is charged with running the special reserve.

Before the island was in private hands, the population of Seychelles Warblers was thought to have shrunk to just 26, barely hanging on in a mangrove swamp after much of their native habitat had been destroyed.    Now, they number more than 3,000 and the greenish-brown bird has been reintroduced to four other islands in the archipelago.   The former plantations have transformed into native forests, teeming with lizards, hermit crabs and seabirds, and the island is the most important nesting site for hawksbill turtles in the western Indian Ocean.   The International Union for Conservation of Nature (IUCN) waxes lyrical about the "unique biodiversity and conservation achievements" of Cousin, "the first island purchased for species conservation", a model since replicated around the world.

- Nature first -
Tourists have been allowed onto the island since 1972, but the message is clear: nature comes first.   In a well-oiled routine, every morning a handful of luxury sailboats and small motorboats anchor off the island, where their occupants wait for Nature Seychelles to skipper them ashore on their boats.   "Tourist boats cannot land directly on the island, the biohazard risk is too big," Shah said.   "Non-indigenous animals who may accidently be on board could come to the island and threaten its (ecological) balance."   Too many tourists can also upset this balance.

Nature Seychelles in July increased the price of visits from 33 to 40 euros ($36 to $44) and removed a free pass for children under 15, resulting in a welcome 10-percent reduction in visitor numbers.   "Something had to be done, there was too much pressure on the environment," said Dailus Laurence, the chief warden of the island.   "When there are too many tourists it can bother nesting birds and turtles who want to come and lay their eggs on the island."

One guide said that some tourists, bothered by the island's ubiquitous mosquitos, would "leave the paths, move away from the group and walk where they are not supposed to", putting fragile habitats at risk.   Shah said that if they wanted to increase the number of tourists, it would require hiring more wardens and guides who live on the island, which would also have a negative impact on nature.   "Our absolute priority is nature, and it comes before tourists. If we have to take more steps to protect it and reduce the number of tourists, we will," he said.
Date: Thu, 16 Jan 2020 02:45:27 +0100 (MET)
By Ivelisse RIVERA, con Leila MACOR en Miami

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

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

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

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

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

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

In the past few days there have been growing calls among Democratic lawmakers for Trump to declare the situation in Puerto Rico a disaster.   It is a delicate subject, as Trump has accused the government of Puerto Rico of incompetence and of siphoning off hurricane relief money, triggering a public spat between the president and the mayor of San Juan, Carmen Yulin Cruz, as well as the former governor Ricardo Rossello, who was forced to step down last summer amid massive protests.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
Date: Wed, 15 Jan 2020 23:16:11 +0100 (MET)

Malabo, Equatorial Guinea, Jan 15, 2020 (AFP) - Firefighters battled to bring a blaze at Malabo's cathedral under control on Wednesday, as flames engulfed parts of the historic building, considered the most important Christian church in Equatorial Guinea.     Dozens of people gathered in silence near the cathedral in the early evening as the fire service sprayed water jets onto the century-old structure.

It was not immediately known whether anyone was hurt in the fire, in which huge flames consumed part of the facade of the building.       "We have just extinguished the fire, it's finished. The roof is gone, it is a catastrophe," firefighter Alfredo Abeso told AFP.   Another firefighter at the scene said: "The whole roof is gone, the interior is burned."   The cause of the fire is not known but the cathedral has been closed to the public since January 7 for restoration work.    Built in a neo-gothic style between 1897 and 1916, the cathedral is one of the central African country's main tourist attractions.

The blaze brought comparisons to the devastating fire that ravaged the 13th century Notre-Dame cathedral in Paris in April 2019.     The French Embassy in Malabo said the fire was a "cruel reminder" of the fire at Notre Dame.    "We share the emotion of our friends in Malabo and Equatorial Guinea and hope that the fire can be brought under control quickly," it said on Twitter.      Paris engineers are still working to stabilise the 13th century cathedral in the French capital after fire tore through its roof and dramatically toppled its spire last year.
Date: Wed, 15 Jan 2020 21:55:41 +0100 (MET)

Rio de Janeiro, Jan 15, 2020 (AFP) - Widespread complaints over foul-smelling drinking water in Rio de Janeiro have triggered a run on supermarket bottled water, though the public utility denied any health risk Wednesday.   Rio governor Wilson Witzel set alarm bells ringing in a Twitter post on Tuesday, saying the situation -- fuelled by social media rumours -- was "unacceptable" and calling for a "rigorous investigation."

Moving to calm growing fears, public water utility Cedae attributed the problems to the presence of geosmin, a harmless organic compound, insisting the resulting earthy-tasting tap water was safe to drink.   "The results of the analyses show the presence of geosmin, at a rate sufficient to change the taste. But there is no risk to health," Sergio Marques, the official in charge of water quality, told a press conference.   Cedae later said it had fired the head of the Guandu treatment plant, which supplies nearly 80 percent of Rio's drinking water.   It said the supply from Guandu would be treated with carbon in the coming days to get rid of the geosmin.

According to O Globo newspaper, nearly 70 districts of the capital have been affected.   It reported that more than 1,300 cases of gastroenteritis were recorded over the last 15 days in Santa Cruz in the west of Rio, where water quality complaints were rife.   Cedae's president Helio Cabral apologized "to the whole population for the problems in the water supply," which began earlier this month.

The problem has been exacerbated by false rumours circulating on social media that the water was toxic.   Despite assurances, many Rio citizens were taking no chances. In supermarkets, mineral water stocks have been selling out and long queues are formed as soon as they are replenished.   Geosmin is also responsible for the earthy taste in some vegetables.
Date: Wed, 15 Jan 2020 21:25:04 +0100 (MET)

Lima, Jan 15, 2020 (AFP) - Five tourists arrested for damaging Peru's iconic Machu Picchu site will be deported to Bolivia later on Wednesday, police said.   A sixth was released from custody and ordered to remain in Machu Picchu pending trial after paying bail of $910.   The six tourists -- four men and two women -- were arrested for damaging Peru's "cultural heritage" after being found in a restricted area of the Temple of the Sun on Sunday.   They were also suspected of defecating inside the 600-year-old temple, an important edifice in the Inca sanctuary.   "We've got the order. Today the five foreign tourists will be expelled," Cusco police official Edward Delgado told AFP.   "We're going to take them by road to the city of Desaguadero, on the border with Bolivia."   The border town, a nine-hour drive away, is the nearest frontier point to the southern Cusco region where Machu Picchu is located.

The sixth tourist, 28-year-old Nahuel Gomez, must sign at a local court every 10 days while awaiting trial.   He admitted to removing a stone slab from a temple wall that was chipped when it fell to the ground, causing a crack in the floor.   He could face four years in prison if found guilty of damaging Peru's cultural heritage.   Several parts of the semicircular Temple of the Sun are off limits to tourists for preservation reasons.   Worshipers at the temple would make offerings to the sun, which was considered the most important deity in the Inca empire as well as other pre-Inca civilizations in the Andean region.   The group -- made up of a Chilean, two Argentines, two Brazilians, including one of the women, and a French woman -- allegedly entered the Inca sanctuary on Saturday and hid on site so they could spend the night there -- which is prohibited.

A source with the public prosecutor's office told AFP that Nahuel admitted to the damage but said "it wasn't intentional, he only leant against the wall."   The Machu Picchu complex -- which includes three distinct areas for agriculture, housing and religious ceremonies -- is the most iconic site from the Inca empire, which ruled over a large swath of western South America for 100 years before the Spanish conquest in the 16th century.   Machu Picchu, which means "old mountain" in the Quechua language indigenous to the area, is at the top of a lush mountain and was built during the reign of the Inca emperor Pachacuti (1438-1471).
Date: Wed, 15 Jan 2020 20:53:05 +0100 (MET)

Alicante, Spain, Jan 15, 2020 (AFP) - A fire broke out Wednesday on the roof of the airport in Alicante, a city on the eastern Mediterranean coast which is a tourism hotspot, forcing its closure to air traffic.   "The fire is under control but it has not been extinguished. Firefighters are continuing to work," a spokesman for Spanish airport operator Aena told AFP, adding the airport will remain closed to air traffic until noon on Thursday.

Ten flights which were due to land at Alicante were cancelled, as were 12 which were supposed to depart from the airport, he said.    Another four flights which were due to land at Alicante were diverted to other Spanish airports.   The flames were visible from inside the terminal, according to an AFP photographer at the scene.   Passengers and workers stood outside as dense smoke rose from the terminal building.   No one was injured and the authorities are still not sure what caused the fire.

The airport serves the eastern region of Valencia, which is home to several popular resorts such as Benidorm. It handled just under 14 million passengers last year, making it Spain's fifth busiest airport.   Aena recommended in a tweet that passengers contact their airline before heading to Alicante airport to see what the status of their flight was.   "We are coordinating with airlines. Consult your company to know if your flight is cancelled or will operate from an alternative airport," it said.
Date: Wed, 15 Jan 2020 11:12:40 +0100 (MET)

Beijing, Jan 15, 2020 (AFP) - A new virus from the same family as the deadly SARS pathogen could have been spread between family members in the Chinese city of Wuhan, local authorities said Wednesday.   The outbreak, which has killed one person, has caused alarm because of the link with SARS (Sudden Acute Respiratory Syndrome), which killed 349 people in mainland China and another 299 in Hong Kong in 2002-2003.   One of the 41 patients reported in the city could have been infected by her husband, Wuhan's health commission said in a statement on Wednesday.   The announcement follows news that a Chinese woman had been diagnosed with the novel coronavirus in Thailand after travelling there from Wuhan.

No human-to-human transmission of the virus behind the Wuhan outbreak has been confirmed so far, but the health commission said the possibility "cannot be excluded".   The commission said that one man who had been diagnosed worked at Huanan Seafood Wholesale Market, which has been identified as the centre of the outbreak, but his wife had been diagnosed with the illness despite reporting "no history of exposure" at the market.   At a press conference on Wednesday following a fact-finding trip to Wuhan, Hong Kong health officials also said that the possibility of human-to-human transmission could not be ruled out despite no "definitive evidence".

Dr Chuang Shuk-kwan, from Hong Kong's Centre for Health Protection, said there were two family group cases among the recorded cases in Wuhan, including the husband and wife and a separate case of a father, son and nephew living together.   However, he said mainland doctors believed the three men were most likely to have been exposed to the same virus in the market.   The market has been closed since January 1.   The woman diagnosed in Thailand, who is currently in a stable condition, had not reported visiting the seafood market, the World Health Organization (WHO) said on Tuesday.

WHO doctor Maria Van Kerkhove said Tuesday that they "wouldn't be surprised if there was some limited human-to-human transmission, especially among families who have close contact with one another".   The US Centers for Disease Control and Prevention issued a Level 1 "Watch" alert for travellers to Wuhan after the patient was diagnosed in Thailand, saying they should practice normal precautions and avoid contact with animals and sick people.

Wuhan's health commission said on Wednesday that most of the patients diagnosed with the virus were male, and many were middle-aged or elderly.   In Hong Kong, hospitals have raised their alert level to "serious" and stepped up detection measures including temperature checkpoints for inbound travellers.   Hong Kong authorities said on Tuesday that the number of people hospitalised with fever or respiratory symptoms in recent days after travelling to Wuhan had grown to 71, including seven new cases since Friday.   Sixty of that total, however, have already been discharged. None have yet been diagnosed with the new coronavirus.
Date: Wed, 15 Jan 2020 03:48:17 +0100 (MET)
By Emile Kouton with Celia Lebur in Lagos

Lome, Jan 15, 2020 (AFP) - After he was struck down by malaria and typhoid, Togolese tailor Ayawo Hievi thought he was set to recover when he started taking drugs prescribed by his doctor.   But far from curing him, the medication he was given at the neighbourhood clinic made him far worse -- eventually costing him one of his kidneys.    The drugs were fake.   "After four days of care, there was no improvement, but I started to feel pain in my belly," Hievi, 52, told AFP.

After two weeks of suffering he became unable to walk and was rushed into the university hospital in the West African nation's capital Lome.    "The doctors told me that my kidneys had been damaged... the quinine and the antibiotics used to treat me in the medical office were fake drugs."   Now, over four years later, he remains crippled by chronic kidney failure and has to go to hospital for dialysis regularly.    Hievi's horror story is far from unique in a continent awash with counterfeit medicines.    The World Health Organization (WHO) estimates that every year some 100,000 people across Africa die from taking "falsified or substandard" medication.

The American Society of Tropical Medicine and Hygiene estimated in 2015 that 122,000 children under five died due to taking poor quality anti-malaria drugs in sub-Saharan Africa.   Weak legislation, poor healthcare systems and widespread poverty have encouraged the growth of this parallel -- and deadly -- market. Since 2013, Africa has made up 42 percent of the fake medicine seized worldwide.    The two drugs most likely to be out-of-date or poor, ineffective copies are antibiotics and anti-malarials, say experts.    And bogus drugs not only pose a risk to the patient -- they also play a worrying part in building resistance to vital frontline medications.

- 'Difficult to trace' -
In a bid to tackle the scourge, presidents from seven countries -- the Republic of Congo, Gambia, Ghana, Niger, Senegal, Togo and Uganda -- meet Friday in Lome to sign an agreement for criminalising trafficking in fake drugs.    The goal is to bolster cooperation between governments and encourage other African nations to join the initiative.   But even if leaders put pen to paper, the task of stamping out the flows of counterfeit medication is huge.    Medicines spread out on plastic sheets or offered at ramshackle stalls are for sale at markets across West Africa.

Those hawked on the streets are often a fraction of the price of what's available in more reputable pharmacies where controls are stricter and supplies often have to come through official channels.    "It is very difficult to trace where the fake medicines come from," said Dr Innocent Kounde Kpeto, the president of Togo's pharmacist association.    "The countries which are mentioned on the boxes are often not the countries of origin or manufacture of these drugs. The manufacturers cover their tracks so as not to be identified".

It is estimated that between 30 and 60 percent of medicine sold in Africa is fake and Kpeto said most of it comes from China or India.    Efforts to staunch the deadly torrents of counterfeits have made some headway.    Some trafficking hubs have been dismantled, such as Adjegounle market in Cotonou that served as a key gateway for fakes heading to giant neighbour Nigeria.   In mid-November, the police in Ivory Coast made a record seizure of 200 tonnes in Abidjan and arrested four suspects including a Chinese national.

Togo is one of the pioneer countries trying to stop the flow.    It changed the law in 2015 and now traffickers can face 20 years in jail and a fine of some $85,000 (75,000 euros).   In a show of force in July the authorities burnt over 67 tonnes of counterfeit pharmaceuticals discovered between     But even given these recent successes, those in the industry like Dr Kpeto insist that the threat is still grave and involves "highly organised criminal networks".    "The phenomenon remains major," he said.    Traffickers can turn an investment of just $1,000 (900 euros) into a profit of $500,000, he claimed.   The fake medicines are smuggled in the same way as guns or narcotics and often bring higher returns.

- 'Die for nothing' -
Nigeria, Africa's most populous country with a market of 200 million people, is the number one destination on the continent for fake drugs and a showcase of difficulties being faced.    In September 2016 the World Customs Organization seized tens of millions of fake pills and medicines at 16 ports around Africa: 35 percent were intended for Nigeria.    Across the vast nation there are tens of thousands of vendors selling the counterfeits.   Competition between traffickers is fierce and the official agency meant to combat the problem is overwhelmed.

In a bid to improve the situation, Vivian Nwakah founded in 2017 start-up Medsaf and raised $1.4 million to help Nigerians track their medication from producer to user.    "The country doesn't have a reliable and centralised distribution network," she said.    "A hospital sometimes has to deal with 30 or 40 distributors for all the medications it needs. How can you have quality control with so many suppliers?"   As a result, fake or faulty medicine has not just flooded markets but also pharmacies and hospitals -- both state and private.    Sometimes, without hospital administrators even being aware, that means the drugs that reach the patients can be expired, poorly stored or the wrong doses. 

Medsaf works to ensure the quality control of thousands of products at over 130 hospitals and pharmacies in Nigeria. It looks forward to expanding deeper into Nigeria as well as Ivory Coast and Senegal.   The company uses technology, database management and analytics to monitor the movement of medications and verifies their official registration number, the expiry dates and storage conditions.   "Technology we use can help to solve most of the issues related to fake drugs," Nwakah said. "People die for nothing. We can change that."
Date: Mon 13 Jan 2020, 00.45 IST
Source: The Hindu [edited]

A 58-year-old woman from Seegemakki village in Tumari Gram Panchayat limits in Sagar taluk died due to Kyasanur Forest Disease (KFD), also known as monkey fever, at a private hospital in Manipal in Udupi district on [Sat 11 Jan 2020].

The deceased, H, who had complained of high fever and aches in joints was admitted to government sub-divisional hospital in Sagar city for treatment on [Tue 7 Jan 2020]. Her blood tested positive for KFD.

Rajesh Suragihalli, District Health Officer, told The Hindu that as her health condition had worsened, she was shifted to a private hospital in Manipal on [Thu 9 Jan 2020] for advanced treatment. She failed to respond to the treatment and breathed her last on [Sat 11 Jan 2020], he said.

Following the death, the Department of Health and Family Welfare has sounded an alert in Sagar and Tirthahalli taluks from where 7 positive cases have been reported since [1 Jan 2020]. The vaccination drive has been stepped up in the villages from where positive cases are reported. Three advanced life support ambulances have been stationed in government sub-divisional hospital in Sagar to shift KFD patients with health complications to private hospitals in Shivamogga city or Manipal for additional treatment, he said.
====================
[Kyasanur Forest disease (KFD) is an acute febrile illness caused by Kyasanur Forest disease virus (KFDV), a member of the family _Flaviviridae_, characterized by severe muscle pain, gastrointestinal symptoms, and bleeding manifestations. The virus was 1st identified in 1957 after it was isolated from a sick monkey from the Kyasanur Forest in Karnataka state of India. The disease is transmitted to humans following a tick bite or contact with an infected animal, especially a sick or recently dead monkey. There is no evidence of person-to-person transmission (<https://www.cdc.gov/vhf/kyasanur/index.html>).

The case fatality of Kyasanur Forest disease (KFD) is 2-10% and mortality is higher in the elderly and in individuals with comorbid conditions. There is no specific treatment for KFD. Prompt symptomatic and supportive treatment can reduce morbidity and mortality. Surveillance (human, monkey, and tick), personal protection against tick bites, and vaccination are the key measures for prevention and control of KFD (<https://idsp.nic.in/WriteReadData/l892s/60398414361527247979.pdf>).

As per the media report above, 7 confirmed KFD cases have been reported from Sagar and Tirthahalli taluks in Karnataka state so far in 2020. KFD typically occurs during the dry season from November through May, which correlates with the increased activity of the nymphs of ticks. Exposure to adult ticks and nymphs in rural or outdoor settings increases the risk of infection; herders, forest workers, farmers, and hunters are particularly at increased risk of contracting the disease. Vaccination and personal protective measures against tick bites are keys to prevent KFD.

The recommended preventive measures include using tick repellents, walking along clear trails, avoiding contact with weeds, and wearing full sleeved clothes and long pants to reduce exposed skin to reduce contact with ticks and subsequent tick bites. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Karnataka State, India: <http://healthmap.org/promed/p/307>]
Date: Mon 13 Jan 2020
Source: Food Safety News [edited]

An emergency committee to control the sale of food has been created in a city in northwest Argentina after a spike in _Salmonella_ cases in early 2020. There have been 51 confirmed cases of salmonellosis in Salta so far in 2020. At least 5 people have been hospitalized but recovered after treatment.

The committee will be responsible for controlling food sold on public roads at street stalls and at commercial premises. It includes experts from the National University of Salta (UNSA) and Catholic University of Salta (Ucasal). Officials hope by increasing controls they can bring the rise in infections under control and minimize the risk to the public. The group, created by the Mayor of Salta Bettina Romero and Undersecretary of Health and Human Environment Monica Torfe, held a meeting with Juan Jose Esteban, manager of the Hospital Senor del Milagro, and teams from the department of epidemiology of the province on preventive measures to tackle the salmonellosis rise this past week.

Norma Sponton, head of the microbiology sector; Teresita Cruz, of the epidemiological surveillance program of the province; Paula Herrera, from the Ministry of Health, and Jose Herrera, from the hospital also participated. Experts from the 2 universities are involved in training the inspectors who will be in charge of carrying out the control tasks.

Food contaminated with _Salmonella_ bacteria does not usually look, smell, or taste spoiled. Symptoms of salmonellosis infection can include diarrhoea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for 4 to 7 days. In some cases, however, diarrhoea may be so severe that patients require hospitalization.
===================
[The serotype of _S. enterica_ is not stated and it is not clear what the food reservoir for this ongoing outbreak is. A food diary of affected persons may be helpful.

The city of Salta is located in north-western Argentina in the province of the same name which can be found on a map at

[HealthMap/ProMED-mail map of Argentina: