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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: Fri, 8 Mar 2019 11:58:53 +0100
By Shatha Yaish

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[HealthMap/ProMED-mail maps:
United Arab Emirates: <http://healthmap.org/promed/p/132]
Date: Wed 5 Sep 2018
Source: BBC [edited]

A total of 19 people have been taken ill after an Emirates airline plane landed in New York, officials say. The plane was quarantined at JFK airport as those on board were checked by health officials. As many as 10 were taken to hospital but others refused treatment.

The US Centers for Disease Control and Prevention (CDC) said that initially about 100 people including some crew had complained of illness. Flight 203 from Dubai landed at 09:10 (13.10 GMT) with 521 passengers.

Emergency vehicles were seen on the runway as it landed. Soon afterwards, Emirates airline tweeted that the sick passengers were being attended to and those who were unaffected would be allowed to leave the plane.

The CDC said in a statement that is was "aware of an Emirates flight from Dubai that arrived this morning at JFK".

"Approximately 100 passengers, including some crew on the flight, complained of illness including cough and some with fever.

"CDC public health officers are working with... officials to evaluate passengers including taking temperatures and making arrangements for transport to local hospitals those that need care."

Later Eric Phillips, spokesman for New York Mayor Bill de Blasio, confirmed that all the passengers were off the plane and the sick people had been taken to hospital.

He said that some of the passengers had originally come from the Saudi Arabian city of Mecca, which was currently experiencing a flu outbreak, and that the passengers' symptoms were "pointing to the flu".
Date: Mon 28 May 2018
Source: EMPRES-I (Global Animal Disease Information System) [edited]

According to an EMPRESS report issued today [Mon 28 May 2018], there was a human case of MERS-CoV infection confirmed by PCR testing in Gayathi, Abu Dhabi, United Arab Emirates. This report was based on an OIE report.

No further information was provided.
=====================
[The most recent confirmed human MERS-CoV infection in the UAE was reported in December 2017 and involved an Omani camel herder who was identified as an asymptomatic infection. This was detected as part of border screening of camels on entry to the UAE following the detection of positive MERS-CoV infection in the camels (see MERS-CoV (01): Malaysia (ex KSA), Saudi Arabia, UAE (ex Oman) http://promedmail.org/post/20180102.5532148).

I was unable to find more information on the case mentioned in the EMPRES report above, from either the HAAD (Health Authority of Abu Dhabi) website, or the OIE or EMPRES websites. Questions that come to mind include: demographics (age, sex); clinical picture (was this based on clinical illness in the human or was this part of screening after identification of MERS-CoV infected camels entering the UAE (where screening is typically done); possible high risk exposures (either contact with camels, contact with other known cases, contact with the health sector before onset of illness, or history of travel to other geographic areas where MERS-CoV circulation is known).

More information from knowledgeable sources would be greatly appreciated.

The HealthMap/ProMED map of the UAE can be found at:
Date: Thu 21 Sep 2017
Source: Eurosurveillance Edition 2017, 22(38) [edited]

ref: Dabrera G, Brandsema P, Lofdahl M, et al. Increase in legionnaires' disease cases associated with travel to Dubai among travellers from the United Kingdom, Sweden and the Netherlands, October 2016 to end August 2017. Euro Surveill. 2017; 22(38): pii=30618.
----------------------------------------------------------------------
Abstract
--------
Between 1 Oct 2016 and 31 Aug 2017, 51 legionnaires' disease (LD) cases from the United Kingdom (UK), Sweden, and the Netherlands were identified with associated travel to Dubai. Cases did not all stay in the same accommodation, indicating that no single accommodation could be the source for all these infections. While local investigations continue into other potential sources, clinicians should remain alert to the possibility of LD among travellers returning from Dubai with respiratory illness.

Introduction
------------
In December 2016, the European Centre for Disease Prevention and Control (ECDC) reported an increase in legionnaires' disease (LD) cases associated with travel to Dubai, United Arab Emirates (UAE) [1] based on cases reported to ELDSNet (European legionnaires' disease surveillance network), an ECDC-operated surveillance system among European Union (EU) countries, Iceland, and Norway [2] for laboratory-confirmed, travel-associated LD (TALD) cases who stayed in commercial accommodation site(s) (such as hotels) during the 2-10-day incubation period.

As this increase in Dubai-associated TALD cases continues, we describe cases reported with symptom onset between 1 Oct 2016 and 31 Aug 2017 among residents from the UK, Sweden, and the Netherlands (the 3 countries that were initially reporting the largest numbers of cases). We describe the ongoing situation as at 18 Sep 2017 to provide further insight into the observed increase and create awareness among physicians and travellers returning with compatible symptoms to consider legionella as a differential diagnosis [1].

[The full Eurosurveillance article can be accessed at the source URL above. - ProMED Mod.ML]
====================
[Dubai is one of the 7 emirates and the most populous city of the United Arab Emirates (UAE) (<http://en.wikipedia.org/wiki/Dubai>). Dubai has become a popular tourist destination. It is said to be the 4th most visited city in world, with over 15 million visitors in 2016, after London, Paris, and Bangkok (<https://www.khaleejtimes.com/listicles/dubai-worlds-fourth-most-popular-destination-in-2016>).

Overnight visitors in Dubai spent almost USD 11 billion in 2014

Dubai can be located on the HealthMap/ProMED-mail interactive map at

In 2009, ProMED-mail first reported legionnaires' disease in 3 travellers to Dubai, one of whom from the UK died (Legionellosis, fatal, hotel - United Arab Emirates: (Dubai) http://promedmail.org/post/20090205.0509). In December 2016, ProMED-mail reported an increase in the number of cases of legionnaires' disease in 2016, compared with previous years, in European travelers returning from Dubai, with 26 cases having their onset of illness since 1 Oct 2016 (Legionellosis - EU: EU travellers, ex United Arab Emirates (Dubai) susp http://promedmail.org/post/20161230.4733569). In June 2017, ProMED-mail reported that an additional 34 cases among European travelers to Dubai, with the most recent case becoming ill in May 2017, suggesting an ongoing exposure risk (Legionellosis - Europe (03): ex United Arab Emirates (Dubai) http://promedmail.org/post/20170602.5079438).

According to the Eurosurveillance report above on 51 legionnaires' disease cases with symptom onset between 1 Oct 2016 and 31 Aug 2017, from the UK, Sweden, and the Netherlands associated with travel to Dubai, of 43 cases staying in commercial accommodation only 15 stayed in sites where there were 2 or more cases, whereas 27 stayed in sites where there were no other cases. In addition, 3 of the 51 cases were associated with a foreign-travel related cluster in other countries.

Of the 51 cases of legionnaires' disease, 50 were infected by organisms speciated as _Legionella pneumophila_. However, the serogroup was known for only 16 cases: 13 of the 16 were serogroup 1, 2 were serogroup 13 and 1 was serogroup 2-14. Sequence-based typing (ST) was available for only 9 cases: 6 cases were ST616, and 3 cases were ST1327. ST616 was only observed in cases associated with travel to Dubai and ST1327 was associated with travel to Dubai for all but one case. Furthermore, 11 cases spent their entire incubation period in Dubai. These findings supported the assertion that at least some of these infections occurred within Dubai. However, the cases for whom sequence-based typing was available were all linked to different accommodations sites.

No increase in pneumonia notifications occurred locally in Dubai between October and December 2016, which suggested an environmental _Legionella_ source in Dubai that might have been frequented more often by foreign travelers than by local residents. Another explanation was that the local Dubai population is predominantly young, with only 8.7 percent in the 50 years or older age group in 2016, and therefore potentially at lower risk for legionnaires' disease than foreign travelers. Also, the investigators noted that the increase in cases of legionnaires' disease among European travelers to Dubai could not be fully explained by an increase in the number of European travelers to Dubai, but so far no environmental sources have been identified in Dubai. - ProMED Mod.ML]
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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:
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Dominican Republic

Dominican Republic US Consular Information Sheet
March 13, 2008
COUNTRY DESCRIPTION: The Dominican Republic covers the eastern two-thirds of the Caribbean island of Hispaniola. The capital city is Santo Domingo, located on the south coast of th
island. Tourist facilities vary according to price and location. Spanish is the official language. Though English is widely spoken in major cities and tourist areas, it is much less common outside these areas. Read the Department of State Background Notes on the Dominican Republic for additional information.

ENTRY/EXIT REQUIREMENTS: All Americans traveling by air outside of the United States are required to present a passport or other valid travel document to enter or re-enter the United States. This requirement will be extended to sea travel (except closed loop cruises), including ferry service, by the summer of 2009. Until then, U.S. citizens traveling by sea must have government-issued photo identification and a document showing their U.S. citizenship (for example, a birth certificate or certificate of nationalization), or other WHTI compliant document such as a passport card for entry or re-entry to the U.S. Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.

Applications for the new U.S. Passport Card are now being accepted. We expect cards will be available and mailed to applicants in spring 2008. The card may not be used to travel by air and is available only to U.S. citizens. Further information is available on our U.S. Passport Card page at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html. We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel. American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

For information concerning entry and exit requirements, travelers may contact the Embassy of the Dominican Republic at 1715 22nd Street NW, Washington, DC 20008, tel. (202) 332-6280. There are also Dominican consulates in Boston, Chicago (Northfield, IL), Mayaguez, Miami, New Orleans, New York, and San Juan. Visit the Embassy of the Dominican Republic web site at http://www.domrep.org for the most current visa information.

Visas: Visitors who do not obtain a Dominican visa prior to entry must purchase a tourist card upon arrival to enter the country. Tourist cards cost ten U.S. dollars, which must be paid in U.S. currency. Tourist cards may be purchased at the Dominican Embassy in Washington or Dominican Consulates prior to arrival, as well as at Dominican airports at the time of entry. Tourist cards normally permit a legal stay of up to 60 days. Visitors who would like to extend their time in the Dominican Republic should visit the Migration Department in Santo Domingo and request an extension. Failure to request an extension will subject the visitor to a surcharge at the airport upon departure.

Travel of children and EXIT requirements: Strict exit requirements apply to minors under 18 years of age (of any nationality) who are residents in the Dominican Republic. Such children traveling alone, without one parent, or with anyone other than the parent(s), must present written authorization from a parent or legal guardian. This authorization must be in Spanish, and it must be notarized at a Dominican consulate in the United States or notarized and then certified at the Dominican Attorney General’s office (Procuraduria de la Republica) if done in the Dominican Republic. Though not a requirement for non-resident minors (in the Dominican Republic), the U.S. Embassy recommends that any minor traveling to the Dominican Republic without one or both parents have a notarized document from the parent(s). In addition to clarifying the reason for travel, this will facilitate departure from the Dominican Republic.

The specific guidelines on the Dominican regulations governing the travel of children in the Dominican Republic can be found (in Spanish) at http://www.migracion.gov.do.

Visit the Embassy of the Dominican Republic web site at http://www.domrep.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:
American citizens should be aware that foreign tourists are often considered attractive targets for criminal activity, and should maintain a low profile to avoid becoming victims of violence or crime. In dealing with local police, U.S. citizens should be aware that the standard of professionalism might vary. Police attempts to solicit bribes have been reported, as have incidents of police using excessive force.

Protests, demonstrations, and general strikes occur periodically. Previous political demonstrations have sometimes turned violent, with participants rioting and erecting roadblocks, and police sometimes using deadly force in response. Political demonstrations do not generally occur in areas frequented by tourists and are generally not targeted at foreigners. However, it is advisable to exercise caution when traveling throughout the country. Street crowds should be avoided. In urban areas, travel should be conducted on main routes whenever possible. Power outages occur frequently throughout the Dominican Republic, and travelers should remain alert during blackout periods, as crime rates often increase during these outages.

U.S. citizens considering overland travel between the Dominican Republic and Haiti should first consult the Country Specific Information Sheet for Haiti as well as the Internet site of the U.S. Embassy in Port-au-Prince for information about travel conditions in Haiti. Santo Domingo and the majority of tourist destinations within the Dominican Republic are located several hours from the Haitian border, and recent events in Haiti have generally not directly affected these areas.

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 Standard 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 continues to be a problem throughout the Dominican Republic. Street crime and petty theft involving U.S. tourists does occur, and precautions should be taken to avoid becoming a target. While pick pocketing and mugging are the most common crimes against tourists, reports of violence against both foreigners and locals are growing. Criminals can be dangerous and visitors walking the streets should always be aware of their surroundings. Valuables left unattended in parked automobiles, on beaches and in other public places are vulnerable to theft, and reports of car theft have increased. Cellular telephones should be carried in a pocket rather than on a belt or in a purse. One common method of street robbery is for at least one person on a moped (often coasting with the engine turned off so as not to draw attention) to approach a pedestrian, grab his or her cell phone, purse or backpack, and then speed away. This type of robbery is particularly dangerous because the motorcyclist reaches the intended victim at 15–20 miles per hour and often knocks the victim to the ground.

Many criminals have weapons and are likely to use them if they meet resistance. Be wary of strangers, especially those who seek you out at celebrations or nightspots. Traveling and moving about in a group is advisable. The dangers present in the Dominican Republic, even in resort areas, are similar to those of many major U.S. cities. Expensive jewelry attracts attention and could prompt a robbery attempt. Limiting the cash and credit cards carried on your person and storing valuables, wallet items, and passports in a safe place is recommended.

Burglaries of private residences continue to be reported as well as crimes of violence. Criminals may also misrepresent themselves in an effort to gain access to your residence or hotel room. In one 2005 homicide, a U.S. citizen was murdered by two men who posed as repairmen to gain access to the apartment. In another, the Dominican police arrested the building’s actual maintenance man and an accomplice for the crime.

The U.S. Embassy continues to receive reports from Americans who have been stopped while driving and asked for “donations” by someone who may appear to be a police officer before they would be allowed to continue on their way. Usually, the person(s) stopping the American drivers had approached from behind on a motorcycle; several of these motorcyclists pulled up alongside the driver's window and indicated that they were carrying a firearm. In some cases, the perpetrators were dressed in the light green uniform of “AMET,” the Dominican traffic police; however, they often seemed too young to be police officers or wore ill-fitting uniforms that might have been stolen. In another incident, individuals dressed in military fatigues told the victim they were police and requested the victim to follow them to the police station prior to robbing him. Such incidents should be reported to the police and the Consular Section. If Dominican police stop an American driver for a traffic violation, the driver should request a traffic ticket rather than paying an on-the-spot fine. The driver also has the right to ask police for identification. New regulations require police to wear a nametag with their last name. While everyone driving in the Dominican Republic should abide by traffic laws and the instructions of legitimate authorities, Americans finding themselves in the aforementioned scenarios should exercise caution. In general, drivers should keep their doors locked and windows closed at all times and leave themselves an escape route when stopping in traffic in the event of an accident or other threat. Incidents involving police may be reported to the Internal Affairs Department of the National Police at 809 688-1777 or 809 688-0777.

In 2006, the U.S. Embassy received reports of Americans and others who were victims of vehicular-armed robberies in the northern provinces of the Dominican Republic. At least three of the reports indicate the victims were intercepted during the morning hours, when there was little other traffic, while driving on rural highways connecting Santiago and Puerto Plata. Drivers should exercise extreme caution when driving at night and use major highways when possible.

Although kidnappings are not common in the Dominican Republic, in 2007, two American citizens were kidnapped and held for ransom, in separate instances.

Many public transportation vehicles are unsafe, especially the route taxis or “carros publicos” in urban areas. These are privately owned vehicles that run along certain routes, can take up to six or more passengers, and are inexpensive. Passengers in “carros publicos” are frequently the victims of pick pocketing, and passengers have on occasion been robbed by “carro publico” drivers. Urban buses (“guaguas”) are only marginally better. The U.S. Embassy is also aware of at least one incident in which the driver of a “motoconcho” (motorcycle taxi) robbed an American passenger. The U.S. Embassy cautions its staff not to use these modes of transportation. As an alternative, some scheduled interurban bus services use modern buses and run on reliable timetables. These are generally the safest means of intercity travel. With respect to taxis, visitors to the Dominican Republic are strongly advised to take only hotel taxis or taxis operated by services whose cabs are arranged in advance by phone and can subsequently be identified and tracked.

Credit card fraud is common and recent reports indicate that its incidence has increased significantly. The U.S. Embassy strongly advises Americans to restrict severely the use of credit/debit cards in the Dominican Republic. The increase in credit card fraud is particularly pronounced in the eastern resort areas of the Dominican Republic. According to reports, store workers, restaurant service staff and hotel employees may conceal devices that can instantly record the credit card information. Often, this device appears to be a normal card reader used by businesses. Credit or debit cards should be carefully protected and never allowed out of the owner’s sight. Stolen cards are often used to the maximum amount before the victims are able to contact the bank. Victims of credit card fraud should contact the bank that issued the credit card immediately. It is advisable to pay close attention to credit card bills following time spent in the Dominican Republic. There have been reports of fraudulent charges appearing months after card usage in the Dominican Republic.

Automated Teller Machines (ATMs) are present throughout Santo Domingo and other major cities. However, as with credit cards, the use of ATMs should be minimized as a means of avoiding theft or misuse. One local ATM fraud scheme involves sticking photographic film or pieces of paper in the card feeder of the ATM so that an inserted card becomes jammed. Once the card owner has concluded the card is irretrievable, the thieves extract both the jamming material and the card, which they then use. There are other ATM scams as well. Exercise caution and be aware of your surroundings when using an ATM card.

The overall level of crime tends to rise during the Christmas season, and visitors to the Dominican Republic should take extra precautions when visiting the country between November and January.

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.

Beaches and Resorts: The Embassy occasionally receives reports of individuals who have become victims of crime, and particularly sexual assault, while at the beach. Vigilance is recommended. The numerous “all-inclusive” resorts serve abundant quantities of alcohol, a practice that encourages inattention and may be a factor in crime or sexual assault.

Tourist Police: The Dominican Republic does have police that are specially trained to assist tourists who require assistance. This public institution is called Politur and represents a cooperative effort between the National Police, Secretary of the Armed Forces, and the Secretary of Tourism. Politur typically has personnel in tourist areas to provide first responder type assistance to tourists. If you are the victim of a crime, Politur can help you get to a police station so that you may file a police report and seek further assistance. For more information on Politur and contact information, use the following link: http://www.politur.gov.do/. Politur is located at the corner of 30 de Marzo and Mexico, Bloque D, Governmental Building, Santo Domingo. The general phone number is 809-686-8639.

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 system and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is limited, especially outside Santo Domingo, and the quality of care varies widely among facilities. There is an emergency 911 service within Santo Domingo, but its reliability is questionable. Outside the capital, emergency services range from extremely limited to nonexistent. Blood supplies at both public and private hospitals are often limited, and not all facilities have blood on hand even for emergencies. Many medical facilities throughout the country do not have staff members who speak or understand English. A private nationwide ambulance service, ProMed, operates in Santo Domingo, Santiago, Puerto Plata and La Romana; Telephone number is 809-548-7200. ProMed expects full payment at the time of transport. The U.S. Embassy maintains a non-comprehensive list of providers of medical care in the Dominican Republic, which can be found at the following link: http://www.usemb.gov.do/Consular/ACS/medical_assistance-e.htm.

Tap water is unsafe to drink and should be avoided. Bottled water and beverages are safe.
Dengue: Dengue is endemic to the Dominican Republic. To reduce the risk of contracting dengue, the U.S. Center for Disease Control (CDC) recommends wearing clothing that exposes as little skin as possible and applying a repellent containing the insecticide DEET (concentration 30 to 35 percent) or Picaridin (concentration 20 percent or greater for tropical travelers). Because of the increased risk of dengue fever and the ongoing risk of malaria in the Dominican Republic (see below), practicing preventative measures is recommended by the CDC. For further information on dengue fever, please visit the CDC web site at http://www.cdc.gov/ncidod/dvbid/dengue.

Malaria: There are occasional reports of cases of malaria in areas frequented by U.S. and European tourists including La Altagracia Province, the easternmost province in which many beach resorts are located. Malaria risk is significantly higher for travelers who go on some of the excursions to the countryside offered by many resorts. Prior to coming to the Dominican Republic, travelers should consult the CDC web site at http://www.cdc.gov/malaria/index.htm for more information and recommendations on malarial prophylaxis.

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.

The U.S. Embassy in Santo Domingo and the CDC are aware of several cases in which U.S. citizens experienced serious complications or died following elective (cosmetic) surgery in the Dominican Republic. The CDC’s web site at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5323a4.htm contains a report on patients who suffered postoperative infections following cosmetic surgery in the Dominican Republic. Patients considering travel to the Dominican Republic for cosmetic surgery may also wish to contact the Dominican Society of Plastic Surgeons (tel. 809-688-8451) to verify the training, qualifications, and reputation of specific doctors.

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Americans traveling in the Dominican Republic should be aware that Dominican hospitals often require payment at the time of service and may take legal measures to prevent patients from departing the country prior to payment. 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 Dominican Republic is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Traffic in the Dominican Republic moves on the right side of the road. Speed limits vary from 25 mph in the city to 50 mph on rural roads, but they are generally not enforced. Drivers are required to carry liability insurance.

If you do drive in the Dominican Republic, you should be aware that the utmost caution and defensive driving are necessary. Traffic laws are similar to those in the United States, but undisciplined driving is common, due to a lack of adequate traffic controls. Many drivers will not use turn indicators. Rather, it is common for a vehicle operator to stick his hand out the window to signal a turn. Drivers can also be aggressive and erratic, often failing to yield the right-of-way even when road signs or signals indicate that they should. Travel at night on intercity highways and in rural areas should be avoided, due to animals on the road, poor road conditions, and other vehicles being driven at excessive speeds, often with malfunctioning headlights or taillights. Blackouts also increase the danger of night travel. Turning right on red lights is permitted, but should be done with caution.

Traffic accidents often result in serious injury or death. This is often the case when heavy vehicles, such as buses or trucks, are involved. Traditionally, vehicles involved in accidents in the Dominican Republic are not moved (even to clear traffic), until authorized by a police officer. Drivers who violate this norm may be held legally liable for the accident.

Dominican law requires that a driver be taken into custody for driving under the influence or being involved in an accident that causes serious injury or death, even if the driver is insured and appears not to have been at fault. The minimum detention period is 48 hours; however, detentions frequently last until a judicial decision is reached (often weeks or months), or until a waiver is signed by the injured party (usually as the result of a cash settlement).

Visitors to the Dominican Republic might want to consider hiring a professional driver during their stay in lieu of driving themselves. Licensed drivers who are familiar with local roads can be hired through local car rental agencies. In case of accidents, only the driver will be taken into custody.

Pedestrians tend to step out into traffic without regard to corners, crosswalks, or traffic signals. Many pedestrians die every year crossing the street (including major, multi-lane highways) at seemingly random locations. Pedestrians do not have the right-of-way, and walking along or crossing busy streets – even at intersections with traffic lights or traffic police present – can be very dangerous.

Seat belts are required by law, and those caught not wearing them will be fined. There are no child car seat laws. The law also requires the use of hands-free cellular devices while driving. Police stop drivers using cell phones without the benefit of these devices. Penalties for those driving under the influence and those involved in accidents resulting in injury or death can be severe.

Motorcycles and motor scooters are common in the Dominican Republic, and they are often driven erratically. Dominican law requires that motorcyclists wear helmets, but local authorities rarely enforce this law. As noted previously in this report, public transportation vehicles such as the route taxis (“carros publicos”) and urban buses (“guaguas”) are unsafe.

Please see the Crime section of this information sheet for more information regarding crimes involving road safety.

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the Dominican Republic’s Civil Aviation Authority (CAA) as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the Dominican Republic’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:
Currency Regulations: It is legal to exchange currency at commercial banks, exchange booths in hotels and exchange houses. The exchange rate is set by the Central Bank, based on prevailing market conditions. The market determines the exchange rate. No more than USD $10,000 or its equivalent in another currency, including Dominican pesos, may be taken out of the Dominican Republic at the time of departure.

Real Estate: Real estate investments require a high level of caution, as property rights are irregularly enforced. Investors often encounter problems in receiving clear title to land, and title insurance is not available. Real estate investments by U.S. citizens have been the subject of both legal and physical takeover attempts. Absentee landlords and absentee owners of undeveloped land are particularly vulnerable. Investors should seek solid property title and not just a “carta de constancia,” which is often confused by foreigners with a title. An official land registry measurement (also known as 'deslinde' or 'mensura catastral') is also desirable for the cautious overseas investor. Squatters, sometimes supported by governmental or non-governmental organizations, have invaded properties belonging to U.S. citizens, threatening violence and blocking the owners from entering their property. In at least one instance, the U.S. citizen landowner was physically assaulted. Several U.S. citizens with long-standing expropriation disputes with the Dominican Government have not received compensation.

Gambling: Many Americans have reported losing large amounts of money at Dominican casinos by playing a game (or variations thereof) known as “Super Keno,” “Caribbean Keno,” “Progressive Keno,” or “Progressive Roulette.” Players have complained that the game’s rules are unclear and/or misleading. Any complaints arising from a casino should be directed to the Office of Casinos at the Secretary of Finance. To register a complaint with this office, call 809-687-5131, ext. 2120.

Divorce: In recent years, there have been a number of businesses, primarily on the Internet, which advertise “Quickie Dominican Divorces.” The services of these businesses should be used with caution, as they may misrepresent the process of obtaining a divorce in the Dominican Republic. While it is relatively simple for foreigners to obtain a divorce in the Dominican Republic, such divorces are only valid if specific steps are taken. Those seeking information regarding divorce should first consult with an attorney in their home state. Additional information is available via the U.S. Embassy's flyer on Divorce in the Dominican Republic at http://www.usemb.gov.do/Consular/ACS/divorce_DR-e.htm.

Alien Smuggling: Dominican authorities may prosecute anyone arrested for organizing the smuggling of aliens into or out of the Dominican Republic. This is in addition to any charges individuals may face in the other country involved, including the United States.

Hurricanes: The Dominican Republic is situated in an area of the Caribbean prone to hurricanes. In the event of a hurricane alert, a notice will be posted on the U.S. Embassy in Santo Domingo's web page at http://www.usemb.gov.do/index.htm. Further information can be obtained by visiting the National Weather Service's web site at http://www.nhc.noaa.gov. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency at http://www.fema.gov.

Water Sports: Visitors to the Dominican Republic, including to local resort areas, should carefully assess the potential risk of recreational activities. Some of the swimming areas at popular beaches around the Dominican Republic are subject to dangerous undertows. Many beaches lack life guards and/or warnings of unsafe conditions. Resort managers usually offer current information on local swimming & surf conditions. Americans are cautioned not to swim alone, particularly at isolated beaches.

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 Dominican laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the Dominican Republic are severe, and convicted offenders can expect long jail sentences and heavy fines. For more information on the Dominican judicial system, procedures, and penalties, please visit the Consular Section’s web page at http://www.usemb.gov.do. 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. The Dominican Republic is a party to the Hague Convention on the Civil Aspects of International Child Abduction. The United States formally accepted the accession of the Dominican Republic on June 1, 2007.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the Dominican Republic 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 Dominican Republic. 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 Consular Section of the U.S. Embassy is located at the corner of Calle César Nicolás Penson and Avenida Máximo Gómez. The American Citizens Services (ACS) Unit can be reached by telephone at 809-731-4294, or via email at acssantodom@state.gov. ACS Unit office hours are 7:30 a.m. to 4:30 p.m., Monday through Thursday, Friday 7:30-12:15, except on U.S. and Dominican holidays. The Chancery of the U.S. Embassy is located a half-mile away from the Consular Section, at the corner of Calle César Nicolás Penson and Calle Leopoldo Navarro. The telephone number is 809-221-2171.

There is a Consular Agency in the north coast city of Puerto Plata at Calle Villanueva esq. Avenida John F. Kennedy, Edificio Abraxa Libraria, 2nd floor, telephone 809-586-4204, 809-586-8017, 809-586-8023; office hours are 9:00 a.m. to 12:00 p.m., and 2:30 p.m. to 5:00 p.m., Monday through Friday, except holidays.
* * *
This replaces the Country Specific Information dated May 09, 2007 to update Safety and Security, Crime, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: 26 Jun 2019
Source: VOX [edited]

Tourist deaths in the Dominican Republic are sparking concern among travellers.  It's not yet clear whether the deaths of 10 Americans over the past year are connected. [Some sources report as many as 13 deaths. - ProMED Mod.TG] Ten known US tourists have died at Dominican Republic resorts, or at the hospital immediately following resort stays -- including 3 within 7 days, and 2 within 3 days -- in just over a year.

Now over a dozen more visitors who fell dangerously ill on vacation in the Dominican Republic are coming forward. Sicknesses reportedly set in quickly, marked by frequently cited symptoms of abdominal pain, nausea, and sweating; guests' descriptions of a "chemical smell" in hotel rooms; and a pattern of minibar liquor consumption before indicators of illness set in.

The Dominican Republic's Ministry of Tourism attributes these deaths to natural causes; local and US federal authorities, however, are investigating the incidents, having left some American travellers uneasy, and the future of the Dominican Republic's robust tourism industry uncertain.  The incidents occurred at a collection of resorts on the island: the Terra Linda Resort in Sousa, the Excellence Resorts in Punta Cana, the Grand Bahia Principe in Punta Cana, the Grand Bahia Principe in La Romana, and the Hard Rock Hotel & Casino in Punta Cana.

At least 3 of the people who died reportedly began experiencing symptoms after having a drink from the minibar in their rooms. The US Embassy in Santo Domingo confirmed earlier this month [June 2019] that the FBI were dispatched to the island to conduct toxicology reports, and the Dominican Republic's Ministry of Health announced samples from the minibar in the guest room of CD and NH of Maryland, who were both found dead on 30 May 2019 in their room at the Grand Bahia Principe La Romana, were undergoing testing. On Monday [24 Jun 2019], the Hard Rock Hotel & Casino announced it'd be removing liquor from minibars in its guest rooms.

As forensic scientist Lawrence Kobilinsky told the "Cut," many of the victims' symptoms might suggest methanol poisoning. Methanol is a toxic, synthetic chemical normally used in antifreeze, also used, illegally, to create counterfeit alcohol. Consuming even a small amount of pure methanol can lead to pulmonary edema, or fluid in the lungs, and respiratory distress, 2 of the official causes of death listed for CD and NH. They're also 2 of the official causes of death listed for SW of Pennsylvania, who also died at Grand Bahia Principe La Romana, after reportedly having a drink from her hotel room minibar, just 5 days before CD and NH's deaths.

The toxicology reports for CD, NH, and SW have not yet been released; the FBI said in mid-June 2019 that answers could be another 30 days coming.

Some recent travellers, however, suspect they were exposed to fumes emitted from the air conditioners in their rooms. CNN reports one Denver couple, KK and TS sued the Grand Bahia Principe La Romana -- the same resort where CD and NH stayed -- earlier this year [2019] for illnesses occurring during a trip last July 2018. KK and TS described a "chemical smell" overtaking their room, an odor similar to paint or industrial cleaner. [Earlier, reports indicated KK and SW described the smell as chemical or pesticide smell. Some of their clinical signs sound like organophosphates. This couple reported earlier a grounds worker was spraying the trees, which reportedly was over the air conditioner. - ProMED Mod.TG] Soon after, they said they experienced excruciating stomach cramps, diarrhoea, bloody stool, incessant sweats and drool, watery eyes, and dizziness. Back home in Denver, their doctors wondered whether they'd been exposed to organophosphates, chemicals most often used in pesticides.

KK said she thought back on what she had seen days earlier: A maintenance person spraying palm plants covering the air conditioning units just outside their room. "I wondered if someone sprayed our unit. They are always constantly out there taking care of the plants. We saw them out there with bug sprayers."

Other tourists told CNN they too became sick after they inhaled what they described as a chemical, or paint-like smell, at the Majestic Elegance Resort in Punta Cana in 2017, and at the Grand Bahia Principe Punta Cana going back to 2016.

As the New York Times reports, poisoning or pesticide exposure is even more likely when more than one person experiences the same outcome on the same timeline, as was the case with CD and NH. Chemicals like organophosphates, adds the Times, can "seep into a vent not adequately sealed, or be sucked inside by a hotel air conditioner." Current scientific literature indicates organophosphate poisoning can lead to respiratory failure in some cases.

Tourism drives much of the Dominican Republic's economy, employing more than 300 000 people and drawing a reported 6.6 million international travellers in 2018. A report on the Dominican Republic's economy from the Canadian Trade Commissioner Service says the Dominican government aims to draw 10 million tourists -- roughly the size of its current population -- by 2020, "generating estimated revenues of US $7.2 billion."

Preliminary autopsies conducted by Dominican authorities have been released by the resorts for several of the 10 Americans known to have died in the past year. In addition to pulmonary edema and respiratory failure, the causes of death for the tourists have included pneumonia, multiple organ failure, and an exceptionally common one: heart attack. According to Tourism Minister Javier Garcia, 5 of the deaths can be categorized as "natural causes." [While the Tourism Minister may report it as "natural causes," an investigation is necessary, including toxicology reports, to be fully certain of the cause of those individuals' deaths. - ProMED Mod.TG]

The Excellence Resorts in Punta Cana told the family of LC of New York City she died in her room on 10 Jun 2019 of a heart attack. Her son BC remains skeptical, telling WCBS, "I do not believe it was of natural causes."

It's not yet clear what caused this spate of heart attacks, respiratory failures, and food poisoning-like illnesses. And it's also not clear whether these catastrophic events, similar as they are in geographic location, presenting symptoms, and outcome, are connected. Neither the US Embassy nor the Dominican Ministry of Public Health has acknowledged the possibility of a connection; in fact, Garcia has said: "These cases are very regrettable, but isolated" [The deaths are indeed tragic and regrettable, but evidence revealed so far does not seem isolated. - ProMED Mod.TG].

The Dominican Republic's Ministry of Tourism asks the public to look at these recent deaths in context: Many millions of people travel to the Dominican Republic each year and don't fall seriously ill or die. A statement released by the ministry earlier this month [June 2019] references statistics and polls conducted by the Central Bank of the Dominican Republic. The "rate of tourist incidents" in 2018, the ministry says, fell to 1.4 per 100 000 tourists from 1.6 the previous year. It also highlights that 99 percent of American tourists told their survey they'd return to the Dominican Republic for future vacations.

Nevertheless, US travellers are concerned by recent news, to say the least. CNBC cites a survey from the American Society of Travel Advisors revealing that 2/3rds of its members have cancelled trips to the Dominican Republic for clients within one week. CBS News adds flights to the Dominican Republic from the US are down 74.3 percent from this time last year [2018], with cancelled flights up by 51.2 percent in recent weeks, according to data from flight analysis agency. The [US] State Department's most recent Travel Advisory on the Dominican Republic -- from April 2019 -- places the country as a Level 2, with the directive, "Exercise Increased Caution." The rationale: crime.  "Here we are talking about 9 people, but there are countries in the area where 10 times the number of Americans have died there," the Dominican Republic's tourism board reportedly said at a press conference on 21 Jun 2109, as covered by NBC News. (Details on the 10th death, of New York native VC on 17 Jun 2019, hadn't yet been released.) "But all eyes are on us."  [Byline: Stephie Grob Plante]
=====================
[There are several reports of individuals complaining of shortness of breath and an ill feeling after consuming products from the mini bar. There were television reports indicating some drink containers were filled by the hotel, or the pool bar and put back into the mini bar.

This is the 1st article reporting methanol. However, methanol is a common product substituted in alcoholic drinks because it is cheap and easy to make. Frequently, this type of alcohol is associated with blindness. An individual, possibly dehydrated, coming in from the sun who consumes the beverage somewhat quickly may react differently. But pulmonary oedema is certainly associated with methanol consumption.


Airway and lungs:
- Breathing difficulty
- No breathing
Eyes:
- Blindness, complete or partial, sometimes described as "snow
blindness"
- Blurred vision
- Dilation (widening) of the pupils [Organophosphates produce pin
point pupils - Mod.TG]
Heart and blood:
- Low blood pressure
Nervous system:
- Agitated behaviour
- Coma (unresponsiveness)
- Confusion
- Difficulty walking
- Dizziness
- Headache
- Seizures
Skin and nails:
- Bluish-colored lips and fingernails
Stomach and intestines:
- Abdominal pain (severe)
- Diarrhea
- Liver problems, including jaundice (yellow skin) and bleeding
- Nausea
- Pancreatitis (nausea, vomiting, and abdominal pain)
- Vomiting, sometimes bloody
Other:
- Fatigue
- Leg cramps
- Weakness

Compare the clinical signs, as listed by the same source
<https://medlineplus.gov/ency/article/002832.htm> for organophosphate poisoning:

Symptoms of organophosphate or carbamate poisoning:

Heart and Blood
- Slow heart rate
Lungs and Airways
- Breathing difficulty
- Wheezing
Nervous System
- Anxiety
- Coma (decreased level of consciousness and lack of responsiveness)
- Convulsions
- Dizziness
- Headache
- Weakness
Bladder and Kidneys
- Increased urination
Eyes, Ears, Nose, and Throat
- Drooling from increased saliva
- Increased tears in the eyes
- Small pupils
Stomach and Intestines
- Abdominal cramps
- Diarrhea
- Loss of appetite
- Nausea and vomiting
Skin
- Blue-colored lips and fingernails

Note: Serious poisoning can occur if an organophosphate gets on your bare skin or if you don't wash your skin soon after it gets on you. Large amounts of the chemical soak through the skin unless you are protected. Life-threatening paralysis and death can occur very quickly.

While the clinical signs have some differences, it could have been a combination of organophosphates and methanol intoxication. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Dominican Republic: <http://healthmap.org/promed/p/24>]
Date: Thu 27 Jun 2019
Source: USA TODAY on Yahoo News [edited]

A Denver man is the latest American tourist to die in the Dominican Republic this year [2019]. [KA] died on Tuesday [25 Jun 2019], the State Department confirmed to USA TODAY.

Denver's 9 News and Fox 31 report [KA] was on vacation with his daughter [MA] when he fell ill in the Caribbean vacation destination. [MA] told 9 News her father started to complain about a painful bump on his leg just before her flight home on Sunday [23 Jun 2019]. She said they stopped by their hotel's medical clinic, but decided against treatment unless the pain became worse.

[MA] had already returned to Denver when her father's pain worsened the following day [24 Jun 2019]. He booked an earlier return flight but was forced to disembark due to his symptoms.

His sister-in-law [MS] told Fox 31 he was dripping with sweat and vomited in the plane's lavatory. "They transferred him to Santo Domingo and (said) his breathing is really bad and his kidneys were failing," she said. [MS] noted while her brother-in-law had undergone a kidney transplant several years earlier, he was in perfect health when he left Colorado.

[KA]'s relatives said they were not even told he had died; they found out only after [MA] called the hospital repeatedly Wednesday [26 Jun 2019] morning. "It's been hard," she told 9News. "Not being able to get a hold of them, or them miscommunicating, or simply not knowing information."

Authorities are conducting an autopsy and investigation to determine the official cause of death, according to 9 News. (The family said they did not receive any diagnosis.)

Questions about safety have dogged the Dominican Republic since late May [2019], when the 1st of several Americans died in their hotel rooms and a Delaware woman claimed she was attacked there in January [2019].

Last week, tourism minister Francisco Javier Garcia held a press conference to dispel those concerns, stating, "The Dominican Republic is a safe country." Garcia also said the confirmed deaths -- 9 including [KA] -- are not out of the ordinary and the number is actually lower than in some previous years. Garcia said by this point in 2011 and 2015, 15 tourists had died in the Dominican Republic.  [Byline: Sara M. Moniuszko]
=====================
[The Dominican Republic is a small place compared with the USA, Europe, Russia, Australia, Canada, Brazil and others.  While this article says there were 9 deaths, including this victim, other sources and listed names add up to 13, with other victims being severely ill and reporting their illness and having survived to tell about it. This is a lot for a small place and even more so given that most of them are reporting the same clinical signs.

An autopsy alone is insufficient for determining a cause of death in these cases. We have been waiting weeks for the release of the toxicology report from the first 10 or more victims, which allegedly the US officials and CDC toxicologist are involved with.

If the man had no prior illness and suddenly started having these pains, sweating and vomiting, it seems quite out of the ordinary. His kidneys may well have failed from the toxins (allegedly) in his system, but it does not mean the kidney failure was the primary reason for death.

The excessive sweating, complained about by every victim prior to death, and by a few who managed to survive, as well as reports of vomiting roll together to make me think this is not a plain and simple death or a death from kidney failure.

I am still suspicious of organophosphates. I am also suspicious of the pain from a bump on his leg. This article does not address anything about the bump. I wonder if there was a bite or sting there? Or was he injected with something?

While the minister of tourism is saying it is safe, there is no indication of security being increased around the resorts to prevent others with nefarious motives from entering the area. There is no indication of an investigation from the resorts or the minister of tourism to assess what is really happening. - ProMED Mod.TG]

[It is also possible that the "bump" on his leg was an abscess either insect bit related or small entry wound related and the disease process described could also be consistent with sepsis, remembering that the individual had a history of a kidney transplant and was most likely on immunosuppressive drugs to prevent rejection of the transplanted kidney. - ProMED Mod.MPP]

[HealthMap/ProMED-mail map:
Dominican Republic: <http://healthmap.org/promed/p/24>]
Date: Sat 15 Jun 2019, 1:03 PM
Source: New York Post [edited]

A group of Jimmy Buffett-diehards from Oklahoma were incredibly sick in paradise -- the latest in an ever-growing list of tourists to be sickened during a jaunt to the Dominican Republic, a report said.

DF, a travel agent who vacationed to Punta Cana with the Buffett-loving Central Oklahoma Parrothead Association, said 4 days into their April [2019] trip, he and other members came down with a mysterious illness. "I can't even explain how sick I was," DF told Oklahoma's News 4. "I lost 14 pounds during that time and was really sick."

By the end of the vacation, 47 of the 114 Oklahomans reported becoming ill, DF said, with many of them too sick to leave their rooms at the Hotel Riu Palace Macao.

DF said it's unclear what caused the illnesses -- Punta Cana doctors suggested a parasite might be to blame. Everyone who got sick swam in the resort pool equipped with a swim-up bar, DF recalled.

Some of the sick Parrotheads, the nickname for fans of the "Why Don't We Get Drunk" singer [Jimmy Buffet], tested positive for _Salmonella_ spp, according to DF, who said he did not.

The latest report of illness comes amid a spate of unexplained deaths on the island nation since January [2019]. The death count ticked to 8 on [Fri 14 Jun 2019], when the family of a 78-year-old Ohio man revealed he died suddenly after dinner and drinks at the Dreams Punta Cana Resort & Spa. Authorities are eyeing bootleg liquor from hotel minibars as the potential killer, sources have told The Post.  "I will not be going back to the Dominican any time soon," DF said.  [Byline: Sara Dorn]
=====================
[These people may be lucky they were only sick and not dead. However, _Salmonella_ sp most often causes diarrhoea and cramps along with severe dehydration and weakness. While an individual may develop a fever and be sweating, the sweating reported in the fatal cases is extreme sweating.

There is no report of the deceased individuals testing positive for salmonellosis.

Regardless of the cause, salmonellosis, or poisoning by something other than bacteria, the resorts involved in these reports appear to have a problem. The problem may be lack of awareness of chemicals from spraying trees above air conditioning units, to someone tampering with alcohol bottles, or perhaps uncleanliness at some eating/drinking  establishment. This many illness and deaths seems quite out of the ordinary for these resorts. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Dominican Republic: <http://healthmap.org/promed/p/24>]
Date: Wed 12 Jun 2019
Source: New York Times [edited]
<https://www.nytimes.com/2019/06/12/travel/dominican-republic-deaths.html>

More than two million Americans visit the Dominican Republic every year, making up about a third of the country's tourists. Six have died in the last year during their visits. Because of the seeming similarities among their deaths, their family members have suggested that they are connected and have raised suspicions about the resorts where they died. Here's what we know, and don't know, about the circumstances.

Who has died, and how?
Yvette Monique Sport, 51, died in June 2018 of a heart attack. Her sister, Felecia Nieves, has said that Ms. Sport had a drink from the minibar in her room at a Bahia Pri­ncipe resort, one of a number on the island, then went to sleep and never woke up.

In July 2018, David Harrison, 45, died at the Hard Rock Hotel & Casino Punta Cana. Mr. Harrison died of a heart attack and The Washington Post reported that his death certificate also listed "pulmonary oedema, an accumulation of fluid in the lungs that can cause respiratory failure, and atherosclerosis" as causes of death. He and his wife were in the Dominican Republic for their wedding anniversary with their son.

In April of this year, Robert Wallace became sick at the Hard Rock Hotel & Casino Punta Cana, where he was attending a wedding and died. The 67 year old's family said that he became ill after drinking scotch from the minibar in the hotel. Miranda Schaup-Werner, 41, of Allentown, Pa., was celebrating her 10th wedding anniversary when she died at the Luxury Bahia Pri­ncipe Bouganville, on May 25 of this year of a heart attack. She had been at the resort for less than 24 hours.

A few days later, Nathaniel Edward Holmes 63, and Cynthia Ann Day, 49, from Prince George's County, Md., were found dead in their room at the Grand Bahia Pri­ncipe La Romana. The two had recently become engaged. An autopsy found that the couple had respiratory failure and pulmonary oedema.

Are the hotels connected?
Four of the dead were staying at Bahia Pri­ncipe resorts, which are part of a group of 14 hotels in the Dominican Republic that are popular among tourists because they are all-inclusive. The Luxury Bahia Pri­ncipe Bouganville, where Ms. Schaup-Werner died, is less than a five-minute walk away from the Grand Bahia Pri­ncipe La Romana, where Mr. Holmes and Ms. Day died. Both are near the town of San Pedro De Macoris.

The Hard Rock is across the island from the other two hotels in Punta Cana. It is not known which Bahia Principe resort Ms. Sport was staying in.

What are the hotels saying?
In a statement on Friday, Bahia Principe said reports of the deaths had been inaccurate and that the hotel was committed to "collaborating completely with the authorities and hope for a prompt resolution of their inquiries and actions." Hard Rock Hotels & Casinos said in a statement on Tuesday evening that it is waiting for official reports about the deaths and is, "Deeply saddened by these two unfortunate incidents, and we extend our sincerest sympathy to the families of Mr. Harrison and Mr. Wallace."

What are Dominican officials doing?
The Dominican Attorney General's office and the national police are investigating the deaths, but tourism officials have been downplaying them. The tourism minister, Francisco Javier Garci­a, said last week that in the last five years, more than 30 million tourists have visited the country, and that these deaths are "isolated incidents" and the island is safe for tourists. "These are situations that can occur in any country, in any hotel in the world," he said. "It's regrettable but sometimes it happens." The tourism ministry said last week that hotels had 60 days to install security cameras. What are U.S. officials saying?

In a statement issued Tuesday evening, the U.S. State Department said that "Dominican authorities have asked for F.B.I. assistance for further toxicology analysis," and it could take up to a month to receive the results. A spokeswoman for the Centers for Disease Control said that the organization had not received a request for assistance from the Dominican Republic relating to these deaths. Are there any theories as to what might be causing the deaths? Tom Inglesby, director of the Johns Hopkins Center for Health Security, said in a phone interview that the symptoms that have been reported, like pulmonary oedema, bleeding and vomiting blood, are "consistent with poisoning," perhaps accidental.

But until toxicology reports are available, he said, it is difficult and too soon to definitively say what caused the visitors' deaths. "It's rare for travellers to die of unknown causes like this, and to have a high number of them in a relatively short period of time is alarming, shocking, sad," Dr. Inglesby said. "It's something that investigators should be able to get to the bottom of." The fact that toxicology reports have not been released or completed is "unconscionable and inexplicable," he said. Have there been other incidents? Two couples have come forward to say they fell ill while staying at one of the Bahia Pri­ncipe resorts where tourists have died. In January 2018, Doug Hand, 40, and his wife Susie Lauterborn, 38, were staying at the Grand Bahia Pri­ncipe La Romana when, he said in a phone interview, they got sick with fevers, nausea, cold sweats, diarrhoea and fatigue. Mr. Hand said that he didn't drink alcohol on the trip, but he did notice a "mouldy, mildew smell like the A.C. or filter hadn't been cleaned."

When Mr. Hand told an employee in the hotel's lobby that his wife was sick, the employee gave him directions to a doctor, but seemed more focused on ensuring the couple attended a meeting about buying time shares, Mr. Hand said. Kaylynn Knull, 29, and Tom Schwander, 33, are suing the resort chain for $1 million, their lawyer told The Times, because the Colorado-based couple became violently ill during their stay at the Grand Bahia Pri­ncipe La Romana last summer. Ms. Knull got a persistent headache and was sweating and drooling profusely, the lawyer, David Columna, said. She also had blurry vision, nausea and diarrhoea, she told CNN, and family doctors determined the couple had been exposed to organophosphates, a class of insecticides. "The hotel did nothing," said Mr. Columna, who is representing Ms. Knull and Mr. Schwander in the Dominican Republic. The couple, he said, "spent the night inhaling the chemical and they are still having side effects of the intoxication and the hotel hasn't given us any idea of what happened." [Byline: Elisabeth Malkin, Tariro Mzezewa]
Date: 6 Jun 2019
Source: Washington Post [edited]

Dominican government officials released more-detailed autopsy results on Thursday [6 Jun 2019] for 3 American tourists who died at adjacent beach resorts owned by the same hotel company during the last week of May 2019.

All 3 victims experienced eerily similar symptoms and internal trauma before their deaths, according to a news release from Dominican authorities. Pathologists said autopsies showed the 3 had internal haemorrhaging, pulmonary oedema, and enlarged hearts.

Toxicology reports are pending [These are likely to be the most interesting. - ProMED Mod.TG].

A U.S. State Department official said authorities have not yet established a connection between the 30 May 2019 deaths of 49-year-old CAD, and 63-year-old NEH, both of Prince George's County, MD, and the death on 25 May 2019 of 41-year-old MSW of Pennsylvania.

The FBI is providing Dominican law enforcement with "technical assistance with the toxicology reports," the State Department official said.

MSW had just checked into the Luxury Bahia Principe Bouganville, in the town of San Pedro de Macoris, and was taking pictures from her room balcony when she started to feel ill.

Less than 2 hours later, she was dead, local authorities said.

The bodies of CAD and HEH were found inside their room at the Grand Bahia Principe La Romana after relatives grew concerned because they had not checked out of the resort.

The hotels are located next to each other on the island's southern coast, about 60 miles from the tourist-heavy Punta Cana area.

Dominican authorities initially did not run toxicology tests for MSW because there were no signs of violence, said Ramon Brito, a spokesman for the National Police's special tourism unit. After the Maryland couple was found, investigators ordered a set of tests to determine whether anything the 3 Americans consumed may have led to their deaths, Brito said.  [Byline: Arelis R. Hernandez]
More ...

World Travel News Headlines

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

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

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

The island of Pag and its Zrce beach are popular with young tourists, notably British, who party there.  Tourism is a pillar of Croatia's economy, with visitors flocking to hundreds of islands and islets along its stunning Adriatic coast.   Last year the country of 4.2 million people welcomed more than 19 million tourists.
Date: Mon, 15 Jul 2019 01:09:24 +0200

Kinshasa, July 14, 2019 (AFP) - The first case of Ebola has been confirmed in Goma, now the biggest city to have been affected by the disease since its outbreak in eastern DR Congo last August, the health ministry said on Sunday.  A sick man had arrived in Goma early Sunday by bus with 18 other passengers and the driver from Butembo, one of the main towns touched by Ebola in Nord-Kivu province.

The man was tested  "and the results of the laboratory test confirmed that he was positive for Ebola," the ministry said in a statement.   It added that his trip began on Friday after "the first symptoms appeared on July 9 (Tuesday)".   "Given that the patient was quickly identified, as well as all the passengers on the bus from Butembo, the risk of the disease spreading in the city of Goma is low," the ministry said.    The passengers and the bus driver will begin getting vaccinations on Monday, it added.

The Ebola outbreak in eastern Democratic Republic of Congo has so far killed 1,655 people and 694 have been cured, according to a health ministry bulletin on Saturday.  And 160,239 people have been vaccinated, it added.  But efforts to tackle the crisis have been hampered both by militia attacks on treatment centres, in which some staff have been killed, and by the hostility of some local people to the medical teams.
Date: Sun, 14 Jul 2019 13:37:24 +0200

Pamplona, Spain, July 14, 2019 (AFP) - Three men were gored Sunday during the eighth and final bull run of Spain's San Fermin festival, bringing to eight the total number of daredevils injured during this year's fiesta.   Among those who were hospitalised this year after being injured by a bull's horns was an American who was wounded in the neck while taking a selfie.    In the last run, two Australians aged 27 and 30 as well as well as a 25-year-old Spaniard from Madrid were gored by the half-tonne fighting bull, "Rabonero", regional health authorities said.

The three men suffered injuries to the armpit, arm and leg from the bull's horns. Another two men were taken to hospital with bruises.   During Sunday's run in the northern city of Pamplona, Rabonero, the heaviest of the six bulls used in the event, became separated from the pack moments into the run and began charging people in its way.   Isolated bulls are more likely to get disoriented and start charging at people.

The bulls from the Miura ranch in the southwestern province of Seville completed the 848.6-metre (928-yard) course from a holding pen to the city bull ring in two minutes and 45 seconds.   Each morning from July 7 to 14, hundreds of daredevils, many wearing traditional white shirts with red scarves tied around their necks, tested their bravery by running ahead of a pack of bulls through the course set up in the narrow, winding streets of the medieval city.

- Like getting hit by a truck -
The bulls face almost certain death in afternoon bullfights, and earlier this month animal rights activists staged a "die-in" protest in the streets of the city to protest the tradition.   At the end of the festival's first run, a bull ran over and sunk one of its horns deep in the neck of a 46-year-old  American from San Francisco, Jaime Alvarez, narrowly missing key arteries.    He was injured as he was trying to take a video-selfie with his mobile phone.   "It was like a truck or car just hitting me in the side of the head. I put my hand on my neck and I saw blood," he told US television from a Pamplona hospital.   His wife had asked him not to take part in the bull run, he added.    He was released from hospital two days later.

Another 23-year-old American from Kentucky and 40-year-old Spaniard were also gored that day.   In addition to the eight men who were gored, another 27 people were taken to hospital for broken bones and bruises suffered during the bull runs.   About 500 more people were treated at the scene for more minor injuries, according to the Red Cross.   The festival dates back to medieval times and was immortalised in Nobel Prize-winning author Ernest Hemingway's 1926 novel "The Sun Also Rises".   It claims scores of casualties every year although last year just two men were gored.

Although the runs are over, the festival's closing ceremony takes place at midnight Sunday.   People from around the world flock to the city of 200,000 residents to test their bravery and enjoy the festival's mix of round-the-clock parties, religious processions and concerts.   Sixteen people have been killed in the bull runs since records started in 1911.   The last death was in 2009 when a bull gored a 27-year-old Spaniard in the neck, heart and lungs.
Date: Sun, 14 Jul 2019 12:47:38 +0200

Labuha, Indonesia, July 14, 2019 (AFP) - A major 7.3-magnitude earthquake hit the remote Maluku islands in eastern Indonesia Sunday, sending panicked residents running into the streets, but no tsunami warning was issued.   The shallow quake struck about 165 kilometres (100 miles) south-southwest of the town of Ternate in North Maluku province at 6:28 pm (0928 GMT), according to the US Geological Survey.
 
"The earthquake was quite strong, sending residents to flee outside. They are panicking and many are now waiting on the roadside," said local disaster mitigation official Mansur, who like many Indonesians goes by one name.   Officials were assessing the situation but there were no immediate reports of casualties, he told AFP.

In the town of Labuha, one of the closest to the epicentre, panicked residents took to motorcycles in a bid to flee to higher ground, according to an AFP photographer in town when the earthquake hit.   Local disaster official Ihsan Subur told Metro TV that no damage or casualties had been reported there so far, but residents took to the streets and many evacuated to higher ground.   "Electricity went of during the earthquake, but now it's back to normal," ubur said, adding that at least seven big aftershocks were felt after the initial quake.

The province was also hit by a 6.9-magnitude tremor last week.   Indonesia experiences frequent seismic and volcanic activity due to its position on the Pacific "Ring of Fire", where tectonic plates collide.   Last year, a 7.5-magnitude quake and a subsequent tsunami in Palu on Sulawesi island killed more than 2,200 people, with another thousand declared missing.   On December 26, 2004, a devastating 9.1-magnitude earthquake struck off the coast of Sumatra and triggered a tsunami that killed 220,000 across the Indian Ocean region, including around 170,000 in Indonesia.
Date: Sun, 14 Jul 2019 09:02:36 +0200

Sydney, July 14, 2019 (AFP) - A strong 6.6-magnitude earthquake struck off northwest Australia Sunday, shaking buildings over a wide area but causing no immediate reports of damage or injuries.   The shallow quake hit early Sunday afternoon 10 kilometres under the Indian Ocean 203 kilometres (126 miles) west of the West Australian beach resort of Broome, the US Geological Survey said. No tsunami alert was issued.   Sergeant Neil Gordon of the Broome police department said the quake rattled the city for more than a minute.   "The building here was shaking for about a minute and a half ... a steady shaking for that period of time," he told AFP by telephone.   He added that there had been "no reports of any injuries or any damage throughout the district," following the tremor.   The national broadcaster ABC said there were some reports of minor damage from the quake, and no injuries.   Australian media said the tremor was felt across a long stretch of the northwestern coast of Australia, from the West Australian capital of Perth and the mining centres of Karatha and Port Hedland to the south and as far as Darwin to the north.

Thursday 11th July 2019
https://www.who.int/csr/don/11-july-2019-ebola-drc/en/

The outbreak of Ebola virus disease (EVD) in North Kivu and Ituri provinces, Democratic Republic of the Congo continues this past week with a similar transmission intensity to the previous week. While the number of new cases continues to ease in former hotspots, such as Butembo, Katwa and Mandima health zones, there has been an increase in cases in Beni, and a high incidence of cases continues in parts of Mabalako Health Zone. In addition to these re-emerging hotspots, there are a large number of people with confirmed and probable infections moving to other health zones, with the greatest number coming from Beni Health Zone. The movement of cases causes the outbreak to spread to new health zones and re-emerge in health zones with previously controlled infections. Overall, this underscores the importance of robust mechanisms for listing and following up contacts and understanding the motivations for peoples’ decisions to move.

After the first reported case in the Ariwara Health Zone on 30 June, no new cases have been observed in that health zone. A response team deployed to that zone continues to identify contacts, engage the community, and vaccinate individuals at risk. Response personnel from the bordering countries of Uganda and South Sudan continue to support operational readiness activities. Resources are being dedicated to monitoring the Uganda-Democratic Republic of the Congo border in that area.

In the 21 days from 19 June through 9 July 2019, 72 health areas within 22 health zones reported new cases, representing 11% of the 664 health areas within North Kivu and Ituri provinces (Figure 2). During this period, a total of 247 confirmed cases were reported, the majority of which were from the health zones of Beni (41%, n=101), Mabalako (19%, n=48), Lubero (6%, n=16), and Mandima (5%, n=13). As of 09 July 2019, a total of 2437 EVD cases, including 2343 confirmed and 94 probable cases, were reported (Table 1). A total of 1646 deaths were reported (overall case fatality ratio 68%), including 1552 deaths among confirmed cases. Of the 2437 confirmed and probable cases with known age and sex, 57% (1384) were female, and 29% (704) were children aged less than 18 years.

Cases continue to increase among health workers, with the cumulative number infected rising to 132 (5% of total cases). Of the 128 health workers with information available, the greatest proportion is among health workers at health posts [poste de santé] (20%, n = 26) and private health facilities (35%, n = 45). The majority (68%, n = 87) of health worker infections were among nurses.

No new EVD cases or deaths have been reported in the Republic of Uganda since the previous EVD Disease Outbreak News publication on 13 June 2019. As of 3 July, 108 contacts exposed to those cases were identified, and they all completed the 21-day follow-up period. All contacts were asymptomatic. Arua district, located in the north-western part of Uganda near the Uganda-Democratic Republic of the Congo border, is currently stepping up its response readiness to prevent imported cases of Ebola following the case that died on 30 June 2019 in Ariwara Health Zone in neighbouring Democratic Republic of the Congo, located 8 kilometres from the Uganda border. This case is known to have over 200 contacts, some of whom are in the communities bordering the Arua district. As of 9 July 2019, two suspected cases in the Arua district were reported and both tested negative. As of 9 July 2019, the cumulative number of individuals vaccinated in Arua district is 811 out of 1092 targeted front line and healthcare workers.

More information here: https://www.who.int/csr/don/11-july-2019-ebola-drc/en/

Date: Sat, 13 Jul 2019 10:41:55 +0200

Kuala Lumpur, July 13, 2019 (AFP) - Flash floods killed a Dutch tourist in a popular cave located in the rugged Mulu National Park on Malaysia's Borneo island, an official said Saturday, as a search continues for a missing guide.    Local fire and rescue chief Law Poh Kiong identified the dead man as 66-year-old Peter Hans Hovenkamp from Utrecht in the central Netherlands.     "He died due to drowning following flash floods in the caves. His body was found in a river inside the cave and was taken to the Miri public hospital for a post-mortem on Saturday," he told AFP.   Law said a search-and-rescue operation involving 16 officers had been launched to locate 20-year local tour guide Roviezal Robin.   Eight other tourists in the same group "almost become victims" but fled to higher ground and escaped from being washed into the river, Law added.

Hovenkamp was reported missing on Friday while the group was touring the popular "Deer Cave", home to an estimated three million bats which form amazing patterns in the sky when they leave each dusk.   Mulu park, located in the remote Borneo jungle of Sarawak state and famous for its caves, cliffs and gorges, is a UNESCO world heritage site.   It sees thousands of visitors annually, particularly for its cooling rains during the summer months.    Law described the death as "a freak tragedy."
Date: Sat, 13 Jul 2019 09:52:36 +0200

Kathmandu, July 13, 2019 (AFP) - Floods and landslides triggered by torrential monsoon rains have killed at least 40 people across South Asia in the last two days, officials said Saturday.   The monsoon, which lasts from June to September, causes widespread death and destruction across South Asia each year.   In Nepal, 27 people have died in floods and landslides after heavy rains hit the country's eastern region and the southern plains.

Bishwaraj Pokharel, spokesperson for Nepal Police, added that another 11 people were injured and 15 others reported missing.    Three of the victims were killed when a wall collapsed in the capital Kathmandu.   "Our first priority is life saving rescue and all our resources have been deployed," Home Ministry official Umakanta Adhikari told AFP.

Police used boats to bring people to safety as rivers swelled, inundating their settlements, while parents were seen wading across chest-high waters carrying children on their shoulders.    Nepal's weather department issued a high alert for the southern Sapta Koshi river on Saturday and sent SMS warnings to people in the area.

In neighbouring India 11 deaths have been recorded in the north-eastern states of Assam and Arunachal Pradesh, officials said Friday.  Monsoon floods have inundated 21 districts in Assam, affecting thousands, officials said Friday.

In Bangladesh aid groups were providing rations to Rohingya refugees in the southeast of the country with the UN World Food Programme saying Friday that two people including a child had died.   Last year, more than 1,200 people were been killed across South Asia in monsoon storms with India's Kerala suffering its worst floods in nearly 100 years.
Date: Fri, 12 Jul 2019 16:00:57 +0200

Chennai, India, July 12, 2019 (AFP) - A special 50-wagon train carrying 2.5 million litres of water arrived in the Indian city of Chennai Friday, as the southern hub reels under one of its worst shortages in decades.    The wagons were hauled by a special locomotive, decorated with flowers and with a "Drinking Water for Chennai" banner on its front.   Four special trains a day have been called up to bring water to Chennai -- India's sixth most populous city -- from Vellore, some 80 miles (125 kilometres) away, to help battle the drought.    The first consignment will be taken to a water treatment centre, and then distributed in trucks to different parts of the metropolis on Saturday.   Chennai has seen only a fraction of the rain it usually receives during June and July.   The city of 4.9 million people also needed trains to bring water in when it suffered a similar crisis in 2001.

The bustling capital of Tamil Nadu state normally requires at least 825 million litres of water a day, but authorities are currently only able to supply 60 percent of that.   With temperatures regularly hitting 40 degrees Celsius (104 Fahrenheit), reservoirs have run dry and other water sources are dwindling further each day.   The Chennai metro has turned off its air conditioning, farmers have been forced to stop watering their crops, and offices have asked staff to work from home.   The city's economy has also taken a hit as some hotels and restaurants shut shop temporarily, and there have been reports of fights breaking out as people queue for water. 
Date: Fri, 12 Jul 2019 11:42:26 +0200

Sydney, July 12, 2019 (AFP) - A looming ban on climbing Australia's Uluru rock, intended to protect the sacred site from damage, has instead triggered a damaging influx of visitors, tourism operators said Friday.    Clambering up the giant red monolith, also known as Ayers Rock, will be prohibited from October -- in line with the wishes of the traditional Aboriginal owners of the land, the Anangu.   But a rush to beat the ban has led to a sharp increase in tourists and is causing its own problems for the World Heritage Uluru-Kata Tjuta National Park.   Families arriving in campers vans and RVs are a particular problem, chief executive of Tourism Central Australia Stephen Schwer told AFP.   "We have got so much of one particular market coming, we don't have enough infrastructure to handle the number of drive travellers."

While most visitors are doing the right thing, camping venues in the area are at capacity with advance bookings, leaving many less organised arrivals to set up illegally.   "People don't realise when they go off the road they are actually trespassing on pastoral land, or Aboriginal land, or protected land," Schwer said.   "We are getting people that are leaving their rubbish behind and lighting fires," he added.   "Sadly, people are also emptying their toilet waste out of their vans on what they think is unpopulated land, but is actually private land."   In the 12 months to June 2019, more than 395,000 people visited the Uluru-Kata National Park, according to Parks Australia, about 20 percent more than the previous year.   Yet just 13 percent of those who visited also climbed the rock, the government agency said.    Tourism operators say that Australian and Japanese tourists most commonly seek to climb Uluru.

The Aboriginal connection to the site dates back tens of thousands of years and it has great spiritual and cultural significance to them.   "Since the hand back of Uluru and Kata Tjuta to traditional owners in 1985, visitors have been encouraged to develop an understanding and respect for Anangu and their culture," a spokesperson for Parks Australia said.     "This is reflected in the 'please don't climb' message," they added.   Lyndee Severin from Curtin Springs station and roadhouse, one of just a few camping venues within 100 kilometres of Uluru, said "the vast majority of people are doing the right thing" but hundreds were setting up illegally by the side of the road or down a bush track.   "So we have some people that think that the rules don't apply to them," she told AFP.