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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: Thu, 2 Apr 2020 12:24:14 +0200 (METDST)

Dubai, April 2, 2020 (AFP) - Emirates Airline said Thursday it is to resume a limited number of outbound passenger flights from April 6, less than two weeks after its coronavirus-enforced stoppage.   "Emirates has received approval from UAE authorities to restart flying a limited number of passenger flights," its chairman, Sheikh Ahmed bin Saeed Al-Maktoum, said on Twitter.   "From April 6, these flights will initially carry travellers outbound from UAE," he said, adding that details would be announced soon.      Dubai-owned carrier Emirates, the largest in the Middle East with 271 wide-body aircraft, grounded passenger operations last week as the UAE halted all passenger flights to fight the spread of coronavirus.

The UAE, which groups seven emirates including Dubai, has declared 814 coronavirus cases along with eight deaths.   It has imposed a sweeping crackdown, including the flight ban and closure of borders.   Sheikh Ahmed said Emirates, which owns the world's largest fleet of Airbus A-380 superjumbos with 113 in its ranks, was looking to gradually resume passenger services.   "Over the time, Emirates looks forward to the gradual resumption of passenger services in line with lifting of travel and operational restrictions, including assurance of health measures to safeguard our people and customers," he said.

When Emirates suspended flights, it cut between 25 percent and 50 percent of the basic salary of its 100,000-strong staff for three months, saying it wanted to avert layoffs.   Dubai's crown prince, Sheikh Hamdan bin Mohammed bin Rashid Al-Maktoum said Tuesday that Dubai will support the airline by injecting new capital.   Tourism, aviation, hotels and entertainment are key contributors to Dubai's mostly non-oil economy.
Date: Mon, 23 Mar 2020 00:45:56 +0100 (MET)

Dubai, March 22, 2020 (AFP) - The United Arab Emirates announced on Monday it will temporarily suspend all passenger and transit flights amid the novel coronavirus outbreak.    The Emirati authorities "have decided to suspend all inbound and outbound passenger flights and the transit of airline passengers in the UAE for two weeks as part of the precautionary measures taken to curb the spread of the COVID-19", reported the official state news agency, WAM.   It said the decision -- which is subject to review in two weeks -- will take effect in 48 hours, adding: "Cargo and emergency evacuation flights would be exempt."

The UAE, whose international airports in Abu Dhabi and Dubai are major hubs, announced on Friday its first two deaths from the COVID-19 disease, having reported more than 150 cases so far.   Monday's announcement came hours after Dubai carrier Emirates announced it would suspend all passenger flights by March 25.    But the aviation giant then reversed its decision, saying it "received requests from governments and customers to support the repatriation of travellers" and will continue to operate passenger flights to 13 destinations.

Emirates had said it will continue to fly to the United Kingdom, Switzerland, Hong Kong, Thailand, Malaysia, the Philippines, Japan, Singapore, South Korea, Australia, South Africa, the United States and Canada.   "We continue to watch the situation closely, and as soon as things allow, we will reinstate our services," said the airline's chairman and CEO, Sheikh Ahmed bin Saeed Al-Maktoum.   Gulf countries have imposed various restrictions to combat the spread of the novel coronavirus pandemic, particularly in the air transport sector.   The UAE has stopped granting visas on arrival and forbidden foreigners who are legal residents but are outside the country from returning.
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:
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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, 2 Apr 2020 11:30:15 +0200 (METDST)

Nicosia, April 2, 2020 (AFP) - Cyprus has extended a ban on all commercial flights for another two weeks until April 17 to curb the spread of the coronavirus, the transport minister said Thursday.   After "evaluating the situation... "we (decided to) extend the decree" introduced for two weeks on March 21 by another 14 days, Yiannis Karousos tweeted.

The transport ministry told local news site Financial Mirror that cargo flights from a list of 28 countries were exempted from the ban as well as flights for stranded foreign nationals and "for humanitarian reasons".   As of Wednesday evening, Cyprus had recorded a total of 397 coronavirus cases and 11 deaths from the pandemic, including two fatalities in the Turkish-run north of the divided island.   The island has imposed tough restrictions on movement, including a nighttime curfew and allowing people to leave their homes only once a day with permission.
Date: Tue, 17 Mar 2020 21:51:30 +0100 (MET)

Nicosia, March 17, 2020 (AFP) - Airports in Cyprus will block the majority of direct passenger flights arriving on the Mediterranean holiday island starting from Saturday, the health ministry said as it battles the novel coronavirus.   For two weeks starting 3 am Cyprus time (0100 GMT) on Saturday, "flights to Larnaca and Paphos Airports are prohibited" from 28 countries, apart from cargo flights, said Minister of Health Constantinos Ioannou on Tuesday.   The countries listed include the United Kingdom and Greece.

The government said it would charter flights to repatriate Cypriots stranded in the UK and Greece.   The Mediterranean holiday island's toll of registered COVID-19 cases rose by four to 56 on Tuesday -- 49 in the Republic of Cyprus and seven in the breakaway Turkish Republic of Northern Cyprus.    Cyprus is divided between EU member the Republic of Cyprus and the northern third controlled by the TRNC, recognised only by Ankara.
Date: Sat, 14 Mar 2020 09:01:14 +0100 (MET)

Nicosia, March 14, 2020 (AFP) - Authorities in northern Cyprus have said only Turkish Cypriots and legal residents will be allowed into the breakaway north of the island until April 1, as a precaution against the coronavirus.   Turkish Cypriot prime minister Ersin Tatar announced the measure after a cabinet meeting that lasted almost six hours on Friday.    Only Turkish Cypriot citizens and "legal residents" with residence and work permits will be allowed into the breakaway Turkish Republic of Northern Cyprus by land, air or sea until April 1, he said.

The Mediterranean island is divided between areas under the control of the Republic of Cyprus, an EU member state, and the breakaway TRNC, which is recognised only by Ankara.   Turkish Cypriot authorities reported their first case of coronavirus on Tuesday -- a 65-year-old German tourist.    Four more people have since tested positive in the north, bringing the total to five -- four German tourists and one Turkish Cypriot who arrived from Britain.   The Cyprus government has announced 21 cases in the Greek Cypriot south. It too has announced it will ban entry to non-residents for 15 days.
Date: Tue, 10 Mar 2020 08:52:27 +0100 (MET)

Nicosia, March 10, 2020 (AFP) - A 65-year-old German tourist has tested positive for COVID-19, the illness caused by the novel coronavirus, the first known case in northern Cyprus, authorities said on Tuesday.   The Mediterranean island is divided between areas under the de facto control of EU member state the Republic of Cyprus and the northern third controlled by the breakaway Turkish Republic of Northern Cyprus, recognised only by Ankara.

Turkish Cypriot Health Minister Ali Pilli told media that the German woman was among a 30-member tourist group who arrived in northern Cyprus from Balingen in Germany on Sunday.   The woman was taken to a hospital in Nicosia after complaining of high fever, was put under quarantine and tested positive on Tuesday morning, the minister said.    The hotel where the German group was staying in the coastal city of Famagusta was also on lockdown, he added.

On Monday the Republic of Cyprus reported its first two confirmed cases of the novel coronavirus, meaning that all 27 European Union member states have now reported infections.   Health Minister Constantinos Ioannou said the two cases were both Cypriot men who had recently travelled home from overseas, and had been among dozens of people tested.   Greek Cypriot authorities on 29 February closed four of the eight checkpoints on the line dividing the island "for more effective control over the entry points", sparking angry protests.
Date: Fri, 28 Feb 2020 16:37:32 +0100 (MET)

Nicosia, Feb 28, 2020 (AFP) - Cyprus on Friday announced the temporary closure of half of the crossing points across the divided island's ceasefire line in an effort to prevent a coronavirus outbreak.   Four of the eight checkpoints will be shut for seven days "for more effective control over the entry points," said health minister Constantinos Ioannou.   The closures, which include a busy pedestrian crossing in the heart of the capital Nicosia, will take effect on Saturday, he told reporters.

The Mediterranean island is divided between the Republic of Cyprus -- a European Union member state -- and the breakaway Turkish Republic of Northern Cyprus, recognised only by Ankara.   Turkey has had troops stationed in the country since 1974 when it invaded and occupied its northern third after a coup sponsored by the military junta then ruling Greece.   It is believed to be the first time that several of the crossings have been closed since they were first opened in 2003.

Cyprus has not reported any cases of novel coronavirus, which has killed more than 2,800 people worldwide, mostly in China where the epidemic started in late December.   Ioannou said the closures were to protect "both communities", and the decision was made following a cabinet meeting to discuss coronavirus.   Cypriot President Nicos Anastasiades has informed Turkish Cypriot leader Mustafa Akinci of the decision.   Other crossings will remain open, including the busy Ayios Dometios checkpoint in the divided capital Nicosia, which is open to vehicle traffic.   Medical checks at that crossing will be increased, Ioannou said.

The United Nations, whose peacekeepers patrol the 180-kilometre (112-mile) ceasefire line, and British authorities, who maintain two military bases on Cyprus, have been informed, Ioannou said.   Anastasiades has offered his summer residence to quarantine those who have visited infected countries but show no symptoms, health officials said on Thursday.   Government buildings in the Troodos mountains will also be used to quarantine people who may be infected with the novel coronavirus.   People travelling from countries designated as high risk -- including China, South Korea, Italy, Japan and Iran -- will be assessed upon arrival, officials said.
More ...

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.
*
*
*
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: Sat, 4 Apr 2020 15:22:33 +0200 (METDST)

Geneva, April 4, 2020 (AFP) - Switzerland on Saturday saw the number of cases of the new coronavirus in the country pass 20,000, as its death toll in the pandemic swelled past 500.   The health ministry said 20,201 people in Switzerland had tested positive for COVID-19 as of Saturday morning -- nearly 1,000 more than a day earlier.   The small Alpine country of some 8.5 million people is thus one of the worst hit compared to population size, now counting 236 registered infections per 100,000 people.    At the same time, an additional 76 people died over the past 24 hours, bringing Switzerland's death toll in the pandemic to 540, the health ministry said.   "We have not yet reached the peak," health ministry official Daniel Koch told reporters.

Worldwide, well over 1.1 million cases have been registered across 188 countries, while close to 60,000 people have died, according to a tally compiled by AFP Saturday from official sources.   The high incidence in Switzerland could in part be linked to the fact that it is among the countries that have administered most tests per capita.   Since the first case surfaced in the country on February 24, more than 150,000 tests have been administered with around 15 percent coming up positive.   Drive-in testing stations have been set up in several places, including in the capital Bern, to help simplify safe testing for COVID-19.   In the past 24 hours, the country has conducted nearly 7,000 tests, including 975 that were positive, the health ministry said.

Switzerland's southern canton of Ticino, which borders hard-hit Italy, has registered most cases, followed by Geneva.   As in other countries, men seemed to suffer more from the virus. Slightly more women had tested positive for the virus, but men accounted for 64 percent of the deaths, the ministry found.   Switzerland has unblocked some $60 billion to buffer the harsh blow to its economy from the pandemic and the measures taken to halt the spread of the virus.   The economic affairs ministry said Saturday some 1.3 million people, or a quarter of the country's workforce, have applied for temporary unemployment benefits since the start of the crisis.
Date: Thu, 26 Mar 2020 17:03:20 +0100 (MET)
By Robin MILLARD

Geneva, March 26, 2020 (AFP) - Switzerland on Thursday joined the small group of countries to declare more than 10,000 officially-recorded cases of COVID-19, as it launched plans to start tracking crowd build-ups through mobile phone data.   The health ministry said 10,661 people in the Alpine country have tested positive for the new coronavirus -- nearly 1,000 more than a day earlier -- while 161 people have died.

Switzerland, which is among the countries that have conducted most COVID-19 tests per capita, is the fifth country in Europe to pass 10,000 officially-recorded cases.   It follows neighbours Italy, Germany and France, and Spain -- all of which have far bigger populations.   Elsewhere, China, Iran and the United States have also passed the five-figure mark, according to the latest World Health Organization situation report on the global pandemic.

Switzerland's Italian-speaking southern region of Ticino, which borders hard-hit northern Italy, is the worst-affected of its 26 cantons, with 393 cases per 100,000 people.   Around two-fifths of Switzerland's COVID-19 deaths have occurred in Ticino.   The first case of the new coronavirus was confirmed in Switzerland on February 24.   Since then, "91,400 tests have been carried out for COVID-19, of which 14 percent were positive," the Federal Office of Public Health said.   Those testing positive have ranged in age from under one to 102, with a median age of 52 years old, and a near-even split of men and women.

- 'Too early' to ease restrictions -
The Swiss government has ordered the closure of schools and all places of leisure, including restaurants, bars and non-food shops.   Last Friday it went further, banning all gatherings of more than five people, while anyone standing closer than two metres to others risks a fine.   "At the moment it would definitely be too early to talk about easing" the restrictions, health ministry official Daniel Koch, who is heading the Swiss response, told a press conference in Bern.   "We must first have proof that we have reached the peak of this epidemic -- which unfortunately is not yet the case."

Revelations this week that majority state-owned telecoms operator Swisscom would provide authorities with mobile phone data to monitor if people were adhering to the restrictions on public gatherings sparked an outcry.   But Koch said it was not a question of monitoring population movements in real time, but instead doing "retrospective analysis".   Meanwhile some 3,800 to 4,000 troops -- "the totality of the medical forces of the Swiss army" -- have been mobilised, said Brigadier General Raynald Droz, chief of staff of the military's joint operations command.   The global number of officially-recorded infections has topped 480,000, with more than 21,800 deaths.
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:
More ...

Greece

Background
Greece offers a great variety of attractions for the international traveller. A beautiful climate linked with great beaches, a vibrant nightlife and historical monuments to rival any other location throughout the world. All of this located
within western Europe and a short flight away from many of the cooler northern destinations - like Ireland. Travellers from these regions descent on Greece in very significant numbers each year and for the vast majority of them they will have a splendid and healthy time. However for some this may not be the case and serious illness and accidents are regularly reported. Following some commonsense rules would go a long way to avoiding disaster and ensuring that this trip is truly one to be remembered for all the right reasons.
Climate
Situated in southern Europe the country enjoys mild winters but very hot summers. There may be occasional cool breezes (meltemia) but these can serve only to fool the traveller into thinking that they are unlikely to burn. Rain is very uncommon during the height of summer (July and August) and all travellers should be advised to use very adequate sun-block lotion at all times.
Slip, Slop, Slap
Following the Australian mantra of Slip, Slop and Slap makes perfect sense. Slip on a shirt, slop on sunscreen and slap on a hat when out and about during the day and this should help protect against the intense suns rays. Nevertheless, despite all their best intentions, travellers get burnt. This is particularly a problem in the first few days after their arrival when they do not realise the intensity of the suns rays and how easily they can be exposed. Falling asleep beside the hotel's swimming pool or on the beach is a very common problem and must be avoided against. The tips of the ears, shoulders (especially along the bra-strap line, ankles and behind the knees are commonly exposed and forgotten areas.
After Sun care
To treat significant sunburn it is important to increase fluid intake but also to take extra salt on your food (unless medically contraindicated for some specific condition like high blood pressure etc). Soothing water soluble lotions (especially ones containing a mild anaesthetic and/or steroid cream) are probably best but certainly avoid any of the ones which paste the skin with a thick layer - which is almost impossible to remove without causing serious pain! The more severe sunburn cases may need medical care and even hospitalisation which really ruins a holiday.
Food & Water
As a European destination Greece has a good level of food and water hygiene. Unfortunately this can vary - especially as you move away from the main tourist destinations and also as the summer temperatures rise and food goes 'off' more quickly. Eating hot food, avoiding cold foods (side-salads, lettuce etc) and never eating undercooked bivalve shellfish (mussels, oysters, clams etc) makes perfect sense. Eating food or taking fruit juice drinks from street vendors is a risk just not worth taking.
Insect bites
There may be both mosquitoes and sandflys about so having good repellents (DEET based ones) is worthwhile. The biggest problem will be early in the morning and towards the end of the daylight hours. However sitting in the shade while having lunch may be nice and cool but it is also often a place where these insects tend to hover looking for their next meal. Just don't allow that meal to be the blood in your unguarded ankle!
Seeing the Monuments
As mentioned previously Greece is covered with ancient monuments and these attract many thousands of tourists each year. The ruins are often not the most hospitable places for sun-sensitive tourists so taking care against the suns rays is essential - especially while standing carefully listening to the tour guide explain some complicated piece of history while the back of your legs get roasted! The other issue, for those trekking through the ruins, is the distinct possibility of a nasty twisted ankle.
Laser Night shows
Many of the ancient sites have beautiful night shows which depict something of the past splendour and are definitely worth seeing. However it is wise to wear good shoes as stumbling across loose stones is a particular problem at night and also bring a small torch, if possible, to guide your way. Getting separated from your travelling companions, or not being able to find your return bus, can lead to some understandable panic so listen carefully to any instructions and look out for some land marks before you get too far away into the night time crowd.
Animal bites
Some tourists may forget that rabies is a problem in many countries throughout the world and, even though Greece is regarded as rabies-free', there is always a problem if someone should get bitten. The possibility that this animal could have been recently smuggled into the country cannot be out ruled and so many would advise full post exposure treatment should this contact occur. Children may be at particular risk due to their inquisitive nature.
Swimming
Sunburn and swimming go hand in hand but drowning can also occur all too frequently within this region. Strong currents, swimming after meals (or alcohol) and the ever popular romantic midnight swim are all serious risk factors. Also children running around the deep end of the pool may lose their footing and topple in without warning. Unfortunately a very small child sinks instantly with very little sign of the emergency to those close by. Parents need to keep aware of this risk at all times.
The summer working holiday
Many of our students head towards Greece for 2 to 3 months during the summer to work. The attractions are obvious but commonsense and sensible life-style choices are needed throughout their stay to lessen the risk of illness or them returning home with an infection they had not bargained for. Unfortunately many return home with life-long illnesses which have been contracted from a single unprotected sexual contact.
Vaccinations for Greece
As a general rule the usual travel vaccines are not recommended for most short-term travellers to this region. However for the student planning to spend a more prolonged period it would be sensible to consider cover against both Hepatitis A and Hepatitis B and also to check that their Tetanus cover is up-to-date.
Summary
This is still one of the most popular destinations for northern European travellers and, in the vast majority of cases, they will have a fantastic time with only good memories. Unfortunately some less prepared folks will end up with serious sunburn and other illnesses or diseases which perhaps are frequently associated with their own lack of care and protection rather than anything specific to this beautiful country.

Travel News Headlines WORLD NEWS

Date: Tue, 7 Apr 2020 12:55:32 +0200 (METDST)

Athens, April 7, 2020 (AFP) - Hundreds of Greek healthcare workers demonstrated on Tuesday to protest at working conditions and lack of manpower and equipment in public hospitals during the coronavirus pandemic.   The demonstrations were staged to coincide with World Health Day, according to the federation of hospital personnel.   "You only saw us when we covered our faces," proclaimed a poster printed by hospital trade unions, bearing a picture of doctors wearing anti-coronavirus masks.    Demonstrators at the large Evangelismos hospital in central Athens held up signs demanding job hiring, virus testing and hospital equipment.

Police tried to enter the hospital courtyard where the rally was taking place before being forced back by demonstrators, an AFP photographer said.   A similar protest was held at the main hospital in Larissa in central Greece, according to images from public television ERT.    Despina Tossonidou, president of the doctors' union at Voula hospital in southern Athens, said that in addition to the hiring of medical staff, intensive care units in private clinics should be requisitioned "to overcome the shortcomings of the public sector" during the virus crisis.   Health care in Greece was drastically affected by the country's 2010-2018 financial crisis and tough austerity required by creditors in exchange for bailouts.

As part of its measures to deal with the pandemic, the government has offered clinics 30 million euros ($32.6 million) and announced the hiring on short-term contracts of 2,000 doctors and 2,000 nursing staff.    "These measures are just a drop in the ocean," said Tossonidou, a radiologist.    "The hospital system needs 30,000 additional permanent doctors," she said, also citing the lack of protective equipment and COVID-19 testing in hospitals.    "The majority of tests are currently carried out in private hospitals at costs ranging from 150 to 300 euros ($163-326)," said Tossonidou.    Greece, a country of around 10.7 million people, has suffered relatively less than other European nations in the pandemic, recording 81 deaths out of 1,755 cases.
Date: Sun, 22 Mar 2020 18:02:51 +0100 (MET)

Athens, March 22, 2020 (AFP) - Greece will impose a nationwide lockdown to stem the spread of the coronavirus, limiting people to their homes except for essential outings, Prime Minister Kyriakos Mitsotakis said Sunday.    "I have given orders that all appropriate action be taken to enforce the ban on all unnecessary movement across the country," Mitsotakis said in a televised address to the nation.   The restrictions will come into force from 6:00 am local time (0400 GMT) on Monday, and will require citizens to carry proof of identity to leave their homes. 

Outings are only permitted for people "going to work, the doctor, or to visit someone who needs help, or those who are buying food or medication", the prime minister said.    Citizens are also permitted to leave the house to walk their pets or exercise outdoors alone or with one other person.

There are 15 recorded deaths and 624 infections from the coronavirus in Greece, which has a population of 11 million.    Since reporting its first death from the virus on March 12, the country has gradually rolled out measures to limit gatherings and non-essential travel along with closing schools, shops and entertainment venues.
Date: Sat, 21 Mar 2020 10:59:18 +0100 (MET)

Athens, March 21, 2020 (AFP) - A strong 5.6 magnitude earthquake struck early Saturday in northwest Greece, damaging property in the city of Parga, authorities said.   The quake struck at 0049 GMT (0249 local time), with the epicentre 11 kilometres (around six miles) from Parga in Kanalaki district, and 316 kilometres northwest of Athens, the Athens geodynamic observatory said.   "No casualties have been reported at the moment," Parga mayor Nikolas Zacharias told AFP by telephone.

"Some old abandoned houses in Kanalaki collapsed and some houses suffered significant damage in this district of 2,500 inhabitants," Zaharias said, adding the temblor was strong throughout the area.   Landslides partially damaged the region's roads, he added.   Greece lies on major fault lines and is regularly hit by earthquakes, but they rarely cause casualties.   In 2017, a 6.7-magnitude earthquake killed two people on the island of Kos in the Aegean sea, causing significant damage.   In 1999, a 5.9-magnitude quake left 143 people dead in Athens and the region northwest of the capital.
Date: Wed, 26 Feb 2020 09:33:48 +0100 (MET)

Athens, Feb 26, 2020 (AFP) - Greece has announced a broad shutdown of public areas and travel restrictions, to be activated in case of a coronavirus outbreak.   The measures, formalised in a decree late on Tuesday, include temporary travel bans to and from countries with a large number of infections.

The decree also permits the requisitioning of beds in hotels and private clinics.   It also foresees the temporary closure of "indoor public gathering areas" such as schools, places of worship, cinemas, theatres, sports halls and businesses.   "We are ready to do whatever is necessary to protect public health," government spokesman Stelios Petsas told reporters.   The country has so far registered no confirmed cases of the virus.   Greece's health ministry has earmarked 13 hospitals nationwide equipped to handle virus cases.

A health ministry spokesman earlier this week noted that owing to the virus' long gestation period, health checks at ports and airports had minor chances of success.   On Monday, the Greek Olympic Committee said it had discussed alternative plans for the Olympic Flame lighting ceremony for the Tokyo 2020 Games in case of a virus outbreak.

The flame for the Tokyo 2020 Olympics is scheduled to be lit on March 12 in ancient Olympia and, following a torch relay on Greek soil, will be handed to the Tokyo organisers at a ceremony on March 19 at the Panathenaic Stadium in Athens.
Date: Tue, 18 Feb 2020 09:07:42 +0100 (MET)

Athens, Feb 18, 2020 (AFP) - Greece was hit with a 24-hour strike Tuesday over a pension reform encouraging people to stay longer in the workforce.   The labour action paralysed public transport in Athens, intercity trains and ferry ship services.   Civil servants are also walking off the job and journalists will stage a three-hour work stoppage against the pension reform.   "This bill is practically the continuation of (austerity) laws introduced in 2010-2019," civil servants' union ADEDY said.

Unions will hold street protests in Athens, Thessaloniki and other major cities later in the day.   The new conservative government says the reform, to be voted by Friday, will make the troubled Greek pension system viable to 2070.   The labour ministry says the overhaul -- the third major revamp in a decade -- will contain pension increases and reduce penalties for pensioners still working.

Successive governments have attempted to reform the pension system, whose previously generous handouts are seen as one of the causes of the decade-long Greek debt crisis.   Chronic overspending and the inaccurate reporting of the budget deficit spooked creditors in 2010, and required three successive bailouts by the European Union and the International Monetary Fund to avert a Greek bankruptcy.   In return for billions of euros in rescue funds, Greece had to adopt unpopular austerity reforms and pension cuts.
More ...

Denmark

Denmark, Greenland and the Faeroe Islands US Consular Information Sheet
March 05, 2008
COUNTRY DESCRIPTION:
Denmark is a highly developed stable democracy with a modern economy.
Greenland is a self-governing dependency of Denmark.
>The Faroe Islands are a self-governing overseas administrative division of Denmark.
For additional information, visit the State Department page http://www.state.gov/p/eur/ci/da.

ENTRY REQUIREMENTS:
Passport and visa regulations are similar for Denmark, Greenland, and the Faroes.
A valid passport is required.
U.S. citizen tourist and business travelers do not need visas for visits of up to 90 days.
That period begins when entering any of the following countries which are parties to the Schengen agreement: Austria, Belgium, The Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, and Sweden.
Contact the Royal Danish Embassy at 3200 Whitehaven Street NW, Washington, DC
20008, telephone (202) 234-4300 or visit its web site at http://www.ambwashington.um.dk/en for the most current visa information.

Note:
Although European Union regulations require that non-EU visitors obtain a stamp in their passports upon initial entry to a Schengen country, many borders are not staffed with officers carrying out this function.
If an American citizen wishes to ensure that his or her entry is properly documented, it may be necessary to request a stamp at an official point of entry.
Under local law, travelers without a stamp in their passports may be questioned and asked to document the length of their stay in Schengen countries at the time of departure or at any other point during their visit, and could face possible fines or other repercussions if unable to do so.

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:
Denmark remains largely free of terrorist incidents, however, the country shares, with the rest of Western Europe, an increased threat of Islamic terrorism.
Like other countries in the Schengen area, Denmark’s open borders with its Western European neighbors allow the possibility of terrorist groups entering and exiting the country with anonymity.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

Public demonstrations occasionally occur in Copenhagen and other Danish cities and are generally peaceful events.
Prior police approval is required for public demonstrations, and police oversight is routinely provided to ensure adequate security for participants and passers-by.
Nonetheless, as with any large crowd comprised of diverse groups, situations may develop which could pose a threat to public safety.
U.S. citizens are advised to avoid areas where public demonstrations are taking place.

From time to time Copenhagen may experience protest activities from young people in their attempt to defend their self-proclaimed rights to either property (club activity buildings) or other privileges provided by Danish public means.
American citizens should be aware that participation in illegal demonstrations or street riots may result in immediate imprisonment and long term bans on re-entering Denmark.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, including the 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, 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:
Denmark, Greenland, and the Faroes all have relatively low violent crime rates, however, non-violent crimes of opportunity have increased over the last few years, especially in Copenhagen and other major Danish cities, where tourists can become targets for pickpockets and sophisticated thieves.
Criminals frequent airports, train stations, and cruise ship quays to take advantage of weary, luggage-burdened travelers.
Thieves also operate at popular tourist attractions, shopping streets, and restaurants.
In hotel lobbies and breakfast areas, thieves take advantage of even a brief lapse in attention to snatch jackets, purses, and backpacks.
Women’s purses placed either on the backs of chairs or on the floor are typical targets for thieves.
Due to the increase of crimes of opportunity, Embassy Copenhagen has experienced a high rise in passport thefts during the summer of 2007.
Car and home break-ins are also on the rise.

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.

Denmark has a program to provide financial compensation to victims who suffer serious criminal injuries.
According to existing regulations, the victim must report the incident to the police within 24 hours.
Danish police routinely inform victims of serious crime of their rights to seek compensation.
The relevant forms can be obtained from the police or the Danish Victims’ Compensation Board:
Civilstyrelsen, Erstatningsnaevnet, Gyldenløvesgade 11, 1600 Copenhagen V, TEL:
(45) 33-92- 3334; FAX:
(45) 39-20-45-05; www.erstatningsnaevnet.dk; email: erstatningsnaevnet@erstatningsnaevnet.dk.
Claim processing time is a minimum of 3 months.
There is no maximum award limit.

See our information for Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Excellent medical facilities are widely available in Denmark.
In Greenland and the Faroe Islands, medical facilities are limited and evacuation is required for serious illness or injury.
Although emergency medical treatment is free of charge, the patient is charged for follow-up care.

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 website at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE:
The Department 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 Denmark is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

A valid U.S. driver's license may be used while visiting Denmark, but the driver must be at least 18 years old.
Driving in Denmark is on the right side of the road.
Road signs use standard international symbols.
Many urban streets have traffic lanes reserved for public transport only.
Unless otherwise noted on traffic signs, the speed limit is 50 km/h in urban areas, 80 km/h on open roads, and 130 km/h on expressways.

Use of seat belts is mandatory for drivers and all passengers.
Children under three years of age must be secured with approved safety equipment appropriate to the child's age, size, and weight.
Children from three to six years of age may use approved child or booster seats instead of seat belts.

Driving under the influence of alcohol or drugs is considered a very serious offense.
The rules are stringently enforced, and violations can result in stiff fines and possible jail sentences.

Copenhagen, the capital and largest city in Denmark, has an extensive and efficient public transportation system.
Trains and buses connect Copenhagen with other major cities in Denmark and to Norway, Sweden, and Germany.
Bicycles are also a common mode of transportation in Denmark.
Passengers exiting public or tourist buses, as well as tourists driving rental cars, should watch for bicycles on their designated paths, which are usually located between the pedestrian sidewalks and the traffic lanes.

Danish expressways, highways, and secondary roads are of high quality and connect all areas of the country.
It is possible to drive from the northern tip of Denmark to the German border in the south in just four hours.
Greenland has no established road system, and domestic travel is performed by foot, boat, or by air.
The majority of the Faroe Islands are connected by bridges or serviced by boat.
Although the largest islands have roads, most domestic travel is done on foot, horseback, boat, or by air.

The emergency telephone number for police/fire/ambulance in Denmark and the Faroe Islands is 112.
In Greenland contact the local police.

Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://www.denmark.org.
See also additional information on driving in Denmark at http://www.trafikken.dk/trafikken.asp?page=company&objno=7.

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

SPECIAL CIRCUMSTANCES:
The official unit of currency in Denmark is the Danish krone.
ATM machines are widely available throughout Denmark.
Please see our information on customs regulations.

For information concerning the importation of pets into Denmark, please visit the following website:
http://www.foedevarestyrelsen.dk.

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 protection 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 Denmark’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Denmark are severe and convicted offenders can expect long jail sentences and heavy fines.
Engaging in illicit 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 Denmark are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov, and to obtain updated information on travel and security within Denmark.
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 Dag Hammarskjolds Alle 24; 2100 Copenhagen, telephone: (45) 33-41-71-00; Embassy fax: (45) 35-43-02-23; Consular Section fax: (45) 35-38-96-16; After-hours emergency telephone: (45) 35-55-92-70.
Information is also available via the U.S. Embassy’s web site at http://denmark.usembassy.gov/.
The United States has no consular presence in Greenland or the Faroe Islands.
* * *
This replaces the Consular Information Sheet dated August 23, 2007 to update the sections on Entry Requirements and Information for Victims of Crime.

Travel News Headlines WORLD NEWS

Date: Tue, 7 Apr 2020 04:07:12 +0200 (METDST)

Copenhagen, April 7, 2020 (AFP) - Denmark is to gradually lift restrictions put in place to fight the new coronavirus, starting with the reopening of day-care nurseries, kindergartens and primary schools from April 15.   Prime Minister Mette Frederiksen said that according to health authorities "it is appropriate and justified to start a slow opening. But on condition that everyone keeps their distance and washes their hands."

The reopening of schools will take place gradually, with kindergartens and primary schools opening from April 15 and middle and high schools waiting until May 10, she told a press conference on Monday.   Bars, restaurants, nightclubs, shopping centres, hairdressers and massage parlours will remain closed, and gatherings of more than 10 people are still prohibited.   "Daily life is not going to return as before for the moment. We will live with many restrictions for many more months," the prime minister warned.   Border closures remain in place and travel abroad is not recommended.

Large gatherings are prohibited until August.   Frederiksen called on Danes to keep observing health rules and social distancing.   "A little slip in our individual behaviour can have a big impact on our well-being as a society," she said.    Denmark closed its borders to foreigners on March 14, the same day it recorded its first coronavirus fatality, and days later closed bars and restaurants and most shops.

The Nordic nation has recorded 4,875 infections and 187 deaths related to COVID-19.    It is the second European country after Austria to unveil its plans for a gradual easing of restrictions.
Date: Thu, 27 Feb 2020 07:21:09 +0100 (MET)

Copenhagen, Feb 27, 2020 (AFP) - Denmark reported its first coronavirus case Thursday, a man who had returned from a skiing holiday in northern Italy which has become a hotspot for the disease.   "The man who came back from a skiing trip with his wife and son on February 24 has been suffering since then from a cough and a temperature," Denmark's public health agency said in a statement.   "The man tested positive, but the results of his wife and son are negative," it said.   The man is relatively well and has returned to his home, where he remains in isolation with his family, it added.   According to public TV station TV2, the man is one of its employees.   Italy has reported 400 coronavirus cases, mostly in the north, and 12 deaths.
Date: Sat 5 Jan 2020
Source: Food Safety News [edited]

Several people part of a _Salmonella_ outbreak in Denmark tasted or ate raw or undercooked sausage, according to a recently published study. In November 2018, an outbreak of monophasic _Salmonella_ Typhimurium was detected. It sickened at least 49 people across the country.

A traditional form of raw Danish pork sausage called medister sausage was believed to be the source of illnesses. Product samples were negative for _Salmonella_, and investigations at the production site did not reveal the source of contamination. Medister sausage is often served in the late autumn months and Christmas season. It is a long, thick sausage made from ground pork, seasoned and stuffed into casings. Due to a control program, _Salmonella_ Enteritidis is all but eliminated in Danish broiler poultry and egg production, but _Salmonella_ Typhimurium still exists in pigs and pork.

In mid-November 2018, Statens Serum Institut (SSI) noted 8 cases of monophasic _Salmonella_ Typhimurium belonging to the same WGS cluster. The sequence type (ST) 5296 had not been detected before but was closely related to ST 34, which is often found in pork products.

In 8 initial hypothesis-generating interviews, 7 people said they had eaten a certain type of classic Danish raw pork sausage known as medister sausage, according to a study published in the journal Epidemiology and Infection. The median age was 65 years with a range from 11 months to 97 years, and 53 percent were male. Seven of 49 cases were children less than 18 years of age. 30 people were hospitalized, and 13 reported bloody diarrhea as one of the symptoms. There were no deaths. The onset date of illness was known for 38 of 49 patients and was between 14 Oct 2018, and 17 Jan 2019.

Almost all interviewed patients had eaten fresh pork, and 28 of them ate medister sausage in the week prior to becoming ill with Salmonella. Six patients said they had partly eaten the medister sausage raw or undercooked. Five people said they had failed to boil it prior to frying as is normally recommended on packages and by the Danish Veterinary and Food Administration (DVFA). In one family, a child had eaten medister sausage that was not thoroughly cooked.

"Consumers have to make sure that pork is handled correctly, in particular when it comes to raw products that need to be thoroughly cooked before consumption. Tasting raw meat or eating undercooked pork meat should be discouraged," said researchers.

Traceback investigations pointed to one manufacturer of minced meat and prepared meat products. A total of 90 batches of ground meat and of prepared meat, including 9 batches of medister sausage, were analyzed for _Salmonella_. Only one sample from a batch of minced pork patty sampled in January 2019 found _Salmonella_, but it was not related to the outbreak strain. Medister sausages were packed at the production site, and no handling of the sausage took place at supermarket level.

"No breaches in procedures or obvious incidents that could explain the presence of a specific type of _Salmonella_ in multiple batches of medister sausage in a prolonged period of several weeks were identified," according to researchers. The DVFA also investigated results of routine sampling at the slaughterhouse providing meat to the manufacturer. As part of mandatory sampling, one of every 1000 carcasses were swap sampled and analyzed for _Salmonella_. It was detected 8 times in these samples, but none were identical to the outbreak strain.

Because shelf life of medister sausage is short, and fresh meat is used for production, none of the raw material meat used to produce the batches suspected of having caused illness was available from the manufacturer by the time the outbreak was detected and investigation started. Researchers said it was likely the bacteria might be present in low numbers and unevenly distributed in the raw material, so the chance of detecting it at sampling might be limited. High fat content may also increase thermal resistance of bacteria so they are not fully eliminated by heating. "It is also likely that only a low _Salmonella_ dose is sufficient for patients to become ill, as medister sausage is a product with a high content of fat (10 to 20 percent) that protects the bacteria past the barrier of the gastric acid."

Samples of medister sausage from more manufacturers, as part of routine surveillance and companies own checks, were positive for Salmonella during the outbreak period. This includes finding the serovars Mbandaka, Typhimurium, and its monophasic variant, which was different from the outbreak strain.  [Byline: Joe Whitworth]
===================
[By monophasic, it is meant that the organism does not have the
complete set of flagellar serotypes. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Thu 24 Oct 2019
Source: Eurosurveillance 2019, 24(43) [edited]

[ref: Agergaard CN, Rosenstierne MW, Boedker R, et al. New tick-borne encephalitis virus hot spot in Northern Zealand, Denmark, October 2019. Euro Surveill. 2019; 24(43): pii=1900639]
---------------------------------------------------------------------
Abstract
--------
Tickborne encephalitis virus (TBEV), a member of the family Flaviviridae, genus _Flavivirus_, causes tickborne encephalitis (TBE). In Denmark, TBE is endemic only on the island of Bornholm, with an incidence of 4 per 100 000 inhabitants per year [1,2]. Here we report 3 clinical cases of TBE in patients hospitalised within a month [June/July 2019] and all residing at the boundary of the same forest, Tisvilde Hegn [Capital Region], in Northern Zealand.

Discussion
----------
The incidence of TBE has been increasing in Denmark, in its neighbouring countries as well and in the rest of Europe in recent years, which mirrors the increased abundance of ticks, the increased geographic spread and potentially climate changes [8-11]. The vector for the European virus subtype, TBEV-Eu, is _Ixodes ricinus_, which is prevalent in most of Europe and the dominant tick species in Denmark (greater than 90%) [12]. In 2009, 2 clinical cases of TBE were reported outside Bornholm and TBEV was detected in Northern Zealand in ticks collected in the forest of Tokkekebb Hegn, which is 40 km [25 mi] south east of Tisvilde Hegn, in 2009, 2010, and 2011 [4,5]. Surprisingly, TBEV was no longer detected in the same area in Tokkekoeb Hegn during 2016 and 2017 [13]. In 2018, another 2 human cases of TBE outside Bornholm were identified on the Island of Funen and in Jutland, respectively, but no new micro foci of TBEV has been localized [14], (data not shown).

All 3 patients presented here live close to Tisvilde Hegn in Northern Zealand, and had typical biphasic disease starting with fever, gastrointestinal or influenza-like symptoms and fatigue, followed by a few days of recovery before clinical meningitis/meningoencephalitis at hospitalisation and neurologic sequelae in terms of primarily fatigue and dizziness.

Subsequent collection of _I. ricinus_ ticks from a part of Tisvilde Hegn surrounding a well-visited forest playground, where Case 3 recalled a tick bite, identified a specific area adjacent to the playground to be an acute, new, high-risk TBEV micro-focus in Northern Zealand. The estimated high prevalence of TBEV is 8% at the centre of the focus which exceeds recent prevalence estimates of 0.6% from endemic Bornholm, as well as Denmark's neighbouring countries and most European countries [4,5,8,10,11,13,15]. The presence of the virus in nymphs, but not adult ticks, and the molecular evolutionary analyses of the homogeneous TBEV sequences suggests a single TBEV introduction in 2019, probably by migrating birds from Norway. Tisvilde Hegn and the forest playground is well-visited by Danish and international tourists, and containment measures such as fencing, grass cutting and signage along the playground's eastern side have been made in order to minimise the risk of further infections and spreading.
====================
[The complete article including figures, tables, and references is available at the source URL above.  There were previous reports of human cases TBE virus infection in Denmark in 2009 and again in 2018. The authors note that TBE virus was not found in ticks in the area in 2016 and 2018, nor were any human cases identified there then. They speculate that the virus was introduced by ticks on migratory birds.

TBE is caused by 3 different subtypes of tick borne encephalitis virus: Western European TBE virus, Far Eastern TBE virus, and Siberian TBE virus. Western European TBE (also known as Central European encephalitis) is endemic in western and central European countries and is expanding its range. - ProMED Mod.TY]

Date: Fri 26 Jul 2019
Source: Food Safety News [edited]
<https://www.foodsafetynews.com/2019/07/wgs-project-helps-denmark-uncover-campylobacter-outbreak/>

Fifty people are ill in Denmark from campylobacteriosis after eating chicken meat but authorities believe the actual number of patients may be much higher. Statens Serum Institut (SSI), Danish Veterinary and Food Administration (Fødevarestyrelsen) and DTU Food -- National Food Institute are investigating the _Campylobacter jejuni_ outbreak. _Campylobacter_ is the main cause of bacterial intestinal infections in Denmark and more than 4500 cases were registered in 2018. The same type of _Campylobacter_, sequence type 122, identified in patients by whole genome sequencing has also been found in chicken meat from one slaughterhouse, named as HKScan in Vinderup, a town in North-western Jutland.

HKScan is a Nordic meat and meals company employing more than 600 people in Denmark at production units in Vinderup and Skovsgaard. The Danish Veterinary and Food Administration is continuing to investigate and officials have been sent to help the company track and eliminate the source of infection. Those sick are 20 women and 30 men aged 14 to 87 with a median age of 49 years. As part of a project this year [2019] involving the Clinical Microbiology Department (KMA) in Aalborg, the Danish Veterinary and Food Administration and SSI; _Campylobacter_ isolates from patients diagnosed in Aalborg since March 2019 have been collected, sent to SSI and whole genome sequenced. _Campylobacter_ isolates are not routinely submitted and sequenced so the outbreak has been detected due to the project and may otherwise have gone unnoticed. In the past it has been difficult to detect and solve such outbreaks.

Some isolates also come from other KMA's as part of the Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP) project. Steen Ethelberg, a senior scientist at SSI, said patients have fallen sick over a couple of months and are still being reported. "The most recent estimate for how many more cases are in the population relative to the diagnosed laboratory controlled cases is a factor of 12 so there would be more cases that are actually ill in any outbreak," he told Food Safety News. "The reason we know about this outbreak is because we are running a project in one part of the country where all the patient isolates are being collected and subjected to whole genome sequencing.

Since the outbreak is mainly based on one of the 10 labs only you would expect patients all over the country. It seems likely that there could be more cases and we also have some smaller clusters detected in the project." Ethelberg said the project is trying to see how WGS may be helpful in understanding _Campylobacter_. "It is about collecting patient isolates from one lab and at the same time analysing chicken meat and subjecting the _Campylobacter_ isolates in chicken meat to WGS and then comparing the sequences. In the project we are learning about the aetiology of _Campylobacter_ but we also see outbreaks in real time.

This outbreak is big enough that we thought it should be reported to the public but in a sense it is not so different because we know many people are ill from _Campylobacter_ from poultry products." The Danish Veterinary and Food Administration has been taking samples for _Campylobacter_ of various cuts of chicken from different stores and these have been sequenced. Annette Perge, from the agency, told Food Safety News that it was still too early to conclude the outbreak was over. "The slaughterhouse produces both fresh and frozen products hence we can't rule out that products may still be on the market or bought and stored frozen at private households.

Based on patient interviews it has not been possible to point out specific products, places of purchase, or periods of purchase," she said. "Furthermore there is no legal requirements stating that _Campylobacter_ is prohibited in poultry meat. However even without legal requirements foods used as intended should not result in illness. The slaughterhouse is a large establishment and their products are sold at all the major Danish retail chains." The agency does not yet know if a link was limited to one farm or establishment, according to Perge. "The link between food isolates and routine samples taken at the slaughterhouse, samples of thigh skin from chickens taken routinely for analyses, and the patient isolates was seen when comparing whole genome sequencing results.

However it has not been possible to verify the link through interview with patients. We have no indication that this outbreak is due to a contamination persisting in the slaughterhouse. They have been allowed to continue production. They are assisting us in any way possible to solve the case." Perge said samples from chickens from a specific farm showed a close resemblance to the patients. "The farm has been visited by the audit team from the slaughterhouse and corrections to practices have been made. At the moment no chickens are delivered for slaughter as they are not yet old enough. Meat from chickens slaughtered from that farm will be tested for _Campylobacter_ and eventual isolates will be sequenced and compared to the outbreak strain. If the meat contains larger numbers of _Campylobacter_, the use of the meat will be restricted." [Byline: Joe Whitworth]
========================
[The source of the outbreak may we'll be chicken, a common vehicle for this enteric pathogen. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Denmark:
<http://healthmap.org/promed/p/111>]
More ...

Somalia

Somalia US Consular Information Sheet
November 04, 2008
COUNTRY DESCRIPTION:
Since the collapse of the central government in 1991, Somalia has been subject to widespread violence and instability.
A Transitional Federal Government (TFG
was established in 2004 to guide the country through a transitional process to result in a new constitution and elections, planned for 2009.
However, the nascent TFG remains fragile and lacks the capacity to provide services inside Somalia.
General insecurity and inter- and intra-clan violence frequently occur throughout the country, and attacks and fighting between anti-government elements and TFG and Ethiopian forces take place regularly in Mogadishu and in regions outside the capital.
The United States has no official representation inside Somalia.

In 1991, the northwest part of the country proclaimed itself the Republic of Somaliland and maintains a separate regional governing authority; however, Somaliland has not received international recognition as an independent state.
The northeastern section of Somalia, known as the semi-autonomous region of Puntland, has also made efforts to establish a regional governing authority but has not claimed independence.
Somalia's economy was seriously damaged by the civil war and its aftermath, but the private sector is trying to reemerge.
Tourist facilities are non-existent.
Read the Department of State Background Notes on Somalia for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport is required for travel to Somaliland and Puntland.
Both regions require a visa and issue their own at their respective ports of entry.
For travel to other parts of Somalia, including Mogadishu, a passport is required; however, there is no established governing authority capable of issuing a universally recognized visa.
Air and seaports are under the control of local authorities that make varying determinations of what is required of travelers who attempt to use these ports of entry.

Travelers may obtain the latest information on visas as well as any additional details regarding entry requirements from the Permanent Representative of the Somali Republic to the United Nations, telephone (212) 688-9410/5046; fax (212) 759-0651, located at 425 East 61st Street, Suite 702, New York, NY
10021.
Persons outside the United States may attempt to contact the nearest Somali embassy or consulate.
All such establishments, where they exist, are affiliated with the TFG, whose authority is not established throughout Somalia.

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:
Since the U.S. does not have an Embassy or any other diplomatic presence in any part of Somalia, including Somaliland and Puntland, the U.S. government cannot provide any consular services to U.S. citizens in Somalia.
Limited American Citizen Services are available for travelers to Somalia at the U.S. Embassies in Nairobi and Djibouti.

While Somaliland has experienced a level of stability that has not been present in other parts of Somalia, please note that the Department of State continues to warn U.S. citizens against all travel to Somalia, including the self-proclaimed “independent Republic of Somaliland”
-- see Department’s Travel Warning for Somalia.
Travelers insisting on traveling to Somaliland despite this warning should nevertheless always check current conditions in Somaliland before traveling.
Terrorist attacks have occurred against international relief workers, including Westerners, throughout Somalia, Puntland, and Somaliland.
In early 2006, an American citizen living and working in southern Somalia was kidnapped and held for ransom before being released.
In July 2007, kidnapping threats were issued against international humanitarian assistance workers in Puntland.
In 2007 and 2008, there were several violent kidnappings and eight assassinations of staff working for international organizations.
Additionally, there have been threats against Westerners in Somalia, including Somaliland. Terrorist operatives and armed groups in Somalia have demonstrated the intent to attack air operations at Mogadishu International Airport.
Additionally, a foreign terrorist organization is ostensibly in control of the southern port city of Kismayo and has openly threatened air traffic out of the local airport.
Armed conflict is commonplace in the capital city of Mogadishu.
All visitors are urged to restrict their movements in the region.
Persons traveling to or through this area should also be aware that incidents such as armed banditry, road assaults, kidnappings for ransom, shootings and grenade attacks on public markets, and detonations of anti-personnel and-vehicle land mines regularly occur.
Sporadic outbreaks of civil unrest persist and armed conflict also occurs in the rest of the country.
Also, illegal roadblocks remain common throughout Somalia and have resulted in serious injury or death.

Cross-border violence occurs periodically.
The area near Somalia’s border with Kenya has been the site of numerous incidents of violent criminal activity, including kidnappings and grenade attacks on hostels used by international aid workers.
U.S. citizens who decide to visit the area should be aware that they could encounter such criminal activity.

Americans considering seaborne travel around Somalia’s coastal waters should exercise extreme caution, given numerous recent incidents of vessel hijacking and/or piracy.
Since 2005 there have been numerous acts and attempted acts of piracy in Somalia's coastal waters, especially off of the Horn of Africa.
Piracy remains rampant off the shores of south central Somalia and Puntland.
Seaborne travelers should exercise extreme caution, as these groups have proven themselves well armed and dangerous.
When transiting in and around the Horn of Africa and/or in the Red Sea, it is strongly recommended that vessels convoy and maintain good communications contact at all times.
Marine channels 13 and 16 VHF-FM are international call-up and emergency channels and are commonly monitored by ships at sea.
2182 MHz is the HF international call-up and emergency channel.
In the Gulf of Aden, transit routes farther offshore reduce, but do not eliminate, the risk of contact with suspected assailants.
Wherever possible, travel in trafficked sea-lanes.
Avoid loitering in or transiting isolated or remote areas.
In the event of an attack, consider activating the “Emergency Position Indicating Radio Beacons (EPIRB).”
Vessels may also contact the Yemeni Coast Guard 24-hour Operations Center at (967) 1-562-402.
The Operations Center staff speaks English.
Due to distances involved, there may be a considerable delay before assistance arrives.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affair’s web site at http://travel.state.gov, 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:
Pervasive and violent crime is an extension of the general state of insecurity in Somalia.
Serious, brutal, and often fatal crimes are very common.
Kidnapping and robbery are a particular problem in Mogadishu and other areas of the south.

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Somalia are extremely limited.
Travelers should carry personal supplies of medications with them.

Malaria is endemic in many areas.
There have been outbreaks of cholera in Mogadishu, Kismayo in the south, and Puntland in the northeast.
For additional information on malaria and cholera, including protective measures, see the CDC travelers' health web page at http://wwwn.cdc.gov/travel/default.aspx.

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.
Travelers are strongly encouraged to purchase such insurance prior to traveling to East Africa if not already covered under their current medical plan.
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 Somalia is provided for general reference only, and it may not be totally accurate in a particular location or circumstance.

There are no traffic lights in the country except in Hargeisa in Somaliland.
The poor condition of most roads makes driving hazardous.
Night driving can be dangerous due to the absence of lighting.
Recent occurrences of land mine detonations on roads point to a potentially fatal risk for drivers.

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Somalia, the U.S. Federal Aviation Administration (FAA) has not assessed Somalia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa
SPECIAL CIRCUMSTANCES:
Water and electricity systems are poor.
Functioning telecommunications systems exist in major towns in Somalia.

There is no organized system of criminal justice in Somalia, nor is there any recognized or established authority to administer a uniform application of due process.
Enforcement of criminal laws is, therefore, haphazard to nonexistent.
Locally established courts operate throughout Somalia under a combination of Somali customary and Islamic Shari'a law, some of which may be hostile towards foreigners.

The Somali shilling is the unit of currency except in Somaliland, which uses the Somaliland shilling.
U.S. dollars are accepted everywhere.
Credit cards are not accepted in Somalia.

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 laws in Somalia, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Somalia 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 on international adoption of children and international parental child abduction, see the Office of Children’s Issues web pages.

In accordance with Somali customary law, any child whose father is a Somali citizen is also considered to be a Somali citizen.
Somali children require their father's permission to leave the country.

REGISTRATION / EMBASSY LOCATION:
There is no U.S. Embassy in Somalia.
U.S. citizens who plan to enter Somalia despite the current Travel Warning 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 Somalia.
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.
Travelers to Somaliland should register with the U.S. Embassy in Djibouti, and travelers to Puntland or southern Somalia should register with the U.S. Embassy in Nairobi.

The U.S. Embassy in Djibouti is located at Plateau du Serpent, Boulevard Marechal Joffre, Djibouti City; telephone (253) 35-39-95.
The after-hours telephone number is (253) 35-13-43.
The mailing address is Ambassade Americaine, B.P. 185, Djibouti, Republique de Djibouti.
The workweek in Djibouti is Sunday through Thursday.
The U.S. Embassy in Nairobi is located on United Nations Avenue, Gigiri, Nairobi, Kenya; telephone (254)(20) 363-6000; fax (254) (20) 363-6410.
In the event of an after-hours emergency, the Embassy duty officer is available at (254) (20) 363-6170.
The Embassy's mailing address is P.O. Box 606 Village Market, 00621 Nairobi, Kenya, or mail using U.S. domestic postage may be addressed to Unit 64100, APO AE 09831, USA.
*

*

*
This replaces the Country Specific Information for Somalia dated October 4, 2007 to update section on Safety and Security.

Travel News Headlines WORLD NEWS

Date: Mon, 30 Mar 2020 08:10:11 +0200 (METDST)

Mogadishu, March 30, 2020 (AFP) - A governor in Somalia's Puntland has been killed in a suicide bombing claimed by the al-Shabaab jihadist group, police and hospital sources said Monday.   Abdisalan Hassan Hersi, governor of Nugaal region, succumbed to his injuries after being rushed to hospital in Garowe, the capital of Puntland where the blast occurred Sunday.   "The doctors tried to save the governor's life but unfortunately he died from his injuries," Mohamed Weli, a police officer in Puntland, told AFP by phone.   "He was in a critical condition when he was admitted to hospital."   A source at the hospital, who did not wish to be identified, said the governor died less than an hour after being admitted to the intensive care ward.   "He was badly wounded in the blast and he had little chance of surviving such serious injuries," the source told AFP.

A former police commander and a civilian also wounded in the blast were being treated at hospital, officials said Monday.   Several witnesses described the attacker running at the governor's vehicle before detonating a suicide vest, triggering an explosion.   Al-Shabaab, an Islamist militant group waging a deadly insurgency in Somalia, claimed responsibility for the attack in a statement.   The Al-Qaeda affiliate was driven out of Mogadishu in 2011 and lost most of their strongholds, but still control vast swathes of the countryside.   They have vowed to overthrow the internationally-backed government in Mogadishu and have carried out many attacks in the capital.
Date: Sun 1 Mar 2020
Source: Anadolu Agency [edited]

At least 7 deaths and over 700 cases have been reported in a cholera outbreak in Somalia, the United Nations said on Sunday [1 Mar 2020]. A total of 732 cases were recorded across the country between [23 Jan 2020 and 25 Feb 2020], according to the UN Office for the Coordination of Humanitarian Affairs (UNOCHA).

It said 7 deaths and 617 cases were reported in the central Hiran region and at least 115 cases were recorded in a week in the southeastern Banadir region, in which the capital Mogadishu is located.  "Three months after Deyr rains flooded parts of Somalia, acute water diarrhoea (AWD)/cholera cases remain high. This situation could worsen when April-June rains start," the UN agency said in a tweet.  It said women and children under the age of 5 were most vulnerable and they would need more help if AWD/cholera cases surge after the next rainfall season.

A doctor in Beledweyne, the capital of the hard-hit Hiran region, told Anadolu Agency that most victims in the latest outbreak were children, women and the elderly. "Children, pregnant women, and elderly people have been most affected. There are many in hospitals right now. We need the federal government, other states, and humanitarian agencies to send medical aid and doctors for our help," said Hussein Abdihakin Mohamed.  [Byline: Mohammed Dhaysane]
Date: Sat, 28 Dec 2019 10:41:13 +0100 (MET)

Mogadishu, Dec 28, 2019 (AFP) - A massive car bomb exploded in a busy area of the Somali capital Mogadishu on Saturday, leaving at least 76 dead and scores injured, an ambulance official said.   "The number of casualties we have confirmed is 76 dead and 70 wounded, it could still be higher," the director of the private Aamin Ambulance services, Abdukadir Abdirahman Haji told AFP.
Date: Thu 5 Dec 2019
Source: Garowe Online [edited]

An outbreak of cholera has killed 7 people in Somalia's southwestern region of Bakol, an official confirmed on Wednesday [4 Dec 2019]. Abdullahi Mohamed Nur, deputy governor of the Bakol region, told journalists that an acute watery diarrhea breakout is causing the deaths.  "Cholera killed 7 people; 5 of them are children while 2 others are adults," Nur said. "No humanitarian aid has been delivered to the region; hence we appeal to the international aid agencies to provide urgent help to these local victims," he added.

Medical sources told the media that many people admitted to local hospitals are suffering from diarrhea disease. This comes amid outpour from Shabelle and Juba rivers, which caused casualties and damage in southern regions. More than 300,000 people have since been displaced from their homes following floods which have hit major parts of the country.
=================
[As stated in Lutwick LI, Preis J, Choi P: Cholera. In: Chronic illness and disability: the pediatric gastrointestinal tract. Greydanus DE, Atay O, Merrick J (eds). NY: Nova Bioscience, 2018; pp 113-136, oral rehydration therapy can be life-saving in outbreaks of cholera and other forms of diarrhea:

"As reviewed by Richard Guerrant et al (1), it was in 1831 that cholera treatment could be accomplished by intravenous replacement, and, although this therapy could produce dramatic improvements, not until 1960 was it 1st recognized that there was no true destruction of the intestinal mucosa, and gastrointestinal rehydration therapy could be effective, and the therapy could dramatically reduce the intravenous needs for rehydration. Indeed, that this rehydration could be just as effective given orally as through an orogastric tube (for example, refs 2 and 3) made it possible for oral rehydration therapy (ORT) to be used in rural remote areas and truly impact on the morbidity and mortality of cholera. Indeed, Guerrant et al (1) highlight the use of oral glucose-salt packets in war-torn Bangladeshi refugees, which reduced the mortality rate from 30% to 3.6% (4) and quotes sources referring to ORT as 'potentially the most important medical advance' of the 20th century. A variety of formulations of ORT exist, generally glucose or rice powder-based, which contain a variety of micronutrients, especially zinc (5).

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

References
------------
1. Guerrant RL, Carneiro-Filho BA, Dillingham RA. Cholera, diarrhea, and oral rehydration therapy: triumph and indictment. Clin Infect Dis 2003;37(3):398-405.
2. Gregorio GV, Gonzales ML, Dans LF, Martinez EG. Polymer-based oral rehydration solution for treating acute watery diarrhoea. Cochrane Database Syst Rev 2009;(2):CD006519.
3. Gore SM, Fontaine O, Pierce NF. Impact of rice based oral rehydration solution on stool output and duration of diarrhea: meta-analysis of 13 clinical trials. BMJ 1992;304(6822):287-91.
4. Mahalanabis D, Choudhuri AB, Bagchi NG, et al. Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med 1973;132(4):197-205.
5. Atia AN, Buchman AL. Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol 2009;104(10):2596-604.
6. WHO. The treatment of diarrhea, a manual for physicians and other senior health workers. 4th ed. 2005.

[HealthMap/ProMED-mail map:
Date: Wed, 24 Jul 2019 23:25:39 +0200

Mogadishu, July 24, 2019 (AFP) - Six people were killed and the mayor of Mogadishu was wounded in a bombing at the mayoral offices in the Somali capital on Wednesday, in an attack claimed by Al-Shabaab jihadists to have been targeting a UN envoy.   United Nations special envoy James Swan had met the mayor, Abdirahman Omar Osman, and left just before the blast at the headquarters of the Banadir district, which encompasses Mogadishu, according to the mission's Twitter account.   "Six people, including two district commissioners and three directors, were killed in the terrorist attack this afternoon," Information Minister Mohamed Abdi Hayir Mareye told reporters.

As well as the mayor, five others, including district commissioners, were injured in the blast and being treated by doctors.   "I deplore this heinous attack which not only demonstrates a violent disregard for the sanctity of human life, but also targets Somalis working to improve the lives of their fellow Somalis in the Mogadishu-Banadir region," Swan said in a statement, confirming he had been in the building earlier in the day.   The Al-Qaeda linked Al-Shabaab jihadist group claimed responsibility for the "well-prepared operation", saying they were targeting Swan.

A security source, who asked not to be named, said a suicide bomber had entered a hall where the officials were meeting and detonated the blast inside.    "The mayor was wounded in the blast and he is currently being treated. Some of the commissioners of Mogadishu district have also been wounded," deputy mayor Mohamed Abdullahi Tulah told the government's radio station Muqdisho.   Security forces are investigating the incident.

"The blast occurred inside but we are not sure what exactly caused it, some reports we are getting indicate it was caused by a suicide bomber... and there are casualties," said security official Mahdi Abdirahman.   "The blast was very heavy, and I saw people fleeing, some with shrapnel wounds, outside the Banadir administration headquarters," said witness Mohamud Shariif, referring to the regional government offices.   In a statement, Shabaab said they had "killed many of the enemy".   Mogadishu is regularly hit by attacks by the Shabaab, which has fought for more than a decade to topple the Somali government.   The city was on Monday struck by a car bomb that left 17 dead and more than two dozen wounded.
More ...

World Travel News Headlines

Date: Wed, 8 Apr 2020 09:21:43 +0200 (METDST)
By Jing Xuan TENG

Wuhan, China, April 8, 2020 (AFP) - Voicing joy and excitement from behind face masks, tens of thousands of people fled Wuhan on Wednesday after a 76-day travel ban was lifted on the Chinese city where the coronavirus first emerged.   Previously quiet train and bus stations bustled as an exodus began from the city of 11 million, with some passengers wearing hazmat suits.

Hao Mei, a single parent from the nearby city of Enshi, said her two children had been home alone since she got stuck in Wuhan, where she works in a school kitchen.   "You have no idea! I was already up around 4 am. I felt so good. My kids are so excited. Mum is finally coming home," the 39-year-old told AFP as she waited to board a train.   "At the start of the lockdown, I cried every night. I was really miserable, because my little girl is still young, she's only 10."

Up to 55,000 people are expected to leave Wuhan on Wednesday just by train, according to government estimates.   Steady streams of cars were on the roads heading out of the city Wednesday morning, after barricades on its outskirts were dismantled with the ban on outbound travel being lifted at midnight.

Ferries, trams and taxis resumed operations and the airport also opened again for domestic flights, with queueing passengers in protective wear wheeling cases.   State news agency Xinhua said there would be around 200 inbound and outbound flights leaving the city on Wednesday.   A group of medics leaving Wuhan hugged their colleagues from the city goodbye as they prepared to board flights home.

- World-first lockdown -
Wuhan led the world with an unprecedented quarantine lockdown on January 23 in a bid to stop the spread of the then-mysterious respiratory virus.   Chinese disease control officials said in January that the virus likely leapt from wildlife to humans at a Wuhan market that sold wild animals for food.   The rest of surrounding Hubei province quickly followed Wuhan, cutting tens of millions of people off from the world.

As the virus spread rapidly around the globe, many countries imposed similar draconian measures that have forced around half of humanity into some form of lockdown.   But while the pandemic continues to worsen in many other parts of the world, with the global death toll surpassing 80,000, the quarantine measures have appeared to pay off in Wuhan and other parts of China.   Its officially reported number of deaths and overall infections has plummeted in recent weeks.

China's ruling Communist Party -- accused of a slow-footed response and an initial attempt to cover up the outbreak -- has portrayed its subsequent containment efforts as a huge success.   "Wuhan deserves to be called the city of heroes," blared an announcement on one of the city's train station PA systems on Wednesday.   "Wuhan has lost a lot in this epidemic, and Wuhan people have paid a big price," a 21-year-old man surnamed Yao, who was heading back to his restaurant job in Shanghai, told AFP.   "Now that the lockdown has been lifted, I think we're all pretty happy."

- 'Not releasing control' -
Restrictions began to be eased for residents of Hubei, which has suffered the majority of China's officially reported 3,300 deaths, about two weeks ago.   Authorities, however, waited until Wednesday to allow normal traffic out of Wuhan amid lingering fears elsewhere in China that people from the city pose a risk.   Those fears were clearly evident throughout Wuhan despite the buzz of excitement.

At the city's Hankou train station, a robot whizzed through crowds of passengers, spraying their feet with disinfectant and playing a recorded message reminding them to wear face masks.   Passengers also had to submit to temperature checks and show a green "health code" on their phone, meaning they are considered healthy, allowing them to travel.   Part of the "health code" approval is based on their neighbourhood having been declared virus-free.

Many travellers from Wuhan will also face two-week quarantines in their destination provinces.   Eastern Zhejiang province said it will make all arrivals from Wuhan for the next two weeks have a nucleic acid test for the virus.   Various restrictions on movement within the sprawling metropolis will also remain in place to guard against a second wave of infections.   The state-run People's Daily newspaper warned Wednesday that opening up "does not mean releasing control".

Officials have said schools in Wuhan will remain closed and citizens are being discouraged from leaving the city, or even their own residential neighbourhoods.   Wuhan public security bureau official Yan Qiangsheng told reporters Wednesday that "lifting the lockdown doesn't mean stopping the anti-virus measures we have in place."    Government estimates said nearly half the people expected to leave Wednesday were bound for the southern economic powerhouse of Guangdong province, a magnet for migrant workers.
Date: Wed, 8 Apr 2020 05:36:53 +0200 (METDST)

Ashgabat, Turkmenistan, April 8, 2020 (AFP) - Authoritarian Turkmenistan gathered thousands of citizens for mass exercise events to mark World Health Day, state media said, ignoring the global trend for social distancing to fight the spread of the coronavirus pandemic.

The Central Asian country, along with North Korea, is one of a handful of territories which claim they have no cases of the virus which is sweeping across the globe.   A state television broadcast late on Tuesday showed hundreds of people wearing identical coloured tracksuits cycling in close formation on a cold, damp day in the capital Ashgabat.

Another sequence showed state employees including medical staff doing stretches inside and outside government buildings.   State media said 7,000 citizens participated in cycling events across the gas-rich ex-Soviet country to celebrate the date, which has been marked internationally since 1950.   President Gurbanguly Berdymukhamedov was shown riding a horse and biking with a small group of officials.

Turkmenistan has yet to register a case of the novel coronavirus that has killed more than 80,000 people worldwide, despite sharing a border with Iran, one of the first countries to be hit hard by the pandemic after China.   The country's government is notoriously secretive and national statistics, whether health-related or economic, are regularly doubted by field experts.

A separate state news report on Wednesday said authorities were building a hospital to treat infectious diseases in the Akhal region that surrounds Ashgabat, but did not mention COVID-19.   Strongman Berdymukhamedov mentioned the coronavirus publicly for the first time last week in a speech where he talked about the economic threat posed by the pandemic.    Turkmenistan and Tajikistan -- another former Soviet Central Asian country that has yet to declare a case of the disease -- both sent children back to school after spring holidays this week.
Date: Tue, 7 Apr 2020 20:44:51 +0200 (METDST)
By Mariëtte Le Roux and AFP bureaus

Paris, April 7, 2020 (AFP) - Paris on Tuesday banned daytime jogging to keep people from bending anti-coronavirus lockdown rules as France breached 10,000 deaths due to the outbreak.   Other cities also announced stricter restrictions, some controversial, on the day top health official Jerome Salomon told journalists 10,328 people had died of COVID-19 in France since March 1.   Of these, 7,091 had perished in hospitals -- 597 in the last 24 hours -- and 3,237 in old age homes, Salomon said, warning "the epidemic is continuing its progression."   "We are in the ascending phase of the epidemic, even if it is slowing a bit," he said, adding "we have not yet reached the peak."

Senior government officials warned it was too early to think of lifting the nationwide lockdown which entered into force on March 17 and is set to run until April 15, for now.   Interior Minister Christophe Castaner has urged municipal officials to toughen restrictions on movement if necessary, and Paris announced it would enforce a ban on individual outdoor sports between the hours of 10:00 am and 07:00 pm starting Wednesday.   Under the nationwide orders, people can leave home only for essential purposes, which include a solo walk or run within a one-kilometre (0.6-mile) radius of home.

But amid a spell of sunny spring weather, large groups of Parisians were seen running, walking and congregating over the weekend, even as police stepped up patrols and already overstretched hospitals grappled with an influx of patients.   "Every excursion avoided aids the fight against the epidemic," Paris Mayor Anne Hidalgo and police chief Didier Lallement said in a statement Tuesday announcing the partial jogging ban.   Paris and other cities have already closed public parks and gardens as part of the nationwide lockdown that requires people to carry a document justifying any excursion from the home.    Those caught without the document risk a fine starting at 135 euros ($147).   In the north of France, the mayor of Marcq-en-Baroeul has made spitting in public, coughing or sneezing without covering one's face, and throwing used masks and gloves in the street punishable by a fine of 68 euros.

But France's Human Rights League said Tuesday it would take the mayor to court for what it considered a violation of fundamental human liberties.   And the Atlantic coastal resort city of Biarritz on Tuesday overturned a two-minute limit it had set for people to spend on public benches after widespread criticism.   Prime Minister Edouard Philippe told parliament, meanwhile, that "the period of confinement will continue."   The lockdown "is difficult for many French people, I am fully aware of this. But it is essential if we do not wish to find ourselves in an even worse situation than the one we are experiencing today," he said.

- 'Far from over' -
Like many other nations, France on Tuesday also debated the merits of encouraging, even compelling, people to wear face masks to prevent virus spread.   Health Minister Olivier Veran told lawmakers it remained an "open question" that required further scientific investigation.   France's Academy of Medicine, which advises the government on epidemics, has advocated mask-wearing as an aid in curbing the outbreak, but international bodies, including the World Health Organization (WHO) disagree.

The WHO said Monday that asking the general public to wear face masks could be justified in areas where hand-washing and physical distancing were difficult, but warned that masks alone could not stop the pandemic.   France's Order of Pharmacists and two labour unions urged the government Tuesday to allow pharmacies to sell "alternative" non-medical grade masks to members of the public as an added protection.    France also announced that anyone wishing to enter the country starting Wednesday would need a special "travel certificate" in an extension of the lockdown measures.
Date: Tue, 7 Apr 2020 18:05:38 +0200 (METDST)

Prague, April 7, 2020 (AFP) - Czech lawmakers on Tuesday gave the green light to extend the state of emergency until April 30, in order to maintain the steps taken against the spread of coronavirus.    The government had asked for an extension until May 11 but failed as 90 of 101 lawmakers present wanted a shorter term.

The state of emergency allows the government to take restrictive steps to combat the coronavirus or buy medical material without declaring a tender.   "I don't want to restrict freedoms a second longer than absolutely necessary," Prime Minister Andrej Babis told lawmakers.   "Unfortunately, the situation is serious and I can't promise that this will be the last time I stand here with this request."

The vote means that all pubs and many shops will remain closed and free movement will be restricted until April 30 in the EU member of 10.7 million people, which has registered 4,944 cases of the virus including 88 deaths.   The cabinet can declare a state of emergency only once for 30 days, which it did on March 12. For an extension, it needs the go-ahead from the parliament.
Date: Tue, 7 Apr 2020 18:05:32 +0200 (METDST)

New York, April 7, 2020 (AFP) - New York state has recorded its highest number of COVID-19 deaths in 24 hours, Governor Andrew Cuomo said on Tuesday, adding though that hospitalizations appeared to be "plateauing."   Cuomo said 731 people succumbed to the new coronavirus on Monday, bringing the state's total death toll to 5,489. The previous single-day record was 630, set on Friday.   New York has borne the brunt of America's deadly coronavirus pandemic, accounting for around half the number of deaths across the country.   COVID-19 has killed more than 11,000 people in the United States, according to a running tally by Johns Hopkins University.

Cuomo said New York appeared be nearing the peak of its pandemic, with a three-day average of hospitalizations down.   He added that intensive care admissions and intubations had also declined.   "We're projecting that we're reaching a plateau in the number of hospitalizations," Cuomo told reporters.   He said social distancing was working, urging New Yorkers to continue to stay indoors unless absolutely necessary.   "I know it's hard but we have to keep doing it," Cuomo implored.   On Monday, the governor extended a shutdown until near the end of the month, ordering schools and non-essential businesses to remain closed until
April 29.

New York City Mayor Bill de Blasio said it was "too early to draw any definite conclusions" about whether the situation was improving in the Big Apple.   "I want to really make sure none of us in public life tell you we have turned a corner until we are absolutely certain," he told reporters.   Elsewhere, a crew member of the military hospital ship USNS Comfort tested positive for the virus, a navy spokesperson told AFP.   The vessel arrived in New York last month to relieve the burden on hospitals overwhelmed with COVID-19 patients.   "The crew member is isolated from patients and other crew members. There is no impact to Comfort's mission, and this will not affect the ability for Comfort to receive patients," said the spokesperson.
Date: Tue, 7 Apr 2020 16:21:31 +0200 (METDST)

Harare, April 7, 2020 (AFP) - Zimbabwean doctors have filed a lawsuit aimed at compelling the government to beef up coronavirus protection for public hospitals and healthcare workers.   In an application filed to the High Court on Sunday, the doctors said the government had failed to set in place "measures to ensure that health practitioners across the country, who include nurses, nurse aides and pharmacists among others, are adequately protected".   The case is being led by the Zimbabwe Association of Doctors for Human Rights (ZADHR).   The doctors, according to a statement on Tuesday by country's human rights lawyers, said there was a "dire shortage" of ventilators, oxygen tanks, biohazard suits and N95 facemasks.   Doctors and nurses staged a walkout last month in protest over a lack of protective clothing to care for coronavirus patients.

Zimbabwe has so far recorded 10 cases of infection, including one fatality.   In their case, the doctors also raise concerns over the scarcity of quarantine and isolation facilities, which they say are only found in the capital Harare and the country's second largest city, Bulawayo.   The ZADHR also complained about inadequate screening of people for coronavirus symptoms across the country.   Zimbabwe has only one COVID-19 test centre, situated at a government hospital in Harare.   The public healthcare system in the country already faces shortages of basic drugs and lacks essential equipment and even running water.   A hearing date is yet to be set. The health ministry could not be immediately reached for comment.
Date: Tue, 7 Apr 2020 15:38:38 +0200 (METDST)

Riyadh, April 7, 2020 (AFP) - Saudi Arabia's health minister on Tuesday warned of a huge spike in coronavirus cases of up to 200,000 within the coming weeks, state media reported.   "Within the next few weeks, studies predict the number of infections will range from a minimum of 10,000 to a maximum of 200,000," the official Saudi Press Agency reported, citing minister Tawfiq al-Rabiah.
Date: Tue, 7 Apr 2020 15:06:49 +0200 (METDST)

Stockholm, April 7, 2020 (AFP) - Sweden on Tuesday reported another 114 coronavirus deaths, bringing the total to 591 in a country that has adopted a softer approach to containing the outbreak than some of its European neighbours.    Sweden's Public Health Agency said it had recorded a total of 7,693 confirmed cases of COVID-19 in the country of around 10 million people.

It reported 114 new deaths on Tuesday, an uptick from preceding daily tolls, but cautioned that some of the fatalities occurred in previous days.    State epidemiologist Anders Tegnell said Tuesday the country has been averaging an average of "a little over 40" deaths a day.    He added that Sweden saw a slight decrease in the number of daily new confirmed cases of the new coronavirus over the last few days, but said it was to early to say whether numbers had peaked.

Sweden has not imposed extraordinary lockdown orders seen elsewhere in Europe to stem the spread of the virus, instead calling for citizens to take responsibility to follow social distancing guidelines.    The government has also banned gatherings of more than 50 people and barred visits to nursing homes.

The Nordic country's softer approach has drawn criticism and curiosity abroad and the been the subject of fierce debate domestically.   Sweden's government has rejected accusations it was passive in the fight to curb the virus.   "It's not business as usual in Sweden," Health Minister Lena Hallengren told reporters last week.
Date: Tue, 7 Apr 2020 13:46:16 +0200 (METDST)

Bucharest, April 7, 2020 (AFP) - A Romanian maternity unit was being investigated on Tuesday after 10 new-borns tested positive for the novel coronavirus, with the suspicion they contracted the virus from healthcare staff.   "The mothers tested negative, but the babies tested positive so we have to consider their contacts with medical staff," Health Minister Nelu Tataru said in an interview with the Antena 3 TV station late on Monday.   The babies have no symptoms and all but one of them, together with their mothers, have gone into self-isolation at home.   Tataru pointed to the "failures in the activities of both maternity officials and the local public health directorate (DSP)" and promised severe measures if necessary.

The local DSP chief has already been dismissed.    "For the past two days I have felt like I am living in a horror film," one of the mothers told the local pressalert.ro website.    "The staff were not wearing masks," she said, adding that the mothers had heard on Wednesday through unofficial channels that there was a case of coronavirus in the hospital.   "On Thursday the hospital was disinfected with us inside," she said.   The unit in the western Romanian city of Timisoara was briefly placed under quarantine on March 31 but was reopened the next day on the orders of the local DSP, which insisted at the time that there was "no risk of infection for patients or doctors" even though 13 members of staff had already tested
positive.

The latest case adds to worries about how Romania's system is coping with the epidemic.    Medical staff have spoken out in recent weeks over insufficient equipment for those on the frontline.   There are more than 4,400 confirmed cases in Romania so far and 180 people have died.    Around 700 of those infected are healthcare workers.
Date: Mon 6 Apr 2020, 10:22 PM IST
Source: The Hindu [edited]

A 55-year-old farmer from Udukere village in Tirthahalli [subdivision of a district] has died due to Kyasanur Forest disease (KFD), also known as monkey fever, at a private hospital at Manipal in Udupi district [Karnataka] on Monday [6 Apr 2020].

With this, the total number of persons who have succumbed to KFD in Shivamogga district since [1 Jan 2020] has risen to 5. The deceased was suffering from high fever, fatigue, and pain in joints. His blood samples tested positive for KFD. He was admitted to the private hospital in Manipal for treatment on [30 Mar 2020].

Ashoka MV, Tirthahalli Taluk [sub district] Health Officer, told The Hindu that, on Monday [6 Apr 2020], the health condition of the patient worsened and he passed away at 11 am.

Meanwhile, 3 new positive cases of KFD were reported from Sagar taluk on [Sun 5 Apr 2020] of which one is from Aralagodu, the epicentre of last year's [2019] outbreak; one from Maralagodu village while another case is from Henni-Vadanabailu village.

On [Mon 6 Apr 2020], a 4-year-old child from Seegemakki village in Sharavati river backwater region showing symptoms of KFD was admitted to the government general hospital in Sagar. His blood samples have been sent to Viral Diagnostic Laboratory in Shivamogga [district in the Karnataka state] for testing.

Shivamogga district has recorded as many as 133 positive cases of KFD since [1 Jan 2020] that include 105 cases from Tirthahalli taluk and 28 cases from Sagar taluk.
===================
[The number of KFD cases is steadily increasing with 5 deaths in Shivamogga district of Karnataka since the beginning of 2020, the latest cluster of 3 cases from Sagar taluk is in fact one each from 3 villages. There is a need for setting up active surveillance for KFD in the districts reporting a high number of cases with robust animal surveillance for early detection and response; as well as risk communication with community engagement to control the spread. - ProMed Mod.UBA]